National Healthcare Quality and Disparities Report
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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 79 Research Studies DisplayedAuerbach AD, Lee TM, Hubbard CC
Diagnostic errors in hospitalized adults who died or were transferred to intensive care.
The objective of this retrospective cohort study was to determine the prevalence, underlying causes, and harms of diagnostic errors in hospitalized adults who were transferred to an intensive care unit or who died. Data was taken from 29 academic medical centers in the U.S. in a random sample of adults hospitalized with general medical conditions. Errors were found to have contributed to temporary harm, permanent harm, or death in nearly 18% of patients; among patients who died, diagnostic error was judged to have contributed to death in 6.6% of cases. The researchers noted that problems with choosing and interpreting tests and the processes involved with clinician assessment were a high priority for improvement efforts.
AHRQ-funded; HS027369.
Citation: Auerbach AD, Lee TM, Hubbard CC .
Diagnostic errors in hospitalized adults who died or were transferred to intensive care.
JAMA Intern Med 2024 Feb; 184(2):164-73. doi: 10.1001/jamainternmed.2023.7347..
Keywords: Diagnostic Safety and Quality, Medical Errors, Hospitals, Inpatient Care, Quality of Care, Patient Safety, Adverse Events
Dalal AK, Schnipper JL, Raffel K
Identifying and classifying diagnostic errors in acute care across hospitals: early lessons from the Utility of Predictive Systems in Diagnostic Errors (UPSIDE) study.
This paper describes the Utility of Predictive Systems in Diagnostic Errors (UPSIDE) study, whose aim was to define the prevalence and underlying causes of diagnostic errors (DEs) in patients who die in the hospital or are transferred to the intensive care unit (ICU) after the first 48 hours. This study was conducted at 31 hospitals with more than 2500 cases reviewed using electronic health records. The authors identified some insights into key requirements into building a robust DE surveillance program by developing these steps: 1) Develop a shared understanding of what constitutes a diagnostic error; 2) Use validated tools to identify diagnostic errors and classify process failures, but respect your context; 3) Develop a standard approach to using electronic health records for case reviews; 4) Ensure reliability and consistency of the case review process; and 5) Link diagnostic error case reviews to institutional safety programs. They also developed steps to establish a diagnosis error review process at the hospital level with six processes.
AHRQ-funded; HS027369; HS026613.
Citation: Dalal AK, Schnipper JL, Raffel K .
Identifying and classifying diagnostic errors in acute care across hospitals: early lessons from the Utility of Predictive Systems in Diagnostic Errors (UPSIDE) study.
J Hosp Med 2024 Feb; 19(2):140-45. doi: 10.1002/jhm.13136..
Keywords: Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety, Quality of Care, Hospitals
Ali KJ, Goeschel CA, DeLia DM
The PRIDx framework to engage payers in reducing diagnostic errors in healthcare.
The authors conducted a literature review and interviewed subject matter experts to develop a multi-component Payer Relationships for Improving Diagnoses (PRIDx) framework. The PRIDx framework can be used to encourage public and private payers to take specific actions to improve diagnostic safety. The authors noted that implementation of the PRIDx framework will require new types of partnerships, including external support from public and private payer organizations, and also require the creation of strong provider incentives.
AHRQ-funded; 2332015000221.
Citation: Ali KJ, Goeschel CA, DeLia DM .
The PRIDx framework to engage payers in reducing diagnostic errors in healthcare.
https://www.pubmed.ncbi.nlm.nih.gov/37795579.
Keywords: Diagnostic Safety and Quality, Quality of Care, Patient Safety
Newman-Toker DE, Nassery N, Schaffer AC
Burden of serious harms from diagnostic error in the USA.
Americans who experience serious harm from misdiagnosis annually. Serious harm is defined as permanent morbidity or morality. This cross-sectional analysis used nationally representative observational data. The authors estimated annual incident vascular events and infections from 21.5 million (M) sampled US hospital discharges (2012-2014). US-based cancer registries were used to find annual new cancers. They derived diagnostic errors and serious harms by multiplying by literature-based rates for disease-specific incidences for 15 major vascular events, infections and cancers ('Big Three' categories). Extrapolating to all diseases (including non-'Big Three' dangerous disease categories), they estimated total serious harms annually in the USA to be 795,000 (plausible range 598,000-1,023,000). Using more conservative assumptions they estimated 549,000 serious harms. These results were compatible with setting-specific serious harm estimates from inpatient, emergency department and ambulatory care. Fifteen dangerous diseases accounted for 50.7% of total serious harms and the top 5 (stroke, sepsis, pneumonia, venous thromboembolism and lung cancer) accounted for 38.7%.
