National Healthcare Quality and Disparities Report
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Topics
- Adverse Events (5)
- Asthma (3)
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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 15 of 15 Research Studies DisplayedHalvorson EE, Thurtle DP, Easter A
Disparities in adverse event reporting for hospitalized children.
The authors compared the adverse event (AE) rate identified by voluntary event reporting (VER) with that identified using the Global Assessment of Pediatric Patient Safety (GAPPS) between hospitalized children by weight category, race, and English proficiency. In the population studied, they identified 288 total AEs, 270 by the GAPPS and 18 by VER. They found a disparity in AE reporting for children with limited English proficiency, with fewer AEs by VER compared with no difference in AEs by GAPPS. They identified no disparities by weight category or race. They concluded that voluntary event reporting may systematically underreport AEs in hospitalized children with limited English proficiency.
AHRQ-funded; HS026038.
Citation: Halvorson EE, Thurtle DP, Easter A .
Disparities in adverse event reporting for hospitalized children.
J Patient Saf 2022 Sep 1;18(6):e928-e33. doi: 10.1097/pts.0000000000001049..
Keywords: Children/Adolescents, Disparities, Adverse Events, Medical Errors, Patient Safety, Hospitals, Hospitalization, Inpatient Care
Masonbrink AR, Harris M, Hall M
Safety events in children's hospitals during the COVID-19 pandemic.
The coronavirus disease 2019 (COVID-19) pandemic has impacted hospitals, potentially affecting quality and safety. The objective of this study was to compare pediatric hospitalization safety events during the pandemic versus previous years. The investigators concluded that postoperative sepsis rates increased among children hospitalized during COVID-19. They suggest that efforts are needed to improve safety of postoperative care for hospitalized children.
AHRQ-funded; HS024554; HS024592.
Citation: Masonbrink AR, Harris M, Hall M .
Safety events in children's hospitals during the COVID-19 pandemic.
Hosp Pediatr 2021 Jun;11(6):e95-e100. doi: 10.1542/hpeds.2020-004937..
Keywords: Children/Adolescents, COVID-19, Patient Safety, Sepsis, Adverse Events, Hospitalization, Hospitals, Inpatient Care, Infectious Diseases, Public Health
Cotter JM, Tyler A, Reese J
Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.
This study looked at pediatric emergency department (ED) inpatient use of dexamethasone versus prednisone by providers for asthma treatment. A survey was distributed to providers who care for inpatient asthmatics. Ninety-two providers completed the survey. When patients received dexamethasone in the ED, 44% continued dexamethasone, 14% switched to prednisone, 2% stopped steroid use, and 40% said it depended on the circumstances. Hospitalists were significantly more likely to continue dexamethasone than pulmonologists (61% versus 15%). Switching to prednisone included factors such as severity of exacerbation (73%) and asthma history (47%). Just over half of providers (5f1%) felt uncomfortable using dexamethasone because of “minimal data to support [its] use inpatient.”
AHRQ-funded; HS026512.
Citation: Cotter JM, Tyler A, Reese J .
Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.
J Asthma 2020 Sep;57(9):942-48. doi: 10.1080/02770903.2019.1622713..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Medication, Inpatient Care, Care Management, Hospitalization, Emergency Department, Practice Patterns, Provider: Physician, Provider
Kaiser SV, Jennings B, Rodean J
Pathways for improving inpatient pediatric asthma care (PIPA): a multicenter, national study.
This study examined whether implementation of a pathway strategy for inpatient pediatric asthma patients improve outcomes for these patients. Outcomes measured included length of stay (LOS), early administration of metered-dose inhalers, screening for secondhand tobacco exposure and referral to cessation resources, and 7-day hospital readmissions or emergency revisits. Eighty-five hospitals were enrolled and 68 completed the study with (n=12,013) admissions. Pathways were associated with increases in early administration of metered-dose inhalers, and referral to smoking cessation resources, but no statistically significant changes in the other outcomes were observed. Most hospitals did improve in at least one outcome.
AHRQ-funded; HS024592; HS024554.
Citation: Kaiser SV, Jennings B, Rodean J .
Pathways for improving inpatient pediatric asthma care (PIPA): a multicenter, national study.
Pediatrics 2020 Jun;145(6):e20193026. doi: 10.1542/peds.2019-3026..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Inpatient Care, Patient-Centered Outcomes Research, Outcomes, Hospitalization, Care Management
Bonafide CP, Xiao R, Brady PW
Prevalence of continuous pulse oximetry monitoring in hospitalized children with bronchiolitis not requiring supplemental oxygen.
This study examined the use of continuous pulse oximetry monitoring in hospitalized children with bronchiolitis who do not require supplemental oxygen. US national guidelines discourage the use but the practice was found to be still fairly widespread. The researchers conducted a multicenter, cross-sectional study of pediatric wards in 56 US and Canadian hospitals in the Pediatric Research in Inpatient Settings Network from December 2018 through March 2019. Patients aged 8 weeks through 23 months were included as a convenience sample. Overall usage was found to be 46% ranging from 6% to 82%.
AHRQ-funded; HS026763.
Citation: Bonafide CP, Xiao R, Brady PW .
