National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 57 Research Studies DisplayedAuerbach AD, Lee TM, Hubbard CC
Diagnostic errors in hospitalized adults who died or were transferred to intensive care.
The objective of this retrospective cohort study was to determine the prevalence, underlying causes, and harms of diagnostic errors in hospitalized adults who were transferred to an intensive care unit or who died. Data was taken from 29 academic medical centers in the U.S. in a random sample of adults hospitalized with general medical conditions. Errors were found to have contributed to temporary harm, permanent harm, or death in nearly 18% of patients; among patients who died, diagnostic error was judged to have contributed to death in 6.6% of cases. The researchers noted that problems with choosing and interpreting tests and the processes involved with clinician assessment were a high priority for improvement efforts.
AHRQ-funded; HS027369.
Citation: Auerbach AD, Lee TM, Hubbard CC .
Diagnostic errors in hospitalized adults who died or were transferred to intensive care.
JAMA Intern Med 2024 Feb; 184(2):164-73. doi: 10.1001/jamainternmed.2023.7347..
Keywords: Diagnostic Safety and Quality, Medical Errors, Hospitals, Inpatient Care, Quality of Care, Patient Safety, Adverse Events
Dalal AK, Schnipper JL, Raffel K
Identifying and classifying diagnostic errors in acute care across hospitals: early lessons from the Utility of Predictive Systems in Diagnostic Errors (UPSIDE) study.
This paper describes the Utility of Predictive Systems in Diagnostic Errors (UPSIDE) study, whose aim was to define the prevalence and underlying causes of diagnostic errors (DEs) in patients who die in the hospital or are transferred to the intensive care unit (ICU) after the first 48 hours. This study was conducted at 31 hospitals with more than 2500 cases reviewed using electronic health records. The authors identified some insights into key requirements into building a robust DE surveillance program by developing these steps: 1) Develop a shared understanding of what constitutes a diagnostic error; 2) Use validated tools to identify diagnostic errors and classify process failures, but respect your context; 3) Develop a standard approach to using electronic health records for case reviews; 4) Ensure reliability and consistency of the case review process; and 5) Link diagnostic error case reviews to institutional safety programs. They also developed steps to establish a diagnosis error review process at the hospital level with six processes.
AHRQ-funded; HS027369; HS026613.
Citation: Dalal AK, Schnipper JL, Raffel K .
Identifying and classifying diagnostic errors in acute care across hospitals: early lessons from the Utility of Predictive Systems in Diagnostic Errors (UPSIDE) study.
J Hosp Med 2024 Feb; 19(2):140-45. doi: 10.1002/jhm.13136..
Keywords: Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety, Quality of Care, Hospitals
Ali KJ, Goeschel CA, Eckroade MM
The TeamSTEPPS for improving diagnosis team assessment tool: scale development and psychometric evaluation.
The authors developed and evaluated the TeamSTEPPS Improving Diagnosis Team Assessment Tool (TAT), which assesses diagnostic teamwork and communication in five critical domains. The TAT was administered as a cross-sectional survey to health professionals in nine diverse US health systems. A psychometric evaluation demonstrated that the TAT was a reliable and valid instrument for assessing teamwork and communication among and across diagnostic teams. The authors concluded that TAT added a novel, evidence-based measurement tool.
AHRQ-funded; 233201500022I.
Citation: Ali KJ, Goeschel CA, Eckroade MM .
The TeamSTEPPS for improving diagnosis team assessment tool: scale development and psychometric evaluation.
Jt Comm J Qual Patient Saf 2024 Feb; 50(2):95-103. doi: 10.1016/j.jcjq.2023.08.009..
Keywords: Diagnostic Safety and Quality, Teams, TeamSTEPPS
Gyftopoulos S, Simon E, Swartz JL
Efficacy and impact of a multimodal intervention on CT pulmonary angiography ordering behavior in the emergency department.
The objective of this study was to evaluate the efficacy of a multimodal intervention to reduce overutilization of computed tomography pulmonary angiography (CTPA) for suspected pulmonary embolism in the emergency department. Results indicated that guideline concordance increased significantly after intervention. The authors concluded that their success in increasing guideline concordance demonstrated the efficacy of a mixed-methods, human-centered approach to behavior change; however, given that neither of the secondary outcomes improved, the results may demonstrate potential limitations to the guidelines directing the ordering of CTPA studies.
