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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 11 of 11 Research Studies DisplayedSteiner MJ, Hall M, Sutton AG
Pediatric hospitalization trends at children's and general hospitals, 2000-2019.
The purpose of this study was to examine whether pediatric inpatient care has been redistributed from general hospitals into children’s hospitals (CHs). The researchers utilized the AHRQ Kids’ Inpatient Database (KID) to identify inpatient nonbirth discharges for children younger than 18 years from 2000 to 2019. The study included 14.758,391 discharges and found that annual inpatient discharges decreased by 26.5% from 2000 to 2019, while the percentage of total national discharges from CHs increased significantly, from 58.9% in 2000 to 81.8% in 2019. Discharges from freestanding CHs increased from 19.3% to 34.2%, those at non-freestanding CHs increased from 39.6% to 47.6%, and percentage of discharges from non-CHs decreased from 41.1%. An increase in inter-facility transfer (IFT) accompanied the changes in the distribution of pediatric discharges. In 2000, 6.1% of total discharges were transferred from one facility to another before discharge; in 2019, 18.8% experienced an IFT. Of children experiencing an IFT in 2019, 88.0% were transferred to a CH.
AHRQ-funded; HS028683.
Citation: Steiner MJ, Hall M, Sutton AG .
Pediatric hospitalization trends at children's and general hospitals, 2000-2019.
JAMA 2023 Nov 21; 330(19):1906-08. doi: 10.1001/jama.2023.19268..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Hospitals
Parikh K, Lopez MA, Hall M
Child Opportunity Index and rehospitalization for ambulatory care sensitive conditions at US children's hospitals.
Lower Child Opportunity Index (COI) has been related with increased health care use, but the relationship with rehospitalization(s) for ambulatory care sensitive conditions (ACSC) is not known. The purpose of this multicenter retrospective cohort study was to determine the relationship between COI and ACSC rehospitalizations. 184,478 children ages 0 to 17 years with a hospital admission for ambulatory care sensitive conditions in 2017 or 2018 were included. Exposure was COI, and the primary outcome was rehospitalization within 1 year of index admission for ACSC. Of hospitalizations, 28.3% were by children from very low COI and 16.5% were by children from very high COI neighborhoods. In risk-adjusted models, ACSC rehospitalization was higher for children from very low COI than very high COI neighborhoods; any rehospitalization occurred for 18.7% from very low COI and 13.5% from very high COI neighborhoods whereas 2 or more rehospitalization occurred for 4.8% from very low COI and 3.2% from very high COI neighborhoods.
AHRQ-funded; HS024554; HS028484; HS026385.
Citation: Parikh K, Lopez MA, Hall M .
Child Opportunity Index and rehospitalization for ambulatory care sensitive conditions at US children's hospitals.
Hosp Pediatr 2023 Nov; 13(11):1028-37. doi: 10.1542/hpeds.2023-007279..
Keywords: Children/Adolescents, Hospital Readmissions, Hospitals, Ambulatory Care and Surgery
Luo BT, Barton HJ, Wooldridge AR
Human factors engineering for the pediatric hospitalist.
The authors summarized how human factors engineering (HFE) can provide a framework and tools to help understand and improve complex care processes and resulting outcomes. They offered examples of HFE's application to pediatric hospital medicine, highlighted an HFE-based framework, provided tools for leveraging this model, and listed resources for those interested in learning more about HFE.
AHRQ-funded; HS027214.
Citation: Luo BT, Barton HJ, Wooldridge AR .
Human factors engineering for the pediatric hospitalist.
Hosp Pediatr 2023 Nov; 13(11):e365-e70. doi: 10.1542/hpeds.2023-007258..
Keywords: Children/Adolescents, Hospitals, Provider: Clinician
McCarthy IM, Raval MV
Price spillovers and specialization in health care: the case of children's hospitals.
The purpose of this study was to explore a possible differentiation effect in which patients perceive specialty hospitals as different from other hospitals, so that specialty hospitals effectively compete in a separate market from general acute care hospitals. The researchers examined this effect in the context of routine pediatric procedures offered by both specialty children's hospitals and general acute care hospitals. The study found substantial empirical evidence of a differentiation effect in which competitive forces from non-children's hospitals appear largely irrelevant for specialty children's hospitals.
AHRQ-funded; HS024712.
Citation: McCarthy IM, Raval MV .
Price spillovers and specialization in health care: the case of children's hospitals.
