National Healthcare Quality and Disparities Report
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Topics
- Adverse Events (6)
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- Care Coordination (1)
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- Healthcare Cost and Utilization Project (HCUP) (8)
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- Healthcare Utilization (1)
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- Heart Disease and Health (2)
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- (-) Hospitalization (51)
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- Patient and Family Engagement (7)
- Patient Experience (3)
- Patient Safety (10)
- Payment (1)
- Pneumonia (1)
- Policy (1)
- Practice Patterns (3)
- Prevention (2)
- Provider (2)
- Provider: Physician (1)
- Public Health (1)
- Quality Improvement (4)
- Quality Measures (2)
- Quality of Care (5)
- Racial and Ethnic Minorities (1)
- Respiratory Conditions (5)
- Screening (1)
- Sepsis (2)
- Sleep Problems (1)
- Stroke (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
26 to 50 of 51 Research Studies DisplayedSelden TM, Karaca Z, Decker S
AHRQ Author: Selden TM, Karaca Z, Decker S
Has inpatient hospital treatment before and after age 65 changed as the difference between private and Medicare payment rates has widened?
This study examined whether inpatient hospital treatment before and after age 65 changed as the difference between private and Medicare payment rates widened. Using a large discharge dataset covering the period 2001-2011, the investigators tracked changes at age 65 in multiple dimensions of hospital care.
AHRQ-authored.
Citation: Selden TM, Karaca Z, Decker S .
Has inpatient hospital treatment before and after age 65 changed as the difference between private and Medicare payment rates has widened?
Int J Health Econ Manag 2018 Dec;18(4):409-23. doi: 10.1007/s10754-018-9240-5..
Keywords: Payment, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Inpatient Care, Medicare
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
Desai NR, Ott LS, George EJ
Variation in and hospital characteristics associated with the value of care for Medicare beneficiaries with acute myocardial infarction, heart failure, and pneumonia.
The objectives of this study were to investigate the association between hospital-level 30-day risk-standardized mortality rates (RSMRs) and 30-day risk-standardized payments (RSPs) for acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PNA); to characterize patterns of value in care; and to identify hospital characteristics associated with high-value care (defined by having lower than median RSMRs and RSPs).
AHRQ-funded; HS023000.
Citation: Desai NR, Ott LS, George EJ .
Variation in and hospital characteristics associated with the value of care for Medicare beneficiaries with acute myocardial infarction, heart failure, and pneumonia.
JAMA Netw Open 2018 Oct 5;1(6):e183519. doi: 10.1001/jamanetworkopen.2018.3519..
Keywords: Cardiovascular Conditions, Elderly, Hospitalization, Hospitals, Heart Disease and Health, Inpatient Care, Medicare, Mortality, Pneumonia
Al Danaf J, Chang BH, Shaear M
Surfacing and addressing hospitalized patients' needs: proactive nurse rounding as a tool.
This paper reported on rounding interventions employed at high performing hospitals, and provided three case studies on how proactive nurse rounding was successfully implemented to improve patient-centredness. The investigators concluded that proactive rounding interventions are a feasible approach to help surface and address hospitalized patients' needs in a timely manner.
AHRQ-funded; HS021921.
Citation: Al Danaf J, Chang BH, Shaear M .
Surfacing and addressing hospitalized patients' needs: proactive nurse rounding as a tool.
J Nurs Manag 2018 Jul;26(5):540-47. doi: 10.1111/jonm.12580..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Hospitalization, Hospitals, Inpatient Care, Nursing, Patient-Centered Healthcare, Patient Experience, Quality Improvement
Pickens G, Karaca Z, Cutler E
AHRQ Author: Karaca Z, Wong HS
Changes in hospital inpatient utilization following health care reform.
The purpose of this retrospective study was to estimate the effects of 2014 Medicaid expansions on inpatient outcomes using population and unemployment data from HCUP’s State Inpatient Databases. Outcomes included total admissions, referral-sensitive surgical and preventable admissions, length of stay, cost, and severity of patient illness. The authors conclude that Medicaid expansions did not change all-payer admission volumes, but expansions were associated with increased Medicaid and decreased uninsured volumes. The results of the study suggest that previously uninsured persons with a greater need for inpatient services were the most likely to gain coverage.
AHRQ-authored; AHRQ-funded.
Citation: Pickens G, Karaca Z, Cutler E .
Changes in hospital inpatient utilization following health care reform.
Health Serv Res 2018 Jun 30;53(4):2446-69. doi: 10.1111/1475-6773.12734..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitalization, Inpatient Care, Medicaid, Policy
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
Goodwin JS, Salameh H, Zhou J
Association of hospitalist years of experience with mortality in the hospitalized Medicare population.
