National Healthcare Quality and Disparities Report
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- Access to Care (1)
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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 90 Research Studies DisplayedMello MM, Greenberg Y, Senecal SK
Case outcomes in a communication-and-resolution program in New York hospitals.
The researchers sought to determine case outcomes in a communication-and-resolution program (CRP) implemented to respond to adverse events in general surgery. They concluded that the bulk of CRPs' work is in investigating and communicating about events not caused by substandard care. These CRPs were quite successful in handling such events, but less consistent in offering compensation in cases involving substandard care.
AHRQ-funded; R18 HS019505.
Citation: Mello MM, Greenberg Y, Senecal SK .
Case outcomes in a communication-and-resolution program in New York hospitals.
Health Serv Res 2016 Dec;51 Suppl 3:2583-99. doi: 10.1111/1475-6773.12594.
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Keywords: Adverse Events, Communication, Medical Errors, Medical Liability, Surgery
Wandling MW, Minami CA, Johnson JK
Development of a conceptual model for surgical quality improvement collaboratives: facilitating the implementation and evaluation of collaborative quality improvement.
The authors sought to create a conceptual model of a surgical quality improvement (QI) collaborative to facilitate the development, implementation, and systematic evaluation of the Illinois Surgical Quality Improvement Collaborative (ISQIC). Their conceptual model has facilitated the ongoing evaluation of ISQIC and can be similarly used by others.
AHRQ-funded; HS024516; HS000078.
Citation: Wandling MW, Minami CA, Johnson JK .
Development of a conceptual model for surgical quality improvement collaboratives: facilitating the implementation and evaluation of collaborative quality improvement.
JAMA Surg 2016 Dec;151(12):1181-83. doi: 10.1001/jamasurg.2016.2817.
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Keywords: Quality Improvement, Surgery
Krakovitz PR, Boss EF
Intraoperative nerve monitoring during thyroidectomy-more complex than cost alone.
This brief invited commentary discussed intraoperative nerve monitoring and surgery.
AHRQ-funded; HS022932.
Citation: Krakovitz PR, Boss EF .
Intraoperative nerve monitoring during thyroidectomy-more complex than cost alone.
JAMA Otolaryngol Head Neck Surg 2016 Dec;142(12):1206-07. doi: 10.1001/jamaoto.2016.3116.
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Keywords: Shared Decision Making, Healthcare Costs, Patient-Centered Outcomes Research, Quality of Life, Surgery
Nathan H, Dimick JB
Opportunities for surgical leadership in managing population health costs.
The concept of population health management—long a mainstay in primary care and chronic disease management—is taking root in surgery. The 2010 Affordable Care Act (ACA) ushered in the implementation of several innovative payment models that shift accountability for population costs to health systems and providers. The authors discuss the implications of th trends for the surgical profession.
AHRQ-funded; HS024763.
Citation: Nathan H, Dimick JB .
Opportunities for surgical leadership in managing population health costs.
Ann Surg 2016 Dec;264(6):909-10. doi: 10.1097/sla.0000000000001759.
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Keywords: Healthcare Costs, Payment, Provider: Health Personnel, Surgery
Frasier LL, Azari DP, Ma Y
A marker-less technique for measuring kinematics in the operating room.
The researchers investigated a novel, marker-less technique for evaluating technical skill during open operations and for differentiating tasks and surgeon experience level. They were able to detect kinematic differences in performance using marker-less tracking during open operative cases. Suturing task evaluation was most sensitive to differences in surgeon role and task category and may represent a scalable approach for providing quantitative feedback to surgeons about technical skill.
AHRQ-funded; HS022403.
Citation: Frasier LL, Azari DP, Ma Y .
A marker-less technique for measuring kinematics in the operating room.
Surgery 2016 Nov;160(5):1400-13. doi: 10.1016/j.surg.2016.05.004.
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Keywords: Surgery, Provider Performance, Patient Safety
Hollingsworth JM, Funk RJ, Garrison SA
Association between physician teamwork and health system outcomes after coronary artery bypass grafting.
The researchers tested whether teamwork (assessed with the bipartite clustering coefficient) among multiple providers dispersed across many care locations is a determinant of surgical outcomes by examining national Medicare data from patients undergoing CABG. They found that health systems with higher teamwork levels had significantly lower 60-day rates of emergency department visit, readmission, and mortality.
