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
26 to 50 of 207 Research Studies DisplayedOtto L, Wang A, Wheeler K
Comparison of manual and computer assigned injury severity scores.
The study objective was to compare the ISS manually assigned by hospital personnel and those generated by the ICDPIC software for value agreement and predictive power of length of stay (LOS) and mortality. The investigators found that the LOS and mortality predictive power were significantly higher for manually assigned ISS when compared with computer assigned ISS in both PTC and NTDB data sets. They indicated that hospitals should be cautious about transitioning to computer assigned ISS, specifically for patients who are critically injured.
AHRQ-funded; HS024263.
Citation: Otto L, Wang A, Wheeler K .
Comparison of manual and computer assigned injury severity scores.
Inj Prev 2020 Aug;26(4):330-33. doi: 10.1136/injuryprev-2019-043224..
Keywords: Health Information Technology (HIT), Injuries and Wounds, Trauma, Hospitals
Lake JG, Miller LG, Fritz SA
Antibiotic duration, but not abscess size, impacts clinical cure of limited skin and soft tissue infection after incision and drainage.
Antibiotics are frequently prescribed following incision and drainage of cutaneous abscesses. In subgroup analyses from a recent clinical trial, the investigators observed higher likelihood of cure with antibiotic courses beyond 5 or 7 days (up to 10). They concluded that antibiotic duration, but not abscess size, impacted clinical cure of limited skin and soft tissue infection after incision and drainage.
AHRQ-funded; HS021736; HS024269.
Citation: Lake JG, Miller LG, Fritz SA .
Antibiotic duration, but not abscess size, impacts clinical cure of limited skin and soft tissue infection after incision and drainage.
Clin Infect Dis 2020 Jul 27;71(3):661-63. doi: 10.1093/cid/ciz1129..
Keywords: Antibiotics, Injuries and Wounds, Medication
Ortiz D, Meagher AD, Lindroth H
A trauma medical home, evaluating collaborative care for the older injured patient: study protocol for a randomized controlled trial.
It is estimated that 55 million adults will be 65 years and older in the USA by 2020. These older adults are at increased risk for injury and their recovery is multi-faceted. A collaborative care model may improve psychological and functional outcomes of the non-neurologically impaired older trauma patient and reduce health care costs. The investigators discussed the proposed study protocol which would evaluate a collaborative care model to help maximize psychological and functional recovery for non-neurologically injured older patients at four level one trauma centers in the Midwest.
AHRQ-funded; HS026390.
Citation: Ortiz D, Meagher AD, Lindroth H .
A trauma medical home, evaluating collaborative care for the older injured patient: study protocol for a randomized controlled trial.
Trials 2020 Jul 16;21(1):655. doi: 10.1186/s13063-020-04582-x..
Keywords: Elderly, Patient-Centered Healthcare, Injuries and Wounds, Care Coordination, Nursing Homes, Care Management
Bushnell GA, Gerhard T, Crystal S
Benzodiazepine treatment and fracture risk in young persons with anxiety disorders.
This study examined whether benzodiazepine treatment increases fall and fracture risk in young persons as it has been shown to do in older adults. They examined whether children (6-17 years) and young adults (18-24) recently diagnosed with anxiety disorder had an increased fracture risk. A cohort of commercially insured children and young adults who had initiated use of benzodiazepine or SSRIs were followed for 3 months, or until fracture, treatment discontinuation or switching or disenrollment occurred. The cohort consisted of 120,715 children and 179,768 young adults. There was an increased fracture rate found in children, but not young adults.
AHRQ-funded; HS026001.
Citation: Bushnell GA, Gerhard T, Crystal S .
Benzodiazepine treatment and fracture risk in young persons with anxiety disorders.
Pediatrics 2020 Jul;146(1):e20193478. doi: 10.1542/peds.2019-3478..
Keywords: Children/Adolescents, Young Adults, Medication, Falls, Injuries and Wounds, Risk, Anxiety, Behavioral Health
Chovatiya R, Silverberg JI
Association of pemphigus and pemphigoid with osteoporosis and pathological fractures.
