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 104 Research Studies DisplayedDurojaiye AB, McGeorge N, Kristen W
Characterizing the utilization of the problem list for pediatric trauma care.
The EHR problem list has the potential to support care coordination among the multidisciplinary care team that cares for pediatric trauma patients. To realize this potential, the need exists to ensure appropriate utilization by formulating acceptable usage and management policy. In this regard, understanding the prevailing utilization pattern is pivotal. To this end, in this study, the investigators analyzed EHR in tandem with trauma registry data at a Level I pediatric trauma center.
AHRQ-funded; HS023837.
Citation: Durojaiye AB, McGeorge N, Kristen W .
Characterizing the utilization of the problem list for pediatric trauma care.
AMIA Annu Symp Proc 2018 Dec 5;2018:404-12..
Keywords: Care Coordination, Children/Adolescents, Electronic Health Records (EHRs), Emergency Department, Health Information Technology (HIT), Hospitals, Registries, Trauma
Meddings J, Smith SN, Hofer TP
Mixed messages to consumers from Medicare: Hospital Compare grades versus value-based payment penalty.
This study examined the discrepancy of ratings with hospitals with low readmission grades for heart failure (HF) and acute myocardial infarction (AMI) on the Hospital Compare website, yet received penalties for excessive readmissions under the hospital Readmissions Reduction Program. A retrospective data analysis was conducted of 2956 hospitals that had publicly reported HF grades on Hospital Compare. Of those, 92% were graded as “no different” than the national rate for HD readmissions, yet included 48.6% that were scored as having excessive HF admissions and 87% received an overall readmission penalty. Of the 120 hospitals graded as “better”, none were scored as having excessive HF readmissions and 50% were penalized. There were similar results for AMI.
AHRQ-funded; HS018334; HS019767.
Citation: Meddings J, Smith SN, Hofer TP .
Mixed messages to consumers from Medicare: Hospital Compare grades versus value-based payment penalty.
Am J Manag Care 2018 Dec;24(12):e399-e403..
Keywords: Medicare, Hospital Readmissions, Heart Disease and Health, Hospitals, Quality of Care, Cardiovascular Conditions, Provider Performance, Payment
Goldman MP, Wong AH, Bhatnagar A
Providers' perceptions of caring for pediatric patients in community hospital emergency departments: a mixed-methods analysis.
Approximately 90% of pediatric emergency care is provided in community emergency departments (CEDs) that care for both adults and children. Paradoxically, the majority of pediatric emergency medicine knowledge generation, quality improvement work, and clinical training occurs in children's hospitals. There is a paucity of information of perceptions on pediatric care from CED providers. The objective of this study was to explore interprofessional CED providers' perceptions of caring for pediatric patients.
AHRQ-funded; HS020286.
Citation: Goldman MP, Wong AH, Bhatnagar A .
Providers' perceptions of caring for pediatric patients in community hospital emergency departments: a mixed-methods analysis.
Acad Emerg Med 2018 Dec;25(12):1385-95. doi: 10.1111/acem.13509..
Keywords: Children/Adolescents, Emergency Department, Hospitals, Provider
Daniel VT, Ayturk D, Kiefe CI
The current State of the acute care surgery workforce: a boots on the ground perspective.
Acute care surgery (ACS) was proposed to address a general surgery workforce crisis; however, the ACS workforce composition is unknown. A national survey was conducted to determine the differences in the emergency general surgery (EGS) workforce between ACS and non-ACS hospitals. The investigators concluded that ACS and non-ACS hospitals differ in their surgical workforce. It is clear that ACS hospitals have more human capital, which suggests that ACS hospitals may require more dedicated resources compared to non-ACS hospitals.
AHRQ-funded; HS022694.
Citation: Daniel VT, Ayturk D, Kiefe CI .
The current State of the acute care surgery workforce: a boots on the ground perspective.
Am J Surg 2018 Dec;216(6):1076-81. doi: 10.1016/j.amjsurg.2018.08.023..
Keywords: Critical Care, Emergency Department, Hospitals, Workforce
Bateni SB, Olson JL, Hoch JS
Drivers of cost for pancreatic surgery: it's not about hospital volume.
