National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Events (2)
- Antibiotics (1)
- Cardiovascular Conditions (1)
- Central Line-Associated Bloodstream Infections (CLABSI) (2)
- Children/Adolescents (3)
- Clinical Decision Support (CDS) (1)
- Community-Acquired Infections (2)
- Diagnostic Safety and Quality (2)
- Disparities (1)
- Elderly (1)
- Electronic Health Records (EHRs) (1)
- Emergency Department (3)
- Emergency Medical Services (EMS) (2)
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- Healthcare-Associated Infections (HAIs) (3)
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- Healthcare Utilization (1)
- Health Information Technology (HIT) (2)
- Heart Disease and Health (1)
- Home Healthcare (1)
- Hospitalization (1)
- Hospitals (2)
- Infectious Diseases (1)
- Intensive Care Unit (ICU) (2)
- Long-Term Care (1)
- Medicare (1)
- Mortality (6)
- Nursing Homes (1)
- Outcomes (5)
- Patient-Centered Outcomes Research (1)
- Patient Safety (1)
- Payment (1)
- Practice Patterns (1)
- Prevention (1)
- Quality Improvement (1)
- Quality Measures (2)
- Quality of Care (3)
- Quality of Life (1)
- Risk (1)
- (-) Sepsis (21)
- Social Determinants of Health (1)
- Surgery (1)
- Training (1)
- Transplantation (1)
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 21 of 21 Research Studies DisplayedRhee C, Kalil AC
Toward a more nuanced approach to the early administration of intravenous fluids in patients with sepsis.
In this paper the authors discuss an article by Lane et al., published in 2018 in JAMA Network Open, related to the early administration of intravenous fluids in patients with sepsis.
AHRQ-funded; HS025008.
Citation: Rhee C, Kalil AC .
Toward a more nuanced approach to the early administration of intravenous fluids in patients with sepsis.
JAMA Netw Open 2018 Dec 7;1(8):e185844. doi: 10.1001/jamanetworkopen.2018.5844..
Keywords: Emergency Medical Services (EMS), Mortality, Sepsis
Keller SC, Williams D, Rock C
A new frontier: central line-associated bloodstream infection surveillance in home infusion therapy.
As more home infusion agencies consider ways to perform surveillance for central line–associated bloodstream infection (CLABSI), an understanding of the assorted challenges is necessary. The authors discussed these challenges, which include a lack of a widely accepted standard definition of CLABSIs in home infusion therapy, the lack of a reporting platform, the absence of a reporting requirement, and barriers in obtaining the needed information to identify the presence of a potential CLABSI and adjudicate whether it meets a CLABSI definition. The 21st Century Cures Act will expand Medicare coverage for home infusion therapy services by 2021, likely leading to increased pressure for home infusion therapy CLABSI surveillance. Benchmarking of CLABSI data can usher in informed work to reduce CLABSIs and enhance patient safety in home infusion therapy.
AHRQ-funded; HS025782.
Citation: Keller SC, Williams D, Rock C .
A new frontier: central line-associated bloodstream infection surveillance in home infusion therapy.
Am J Infect Control 2018 Dec;46(12):1419-21. doi: 10.1016/j.ajic.2018.05.016..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Home Healthcare, Patient Safety, Sepsis, Infectious Diseases, Prevention
Kempker JA, Martin GS
Severity and timing of onset drive economic costs and clinical outcomes with sepsis.
Sepsis disproportionately affects older adults (mean age, 65 yr); is predominantly community acquired (87%); is expensive (mean hospital costs $21,500); and is associated with high hospital mortality (one in eight patients) and high rates of 30-day readmission for survivors (one in eight patients). In this editorial, the authors discuss an article- by Paoli et al, published in 2018 in Volume 46 of Critical Care Medicine- on sepsis epidemiology.
AHRQ-funded; HS025240.
Citation: Kempker JA, Martin GS .
Severity and timing of onset drive economic costs and clinical outcomes with sepsis.
