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
26 to 50 of 221 Research Studies DisplayedLi RD, Joung RH, BC BC
Comprehensive evaluation of the trends in length of stay and post-discharge complications after colon surgery in the USA.
The purpose of this study focusing on colon surgery was to 1) describe temporal changes in length of stay (LOS) and post-discharge complications and 2) assess risk factors related with post-discharge complications. The study found that of the 98,136 patients who underwent colon resection between 2012 and 2018, the median LOS decreased from 5 days in 2012 to 4 days in 2018. Overall, the 30-day complication rate was 21.5%, which decreased during the study period. Of the 13 individual complications evaluated, 4 demonstrated a significant increase in the proportion of post-discharge events including overall SSI, superficial SSI, wound disruption, and UTI. Factors associated with the development of any post-discharge complication included female sex, ASA III/IV/V, dependent functional status, and higher BMI. Intraoperative factors included wound class, operation time, and approach. The study concluded that LOS and 30-day complications decreased over time, however the percentage of incidents taking place post-discharge increased for a number of complications.
AHRQ-funded; HS024516; HS026385
Citation: Li RD, Joung RH, BC BC .
Comprehensive evaluation of the trends in length of stay and post-discharge complications after colon surgery in the USA.
J Gastrointest Surg 2022 Oct;26(10):2184-92. doi: 10.1007/s11605-022-05391-0..
Keywords: Surgery, Adverse Events, Hospital Discharge
Bucher BT, Yang M, Richards Steed R, BT, Yang M, Richards Steed R
Geographic proximity of family members and healthcare utilization after complex surgical procedures.
This retrospective cohort study sought to determine the relationship between a patient's proximal familial social support, defined as the geographic proximity of family members, and healthcare utilization after complex cardiovascular and oncologic procedures. The authors defined healthcare utilization outcomes as 30-day all-cause readmission unplanned readmission, nonindex hospital readmission, index hospital length of stay, and home discharge disposition. The number of first-degree relatives (FDRs) living within 30 miles of the patient was measured using 60,895 patients undergoing complex cardiovascular procedures or oncologic procedures. Compared with patients with 0 to 1 FDRs, patients with 6+ FDRs living in close proximity had significantly lower rates of all-cause readmission (12.1% vs 13.5%), unplanned readmission, nonindex readmission; higher rates of home discharge. A larger number of FDRs living within 30 miles of the patient was significantly associated with a lower likelihood of all-cause readmission, 30-day unplanned readmission, nonindex readmission; higher likelihood of home discharge; and shorter index length of stay.
AHRQ-funded; HS025776.
Citation: Bucher BT, Yang M, Richards Steed R, BT, Yang M, Richards Steed R .
Geographic proximity of family members and healthcare utilization after complex surgical procedures.
Ann Surg 2022 Oct 1;276(4):720-31. doi: 10.1097/sla.0000000000005584..
Keywords: Surgery, Hospital Discharge, Hospital Readmissions, Healthcare Utilization
Bourgoin A, Balaban R, Hochman M
AHRQ Author: Perfetto D, Hogan EM
Improving quality and safety for patients after hospital discharge: primary care as the lead integrator in postdischarge care transitions.
The purpose of this study was to explain primary care-based transition workflow processes for hospitalized patients. The researchers conducted interviews with primary care thought leaders, staff at 9 primary care sites, community agency staff, and recently discharged patients. The researchers found that primary care postdischarge workflows vary across the different settings, rarely include communications with the patient or the inpatient team during the hospitalization and vary widely across settings. The researchers recommended the use of principles for primary care practices to encourage active participation in the full spectrum of postdischarge care, from admission through the first postdischarge visit to primary care.
AHRQ-authored; AHRQ-funded; 233201500019I/HHSP23337002T.
Citation: Bourgoin A, Balaban R, Hochman M .
Improving quality and safety for patients after hospital discharge: primary care as the lead integrator in postdischarge care transitions.
J Ambul Care Manage 2022 Oct-Dec;45(4):310-20. doi: 10.1097/jac.0000000000000433..