AHRQ-funded; HS024376.
Citation: Gyftopoulos S, Simon E, Swartz JL .
Efficacy and impact of a multimodal intervention on CT pulmonary angiography ordering behavior in the emergency department.
J Am Coll Radiol 2024 Feb; 21(2):309-18. doi: 10.1016/j.jacr.2023.02.033.
Keywords: Emergency Department, Respiratory Conditions, Imaging, Diagnostic Safety and Quality, Blood Clots
Ali KJ, Goeschel CA, DeLia DM
The PRIDx framework to engage payers in reducing diagnostic errors in healthcare.
The authors conducted a literature review and interviewed subject matter experts to develop a multi-component Payer Relationships for Improving Diagnoses (PRIDx) framework. The PRIDx framework can be used to encourage public and private payers to take specific actions to improve diagnostic safety. The authors noted that implementation of the PRIDx framework will require new types of partnerships, including external support from public and private payer organizations, and also require the creation of strong provider incentives.
AHRQ-funded; 2332015000221.
Citation: Ali KJ, Goeschel CA, DeLia DM .
The PRIDx framework to engage payers in reducing diagnostic errors in healthcare.
https://www.pubmed.ncbi.nlm.nih.gov/37795579.
Keywords: Diagnostic Safety and Quality, Quality of Care, Patient Safety
Liu SK, Bourgeois F, Dong J
What's going well: a qualitative analysis of positive patient and family feedback in the context of the diagnostic process.
This paper evaluated positive patient/family feedback to generate broader perspectives on what constitutes a "good" diagnostic process (DxP). Eligible participants included patients/families living with chronic conditions with visits in three urban pediatric subspecialty clinics (site 1) and one rural adult primary care clinic (site 2) who were then invited to complete a survey between December 2020 and March 2020. The authors adapted the Healthcare Complaints Analysis Tool (HCAT) to conduct a qualitative analysis on a subset of patient/family responses with ≥20 words. A total of 7,075 surveys were completed before 18,129 visits (39 %) at site 1, and 460 surveys were completed prior to 706 (65 %) visits at site 2. Positive feedback was provided by 1,578 participants, ranging from 1-79 words. Categories of 272 comments with ≥20 words described: Relationships (60 %), Clinical Care (36 %), and Environment (4 %). In the Relationships category patients/families most commonly noted: thorough and competent attention (46 %), clear communication and listening (41 %) and emotional support and human connection (39 %). For Clinical Care, patients highlighted: timeliness (31 %), effective clinical management (30 %), and coordination of care (25 %).
AHRQ-funded; HS027367.
Citation: Liu SK, Bourgeois F, Dong J .
What's going well: a qualitative analysis of positive patient and family feedback in the context of the diagnostic process.
Diagnosis 2024 Feb 1; 11(1):63-72. doi: 10.1515/dx-2023-0075.
Keywords: Diagnostic Safety and Quality, Clinician-Patient Communication, Communication, Patient and Family Engagement
Newman-Toker DE, Nassery N, Schaffer AC
Burden of serious harms from diagnostic error in the USA.
Americans who experience serious harm from misdiagnosis annually. Serious harm is defined as permanent morbidity or morality. This cross-sectional analysis used nationally representative observational data. The authors estimated annual incident vascular events and infections from 21.5 million (M) sampled US hospital discharges (2012-2014). US-based cancer registries were used to find annual new cancers. They derived diagnostic errors and serious harms by multiplying by literature-based rates for disease-specific incidences for 15 major vascular events, infections and cancers ('Big Three' categories). Extrapolating to all diseases (including non-'Big Three' dangerous disease categories), they estimated total serious harms annually in the USA to be 795,000 (plausible range 598,000-1,023,000). Using more conservative assumptions they estimated 549,000 serious harms. These results were compatible with setting-specific serious harm estimates from inpatient, emergency department and ambulatory care. Fifteen dangerous diseases accounted for 50.7% of total serious harms and the top 5 (stroke, sepsis, pneumonia, venous thromboembolism and lung cancer) accounted for 38.7%.
