National Healthcare Quality and Disparities Report
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Topics
- Adverse Drug Events (ADE) (1)
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- Children/Adolescents (1)
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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 17 of 17 Research Studies DisplayedSaluja S, Hochman M, Bourgoin A
Primary care: the new frontier for reducing readmissions.
To date, efforts to reduce hospital readmissions have centered largely on hospitals. In a recently published environmental scan, the investigators examined the literature focusing on primary care-based efforts to reduce readmissions. They found that multi-component care transitions programs that are initiated early in the hospitalization and are part of broader primary care practice transformation appear most promising.
AHRQ-funded; 233201500019I.
Citation: Saluja S, Hochman M, Bourgoin A .
Primary care: the new frontier for reducing readmissions.
J Gen Intern Med 2019 Dec;34(12):2894-97. doi: 10.1007/s11606-019-05428-2.
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Keywords: Primary Care, Hospital Readmissions, Hospitals, Transitions of Care, Primary Care: Models of Care, Healthcare Delivery
Mixon AS, Kripalani S, Stein J
An on-treatment analysis of the MARQUIS study: interventions to improve inpatient medication reconciliation.
This paper examined evidence-based interventions implemented in five US hospitals to improve inpatient medication reconciliation. The sites implemented one to seven interventions in 791 patients during a 25-month implementation period. Three interventions were associated with significant decreases in potentially harmful reconciliation rates while two interventions were associated with significant increases. The positive interventions included: defining clinical roles and responsibilities, training, and hiring staff to perform discharge medication reconciliation. The negative interventions were training staff to take medication histories and implementing a new electronic health record (EHR) system.
AHRQ-funded; HS019598.
Citation: Mixon AS, Kripalani S, Stein J .
An on-treatment analysis of the MARQUIS study: interventions to improve inpatient medication reconciliation.
J Hosp Med 2019 Oct;14(10):614-17. doi: 10.12788/jhm.3308..
Keywords: Medication, Evidence-Based Practice, Adverse Drug Events (ADE), Adverse Events, Medical Errors, Patient Safety, Hospitals, Healthcare Delivery, Inpatient Care
Alexander LT, Fuentes-Rivera E, Saavedra-Avendano B
Utilisation of second-trimester spontaneous and induced abortion services in public hospitals in Mexico, 2007-2015.
This study examined data on utilization of in-facility second-trimester abortion services in Mexico. Data from Mexico’s Automated Hospital Discharge System (SAEH) from 2007-2015 was used to identify second-trimester abortions in public hospitals across Mexico’s 32 states. A total 145,956 second-trimester abortion services or 13.4% of total documented hospitalizations for abortion were identified. The rate remained constant for women aged 15-44 years. Women living in poorer socioeconomic conditions or highly marginalized municipalities were most likely to have second-trimester abortions compared to women in higher socioeconomic conditions who were able to utilize services in their first trimester.
AHRQ-funded; HS025155; HS022981.
Citation: Alexander LT, Fuentes-Rivera E, Saavedra-Avendano B .
Utilisation of second-trimester spontaneous and induced abortion services in public hospitals in Mexico, 2007-2015.
BMJ Sex Reprod Health 2019 Oct;45(4):283-89. doi: 10.1136/bmjsrh-2018-200300..
Keywords: Pregnancy, Women, Healthcare Utilization, Hospitals, Healthcare Delivery
Timbie JW, Kranz AM, Mahmud A
Federally qualified health center strategies for integrating care with hospitals and their association with measures of communication.
Federally qualified health centers have aligned clinical services and systems with local hospitals, but little is known about the specific care integration strategies health centers use or their impact on care. In this study, a research team examined the use of strategies by health centers to integrate care with hospitals and emergency departments (EDs) and their association with performance on measures of health center-hospital communication.
AHRQ-funded; HS024067.
Citation: Timbie JW, Kranz AM, Mahmud A .
Federally qualified health center strategies for integrating care with hospitals and their association with measures of communication.
Jt Comm J Qual Patient Saf 2019 Sep;45(9):620-28. doi: 10.1016/j.jcjq.2019.06.004..
Keywords: Patient-Centered Healthcare, Patient-Centered Outcomes Research, Hospitals, Communication, Emergency Department, Care Coordination, Healthcare Delivery
Hussain FS, Sosa T, Ambroggio L
Emergency transfers: an important predictor of adverse outcomes in hospitalized children.
