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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 25 of 221 Research Studies DisplayedBernstein EY, Bernstein TP, Trivedi S
Outcomes after initiation of medications for alcohol use disorder at hospital discharge.
This study looked at outcomes after initiation of medications for alcohol use disorder (MAUD), which are very underutilized. The primary outcome was a composite of all-cause mortality or return to hospital within 30 days of discharge. Secondary outcomes included the previous components separately, return to hospital for alcohol-related diagnoses, and primary care or mental health follow-up within 30 days of discharge. There were 6794 unique individuals representing 9834 alcohol-related hospitalizations (median [IQR] age, 54 years; 3205 hospitalizations among females [32.6%]; 1754 hospitalizations among Black [17.8%], 712 hospitalizations among Hispanic [7.2%], and 7060 hospitalizations among White [71.8%] patients). Of these, 2% of hospitalizations involved discharged MAUD initiation. Discharge MAUD initiation was associated with a 42% decreased incidence of the primary outcome (incident rate ratio, 0.58). These findings were consistent among secondary outcomes (eg, incident rate ratio for all-cause return to hospital, 0.56) except for mortality, which was rare in both groups. Discharge MAUD initiation was associated with a 51% decreased incidence of alcohol-related return to hospital.
AHRQ-funded; HS026215.
Citation: Bernstein EY, Bernstein TP, Trivedi S .
Outcomes after initiation of medications for alcohol use disorder at hospital discharge.
JAMA Netw Open 2024 Mar 4; 7(3):e243387. doi: 10.1001/jamanetworkopen.2024.3387..
Keywords: Medication, Alcohol Use, Substance Abuse, Behavioral Health, Outcomes, Hospital Discharge
Carroll AR, Johnson JA, Stassun JC
Health literacy-informed communication to reduce discharge medication errors in hospitalized children: a randomized clinical trial.
This study’s objective was to test a health literacy-informed communication intervention to decrease liquid medication dosing errors compared with standard counseling in hospitalized children. This parallel, randomized clinical trial was conducted from June 22, 2021, to August 20, 2022, at a tertiary care, US children's hospital. English- and Spanish-speaking caregivers of hospitalized children 6 years or younger prescribed a new, scheduled liquid medication at discharge were included in the analysis. Observed dosing errors were the main outcome measured, and secondary outcomes included caregiver-reported medication knowledge. Among 198 randomized caregivers (mean age 31.4 years; 186 women [93.9%]; 36 [18.2%] Hispanic or Latino and 158 [79.8%] White), the primary outcome was available for 151 (76.3%). The observed mean (SD) percentage dosing error was 1.0% (2.2 percentage points) among the intervention group and 3.3% (5.1 percentage points) among the standard counseling group (absolute difference, 2.3 percentage points). Twenty-four of 79 caregivers in the intervention group (30.4%) measured an incorrect dose compared with 39 of 72 (54.2%) in the standard counseling group. The intervention enhanced caregiver-reported medication knowledge compared with the standard counseling group for medication dose (71 of 76 [93.4%] vs 55 of 69 [79.7%]), duration of administration (65 of 76 [85.5%] vs 49 of 69 [71.0%], and correct reporting of 2 or more medication adverse effects (60 of 76 [78.9%] vs 13 of 69 [18.8%]).
AHRQ-funded; HS026122.
Citation: Carroll AR, Johnson JA, Stassun JC .
Health literacy-informed communication to reduce discharge medication errors in hospitalized children: a randomized clinical trial.
JAMA Netw Open 2024 Jan 2; 7(1):e2350969. doi: 10.1001/jamanetworkopen.2023.50969..
Keywords: Children/Adolescents, Health Literacy, Communication, Medication, Adverse Drug Events (ADE), Adverse Events, Medical Errors, Clinician-Patient Communication, Hospital Discharge, Medication: Safety
Roemer M, Schaefer MB, Pickens GT
AHRQ Author: Roemer M
Estimating state-specific population-based hospitalization rates from in-state hospital discharge data.
