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 138 Research Studies DisplayedLake ET, Staiger D, Smith JG
The association of missed nursing care with very low birthweight infant outcomes.
This study examined the association of missed nursing care and health outcomes of very low birthweight (VLBW) infants in neonatal intensive care units (NICUs). The authors used 2016 hospital administrative discharge abstracts for VLBW newborns (n = 7,595) and NICU registered nurse survey responses (n = 6,963) from the National Database of Nursing Quality Indicators. Mortality, morbidity, and length of stay (LOS) was examined in 190 sample hospitals from 19 states in all regions. There was a significant association between higher odds of bloodstream infection and longer LOS, but not mortality or severe intraventricular hemorrhage and missed nursing care.
AHRQ-funded; HS024918.
Citation: Lake ET, Staiger D, Smith JG .
The association of missed nursing care with very low birthweight infant outcomes.
Med Care Res Rev 2023 Jun; 80(3):293-302. doi: 10.1177/10775587221150950..
Keywords: Healthcare Cost and Utilization Project (HCUP), Quality Indicators (QIs), Nursing, Newborns/Infants, Outcomes, Healthcare Utilization, Quality of Care
Sanghavi P, Chen Z
Underreporting of quality measures and associated facility characteristics and racial disparities in US nursing home ratings.
The purpose of this study was to evaluate the relationship between nursing home characteristics and reporting of 2 of 3 specific clinical outcomes reported by the Nursing Home Care Compare (NHCC) website: major injury falls and pressure ulcers. The researchers of this quality improvement study utilized hospitalization data for all Medicare fee-for-service beneficiaries between January 1, 2011, and December 31, 2017. Hospital admission claims for major injury falls and pressure ulcers were linked with facility-reported evaluations at the nursing home resident level. For each linked hospital claim, it was determined whether the nursing home had reported the event and rates of reporting were computed. To evaluate whether nursing homes reported similarly on both measures, the researchers estimated the relationship between reporting of major injury falls and pressure ulcers within a nursing home, and explored racial and ethnic disparities that could otherwise explain the associations. The study sample included 13,179 nursing homes where 131,000 residents experienced major injury fall or pressure ulcer hospitalizations. Of the 98,669 major injury fall hospitalizations, 60.0% were reported, and of the 39,894 stage 3 or 4 pressure ulcer hospitalizations, 67.7% were reported. Underreporting for both conditions was pervasive, with 69.9% and 71.7% of nursing homes having reporting rates less than 80% for major injury fall and pressure ulcer hospitalizations, respectively. Lower reporting rates had few correlations with facility characteristics other than racial and ethnic composition. Facilities with high vs low fall reporting rates had significantly more White residents (86.9% vs 73.3%), and facilities with high vs low pressure ulcer reporting rates had significantly fewer White residents (69.7% vs 74.9%).
AHRQ-funded; HS026957.
Citation: Sanghavi P, Chen Z .
Underreporting of quality measures and associated facility characteristics and racial disparities in US nursing home ratings.
JAMA Netw Open 2023 May; 6(5):e2314822. doi: 10.1001/jamanetworkopen.2023.14822..
Keywords: Quality Measures, Quality of Care, Elderly, Disparities, Racial and Ethnic Minorities, Nursing Homes, Pressure Ulcers, Healthcare-Associated Infections (HAIs), Quality Indicators (QIs), Long-Term Care
Sullivan CE, Day SW, Ivankova N
Establishing nursing-sensitive quality indicators for pediatric oncology: an international mixed methods Delphi study.
The purpose of this study was to create an initial core set of Nursing-sensitive indicators (NSIs) for international pediatric oncology nursing that would be important, actionable, and feasible to measure across different resource settings and countries. The researchers utilized purposive snowball sampling to identify 122 expert pediatric oncology nurses from 43 countries for participation. In round 1, the panelists identified five potential NSIs and constructs. These results were applied to round 2 in which panelists chose their top 10 NSIs and constructs and ranked them according to importance to patient care quality. Those results were then applied to round 3, in which panelists ranked the top 10 NSIs and constructs by order of importance for the particular population, then rated each NSI/Construct for actionability and feasibility of measurement. The study identified the preliminary core set of NSIs and constructs identified by the expert panel, and ranked them in the following order of importance: safe chemotherapy administration and handling, infection prevention/control, pediatric oncology nursing orientation program, early warning score system/recognition of patient deterioration, chemotherapy/biotherapy education/course, pain assessment/management, symptom assessment/management, patient and family education, palliative/end of life care, and continuing nursing education/competency. The study reported that all NSIs and constructs were rated as actionable; all constructs except palliative/end of life care were rated as feasible to measure. The researchers concluded that initial core NSIs and constructs offer improved insight into typical features of international pediatric oncology nursing practice that are important, actionable, and feasible for quality measurement.