Keywords: Quality of Care, Patient Safety, Hospital Discharge, Transitions of Care, Hospitals, Workflow
Vaughn VM, Ratz D, Greene MT
Antibiotic stewardship strategies and their association with antibiotic overuse after hospital discharge: an analysis of the Reducing Overuse of Antibiotics at Discharge (ROAD) home framework.
Researchers sought to understand strategies to optimize antibiotic prescribing at discharge. Surveying Michigan hospitals on their antibiotic stewardship strategies for community-acquired pneumonia (CAP) and urinary tract infection (UTI), they found that the more stewardship strategies a hospital reported, the lower its antibiotic overuse at discharge.
AHRQ-funded; HS026530.
Citation: Vaughn VM, Ratz D, Greene MT .
Antibiotic stewardship strategies and their association with antibiotic overuse after hospital discharge: an analysis of the Reducing Overuse of Antibiotics at Discharge (ROAD) home framework.
Clin Infect Dis 2022 Sep 29;75(6):1063-72. doi: 10.1093/cid/ciac104..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Hospital Discharge, Transitions of Care
Topham EW, Bristol A, Luther B
Caregiver inclusion in IDEAL discharge teaching: implications for transitions from hospital to home.
The purpose of this study was to explore perceptions of caregivers regarding their discharge preparation, focusing particular attention on whether and how they believed discharge preparation impacted post-discharge patient outcomes. Through interviews with four English-speaking caregivers, findings showed that, once home, the caregivers reported gaps in their knowledge of how to care for the patient, suggesting key gaps related to knowledge of warning signs and problems. Two of the four caregiver participants attributed a hospital readmission to post-discharge knowledge gaps. This study of caregiver experiences suggests that AHRQ’s IDEAL discharge planning strategy remains a useful and important framework for case managers to follow when providing discharge services.
AHRQ-funded; HS026248.
Citation: Topham EW, Bristol A, Luther B .
Caregiver inclusion in IDEAL discharge teaching: implications for transitions from hospital to home.
Prof Case Manag 2022 Jul-Aug;27(4):181-93. doi: 10.1097/ncm.0000000000000563..
Keywords: Hospital Discharge, Transitions of Care, Caregiving
King C, Cook R, Korthuis PT
Causes of death in the 12 months after hospital discharge among patients with opioid use disorder.
This study described causes of death in the year post-discharge among hospitalized patients with Opioid Use Disorder (OUD). Data was analyzed from participants at least 18 years old with Medicaid insurance, who had a diagnosis of OUD during a general hospital admission in Oregon. Findings showed that hospitalized patients with OUD were at high risk of death, from drug and non-drug related causes, in the year after discharge. Recommendations included future research considering not only overdose, but a more comprehensive definition of drug-related death in understanding post-discharge mortality among hospitalized patients with OUD.
AHRQ-funded; HS026370.
Citation: King C, Cook R, Korthuis PT .
Causes of death in the 12 months after hospital discharge among patients with opioid use disorder.
J Addict Med 2022 Jul-Aug;16(4):466-69. doi: 10.1097/adm.0000000000000915..
Keywords: Mortality, Hospital Discharge, Hospitals, Opioids, Substance Abuse, Behavioral Health
Giesler DL, Krein S, Brancaccio A
Reducing overuse of antibiotics at discharge home: a single-center mixed methods pilot study.
This article described a single-center, controlled pilot study of a pharmacist-facilitated antibiotic timeout prior to hospital discharge. The timeout addressed key elements of duration and was designed and implemented using iterative cycles with rapid feedback. The authors evaluated implementation outcomes related to feasibility, including usability, adherence, and acceptability. The pharmacists conducted 288 antibiotic timeouts with a mean duration of 2.5 minutes. Pharmacists recommended an antibiotic change in 25% of timeouts with 70% of recommended changes accepted by hospitalists. Barriers included unanticipated and weekend discharges. There were no differences in antibiotic use after discharge during the intervention compared to control services.
AHRQ-funded; HS026530.
