National Healthcare Quality and Disparities Report
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Topics
- Antimicrobial Stewardship (3)
- Children/Adolescents (4)
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- Communication (1)
- Comparative Effectiveness (2)
- Dementia (2)
- Diagnostic Safety and Quality (1)
- Disparities (1)
- Elderly (15)
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- Healthcare-Associated Infections (HAIs) (3)
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- Hospital Readmissions (1)
- Implementation (1)
- Influenza (1)
- (-) Long-Term Care (30)
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- Nursing Homes (17)
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- Outcomes (1)
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- Patient-Centered Outcomes Research (2)
- Patient Safety (3)
- Payment (1)
- Policy (1)
- Practice Patterns (1)
- Pressure Ulcers (2)
- Prevention (3)
- Provider Performance (2)
- Public Reporting (1)
- Quality Improvement (4)
- Quality Indicators (QIs) (1)
- Quality Measures (2)
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- Racial and Ethnic Minorities (1)
- Risk (2)
- Shared Decision Making (1)
- Telehealth (1)
- Tools & Toolkits (1)
- Vaccination (1)
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 25 of 30 Research Studies DisplayedShah MN, Wasserman EB, Gillespie SM
High-intensity telemedicine decreases emergency department use for ambulatory care sensitive conditions by older adult senior living community residents.
The aim of this study was to assess the effect of a high-intensity telemedicine program for senior living community (SLC) residents on the rate of Emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs). It found that providing acute illness care by high-intensity telemedicine to older adults residing in SLCs significantly decreases the rate of ED use for ACSCs over 1 year.
AHRQ-funded; HS018047.
Citation: Shah MN, Wasserman EB, Gillespie SM .
High-intensity telemedicine decreases emergency department use for ambulatory care sensitive conditions by older adult senior living community residents.
J Am Med Dir Assoc 2015 Dec;16(12):1077-81. doi: 10.1016/j.jamda.2015.07.009..
Keywords: Elderly, Telehealth, Health Information Technology (HIT), Emergency Department, Healthcare Utilization, Long-Term Care
Murray MT, Neu N, Cohen B
Developing case definitions for health care-associated infections for pediatric long-term care facilities.
The researchers performed a pilot study to assess the utility of the Society for Healthcare Epidemiology of America/CDC surveillance case definitions for children in pediatric long-term care facilities (pLTCFs). They concluded that the current surveillance definitions for healthcare-acquired infections in adult long-term care appear to have limited utility for the pLTC population.
AHRQ-funded; HS021470.
Citation: Murray MT, Neu N, Cohen B .
Developing case definitions for health care-associated infections for pediatric long-term care facilities.
Clin Pediatr 2015 Dec;54(14):1380-2. doi: 10.1177/0009922815599379..
Keywords: Children/Adolescents, Healthcare-Associated Infections (HAIs), Long-Term Care, Patient Safety, Children/Adolescents
Lepore M, Leland NE
Nursing homes that increased the proportion of Medicare days saw gains in quality outcomes for long-stay residents.
The authors examined nationwide facility-level nursing home data for the period 2007-2010. They found that increasing the proportion of Medicare-covered patient days in a nursing home was significantly associated with improvements in the quality of daily pain, pressure ulcers, and performing activities of daily living.
AHRQ-funded; HS022907.
Citation: Lepore M, Leland NE .
Nursing homes that increased the proportion of Medicare days saw gains in quality outcomes for long-stay residents.
Health Aff 2015 Dec;34(12):2121-8. doi: 10.1377/hlthaff.2015.0303.
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Keywords: Long-Term Care, Medicare, Nursing Homes, Patient-Centered Outcomes Research, Quality Improvement
Simmons SF, Keeler E, An R
Cost-effectiveness of nutrition intervention in long-term care.
The researchers sought to determine the cost-effectiveness of two nutrition interventions on food, beverage, and supplement intake and body weight. They found that oral liquid nutrition supplements and snack offers were efficacious in promoting caloric intake when coupled with assistance to promote consumption and a variety of options, but neither intervention resulted in significant weight gain.
AHRQ-funded; HS018580.
Citation: Simmons SF, Keeler E, An R .
Cost-effectiveness of nutrition intervention in long-term care.
J Am Geriatr Soc 2015 Nov;63(11):2308-16. doi: 10.1111/jgs.13709..
Keywords: Elderly, Long-Term Care, Nursing Homes, Nutrition, Comparative Effectiveness
Rahman M, Keohane L, Trivedi AN
High-cost patients had substantial rates of leaving Medicare Advantage and joining traditional Medicare.
