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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 762 Research Studies DisplayedChen VW, Rosen T, Dong Y
Case sampling for evaluating hospital postoperative morbidity in US surgical quality improvement programs.
This study examined whether US surgical quality improvement (QI) programs using case sampling is robust enough for identifying hospitals with higher than expected complications. Eligible patients were 18 years and older who underwent a noncardiac operation at US Department of Veterans Affairs (VA) hospitals with a record in the VA Surgical Quality Improvement Program (systematic sample) and the VA Corporate Data Warehouse surgical domain (100% of surgical cases). Most patients in both samples were men (90.2% vs 91.2%) and White (74.7% vs 74.5%). Overall, 30-day complication rates were 7.6% and 5.3% for the sample and universal review cohorts, respectively. Using over 2145 hospital quarters of data, hospitals were identified as an outlier in 15.0% of quarters using the sample and 18.2% with universal review. Average hospital quarterly complication rates were 4.7% for outliers identified using the sample only, 7.2% for universal only, and 7.4% for concurrent identification in both sources. For nonsampled cases, average hospital quarterly complication rates were 7.0% at outliers and 4.4% at nonoutliers. Among outlier hospital quarters in the sample, 54.2% were concurrently identified with universal review, and for those identified with universal review, 44.6% were concurrently identified using the sample.
AHRQ-funded; HS028560.
Citation: Chen VW, Rosen T, Dong Y .
Case sampling for evaluating hospital postoperative morbidity in US surgical quality improvement programs.
JAMA Surg 2024 Mar; 159(3):315-22. doi: 10.1001/jamasurg.2023.6524..
Keywords: Surgery, Quality Improvement, Quality of Care, Hospitals
Parikh K, Hall M, Tieder JS
Disparities in racial, ethnic, and payer groups for pediatric safety events in US hospitals.
A retrospective cohort study using the 2019 Kids' Inpatient Database found disparities in pediatric safety events. Black and Hispanic children had significantly higher odds in 5 of 7 safety indicators compared to white children, especially in postoperative sepsis and respiratory failure. Medicaid-covered children also showed higher odds in 4 of 7 indicators compared to privately insured children, highlighting the need for targeted interventions to enhance hospital patient safety, particularly among minority and Medicaid-covered populations.
AHRQ-funded; HS028484.
Citation: Parikh K, Hall M, Tieder JS .
Disparities in racial, ethnic, and payer groups for pediatric safety events in US hospitals.
Pediatrics 2024 Mar; 153(3):e2023063714. doi: 10.1542/peds.2023-063714.
Keywords: Healthcare Cost and Utilization Project (HCUP), Disparities, Racial and Ethnic Minorities, Children/Adolescents, Patient Safety, Hospitals
Bui LN, Knox M, Miller-Rosales C
Hospital capabilities associated with behavioral health integration within emergency departments.
The objective of this study was to identify hospital capabilities associated with behavioral health processes in emergency departments. Responses to the National Survey of Healthcare Organizations and Systems were linked American Hospital Association Annual Survey data. Most hospitals reported screening for behavioral health conditions and provided direct referrals to community-based clinicians. Approximately half the hospitals used team approaches to behavioral health. Hospitals that reported more barriers to care delivery innovations also reported less screening and usage of a team approach. The authors concluded that research and interventions which focus on removing barriers or adding processes to disseminate best practices offer a path to accelerate behavioral health integration in emergency departments.
AHRQ-funded; HS024075.
Citation: Bui LN, Knox M, Miller-Rosales C .
Hospital capabilities associated with behavioral health integration within emergency departments.
Med Care 2024 Mar; 62(3):170-74. doi: 10.1097/mlr.0000000000001973.
Keywords: Behavioral Health, Emergency Department, Hospitals, Substance Abuse, Teams, Telehealth, Health Information Technology (HIT)
Wu J, Yuan CT, Moyal-Smith R
Electronic health record-supported implementation of an evidence-based pathway for perioperative surgical care.