AHRQ-funded; HS027614; HS029350.
Citation: Newman-Toker DE, Nassery N, Schaffer AC .
Burden of serious harms from diagnostic error in the USA.
BMJ Qual Saf 2024 Jan 19; 33(2):109-20. doi: 10.1136/bmjqs-2021-014130..
Keywords: Healthcare Cost and Utilization Project (HCUP), Diagnostic Safety and Quality, Medical Errors, Patient Safety, Quality of Care, Adverse Events
Ma X, Chen Y, Cole SR
A hybrid Bayesian hierarchical model combining cohort and case-control studies for meta-analysis of diagnostic tests: accounting for partial verification bias.
In this paper, the authors proposed a novel hybrid Bayesian hierarchical model combining cohort and case-control studies while simultaneously correcting partial verification bias. They presented two case studies on assessing the diagnostic accuracy of gadolinium-enhanced magnetic resonance imaging in detecting lymph node metastases and of adrenal fluorine-18 fluorodeoxyglucose positron emission tomography in characterizing adrenal masses.
AHRQ-funded; HS022900.
Citation: Ma X, Chen Y, Cole SR .
A hybrid Bayesian hierarchical model combining cohort and case-control studies for meta-analysis of diagnostic tests: accounting for partial verification bias.
Stat Methods Med Res 2016 Dec;25(6):3015-37. doi: 10.1177/0962280214536703.
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Keywords: Cancer, Diagnostic Safety and Quality, Imaging, Research Methodologies
Kannampallil T, Galanter WL, Falck S
Characterizing the pain score trajectories of hospitalized adult medical and surgical patients: a retrospective cohort study.
The authors described a 1-year, retrospective, observational study to characterize pain trajectories of hospitalized adults during the first 48 hours after admission at an urban academic medical center. They found that trajectories showed differences based on race, gender, service, and initial pain score, with patients presumed to have dissimilar pain experiences having markedly different pain trajectories. Pain reduction 48 hours after admission was approximately 50% of the initial pain, while most patients' pain failed to fully resolve.
AHRQ-funded; HS021093.
Citation: Kannampallil T, Galanter WL, Falck S .
Characterizing the pain score trajectories of hospitalized adult medical and surgical patients: a retrospective cohort study.
Pain 2016 Dec;157(12):2739-46. doi: 10.1097/j.pain.0000000000000693.
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Keywords: Diagnostic Safety and Quality, Hospitalization, Pain
Sulzer SH, Muenchow E, Potvin A
Improving patient-centered communication of the borderline personality disorder diagnosis.
This study aimed to understand how clinicians communicate the diagnosis of borderline personality disorder (BPD) with patients, and compare these practices with patient communication preferences. It found that the majority of clinicians sampled did not actively share the BPD diagnosis with their patients, while the majority of patients wanted to be told that they had the disorder, as well as have their providers discuss the stigma they would face.
AHRQ-funded; HS000032.
Citation: Sulzer SH, Muenchow E, Potvin A .
Improving patient-centered communication of the borderline personality disorder diagnosis.
J Ment Health 2016;25(1):5-9. doi: 10.3109/09638237.2015.1022253.
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Keywords: Communication, Diagnostic Safety and Quality, Behavioral Health, Clinician-Patient Communication, Social Stigma
Thomas GW, Rojas-Murillo S, Hanley JM
Skill assessment in the interpretation of 3D fracture patterns from radiographs.
The researchers determined if 3D radiographic image interpretation can be reliably assessed, and whether this assessment varies by level of training. They concluded that the interpretation of radiographs to discern 3D information is a promising and a relatively unexplored area for surgical skill education and assessment.
AHRQ-funded; HS022077.
Citation: Thomas GW, Rojas-Murillo S, Hanley JM .
Skill assessment in the interpretation of 3D fracture patterns from radiographs.
Iowa Orthop J 2016;36:1-6.
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Keywords: Diagnostic Safety and Quality, Education: Continuing Medical Education, Injuries and Wounds, Imaging, Training
Brody AM, Sharma VK, Singh A
Barriers to emergency physician diagnosis and treatment of uncontrolled chronic hypertension.
