National Healthcare Quality and Disparities Report
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Topics
- Adverse Events (3)
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- Children/Adolescents (5)
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- Disparities (1)
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- Neurological Disorders (1)
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- Pneumonia (1)
- Policy (1)
- Practice Patterns (1)
- Provider Performance (1)
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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
1 to 22 of 22 Research Studies DisplayedHeslin KC, Owens PL, Simpson LA
AHRQ Author: Heslin KC Owens PL
Annual report on health care for children and youth in the united states: focus on 30-day unplanned inpatient readmissions, 2009 to 2014.
The authors describe trends in unplanned 30-day all-condition hospital readmissions for children aged 1 to 17 years between 2009 and 2014. Using HCUP data, they found that the rate of readmission was essentially stable between 2009 and 2014. In 2009, the most common reason for readmission was sickle cell anemia, whereas in 2014 the most common reason was epilepsy. Pneumonia fell from the second to the sixth most common reason for readmission over this period. The authors suggest that their study provides a baseline assessment for examining trends in 30-day unplanned pediatric readmissions, an important quality metric as the provisions of the Children's Health Insurance Program Reauthorization Act and the Affordable Care Act are changed and implemented in the future.
AHRQ-authored.
Citation: Heslin KC, Owens PL, Simpson LA .
Annual report on health care for children and youth in the united states: focus on 30-day unplanned inpatient readmissions, 2009 to 2014.
Acad Pediatr 2018 Nov - Dec;18(8):857-72. doi: 10.1016/j.acap.2018.06.006..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Hospital Readmissions, Hospitalization, Hospitals, Sickle Cell Disease, Pneumonia, Neurological Disorders
Wu VY, Fingar KR, Jiang HJ
AHRQ Author: Jiang HJ
Early impact of the Affordable Care Act coverage expansion on safety-net hospital inpatient payer mix and market shares.
The purpose of the study was to examine the impact of the Affordable Care Act's coverage expansion on safety-net hospitals (SNHs). The investigators concluded that postexpansion, non-SNHs experienced a greater percentage increase in Medicaid stays than did SNHs, which may reflect patients choosing non-SNHs over SNHs or a crowd-out of private insurance.
AHRQ-authored; AHRQ-funded; 290201300002.
Citation: Wu VY, Fingar KR, Jiang HJ .
Early impact of the Affordable Care Act coverage expansion on safety-net hospital inpatient payer mix and market shares.
Health Serv Res 2018 Oct;53(5):3617-39. doi: 10.1111/1475-6773.12812..
Keywords: Policy, Healthcare Cost and Utilization Project (HCUP), Hospitals, Medicaid
Rosko M, Wong HS, Mutter R
AHRQ Author: Wong HS Mutter R
Characteristics of high- and low-efficiency hospitals.
Researchers compared the performance, operating characteristics, and market environments of low- and high-efficiency hospitals in the states that supplied inpatient data to HCUP from 2006 to 2010. Their findings indicated that the most efficient hospitals tended to be nonteaching, investor-owned, and members of multihospital systems; these hospitals also tended to have lower average costs and higher labor productivity and profit margins when compared to the least efficient hospitals. High-efficiency hospitals had a higher proportion of Medicaid and Medicare admissions and were usually located in areas with lower health maintenance organization penetration and less competition. The researchers conclude that these results suggest opportunities for public policies that support improved efficiency in the hospital sector.
AHRQ-authored.
Citation: Rosko M, Wong HS, Mutter R .
Characteristics of high- and low-efficiency hospitals.
Med Care Res Rev 2018 Aug;75(4):454-78. doi: 10.1177/1077558716689197..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitals, Healthcare Costs
Leyenaar JK, Shieh MS, Lagu T
Hospital and community characteristics associated with pediatric direct admission to hospital.
Researchers aimed to determine the relationships between hospital and community factors and pediatric direct admission rates, and to evaluate the degree to which these characteristics explain variation in risk-adjusted direct admission rates. Using HCUP data, they found that direct admission rates were associated with several hospital and community characteristics, but the majority of variation in hospitals' direct admission rates was not explained by these factors. They recommended that their findings suggest opportunities for diverse hospital types to develop the infrastructure and communication systems necessary to support pediatric direct admissions.