Prevalence of continuous pulse oximetry monitoring in hospitalized children with bronchiolitis not requiring supplemental oxygen.
JAMA 2020 Apr 21;323(15):1467-77. doi: 10.1001/jama.2020.2998..
Keywords: Children/Adolescents, Respiratory Conditions, Inpatient Care, Hospitalization, Care Management, Evidence-Based Practice
Feng JY, Toomey SL, Elliott MN
Factors associated with family experience in pediatric inpatient care.
Researchers assessed which aspects of pediatric inpatient experience have the strongest relationships with parents' willingness to recommend a hospital. Their cross-sectional study examined surveys completed by parents of children hospitalized at hospitals using the Child Hospital Consumer Assessment of Healthcare Providers and Systems Survey. They found that child comfort and nurse-parent communication showed the strongest relationships with willingness to recommend, followed by preparing to leave the hospital, doctor-parent communication, and keeping parents informed. They recommended improvement efforts focusing on creating an age-appropriate environment, improving the effectiveness of provider interactions, and engaging parents to share their values and concerns.
AHRQ-funded; HS020513; HS025299.
Citation: Feng JY, Toomey SL, Elliott MN .
Factors associated with family experience in pediatric inpatient care.
Pediatrics 2020 Mar;145(3): e20191264. doi: 10.1542/peds.2019-1264..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Children/Adolescents, Quality Measures, Quality of Care, Inpatient Care, Patient Experience, Hospitals, Hospitalization, Patient and Family Engagement, Clinician-Patient Communication
Khan A, Yin HS, Brach C
AHRQ Author: Brach C
Association between parent comfort with English and adverse events among hospitalized children.
The purpose of this study was to examine the association between parents’ limited comfort with English (LCE) and adverse events in a cohort of hospitalized children. Participants included Arabic-, Chinese-, English-, and Spanish-speaking parents of patients 17 years and younger in the pediatric units of seven North American hospitals. Findings showed that hospitalized children of parents expressing LCE were twice as likely to experience harms due to medical care. Targeted strategies are needed to improve communication and safety for this vulnerable group of children.
AHRQ-authored; AHRQ-funded; HS022986.
Citation: Khan A, Yin HS, Brach C .
Association between parent comfort with English and adverse events among hospitalized children.
JAMA Pediatr 2020 Dec;174(12):e203215. doi: 10.1001/jamapediatrics.2020.3215..
Keywords: Children/Adolescents, Caregiving, Cultural Competence, Clinician-Patient Communication, Communication, Adverse Events, Patient Safety, Inpatient Care, Hospitalization
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
Beck J, Wignall J, Jacob-Files E
Parent attitudes and preferences for discussing health care costs in the inpatient setting.
This study examined parent attitudes towards discussing their child’s health care costs in an inpatient setting with health care providers and others. Semistructured interviews were conducted with 42 parents of children who received care at a tertiary academic children’s hospital with and without chronic disease. Two domains for discussion were identified: factors that influence the parent’s desire to discuss health care costs in the inpatient setting and parent preference regarding the execution of cost discussions. Most parents highlighted concerns regarding physician involvement and felt that it was better explored with a financial counselor or social worker. They also felt that the discussions should be optional.
AHRQ-funded; HS024299.
Citation: Beck J, Wignall J, Jacob-Files E .
Parent attitudes and preferences for discussing health care costs in the inpatient setting.
Pediatrics 2019 Aug;144(2). doi: 10.1542/peds.2018-4029..
Keywords: Caregiving, Children/Adolescents, Healthcare Costs, Inpatient Care, Hospitalization, Hospitals
Glick AF, Brach C, Yin HS
AHRQ Author: Brach C
Health literacy in the inpatient setting: implications for patient care and patient safety.
This article considers how health literacy plays a part in events that lead up to children's hospitalizations both during hospital admission and after discharge. The authors discussed interventions that incorporate health-literacy-informed strategies and that target patients, families, and health care systems that should be implemented to improve patient outcomes and patient-centered and family-centered care.
AHRQ-authored.
Citation: Glick AF, Brach C, Yin HS .
Health literacy in the inpatient setting: implications for patient care and patient safety.
Pediatr Clin North Am 2019 Aug;66(4):805-26. doi: 10.1016/j.pcl.2019.03.007..
Keywords: Children/Adolescents, Health Literacy, Hospital Discharge, Hospitalization, Hospitals, Inpatient Care, Patient Safety
Lifland B, Wright DR, Mangione-Smith R
The impact of an adolescent depressive disorders clinical pathway on healthcare utilization.
The purpose of this study was to examine the association between level of adherence to an adolescent depressive disorders inpatient clinical pathway with psychiatric patients’ length of stay (LOS), cost, and readmissions. Patients in the high-adherence category were found to have significantly longer LOS and higher costs when compared to those in the low-adherence category. The authors conclude that understanding which of the care processes within the pathway are most cost-effective for improving patient-centered outcomes requires further investigation.
AHRQ-funded; HS024299.
Citation: Lifland B, Wright DR, Mangione-Smith R .
The impact of an adolescent depressive disorders clinical pathway on healthcare utilization.
