National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Arthritis (1)
- Cancer (2)
- Cancer: Lung Cancer (1)
- Cancer: Prostate Cancer (1)
- Children/Adolescents (2)
- Diagnostic Safety and Quality (1)
- Disparities (2)
- Elderly (1)
- Evidence-Based Practice (2)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Delivery (1)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (1)
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- Human Immunodeficiency Virus (HIV) (1)
- Implementation (1)
- Infectious Diseases (1)
- Long-Term Care (1)
- Maternal Care (1)
- Nursing Homes (1)
- Outcomes (1)
- Patient-Centered Outcomes Research (2)
- Pressure Ulcers (1)
- Primary Care (1)
- Provider Performance (1)
- Quality Improvement (3)
- Quality Indicators (QIs) (1)
- (-) Quality Measures (9)
- Quality of Care (8)
- Racial and Ethnic Minorities (1)
- Sexual Health (1)
- Telehealth (1)
- Women (2)
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 9 of 9 Research Studies DisplayedBingham CA, Harris JG, Qui T
Pediatric Rheumatology Care and Outcomes Improvement Network's quality measure set to improve care of children with juvenile idiopathic arthritis.
The objective of this study was to describe the selection, development, and implementation of quality measures for juvenile idiopathic arthritis (JIA) by the Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), a multihospital learning health network. Clinicians in PR-COIN and parents of children with JIA collaboratively selected outcome quality measures and a committee of rheumatologists and data analysts developed operational definitions. Initial measures were clinical inactive disease, low pain score, and optimal physical functioning; the revised set included additional measures of disease activity, data quality, and a balancing measure. The authors concluded that PR-COIN's set of JIA quality measures is the first comprehensive set used at the point-of-care for a large cohort of JIA patients in a variety of pediatric rheumatology practice settings.
AHRQ-funded; HS021114.
Citation: Bingham CA, Harris JG, Qui T .
Pediatric Rheumatology Care and Outcomes Improvement Network's quality measure set to improve care of children with juvenile idiopathic arthritis.
Arthritis Care Res 2023 Dec; 75(12):2442-52. doi: 10.1002/acr.25168.
Keywords: Children/Adolescents, Arthritis, Quality Measures, Quality Improvement, Quality of Care, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Agniel D, Cabreros I, Damberg CL
A formal framework for incorporating equity into health care quality measurement.
This paper examines how tying incentives on the basis of stratification or disparities in quality measurement may have unintended consequences or limited effects. Addressing one aspect of equity may be in competition with addressing others. The authors proposed equity weighting, a new measurement framework to advance equity on multiple fronts that addresses the shortcomings of existing approaches and explicitly calibrates incentives to align with equity goals. They used colorectal cancer screening data derived from 2017 Medicare claims to illustrate how equity weighting fixes unintended consequences in other methods and how it can be adapted to policy goals.
AHRQ-funded; HS024067.
Citation: Agniel D, Cabreros I, Damberg CL .
A formal framework for incorporating equity into health care quality measurement.
Health Aff 2023 Oct; 42(10):1383-91. doi: 10.1377/hlthaff.2022.01483..
Keywords: Quality Measures, Quality Improvement, Quality of Care, Disparities
Murphy DR, Zimolzak AJ, Upadhyay DK
Developing electronic clinical quality measures to assess the cancer diagnostic process.
Electronic clinical quality measures (eCQMs) to evaluate quality of cancer diagnosis could facilitate quantification and improvement of diagnostic performance. The purpose of this study was to developed 2 eCQMs to evaluate diagnostic assessment of red-flag clinical findings for colorectal cancer (CRC) and lung cancer. At each site the researchers assessed 100 positive and 20 negative randomly chosen records for each eCQM at each site to validate accuracy and categorized missed opportunities associated with system, provider, or patient factors. The researchers applied the CRC eCQM at both sites, while the lung cancer eCQM was only applied at the VA due to an absence of structured data indicating level of cancer suspicion on most chest imaging results at Geisinger. The study found that for the CRC eCQM, the appropriate follow-up took place in 26, 746 out of 74, 314 patients (36.0%) in the VA after removing clinical exclusions and in 1,009 out of 2,461 patients (41.1%) at Geisinger. The appropriate assessment for lung cancer in the VA took place in 25, 166 out of 40, 924 patients (61.5). Provider factors were cited by reviewers the primary source of missed opportunities at both sites.
AHRQ-funded; HS022087.
Citation: Murphy DR, Zimolzak AJ, Upadhyay DK .
Developing electronic clinical quality measures to assess the cancer diagnostic process.
J Am Med Inform Assoc 2023 Aug 18; 30(9):1526-31. doi: 10.1093/jamia/ocad089..
Keywords: Cancer: Lung Cancer, Cancer, Quality Measures, Diagnostic Safety and Quality, Quality of Care
Rome D, Sales A, Cornelius T
Impact of telemedicine modality on quality metrics in diverse settings: implementation science-informed retrospective cohort study.
The objective of this study was to assess telemedicine uptake during the COVID-19 pandemic and impact of visit modality on primary care quality metrics in diverse, low socioeconomic status settings. Research was informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Researchers found that there were marginally better quality metrics for in-person care versus video and phone visits, and that de-adoption of telemedicine was marked within 2 years in the study population. They concluded that the impact of visit modality on quality outcomes, provider and patient preferences, and technological barriers in historically marginalized settings should be considered.