AHRQ-funded; HS024133.
Citation: Leyenaar JK, Shieh MS, Lagu T .
Hospital and community characteristics associated with pediatric direct admission to hospital.
Acad Pediatr 2018 Jul;18(5):525-34. doi: 10.1016/j.acap.2017.10.002..
Keywords: Children/Adolescents, Hospitalization, Healthcare Cost and Utilization Project (HCUP), Hospitals
Sun SA, Ma X, Li G
Epidemiologic patterns of in-hospital anaphylaxis in pediatric surgical patients.
This research letter looks into epidemiologic patterns of in-hospital anaphylaxis in pediatric surgical patients. Data from the study came from the Kids’ Inpatient Database (KIDS), which is released every 3 years. The data came from the 2003, 2006, 2009 and 2012 KID data sets. Children were included if they had a surgical admission for anaphylaxis which is interpreted as an in-hospital event. Overall in-hospital mortality for all children was 0.38% but for in-hospital anaphylaxis was 2.47%. The most common reason children were in the hospital before the event was hematological and myeloproliferative disorders, with the largest percentage undergoing bone marrow transplant procedures. Although the exact cause of the reaction was not known, hypersensitivity to chemotherapeutic agents and more recent mAb treatments have been identified as reasons for the in-hospital anaphylaxis.
AHRQ-funded; HS022941.
Citation: Sun SA, Ma X, Li G .
Epidemiologic patterns of in-hospital anaphylaxis in pediatric surgical patients.
J Allergy Clin Immunol 2018 May;141(5):1904-05.e2. doi: 10.1016/j.jaci.2017.11.030..
Keywords: Adverse Events, Children/Adolescents, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Hospitals, Inpatient Care, Practice Patterns, Surgery
Fingar KR, Coffey RM, Mulcahy AW
AHRQ Author: Andrews RM, Stocks C
Shifts in Medicaid and uninsured payer mix at safety-net and non-safety-net hospitals during the Great Recession.
The authors examined payer mix at safety-net hospitals (SNHs) and non-SNHs during a period covering the Great Recession using data from 38 states. The number of privately insured stays decreased at both SNHs and non-SNHs. Non-SNHs increasingly served Medicaid-enrolled and uninsured patients; in SNHs, the number of Medicaid stays decreased and uninsured stays remained stable.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Fingar KR, Coffey RM, Mulcahy AW .
Shifts in Medicaid and uninsured payer mix at safety-net and non-safety-net hospitals during the Great Recession.
J Healthc Manag 2018 May-Jun;63(3):156-72. doi: 10.1097/jhm-d-16-00024.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitals, Medicaid, Uninsured
Dynan L, Goudie A, Brady PW
Pediatric adverse event rates associated with inexperience in teaching hospitals: a multilevel analysis.
In this article, the investigators hypothesize that adverse event rates increase with the availability of more complex services and technologies (transplantation and pediatric open-heart surgery); increase as experience of providers decreases (July effect); and increase with residents per bed, a measure of both average provider inexperience and congestion. Using multilevel analysis, they found empirical evidence in support of their three hypotheses.
AHRQ-funded; HS023827.
Citation: Dynan L, Goudie A, Brady PW .
Pediatric adverse event rates associated with inexperience in teaching hospitals: a multilevel analysis.
J Healthc Qual 2018 Mar/Apr;40(2):69-78. doi: 10.1097/jhq.0000000000000121..
Keywords: Children/Adolescents, Healthcare Cost and Utilization Project (HCUP), Adverse Events, Hospitals, Inpatient Care, Medical Errors, Patient Safety
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
Henke RM, Karaca Z, Moore B
AHRQ Author: Karaca Z, Wong HS
Impact of health system affiliation on hospital resource use intensity and quality of care.
