National Healthcare Quality and Disparities Report
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Search All Research Studies
Topics
- Adverse Drug Events (ADE) (2)
- Care Coordination (3)
- Caregiving (2)
- Children/Adolescents (1)
- Communication (3)
- Elderly (1)
- Health Information Technology (HIT) (1)
- Home Healthcare (2)
- (-) Hospital Discharge (11)
- Hospital Readmissions (1)
- (-) Hospitals (11)
- Long-Term Care (1)
- Medical Errors (1)
- Medical Liability (1)
- Medication (2)
- Medication: Safety (2)
- Nursing Homes (4)
- Patient-Centered Healthcare (1)
- Patient and Family Engagement (1)
- Patient Experience (1)
- Patient Safety (4)
- Quality Improvement (1)
- Quality of Care (2)
- Risk (1)
- (-) Transitions of Care (11)
- Workflow (1)
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 DisplayedDesai AD, Tolpadi A, Parast L
Improving the quality of written discharge instructions: a multisite collaborative project.
This study assessed the association between participation in an Institute for Healthcare Improvement Virtual Breakthrough Series collaborative and the quality of pediatric written discharge instructions across 8 US hospitals. The authors conducted a multicenter, interrupted time-series analysis of a medical records-based quality measure focused on written discharge instruction content (0-100 scale, higher scores reflect better quality). They obtained data from a random sample of pediatric patients (n = 5739) discharged from participating hospitals between September 2015 and August 2016, and between December 2017 and January 2020. The study periods consisted of 3 phases: 1) a 14-month pre-collaborative phase; 2) a 12-month quality improvement collaborative phase when hospitals implemented multiple rapid cycle tests of change and shared improvement strategies; and 3) a 12-month postcollaborative phase. Among hospitals with high baseline performance, measure scores improved beyond expected for the precollaborative trend, but hospitals with low baseline performance, measure scores increased at a lower than expected rate.
AHRQ-funded; HS025291.
Citation: Desai AD, Tolpadi A, Parast L .
Improving the quality of written discharge instructions: a multisite collaborative project.
Pediatrics 2023 May; 151(5):e2022059452. doi: 10.1542/peds.2022-059452..
Keywords: Hospital Discharge, Transitions of Care, Hospitals
Xiao Y, Smith A, Abebe E
Understanding hazards for adverse drug events among older adults after hospital discharge: insights from frontline care professionals.
The purpose of this study was to utilize a systems approach to examine hazards to medication safety for older adults during care transitions. The researchers interviewed 38 hospital-based professionals (5 hospitalists, 24 nurses, 4 clinical pharmacists, 3 pharmacy technicians, and 2 social workers) from 4 hospitals about ADE risks after hospital discharge among older adults. For each concern the participants provided, the hazard for medication-related harms was coded and grouped by its sources utilizing a human factors and systems engineering model. The study found that the hazards fell into 6 groups: 1) medication tasks related at home, 2) patient and caregiver related, 3) hospital work system related, 4) home resource related, 5) hospital professional-patient collaborative work related, and 6) external environment related. The type of medications indicated most frequently when describing concerns included anticoagulants, insulins, and diuretics. The types of hazards coded the most were: complex dosing, patient and caregiver knowledge gaps in medication management, errors in discharge medications, unaffordable cost, inadequate understanding about changes in medications, and gaps in access to care or in sharing medication information.
AHRQ-funded; HS024436.
Citation: Xiao Y, Smith A, Abebe E .
Understanding hazards for adverse drug events among older adults after hospital discharge: insights from frontline care professionals.
J Patient Saf 2022 Dec 1;18(8):e1174-e80. doi: 10.1097/pts.0000000000001046..
Keywords: Elderly, Adverse Drug Events (ADE), Medication, Medication: Safety, Hospital Discharge, Hospitals, Transitions of Care
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
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
Amar-Dolan LG, Horn MH, O'Connell B B
"This is how hard it is". family experience of hospital-to-home transition with a tracheostomy.
This study explores the experience of family caregivers of children and young adults with a tracheostomy during the transition from hospital to home care. Researchers sought to identify the specific unmet needs of families to direct future interventions. Using semi-structured interviews, they found a need for family-centered discharge processes including coordination of care and teaching focused on emergency preparedness.
AHRQ-funded; HS000063.
Citation: Amar-Dolan LG, Horn MH, O'Connell B B .
"This is how hard it is". family experience of hospital-to-home transition with a tracheostomy.
Ann Am Thorac Soc 2020 Jul;17(7):860-68. doi: 10.1513/AnnalsATS.201910-780OC..
Keywords: Transitions of Care, Home Healthcare, Caregiving, Patient Experience, Care Coordination, Hospital Discharge, Hospitals, Children/Adolescents, Patient-Centered Healthcare
Campbell Britton M, Petersen-Pickett J, Hodshon B
Mapping the care transition from hospital to skilled nursing facility.
Researchers used process mapping to illustrate the sequence of events involved with hospital discharge and admission to a skilled nursing facility (SNF). These transitions are often associated with breakdowns in communication that may place patients at risk for adverse events. A quality improvement (QI) team worked with frontline staff at an academic medical center and two local SNFs in the northeastern United States. The final process map included care management, medicine, nursing, admissions and physical therapy service staff. The process map showed numerous activities that need to be coordinated between care teams, and highlighted specific opportunities for improving communication between different teams.
AHRQ-funded; HS023554.
Citation: Campbell Britton M, Petersen-Pickett J, Hodshon B .
Mapping the care transition from hospital to skilled nursing facility.