This case-control study aimed to determine the predictive validity of an emergency transfer (ET) for outcomes in a free-standing children's hospital. Controls were matched in terms of age, hospital unit, and time of year. Patients who experienced an ET had a significantly higher likelihood of in-hospital mortality (22% vs 9%), longer ICU length of stay (4.9 vs 2.2 days), and longer posttransfer length of stay (26.4 vs 14.7 days) compared with controls (P < .03 for each).
AHRQ-funded; HS023827.
Citation: Hussain FS, Sosa T, Ambroggio L .
Emergency transfers: an important predictor of adverse outcomes in hospitalized children.
J Hosp Med 2019 Aug;14(8):482-85. doi: 10.12788/jhm.3219..
Keywords: Transitions of Care, Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Adverse Events, Outcomes, Patient-Centered Outcomes Research, Inpatient Care, Hospitalization, Hospitals, Healthcare Delivery
Ingraham A, Wang X, Havlena J
Factors associated with the interhospital transfer of emergency general surgery patients.
Researchers used data from the Nationwide Inpatient Sample to determine patient- and hospital-level factors associated with interhospital emergency general surgery (EGS) transfers. They identified that hospital-level characteristics more strongly predicted the need for transfer than patient-related factors. They recommended considering these factors in order to facilitate transfer decision-making.
AHRQ-funded; HS025224.
Citation: Ingraham A, Wang X, Havlena J .
Factors associated with the interhospital transfer of emergency general surgery patients.
J Surg Res 2019 Aug;240:191-200. doi: 10.1016/j.jss.2018.11.053..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Surgery, Shared Decision Making, Hospitals, Healthcare Delivery, Transitions of Care
Ward ST, Dimick JB, Zhang W
Association between hospital staffing models and failure to rescue.
The purpose of this study was to identify hospital staffing models associated with failure to rescue (FTR) rates at low- and high-performing hospitals. The investigators concluded that low FTR hospitals had significantly more staffing resources than high FTR hospitals. They indicated that although hiring additional staff may be beneficial, there remain significant financial limitations for many hospitals to implement robust staffing models.
AHRQ-funded; HS023621; HS024403.
Citation: Ward ST, Dimick JB, Zhang W .
Association between hospital staffing models and failure to rescue.
Ann Surg 2019 Jul;270(1):91-94. doi: 10.1097/sla.0000000000002744..
Keywords: Patient Safety, Hospitals, Workforce, Quality Indicators (QIs), Quality Improvement, Quality of Care, Healthcare Delivery
Barbash IJ, Wallace DJ, Kahn JM
Effects of changes in ICU bed supply on ICU utilization.
The purpose of this study was to determine the relationship between intensive care unit (ICU) bed supply and ICU admission in US hospitals. Using a difference-in-differences approach, researchers compared the risk-adjusted probability of ICU admission at hospitals that increased their ICU bed supply over time with matched hospitals that did not. Subjects were three patient groups with a low likelihood of benefiting from ICU admission: low-severity patients with acute myocardial infarction and pulmonary embolism, and high-severity patients with metastatic cancer at the end of life. Results showed that increases in ICU bed supply were associated with inconsistent changes in the probability of ICU admission that varied across patient subgroups.
AHRQ-funded; HS025455.
Citation: Barbash IJ, Wallace DJ, Kahn JM .
Effects of changes in ICU bed supply on ICU utilization.
Med Care 2019 Jul;57(7):544-50. doi: 10.1097/mlr.0000000000001137..
Keywords: Intensive Care Unit (ICU), Critical Care, Healthcare Utilization, Hospitalization, Healthcare Delivery, Hospitals
Boltey EM, Iwashyna TJ, Hyzy RC
Ability to predict team members' behaviors in ICU teams is associated with routine ABCDE implementation.