This study examines the role of electronic health records (EHRs) in implementing enhanced recovery pathways (ERPs) for perioperative surgical care. Interviews with informaticians and clinicians from eight US hospitals revealed three thematic clusters: "EHR difficulties," "EHR enablers," and "EHR barriers." Researchers concluded that high performers and improvers successfully integrated ERPs into EHRs with dedicated multidisciplinary teams, while others faced challenges. Early involvement of informatics expertise benefited ERP implementation and sustainability.
AHRQ-funded; 2332015000201.
Citation: Wu J, Yuan CT, Moyal-Smith R .
Electronic health record-supported implementation of an evidence-based pathway for perioperative surgical care.
J Am Med Inform Assoc 2024 Feb 16; 31(3):591-99. doi: 10.1093/jamia/ocad237.
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Surgery, Evidence-Based Practice, Hospitals
Auerbach 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
Kalata S, Schaefer SL, Nuliyahu U
Low-volume elective surgery and outcomes in Medicare beneficiaries treated at hospital networks.
This cross-sectional study’s objective was to quantify low-volume surgery and associated outcomes within hospital networks. This study used Medicare Provider Analysis and Review data to examine fee-for-service beneficiaries aged 66 to 99 years who underwent 1 of 10 elective surgical procedures (abdominal aortic aneurysm repair, carotid endarterectomy, mitral valve repair, hip or knee replacement, bariatric surgery, or resection for lung, esophageal, pancreatic, or rectal cancers) in a network hospital from 2016 to 2018. Hospital volume for each procedure (calculated with the use of National Inpatient Sample data) was compared with yearly hospital volume standards for that procedure recommended by The Leapfrog Group. The authors analyzed primary outcomes which were postoperative complications, 30-day readmission, and 30-day mortality, stratified by the volume status of the hospital and network type. Secondary outcome was the availability of a different high-volume hospital within the same network or outside the network and its proximity to the patient (based on hospital referral region and zip code). In all, data were analyzed for 950,079 Medicare fee-for-service beneficiaries (average age 74.4 years; 621,138 females and 427,931 males) who underwent 1,049,069 procedures at 2469 hospitals within 382 networks. Of these networks, almost 100% [380 (99.5%)] had at least 1 low-volume hospital performing the elective procedure of interest. In 79.8% of procedures that were performed at low-volume hospitals, there was a hospital that met volume standards within the same network and hospital referral region located a median (IQR) distance of 29 (12-60) miles from the patient's home. In adjusted analyses, postoperative outcomes were inferior at low-volume hospitals compared with hospitals meeting volume standards, with a 30-day mortality of 8.1% at low-volume hospitals vs 5.5% at hospitals that met volume standards.
AHRQ-funded; HS028606.
Citation: Kalata S, Schaefer SL, Nuliyahu U .
Low-volume elective surgery and outcomes in Medicare beneficiaries treated at hospital networks.
JAMA Surg 2024 Feb; 159(2):203-10. doi: 10.1001/jamasurg.2023.6542.
Keywords: Surgery, Medicare, Hospitals, Outcomes
Nash KA, Weerahandi H, Yu H
Measuring equity in readmission as a distinct assessment of hospital performance.
This study examined the measure of equitable readmissions in hospitals as developed by the Centers for Medicare & Medicaid Services (CMS). Objectives were to define a measure of equitable readmissions; identify hospitals with equitable readmissions by insurance (dual eligible vs non-dual eligible) or patient race (Black vs White); and compare hospitals with and without equitable readmissions by hospital characteristics and performance on accountability measures (quality, cost, and value). The authors used data from a cross-section of hospitals who were eligible for the CMS Hospital-Wide Readmission measure using Medicare data from July 2018 through June 2019. Of 4638 hospitals, they found that 74% served a sufficient number of dual-eligible patients, and 42% served a sufficient number of Black patients to apply CMS Disparity Methods by insurance and race. Of these eligible hospitals, 17% had equitable readmission rates by insurance and 30% by race. Hospitals with equitable readmissions by insurance or race cared for a lower percentage of Black patients (insurance, 1.9% vs 3.3%, race, 7.6% vs 9.3%), and differed from nonequitable hospitals in multiple domains (teaching status, geography, size. In examining equity by insurance, hospitals with low costs were more likely to have equitable readmissions, and there was no relationship between quality and value, and equity. In examining equity by race, hospitals with high overall quality were more likely to have equitable readmissions, and there was no relationship between cost and value, and equity.
