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 139 Research Studies DisplayedWang J, Gong Y
Potential of decision support in preventing pressure ulcers in hospitals.
The development of hospital-acquired pressure ulcers signals low quality of care. To meet the challenges of consistently translating best practices into effective clinical practices and promote effective teamwork communication and interprofessional collaboration, the authors consider the failure of consistent care delivery as loss of information and reveal the opportunities of informatics methods to reinforce information delivery, evidenced by typical cases. They then explain and summarize information-related issues existing at the initial assessment upon hospital admission, routine treatments, and team communication.
AHRQ-funded; HS022895.
Citation: Wang J, Gong Y .
Potential of decision support in preventing pressure ulcers in hospitals.
Stud Health Technol Inform 2017;241:15-20.
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Keywords: Clinical Decision Support (CDS), Decision Making, Hospitals, Patient Safety, Pressure Ulcers, Prevention
Liang C, Gong Y
Predicting harm scores from patient safety event reports.
The Harm Scale developed by the AHRQ is widely used in the US hospitals. However, recent studies have indicated a moderate to poor inter-rater reliability of the scale across a number of US hospitals. This study proposed that key information to identify and refine the severity of harm is contained in the narrative data in patient safety reports. The researchers found that using automated text classification to categorize harm score provided reduced subjective judgments and improved efficiency.
AHRQ-funded; HS022895.
Citation: Liang C, Gong Y .
Predicting harm scores from patient safety event reports.
Stud Health Technol Inform 2017;245:1075-79..
Keywords: Adverse Events, Data, Hospitals, Patient Safety
Adrion ER, Kocher KE, Nallamothu BK
Rising use of observation care among the commercially insured may lead to total and out-of-pocket cost savings.
Using multipayer commercial claims for the period 2009-13, the investigators evaluated utilization and spending among patients admitted for six conditions that are commonly managed with either observation care or short-stay hospitalizations. In their study period, the use of observation care increased relative to that of short-stay hospitalizations. In addition, total and out-of-pocket spending were substantially lower for observation care, though both grew rapidly--and at rates much higher than spending in the inpatient setting--over the study period.
AHRQ-funded; HS000053.
Citation: Adrion ER, Kocher KE, Nallamothu BK .
Rising use of observation care among the commercially insured may lead to total and out-of-pocket cost savings.
Health Aff 2017 Dec;36(12):2102-09. doi: 10.1377/hlthaff.2017.0774..
Keywords: Health Insurance, Healthcare Costs, Healthcare Delivery, Healthcare Utilization, Hospitalization, Hospitals, Medicare
Fisher KA, Mazor KM, Goff S
Successful use of noninvasive ventilation in chronic obstructive pulmonary disease. how do high-performing hospitals do it?
To identify approaches used by hospitals that have been successful in implementing Noninvasive ventilation (NIV) to treat patients with severe exacerbations of chronic obstructive pulmonary disease (COPD). The authors identified factors, such as respiratory therapist autonomy, that facilitated essential processes (e.g., timely initiation) of NIV use at high-performing hospitals.
AHRQ-funded; HS024596.
Citation: Fisher KA, Mazor KM, Goff S .
Successful use of noninvasive ventilation in chronic obstructive pulmonary disease. how do high-performing hospitals do it?
Ann Am Thorac Soc 2017 Nov;14(11):1674-81. doi: 10.1513/AnnalsATS.201612-1005OC..
Keywords: Respiratory Conditions, Hospitals, Patient-Centered Outcomes Research
Leider JP, Tung GJ, Lindrooth RC
Establishing a baseline: community benefit spending by not-for-profit hospitals prior to implementation of the Affordable Care Act.
This article examines how not-for-profit hospitals spent Community Benefit dollars prior to full implementation of the Affordable Care Act (ACA). Using data from 2009 to 2012 hospital tax and other governmental filings, the researchers constructed national, hospital-referral-region, and facility-level estimates of Community Benefit spending.
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AHRQ-funded; HS024959
Citation: Leider JP, Tung GJ, Lindrooth RC .
Establishing a baseline: community benefit spending by not-for-profit hospitals prior to implementation of the Affordable Care Act.
J Public Health Manag Pract 2017 Nov/Dec;23(6):e1-e9. doi: 10.1097/phh.0000000000000493.