AHRQ-funded; HS027614; HS029350.
Citation: Newman-Toker DE, Nassery N, Schaffer AC .
Burden of serious harms from diagnostic error in the USA.
BMJ Qual Saf 2024 Jan 19; 33(2):109-20. doi: 10.1136/bmjqs-2021-014130..
Keywords: Healthcare Cost and Utilization Project (HCUP), Diagnostic Safety and Quality, Medical Errors, Patient Safety, Quality of Care, Adverse Events
Li J
Home health agencies with high quality of patient care star ratings reduced short-term hospitalization rates and increased days independently at home.
Accurate Medicare Quality of Patient Care home health star ratings are crucial to helping patients find high-quality care, yet critics of these ratings indicate that they are not valid. The purpose of this retrospective study was to assess whether using the highest-rated home health agency available in a ZIP code improves outcomes. The researchers included 1,870,080 Medicare fee-for-service beneficiaries using home health care from July 2015 through July 2016 in the United States. The study found that treatment by the highest-rated agencies available decreased risks of hospitalization, emergency department use, and institutionalization during the initial episode, and increased days independently at home by 2.6% or 3.75 days in the 180 days after the end of the initial episode. Treatment effects were stronger for agencies that were above-average, had 1 or more stars than the next-best agency, and nonrural residents. Effects were positive for both postacute and community-entry patients.
AHRQ-funded; HS026836.
Citation: Li J .
Home health agencies with high quality of patient care star ratings reduced short-term hospitalization rates and increased days independently at home.
Med Care 2024 Jan; 62(1):11-20. doi: 10.1097/mlr.0000000000001930..
Keywords: Home Healthcare, Quality of Care, Hospitalization, Provider Performance
Collinsworth AW, Masica AL, Priest EL
Modifying the electronic health record to facilitate the implementation and evaluation of a bundled care program for intensive care unit delirium.
This case study describes how an integrated health care delivery system modified its inpatient electronic health record to accelerate the implementation and evaluation of ABCDE bundle deployment as a safety and quality initiative for the prevention of delirium in intensive care unit patients.
AHRQ-funded; HS021459
Citation: Collinsworth AW, Masica AL, Priest EL .
Modifying the electronic health record to facilitate the implementation and evaluation of a bundled care program for intensive care unit delirium.
eGEMS. 2014;2(1):1121. doi: 10.13063/2327-9214.1121..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Intensive Care Unit (ICU), Patient Safety, Quality of Care
Berry JG, Hall M, Neff J
Children with medical complexity and Medicaid: spending and cost savings.
The authors described the expenditures for children with medical complexity insured by Medicaid across the care continuum, reported the increasingly large amount of spending on hospital care for these children, and presented a business case that estimates how cost savings might be achieved from potential reductions in hospital and emergency department use and shows how the savings could underwrite investments in outpatient and community care. They concluded by discussing the importance of these findings in the context of Medicaid's quality of care and health care reform.
AHRQ-funded; HS023092.
Citation: Berry JG, Hall M, Neff J .
Children with medical complexity and Medicaid: spending and cost savings.
Health Aff 2014 Dec;33(12):2199-206. doi: 10.1377/hlthaff.2014.0828.
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Keywords: Children/Adolescents, Medicaid, Healthcare Costs, Inpatient Care, Quality of Care
Hwang D, Teno JM, Clark M
Family perceptions of quality of hospice care in the nursing home.
The investigators examined bereaved family members' perceptions of nursing home-hospice collaborations in terms of what family members believe went well or could have been improved. The focus group participants identified three major aspects of collaboration as important to care delivery: knowing who (nursing home or hospice) is responsible for which aspects of patient care, concern about information coordination between the nursing home and hospice, and the need for hospice to advocate for high-quality care rather than their having to directly do so on behalf of their family members. These concerns have been incorporated into the revised Family Evaluation of Hospice Care, a post-death survey used to evaluate quality of hospice care.
AHRQ-funded; HS019675.
Citation: Hwang D, Teno JM, Clark M .
Family perceptions of quality of hospice care in the nursing home.
J Pain Symptom Manage 2014 Dec;48(6):1100-7. doi: 10.1016/j.jpainsymman.2014.04.003.