AHRQ-funded; HS013852.
Citation: Sullivan CE, Day SW, Ivankova N .
Establishing nursing-sensitive quality indicators for pediatric oncology: an international mixed methods Delphi study.
J Nurs Scholarsh 2023 Jan; 55(1):388-400. doi: 10.1111/jnu.12798..
Keywords: Children/Adolescents, Quality Indicators (QIs), Quality of Care, Nursing, Cancer
Bolte TB, Swanson MB, Kaldjian AM
Hospitals that report severe sepsis and septic shock bundle compliance have more structured sepsis performance improvement.
This study linked survey data on quality improvement (QI) practices from Iowa hospitals to severe sepsis/septic shock (SEP-1) performance data and mortality. All Iowa hospitals (100%) completed the survey. SEP-1 reporting hospitals were more likely to have sepsis QI practices, including reporting sepsis quality to providers (64% versus 38%) and using the case review process to develop sepsis care plans. Increased SEP-1 scores were not associated with sepsis QI practices. A sepsis registry was associated with decreased odds of being in the bottom quartile of sepsis mortality, and presence of a sepsis committee was associated with lower hospital-specific mortality.
AHRQ-funded; HS025753.
Citation: Bolte TB, Swanson MB, Kaldjian AM .
Hospitals that report severe sepsis and septic shock bundle compliance have more structured sepsis performance improvement.
J Patient Saf 2022 Dec 1;18(8):e1231-e36. doi: 10.1097/pts.0000000000001062..
Keywords: Sepsis, Hospitals, Quality Improvement, Quality Indicators (QIs), Quality of Care
Waters TM, Burns N, Kaplan CM
Combined impact of medicare's hospital pay for performance programs on quality and safety outcomes is mixed.
The authors examined the combined impact of Medicare's pay for performance (P4P) programs on clinical areas and populations targeted by the programs, as well as those outside their focus. Using HCUP data, and consistent with previous studies for individual programs, they detected minimal, if any, effect of Medicare's hospital P4P programs on quality and safety. They recommended a redesigning of the P4P programs before continuing to expand them.
AHRQ-funded; HS025148.
Citation: Waters TM, Burns N, Kaplan CM .
Combined impact of medicare's hospital pay for performance programs on quality and safety outcomes is mixed.
BMC Health Serv Res 2022 Jul 28;22(1):958. doi: 10.1186/s12913-022-08348-w..
Keywords: Healthcare Cost and Utilization Project (HCUP), Medicare, Payment, Provider Performance, Hospitals, Quality Indicators (QIs), Quality Measures, Quality Improvement, Quality of Care, Patient Safety
Hoffmann JA, Johnson JK, Pergjika A
Development of quality measures for pediatric agitation management in the emergency department.
This study’s objective was to develop quality measures for pediatric emergency department (ED) agitation management informed by multidisciplinary perspectives. A multidisciplinary panel was created to develop quality measures for pediatric ED agitation management through the modified Delphi method. The panelists included 36 physicians, nurses, social workers, security, child life specialists, hospital data analysts, and parents. Measures were ranked by panelists in importance and feasibility on a 9-point scale during 2 survey rounds, with a teleconference discussion between surveys. Consensus was defined at >75% of panelists ranking a quality measure greater or equal to 7 in importance and median feasibility of greater or equal to 4. Consensus was reached on 20 quality measures that incorporated multidisciplinary perspectives.
AHRQ-funded; HS026385.
Citation: Hoffmann JA, Johnson JK, Pergjika A .
Development of quality measures for pediatric agitation management in the emergency department.
J Healthc Qual 2022 Jul-Aug;44(4):218-29. doi: 10.1097/jhq.0000000000000339..
Keywords: Children/Adolescents, Quality Measures, Quality Indicators (QIs), Quality of Care, Emergency Department
Probst MA, Janke AT, Haimovich AD
Development of a novel emergency department quality measure to reduce very low-risk syncope hospitalizations.