This study surveyed a national sample of emergency physicians on their perceived barriers in establishing an ED diagnosis of asymptomatic hypertension (HTN) and ED treatment of such patients. It found that the most common barriers to diagnosis of HTN were uncertainty regarding the validity of ED blood pressure measurements (92 percent)and reluctance to diagnose a condition which cannot be comprehensively managed in the ED setting (29 percent).
AHRQ-funded; HS000011.
Citation: Brody AM, Sharma VK, Singh A .
Barriers to emergency physician diagnosis and treatment of uncontrolled chronic hypertension.
Am J Emerg Med 2016 Nov;34(11):2241-42. doi: 10.1016/j.ajem.2016.08.050.
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Keywords: Blood Pressure, Emergency Department, Diagnostic Safety and Quality, Chronic Conditions
Thomson J, Hall M, Berry JG
Diagnostic testing and hospital outcomes of children with neurologic impairment and bacterial pneumonia.
This study assessed hospital-level variability in diagnostic testing and outcomes for children with neurologic impairment hospitalized with pneumonia. For children with neurologic impairment hospitalized with pneumonia, across hospital differences in diagnostic testing were not associated with clinically meaningful differences in outcomes. High-utilizing hospitals may be able to decrease diagnostic testing for children with neurologic impairment hospitalized with pneumonia without adversely impacting outcomes.
AHRQ-funded; HS023092.
Citation: Thomson J, Hall M, Berry JG .
Diagnostic testing and hospital outcomes of children with neurologic impairment and bacterial pneumonia.
J Pediatr 2016 Nov;178:156-63.e1. doi: 10.1016/j.jpeds.2016.07.024.
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Keywords: Children/Adolescents, Diagnostic Safety and Quality, Outcomes, Hospitalization
Elmore JG, Cook AJ, Bogart A
Radiologists' interpretive skills in screening vs. diagnostic mammography: are they related?
This study aimed to determine whether radiologists who perform well in screening also perform well in interpreting diagnostic mammography. It evaluated the accuracy of 468 radiologists interpreting 2,234,947 screening and 196,164 diagnostic mammograms and found a moderate correlation for radiologists' accuracy when interpreting screening versus their accuracy on diagnostic examinations.
AHRQ-funded; HS010591.
Citation: Elmore JG, Cook AJ, Bogart A .
Radiologists' interpretive skills in screening vs. diagnostic mammography: are they related?
Clin Imaging 2016 Nov - Dec;40(6):1096-103. doi: 10.1016/j.clinimag.2016.06.014.
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Keywords: Cancer: Breast Cancer, Diagnostic Safety and Quality, Screening, Imaging, Women, Provider Performance
Singh H, Zwaan L
Annals for hospitalists inpatient notes - Reducing diagnostic error-a new horizon of opportunities for hospital medicine.
The authors argue that given the importance of diagnoses in the hospital, hospitalists are well-positioned to lead efforts to promote correct and timely diagnosis. However, to reduce harms from diagnostic errors, hospitalists must first understand how these errors occur and then develop practical strategies to avoid them.
AHRQ-funded; HS022087; HS023602.
Citation: Singh H, Zwaan L .
Annals for hospitalists inpatient notes - Reducing diagnostic error-a new horizon of opportunities for hospital medicine.
Ann Intern Med 2016 Oct 18;165(8):HO2-HO4. doi: 10.7326/m16-2042.
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Keywords: Medical Errors, Diagnostic Safety and Quality, Patient Safety, Health Information Technology (HIT), Inpatient Care
Kantor R, Thyssen JP, Paller AS
Atopic dermatitis, atopic eczema, or eczema? A systematic review, meta-analysis, and recommendation for uniform use of 'atopic dermatitis'.
The authors sought to determine the most commonly-used terms for atopic dermatitis. They found that atopic dermatitis was the most commonly-used term in studies across almost all publication types, languages, and journals and appears to be increasing in popularity. They concluded by suggesting the use of the term atopic dermatitis in publications, healthcare clinician training, and patient education.
AHRQ-funded; HS023011.
Citation: Kantor R, Thyssen JP, Paller AS .
Atopic dermatitis, atopic eczema, or eczema? A systematic review, meta-analysis, and recommendation for uniform use of 'atopic dermatitis'.