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Keywords: Care Coordination, Nursing Homes, Palliative Care, Quality of Care
Abdelsattar ZM, Wong SL, Birkmeyer NJ
Multi-institutional assessment of sphincter preservation for rectal cancer.
This study sought to identify whether variation in sphincter preservation surgery (SPS) rates for patients with rectal cancer can be explained by patient, tumor, or treatment-related factors across hospitals. It found that SPS rates vary by hospital, even after accounting for clinical characteristics using detailed chart review.
AHRQ-funded; HS000053
Citation: Abdelsattar ZM, Wong SL, Birkmeyer NJ .
Multi-institutional assessment of sphincter preservation for rectal cancer.
Ann Surg Oncol. 2014 Dec;21(13):4075-80. doi: 10.1245/s10434-014-3882-4..
Keywords: Cancer: Colorectal Cancer, Quality of Care, Surgery
Bundy DG, Gaur AH, Billett AL
Preventing CLABSIs among pediatric hematology/oncology inpatients: national collaborative results.
This study assessed the feasibility of a multicenter effort to standardize central line (CL) care and central line-associated bloodstream infection (CLABSI) tracking and to quantify the impact of standardizing these processes on CLABSI rates. It found a reduction of 28 percent in the mean CLABSI rate from 2.85 to 2.04 per 1,000 CL days over almost 3 years.
AHRQ-funded; HS019590
Citation: Bundy DG, Gaur AH, Billett AL .
Preventing CLABSIs among pediatric hematology/oncology inpatients: national collaborative results.
Pediatrics. 2014 Dec;134(6):e1678-85. doi: 10.1542/peds.2014-0582..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Quality of Care, Children/Adolescents
Mukamel DB, Haeder SF, Weimer DL
Top-down and bottom-up approaches to health care quality: the impacts of regulation and report cards.
The authors reviewed the extant literature on regulation and report cards. They found evidence of both functional and dysfunctional effects and identified the areas in which additional research would most likely be valuable.
AHRQ-funded; HS021844.
Citation: Mukamel DB, Haeder SF, Weimer DL .
Top-down and bottom-up approaches to health care quality: the impacts of regulation and report cards.
Annu Rev Public Health 2014;35:477-97. doi: 10.1146/annurev-publhealth-082313-115826.
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Keywords: Quality of Care, Policy, Policy, Public Reporting
Einbinder J, Hebel E, Wright A
The number needed to remind: a measure for assessing CDS effectiveness.
The purpose of this paper is to provide a better understanding of population based clinical decision support (CDS) performance measurement, to identify best practices for designing and implementing CDS, and to introduce two new quality measures, titled Reminder Performance (RP) and the Number Needed to Remind (NNR) for evaluating the effectiveness of clinical reminders in the context of the CDS Dashboards.
AHRQ-funded; 290200810010.
Citation: Einbinder J, Hebel E, Wright A .
The number needed to remind: a measure for assessing CDS effectiveness.
AMIA Annu Symp Proc 2014 Nov 14;2014:506-15..
Keywords: Shared Decision Making, Clinical Decision Support (CDS), Quality Measures, Quality of Care
Garg N, Kuperman G, Onyile A
Validating health information exchange (HIE) data for quality measurement across four hospitals.
The study objective was to validate the secondary use of HIE data for two emergency department (ED) quality measures: identification of frequent ED users and early (72-hour) ED returns in four hospitals. It found that there was no significant difference in the total counts for frequent ED users or early ED returns for any of the four hospitals.
AHRQ-funded; HS021261.
Citation: Garg N, Kuperman G, Onyile A .
Validating health information exchange (HIE) data for quality measurement across four hospitals.
AMIA Annu Symp Proc 2014 Nov 14;2014:573-9..
Keywords: Electronic Health Records (EHRs), Emergency Department, Quality of Care, Health Information Exchange (HIE), Quality Measures
Berner ES, Burkhardt JH, Panjamapirom A
Cost implications of human and automated follow-up in ambulatory care.
This study tracked costs associated with using nurse-initiated telephone calls or interactive voice response (IVR) over the first two years of followup for a practice assumed to have 4800 acute care patient visits per year. For the first two years, costs were approximately the same but, in subsequent years, IVR followup is approximately $9000 per year less expensive than nurse followup.
AHRQ-funded; HS017060
Citation: Berner ES, Burkhardt JH, Panjamapirom A .
Cost implications of human and automated follow-up in ambulatory care.