In order to support coordination among ICU team members, researchers developed a shared mental model (SMM). After administering a survey at the 2016 MHA Keystone Center ICU workshop, different components of SMMs were measured using five items from a validated survey, each on a 5-point Likert scale. Self-reported routine ABCDE implementation was measured using a single item 4-point Likert scale, and the relationship between SMMs and routine ABCDE implementation measured using logistic regression. The majority of survey respondents reported using the ABCDE bundle routinely. Odds of reporting routine ABCDE implementation significantly decreased when clinicians agreed it was difficult to predict team members' behaviors. The researchers conclude that increased awareness of team members' behaviors may be a mechanism to improve the implementation of complex care bundles such as ABCDE.
AHRQ-funded; HS024552.
Citation: Boltey EM, Iwashyna TJ, Hyzy RC .
Ability to predict team members' behaviors in ICU teams is associated with routine ABCDE implementation.
J Crit Care 2019 Jun;51:192-97. doi: 10.1016/j.jcrc.2019.02.028..
Keywords: Care Management, Critical Care, Hospitals, Intensive Care Unit (ICU), Healthcare Delivery, Teams
Lauerman MH, Herrera AV, Albrecht JS
Interhospital transfers with wide variability in emergency general surgery.
This study examined modern hospital practices for interhospital transfers of emergency general surgery patients. A retrospective review of the Maryland Health Services Cost Review Commission database was conducted from 2013 to 2015. The majority of patients (94.1%) were not transferred with only 3.2% transferred to a hospital and 2.7% transferred from a hospital. For individual hospitals, there was a range of 0-30.5% of encounters transferred to a hospital, 0.02-14.62% transferred from a hospital and 69.25-99.95% not transferred.
AHRQ-funded; HS024560.
Citation: Lauerman MH, Herrera AV, Albrecht JS .
Interhospital transfers with wide variability in emergency general surgery.
Am Surg 2019 Jun;85(6):595-600..
Keywords: Emergency Department, Healthcare Delivery, Hospitalization, Hospitals, Outcomes, Quality of Care, Surgery, Transitions of Care
Mueller SK, Schnipper JL
Physician perspectives on interhospital transfers.
This study examined physician perspectives of the common problems that occur during acute care hospital interhospital transfers. The process tends to be nonstandardized which creates a number of issues. These issues include: patients sometimes, frequently, or always arriving without required specialized care (56% of the time), arriving with unrealistic expectations of care (77.2% of responses), arrived more than 24 hours after accepted transfer in 80.1% of responses, and arrived without necessary transfer records 86.9% of the time. The last issue and also time of day of arrival many physicians felt posed a risk to the transferred patients.
AHRQ-funded; HS023331.
Citation: Mueller SK, Schnipper JL .
Physician perspectives on interhospital transfers.
J Patient Saf 2019 Jun;15(2):86-89. doi: 10.1097/pts.0000000000000312..
Keywords: Healthcare Delivery, Hospitals, Patient Safety, Provider, Provider: Physician, Transitions of Care
Borza T, Oerline MK, Skolarus TA
Association between hospital participation in Medicare Shared Savings Program Accountable Care Organizations and readmission following major surgery.
Accountable Care Organizations (ACOs) and readmission rates following major surgery. A retrospective cohort study was conducted using a 20% national Medicare sample to identify beneficiaries undergoing 1 of 7 common surgical procedures: abdominal aortic aneurysm repair, colectomy, cystectomy, prostatectomy, lung resection, total knee arthroplasty, and total hip arthroplasty between 2010 and 2014. Thirty-day risk-adjusted readmission rates was the primary outcome studied. Out of 2974 hospitals in the study, 389 were ACO affiliated. While rates fell for both cohorts, ACO hospitals had a higher decrease in hospitalizations over the same time period.
AHRQ-funded; HS024728; HS024525.
Citation: Borza T, Oerline MK, Skolarus TA .
Association between hospital participation in Medicare Shared Savings Program Accountable Care Organizations and readmission following major surgery.
Ann Surg 2019 May;269(5):873-78. doi: 10.1097/sla.0000000000002737..
Keywords: Hospitals, Surgery, Hospital Readmissions, Medicare, Healthcare Costs, Healthcare Delivery
Larsen E, Hoffman D, Rivera C
Continuing patient care during electronic health record downtime.
This study examined the impact of electronic health record (EHR) downtime in hospitals on patient care. Two mid-Atlantic hospitals where the EHR system was either fully or partially unavailable were used to document the problems using historic performance data and semistructured interviews. A total of 17 hospital employees were interviewed. Laboratory test results were delayed an average of 62% during downtime events. Paper documentation created during the downtime period was often incomplete or incorrect. The authors provided recommendations to improve downtime contingency plans based on their findings.