The purpose of this study was to develop a new quality measure to apply with very low risk adult emergency department patients under 50 years of age and with no history of heart disease presenting with syncope. The study found that of the 3,292 patients meeting the study criteria, .46% suffered serious adverse events within 30 days after discharge. When the criteria were applied to the 2019 Nationwide Emergency Department Sample (NEDS) to assess its potential effect (assessing for hospital-level factors associated with hospitalization variation), of the 566,031 patients meeting the criteria, 2.7% were hospitalized. The researchers identified factors associated with increased hospitalization rates, which included a yearly ED volume of more than 80,000 and metropolitan teaching status. The study concluded that the novel syncope quality measure developed by the researchers can evaluate variation in low-value hospitalizations for unexplained syncope.
AHRQ-funded; HS022882.
Citation: Probst MA, Janke AT, Haimovich AD .
Development of a novel emergency department quality measure to reduce very low-risk syncope hospitalizations.
Ann Emerg Med 2022 Jun;79(6):509-17. doi: 10.1016/j.annemergmed.2022.03.008..
Keywords: Emergency Department, Quality Measures, Hospitalization, Quality Indicators (QIs), Quality of Care
Zrelak PA, Utter GH, McDonald KM
Incorporating harms into the weighting of the revised Agency for Healthcare Research and Quality Patient Safety for Selected Indicators Composite (Patient Safety Indicator 90).
The purpose of this study was to reweight AHRQ’s Patient Safety for Selected Indicators Composite (Patient Safety Indicator 90) from weights based solely on the frequency of component Patient Safety Indicators (PSIs) to those that incorporate excess harm reflecting patients' preferences for outcome-related health states. Findings showed that including harms in the weighting scheme changed individual component weights from the original frequency-based weighting. In the reweighted composite, PSIs 11, 13, and 12 contributed the greatest harm. The investigators concluded that reformulation of PSI 90 with harm-based weights is feasible and results in satisfactory reliability and discrimination.
AHRQ-authored; AHRQ-funded; 290201200003I.
Citation: Zrelak PA, Utter GH, McDonald KM .
Incorporating harms into the weighting of the revised Agency for Healthcare Research and Quality Patient Safety for Selected Indicators Composite (Patient Safety Indicator 90).
Health Serv Res 2022 Jun;57(3):654-67. doi: 10.1111/1475-6773.13918..
Keywords: Healthcare Cost and Utilization Project (HCUP), Patient Safety, Quality Indicators (QIs), Quality Measures, Quality of Care, Adverse Events, Medicare
Milliren CE, Bailey G, Graham DA
Relationships between pediatric safety indicators across a national sample of pediatric hospitals: dispelling the myth of the "safest" hospital.
This observational study aimed to explore the covariance of pediatric hospital quality indicators and evaluate the use of a single composite score. Pediatric hospital performance across 13 safety indicators were extracted from the Pediatric Health Information System, a comparative database of children’s hospitals in the U.S. Patients discharged from 36 hospitals from 2016 to 2019 were included. The authors investigated relationships among patient safety measures from AHRQ pediatric quality indicators and Center for Medicare and Medicaid Services hospital-acquired conditions. They identified 5 orthogonal variance components accounting for 68% of variation in pediatric hospital quality indicators. The ranking comparison and summary found greater within-hospital variation compared with between-hospital variation. They observed discordant rankings among commonly used summary measures and concluded that these measures demonstrate at least 2 underlying variance components.
AHRQ-funded; HS026246.
Citation: Milliren CE, Bailey G, Graham DA .
Relationships between pediatric safety indicators across a national sample of pediatric hospitals: dispelling the myth of the "safest" hospital.
J Patient Saf 2022 Jun 1;18(4):e741-e46. doi: 10.1097/pts.0000000000000938..
Keywords: Children/Adolescents, Quality Indicators (QIs), Quality Measures, Patient Safety, Hospitals, Quality of Care
Ellsworth BL, Metz AK, Mott MM
Review of cancer-specific quality measures promoting the avoidance of low-value care.
The purpose of this study was to explore cancer quality measures to identify and describe those that encourage the avoidance of caner overtreatment and low-value care. The study also aimed to identify gaps that could direct the future development of cancer-specific quality measures. The researchers collected, reviewed, and identified 313 quality measures encouraging the avoidance of low-value cancer care, from six leading quality measures organizations. Of the 313 quality measures identified, 55 (18%) focused on avoidance of low-value care. Quality measure most likely to focus on low-value care included: 13 end-of-life care measures (50%); 12 breast cancer care measures (18%); 9 lung cancer care measures (31%); 8 colon cancer care measures (20%); 5 prostate cancer care measures (38%); and 4 general cancer care measures (3%). The study concluded that the majority of cancer quality measures are not aimed at avoiding cancer over-treatment and low value care, and existing recommendations have not been incorporated in the field.