AHRQ-funded; HS022882.
Citation: Nash KA, Weerahandi H, Yu H .
Measuring equity in readmission as a distinct assessment of hospital performance.
JAMA 2024 Jan 9; 331(2):111-23. doi: 10.1001/jama.2023.24874..
Keywords: Hospital Readmissions, Hospitals, Provider Performance, Disparities
Wolf RM, Hall M, Williams DJ
Disparities in pharmacologic restraint for children hospitalized in mental health crisis.
This retrospective cohort study examined associations between pharmacologic restraint use and race and ethnicity among children (aged 5-≤18 years) admitted for mental health conditions to acute care nonpsychiatric children's hospitals. Study period was 2018 to 2022 and was conducted at 41 US children’s hospitals and included a cohort of 61,503 hospitalizations. Compared with non-Hispanic Black children, children of non-Hispanic White (adjusted odds ratio [aOR], 0.81), Asian (aOR, 0.82), or other race and ethnicity (aOR, 0.68) were less likely to receive pharmacologic restraint, with no significant difference with Hispanic children. When stratified by sex, racial/ethnic differences were magnified in males, except for Hispanic males, and not found in females. Sensitivity analysis revealed amplified disparities for all racial/ethnic groups, including Hispanic youth.
AHRQ-funded; HS026122.
Citation: Wolf RM, Hall M, Williams DJ .
Disparities in pharmacologic restraint for children hospitalized in mental health crisis.
Pediatrics 2024 Jan; 153(1). doi: 10.1542/peds.2023-061353..
Keywords: Disparities, Children/Adolescents, Behavioral Health, Inpatient Care, Hospitals, Medication
Ray M, Zhao S, Wang S
Improving hospital quality risk-adjustment models using interactions identified by hierarchical group lasso regularisation.
This study’s goal was to see if using hierarchical group lasso regularization (HGLR) improved hospital quality risk adjustment (RA) models. The authors analyzed patient discharge de-identified data from 14 State Inpatient Databases, AHRQ Healthcare Cost and Utilization Project, California Department of Health Care Access and Information, and New York State Department of Health. They used HGLR to identify first-order interactions in several AHRQ inpatient quality indicators (IQI) - IQI 09 (Pancreatic Resection Mortality Rate), IQI 11 (Abdominal Aortic Aneurysm Repair Mortality Rate), and Patient Safety Indicator 14 (Postoperative Wound Dehiscence Rate). These RA models were compared with stratum-specific and composite main effects models with covariates selected by least absolute shrinkage and selection operator (LASSO). HGLR identified clinical meaning interactions for all models, with model performance similar or superior for composite models with HGLR-selected features, compared to those with LASSO-selected features. HGLR was found to be scalable to handle a large number of covariates and their interactions and is customizable to use multiple CPU cores to reduce analysis time.
AHRQ-funded; 290201200003I.
Citation: Ray M, Zhao S, Wang S .
Improving hospital quality risk-adjustment models using interactions identified by hierarchical group lasso regularisation.
BMC Health Serv Res 2023 Dec 15; 23(1):1419. doi: 10.1186/s12913-023-10423-9..
Keywords: Quality of Care, Hospitals, Risk
Schnipper JL, Raffel KE, Keniston A
Achieving diagnostic excellence through prevention and teamwork (ADEPT) study protocol: a multicenter, prospective quality and safety program to improve diagnostic processes in medical inpatients.
