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
76 to 100 of 112 Research Studies DisplayedAldina S, Goldhaber-Fiebert SN, Hannenberg AA
Factors associated with the use of cognitive aids in operating room crises: a cross-sectional study of US hospitals and ambulatory surgical centers.
This study examined organizational context and implementation process factors influencing the use of cognitive aids for OR crises. It found that small facility size was associated with a fourfold increase in the odds of a facility reporting more successful implementation. Completing more implementation steps was also significantly associated with more successful implementation.
AHRQ-funded; HS024235.
Citation: Aldina S, Goldhaber-Fiebert SN, Hannenberg AA .
Factors associated with the use of cognitive aids in operating room crises: a cross-sectional study of US hospitals and ambulatory surgical centers.
Implement Sci 2018 Mar 26;13(1):50. doi: 10.1186/s13012-018-0739-4.
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Keywords: Adverse Events, Ambulatory Care and Surgery, Patient Safety, Quality Improvement, Quality of Care, Hospitals, Shared Decision Making, Clinical Decision Support (CDS)
Gowrisankaran G, Lucarelli C, Schmidt-Dengler P
Can amputation save the hospital? The impact of the Medicare Rural Flexibility Program on demand and welfare.
This paper sought to understand the impact of the Medicare Rural Hospital Flexibility (Flex) Program on hospital choice and consumer welfare for rural residents. The Flex Program created a new class of hospital, the Critical Access Hospital (CAH), which received more generous Medicare reimbursements in return for limits on capacity and length of stay. The investigators found that conversion to CAH status resulted in a 4.7 percent drop in inpatient admissions to participating hospitals, almost all of which was driven by factors other than capacity constraints.
AHRQ-funded; HS018424.
Citation: Gowrisankaran G, Lucarelli C, Schmidt-Dengler P .
Can amputation save the hospital? The impact of the Medicare Rural Flexibility Program on demand and welfare.
J Health Econ 2018 Mar;58:110-22. doi: 10.1016/j.jhealeco.2018.01.004..
Keywords: Rural Health, Access to Care, Hospitals, Medicare, Payment
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
Bhise V, Sittig DF, Vaghani V
An electronic trigger based on care escalation to identify preventable adverse events in hospitalised patients.
Researchers refined the methods of the Institute of Healthcare Improvement's Global Trigger Tool application and leveraged electronic health record data to improve detection of preventable adverse events, including diagnostic errors. In the studied sample, preventable adverse events were identified, including adverse drug events, patient falls, procedure-related complications, and hospital-associated infections. The authors concluded that such e-triggers can help overcome limitations of currently available methods to detect preventable harm in hospitalized patients.
AHRQ-funded; HS022087; HS023602.
Citation: Bhise V, Sittig DF, Vaghani V .
An electronic trigger based on care escalation to identify preventable adverse events in hospitalised patients.
BMJ Qual Saf 2018 Mar;27(3):241-46. doi: 10.1136/bmjqs-2017-006975..
Keywords: Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitalization, Hospitals, Patient Safety, Prevention, Quality of Care, Quality Improvement, Quality Indicators (QIs)
Makam AN, Nguyen OK, Xuan L
Factors associated with variation in long-term acute care hospital vs skilled nursing facility use among hospitalized older adults.
This study examined factors associated with variation in long-term acute care hospitals (LTACs) vs less costly skilled nursing facilities (SNFs) transfer among hospitalized older adults. It concluded that half of the variation in LTAC vs SNF transfer is independent of patients' illness severity or clinical complexity, and is explained by where the patient was hospitalized and in what region, with far greater use in the South.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Xuan L .
Factors associated with variation in long-term acute care hospital vs skilled nursing facility use among hospitalized older adults.
JAMA Intern Med 2018 Mar;178(3):399-405. doi: 10.1001/jamainternmed.2017.8467.
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Keywords: Elderly, Long-Term Care, Hospitals, Nursing Homes, Transitions of Care
Sills MR, Macy ML, Kocher KE
Return visit admissions may not indicate quality of emergency department care for children.
The goal of this retrospective analysis was to test the hypothesis that in-hospital outcomes are worse among children admitted during a return ED visit than among those admitted during an index visit. Children who were hospitalized in Florida and New York hospitals during a return visit within 7 days were classified as "ED return admissions" or "readmissions"; in-hospital outcomes for ED return admissions and readmissions were compared to "index admissions without return admission". The results indicate that children who are initially discharged from the ED and then have a return admission had lower severity but similar cost in comparison with children who experienced an index admission without a return admission. The authors conclude that this suggests that ED return visit admissions do not involve worse outcomes than index admissions.