AHRQ-funded; HS020927.
Citation: Hollingsworth JM, Funk RJ, Garrison SA .
Association between physician teamwork and health system outcomes after coronary artery bypass grafting.
Circ Cardiovasc Qual Outcomes 2016 Nov;9(6):641-48. doi: 10.1161/circoutcomes.116.002714.
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Keywords: Teams, Outcomes, Medicare, Surgery, Hospital Readmissions, Cardiovascular Conditions
Pershing S, Morrison DE, Hernandez-Boussard T
Cataract surgery complications and revisit rates among three states.
The authors studied cataract procedures from California, Florida, and New York, to characterize population-based 30-day procedure-related readmissions following surgery. Their results highlight the importance of age as a risk factor for cataract surgery readmissions, and suggest a relationship between black or Hispanic race, Medicaid insurance, and diabetes associated with higher risk for cataract surgery complications.
AHRQ-funded; HS018558.
Citation: Pershing S, Morrison DE, Hernandez-Boussard T .
Cataract surgery complications and revisit rates among three states.
Am J Ophthalmol 2016 Nov;171:130-38. doi: 10.1016/j.ajo.2016.08.036.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Eye Disease and Health, Surgery, Hospital Readmissions, Adverse Events
Nguyen UD, Ayers DC, Li W
Preoperative pain and function: profiles of patients selected for total knee arthroplasty.
The researchers examined patient-reported preoperative pain and function profiles to understand symptom severity at the time of total knee arthroplasty (TKA) decision. Of 6,936 patients, 77 percent had high pain and poor function (group 4), 19 percent had high pain "or" poor function (groups 2-3), and 5 percent had little pain and high function before TKA (group 1).
AHRQ-funded; HS018910.
Citation: Nguyen UD, Ayers DC, Li W .
Preoperative pain and function: profiles of patients selected for total knee arthroplasty.
J Arthroplasty 2016 Nov;31(11):2402-07.e2. doi: 10.1016/j.arth.2016.04.015.
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Keywords: Pain, Surgery, Arthritis, Comparative Effectiveness, Patient-Centered Outcomes Research
Varban OA, Greenberg CC, Schram J
Surgical skill in bariatric surgery: Does skill in one procedure predict outcomes for another?
Whether skill for one bariatric procedure can predict outcomes for another related procedure is unknown. This study found that video ratings of surgical skill with laparoscopic gastric bypass do not predict outcomes of laparoscopic sleeve gastrectomy. Evaluation of surgical skill with one procedure may not apply to other related procedures and may require independent assessment of surgical technical proficiency.
AHRQ-funded; R01 HS023597.
Citation: Varban OA, Greenberg CC, Schram J .
Surgical skill in bariatric surgery: Does skill in one procedure predict outcomes for another?
Surgery 2016 Nov;160(5):1172-81. doi: 10.1016/j.surg.2016.04.033.
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Keywords: Surgery, Obesity: Weight Management, Obesity, Outcomes, Provider Performance
Pradarelli JC, Healy MA, Osborne NH
Variation in Medicare expenditures for treating perioperative complications: the cost of rescue.
The researchers evaluated differences across hospitals in the costs of care for patients surviving perioperative complications after major inpatient surgery. After 4 selected inpatient operations, substantial variation was observed across hospitals regarding Medicare episode payments for patients rescued from perioperative complications. Notably, higher Medicare payments were not associated with improved clinical performance.
AHRQ-funded; HS017765.
Citation: Pradarelli JC, Healy MA, Osborne NH .
Variation in Medicare expenditures for treating perioperative complications: the cost of rescue.
JAMA Surg 2016 Oct 5:e163340. doi: 10.1001/jamasurg.2016.3340.
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Keywords: Medicare, Adverse Events, Surgery, Healthcare Costs, Patient Safety
Waljee JF, Ghaferi A, Cassidy R
Are patient-reported outcomes correlated with clinical outcomes after surgery? A population-based study.
The researchers evaluated the extent to which patient-reported outcomes (eg, health-related quality of life) are distinct from clinical outcomes following bariatric surgery. They concluded that patient-reported outcomes are not correlated with early perioperative events, but are correlated with measures of clinical effectiveness after bariatric surgery.
AHRQ-funded; HS023313.