Citation: Giesler DL, Krein S, Brancaccio A .
Reducing overuse of antibiotics at discharge home: a single-center mixed methods pilot study.
Am J Infect Control 2022 Jul;50(7):777-86. doi: 10.1016/j.ajic.2021.11.016..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Hospital Discharge, Transitions of Care
Vaughn VM, Hersh AL, Spivak ES
Antibiotic overuse and stewardship at hospital discharge: the reducing overuse of antibiotics at discharge home framework.
In this review, the authors discussed what is currently known about antibiotic overuse at hospital discharge, key barriers, and targets for improving antibiotic prescribing at discharge. They introduced an evidence-based framework, the Reducing Overuse of Antibiotics at Discharge Home Framework, for conducting discharge antibiotic stewardship.
AHRQ-funded; HS026530.
Citation: Vaughn VM, Hersh AL, Spivak ES .
Antibiotic overuse and stewardship at hospital discharge: the reducing overuse of antibiotics at discharge home framework.
Clin Infect Dis 2022 May 3;74(9):1696-702. doi: 10.1093/cid/ciab842..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Hospital Discharge, Hospitals
Schmutz KE, Wallace AS, Bristol AA
Hospital discharge during COVID-19: the role of social resources.
The purpose of this qualitative study was to examine the effect of the COVID-19 pandemic on the ability of patients to obtain and receive support post-discharge after medical or surgical hospital services. The researchers utilized the Individual and Family Self-Management Theory as a framework for semi-structured interviews conducted with 26 patients discharged from the hospital. The study found that the majority of participants described minimal impact on their ability to secure support, with the exception of one participant whose support changes radically affected her experience post-discharge. The researchers concluded that strong pre-existing social support networks were protective for patients returning home after hospitalization during the pandemic.
AHRQ-funded; HS026248.
Citation: Schmutz KE, Wallace AS, Bristol AA .
Hospital discharge during COVID-19: the role of social resources.
Clin Nurs Res 2022 May;31(4):724-32. doi: 10.1177/10547738221075760..
Keywords: COVID-19, Hospital Discharge, Hospitals
Mitchell SE, Reichert M, Howard JM
Reducing readmission of hospitalized patients with depressive symptoms: a randomized trial.
The purpose of this randomized controlled trial study was to assess whether post-discharge depression treatment will benefit hospitalized patients by reducing readmissions. Participants included hospitalized patients with a patient health questionnaire-9 score of 10 or higher. The researchers delivered the Re-Engineered Discharge (RED) and randomized participants to groups receiving RED-only or RED for Depression (RED-D), a 12-week post-discharge telehealth intervention. The study found that at 30 days, the intention-to-treat analysis showed no differences between RED-D vs RED-only in hospital readmission or reutilization. The intention-to-treat analysis also showed no differences at 90 days in readmission or reutilization. In the as-treated analysis, each additional RED-D session was associated with a decrease in 30- and 90-day readmissions. At 30 days, among 104 participants receiving 3 or more sessions, there were fewer readmissions compared with the control group. At 90 days, among 109 participants receiving 6 or more sessions, there were fewer readmissions. The study concluded that unplanned hospital use can be decreased with post-discharge treatment of depression and support for care transition.
AHRQ-funded; HS019700.
Citation: Mitchell SE, Reichert M, Howard JM .
Reducing readmission of hospitalized patients with depressive symptoms: a randomized trial.
Ann Fam Med 2022 May-Jun;20(3):246-54. doi: 10.1370/afm.2801..
Keywords: Depression, Behavioral Health, Hospital Readmissions, Hospital Discharge, Transitions of Care
Sharara SL, Arbaje AI, Cosgrove SE
The voice of the patient: patient roles in antibiotic management at the hospital-to-home transition.
The objective of this study was to characterize tasks required for patient-performed antibiotic medication management (MM) at the hospital-to-home transition, as well as barriers to and strategies for patient-led antibiotic MM. The overall goal was to understand patients' role in managing antibiotics at the hospital-to-home transition. The investigators concluded that there are many opportunities to improve patient-led antibiotic MM at the hospital-to-home transition.