The investigators examined the rates at which participants who used three high-cost services switched between Medicare Advantage and traditional Medicare. They found that the switching rate from 2010 to 2011 away from Medicare Advantage and to traditional Medicare exceeded the switching rate in the opposite direction for participants who used long-term nursing home care, short-term nursing home care, and home health care. These results were magnified among people who were enrolled in both Medicare and Medicaid.
AHRQ-funded; HS000011.
Citation: Rahman M, Keohane L, Trivedi AN .
High-cost patients had substantial rates of leaving Medicare Advantage and joining traditional Medicare.
Health Aff 2015 Oct;34(10):1675-81. doi: 10.1377/hlthaff.2015.0272.
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Keywords: Healthcare Costs, Home Healthcare, Long-Term Care, Medicare, Nursing Homes
Konetzka RT, Brauner DJ, Coca Perraillon M
The role of severe dementia in nursing home report cards.
This article examined the intended and unintended effects of quality reporting for nursing home residents with severe dementia relative to other residents, using a difference-in-differences design to examine selected reported and unreported quality measures. The results indicate that prior to public reporting, nursing home residents with severe dementia were at significantly higher risk of poor outcomes on most reported quality measures.
AHRQ-funded; HS018718.
Citation: Konetzka RT, Brauner DJ, Coca Perraillon M .
The role of severe dementia in nursing home report cards.
Med Care Res Rev 2015 Oct;72(5):562-79. doi: 10.1177/1077558715588436.
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Keywords: Dementia, Nursing Homes, Long-Term Care, Quality Measures
Mukamel DB, Ye Z, Glance LG
Does mandating nursing home participation in quality reporting make a difference? Evidence from Massachusetts.
This study investigated one of the mechanisms that may detract from the effectiveness of quality report cards: voluntary versus mandatory participation of nursing homes in public quality reporting. It found that once reporting became mandatory, nonvolunteers improved more than volunteers in all but 2 staffing measures.
AHRQ-funded; HS021844.
Citation: Mukamel DB, Ye Z, Glance LG .
Does mandating nursing home participation in quality reporting make a difference? Evidence from Massachusetts.
Med Care 2015 Aug;53(8):713-9. doi: 10.1097/mlr.0000000000000390..
Keywords: Nursing Homes, Long-Term Care, Public Reporting, Provider Performance, Quality Improvement, Quality of Care, Quality Indicators (QIs), Quality Measures, Elderly
Grebla RC, Keohane L, Lee Y
Waiving the three-day rule: admissions and length-of-stay at hospitals and skilled nursing facilities did not increase.
The authors compared hospital and postacute skilled nursing facility utilization among Medicare Advantage enrollees in matched plans that did or did not eliminate that requirement in 2006-10. Among hospitalized enrollees with a skilled nursing facility admission, the mean hospital length-of-stay declined for those no longer subject to the qualifying stay but increased among those still subject to it. The elimination of the three-day-stay requirement was not associated with more hospital or skilled nursing facility admissions or with longer lengths-of-stay in a skilled nursing facility.
AHRQ-funded; HS000011.
Citation: Grebla RC, Keohane L, Lee Y .
Waiving the three-day rule: admissions and length-of-stay at hospitals and skilled nursing facilities did not increase.
Health Aff 2015 Aug;34(8):1324-30. doi: 10.1377/hlthaff.2015.0054.
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Keywords: Elderly, Hospitalization, Long-Term Care, Nursing Homes, Patient-Centered Outcomes Research
Tjia J, Field T, Mazor K
Dissemination of evidence-based antipsychotic prescribing guidelines to nursing homes: a cluster randomized trial.
This study evaluated the effectiveness of efforts to translate and disseminate evidence-based guidelines about atypical antipsychotic use to nursing homes (NHs). It found that RE-AIM indicators suggest some success in disseminating the toolkit and differences in reach, adoption, and implementation according to dissemination strategy but no measurable effect on antipsychotic prescribing trends.
AHRQ-funded; HS019351.
Citation: Tjia J, Field T, Mazor K .
Dissemination of evidence-based antipsychotic prescribing guidelines to nursing homes: a cluster randomized trial.
J Am Geriatr Soc 2015 Jul;63(7):1289-98. doi: 10.1111/jgs.13488..
Keywords: Communication, Evidence-Based Practice, Guidelines, Long-Term Care, Medication, Nursing Homes, Practice Patterns, Tools & Toolkits, Implementation
Murray MT, Pavia M, Jackson O
Health care-associated infection outbreaks in pediatric long-term care facilities.
