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
1 to 25 of 69 Research Studies DisplayedMurugiah K, Wang Y, Desai NR
Hospital variation in outcomes for transcatheter aortic valve replacement among Medicare beneficiaries, 2011 to 2013.
The researchers studied hospital performance on transcatheter aortic valve replacement (TAVR) using data from all Medicare fee-for-service (FFS) beneficiaries 65 years of age and older who underwent TAVR from January 1, 2011, to December 31, 2013. They found that for an individual patient, the between-hospital variation translates to a great than 2-fold higher risk of dying within 30 days for a patient undergoing TAVR at a hospital 1 SD above the national average compared with undergoing TAVR at a hospital 1 SD below; the between-hospital variation was
AHRQ-funded; HS023000.
Citation: Murugiah K, Wang Y, Desai NR .
Hospital variation in outcomes for transcatheter aortic valve replacement among Medicare beneficiaries, 2011 to 2013.
J Am Coll Cardiol 2015 Dec 15;66(23):2678-79. doi: 10.1016/j.jacc.2015.10.008.
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Keywords: Cardiovascular Conditions, Hospitals, Medicare, Patient-Centered Outcomes Research, Surgery
Elliott MN, Cohea CW, Lehrman WG
Accelerating improvement and narrowing gaps: trends in patients' experiences with hospital care reflected in HCAHPS public reporting.
The researchers describe the experiences of over 4 million patients discharged from hospitals that participated in the second and fifth years of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) public reporting and assess the changes in HCAHPS scores across different types of hospital and patient groups. They found that HCAHPS scores increased by 2.8 percentage points from 2008 to 2011 in the most positive response category.
AHRQ-funded; HS016978.
Citation: Elliott MN, Cohea CW, Lehrman WG .
Accelerating improvement and narrowing gaps: trends in patients' experiences with hospital care reflected in HCAHPS public reporting.
Health Serv Res 2015 Dec;50(6):1850-67. doi: 10.1111/1475-6773.12305..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Hospitals, Quality of Care, Public Reporting
Lee DC, Carr BG, Smith TE
The impact of hospital closures and hospital and population characteristics on increasing emergency department volume: a geographic analysis.
The objective of this study was to test the association of hospital and population characteristics and the effect of hospital closures with increases in emergency department volume. Emergency volume increased nearly twice as fast at tertiary referral centers (4.8 percent) and nonurban hospitals (3.7 percent versus urban at 2.1 percent) after adjusting for other characteristics. The effect of hospital closures also strongly predicted variation in growth.
AHRQ-funded; HS018362; HS010914.
Citation: Lee DC, Carr BG, Smith TE .
The impact of hospital closures and hospital and population characteristics on increasing emergency department volume: a geographic analysis.
Popul Health Manag 2015 Dec;18(6):459-66. doi: 10.1089/pop.2014.0123.
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Keywords: Emergency Medical Services (EMS), Emergency Department, Hospitals, Access to Care
Hignett S, Wolf L, Taylor E
Firefighting to innovation: using human factors and ergonomics to tackle slip, trip, and fall risks in hospitals.
The aim of this study was to use a theoretical model (bench) for human factors and ergonomics (HFE) and a comparison with occupational slips, trips, and falls (STFs) risk management to discuss patient STF interventions (bedside). : Three case studies are used to discuss how HFE has been, or could be, applied to STF risk management.
AHRQ-funded; HS021824.
Citation: Hignett S, Wolf L, Taylor E .
Firefighting to innovation: using human factors and ergonomics to tackle slip, trip, and fall risks in hospitals.
Hum Factors 2015 Nov;57(7):1195-207. doi: 10.1177/0018720815593642.
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Keywords: Patient Safety, Risk, Falls, Hospitals
Blecker S, Goldfeld K, Park H
Impact of an intervention to improve weekend hospital care at an academic medical center: an observational study.
The purpose of this study was to evaluate the impact of a weekend hospital intervention on processes of care and clinical outcomes. The multifaceted intervention included expanded weekend diagnostic services, improved weekend discharge processes, and increased physician and care management services on weekends. The intervention was associated with a reduction in length of stay and an increase in weekend discharges.
AHRQ-funded; HS023683.
Citation: Blecker S, Goldfeld K, Park H .
Impact of an intervention to improve weekend hospital care at an academic medical center: an observational study.
