National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Burnout (1)
- Cancer (1)
- COVID-19 (1)
- Critical Care (1)
- Education: Curriculum (1)
- Electronic Health Records (EHRs) (2)
- Emergency Department (1)
- Healthcare Costs (1)
- Health Information Technology (HIT) (1)
- Hospitals (4)
- Maternal Care (1)
- Medicare (3)
- Nursing (2)
- Outcomes (2)
- Palliative Care (1)
- Patient Safety (1)
- Primary Care (2)
- Provider (2)
- Provider: Clinician (1)
- Provider: Health Personnel (3)
- Provider: Nurse (3)
- Provider: Physician (1)
- Quality of Care (3)
- Racial and Ethnic Minorities (1)
- Surgery (2)
- Vulnerable Populations (1)
- (-) Workforce (14)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 14 of 14 Research Studies DisplayedMullens CL, Lussiez A, Scott JW
Association of health professional shortage area hospital designation with surgical outcomes and expenditures among Medicare beneficiaries.
This study’s objective was to compare surgical outcomes and expenditures at hospitals located in Health Professional Shortage Areas to nonshortage area designated hospitals among Medicare beneficiaries. This cross-sectional retrospective study used data from 842,787 Medicare beneficiary patient admissions to hospitals with and without Health Professional Shortage Area designations for common operations including appendectomy, cholecystectomy, colectomy, and hernia repair from 2014 to 2018. Primary outcomes measures were 30-day mortality, hospital readmissions, and 30-day surgical episode payments. Patients (mean age=75.6 years, males=44.4%) undergoing common surgical procedures in shortage area hospitals were less likely to be White (84.6% vs 88.4%) and less likely to have≥2 Elixhauser comorbidities (75.5% vs 78.2%). Patients undergoing surgery at Health Professional Shortage Area hospitals had lower risk-adjusted rates of 30-day mortality (6.05% vs 6.69%) and readmission (14.99% vs 15.74%). Medicare expenditures at Health Professional Shortage Area hospitals were also lower than nonshortage designated hospitals ($28,517 vs $29,685).
AHRQ-funded; HS028606; HS028672.
Citation: Mullens CL, Lussiez A, Scott JW .
Association of health professional shortage area hospital designation with surgical outcomes and expenditures among Medicare beneficiaries.
Ann Surg 2023 Oct 1; 278(4):e733-e39. doi: 10.1097/sla.0000000000005762..
Keywords: Hospitals, Surgery, Medicare, Healthcare Costs, Workforce, Outcomes
Nguyen CA, Beaulieu ND, Wright AA
Organization of cancer specialists in US physician practices and health systems.
This study’s objective was to describe the supply of cancer specialists, the organization of cancer care within versus outside of health systems, and the distance to multispecialty cancer centers. The authors used the 2018 Health Systems and Provider Database from the National Bureau of Economic Research and 2018 Medicare data to identify 46,341 unique physicians providing cancer care. They stratified physicians by discipline (adult/pediatric medical oncologists, radiation oncologists, surgical/gynecologic oncologists, other surgeons performing cancer surgeries, or palliative care physicians), system type (National Cancer Institute [NCI] Cancer Center system, non-NCI academic system, nonacademic system, or nonsystem/independent practice), practice size, and composition (single disciplinary oncology, multidisciplinary oncology, or multispecialty). They computed the density of cancer specialists by county and calculated distances to the nearest NCI Cancer Center. Results found that more than half of all cancer specialists (57.8%) practiced in health systems, but 55.0% of cancer-related visits occurred in independent practices. A majority of system-based physicians were in large practices with more than 100 physicians, while those in independent practices were in smaller practices. Breakdown by specialty type showed that practices in NCI Cancer Center systems (95.2%), non-NCI academic systems (95.0%), and nonacademic systems (94.3%) were primarily multispecialty, while fewer independent practices (44.8%) were. Many rural areas had sparse cancer specialty density, where the median travel distance to an NCI Cancer Center was 98.7 miles. Higher-income areas had shorter distances to NCI Cancer centers than low-income areas, even for individuals in suburban and rural areas.
AHRQ-funded; HS024072.
