National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (3)
- Adverse Events (2)
- Antibiotics (8)
- Antimicrobial Stewardship (5)
- Behavioral Health (3)
- Burnout (1)
- Cardiovascular Conditions (2)
- Care Management (1)
- Children's Health Insurance Program (CHIP) (1)
- Children/Adolescents (4)
- Chronic Conditions (1)
- Clinical Decision Support (CDS) (2)
- Clostridium difficile Infections (1)
- Comparative Effectiveness (2)
- Critical Care (2)
- Dementia (1)
- Diagnostic Safety and Quality (1)
- Digestive Disease and Health (1)
- Elderly (8)
- Electronic Health Records (EHRs) (4)
- Emergency Department (3)
- Evidence-Based Practice (5)
- Genetics (1)
- Guidelines (2)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (3)
- Health Insurance (2)
- Health Services Research (HSR) (1)
- Heart Disease and Health (2)
- Hospital Discharge (1)
- Hospitals (3)
- Implementation (1)
- Intensive Care Unit (ICU) (1)
- Kidney Disease and Health (1)
- Long-Term Care (4)
- Medical Errors (1)
- (-) Medication (45)
- Medication: Safety (11)
- Mortality (3)
- Neurological Disorders (1)
- Newborns/Infants (2)
- Nursing Homes (6)
- Obesity (1)
- Obesity: Weight Management (1)
- Opioids (4)
- Organizational Change (1)
- Outcomes (1)
- Patient-Centered Healthcare (2)
- Patient-Centered Outcomes Research (1)
- Patient Safety (17)
- Practice Patterns (3)
- Prevention (2)
- Primary Care (2)
- Provider (1)
- Provider: Pharmacist (3)
- Quality Improvement (21)
- Quality Indicators (QIs) (2)
- Quality Measures (5)
- (-) Quality of Care (45)
- Registries (1)
- Respiratory Conditions (2)
- Sepsis (2)
- Shared Decision Making (4)
- Substance Abuse (3)
- Surgery (1)
- Tools & Toolkits (2)
- Urinary Tract Infection (UTI) (1)
- Workflow (1)
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 25 of 45 Research Studies DisplayedPak TR, Young J, McKenna CS
Risk of misleading conclusions in observational studies of time-to-antibiotics and mortality in suspected sepsis.
Important studies indicate that every hour of sepsis that elapses until antibiotics are administered increases mortality. The researchers of this study found determined that analyses in the influential studies often adjusted for limited covariates, included patients with long delays until antibiotic administration, combined sepsis and septic shock, and used linear models presuming each hour of delay has equal impact on the sepsis and the patient. The purpose of this study was to assess the effect of the analytic decisions on the relationships between time-to-antibiotics and mortality. The researchers retrospectively identified 104,248 adults admitted from 2015-2022 to five hospitals with suspected infection. The patients included 25,990 with suspected septic shock and 23,619 with sepsis without shock. The study found that changing covariates, maximum time-to-antibiotics, and severity stratification altered the magnitude, direction, and significance of observed relationships between time-to-antibiotics and mortality. In a fully adjusted model of patients treated within 6 hours, every hour related with higher mortality for septic shock, but not sepsis without shock or suspected infection alone. Modeling every hour independently confirmed that every hour delay was related with greater mortality for septic shock, but only delays of greater than 6 hours were related with greater mortality for sepsis without shock.
AHRQ-funded; HS027170.
Citation: Pak TR, Young J, McKenna CS .
Risk of misleading conclusions in observational studies of time-to-antibiotics and mortality in suspected sepsis.
Clin Infect Dis 2023 Nov 30; 77(11):1534-43. doi: 10.1093/cid/ciad450..
Keywords: Antibiotics, Medication, Sepsis, Mortality, Quality of Care
Schnipper JL, Reyes Nieva H, Yoon C
What works in medication reconciliation: an on-treatment and site analysis of the MARQUIS2 study.