AHRQ-funded; HS026995.
Citation: Sharara SL, Arbaje AI, Cosgrove SE .
The voice of the patient: patient roles in antibiotic management at the hospital-to-home transition.
J Patient Saf 2022 Apr 1;18(3):e633-e39. doi: 10.1097/pts.0000000000000899..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Hospital Discharge, Transitions of Care, Patient Self-Management
Fraiman YS, Stewart JE, Litt JS
Race, language, and neighborhood predict high-risk preterm infant follow up program participation.
This study investigated whether infants born to Black mothers, non-English speaking mothers, and mothers who live in “Very Low” Child Opportunity Index (COI) neighborhoods would have decreased odds of using the Infant Follow Up Program (IFUP) for their preterm infants after discharge from a NICU. A total of 477 infants eligible for IFUP between 2015 and June 2017 from a single large academic Level III NICU were included. Primary outcome considered was at least one visit to IFUP. Two hundred infants (41.9%) participated in IFUP, with the odds of participation lower for Black compared to white race, “Very Low” COI compared to “Very High”, and primary non-English speaking.
AHRQ-funded; HS000063.
Citation: Fraiman YS, Stewart JE, Litt JS .
Race, language, and neighborhood predict high-risk preterm infant follow up program participation.
J Perinatol 2022 Feb;42(2):217-22. doi: 10.1038/s41372-021-01188-2..
Keywords: Newborns/Infants, Hospital Discharge, Transitions of Care, Racial and Ethnic Minorities
Fierro J, Herrick H, Fregene N
Home pulse oximetry after discharge from a quaternary-care children's hospital: prescriber patterns and perspectives.
Researchers conducted a mixed-methods analysis of pediatric home pulse oximetry orders to determine prescribed alarm parameter limits and recommended interventions. Semi-structured qualitative interviews were conducted with pediatric providers managing patients who received home oxygen and pulse oximetry. Results showed significant variability in home pulse oximetry prescribing practices; provider interviews highlighted the importance of the provider-patient relationship and areas for improvement. The researchers concluded that there is an opportunity to create standardized guidelines that optimize the use of home monitoring devices for patients, families, and pulmonary providers.
AHRQ-funded; HS026620.
Citation: Fierro J, Herrick H, Fregene N .
Home pulse oximetry after discharge from a quaternary-care children's hospital: prescriber patterns and perspectives.
Pediatr Pulmonol 2022 Jan;57(1):209-16. doi: 10.1002/ppul.25722..
Keywords: Children/Adolescents, Hospital Discharge
Herzig SJ, Anderson TS,, Jung y
Risk factors for opioid-related adverse drug events among older adults after hospital discharge.
This study examined patient- and prescribing-related risk factors for opioid-related adverse drug events (ADEs) after hospital discharge among medical patients. Administrative billing codes and medication claims were used to define potential opioid-related ADEs within 30 days of hospital discharge. Findings showed that potential opioid-related ADEs occurred in 7% of older adults discharged from a medical hospitalization with an opioid prescription. Recommendations included using identified risk factors to inform physician decision-making, having conversations with older adults about risk, and increasing development and targeting of harm reduction strategies.
AHRQ-funded; HS026215.
Citation: Herzig SJ, Anderson TS,, Jung y .
Risk factors for opioid-related adverse drug events among older adults after hospital discharge.
J Am Geriatr Soc 2022 Jan;70(1):228-34. doi: 10.1111/jgs.17453..
Keywords: Elderly, Opioids, Risk, Adverse Drug Events (ADE), Adverse Events, Medication, Hospital Discharge
Vaughn VM, Gandhi TN, Chopra V
Antibiotic overuse after hospital discharge: a multi-hospital cohort study.
Antibiotics are commonly prescribed to patients as they leave the hospital. In this study, the investigators aimed to create a comprehensive metric to characterize antibiotic overuse after discharge among hospitalized patients treated for pneumonia or urinary tract infection (UTI) and determine whether overuse varied across hospitals and conditions. The investigators concluded that antibiotic overuse after discharge was common and varied widely between hospitals.