Citation: Waljee JF, Ghaferi A, Cassidy R .
Are patient-reported outcomes correlated with clinical outcomes after surgery? A population-based study.
Ann Surg 2016 Oct;264(4):682-9. doi: 10.1097/sla.0000000000001852.
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Keywords: Surgery, Obesity, Adverse Events, Patient-Centered Outcomes Research, Patient Safety
Pezold ML, Pusic AL, Cohen WA
Defining a research agenda for patient-reported outcomes in surgery: using a Delphi survey of stakeholders.
The authors sought to create a research agenda to help determine future directions and advance cross-disciplinary collaboration on the use of patient-reported outcomes (PROs) in surgery. They concluded that the Patient-Reported Outcomes in Surgery Conference research agenda was created using a modified Delphi survey of stakeholders that will help researchers, surgeons, and funders identify crucial areas of future PROs research in surgery.
AHRQ-funded; HS023357; HS000066.
Citation: Pezold ML, Pusic AL, Cohen WA .
Defining a research agenda for patient-reported outcomes in surgery: using a Delphi survey of stakeholders.
JAMA Surg 2016 Oct;151(10):930-36. doi: 10.1001/jamasurg.2016.1640.
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Keywords: Patient-Centered Outcomes Research, Research Methodologies, Surgery, Quality Indicators (QIs)
Ban KA, Cohen ME, Ko CY
Evaluation of the ProPublica surgeon scorecard "Adjusted Complication Rate" measure specifications.
The authors sought to (1) determine the proportion of cases excluded by ProPublica's specifications, (2) assess the proportion of inpatient complications excluded from ProPublica's measure, and (3) examine the validity of ProPublica's outcome measure by comparing performance on the measure to well-established postoperative outcome measures. They found that ProPublica's outcome measure specifications exclude 82% of cases, miss 84% of postoperative complications, and correlate poorly with well-established postoperative outcomes.
AHRQ-funded; HS021857.
Citation: Ban KA, Cohen ME, Ko CY .
Evaluation of the ProPublica surgeon scorecard "Adjusted Complication Rate" measure specifications.
Ann Surg 2016 Oct;264(4):566-74. doi: 10.1097/sla.0000000000001858.
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Keywords: Adverse Events, Outcomes, Public Reporting, Quality Measures, Surgery
Morris MS, Graham LA, Richman JS
Postoperative 30-day readmission: time to focus on what happens outside the hospital.
The authors of this study aimed to understand the relative contribution of preoperative patient factors, operative characteristics, and postoperative hospital course on 30-day postoperative readmissions. They found that although postoperative readmissions are difficult to predict at the time of discharge, preoperative factors are the most important.
AHRQ-funded; HS013852.
Citation: Morris MS, Graham LA, Richman JS .
Postoperative 30-day readmission: time to focus on what happens outside the hospital.
Ann Surg 2016 Oct;264(4):621-31. doi: 10.1097/sla.0000000000001855.
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Keywords: Hospital Readmissions, Surgery, Adverse Events, Risk, Risk
Dy CJ, Baty J, Saeed MJ
A population-based analysis of time to surgery and travel distances for brachial plexus surgery.
Since the published brachial plexus injuries (BPI) experience is largely from individual centers, the authors used a population-based approach to evaluate the delivery of care for patients with BPI. They found that nearly one third of patients underwent BPI surgery more than 1 year after the injury, with patients initially treated at smaller hospitals at risk for undergoing delayed BPI surgery. These findings can inform efforts to expedite timely referral of patients with BPI to experienced centers.
AHRQ-funded; HS019455.
Citation: Dy CJ, Baty J, Saeed MJ .
A population-based analysis of time to surgery and travel distances for brachial plexus surgery.
J Hand Surg Am 2016 Sep;41(9):903-09.e3. doi: 10.1016/j.jhsa.2016.07.054.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Healthcare Delivery, Surgery, Neurological Disorders
Taylor LK, Thomas GW, Karam MD
Assessing wire navigation performance in the operating room.
The researchers sought to develop meaningful, objective measures of wire navigation performance in the operating room. They concluded that several video-based metrics were consistent across the 4 video reviewers and are likely to be useful for performance assessment. The tip-apex distance (TAD) measurement was less reliable than previous reports have suggested, but remains a valuable metric of performance.