Citation: Nguyen CA, Beaulieu ND, Wright AA .
Organization of cancer specialists in US physician practices and health systems.
J Clin Oncol 2023 Sep 10; 41(26):4226-35. doi: 10.1200/jco.23.00626..
Keywords: Cancer, Provider: Physician, Workforce
Mullens CL, Lussiez A, Scott JW
High-risk surgery among Medicare beneficiaries living in health professional shortage areas.
This study’s objective was to compare high-risk surgical outcomes at hospitals located in Health Professional Shortage Areas to nonshortage area designated hospitals among Medicare beneficiaries. The authors performed a retrospective review of Medicare beneficiaries living in health professional shortage areas and nonshortage areas who underwent abdominal aortic aneurysm repair, coronary artery bypass graft, esophagectomy, liver resection, pancreatectomy, or rectal resection between 2014 and 2018. They compared rates of postoperative complications and 30-day mortality between the patient cohorts. They used beneficiary and hospital ZIP codes to quantify travel time to obtain care. Compared with patients living in nonshortage areas, patients living in health professional shortage areas traveled longer (median 60.0 vs 28.0 minutes). There were no differences in risk-adjusted rates of complications (28.5% vs 28.6%) and small differences in rates of 30-day mortality (4.2% vs 4.4%) between beneficiaries living in shortage areas versus those not in shortage areas, respectively.
AHRQ-funded; HS028606; HS028672; HS027788.
Citation: Mullens CL, Lussiez A, Scott JW .
High-risk surgery among Medicare beneficiaries living in health professional shortage areas.
J Rural Health 2023 Sep; 39(4):824-32. doi: 10.1111/jrh.12748..
Keywords: Surgery, Hospitals, Workforce, Medicare, Outcomes
Simpson KR, Spetz J, Gay CL
Hospital characteristics associated with nurse staffing during labor and birth: Inequities for the most vulnerable maternity patients.
The objective of this study was to estimate the relationship between hospital characteristics and adherence with Association of Women's Health, Obstetric and Neonatal Nurses nurse staffing guidelines. Registered nurses were enrolled in a cross-sectional survey; hospital characteristics were obtained from the 2018 American Hospital Association Annual Survey. The findings indicated that, overall, nurses reported strong adherence to staffing guidelines within their hospitals. Higher birth volume, teaching status, higher percentage of Medicaid-paid births, and presence of a neonatal intensive care unit were all associated with lower mean adherence scores.
AHRQ-funded; HS025715.
Citation: Simpson KR, Spetz J, Gay CL .
Hospital characteristics associated with nurse staffing during labor and birth: Inequities for the most vulnerable maternity patients.
Nurs Outlook 2023 May; 71(3):101960. doi: 10.1016/j.outlook.2023.101960..
Keywords: Hospitals, Maternal Care, Provider: Nurse, Workforce, Vulnerable Populations
Moy AJ, Cato KD, Withall J
Using time series clustering to segment and infer emergency department nursing shifts from electronic health record log files.
Clinical shifts are an essential unit of work recognized in clinical settings and may function as a primary unit of analysis in the study of documentation burden. The purpose of this proof- of-concept study was to investigate the feasibility of a new approach utilizing time series clustering to segment and infer clinician shifts from electronic health record (HER) log files. The researchers recorded 33,535,585 events between April-June 2021 and computationally identified 43,911 potential shifts among 2,285 emergency department nurses. On average, shifts were 10.6±3.1 hours in duration. Researchers classified the shifts based on type: day, evening, night; and length: 12-hour, 8-hour, other. The preliminary results of the study found that unsupervised clustering methods may be a feasible approach for quickly identifying clinician shifts.
AHRQ-funded; HS028454.
Citation: Moy AJ, Cato KD, Withall J .
Using time series clustering to segment and infer emergency department nursing shifts from electronic health record log files.