The researchers performed a retrospective study from January 2010- December 2013 at 3 pediatric long-term care facilities to describe HAI outbreaks and associated infection control interventions. They found that there were 62 outbreaks involving 700 cases in residents and 250 cases in staff. The most common interventions were isolation precautions and education and in-services.
AHRQ-funded; HS021470.
Citation: Murray MT, Pavia M, Jackson O .
Health care-associated infection outbreaks in pediatric long-term care facilities.
Am J Infect Control 2015 Jul;43(7):756-8. doi: 10.1016/j.ajic.2015.03.010..
Keywords: Healthcare-Associated Infections (HAIs), Long-Term Care, Children/Adolescents, Children/Adolescents, Patient Safety
Holden TR, Smith MA, Bartels CM
Hospice enrollment, local hospice utilization patterns, and rehospitalization in Medicare patients.
The study objective was to examine the association between hospice enrollment, local hospice utilization patterns and 30-day rehospitalization in Medicare patients. It found that area-level hospice utilization is inversely proportional to rehospitalization rates. This relationship is not fully explained by direct hospice enrollment, and may reflect a spillover effect of the benefits of hospice extending to nonenrollees.
AHRQ-funded; HS000083.
Citation: Holden TR, Smith MA, Bartels CM .
Hospice enrollment, local hospice utilization patterns, and rehospitalization in Medicare patients.
J Palliat Med 2015 Jul;18(7):601-12. doi: 10.1089/jpm.2014.0395..
Keywords: Long-Term Care, Palliative Care, Hospital Readmissions, Medicare, Healthcare Utilization
Carter EJ, Cohen B, Murray MT
Using workflow diagrams to address hand hygiene in pediatric long-term care facilities.
The aim of the study was to engage staff in the development of workflow diagrams, which highlighted hand hygiene (HH) practices during commonly performed patient-care activities. Facility teams developed six workflow diagrams that underwent 22 validation observations. Four main themes emerged: 1) diagram specificity, 2) wording and layout, 3) timing of HH indications, and 4) environmental hygiene.
AHRQ-funded; HS021470.
Citation: Carter EJ, Cohen B, Murray MT .
Using workflow diagrams to address hand hygiene in pediatric long-term care facilities.
J Pediatr Nurs 2015 Jul-Aug;30(4):e17-21. doi: 10.1016/j.pedn.2014.12.002..
Keywords: Patient Safety, Quality of Care, Children/Adolescents, Long-Term Care
Nace DA, Lin CJ, Ross TM
Randomized, controlled trial of high-dose influenza vaccine among frail residents of long-term care facilities.
The researchers compared high-dose to standard-dose inactivated influenza vaccine in residents of long-term-care facilities (LTCFs) during the 2011-2012 and 2012-2013 influenza seasons. They found that, among frail, elderly residents of LTCFs, high-dose influenza vaccine produced superior responses for all strains except influenza A(H1N1) in 2012-2013.
AHRQ-funded; HS023779.
Citation: Nace DA, Lin CJ, Ross TM .
Randomized, controlled trial of high-dose influenza vaccine among frail residents of long-term care facilities.
J Infect Dis 2015 Jun 15;211(12):1915-24. doi: 10.1093/infdis/jiu622.
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Keywords: Elderly, Influenza, Long-Term Care, Prevention, Vaccination
Shepherd MM, Wipke-Tevis DD, Alexander GL
Analysis of qualitative interviews about the impact of information technology on pressure ulcer prevention programs: implications for the wound, ostomy and continence nurse.
The purpose of this study was to compare pressure ulcer prevention programs in 2 long-term care facilities with diverse Information Technology Sophistication (ITS), one with high sophistication and one with low sophistication, and to identify implications for the WOC nurse. Its findings suggest that effective strategies for staff education and communication regarding pressure ulcer prevention differ based on the level of ITS within a given facility.
AHRQ-funded; HS016862.
Citation: Shepherd MM, Wipke-Tevis DD, Alexander GL .
Analysis of qualitative interviews about the impact of information technology on pressure ulcer prevention programs: implications for the wound, ostomy and continence nurse.
J Wound Ostomy Continence Nurs 2015 May-Jun;42(3):235-41. doi: 10.1097/won.0000000000000136.
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Keywords: Health Information Technology (HIT), Pressure Ulcers, Prevention, Long-Term Care, Comparative Effectiveness
Daly JM, Bay CP, Levy BT
Caring for people with dementia and challenging behaviors in nursing homes: a needs assessment geriatric nursing.