Keywords: Healthcare Costs, Policy, Hospitals
Walker DM, Sieck CJ, Menser T
Information technology to support patient engagement: where do we stand and where can we go?.
The authors evaluated the current capability of hospitals to offer health information technology that facilitates patient engagement (PE). They concluded that, while hospitals have reached modest levels of adoption of PE technologies, consistent monitoring of this capacity can identify opportunities to use technology to facilitate engagement.
AHRQ-funded; HS024091.
Citation: Walker DM, Sieck CJ, Menser T .
Information technology to support patient engagement: where do we stand and where can we go?.
J Am Med Inform Assoc 2017 Nov 1;24(6):1088-94. doi: 10.1093/jamia/ocx043.
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Keywords: Health Information Technology (HIT), Hospitals, Patient and Family Engagement
Knelson LP, Ramadanovic GK, Chen LF
Self-monitoring by environmental services may not accurately measure thoroughness of hospital room cleaning.
The hospital environment and environmental contamination are increasingly emphasized in the prevention of healthcare associated infection. In this study, the authors compare cleaning compliance data collected by environmental services (EVS) supervisors with parallel cleaning compliance data collected by study personnel. The investigators concluded that their findings validate the recommendations in the CDC tool kit that independent observers should be used to achieve the most objective approach to monitoring.
AHRQ-funded; HS023866.
Citation: Knelson LP, Ramadanovic GK, Chen LF .
Self-monitoring by environmental services may not accurately measure thoroughness of hospital room cleaning.
Infect Control Hosp Epidemiol 2017 Nov;38(11):1371-73. doi: 10.1017/ice.2017.205..
Keywords: Hospitals, Prevention, Patient Safety, Healthcare-Associated Infections (HAIs)
Ellimoottil C, Syrjamaki JD, Volt JD
Validation of a claims-based algorithm to characterize episodes of care.
The Michigan Value Collaborative (MVC) developed a claims-based algorithm to provide hospitals with data on events that occur to patients beyond the hospitalization. In this article, the investigators discuss the validation of MVC's claims-based algorithm. They indicate that their findings suggest that the MVC claims-based algorithm identifies and classifies claims with high fidelity and outperforms medical records in the identification of postdischarge events.
AHRQ-funded; HS024193.
Citation: Ellimoottil C, Syrjamaki JD, Volt JD .
Validation of a claims-based algorithm to characterize episodes of care.
Am J Manag Care 2017 Nov;23(11):e382-e86..
Keywords: Hospital Discharge, Hospital Readmissions, Hospitalization, Hospitals, Quality of Care, Quality Improvement
Rhee C, Dantes R, Epstein L
Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014.
The researchers estimated the US national incidence of sepsis and trends using detailed clinical data from the electronic health record (EHR) systems of diverse hospitals. In clinical data from 409 hospitals, sepsis was present in 6 percent of adult hospitalizations, and in contrast to claims-based analyses, neither the incidence of sepsis nor the combined outcome of death or discharge to hospice changed significantly between 2009-2014.
AHRQ-funded; HS025008.
Citation: Rhee C, Dantes R, Epstein L .
Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014.
JAMA 2017 Oct 3;318(13):1241-49. doi: 10.1001/jama.2017.13836.
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Keywords: Data, Electronic Health Records (EHRs), Hospitals, Mortality, Sepsis
Elysee G, Herrin J, Horwitz LI
An observational study of the relationship between meaningful use-based electronic health information exchange, interoperability, and medication reconciliation capabilities.
Stagnation in hospitals' adoption of data integration functionalities coupled with reduction in the number of operational health information exchanges could become a significant impediment to hospitals' adoption of 3 critical capabilities: electronic health information exchange, interoperability, and medication reconciliation, in which electronic systems are used to assist with resolving medication discrepancies and improving patient safety. This observational study examines the relationship between meaningful use-based electronic health information exchange, interoperability, and medication reconciliation capabilities.
AHRQ-funded; HS022882.
Citation: Elysee G, Herrin J, Horwitz LI .
An observational study of the relationship between meaningful use-based electronic health information exchange, interoperability, and medication reconciliation capabilities.
Medicine 2017 Oct;96(41):e8274. doi: 10.1097/MD.0000000000008274..
Keywords: Electronic Health Records (EHRs), Health Information Exchange (HIE), Health Information Technology (HIT), Hospitals, Medication
Masnick M, Morgan DJ, Sorkin JD
Can national healthcare-associated infections (HAIs) data differentiate hospitals in the United States?