Researchers sought to determine whether pemphigus and bullous pemphigoid (BP) are associated with osteoporosis and fractures in the US. Subjects for this cross-sectional study included adults with pemphigus or with BP from the 2006-2012 National Emergency Department Sample. The researchers found that, when compared to BP, pemphigus was associated with higher odds of osteopenia, osteoporosis, and fractures, particularly of the ulna and radius. Patients with pemphigus or BP as well as long-term systemic corticosteroid use had the highest odds of osteoporosis and fractures. The researchers suggested that patients with these conditions may benefit from increased screening for osteoporosis and interventions to prevent fractures.
AHRQ-funded; HS023011.
Citation: Chovatiya R, Silverberg JI .
Association of pemphigus and pemphigoid with osteoporosis and pathological fractures.
Arch Dermatol Res 2020 May;312(4):263-71. doi: 10.1007/s00403-019-02010-y..
Keywords: Healthcare Cost and Utilization Project (HCUP), Osteoporosis, Injuries and Wounds, Emergency Department
Tignanelli CJ, Silverman GM, Lindemann EA
Natural language processing of prehospital emergency medical services trauma records allows for automated characterization of treatment appropriateness.
Incomplete prehospital trauma care is a significant contributor to preventable deaths. Current databases lack timelines easily constructible of clinical events. Temporal associations and procedural indications are critical to characterize treatment appropriateness. Natural language processing (NLP) methods present a novel approach to bridge this gap. In this study, the investigators sought to evaluate the efficacy of a novel and automated NLP pipeline to determine treatment appropriateness from a sample of prehospital EMS motor vehicle crash records.
AHRQ-funded; HS026379.
Citation: Tignanelli CJ, Silverman GM, Lindemann EA .
Natural language processing of prehospital emergency medical services trauma records allows for automated characterization of treatment appropriateness.
J Trauma Acute Care Surg 2020 May;88(5):607-14. doi: 10.1097/ta.0000000000002598.
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Keywords: Trauma, Injuries and Wounds, Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Improvement, Quality of Care
Henry MK, Feudtner C, Fortin K
Occult head injuries in infants evaluated for physical abuse.
Abusive head injuries in infants may be occult but clinically or forensically important. Data conflict regarding yield of neuroimaging in detecting occult head injuries in infants evaluated for physical abuse, with prior studies identifying yields of 4.3-37.3 %. The objectives of this study were (1) To quantify yield of computed tomography or magnetic resonance imaging in identification of occult head injuries in infants with concerns for physical abuse and (2) To evaluate risk factors for occult head injuries.
AHRQ-funded; HS024194.
Citation: Henry MK, Feudtner C, Fortin K .
Occult head injuries in infants evaluated for physical abuse.
Child Abuse Negl 2020 May;103:104431. doi: 10.1016/j.chiabu.2020.104431..
Keywords: Newborns/Infants, Brain Injury, Domestic Violence, Imaging, Diagnostic Safety and Quality, Injuries and Wounds
Goyal MK, Johnson TJ, Chamberlain JM
Racial and ethnic differences in emergency department pain management of children with fractures.
Researchers tested the hypotheses that minority children with long-bone fractures are less likely to receive analgesics, to receive opioid analgesics, and to achieve pain reduction. Using data from the Pediatric Emergency Care Applied Research Network Registry, they found that there are differences in process and outcome measures by race and ethnicity in the emergency department management of pain among children with long-bone fractures. Although minority children are more likely to receive analgesics and achieve reduction in pain, they are less likely to receive opioids and achieve optimal pain reduction.
AHRQ-funded; HS020270.
Citation: Goyal MK, Johnson TJ, Chamberlain JM .
Racial and ethnic differences in emergency department pain management of children with fractures.
Pediatrics 2020 May;145(5):e20193370. doi: 10.1542/peds.2019-3370..
Keywords: Children/Adolescents, Racial and Ethnic Minorities, Emergency Department, Pain, Injuries and Wounds, Medication, Opioids, Disparities
Sanghavi P, Pan S, Caudry D
Assessment of nursing home reporting of major injury falls for quality measurement on Nursing Home Compare.