Health Econ 2023 Oct; 32(10):2408-23. doi: 10.1002/hec.4734..
Keywords: Children/Adolescents, Hospitals, Healthcare Delivery
Pantell MS, Holmgren AJ, Leary JC
Social and medical care integration practices among children's hospitals.
This study sought to describe screening practices for adverse social determinants of health (SDOH) among a national sample of children’s hospitals. The authors analyzed responses to the 2020 American Hospital Association Annual Survey. Among children's hospitals, they calculated the prevalence of screening for social needs, strategies to address social risks/needs, partnerships with community-based organizations to address social risks/needs at the individual and community level, and rates of impact assessments of how social risk-related interventions affect outcomes. They also used χ2 tests to compare results by hospital characteristics and weighted results to adjust for nonresponse. Out of 82 children’s hospitals in the sample, a total of 79.6% screened for and 96.0% had strategies to address at least 1 social risk factor, although rates varied by SDOH domain. These hospitals more commonly partnered with community-based organizations to address patient-level social risks than participated in community-level initiatives. SDOH intervention effectiveness was assessed in a total of 39.2% of hospitals. The authors found differences in social risk-related care practices commonly varied by hospital ownership and Medicaid population but not by region.
AHRQ-funded; HS028473.
Citation: Pantell MS, Holmgren AJ, Leary JC .
Social and medical care integration practices among children's hospitals.
Hosp Pediatr 2023 Oct; 13(10):886-94. doi: 10.1542/hpeds.2023-007246..
Keywords: Children/Adolescents, Hospitals, Social Determinants of Health
Weaver MS, Ulrich CM, Moon MR
Adherence to the AAP's institutional ethics committee policy recommendations.
The aim of this study was to determine the level at which pediatric institutional ethics committees (IECs) comply with to the American Academy of Pediatrics (AAP) IEC Policy Statement recommendations. The researchers utilized a convenience sample taken from the Children's Hospital Association membership who were invited to complete an electronic survey in spring 2022. A total of 117 out of 181 surveys were completed (65%). The study found that stark gaps in IEC practice included: lack of membership diversity, needs for training to maintain members' competencies, organizational quality improvement, and scope of ethics service. Results indicated that 25% of IECs did not have a systematic method for informing hospital staff about ethics consultancy services and how to place an ethics consult. Further, 19% of responding IEC services did not inform patients or families about the availability of ethics consult services. 33% of the responding children's hospitals did not provide resources for the IECs to provide ethics education at their facility.
AHRQ-funded; HS028427.
Citation: Weaver MS, Ulrich CM, Moon MR .
Adherence to the AAP's institutional ethics committee policy recommendations.
Hosp Pediatr 2023 Sep; 13(9):e246-e50. doi: 10.1542/hpeds.2023-007124..
Keywords: Children/Adolescents, Policy, Hospitals
Congdon M, Rauch B, Carroll B
Opportunities for diagnostic improvement among pediatric hospital readmissions.
The purpose of this retrospective cohort study was to: 1) identify and describe diagnostic errors, termed "missed opportunities for improving diagnosis" (MOIDs) in general pediatric patients who experienced hospital readmission, 2) outline improvement opportunities, and 3) explore factors associated with increased risk of MOID. The researchers included unplanned readmissions within 15 days of discharge from a freestanding children's hospital between October 2018 and September 2020. Health records were reviewed and discussed by practicing inpatient physicians to identify MOIDs using SaferDx, an established instrument. MOIDs were evaluated using a diagnostic-specific tool to identify improvement opportunities within the diagnostic process. The study found that MOIDs were identified in 6.3% of 348 readmissions. Opportunities for improvement included: delay in considering the correct diagnosis (50%) and failure to order needed test (45%). Patients with MOIDs were older than patients without MOIDs but similar in gender, primary language, race, ethnicity, and insurance type. The researchers did not identify conditions related with higher risk of MOID. Lower respiratory tract infections accounted for 26% of admission diagnoses but only 1 (4.5%) case of MOID.
AHRQ-funded; HS028682.
Citation: Congdon M, Rauch B, Carroll B .
Opportunities for diagnostic improvement among pediatric hospital readmissions.
Hosp Pediatr 2023 Jul; 13(7):563-71. doi: 10.1542/hpeds.2023-007157..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Hospitals, Hospital Readmissions
Leyenaar JK, Hill V, Lam V
Direct admission to hospital for children in the United States.
