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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 16 of 16 Research Studies DisplayedChen VW, Rosen T, Dong Y
Case sampling for evaluating hospital postoperative morbidity in US surgical quality improvement programs.
This study examined whether US surgical quality improvement (QI) programs using case sampling is robust enough for identifying hospitals with higher than expected complications. Eligible patients were 18 years and older who underwent a noncardiac operation at US Department of Veterans Affairs (VA) hospitals with a record in the VA Surgical Quality Improvement Program (systematic sample) and the VA Corporate Data Warehouse surgical domain (100% of surgical cases). Most patients in both samples were men (90.2% vs 91.2%) and White (74.7% vs 74.5%). Overall, 30-day complication rates were 7.6% and 5.3% for the sample and universal review cohorts, respectively. Using over 2145 hospital quarters of data, hospitals were identified as an outlier in 15.0% of quarters using the sample and 18.2% with universal review. Average hospital quarterly complication rates were 4.7% for outliers identified using the sample only, 7.2% for universal only, and 7.4% for concurrent identification in both sources. For nonsampled cases, average hospital quarterly complication rates were 7.0% at outliers and 4.4% at nonoutliers. Among outlier hospital quarters in the sample, 54.2% were concurrently identified with universal review, and for those identified with universal review, 44.6% were concurrently identified using the sample.
AHRQ-funded; HS028560.
Citation: Chen VW, Rosen T, Dong Y .
Case sampling for evaluating hospital postoperative morbidity in US surgical quality improvement programs.
JAMA Surg 2024 Mar; 159(3):315-22. doi: 10.1001/jamasurg.2023.6524..
Keywords: Surgery, Quality Improvement, Quality of Care, Hospitals
Chen VW, Chidi AP, Dong Y
Risk-adjusted cumulative sum for early detection of hospitals with excess perioperative mortality.
This study’s goal was to compare the risk-adjusted cumulative sum (CUSUM) with episodic evaluation for early detection of hospitals with excess perioperative mortality. The study cohort included 697,566 patients treated at 104 Veterans’ Affairs hospitals across 24 quarters with a mean age of 60.9 years and 91.4% male. These patients underwent a noncardiac operation at a Veterans Affairs hospital, had a record in the Veterans Affairs Surgical Quality Improvement Program (January 1, 2011, through December 31, 2016), and were aged 18 years or older. For each hospital, the median number of quarters detected with observed to expected ratios, at least 1 CUSUM signal, and more than 1 CUSUM signal was 2 quarters (IQR, 1-4 quarters), 8 quarters (IQR, 4-11 quarters), and 3 quarters (IQR, 1-4 quarters). Outlier hospitals were identified 33.3% of the time (830 quarters) with at least 1 CUSUM signal within a quarter, 12.5% (311 quarters) with more than 1 CUSUM signal, and 11.0% (274 quarters) with observed to expected ratios at the end of the quarter. The CUSUM detection occurred a median of 49 days (IQR, 25-63 days) before observed to expected ratio reporting (1 signal, 35 days [IQR, 17-54 days]; 2 signals, 49 days [IQR, 26-61 days]; 3 signals, 58 days [IQR, 44-69 days]; ≥4 signals, 49 days [IQR, 42-69 days]. Of 274 hospital quarters detected with observed to expected ratios, 72.6% were concurrently detected by at least 1 CUSUM signal vs 42.7% by more than 1 CUSUM signal. There was a dose-response relationship between the number of CUSUM signals in a quarter and the median observed to expected ratio (0 signals, 0.63; 1 signal, 1.28; 2 signals, 1.58; 3 signals, 2.08; ≥4 signals, 2.49).
AHRQ-funded; HS013853.
Citation: Chen VW, Chidi AP, Dong Y .
Risk-adjusted cumulative sum for early detection of hospitals with excess perioperative mortality.
JAMA Surg 2023 Nov; 158(11):1176-83. doi: 10.1001/jamasurg.2023.3673..
Keywords: Quality Improvement, Surgery, Hospitals, Patient Safety, Mortality, Quality of Care
Silver CM, Yang AD, Shan Y
Changes in surgical outcomes in a Statewide Quality Improvement Collaborative with introduction of simultaneous, comprehensive interventions.