AHRQ-funded; HS022077.
Citation: Taylor LK, Thomas GW, Karam MD .
Assessing wire navigation performance in the operating room.
J Surg Educ 2016 Sep-Oct;73(5):780-7. doi: 10.1016/j.jsurg.2016.03.018.
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Keywords: Surgery, Provider Performance, Injuries and Wounds, Orthopedics
Mueller SK, Yoon C, Schnipper JL
Association of a web-based handoff tool with rates of medical errors.
The researchers implemented a web-based handoff tool and training for health care professionals and evaluated the association of the tool with rates of medical errors in adult medical and surgical patients. They found that implementation of this tool was associated with a significant reduction in rates of medical errors, driven largely by a reduction in errors attributable to communication failure and errors that occurred during end-of-shift handoffs.
AHRQ-funded; HS023331.
Citation: Mueller SK, Yoon C, Schnipper JL .
Association of a web-based handoff tool with rates of medical errors.
JAMA Intern Med 2016 Sep;176(9):1400-2. doi: 10.1001/jamainternmed.2016.4258.
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Keywords: Medical Errors, Patient Safety, Surgery, Tools & Toolkits, Web-Based
Long S, Thomas GW, Anderson DD
Designing an affordable wire navigation surgical simulator.
This project was focused on developing a more affordable surgical simulator that could provide high-fidelity training for the task of wire navigation. The goal of the simulator, was to provide simulated X-ray images of a real K-wire as it is placed into an artificial bone. In testing the performance of the simulator, only of the 491 reconstructions were deemed as failed reconstructions, a success rate of roughly 98 percent.
AHRQ-funded; HS022077.
Citation: Long S, Thomas GW, Anderson DD .
Designing an affordable wire navigation surgical simulator.
J Med Device 2016 Sep;10(3). doi: 10.1115/1.4033799.
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Keywords: Surgery, Simulation, Patient Safety, Training
Goodman SM, Mandl LA, Parks ML
Disparities in TKA outcomes: census tract data show interactions between race and poverty.
Race is an important predictor of total knee arthroplasty (TKA) outcomes in the United States; however, analyses of race can be confounded by socioeconomic factors, which can result in difficulty determining the root cause of disparate outcomes after TKA. This study found that blacks and whites living in communities with little poverty have similar patient-reported TKA outcomes, whereas in communities with high levels of poverty, there are important racial disparities.
AHRQ-funded; HS016075.
Citation: Goodman SM, Mandl LA, Parks ML .
Disparities in TKA outcomes: census tract data show interactions between race and poverty.
Clin Orthop Relat Res 2016 Sep;474(9):1986-95. doi: 10.1007/s11999-016-4919-8.
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Keywords: Disparities, Racial and Ethnic Minorities, Social Determinants of Health, Patient-Centered Outcomes Research, Surgery
Nieman CL, Tunkel DE, Boss EF
Do race/ethnicity or socioeconomic status affect why we place ear tubes in children?
The study’s objective was to analyze the association of patient- and neighborhood-level demographics and SES with clinical indications for tympanostomy tube (TT). It found that among children receiving tubes, those from high poverty areas were more likely than those from low poverty neighborhoods to receive tubes for the indication of chronic otitis media with effusion (OME) as opposed to recurrent acute otitis media (RAOM).
AHRQ-funded; HS022932.
Citation: Nieman CL, Tunkel DE, Boss EF .
Do race/ethnicity or socioeconomic status affect why we place ear tubes in children?
Int J Pediatr Otorhinolaryngol 2016 Sep;88:98-103. doi: 10.1016/j.ijporl.2016.06.029.
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Keywords: Children/Adolescents, Ear Infections, Racial and Ethnic Minorities, Social Determinants of Health, Surgery, Low-Income
Tedesco D, Hernandez-Boussard T, Carretta E
Evaluating patient safety indicators in orthopedic surgery between Italy and the USA.
The authors compared patient safety in major orthopedic procedures between an orthopedic hospital in Italy and 26 Florida hospitals of similar size. AHRQ Patient Safety Indicators (PSIs) were used to identify inpatient adverse events (AEs). They found that US patients had lower adjusted odds of developing a PSI compared to Italy for pressure ulcers, hemorrhage or hematoma, and physiologic and metabolic derangement. while Italian patients had lower odds of pulmonary embolism/deep vein thrombosis compared to US patients.
