National Healthcare Quality and Disparities Report
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Topics
- Access to Care (1)
- Adverse Events (3)
- Asthma (1)
- Cardiovascular Conditions (2)
- Care Coordination (1)
- (-) Children/Adolescents (16)
- Comparative Effectiveness (1)
- COVID-19 (1)
- Critical Care (6)
- Education: Continuing Medical Education (2)
- Electronic Health Records (EHRs) (2)
- Emergency Department (4)
- Evidence-Based Practice (4)
- Health Information Technology (HIT) (2)
- Hospitals (1)
- Inpatient Care (1)
- Intensive Care Unit (ICU) (6)
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- Medication: Safety (1)
- Outcomes (5)
- Palliative Care (1)
- Patient-Centered Outcomes Research (4)
- Patient Safety (4)
- Quality Improvement (3)
- Quality of Care (2)
- (-) Registries (16)
- Respiratory Conditions (3)
- Simulation (1)
- Social Determinants of Health (1)
- Surgery (2)
- Training (1)
- Transplantation (2)
- Trauma (1)
- Treatments (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 16 of 16 Research Studies DisplayedCapone CA, Emerson B, Sweberg T
Intubation practice and outcomes among pediatric emergency departments: a report from National Emergency Airway Registry for Children (NEAR4KIDS).
The purpose of this study was to describe Tracheal Intubation (TI) practice and outcomes in pediatric Emergency Departments as compared to those in intensive care units (ICUs) and use the resulting data to identify targets for quality improvement. The researchers analyzed consecutive TI encounters from pediatric EDs and ICUs in the National Emergency Airway Registry for Children (NEAR4KIDS) database from 2015 to 2018. The study found a total of 12,512 TIs in 51 pediatric/cardiac ICUs, and 756 TIs in 13 pediatric EDs and were reported. Proportion of TIs for shock (26% ED vs. 14% ICU), respiratory decompensation (52% vs. 64%), and neurologic deterioration (30% vs. 11%) also differed by location. Limited neck mobility was reported more often in the ED (16% vs. 6%). TIs in the ED were performed more often via video laryngoscopy (64% vs. 29%). Oxygen desaturation was less commonly reported in ED TIs (13.6%) than ICU TIs (17%). Among ED TIs, shock as an indication and limited mouth opening were independently associated with adverse TI-associated events (TIAEs). The study concluded that TI characteristics vary between pediatric EDs and ICUs, yet outcomes are similar.
AHRQ-funded; HS022464.
Citation: Capone CA, Emerson B, Sweberg T .
Intubation practice and outcomes among pediatric emergency departments: a report from National Emergency Airway Registry for Children (NEAR4KIDS).
Acad Emerg Med 2022 Apr;29(4):406-14. doi: 10.1111/acem.14431..
Keywords: Children/Adolescents, Emergency Department, Registries, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice, Critical Care, Intensive Care Unit (ICU)
de Loizaga SR, Schneider K, Beck AF
Socioeconomic impact on outcomes during the first year of life of patients with single ventricle heart disease: an analysis of the National Pediatric Cardiology Quality Improvement Collaborative Registry.
In a retrospective cohort analysis of infants enrolled in the National Pediatric Cardiology Improvement Collaborative, researchers investigated the impact of community-level deprivation on morbidity and mortality for infants with single ventricle heart disease in the first year of life. They found that community deprivation was associated with mortality and length of stay for patients with single ventricle congenital heart disease. While patients near the mean deprivation index had a higher hazard of one year mortality compared to those at the extremes of the deprivation index, length of stay and deprivation index were linearly associated, demonstrating the complex nature of socioeconomic factors.
AHRQ-funded; HS021114.
Citation: de Loizaga SR, Schneider K, Beck AF .
Socioeconomic impact on outcomes during the first year of life of patients with single ventricle heart disease: an analysis of the National Pediatric Cardiology Quality Improvement Collaborative Registry.
Pediatr Cardiol 2022 Mar;43(3):605-15. doi: 10.1007/s00246-021-02763-2..