AHRQ-funded; HS026030.
Citation: Ellsworth BL, Metz AK, Mott MM .
Review of cancer-specific quality measures promoting the avoidance of low-value care.
Ann Surg Oncol 2022 Jun;39(6):3750-62. doi: 10.1245/s10434-021-11303-4..
Keywords: Cancer, Quality Measures, Quality Indicators (QIs), Quality of Care
Olin SS, Freed GL, Scholle SH
Aligning to improve pediatric health care quality.
The authors presented a population health framework for collaboration and coordination across the delivery system to improve care quality, with quality measures as key tools for monitoring and incentivizing collaboration and alignment of efforts across levels, based on each entity's sphere of influence within the Applegate Alignment Framework.
AHRQ-funded; HS025296; HS025292.
Citation: Olin SS, Freed GL, Scholle SH .
Aligning to improve pediatric health care quality.
Acad Pediatr 2022 Apr;22(3s):S115-s18. doi: 10.1016/j.acap.2021.08.021..
Keywords: Children/Adolescents, Quality Improvement, Quality Measures, Quality Indicators (QIs), Quality of Care, Medicaid
Parast L, Burkhart Q, Bardach NS
Development and testing of an emergency department quality measure for pediatric suicidal ideation and self-harm.
The authors sought to develop and test a new quality measure assessing timeliness of follow-up mental health care for youth presenting to the emergency department (ED) with suicidal ideation or self-harm. Using Medicaid administrative data, they concluded that this new ED quality measure may be useful for monitoring and improving the quality of care for this vulnerable population; however, they recommended future work in order to establish the measure's predictive validity using more prevalent outcomes such as recurrence of suicidal ideation or deliberate self-harm.
AHRQ-funded; HS025291.
Citation: Parast L, Burkhart Q, Bardach NS .
Development and testing of an emergency department quality measure for pediatric suicidal ideation and self-harm.
Acad Pediatr 2022 Apr;22(3s):S92-s99. doi: 10.1016/j.acap.2021.03.005..
Keywords: Children/Adolescents, Emergency Department, Behavioral Health, Quality Measures, Quality Indicators (QIs), Quality of Care
Morden E, Byron S, Roth L
Health plans struggle to report on depression quality measures that require clinical data.
This study examined challenges and opportunities for reporting 5 HEDIS measures which used electronic clinical data to assess adolescent and perinatal depression care quality. Two learning collaboratives were convened with 10 health plans from 5 states. The authors conducted analysis of notes from collaborative meetings and individual calls with health plans to identify key challenges and strategies for reporting. The challenges most reported included: 1) lack of access to clinical data sources where the results of patient-reported tools were documented; 2) unavailability of the results of patient-reported tools in usable data fields; 3) lack of routine depression screening and ongoing assessment occurring in provider practices.
AHRQ-funded; HS025296.
Citation: Morden E, Byron S, Roth L .
Health plans struggle to report on depression quality measures that require clinical data.
Acad Pediatr 2022 Apr;22(3s):S133-s39. doi: 10.1016/j.acap.2021.09.022..
Keywords: Children/Adolescents, Depression, Behavioral Health, Quality Indicators (QIs), Quality Measures, Quality of Care
Leyenaar JK, Esporas M, Mangione-Smith R
How does pediatric quality measure development reflect the real world needs of hospitalized children?
This study examined to what extent do the Pediatric Quality Measures Program (PQMP) reflect the real world needs of hospitalized children. The authors discussed recent advances in pediatric quality measurement in the context of the current epidemiology of pediatric hospitalization in the US. The history of PQMP is discussed, including AHRQ’s role from 2011 to 2016 as the manager of cooperative agreement grants to seven academic medical centers to develop the initial set of evidence-based quality measures designed to improve children’s quality of care. During the second phase (2016 to 2020), 6 institutions were funded to implement and disseminate these quality measures, with a goal of determining their feasibility and usability. The majority of these measures were developed at large children’s hospitals. However, 20% of children live in rural areas not near a children’s hospital. Among all general hospitals that admit children, 80% have pediatric volumes of less than 375 hospitalizations per year. Unique strategies will be needed to evaluate healthcare quality at these hospitals. The role of interhospital transfer to larger children’s hospitals is also discussed and how it impacts quality of care.