AMIA Annu Symp Proc 2023 Apr 29; 2022:805-14..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Emergency Department, Workforce
Aiken LH, Sloane DM, McHugh MD
A repeated cross-sectional study of nurses immediately before and during the COVID-19 pandemic: Implications for action
The goal of this cross-sectional study was to establish whether hospital nursing care shortages are primarily due to the COVID pandemic, and therefore likely to subside, or if shortages are due to understaffing and poor working conditions that predated the pandemic. The study considered registered nurses in New York and Illinois, and a subset of staff nurses employed in 357 hospitals, before and during the pandemic. While no evidence was found to show that large numbers of nurses left in the first 18 months of the pandemic, the study’s findings indicate that nurses in hospitals with better staffing and more favorable work environments prior to the pandemic reported significantly better outcomes. The authors concluded that policies that prevent chronic understaffing have the most potential to stabilize the hospital nurse workforce.
AHRQ-funded; HS028978.
Citation: Aiken LH, Sloane DM, McHugh MD .
A repeated cross-sectional study of nurses immediately before and during the COVID-19 pandemic: Implications for action
Nurs Outlook 2023 Jan-Feb; 71(1):101903. doi: 10.1016/j.outlook.2022.11.007..
Keywords: COVID-19, Provider: Nurse, Workforce, Burnout
Larson EL, Cohen B, Liu J
Assessing intensity of nursing care needs using electronically available data.
The aim of this project was to develop and test a Nursing Intensity of Care Index using electronically available data from 152,072 patient discharges from three hospitals. In preliminary testing, data for the Nursing Intensity of Care Index, which accurately reflect nursing care intensity, can be obtained electronically in real time. The next steps will be a discrete-event simulation model and large-scale field trials.
AHRQ-funded; HS024915.
Citation: Larson EL, Cohen B, Liu J .
Assessing intensity of nursing care needs using electronically available data.
Comput Inform Nurs 2017 Dec;35(12):617-23. doi: 10.1097/cin.0000000000000375.
.
.
Keywords: Electronic Health Records (EHRs), Nursing, Workforce
Dyrbye LN, Shanafelt TD, Sinsky CA
AHRQ Author: Meyers D
https://nam.edu/burnout-among-health-care-professionals-a-call-to-explore-and-address-this-underrecognized-threat-to-safe-high-quality-care
Burnout among health care professionals: a call to explore and address this underrecognized threat to safe, high-quality care.
The high prevalence of burnout among health care professionals is cause for concern because it appears to be affecting quality, safety, and health care system performance. Efforts are needed to address this growing problem. Progress will require methodologically sound studies, adequate funding, and collaborative efforts. The authors hope that research sponsors, institutions, clinician organizations, researchers, clinicians, and patients join in supporting enhanced research efforts focused on these topics.
AHRQ-authored.
Citation: Dyrbye LN, Shanafelt TD, Sinsky CA .
Burnout among health care professionals: a call to explore and address this underrecognized threat to safe, high-quality care.
NAM Perspectives 2017 Jul 5.
.
.
Keywords: Quality of Care, Provider: Health Personnel, Patient Safety, Workforce
Loresto FL, Jr., Jupiter D, Kuo YF
Examining differences in characteristics between patients receiving primary care from nurse practitioners or physicians using Medicare Current Beneficiary Survey data and Medicare claims data.
There is a perception that nurse practitioners (NPs), as compared with primary care medical doctors (PCMDs), tend to provide care to healthier patients. In this study, patients utilizing NP-only or PCMD-only models for primary care were characterized and compared in terms of functional, cognitive, and psychological factors. The results were contrary to the initial perception. In terms of health status, NP-only patients were similar to PCMD-only patients.
AHRQ-funded; HS020642.
Citation: Loresto FL, Jr., Jupiter D, Kuo YF .
Examining differences in characteristics between patients receiving primary care from nurse practitioners or physicians using Medicare Current Beneficiary Survey data and Medicare claims data.
J Am Assoc Nurse Pract 2017 Jun;29(6):340-47. doi: 10.1002/2327-6924.12465.
.
.
Keywords: Provider: Health Personnel, Medicare, Primary Care, Workforce
Washington DM, Paasche-Orlow MK, Liebschutz JM
Promoting progress or propagating problems: strategic plans and the advancement of academic faculty diversity in U.S. medical schools.
