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
276 to 300 of 323 Research Studies DisplayedToth M, Holmes M, Van Houtven C
Rural Medicare beneficiaries have fewer follow-up visits and greater emergency department use postdischarge.
This study tested whether rural Medicare beneficiaries have a lower likelihood of follow-up care and greater likelihood of a readmission and ED visit within 30 days postdischarge, compared with urban beneficiaries. The results provide evidence of lower quality postdischarge care for Medicare beneficiaries in rural settings.
AHRQ-funded; HS000032.
Citation: Toth M, Holmes M, Van Houtven C .
Rural Medicare beneficiaries have fewer follow-up visits and greater emergency department use postdischarge.
Med Care 2015 Sep;53(9):800-8. doi: 10.1097/mlr.0000000000000401..
Keywords: Rural Health, Elderly, Medicare, Hospital Readmissions, Emergency Department, Hospital Discharge
Donnelly JP, Hohmann SF, Wang HE
Unplanned readmissions after hospitalization for severe sepsis at academic medical center-affiliated hospitals.
The researchers sought to characterize 7- and 30-day readmission rates following hospital admission for severe sepsis as well as institutional variations in readmission. They concluded that severe sepsis readmission places a substantial burden on the healthcare system, with one in 15 and one in five severe sepsis discharges readmitted within 7 and 30 days, respectively.
AHRQ-funded; HS013852.
Citation: Donnelly JP, Hohmann SF, Wang HE .
Unplanned readmissions after hospitalization for severe sepsis at academic medical center-affiliated hospitals.
Crit Care Med 2015 Sep;43(9):1916-27. doi: 10.1097/ccm.0000000000001147..
Keywords: Hospital Readmissions, Hospitals, Risk, Sepsis
Brooke BS, Goodney PP, Kraiss LW
Readmission destination and risk of mortality after major surgery: an observational cohort study.
This study examined the association between readmission destination and mortality risk in the USA in Medicare beneficiaries after a range of common operations. It found that patients who are readmitted to hospital after various major operations consistently achieve improved survival if they return to the hospital where their surgery took place.
AHRQ-funded; HS021581.
Citation: Brooke BS, Goodney PP, Kraiss LW .
Readmission destination and risk of mortality after major surgery: an observational cohort study.
Lancet 2015 Aug 29;386(9996):884-95. doi: 10.1016/s0140-6736(15)60087-3..
Keywords: Hospital Readmissions, Mortality, Surgery, Elderly, Outcomes, Hospitals
McElroy LM, Schmidt KA, Richards CT
Early postoperative emergency department care of abdominal transplant recipients.
The goal of this study was to describe early postoperative ED care of transplant recipients. It found that transplant recipients have a high frequency of ED visits in the first post transplantation year and high rates of subsequent hospital admission.
AHRQ-funded; HS000078.
Citation: McElroy LM, Schmidt KA, Richards CT .
Early postoperative emergency department care of abdominal transplant recipients.
Transplantation 2015 Aug;99(8):1652-7. doi: 10.1097/tp.0000000000000781..
Keywords: Emergency Department, Transplantation, Hospital Readmissions, Hospitals
Williams TP, Dimou FM, Adhikari D
Hospital readmission after emergency room visit for cholelithiasis.
This study evaluated the surgical follow-up and outcomes in patients seen in the emergency department (ED) for an episode of symptomatic cholelithiasis and discharged home for elective follow-up. It found that the failure to achieve a timely surgical follow-up leads to multiple ED readmissions and emergent gallstone-related hospitalizations, including emergency cholecystectomy.
AHRQ-funded; HS022134.
Citation: Williams TP, Dimou FM, Adhikari D .
Hospital readmission after emergency room visit for cholelithiasis.
J Surg Res 2015 Aug;197(2):318-23. doi: 10.1016/j.jss.2015.04.032..
Keywords: Hospital Readmissions, Patient-Centered Outcomes Research, Emergency Department, Hospital Discharge, Surgery
Balaban RB, Galbraith AA, Burns ME
A patient navigator intervention to reduce hospital readmissions among high-risk safety-net patients: a randomized controlled trial.
