National Healthcare Quality and Disparities Report
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- Access to Care (4)
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- (-) Ambulatory Care and Surgery (57)
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- Digestive Disease and Health (1)
- Education: Patient and Caregiver (3)
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- Electronic Health Records (EHRs) (10)
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- Healthcare-Associated Infections (HAIs) (4)
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- Neurological Disorders (2)
- Opioids (2)
- Organizational Change (1)
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- Pain (1)
- Palliative Care (1)
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- Patient-Centered Outcomes Research (2)
- Patient and Family Engagement (1)
- Patient Experience (3)
- Patient Safety (12)
- Payment (4)
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- Quality Indicators (QIs) (1)
- Quality Measures (1)
- Quality of Care (5)
- Racial and Ethnic Minorities (1)
- Registries (1)
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- Risk (2)
- Rural/Inner-City Residents (1)
- Screening (1)
- Stress (1)
- Substance Abuse (1)
- Surgery (5)
- Teams (1)
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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 57 Research Studies DisplayedGooding HC, Brown CA, Wisk LE
Investing in our future: the importance of ambulatory visits to achieving blood pressure control in young adults.
In this commentary, the authors discuss an article written by King, et al. and published in 2017 in the Journal of Clinical Hypertension, entitled “The importance of frequent return visits and hypertension control among US young adults: a multidisciplinary group practice observational study.”
AHRQ-funded; K12 HS022986.
Citation: Gooding HC, Brown CA, Wisk LE .
Investing in our future: the importance of ambulatory visits to achieving blood pressure control in young adults.
J Clin Hypertens 2017 Dec;19(12):1298-300. doi: 10.1111/jch.13100..
Keywords: Ambulatory Care and Surgery, Care Management, Blood Pressure, Young Adults
Sarkar U, McDonald K, Motala A
Pragmatic insights on patient safety priorities and intervention strategies in ambulatory settings.
In this article, the investigators (1) reviewed the methods and results for the key informant input process for a Technical Brief on ambulatory safety commissioned by the Agency for Healthcare Research and Quality (AHRQ), (2) summarized the key informant perspectives on ambulatory safety, (3) expanded on key informant input with specific recommendations for an ambulatory safety agenda, (4) reported on existing initiatives and progress related to key informant perspectives and our recommendations, and (5) proposed specific research and policy activities that would advance ambulatory safety.
AHRQ-funded; 290201500010I.
Citation: Sarkar U, McDonald K, Motala A .
Pragmatic insights on patient safety priorities and intervention strategies in ambulatory settings.
Jt Comm J Qual Patient Saf 2017 Dec;43(12):661-70. doi: 10.1016/j.jcjq.2017.06.009..
Keywords: Ambulatory Care and Surgery, Patient Safety, Quality of Care
Biener AI, Selden TM
AHRQ Author: Biener AI, Selden TM
Public and private payments for physician office visits.
Using data for 2014-15 from the Medical Expenditure Panel Survey to estimate standardized payments for nonelderly adults' physician office visits by type of insurance, researchers found that adults with public insurance, especially Medicaid, had substantially lower provider payments, out-of-pocket spending, and third-party payments than their peers with employer-sponsored or Marketplace insurance.
AHRQ-authored.
Citation: Biener AI, Selden TM .
Public and private payments for physician office visits.
Health Aff 2017 Dec;36(12):2160-64. doi: 10.1377/hlthaff.2017.0749.
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Keywords: Healthcare Costs, Payment, Health Insurance, Ambulatory Care and Surgery, Medical Expenditure Panel Survey (MEPS)
Kohler-Forsberg O, Madsen T, Behrendt-Moller I
Trajectories of suicidal ideation over 6 months among 482 outpatients with bipolar disorder.
The researchers aimed to investigate 6-months trajectories of suicidal ideation among adults with bipolar disorder. Using data from the Bipolar CHOICE study, they identified four distinct trajectories and found that more than one in ten adult outpatients with bipolar disorder had moderately increased suicidal ideation throughout 6 months of pharmacotherapy. They recommended that the identified predictors may help clinicians to identify those with additional need for treatment against suicidal thoughts, and future studies need to investigate whether targeted treatment may improve the course of persistent suicidal ideation.
AHRQ-funded; HS019371.
Citation: Kohler-Forsberg O, Madsen T, Behrendt-Moller I .
Trajectories of suicidal ideation over 6 months among 482 outpatients with bipolar disorder.
J Affect Disord 2017 Dec 1;223:146-52. doi: 10.1016/j.jad.2017.07.038.