Crit Care Med 2018 Dec;46(12):2043-44. doi: 10.1097/ccm.0000000000003376..
Keywords: Healthcare Costs, Mortality, Outcomes, Sepsis
George M, Iramiot JS, Muhindo R
Bacterial aetiology and antibiotic susceptibility profile of post-operative sepsis among surgical patients in a tertiary hospital in rural Eastern Uganda.
This study aimed at determining the prevalence and antimicrobial resistance patterns of bacterial pathogens isolated from post-operative wound infections at Mbale Regional Referral Hospital. The investigators found that Staphylococcus aureus was the most common causative agent associated with postoperative sepsis with most of the strains being MRSA. Multi-drug resistance was observed in 60.6% of the isolated organisms in their study.
AHRQ-funded; HS020098.
Citation: George M, Iramiot JS, Muhindo R .
Bacterial aetiology and antibiotic susceptibility profile of post-operative sepsis among surgical patients in a tertiary hospital in rural Eastern Uganda.
Microbiol Res J Int 2018;24(2). doi: 10.9734/mrji/2018/41690..
Keywords: Adverse Events, Healthcare-Associated Infections (HAIs), Sepsis, Surgery
Rhee C, Filben MR, Massaro AF
Compliance with the national SEP-1 quality measure and association with sepsis outcomes: a multicenter retrospective cohort study.
Many septic patients receive care that fails the Centers for Medicare and Medicaid Services' SEP-1 measure, but it is unclear whether this reflects meaningful lapses in care, differences in clinical characteristics, or excessive rigidity of the "all-or-nothing" measure. This study’s investigators compared outcomes in cases that passed versus failed SEP-1 during the first 2 years after the measure was implemented.
AHRQ-funded; HS025008.
Citation: Rhee C, Filben MR, Massaro AF .
Compliance with the national SEP-1 quality measure and association with sepsis outcomes: a multicenter retrospective cohort study.
Crit Care Med 2018 Oct;46(10):1585-91. doi: 10.1097/ccm.0000000000003261..
Keywords: Quality Measures, Quality Measures, Outcomes, Sepsis
Hume PS, Varon J, Englert JA
Trends in "usual care" for septic shock.
The investigators examined changes in treatment patterns for septic shock in the emergency department (ED) of a large academic hospital. The investigators observed, from 2003 to 2013, significant reductions in time to antibiotics and fluids for patients with septic shock in the ED, underscoring the evolution of “usual care” over time. These findings may explain why early goal-directed therapy is not beneficial in the current era and may help inform ongoing deliberations regarding best practices for sepsis care.
AHRQ-funded; HS025008.
Citation: Hume PS, Varon J, Englert JA .
Trends in "usual care" for septic shock.
Infect Control Hosp Epidemiol 2018 Sep;39(9):1125-26. doi: 10.1017/ice.2018.154..
Keywords: Antibiotics, Emergency Department, Practice Patterns, Sepsis
Rhee C, Brown SR, Jones TM
Variability in determining sepsis time zero and bundle compliance rates for the Centers for Medicare and Medicaid services SEP-1 measure.
This study compared sepsis ‘time zero’ and CMS SEP-1 pass rates among 3 abstractors in 3 hospitals. Abstractors agreed on time zero in 29 out of 80 cases, and the perceived pass rates ranged from 9 to 19 out of 80 cases (23%). The authors conclude that this variability in time zero and perceived pass rates limits the utility of SEP-1 for measuring quality.
AHRQ-funded; HS025008.
Citation: Rhee C, Brown SR, Jones TM .
Variability in determining sepsis time zero and bundle compliance rates for the Centers for Medicare and Medicaid services SEP-1 measure.
Infect Control Hosp Epidemiol 2018 Aug;39(8):994-96. doi: 10.1017/ice.2018.134..
Keywords: Guidelines, Quality of Care, Quality Measures, Sepsis
Sloane PD, Ward K, Weber DJ
Can sepsis be detected in the nursing home prior to the need for hospital transfer?
