National Healthcare Quality and Disparities Report
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- Access to Care (1)
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- (-) Quality of Care (113)
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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
76 to 100 of 113 Research Studies DisplayedOrnstein SM, Nemeth LS, Nietert PJ
Learning from primary care meaningful use exemplars.
This report presents the results of a multimethod study combining an EHR-based clinical quality measurements (CQM) performance assessment, a provider survey, and focus groups among high CQM performers. It concluded that purposeful use of EHR functionality coupled with staff education in a milieu where Quality Improvement is valued and supported is associated with higher performance on CQM.
AHRQ-funded; HS022701; HS018984.
Citation: Ornstein SM, Nemeth LS, Nietert PJ .
Learning from primary care meaningful use exemplars.
J Am Board Fam Med 2015 May-Jun;28(3):360-70. doi: 10.3122/jabfm.2015.03.140219..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Quality Indicators (QIs), Quality of Care
Konetzka RT, Grabowski DC, Perraillon MC
Nursing home 5-star rating system exacerbates disparities in quality, by payer source.
The researchers examined how the Centers for Medicare and Medicare Services’ five-star rating system for nursing homes has affected residents who are dually enrolled in Medicare and Medicaid (“dual eligibles”). They found that by 2010 the increased likelihood of choosing the highest-rated homes was substantially smaller for dual eligibles than for non–dual eligibles.
AHRQ-funded; HS021877.
Citation: Konetzka RT, Grabowski DC, Perraillon MC .
Nursing home 5-star rating system exacerbates disparities in quality, by payer source.
Health Aff 2015 May;34(5):819-27. doi: 10.1377/hlthaff.2014.1084..
Keywords: Nursing Homes, Medicare, Medicaid, Quality of Care
Abrahamson K, Miech E, Davila HW
Pay-for-performance policy and data-driven decision making within nursing homes: a qualitative study.
The researchers explored ways in which data were collected, thought about and used by nursing home employees as a result of participation in a pay-for-performance (P4P) program. Their findings indicated that participants in the Minnesota Performance-based Incentive Payment Program’s quality improvement (QI) projects perceived a change in the rate and manner in which they gathered, used, and considered data in their QI decisions.
AHRQ-funded; HS018464
Citation: Abrahamson K, Miech E, Davila HW .
Pay-for-performance policy and data-driven decision making within nursing homes: a qualitative study.
BMJ Qual Saf. 2015 May;24(5):311-7. doi: 10.1136/bmjqs-2014-003362..
Keywords: Nursing Homes, Long-Term Care, Payment, Provider Performance, Shared Decision Making, Policy, Quality Improvement, Quality of Care
Zhu J, Weingart SN, Ritter GA
Racial/Ethnic disparities in patient experience with communication in hospitals: real differences or measurement errors?
This study examined assumptions about the degree of commonality across racial/ethnic groups in their perceptions and investigated the validity of racial/ethnic differences in communication quality. Its results provide strongest support for racial/ethnic comparisons on communication with nurses and doctors, and reason to caution against comparisons on communication about medicines due to significant differences in model parameters across groups.
AHRQ-funded; 290010003.
Citation: Zhu J, Weingart SN, Ritter GA .
Racial/Ethnic disparities in patient experience with communication in hospitals: real differences or measurement errors?
Med Care 2015 May;53(5):446-54. doi: 10.1097/mlr.0000000000000350..
Keywords: Disparities, Clinician-Patient Communication, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Racial and Ethnic Minorities, Quality of Care
Kamal AH
Signposts along the journey toward high-quality palliative care: the value of measuring what matters.
The author of this letter discusses the rationale behind and the usefulness of the group of palliative care measures that were chosen through the deliberations of a Technical Advisory Panel, a Clinical User Panel, and public comment. He states that the 10 measures chosen represent important signposts along the journey toward high quality palliative care and that this is the first iteration of this effort, with updates planned.
AHRQ-funded; HS022763.
Citation: Kamal AH .
Signposts along the journey toward high-quality palliative care: the value of measuring what matters.
J Pain Symptom Manage 2015 May;49(5):e1-2. doi: 10.1016/j.jpainsymman.2015.03.002..