This paper describes the protocol for a study that will build surveillance for hospital diagnostic errors into usual care, benchmark diagnostic performance across sites, pilot test interventions, and evaluate the program's impact on diagnostic error rates. The authors will test achieving diagnostic excellence through prevention and teamwork (ADEPT), a multicenter, real-world quality and safety program utilizing interrupted time-series techniques to evaluate outcomes. They will use a randomly sampled population of medical patients hospitalized at 16 US hospitals who died, were transferred to intensive care, or had a rapid response during the hospitalization. There will be surveillance for diagnostic errors on 10 events per month per site using a previously established two-person adjudication process. With guidance from national experts in quality and safety, study sites will report and benchmark diagnostic error rates, share lessons regarding underlying causes, and design, implement, and pilot test interventions using both Safety I and Safety II approaches aimed at patients, providers, and health systems. The primary outcome sought after will be the number of diagnostic errors per patient, using segmented multivariable regression to evaluate change in y-intercept and change in slope after initiation of the program.
AHRQ-funded; HS029366.
Citation: Schnipper JL, Raffel KE, Keniston A .
Achieving diagnostic excellence through prevention and teamwork (ADEPT) study protocol: a multicenter, prospective quality and safety program to improve diagnostic processes in medical inpatients.
J Hosp Med 2023 Dec; 18(12):1072-81. doi: 10.1002/jhm.13230..
Keywords: Diagnostic Safety and Quality, Patient Safety, Quality of Care, Hospitals, Inpatient Care
Mueller SK, Garabedian P, Goralnick E
Advancing health information during interhospital transfer: an interrupted time series.
The researchers report that health information exchange (HIE) during the interhospital transfer (IHT) of patients between acute care hospitals is subject to fragmented communication and unreliable access to clinical information. This proposed study will design, implement, and rigorously evaluate the implementation of a HIE platform to improve data access during IHT. The four-fold purposes of this study are to: 1) optimize clinician workflow, data visualization, and interoperability through user-centered design sessions for HIE platform development; 2) evaluate the impact of the intervention on clinician-reported medical errors among 500 pre- and 500 postintervention IHT patients using interrupted time series methodology; 3) evaluate intervention fidelity, use, and perceived usability of the platform, and barriers and facilitators of implementation from interprofessional stakeholder input, using mixed-methods evaluation; and 4) combine primary findings to develop a toolkit for spread and sustainability.
AHRQ-funded; HS028982.
Citation: Mueller SK, Garabedian P, Goralnick E .
Advancing health information during interhospital transfer: an interrupted time series.
J Hosp Med 2023 Dec; 18(12):1063-71. doi: 10.1002/jhm.13221..
Keywords: Health Information Exchange (HIE), Health Information Technology (HIT), Hospitals, Transitions of Care
Meille G, Decker SL, Owens PL
AHRQ Author: Meille G, Decker SL, Owens PL
COVID-19 admission rates and changes in US hospital inpatient and intensive care unit occupancy.
The objective of this cross-sectional study was to measure the relationship between COVID-19 admission rates and hospital occupancy in different US areas at different time periods during 2020. Data were taken from the HCUP State Inpatient Databases for patients in nonfederal acute care hospitals. The results showed that hospital occupancy decreased during weeks with low COVID-19 admissions and increased during weeks with high COVID-19 admissions; the largest changes occurred early in the pandemic. The authors concluded that their findings suggest that COVID-19 surges strained intensive care unit capacity and were associated with decreases in the number of surgical patients. These occupancy fluctuations may have affected quality of care and hospital finances.
AHRQ-authored.
Citation: Meille G, Decker SL, Owens PL .
COVID-19 admission rates and changes in US hospital inpatient and intensive care unit occupancy.
JAMA Health Forum 2023 Dec; 4(12):e234206. doi: 10.1001/jamahealthforum.2023.4206..
Keywords: COVID-19, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Hospitals
Danilack VA, Siegel-Reamer L, Lum L
From "disappointing" to "fantastic": women's experiences with labor induction in a U.S. tertiary hospital.