The objective of this study was to assess the association of patient exposure to system-level intervention and receipt based on the results of the second Multicenter Medication Reconciliation Quality Improvement Study, which demonstrated a marked reduction in medication discrepancies per patient. Researchers conducted an on-treatment analysis of system-level interventions at 17 North American hospitals. The patient-level interventions most associated with discrepancy reductions were receipt of a best-possible medication history of admitted patients in the ED and admission and discharge medication reconciliation by a trained clinician. System-level interventions were also associated with a minor reduction in discrepancies for the average patient. The researchers concluded that these findings might be used to help hospitals and health systems prioritize interventions to improve medication safety during care transitions.
AHRQ-funded; HS023757.
Citation: Schnipper JL, Reyes Nieva H, Yoon C .
What works in medication reconciliation: an on-treatment and site analysis of the MARQUIS2 study.
BMJ Qual Saf 2023 Aug; 32(8):457-69. doi: 10.1136/bmjqs-2022-014806..
Keywords: Medication, Medication: Safety, Quality Improvement, Quality of Care, Patient Safety, Hospital Discharge
Sikora A, Martin GS
Critical care pharmacists: improving care by increasing access to medication expertise.
This article discusses the shortage and need for critical care pharmacists in ICUs to improve care and prevent medication errors. There is a gap in critical care pharmacists with both low supply and low demand. Identifying the optimal patient:pharmacist ratio in the ICU is a key question. The authors discuss ways to reduce the gap by increasing the number of critical care pharmacy residency programs and including critical care pharmacists more in multidisciplinary rounds. The authors developed a toolkit for increasing critical care pharmacy services in five actionable steps and provide an annotated bibliography of key references.
AHRQ-funded; HS028485.
Citation: Sikora A, Martin GS .
Critical care pharmacists: improving care by increasing access to medication expertise.
Ann Am Thorac Soc 2022 Nov;19(11):1796-98. doi: 10.1513/AnnalsATS.202206-502VP..
Keywords: Provider: Pharmacist, Medication, Quality Improvement, Quality of Care, Critical Care
Schnipper JL, Reyes Nieva H, Mallouk M
Effects of a refined evidence-based toolkit and mentored implementation on medication reconciliation at 18 hospitals: results of the MARQUIS2 study.
This study was a follow-up of the first Multicenter Medication Reconciliation Quality Improvement Study (MARQUIS1) that demonstrated mentored implementation of a medication reconciliation best practices toolkit. The toolkit decreased total unintentional medication discrepancies in five hospitals, but results varied by site. The toolkit has been refined with lessons learned and retooled as MARQUIS2. The tool was implemented at 18 North American hospitals or hospital systems from 2016 to 2018, offering 17 system-level and 6-patient-level interventions. One of eight physicians coached each site remotely via monthly calls and one or two site visits. A total of 4947 patients were sampled, with 1229 preimplementation and 3718 postimplementation. A steady decline in medication discrepancy rates were experienced from 2.85 discrepancies per patient down to 0.98 discrepancies. An interrupted time series analysis of the 17 sites showed the intervention was associated with a 5% relative decrease in discrepancies per month.
AHRQ-funded; HS025486; HS023757.
Citation: Schnipper JL, Reyes Nieva H, Mallouk M .
Effects of a refined evidence-based toolkit and mentored implementation on medication reconciliation at 18 hospitals: results of the MARQUIS2 study.
BMJ Qual Saf 2022 Apr;31(4):278-86. doi: 10.1136/bmjqs-2020-012709..
Keywords: Medication, Evidence-Based Practice, Tools & Toolkits, Implementation, Quality Improvement, Quality of Care, Medication: Safety, Patient Safety
Huo T, Li Q, Cardel MI
AHRQ Author: Mistry K
Enhancing quality measurement with clinical information: a use case of body mass index change among children taking second generation antipsychotics.
