National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (2)
- Adverse Events (8)
- Blood Thinners (3)
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- (-) Cardiovascular Conditions (15)
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- Comparative Effectiveness (1)
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- Medication: Safety (3)
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- Patient-Centered Outcomes Research (3)
- (-) Patient Safety (15)
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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 15 of 15 Research Studies DisplayedBarnes GD
Combining antiplatelet and anticoagulant therapy in cardiovascular disease.
The author describes results of a number of randomized clinical trials that have explored different combinations of anticoagulation plus antiplatelet agents aimed at minimizing bleeding risk while preserving low thrombotic event rates. Findings include shorter courses with fewer antithrombotic agents as being effective, particularly when direct oral anticoagulants are combined with clopidogrel. Combined use of very low-dose rivaroxaban plus aspirin also demonstrated benefit in atherosclerotic diseases, including coronary and peripheral artery disease. Use of proton pump inhibitor therapy while patients were taking multiple antithrombotic agents had the potential to further reduce upper gastrointestinal bleeding risk in select populations. The author recommends that applying this evidence to patients with multiple thrombotic conditions will help to avoid costly and life-threatening adverse medication events.
AHRQ-funded; HS026874; HS026322.
Citation: Barnes GD .
Combining antiplatelet and anticoagulant therapy in cardiovascular disease.
Hematology Am Soc Hematol Educ Program 2020 Dec 4;2020(1):642-48. doi: 10.1182/hematology.2020000151..
Keywords: Blood Thinners, Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Cardiovascular Conditions
Yao X, Inselman JW, Ross JS
Comparative effectiveness and safety of oral anticoagulants across kidney function in patients with atrial fibrillation.
Patients with atrial fibrillation and severely decreased kidney function were excluded from the pivotal non-vitamin K antagonist oral anticoagulants (NOAC) trials, thereby raising questions about comparative safety and effectiveness in patients with reduced kidney function. This study aimed to compare oral anticoagulants across the range of kidney function in patients with atrial fibrillation.
AHRQ-funded; HS025517; HS025164; HS025402; HS022882; HS024075.
Citation: Yao X, Inselman JW, Ross JS .
Comparative effectiveness and safety of oral anticoagulants across kidney function in patients with atrial fibrillation.
Circ Cardiovasc Qual Outcomes 2020 Oct;13(10):e006515. doi: 10.1161/circoutcomes.120.006515..
Keywords: Kidney Disease and Health, Cardiovascular Conditions, Blood Thinners, Medication, Medication: Safety, Patient Safety, Comparative Effectiveness, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes
Abraham NS, Yang EH, Noseworthy PA
Fewer gastrointestinal bleeds with ticagrelor and prasugrel compared with clopidogrel in patients with acute coronary syndrome following percutaneous coronary intervention.
The goal of this study was to compare gastrointestinal bleeding (GIB) rates associated with clopidogrel, prasugrel, and ticagrelor using national medical and pharmacy claims data from privately insured and Medicare Advantage enrollees. Findings showed that, in the first year following percutaneous coronary intervention for acute coronary syndrome, ticagrelor and prasugrel were associated with fewer GIB events compared with clopidogrel.
AHRQ-funded; HS025402.
Citation: Abraham NS, Yang EH, Noseworthy PA .
Fewer gastrointestinal bleeds with ticagrelor and prasugrel compared with clopidogrel in patients with acute coronary syndrome following percutaneous coronary intervention.
Aliment Pharmacol Ther 2020 Aug;52(4):646-54. doi: 10.1111/apt.15790..
Keywords: Medication: Safety, Medication, Blood Thinners, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Cardiovascular Conditions, Surgery
Wang Y, Eldridge N, Metersky ML
AHRQ Author: Eldridge N, Rodrick D
Association between Medicare expenditures and adverse events for patients with acute myocardial infarction, heart failure, or pneumonia in the United States.