The purpose of the study is to describe the association of hospitalist years of experience with 30-day mortality and hospital mortality of their patients. The authors noted that patients cared for by hospitalists in their first year of practice experienced higher mortality. The authors asserted that early-career hospitalists may require additional support to ensure optimal outcomes for their patients.
AHRQ-funded; HS022134.
Citation: Goodwin JS, Salameh H, Zhou J .
Association of hospitalist years of experience with mortality in the hospitalized Medicare population.
JAMA Intern Med 2018 Feb;178(2):196-203. doi: 10.1001/jamainternmed.2017.7049..
Keywords: Hospitalization, Inpatient Care, Medicare, Mortality, Provider
Huerta TR, McAlearney AS, Rizer MK
Introducing a patient portal and electronic tablets to inpatient care.
The researchers implemented a pilot inpatient portal (MyChart Bedside [Epic Systems]) using Android tablets to provide patients and their families and caregivers with an expected care plan each day, a roster of the care team, the ability to exchange secure messages with the care team, a way to write and save notes, and access to health information. They conducted the 90-day pilot program in 15 rooms on 1 patient unit in each of 2 hospitals and gave tablets to 179 patients. They found that patients wanted immediate access to laboratory results, that patients admitted for 1-2 days found the tablets less important, that those readmitted insisted on having a tablet, and that those with their own electronic devices were less likely to accept the tablet.
AHRQ-funded; HS024091.
Citation: Huerta TR, McAlearney AS, Rizer MK .
Introducing a patient portal and electronic tablets to inpatient care.
Ann Intern Med 2017 Dec 5;167(11):816-17. doi: 10.7326/m17-1766.
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Keywords: Health Information Technology (HIT), Hospitalization, Inpatient Care, Web-Based, Electronic Health Records (EHRs)
Lindenauer PK, Shieh MS, Stefan MS
Hospital procalcitonin testing and antibiotic treatment of patients admitted for chronic obstructive pulmonary disease exacerbation
The purpose of this study was to determine the impact of procalcitonin (PCT) testing on antibiotic treatment of patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD) in routine practice. The study conclude that as currently implemented, PCT testing appears to have had little impact on decisions to initiate antibiotic therapy or on duration of treatment for COPD exacerbations.
AHRQ-funded; HS024596.
Citation: Lindenauer PK, Shieh MS, Stefan MS .
Hospital procalcitonin testing and antibiotic treatment of patients admitted for chronic obstructive pulmonary disease exacerbation
Ann Am Thorac Soc 2017 Dec;14(12):1779-85. doi: 10.1513/AnnalsATS.201702-133OC..
Keywords: Antibiotics, Respiratory Conditions, Hospitalization, Inpatient Care, Patient-Centered Outcomes Research
Badawy J, Nguyen OK, Clark C
Is everyone really breathing 20 times a minute? Assessing epidemiology and variation in recorded respiratory rate in hospitalised adults.
The researchers sought to assess the potential accuracy of respiratory rate (RR) by analyzing the distribution and variation as a proxy, since RR should be normally distributed if recorded accurately. The observed patterns suggest that RR is inaccurately recorded, even among those with cardiopulmonary compromise, and represents a 'spot' estimate with values of 18 and 20 breaths per minute representing 'normal.’
AHRQ-funded; HS022418.
Citation: Badawy J, Nguyen OK, Clark C .
Is everyone really breathing 20 times a minute? Assessing epidemiology and variation in recorded respiratory rate in hospitalised adults.
BMJ Qual Saf 2017 Oct;26(10):832-36. doi: 10.1136/bmjqs-2017-006671.
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Keywords: Hospitalization, Inpatient Care, Patient Safety, Quality Improvement, Respiratory Conditions
Eriksson CO, Stoner RC, Eden KB
The association between hospital capacity strain and inpatient outcomes in highly developed countries: a systematic review.
This systematic literature review sought to understand whether hospital capacity strain is associated with worse health outcomes for hospitalized patients and to evaluate benefits and harms of health system interventions to improve care quality during times of hospital capacity strain. It concluded that in highly developed countries, hospital capacity strain is associated with increased mortality and worsened health outcomes.
AHRQ-funded; HS022981.
Citation: Eriksson CO, Stoner RC, Eden KB .
The association between hospital capacity strain and inpatient outcomes in highly developed countries: a systematic review.
J Gen Intern Med 2017 Jun;32(6):686-96. doi: 10.1007/s11606-016-3936-3.