Researchers compared healthcare costs of pancreatic surgery between high- and low-volume centers. They found there was no significant difference in costs, however high-volume centers have better outcomes for morbidity and mortality.
AHRQ-funded; HS022236.
Citation: Bateni SB, Olson JL, Hoch JS .
Drivers of cost for pancreatic surgery: it's not about hospital volume.
Ann Surg Oncol 2018 Dec;25(13):3804-11. doi: 10.1245/s10434-018-6758-1..
Keywords: Healthcare Costs, Hospitals, Outcomes, Patient Safety, Surgery
Agarwal D, Werner RM
Effect of hospital and post-acute care provider participation in accountable care organizations on patient outcomes and Medicare spending.
The purpose of this study was to test for differences in patient outcomes when hospital and post-acute care (PAC) providers participated in accountable care organizations (ACOs). The investigators concluded that hospital and skilled nursing facilities (SNF) participation in an ACO was associated with lower readmission rates, Medicare spending on SNF, and SNF length of stay.
AHRQ-funded; HS024266.
Citation: Agarwal D, Werner RM .
Effect of hospital and post-acute care provider participation in accountable care organizations on patient outcomes and Medicare spending.
Health Serv Res 2018 Dec;53(6):5035-56. doi: 10.1111/1475-6773.13023..
Keywords: Hospital Readmissions, Hospitals, Medicare, Nursing Homes, Outcomes
Schnipper JL, Mixon A, Stein J
Effects of a multifaceted medication reconciliation quality improvement intervention on patient safety: final results of the MARQUIS study.
The authors of this paper conducted a pragmatic quality improvement (QI) study at five US hospitals, two of which included concurrent controls. The investigators found that a mentored implementation of a multifaceted medication reconciliation QI initiative was associated with a reduction in total, but not potentially harmful, medication discrepancies. They suggest that the effect of EHR implementation on medication discrepancies warrants further study.
AHRQ-funded; HS019598.
Citation: Schnipper JL, Mixon A, Stein J .
Effects of a multifaceted medication reconciliation quality improvement intervention on patient safety: final results of the MARQUIS study.
BMJ Qual Saf 2018 Dec;27(12):954-64. doi: 10.1136/bmjqs-2018-008233..
Keywords: Hospitals, Medication, Medication: Safety, Patient Safety, Quality Improvement
Goodman KE, Simner PJ, Klein EY
How frequently are hospitalized patients colonized with carbapenem-resistant
This study evaluated whether hospitalized patients who tested positive for carbapenem-resistant Enteriobacteriaceae (CRE) were on contact precautions so that staff and other patients would not risk transmission. Since CRE colonization at admission was infrequent, there is some risk of transmission.
AHRQ-funded; HS025089.
Citation: Goodman KE, Simner PJ, Klein EY .
How frequently are hospitalized patients colonized with carbapenem-resistant
Infect Control Hosp Epidemiol 2018 Dec;39(12):1491-93. doi: 10.1017/ice.2018.236..
Keywords: Hospitalization, Hospitals, Infectious Diseases, Prevention, Risk
Huckfeldt P, Escarce J, Wilcock A
HF mortality trends under Medicare readmissions reduction program at penalized and nonpenalized hospitals.
After announcement and implementation of the Medicare Hospital Readmissions Reduction Program (HRRP), 30-day readmissions declined rapidly among seniors with heart failure (HF) while 30-day mortality rose. This raised questions about whether the policy was responsible, because lower HF readmission rates have historically been associated with higher mortality. In this study, the investigators compared trends in heart failure (HF) mortality at penalized and nonpenalized hospitals nationally.
AHRQ-funded; HS024284.
Citation: Huckfeldt P, Escarce J, Wilcock A .
HF mortality trends under Medicare readmissions reduction program at penalized and nonpenalized hospitals.
J Am Coll Cardiol 2018 Nov 13;72(20):2539-40. doi: 10.1016/j.jacc.2018.08.2174..
Keywords: Mortality, Heart Disease and Health, Cardiovascular Conditions, Hospital Readmissions, Medicare, Hospitals, Provider Performance, Payment
Rolnick JA, Ryskina KL
The use of individual provider performance reports by US Hospitals.