Adm Policy Ment Health 2018 Nov;45(6):979-87. doi: 10.1007/s10488-018-0878-6..
Keywords: Care Management, Children/Adolescents, Depression, Healthcare Costs, Healthcare Utilization, Hospital Readmissions, Hospitalization, Inpatient Care, Behavioral Health, Outcomes, Patient-Centered Outcomes Research
Sun SA, Ma X, Li G
Epidemiologic patterns of in-hospital anaphylaxis in pediatric surgical patients.
This research letter looks into epidemiologic patterns of in-hospital anaphylaxis in pediatric surgical patients. Data from the study came from the Kids’ Inpatient Database (KIDS), which is released every 3 years. The data came from the 2003, 2006, 2009 and 2012 KID data sets. Children were included if they had a surgical admission for anaphylaxis which is interpreted as an in-hospital event. Overall in-hospital mortality for all children was 0.38% but for in-hospital anaphylaxis was 2.47%. The most common reason children were in the hospital before the event was hematological and myeloproliferative disorders, with the largest percentage undergoing bone marrow transplant procedures. Although the exact cause of the reaction was not known, hypersensitivity to chemotherapeutic agents and more recent mAb treatments have been identified as reasons for the in-hospital anaphylaxis.
AHRQ-funded; HS022941.
Citation: Sun SA, Ma X, Li G .
Epidemiologic patterns of in-hospital anaphylaxis in pediatric surgical patients.
J Allergy Clin Immunol 2018 May;141(5):1904-05.e2. doi: 10.1016/j.jaci.2017.11.030..
Keywords: Adverse Events, Children/Adolescents, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Hospitals, Inpatient Care, Practice Patterns, Surgery
Parikh K, Keller S, Ralston S
Inpatient quality improvement interventions for asthma: a meta-analysis.
This article reviewed interventional studies of inpatient-initiated asthma quality improvement (QI) to synthesize its impact on health care utilization. Thirty articles were included; 12 provided data on health care reutilization outcomes. The selected studies were categorized by intervention type and outcome. Risk ratios for readmissions were examined and a subanalyis of multimodal interventions conducted; the latter suggested lower readmission rates. A subanalysis of education and discharge planning interventions did not show an effect. The authors did not identify any inpatient strategies that impacted health care reutilization within 30 days of index hospitalization, but note that multimodal interventions demonstrated impact over the longer interval.
AHRQ-funded; HS024554.
Citation: Parikh K, Keller S, Ralston S .
Inpatient quality improvement interventions for asthma: a meta-analysis.
Pediatrics 2018 May;141(5). doi: 10.1542/peds.2017-3334.
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Keywords: Asthma, Children/Adolescents, Hospitalization, Inpatient Care, Quality Improvement
Wickremasinghe AC, Kuzniewicz MW, McCulloch CE
Efficacy of subthreshold newborn phototherapy during the birth hospitalization in preventing readmission for phototherapy.
The purpose of this study was to estimate the efficacy of subthreshold phototherapy for newborns with total serum bilirubin (TSB) levels from 0.1 to 3.0 mg/dL below the appropriate AAP phototherapy threshold during the birth hospitalization in preventing readmissions for phototherapy, and to identify predictors of readmission for phototherapy. The investigators concluded that subthreshold phototherapy during the birth hospitalization is effective in preventing readmissions for phototherapy; however, for each readmission prevented, many newborns require phototherapy who would otherwise not need it.
AHRQ-funded; HS020618.
Citation: Wickremasinghe AC, Kuzniewicz MW, McCulloch CE .
Efficacy of subthreshold newborn phototherapy during the birth hospitalization in preventing readmission for phototherapy.
JAMA Pediatr 2018 Apr;172(4):378-85. doi: 10.1001/jamapediatrics.2017.5630..
Keywords: Children/Adolescents, Evidence-Based Practice, Hospital Readmissions, Hospitalization, Inpatient Care, Newborns/Infants
Parast L, Bardach NS, Burkhart Q
Development of new quality measures for hospital-based care of suicidal youth.
This study researched the value of 4 new quality measures developed to assess hospital-based care for suicidal youth. The four quality measures focused on counseling caregivers about restricting access to lethal means of self-harm, and the benefits and risks of antidepressant medications. They were divided into measures for the emergency department (ED) and inpatient measures. Survey field tests were conducted with caregivers of youth who were admitted to the ED or inpatient care for suicidality at 1 of 2 children’s hospitals between July 2013 and June 2014. Most caregivers did receive counseling about restricting their child’s access to lethal means of self-harm and also reported higher rates of counseling of benefits on antidepressants both in the ED and in the inpatient setting than the risks.
AHRQ-funded; HS020506.
Citation: Parast L, Bardach NS, Burkhart Q .
Development of new quality measures for hospital-based care of suicidal youth.
Acad Pediatr 2018 Apr;18(3):248-55. doi: 10.1016/j.acap.2017.09.017..
Keywords: Caregiving, Children/Adolescents, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Education: Patient and Caregiver, Emergency Department, Hospitalization, Hospitals, Inpatient Care, Behavioral Health, Prevention, Quality of Care, Quality Measures