The purpose of this study was to evaluate whether hospital-specific adverse event rates were associated with hospital-specific risk-standardized 30-day episode-of-care Medicare expenditures for fee-for-service patients discharged with acute myocardial infarction (AMI), heart failure (HF), or pneumonia. Investigators concluded that hospitals with high adverse event rates were more likely to have high 30-day episode-of-care Medicare expenditures for patients discharged with AMI, HF, or pneumonia.
AHRQ-authored; AHRQ-funded; 290201200003C.
Citation: Wang Y, Eldridge N, Metersky ML .
Association between Medicare expenditures and adverse events for patients with acute myocardial infarction, heart failure, or pneumonia in the United States.
JAMA Netw Open 2020 Apr;3(4):e202142. doi: 10.1001/jamanetworkopen.2020.2142..
Keywords: Adverse Events, Patient Safety, Heart Disease and Health, Cardiovascular Conditions, Pneumonia, Medicare, Healthcare Costs
Stangenes SR, Painter IS, Rea TD
Delays in recognition of the need for telephone-assisted CPR due to caller descriptions of chief complaint.
The objective of this study was to test if caller descriptions of chief complaint delays emergency medical dispatchers' (EMDs) recognition of the need for telephone-assisted CPR (T-CPR). The investigators conducted an analysis of N = 433 cardiac arrest calls from six large call centers in the United States. They concluded that caller chief complaint description affected the time to recognition of the need for T-CPR.
AHRQ-funded; HS021658.
Citation: Stangenes SR, Painter IS, Rea TD .
Delays in recognition of the need for telephone-assisted CPR due to caller descriptions of chief complaint.
Resuscitation 2020 Apr;149:82-86. doi: 10.1016/j.resuscitation.2020.02.013..
Keywords: Emergency Medical Services (EMS), Cardiovascular Conditions, Patient Safety, Quality of Care, Telehealth, Health Information Technology (HIT), Communication
Dhruva SS, Ross JS, Mortazavi BJ
Association of use of an intravascular microaxial left ventricular assist device vs intra-aortic balloon pump with in-hospital mortality and major bleeding among patients with acute myocardial infarction complicated by cardiogenic shock.
This study examines outcomes among patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) complicated by cardiogenic shock. Two interventions are compared: intravascular microaxial left ventricular assist devices (LVADs) versus intra-aortic balloon pumps (IABPs). The American College of Cardiology’s National Cardiovascular Data Registry was used to identify patients with AMI complicated by cardiogenic shock from hospitals participating in the CathPCI and Chest Pain-MI registries and identified 28,304 patients. Over the study period (2015 to 2017), LVAD was used in 6.2% of patients and IABP in 29.9%. LVAD was shown to have higher rates of in-hospital death and major bleeding complications compared to IABP.
AHRQ-funded; HS022882; HS025402; HS025517; HS026379.
Citation: Dhruva SS, Ross JS, Mortazavi BJ .
Association of use of an intravascular microaxial left ventricular assist device vs intra-aortic balloon pump with in-hospital mortality and major bleeding among patients with acute myocardial infarction complicated by cardiogenic shock.
JAMA 2020 Feb 25;323(8):734-45. doi: 10.1001/jama.2020.0254..
Keywords: Medical Devices, Heart Disease and Health, Cardiovascular Conditions, Mortality, Adverse Events, Registries, Patient Safety, Patient-Centered Outcomes Research, Evidence-Based Practice
Fakhri B, Fiala MA, Shah N
Measuring cardiopulmonary complications of carfilzomib treatment and associated risk factors using the SEER-Medicare database.
This study’s goal was to measure rates of cardiopulmonary complications from carfilzomib treatment in patients with recurrent myeloma. Myeloma case data was extracted from the SEER-Medicare linked database from 2000 to 2013, and corresponding claims through 2014. There were 635 patients identified as being treated with carfilzomib. Of these, median age was 72 years, 55% were male, and 79% were white. Median duration of treatment was 58 days. Overall, 66% of patients had codes identifying cardiac or pulmonary adverse events. Cardiac adverse events included hypertension, peripheral edema and heart failure. Pulmonary adverse events included dyspnea, cough, and pneumonia.