In this study, the investigators examined overall trends in how hospitals use the electronic health record to track and provide feedback on provider performance. They used data from 2013 to 2015 from the American Hospital Association (AHA) Annual Survey Information Technology Supplement, which asked hospitals if they have used electronic data to create performance profiles. They linked these data to AHA Annual Survey responses for all general adult and pediatric hospitals and used Multivariable logistic regression to model the odds of use as a function of hospital characteristics.
AHRQ-funded; HS022198.
Citation: Rolnick JA, Ryskina KL .
The use of individual provider performance reports by US Hospitals.
J Hosp Med 2018 Aug;13(8):562-65. doi: 10.12788/jhm.2922..
Keywords: Provider Performance, Quality of Care, Provider, Hospitals, Electronic Health Records (EHRs), Health Information Technology (HIT)
Heslin KC, Owens PL, Simpson LA
AHRQ Author: Heslin KC Owens PL
Annual report on health care for children and youth in the united states: focus on 30-day unplanned inpatient readmissions, 2009 to 2014.
The authors describe trends in unplanned 30-day all-condition hospital readmissions for children aged 1 to 17 years between 2009 and 2014. Using HCUP data, they found that the rate of readmission was essentially stable between 2009 and 2014. In 2009, the most common reason for readmission was sickle cell anemia, whereas in 2014 the most common reason was epilepsy. Pneumonia fell from the second to the sixth most common reason for readmission over this period. The authors suggest that their study provides a baseline assessment for examining trends in 30-day unplanned pediatric readmissions, an important quality metric as the provisions of the Children's Health Insurance Program Reauthorization Act and the Affordable Care Act are changed and implemented in the future.
AHRQ-authored.
Citation: Heslin KC, Owens PL, Simpson LA .
Annual report on health care for children and youth in the united states: focus on 30-day unplanned inpatient readmissions, 2009 to 2014.
Acad Pediatr 2018 Nov - Dec;18(8):857-72. doi: 10.1016/j.acap.2018.06.006..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Hospital Readmissions, Hospitalization, Hospitals, Sickle Cell Disease, Pneumonia, Neurological Disorders
Makam AN, Nguyen OK, Kirby B
Effect of site-neutral payment policy on long-term acute care hospital use.
The purpose of this study was to assess the projected effect of the Centers for Medicare and Medicaid Services new site-neutral payment policy, which aims to decrease unnecessary long-term acute care hospital (LTACH) admissions by reducing reimbursements for less-ill individuals by 2020. The investigators concluded that the site-neutral payment policy may limit LTACH access in existing LTAC-scarce markets, with potential adverse implications for recovery of hospitalized older adults.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Kirby B .
Effect of site-neutral payment policy on long-term acute care hospital use.
J Am Geriatr Soc 2018 Nov;66(11):2104-11. doi: 10.1111/jgs.15539..
Keywords: Policy, Hospitalization, Payment, Long-Term Care, Healthcare Costs, Medicare, Elderly, Hospitals
Kaiser SV, Lam R, Joseph GB
Limitations of using pediatric respiratory illness readmissions to compare hospital performance.
Researcher sought to determine if a National Quality Forum (NQF)-endorsed measure for pediatric lower respiratory illness (LRI) 30-day readmission rates can meaningfully identify high- and low-performing hospitals. Subjects were children with LRI (bronchiolitis, influenza, or pneumonia as primary diagnosis, or with an LRI as a secondary diagnosis with a primary diagnosis of respiratory failure, sepsis, bacteremia, or asthma) from all hospital admissions in California from 2012 to 2014. The researchers were unable to identify meaningful variation in hospital performance without broadening the metric definition and merging multiple years of data. They recommend that utilizers of pediatric-quality measures consider modifying metrics to better evaluate the quality of pediatric care at low-volume hospitals.
AHRQ-funded; HS024385; HS022835; HS024592; HS025297.
Citation: Kaiser SV, Lam R, Joseph GB .
Limitations of using pediatric respiratory illness readmissions to compare hospital performance.
J Hosp Med 2018 Nov;13(11):737-42. doi: 10.12788/jhm.2988..
