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
51 to 75 of 138 Research Studies DisplayedVergis A, Hardy K, Stogryn S
Fellow and attending surgeon operative notes are deficient in reporting established quality indicators for Roux-en-y gastric bypass: a preliminary retrospective analysis of operative dictation.
This retrospective analysis investigated the completeness of reporting documentation for Roux-en-Y Gastric Bypass (RYGB) surgery. A total of 40 bariatric fellow and 40 attending RYGB narrative reports were analyzed. Fellows had a mean completion rate of 66.4% compared to 61.5% for attendings. Fellows also did a better job of completing subsections, with the exception of closure details. This information is important to communicating operative events and can make an impact on patient safety and quality.
AHRQ-funded; HS018546.
Citation: Vergis A, Hardy K, Stogryn S .
Fellow and attending surgeon operative notes are deficient in reporting established quality indicators for Roux-en-y gastric bypass: a preliminary retrospective analysis of operative dictation.
Cureus 2019 Apr 24;11(4):e4535. doi: 10.7759/cureus.4535..
Keywords: Obesity, Quality of Care, Quality Indicators (QIs), Patient Safety, Provider, Provider: Physician, Surgery
Cefalu MS, Elliott MN, Setodji CM
Hospital quality indicators are not unidimensional: a reanalysis of Lieberthal and Comer.
The objective of this study was to evaluate the dimensionality of hospital quality indicators treated as unidimensional in a prior publication. The investigators found that there were four underlying dimensions of hospital quality: patient experience, mortality, and two clinical process dimensions. They concluded that hospital quality should be measured using a variety of indicators reflecting different dimensions of quality.
AHRQ-funded; HS016980; HS016978.
Citation: Cefalu MS, Elliott MN, Setodji CM .
Hospital quality indicators are not unidimensional: a reanalysis of Lieberthal and Comer.
Health Serv Res 2019 Apr;54(2):502-08. doi: 10.1111/1475-6773.13056..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Hospitals, Patient Experience, Provider Performance, Quality of Care, Quality Indicators (QIs), Quality Measures
Blay E, Huang R, Chung JW
Evaluating the impact of the venous thromboembolism outcome measure on the PSI 90 composite quality metric.
Patient Safety Indicator (PSI) 90 is a composite measure widely used in federal pay-for-performance and public reporting programs. A component metric of PSI 90, venous thromboembolism (VTE) rate, has been shown to be subject to surveillance bias and not a valid measure for hospital quality comparisons. A study was conducted to examine how hospital PSI 90 scores would change if the VTE measure were removed from calculation of this composite measure.
AHRQ-funded; HS021857.
Citation: Blay E, Huang R, Chung JW .
Evaluating the impact of the venous thromboembolism outcome measure on the PSI 90 composite quality metric.
Jt Comm J Qual Patient Saf 2019 Mar;45(3):148-55. doi: 10.1016/j.jcjq.2018.08.009..
Keywords: Blood Clots, Patient Safety, Quality Measures, Quality Indicators (QIs), Quality of Care
Shah T, Patel-Teague S, Kroupa L
Impact of a national QI programme on reducing electronic health record notifications to clinicians.
In this study, the investigators evaluated the impact of a national, multicomponent, quality improvement (QI) programme designed to reduce low-value EHR notifications. The investigators found that, based on prior estimates on time to process notifications, this national QI programme potentially saved 1.5 hours per week per PCP to enable higher value work. The investigators also found that the number of daily notifications remained high, suggesting the need for additional multifaceted interventions and protected clinical time to help manage them.
AHRQ-funded; HS022087.
Citation: Shah T, Patel-Teague S, Kroupa L .
Impact of a national QI programme on reducing electronic health record notifications to clinicians.
BMJ Qual Saf 2019 Jan;28(1):10-14. doi: 10.1136/bmjqs-2017-007447..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Indicators (QIs), Quality Improvement, Quality of Care, Primary Care, Primary Care: Models of Care
Gupta S, Zengul FD, Davlyatov GK
Reduction in hospitals' readmission rates: role of hospital-based skilled nursing facilities.
The purpose of this study was to examine the association between hospital-based skilled nursing facilities (HBSNFs) and hospitals' readmission rates. Data sources included the American Hospital Association Annual Survey, Area Health Resources Files, CMS Medicare cost reports and Hospital Compare. Results showed that the presence of HBSNFs was associated with lower readmission rates for acute myocardial infarction and pneumonia. Further, higher skilled nursing facilities to hospitals ratio were associated with lower readmission rates.
AHRQ-funded; HS023345.
Citation: Gupta S, Zengul FD, Davlyatov GK .