The authors sought to examine the extent to which body mass index (BMI) was available in electronic health records for Florida Medicaid recipients aged 5 to 18 years taking Second-Generation Antipsychotics (SGAP). They concluded that meeting the 2030 CMS goal of digital monitoring of quality of care will require continuing expansion of clinical encounter data capture to provide the data needed for digital quality monitoring. Using linked electronic health records and claims data allows identifying children at higher risk for SGAP-induced weight gain.
AHRQ-authored; AHRQ-funded; HS025298.
Citation: Huo T, Li Q, Cardel MI .
Enhancing quality measurement with clinical information: a use case of body mass index change among children taking second generation antipsychotics.
Acad Pediatr 2022 Apr;22(3S):S140-S49. doi: 10.1016/j.acap.2021.11.012..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Obesity, Obesity: Weight Management, Quality Measures, Quality of Care
Vaughan CP, Hwang U, Vandenberg AE
Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme.
Enhancing quality of prescribing practices for older adults discharged from the Emergency Department (EQUIPPED) aims to reduce the monthly proportion of potentially inappropriate medications (PIMs) prescribed to older adults discharged from the ED to 5% or less. In this paper, the investigator described prescribing outcomes at three academic health systems adapting and sequentially implementing the EQUIPPED medication safety programme.
AHRQ-funded; HS024499.
Citation: Vaughan CP, Hwang U, Vandenberg AE .
Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme.
BMJ Open Qual 2021 Nov;10(4). doi: 10.1136/bmjoq-2021-001369..
Keywords: Elderly, Medication: Safety, Medication, Patient Safety, Emergency Department, Quality Improvement, Quality of Care
Baughman AW, Triantafylidis LK, O'Neil N
Improving medication reconciliation with comprehensive evaluation at a Veterans Affairs skilled nursing facility.
This study described a quality improvement (QI) approach to improve medication reconciliation in a skilled nursing facility (SNF) setting as part of the Multi-Center Medication Reconciliation Quality Improvement Study 2 (MARQUIS2). Findings showed that SNFs represent a critical setting for medication reconciliation efforts due to challenges completing the reconciliation process and the concomitant high risk of adverse drug events in this population. Initial baseline assessments effectively identified existing problems and can be used to guide targeted interventions.
AHRQ-funded; HS023757.
Citation: Baughman AW, Triantafylidis LK, O'Neil N .
Improving medication reconciliation with comprehensive evaluation at a Veterans Affairs skilled nursing facility.
Jt Comm J Qual Patient Saf 2021 Oct;47(10):646-53. doi: 10.1016/j.jcjq.2021.06.001..
Keywords: Medication, Quality Improvement, Quality of Care
Anderson KE, Saloner B, Eckstein J
Quality of buprenorphine care for insured adults with opioid use disorder.
This retrospective cohort study evaluated the quality of treatment for insured adults with opioid use disorder (OUD) in the United States. A total of 45,210 commercially insured and Medicare Advantage (MA) enrollees 18 years or older from the OptumLabs Data Warehouse database with an OUD diagnosis in 2018 were analyzed. The treatment analyzed was use of buprenorphine. Only 1 in 10 eligible individuals with OUD initiated buprenorphine within 365 days of diagnosis with 2850 individuals (6.3%) initiating buprenorphine within 14 days of diagnosis. Of the 4600 individuals who received buprenorphine, half were maintained in care with 180 days or more of covered treatment. Treatment quality was generally lower for individuals with MA compared with commercial coverage as well as Hispanic and Black adults compared with White adults.
AHRQ-funded; HS000029.
Citation: Anderson KE, Saloner B, Eckstein J .
Quality of buprenorphine care for insured adults with opioid use disorder.
Med Care 2021 May;59(5):393-401. doi: 10.1097/mlr.0000000000001530..
Keywords: Opioids, Medication, Substance Abuse, Quality of Care
Anderson KE, Alexander GC, Niles L
Quality of preventive and chronic illness care for insured adults with opioid use disorder.