Keywords: Children/Adolescents, Social Determinants of Health, Quality Improvement, Quality of Care, Cardiovascular Conditions, Registries, Outcomes
Bhalala US, Gist KM, Tripathi S
Characterization and outcomes of hospitalized children with coronavirus disease 2019: a report from a multicenter, viral infection and respiratory illness universal study (Coronavirus Disease 2019) registry.
The purpose of this retrospective study was to examine data from the Society of Critical Care Medicine Viral Infection and Respiratory Illness Universal Study (Coronavirus Disease 2019) registry and describe the characteristics, ICU admissions, and outcomes in children hospitalized with COVID-19. The study included 874 children under the age of 18 hospitalized with coronavirus disease 2019 at 51 participating hospital centers from February 2020 to January 2021. The primary outcome was ICU admission. Secondary outcomes included hospital and ICU duration of stay and ICU, hospital, and 28-day mortality. The researchers found that the median age was 8 years, with 62.9% non-Hispanic and a boy to girl ratio of 1:2. A total of 28.2% of the children met the Centers for Disease Control and Prevention criteria for multisystem inflammatory syndrome in children, and 46.2% were admitted to the ICU. A child’s age, the presence of a fever, multisystem inflammatory syndrome, and pre-existing seizure disorder were independently associated with a greater odds of ICU admission. The rate of hospital mortality for this group was 1.8%. The median duration of ICU stay was 3.9 days and the median duration of hospital stay was 4 days. For those patients with 28-day data, the survival rate was 86.3%. The researchers concluded that in this study, older age, fever, multisystem inflammatory syndrome in children, and seizure disorder were independently related with ICU admission.
AHRQ-funded; HS026393; HS026485.
Citation: Bhalala US, Gist KM, Tripathi S .
Characterization and outcomes of hospitalized children with coronavirus disease 2019: a report from a multicenter, viral infection and respiratory illness universal study (Coronavirus Disease 2019) registry.
Crit Care Med 2022 Jan;50(1):e40-e51. doi: 10.1097/ccm.0000000000005232..
Keywords: COVID-19, Children/Adolescents, Registries, Patient-Centered Outcomes Research, Evidence-Based Practice, Inpatient Care
Colman N, Newman JW, Nishisaki A
Translational simulation improves compliance with the NEAR4KIDS Airway Safety Bundle in a single-center PICU.
This single-center retrospective review discusses a translational simulation conducted to improve compliance with the National Emergency Airway Registry for Children (NEAR4KIDS) Airway Safety Quality Improvement (QI) bundle to improve the safety of tracheal intubations. The simulation was implemented between March and December 2018. Bundle adherence was assessed 12 months before simulation and 9 months after. Primary outcomes measures were compliance with the bundle and utilization of apneic oxygenation and secondary outcomes was the occurrence of adverse tracheal intubation-associated events. Preintervention bundle compliance was 66%, which increased to 93.7% after the simulation intervention. Adherence to apneic oxygenation was 27.9% before the intervention and increased to 77.9% after. There was no difference in the occurrence of tracheal intubation events.
AHRQ-funded; HS024511.
Citation: Colman N, Newman JW, Nishisaki A .
Translational simulation improves compliance with the NEAR4KIDS Airway Safety Bundle in a single-center PICU.
Pediatr Qual Saf 2021 May-Jun;6(3):e409. doi: 10.1097/pq9.0000000000000409..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Registries, Simulation, Patient Safety, Quality Improvement, Quality of Care
Branca A, Tellez D, Berkenbosch J
The new trainee effect in tracheal intubation procedural safety across PICUs in North America: a report from National Emergency Airway Registry for Children.
Researchers evaluated the effect of the timing of the PICU fellow academic cycle on tracheal intubation-associated events in a retrospective cohort study of 37 PICUs participating in the National Emergency Airway Registry for Children.. They found that the New Trainee Effect in tracheal intubation safety outcomes was not observed in various types of PICUs. There was a significant improvement in pediatric critical care medicine fellows' first attempt success and a significant decline in tracheal intubation-associated event rates, indicating substantial skills acquisition throughout pediatric critical care medicine fellowship.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Branca A, Tellez D, Berkenbosch J .