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Keywords: Behavioral Health, Medication, Ambulatory Care and Surgery, Patient-Centered Healthcare
Cotter D, Barrus D, Ma M
Effects of ESRD bundling on efficiency of U.S. dialysis centers.
The study aim was to evaluate whether the 2011 ESRD Prospective Payment System (PPS) improved the efficiency of U.S. dialysis centers and to identify which providers demonstrated changes in their efficiency after the PPS implementation. It found that about 36 percent of facilities were functioning efficiently in 2010, dropping to only 21-22 percent efficiently operating facilities in 2011-12.
AHRQ-funded; HS024190.
Citation: Cotter D, Barrus D, Ma M .
Effects of ESRD bundling on efficiency of U.S. dialysis centers.
Nephrol News Issues 2017 Oct 18.
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Keywords: Kidney Disease and Health, Payment, Ambulatory Care and Surgery
Clarity C, Sarkar U, Lee J
Clinician perspectives on the management of abnormal subcritical tests in an urban academic safety-net health care system.
Missed or delayed follow-up of abnormal subcritical tests (tests that do not require immediate medical attention) can lead to poor patient outcomes. Safety-net health systems with limited resources and socially complex patients are vulnerable to safety gaps resulting from delayed management. In this study, clinician perspectives to identify system challenges, vulnerable situations, and potential solutions, were sought in focus groups.
AHRQ-funded; HS023558.
Citation: Clarity C, Sarkar U, Lee J .
Clinician perspectives on the management of abnormal subcritical tests in an urban academic safety-net health care system.
Jt Comm J Qual Patient Saf 2017 Oct;43(10):517-23. doi: 10.1016/j.jcjq.2017.05.007..
Keywords: Urban Health, Rural/Inner-City Residents, Diagnostic Safety and Quality, Patient Safety, Vulnerable Populations, Ambulatory Care and Surgery, Communication, Provider: Clinician
Ratanawongsa N, Matta GY, Lyles CR
Multitasking and silent electronic health record use in ambulatory visits.
The researchers studied time allocation and transitions into and out of silent electronic health record (EHR) use in clinics after EHR implementation. Silent EHR use (n = 193 instances) occurred while clinicians viewed (39.4 percent) or entered (24.4 percent) information, prescribed (13.5 percent), reconciled medications (8.3 percent), arranged appointments (5.2 percent), ordered tests or referrals (5.2 percent),and sought or typed patient education (3.1 percent).
AHRQ-funded; HS022408; HS023558; HS022561.
Citation: Ratanawongsa N, Matta GY, Lyles CR .
Multitasking and silent electronic health record use in ambulatory visits.
JAMA Intern Med 2017 Sep;177(9):1382-85. doi: 10.1001/jamainternmed.2017.2668.
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Keywords: Electronic Health Records (EHRs), Ambulatory Care and Surgery, Health Information Technology (HIT)
Ray KN, Martsolf GR, Mehrotra A
Trends in visits to specialist physicians involving nurse practitioners and physician assistants, 2001 to 2013.
The purpose of this study is to examine trends in specialist physician visits where nurse practitioners (NPs) and physician assistants (PAs) provide care, based on the hypothesis that NPs and PAs provide care to patients of specialist physicians in increasing numbers, primarily for routine follow-up visits. Using the National Ambulatory Medical Care Survey (NAMCS) information on samples office visits, researchers identified visits to specialist physicians, divided these into surgical and medical specialists and examined unadjusted trends from 2001 - 2013 in the percentage of visits with NP or PA involvement. Visit characteristics associated with higher likelihood of NP or PA involvement were examined.
AHRQ-funded; HS022989.
Citation: Ray KN, Martsolf GR, Mehrotra A .
Trends in visits to specialist physicians involving nurse practitioners and physician assistants, 2001 to 2013.
JAMA Intern Med 2017 Aug;177(8):1213-16. doi: 10.1001/jamainternmed.2017.1630..
Keywords: Access to Care, Ambulatory Care and Surgery, Healthcare Delivery, Primary Care, Provider
Davis MM, Howk S, Spurlock M
A qualitative study of clinic and community member perspectives on intervention toolkits: "unless the toolkit is used it won't help solve the problem.".
Researchers conducted this study to explore what clinic and community-based users want in intervention toolkits and to identify the factors that support application in practice. They found that participants wanted toolkits targeted at the right audience and demonstrated to be effective. Well organized toolkits, often with a quick start guide, with tools that were easy to tailor and apply were desired.
AHRQ-funded; HS022981.
Citation: Davis MM, Howk S, Spurlock M .