This study assessed the impact of hospital affiliation, centralization, and managed care plan ownership on inpatient cost and quality. It found that hospitals affiliated with health systems had a higher cost per discharge and better quality of care compared with independent hospitals. Centralized systems in particular had the highest cost per discharge and longest stays. Independent hospitals with managed care plans had a higher cost per discharge.
AHRQ-authored.
Citation: Henke RM, Karaca Z, Moore B .
Impact of health system affiliation on hospital resource use intensity and quality of care.
Health Serv Res 2018 Feb;53(1):63-86. doi: 10.1111/1475-6773.12631..
Keywords: Healthcare Costs, Quality of Care, Health Systems, Healthcare Cost and Utilization Project (HCUP), Hospitals
Wong H, Karaca Z, Gibson TB
AHRQ Author: Wong H, Karaca Z
A quantitative observational study of physician influence on hospital costs.
Physicians serve as the nexus of treatment decision-making in hospitalized patients; however, little empirical evidence describes the influence of individual physicians on hospital costs. In this study, the extent to which hospital costs vary across physicians and physician characteristics is examined. Among other findings, the investigators observed sizable variation in average costs of hospital inpatient stays across medical specialties.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Wong H, Karaca Z, Gibson TB .
A quantitative observational study of physician influence on hospital costs.
Inquiry 2018 Jan-Dec;55:46958018800906. doi: 10.1177/0046958018800906..
Keywords: Shared Decision Making, Healthcare Costs, Healthcare Cost and Utilization Project (HCUP), Hospitals
Basu J, Hanchate A, Bierman A
AHRQ Author: Basu J, Bierman A
Racial/ethnic disparities in readmissions in US hospitals: the role of insurance coverage.
This study examined differences in rates of 30-day readmissions across patients by race/ethnicity and the extent to which these differences were moderated by insurance coverage. It found higher readmission risk for non-Hispanic blacks, compared with non-Hispanic whites, among those covered by Medicare and private insurance, but lower risk among uninsured and similar risk among Medicaid.
AHRQ-authored.
Citation: Basu J, Hanchate A, Bierman A .
Racial/ethnic disparities in readmissions in US hospitals: the role of insurance coverage.
Inquiry 2018 Jan-Dec;55:46958018774180. doi: 10.1177/0046958018774180.
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Keywords: Disparities, Health Insurance, Healthcare Cost and Utilization Project (HCUP), Hospitals, Hospital Readmissions
Cutler E, Karaca Z, Henke R
AHRQ Author: Karaca Z, Wong HS
The effects of Medicare accountable organizations on inpatient mortality rates.
This study examined whether Medicare Accountable Care Organizations (ACOs) have improved hospital quality of care, specifically focusing on preventable inpatient mortality. The investigators concluded that, on average, Medicare ACO hospitals are not associated with improved mortality rates for the studied inpatient quality indicator conditions. They suggest that stakeholders may potentially consider providing ACOs with incentives or designing new programs for ACOs to target inpatient mortality reductions.
AHRQ-authored.
Citation: Cutler E, Karaca Z, Henke R .
The effects of Medicare accountable organizations on inpatient mortality rates.
Inquiry 2018 Jan-Dec;55:46958018800092. doi: 10.1177/0046958018800092..
Keywords: Quality of Care, Healthcare Cost and Utilization Project (HCUP), Hospitals, Medicare, Mortality
Leyenaar JK, Ralston SL, Shieh MS
Epidemiology of pediatric hospitalizations at general hospitals and freestanding children's hospitals in the United States.
Researchers described the volume and characteristics of pediatric hospitalizations at acute care general and freestanding children's hospitals in the United States. They found that, in 2012, more than 70 percent of pediatric hospitalizations occurred at general hospitals in the United States. Although the most common reasons for hospitalization were similar, the most costly conditions differed.
AHRQ-funded; HS024133.
Citation: Leyenaar JK, Ralston SL, Shieh MS .
Epidemiology of pediatric hospitalizations at general hospitals and freestanding children's hospitals in the United States.