Researchers investigated whether a comprehensive quality improvement program implemented simultaneously across hospitals at the formation of a quality improvement collaborative (QIC) would improve patient outcomes. They analyzed risk-adjusted rates of postoperative morbidity and mortality for patients who had undergone surgery at hospitals in the Illinois Surgical Quality Improvement Collaborative (ISQIC); analyses compared ISQIC hospitals with hospitals in the NSQIP Participant Use File (PUF). Although complication rates decreased at both ISQIC and PUF hospitals, findings showed that participation in ISQIC was associated with a significantly greater improvement in death or serious morbidity. The researchers concluded that these results emphasize the potential of QICs to improve patient outcomes.
AHRQ-funded; HS024516.
Citation: Silver CM, Yang AD, Shan Y .
Changes in surgical outcomes in a Statewide Quality Improvement Collaborative with introduction of simultaneous, comprehensive interventions.
J Am Coll Surg 2023 Jul 1; 237(1):128-38. doi: 10.1097/xcs.0000000000000679..
Keywords: Surgery, Outcomes, Quality Improvement, Quality of Care, Hospitals
Ingraham A, Reinke CE
Optimizing safety for surgical patients undergoing interhospital transfer.
This article discusses the need for standardization and improvement of the interhospital transfer process. The authors advocate studying and adapting quality improvement efforts directed at other transitions of care so that care will improve for surgical patients transferred between acute care institutions.
AHRQ-funded; HS025224.
Citation: Ingraham A, Reinke CE .
Optimizing safety for surgical patients undergoing interhospital transfer.
Surg Clin North Am 2021 Feb;101(1):57-69. doi: 10.1016/j.suc.2020.09.002..
Keywords: Patient Safety, Surgery, Transitions of Care, Hospitals, Quality Improvement, Quality of Care
Mouch CA, Baskin AS, Yearling R CA, Baskin AS, Yearling R
Sleep patterns and quality among inpatients recovering from elective surgery: a mixed-method study.
This study examined sleep quality and barriers to sleep among adult hospital inpatients recovering from elective surgery. A quantitative survey was used followed by a qualitative phone interview with a subsample of participants. Of 113 eligible patients, 102 (90%) completed the survey. Less than half reported sleeping well the night prior to surgery and 93% reported less sleep in the hospital compared to home. A median of 5 (4-7) interruptions were reported each night. Patients with more than three interruptions were likely to report poor sleep compared with those who had three or less. Barriers to sleep included staff interruptions and roommate noise but not pain. Patients interviewed suggested improved timing and knowledge of interruptions or use of noise-reduction aids that would facilitate sleep.
AHRQ-funded; HS026030.
Citation: Mouch CA, Baskin AS, Yearling R CA, Baskin AS, Yearling R .
Sleep patterns and quality among inpatients recovering from elective surgery: a mixed-method study.
J Surg Res 2020 Oct;254:268-74. doi: 10.1016/j.jss.2020.04.032..
Keywords: Sleep Problems, Surgery, Quality Improvement, Quality of Care, Inpatient Care, Hospitals, Patient Experience
Sheetz KH, Ryan A
Accuracy of quality measurement for the hospital acquired conditions reduction program.
Accuracy of quality measurement for the hospital acquired conditions reduction program.
AHRQ-funded; HS026244; HS000053.
Citation: Sheetz KH, Ryan A .
Accuracy of quality measurement for the hospital acquired conditions reduction program.
BMJ Qual Saf 2020 Jul;29(7):605-07. doi: 10.1136/bmjqs-2019-009747..
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Quality Measures, Quality Improvement, Quality of Care, Surgery, Infectious Diseases
Sheetz KH, Dimick JB, Nathan H
Centralization of high-risk cancer surgery within existing hospital systems.
Centralization is often proposed as a strategy to improve the quality of certain high-risk health care services. In this study, the investigators evaluated the extent to which existing hospital systems centralize high-risk cancer surgery and whether centralization is associated with short-term clinical outcomes. The investigators concluded that greater centralization of complex cancer surgery within existing hospital systems was associated with better outcomes.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Dimick JB, Nathan H .
Centralization of high-risk cancer surgery within existing hospital systems.
J Clin Oncol 2019 Dec 1;37(34):3234-42. doi: 10.1200/jco.18.02035..