Reduction in hospitals' readmission rates: role of hospital-based skilled nursing facilities.
Inquiry 2019 Jan-Dec;56:46958018817994. doi: 10.1177/0046958018817994..
Keywords: Hospital Readmissions, Transitions of Care, Care Coordination, Hospitals, Quality Indicators (QIs), Quality Measures, Quality of Care
Hsu YJ, Kosinski AS, Wallace AS
Using a society database to evaluate a patient safety collaborative: the Cardiovascular Surgical Translational Study.
The authors assessed the utility of using external databases for quality improvement (QI) evaluations in the context of an innovative QI collaborative aimed to reduce three infections and improve patient safety across the cardiac surgery service line. They compared changes in each outcome between 15 intervention hospitals and 52 propensity score-matched hospitals, and found that improvement trends in several outcomes among the studied intervention hospitals were not statistically different from those in comparison hospitals. They conclude that using external databases may permit comparative effectiveness assessment by providing concurrent comparison groups, additional outcome measures, and longer follow-up.
AHRQ-funded; HS019934.
Citation: Hsu YJ, Kosinski AS, Wallace AS .
Using a society database to evaluate a patient safety collaborative: the Cardiovascular Surgical Translational Study.
J Comp Eff Res 2019 Jan;8(1):21-32. doi: 10.2217/cer-2018-0051..
Keywords: Patient Safety, Quality Improvement, Quality Indicators (QIs), Quality of Care, Surgery, Cardiovascular Conditions, Comparative Effectiveness, Data, Hospitals, Research Methodologies, Patient-Centered Outcomes Research
Bath J, Dombrovskiy VY, Vogel TR
Impact of patient safety indicators on readmission after abdominal aortic surgery.
This analysis evaluated whether Patient Safety Indicator (PSI) events after open surgical repair or endovascular aneurysm repair of abdominal aortic aneurysm (AAA) were associated with increased risk of readmission. The investigators concluded that Agency for Healthcare Quality and Research PSI events may be used to identify patients at the greatest risk for readmission after AAA repair. The risk for 30-day readmission was 71% higher when a PSI event occurred and was not associated with the type of repair.
AHRQ-funded; HS022140.
Citation: Bath J, Dombrovskiy VY, Vogel TR .
Impact of patient safety indicators on readmission after abdominal aortic surgery.
J Vasc Nurs 2018 Dec;36(4):189-95. doi: 10.1016/j.jvn.2018.08.002..
Keywords: Patient Safety, Quality Indicators (QIs), Surgery
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
Khoong EC, Cherian R, Rivadeneira NA
Accurate measurement In California's safety-net health systems has gaps and barriers.
The purpose of this study was to measure California’s pay-for-performance program in safety-net hospitals. Results showed both suboptimal performance in aspects of ambulatory safety and questionable reliability in data reporting. Health care systems that lack seamlessly integrated electronic health records and patient registries encountered barriers to reporting reliable ambulatory safety data, precluding accurate performance measurement in many areas. The authors recommended that policymakers and safety advocates support the development of information systems and measures that facilitate the accurate ascertainment of the health systems, patients, and clinical tasks at greatest risk for ambulatory safety failures.
AHRQ-funded; HS024412; HS024426.
Citation: Khoong EC, Cherian R, Rivadeneira NA .
Accurate measurement In California's safety-net health systems has gaps and barriers.
Health Aff 2018 Nov;37(11):1760-69. doi: 10.1377/hlthaff.2018.0709..
Keywords: Ambulatory Care and Surgery, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety, Provider Performance, Quality Indicators (QIs), Payment
Utter GH, Cox GL, Atolagbe OO
Conversion of the Agency for Healthcare Research and Quality's Quality indicators from ICD-9-CM to ICD-10-CM/PCS: the process, results, and implications for users.
The purpose of this study was to describe the process, results, and implications for users, of converting the Agency for Healthcare Research and Quality's (AHRQ) Quality Indicators (QIs) from International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) specifications to ICD, 10th Revision, Clinical Modification and Procedure Classification System (ICD-10-CM/PCS) specifications.
AHRQ-funded; 290201200003I; 290201200001C.
Citation: Utter GH, Cox GL, Atolagbe OO .
Conversion of the Agency for Healthcare Research and Quality's Quality indicators from ICD-9-CM to ICD-10-CM/PCS: the process, results, and implications for users.
Health Serv Res 2018 Oct;53(5):3704-27. doi: 10.1111/1475-6773.12981..