The purpose of this study was to develop weights to estimate state population-based hospitalization rates for all residents of a state using only data from in-state hospitals. The researchers utilized Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases (SID), for data from 2018-2019, including 47 states plus Washington D.C. and excluding residents treated in other states. SID were based on administrative billing records collected by hospitals, shared with statewide data organizations, and provided to HCUP. The study found that of 34,186,766 discharged patients in 2018, 4.2% were movers. A greater share of movers (vs. stayers) lived in state border and rural counties; a lower share had discharges billed to Medicaid or were hospitalized for maternal/neonatal services. The difference between 2019 observed and estimated total discharges for all included states and D.C. was 9,402. The researchers reported an overestimation of discharges with an expected payer of Medicaid, from the lowest income communities, and for maternal/neonatal care. The researchers reported an underestimation of discharges with an expected payer of private insurance, from the highest income communities, and with injury diagnoses and surgical services. Estimates for the majority of subsets were reported to be not within a 95% confidence interval, attributed to factors such as hospital closures/openings, shifting consumer preferences, and other issues impossible to account for.
AHRQ-authored; AHRQ-funded; 290201800001C.
Citation: Roemer M, Schaefer MB, Pickens GT .
Estimating state-specific population-based hospitalization rates from in-state hospital discharge data.
Health Serv Res 2023 Dec; 58(6):1314-27. doi: 10.1111/1475-6773.14216..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitalization, Hospital Discharge
Cavallaro SC, Michelson KA, D'Ambrosi G
Critical revisits among children after emergency department discharge.
This retrospective study’s objectives were to determine the rate of critical emergency department (ED) revisits among children discharged from the ED and to identify factors associated with critical revisits. Using the HCUP State ED Databases (SEDD) and State Inpatient Databases (SID), researchers examined data from six states, including patients under 21 years old. The findings indicated that critical ED revisits after discharge were uncommon and patient death within three days of ED discharge were rare; patients with complex chronic conditions were more likely to have a critical ED revisit. The researchers concluded that future research should focus on understanding higher risk among patients with asthma or a history of complex chronic conditions.
AHRQ-funded; HS026503.
Citation: Cavallaro SC, Michelson KA, D'Ambrosi G .
Critical revisits among children after emergency department discharge.
Ann Emerg Med 2023 Nov; 82(5):575-82. doi: 10.1016/j.annemergmed.2023.06.006..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department, Hospital Discharge
Ryus CR, Janke AT, Kunnath N
Association of hospital discharge against medical advice and coded housing instability in the US.
This study examined the relationship between discharge type and housing instability, then identified primary reasons for hospitalization among self-discharged patients with housing instability. This cross-sectional, retrospective study analyzed the National Inpatient Sample between January 2017 and December 2019, available from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project. Among 85,402,831 hospitalizations analyzed, 1.6% resulted in self-discharge. Compared to admissions with planned discharges, self-discharges were more likely to have coded housing instability. Among hospitalizations resulting in self-discharge, admissions with coded housing instability were more likely to result in self-discharge than those without coded housing instability. Relationships between housing instability and self-discharges were found among major medical conditions: septicemia, acute myocardial infarction, and respiratory failure. Alcohol-related disorders and opioid-related disorders were among the highest self-discharge volumes, but relationships were minimal.
AHRQ-funded; HS028963.
Citation: Ryus CR, Janke AT, Kunnath N .
Association of hospital discharge against medical advice and coded housing instability in the US.
J Gen Intern Med 2023 Oct; 38(13):3082-85. doi: 10.1007/s11606-023-08240-1..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospital Discharge, Social Determinants of Health, Vulnerable Populations, Hospital Readmissions
Giles C, Novakovic M, Hopman W
The quality of discharge summaries after acute kidney injury.
The objectives of this retrospective chart review were to determine the quality of discharge summaries in acute kidney injury (AKI) patients and to identify predictors for higher quality summaries. Researchers examined the discharge summaries for 300 randomly selected adult patients who survived a hospitalization with AKI at a tertiary care hospital in Ontario. Results showed that most discharge summaries were missing key AKI elements, even for patients with severe AKI. The researchers concluded that these gaps indicated opportunities for improving discharge summary communication following AKI.
AHRQ-funded; HS028060.
Citation: Giles C, Novakovic M, Hopman W .
The quality of discharge summaries after acute kidney injury.
Can J Kidney Health Dis 2023 Jan-Dec; 10:20543581231199018. doi: 10.1177/20543581231199018..
Keywords: Kidney Disease and Health, Injuries and Wounds, Hospital Discharge
Anderson AJ, Noyes K, Hewner S
Expanding the evidence for cross-sector collaboration in implementation science: creating a collaborative, cross-sector, interagency, multidisciplinary team to serve patients experiencing homelessness and medical complexity at hospital discharge.