Investigators sought to measure quality of non-opioid use disorder (OUD) preventive and chronic illness care and care coordination for individuals with OUD compared with individuals without OUD. They used deidentified data on outpatients throughout the United States from claims for commercially insured and Medicare Advantage enrollees aged 18 years or older with diagnosis codes for OUD. They found that individuals with OUD have moderately lower quality of care across preventive and chronic illness care and care coordination for non-OUD care compared with individuals without OUD. They recommended more attention to measurement and improvement of non-OUD care for these individuals.
AHRQ-funded; HS000029.
Citation: Anderson KE, Alexander GC, Niles L .
Quality of preventive and chronic illness care for insured adults with opioid use disorder.
JAMA Netw Open 2021 Apr;4(4):e214925. doi: 10.1001/jamanetworkopen.2021.4925..
Keywords: Opioids, Medication, Substance Abuse, Quality Indicators (QIs), Quality of Care, Behavioral Health, Chronic Conditions, Prevention
Tamma PD, Miller MA, Dullabh P
AHRQ Author: Miller MA
Association of a safety program for improving antibiotic use with antibiotic use and hospital-onset Clostridioides difficile infection rates among US hospitals.
Regulatory agencies and professional organizations recommend antibiotic stewardship programs (ASPs) in US hospitals. The optimal approach to establish robust, sustainable ASPs across diverse hospitals is unknown. The purpose of this study was to assess whether the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use was associated with reductions in antibiotic use across US hospitals. The investigators concluded that AHRQ Safety Program appeared to enable diverse hospitals to establish ASPs and teach frontline clinicians to self-steward their antibiotic use.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Tamma PD, Miller MA, Dullabh P .
Association of a safety program for improving antibiotic use with antibiotic use and hospital-onset Clostridioides difficile infection rates among US hospitals.
JAMA Netw Open 2021 Feb;4(2):e210235. doi: 10.1001/jamanetworkopen.2021.0235..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Shared Decision Making, Clostridium difficile Infections, Patient Safety, Quality Improvement, Quality of Care, Hospitals
Hanlon JT, Perera S, Schweon S
Improvements in antibiotic appropriateness for cystitis in older nursing home residents: a quality improvement study with randomized assignment.
This study evaluated the impact of an educational quality improvement initiative on the appropriateness of antibiotic prescribing restricted to uncomplicated cystitis in older noncatheterized nursing home residents. This 1-year case-control study used 25 participating nursing homes that were randomized to the intervention or usual care group by strata that included state, urban/rural status, bed size, and geographic separation. A total of 75 cases of cystitis were found in the intervention groups and 92 in the control groups. The intervention group had a nonsignificant 21% reduction in the risk of antibiotic prescribing. There was a favorable comparison in appropriateness of duration. However, the intervention group had more problems with drug-drug interactions than the control group (8% vs 1%). There were also more problems with dosage in the intervention group. Both groups had similar rates of problems with choice or effectiveness (44% vs 45%). The most common antibiotic class that was prescribed inappropriately was quinolones.
AHRQ-funded; R18 HS023779.
Citation: Hanlon JT, Perera S, Schweon S .
Improvements in antibiotic appropriateness for cystitis in older nursing home residents: a quality improvement study with randomized assignment.
J Am Med Dir Assoc 2021 Jan;22(1):173-77. doi: 10.1016/j.jamda.2020.07.040..
Keywords: Elderly, Nursing Homes, Long-Term Care, Antibiotics, Medication, Quality Improvement, Quality of Care, Urinary Tract Infection (UTI), Shared Decision Making
Smith LB, Desai NR, Dowd B
Patient and provider-level factors associated with changes in utilization of treatments in response to evidence on ineffectiveness or harm.
High-quality health care not only includes timely access to effective new therapies but timely abandonment of therapies when they are found to be ineffective or unsafe. Little is known about changes in use of medications after they are shown to be ineffective or unsafe. In this study, the investigators examined changes in use of two medications: fenofibrate, which was found to be ineffective when used with statins among patients with Type 2 diabetes (ACCORD lipid trial); and dronedarone, which was found to be unsafe in patients with permanent atrial fibrillation (PALLAS trial).
