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
101 to 125 of 167 Research Studies DisplayedEverson J, Butler E
Hospital adoption of multiple health information exchange approaches and information accessibility.
The aim of this study was to determine the change in adoption of 3 types of electronic health information exchange (HIE) in hospitals for 3 types of information exchange: secure messaging, provider portals, and use of an HIE; and to assess if growth in each approach corresponded to an increased ability to access and integrate patient information from outside providers. A sample of 1917 hospitals that responded to the American Hospital Association Information Technology Supplement every year from 2014 to 2016 was used for the analysis. Adoption of each approach increased by 9-15 percentage points over that time. The average number of HIE approaches increased from 1.0 to 1.4. The likelihood of having outside information increased by 10.3 percentage points with adoption of 1 approach, and by 9.5 percentage points with adoption of a second approach.
AHRQ-funded; HS026395.
Citation: Everson J, Butler E .
Hospital adoption of multiple health information exchange approaches and information accessibility.
J Am Med Inform Assoc 2020 Apr 1;27(4):577-83. doi: 10.1093/jamia/ocaa003..
Keywords: Health Information Technology (HIT), Health Information Exchange (HIE), Hospitals
Smith ME, Nuliyalu U, Dimick JB
Local referral of high-risk pancreatectomy patients to improve surgical outcomes and minimize travel burden.
Referring patients to high-quality hospitals for complex procedures may improve outcomes. This is most feasible within small geographic areas. However, access to specialized surgical procedures may be an implementation barrier. In this study, the investigators sought to determine the availability of high-quality hospitals performing pancreatectomy and the potential benefit and travel burden of referral within small geographic areas.
AHRQ-funded; HS024763.
Citation: Smith ME, Nuliyalu U, Dimick JB .
Local referral of high-risk pancreatectomy patients to improve surgical outcomes and minimize travel burden.
J Gastrointest Surg 2020 Apr;24(4):882-89. doi: 10.1007/s11605-019-04245-6..
Keywords: Surgery, Hospitals, Outcomes, Quality of Care
Fahrenbach J, Chin MH, Huang ES
Neighborhood disadvantage and hospital quality ratings in the Medicare Hospital Compare Program.
This study examined the relationship between neighborhood social risk factors (SRFs) and hospital ratings in Medicare's Hospital Compare Program. Results showed that lower hospital summary scores were associated with caring for neighborhoods with higher social risk. Associations between neighborhood SRFs and hospital ratings were largest in the timeliness of care, patient experience, and hospital readmission groups and smallest in the safety, efficiency, and effectiveness of care groups. Failing to account for neighborhood social risk in hospital rating systems may reinforce hidden disincentives to care for medically underserved areas in the United States.
AHRQ-funded; HS023007.
Citation: Fahrenbach J, Chin MH, Huang ES .
Neighborhood disadvantage and hospital quality ratings in the Medicare Hospital Compare Program.
Med Care 2020 Apr;58(4):376-83. doi: 10.1097/mlr.0000000000001283..
Keywords: Quality of Care, Hospitals, Medicare, Quality Indicators (QIs), Patient Experience, Social Determinants of Health
Myers LC, Faridi MK, Hasegawa K
The hospital readmissions reduction program and readmissions for chronic obstructive pulmonary disease, 2006-2015.
In October 2012, the initial phase of the Hospital Readmission Reduction Program imposed financial penalties on hospitals with higher-than-expected risk-adjusted 30-day readmission rates for Medicare beneficiaries with congestive heart failure, myocardial infarction, and pneumonia. In this study, the investigators hypothesized that these penalties may also be associated with decreased readmissions for chronic obstructive pulmonary disease (COPD) in the general population before COPD became a target condition (October 2014).
AHRQ-funded; HS023305.
Citation: Myers LC, Faridi MK, Hasegawa K .
The hospital readmissions reduction program and readmissions for chronic obstructive pulmonary disease, 2006-2015.
Ann Am Thorac Soc 2020 Apr;17(4):450-56. doi: 10.1513/AnnalsATS.201909-672OC..
Keywords: Respiratory Conditions, Hospital Readmissions, Hospitals, Chronic Conditions, Medicare
Ho V, Metcalfe L, Vu L
Annual spending per patient and quality in hospital-owned versus physician-owned organizations: an observational study.