This study examined women’s expectations and experiences regarding labor induction. Labor induction patients were recruited in a US tertiary care hospital's postpartum mother-baby unit and invited to participate in semi-structured qualitative interviews. From April to September 2018, 26 women were interviewed about expectations and experiences of the labor induction process, side effects and health outcomes of concern, reflections on personal tolerance of different interventions, and thoughts about an ideal process. A wide range of experiences were described- with characterizations from horrible, frustrating, and terrifying to simple, fast and smooth. The Foley balloon catheter was the most polarizing induction method. Other concerns centered on the health of their baby, and an ideal induction involved fewer interventions.
AHRQ-funded; HS025013.
Citation: Danilack VA, Siegel-Reamer L, Lum L .
From "disappointing" to "fantastic": women's experiences with labor induction in a U.S. tertiary hospital.
Birth 2023 Dec; 50(4):959-67. doi: 10.1111/birt.12750..
Keywords: Women, Maternal Care, Hospitals, Patient Experience
Hasegawa S, Livorsi DJ, Perencevich EN S, Livorsi DJ, Perencevich EN
Diagnostic accuracy of hospital antibiograms in predicting the risk of antimicrobial resistance in enterobacteriaceae isolates: a nationwide multicenter evaluation at the Veterans Health Administration.
This study examined the effectiveness of an antibiogram to predict antimicrobial resistance (AMR) at the patient-level for Escherichia coli and Klebsiella spp. The authors retrospectively generated hospital antibiograms for the nationwide Veterans Health Administration (VHA) facilities from 2000 to 2019 using all clinical culture specimens positive for E. coli and Klebsiella spp., then assessed the diagnostic accuracy of an antibiogram to predict resistance for isolates in the following calendar year using logistic regression models and predefined 5-step interpretation thresholds. At 127 VHA facilities, the discrimination abilities of hospital-level antibiograms in predicting individual patient AMR were mostly poor, with the areas under the receiver operating curve at 0.686 and 0.715 for ceftriaxone, 0.637 and 0.675 for fluoroquinolones, and 0.576 and 0.624 for trimethoprim-sulfamethoxazole, respectively.
AHRQ-funded; HS027472.
Citation: Hasegawa S, Livorsi DJ, Perencevich EN S, Livorsi DJ, Perencevich EN .
Diagnostic accuracy of hospital antibiograms in predicting the risk of antimicrobial resistance in enterobacteriaceae isolates: a nationwide multicenter evaluation at the Veterans Health Administration.
Clin Infect Dis 2023 Nov 30; 77(11):1492-500. doi: 10.1093/cid/ciad467..
Keywords: Diagnostic Safety and Quality, Hospitals
Steiner MJ, Hall M, Sutton AG
Pediatric hospitalization trends at children's and general hospitals, 2000-2019.
The purpose of this study was to examine whether pediatric inpatient care has been redistributed from general hospitals into children’s hospitals (CHs). The researchers utilized the AHRQ Kids’ Inpatient Database (KID) to identify inpatient nonbirth discharges for children younger than 18 years from 2000 to 2019. The study included 14.758,391 discharges and found that annual inpatient discharges decreased by 26.5% from 2000 to 2019, while the percentage of total national discharges from CHs increased significantly, from 58.9% in 2000 to 81.8% in 2019. Discharges from freestanding CHs increased from 19.3% to 34.2%, those at non-freestanding CHs increased from 39.6% to 47.6%, and percentage of discharges from non-CHs decreased from 41.1%. An increase in inter-facility transfer (IFT) accompanied the changes in the distribution of pediatric discharges. In 2000, 6.1% of total discharges were transferred from one facility to another before discharge; in 2019, 18.8% experienced an IFT. Of children experiencing an IFT in 2019, 88.0% were transferred to a CH.
AHRQ-funded; HS028683.
Citation: Steiner MJ, Hall M, Sutton AG .
Pediatric hospitalization trends at children's and general hospitals, 2000-2019.