AHRQ-funded; HS018558.
Citation: Tedesco D, Hernandez-Boussard T, Carretta E .
Evaluating patient safety indicators in orthopedic surgery between Italy and the USA.
Int J Qual Health Care 2016 Sep;28(4):486-91. doi: 10.1093/intqhc/mzw053.
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Keywords: Adverse Events, Orthopedics, Patient Safety, Quality Indicators (QIs), Surgery
Dimou FM, Adhikari D, Mehta HB
Incidence of hepaticojejunostomy stricture after hepaticojejunostomy.
The authors aimed to determine the timing, incidence, and management of stricture after biliary-enteric anastomosis. They found that younger age was associated with a decreased likelihood of stricture formation and that the presence of an endostent predicted stricture formation. They concluded that biliary-enteric anastomotic strictures occur with significant frequency after a biliary-enteric anastomosis, and that while many patients are managed nonoperatively, stricture diagnosis remains burdensome.
AHRQ-funded; HS022134.
Citation: Dimou FM, Adhikari D, Mehta HB .
Incidence of hepaticojejunostomy stricture after hepaticojejunostomy.
Surgery 2016 Sep;160(3):691-8. doi: 10.1016/j.surg.2016.05.021.
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Keywords: Surgery, Adverse Events, Digestive Disease and Health, Elderly, Patient-Centered Outcomes Research
Spector WD, Limcangco R, Owens PL
AHRQ Author: Spector WD, Limcangco R, Owens PL, Steiner CA
Marginal hospital cost of surgery-related hospital-acquired pressure ulcers.
The researchers estimated the hospital marginal cost of a hospital-acquired pressure ulcer (HAPU) for adults patients who were hospitalized for major surgeries, adjusted for patient characteristics, comorbidities, procedures, and hospital characteristics. They found that 3.5 percent of major surgical patients developed HAPUs and that the HAPUs added approximately $8,200 to the cost of a surgical stay after adjusting for comorbidities, patient characteristics, procedures, and hospital characteristics.
AHRQ-authored.
Citation: Spector WD, Limcangco R, Owens PL .
Marginal hospital cost of surgery-related hospital-acquired pressure ulcers.
Med Care 2016 Sep;54(9):845-51. doi: 10.1097/mlr.0000000000000558.
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Keywords: Pressure Ulcers, Surgery, Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Patient Safety
Bangalore S, Guo Y, Xu J
Rates of invasive management of cardiogenic shock in New York before and after exclusion from public reporting.
The purpose of the study was to evaluate whether the referral rates for cardiac catheterization, percutaneous coronary intervention (PCI), or coronary artery bypass graft have improved in New York since cardiogenic shock was excluded from public reporting in 2008 and compare them with corresponding rates in Michigan, New Jersey, and California. Although rates of PCI, invasive management, and revascularization have increased substantially after the exclusion of cardiogenic shock from public reporting in New York, these rates remain consistently lower than those observed in other states without public reporting.
AHRQ-funded; HS023683.
Citation: Bangalore S, Guo Y, Xu J .
Rates of invasive management of cardiogenic shock in New York before and after exclusion from public reporting.
JAMA Cardiol 2016 Sep 1;1(6):640-7. doi: 10.1001/jamacardio.2016.0785..
Keywords: Healthcare Cost and Utilization Project (HCUP), Public Reporting, Surgery, Cardiovascular Conditions
Bekelis K, Gottlieb D, Su Y
Surgical clipping versus endovascular coiling for elderly patients presenting with subarachnoid hemorrhage.
The authors studied elderly Medicare patients who underwent treatment for ruptured cerebral aneurysms. They did not demonstrate a difference in mortality, rate of discharge to rehabilitation, and readmissions between surgical clipping and endovascular coiling of ruptured cerebral aneurysms, although clipping was associated with a slightly longer length of stay.
AHRQ-funded; HS021581.
Citation: Bekelis K, Gottlieb D, Su Y .
Surgical clipping versus endovascular coiling for elderly patients presenting with subarachnoid hemorrhage.
J Neurointerv Surg 2016 Sep;8(9):913-8. doi: 10.1136/neurintsurg-2015-011890.
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Keywords: Brain Injury, Surgery, Comparative Effectiveness, Outcomes, Elderly