The purpose of this study was to assess the accuracy of nursing home self-report of major injury falls on the Minimum Data Set (MDS). They linked inpatient claims for major injury falls with MDS assessments. The investigators concluded that the nursing home-reported data used for the Nursing Home Compare (NHC) falls measure may be highly inaccurate.
AHRQ-funded; HS026957.
Citation: Sanghavi P, Pan S, Caudry D .
Assessment of nursing home reporting of major injury falls for quality measurement on Nursing Home Compare.
Health Serv Res 2020 Apr;55(2):201-10. doi: 10.1111/1475-6773.13247..
Keywords: Falls, Nursing Homes, Quality Measures, Quality Indicators (QIs), Quality of Care, Elderly, Public Reporting, Injuries and Wounds
Shaheen MS, Silverberg JI
Association of asthma with osteopenia, osteoporosis, osteomalacia, and fractures.
Previous studies that examined the relationship between asthma, osteoporosis, and pathologic fractures found conflicting results. The objective of this study was to determine whether asthma was associated with osteopenia, osteoporosis, osteomalacia, and fractures in U.S. adults. The investigators concluded that ED visits with asthma were associated with osteopenia, osteoporosis, osteomalacia, and pathologic fractures.
Citation: Shaheen MS, Silverberg JI .
Association of asthma with osteopenia, osteoporosis, osteomalacia, and fractures.
Allergy Asthma Proc 2020 Mar 1;41(2):112-19. doi: 10.2500/aap.2020.41.190035.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Osteoporosis, Injuries and Wounds, Emergency Department
Bowman JA, Jurkovich GJ, Nuño M
Hospital-level intensive care unit admission for patients with isolated blunt abdominal solid organ injury.
This study’s objective was to determine the optimal level of care for hemodynamically stable patients with isolated blunt hepatic, renal, or splenic injuries. A retrospective cohort study was conducted using the 2015 and 2016 National Trauma Data Bank. The intervariability of intensive care unit (ICU) admission for these patients was determined. Hospitals were categorized into quartiles based on the proportion of eligible patients admitted to an ICU. Primary outcomes were a composite of organ failure, infection, or death during hospitalization. Findings were that greater hospital-level ICU use was not associated with a decreased likelihood of the composite outcome or infection or death. These outcomes were fairly rare to begin with.
AHRQ-funded; HS022236.
Citation: Bowman JA, Jurkovich GJ, Nuño M .
Hospital-level intensive care unit admission for patients with isolated blunt abdominal solid organ injury.
J Trauma Acute Care Surg 2020 Mar;88(3):408-15. doi: 10.1097/ta.0000000000002581.
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Keywords: Injuries and Wounds, Intensive Care Unit (ICU), Critical Care, Patient-Centered Outcomes Research, Evidence-Based Practice
Zive D, Newgard CD, Lin A
Injured older adults transported by emergency medical services: one year outcomes by POLST status.
Advance care planning documents, including Physician Orders for Life-Sustaining Treatment (POLST), are intended to guide care near end of life, particularly in emergency situations. Yet, research on POLST during emergency care is sparse. This study examined one year outcomes, by Physician Orders for Life-Sustaining Treatment status, of injured adults transported by EMS. The investigators concluded that among injured older adults transported by ambulance in Oregon, one in 5 had an active POLST form at the time of 9-1-1 contact, the prevalence of which increased over the following year.
AHRQ-funded; HS023796.
Citation: Zive D, Newgard CD, Lin A .
Injured older adults transported by emergency medical services: one year outcomes by POLST status.
Prehosp Emerg Care 2020 Mar-Apr;24(2):257-64. doi: 10.1080/10903127.2019.1615154..
Keywords: Elderly, Injuries and Wounds, Emergency Medical Services (EMS), Emergency Department
Morris RS, Milia D, Glover J
Predictors of elderly mortality after trauma: a novel outcome score.
Elderly trauma patients are at high risk for mortality, even when presenting with minor injuries. Previous prognostic models are poorly used because of their reliance on elements unavailable during the index hospitalization. The purpose of this study was to develop a predictive algorithm to accurately estimate in-hospital mortality using easily available metrics. A two-tiered scoring system to predict in-hospital mortality was developed: a quick elderly mortality after trauma (qEMAT) score for use at initial patient presentation and a full EMAT (fEMAT) score for use after radiologic evaluation.