This study was designed to determine whether patients using the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website can use nationally reported healthcare-associated infection (HAI) data to differentiate hospitals. The authors concluded that HAI data generally are reported by enough hospitals to meet minimal criteria for useful comparisons in many geographic locations, though this varies by type of HAI.
AHRQ-funded; HS018111.
Citation: Masnick M, Morgan DJ, Sorkin JD .
Can national healthcare-associated infections (HAIs) data differentiate hospitals in the United States?
Infect Control Hosp Epidemiol 2017 Oct;38(10):1167-71. doi: 10.1017/ice.2017.179..
Keywords: Quality of Care, Healthcare-Associated Infections (HAIs), Hospitals, Provider Performance, Quality Measures
Arbaje AI, Yu Q, Wang J J
Senior services in US hospitals and readmission risk in the Medicare population.
The purpose of this study was to determine whether hospitals' Senior Care Services Scale (SCSS) scores were associated with risk of readmission among Medicare beneficiaries. The study concluded that senior services at the hospital-level represented a modifiable risk factor with important impact. Employing organization-level characteristics in readmission risk prediction tools should be expanded.
AHRQ-funded; HS022916
Citation: Arbaje AI, Yu Q, Wang J J .
Senior services in US hospitals and readmission risk in the Medicare population.
Int J Qual Health Care 2017 Oct 1;29(6):845-52. doi: 10.1093/intqhc/mzx112..
Keywords: Elderly, Health Services Research (HSR), Hospital Readmissions, Hospitals, Medicare
Ban KA, Gibbons MM, Ko CY
Surgical technical evidence review for colorectal surgery conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
The objective of this article is to provide a comprehensive review of the evidence supporting the surgical components of the Improving Surgical Care and Recovery (ISCR) colorectal (CR) pathway. This review will evaluate the evidence supporting CR pathways and develop an evidence-based CR protocol to help hospitals participating in the ISCR program implement evidence-based practices.
AHRQ-funded; 233201500020I.
Citation: Ban KA, Gibbons MM, Ko CY .
Surgical technical evidence review for colorectal surgery conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
J Am Coll Surg 2017 Oct;225(4):548-57.e3. doi: 10.1016/j.jamcollsurg.2017.06.017.
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Keywords: Evidence-Based Practice, Hospitals, Patient Safety, Quality Improvement, Surgery, Quality of Care, Guidelines
Parker MW, Carroll M, Bolser B
Implementation of a communication bundle for high-risk patients.
This study occurs in a large pediatric hospital with a history of success in decreasing unrecognized deterioration, in which patients at higher risk of deterioration are termed "watchers." Because communication errors often contribute to unrecognized deterioration, clear and timely communication of watcher status to all team members and contingency planning was desired. The researchers sought to increase the percentage of eligible watchers with a complete communication, teamwork, and planning bundle within 2 hours of identification from 28% to 80%.
AHRQ-funded; HS023827.
Citation: Parker MW, Carroll M, Bolser B .
Implementation of a communication bundle for high-risk patients.
Hosp Pediatr 2017 Sep;7(9):523-29. doi: 10.1542/hpeds.2016-0170..
Keywords: Children/Adolescents, Communication, Healthcare Delivery, Hospitals, Inpatient Care
Khan A, Furtak SL, Melvin P
Parent-provider miscommunications in hospitalized children.
The objectives of this study were to: (1) examine characteristics of parent-provider miscommunications about hospitalized children; (2) describe associations among parent-provider miscommunications, parent-reported errors, and hospital experience; and (3) compare parent and attending physician reports of parent-provider miscommunications. The investigators found that parent-provider miscommunications were associated with parent-reported errors and suboptimal hospital experience. Parents reported parent-provider miscommunications more often than attending physicians did.
AHRQ-funded; HS022986; HS000063.
Citation: Khan A, Furtak SL, Melvin P .
Parent-provider miscommunications in hospitalized children.
Hosp Pediatr 2017 Sep;7(9):505-15. doi: 10.1542/hpeds.2016-0190..
Keywords: Adverse Events, Caregiving, Children/Adolescents, Clinician-Patient Communication, Communication, Hospitalization, Hospitals, Medical Errors, Patient Safety
Adelman JS, Berger MA, Rai A
A national survey assessing the number of records allowed open in electronic health records at hospitals and ambulatory sites.