This study examined whether there are patient spending differences between practices owned by hospitals versus independent physician practices. The study used data from patients aged 19 to 64 enrolled in a Blue Cross Blue Shield Preferred Provider organization in the four largest metropolitan areas in Texas. Spending was found to be significantly higher for durable medical equipment, imaging, unclassified services, and outpatient care in hospital-owned practices. Estimates were that expenses were 5.8% higher in those practices.
AHRQ-funded; HS024727.
Citation: Ho V, Metcalfe L, Vu L .
Annual spending per patient and quality in hospital-owned versus physician-owned organizations: an observational study.
J Gen Intern Med 2020 Mar;35(3):649-55. doi: 10.1007/s11606-019-05312-z..
Keywords: Hospitals, Healthcare Costs, Quality of Care
Khan SH, Xu C, Purpura R
Decreasing delirium through music: a randomized pilot trial.
This randomized controlled trial examined the use of music to decrease delirium in intensive care unit (ICU) patients. Patients were either provided personalized music (PM), slow-tempo music (STM), or an audiobook (for attention control). They were provided noise-cancelling headphones and used mp3 plays to listen to their music/audiobook for 1-hour sessions twice daily up to 7 days. Delirium and delirium severity were assessed twice daily using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Out of 1589 patients screen, 117 (7.4%) were eligible. Of those 52 were randomized between the three groups. Adherence was higher in the groups listening to music and 80% of patients surveyed rated the music as enjoyable. Median rates of delirium/coma-free days by day 7 was 2 for PM, 3 for STM, and 2 for AC. Medium delirium severity rates (from 1-7) was 5.5 for PM, 3.5 for STM, and 4 for AC.
AHRQ-funded; HS024384.
Citation: Khan SH, Xu C, Purpura R .
Decreasing delirium through music: a randomized pilot trial.
Am J Crit Care 2020 Mar 1;29(2):e31-e38. doi: 10.4037/ajcc2020175..
Keywords: Intensive Care Unit (ICU), Inpatient Care, Neurological Disorders, Prevention, Hospitals
Feng JY, Toomey SL, Elliott MN
Factors associated with family experience in pediatric inpatient care.
Researchers assessed which aspects of pediatric inpatient experience have the strongest relationships with parents' willingness to recommend a hospital. Their cross-sectional study examined surveys completed by parents of children hospitalized at hospitals using the Child Hospital Consumer Assessment of Healthcare Providers and Systems Survey. They found that child comfort and nurse-parent communication showed the strongest relationships with willingness to recommend, followed by preparing to leave the hospital, doctor-parent communication, and keeping parents informed. They recommended improvement efforts focusing on creating an age-appropriate environment, improving the effectiveness of provider interactions, and engaging parents to share their values and concerns.
AHRQ-funded; HS020513; HS025299.
Citation: Feng JY, Toomey SL, Elliott MN .
Factors associated with family experience in pediatric inpatient care.
Pediatrics 2020 Mar;145(3): e20191264. doi: 10.1542/peds.2019-1264..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Children/Adolescents, Quality Measures, Quality of Care, Inpatient Care, Patient Experience, Hospitals, Hospitalization, Patient and Family Engagement, Clinician-Patient Communication
Pruitt LCC, Skarda DE, Rollins MD
Hirschsprung-associated enterocolitis in children treated at US children's hospitals.
The incidence of and risk factors for Hirschsprung's-associated enterocolitis (HAEC) following pull-through have been limited to single institutions studies. In this retrospective cohort study, the investigators characterized the incidence of, risk factors for, and consequences of post-operative HAEC. The investigators concluded that HAEC following pull-through occurs in a large proportion of infants with HD and predicts reoperation. They suggest that multicenter studies are needed to develop prediction models and treatment protocols for HAEC.
AHRQ-funded; HS025776.
Citation: Pruitt LCC, Skarda DE, Rollins MD .
Hirschsprung-associated enterocolitis in children treated at US children's hospitals.
J Pediatr Surg 2020 Mar;55(3):535-40. doi: 10.1016/j.jpedsurg.2019.10.060.