AHRQ-funded; HS025291.
Citation: Leyenaar JK, Esporas M, Mangione-Smith R .
How does pediatric quality measure development reflect the real world needs of hospitalized children?
Acad Pediatr 2022 Apr;22(3s):S70-s72. doi: 10.1016/j.acap.2021.01.019..
Keywords: Children/Adolescents, Quality Measures, Quality Improvement, Quality of Care, Quality Indicators (QIs), Hospitals
Richardson JE, Rasmussen LV, Dorr DA
Generating and reporting electronic clinical quality measures from electronic health records: strategies from EvidenceNOW cooperatives.
This study’s goal was to characterize strategies that seven regional cooperatives participating in the EvidenceNOW initiative developed to generate and report electronic health record (EHR)-based electronic clinical quality measures (eCQMs) for quality improvement (QI) in small-to-medium-sized practices. Findings showed that cooperatives ultimately generated and reported eCQMs using hybrid strategies because they determined that neither EHRs alone nor centralized sources alone could operationalize eCQMs for QI. In order to attain this goal, cooperatives needed to devise solutions and utilize resources that often are unavailable to typical small-to-medium-sized practices.
AHRQ-funded; HS023921.
Citation: Richardson JE, Rasmussen LV, Dorr DA .
Generating and reporting electronic clinical quality measures from electronic health records: strategies from EvidenceNOW cooperatives.
Appl Clin Inform 2022 Mar;13(2):485-94. doi: 10.1055/s-0042-1748145..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Indicators (QIs), Quality Measures, Quality of Care, Evidence-Based Practice, Primary Care
Konetzka RT, Davila H, Brauner DJ
The quality measures domain in Nursing Home Compare: is high performance meaningful or misleading?
The Federal Centers for Medicare and Medicaid Services publishes a Nursing Home Compare (NHC) web site that provides information to compare nursing homes across the nation. Since NHC began reporting the percent of nursing home residents suffering adverse outcomes, the negative outcomes decreased dramatically. However, the validity of scores has been questioned for nursing homes that score well on facility-reported measures but scored poorly on inspections. The study purpose was to determine whether nursing homes with these “discordant” scores are better than nursing homes that score poorly across all domains. The researchers analyzed national data from 2012- 2016, conducted in-depth interviews and observations of 12 nursing homes in 2017 to 2018, and studied nursing home performance trajectories over time. Both qualitative and quantitative methods were utilized and interpreted together. The study found that facilities identified as discordant took part in more quality improvement (QI) activities than those identified as poor performers, but those QI activities were lower-resource improvements and not of the type and scope that would impact improvements across other quality domains. It was determined that the poor-performing facilities appeared to lack the leadership and staff continuity required for even low-resource improvements. The study concluded that while high performance on quality measures using facility-reported data is mostly meaningful, and the quality measures domain should continue to be utilized in Nursing Home Compare, facilities identified as discordant still have quality defects.
AHRQ-funded; HS024967.
Citation: Konetzka RT, Davila H, Brauner DJ .
The quality measures domain in Nursing Home Compare: is high performance meaningful or misleading?
Gerontologist 2022 Feb 9;62(2):293-303. doi: 10.1093/geront/gnab054..
Keywords: Nursing Homes, Long-Term Care, Provider Performance, Quality Indicators (QIs), Quality Measures, Quality of Care
Schwartz ML, Rahman M, Thomas KS
Consumer selection and home health agency quality and patient experience stars.
The objective of this study was to compare the impact of the introduction of two distinct sets of star ratings, quality of care, and patient experience, on home health agency (HHA) selection. The investigators concluded that the introduction of quality of care and patient experience stars were associated with changes in HHA selection; however, the strength of these relationships was weaker than observed in other health care settings where a single star rating was reported.
AHRQ-funded; HS026440.
Citation: Schwartz ML, Rahman M, Thomas KS .
Consumer selection and home health agency quality and patient experience stars.
Health Serv Res 2022 Feb;57(1):113-24. doi: 10.1111/1475-6773.13867..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Home Healthcare, Patient Experience, Quality Measures, Quality of Care, Provider Performance, Quality Indicators (QIs)
Izadi Z, Schmajuk G, Gianfrancesco M
Significant gains in rheumatoid arthritis quality measures among RISE Registry practices.