To reduce the risk of wrong-patient errors, safety experts recommend limiting the number of patient records providers can open at once in electronic health records (EHRs). However, it is unknown whether health care organizations follow this recommendation or what rationales drive their decisions. To address this gap, researchers conducted an electronic survey via 2 national listservs. Results demonstrate no consensus on the number of records to be allowed open at once in EHRs.
AHRQ-funded; HS023704.
Citation: Adelman JS, Berger MA, Rai A .
A national survey assessing the number of records allowed open in electronic health records at hospitals and ambulatory sites.
J Am Med Inform Assoc 2017 Sep 1;24(5):992-95. doi: 10.1093/jamia/ocx034.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitals
Fowler AC, Grabowski DC, Gambrel RJ
Corporate investors increased common ownership in hospitals and the postacute care and hospice sectors.
The researchers used data from the Provider Enrollment, Chain, and Ownership System of the Centers for Medicare and Medicaid Services to identify common investor ownership linkages across the acute care, postacute care, and hospice sectors within the same geographic markets. To our knowledge, this study provides the first description of common investor ownership trends in these sectors.
AHRQ-funded; HS024072.
Citation: Fowler AC, Grabowski DC, Gambrel RJ .
Corporate investors increased common ownership in hospitals and the postacute care and hospice sectors.
Health Aff 2017 Sep;36(9):1547-55. doi: 10.1377/hlthaff.2017.0591.
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Keywords: Hospitals, Health Systems
Shih YT, Shen C, Hu JC
Do robotic surgical systems improve profit margins? A cross-sectional analysis of California hospitals.
The aim of this study was to examine the association between ownership of robotic surgical systems and hospital profit margins. Hospitals with robotic surgical systems tended to report more favorable profit margins. However, multilevel logistic regression showed that this relationship (an association, not causality) became only marginally significant after controlling for other hospital characteristics.
AHRQ-funded; HS020263; HS024608.
Citation: Shih YT, Shen C, Hu JC .
Do robotic surgical systems improve profit margins? A cross-sectional analysis of California hospitals.
Value Health 2017 Sep;20(8):1221-25. doi: 10.1016/j.jval.2017.05.010.
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Keywords: Healthcare Costs, Hospitals, Surgery
Soban LM, Kim L, Yuan AH
Organisational strategies to implement hospital pressure ulcer prevention programmes: findings from a national survey.
The researchers describe the presence and operationalisation of organisational strategies to support implementation of pressure ulcer prevention programmes across acute care hospitals in a large, integrated health-care system. Organisational strategies that support implementation of a pressure ulcer prevention programme (policy, committee, staff education, wound care specialists, and use of performance data) were reported at high level.
AHRQ-funded; HS000046.
Citation: Soban LM, Kim L, Yuan AH .
Organisational strategies to implement hospital pressure ulcer prevention programmes: findings from a national survey.
J Nurs Manag 2017 Sep;25(6):457-67. doi: 10.1111/jonm.12416.
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Keywords: Pressure Ulcers, Prevention, Hospitals, Patient Safety, Implementation, Organizational Change
Fisher KA, Landyn V, Lindenauer PK
Procalcitonin test availability: a survey of acute care hospitals in Massachusetts.
In this study, the investigators conducted a survey of all acute care short-stay hospitals in the state of Massachusetts in August, 2016 to determine procalcitonin (PCT) assay availability, whether testing is performed on site or at an outside laboratory, and turnaround time. They indicate that their findings demonstrated that PCT testing in routine clinical practice was not available to clinicians in a manner that would be expected to yield timely results or favorably impact antibiotic prescribing in the majority of hospitals in Massachusetts.
AHRQ-funded; HS024596.
Citation: Fisher KA, Landyn V, Lindenauer PK .
Procalcitonin test availability: a survey of acute care hospitals in Massachusetts.
Ann Am Thorac Soc 2017 Sep;14(9):1489-91. doi: 10.1513/AnnalsATS.201704-306RL..
Keywords: Diagnostic Safety and Quality, Hospitals
McHugh JP, Foster A, Mor V JP, Foster A, Mor V
Reducing hospital readmissions through preferred networks of skilled nursing facilities.