The researchers sough to determine if an intervention by patient navigators, hospital-based Community Health Workers, reduces readmissions among high risk, low socioeconomic status patients. They found that, overall, 30-day readmission rates did not differ between intervention and control patients.
AHRQ-funded; HS020628.
Citation: Balaban RB, Galbraith AA, Burns ME .
A patient navigator intervention to reduce hospital readmissions among high-risk safety-net patients: a randomized controlled trial.
J Gen Intern Med 2015 Jul;30(7):907-15. doi: 10.1007/s11606-015-3185-x..
Keywords: Hospital Readmissions, Low-Income, Social Determinants of Health, Patient Safety
Moghavem N, Morrison D, Ratliff JK
Cranial neurosurgical 30-day readmissions by clinical indication.
The objects of this study were to determine population-level, 30-day, all-cause readmission rates for cranial neurosurgery and identify factors associated with readmission. It fund that the frequency of 30-day readmission rates for patients undergoing cranial neurosurgery varied by diagnosis between 14% and 24%. Important patient characteristics and comorbidities that were associated with an increased readmission risk were identified.
AHRQ-funded; HS018558.
Citation: Moghavem N, Morrison D, Ratliff JK .
Cranial neurosurgical 30-day readmissions by clinical indication.
J Neurosurg 2015 Jul;123(1):189-97. doi: 10.3171/2014.12.jns14447..
Keywords: Hospital Readmissions, Surgery, Patient Safety, Outcomes
Holden TR, Smith MA, Bartels CM
Hospice enrollment, local hospice utilization patterns, and rehospitalization in Medicare patients.
The study objective was to examine the association between hospice enrollment, local hospice utilization patterns and 30-day rehospitalization in Medicare patients. It found that area-level hospice utilization is inversely proportional to rehospitalization rates. This relationship is not fully explained by direct hospice enrollment, and may reflect a spillover effect of the benefits of hospice extending to nonenrollees.
AHRQ-funded; HS000083.
Citation: Holden TR, Smith MA, Bartels CM .
Hospice enrollment, local hospice utilization patterns, and rehospitalization in Medicare patients.
J Palliat Med 2015 Jul;18(7):601-12. doi: 10.1089/jpm.2014.0395..
Keywords: Long-Term Care, Palliative Care, Hospital Readmissions, Medicare, Healthcare Utilization
Carey K
Measuring the hospital length of stay/readmission cost trade-off under a bundled payment mechanism.
This paper investigates the relationship between length of stay and readmission within 30 days of discharge from an acute care hospitalization. It found that the cost of an additional day of stay was offset by expected cost savings from an avoided readmission in the range of 15 to 65 percent.
AHRQ-funded; HS020995.
Citation: Carey K .
Measuring the hospital length of stay/readmission cost trade-off under a bundled payment mechanism.
Health Econ 2015 Jul;24(7):790-802. doi: 10.1002/hec.3061..
Keywords: Hospital Readmissions, Hospitalization, Elderly, Hospital Discharge, Medicare
Gonzalez AA, Abdelsattar ZM, Dimick JB
Time-to-readmission and mortality after high-risk surgery.
This study used 5 years of data on Medicare beneficiaries undergoing high-risk surgical procedures to investigate whether postdischarge mortality varies by time to readmission. It found that surgical readmissions within 10 days of discharge are disproportionately common and associated with increased mortality independent of index complications.
AHRQ-funded; HS017765; HS000053.
Citation: Gonzalez AA, Abdelsattar ZM, Dimick JB .
Time-to-readmission and mortality after high-risk surgery.
Ann Surg 2015 Jul;262(1):53-9. doi: 10.1097/sla.0000000000000912..
Keywords: Patient Safety, Mortality, Hospital Readmissions, Adverse Events, Surgery
Duseja R, Bardach NS, Lin GA
Revisit rates and associated costs after an emergency department encounter: a multistate analysis.
This study describes revisit rates, variation in revisit rates by diagnosis and state, and associated costs. It found that revisits after an index ED encounter are more frequent than previously reported, in part because many occur outside the index institution. Among ED patients in Florida, more resources are spent on revisits than on index ED visits.
AHRQ-funded; HS020667.
Citation: Duseja R, Bardach NS, Lin GA .