The purpose of this study was to determine whether and to what extent simple screening tools might identify nursing home (NH) residents who are at high risk of becoming septic. The authors concluded that NHs need better systems to monitor NH residents whose status is changing, and to present that information to medical providers in real time, either through rapid medical response programs or telemetry.
AHRQ-funded; HS022846.
Citation: Sloane PD, Ward K, Weber DJ .
Can sepsis be detected in the nursing home prior to the need for hospital transfer?
J Am Med Dir Assoc 2018 Jun;19(6):492-96.e1. doi: 10.1016/j.jamda.2018.02.001..
Keywords: Sepsis, Nursing Homes, Long-Term Care, Diagnostic Safety and Quality, Elderly
Austrian JS, Jamin CT, Doty GR
Impact of an emergency department electronic sepsis surveillance system on patient mortality and length of stay.
The goal of this study was to determine if an electronic health record (EHR) based sepsis alert system could improve quality of care and clinical outcomes for patients with sepsis. A patient-level, interrupted time series study of emergency department patients with severe sepsis or septic shock was conducted, with an intervention introduced at the approximate mid-point--a system of interruptive sepsis alerts triggered by abnormal vital signs or laboratory results. Mean length of stay for patients with sepsis decreased significantly following the introduction of the alert, but the alert system had no effect on mortality or other clinical or process measures. The researchers conclude that a more sophisticated algorithm for sepsis identification is needed to improve outcomes.
AHRQ-funded; HS023683.
Citation: Austrian JS, Jamin CT, Doty GR .
Impact of an emergency department electronic sepsis surveillance system on patient mortality and length of stay.
J Am Med Inform Assoc 2018 May;25(5):523-29. doi: 10.1093/jamia/ocx072..
Keywords: Electronic Health Records (EHRs), Emergency Department, Health Information Technology (HIT), Hospitals, Mortality, Outcomes, Quality Improvement, Quality of Care, Sepsis
Valley TS, Nallamothu BK, Heung M
Hospital variation in renal replacement therapy for sepsis in the United States.
This retrospective cohort study estimated the risk- and reliability-adjusted rate of acute renal replacement therapy use for patients with sepsis and acute kidney injury at each hospital sampled by the Nationwide Inpatient Sample in 2011. The investigators examined the association between hospital-specific renal replacement therapy rate and in-hospital mortality and hospital costs after adjusting for patient and hospital characteristics.
AHRQ-funded; HS020672.
Citation: Valley TS, Nallamothu BK, Heung M .
Hospital variation in renal replacement therapy for sepsis in the United States.
Crit Care Med 2018 Feb;46(2):e158-e65. doi: 10.1097/ccm.0000000000002878..
Keywords: Healthcare Costs, Healthcare Utilization, Healthcare Cost and Utilization Project (HCUP), Hospitals, Sepsis
Geis GL, Wheeler DS, Bunger A
A validation argument for a simulation-based training course centered on assessment, recognition, and early management of pediatric sepsis.
The aim of this study was to create a validity argument for the use of a simulation-based training course centered on assessment, recognition, and early management of sepsis in a laboratory-based setting. The authors concluded that, although incomplete, evidence from initial testing suggests that the simulations of pediatric sepsis were sufficiently valid to justify their use in training novice pediatric physicians in the assessment, recognition, and management of pediatric sepsis.
AHRQ-funded; HS020455.
Citation: Geis GL, Wheeler DS, Bunger A .
A validation argument for a simulation-based training course centered on assessment, recognition, and early management of pediatric sepsis.
Simul Healthc 2018 Feb;13(1):16-26. doi: 10.1097/sih.0000000000000271..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Sepsis, Training
Prescott HC, Costa DK
Improving long-term outcomes after sepsis.
This study discusses how to improve long term outcomes after sepsis and asserts that to improve long-term outcomes, in-hospital care should focus on early, effective treatment of sepsis; minimization of delirium, distress, and immobility; and preparing patients for hospital discharge.