AHRQ-funded; HS025164.
Citation: Smith LB, Desai NR, Dowd B .
Patient and provider-level factors associated with changes in utilization of treatments in response to evidence on ineffectiveness or harm.
Int J Health Econ Manag 2020 Sep;20(3):299-317. doi: 10.1007/s10754-020-09282-2..
Keywords: Healthcare Utilization, Medication, Medication: Safety, Patient Safety, Quality of Care
Co Z, Holmgren AJ, Classen DC
The tradeoffs between safety and alert fatigue: data from a national evaluation of hospital medication-related clinical decision support.
This study evaluated the overall performance of hospitals that used the Computerized Physician Order Entry Evaluation Tool in 2017 and 2018 and compared performances for fatal orders and nuisance orders each year. The authors evaluated 1599 hospitals that took the test by using their overall percentage scores along with the percentage of fatal orders appropriately alerted on and the percentage of nuisance orders incorrectly alerted on. Overall hospital scores improved from 58.1% in 2017 to 66.2% in 2018. Fatal order performance improved slightly from 78.8% to 83.0%, but there no very little change in nuisance order performance (89.0% to 89.7%). Conclusions were that perhaps hospitals are not targeting the deadliest orders first and some hospitals may be achieving higher scores by over-alerting. This has the potential to cause clinician burnout and even worsen patient safety.
AHRQ-funded; HS023696.
Citation: Co Z, Holmgren AJ, Classen DC .
The tradeoffs between safety and alert fatigue: data from a national evaluation of hospital medication-related clinical decision support.
J Am Med Inform Assoc 2020 Aug;27(8):1252-58. doi: 10.1093/jamia/ocaa098..
Keywords: Medication: Safety, Medication, Patient Safety, Clinical Decision Support (CDS), Shared Decision Making, Burnout, Hospitals, Health Information Technology (HIT), Quality of Care
Nace DA, Hanlon JT, Crnich CJ
A multifaceted antimicrobial stewardship program for the treatment of uncomplicated cystitis in nursing home residents.
This study describes the result of implementing a multifaceted antimicrobial stewardship program to reduce antibiotic use in nursing homes for urinary tract infections that are unlikely cystitis. Reduction in antibiotic use decreases incidence of Clostridioides difficile (C difficile) infections, as well as adverse drug reactions and antimicrobial drug resistance. This one-year case-control study included 12 intervention nursing homes and 13 control group nursing homes. The intervention nursing homes received a 1-hour introductory webinar, pocket-sized educational cards, tools for system change, and educational clinical vignettes addressing the diagnosis and treatment of suspected uncomplicated cystitis. Additionally, they received a monthly coaching call as well as a quarterly feedback report. In the intervention nursing homes, fewer unlikely cystitis cases were treated with antibiotics and C difficile infection rates were also lower. There was no increase in all-cause hospitalizations or deaths due to the intervention.
AHRQ-funded; HS023779.
Citation: Nace DA, Hanlon JT, Crnich CJ .
A multifaceted antimicrobial stewardship program for the treatment of uncomplicated cystitis in nursing home residents.
JAMA Intern Med 2020 Jul;180(7):944-51. doi: 10.1001/jamainternmed.2020.1256..
Keywords: Antimicrobial Stewardship, Antibiotics, Nursing Homes, Elderly, Quality Improvement, Quality of Care, Medication
Crystal S, Jarrín OF, Rosenthal M
National partnership to improve dementia care in nursing homes campaign: state and facility strategies, impact, and antipsychotic reduction outcomes.