AHRQ-funded; HS026379.
Citation: Morris RS, Milia D, Glover J .
Predictors of elderly mortality after trauma: a novel outcome score.
J Trauma Acute Care Surg 2020 Mar;88(3):416-24. doi: 10.1097/ta.0000000000002569..
Keywords: Elderly, Mortality, Trauma, Injuries and Wounds
Probst MA, Gupta M, Hendey GW
Prevalence of intracranial injury in adult patients with blunt head trauma with and without anticoagulant or antiplatelet use.
In this study, the investigators determined the prevalence of significant intracranial injury among adults with blunt head trauma who are receiving preinjury anticoagulant or antiplatelet medications. The investigators concluded that patients receiving preinjury warfarin or a combination of aspirin and clopidogrel were at increased risk for significant intracranial injury, but not those receiving aspirin alone. They suggested that clinicians should have a low threshold for neuroimaging when evaluating patients receiving warfarin or a combination of aspirin and clopidogrel.
AHRQ-funded; HS009699.
Citation: Probst MA, Gupta M, Hendey GW .
Prevalence of intracranial injury in adult patients with blunt head trauma with and without anticoagulant or antiplatelet use.
Ann Emerg Med 2020 Mar;75(3):354-64. doi: 10.1016/j.annemergmed.2019.10.004..
Keywords: Brain Injury, Injuries and Wounds, Blood Thinners, Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events, Risk
Williams CN, Hartman ME, McEvoy CT
Sleep-wake disturbances after acquired brain injury in children surviving critical care.
Sleep-wake disturbances are underevaluated among children with acquired brain injury surviving critical care. In this prospective cohort study, the investigators aimed to quantify severity, phenotypes, and risk factors for sleep-wake disturbances. The investigators concluded that over half of children surviving critical care with acquired brain injury have sleep-wake disturbances. They indicated that many sleep-wake disturbances phenotypes were identified, but most children had disturbance in initiation and maintenance of sleep.
AHRQ-funded; HS022981.
Citation: Williams CN, Hartman ME, McEvoy CT .
Sleep-wake disturbances after acquired brain injury in children surviving critical care.
Pediatr Neurol 2020 Feb;103:43-51. doi: 10.1016/j.pediatrneurol.2019.08.010..
Keywords: Children/Adolescents, Brain Injury, Critical Care, Sleep Problems, Trauma, Injuries and Wounds, Neurological Disorders
Bowman JA, Jurkovich GJ, Nishijima DK
Older adults with isolated rib fractures do not require routine intensive care unit admission.
This study examined whether older adults with isolated rib fractures should be admitted to an intensive care unit (ICU) due to higher presumed morbidity and mortality. Patients 50 years and older who were admitted between 2013 and 2017 were analyzed. The outcomes being looked at were any critical care intervention or adverse event based on accepted critical care guidelines. Out of 401 patients, 251 (63%) were admitted to the ICU. In the ICU, 33% experienced an adverse event while only 7% admitted to the ward experienced an adverse event. The most common events were hypotension, frequent respiratory therapy and oxygen desaturation. Predictors of these events included incentive spirometry, use of a walker, increased chest Abbreviated Injury Scale score, age 72 or greater, and active smoking. The investigators concluded routine ICU admission is not necessary for most older adults with isolated rib fractures.
AHRQ-funded; HS022236.
Citation: Bowman JA, Jurkovich GJ, Nishijima DK .
Older adults with isolated rib fractures do not require routine intensive care unit admission.
J Surg Res 2020 Jan;245:492-99. doi: 10.1016/j.jss.2019.07.098..
Keywords: Elderly, Injuries and Wounds, Intensive Care Unit (ICU), Patient-Centered Outcomes Research, Outcomes
Conley RB, Adib G, Adler G
AHRQ Author: Tracer H
Secondary fracture prevention: consensus clinical recommendations from a multistakeholder coalition.