J Gen Intern Med 2015 Nov;30(11):1657-64. doi: 10.1007/s11606-015-3330-6.
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Keywords: Quality Improvement, Quality of Care, Hospitals, Hospital Discharge, Hospital Readmissions, Healthcare Delivery, Outcomes, Patient-Centered Outcomes Research
Croft LD, Liquori M, Ladd J
The effect of contact precautions on frequency of hospital adverse events.
The researchers sought to determine whether use of contact precautions on hospital ward patients is associated with patient adverse events. They concluded that hospital ward patients on contact precautions were less likely to experience noninfectious adverse events during their hospital stay than patients not on contact precautions.
AHRQ-funded; HS018111.
Citation: Croft LD, Liquori M, Ladd J .
The effect of contact precautions on frequency of hospital adverse events.
Infect Control Hosp Epidemiol 2015 Nov;36(11):1268-74. doi: 10.1017/ice.2015.192.
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Keywords: Adverse Events, Patient Safety, Prevention, Hospitals
Han JH, Sullivan N, Leas BF
Cleaning hospital room surfaces to prevent health care-associated infections: a technical brief.
The authors review the evidence examining current methods of cleaning, disinfecting, and monitoring cleanliness of patient rooms, as well as contextual factors that may affect implementation and effectiveness. Their review of the literature indicates an increased interest in environmental cleaning and disinfecting for the prevention of HAIs. However, there are many limitations in the current evidence base.
AHRQ-funded; 290201200011I.
Citation: Han JH, Sullivan N, Leas BF .
Cleaning hospital room surfaces to prevent health care-associated infections: a technical brief.
Ann Intern Med 2015 Oct 20;163(8):598-607. doi: 10.7326/m15-1192..
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Healthcare-Associated Infections (HAIs), Patient Safety
Korst LM, Feldman DS, Bollman DL
Cross-sectional survey of California childbirth hospitals: implications for defining maternal levels of risk-appropriate care.
The researchers examined the extent to which hospitals could be classified by increasingly sophisticated maternal levels of care. They concluded that childbirth services varied widely across California hospitals, and most hospitals did not fit easily into proposed levels. Cognizance of this existing variation is critical to determining the optimal configuration of services for basic, intermediate, and regional maternal levels of care.
AHRQ-funded; HS020915.
Citation: Korst LM, Feldman DS, Bollman DL .
Cross-sectional survey of California childbirth hospitals: implications for defining maternal levels of risk-appropriate care.
Am J Obstet Gynecol 2015 Oct;213(4):527.e1-27.e12. doi: 10.1016/j.ajog.2015.07.014..
Keywords: Labor and Delivery, Maternal Care, Hospitals, Access to Care
Ramamonjiarivelo Z, Weech-Maldonado R, Hearld L
Public hospitals in financial distress: Is privatization a strategic choice?
The purpose of this study was to investigate whether financial distress is associated with privatization among public hospitals. It found that public hospitals in financial distress had greater odds of being privatized than public hospitals not in financial distress. The study population consisted of all U.S. nonfederal acute care public hospitals in 1997 tracked through 2009.
AHRQ-funded; HS019465.
Citation: Ramamonjiarivelo Z, Weech-Maldonado R, Hearld L .
Public hospitals in financial distress: Is privatization a strategic choice?
Health Care Manage Rev 2015 Oct-Dec;40(4):337-47. doi: 10.1097/hmr.0000000000000032.
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Keywords: Hospitals, Healthcare Costs
Korst LM, Feldman DS, Bollman DL
Variation in childbirth services in California: a cross-sectional survey of childbirth hospitals.
The objective of the study was to describe the resources and activities associated with childbirth services. It concluded that childbirth services varied widely across California hospitals. Cognizance of this variation and linkage of these data to childbirth outcomes should assist in the identification of key resources and activities that optimize the hospital environment for pregnant women.
AHRQ-funded; HS020915.
Citation: Korst LM, Feldman DS, Bollman DL .
Variation in childbirth services in California: a cross-sectional survey of childbirth hospitals.
Am J Obstet Gynecol 2015 Oct;213(4):523.e1-8. doi: 10.1016/j.ajog.2015.08.013..
Keywords: Labor and Delivery, Maternal Care, Hospitals, Access to Care
Moehring RW, Hazen KC, Hawkins MR
Challenges in preparation of cumulative antibiogram reports for community hospitals.