The new trainee effect in tracheal intubation procedural safety across PICUs in North America: a report from National Emergency Airway Registry for Children.
Pediatr Crit Care Med 2020 Dec;21(12):1042-50. doi: 10.1097/pcc.0000000000002480..
Keywords: Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Adverse Events, Patient Safety, Registries, Education: Continuing Medical Education, Training
Miller Miller AG, Napolitano N, Turner DA, Miller AG, Napolitano N, Turner DA Miller AG, Napolitano N, Turner DA, Miller AG, Napolitano N, Turner DA
Respiratory therapist intubation practice in pediatric ICUs: a multicenter registry study.
Tracheal intubation by respiratory therapists (RTs) is a well-established practice that has been described primarily in adult and neonatal patients. However, minimal data exist regarding RTs' intubation performance in pediatric ICUs. The purpose of this study was to describe the current landscape of intubations performed by RTs in pediatric ICUs. The investigators found that RTs infrequently intubated in pediatric ICUs, with success rates similar to other providers but higher adverse event rates. RTs were more likely to use video laryngoscopy than other providers.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Miller Miller AG, Napolitano N, Turner DA, Miller AG, Napolitano N, Turner DA Miller AG, Napolitano N, Turner DA, Miller AG, Napolitano N, Turner DA .
Respiratory therapist intubation practice in pediatric ICUs: a multicenter registry study.
Respir Care 2020 Oct;65(10):1534-40. doi: 10.4187/respcare.07667..
Keywords: Children/Adolescents, Respiratory Conditions, Intensive Care Unit (ICU), Registries, Critical Care
Mogul DB, Perito ER, Wood N
Impact of acuity circles on outcomes for pediatric liver transplant candidates.
In December 2018, UNOS approved an allocation scheme based on recipients' geographic distance from a deceased donor ("acuity circles"). Previous analyses suggested acuity circles (AC) would reduce waitlist mortality overall, but their impact on pediatric subgroups was not considered. In this study, the investigators applied Scientific Registry of Transplant Recipients data from 2011-2016 towards the Liver Simulated Allocation Model (LSAM) to compare outcomes by age and illness severity for the UNOS-approved AC and the existing Donor Service Area (DSA)/Region-based allocation schemes.
AHRQ-funded; HS023876.
Citation: Mogul DB, Perito ER, Wood N .
Impact of acuity circles on outcomes for pediatric liver transplant candidates.
Transplantation 2020 Aug;104(8):1627-32. doi: 10.1097/tp.0000000000003079..
Keywords: Children/Adolescents, Transplantation, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice, Registries, Surgery, Access to Care
Johnson MD, Zorc JJ, Nelson DS
Intravenous magnesium in asthma pharmacotherapy: variability in use in the PECARN Registry.
Researchers examined the use, efficacy, and safety of intravenous magnesium sulfate (IVMg) in children with asthma whose emergency department (ED) management is recorded in the Pediatric Emergency Care Applied Research Network (PECARN) Registry. They found that, in PECARN Registry EDs, administration of IVMg occurred late in ED treatment, for a minority of the children likely to benefit, with variation between sites, which suggested the current clinical role for IVMg in preventing hospitalization was limited. Discharge after IVMg administration would likely be safe. They recommended further research to assess the efficacy and safety of early IVMg administration.
AHRQ-funded; HS020270.
Citation: Johnson MD, Zorc JJ, Nelson DS .
Intravenous magnesium in asthma pharmacotherapy: variability in use in the PECARN Registry.
J Pediatr 2020 May;220:165-74.e2. doi: 10.1016/j.jpeds.2020.01.062..
Keywords: Children/Adolescents, Asthma, Medication, Emergency Department, Registries, Treatments, Patient Safety, Medication: Safety
Bowring MG, Massie AB, Chu NM
Projected 20- and 30-year outcomes for pediatric liver transplant recipients in the United States.