Keywords: Quality Indicators (QIs), Quality Measures, Quality Measures
Anderson JE, Utter GH, Romano PS
Surgeon-reported complications vs AHRQ patient safety indicators: a comparison of two approaches to identifying adverse events.
This retrospective observational study compared 2 approaches for identifying adverse medical events: surgeon-reported complications vs AHRQ patient safety indicators (PSI). The study analyzed the degree to which these 2 processes captured PSI-defined events and reasons for exclusion by each process.
AHRQ-funded; article doesn't include grant number
Citation: Anderson JE, Utter GH, Romano PS .
Surgeon-reported complications vs AHRQ patient safety indicators: a comparison of two approaches to identifying adverse events.
J Am Coll Surg 2018 Sep;227(3):313-20. doi: 10.1016/j.jamcollsurg.2018.06.008..
Keywords: Adverse Events, Patient Safety, Quality Indicators (QIs), Surgery
Cary MP, Prvu Bettger J, Jarvis JM
Successful community discharge following postacute rehabilitation for Medicare beneficiaries: analysis of a patient-centered quality measure.
The purpose of this study was to determine the sociodemographic and clinical characteristics as well as health services use associated with successful community discharge. The investigators retrospectively examined 167,664 Medicare beneficiaries discharged from inpatient rehabilitation facilities (IRFs) in 2013 to determine the sociodemographic and clinical characteristics as well as health services use associated with successful community discharge.
AHRQ-funded; HS022134.
Citation: Cary MP, Prvu Bettger J, Jarvis JM .
Successful community discharge following postacute rehabilitation for Medicare beneficiaries: analysis of a patient-centered quality measure.
Health Serv Res 2018 Aug;53(4):2470-82. doi: 10.1111/1475-6773.12796..
Keywords: Elderly, Medicare, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Rehabilitation, Quality Indicators (QIs), Quality Measures
Comfort LN, Shortell SM, Rodriguez HP
Medicare accountable care organizations of diverse structures achieve comparable quality and cost performance.
The purpose of this study was to examine whether an empirically derived taxonomy of Accountable Care Organizations (ACOs) was associated with quality and spending performance among patients of ACOs in the Medicare Shared Savings Program (MSSP). The investigators found that there was greater heterogeneity within ACO types than between ACO types; there were no consistent differences in quality by ACO type, nor were there differences in likelihood of achieving savings or overall spending per-person-year; and was evidence for higher spending on physician services for physician-led ACOs.
AHRQ-funded; HS024075.
Citation: Comfort LN, Shortell SM, Rodriguez HP .
Medicare accountable care organizations of diverse structures achieve comparable quality and cost performance.
Health Serv Res 2018 Aug;53(4):2303-23. doi: 10.1111/1475-6773.12829..
Keywords: Medicare, Healthcare Costs, Quality Indicators (QIs), Quality of Care
Arthur KC, Mangione-Smith R, Burkhart Q
Quality of care for children with medical complexity: an analysis of continuity of care as a potential quality indicator.
The objective of this study was to examine the relationship between continuity of care for children with medical complexity (CMC) and emergency department (ED) utilization, care coordination quality, and family effects related to care coordination. The investigators measured ED utilization and primary care continuity with the Bice-Boxerman continuity of care index for 1477 CMC using administrative data from Minnesota and Washington state Medicaid agencies. They concluded that continuity of care holds promise as a quality measure for CMC because of its association with lower ED utilization and more frequent receipt of care coordination.
AHRQ-funded; HS020506.
Citation: Arthur KC, Mangione-Smith R, Burkhart Q .
Quality of care for children with medical complexity: an analysis of continuity of care as a potential quality indicator.
Acad Pediatr 2018 Aug;18(6):669-76. doi: 10.1016/j.acap.2018.04.009..
Keywords: Care Coordination, Children/Adolescents, Chronic Conditions, Emergency Department, Healthcare Utilization, Primary Care, Quality of Care, Quality Indicators (QIs), Quality Measures
Parast L, Burkhart Q, Gidengil C
Validation of new care coordination quality measures for children with medical complexity.
The purpose of this paper was to validate new caregiver-reported quality measures assessing care coordination services for children with medical complexity (CMC). Results showed that 19 newly-developed Family Experiences with Coordination of Care quality measures demonstrated convergent validity with previously-validated CAHPS measures. These new measures are valid for assessing the quality of care coordination services provided to CMC and may be useful for evaluating new models of care focused on improving these services.
AHRQ-funded; HS020506.
Citation: Parast L, Burkhart Q, Gidengil C .
Validation of new care coordination quality measures for children with medical complexity.
Acad Pediatr 2018 Jul;18(5):581-88. doi: 10.1016/j.acap.2018.03.006..