Allergy 2016 Oct;71(10):1480-5. doi: 10.1111/all.12982.
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Keywords: Education: Patient and Caregiver, Diagnostic Safety and Quality, Patient-Centered Healthcare, Clinician-Patient Communication, Skin Conditions
Carmody D, Naylor RN, Bell CD
GCK-MODY in the US National Monogenic Diabetes Registry: frequently misdiagnosed and unnecessarily treated.
GCK-MODY (diabetes caused by mutations in the glucokinase (GCK) gene) leads to mildly elevated blood glucose typically not requiring therapy. It has been described in all ethnicities, but mainly in Caucasian Europeans. The researchers describe our US cohort of GCK-MODY. Their data show that a high detection rate of GCK-MODY is possible based on clinical phenotype and that prior to genetic diagnosis, a large percentage are inappropriately treated with glucose-lowering therapies.
AHRQ-funded; HS023007.
Citation: Carmody D, Naylor RN, Bell CD .
GCK-MODY in the US National Monogenic Diabetes Registry: frequently misdiagnosed and unnecessarily treated.
Acta Diabetol 2016 Oct;53(5):703-8. doi: 10.1007/s00592-016-0859-8.
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Keywords: Diabetes, Registries, Diagnostic Safety and Quality, Genetics
Kopylov U, Boucher G, Waterman M
Genetic predictors of benign course of ulcerative colitis - a North American inflammatory bowel disease genetics consortium study.
The aim of this project was to identify the genetic predictors of benign ulcerative colitis (UC) phenotype. No single-nucleotide polymorphisms from inflammatory bowel disease susceptibility loci were found to be associated with a benign UC disease course. These findings suggested on the exploratory analysis merit extension to larger discovery cohorts.
AHRQ-funded; HS021747.
Citation: Kopylov U, Boucher G, Waterman M .
Genetic predictors of benign course of ulcerative colitis - a North American inflammatory bowel disease genetics consortium study.
Inflamm Bowel Dis 2016 Oct;22(10):2311-6. doi: 10.1097/mib.0000000000000913.
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Keywords: Diabetes, Diagnostic Safety and Quality, Genetics
Olfson M, Blanco C, Marcus SC
Treatment of adult depression in the United States.
The researchers characterized the treatment of adult depression in the United States. They concluded that most US adults who screen positive for depression did not receive treatment for depression, whereas most who were treated did not screen positive. In light of these findings, it is important to strengthen efforts to align depression care with each patient's clinical needs.
AHRQ-funded; HS02112.
Citation: Olfson M, Blanco C, Marcus SC .
Treatment of adult depression in the United States.
JAMA Intern Med 2016 Oct;176(10):1482-91. doi: 10.1001/jamainternmed.2016.5057.
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Keywords: Medication, Depression, Diagnostic Safety and Quality, Medical Expenditure Panel Survey (MEPS)
Murphy DR, Meyer AN, Bhise V
Computerized triggers of big data to detect delays in follow-up of chest imaging results.
A "trigger" algorithm was used to identify delays in follow-up of abnormal chest imaging results in a large national clinical data warehouse of electronic health record (EHR) data. In this study, the authors applied a trigger in a repository hosting EHR data from all Department of Veterans Affairs health-care facilities and analyzed data from seven facilities. The investigators concluded that application of triggers on "big" EHR data may aid in identifying patients experiencing delays in diagnostic evaluation of chest imaging results suspicious for malignancy.
Citation: Murphy DR, Meyer AN, Bhise V .
Computerized triggers of big data to detect delays in follow-up of chest imaging results.
Chest 2016 Sep;150(3):613-20. doi: 10.1016/j.chest.2016.05.001..
Keywords: Imaging, Electronic Health Records (EHRs), Health Information Technology (HIT), Data, Diagnostic Safety and Quality, Cancer
Sjoding MW, Cooke CR, Iwashyna TJ
Acute respiratory distress syndrome measurement error. Potential effect on clinical study results.
This study investigated how the degree of variability in acute respiratory distress syndrome (ARDS) measurement commonly reported in clinical studies affects study power, the accuracy of treatment effect estimates, and the measured strength of risk factor associations. It found that lower reliability measurement of ARDS during patient enrollment in randomized controlled trials seriously degraded study power and effect size estimates of clinical studies.