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Keywords: Children/Adolescents, Digestive Disease and Health, Surgery, Adverse Events, Risk, Hospitals
Ilies I, Benneyan JC, Jabur TBC
Impact of molecular testing on reported Clostridoides difficile infection rates.
This study examined the impact of changing from the enzyme immunoassay (EIA) method to nucleic acid amplification tests (NAATs) to detect incidence of Cloistridoides difficile infection (CDI) in hospitals. The authors analyzed retrospective data from 2009-2017 from 47 hospitals in the southeastern United States. During that time period 37 hospitals switched to NAAT, including 24 with good pre- and post-switch data for statistical analysis. The incidence of CDI detection did go up in hospitals that had transitioned from 10.9 to 23.9 per 10,000 patient days, an average increase of 75%.
AHRQ-funded; HS023821.
Citation: Ilies I, Benneyan JC, Jabur TBC .
Impact of molecular testing on reported Clostridoides difficile infection rates.
Infect Control Hosp Epidemiol 2020 Mar;41(3):306-12. doi: 10.1017/ice.2019.327..
Keywords: Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Patient Safety, Hospitals
Arbaje AI, Werner NE, Kasda EM
Learning from lawsuits: using malpractice claims data to develop care transitions planning tools.
This study used malpractice claims data to evaluate safety risks during care transitions from hospital to home and to help develop care transitions planning tools and pilot test them. The authors analyzed closed malpractice claims for 230 adult patients discharged from 4 hospital sites. Two structured focus groups were also conducted for stakeholders to review concerns. This led to the development of two care transitions planning tools – one for patients/caregivers and one for healthcare providers. Feasibility on 53 patient discharges were tested for both tools. A total of 33 risk factors corresponding to hospital work system elements, care transitions processes, and care outcomes were found using qualitative analysis. Providers found the tool easy to use and patients felt the length and response of the tool was acceptable.
AHRQ-funded; HS022916; HS019519.
Citation: Arbaje AI, Werner NE, Kasda EM .
Learning from lawsuits: using malpractice claims data to develop care transitions planning tools.
J Patient Saf 2020 Mar;16(1):52-57. doi: 10.1097/pts.0000000000000238.
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Keywords: Medical Liability, Transitions of Care, Risk, Hospital Discharge, Hospitals, Patient Safety
McHaney-Lindstrom M, Hebert C, Miller H
Network analysis of intra-hospital transfers and hospital onset Clostridium difficile infection.
This paper explores how social network analysis (SNA) software can be used to analyze intra-hospital networks of individuals with a healthcare associated infection (HAI) for further analysis in a GIS environment. The SNA analysis compared cases to controls which highlighted significant differences in the overall structure of the networks.
AHRQ-funded; HS024379.
Citation: McHaney-Lindstrom M, Hebert C, Miller H .
Network analysis of intra-hospital transfers and hospital onset Clostridium difficile infection.
Health Info Libr J 2020 Mar;37(1):26-34. doi: 10.1111/hir.12274..
Keywords: Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Infectious Diseases, Hospitals, Public Health
Sharma R, Zachrison KS, Viswanathan A
Trends in telestroke care delivery: a 15-year experience of an academic hub and its network of spokes.
Telestroke provides access to vascular neurology expertise for hospitals lacking stroke coverage, and its use has risen rapidly in the past decade. In this study the investigators aimed to characterize consultations, spoke behavior, and the relationship between spoke telestroke utilization (number of telestroke consults per year) and spoke alteplase treatment metrics in an academic telestroke network.
AHRQ-funded; HS024561.
Citation: Sharma R, Zachrison KS, Viswanathan A .
Trends in telestroke care delivery: a 15-year experience of an academic hub and its network of spokes.
Circ Cardiovasc Qual Outcomes 2020 Mar;13(3):e005903. doi: 10.1161/circoutcomes.119.005903..
Keywords: Telehealth, Health Information Technology (HIT), Stroke, Healthcare Delivery, Care Management, Hospitals
Manojlovich M, Harrod M, Hofer TP
Using qualitative methods to explore communication practices in the context of patient care rounds on general care units.