AHRQ-funded; HS024552.
Citation: Prescott HC, Costa DK .
Improving long-term outcomes after sepsis.
Crit Care Clin 2018 Jan;34(1):175-88. doi: 10.1016/j.ccc.2017.08.013..
Keywords: Outcomes, Quality of Life, Sepsis
Gurigis FW, Donnelly JP, Dodani S
Cholesterol levels and long-term rates of community-acquired sepsis.
The researchers sought to determine the relationship between baseline cholesterol levels and long-term rates of sepsis. They found that low low-density lipoprotein cholesterol (LDL-C) was associated with higher long-terms rates of community-acquired sepsis. High-density lipoprotein cholesterol (HDL-C) level was not associated with long-term sepsis rates.
AHRQ-funded; HS013852.
Citation: Gurigis FW, Donnelly JP, Dodani S .
Cholesterol levels and long-term rates of community-acquired sepsis.
Crit Care 2016 Dec 23;20(1):408. doi: 10.1186/s13054-016-1579-8.
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Keywords: Heart Disease and Health, Community-Acquired Infections, Sepsis
Wheeler DS, Wong HR
Sepsis in pediatric cardiac intensive care.
The authors reviewed risk factors for developing sepsis; the role of biomarkers; and the pathophysiology and management of severe sepsis and septic shock. They concluded that while scientific advances in the diagnosis and clinical staging of sepsis offer tremendous promise for the future, it is also evident that sepsis mortality has not improved enough, even with progress in our understanding of the molecular pathophysiology of sepsis.
AHRQ-funded; HS020455.
Citation: Wheeler DS, Wong HR .
Sepsis in pediatric cardiac intensive care.
Pediatr Crit Care Med 2016 Aug;17(8 Suppl 1):S266-71. doi: 10.1097/pcc.0000000000000796.
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Keywords: Cardiovascular Conditions, Children/Adolescents, Intensive Care Unit (ICU), Children/Adolescents, Sepsis
Donnelly JP, Locke JE, MacLennan PA
Inpatient mortality among solid organ transplant recipients hospitalized for sepsis and severe sepsis.
The researchers investigated the impact of solid organ transplant (SOT) on outcomes following sepsis. They found that among patients hospitalized for severe sepsis or sepsis, those with SOT had lower inpatient mortality than those without SOT.
AHRQ-funded; HS013852.
Citation: Donnelly JP, Locke JE, MacLennan PA .
Inpatient mortality among solid organ transplant recipients hospitalized for sepsis and severe sepsis.
Clin Infect Dis 2016 Jul 15;63(2):186-94. doi: 10.1093/cid/ciw295.
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Keywords: Transplantation, Mortality, Sepsis, Hospitalization, Patient-Centered Outcomes Research
Moore JX, Donnelly JP, Griffin R
Defining sepsis mortality clusters in the United States.
The researchers aimed to identify US counties with high sepsis mortality and to assess the community characteristics associated with increased sepsis mortality. They found that sepsis mortality is higher in the southern United States and that regions of high sepsis mortality are characterized by lower education, income, employment, and insurance coverage.
AHRQ-funded; HS013852.
Citation: Moore JX, Donnelly JP, Griffin R .
Defining sepsis mortality clusters in the United States.
Crit Care Med 2016 Jul;44(7):1380-7. doi: 10.1097/ccm.0000000000001665.
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Keywords: Mortality, Sepsis, Social Determinants of Health
Wang HE, Donnelly JP, Griffin R
Derivation of novel risk prediction scores for community-acquired sepsis and severe sepsis.
The researchers derived and internally validated a Sepsis Risk Score and a Severe Sepsis Risk Score predicting future sepsis and severe sepsis events among community-dwelling adults. They concluded that the Sepsis Risk Score and Severe Sepsis Risk Score predict 10-year sepsis and severe sepsis risk among community-dwelling adults and may aid in sepsis prevention or mitigation efforts.
AHRQ-funded; HS013852.