J Hosp Med 2016 Nov;11(11):743-49. doi: 10.1002/jhm.2624.
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Keywords: Children/Adolescents, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Hospitals, Children/Adolescents
Thompson MP, Kaplan CM, Cao Y
Reliability of 30-day readmission measures used in the hospital readmission reduction program.
The researchers assessed the reliability of risk-standardized readmission rates (RSRRs) for medical conditions and surgical procedures used in the Hospital Readmission Reduction Program (HRRP). They found that approximately 25 percent of payments for excess readmissions were tied to unreliable RSRRs. Unreliable measures blur the connection between hospital performance and incentives, and threaten the success of the HRRP.
AHRQ-funded; HS023783.
Citation: Thompson MP, Kaplan CM, Cao Y .
Reliability of 30-day readmission measures used in the hospital readmission reduction program.
Health Serv Res 2016 Oct 21;51(6):2095-114. doi: 10.1111/1475-6773.12587.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Hospitals, Elderly, Quality Measures
Jiang HJ, Reiter KL, Wang J
AHRQ Author: Jiang HJ
Measuring mortality performance: How did safety-net hospitals compare with other hospitals?
This study assessed mortality performance of safety-net hospitals (SNHs) using all-payer databases and measures for a broad range of conditions and procedures. It found small differences in risk-adjusted mortality rates between SNHs and non-SNHs only among teaching hospitals. After controlling for hospital factors, these differences were substantially reduced and remained significant only for surgical mortality rates.
AHRQ-authored.
Citation: Jiang HJ, Reiter KL, Wang J .
Measuring mortality performance: How did safety-net hospitals compare with other hospitals?
Med Care 2016 Jul;54(7):648-56. doi: 10.1097/mlr.0000000000000540.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitals, Mortality, Provider Performance
Basu J, Avila R, Ricciardi R
AHRQ Author: Basu J, Ricciardi R
Hospital readmission rates in U.S. states: are readmissions higher where more patients with multiple chronic conditions cluster?
This study examines small area variations in readmission rates to assess whether higher readmission rate in an area is associated with higher clusters of patients with multiple chronic conditions. It found that areas with higher concentration of patients with increased comorbid conditions are more likely to have higher readmission rates.
AHRQ-authored.
Citation: Basu J, Avila R, Ricciardi R .
Hospital readmission rates in U.S. states: are readmissions higher where more patients with multiple chronic conditions cluster?
Health Serv Res 2016 Jun;51(3):1135-51. doi: 10.1111/1475-6773.12401..
Keywords: Chronic Conditions, Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Hospitals
Yanamadala S, Morrison D, Curtin C
Electronic health records and quality of care: an observational study modeling impact on mortality, readmissions, and complications.
The authors assessed the relationship between electronic health records (EHR) adoption and patient outcomes. Their results indicate that patients receiving medical and surgical care at hospitals with no EHR system have similar outcomes compared to patients seeking care at hospitals with a full EHR system. They concluded that EHRs may play a smaller role than expected in patient outcomes and overall quality of care.
AHRQ-funded; HS024096.
Citation: Yanamadala S, Morrison D, Curtin C .
Electronic health records and quality of care: an observational study modeling impact on mortality, readmissions, and complications.
Medicine (Baltimore) 2016 May;95(19):e3332. doi: 10.1097/md.0000000000003332.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Electronic Health Records (EHRs), Quality of Care, Mortality, Hospitals
Brown JR, Rezaee ME, Nichols EL
Incidence and in-hospital mortality of acute kidney injury (AKI) and dialysis-requiring AKI (AKI-D) after cardiac catheterization in the National Inpatient Sample.
This study examined cardiac catheterization or percutaneous coronary intervention (PCI) hospital discharges from the nationally representative National Inpatient Sample to determine annual population incidence rates for AKI and AKI-D in the United States from 2001 to 2011. It found that the incidence of AKI among cardiac catheterization and PCI patients has increased sharply in the United States; however, mortality has significantly declined.
AHRQ-funded; HS018443.