AHRQ-funded; HS024160; HS016418.
Citation: Sills MR, Macy ML, Kocher KE .
Return visit admissions may not indicate quality of emergency department care for children.
Acad Emerg Med 2018 Mar;25(3):283-92. doi: 10.1111/acem.13324..
Keywords: Children/Adolescents, Emergency Department, Hospital Discharge, Hospital Readmissions, Hospitals, Quality of Care, Outcomes
Spatz ES, Wang Y, Beckman AL
Traditional Chinese medicine for acute myocardial infarction in western medicine hospitals in China.
This study examined the use of traditional Chinese medicine (TCM) in patients admitted for acute myocardial infarction (AMI) in China during the first 24 hours of hospitalization. The data came from the China Patient-centered Evaluative Assessment of Cardiac Events Retrospective Study of Acute Myocardial Infarction. A chart review was done of randomly sampled patients in 2001, 2006 and 2011 in 162 Western medicine hospitals across China. Nearly all (99%) hospitals used some form of TCM, with Salvia miltiorrhiza being the most commonly prescribed. This TCM treatment (and others) was used intravenously and use has increased over the span of the study, despite lack of evidence of benefit or harm.
AHRQ-funded; HS023000.
Citation: Spatz ES, Wang Y, Beckman AL .
Traditional Chinese medicine for acute myocardial infarction in western medicine hospitals in China.
Circ Cardiovasc Qual Outcomes 2018 Mar;11(3):e004190. doi: 10.1161/circoutcomes.117.004190..
Keywords: Adverse Events, Cardiovascular Conditions, Complementary and Alternative Medicine, Heart Disease and Health, Hospitals, Mortality, Outcomes, Patient-Centered Outcomes Research, Patient Safety, Practice Patterns, Risk
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
Shubeck SP, Thumma JR, Dimick JB
Hospital quality, patient risk, and Medicare expenditures for cancer surgery.
The authors evaluated the potential interactive effect of hospital quality and patient risk on expenditures for cancer resections. They found that the total episode expenditures for cancer resections were lower when care was delivered at low-complication, high-quality hospitals. Expenditure differences were particularly large for high-risk patients, suggesting that the selective referral of high-risk patients to high-quality centers may be an effective strategy for optimizing value in cancer surgery.
AHRQ-funded; HS024763.
Citation: Shubeck SP, Thumma JR, Dimick JB .
Hospital quality, patient risk, and Medicare expenditures for cancer surgery.
Cancer 2018 Feb 15;124(4):826-32. doi: 10.1002/cncr.31120.
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Keywords: Cancer, Healthcare Costs, Quality of Care, Hospitals, Surgery
Desai S, McWilliams JM
Consequences of the 340B drug pricing program.
Researchers used Medicare claims and a regression-discontinuity design, taking advantage of the threshold for program eligibility among general acute care hospitals to isolate the effects of the 340B Drug Pricing Program on hospital-physician consolidation and on the outpatient administration of parenteral drugs. They concluded that the Program has been associated with hospital-physician consolidation in hematology-oncology and with more hospital-based administration of parenteral drugs in hematology-oncology and ophthalmology.
AHRQ-funded; HS024072.
Citation: Desai S, McWilliams JM .
Consequences of the 340B drug pricing program.
N Engl J Med 2018 Feb 8;378(6):539-48. doi: 10.1056/NEJMsa1706475.
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Keywords: Healthcare Costs, Payment, Hospitals, Medicare, Medication
Hermann LE, Hall M, Kyler K
The pipeline from abstract presentation to publication in pediatric hospital medicine.
The authors of this article identified the publication rate of abstracts submitted to the 2014 Pediatric Hospital Medicine (PHM) conference and determined whether presentation format was associated with subsequent journal publication or time to publication. They found that abstracts accepted for oral presentation had more than 7-fold greater odds of publication and a 4-fold greater likelihood of publication at each month compared with rejected abstracts. Median journal impact factor was significantly higher for oral presentations than for other presentation formats. They concluded that abstract reviewers may be able to identify methodologically sound studies for presentation; however, the low overall publication rate may indicate that presented results are preliminary or signify a need for increased mentorship and resources for research development in PHM.
AHRQ-funded; 2337002T; 233201500016I.
Citation: Hermann LE, Hall M, Kyler K .
The pipeline from abstract presentation to publication in pediatric hospital medicine.