Researchers aimed to use national registry data and parametric models to project 20- and 30-year post-transplant outcomes for recently transplanted pediatric liver transplant (LT) recipients. Using Scientific Registry of Transplant Recipients data, they found that projected long-term outcomes for recently transplanted pediatric LT recipients are excellent, reflective of substantial improvements in medical care, and informative for physician-patient education and decision making in the current era.
AHRQ-funded; HS023876.
Citation: Bowring MG, Massie AB, Chu NM .
Projected 20- and 30-year outcomes for pediatric liver transplant recipients in the United States.
J Pediatr Gastroenterol Nutr 2020 Mar;70(3):356-63. doi: 10.1097/mpg.0000000000002592..
Keywords: Children/Adolescents, Transplantation, Patient-Centered Outcomes Research, Outcomes, Surgery, Registries, Evidence-Based Practice
Sanders R, Edwards L, Nishisaki A
Tracheal intubations for critically Ill children outside specialized centers in the United Kingdom-patient, provider, practice factors, and adverse events.
This editorial discusses a research study on outcomes of performing pediatric trachael intubations (TIs) and how the results can be applied to performing intubations on critically ill children in the United Kingdom outside of specialized centers. One of the authors is from a U.S. site that submits its airway management data to the National Emergency Airway Registry for Children (NEAR4KIDS). The results from the registry were compared to the results from the study. A total of 1,051 patients out of 1,237 eligible patients were analyzed. The results came from 47 nonspecialized local hospitals in the North Thames and East Anglia region of the UK. Adverse TI-associated events (TIAEs) occurred in 22.7% of the patients, which is higher than those in PICUs and cardiac ICUs. The majority of intubations were performed by the anesthesiologist in the team. The results were similar to those in the NEAR4KIDS registry. There were more complications with children with a higher grade of airway difficulties and comorbidities. The authors believe that pediatric airway management for acutely ill children would benefit from new strategies. They recommend a system change using Plan, Do, Study, Act (PDSA) cycles.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Sanders R, Edwards L, Nishisaki A .
Tracheal intubations for critically Ill children outside specialized centers in the United Kingdom-patient, provider, practice factors, and adverse events.
Pediatr Crit Care Med 2019 Jun;20(6):572-73. doi: 10.1097/pcc.0000000000001946..
Keywords: Adverse Events, Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Outcomes, Patient Safety, Registries, Respiratory Conditions
Anderson JB, Brown DW, Lihn S
Power of a learning network in congenital heart disease.
This paper discusses the efforts of the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC). The collaborative formed to improve outcomes in infants with hypoplastic left heart syndrome. It sought to (1) decrease mortality, (2) reduce growth failure, and (3) reduce hospital readmissions due to major medical problems during the interstage period between discharge following stage 1 palliation (S1P) and admission for stage 2 palliation (S2P).
AHRQ-funded; HS016957.
Citation: Anderson JB, Brown DW, Lihn S .
Power of a learning network in congenital heart disease.
World J Pediatr Congenit Heart Surg 2019 Jan;10(1):66-71. doi: 10.1177/2150135118815023..
Keywords: Cardiovascular Conditions, Children/Adolescents, Education: Continuing Medical Education, Palliative Care, Quality Improvement, Registries
Durojaiye AB, McGeorge N, Kristen W
Characterizing the utilization of the problem list for pediatric trauma care.
The EHR problem list has the potential to support care coordination among the multidisciplinary care team that cares for pediatric trauma patients. To realize this potential, the need exists to ensure appropriate utilization by formulating acceptable usage and management policy. In this regard, understanding the prevailing utilization pattern is pivotal. To this end, in this study, the investigators analyzed EHR in tandem with trauma registry data at a Level I pediatric trauma center.
AHRQ-funded; HS023837.
Citation: Durojaiye AB, McGeorge N, Kristen W .
Characterizing the utilization of the problem list for pediatric trauma care.
AMIA Annu Symp Proc 2018 Dec 5;2018:404-12..