This report discussed the challenges for implementing cross-sector collaboration (CSC). A recuperative care collaborative in Buffalo, NY, provided care transition support at an acute care hospital discharge via a medical respite program for people who had experienced homelessness. Using the Expert Recommendations for Implementing Change (ERIC) framework and feedback from the cross-sector collaborative team, implementation strategies were derived from three validated ERIC implementation strategy clusters: development of stakeholder relationships, use of evaluative and iterative strategies, and changes to infrastructure. The authors concluded that future research would address external organizational influences and emphasize CSC as central to interventions.
AHRQ-funded; HS028000.
Citation: Anderson AJ, Noyes K, Hewner S .
Expanding the evidence for cross-sector collaboration in implementation science: creating a collaborative, cross-sector, interagency, multidisciplinary team to serve patients experiencing homelessness and medical complexity at hospital discharge.
Front Health Serv 2023 Sep 8; 3:1124054. doi: 10.3389/frhs.2023.1124054..
Keywords: Hospital Discharge, Chronic Conditions, Vulnerable Populations, Care Coordination, Transitions of Care
Bristol AA, Elmore CE, Weiss ME
Mixed-methods study examining family carers' perceptions of the relationship between intrahospital transitions and patient readiness for discharge.
Intrahospital transitions (IHTs) may disrupt care coordination. Family caregivers often serve as liaisons between the patient and healthcare professionals, yet caregivers are often excluded from care planning during IHTs. The aim of this sequential, explanatory mixed-methods study was to examine family caregiver’s perceptions about IHTs, patient and caregiver ratings of patient discharge readiness, and caregiver self-perception of level of preparedness for engaging in care at home. The researchers conducted a retrospective analysis of hospital inpatients from a parent study for whom patient and family caregiver Readiness for Hospital Discharge Scale (RHDS) score frequency of IHTs and patient and caregiver characteristics were available. The study found that a total of 268 patients discharged from July 2020 to April 2021 had completed the RHDS and 23 completed the semi-structured interviews. The majority of patients experienced 0-2 IHTs and reported high levels of discharge readiness. No association was found between IHTs and patients' RHDS scores in the quantitative analysis. However, caregiver’s perceptions of patient discharge readiness were negatively correlated with increased IHTs. In addition, non-spouse caregivers reported lower RHDS scores than spousal caregivers. During interviews, caregivers shared barriers experienced during IHTs and described the importance of being included in discharge care planning.
AHRQ-funded; HS026248; HS026505.
Citation: Bristol AA, Elmore CE, Weiss ME .
Mixed-methods study examining family carers' perceptions of the relationship between intrahospital transitions and patient readiness for discharge.
BMJ Qual Saf 2023 Aug; 32(8):447-56. doi: 10.1136/bmjqs-2022-015120..
Keywords: Caregiving, Hospital Discharge, Transitions 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
Shannon EM, Mueller SK, Schnipper JL
Patient, caregiver, and clinician experience with a technologically enabled pillbox: a qualitative study.
The purpose of this study was to explore whether medication safety could be improved by the use of a technologically-enabled pillbox prescribed to patients at hospital discharge. The study included semi-structured telephone interviews with patients, patient caregivers, and inpatient and outpatient clinicians who participated in the Smart Pillbox Transition Study. The researchers utilized the Systems Engineering Initiative for Patient Safety (SEIPS) framework to develop an interview guide, which included the a priori domains of 1) barriers to implementation, 2) facilitators of the intervention, and 3) general feedback regarding experience with the intervention. The study found patient-endorsed barriers in the theme of technology and tools included signal issues, inappropriate alarms, and portability. Barriers in the theme of logistics and tasks included coordination with pharmacists in the event of a prescription change. Barriers mentioned by clinicians included patients who were poor fits for the intervention and competing demands at discharge (under the themes of personnel and patients, and logistics and tasks, respectively). Facilitators that were reported often by patients and caregivers in the theme of technology and tools included useful alarms and ease of use. Clinicians reported that communication with pharmacy and study staff facilitated the intervention.
AHRQ-funded.
Citation: Shannon EM, Mueller SK, Schnipper JL .
Patient, caregiver, and clinician experience with a technologically enabled pillbox: a qualitative study.