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Keywords: Hospitalization, Hospitals, Inpatient Care, Patient-Centered Outcomes Research, Patient Safety
Hines AL, Raetzman SO, Barrett ML
AHRQ Author: Moy E, Andrews RM
Managed care and inpatient mortality in adults: effect of primary payer.
This study provides a comprehensive assessment of the association between managed care and inpatient mortality for Medicare and privately insured patients. Privately insured patients in managed care plans, especially older adults, had better outcomes than those in fee-for-service (FFS) plans. Patients in Medicare managed care had outcomes similar to those in Medicare FFS.
AHRQ-authored.
Citation: Hines AL, Raetzman SO, Barrett ML .
Managed care and inpatient mortality in adults: effect of primary payer.
BMC Health Serv Res 2017 Feb 8;17(1):121. doi: 10.1186/s12913-017-2062-1.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Health Insurance, Inpatient Care, Mortality, Outcomes, Hospitalization, Medicare
Prey JE, Qian M, Restaino S
Reliability and validity of the patient activation measure in hospitalized patients.
The objectives of this article are to describe the internal consistency reliability and construct validity of the PAM-13 for hospitalized cardiology and oncology patients and to examine the predictors of low patient activation in the same population. The authors found that patients with unplanned admissions were more likely to have low activation than patients with planned admissions. They also found that PAM-13 was modestly correlated with each of the PROMIS Global Health components: global, physical and mental health. They concluded that this study demonstrates the PAM-13 is a reliable and valid measure for use in the inpatient hospital setting and that type of admission is an important predictor of patient activation.
AHRQ-funded; HS021816.
Citation: Prey JE, Qian M, Restaino S .
Reliability and validity of the patient activation measure in hospitalized patients.
Patient Educ Couns 2016 Dec;99(12):2026-33. doi: 10.1016/j.pec.2016.06.029.
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Keywords: Cancer, Cardiovascular Conditions, Hospitalization, Inpatient Care, Patient and Family Engagement
Kronick R, Arnold S, Brady J
AHRQ Author: Arnold S, Brady J
Improving safety for hospitalized patients: much progress but many challenges remain.
Over the past few years hospitals have made substantial progress in reducing harms. The authors review the evidence demonstrating progress and what is known about the factors contributing to progress. The authors concluded that to parallel the effort that has been made to date on hospital safety, substantial effort is needed to determine how to measure and reduce diagnostic errors and ensure that this information is integrated into practice where it will translate into meaningful benefits for patients.
AHRQ-authored.
Citation: Kronick R, Arnold S, Brady J .
Improving safety for hospitalized patients: much progress but many challenges remain.
JAMA 2016 Aug 2;316(5):489-90. doi: 10.1001/jama.2016.7887.
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Keywords: Patient Safety, Hospitalization, Hospitals, Inpatient Care
Hsu DY, Gordon K, Silverberg JI
Serious infections in hospitalized patients with psoriasis in the United States.
The researchers sought to determine rates and predictors of serious infections in hospitalized psoriasis patients and quantify costs of care, length of stay, and mortality. Among patients with psoriasis, rates of serious infections increased over all time intervals analyzed and were significantly higher compared with those without psoriasis across all time intervals.
AHRQ-funded; HS023011.
Citation: Hsu DY, Gordon K, Silverberg JI .
Serious infections in hospitalized patients with psoriasis in the United States.
J Am Acad Dermatol 2016 Aug;75(2):287-96. doi: 10.1016/j.jaad.2016.04.005..
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Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitalization, Healthcare Costs, Inpatient Care
Masterson Creber R, Prey J, Ryan B
Engaging hospitalized patients in clinical care: study protocol for a pragmatic randomized controlled trial.
The purpose of this paper is to describe the protocol for a study to assess how patients' information needs during hospitalization can be addressed with health information technologies using a personalized inpatient portal. The study is designed to test whether the portal will improve patient engagement.
AHRQ-funded; HS021816.
Citation: Masterson Creber R, Prey J, Ryan B .
Engaging hospitalized patients in clinical care: study protocol for a pragmatic randomized controlled trial.
Contemp Clin Trials 2016 Mar;47:165-71. doi: 10.1016/j.cct.2016.01.005.
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Keywords: Health Information Technology (HIT), Hospitalization, Inpatient Care, Patient and Family Engagement, Web-Based
Miller AD, Mishra SR, Kendall L
Partners in care: Design considerations for caregivers and patients during a hospital stay.
The researchers described how caregivers and patients coordinate and collaborate to manage patients' care and wellbeing during a hospital stay. They defined and described five roles caregivers adopt: companion, assistant, representative, navigator, and planner, and show how patients and caregivers negotiate these roles and responsibilities throughout a hospital stay. Finally, they identified key design considerations for technology to support patients and caregivers during a hospital stay.