This study examines the success of the national partnership campaign to reduce prescription of antipsychotic medications to elderly nursing home residents with dementia. Antipsychotic medications have been shown to increase mortality. Use of these medications had increased 23.9% in dementia patients by 2011. The campaign reduced use by 40.1% to 14.3% by the second quarter of 2019. The campaign measured progress with public reporting of quality measures, increased regulatory scrutiny, and accompanying state and facility initiatives. Sedative-hypnotic medication use also decreased in tandem with antipsychotic reduction suggesting that the campaign increased attention to the use of other risky psychotropic medications.
AHRQ-funded; HS023464; HS022406; HS023258; HS021112.
Citation: Crystal S, Jarrín OF, Rosenthal M .
National partnership to improve dementia care in nursing homes campaign: state and facility strategies, impact, and antipsychotic reduction outcomes.
Innov Aging 2020 Jun 2;4(3):igaa018. doi: 10.1093/geroni/igaa018..
Keywords: Elderly, Nursing Homes, Long-Term Care, Dementia, Neurological Disorders, Quality Improvement, Quality of Care, Medication, Mortality
Hansen JE, Brown DW, Hanke SP
Angiotensin-converting enzyme inhibitor prescription for patients with single ventricle physiology enrolled in the NPC-QIC registry.
This study examined trends in the routine use of angiotension-converting enzyme inhibitors (ACEI) during palliation of hypoplastic left heart syndrome, which is considered controversial. The authors used patients enrolled in the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) registry from 2008 to 2016 who had been prescribed ACEI between stage 1 palliation (stage I Norwood procedure) discharge and stage 2 palliation (stage II superior cavopulmonary anastomosis procedure) admission. ACEI prescriptions declined from 45% in the pre-2010 period to 36.8% from 2011 to 2016. No difference was found in interstage mortality, change in atrioventricular valve regurgitation, or change in ventricular dysfunction between groups. Atrioventricular septal defect, and preoperative mechanical ventilation were associated with increased ACEI prescription.
AHRQ-funded; HS021114.
Citation: Hansen JE, Brown DW, Hanke SP .
Angiotensin-converting enzyme inhibitor prescription for patients with single ventricle physiology enrolled in the NPC-QIC registry.
J Am Heart Assoc 2020 May 18;9(10):e014823. doi: 10.1161/jaha.119.014823..
Keywords: Newborns/Infants, Medication, Heart Disease and Health, Cardiovascular Conditions, Practice Patterns, Registries, Quality Improvement, Quality of Care
Griffey RT, Schneider RM, Todorov AA
Adverse events present on arrival to the emergency department: the ED as a dual safety net.
This study examined the prevalence of adverse events due to medication-related or patient care-related events that present on arrival (POA) to the emergency department (ED). This retrospective observation study tested the ED Trigger Tool from data at an urban academic medical center. Adults who completed an ED visit were eligible (N=92,859). A total of 5,582 visits gave a trigger. The majority of AEs (1,181) identified were from patients who were white and older. In total, POA AEs accounted for an estimated 7.65% of ED visits.
AHRQ-funded; HS025052.
Citation: Griffey RT, Schneider RM, Todorov AA .
Adverse events present on arrival to the emergency department: the ED as a dual safety net.
Jt Comm J Qual Patient Saf 2020 Apr;46(4):192-98. doi: 10.1016/j.jcjq.2019.12.003..
Keywords: Adverse Events, Adverse Drug Events (ADE), Emergency Department, Medication, Patient Safety, Quality of Care
Williams AR, Samples H, Crystal S
AHRQ Author: H
Acute care, prescription opioid use, and overdose following discontinuation of long-term buprenorphine treatment for opioid use disorder.
Although buprenorphine treatment reduces risk of overdose and death in opioid use disorder, most patients discontinue treatment within a few weeks or months. In this study, adverse health outcomes following buprenorphine discontinuation were compared among patients who were successfully retained beyond 6 months of continuous treatment, a minimum treatment duration recently endorsed by the National Quality Forum.
AHRQ-funded; HS021112; HS023258.
Citation: Williams AR, Samples H, Crystal S .