AHRQ-funded; HS020672.
Citation: Sjoding MW, Cooke CR, Iwashyna TJ .
Acute respiratory distress syndrome measurement error. Potential effect on clinical study results.
Ann Am Thorac Soc 2016 Jul;13(7):1123-8. doi: 10.1513/AnnalsATS.201601-072OC.
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Keywords: Diagnostic Safety and Quality, Research Methodologies, Respiratory Conditions
Wang SY, Hsu SH, Gross CP
Association between time since cancer diagnosis and health-related quality of life: a population-level analysis.
The purpose of this paper is to examine the association between time since cancer diagnosis and health-related quality of life (HRQOL) among cancer survivors in remission. The researchers found that most cancer survivors did not experience poorer mental health, but that survivors of prostate or cervical cancer had lower mental component summary scores after 10 years of diagnosis. They concluded that the level of HRQOL among cancer survivors depends on time since cancer diagnosis and cancer type.
AHRQ-funded; HS023900.
Citation: Wang SY, Hsu SH, Gross CP .
Association between time since cancer diagnosis and health-related quality of life: a population-level analysis.
Value Health 2016 Jul-Aug;19(5):631-8. doi: 10.1016/j.jval.2016.02.010.
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Keywords: Cancer, Diagnostic Safety and Quality, Health Status, Patient-Centered Outcomes Research, Quality of Life
Meyer AN, Murphy DR, Singh H
Communicating findings of delayed diagnostic evaluation to primary care providers.
In this study, researchers examined the effectiveness of various communication strategies to inform primary care practitioners (PCPs) about the delayed follow-up of cancer-related abnormal or "red-flag" findings. They found that strategies (emails, phone calls, contacting clinic directors) to communicate to PCPs information on delayed follow-up of findings suspicious for cancer were useful, but not fail-safe.
AHRQ-funded; HS022901.
Citation: Meyer AN, Murphy DR, Singh H .
Communicating findings of delayed diagnostic evaluation to primary care providers.
J Am Board Fam Med 2016 Jul-Aug;29(4):469-73. doi: 10.3122/jabfm.2016.04.150363.
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Keywords: Cancer, Communication, Diagnostic Safety and Quality, Primary Care
Wiseman JT, Fernandes-Taylor S, Gunter R
Inter-rater agreement and checklist validation for postoperative wound assessment using smartphone images in vascular surgery.
The authors evaluated whether smartphone digital images can supplant in-person evaluation of postoperative vascular surgery wounds. They concluded that using smartphone digital images is a valid method for evaluating postoperative vascular surgery wounds and is comparable to in-person evaluation with regard to most wound characteristics. The inter-rater reliability for determining treatment recommendations was universally high.
AHRQ-funded; HS023395.
Citation: Wiseman JT, Fernandes-Taylor S, Gunter R .
Inter-rater agreement and checklist validation for postoperative wound assessment using smartphone images in vascular surgery.
J Vasc Surg Venous Lymphat Disord 2016 Jul;4(3):320-28.e2. doi: 10.1016/j.jvsv.2016.02.001.
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Keywords: Healthcare-Associated Infections (HAIs), Injuries and Wounds, Telehealth, Surgery, Health Information Technology (HIT), Diagnostic Safety and Quality
Sjoding MW, Prescott HC, Wunsch H
Longitudinal changes in ICU admissions among elderly patients in the United States.
The researchers sought to describe the changing demographics, diagnoses, and outcomes of patients admitted to critical care units in the U.S. hospitals. They ound that patients with infectious diseases increased from 8.8 percent to 17.2 percent of admissions, and explicitly labeled sepsis moved from the 11th-ranked diagnosis in 1996 to the top-ranked primary discharge diagnosis in 2010.
AHRQ-funded; HS020672.
Citation: Sjoding MW, Prescott HC, Wunsch H .
Longitudinal changes in ICU admissions among elderly patients in the United States.
Crit Care Med 2016 Jul;44(7):1353-60. doi: 10.1097/ccm.0000000000001664.
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Keywords: Elderly, Intensive Care Unit (ICU), Hospitalization, Diagnostic Safety and Quality, Critical Care