Citation: Brown JR, Rezaee ME, Nichols EL .
Incidence and in-hospital mortality of acute kidney injury (AKI) and dialysis-requiring AKI (AKI-D) after cardiac catheterization in the National Inpatient Sample.
J Am Heart Assoc 2016 Mar 15;5(3):e002739. doi: 10.1161/jaha.115.002739.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Adverse Events, Mortality, Patient Safety, Surgery, Heart Disease and Health, Cardiovascular Conditions, Kidney Disease and Health, Dialysis, Hospitals
Reiter KL, Jiang HJ, Wang J
AHRQ Author: Jiang HJ
Facing the recession: how did safety-net hospitals fare financially compared with their peers?
The authors examined the effect of the recession on the financial performance of safety-net versus non-safety-net hospitals. They concluded that safety-net hospitals may not be disproportionately vulnerable to macro-economic fluctuations, but their significantly lower margins leave less financial cushion to weather sustained financial pressure.
AHRQ-authored.
Citation: Reiter KL, Jiang HJ, Wang J .
Facing the recession: how did safety-net hospitals fare financially compared with their peers?
Health Serv Res 2014 Dec;49(6):1747-66. doi: 10.1111/1475-6773.12230.
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Keywords: Healthcare Costs, Healthcare Cost and Utilization Project (HCUP), Hospitals
Paez K, Roper RA, Andrews RM
AHRQ Author: Roper RA, Andrews RM
Health information technology and hospital patient safety: a conceptual model to guide research.
The authors developed a conceptual model to guide research in sorting out the complex relationships between health information technology (HIT) and the quality and safety of care. They found the model difficult to operationalize because available HIT adoption data did not characterize features and extent of usage, and patient safety measures did not elucidate the process failures leading to safety-related outcomes. Their findings illustrated the critical need for collecting data that are germane to HIT and the possible mechanisms by which HIT may affect inpatient safety.
AHRQ-authored; AHRQ-funded.
Citation: Paez K, Roper RA, Andrews RM .
Health information technology and hospital patient safety: a conceptual model to guide research.
Jt Comm J Qual Patient Saf 2013 Sep;39(9):415-25.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Health Information Technology (HIT), Hospitals, Quality of Care, Patient Safety
Henke RM, Maeda JL, Marder WD
AHRQ Author: Friedman BS, Wong HS
Medicare and commercial inpatient resource use: impact of hospital competition.
The authors examined the influence of hospital competition on small-area inpatient resource use by payer. Using HCUP data, they found that policies or incentives that promote or encourage competition in less competitive markets may reduce variation in resource use for both Medicare and private payers.
AHRQ-authored; AHRQ-funded; 290200600009C.
Citation: Henke RM, Maeda JL, Marder WD .
Medicare and commercial inpatient resource use: impact of hospital competition.
Am J Manag Care 2013 Jun;19(6):e238-48.
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Keywords: Healthcare Utilization, Healthcare Cost and Utilization Project (HCUP), Hospitals, Medicare
Rubinson L, Mutter R, Viboud C
AHRQ Author: Mutter R
Impact of the fall 2009 influenza A(H1N1)pdm09 pandemic on US hospitals.
The authors investigated the impact of the 2009 influenza A(H1N1)pdm09 pandemic on US hospitals. They found that the fall 2009 pandemic period substantially impacted US hospitals, mostly through increased emergency department visits. Furhter, for a small proportion of hospitals that experienced a high surge in inpatient admissions, increased mortality from selected clinical conditions was associated with both prepandemic outcomes and surge, highlighting the linkage between daily hospital operations and disaster preparedness.
AHRQ-authored.
Citation: Rubinson L, Mutter R, Viboud C .
Impact of the fall 2009 influenza A(H1N1)pdm09 pandemic on US hospitals.
Med Care 2013 Mar;51(3):259-65. doi: 10.1097/MLR.0b013e31827da8ea.
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Keywords: Emergency Department, Emergency Preparedness, Healthcare Cost and Utilization Project (HCUP), Hospitals, Influenza