Keywords: Palliative Care, Quality of Care, Patient Safety, Quality Measures
Linder JA
Comparative effectiveness of three anxiolytics for acute respiratory infections: antibiotics, C-reactive protein point-of-care testing, and improved communication.
Forty years of randomized controlled trials, as well as more recent guidelines and performance measures, indicate that antibiotics are not beneficial for acute bronchitis and that the right antibiotic prescribing rate is zero. The author argues that the best cure for acute respiratory infection-related anxiety appears to be improved communication, facilitated by the use of well-designed patient information materials.
AHRQ-funded; HS018419.
Citation: Linder JA .
Comparative effectiveness of three anxiolytics for acute respiratory infections: antibiotics, C-reactive protein point-of-care testing, and improved communication.
J Gen Intern Med 2015 Apr;30(4):387-9. doi: 10.1007/s11606-015-3181-1..
Keywords: Comparative Effectiveness, Medication, Quality of Care
Rodriguez MI, Darney BG, Elman E
Examining quality of contraceptive services for adolescents in Oregon's family planning program.
This study assessed the quality of care provided to adolescents (10–19 years old) compared to women (aged 20–25 years) who accessed services in Oregon's Contraceptive Care (CCare) program. It found that although adolescents served by CCare are more likely to initiate contraception, they are less likely to receive long-acting reversible contraception (LARC) than women aged 20–25 years.
AHRQ-funded; HS017582.
Citation: Rodriguez MI, Darney BG, Elman E .
Examining quality of contraceptive services for adolescents in Oregon's family planning program.
Contraception 2015 Apr;91(4):328-35. doi: 10.1016/j.contraception.2014.12.008..
Keywords: Children/Adolescents, Sexual Health, Quality of Care, Women
Newman ED, Lerch V, Billet J
Improving the quality of care of patients with rheumatic disease using patient-centric electronic redesign software.
To improve the quality of care for patients with rheumatic disease, the researchers developed electronic data capture, aggregation, display, and documentation software. They found that their software was adopted for use by 86% of patients and rheumatologists. They concluded that the software was well-adopted by patients and providers. Post-implementation, significant improvements in quality of care, efficiency of care, and productivity were demonstrated.
AHRQ-funded; 290200600019I.
Citation: Newman ED, Lerch V, Billet J .
Improving the quality of care of patients with rheumatic disease using patient-centric electronic redesign software.
Arthritis Care Res 2015 Apr;67(4):546-53. doi: 10.1002/acr.22479..
Keywords: Health Information Technology (HIT), Quality of Care, Arthritis, Patient-Centered Outcomes Research
Kerr EA, Chen J, Sussman JB
Stress testing before low-risk surgery: so many recommendations, so little overuse.
The researchers sought to determine the prevalence of cardiac stress testing before low-risk surgeries, prior to commencement of a campaign to reduce routine stress testing, in order to estimate the potential effect of the campaign on future use of resources. Their study of VA and Medicare patients found that the use of routine preoperative stress testing before low-risk surgeries was very low, suggesting that interventions to further decrease testing would minimally improve quality.
AHRQ-funded; HS018781
Citation: Kerr EA, Chen J, Sussman JB .
Stress testing before low-risk surgery: so many recommendations, so little overuse.
JAMA Intern Med. 2015 Apr;175(4):645-7. doi: 10.1001/jamainternmed.2014.7877..
Keywords: Shared Decision Making, Guidelines, Quality of Care, Healthcare Utilization, Surgery
Nembhard IM, Yuan CT, Shabanova V
The relationship between voice climate and patients' experience of timely care in primary care clinics.
The aims of this study were to assess the relationship between organizational climate and patients’ reports of timely care in primary care clinics and to broadly examine the link between staff’s work environment and patient care experiences. It found that clinical and administrative staff (e.g., nurses and office assistants) reported clinics’ climates to be significantly less supportive of voice than did clinical leaders (e.g., physicians).
AHRQ-funded; HS018987; HS016978.
Citation: Nembhard IM, Yuan CT, Shabanova V .
The relationship between voice climate and patients' experience of timely care in primary care clinics.
Health Care Manage Rev 2015 Apr-Jun;40(2):104-15. doi: 10.1097/hmr.0000000000000017..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Primary Care, Quality of Care, Organizational Change, Provider
Lyratzopoulos G, Vedsted P, Singh H
Understanding missed opportunities for more timely diagnosis of cancer in symptomatic patients after presentation.