Am J Manag Care. 2014 Nov;20(11 Spec No. 17):SP531-40..
Keywords: Healthcare Costs, Primary Care, Quality of Care, Critical Care
Martsolf GR, Auerbach D, Benevent R
AHRQ Author: Stocks C, Jiang HJ
Examining the value of inpatient nurse staffing: an assessment of quality and patient care costs.
The authors assessed the effect of nurse staffing on quality of care and inpatient care costs. They found that increases in nurse staffing levels were associated with reductions in nursing-sensitive adverse events and length of stay, while changing skill mix by increasing the number of registered nurses, as a proportion of licensed nursing staff, led to reductions in costs.
AHRQ-authored; AHRQ-funded; 290200600009C.
Citation: Martsolf GR, Auerbach D, Benevent R .
Examining the value of inpatient nurse staffing: an assessment of quality and patient care costs.
Med Care 2014 Nov;52(11):982-8. doi: 10.1097/mlr.0000000000000248.
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Keywords: Healthcare Costs, Quality of Care, Healthcare Cost and Utilization Project (HCUP), Inpatient Care, Nursing
Thomas KS, Rahman M, Mor V
Influence of hospital and nursing home quality on hospital readmissions.
The authors sought to determine whether the quality of the hospital and of the nursing home (NH) to which a patient was discharged were related to the likelihood of rehospitalization. They found that patients discharged from higher-quality hospitals and patients who received care in higher-quality NHs were less likely to be rehospitalized within 30 days. They concluded that the passage of the Affordable Care Act changed the accountability of hospitals for patients' outcomes after discharge, and that their study highlights the joint accountability of hospitals and NHs for rehospitalization of patients.
AHRQ-funded; HS000011.
Citation: Thomas KS, Rahman M, Mor V .
Influence of hospital and nursing home quality on hospital readmissions.
Am J Manag Care 2014 Nov;20(11):e523-31.
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Keywords: Quality of Care, Hospitals, Nursing Homes, Patient-Centered Outcomes Research, Hospital Readmissions
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
Ramnath VR, Khazeni N
Centralized monitoring and virtual consultant models of tele-ICU care: a side-by-side review.
This side-by-side review directly compares the Centralized Monitoring and Virtual Consultant tele-ICU Models. The Centralized Monitoring tele-ICU Model showed improved mortality and/or length of stay and staff acceptance, particularly in rural or specific patient populations, but with high costs and unclear savings. The Virtual Consultant Model could not be adequately evaluated for effects on clinical outcomes or staff acceptance given minimal data; however, it can be both portable and implemented at a lower cost profile. Improved compliance with clinical practice guidelines was seen in both models. Further study is recommended.
AHRQ-funded; HS019816.
Citation: Ramnath VR, Khazeni N .
Centralized monitoring and virtual consultant models of tele-ICU care: a side-by-side review.
Telemed J E Health 2014 Oct;20(10):962-71. doi: 10.1089/tmj.2014.0024.
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Keywords: Critical Care, Comparative Effectiveness, Quality of Care, Intensive Care Unit (ICU), Telehealth
Ramnath VR, Ho L, Maggio LA
Centralized monitoring and virtual consultant models of tele-ICU care: a systematic review.
This systematic literature review compares the Centralized Monitoring and Virtual Consultant tele-ICU Models. Compared with the Virtual Consultant tele-ICU Model, studies addressing the Centralized Monitoring Model of tele-ICU care were greater in quantity and sample size, with qualitative conclusions of clinical outcomes, staff satisfaction and workload, and financial sustainability largely consistent with past systematic reviews.
AHRQ-funded; HS019816.
Citation: Ramnath VR, Ho L, Maggio LA .
Centralized monitoring and virtual consultant models of tele-ICU care: a systematic review.
Telemed J E Health 2014 Oct;20(10):936-61. doi: 10.1089/tmj.2013.0352.
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Keywords: Critical Care, Comparative Effectiveness, Quality of Care, Intensive Care Unit (ICU), Telehealth
Schlesinger M, Kanouse DE, Martino SC
Complexity, public reporting, and choice of doctors: a look inside the blackest box of consumer behavior.
The authors identified four pathways through which complexity may impair consumer choice. They examined these pathways using data from an experiment in which consumers hypothetically selected a primary care physician. They found that some of the loss of decision quality accompanying more complex choice sets can be explained by consumers' skills and decision-making style, but even after accounting for these factors, complexity undermines the quality of decision making in ways that cannot be fully explained. They concluded by discussing implications for report designers, sponsors, and policy makers aspiring to promote consumer empowerment and health care quality.