ACI Open 2023 Jul; 7(2):e61-e70..
Keywords: Medication, Health Information Technology (HIT), Patient Self-Management, Hospital Discharge, Medication: Safety, Patient Safety
Piniella NR, Fuller TE, Smith L
Early expected discharge date accuracy during hospitalization: a multivariable analysis.
The purpose of this study was to assess the level at which accurate estimation of an expected discharge date (EDD) early during hospitalization impacts clinical operations and discharge planning. The researchers conducted a retrospective study of patients discharged from six general medicine units at an academic medical center in Boston, MA from January 2017 to June 2018. All EDD entries and patient, encounter, unit, and provider data were extracted from the electronic health record (EHR), and public weather data. The study found that of 3917 eligible hospitalizations 22.7% had at least one accurate early EDD entry. Clinician-entered EDD, admit day and discharge day during the work week, and teaching clinical units were the factors significantly positively associated with an accurate early EDD. An Elixhauser Comorbidity Index of 11 or more and length of stay of two or more days were the factors significantly negatively associated with an accurate early EDD. The researchers concluded that EDDs entered within the first 24 hours of admission were frequently inaccurate. Few of the factors associated with accurate early EDD entries would be useful for prospective prediction.
AHRQ-funded; HS024751.
Citation: Piniella NR, Fuller TE, Smith L .
Early expected discharge date accuracy during hospitalization: a multivariable analysis.
J Med Syst 2023 May 12; 47(1):63. doi: 10.1007/s10916-023-01952-1..
Keywords: Hospital Discharge, Hospitalization
Skains RM, Zhang Y, Osborne JD
Hospital-associated disability due to avoidable hospitalizations among older adults.
A frequent complication during the course of acute care hospitalizations in older adults is Hospital-associated disability (HAD). Numerous admissions are for ambulatory care sensitive conditions (ACSCs), which are considered potentially avoidable hospitalizations-conditions that may be able to be treated in outpatient settings to prevent hospitalization and HAD. The purpose of this study was to compare the incidence of HAD between older adults hospitalized for ACSCs versus those hospitalized for other diagnoses. The researchers conducted a retrospective cohort study of 38,960 older adults 65 years of age or older admitted to inpatient (non-ICU) medical and surgical units of a large southeastern regional academic medical center. The primary study outcome was HAD. The study found that 10% of older adults were admitted for an ACSC, with rates of HAD in those admitted for ACSCs lower than those admitted for other conditions. Age, comorbidity, admission functional status, and admission cognitive impairment were significant predictors for development of HAD. Compared with admissions for other conditions, ACSC admissions to medical and medical/surgical services had decreased odds of HAD, with no significant differences between ACSC and non-ACSC admissions to surgical services.
AHRQ-funded; HS013852.
Citation: Skains RM, Zhang Y, Osborne JD .
Hospital-associated disability due to avoidable hospitalizations among older adults.
J Am Geriatr Soc 2023 May; 71(5):1395-405. doi: 10.1111/jgs.18238..
Keywords: Elderly, Hospitalization, Hospital Discharge
Desai AD, Tolpadi A, Parast L
Improving the quality of written discharge instructions: a multisite collaborative project.
This study assessed the association between participation in an Institute for Healthcare Improvement Virtual Breakthrough Series collaborative and the quality of pediatric written discharge instructions across 8 US hospitals. The authors conducted a multicenter, interrupted time-series analysis of a medical records-based quality measure focused on written discharge instruction content (0-100 scale, higher scores reflect better quality). They obtained data from a random sample of pediatric patients (n = 5739) discharged from participating hospitals between September 2015 and August 2016, and between December 2017 and January 2020. The study periods consisted of 3 phases: 1) a 14-month pre-collaborative phase; 2) a 12-month quality improvement collaborative phase when hospitals implemented multiple rapid cycle tests of change and shared improvement strategies; and 3) a 12-month postcollaborative phase. Among hospitals with high baseline performance, measure scores improved beyond expected for the precollaborative trend, but hospitals with low baseline performance, measure scores increased at a lower than expected rate.
AHRQ-funded; HS025291.
Citation: Desai AD, Tolpadi A, Parast L .
Improving the quality of written discharge instructions: a multisite collaborative project.
Pediatrics 2023 May; 151(5):e2022059452. doi: 10.1542/peds.2022-059452..