The authors highlight factors involved in missed opportunities to diagnose cancer more promptly in symptomatic patients and discuss responsible mechanisms and potential strategies to shorten intervals from presentation to diagnosis. They also provide a conceptual foundation for the development of future interventions to minimize the occurrence of missed opportunities in cancer diagnosis.
AHRQ-funded; HS022087.
Citation: Lyratzopoulos G, Vedsted P, Singh H .
Understanding missed opportunities for more timely diagnosis of cancer in symptomatic patients after presentation.
Br J Cancer 2015 Mar 31;112 Suppl 1:S84-91. doi: 10.1038/bjc.2015.47..
Keywords: Cancer, Diagnostic Safety and Quality, Quality of Care
Brown SE, Ratcliffe SJ, Halpern SD
Assessing the utility of ICU readmissions as a quality metric: an analysis of changes mediated by residency work-hour reforms.
This study sought to determine whether ICU readmission rates changed after the 2003 Accreditation Council for Graduate Medical Education Resident Duty Hours reform and whether there were temporally corresponding changes in other ICU outcomes. The decrease in ICU readmission rates after reform, without corresponding changes in mortality, suggest that ICU readmissions are not causally related to other untoward patient outcomes.
AHRQ-funded; HS018406.
Citation: Brown SE, Ratcliffe SJ, Halpern SD .
Assessing the utility of ICU readmissions as a quality metric: an analysis of changes mediated by residency work-hour reforms.
Chest 2015 Mar;147(3):626-36. doi: 10.1378/chest.14-1060..
Keywords: Intensive Care Unit (ICU), Hospital Readmissions, Quality of Care, Patient Safety, Outcomes
Hilligoss B, Mansfield JA, Patterson ES
Collaborating-or "selling" patients? A conceptual framework for emergency department-to-inpatient handoff negotiations.
The authors propose an empirically grounded conceptual framework of emergency department admission handoff negotiations that represents handoffs as situated within ongoing flows of action, variable negotiation contexts, stable organizational structures, and macro environments. The purpose of this framework is to raise awareness of potential opportunities to intervene and improve the contexts in which handoffs occur in order to foster greater collaboration and improve resilience.
AHRQ-funded; HS018758
Citation: Hilligoss B, Mansfield JA, Patterson ES .
Collaborating-or "selling" patients? A conceptual framework for emergency department-to-inpatient handoff negotiations.
Jt Comm J Qual Patient Saf. 2015 Mar;41(3):134-43..
Keywords: Emergency Department, Emergency Medical Services (EMS), Quality of Care, Patient Safety
Abdelsattar ZM, Reames BN, Regenbogen SE
Critical evaluation of the scientific content in clinical practice guidelines.
The researchers sought to critically evaluate clinical practice guidelines (CPGs) on the basis of their overall development quality, the evidence base used to synthesize recommendations, and the scientific agreement between CPGs on key processes of care. They concluded that there is significant variation in CPG development processes, with associated differences in scientific content and interpretation of evidence, resulting in conflicting recommendations.
AHRQ-funded: HS000053.
Citation: Abdelsattar ZM, Reames BN, Regenbogen SE .
Critical evaluation of the scientific content in clinical practice guidelines.
Cancer 2015 Mar 1;121(5):783-9. doi: 10.1002/cncr.29124..
Keywords: Care Management, Evidence-Based Practice, Guidelines, Quality of Care
Waters TM, Daniels MJ, Bazzoli GJ
Effect of Medicare's nonpayment for hospital-acquired conditions: lessons for future policy.
This study measured the association between Medicare’s nonpayment policy and 4 outcomes addressed by the Hospital-Acquired Conditions Initiative and found improvements in both the rates of central-line associated bloodstream infections and catheter-related urinary tract infections but no improvements for either hospital acquired pressure ulcers or injurious patient falls.
AHRQ-funded; HS020627
Citation: Waters TM, Daniels MJ, Bazzoli GJ .
Effect of Medicare's nonpayment for hospital-acquired conditions: lessons for future policy.
JAMA Intern Med. 2015 Mar;175(3):347-54. doi: 10.1001/jamainternmed.2014.5486..