AHRQ-funded; HS025198.
Citation: Rome D, Sales A, Cornelius T .
Impact of telemedicine modality on quality metrics in diverse settings: implementation science-informed retrospective cohort study.
J Med Internet Res 2023 Jul 26; 25:e47670. doi: 10.2196/47670..
Keywords: Telehealth, Health Information Technology (HIT), Implementation, Quality Measures, Quality of Care
Smith DC, Phillippi JC, Tilden EL
Comparing cesarean birth utilization between US hospitals: a demonstration of the robson ten-group classification system for use in quality improvement and benchmarking.
The objective of this study was to describe the application and utility of the World Health Organization-endorsed Robson Ten-Group Classification System (TGCS) to compare hospital-level cesarean births rates for use in quality improvement and benchmarking. The authors conducted a descriptive, secondary data analysis of the Consortium on Safe Labor dataset using data from births from 2002-08 at 12 sites across the US. Results showed a variation in use of cesarean birth, labor induction, and trial of labor after cesarean (TOLAC) across the 12 sites. The authors concluded that TGCS provides a method for between-hospital comparisons and adoption of TGCS in the US would provide an effective benchmarking tool to assist in reducing the use of cesarean birth and increasing the support of TOLAC.
AHRQ-funded; HS024733.
Citation: Smith DC, Phillippi JC, Tilden EL .
Comparing cesarean birth utilization between US hospitals: a demonstration of the robson ten-group classification system for use in quality improvement and benchmarking.
J Perinat Neonatal Nurs 2023 Jul-Sep; 37(3):214-22. doi: 10.1097/jpn.0000000000000670..
Keywords: Hospitals, Healthcare Utilization, Maternal Care, Women, Quality Improvement, Quality Measures, Quality of Care
Teixeira da Silva D, Makeneni S, Wall H
Measuring quality STI care among adolescent female primary care patients in Philadelphia.
The purpose of this study was to develop and apply a cross-setting, sexually transmitted infection (STI) Care Continuum to improve STI care quality, to assess adherence to guideline-recommended care, and to standardize progress measurement toward National Strategic goals. Review of the CDC STI treatment guidelines identified seven distinct steps of care for gonorrhea, chlamydia, and syphilis; researchers used Youth Risk Behavior Surveillance Survey data to estimate step 1, and electronic health record data for steps 2, 3, 4, 6 and 7. The researchers concluded that local application of an STI Care Continuum identified STI testing, retesting, and HIV testing as areas for improvement. Similar methods may be applied to target resources, standardize data collection and reporting, and improve STI care quality.
AHRQ-funded; HS026116.
Citation: Teixeira da Silva D, Makeneni S, Wall H .
Measuring quality STI care among adolescent female primary care patients in Philadelphia.
Sex Transm Infect 2023 Jun; 99(4):272-75. doi: 10.1136/sextrans-2022-055623..
Keywords: Children/Adolescents, Sexual Health, Infectious Diseases, Primary Care, Women, Human Immunodeficiency Virus (HIV), Quality Measures, 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
JE Wallis, CJD Huang, LC
AHRQ Author: Tallman
Association between adherence to radiation therapy quality metrics and patient reported outcomes in prostate cancer.
Researchers evaluated the impact of compliance with nationally recognized radiation therapy quality measures on patient-reported health-related quality of life outcomes in the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) population-based, prospective cohort study of men with localized prostate cancer. Eight quality measures were identified based on national guidelines. In multivariable analyses, no clinically significant associations were discovered between compliance with evaluated radiation therapy quality measures and patient-reported outcomes such as urinary irritation, urinary incontinence, bowel, sexual or hormonal function. The researchers concluded that further work would be needed to identify patient-centered quality measures of prostate cancer care.
AHRQ-funded; HS019356.
Citation: JE Wallis, CJD Huang, LC .
Association between adherence to radiation therapy quality metrics and patient reported outcomes in prostate cancer.
Prostate Cancer Prostatic Dis 2023 Mar;26(1):80-87. doi: 10.1038/s41391-022-00518-5.
Keywords: Cancer: Prostate Cancer, Cancer, Patient-Centered Outcomes Research, Evidence-Based Practice, Quality Measures
Beaulieu ND, Chernew ME, McWilliams JM
Organization and performance of US health systems.
The objectives of this evidence review were to identify and describe health systems in the US, to assess differences between physicians and hospitals in and outside of health systems, and to compare quality and cost of care delivered by physicians and hospitals in and outside of health systems. A total of 580 health systems in a great variety of sizes were identified; prices for physician, hospital services, and total spending were assessed in 2018 commercial claims data. Health system physicians and hospitals were shown to deliver a large portion of medical services. Clinical quality performance and patient experience measures were slightly better in systems; however, spending and prices were significantly higher, especially in small practices. The authors concluded that slight quality differentials in combination with large price differentials suggested that health systems have not realized their potential for better care at equal or lower cost.
AHRQ-funded; HS024072.
Citation: Beaulieu ND, Chernew ME, McWilliams JM .
Organization and performance of US health systems.
JAMA 2023 Jan 24; 329(4):325-35. doi: 10.1001/jama.2022.24032..
Keywords: Health Systems, Healthcare Delivery, Provider Performance, Quality Measures, Quality of Care, Hospitals