A qualitative study of clinic and community member perspectives on intervention toolkits: "unless the toolkit is used it won't help solve the problem.".
BMC Health Serv Res 2017 Jul 18;17(1):497. doi: 10.1186/s12913-017-2413-y.
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Keywords: Provider: Health Personnel, Ambulatory Care and Surgery, Primary Care, Tools & Toolkits, Implementation
Lee SY, Cherian R, Ly I
Designing and implementing an electronic patient registry to improve warfarin monitoring in the ambulatory setting.
The researchers designed and implemented an electronic registry in conjunction with a complementary work flow that established an active tracking system leading to improved treatment monitoring for patients on anticoagulation therapy. For the cohort of the 357 patients in the registry, the no-show rate decreased from 31 percent (preimplementation) to 21 percent (postimplementation).
AHRQ-funded; HS023558; HS021322.
Citation: Lee SY, Cherian R, Ly I .
Designing and implementing an electronic patient registry to improve warfarin monitoring in the ambulatory setting.
Jt Comm J Qual Patient Saf 2017 Jul;43(7):353-60. doi: 10.1016/j.jcjq.2017.03.006.
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Keywords: Health Information Technology (HIT), Registries, Blood Thinners, Medication, Ambulatory Care and Surgery
Simon TD, Cawthon ML, Popalisky J
Development and validation of the Pediatric Medical Complexity Algorithm (PMCA) Version 2.0.
The Pediatric Medical Complexity Algorithm (PMCA) was developed to stratify children by level of medical complexity. The researchers sought to refine PMCA and evaluate its performance based on the duration of eligibility and completeness of Medicaid data. They concluded that PMCA version 2.0 identifies children with C-CD with good sensitivity and very good specificity when applied to Medicaid data.
AHRQ-funded; HS020506.
Citation: Simon TD, Cawthon ML, Popalisky J .
Development and validation of the Pediatric Medical Complexity Algorithm (PMCA) Version 2.0.
Hosp Pediatr 2017 Jul;7(7):373-77. doi: 10.1542/hpeds.2016-0173.
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Keywords: Chronic Conditions, Hospitals, Medicaid, Ambulatory Care and Surgery, Children/Adolescents
Arnold S
AHRQ Author: Arnold S
The imperative to address diagnostic safety.
Diagnostic errors are likely to impact most of us in our lifetime. The author discusses two studies pointing to the vastness of the challenge and the urgency to act now. He also discusses other aspects of this issue and highlights two current AHRQ dedicated research opportunities on diagnostic safety: one to look at the incidence and causes of diagnostic errors in ambulatory care, and the second to look at improvement strategies and interventions.
AHRQ-authored.
Citation: Arnold S .
The imperative to address diagnostic safety.
Diagnosis 2017 Jun 27;4(2):55-56. doi: 10.1515/dx-2017-0017.
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Keywords: Diagnostic Safety and Quality, Medical Errors, Ambulatory Care and Surgery, Patient Safety, Quality Improvement
McDonald KM, Su G, Lisker S
Implementation science for ambulatory care safety: a novel method to develop context-sensitive interventions to reduce quality gaps in monitoring high-risk patients.
The researchers aimed to demonstrate a novel method to identify common vulnerabilities across clinics and generate attributes for context-flexible population-level monitoring solutions for widespread implementation to improve quality. Using a National Academies framework and context-sensitivity theory, they identified common systems vulnerabilities and developed preliminary concepts for improving the robustness for monitoring patients with high-risk conditions ("design seeds" for potential solutions).
AHRQ-funded; HS023558.
Citation: McDonald KM, Su G, Lisker S .
Implementation science for ambulatory care safety: a novel method to develop context-sensitive interventions to reduce quality gaps in monitoring high-risk patients.
Implement Sci 2017 Jun 24;12(1):79. doi: 10.1186/s13012-017-0609-5.
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Keywords: Ambulatory Care and Surgery, Patient Safety, Quality Improvement
Calvitti A, Hochheiser H, Ashfaq S
Physician activity during outpatient visits and subjective workload.
The researchers describe methods for capturing and analyzing EHR use and clinical workflow of physicians during outpatient encounters and relating activity to physicians' self-reported workload. They found that visit activity was highly variable across individual physicians, and the observed activity metrics ranged widely as correlates to subjective workload.
AHRQ-funded; HS021290.
Citation: Calvitti A, Hochheiser H, Ashfaq S .
Physician activity during outpatient visits and subjective workload.
J Biomed Inform 2017 May;69:135-49. doi: 10.1016/j.jbi.2017.03.011.