Keywords: Quality of Care, Healthcare-Associated Infections (HAIs), Medicare, Patient Safety
Kern LM, Edwards AM, Pichardo M
Electronic health records and health care quality over time in a federally qualified health center.
The researchers sought to determine the association between EHRs and quality of care in a large Federally Qualified Health Center (FQHC), during the 3 years following EHR implementation. They found that the magnitude of absolute improvement ranged from 5 percent to 20 percent per measure. EHRs were associated with continuing improvement in health care quality for at least 3 years post-implementation in the safety-net setting of a FQHC.
AHRQ-funded; HS017067.
Citation: Kern LM, Edwards AM, Pichardo M .
Electronic health records and health care quality over time in a federally qualified health center.
J Am Med Inform Assoc 2015 Mar;22(2):453-8. doi: 10.1093/jamia/ocu049..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Quality of Care
Chung JW, Ju MH, Kinnier CV
Postoperative venous thromboembolism outcomes measure: analytic exploration of potential misclassification of hospital quality due to surveillance bias.
The authors discuss problems associated with AHRQ’s Patient Safety Indicator (PS112), Postoperative Venous Thromboembolism such as identifying truly poor-quality hospitals from those that only seem to be poor-quality because of hospital-to-hospital variations in imaging rates for venous thromboembolism (VTE). They call for the development of administrative codes that enable reliable identification and exclusion of sub-clinical VTE from the measure numerator.
AHRQ-funded; HS021857
Citation: Chung JW, Ju MH, Kinnier CV .
Postoperative venous thromboembolism outcomes measure: analytic exploration of potential misclassification of hospital quality due to surveillance bias.
Ann Surg. 2015 Mar;261(3):443-4. doi: 10.1097/sla.0000000000000850..
Keywords: Quality Indicators (QIs), Blood Clots, Quality of Care, Adverse Events
Lee MJ, Shonnard N, Farrokhi F
The Spine Surgical Care and Outcomes Assessment Program (Spine SCOAP): a surgeon-led approach to quality and safety.
The researchers sought to identify variation in utilization, processes of care, and outcomes in spine surgery to improve statewide quality and safety. They found significant variability in the indications, process of care, and outcomes related to spine surgery. This variability indicates the need for continued surveillance initiatives and point to opportunities for quality improvement and research.
AHRQ-funded; HS020025.
Citation: Lee MJ, Shonnard N, Farrokhi F .
The Spine Surgical Care and Outcomes Assessment Program (Spine SCOAP): a surgeon-led approach to quality and safety.
Spine 2015 Mar 1;40(5):332-41. doi: 10.1097/brs.0000000000000750..
Keywords: Surgery, Quality of Care, Patient Safety, Comparative Effectiveness, Outcomes
Michtalik HJ, Carolan HT, Haut ER
Use of provider-level dashboards and pay-for-performance in venous thromboembolism prophylaxis.
The researchers sequentially examined an individualized physician dashboard and pay-for-performance program to improve venous thromboembolism (VTE) prophylaxis rates among hospitalists. They found that direct feedback using dashboards was associated with significantly improved compliance, with further improvement after incorporating an individual physician pay-for-performance program.
AHRQ-funded; HS017952; HS022331.
Citation: Michtalik HJ, Carolan HT, Haut ER .
Use of provider-level dashboards and pay-for-performance in venous thromboembolism prophylaxis.
J Hosp Med 2015 Mar;10(3):172-8. doi: 10.1002/jhm.2303..
Keywords: Provider Performance, Payment, Blood Clots, Prevention, Quality Improvement, Quality of Care, Hospitals, Patient Safety
Singh H, Sittig DF
Advancing the science of measurement of diagnostic errors in healthcare: the Safer Dx framework.
The Safer Dx framework can help stakeholders measure a monitor diagnostic errors, which are considered hard to tackle and remain elusive to improvement efforts because they are difficult to define and measure.
AHRQ-funded; HS022087
Citation: Singh H, Sittig DF .
Advancing the science of measurement of diagnostic errors in healthcare: the Safer Dx framework.
BMJ Qual Saf. 2015 Feb;24(2):103-10. doi: 10.1136/bmjqs-2014-003675..