AHRQ-funded; HS019455.
Citation: Fakhri B, Fiala MA, Shah N .
Measuring cardiopulmonary complications of carfilzomib treatment and associated risk factors using the SEER-Medicare database.
Cancer 2020 Feb 15;128(4):808-13. doi: 10.1002/cncr.32601..
Keywords: Adverse Events, Medication, Cardiovascular Conditions, Risk, Cancer, Patient Safety
Amin AP, McNeely C, Spertus JA
Incremental cost of acute kidney injury after percutaneous coronary intervention in the United States.
This study examined incremental costs of acute kidney injury (AKI) complications from percutaneous coronary intervention (PCI), which is a common and severe complication. Out of a sample of over 1.4 million PCI patients at 518 US hospitals from 2006 to 2015, AKI occurred in 5.73% of PCI patients. Those with AKI had at least double the hospitalization costs and the incremental cost was $9,448. It was also independently associated with an incremental length of stay of 3.6 days. AKI cost burden was extrapolated at 411.3 million US dollars annually.
AHRQ-funded; HS022481.
Citation: Amin AP, McNeely C, Spertus JA .
Incremental cost of acute kidney injury after percutaneous coronary intervention in the United States.
Am J Cardiol 2020 Jan;125(1):29-33. doi: 10.1016/j.amjcard.2019.09.042..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Adverse Events, Healthcare Costs, Kidney Disease and Health, Patient Safety, Registries
Ellis MC, Paugh TA, Dickinson TA
Nadir hematocrit on bypass and rates of acute kidney injury: does sex matter?
Recent literature has suggested that women, although more often exposed to lower nadir hematocrit (Hct), have a lower risk of postoperative renal dysfunction. The researchers assessed whether this relationship held across a large multicenter registry. They found that lower nadir Hct was associated with an increased risk of AKI, and the effect appears to be stronger among men than women.
AHRQ-funded; HS022535; HS022909.
Citation: Ellis MC, Paugh TA, Dickinson TA .
Nadir hematocrit on bypass and rates of acute kidney injury: does sex matter?
Ann Thorac Surg 2015 Nov;100(5):1549-54; discussion 54-5. doi: 10.1016/j.athoracsur.2015.05.080..
Keywords: Risk, Cardiovascular Conditions, Surgery, Adverse Events, Patient Safety
Thompson DA, Marsteller JA, Pronovost PJ
Locating errors through networked surveillance: A multimethod approach to peer assessment, hazard identification, and prioritization of patient safety efforts in cardiac surgery.
The objectives of the study were to develop a scientifically sound and feasible peer-to-peer assessment model that allows health-care organizations to evaluate patient safety in cardiovascular operating rooms and to establish safety priorities for improvement. It identified 6 top priority hazard themes: safety culture, teamwork and communication, infection prevention, transitions of care, failure to adhere to practices or policies, and operating room layout and equipment.
AHRQ-funded; HS013904.
Citation: Thompson DA, Marsteller JA, Pronovost PJ .
Locating errors through networked surveillance: A multimethod approach to peer assessment, hazard identification, and prioritization of patient safety efforts in cardiac surgery.
J Patient Saf 2015 Sep;11(3):143-51. doi: 10.1097/pts.0000000000000059..
Keywords: Patient Safety, Medical Errors, Adverse Events, Surgery, Cardiovascular Conditions, Prevention
Likosky DS, Paone G, Zhang M
Red blood cell transfusions impact pneumonia rates after coronary artery bypass grafting.