Keywords: Surgery, Cancer, Risk, Hospitals, Health Systems, Quality Improvement, Quality Indicators (QIs), Quality of Care, Outcomes
Smith AB, Mueller D, Garren B
Using qualitative research to reduce readmissions and optimize perioperative cystectomy care.
This study examined the need for qualitative research on meaningful patient-reported outcomes (PROs) to prevent complications and readmissions after cystectomy. The investigators looked at the potential use of mobile communication devices (mHealth) to capture patients’ experiences and to improve outcomes. Interviews were conducted with 15 readmitted patients and 10 of their partners over 45 semi-structured in-depth interviews. The most common perspectives were that patients and their caregivers were overloaded with cystectomy education; they need to know what are normal post-operative symptoms; and that using mHealth would help with patient and caregiver education.
AHRQ-funded; HS024134.
Citation: Smith AB, Mueller D, Garren B .
Using qualitative research to reduce readmissions and optimize perioperative cystectomy care.
Cancer 2019 Oct 15;125(20):3545-53. doi: 10.1002/cncr.32362..
Keywords: Hospital Readmissions, Surgery, Health Information Technology (HIT), Quality Improvement, Quality of Care, Hospitals, Patient-Centered Healthcare
Schwarzkopf R, Behery OA, Yu H
Patterns and costs of 90-day readmission for surgical and medical complications following total hip and knee arthroplasty.
Unplanned readmissions following elective total hip (THA) and knee (TKA) arthroplasty as a result of surgical complications likely have different quality improvement targets and cost implications than those for nonsurgical readmissions. In this study, the investigators compared payments, timing, and location of unplanned readmissions with Center for Medicare and Medicaid Services (CMS)-defined surgical complications to readmissions without such complications.
AHRQ-funded; HS022882.
Citation: Schwarzkopf R, Behery OA, Yu H .
Patterns and costs of 90-day readmission for surgical and medical complications following total hip and knee arthroplasty.
J Arthroplasty 2019 Oct;34(10):2304-07. doi: 10.1016/j.arth.2019.05.046..
Keywords: Orthopedics, Surgery, Hospital Readmissions, Adverse Events, Quality Improvement, Quality of Care, Medicare, Hospitals
Odell DD, Quinn CM, Matulewicz RS
Association between hospital safety culture and surgical outcomes in a statewide surgical quality improvement collaborative.
The "safety culture" within hospital systems is increasingly recognized as important to delivery of high-quality care. In this study, the investigators examined the safety culture in a statewide hospital quality improvement collaborative and its associations with surgical outcomes. The authors found, among other results that operating room safety culture scores were highest (97.7% positive) compared with the other domains, and ratings of hospital management were lowest (75.9% positive).
AHRQ-funded; HS024516.
Citation: Odell DD, Quinn CM, Matulewicz RS .
Association between hospital safety culture and surgical outcomes in a statewide surgical quality improvement collaborative.
J Am Coll Surg 2019 Aug;229(2):175-83. doi: 10.1016/j.jamcollsurg.2019.02.046..
Keywords: Hospitals, Patient Safety, Quality of Care, Quality Improvement, Outcomes, Surgery, Surveys on Patient Safety Culture
Hsu YJ, Kosinski AS, Wallace AS
Using a society database to evaluate a patient safety collaborative: the Cardiovascular Surgical Translational Study.
The authors assessed the utility of using external databases for quality improvement (QI) evaluations in the context of an innovative QI collaborative aimed to reduce three infections and improve patient safety across the cardiac surgery service line. They compared changes in each outcome between 15 intervention hospitals and 52 propensity score-matched hospitals, and found that improvement trends in several outcomes among the studied intervention hospitals were not statistically different from those in comparison hospitals. They conclude that using external databases may permit comparative effectiveness assessment by providing concurrent comparison groups, additional outcome measures, and longer follow-up.
AHRQ-funded; HS019934.
Citation: Hsu YJ, Kosinski AS, Wallace AS .
Using a society database to evaluate a patient safety collaborative: the Cardiovascular Surgical Translational Study.
J Comp Eff Res 2019 Jan;8(1):21-32. doi: 10.2217/cer-2018-0051..