This study used a concurrent mixed-methods approach to examine changes in rehospitalization rates and differences in practices between hospitals that did and did not develop formal skilled nursing facilities (SNF) networks.
AHRQ-funded; HS023961.
Citation: McHugh JP, Foster A, Mor V JP, Foster A, Mor V .
Reducing hospital readmissions through preferred networks of skilled nursing facilities.
Health Aff 2017 Sep;36(9):1591-98. doi: 10.1377/hlthaff.2017.0211..
Keywords: Care Coordination, Hospital Readmissions, Hospitals, Nursing Homes, Transitions of Care
Jackson SS, Leekha S, Magder LS
The effect of adding comorbidities to current Centers for Disease Control and Prevention central-line-associated bloodstream infection risk-adjustment methodology.
The authors of this study hypothesized that risk adjustment would be improved by including patient demographics and comorbidities from electronically available hospital discharge codes to current Centers for Disease Control and Prevention central-line-associated bloodstream infection risk-adjustment methodology. They concluded that their risk-adjustment model for CLABSI using electronically available comorbidities demonstrated better discrimination than did the CDC model.
AHRQ-funded; HS022291.
Citation: Jackson SS, Leekha S, Magder LS .
The effect of adding comorbidities to current Centers for Disease Control and Prevention central-line-associated bloodstream infection risk-adjustment methodology.
Infect Control Hosp Epidemiol 2017 Sep;38(9):1019-24. doi: 10.1017/ice.2017.129..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Hospitals, Patient Safety, Risk
Calderwood MS, Huang SS, Keller V
Variable case detection and many unreported cases of surgical-site infection following colon surgery and abdominal hysterectomy in a statewide validation.
This study assesses hospital surgical-site infection (SSI) identification and reporting following colon surgery and abdominal hysterectomy via a statewide external validation. The authors concluded that claims-based surveillance is a standardized approach that hospitals can use to augment traditional surveillance methods and health departments can use for external validation.
AHRQ-funded; HS021424.
Citation: Calderwood MS, Huang SS, Keller V .
Variable case detection and many unreported cases of surgical-site infection following colon surgery and abdominal hysterectomy in a statewide validation.
Infect Control Hosp Epidemiol 2017 Sep;38(9):1091-97. doi: 10.1017/ice.2017.134..
Keywords: Healthcare-Associated Infections (HAIs), Surgery, Injuries and Wounds, Patient Safety, Women, Adverse Events, Diagnostic Safety and Quality, Hospitals
Goldberg EM, Morphis B, Youssef R
An analysis of diagnoses that drive readmission: what can we learn from the hospitals in Southern New England with the highest and lowest readmission performance?
This study examined the most common diagnoses driving readmissions among fee-for-service Medicare beneficiaries in the hospitals with the highest and lowest readmission performance in Southern New England from 2014 to 2016. It found that the lowest-performing hospitals readmitted higher percentages of patients for sepsis and complications of device, implant, or graft, compared to highest-performing hospitals.
AHRQ-funded; HS000011.
Citation: Goldberg EM, Morphis B, Youssef R .
An analysis of diagnoses that drive readmission: what can we learn from the hospitals in Southern New England with the highest and lowest readmission performance?
R I Med J 2017 Aug;100(8):23-28.
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Keywords: Adverse Events, Diagnostic Safety and Quality, Hospital Readmissions, Hospitals, Quality Indicators (QIs)
Luxenberg A, Chan B, Khanna R
Efficiency and interpretability of text paging communication for medical inpatients: a mixed-methods analysis.
The purpose of this analysis was to investigate text page message content and structure, focusing on efficiency and safety. The authors analyzed the messages generated at an academic tertiary care hospital sent or received by hospital staff via an internal service, including those relating to the care of specific patients. While most messages were nonurgent, those that were lacked consistent language to indicate urgency. The authors conclude that text paging has significant limitations for real-time communication in acute-care settings, and their data should be a basis to inform the development of guidelines on the effective, efficient use of text paging.
AHRQ-funded; HS023558.
Citation: Luxenberg A, Chan B, Khanna R .
Efficiency and interpretability of text paging communication for medical inpatients: a mixed-methods analysis.
JAMA Intern Med 2017 Aug;177(8):1218-20. doi: 10.1001/jamainternmed.2017.2133..
Keywords: Communication, Inpatient Care, Hospitals, Patient Safety