AHRQ-funded; HS024350.
Citation: Larsen E, Hoffman D, Rivera C .
Continuing patient care during electronic health record downtime.
Appl Clin Inform 2019 May;10(3):495-504. doi: 10.1055/s-0039-1692678..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare Delivery, Hospitals, Quality of Care
Bazzoli GJ, Harless DW, Chukmaitov AS
A taxonomy of hospitals participating in Medicare accountable care organizations.
In this study, the investigators identified hospital ACO participant subgroups that share certain capabilities and competencies to provide deeper understanding of the structure and operation of these organizations. Their findings provide a baseline to track the evolution of accountable care organization (ACO) hospitals over time. The authors suggest that ACOs need to consider not only geographic and service mix when selecting hospital participants but also their vertical integration features and management competencies.
AHRQ-funded; HS023332.
Citation: Bazzoli GJ, Harless DW, Chukmaitov AS .
A taxonomy of hospitals participating in Medicare accountable care organizations.
Health Care Manage Rev 2019 Apr/Jun;44(2):93-103. doi: 10.1097/hmr.0000000000000159..
Keywords: Healthcare Delivery, Hospitals, Medicare
Sadasivaiah S, Lyles CR, Kyoi S
Disparities in patient-reported interest in web-based patient portals: survey at an urban academic safety-net hospital.
Offering hospitalized patients' enrollment into a health system's patient portal may improve patient experience and engagement throughout the care continuum, especially across care transitions, but this process is less studied than portal engagement in the ambulatory setting. The objective of this study was to evaluate sociodemographic characteristics associated with interest in a health care system's portal among hospitalized patients and reasons for no interest.
AHRQ-funded; HS022408; HS022561; HS023558.
Citation: Sadasivaiah S, Lyles CR, Kyoi S .
Disparities in patient-reported interest in web-based patient portals: survey at an urban academic safety-net hospital.
J Med Internet Res 2019 Mar 26;21(3):e11421. doi: 10.2196/11421..
Keywords: Disparities, Patient-Centered Healthcare, Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare Delivery, Hospitals, Patient and Family Engagement, Urban Health
Shah S, Xian Y, Sheng S
Use, temporal trends, and outcomes of endovascular therapy after interhospital transfer in the United States.
This study examined the use, trends and outcomes of endovascular therapy (EVT) after interhospital transfer in the United Sates. This cohort study analyzed trends from over 1.8 million patients with ischemic stroke admitted to 2143 Get With The Guidelines-Stroke participating hospitals between 2012 and 2017. There were differences in mortality for interhospital transfer patients, although those differences disappeared after adjusting for delay in EVT initiation.
AHRQ-funded; HS024561.
Citation: Shah S, Xian Y, Sheng S .
Use, temporal trends, and outcomes of endovascular therapy after interhospital transfer in the United States.
Circulation 2019 Mar 26;139(13):1568-77. doi: 10.1161/circulationaha.118.036509..
Keywords: Stroke, Cardiovascular Conditions, Transitions of Care, Outcomes, Healthcare Delivery, Hospitals, Mortality, Quality of Care
Chan CW, Green LV, Lekwijit S
Assessing the impact of service level when customer needs are uncertain: an empirical investigation of hospital step-down units.
In this study, the authors focused on estimating costs and benefits in a complex healthcare setting where the major differentiation among server types is the intensity of the service provided. They used data from ten hospitals and found that a step-down unit may be a cost-effective way to treat patients when used for those who are post-intensive care unit. However, they also found that the impact of step-down-unit care is more nuanced for patients admitted from the emergency department and may result in increased mortality risk and hospital length of stay for patients who should be treated in the intensive care unit. The authors recommended more study in this area.
AHRQ-funded; HS018480.
Citation: Chan CW, Green LV, Lekwijit S .
Assessing the impact of service level when customer needs are uncertain: an empirical investigation of hospital step-down units.
Management Science 2019 Feb;65(2):751-75. doi: 10.1287/mnsc.2017.2974..
Keywords: Care Management, Healthcare Costs, Healthcare Delivery, Hospitals, Inpatient Care