Keywords: Children/Adolescents, Respiratory Conditions, Provider Performance, Hospital Readmissions, Hospitals, Quality Indicators (QIs), Quality Measures, Quality of Care, Quality Improvement
Prey JE, Polubriaginof F, Grossman LV
Engaging hospital patients in the medication reconciliation process using tablet computers.
Researchers conducted a pilot study to determine whether patients’ use of an electronic home medication review tool on a table computer could improve medication safety before or after hospitalization. Patients were randomized to the tool and out of 76 patients approached, 65 participated. About three-quarters (74%) made changes to their home medication list. Out of that total, 74% of the changes identified had a significant or greater potential severity, and 49% had a greater than 50-50 chance of harm. This medication reconciliation tool showed great potential to improve medication safety during and after hospitalization.
AHRQ-funded; HS021816.
Citation: Prey JE, Polubriaginof F, Grossman LV .
Engaging hospital patients in the medication reconciliation process using tablet computers.
J Am Med Inform Assoc 2018 Nov;25(11):1460-69. doi: 10.1093/jamia/ocy115..
Keywords: Adverse Drug Events (ADE), Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitalization, Hospitals, Medication, Medication: Safety, Patient and Family Engagement, Patient Safety, Prevention
Smith ME, Wells EE, Friese CR
Interpersonal and organizational dynamics are key drivers of failure to rescue.
This qualitative study of providers from hospitals with high and low rescue rates identified key factors that providers believe influence the successful rescue of surgical patients. These factors are: teamwork, action taking, psychological safety, recognition of complications, and communication. Providers surveyed agreed on two targets for improvement: delayed recognition of developing complications, and poor interprofessional communication and inability to express clinical concerns. The authors conclude that, to improve perioperative outcomes, hospitals and payers should shift their attention to improving early detection and increasing communication effectiveness when major complications occur.
AHRQ-funded; HS023621; HS024403.
Citation: Smith ME, Wells EE, Friese CR .
Interpersonal and organizational dynamics are key drivers of failure to rescue.
Health Aff 2018 Nov;37(11):1870-76. doi: 10.1377/hlthaff.2018.0704..
Keywords: Adverse Events, Communication, Hospitals, Mortality, Organizational Change, Patient Safety, Surgery
Aiken LH, Sloane DM, Barnes H
Nurses' and patients' appraisals show patient safety in hospitals remains a concern.
This study analyzed if there is a positive correlation between improvements of work environments for nurses and improvements in patient safety. A total of 535 hospitals in four large states at two points in time between 2005 and 2016 were studied. Survey data showed an improvement of work environment with 21% of study hospitals, and 7% had worse scores. For the hospitals with improved work environments, patients and nurses both reported high scores for patient safety indicators. For work environments which deteriorated, favorable patient safety grades went down 21%.
AHRQ-funded; HS022406.
Citation: Aiken LH, Sloane DM, Barnes H .
Nurses' and patients' appraisals show patient safety in hospitals remains a concern.
Health Aff 2018 Nov;37(11):1744-51. doi: 10.1377/hlthaff.2018.0711..
Keywords: Burnout, Hospitals, Patient Experience, Patient Safety, Provider: Nurse, Quality of Care, Quality Improvement
Berry WR, Edmondson L, Gibbons LR
Scaling safety: the South Carolina surgical safety checklist experience.
This article describes a voluntary initiative launched in South Carolina hospitals to encourage the use of the World Health Organization's Surgical Safety Checklist in all operating rooms. Hospitals that reported completing their implementation of the checklist in operating rooms showed significantly higher levels of physician participation and engaged in more personal, interactive activities, such as in-person meetings and teamwork skills training. The authors recommend that programs be designed to engage all stakeholders, and that a variety of program activities over the duration of the program that allow hospital and individual participation be offered.
AHRQ-funded; HS019631.
Citation: Berry WR, Edmondson L, Gibbons LR .
Scaling safety: the South Carolina surgical safety checklist experience.
Health Aff 2018 Nov;37(11):1779-86. doi: 10.1377/hlthaff.2018.0717..