JAMA 2023 Nov 21; 330(19):1906-08. doi: 10.1001/jama.2023.19268..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Hospitals
Parikh K, Lopez MA, Hall M
Child Opportunity Index and rehospitalization for ambulatory care sensitive conditions at US children's hospitals.
Lower Child Opportunity Index (COI) has been related with increased health care use, but the relationship with rehospitalization(s) for ambulatory care sensitive conditions (ACSC) is not known. The purpose of this multicenter retrospective cohort study was to determine the relationship between COI and ACSC rehospitalizations. 184,478 children ages 0 to 17 years with a hospital admission for ambulatory care sensitive conditions in 2017 or 2018 were included. Exposure was COI, and the primary outcome was rehospitalization within 1 year of index admission for ACSC. Of hospitalizations, 28.3% were by children from very low COI and 16.5% were by children from very high COI neighborhoods. In risk-adjusted models, ACSC rehospitalization was higher for children from very low COI than very high COI neighborhoods; any rehospitalization occurred for 18.7% from very low COI and 13.5% from very high COI neighborhoods whereas 2 or more rehospitalization occurred for 4.8% from very low COI and 3.2% from very high COI neighborhoods.
AHRQ-funded; HS024554; HS028484; HS026385.
Citation: Parikh K, Lopez MA, Hall M .
Child Opportunity Index and rehospitalization for ambulatory care sensitive conditions at US children's hospitals.
Hosp Pediatr 2023 Nov; 13(11):1028-37. doi: 10.1542/hpeds.2023-007279..
Keywords: Children/Adolescents, Hospital Readmissions, Hospitals, Ambulatory Care and Surgery
O'Leary KJ, Johnson JK, Williams MV
Effect of complementary interventions to redesign care on teamwork and quality for hospitalized medical patients: a pragmatic controlled trial.
The objective of this pragmatic controlled trial was to evaluate the effect of interventions to redesign hospital care delivery on teamwork and patient outcomes. Survey participants were healthcare professionals and hospitalized medical patients in medical units at four U.S. hospitals. The results showed that the median teamwork climate score was higher after the intervention among nurses, but that interventions to redesign care for hospitalized patients were not associated with improved patient outcomes.
AHRQ-funded; HS02564.
Citation: O'Leary KJ, Johnson JK, Williams MV .
Effect of complementary interventions to redesign care on teamwork and quality for hospitalized medical patients: a pragmatic controlled trial.
Ann Intern Med 2023 Nov; 176(11):1456-64. doi: 10.7326/m23-0953..
Keywords: Teams, Inpatient Care, Hospitals, Quality of Care, Outcomes
Luo BT, Barton HJ, Wooldridge AR
Human factors engineering for the pediatric hospitalist.
The authors summarized how human factors engineering (HFE) can provide a framework and tools to help understand and improve complex care processes and resulting outcomes. They offered examples of HFE's application to pediatric hospital medicine, highlighted an HFE-based framework, provided tools for leveraging this model, and listed resources for those interested in learning more about HFE.
AHRQ-funded; HS027214.
Citation: Luo BT, Barton HJ, Wooldridge AR .
Human factors engineering for the pediatric hospitalist.
Hosp Pediatr 2023 Nov; 13(11):e365-e70. doi: 10.1542/hpeds.2023-007258..
Keywords: Children/Adolescents, Hospitals, Provider: Clinician
Henke RM, Fingar KR, Liang L
AHRQ Author: Liang L, Jiang HJ
Medicare Advantage in rural areas: implications for hospital sustainability.
This study examined the association between Medicare Advantage penetration levels in rural areas and hospital financial distress and closure. This retrospective study followed rural general acute hospitals open from 2008-2019 or until closure using HCUP State Inpatient Databases for 14 states. Medicare Advantage penetration at rural hospitals grew from 6.5% in 2008 to 20.6% in 2019. A 1-percentage point increase in hospital penetration was associated with an increase in financial stability of 0.04 units on the Altman Z score and a 4% reduction in risk of closure (HR, 0.96).
AHRQ-authored; AHRQ-funded; 290201800005C.