AHRQ-funded; HS026530.
Citation: Vaughn VM, Gandhi TN, Chopra V .
Antibiotic overuse after hospital discharge: a multi-hospital cohort study.
Clin Infect Dis 2020 Dec 6;73(11):e4499-e506. doi: 10.1093/cid/ciaa1372..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Hospital Discharge
Brajcich BC, Shallcross ML, Johnson JK
Barriers to post-discharge monitoring and patient-clinician communication: a qualitative study.
This study used semi-structured interviews and focus groups to identify barriers to post-discharge monitoring and patient-clinician communication. Participants were gastrointestinal surgery patients and clinicians, with a total of 15 patients and 17 clinicians. Four themes and four barriers were identified from patient and clinician interviews and focus groups. Patient-identified barriers included education and expectation setting, technology access and literacy, availability of resources and support, and misalignment of communication preferences. Clinician-identified barriers included health education, access to clinical team, healthcare practitioner time constraints, and care team experience and consistency.
AHRQ-funded; HS026385.
Citation: Brajcich BC, Shallcross ML, Johnson JK .
Barriers to post-discharge monitoring and patient-clinician communication: a qualitative study.
J Surg Res 2021 Dec;268:1-8. doi: 10.1016/j.jss.2021.06.032..
Keywords: Hospital Discharge, Clinician-Patient Communication, Care Management, Transitions of Care
Deshpande BR, McCarthy EP, Jung Y
Initiation of long-acting opioids following hospital discharge among Medicare beneficiaries.
This study investigated the incidence of long-acting opioid initiation following acute care hospitalization among a retrospective cohort of Medicare beneficiaries in 2016 who were 65 years or older, who did not have cancer or hospice care, and had not filled an opioid prescription within the preceding 90 days. Among 258,193 hospitalizations, 18.6% were associated with a claim for a new opioid prescription in the week after hospital discharge: 0.3% with both short- and long-acting opioids, 0.1% with long-acting opioids only, and 18.2% with short-acting opioids only. Most long-acting opioid prescriptions occurred with surgical patients (81.7%). Beneficiaries of long-acting opioids were younger, had a higher prevalence of diseases of the musculoskeletal and connective tissues, and had more known risk factors of opioid-related adverse events compared to patients prescribed short-acting opioids.
AHRQ-funded; HS026215.
Citation: Deshpande BR, McCarthy EP, Jung Y .
Initiation of long-acting opioids following hospital discharge among Medicare beneficiaries.
J Hosp Med 2021 Dec;16(12):724-26. doi: 10.12788/jhm.3721..
Keywords: Opioids, Medication, Hospital Discharge
Barreto EF, Schreier DJ, May HP
Incidence of serum creatinine monitoring and outpatient visit follow-up among acute kidney injury survivors after discharge: a population-based cohort study.
This study evaluated the frequency of follow-up after hospital discharge among acute kidney injury (AKI) survivors. This population-based cohort study included adult residents of Olmsted County hospitalized from an episode of stage II or II AK between 2006 and 2014. Follow-up visits at 30-days, 90 days, and 1 year were included. In the 627 included AKI survivors, the cumulative incidence of a follow-up serum creatinine (SCr) level was 80%, a healthcare visit 82%, or both was 70%. At 90 days and 1 year after discharge, cumulative incidents of meeting both follow-up criteria rose to 82 and 91% respectively. Independent predictors of receiving both were not related to demographic or socioeconomic factors but to lower estimated glomerular filtration rate at discharge, higher comorbidity burden, longer length of hospitalization, and greater maximum AKI severity.
AHRQ-funded; HS028060.
Citation: Barreto EF, Schreier DJ, May HP .
Incidence of serum creatinine monitoring and outpatient visit follow-up among acute kidney injury survivors after discharge: a population-based cohort study.
Am J Nephrol 2021;52(10-11):817-26. doi: 10.1159/000519375..