J Hosp Med 2018 Feb;13(2):90-95. doi: 10.12788/jhm.2853..
Keywords: Children/Adolescents, Health Services Research (HSR), Hospitals
Ibrahim AM, Dimick JB, Sinha SS
Association of coded severity with readmission reduction after the hospital readmissions reduction program.
This research letter describes a study which examined coding by hospitals used to determine rates of readmission under the Hospital Readmission Reduction Program (HRRP). Hospitals who go above a certain rate are subject to financial penalties for 3 targed medical conditions. It was determined that hospitals have begun to change their coding to show increased severity of illness in many of those readmissions. Data came from discharges from the Medicare Provider Analysis and review file between 2008 and 2014. Researchers compared coding severity levels from before HRRP was implemented and post April 1, 2010 when it began.
AHRQ-funded; HS024525; HS024728.
Citation: Ibrahim AM, Dimick JB, Sinha SS .
Association of coded severity with readmission reduction after the hospital readmissions reduction program.
JAMA Intern Med 2018 Feb;178(2):290-92. doi: 10.1001/jamainternmed.2017.6148..
Keywords: Hospital Readmissions, Hospitals, Medicare, Policy
Baker LC, Bundorf MK, Devlin AM
Hospital ownership of physicians: hospital versus physician perspectives.
There has been significant interest from health services researchers and policy makers about recent trends in hospitals' ownership of physician practices, however, few studies have investigated the strengths and weaknesses of available data sources. In this article, the investigators compare results from two national surveys that have been used to assess ownership patterns, one of hospitals (the American Hospital Association survey) and one of physicians (the SK&A survey).
AHRQ-funded; HS024535.
Citation: Baker LC, Bundorf MK, Devlin AM .
Hospital ownership of physicians: hospital versus physician perspectives.
Med Care Res Rev 2018 Feb;75(1):88-99. doi: 10.1177/1077558716676018..
Keywords: Health Services Research (HSR), Hospitals, Provider
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
Kerstenetzky L, Birschbach MJ, Beach KF
Improving medication information transfer between hospitals, skilled-nursing facilities, and long-term-care pharmacies for hospital discharge transitions of care: a targeted needs assessment using the Intervention Mapping framework.
The authors of this study report on the development of a logic model that will be used to explore methods for minimizing patient care medication delays and errors while further improving handoff communication to skilled nurse facilities and long term care pharmacy staff.
AHRQ-funded; HS021984.
Citation: Kerstenetzky L, Birschbach MJ, Beach KF .
Improving medication information transfer between hospitals, skilled-nursing facilities, and long-term-care pharmacies for hospital discharge transitions of care: a targeted needs assessment using the Intervention Mapping framework.
Res Social Adm Pharm 2018 Feb;14(2):138-45. doi: 10.1016/j.sapharm.2016.12.013..
Keywords: Adverse Drug Events (ADE), Hospital Discharge, Hospitals, Long-Term Care, Medical Errors, Medication, Medication: Safety, Nursing Homes, Patient Safety, Transitions of Care
Rangachari P
Innovation implementation in the context of hospital QI: lessons learned and strategies for success.
This paper conducts an integrative review of the literature on "innovation implementation" in hospitals and health systems over the last decade, since the spotlight was cast on "innovation implementation failure" in health care organizations (HCOs). It summarizes the lessons learned from the literature, discusses the relevance of management research on innovation implementation in HCOs, and identifies future research avenues.
AHRQ-funded; HS024335.
Citation: Rangachari P .
Innovation implementation in the context of hospital QI: lessons learned and strategies for success.
Innov Entrep Health 2018;5:1-14. doi: 10.2147/ieh.s151040.
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Keywords: Evidence-Based Practice, Health Systems, Health Information Technology (HIT), Implementation, Quality Improvement, Hospitals, Quality of Care
Yang L, Liu C, Huang C
Patients' perceptions of interactions with hospital staff are associated with hospital readmissions: a national survey of 4535 hospitals.
The researchers examined the extent to which patients' experience with hospital care is related to hospital readmission. Their finding suggests that hospitals with better staff responsiveness were significantly more likely to have lower 30-day readmissions for all conditions. The effect size depended on the baseline readmission rates, with the largest effect on hospitals in the upper 75th quartile.
AHRQ-funded; HS021844.
Citation: Yang L, Liu C, Huang C .
Patients' perceptions of interactions with hospital staff are associated with hospital readmissions: a national survey of 4535 hospitals.