Citation: Henke RM, Fingar KR, Liang L .
Medicare Advantage in rural areas: implications for hospital sustainability.
Am J Manag Care 2023 Nov; 29(11):594-600. doi: 10.37765/ajmc.2023.89455..
Keywords: Medicare, Rural Health, Rural/Inner-City Residents, Hospitals
McLoone M, McNamara M, Jennings MA
Observing sources of system resilience using in situ alarm simulations.
The authors conducted in situ simulations of a hypoxemic-event alarm in medical/surgical and intensive care units at a tertiary care pediatric hospital to identify sources of resilience in alarm systems. They collected data on response timing, made observations of the environment, and conducted postsimulation debrief interviews. Four primary means of successful alarm responses were mapped to domains of the Systems Engineering Initiative for Patient Safety framework to guide future alarm system design and improvement.
AHRQ-funded; HS026620; HS028682.
Citation: McLoone M, McNamara M, Jennings MA .
Observing sources of system resilience using in situ alarm simulations.
J Hosp Med 2023 Nov; 18(11):994-98. doi: 10.1002/jhm.13217..
Keywords: Patient Safety, Hospitals
Chen VW, Chidi AP, Dong Y
Risk-adjusted cumulative sum for early detection of hospitals with excess perioperative mortality.
This study’s goal was to compare the risk-adjusted cumulative sum (CUSUM) with episodic evaluation for early detection of hospitals with excess perioperative mortality. The study cohort included 697,566 patients treated at 104 Veterans’ Affairs hospitals across 24 quarters with a mean age of 60.9 years and 91.4% male. These patients underwent a noncardiac operation at a Veterans Affairs hospital, had a record in the Veterans Affairs Surgical Quality Improvement Program (January 1, 2011, through December 31, 2016), and were aged 18 years or older. For each hospital, the median number of quarters detected with observed to expected ratios, at least 1 CUSUM signal, and more than 1 CUSUM signal was 2 quarters (IQR, 1-4 quarters), 8 quarters (IQR, 4-11 quarters), and 3 quarters (IQR, 1-4 quarters). Outlier hospitals were identified 33.3% of the time (830 quarters) with at least 1 CUSUM signal within a quarter, 12.5% (311 quarters) with more than 1 CUSUM signal, and 11.0% (274 quarters) with observed to expected ratios at the end of the quarter. The CUSUM detection occurred a median of 49 days (IQR, 25-63 days) before observed to expected ratio reporting (1 signal, 35 days [IQR, 17-54 days]; 2 signals, 49 days [IQR, 26-61 days]; 3 signals, 58 days [IQR, 44-69 days]; ≥4 signals, 49 days [IQR, 42-69 days]. Of 274 hospital quarters detected with observed to expected ratios, 72.6% were concurrently detected by at least 1 CUSUM signal vs 42.7% by more than 1 CUSUM signal. There was a dose-response relationship between the number of CUSUM signals in a quarter and the median observed to expected ratio (0 signals, 0.63; 1 signal, 1.28; 2 signals, 1.58; 3 signals, 2.08; ≥4 signals, 2.49).
AHRQ-funded; HS013853.
Citation: Chen VW, Chidi AP, Dong Y .
Risk-adjusted cumulative sum for early detection of hospitals with excess perioperative mortality.
JAMA Surg 2023 Nov; 158(11):1176-83. doi: 10.1001/jamasurg.2023.3673..
Keywords: Quality Improvement, Surgery, Hospitals, Patient Safety, Mortality, Quality of Care
Thom KA, Rock C, Robinson GL
Direct gloving vs hand hygiene before donning gloves in adherence to hospital infection control practices: a cluster randomized clinical trial.