Keywords: Kidney Disease and Health, Hospital Discharge, Care Management, Healthcare Utilization
Choe AY, Schondelmeyer AC, Thomson J
Improving discharge instructions for hospitalized children with limited english proficiency.
Research was conducted on an intervention for patients with limited English proficiency (LEP) who are discharged from the hospital without instructions in their preferred language. The objective was to increase the percentage of patients with LEP on the hospital medicine service who received translated discharge instructions from 12% to 80%. During the 18-month study period 540 patients with LEP were discharged. Spanish was the preferred language of 66% of these patients. The percentage of patients who received translated discharge instructions increased from 12% to 50% in 3 months, and to 77% in 18 months. For Spanish-language patients, the percentage increased to 96% by 18 months.
AHRQ-funded; HS026763; HS025138.
Citation: Choe AY, Schondelmeyer AC, Thomson J .
Improving discharge instructions for hospitalized children with limited english proficiency.
Hosp Pediatr 2021 Nov;11(11):1213-22. doi: 10.1542/hpeds.2021-005981.
AHRQ-funded; HS026763; HS025138..
AHRQ-funded; HS026763; HS025138..
Keywords: Children/Adolescents, Hospital Discharge, Clinician-Patient Communication, Cultural Competence, Communication
Parikh K, Richmond M, Lee M
Outcomes from a pilot patient-centered hospital-to-home transition program for children hospitalized with asthma.
The purpose of this study was to evaluate a multi-component hospital-to-home (H2H) transition program for children hospitalized with an asthma exacerbation. A pilot prospective randomized clinical trial of guideline-based asthma care with and without a patient-centered multi-component H2H program was conducted among children enrolled in K-8(th) grade on Medicaid hospitalized for an asthma exacerbation. The investigators concluded that the pilot data suggested that comprehensive care coordination initiated during the inpatient stay was feasible and acceptable.
AHRQ-funded; HS024554.
Citation: Parikh K, Richmond M, Lee M .
Outcomes from a pilot patient-centered hospital-to-home transition program for children hospitalized with asthma.
J Asthma 2021 Oct;58(10):1384-94. doi: 10.1080/02770903.2020.1795877..
Keywords: Children/Adolescents, Patient-Centered Healthcare, Transitions of Care, Asthma, Hospital Discharge, Care Coordination, Chronic Conditions
Holler E, Meagher AD, Ortiz D
Preinjury functional independence is not associated with discharge location in older trauma patients.
This study’s purpose was to evaluate the association between pre-injury Katz Index of Independence in Activities of Daily Living (Katz ADL) functional status and discharge to a facility in non-neurologically injured trauma patients. Data from 207 subjects in the Trauma Medical Home study cohort was obtained. Patients were predominantly white (89.4%) and female (52.2%). The most common trauma injury was a fall (48.3%), followed by automobile crash (41.1%). There was no relationship between pre-injury independence and the likelihood of discharge home. Over half of patients (51.7%) were discharged home, 37.7% to subacute rehabilitation., 10.1% to acute rehabilitation, and 0.5% to long-term acute care. Patients who self-reported depression and anxiety who weren’t sent home was associated with age, being single, and being female.
AHRQ-funded; HS026390.
Citation: Holler E, Meagher AD, Ortiz D .
Preinjury functional independence is not associated with discharge location in older trauma patients.
J Surg Res 2021 Oct;266:413-20. doi: 10.1016/j.jss.2021.04.029..
Keywords: Elderly, Trauma, Hospital Discharge
Herzig SJ, Anderson TS, Jung Y
Relative risks of adverse events among older adults receiving opioids versus NSAIDs after hospital discharge: a nationwide cohort study.