J Eval Clin Pract 2020 Jun;26(3):786-90. doi: 10.1111/jep.13238..
Keywords: Transitions of Care, Care Coordination, Quality Improvement, Communication, Hospital Discharge, Hospitals, Nursing Homes, Quality of Care
Fuller TE, Pong DD, Piniella N
Interactive digital health tools to engage patients and caregivers in discharge preparation: implementation study.
This clinical trial studied implementation of a suite of EHR-integrated digital health tools to engage patients, caregivers, and clinicians in discharge preparation during hospitalization. Patients who were enrolled agreed to watch a discharge video, complete a checklist assessing discharge readiness, and request postdischarge text messaging with a physician 24 to 48 hours before their expected discharge date. Out of 752 patient admissions, from December 2017 to July 2018, 510 participated, 416 watched the video and completed the checklist, and 94 completed only the checklist. Most patients endorsed the tools, but felt that the video and checklist would be more useful closer to the actual discharge date. Clinicians participating in focus groups perceived the value for patients but felt that there were a number of limitations including low awareness and variable workflow regarding the intervention. A number of strategies were offered by the authors to address implementation barriers and promote adoption of these tools.
AHRQ-funded; HS024751.
Citation: Fuller TE, Pong DD, Piniella N .
Interactive digital health tools to engage patients and caregivers in discharge preparation: implementation study.
J Med Internet Res 2020 Apr 28;22(4):e15573. doi: 10.2196/15573..
Keywords: Health Information Technology (HIT), Patient and Family Engagement, Caregiving, Hospital Discharge, Transitions of Care, Hospitals
Arbaje AI, Werner NE, Kasda EM
Learning from lawsuits: using malpractice claims data to develop care transitions planning tools.
This study used malpractice claims data to evaluate safety risks during care transitions from hospital to home and to help develop care transitions planning tools and pilot test them. The authors analyzed closed malpractice claims for 230 adult patients discharged from 4 hospital sites. Two structured focus groups were also conducted for stakeholders to review concerns. This led to the development of two care transitions planning tools – one for patients/caregivers and one for healthcare providers. Feasibility on 53 patient discharges were tested for both tools. A total of 33 risk factors corresponding to hospital work system elements, care transitions processes, and care outcomes were found using qualitative analysis. Providers found the tool easy to use and patients felt the length and response of the tool was acceptable.
AHRQ-funded; HS022916; HS019519.
Citation: Arbaje AI, Werner NE, Kasda EM .
Learning from lawsuits: using malpractice claims data to develop care transitions planning tools.
J Patient Saf 2020 Mar;16(1):52-57. doi: 10.1097/pts.0000000000000238.
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Keywords: Medical Liability, Transitions of Care, Risk, Hospital Discharge, Hospitals, Patient Safety
Campbell Britton M, Hodshon B, Chaudhry SI
Implementing a warm handoff between hospital and skilled nursing facility clinicians.
This study focused on increasing better communication during transfers from hospitals and skilled nursing facilities (SNFs). Warm handoffs between hospital and SNF physicians was implemented. Participation in warm handoffs gradually increased – starting at 15.78% in stage 1 and increasing to 46.89% in stage 3. A total of 2417 patient discharges were included in this study.
AHRQ-funded; HS023554.
Citation: Campbell Britton M, Hodshon B, Chaudhry SI .
Implementing a warm handoff between hospital and skilled nursing facility clinicians.
J Patient Saf 2019 Sep;15(3):198-204. doi: 10.1097/pts.0000000000000529..
Keywords: Communication, Patient Safety, Hospital Discharge, Transitions of Care, Care Coordination, Hospitals, Nursing Homes
Jones CD, Jones J, Bowles KH
Quality of hospital communication and patient preparation for home health care: results from a statewide survey of home health care nurses and staff.
The purpose of this study was to evaluate the quality of communication between hospitals and home health care (HHC) clinicians and patient preparedness to receive HHC in a statewide sample of HHC nurses and staff. The authors concluded that communication between hospitals and HHC was suboptimal, and patients were often not prepared to receive HHC. They suggest that providing EHR access for HHC clinicians is a promising solution to improve the quality of communication.
AHRQ-funded; HS024569.
Citation: Jones CD, Jones J, Bowles KH .
Quality of hospital communication and patient preparation for home health care: results from a statewide survey of home health care nurses and staff.
J Am Med Dir Assoc 2019 Apr;20(4):487-91. doi: 10.1016/j.jamda.2019.01.004..
Keywords: Transitions of Care, Home Healthcare, Hospital Discharge, Hospitals, Communication
Kerstenetzky L, Birschbach MJ, Beach KF
Improving medication information transfer between hospitals, skilled-nursing facilities, and long-term-care pharmacies for hospital discharge transitions of care: a targeted needs assessment using the Intervention Mapping framework.
The authors of this study report on the development of a logic model that will be used to explore methods for minimizing patient care medication delays and errors while further improving handoff communication to skilled nurse facilities and long term care pharmacy staff.
AHRQ-funded; HS021984.
Citation: Kerstenetzky L, Birschbach MJ, Beach KF .
Improving medication information transfer between hospitals, skilled-nursing facilities, and long-term-care pharmacies for hospital discharge transitions of care: a targeted needs assessment using the Intervention Mapping framework.
Res Social Adm Pharm 2018 Feb;14(2):138-45. doi: 10.1016/j.sapharm.2016.12.013..
Keywords: Adverse Drug Events (ADE), Hospital Discharge, Hospitals, Long-Term Care, Medical Errors, Medication, Medication: Safety, Nursing Homes, Patient Safety, Transitions of Care