Acute care, prescription opioid use, and overdose following discontinuation of long-term buprenorphine treatment for opioid use disorder.
Am J Psychiatry 2020 Feb;177(2):117-24. doi: 10.1176/appi.ajp.2019.19060612..
Keywords: Opioids, Medication, Substance Abuse, Medication, Quality of Care
Simpson KR, Lyndon A, Spetz J
A 2-year pragmatic trial of antibiotic stewardship in 27 community nursing homes.
The purpose of this study was to determine associations between missed nursing care and nurse staffing during labor and birth, and exclusive breast milk feeding at hospital discharge. Exclusive breast milk feeding is a national quality indicator of inpatient maternity care. Nurses have substantial responsibility for direct support of infant feeding during the childbirth hospitalization. The investigators indicate that the results support exclusive breast milk feeding as a nurse-sensitive quality indicator.
AHRQ-funded; HS022846.
Citation: Simpson KR, Lyndon A, Spetz J .
A 2-year pragmatic trial of antibiotic stewardship in 27 community nursing homes.
J Am Geriatr Soc 2020 Jan;68(1):46-54. doi: 10.1111/jgs.16059..
Keywords: Antibiotics, Medication, Antimicrobial Stewardship, Nursing Homes, Long-Term Care, Quality Improvement, Quality of Care
Stoops C, Stone S, Evans E
Baby NINJA (Nephrotoxic Injury Negated by Just-in-Time Action): reduction of nephrotoxic medication-associated acute kidney injury in the neonatal intensive care unit.
The purpose of this study was to test if acute kidney injury (AKI) is preventable in patients in the neonatal intensive care unit and if infants at high-risk of nephrotoxic medication-induced AKI can be identified using a systematic surveillance program previously used in the pediatric non-intensive care unit setting. The authors concluded that a systematic surveillance program to identify high-risk infants can prevent nephrotoxic-induced AKI and has the potential to prevent short and long-term consequences of AKI in critically ill infants.
AHRQ-funded; HS023763.
Citation: Stoops C, Stone S, Evans E .
Baby NINJA (Nephrotoxic Injury Negated by Just-in-Time Action): reduction of nephrotoxic medication-associated acute kidney injury in the neonatal intensive care unit.
J Pediatr 2019 Dec;215:223-28.e6. doi: 10.1016/j.jpeds.2019.08.046..
Keywords: Newborns/Infants, Medication, Medication: Safety, Patient Safety, Kidney Disease and Health, Intensive Care Unit (ICU), Critical Care, Quality Improvement, Quality of Care, Prevention, Adverse Drug Events (ADE), Adverse Events
Mafi JN, May FP, Kahn KL
Low-value proton pump inhibitor prescriptions among older adults at a large academic health system.
Researchers sought to characterize the prevalence of potentially low-value proton pump inhibitor (PPI) prescriptions among older adults to inform a quality improvement intervention. Subjects were patients, aged 65 years or older, receiving primary care at a large academic health system in 2018. The researchers found that one in eight older adults were prescribed a PPI, and over one-third of prescriptions were potentially low-value. They conclude that, with most potentially low-value prescribing concentrated among a small subset of primary care physicians, interventions targeting them and/or applying EHR-based automatic stopping rules may protect older adults from harm.
AHRQ-funded; HS024067.
Citation: Mafi JN, May FP, Kahn KL .
Low-value proton pump inhibitor prescriptions among older adults at a large academic health system.
J Am Geriatr Soc 2019 Dec;67(12):2600-05. doi: 10.1111/jgs.16117..
Keywords: Elderly, Medication, Quality Improvement, Quality of Care, Primary Care
Ailabouni NJ, Marcum ZA, Schmader KE
Medication use quality and safety in older adults: 2018 update.