Revisit rates and associated costs after an emergency department encounter: a multistate analysis.
Ann Intern Med 2015 Jun 2;162(11):750-6. doi: 10.7326/m14-1616..
Keywords: Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Emergency Department, Hospitalization, Hospital Readmissions
Lopes RD, Gharacholou SM, Holmes DN
Cumulative incidence of death and rehospitalization among the elderly in the first year after NSTEMI.
The researchers evaluated mortality and cause-specific rehospitalization rates in elderly non-ST-segment elevation myocardial infarction survivors with ischemic heart disease. They found that rehospitalization rates do not rise substantially with advancing age, and rehospitalization is often for noncardiac diagnoses.
AHRQ-funded; HS021092.
Citation: Lopes RD, Gharacholou SM, Holmes DN .
Cumulative incidence of death and rehospitalization among the elderly in the first year after NSTEMI.
Am J Med 2015 Jun;128(6):582-90. doi: 10.1016/j.amjmed.2014.12.032.
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Keywords: Elderly, Mortality, Heart Disease and Health, Cardiovascular Conditions, Hospital Readmissions
Shih T, Ryan AM, Gonzalez AA
Medicare's hospital readmissions reduction program in surgery may disproportionately affect minority-serving hospitals.
The authors aimed to project readmission penalties for hospitals performing cardiac surgery and examine how these penalties will affect minority-serving hospitals. They found that minority-serving hospitals would disproportionately bear the burden of readmission penalties if expanded to include cardiac surgery.
AHRQ-funded; HS018546.
Citation: Shih T, Ryan AM, Gonzalez AA .
Medicare's hospital readmissions reduction program in surgery may disproportionately affect minority-serving hospitals.
Ann Surg 2015 Jun;261(6):1027-31. doi: 10.1097/sla.0000000000000778.
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Keywords: Hospitals, Medicare, Racial and Ethnic Minorities, Hospital Readmissions, Surgery
Amarasingham R, Velasco F, Xie B
Electronic medical record-based multicondition models to predict the risk of 30 day readmission or death among adult medicine patients: validation and comparison to existing models.
The purpose of this study was to evaluate the degree to which electronic medical record-based risk models for 30-day readmission or mortality accurately identify high risk patients and to compare these models with published claims-based models. The researchers found that a new electronic multicondition model based on information derived from the electronic medical record predicted mortality and readmission at 30 days, and was superior to previously published claims-based models
AHRQ-funded; HS022418.
Citation: Amarasingham R, Velasco F, Xie B .
Electronic medical record-based multicondition models to predict the risk of 30 day readmission or death among adult medicine patients: validation and comparison to existing models.
BMC Med Inform Decis Mak 2015 May 20;15:39. doi: 10.1186/s12911-015-0162-6.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Mortality, Hospital Readmissions, Risk
Field TS, Ogarek J, Garber L
Association of early post-discharge follow-up by a primary care physician and 30-day rehospitalization among older adults.
The researchers aimed to determine whether an office visit with a primary care physician within 7 days after discharge is associated with 30-day rehospitalization. Of 3,661 patients discharged to home during the study year, 1,808 received an office visit within 7 days and of these, 1,000 were with a primary care physician. No protective effect for office visits within 7 days was found.
AHRQ-funded; HS017203.
Citation: Field TS, Ogarek J, Garber L .
Association of early post-discharge follow-up by a primary care physician and 30-day rehospitalization among older adults.
J Gen Intern Med 2015 May;30(5):565-71. doi: 10.1007/s11606-014-3106-4..
Keywords: Hospital Readmissions, Primary Care, Hospital Discharge, Elderly, Healthcare Costs
Sjoding MW, Iwashyna TJ, Dimick JB
Gaming hospital-level pneumonia 30-day mortality and readmission measures by legitimate changes to diagnostic coding.
The researchers sought to determine the degree to which hospitals can game mortality or readmission measures and change their rankings by recoding patients with pneumonia. They concluded that hospitals can improve apparent pneumonia mortality and readmission rates by recoding pneumonia patients. Centers for Medicare and Medicaid Services should consider changes to their methods used to calculate hospital-level pneumonia outcome measures.
AHRQ-funded; HS020672.