Keywords: Patient Safety, Quality Improvement, Quality Indicators (QIs), Quality of Care, Surgery, Cardiovascular Conditions, Comparative Effectiveness, Data, Hospitals, Research Methodologies, Patient-Centered Outcomes Research
Ban KA, Gibbons MM, Ko CY
Surgical technical evidence review for colorectal surgery conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
The objective of this article is to provide a comprehensive review of the evidence supporting the surgical components of the Improving Surgical Care and Recovery (ISCR) colorectal (CR) pathway. This review will evaluate the evidence supporting CR pathways and develop an evidence-based CR protocol to help hospitals participating in the ISCR program implement evidence-based practices.
AHRQ-funded; 233201500020I.
Citation: Ban KA, Gibbons MM, Ko CY .
Surgical technical evidence review for colorectal surgery conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
J Am Coll Surg 2017 Oct;225(4):548-57.e3. doi: 10.1016/j.jamcollsurg.2017.06.017.
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Keywords: Evidence-Based Practice, Hospitals, Patient Safety, Quality Improvement, Surgery, Quality of Care, Guidelines
Berian JR, Thomas JM, Minami CA
Evaluation of a novel mentor program to improve surgical care for US hospitals.
This study evaluated a novel mentor program for 27 US surgeons, charged with improving quality at their respective hospitals, having been paired 1:1 with 27 surgeon mentors through a state-wide quality improvement (QI) initiative. It found that mentorship played a vital role in advancing surgeon knowledge and engagement with QI in the Illinois Surgical Quality Improvement Collaborative.
AHRQ-funded; HS024516.
Citation: Berian JR, Thomas JM, Minami CA .
Evaluation of a novel mentor program to improve surgical care for US hospitals.
Int J Qual Health Care 2017 Apr 1;29(2):234-42. doi: 10.1093/intqhc/mzx005.
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Keywords: Hospitals, Quality Improvement, Patient Safety, Surgery, Quality of Care, Provider: Physician, Provider
Brooks JV, Gorbenko K, Bosk C
Interactional resources for quality improvement: Learning from participants through a qualitative study.
The aim of this analysis was to identify the types of interactional support hospital teams sought in a surgical quality improvement project. Respondents reported needing the following types of interactional support: (1) a critical outside perspective on their implementation progress; (2) opportunities to learn from peers, especially around clinical innovations; and (3) external validation to help establish visibility for and commitment to the project.
AHRQ-funded; 290201000027I.
Citation: Brooks JV, Gorbenko K, Bosk C .
Interactional resources for quality improvement: Learning from participants through a qualitative study.
Qual Manag Health Care 2017 Apr/Jun;26(2):55-62. doi: 10.1097/qmh.0000000000000128.
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Keywords: Quality Improvement, Quality of Care, Surgery, Hospitals, Teams
Healy MA, Krell RW, Abdelsattar ZM
Pancreatic resection results in a statewide surgical collaborative.
This study sought to investigate changes over time in adverse outcomes after pancreatectomy across hospitals with different caseloads in a statewide surgical collaborative. It concluded that participation in regional quality collaboratives by lower-volume hospitals can attenuate the volume–outcome relationship for pancreatic surgery.
AHRQ-funded; HS20937; HS000053.
Citation: Healy MA, Krell RW, Abdelsattar ZM .
Pancreatic resection results in a statewide surgical collaborative.
Ann Surg Oncol 2015 Aug;22(8):2468-74. doi: 10.1245/s10434-015-4529-9..
Keywords: Surgery, Patient Safety, Adverse Events, Hospitals, Quality Improvement, Quality of Care
Dahlke AR, Chung JW, Holl JL
Evaluation of initial participation in public reporting of American College of Surgeons NSQIP surgical outcomes on Medicare's Hospital Compare website.
The objective of this paper was to compare CMS-National Surgical Quality Improvement Program (CMS-NSQIP) participating hospitals with American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) hospitals that elected not to participate in Hospital Compare. The researchers found few measurable differences between CMS-NSQIP participating and nonparticipating hospitals.
AHRQ-funded; HS021857.
Citation: Dahlke AR, Chung JW, Holl JL .
Evaluation of initial participation in public reporting of American College of Surgeons NSQIP surgical outcomes on Medicare's Hospital Compare website.
J Am Coll Surg 2014 Mar;218(3):374-80, 80.e1-5. doi: 10.1016/j.jamcollsurg.2013.11.022.
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Keywords: Hospitals, Outcomes, Public Reporting, Quality Improvement, Surgery