AHRQ-funded; HS022894.
Citation: Miller AD, Mishra SR, Kendall L .
Partners in care: Design considerations for caregivers and patients during a hospital stay.
Cscw 2016 Feb-Mar;2016:756-69. doi: 10.1145/2818048.2819983..
Keywords: Care Coordination, Caregiving, Hospitalization, Inpatient Care, Patient and Family Engagement
Selden TM, Karaca Z, Keenan P
AHRQ Author: Selden TM, Karaca Z, Keenan P, Kronick R
The growing difference between public and private payment rates for inpatient hospital care.
The difference between private and public (Medicare and Medicaid) payment rates for inpatient hospital stays widened between 1996 and 2012. Medical Expenditure Panel Survey data reveal that standardized private insurer payment rates in 2012 were approximately 75 percent greater than Medicare's-a sharp increase from the differential of approximately 10 percent in the period 1996-2001.
AHRQ-authored.
Citation: Selden TM, Karaca Z, Keenan P .
The growing difference between public and private payment rates for inpatient hospital care.
Health Aff 2015 Dec;34(12):2147-50. doi: 10.1377/hlthaff.2015.0706.
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Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Inpatient Care, Hospitalization
Smith MW, Friedman B, Karaca Z
AHRQ Author: Friedman B, Karaca Z, Wong HS
Predicting inpatient hospital payments in the United States: a retrospective analysis.
The researchers evaluated whether payment-to-charge ratios (PCRs) can be predicted for hospitals in States that do not provide detailed financial data. They found that inpatient payments can be estimated with modest accuracy for community hospital stays funded by Medicare, Medicaid, and private insurance.
AHRQ-authored.
Citation: Smith MW, Friedman B, Karaca Z .
Predicting inpatient hospital payments in the United States: a retrospective analysis.
BMC Health Serv Res 2015 Sep 10;15(1):372. doi: 10.1186/s12913-015-1040-8..
Keywords: Healthcare Cost and Utilization Project (HCUP), Inpatient Care, Healthcare Costs, Hospitalization
Press VG, Matthiesen MI, Ranadive A
Insights into inpatients with poor vision: a high value proposition.
The researchers studied the initial feasibility and efficacy of screening and correcting inpatients’ vision. Over 800 hospitalized patients’ vision was screened. Those participants who failed a vision screen (Snellen chart) test performed by research assistants were given non-prescription readers that corrected most participants’ vision.
AHRQ-funded; HS016967.
Citation: Press VG, Matthiesen MI, Ranadive A .
Insights into inpatients with poor vision: a high value proposition.
J Hosp Med 2015 May;10(5):311-3. doi: 10.1002/jhm.2342..
Keywords: Eye Disease and Health, Screening, Inpatient Care, Hospitalization
Hernandez-Boussard T, McDonald KM, Rhoads KF
Patient safety in plastic surgery: identifying areas for quality improvement efforts.
The study’s aim was to assess risk-adjusted rates of inpatient adverse events (AEs) for general reconstructive soft tissue procedures using established measures. It found that plastic surgery patients had a significantly lower risk-adjusted rate compared to other surgical inpatients for all events evaluated except for failure to rescue and postoperative hemorrhage or hematoma.
AHRQ-funded; HS018558.
Citation: Hernandez-Boussard T, McDonald KM, Rhoads KF .
Patient safety in plastic surgery: identifying areas for quality improvement efforts.
Ann Plast Surg 2015 May;74(5):597-602. doi: 10.1097/SAP.0b013e318297791e..
Keywords: Healthcare Cost and Utilization Project (HCUP), Adverse Events, Inpatient Care, Hospitalization, Patient Safety
Cooke CR, Iwashyna TJ
Sepsis mandates: improving inpatient care while advancing quality improvement.
In light of improvements in the care of the acutely ill hospitalized patients and changes in the epidemiology of hospital care, the authors recommend new quality mandates focused on sepsis. These mandates should: (1) address the reality that sepsis is frequently underdiagnosed, (2) focus on catalyzing and aggregating local efforts for quality improvements, and (3) plan for a phased implementation, improving measures in select sites prior to national roll-out.
AHRQ-funded; HS020672
Citation: Cooke CR, Iwashyna TJ .
Sepsis mandates: improving inpatient care while advancing quality improvement.
JAMA. 2014 Oct 8;312(14):1397-8. doi: 10.1001/jama.2014.11350..
Keywords: Quality of Care, Hospitalization, Inpatient Care, Critical Care, Sepsis