This descriptive cohort study of antibiogram reporting practices included community hospitals enrolled in the Duke Infection Control Outreach Network. Survey respondents’ self-assessment of full or partial compliance with Clinical and Laboratory Standards Institute (CLSI) guidelines was 50 percent and 15 percent, respectively; 33 percent reported uncertainty with CLSI guidelines. Full adherence to CLSI guidelines for hospital antibiograms was uncommon.
AHRQ-funded; HS023866.
Citation: Moehring RW, Hazen KC, Hawkins MR .
Challenges in preparation of cumulative antibiogram reports for community hospitals.
J Clin Microbiol 2015 Sep;53(9):2977-82. doi: 10.1128/jcm.01077-15..
Keywords: Hospitals, Patient Safety, Guidelines
Aboumatar HJ, Chang BH, Danaf J
Promising practices for achieving patient-centered hospital care: a national study of high-performing US hospitals.
The researchers conducted a national study of hospitals that achieved the highest performance on Hospital Consumer Assessment of Healthcare Providers and Systems HCAHPS to identify promising practices for improving patient-centeredness, common challenges met, and how those were addressed. They found that high-performing hospitals used a set of patient-centered care processes that involved both leaders and clinicians in ensuring that patient needs and preferences are addressed.
AHRQ-funded; HS021921.
Citation: Aboumatar HJ, Chang BH, Danaf J .
Promising practices for achieving patient-centered hospital care: a national study of high-performing US hospitals.
Med Care 2015 Sep;53(9):758-67. doi: 10.1097/mlr.0000000000000396..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Hospitals, Patient Experience, Quality of Care, Patient-Centered Outcomes Research
Jenkins PC, Richardson CR, Norton EC
Trauma surge index: advancing the measurement of trauma surges and their influence on mortality.
The authors developed a new measure of hospital capacity strain corresponding to trauma admissions and examined the relationship between trauma surges and inpatient mortality. Their Trauma Surge Index (TSI) method can be implemented by hospitals and trauma systems to examine periods of high-capacity strain retrospectively, identify specific resources that might have been needed, and better direct future investments in an evidence-based manner.
AHRQ-funded; HS020672.
Citation: Jenkins PC, Richardson CR, Norton EC .
Trauma surge index: advancing the measurement of trauma surges and their influence on mortality.
J Am Coll Surg 2015 Sep;221(3):729-38.e1. doi: 10.1016/j.jamcollsurg.2015.05.016.
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Keywords: Emergency Preparedness, Hospitals, Injuries and Wounds, Mortality, Trauma
Donnelly JP, Hohmann SF, Wang HE
Unplanned readmissions after hospitalization for severe sepsis at academic medical center-affiliated hospitals.
The researchers sought to characterize 7- and 30-day readmission rates following hospital admission for severe sepsis as well as institutional variations in readmission. They concluded that severe sepsis readmission places a substantial burden on the healthcare system, with one in 15 and one in five severe sepsis discharges readmitted within 7 and 30 days, respectively.
AHRQ-funded; HS013852.
Citation: Donnelly JP, Hohmann SF, Wang HE .
Unplanned readmissions after hospitalization for severe sepsis at academic medical center-affiliated hospitals.
Crit Care Med 2015 Sep;43(9):1916-27. doi: 10.1097/ccm.0000000000001147..
Keywords: Hospital Readmissions, Hospitals, Risk, Sepsis
Brooke BS, Goodney PP, Kraiss LW
Readmission destination and risk of mortality after major surgery: an observational cohort study.
This study examined the association between readmission destination and mortality risk in the USA in Medicare beneficiaries after a range of common operations. It found that patients who are readmitted to hospital after various major operations consistently achieve improved survival if they return to the hospital where their surgery took place.
AHRQ-funded; HS021581.
Citation: Brooke BS, Goodney PP, Kraiss LW .
Readmission destination and risk of mortality after major surgery: an observational cohort study.
Lancet 2015 Aug 29;386(9996):884-95. doi: 10.1016/s0140-6736(15)60087-3..
Keywords: Hospital Readmissions, Mortality, Surgery, Elderly, Outcomes, Hospitals
Sundararajan V, Romano PS, Quan H
Capturing diagnosis-timing in ICD-coded hospital data: recommendations from the WHO ICD-11 topic advisory group on quality and safety.