AHRQ-funded; HS016978; HS016980.
Citation: Schlesinger M, Kanouse DE, Martino SC .
Complexity, public reporting, and choice of doctors: a look inside the blackest box of consumer behavior.
Med Care Res Rev 2014 Oct;71(5 Suppl):38s-64s. doi: 10.1177/1077558713496321.
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Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Shared Decision Making, Quality of Care, Primary Care, Public Reporting
Shaller D, Kanouse DE, Schlesinger M
Context-based strategies for engaging consumers with public reports about health care providers.
The authors identified three key factors influencing consumer engagement and showed how they manifest in different ways and combinations for four particular choice contexts that appear to offer realistic opportunities for engagement. They also analyzed how these engagement factors play out differently in each choice context and suggest specific strategies that sponsors of public reports can use in each context.
AHRQ-funded; HS016978; HS016980.
Citation: Shaller D, Kanouse DE, Schlesinger M .
Context-based strategies for engaging consumers with public reports about health care providers.
Med Care Res Rev 2014 Oct;71(5 Suppl):17s-37s. doi: 10.1177/1077558713493118.
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Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Quality of Care, Patient and Family Engagement, Public Reporting
Huang SS, Septimus E, TR TR
Cost savings of universal decolonization to prevent intensive care unit infection: implications of the REDUCE MRSA trial.
The researchers estimated the incremental effect on healthcare costs associated with targeted decolonization and universal decolonization compared with screening and isolation, which is considered the current standard of care. They found that a strategy of universal decolonization for patients admitted to the ICU would both reduce bloodstream infections and like reduce healthcare costs when compared to other strategies.
AHRQ-funded; 290201000008I; 29032007T.
Citation: Huang SS, Septimus E, TR TR .
Cost savings of universal decolonization to prevent intensive care unit infection: implications of the REDUCE MRSA trial.
Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S23-31. doi: 10.1086/677819..
Keywords: Healthcare Costs, Quality of Care, Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU), Patient Safety
Nembhard IM, Cherian P, Bradley EH
Deliberate learning in health care: the effect of importing best practices and creative problem solving on hospital performance improvement.
The authors examined the effect on quality improvement of two common but distinct approaches to organizational learning, importing best practices and creative problem solving, in hospitals focused on improving treatment time for patients with heart attacks. They found that importing best practices helps hospitals achieve initial phase improvement, after which significant further improvement requires creative problem solving as well.
AHRQ-funded; HS018987.
Citation: Nembhard IM, Cherian P, Bradley EH .
Deliberate learning in health care: the effect of importing best practices and creative problem solving on hospital performance improvement.
Med Care Res Rev 2014 Oct;71(5):450-71. doi: 10.1177/1077558714536619.
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Keywords: Quality Improvement, Quality of Care, Hospitals, Organizational Change
Anhang Price R, Elliott MN, Zaslavsky AM
Examining the role of patient experience surveys in measuring health care quality.
The authors reviewed the literature on the association between patient experiences and other measures of health care quality. They concluded that patient experience measures that are collected using psychometrically sound instruments, employing recommended sample sizes and adjustment procedures, and implemented according to standard protocols are intrinsically meaningful and are appropriate complements for clinical process and outcome measures in public reporting and pay-for-performance programs.
AHRQ-funded; HS016980; HS016978.
Citation: Anhang Price R, Elliott MN, Zaslavsky AM .
Examining the role of patient experience surveys in measuring health care quality.
Med Care Res Rev 2014 Oct;71(5):522-54. doi: 10.1177/1077558714541480.
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Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Quality of Care, Quality Improvement, Quality Measures
Damberg CL, McNamara P
AHRQ Author: McNamara P
Postscript: research agenda to guide the next generation of public reports for consumers.
The authors identified five areas for additional public reporting tools research that, if addressed, could foster better design and delivery of quality and cost information to consumers.
AHRQ-authored.
Citation: Damberg CL, McNamara P .
Postscript: research agenda to guide the next generation of public reports for consumers.
Med Care Res Rev 2014 Oct;71(5 Suppl):97s-107s. doi: 10.1177/1077558714535982.
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Keywords: Education: Patient and Caregiver, Shared Decision Making, Quality of Care, Health Services Research (HSR), Public Reporting