This study examined performance on rheumatoid arthritis (RA) quality measures and assessed the association between practice characteristics and changes in performance over time among participating practices. The authors analyzed data from practices enrolled in the American College of Rheumatology Rheumatology Informatics System for Effectiveness (RISE) registry from 2015 to 2017. Eight quality measures in the areas of RA disease management, cardiovascular risk reduction, and patient safety were analyzed. Data from 59,986 patients from 54 practices were examined. Cohort characteristics were a mean age of 62 years, 77% female, 69% Caucasian, and most patients (46%) were seen in a single-specialty group practice. Measures related to RA functional status and disease activity assessment improved over time, with single-specialty group practices having the fastest rates of improvement across all measures.
AHRQ-funded; HS025638; HS024412.
Citation: Izadi Z, Schmajuk G, Gianfrancesco M .
Significant gains in rheumatoid arthritis quality measures among RISE Registry practices.
Arthritis Care Res 2022 Feb;74(2):219-28. doi: 10.1002/acr.24444..
Keywords: Arthritis, Chronic Conditions, Quality Measures, Quality Indicators (QIs), Registries, Quality of Care
Hysong Hysong, Arredondo K, Hughes AM
An evidence-based, structured, expert approach to selecting essential indicators of primary care quality.
The purpose of this article was to illustrate the application of an evidence-based, structured performance measurement methodology to identify, prioritize, and generate new measures of health care quality, using primary care as a case example. Subject matter experts identified three fundamental objectives: access, patient-health care team partnerships, and technical quality. The authors indicated that their article provides an actionable guide to applying their Productivity Measurement and Enhancement System, which can be adapted to the needs of various industries, including measure selection and modification from existing data sources, and proposing new measures.
Citation: Hysong Hysong, Arredondo K, Hughes AM .
An evidence-based, structured, expert approach to selecting essential indicators of primary care quality.
PLoS One 2022 Jan 18;17(1):e0261263. doi: 10.1371/journal.pone.0261263..
Keywords: Primary Care, Evidence-Based Practice, Quality Improvement, Quality Indicators (QIs), Quality Measures, Quality of Care
Yount N, Zebrak KA, Famolaro T
Linking patient safety culture to quality ratings in the nursing home setting.
This study examined the relationship between scores on the AHRQ Surveys on Patient Safety Culture™ (SOPS®) Nursing Home Survey (NH SOPS) and Centers for Medicare and Medicaid Services Nursing Home Five-Star Quality Ratings. The authors used data on 186 nursing homes to conduct multiple regression analyses predicting the Five-Star Quality Ratings from the NH SOPS survey measures. Five NH SOPS measures were related to the Overall, Health Inspections, and Quality Five-Star Ratings; four NH SOPS measures were related to at least two of the four Five-Star Quality Ratings and three SOPS measures were related to one Five-Star Rating. No NH SOPS measures were significantly associated with the Staffing Five-Star Rating.
AHRQ-funded; 233201500026I.
Citation: Yount N, Zebrak KA, Famolaro T .
Linking patient safety culture to quality ratings in the nursing home setting.
J Appl Gerontol 2022 Jan;41(1):73-81. doi: 10.1177/0733464820969283..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Safety, Nursing Homes, Long-Term Care, Quality Indicators (QIs), Quality Measures, Quality Improvement, Quality of Care
Davila H, Shippee TP, Park YS
Inside the black box of improving on nursing home quality measures.
This qualitative study investigated how nursing homes (NHs) interact with quality measures (QMs) used by Nursing Home Compare (NHC) as part of its 5-star rating system. Semistructured interviews were conducted with 110 NH personnel and 23 NH provider association representatives. Observations of organizational processes in 12 NHs in three states were also done. The authors found that most NHs are working to improve the quality of care they provide, not merely to improve their QM scores. They also found limitations with the QMs, suggesting that the QMs on their own may not accurately reflect the quality of care that NHs provide. The findings suggest several changes to improve NHC.
AHRQ-funded; HS024967.
Citation: Davila H, Shippee TP, Park YS .
Inside the black box of improving on nursing home quality measures.
Med Care Res Rev 2021 Dec;78(6):758-70. doi: 10.1177/1077558720960326..