Keywords: Hospital Discharge, Transitions of Care, Hospitals
Herges JR, May HP, Meade L
Pharmacist-provider collaborative visits after hospital discharge in a comprehensive acute kidney injury survivor model.
This pilot study’s objective was to describe pharmacist contributions to a comprehensive postdischarge acute kidney injury (AKI) survivorship program in primary care (the AKI in Care Transitions [ACT] program). The program was piloted from May to December of 2021 at Mayo Clinic as a bundled care strategy for patients who survived an episode of AKI and were discharged home without the need for hemodialysis. Predischarge patients received education and care coordination from nurses and later completed postdischarge laboratory assessment and clinician follow-up in primary care. During follow-up, patients completed a 30-minute comprehensive medication management visit with a pharmacist focusing on AKI survivorship considerations. Pharmacists made 28 medication therapy recommendations (median 3 per patient) and identified 14 medication discrepancies for the 11 patients who completed the pilot program, with 86% of the medication therapy recommendations being acted on by the PCP within 7 days. Six recommendations were made to initiate renoprotective medications, and 5 were acted on.
AHRQ-funded; HS028060.
Citation: Herges JR, May HP, Meade L .
Pharmacist-provider collaborative visits after hospital discharge in a comprehensive acute kidney injury survivor model.
J Am Pharm Assoc 2023 May-Jun; 63(3):909-14. doi: 10.1016/j.japh.2022.12.029..
Keywords: Provider: Pharmacist, Kidney Disease and Health, Hospital Discharge
Kimchi A, Aronow HU, Ni YM
Postdischarge noninvasive telemonitoring and nurse telephone coaching improve outcomes in heart failure patients with high burden of comorbidity.
The purpose of this study was to explore how comorbidity burden modulates the effectiveness of Noninvasive telemonitoring and nurse telephone coaching (NTM-NTC) and identify patients with HF who may benefit from postdischarge NTM-NTC based on their burden of comorbidity. METHODS AND RESULTS: In the Better Effectiveness After Transition - Heart Failure trial, patients hospitalized for acute decompensated HF were randomized to postdischarge NTM-NTC or usual care. In this secondary analysis of 1313 patients with complete data, comorbidity burden was assessed by scoring complication and coexisting diagnoses from index admissions. Clinical outcomes included 30-day and 180-day readmissions, mortality, days alive, and combined days alive and out of the hospital. Patients had a mean of 5.7 comorbidities and were stratified into low (0-2), moderate (3-8), and high comorbidity (≥9) subgroups. Increased comorbidity burden was associated with worse outcomes. NTM-NTC was not associated with readmission rates in any comorbidity subgroup. Among high comorbidity patients, NTM-NTC was associated with significantly lower mortality at 30 days (hazard ratio 0.25, 95% confidence interval 0.07-0.90) and 180 days (hazard ratio 0.51, 95% confidence interval 0.27-0.98), as well as more days alive (160.1 vs 140.3, P = .029) and days alive out of the hospital (152.0 vs 133.2, P = .044) compared with usual care. CONCLUSIONS: Postdischarge NTM-NTC improved survival among patients with HF with a high comorbidity burden. Comorbidity burden may be useful for identifying patients likely to benefit from this management strategy.
AHRQ-funded; HS019311.
Citation: Kimchi A, Aronow HU, Ni YM .
Postdischarge noninvasive telemonitoring and nurse telephone coaching improve outcomes in heart failure patients with high burden of comorbidity.
J Card Fail 2023 May; 29(5):774-83. doi: 10.1016/j.cardfail.2022.11.012..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Telehealth, Health Information Technology (HIT), Hospital Discharge
Carroll AR, Schlundt D, Bonnet K
Caregiver and clinician perspectives on discharge medication counseling: a qualitative study.
This study’s objective was to explore the perspectives of multidisciplinary clinicians and caregivers regarding discharge medication counseling for children and to develop a conceptual model to inform intervention efforts to reduce discharge medication dosing errors. The authors conducted a qualitative analysis using results from focus groups and individual interviews with 17 caregivers and 16 clinicians. Domains and subthemes included: (1) infrastructure of healthcare delivery, including supplies for counseling, content and organization of discharge instructions, clinician training and education, roles and responsibilities of team members, and hospital pharmacy delivery and counseling program; (2) processes of healthcare delivery, including medication reconciliation, counseling content, counseling techniques, and language barriers and health literacy; and (3) measurable outcomes, including medication dosing accuracy and caregiver understanding and adherence to discharge instructions. The conceptual model that resulted from this analysis can be applied to the development and evaluation of interventions to reduce discharge medication dosing errors following a hospitalization.