This study examined communication practices between nurses and physicians in general care units at 4 Midwestern hospitals. A total of 163 physicians, registered nurses, and nurse practitioners participated. The researchers observed and shadowed clinicians during rounds and other times during a 2 week period as well as conducting interviews and holding focus groups. Workflow differences affected rounds and subsequently communication practices. Good rapport between physicians and nurses contributed to nurse participation during rounds. Lower rapport made some nurses feel uncomfortable accompanying physicians during rounds unless invited.
AHRQ-funded; HS022305.
Citation: Manojlovich M, Harrod M, Hofer TP .
Using qualitative methods to explore communication practices in the context of patient care rounds on general care units.
J Gen Intern Med 2020 Mar;35(3):839-45. doi: 10.1007/s11606-019-05580-9..
Keywords: Communication, Provider: Physician, Provider: Nurse, Provider, Hospitals, Teams, Inpatient Care, Healthcare Delivery
Mohr NM, Wu C, Ward MJ
Potentially avoidable inter-facilit transfer from Veterans Health Administration emergency departments: a cohort study.
The objective of this study was to describe ED-based inter-facility transfer practices within the Veterans Health Administration (VHA) and to estimate the proportion of potentially avoidable transfers. Results showed that VHA inter-facility transfer was commonly performed for mental health and cardiac evaluation, particularly for patients in rural settings. The proportion that are potentially avoidable is small. Future work should focus on improving capabilities to provide specialty evaluation locally for these conditions, possibly using telehealth solutions.
AHRQ-funded; HS025753.
Citation: Mohr NM, Wu C, Ward MJ .
Potentially avoidable inter-facilit transfer from Veterans Health Administration emergency departments: a cohort study.
BMC Health Serv Res 2020 Feb 12;20(1):110. doi: 10.1186/s12913-020-4956-6..
Keywords: Emergency Department, Hospitals, Healthcare Delivery, Access to Care, Rural Health
Scott HF, Colborn KL, Sevick CJ
Development and validation of a predictive model of the risk of pediatric septic shock using data known at the time of hospital arrival.
The purpose of this observational cohort study was to derive and validate a model of risk of septic shock among children with suspected sepsis, using data known in the electronic health record at hospital arrival. The investigators concluded that their model estimated the risk of septic shock in children at hospital arrival earlier than existing models. They indicate it leveraged the predictive value of routine electronic health record data through a modern predictive algorithm and suggest it has the potential to enhance clinical risk stratification in the critical moments before deterioration.
AHRQ-funded; HS025696.
Citation: Scott HF, Colborn KL, Sevick CJ .
Development and validation of a predictive model of the risk of pediatric septic shock using data known at the time of hospital arrival.
J Pediatr 2020 Feb;217:145-51.e6. doi: 10.1016/j.jpeds.2019.09.079..
Keywords: Children/Adolescents, Sepsis, Emergency Department, Hospitals, Risk, Electronic Health Records (EHRs), Health Information Technology (HIT)
Piper KN, Baxter KJ, McCarthy I
Distinguishing children's hospitals from non-children's hospitals in large claims data.
The first methodologic step needed to compare pediatric health outcomes at children's hospitals (CHs) and non-children's hospitals (NCHs) is to classify hospitals into CH and NCH categories. However, there are currently no standardized or validated methods for classifying hospitals. The purpose of this study was to describe a novel and reproducible hospital classification methodology. The investigators concluded that using American Hospital Association survey data was a feasible and valid method for classifying hospitals into CH and NCH categories by using a reproducible multitiered system.
AHRQ-funded; HS024712.
Citation: Piper KN, Baxter KJ, McCarthy I .
Distinguishing children's hospitals from non-children's hospitals in large claims data.
Hosp Pediatr 2020 Feb;10(2):123-28. doi: 10.1542/hpeds.2019-0218..
Keywords: Children/Adolescents, Hospitals
Colton K, Richards CT, Pruitt PB
Early stroke recognition and time-based emergency care performance metrics for intracerebral hemorrhage.
This study compared time for early stroke recognition for intracerebral hemorrhage for hospitals with and without stroke teams. An observational cohort study was conducted at an urban comprehensive stroke center from 2009 to 2017 with 204 cases included. Stroke team activation resulted in faster emergency care compared to no activation. This process resulted in shorter onset-to-arrival times, higher NIH Stroke Scale scores, and higher Glasgow Coma Scale scores.