This retrospective cohort study’s objective was to determine the incidence and risk of post-discharge adverse events among opioid claims in the week after hospital discharge, compared to those with nonsteroidal anti-inflammatory drugs (NSAIDs) claims alone. A national sample of Medicare beneficiaries age 65 and older who were hospitalized in the United States in 2016 was used. Beneficiaries who were admitted from or discharged to a facility were excluded. The authors used 3:1 propensity matching to match beneficiaries with an opioid claim in the week after discharge (13,385) with beneficiaries with NSAID claim alone (4,677). Beneficiaries receiving opioids had a higher incidence of death, healthcare utilization, and any potential adverse effect compared to those with an NSAID claim only. Specific adverse effects included higher relative risk of fall/fracture, nausea/vomiting, and slowed colonic motility.
AHRQ-funded; HS026215.
Citation: Herzig SJ, Anderson TS, Jung Y .
Relative risks of adverse events among older adults receiving opioids versus NSAIDs after hospital discharge: a nationwide cohort study.
PLoS Med 2021 Sep 27;18(9):e1003804. doi: 10.1371/journal.pmed.1003804..
Keywords: Elderly, Opioids, Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Risk, Hospital Discharge
Siddique SM, Tipton K, Leas B
Interventions to reduce hospital length of stay in high-risk populations: a systematic review.
Many strategies to reduce hospital length of stay (LOS) have been implemented, but few studies have evaluated hospital-led interventions focused on high-risk populations. The Agency for Healthcare Research and Quality (AHRQ) Learning Health System panel commissioned this study to further evaluate system-level interventions for LOS reduction. The objective of this study was to identify and synthesize evidence regarding potential systems-level strategies to reduce LOS for patients at high risk for prolonged LOS.
AHRQ-funded; 75Q80120D00002.
Citation: Siddique SM, Tipton K, Leas B .
Interventions to reduce hospital length of stay in high-risk populations: a systematic review.
JAMA Netw Open 2021 Sep;4(9):e2125846. doi: 10.1001/jamanetworkopen.2021.25846..
Keywords: Learning Health Systems, Health Systems, Evidence-Based Practice, Hospital Discharge, Risk, Inpatient Care, Care Management
Pritchard KT, Hong I, Goodwin JS
Association of social behaviors with community discharge in patients with total hip and knee replacement.
The objective of this retrospective cohort study was to understand the association between social determinants of health and community discharge after elective total joint arthroplasty. Social determinants of health are associated with odds of community discharge after total hip and knee joint arthroplasty. The investigators concluded that their findings demonstrated the value of using electronic health record data to analyze more granular patient factors associated with patient discharge location after total joint arthroplasty. Although bundled payment is increasing community discharge rates, post-acute care facilities.
AHRQ-funded; HS026133.
Citation: Pritchard KT, Hong I, Goodwin JS .
Association of social behaviors with community discharge in patients with total hip and knee replacement.
J Am Med Dir Assoc 2021 Aug;22(8):1735-43.e3. doi: 10.1016/j.jamda.2020.08.021..
Keywords: Orthopedics, Surgery, Hospital Discharge
Manges KA, Ayele R, Leonard C
Differences in transitional care processes among high-performing and low-performing hospital-SNF pairs: a rapid ethnographic approach.
This study’s objective was to explore differences between low- and high-performing hospitals and skilled nursing facilities (SNFs) pairs and postacute care outcomes. The authors used flow maps and thematic analysis to describe the process of hospitals discharging patients to SNFs and to identify differences in subprocesses used by high-performing and low-performing hospitals. Hospitals were classified based on their 30-day readmission rates from SNFs. The final sample included 148 hours of observations with 30 clinicians across four hospitals and five corresponding SNFs. High-performing sites differed in each stage from low-performing sites by focusing on 1) earlier, ongoing, systematic identification of high-risk patients; 2) discussing the decision to go to an SNF as an iterative team-based process and 3) anticipating barriers with knowledge of transitional and SNF care processes.
AHRQ-funded; HS026116.
Citation: Manges KA, Ayele R, Leonard C .
Differences in transitional care processes among high-performing and low-performing hospital-SNF pairs: a rapid ethnographic approach.
BMJ Qual Saf 2021 Aug;30(8):648-57. doi: 10.1136/bmjqs-2020-011204..
Keywords: Transitions of Care, Hospitals, Nursing Homes, Hospital Readmissions, Hospital Discharge