Keywords: Nursing Homes, Quality Indicators (QIs), Quality Measures, Quality Improvement, Quality of Care, Provider Performance, Long-Term Care
Holmgren AJ, Kuznetsova M, Classen D
Assessing hospital electronic health record vendor performance across publicly reported quality measures.
The authors measured hospital performance, stratified by electronic health record (EHR) vendor, across 4 quality metrics. They found that no EHR vendor was associated with higher quality across all measures, and the 2 largest vendors were not associated with the highest scores. Only a small fraction of quality variation was explained by EHR vendor choice. They concluded that top performance on quality measures can be achieved with any EHR vendor, as much of quality performance is driven by the hospital and how it uses the EHR.
AHRQ-funded; HS023696.
Citation: Holmgren AJ, Kuznetsova M, Classen D .
Assessing hospital electronic health record vendor performance across publicly reported quality measures.
J Am Med Inform Assoc 2021 Sep 18;28(10):2101-07. doi: 10.1093/jamia/ocab120..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Indicators (QIs), Quality Measures, Hospitals, Quality of Care, Provider Performance
Tedesco D, Moghavem N, Weng Y
Improvement in patient safety may precede policy changes: trends in patient safety indicators in the United States, 2000-2013.
This study’s aim was to assess changes in national patient safety trends that corresponded to U.S. pay-for-performance reforms. The study analyzed 13 patient safety indicators (PSIs) that were developed by AHRQ. PSI trends, Center for Medicaid and Medicare Services payment policy changes, and Inpatient Prospective Payment System regulations and notices between 2000 and 2013 were analyzed. Twelve of the thirteen PSIs had decreasing or stable trends in the last 5 years of the study. Central-line bloodstream infections had the greatest annual decrease (-31.1 annual percent change between 2006 and 2013) whereas postoperative respiratory failure had the smallest annual percent change (-3.5 between 2005 and 2013). Significant decreases in trends preceded federal payment reform initiatives in all but postoperative hip fracture. These findings suggest that intense public discourses targeting patient safety may drive national policy reforms.
AHRQ-funded; HS018558.
Citation: Tedesco D, Moghavem N, Weng Y .
Improvement in patient safety may precede policy changes: trends in patient safety indicators in the United States, 2000-2013.
J Patient Saf 2021 Jun 1;17(4):e327-e34. doi: 10.1097/pts.0000000000000615..
Keywords: Patient Safety, Quality Improvement, Quality Indicators (QIs), Quality Measures, Quality of Care, Policy
Palen TE, Peterson L, Palen TE
Clinical quality measure exchange is not easy.
The Trial of Aggregate Data Exchange for Maintenance of Certification and Raising Quality was a randomized controlled trial which first had to test whether quality reporting could be a by-product of clinical care. The investigators reported on the initial descriptive study of the capacity for and quality of exchange of whole-panel, standardized quality measures from health systems. They concluded that the secure transfer of standardized, physician-level quality measures from 4 health systems with mature measure processes proved difficult. There were many errors that required human intervention and manual repair, precluding full automation.
AHRQ-funded; HS022583.
Citation: Palen TE, Peterson L, Palen TE .
Clinical quality measure exchange is not easy.
Ann Fam Med 2021 May-Jun;19(3):207-11. doi: 10.1370/afm.2649..
Keywords: Quality Measures, Quality Indicators (QIs), Quality of Care, Health Information Exchange (HIE), Health Information Technology (HIT)
Anderson KE, Alexander GC, Niles L
Quality of preventive and chronic illness care for insured adults with opioid use disorder.
Investigators sought to measure quality of non-opioid use disorder (OUD) preventive and chronic illness care and care coordination for individuals with OUD compared with individuals without OUD. They used deidentified data on outpatients throughout the United States from claims for commercially insured and Medicare Advantage enrollees aged 18 years or older with diagnosis codes for OUD. They found that individuals with OUD have moderately lower quality of care across preventive and chronic illness care and care coordination for non-OUD care compared with individuals without OUD. They recommended more attention to measurement and improvement of non-OUD care for these individuals.
AHRQ-funded; HS000029.
Citation: Anderson KE, Alexander GC, Niles L .
Quality of preventive and chronic illness care for insured adults with opioid use disorder.
JAMA Netw Open 2021 Apr;4(4):e214925. doi: 10.1001/jamanetworkopen.2021.4925..
Keywords: Opioids, Medication, Substance Abuse, Quality Indicators (QIs), Quality of Care, Behavioral Health, Chronic Conditions, Prevention