AHRQ-funded; HS023437.
Citation: Colton K, Richards CT, Pruitt PB .
Early stroke recognition and time-based emergency care performance metrics for intracerebral hemorrhage.
J Stroke Cerebrovasc Dis 2020 Feb;29(2):104552. doi: 10.1016/j.jstrokecerebrovasdis.2019.104552..
Keywords: Stroke, Emergency Department, Provider Performance, Diagnostic Safety and Quality, Quality Improvement, Quality Indicators (QIs), Patient-Centered Outcomes Research, Outcomes, Quality of Care, Evidence-Based Practice, Hospitals
Ellis RJ, Schlick CJR, Feinglass J
Failure to administer recommended chemotherapy: acceptable variation or cancer care quality blind spot?
This study examined hospital variation in cancer patients who did not receive recommended chemotherapy. Patients with breast, colon, and lung cancers who did not receive chemotherapy from 2000 to 2015 were identified from the National Cancer Database. A total of 183,148 patients at 1281 hospitals were included. For breast cancer, 3.5% of patients failed to receive recommended chemotherapy, and 6.6% with colon, and 10.7% with lung cancer. Sociodemographic factors showed that patients were less likely to receive chemotherapy if they were uninsured or on Medicaid, as were non-Hispanic black patients with both breast and colon cancer. There was also significant hospital variation with failure to administer as high as 21.8% for breast, 40.2% for colon, and 40.0% for lung cancer.
AHRQ-funded; HS000078; HS026385.
Citation: Ellis RJ, Schlick CJR, Feinglass J .
Failure to administer recommended chemotherapy: acceptable variation or cancer care quality blind spot?
BMJ Qual Saf 2020 Feb;29(2):103-12. doi: 10.1136/bmjqs-2019-009742..
Keywords: Treatments, Cancer, Healthcare Delivery, Access to Care, Healthcare Utilization, Social Determinants of Health, Vulnerable Populations, Uninsured, Hospitals, Quality of Care
Dworsky JQ, Childers CP, Gornbein J
Hospital experience predicts outcomes after high-risk geriatric surgery.
This study examined if there an association between a hospital’s annual volume of high-risk geriatric surgery and their risk of inpatient mortality, postoperative length of stay, and discharge to nursing facility. Using the 2014 National Inpatient Sample, older adults were identified who had undergone high-risk geriatric surgery. There were an estimated 514,950 hospital encounters at 3,115 hospitals undergoing surgery. A higher proportion of high-risk geriatric surgery patients was associated with decreased mortality and shorter postoperative length of stay. Higher volume hospitals were not associated with mortality but was associated with longer length of stay and decreased discharge to nursing facilities.
AHRQ-funded; HS000046; HS025079.
Citation: Dworsky JQ, Childers CP, Gornbein J .
Hospital experience predicts outcomes after high-risk geriatric surgery.
Surgery 2020 Feb;167(2):468-74. doi: 10.1016/j.surg.2019.07.026..
Keywords: Healthcare Cost and Utilization Project (HCUP), Elderly, Surgery, Risk, Hospitals, Outcomes, Mortality
Haldar S, Mishra SR, Pollack AH
Informatics opportunities to involve patients in hospital safety: a conceptual model.
This study investigated how hospital inpatients experience undesirable events (UEs) and to see if those present opportunities for new informatics solutions. The authors surveyed 242 patients and caregivers during their hospital stay and asked them open-ended questions about their experiences with UEs. They then developed a 4-stage conceptual model which illustrates inpatient experiences: from when they first encounter UEs, and opportunities to promote inpatients’ participation and engagement in the quality and safety of their care, help healthcare systems learn from inpatient experience, and reduce those harmful events.
AHRQ-funded; HS022894.
Citation: Haldar S, Mishra SR, Pollack AH .
Informatics opportunities to involve patients in hospital safety: a conceptual model.
J Am Med Inform Assoc 2020 Feb;27(2):202-11. doi: 10.1093/jamia/ocz167.
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Keywords: Patient Safety, Hospitals, Health Information Technology (HIT), Patient and Family Engagement, Patient Experience, Quality of Care
Hoffman GJ, Min LC, Liu H
Role of post-acute care in readmissions for preexisting healthcare-associated infections.