Keywords: Hospitals, Patient Safety, Surgery
Desai NR, Ott LS, George EJ
Variation in and hospital characteristics associated with the value of care for Medicare beneficiaries with acute myocardial infarction, heart failure, and pneumonia.
The objectives of this study were to investigate the association between hospital-level 30-day risk-standardized mortality rates (RSMRs) and 30-day risk-standardized payments (RSPs) for acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PNA); to characterize patterns of value in care; and to identify hospital characteristics associated with high-value care (defined by having lower than median RSMRs and RSPs).
AHRQ-funded; HS023000.
Citation: Desai NR, Ott LS, George EJ .
Variation in and hospital characteristics associated with the value of care for Medicare beneficiaries with acute myocardial infarction, heart failure, and pneumonia.
JAMA Netw Open 2018 Oct 5;1(6):e183519. doi: 10.1001/jamanetworkopen.2018.3519..
Keywords: Cardiovascular Conditions, Elderly, Hospitalization, Hospitals, Heart Disease and Health, Inpatient Care, Medicare, Mortality, Pneumonia
Edworthy JR, McNeer RR, Bennett CL
Getting better hospital alarm sounds into a global standard.
The reserved set of audible alarm signals embodied within the global medical device safety standard, IEC 60601-1-8, is known to be problematic and in need of updating. The current alarm signals are not only suboptimal, but there is also little evidence beyond learnability (which is known to be poor) that demonstrates their performance in realistic and representative clinical environments. In this article, the authors describe the process of first designing and then testing potential replacement audible alarm signals for IEC 60601-1-8.
AHRQ-funded; HS024679; HS024379.
Citation: Edworthy JR, McNeer RR, Bennett CL .
Getting better hospital alarm sounds into a global standard.
Ergon Des 2018 Oct 1;26(4):4-13. doi: 10.1177/1064804618763268..
Keywords: Hospitals, Patient Safety
Middleton A, Kuo YF, Graham JE
Readmission patterns over 90-day episodes of care among Medicare fee-for-service beneficiaries discharged to post-acute care.
This retrospective cohort study’s objective was to examine readmission patterns over 90-day episodes of care in patients discharged from hospitals to skilled nursing facilities (SNFs). Data was used from a national cohort of Medicare fee-for-service beneficiaries discharged from SNF care from July 2013 to July 2014. The cohort studied were adults 65 years and older who were hospitalized for stroke, joint replacement, or hip fracture, and had survived 90 days post-discharge. Patients with hemorrhagic stroke were more likely than those with ischemic stroke to be rehospitalized over the first 30 days after discharge. For patients receiving nonelective joint replacements, readmissions increased from the 30 to 90-day period post-acute discharge.
AHRQ-funded; HS022134.
Citation: Middleton A, Kuo YF, Graham JE .
Readmission patterns over 90-day episodes of care among Medicare fee-for-service beneficiaries discharged to post-acute care.
J Am Med Dir Assoc 2018 Oct;19(10):896-901. doi: 10.1016/j.jamda.2018.03.006..
Keywords: Hospital Readmissions, Hospital Discharge, Medicare, Hospitals, Elderly
Leyenaar JK, Bogetz JF
Child mortality in the United States: bridging palliative care and public health perspectives.
This commentary discusses the findings of the article by Trowbridge et al in this same issue of Pediatrics, which examines modes of death rather than causes of death at a freestanding children’s hospital. Five distinct categories were created: withdrawal of life-sustaining technology; non-escalation of care; failed resuscitation; code then withdrawal; death by neurological criteria. More than 60% of the deaths were infants. The authors of this commentary note that conceptualizing the findings of this study from a public health perspective raises important questions about how causes of death are associated with end-of-life care in hospitals.
AHRQ-funded; HS024133.
Citation: Leyenaar JK, Bogetz JF .
Child mortality in the United States: bridging palliative care and public health perspectives.
Pediatrics 2018 Oct;142(4). doi: 10.1542/peds.2018-1927..
Keywords: Children/Adolescents, Hospitals, Mortality, Palliative Care, Patient-Centered Outcomes Research, Public Health
Wu VY, Fingar KR, Jiang HJ
AHRQ Author: Jiang HJ
Early impact of the Affordable Care Act coverage expansion on safety-net hospital inpatient payer mix and market shares.