This article describes clinical recommendations that were developed by a multistakeholder coalition for the optimal prevention of secondary fractures among people aged 65 years and older with a hip or vertebral fracture. There were 13 recommendations developed (7 primary and 6 secondary).
AHRQ-authored.
Citation: Conley RB, Adib G, Adler G .
Secondary fracture prevention: consensus clinical recommendations from a multistakeholder coalition.
J Bone Miner Res 2020 Jan;35(1):36-52. doi: 10.1002/jbmr.3877..
Keywords: Prevention, Guidelines, Injuries and Wounds, Evidence-Based Practice
Song J, Tark A, Larson EL
The relationship between pocket hematoma and risk of wound infection among patients with a cardiovascular implantable electronic device: an integrative review.
Pocket hematoma is a common adverse event following the insertion of cardiovascular implantable electronic devices (CIEDs), but the risk of wound infections associated with a pocket hematoma is unclear. The objective of this integrative review was to examine the relationship between pocket hematoma and risk of wound infection in a CIED population.
AHRQ-funded; HS024915.
Citation: Song J, Tark A, Larson EL .
The relationship between pocket hematoma and risk of wound infection among patients with a cardiovascular implantable electronic device: an integrative review.
Heart Lung 2020 Jan-Feb;49(1):92-98. doi: 10.1016/j.hrtlng.2019.09.009..
Keywords: Medical Devices, Cardiovascular Conditions, Surgery, Adverse Events, Healthcare-Associated Infections (HAIs), Injuries and Wounds, Risk
Venema DM, Skinner AM, Nailon R
Patient and system factors associated with unassisted and injurious falls in hospitals: an observational study.
Unassisted falls are more likely to result in injury than assisted falls. However, little is known about risk factors for falling unassisted. Furthermore, rural hospitals, which care for a high proportion of older adults, are underrepresented in research on hospital falls. This study identified risk factors for unassisted and injurious falls in rural hospitals.
AHRQ-funded; HS021429.
Citation: Venema DM, Skinner AM, Nailon R .
Patient and system factors associated with unassisted and injurious falls in hospitals: an observational study.
BMC Geriatr 2019 Dec 11;19(1):348. doi: 10.1186/s12877-019-1368-8..
Keywords: Falls, Injuries and Wounds, Patient Safety, Elderly, Risk, Hospitals, Adverse Events
Yang AD, Quinn CM, Hewitt DB
National evaluation of needlestick events and reporting among surgical residents.
Needlestick injuries pose significant health hazards; however, the nationwide frequency of needlesticks and reporting practices among surgical residents are unknown. The objectives of this study were to examine the rate and circumstances of self-reported needlestick events in US surgery residents, assess factors associated with needlestick injuries, evaluate reporting practices, and identify reporting barriers.
AHRQ-funded; HS000078.
Citation: Yang AD, Quinn CM, Hewitt DB .
National evaluation of needlestick events and reporting among surgical residents.
J Am Coll Surg 2019 Dec;229(6):609-20. doi: 10.1016/j.jamcollsurg.2019.09.001..
Keywords: Education: Continuing Medical Education, Surgery, Injuries and Wounds, Provider
Zins ZP, Wheeler KK, Brink F
Trends in US physician diagnosis of child physical abuse and neglect injuries, 2006-2014.
The purpose of this study was to determine if US child physical abuse and neglect injury rates changed from 2006 to 2014, whether definitive diagnoses of physical abuse and neglect were used more often over time, and what patient factors influenced definitive physical maltreatment diagnoses. The investigators found that definitive diagnoses of physical abuse and neglect increased over the study period and were associated with hospital volume and patient characteristics which may reflect provider experience and possible bias.
AHRQ-funded; HS024263.
Citation: Zins ZP, Wheeler KK, Brink F .
Trends in US physician diagnosis of child physical abuse and neglect injuries, 2006-2014.
Child Abuse Negl 2019 Dec;98:104179. doi: 10.1016/j.chiabu.2019.104179..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Diagnostic Safety and Quality, Domestic Violence, Injuries and Wounds, Emergency Department, Hospitalization
Berry SD, Zullo AR, Zhang T
Validation of the FRAiL model to predict non-vertebral and hip fractures in nursing home residents.