Citation: Sjoding MW, Iwashyna TJ, Dimick JB .
Gaming hospital-level pneumonia 30-day mortality and readmission measures by legitimate changes to diagnostic coding.
Crit Care Med 2015 May;43(5):989-95. doi: 10.1097/ccm.0000000000000862..
Keywords: Elderly, Hospital Readmissions, Medicare, Mortality, Pneumonia, Quality Indicators (QIs)
Singh JA, Inacio MC, Namba RS
Rheumatoid arthritis is associated with higher ninety-day hospital readmission rates compared to osteoarthritis after hip or knee arthroplasty: a cohort study.
This study examined whether an underlying diagnosis of rheumatoid arthritis (RA) or osteoarthritis (OA) impacts the 90-day readmission rates after total hip arthroplasty (THA) or total knee arthroplasty (TKA). The 90-day post arthroplasty readmission risk after THA or TKA is higher in patients with rheumatoid arthritis (RA) compared to osteoarthritis.
AHRQ-funded; HS021110.
Citation: Singh JA, Inacio MC, Namba RS .
Rheumatoid arthritis is associated with higher ninety-day hospital readmission rates compared to osteoarthritis after hip or knee arthroplasty: a cohort study.
Arthritis Care Res 2015 May;67(5):718-24. doi: 10.1002/acr.22497..
Keywords: Arthritis, Hospital Readmissions, Arthritis, Surgery
Holdsworth La E, Zhu R, Hassmiller Lich K
The effects of state psychiatric hospital waitlist policies on length of stay and time to readmission.
This study examined the effects of a waitlist policy for state psychiatric hospitals on length of stay and time to readmission. The authors found that waitlists were associated with increased length of stay and time to readmission.
AHRQ-funded; HS000032.
Citation: Holdsworth La E, Zhu R, Hassmiller Lich K .
The effects of state psychiatric hospital waitlist policies on length of stay and time to readmission.
Adm Policy Ment Health 2015 May;42(3):332-42. doi: 10.1007/s10488-014-0573-1.
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Keywords: Hospitals, Behavioral Health, Policy, Substance Abuse, Hospital Readmissions
Shah T, Churpek MM, Coca Perraillon M
Understanding why patients with COPD get readmitted: a large national study to delineate the Medicare population for the readmissions penalty expansion.
The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals for 30-day readmissions and was extended to COPD in October 2014. The authors investigated readmission risk factors and reasons for readmission in order to guide hospitals in initiating programs to reduce COPD readmissions. They found that patients discharged home without home care were more likely to be readmitted for COPD than patients discharged to post-acute care, and those readmitted were more likely to be dually enrolled in Medicare and Medicaid, have a longer median length of stay, and have more comorbidities. They concluded that the addition of COPD to the readmissions penalty may further worsen the disproportionately high penalties seen in safety net hospitals.
AHRQ-funded; HS021877.
Citation: Shah T, Churpek MM, Coca Perraillon M .
Understanding why patients with COPD get readmitted: a large national study to delineate the Medicare population for the readmissions penalty expansion.
Chest 2015 May;147(5):1219-26. doi: 10.1378/chest.14-2181.
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Keywords: Respiratory Conditions, Elderly, Medicare, Hospital Readmissions
Hinami K, Smith J, Deamant CD
When do patient-reported outcome measures inform readmission risk?
The study sought was to characterize changes in patient-reported outcome measures from hospital discharge to assess when they best inform risk of utilization as defined by readmissions or emergency department use. It concluded that routine measurement of patient-reported outcomes can help identify patients at higher risk for utilizations. For example, in-hospital assessments revealing high symptom burden and poor health status predicted 14-day reutilization.
AHRQ-funded; HS019481.
Citation: Hinami K, Smith J, Deamant CD .
When do patient-reported outcome measures inform readmission risk?
J Hosp Med 2015 May;10(5):294-300. doi: 10.1002/jhm.2366..
Keywords: Emergency Department, Healthcare Utilization, Hospital Discharge, Hospital Readmissions, Outcomes
Ayers DC, Fehring TK, Odum SM
Using joint registry data from FORCE-TJR to improve the accuracy of risk-adjustment prediction models for thirty-day readmission after total hip replacement and total knee replacement.