The authors conducted a needs assessment of directors of nursing (DON) in Iowa nursing homes in relation to caring for patients with Behavioral and Psychological Symptoms of Dementia. They found that facilities with a larger proportion of patients with challenging behaviors being treated with non-drug approaches instead of antipsychotics had DONs who were more likely to be confident in non-drug management strategies and have knowledge about the FDA antipsychotic medications risks.
AHRQ-funded; HS019355.
Citation: Daly JM, Bay CP, Levy BT .
Caring for people with dementia and challenging behaviors in nursing homes: a needs assessment geriatric nursing.
Geriatr Nurs 2015 May-Jun;36(3):182-91. doi: 10.1016/j.gerinurse.2015.01.001.
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Keywords: Elderly, Dementia, Nursing Homes, Long-Term Care, Nursing
Abrahamson K, Miech E, Davila HW
Pay-for-performance policy and data-driven decision making within nursing homes: a qualitative study.
The researchers explored ways in which data were collected, thought about and used by nursing home employees as a result of participation in a pay-for-performance (P4P) program. Their findings indicated that participants in the Minnesota Performance-based Incentive Payment Program’s quality improvement (QI) projects perceived a change in the rate and manner in which they gathered, used, and considered data in their QI decisions.
AHRQ-funded; HS018464
Citation: Abrahamson K, Miech E, Davila HW .
Pay-for-performance policy and data-driven decision making within nursing homes: a qualitative study.
BMJ Qual Saf. 2015 May;24(5):311-7. doi: 10.1136/bmjqs-2014-003362..
Keywords: Nursing Homes, Long-Term Care, Payment, Provider Performance, Shared Decision Making, Policy, Quality Improvement, Quality of Care
Min L, Galecki A, Mody L
Functional disability and nursing resource use are predictive of antimicrobial resistance in nursing homes.
This study used a simple measure of activities of daily living, wounds, and indwelling devices (urinary catheter, feeding tube) to predict prevalent, new, and intermittent multidrug-resistant organism (MDRO) acquisition in nursing home (NH) residents. It found that MDRO acquisition is common in community NHs. The need for nursing care predicts new MDRO acquisition in NHs, suggesting potential mechanisms for MDRO acquisition and strategies for future interventions for high-risk individuals.
AHRQ-funded; HS019979.
Citation: Min L, Galecki A, Mody L .
Functional disability and nursing resource use are predictive of antimicrobial resistance in nursing homes.
J Am Geriatr Soc 2015 Apr;63(4):659-66. doi: 10.1111/jgs.13353..
Keywords: Nursing Homes, Antimicrobial Stewardship, Elderly, Long-Term Care, Risk
Kohli P, Arbaje AI, Leff B
Assisted living facility use by the program of all-inclusive care for the elderly.
The authors discussed the Program of All-Inclusive Care for the Elderly (PACE) program for a nursing-home-eligible population. They concluded that assisted living facilities offer the additional resource of continuously supervised residential care, which can work synergistically with the clinical support and care direction of PACE toward the goal of extending care outside of nursing homes, meeting individual care needs, and providing high-value care.
AHRQ-funded; HS022916.
Citation: Kohli P, Arbaje AI, Leff B .
Assisted living facility use by the program of all-inclusive care for the elderly.
J Am Geriatr Soc 2015 Mar;63(3):594-6. doi: 10.1111/jgs.13289.
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Keywords: Elderly, Long-Term Care
Liu W, Unick J, Galik E
Barthel Index of activities of daily living: item response theory analysis of ratings for long-term care residents.
This study compared the fit and appropriateness of the one-parameter logistic model (1PL), the partial credit model (PCM), and the extension of the generalized partial credit model implemented in ConQuest (GPCM-CQ) for the 15-item Barthel Index (BI). GPCM-CQ results suggested that further revision of the BI may be warranted.
AHRQ-funded; HS013372.
Citation: Liu W, Unick J, Galik E .
Barthel Index of activities of daily living: item response theory analysis of ratings for long-term care residents.
Nurs Res 2015 Mar-Apr;64(2):88-99. doi: 10.1097/nnr.0000000000000072..
Keywords: Long-Term Care, Nursing Homes
Jump RL, Heath B, Crnich CJ
Knowledge, beliefs, and confidence regarding infections and antimicrobial stewardship: a survey of Veterans Affairs providers who care for older adults.
The reseasrchers conducted an anonymous survey of providers who care for older adults from 10 Veterans Affairs long-term-care facilities to assess their knowledge, beliefs, and confidence toward treating infections and antimicrobial stewardship. They found that the average score on 5 questions assessing knowledge was 3.6 out of 5.0, thus supporting a need for education regarding the care of older adults with infections.