This study created a tool to assess non-vertebral and hip fracture risk in long-term nursing home (NH) residents called FRAiL (Fracture Risk Assessment in Long term care). The objective of this retrospective cohort study was to assess the performance of the model to predict 2-year risk of fractures in a separate large cohort of NH residents. The study included most long-stay NH residents in the United States (n = 896,840). Fractures were identified using Medicare claims. The mean age of NH residents was 83.8 years and 70.7% were women. Over the 2-year follow-up period 4.6% were hospitalized with non-vertebral fractures, the majority being hip fractures. In the fully adjusted model, 14 out of 15 model characteristics remained significant predictors of non-vertebral fractures. Female sex, wandering, and falls were strongly associated with non-vertebral fractures.
AHRQ-funded; HS022998.
Citation: Berry SD, Zullo AR, Zhang T .
Validation of the FRAiL model to predict non-vertebral and hip fractures in nursing home residents.
Bone 2019 Nov;128:115050. doi: 10.1016/j.bone.2019.115050..
Keywords: Elderly, Nursing Homes, Long-Term Care, Injuries and Wounds
Caroff DA, Chan C, Kleinman K
Association of open approach vs laparoscopic approach with risk of surgical site infection after colon surgery.
The authors assessed whether laparoscopic colon surgery is associated with a lower surgical site infection rate than open-approach laparoscopy. They found that policy changes that promote surgical education and resources for laparoscopy, especially at low-adoption hospitals, may be associated with reduced colon surgical site infection rates. They recommend support of the development of innovative educational policies to help achieve improvement in patient outcomes and decreased health care use in colon surgery.
AHRQ-funded; HS021424.
Citation: Caroff DA, Chan C, Kleinman K .
Association of open approach vs laparoscopic approach with risk of surgical site infection after colon surgery.
JAMA Netw Open 2019 Oct 2;2(10):e1913570. doi: 10.1001/jamanetworkopen.2019.13570..
Keywords: Surgery, Healthcare-Associated Infections (HAIs), Injuries and Wounds, Patient Safety, Risk
Qi AC, Peacock K, Luke AA
Associations between social risk factors and surgical site infections after colectomy and abdominal hysterectomy.
The purpose of this study was to determine whether social risk factors, including race/ethnicity, insurance status, and neighborhood income, were associated with higher rates of surgical site infections (SSI) after colectomy or abdominal hysterectomy, 2 surgical procedures for which SSI rates are publicly reported and included in pay-for-performance programs by Medicare and other groups. The investigators report that inconsistent associations between social risk factors and SSIs were found.
AHRQ-funded; HS019455.
Citation: Qi AC, Peacock K, Luke AA .
Associations between social risk factors and surgical site infections after colectomy and abdominal hysterectomy.
JAMA Netw Open 2019 Oct 2;2(10):e1912339. doi: 10.1001/jamanetworkopen.2019.12339..
Keywords: Healthcare Cost and Utilization Project (HCUP), Risk, Surgery, Healthcare-Associated Infections (HAIs), Injuries and Wounds, Adverse Events, Social Determinants of Health
Brescia AA, Wu X, Paone G
Effect of sex on nadir hematocrit and rates of acute kidney injury in coronary artery bypass.
Researchers explored whether there a sex-related difference on nadir hematocrit and rates of acute kidney injury in coronary artery bypass. A prospective, observational study was conducted of 17,363 patients not on dialysis undergoing the procedure between 2011 and 2016 across 41 institutions from the Perfusion Measure and Outcomes registry. There was no sex-related differences found for nadir hematocrit or rates of acute kidney injury.
AHRQ-funded; HS026003; HS022535.
Citation: Brescia AA, Wu X, Paone G .
Effect of sex on nadir hematocrit and rates of acute kidney injury in coronary artery bypass.
J Thorac Cardiovasc Surg 2019 Oct;158(4):1073-80.e4. doi: 10.1016/j.jtcvs.2019.03.042..
Keywords: Injuries and Wounds, Sex Factors, Kidney Disease and Health, Adverse Events, Surgery, Heart Disease and Health, Cardiovascular Conditions