BMC Health Serv Res 2018 Jan 29;18(1):50. doi: 10.1186/s12913-018-2848-9.
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Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Hospitals, Patient Experience, Patient Experience, Hospital Readmissions
Lau BD, Streiff MB, Kraus PS
Missed doses of venous thromboembolism (VTE) prophylaxis at community hospitals: cause for alarm.
This study examined the rate of missed doses of venous thromboembolism (VTE) prophylaxis at community hospitals in the Washington, DC and greater Baltimore metropolitan areas. This retrospective study included four hospitals within the Johns Hopkins Health System. Non-administration of VTE prophylaxis was found 10.9% to 15.0% of the time among the three community hospitals. About 43.6% of patients missed at least one dose in all four hospitals. The investigators weren’t able to categorize patients by specialty, however it has been reported that more doses are missed with medically ill patients than other hospitalized patients.
AHRQ-funded; HS024547.
Citation: Lau BD, Streiff MB, Kraus PS .
Missed doses of venous thromboembolism (VTE) prophylaxis at community hospitals: cause for alarm.
J Gen Intern Med 2018 Jan;33(1):19-20. doi: 10.1007/s11606-017-4203-y..
Keywords: Blood Clots, Prevention, Blood Thinners, Patient Adherence/Compliance, Medication, 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
Hsuan C, Horwitz JR, Ponce NA
Complying with the Emergency Medical Treatment and Labor Act (EMTALA): challenges and solutions.
EMTALA, which requires Medicare-participating hospitals to provide emergency care to patients regardless of their ability to pay, plays an important role in protecting the uninsured. Yet many hospitals do not comply. This study examines the reasons for noncompliance and proposes solutions. Respondents identified 5 main causes of noncompliance as well as suggesting methods to improve compliance.
AHRQ-funded; HS024247.
Citation: Hsuan C, Horwitz JR, Ponce NA .
Complying with the Emergency Medical Treatment and Labor Act (EMTALA): challenges and solutions.
J Healthc Risk Manag 2018 Jan;37(3):31-41. doi: 10.1002/jhrm.21288.
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Keywords: Emergency Medical Services (EMS), Payment, Hospitals, Medicare, Uninsured
Burke RE, Jones CD, Hosokawa P
Influence of nonindex hospital readmission on length of stay and mortality.
The purpose of this study was to describe the prevalence of nonindex 30-day readmissions in a nationally representative sample of all payers and associations with outcomes. The investigators conclude that nonindex readmissions are common and associated with worse outcomes; the common findings across cohorts highlighted the importance for hospitals and care systems participating in value-based payment models.
AHRQ-funded; HS024569.
Citation: Burke RE, Jones CD, Hosokawa P .
Influence of nonindex hospital readmission on length of stay and mortality.
Med Care 2018 Jan;56(1):85-90. doi: 10.1097/mlr.0000000000000829..
Keywords: Hospitals, Mortality, Outcomes, Hospital Readmissions
Campione J, Famolaro T
Promising practices for improving hospital patient safety culture.
This study was conducted to gain knowledge about promising best practices used by hospitals to improve patient safety culture hospitalwide. Among six large hospitals that improved their hospitalwide culture score, the common best practices were the implementation of routine culture measurement with a wide dissemination of results, and multifaceted patient safety programs and education.
AHRQ-funded; 290201300003C.
Citation: Campione J, Famolaro T .
Promising practices for improving hospital patient safety culture.
Jt Comm J Qual Patient Saf 2018 Jan;44(1):23-32. doi: 10.1016/j.jcjq.2017.09.001.
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Keywords: Hospitals, Patient Safety, Quality of Care, Quality Improvement
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
Lindrooth RC, Perraillon MC, Hardy RY
Understanding the relationship between Medicaid expansions and hospital closures.
The investigators hypothesized that Medicaid expansion of eligibility for childless adults prevents hospital closures because increased Medicaid coverage for previously uninsured people reduces uncompensated care expenditures and strengthens hospitals' financial position. They tested this hypothesis using data for the period 2008-16 on hospital closures and financial performance and discuss their findings in this paper.
AHRQ-funded; HS024959; HS025208.
Citation: Lindrooth RC, Perraillon MC, Hardy RY .
Understanding the relationship between Medicaid expansions and hospital closures.
Health Aff 2018 Jan;37(1):111-20. doi: 10.1377/hlthaff.2017.0976..
Keywords: Healthcare Costs, Policy, Hospitals, Medicaid, Rural Health