The purpose of the study was to examine the impact of the Affordable Care Act's coverage expansion on safety-net hospitals (SNHs). The investigators concluded that postexpansion, non-SNHs experienced a greater percentage increase in Medicaid stays than did SNHs, which may reflect patients choosing non-SNHs over SNHs or a crowd-out of private insurance.
AHRQ-authored; AHRQ-funded; 290201300002.
Citation: Wu VY, Fingar KR, Jiang HJ .
Early impact of the Affordable Care Act coverage expansion on safety-net hospital inpatient payer mix and market shares.
Health Serv Res 2018 Oct;53(5):3617-39. doi: 10.1111/1475-6773.12812..
Keywords: Policy, Healthcare Cost and Utilization Project (HCUP), Hospitals, Medicaid
Bazzoli GJ, Thompson MP, Waters TM
Medicare payment penalties and safety net hospital profitability: minimal impact on these vulnerable hospitals.
The purpose of this study was to examine relationships between penalties assessed by Medicare's Hospital Readmission Reduction Program and Value-Based Purchasing Program and hospital financial condition. The investigators conducted bivariate and multivariate analysis of pooled cross-sectional data and found that safety net hospitals appear to rely on nonpatient care revenues to offset higher penalties for the years studied. They assert that while reassuring, these funding streams are volatile and may not be able to compensate for cumulative losses over time.
AHRQ-funded; HS023783.
Citation: Bazzoli GJ, Thompson MP, Waters TM .
Medicare payment penalties and safety net hospital profitability: minimal impact on these vulnerable hospitals.
Health Serv Res 2018 Oct;53(5):3495-506. doi: 10.1111/1475-6773.12833.
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Keywords: Payment, Hospitals, Medicare
Mittal M, Wang CE, Goben AH
Proprietary management and higher readmission rates: a correlation.
This study examined readmission rates of patients for six diseases including acute myocardial infarction, heart failure, coronary artery bypass graft, pneumonia, COPD, and total hip or total knee arthroplasty from the Center for Medicare and Medicaid Readmissions Reduction Production (HRRP) for 2012 to 2015. The type of hospital ownership was the variable that was being studied. There were statistically higher readmission rates in proprietary (for profit) hospitals compared to government and non-profit hospitals. This was true regardless of their location.
AHRQ-funded; HS024679.
Citation: Mittal M, Wang CE, Goben AH .
Proprietary management and higher readmission rates: a correlation.
PLoS One 2018 Sep 18;13(9):e0204272. doi: 10.1371/journal.pone.0204272..
Keywords: Cardiovascular Conditions, Hospital Readmissions, Hospitals, Orthopedics, Respiratory Conditions
Yokoe DS, Avery TR, Platt R
Ranking hospitals based on colon surgery and abdominal hysterectomy surgical site infection outcomes: impact of limiting surveillance to the operative hospital.
This study examined how hospitals are ranked based on colon surgery and abdominal surgical site infection (SSI) outcomes. This ranking can impact how financial penalties are determined. Currently SSI surveillance focuses mainly on the operative hospital, but patients sometimes go to a different hospital after an SSI as opposed to readmission in the operative hospital. The authors used data from a California statewide hospital registry to assess for evidence of SSI for surgeries performed from March 2011 through November 2013. This analysis showed show that operational hospital surveillance alone would have missed 7.2% of colon surgery and 13.4% of abdominal hysterectomy SSIs. This leads to an inaccurate assignment or avoidance of financial penalties for approximately 1 in 11-16 hospitals.
AHRQ-funded; HS021424.
Citation: Yokoe DS, Avery TR, Platt R .
Ranking hospitals based on colon surgery and abdominal hysterectomy surgical site infection outcomes: impact of limiting surveillance to the operative hospital.
Clin Infect Dis 2018 Sep 14;67(7):1096-102. doi: 10.1093/cid/ciy223..
Keywords: Surgery, Healthcare-Associated Infections (HAIs), Infectious Diseases, Injuries and Wounds, Adverse Events, Hospitals, Payment, Patient Safety, Provider Performance