The aim of this study was to investigate whether academic institutions that have engaged in strategic planning for faculty diversity, as exhibited by plan presence on their websites, had a higher rate of underrepresented minorities in medicine (URM) faculty growth than institutions who do not have evidence of such planning.
AHRQ-funded; HS022242.
Citation: Washington DM, Paasche-Orlow MK, Liebschutz JM .
Promoting progress or propagating problems: strategic plans and the advancement of academic faculty diversity in U.S. medical schools.
J Natl Med Assoc 2017 Summer;109(2):72-78. doi: 10.1016/j.jnma.2016.10.001..
Keywords: Education: Curriculum, Racial and Ethnic Minorities, Workforce
Kavalieratos D, Siconolfi DE, Steinhauser KE
"It is like heart failure. It is chronic ... and it will kill you": a qualitative analysis of burnout among hospice and palliative care clinicians.
This study explored burnout among palliative care clinicians, specifically their experiences with burnout, their perceived sources of burnout, and potential individual, interpersonal, organizational, and policy-level solutions to address burnout. Common sources of burnout included increasing workload, tensions between nonspecialists and palliative care specialists, and regulatory issues. Participants proposed antiburnout solutions, including promoting the provision of generalist palliative care, frequent rotations on-and-off service, and organizational support for self-care.
AHRQ-funded; HS023681; HS022989.
Citation: Kavalieratos D, Siconolfi DE, Steinhauser KE .
"It is like heart failure. It is chronic ... and it will kill you": a qualitative analysis of burnout among hospice and palliative care clinicians.
J Pain Symptom Manage 2017 May;53(5):901-10.e1. doi: 10.1016/j.jpainsymman.2016.12.337.
.
.
Keywords: Provider: Health Personnel, Palliative Care, Workforce
Poghosyan L, Liu J, Shang J
Practice environments and job satisfaction and turnover intentions of nurse practitioners: implications for primary care workforce capacity.
Researchers examined nurse practitioner (NP) practice environments in primary care organizations and the extent to which they were associated with NP retention measures. NPs rated the relationship between NPs and physicians favorably, contrary to the relationship between NPs and administrators. With every unit increase in each standardized subscale score, the odds of job satisfaction increased about 20 percent whereas the odds of intention of turnover decreased about 20 percent.
AHRQ-funded; HS020999.
Citation: Poghosyan L, Liu J, Shang J .
Practice environments and job satisfaction and turnover intentions of nurse practitioners: implications for primary care workforce capacity.
Health Care Manage Rev 2017 Apr/Jun;42(2):162-71. doi: 10.1097/hmr.0000000000000094.
.
.
Keywords: Primary Care, Provider: Nurse, Provider: Clinician, Provider, Workforce
Scott KW, Orav EJ, Cutler DM
Changes in hospital-physician affiliations in U.S. hospitals and their effect on quality of care.
This study examined changes in U.S. acute care hospitals that reported employment relationships with their physicians and to determine whether quality of care improved after the hospitals switched to this integration model. It concluded that during the past decade, hospitals have increasingly become employers of physicians. The study's findings suggest that physician employment alone probably is not a sufficient tool for improving hospital care.
AHRQ-funded; HS000055.
Citation: Scott KW, Orav EJ, Cutler DM .
Changes in hospital-physician affiliations in U.S. hospitals and their effect on quality of care.
Ann Intern Med 2017 Jan 3;166(1):1-8. doi: 10.7326/m16-0125.
.
.
Keywords: Hospitals, Quality of Care, Critical Care, Workforce
de Cordova PB
Staffing and nurse-perceived quality of care.
This article comments on a study by Cho and colleagues, the purpose of which was to explore the associations between nurse staffing and overtime with nurse-perceived patient safety and care left undone. Cho and colleagues found that as patients per nurse and nurse work hours increase, so does the perception of reduced patient safety. The author argues that the study reinforces the view that educating nurses, administrators and policymakers about the importance of nurse staffing on quality care should continue.
AHRQ-funded; HS024339.
Citation: de Cordova PB .
Staffing and nurse-perceived quality of care.
Evid Based Nurs 2017 Jan;20(1):19. doi: 10.1136/eb-2016-102478.
.
.
Keywords: Quality of Care, Provider, Nursing, Workforce