AHRQ-funded; HS023866.
Citation: Jump RL, Heath B, Crnich CJ .
Knowledge, beliefs, and confidence regarding infections and antimicrobial stewardship: a survey of Veterans Affairs providers who care for older adults.
Am J Infect Control 2015 Mar;43(3):298-300. doi: 10.1016/j.ajic.2014.11.017.
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Keywords: Antimicrobial Stewardship, Healthcare-Associated Infections (HAIs), Long-Term Care, Medication
Liu W, Galik E, Resnick B
The Self-Efficacy for Functional Abilities Scale for older adults in long-term care: two-level exploratory and confirmatory factor analysis.
The purpose of this study is to examine the underlying factor structure of the 11 Self-Efficacy for Functional Abilities (SEFA) items among older adults in long-term care using factor analysis modeling approaches. The findings from this study provide support for the single-factor structure of the SEFA scale as a valid and reliable measure of self-efficacy for functional ability when used among these individuals.
AHRQ-funded; HS/MH 13372.
Citation: Liu W, Galik E, Resnick B .
The Self-Efficacy for Functional Abilities Scale for older adults in long-term care: two-level exploratory and confirmatory factor analysis.
J Nurs Meas 2015;23(1):112-26..
Keywords: Elderly, Long-Term Care, Nursing Homes
McGarry BE, Temkin-Greener H, Li Y
Role of race and ethnicity in private long-term care insurance ownership.
The authors sought to determine if racial/ethnic disparities exist in the ownership of private long-term care insurance (LTCI) among current Medicare beneficiaries. They found that 12.3% of Blacks and 5.8% of Hispanics, compared with 20.2% of Whites, reported having LTCI coverage and that Hispanics were 48% less likely to have LTCI compared with Whites. Hispanic women were 81% less likely to be insured compared with White women.
AHRQ-funded; HS000044.
Citation: McGarry BE, Temkin-Greener H, Li Y .
Role of race and ethnicity in private long-term care insurance ownership.
Gerontologist 2014 Dec;54(6):1001-12. doi: 10.1093/geront/gnt102.
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Keywords: Disparities, Elderly, Health Insurance, Long-Term Care, Racial and Ethnic Minorities
Larson EL, Cohen B, Murray M
Challenges in conducting research in pediatric long-term care facilities.
The purposes of this article are to describe the challenges associated with conducting research in pediatric long-term care facilities (LTCFs) and to recommend approaches to build a successful collaborative relationship between the clinical and administrative staff in LTCFs and the academic research team.
AHRQ-funded; HS021470.
Citation: Larson EL, Cohen B, Murray M .
Challenges in conducting research in pediatric long-term care facilities.
Clin Pediatr 2014 Oct;53(11):1041-6. doi: 10.1177/0009922814540986..
Keywords: Children/Adolescents, Long-Term Care, Health Services Research (HSR)
Furuno JP, Comer AC, Johnson JK
Using antibiograms to improve antibiotic prescribing in skilled nursing facilities.
The researchers describe the design and implementation of a skilled nursing facility (SNF) specific antibiogram to improve empirical antibiotic prescribing. They estimated the frequency of inappropriate antibiotic prescribing in 3 Maryland SNFs and measured the effectiveness of the antibiograms on antibiotic prescribing in 1 of the SNFs.
AHRQ-funded; 290200600020I
Citation: Furuno JP, Comer AC, Johnson JK .
Using antibiograms to improve antibiotic prescribing in skilled nursing facilities.
Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S56-61. doi: 10.1086/677818..
Keywords: Long-Term Care, Antimicrobial Stewardship, Nursing Homes, Diagnostic Safety and Quality
Abrahamson K, Mueller C, Davila HW
Nurses as boundary-spanners in reducing avoidable hospitalizations among nursing home residents.
The researchers interviewed 76 nurses working at 38 nursing homes that were implementing quality improvement projects to reduce avoidable hospitalizations. They explored the role of the nurse as boundary-spanner between the organizational goals of the nursing home and external stakeholder systems and how that influences the nursing staff experience.
AHRQ-funded; HS018464
Citation: Abrahamson K, Mueller C, Davila HW .
Nurses as boundary-spanners in reducing avoidable hospitalizations among nursing home residents.
Res Gerontol Nurs. 2014 Sep-Oct;7(5):235-43. doi: 10.3928/19404921-20140519-01..
Keywords: Nursing Homes, Long-Term Care, Elderly, Quality of Care, Quality Improvement