Citation: Wang HE, Donnelly JP, Griffin R .
Derivation of novel risk prediction scores for community-acquired sepsis and severe sepsis.
Crit Care Med 2016 Jul;44(7):1285-94. doi: 10.1097/ccm.0000000000001666.
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Keywords: Community-Acquired Infections, Risk, Risk, Sepsis
Harrison AM, Gajic O, Pickering BW
Development and implementation of sepsis alert systems.
Development and implementation of sepsis alert systems is challenging, particularly outside the monitored intensive care unit (ICU) setting. Current evidence does not support routine use of sepsis alert systems in clinical practice. Continuous improvement in the afferent and efferent aspects will help translate theoretic advantages into measurable patient benefit.
AHRQ-funded; HS022799.
Citation: Harrison AM, Gajic O, Pickering BW .
Development and implementation of sepsis alert systems.
Clin Chest Med 2016 Jun;37(2):219-29. doi: 10.1016/j.ccm.2016.01.004..
Keywords: Intensive Care Unit (ICU), Sepsis, Outcomes, Adverse Events
Kessler DO, Walsh B, Whitfill T
Disparities in adherence to pediatric sepsis guidelines across a spectrum of emergency departments: a multicenter, cross-sectional observational in situ simulation study.
The authors sought to measure and compare adherence to pediatric sepsis guidelines across a spectrum of emergency departments. They found that among 47 teams across 24 emergency departments, adherent teams had significantly higher Emergency Medical Services for Children readiness scores, MD composition of physicians to total team members, teamwork scores, provider perceptions of pediatric preparedness, and provider perceptions of sepsis preparedness. They concluded that only composite team experience level of the providers was associated with improved guideline adherence.
AHRQ-funded; HS020286.
Citation: Kessler DO, Walsh B, Whitfill T .
Disparities in adherence to pediatric sepsis guidelines across a spectrum of emergency departments: a multicenter, cross-sectional observational in situ simulation study.
J Emerg Med 2016 Mar;50(3):403-15.e1-3. doi: 10.1016/j.jemermed.2015.08.004.
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Keywords: Emergency Department, Disparities, Guidelines, Children/Adolescents, Sepsis
Taylor RA, Pare JR, Venkatesh AK
Prediction of in-hospital mortality in emergency department patients with sepsis: A local big data-driven, machine learning approach.
In this proof-of-concept study, a local, big data-driven, machine learning approach is compared to existing clinical decision rules (CDRs) and traditional analytic methods using the prediction of sepsis in-hospital mortality as the use case. It concluded that this approach outperformed existing CDRs as well as traditional analytic techniques for predicting in-hospital mortality of ED patients with sepsis.
AHRQ-funded; HS021271.
Citation: Taylor RA, Pare JR, Venkatesh AK .
Prediction of in-hospital mortality in emergency department patients with sepsis: A local big data-driven, machine learning approach.
Acad Emerg Med 2016 Mar;23(3):269-78. doi: 10.1111/acem.12876.
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Keywords: Emergency Medical Services (EMS), Mortality, Clinical Decision Support (CDS), Sepsis, Health Information Technology (HIT)
Calderwood MS, Vaz LE, Tse Kawai A
Impact of hospital operating margin on central line-associated bloodstream infections following Medicare's hospital-acquired conditions payment policy.
In October 2008, Medicare ceased additional payment for hospital-acquired conditions not present on admission. The researchers evaluated the policy's differential impact in hospitals with high vs low operating margins. They concluded that Medicare's payment policy may have had an impact on reducing central line-associated bloodstream infections in hospitals with low operating margins.
AHRQ-funded; HS018414.
Citation: Calderwood MS, Vaz LE, Tse Kawai A .
Impact of hospital operating margin on central line-associated bloodstream infections following Medicare's hospital-acquired conditions payment policy.
Infect Control Hosp Epidemiol 2016 Jan;37(1):100-3. doi: 10.1017/ice.2015.250.
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Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Medicare, Quality of Care, Payment, Sepsis