The purpose of this paper is to develop a policy statement to present recommendations to optimize the quality and safety of this hospital admission approach for children, as one in four unscheduled hospital admissions for children and adolescents in the United States occurs via direct admission, defined as hospital admission without first receiving care in the hospital's emergency department. Recommendations in the proposed policy statement provide guidance related to: (i) direct admission written guidelines, (ii) clear systems of communication between members of the health care team and with families of children requiring admission, (iii) triage systems to identify patient acuity and disease severity, (iv) identification of hospital resources needed to support direct admission systems of care, (v) consideration of patient populations that may be at increased risk of adverse outcomes during the hospital admission process, (vi) addressing the relevance of local factors and resources, and (vii) ongoing evaluation of direct admission processes and outcomes. The recommendations are intended to support the implementation of safe direct admission processes and to foster awareness of outcomes associated with this common portal of hospital admission.
AHRQ-funded; HS024133.
Citation: Leyenaar JK, Hill V, Lam V .
Direct admission to hospital for children in the United States.
Pediatrics 2023 Mar;151(3):e2022060973. doi: 10.1542/peds.2022-060973.
Keywords: Children/Adolescents, Hospitals, Hospitalization
Wolf RM, Hall M, Williams DJ
Pharmacologic restraint use for children experiencing mental health crises in pediatric hospitals.
This study’s objective was to determine hospital-level incidence and variation of pharmacologic restraint use among children admitted for mental health conditions in children's hospitals. The authors examined data for children (5 to ≤18 years) admitted to children's hospitals with a primary mental health condition from 2018 to 2020 using the Pediatric Health Information System database. Of 29,834 included encounters, 12.6% had pharmacologic restraint use, with three hospitals the highest utilizers of all drug classes. Adjusted hospital rates ranged from 35 to 389 pharmacologic restraint use days per 1000 mental health bed days with a mean of 175. There were no significant differences in pharmacologic restraint use found in the hospital-level analysis.
AHRQ-funded; HS026122.
Citation: Wolf RM, Hall M, Williams DJ .
Pharmacologic restraint use for children experiencing mental health crises in pediatric hospitals.
J Hosp Med 2023 Feb; 18(2):120-29. doi: 10.1002/jhm.13009..
Keywords: Children/Adolescents, Behavioral Health, Hospitals, Medication
Westley L, Manworren RCB, Griffith DM
Using hospital incident command systems to respond to the pediatric mental and behavioral health crisis of the COVID-19 pandemic.
The purpose of this study was to quantify issues related to hospital incident command systems (HICS) implemented to expand mental and behavioral healthcare (MBHC) services during the COVID-19 pandemic, and track progress toward HICS goals. The researchers analyzed data on patient census, nurse vacancies, staff injuries, and staff perceptions and resources were developed. The study found that after HICS implementation, 84% of nurses reported confidence in providing care to youth with acute MBHC needs.
AHRQ-funded; HS026385.
Citation: Westley L, Manworren RCB, Griffith DM .
Using hospital incident command systems to respond to the pediatric mental and behavioral health crisis of the COVID-19 pandemic.
J Nurs Adm 2023 Feb; 53(2):96-103. doi: 10.1097/nna.0000000000001254..
Keywords: COVID-19, Children/Adolescents, Behavioral Health, Hospitals
Kelly MM, Hoonakker PLT, Nacht CL
Parent perspectives on sharing pediatric hospitalization clinical notes.
This qualitative study sought to identify parent perceptions of the benefits and challenges of real-time note access during their child's hospitalization and strategies to optimize note-sharing at the bedside. The study conducted 60-minute interviews with 28 parents who were given access to their child's admission and daily progress notes on a bedside tablet (iPad) and interviewed upon discharge. The parents described 6 benefits of having note access, which: provided a recap and improved their knowledge about their child's care plan, enhanced communication, facilitated empowerment, increased autonomy, and incited positive emotions. Potential challenges described included: causing confusion, hindering communication with the health care team, highlighting problems with note content, and inciting negative emotions. The parents recommended 4 strategies to support sharing: provide preemptive communication about expectations, optimize the note release process, consider parent-friendly note template modifications, and offer informational resources for parents.
AHRQ-funded; HS027214.
Citation: Kelly MM, Hoonakker PLT, Nacht CL .
Parent perspectives on sharing pediatric hospitalization clinical notes.
Pediatrics 2023 Jan; 151(1). doi: 10.1542/peds.2022-057756..
Keywords: Children/Adolescents, Hospitals, Clinician-Patient Communication, Communication, Hospitalization