AHRQ-funded; HS026122.
Citation: Carroll AR, Schlundt D, Bonnet K .
Caregiver and clinician perspectives on discharge medication counseling: a qualitative study.
Hosp Pediatr 2023 Apr; 13(4):325-42. doi: 10.1542/hpeds.2022-006937..
Keywords: Children/Adolescents, Medication, Hospital Discharge, Education: Patient and Caregiver, Caregiving
Burden M, Keniston A, Gundareddy VP
Discharge in the A.M.: a randomized controlled trial of physician rounding styles to improve hospital throughput and length of stay.
In an effort to alleviate hospital capacity constraints, medical facilities frequently promote the prioritization of early morning discharges, which could potentially lead to unintended repercussions. The purpose of this study was to investigate the impact of hospitalist physicians focusing on discharging patients before attending to other tasks in comparison to their customary rounding practices. This prospective, multi-center randomized controlled trial involved three major academic hospitals. Participants included Hospital Medicine attending-level physicians and the patients under their care during the study, who were at least 18 years old, admitted to a Medicine service, and assigned to a hospitalist team through routine procedures. Physicians were randomized into two groups: 1) giving precedence to discharging patients as care permitted or 2) maintaining their usual practice. The primary outcome measure was the time of discharge order. Secondary outcomes encompassed actual discharge time, length of stay (LOS), and order timings for procedures, consultations, and imaging. The study found that between February 9, 2021, and July 31, 2021, 59 physicians were randomized to prioritize patient discharges or maintain their usual rounding practice, resulting in the discharge of 4,437 patients. In the primary adjusted analysis (intention-to-treat), there was no significant difference in discharge order time or actual discharge time between physicians who prioritized discharging patients first and those who followed their usual rounding style. Additionally, LOS and order times for other physician orders remained unchanged.
AHRQ-funded; HS027231
Citation: Burden M, Keniston A, Gundareddy VP .
Discharge in the A.M.: a randomized controlled trial of physician rounding styles to improve hospital throughput and length of stay.
J Hosp Med 2023 Apr;18(4):302-15. doi: 10.1002/jhm.13060.
Keywords: Hospital Discharge, Hospitals
Anesi GL, Dres E, Chowdhury M
Among-hospital variation in ICU admission practices and associated outcomes for patients with acute respiratory failure.
Prior research has demonstrated a connection between hospital strain and ICU admission, and has suggested that ICU admission, compared to ward admission, could be advantageous for certain patients with acute respiratory failure (ARF). The purpose of this study was to explore how strain-process-outcomes relationships in ARF patients may differ among hospitals and to identify hospital practice discrepancies that may explain such variation. The researchers analyzed high-acuity ARF patients who did not necessitate mechanical ventilation or vasopressors in the emergency department (ED) and were admitted to 27 US hospitals between 2013 and 2018. The researchers compared hospital strain-ICU admission relationships and hospital length of stay (LOS) and mortality for patients initially admitted to the ICU versus the ward. Additionally, they investigated hospital practices and assessed their associations with those processes and outcomes. The study found that substantial variation was observed among hospitals in ICU admission rates, hospital strain-ICU admission relationships, and the impact of ICU admission on hospital LOS and mortality. Overall, ED patients with ARF had a median hospital LOS that was 0.82 days shorter if initially admitted to the ICU rather than the ward. However, among the 27 hospitals this effect ranged from 5.85 days shorter to 4.38 days longer. In exploratory analyses, only a limited number of identified hospital practices—such as the presence of sepsis ED disposition guidelines and maximum ED patient capacity—were potentially linked to hospital strain-ICU admission relationships.
AHRQ-funded; HS026372.
Citation: Anesi GL, Dres E, Chowdhury M .
Among-hospital variation in ICU admission practices and associated outcomes for patients with acute respiratory failure.
Ann Am Thorac Soc 2023 Mar; 20(3):406-13. doi: 10.1513/AnnalsATS.202205-429OC.