Researchers examined the risk of preexisting healthcare-associated infections (HAIs) readmissions according to patient discharge disposition and comorbidity level. They found that skilled nursing facility discharges were associated with fewer avoidable readmissions for preexisting HAIs compared with home discharges. They recommended further research to identify modifiable mechanisms to improve posthospital infection care at home.
AHRQ-funded; HS025838; HS025451.
Citation: Hoffman GJ, Min LC, Liu H .
Role of post-acute care in readmissions for preexisting healthcare-associated infections.
J Am Geriatr Soc 2020 Feb;68(2):370-78. doi: 10.1111/jgs.16208..
Keywords: Healthcare-Associated Infections (HAIs), Hospital Readmissions, Hospital Discharge, Hospitals, Patient Safety, Elderly
Everson J, Adler-Milstein J
Sharing information electronically with other hospitals is associated with increased sharing of patients.
This study examined whether patient sharing between hospitals increased when they participated in a health information organization (HIO). The researchers used national data on hospital participation in HIOs from the American Hospital Association Information Technology Supplement and data on the volume of Medicare patients shared between pairs of hospitals from 2010 to 2016. They found that there an increase in patient sharing in competitive markets and with larger hospitals. Participation by only one hospital had no impact on patient sharing.
AHRQ-funded; HS026395.
Citation: Everson J, Adler-Milstein J .
Sharing information electronically with other hospitals is associated with increased sharing of patients.
Health Serv Res 2020 Feb;55(1):128-35. doi: 10.1111/1475-6773.13240..
Keywords: Health Information Technology (HIT), Health Information Exchange (HIE), Hospitals
Strobel RJ, Likosky DS, Brescia AA
The effect of hospital market competition on the adoption of transcatheter aortic valve replacement.
The use of transcatheter aortic valve replacement (TAVR) has grown rapidly. The purpose of this study was to assess whether hospital market competition was associated with the use of TAVR. The investigators concluded that market competition was positively associated with a hospital's adoption of TAVR and indicated that future studies should further examine the impact of competition on quality and appropriateness.
AHRQ-funded; HS026003.
Citation: Strobel RJ, Likosky DS, Brescia AA .
The effect of hospital market competition on the adoption of transcatheter aortic valve replacement.
Ann Thorac Surg 2020 Feb;109(2):473-79. doi: 10.1016/j.athoracsur.2019.06.025..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitals, Cardiovascular Conditions, Heart Disease and Health, Surgery
Langhoff E, Siu A, Boockvar K
The VA and Non-VA experience of tracking good care.
This study compared how well Department of Veterans Affairs (VA) hospitals perform against non-VA hospitals. Three widely referenced public health care ranking models: the U.S. News America’s Best Hospitals, Truven Health Analytics, and Hospital Compare along with the VA model were examined. The authors found that the metrics used across the 4 models are neither comparable nor transparent. They found there were 6-46% reporting deficiencies in reporting hospital metrics in non-VA hospitals, while VA reporting is 100% of their metrics. VA inpatient satisfaction fell far short of the private sector, but both sets of rankings increased over time.
AHRQ-funded; HS022924.
Citation: Langhoff E, Siu A, Boockvar K .
The VA and Non-VA experience of tracking good care.
Popul Health Manag 2020 Feb;23(1):92-100. doi: 10.1089/pop.2019.0039..
Keywords: Hospitals, Provider Performance, Patient Experience, Quality of Care
Haidari ES, Lee HC, Illuzzi JL
Utility of birth certificate data for evaluating hospital variation in admissions to NICUs.
Efforts to study potential overuse of NICU admissions and hospital variation in practice are often hindered by a lack of an appropriate data source. In this study, the investigators examined the concordance of hospital-level NICU admission rates between birth certificate data and California Children's Services (CCS) data to inform the utility of birth certificate data in studying hospital variation in NICU admissions.
AHRQ-funded; HS023801.
Citation: Haidari ES, Lee HC, Illuzzi JL .
Utility of birth certificate data for evaluating hospital variation in admissions to NICUs.
Hosp Pediatr 2020 Feb;10(2):190-94. doi: 10.1542/hpeds.2019-0116..
Keywords: Newborns/Infants, Hospitalization, Hospitals