Keywords: Care Coordination, Children/Adolescents, Chronic Conditions, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Quality Indicators (QIs), Quality Measures, Quality Improvement, Quality of Care
Briggs ADM, Alderwick H, Fisher ES
Overcoming challenges to US payment reform: could a place-based approach help?
Place-based approaches are defined as giving health care organizations or systems some degree of responsibility for the health or care of all individuals living in a specific place, a geographically defined area such as a county, hospital referral region, or state. As the United States moves away from mandatory participation in payment reform, the current place-based reforms in England offer some useful insights for US policy makers.
AHRQ-funded; HS024075.
Citation: Briggs ADM, Alderwick H, Fisher ES .
Overcoming challenges to US payment reform: could a place-based approach help?
JAMA 2018 Apr 17;319(15):1545-46. doi: 10.1001/jama.2018.1542.
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Keywords: Payment, Policy, Quality Indicators (QIs)
Rahman F, Guan J, Glazier RH
AHRQ Author: Bierman AS
Association between quality domains and health care spending across physician networks.
One of the more fundamental health policy questions is the relationship between health care quality and spending. Researchers measured 65 validated quality indicators (QI) across Ontario physician networks. Higher physician spending, especially outpatient primary care spending, was associated with lower rates of avoidable hospitalizations and higher rates of timely hospital-community transitions and moderately associated with lower readmission rates.
AHRQ-authored.
Citation: Rahman F, Guan J, Glazier RH .
Association between quality domains and health care spending across physician networks.
PLoS One 2018 Apr 3;13(4):e0195222. doi: 10.1371/journal.pone.0195222.
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Keywords: Healthcare Costs, Quality of Care, Patient-Centered Outcomes Research, Quality Indicators (QIs)
McMahon LF, Jr., Howell JD
The hospital: still the doctors' workplace(s) - a cautionary note for approaches to safety and value improvement.
The authors discuss a study by Shahian et al. exploring an important concept: What is the relationship between global hospital safety indicators and specific hospital-level clinical outcomes? They insist that studies assessing hospital quality, safety, and outcomes also address the multiproduct nature of hospital outcomes, operations, safety, and quality.
AHRQ-funded; HS018334.
Citation: McMahon LF, Jr., Howell JD .
The hospital: still the doctors' workplace(s) - a cautionary note for approaches to safety and value improvement.
Health Serv Res 2018 Apr;53(2):601-07. doi: 10.1111/1475-6773.12780.
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Keywords: Hospitals, Outcomes, Quality Indicators (QIs), Quality Improvement
Lau BD, Streiff MB, Pronovost PJ
Venous thromboembolism quality measures fail to accurately measure quality.
This study reviewed a large number of international quality measures for venous thromboembolism (VTE) prevention. Researchers discovered that none of them accurately characterize VTE prevention methods or outcomes in hospitalized patients. They describe an ideal, defect-free VTE prevention process.
AHRQ-funded; HS024547.
Citation: Lau BD, Streiff MB, Pronovost PJ .
Venous thromboembolism quality measures fail to accurately measure quality.
Circulation 2018 Mar 20;137(12):1278-84. doi: 10.1161/circulationaha.116.026897..
Keywords: Blood Clots, Hospitalization, Prevention, Quality Indicators (QIs), Quality Measures
Bhise V, Sittig DF, Vaghani V
An electronic trigger based on care escalation to identify preventable adverse events in hospitalised patients.
Researchers refined the methods of the Institute of Healthcare Improvement's Global Trigger Tool application and leveraged electronic health record data to improve detection of preventable adverse events, including diagnostic errors. In the studied sample, preventable adverse events were identified, including adverse drug events, patient falls, procedure-related complications, and hospital-associated infections. The authors concluded that such e-triggers can help overcome limitations of currently available methods to detect preventable harm in hospitalized patients.
AHRQ-funded; HS022087; HS023602.
Citation: Bhise V, Sittig DF, Vaghani V .
An electronic trigger based on care escalation to identify preventable adverse events in hospitalised patients.
BMJ Qual Saf 2018 Mar;27(3):241-46. doi: 10.1136/bmjqs-2017-006975..
Keywords: Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitalization, Hospitals, Patient Safety, Prevention, Quality of Care, Quality Improvement, Quality Indicators (QIs)
Ryskina KL, Konetzka RT, Werner RM
Association between 5-Star nursing home report card ratings and potentially preventable hospitalizations.