Keywords: Intensive Care Unit (ICU), Respiratory Conditions, Hospital Discharge
Goodhope NR, Anderson TS, Jung Y
Initiation of psychotropic and opioid medications after hospital discharge in older adults with dementia.
Despite the high number of people suffering from opioid addiction in the USA, access to treatment remains limited, with only a fraction of those in need receiving life-saving medications for opioid use disorder (MOUD). The current healthcare system and policies create unnecessary barriers to care, exacerbating treatment and illness burdens. This study proposes the use of a minimally disruptive medicine (MDM) framework to reduce disruptions in patients' lives, improve healthcare quality and delivery, and save lives. To achieve this, the authors suggest policy changes that expand MOUD to all healthcare settings, promote flexible and patient-centered medication choices, reduce treatment requirements, and address systemic disparities and inequities. By adopting an MDM approach, clinicians, health systems, and policymakers can create a more patient-centered and accessible care system for those battling opioid addiction.
AHRQ-funded; HS026216.
Citation: Goodhope NR, Anderson TS, Jung Y .
Initiation of psychotropic and opioid medications after hospital discharge in older adults with dementia.
J Gen Intern Med 2023 Feb; 38(3):824-27. doi: 10.1007/s11606-022-07874-x..
Keywords: Elderly, Opioids, Medication, Dementia, Hospital Discharge
Iantorno SE, Ulugia JG, Kastenberg ZJ
Postdischarge racial and ethnic disparities in pediatric appendicitis: a mediation analysis.
This retrospective cohort study sought to explore whether racial and ethnic disparities for children presenting with acute appendicitis persist after initial management and hospital discharge. The cohort included children under 18 years who underwent treatment for acute appendicitis in 47 U.S. Children's Hospitals from 2017 to 2019. Findings showed that children of racial and ethnic minorities were more likely to visit the emergency department after treatment for acute appendicitis, but Hispanic/Latinx patients did not have a corresponding increase in readmission. These differences were mediated mainly by insurance status and urban residence.
AHRQ-funded; HS025776.
Citation: Iantorno SE, Ulugia JG, Kastenberg ZJ .
Postdischarge racial and ethnic disparities in pediatric appendicitis: a mediation analysis.
J Surg Res 2023 Feb;282:174-82. doi: 10.1016/j.jss.2022.09.027..
Keywords: Children/Adolescents, Racial and Ethnic Minorities, Disparities, Hospital Discharge, Surgery
Theiss LM, Wood L, Shao C
Disparities in perioperative use of patient engagement technologies - not all use is equal.
The objective of this retrospective cohort study was to determine the association of patient-level characteristics and the use of a patient engagement technology during the perioperative period. Patients who had undergone elective colorectal surgery were enrolled in a patient engagement technology at a single institution and received educational content, healthcare reminders, patient reported outcome surveys, and health checks. Findings indicated that use of a patient engagement technology in the perioperative period differs significantly by sex, race/ethnicity, and insurance status. The authors concluded that this diverse usage should be considered during implementation of interventions to improve surgical outcomes.
AHRQ-funded; HS023009.
Citation: Theiss LM, Wood L, Shao C .
Disparities in perioperative use of patient engagement technologies - not all use is equal.
Ann Surg 2023 Jan;277(1):e218-e25. doi: 10.1097/sla.0000000000004970.
Keywords: Patient and Family Engagement, Disparities, Surgery, Hospital Discharge
Keeney T, Lee Lee, Basford JR
Association of function, symptoms, and social support reported in standardized outpatient clinic questionnaires with subsequent hospital discharge disposition and 30-day readmissions.
The objective of this retrospective cohort study was to determine whether patient-reported information which is routinely collected in an outpatient setting was associated with hospital readmission within 30 days of discharge; the need for post-acute care after a subsequent hospital admission was also examined. Participants were patients hospitalized between May 2004 and May 2014 in a Midwestern health system. Six domains of patient-reported information were collected in outpatient clinic settings and linked to electronic health record hospitalization data. These domains were found to be significantly associated with 30-day readmission and placement in a facility. The authors concluded that further research is needed to determine whether these data can be leveraged to guide interventions to address patient needs and improve outcomes.
AHRQ-funded; HS000011.
Citation: Keeney T, Lee Lee, Basford JR .
Association of function, symptoms, and social support reported in standardized outpatient clinic questionnaires with subsequent hospital discharge disposition and 30-day readmissions.