This study identified four key articles from 2018 that address medication use quality and safety for older adults. The first study highlighted a cluster-randomized trial that utilized a pharmacist-led education-based intervention delivered to both patients and doctors to deprescribe four types of inappropriate medications. The second study from the UK examined the association between anticholinergic exposure, overall and by medication class, and dementia risk in 40,770 older adults. The third study was a Swedish longitudinal cohort study examining the association between antihypertensive medications and incident dementia. The fourth and last study was a randomized, double-blind, placebo-controlled trial and examined the effect of daily low-dose aspirin for primary prevention of cardiac events and hemorrhage in 19,144 community-dwelling older adults.
AHRQ-funded; HS022982.
Citation: Ailabouni NJ, Marcum ZA, Schmader KE .
Medication use quality and safety in older adults: 2018 update.
J Am Geriatr Soc 2019 Dec;67(12):2458-62. doi: 10.1111/jgs.16243..
Keywords: Elderly, Medication, Medication: Safety, Patient Safety, Quality of Care, Provider: Pharmacist, Provider
Blecker S, Austrian JS, Horwitz LI
Interrupting providers with clinical decision support to improve care for heart failure.
The goal of this study was to develop a clinical decision support (CDS) system to recommend an angiotenson converting enzyme (ACE) inhibitor during hospitalization so it could be promoted for continuation at discharge. Patients who were hospitalized with reduced ejection fraction were pseudo-randomized to deliver interruptive or non-interruptive CDS alerts to providers based on the patients’ even or odd medical record number. The utilization rate was higher for interruptive alert versus non-interruptive alert hospitalizations for a sample of 958. This resulted in improved quality of care for heart failure patients.
AHRQ-funded; HS023683.
Citation: Blecker S, Austrian JS, Horwitz LI .
Interrupting providers with clinical decision support to improve care for heart failure.
Int J Med Inform 2019 Nov;131:103956. doi: 10.1016/j.ijmedinf.2019.103956..
Keywords: Clinical Decision Support (CDS), Shared Decision Making, Heart Disease and Health, Cardiovascular Conditions, Medication, Medication: Safety, Patient Safety, Quality Improvement, Quality of Care
Olin S, Storfer-Isser A, Morden E
Quality measures for managing prescription of antipsychotic medication among youths: factors associated with health plan performance.
This study examined the performance of health plans on two Healthcare Effectiveness Data and Information Set (HEDIS) measures: metabolic monitoring of children and adolescents prescribed an antipsychotic and use of first-line psychosocial care for children and adolescents prescribed an antipsychotic for a nonindicated use. This study then identified key plan characteristics and other contextual factors associated with health plan performance on quality measures related to pediatric antipsychotic prescribing. Findings suggested that quality measures, in conjunction with policies such as prior authorization, can encourage better care delivery to vulnerable populations.
ARHQ-funded; HS020503; HS025296.
Citation: Olin S, Storfer-Isser A, Morden E .
Quality measures for managing prescription of antipsychotic medication among youths: factors associated with health plan performance.
Psychiatr Serv 2019 Nov;70(11):1020-26. doi: 10.1176/appi.ps.201900089..
Keywords: Children/Adolescents, Medication, Behavioral Health, Quality Measures, Quality of Care, Health Insurance
Andereck JW, Reuter QR, Allen KC
A quality improvement initiative featuring peer-comparison prescribing feedback reduces emergency department opioid prescribing.
This study compared opioid prescribing rates in emergency departments before and after a quality improvement initiative featuring peer-comparison feedback. All 117 ED prescribers at an urban academic medical center were provided regular feedback on their opioid prescribing rate compared to their de-identified peers. Pre-intervention rates were 8.6% compared to post-intervention at 4.8%.
AHRQ-funded; HS023011.
Citation: Andereck JW, Reuter QR, Allen KC .
A quality improvement initiative featuring peer-comparison prescribing feedback reduces emergency department opioid prescribing.
Jt Comm J Qual Patient Saf 2019 Oct;45(10):669-79. doi: 10.1016/j.jcjq.2019.07.008..
Keywords: Emergency Department, Opioids, Medication, Practice Patterns, Quality Improvement, Quality of Care