The goal of this study was to test whether the improvements in nursing homes’ 5-star ratings were correlated with reductions in rates of hospitalization; the researchers’ hypothesis was that increased attention to ratings motivated nursing homes to make changes to improve ratings but did not affect hospitalization rate, resulting in a weakened association between ratings and hospitalizations. 2007-2010 Medicare hospital claims and nursing home clinical assessment data were used to compare the correlation between nursing homes’ ratings and hospitalization rates. Correlation weakened slightly after the ratings became publicly available. The researchers conclude that improvements in nursing home ratings after the release of Medicare's 5-star rating system were not accompanied by improvements in a broader measure of outcomes for post-acute care patients and, although this dissociation may be due to additional factors, the 5-star ratings became less meaningful as an indicator of nursing home quality for these patients.
AHRQ-funded; HS021861.
Citation: Ryskina KL, Konetzka RT, Werner RM .
Association between 5-Star nursing home report card ratings and potentially preventable hospitalizations.
Inquiry 2018 Jan-Dec;55:46958018787323. doi: 10.1177/0046958018787323..
Keywords: Elderly, Nursing Homes, Medicare, Quality Indicators (QIs), Provider Performance, Quality Measures, Hospitalization, Quality of Care
Wang Y, Spatz ES, Tariq M
Home health agency performance in the United States: 2011-15.
This review’s evaluation of home health agency quality performance included 11,462 Medicare-certified home health agencies that served 92.4 percent of all ZIP codes nationwide, accounting for 315.2 million people. It found that home health agency performance on several quality indicators varied, and many agencies were persistently in the lowest quartile of performance.
AHRQ-funded; HS023000.
Citation: Wang Y, Spatz ES, Tariq M .
Home health agency performance in the United States: 2011-15.
J Am Geriatr Soc 2017 Dec;65(12):2572-79. doi: 10.1111/jgs.14987.
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Keywords: Quality of Care, Home Healthcare, Quality Indicators (QIs), Quality Measures
Gray, 2nd DM, Hefner JL, Nguyen MC
The link between clinically validated patient safety indicators and clinical outcomes.
The authors performed a retrospective analysis of patient discharges from an academic medical center comprising 6 hospitals from July 2012 to June 2014. The study demonstrated a strong association between clinically validated PSIs and patient outcomes. The findings have important implications in policy and practice as health care reform dictates improvement in the experience of care, health of populations, and per capita costs.
AHRQ-funded; HS024379.
Citation: Gray, 2nd DM, Hefner JL, Nguyen MC .
The link between clinically validated patient safety indicators and clinical outcomes.
Am J Med Qual 2017 Nov/Dec;32(6):583-90. doi: 10.1177/1062860616683014..
Keywords: Outcomes, Patient Safety, Quality Indicators (QIs)
Davies S, Schultz E, Raven M
AHRQ Author: Stocks C
Development and validation of the Agency for Healthcare Research and Quality Measures of Potentially Preventable Emergency Department (ED) Visits: the ED Prevention Quality Indicators for general health conditions.
The researchers sought to develop and validate rates of potentially preventable emergency department (ED) visits as indicators of community health. ED Prevention Quality Indicators (PQI) rates varied widely across U.S. communities. Indicator rates were significantly associated with county-level poverty, median income, Medicaid insurance, and levels of uninsurance. A few indicators were significantly associated with PCP density, with higher rates in areas with greater density.
AHRQ-authored; AHRQ-funded; 2902012000031.
Citation: Davies S, Schultz E, Raven M .
Development and validation of the Agency for Healthcare Research and Quality Measures of Potentially Preventable Emergency Department (ED) Visits: the ED Prevention Quality Indicators for general health conditions.
Health Serv Res 2017 Oct;52(5):1667-84. doi: 10.1111/1475-6773.12687.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Quality Indicators (QIs), Patient Safety, Prevention
Goldberg EM, Morphis B, Youssef R
An analysis of diagnoses that drive readmission: what can we learn from the hospitals in Southern New England with the highest and lowest readmission performance?
This study examined the most common diagnoses driving readmissions among fee-for-service Medicare beneficiaries in the hospitals with the highest and lowest readmission performance in Southern New England from 2014 to 2016. It found that the lowest-performing hospitals readmitted higher percentages of patients for sepsis and complications of device, implant, or graft, compared to highest-performing hospitals.
AHRQ-funded; HS000011.
Citation: Goldberg EM, Morphis B, Youssef R .
An analysis of diagnoses that drive readmission: what can we learn from the hospitals in Southern New England with the highest and lowest readmission performance?
R I Med J 2017 Aug;100(8):23-28.
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Keywords: Adverse Events, Diagnostic Safety and Quality, Hospital Readmissions, Hospitals, Quality Indicators (QIs)