Keywords: Health Information Technology (HIT), Quality of Care, Patient Safety
Paddock SM, Adams JL, Hoces de la Guardia F
Better-than-average and worse-than-average hospitals may not significantly differ from average hospitals: an analysis of Medicare Hospital Compare ratings.
The researchers examine the degree to which a consumer might be misled by comparing hospitals based on performance tiers by using 30-day mortality and readmission outcome measures from Medicare Hospital Compare. They found that in the majority of cases, performances for hospitals reported as either top or bottom tier on the Medicare website did not significantly differ from that of mid-tier hospitals.
AHRQ-funded; HS021860
Citation: Paddock SM, Adams JL, Hoces de la Guardia F .
Better-than-average and worse-than-average hospitals may not significantly differ from average hospitals: an analysis of Medicare Hospital Compare ratings.
BMJ Qual Saf. 2015 Feb;24(2):128-34. doi: 10.1136/bmjqs-2014-003405..
Keywords: Quality of Care, Hospitalization, Medicare
Wang G, Gold M, Siegel J
AHRQ Author: Siegel J
Deliberation: obtaining informed input from a diverse public.
The Deliberative Methods Demonstration was a randomized controlled experiment comparing four deliberation methods and a reading materials control group. After surveying 907 participants before and after deliberation, the researchers found that changes in knowledge about using medical evidence in decisionmaking were not associated with race, ethnicity, or education.
AHRQ-authored.
Citation: Wang G, Gold M, Siegel J .
Deliberation: obtaining informed input from a diverse public.
J Health Care Poor Underserved. 2015 Feb;26(1):223-42. doi: 10.1353/hpu.2015.0021..
Keywords: Disparities, Quality of Care, Shared Decision Making, Racial and Ethnic Minorities, Social Determinants of Health
Minami CA, Dahlke A, Bilimoria KY
Public reporting in surgery: an emerging opportunity to improve care and inform patients.
The authors reviewed the benefits and concerns surrounding public reporting and then suggested some possible solutions to these problems in a stride toward better implementation and utilization of public reporting to improve surgical outcomes. They concluded that, although there are problems with the current approach, continual refinement of public reporting systems has the potential to provide individualized, relevant data that would not only lend a sense of agency to the American public but also motivate hospitals to engage in meaningful quality improvement.
AHRQ-funded; HS021857.
Citation: Minami CA, Dahlke A, Bilimoria KY .
Public reporting in surgery: an emerging opportunity to improve care and inform patients.
Ann Surg 2015 Feb;261(2):241-2. doi: 10.1097/sla.0000000000001033.
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Keywords: Quality of Care, Outcomes, Public Reporting, Quality Improvement, Surgery
Kamal AH, Nipp RD, Bull JH
Quality of palliative care for patients with advanced cancer in a community consortium.
The authors formed the Carolinas Consortium for Palliative Care and collected a quality data registry to monitor their practice and to inform quality improvement efforts. They demonstrated that measures evaluating process assessment, as opposed to interventions, are better documented. They concluded that analyzing data on quality is feasible and valuable in community-based palliative care and that, overall, processes to collect data on quality using nontechnology methods may underestimate true adherence to quality measures.
AHRQ-funded; HS022763.
Citation: Kamal AH, Nipp RD, Bull JH .
Quality of palliative care for patients with advanced cancer in a community consortium.
J Pain Symptom Manage 2015 Feb;49(2):289-92. doi: 10.1016/j.jpainsymman.2014.05.024.
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Keywords: Cancer, Healthcare Delivery, Quality of Care, Palliative Care, Registries
Anhang Price R, Elliott MN, Cleary PD
Should health care providers be accountable for patients' care experiences?
Using evidence from the Consumer Assessment of Healthcare Providers and Systems surveys, the authors address seven common critiques of patient experience measures. These include: lack of consumer expertise, the subjectivity of patient satisfaction, and the trade-off between providing good patient experiences and providing high-quality clinical care.
AHRQ-funded; HS016980; HS016978
Citation: Anhang Price R, Elliott MN, Cleary PD .
Should health care providers be accountable for patients' care experiences?
J Gen Intern Med. 2015 Feb;30(2):253-6. doi: 10.1007/s11606-014-3111-7..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Quality of Care, Patient Experience, Patient-Centered Healthcare