The purpose of this project was to develop a consensus opinion regarding capturing diagnosis-timing in coded hospital data. The WHO Quality and Safety Topic Advisory Group has undertaken a narrative literature review, scanned national experiences focusing on countries currently using timing flags, and held a series of meetings to derive formal recommendations regarding diagnosis-timing reporting. This paper discusses their concerns and recommendations.
AHRQ-funded; HS020543.
Citation: Sundararajan V, Romano PS, Quan H .
Capturing diagnosis-timing in ICD-coded hospital data: recommendations from the WHO ICD-11 topic advisory group on quality and safety.
Int J Qual Health Care 2015 Aug;27(4):328-33. doi: 10.1093/intqhc/mzv037..
Keywords: Patient Safety, Quality of Care, Quality Improvement, Hospitals, Data
McElroy LM, Schmidt KA, Richards CT
Early postoperative emergency department care of abdominal transplant recipients.
The goal of this study was to describe early postoperative ED care of transplant recipients. It found that transplant recipients have a high frequency of ED visits in the first post transplantation year and high rates of subsequent hospital admission.
AHRQ-funded; HS000078.
Citation: McElroy LM, Schmidt KA, Richards CT .
Early postoperative emergency department care of abdominal transplant recipients.
Transplantation 2015 Aug;99(8):1652-7. doi: 10.1097/tp.0000000000000781..
Keywords: Emergency Department, Transplantation, Hospital Readmissions, Hospitals
Kawai AT, Calderwood MS, Jin R
Impact of the Centers for Medicare and Medicaid services hospital-acquired conditions policy on billing rates for 2 targeted healthcare-associated infections.
The 2008 Centers for Medicare & Medicaid Services (CMS) hospital-acquired conditions policy limited additional payment for conditions deemed reasonably preventable. This study examined whether this policy was associated with decreases in billing rates for 2 targeted conditions, vascular catheter-associated infections (VCAI) and catheter-associated urinary tract infections (CAUTI). The CMS policy appears to have been associated with immediate reductions in billing rates for VCAI and CAUTI, followed by a slight decreasing trend or leveling-off in rates.
AHRQ-funded; HS018414.
Citation: Kawai AT, Calderwood MS, Jin R .
Impact of the Centers for Medicare and Medicaid services hospital-acquired conditions policy on billing rates for 2 targeted healthcare-associated infections.
Infect Control Hosp Epidemiol 2015 Aug;36(8):871-7. doi: 10.1017/ice.2015.86.
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Keywords: Healthcare-Associated Infections (HAIs), Policy, Medicare, Payment, Hospitals, Catheter-Associated Urinary Tract Infection (CAUTI), Urinary Tract Infection (UTI), Healthcare Costs
Nuckols TK, Asch SM, Patel V
Implementing Computerized Provider Order Entry In Acute Care Hospitals in the United States could generate substantial savings to society.
This study was conducted to evaluate from the societal perspective the cost-utility of implementing computerized physician order entry (CPOE) in acute care hospitals in the United States. It found that relative to paper ordering and using typical estimates of implementation costs, CPOE had, on average, a 99 percent probability of yielding savings to society and improving health.
AHRQ-funded; HS017954.
Citation: Nuckols TK, Asch SM, Patel V .
Implementing Computerized Provider Order Entry In Acute Care Hospitals in the United States could generate substantial savings to society.
Jt Comm J Qual Patient Saf 2015 Aug;41(8):341-50..
Keywords: Health Information Technology (HIT), Hospitals, Clinical Decision Support (CDS), Healthcare Costs
Zingmond DS, Parikh P, Louie R
Improving hospital reporting of patient race and ethnicity--approaches to data auditing.
This study investigated new metrics to improve the reporting of patient race and ethnicity (R/E) by hospitals. It examined agreement between hospital reported R/E versus self-report among mothers delivering babies and a cancer cohort in California. It concluded that comparison between reported R/E and R/E estimates using zip code level data may be a reasonable first approach to evaluate and track hospital R/E reporting.
AHRQ-funded; HS019963.
Citation: Zingmond DS, Parikh P, Louie R .
Improving hospital reporting of patient race and ethnicity--approaches to data auditing.
Health Serv Res 2015 Aug;50 Suppl 1:1372-89. doi: 10.1111/1475-6773.12324..