This study describes the relationship between red blood cell (RBC) transfusion and postoperative pneumonia after CABG. It found a significant volume dependent association between an increasing number of RBCs and the odds of pneumonia, which persisted after risk adjustment. It included a total of 16,182 consecutive patients who underwent isolated CABG between 2011 and 2013 at 1 of 33 hospitals in the state of Michigan.
AHRQ-funded; HS022535; HS022909.
Citation: Likosky DS, Paone G, Zhang M .
Red blood cell transfusions impact pneumonia rates after coronary artery bypass grafting.
Ann Thorac Surg 2015 Sep;100(3):794-801. doi: 10.1016/j.athoracsur.2015.03.089..
Keywords: Surgery, Cardiovascular Conditions, Patient Safety
Goldberger ZD, Nallamothu BK, Nichol G
Policies allowing family presence during resuscitation and patterns of care during in-hospital cardiac arrest.
A growing number of hospitals have begun to implement policies allowing for family presence during resuscitation (FPDR). However, the overall safety of these policies and their effect on resuscitation care is unknown. This study suggests that hospitals with an FPDR policy generally have no statistically significant differences in outcomes and processes of care as hospitals without this policy.
AHRQ-funded; HS020672.
Citation: Goldberger ZD, Nallamothu BK, Nichol G .
Policies allowing family presence during resuscitation and patterns of care during in-hospital cardiac arrest.
Circ Cardiovasc Qual Outcomes 2015 May;8(3):226-34. doi: 10.1161/circoutcomes.114.001272..
Keywords: Cardiovascular Conditions, Patient Safety, Patient-Centered Outcomes Research, Inpatient Care
Brooks JM, Cook E, Chapman CG
Statin use after acute myocardial infarction by patient complexity: are the rates right?
The researchers assessed the benefits and risks associated with higher rates of statin use after AMI by baseline patient complexity. Their results provide strong evidence that providers were attempting to individualize statin prescribing to patients after AMI. Statin users after AMI were less complex and had higher rates of prior statin use.
AHRQ-funded; HS019574.
Citation: Brooks JM, Cook E, Chapman CG .
Statin use after acute myocardial infarction by patient complexity: are the rates right?
Med Care 2015 Apr;53(4):324-31. doi: 10.1097/mlr.0000000000000322..
Keywords: Patient Safety, Risk, Cardiovascular Conditions, Heart Disease and Health, Medication
Shih T, Zhang M, Kommareddi M
Center-level variation in infection rates after coronary artery bypass grafting.
This study was undertaken to compare observed and expected rates of healthcare-acquired infections (HAIs) across all 33 institutions performing isolated CABG surgery in the state of Michigan. Although predicted risk of HAI differed in absolute terms by 2.8 percent across centers, The study found that observed rates varied by 18.2 percent. Differences in observed rates of infections could not be fully explained by patient case mix.
AHRQ-funded; HS022535.
Citation: Shih T, Zhang M, Kommareddi M .
Center-level variation in infection rates after coronary artery bypass grafting.
Circ Cardiovasc Qual Outcomes 2014 Jul;7(4):567-73. doi: 10.1161/circoutcomes.113.000770..
Keywords: Healthcare-Associated Infections (HAIs), Surgery, Cardiovascular Conditions, Patient Safety
Rome BN, Kramer DB, Kesselheim AS
Approval of high-risk medical devices in the US: implications for clinical cardiology.
The authors review the premarket approval (PMA) process to approve high-risk cardiovascular devices, as well as the five different types of PMA supplements used to approve alterations to device design. They summarize the types of data required to approve new high-risk cardiovascular devices and discuss implications of the PMA process for clinicians and patients.
AHRQ-funded; HS018465
Citation: Rome BN, Kramer DB, Kesselheim AS .
Approval of high-risk medical devices in the US: implications for clinical cardiology.
Curr Cardiol Rep. 2014;16(6):489. doi: 10.1007/s11886-014-0489-0..
Keywords: Medical Devices, Cardiovascular Conditions, Patient Safety