Keywords: Care Coordination, Children/Adolescents, Electronic Health Records (EHRs), Emergency Department, Health Information Technology (HIT), Hospitals, Registries, Trauma
Kojima T, Harwayne-Gidansky I, Shenoi AN
Cricoid pressure during induction for tracheal intubation in critically ill children: a report from National Emergency Airway Registry for Children.
The objective of this retrospective cohort study was to evaluate the association between cricoid pressure use and the occurrence of regurgitation during tracheal intubation for critically ill children in pediatric intensive care unit (PICU). The investigators found that cricoid pressure during induction and mask ventilation before tracheal intubation in the current ICU practice was not associated with a lower regurgitation rate after adjusting for previously reported confounders.
AHRQ-funded; HS024511.
Citation: Kojima T, Harwayne-Gidansky I, Shenoi AN .
Cricoid pressure during induction for tracheal intubation in critically ill children: a report from National Emergency Airway Registry for Children.
Pediatr Crit Care Med 2018 Jun;19(6):528-37. doi: 10.1097/pcc.0000000000001531.
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Keywords: Children/Adolescents, Critical Care, Children/Adolescents, Registries, Respiratory Conditions
Deakyne Davies SJ, Grundmeier RW, Campos DA
The pediatric emergency care applied research network registry: a multicenter electronic health record registry of pediatric emergency care.
In this paper, the authors described the Pediatric Emergency Care Applied Research Network (PECARN) Registry, which demonstrates that emergency department (ED) data from disparate health systems and EHR vendors can be harmonized for use in a single registry with a common data model. The authors concluded that the Registry is a robust harmonized clinical registry that includes data from diverse patients, sites, and EHR vendors derived via data extraction, deidentification, and secure submission to a central data coordinating center. They suggested that the data provided be used for benchmarking, clinical quality improvement, and comparative effectiveness research.
AHRQ-funded; HS020270.
Citation: Deakyne Davies SJ, Grundmeier RW, Campos DA .
The pediatric emergency care applied research network registry: a multicenter electronic health record registry of pediatric emergency care.
Appl Clin Inform 2018 Apr;9(2):366-76. doi: 10.1055/s-0038-1651496..
Keywords: Children/Adolescents, Registries, Emergency Department, Electronic Health Records (EHRs), Health Information Technology (HIT)
Dotson JL, Crandall WV, Zhang P
Feasibility and validity of the pediatric ulcerative colitis activity index in routine clinical practice.
The specific objectives of this study were to evaluate the feasibility of using the Pediatric Ulcerative Colitis Activity Index (PUCAI) in routine clinical practice settings and the cross-sectional and longitudinal associations between PUCAI and physician global assessment. Based on a population drawn from a large, diverse collection of pediatric gastroenterology practices, the study concluded that the PUCAI is feasible to use in routine clinical settings.
AHRQ-funded; HS020024.
Citation: Dotson JL, Crandall WV, Zhang P .
Feasibility and validity of the pediatric ulcerative colitis activity index in routine clinical practice.
J Pediatr Gastroenterol Nutr 2015 Feb;60(2):200-4. doi: 10.1097/mpg.0000000000000568.
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Keywords: Children/Adolescents, Registries, Children/Adolescents, Comparative Effectiveness
Nett S, Emeriaud G, Jarvis JD
Site-level variance for adverse tracheal intubation-associated events across 15 North American PICUs: a report from the national emergency airway registry for children*.
This observational study of 15 pediatric intensive care units (PICUs) found that substantial site-level variance exists in tracheal intubation practice, adverse tracheal intubation associated-events and severe tracheal intubation associated-events. After adjusting for patient and provider characteristics, neither PICU size nor presence of fellowship training program explained site-level variance.
AHRQ-funded; HS021583
Citation: Nett S, Emeriaud G, Jarvis JD .
Site-level variance for adverse tracheal intubation-associated events across 15 North American PICUs: a report from the national emergency airway registry for children*.
Pediatr Crit Care Med. 2014 May;15(4):306-13. doi: 10.1097/pcc.0000000000000120..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Registries, Adverse Events