Keywords: Racial and Ethnic Minorities, Hospitals, Hospital Discharge, Health Services Research (HSR), Registries, Quality Improvement, Quality of Care, Data
Healy MA, Krell RW, Abdelsattar ZM
Pancreatic resection results in a statewide surgical collaborative.
This study sought to investigate changes over time in adverse outcomes after pancreatectomy across hospitals with different caseloads in a statewide surgical collaborative. It concluded that participation in regional quality collaboratives by lower-volume hospitals can attenuate the volume–outcome relationship for pancreatic surgery.
AHRQ-funded; HS20937; HS000053.
Citation: Healy MA, Krell RW, Abdelsattar ZM .
Pancreatic resection results in a statewide surgical collaborative.
Ann Surg Oncol 2015 Aug;22(8):2468-74. doi: 10.1245/s10434-015-4529-9..
Keywords: Surgery, Patient Safety, Adverse Events, Hospitals, Quality Improvement, Quality of Care
Toomey SL, Zaslavsky AM, Elliott MN
The development of a pediatric inpatient experience of care measure: Child HCAHPS.
This article describes the development of Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), which included a national field test with 69 hospitals in 34 States, psychometric analysis, and end-user testing of the final survey. The final Child HCAHPS instrument has 62 items, including 39 patient experience items, 10 screeners, 12 demographic/descriptive items and 1 open-ended item.
AHRQ-funded; HS020513.
Citation: Toomey SL, Zaslavsky AM, Elliott MN .
The development of a pediatric inpatient experience of care measure: Child HCAHPS.
Pediatrics 2015 Aug;136(2):360-9. doi: 10.1542/peds.2015-0966..
Keywords: Children/Adolescents, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Hospitals, Inpatient Care, Patient Experience, Quality of Care
Rajaram R, Chung JW, Kinnier CV
Hospital characteristics associated with penalties in the Centers for Medicare & Medicaid Services Hospital-Acquired Condition Reduction Program.
The purpose of this study was to examine the characteristics of hospitals penalized by the Hospital-Acquired Condition (HAC) Reduction Program. It found that among hospitals participating in the HAC Reduction Program, hospitals that were penalized more frequently had more quality accreditations, and had better performance on other process and outcome measure.
AHRQ-funded; HS000078.
Citation: Rajaram R, Chung JW, Kinnier CV .
Hospital characteristics associated with penalties in the Centers for Medicare & Medicaid Services Hospital-Acquired Condition Reduction Program.
JAMA 2015 Jul 28;314(4):375-83. doi: 10.1001/jama.2015.8609..
Keywords: Hospitals, Healthcare-Associated Infections (HAIs), Patient Safety, Provider Performance
Nembhard IM, Labao I, Savage S
Breaking the silence: determinants of voice for quality improvement in hospitals.
The researchers examined the drivers of “voice” for health professionals in hospitals. “Voice” is understood as the discretionary communication of ideas, suggestions, concerns, or opinions about work-related issues with the intent to improve organizational or unit functioning. They found that factors related to individuals (e.g., tenure), work (e.g., work configuration), organizational context (e.g., culture), data (e.g., benchmarking), and the external environment (e.g., attention) influenced health professionals’ voice.
AHRQ-funded; HS018987.
Citation: Nembhard IM, Labao I, Savage S .
Breaking the silence: determinants of voice for quality improvement in hospitals.
Health Care Manage Rev 2015 Jul-Sep;40(3):225-36. doi: 10.1097/hmr.0000000000000028..
Keywords: Hospitals, Quality Improvement, Quality of Care, Communication, Organizational Change, Health Services Research (HSR)
Kleweno CP, O'Toole RV, Ballreich J
Does fracture care make money for the hospital? An analysis of hospital revenues and costs for treatment of common fractures.
The authors sought to determine the relative profitability for a hospital of treatment of common fractures within a state-regulated reimbursement system. They found that the factors most influencing cost included length of stay, supplies, and operating room use, and that the most profitable diagnosis was pelvic fracture.
AHRQ-funded; HS000029.
Citation: Kleweno CP, O'Toole RV, Ballreich J .
Does fracture care make money for the hospital? An analysis of hospital revenues and costs for treatment of common fractures.
J Orthop Trauma 2015 Jul;29(7):e219-24. doi: 10.1097/bot.0000000000000263.
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Keywords: Injuries and Wounds, Healthcare Costs, Hospitals, Orthopedics