The purpose of this study was to assess the effectiveness of a direct-gloving policy on adherence to infection prevention control practices in a hospital setting. In this study, hospital units were randomly assigned to either the intervention (hand hygiene not required before putting on gloves) or to usual care (hand hygiene required prior to before putting on nonsterile gloves). The primary study outcome was adherence to the expected practice upon room entry and room exit. Thirteen hospital units participated in the trial, and 3,790 health care personnel (HCP) were observed. The study found that adherence to expected practice was higher in the 6 units with the direct-gloving intervention than in the 7 usual care units even when controlling for baseline hand hygiene rates, unit type, and universal gloving policies. The intervention had no effect on hand hygiene adherence measured at entry to non-contact precautions rooms or at room exit. The intervention was related with increased total bacteria colony counts and increased detection of pathogenic bacteria on gloves in the ED and reduced colony counts in pediatrics units, with no change in either total colony count for adult intensive care unit or presence of pathogenic bacteria for adult intensive care unit.
AHRQ-funded; HS024108.
Citation: Thom KA, Rock C, Robinson GL .
Direct gloving vs hand hygiene before donning gloves in adherence to hospital infection control practices: a cluster randomized clinical trial.
JAMA Netw Open 2023 Oct 2; 6(10):e2336758. doi: 10.1001/jamanetworkopen.2023.36758..
Keywords: Hospitals, Patient Safety, Guidelines, Healthcare-Associated Infections (HAIs)
Mullens CL, Lussiez A, Scott JW
Association of health professional shortage area hospital designation with surgical outcomes and expenditures among Medicare beneficiaries.
This study’s objective was to compare surgical outcomes and expenditures at hospitals located in Health Professional Shortage Areas to nonshortage area designated hospitals among Medicare beneficiaries. This cross-sectional retrospective study used data from 842,787 Medicare beneficiary patient admissions to hospitals with and without Health Professional Shortage Area designations for common operations including appendectomy, cholecystectomy, colectomy, and hernia repair from 2014 to 2018. Primary outcomes measures were 30-day mortality, hospital readmissions, and 30-day surgical episode payments. Patients (mean age=75.6 years, males=44.4%) undergoing common surgical procedures in shortage area hospitals were less likely to be White (84.6% vs 88.4%) and less likely to have≥2 Elixhauser comorbidities (75.5% vs 78.2%). Patients undergoing surgery at Health Professional Shortage Area hospitals had lower risk-adjusted rates of 30-day mortality (6.05% vs 6.69%) and readmission (14.99% vs 15.74%). Medicare expenditures at Health Professional Shortage Area hospitals were also lower than nonshortage designated hospitals ($28,517 vs $29,685).
AHRQ-funded; HS028606; HS028672.
Citation: Mullens CL, Lussiez A, Scott JW .
Association of health professional shortage area hospital designation with surgical outcomes and expenditures among Medicare beneficiaries.
Ann Surg 2023 Oct 1; 278(4):e733-e39. doi: 10.1097/sla.0000000000005762..
Keywords: Hospitals, Surgery, Medicare, Healthcare Costs, Workforce, Outcomes
Gupta AB, Greene MT, Fowler KE
Associations between hospitalist shift busyness, diagnostic confidence, and resource utilization: a pilot study.
Hospitalists are frequently attending to multiple tasks when overseeing patient care, and patients are at risk for diagnostic errors. The purpose of this single-center, prospective, pilot observational study was to measure hospitalist workload and examine its influences on diagnostic performance in a real-world clinical setting. The researchers had hospitalists admitting new patients to the hospital complete an abbreviated Mindful Attention Awareness Tool and a survey on diagnostic confidence upon shift completion. Complete data were available for 37 unique hospitalists who admitted 160 unique patients. The study found that increases in admissions and pages were related with higher odds of hospitalists reporting it was "difficult to focus on what is happening in the present." Increased pages was associated with a decrease in the number of differential diagnoses listed.
AHRQ-funded; HS024385; HS025891.
Citation: Gupta AB, Greene MT, Fowler KE .
Associations between hospitalist shift busyness, diagnostic confidence, and resource utilization: a pilot study.
J Patient Saf 2023 Oct 1; 19(7):447-52. doi: 10.1097/pts.0000000000001157..
Keywords: Hospitals, Diagnostic Safety and Quality, Patient Safety