The authors argue that registry data offer the opportunity to combine clinical information currently available in registries (such as the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement [FORCE-TJR] registry based at the University of Massachusetts Medical School) with the administrative data currently used by CMS. Doing so will improve the risk adjustment for patients having total joint replacement by making the data more accurate and more fair for hospitals and surgeons.
AHRQ-funded; HS018910.
Citation: Ayers DC, Fehring TK, Odum SM .
Using joint registry data from FORCE-TJR to improve the accuracy of risk-adjustment prediction models for thirty-day readmission after total hip replacement and total knee replacement.
J Bone Joint Surg Am 2015 Apr 15;97(8):668-71. doi: 10.2106/jbjs.n.00889..
Keywords: Registries, Surgery, Hospital Readmissions, Risk
Brown SE, Ratcliffe SJ, Halpern SD
Assessing the utility of ICU readmissions as a quality metric: an analysis of changes mediated by residency work-hour reforms.
This study sought to determine whether ICU readmission rates changed after the 2003 Accreditation Council for Graduate Medical Education Resident Duty Hours reform and whether there were temporally corresponding changes in other ICU outcomes. The decrease in ICU readmission rates after reform, without corresponding changes in mortality, suggest that ICU readmissions are not causally related to other untoward patient outcomes.
AHRQ-funded; HS018406.
Citation: Brown SE, Ratcliffe SJ, Halpern SD .
Assessing the utility of ICU readmissions as a quality metric: an analysis of changes mediated by residency work-hour reforms.
Chest 2015 Mar;147(3):626-36. doi: 10.1378/chest.14-1060..
Keywords: Intensive Care Unit (ICU), Hospital Readmissions, Quality of Care, Patient Safety, Outcomes
Merkow RP, Ju MH, Chung JW
Underlying reasons associated with hospital readmission following surgery in the United States.
The objectives of this study were to characterize the reasons for and timing of readmissions and to examine factors associated with unplanned surgical readmissions. It found that readmissions after surgery were mostly associated with postdischarge complications related to the procedure and not with exacerbation of prior index admission complications.
AHRQ-funded; HS21857.
Citation: Merkow RP, Ju MH, Chung JW .
Underlying reasons associated with hospital readmission following surgery in the United States.
JAMA 2015 Feb 3;313(5):483-95. doi: 10.1001/jama.2014.18614..
Keywords: Surgery, Hospital Readmissions, Injuries and Wounds
Smith MW, Stocks C, Santora PB
AHRQ Author: Stocks C
Hospital readmission rates and emergency department visits for mental health and substance abuse conditions.
The purpose of this study is to examine data on the readmission rates and ED visits of individuals diagnosed with mental health and substance abuse (MHSA) conditions to determine which individuals with specific MHSA conditions are more likely to return to the ED or be readmitted. It found that alcohol or drug dependence, dementias, psychotic disorders, autism, impulse control disorders, and personality disorders were most strongly associated with future inpatient admission or ED revisit.
AHRQ-authored; AHRQ-funded; 290200600009C.
Citation: Smith MW, Stocks C, Santora PB .
Hospital readmission rates and emergency department visits for mental health and substance abuse conditions.
Community Ment Health J 2015 Feb;51(2):190-7. doi: 10.1007/s10597-014-9784-x..
Keywords: Emergency Department, Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Behavioral Health, Substance Abuse
Shy BD, Shapiro JS, Shearer PL
A conceptual framework for improved analyses of 72-hour return cases.
The researchers describe the potential importance and limitations of reviewing cases where patients return to emergency departments (EDs) within 72-hours of discharge. They outline a novel framework for carrying out this practice. Within this framework, they describe the selection, training, and monitoring of QA reviewers, the attention reviewers should give to returning ED patients who are subsequently admitted, as well as several other topics.
AHRQ-funded; HS021261.
Citation: Shy BD, Shapiro JS, Shearer PL .
A conceptual framework for improved analyses of 72-hour return cases.
Am J Emerg Med 2015 Jan;33(1):104-7. doi: 10.1016/j.ajem.2014.08.005..
Keywords: Emergency Department, Hospital Discharge, Hospital Readmissions