Arch Phys Med Rehabil 2022 Dec;103(12):2383-90. doi: 10.1016/j.apmr.2022.06.004..
Keywords: Hospital Discharge, Hospital Readmissions
Xiao Y, Smith A, Abebe E
Understanding hazards for adverse drug events among older adults after hospital discharge: insights from frontline care professionals.
The purpose of this study was to utilize a systems approach to examine hazards to medication safety for older adults during care transitions. The researchers interviewed 38 hospital-based professionals (5 hospitalists, 24 nurses, 4 clinical pharmacists, 3 pharmacy technicians, and 2 social workers) from 4 hospitals about ADE risks after hospital discharge among older adults. For each concern the participants provided, the hazard for medication-related harms was coded and grouped by its sources utilizing a human factors and systems engineering model. The study found that the hazards fell into 6 groups: 1) medication tasks related at home, 2) patient and caregiver related, 3) hospital work system related, 4) home resource related, 5) hospital professional-patient collaborative work related, and 6) external environment related. The type of medications indicated most frequently when describing concerns included anticoagulants, insulins, and diuretics. The types of hazards coded the most were: complex dosing, patient and caregiver knowledge gaps in medication management, errors in discharge medications, unaffordable cost, inadequate understanding about changes in medications, and gaps in access to care or in sharing medication information.
AHRQ-funded; HS024436.
Citation: Xiao Y, Smith A, Abebe E .
Understanding hazards for adverse drug events among older adults after hospital discharge: insights from frontline care professionals.
J Patient Saf 2022 Dec 1;18(8):e1174-e80. doi: 10.1097/pts.0000000000001046..
Keywords: Elderly, Adverse Drug Events (ADE), Medication, Medication: Safety, Hospital Discharge, Hospitals, Transitions of Care
Soper NS, Appukutty AJ, Paje D
Antibiotic overuse after discharge from medical short-stay units.
This study investigated antibiotic overuse after discharge from medical short-stay units (SSUs). This cross-sectional study included patients hospitalized in 2 different medical SSUs with a total of 40 beds at a single academic medical center. Eligible adults were discharged with an oral antibiotic from either SSU from May 2018 to September 2019. Of 100 patients discharged from SSUs with antibiotics, 47 had a skin and soft-tissue infection (SSTI), 22 pneumonia, 21 UTI, and 10 had “other” infections. Overall, 78 cases (78%) were defined as overuse, including 39 of 47 of those treated for SSTI, 17 of 21 for UTI, and 14 of 22 for pneumonia. The most common types of overuse were excess duration and guideline discordant selection. Examples of factors influencing overuse included consultant recommendations, miscalculation of duration, and the need for source control procedure.
AHRQ-funded; HS026530.
Citation: Soper NS, Appukutty AJ, Paje D .
Antibiotic overuse after discharge from medical short-stay units.
Nov;43(11):1689-92. doi: 10.1017/ice.2021.346..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Pneumonia, Skin Conditions, Urinary Tract Infection (UTI), Respiratory Conditions, Hospital Discharge
Harrison JD, Sudore RL, Auerbach AD
Automated telephone follow-up programs after hospital discharge: do older adults engage with these programs?
The purpose of this study was to examine whether and how older adults experience automated post-hospital discharge telephone follow-up programs and characterize the prevalence of patient-reported post-discharge issues. Eighteen thousand and seventy-six patients, all part of a post-hospital discharge program between May 1, 2018 and April 30, 2019, were included and categorized into age groups. The study found that more patients 65-84 years old were reached compared to patients 64 years old or less (84.3% compared to 78.9%). Patients aged 85 or older were more likely to have questions about their follow-up plans and require assistance scheduling appointments compared to those 64 years old or less (19.0% vs. 11.9%). The researchers concluded that post-hospital automated telephone calls are effective at reaching older adults.
AHRQ-funded; HS026383.
Citation: Harrison JD, Sudore RL, Auerbach AD .
Automated telephone follow-up programs after hospital discharge: do older adults engage with these programs?
J Am Geriatr Soc 2022 Oct;70(10):2980-87. doi: 10.1111/jgs.17939..
Keywords: Elderly, Patient and Family Engagement, Hospital Discharge, Transitions of Care, Telehealth, Health Information Technology (HIT)