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Keywords: Healthcare Delivery, Electronic Health Records (EHRs), Health Information Technology (HIT), Workflow, Ambulatory Care and Surgery
Tu JV, Maclagan LC, Ko DT
AHRQ Author: Bierman A
The Cardiovascular Health in Ambulatory Care Research Team performance indicators for the primary prevention of cardiovascular disease: a modified Delphi panel study.
The researchers developed a set of key performance indicators that can be used to measure and improve cardiovascular care in the primary care setting. A set of 28 indicators of primary prevention performance were identified, which were grouped into 5 domains: risk factor prevalence, screening, management, intermediate outcomes and long-term outcomes.
AHRQ-authored.
Citation: Tu JV, Maclagan LC, Ko DT .
The Cardiovascular Health in Ambulatory Care Research Team performance indicators for the primary prevention of cardiovascular disease: a modified Delphi panel study.
CMAJ Open 2017 Apr 25;5(2):E315-e21. doi: 10.9778/cmajo.20160139.
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Keywords: Cardiovascular Conditions, Quality of Care, Ambulatory Care and Surgery, Prevention, Quality Indicators (QIs)
Carey K
Ambulatory surgery centers and prices in hospital outpatient departments.
Specialty providers claim to offer a new competitive benchmark for efficient delivery of health care. This article explores this view by examining evidence for price competition between ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). For the procedures examined, HOPDs received payments from commercial insurers in the range of 3.25 percent to 5.15 percent lower for each additional ASC per 100,000 persons in a market.
AHRQ-funded; HS023780.
Citation: Carey K .
Ambulatory surgery centers and prices in hospital outpatient departments.
Med Care Res Rev 2017 Apr;74(2):236-48. doi: 10.1177/1077558716633010.
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Keywords: Ambulatory Care and Surgery, Healthcare Costs, Payment, Hospitals
Martsolf G, Fingar KR, Coffey R
AHRQ Author: Elixhauser A
Association between the opening of retail clinics and low-acuity emergency department visits.
This study assessed whether the opening of retail clinics near emergency departments (ED) is associated with decreased ED utilization for low-acuity conditions. It concluded that with increased patient demand resulting from the expansion of health insurance coverage, retail clinics may emerge as an important care location, but to date, they have not been associated with a meaningful reduction in low-acuity ED visits.
AHRQ-authored; AHRQ-funded.
Citation: Martsolf G, Fingar KR, Coffey R .
Association between the opening of retail clinics and low-acuity emergency department visits.
Ann Emerg Med 2017 Apr;69(4):397-403.e5. doi: 10.1016/j.annemergmed.2016.08.462.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Healthcare Utilization, Emergency Medical Services (EMS), Health Services Research (HSR), Ambulatory Care and Surgery
Gallo KP, Olin SS, Storfer-Isser A
Parent burden in accessing outpatient psychiatric services for adolescent depression in a large state system.
This study examined barriers facing parents who seek outpatient psychiatric care in a large state system for adolescents with depression. It found that virtually all clinics required at least one intake or therapy appointment before receipt of a psychiatry appointment. Parental burden did not differ by region, urbanicity, clinic type, seasonality (spring or summer), or insurance status.
AHRQ-funded; HS020503.
Citation: Gallo KP, Olin SS, Storfer-Isser A .
Parent burden in accessing outpatient psychiatric services for adolescent depression in a large state system.
Psychiatr Serv 2017 Apr;68(4):411-14. doi: 10.1176/appi.ps.201600111.
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Keywords: Access to Care, Children/Adolescents, Depression, Behavioral Health, Ambulatory Care and Surgery
Federman AD, Sanchez-Munoz A, Jandorf L
Patient and clinician perspectives on the outpatient after-visit summary: a qualitative study to inform improvements in visit summary design.
The researchers explored patients' and clinicians' perspectives on electronic health record (EHR)-generated outpatient after-visit summaries (AVSs) to inform efforts to maximize the document's utility. They learned that core themes included the use and purpose of the AVS, content modification and prioritization, formatting improvements, customization, privacy and accuracy concerns, and clinician workflow concerns.
AHRQ-funded; HS023844.
Citation: Federman AD, Sanchez-Munoz A, Jandorf L .
Patient and clinician perspectives on the outpatient after-visit summary: a qualitative study to inform improvements in visit summary design.
J Am Med Inform Assoc 2017 Apr;24(e1):e61-e68. doi: 10.1093/jamia/ocw106.
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Keywords: Electronic Health Records (EHRs), Ambulatory Care and Surgery, Primary Care, Clinician-Patient Communication, Education: Patient and Caregiver
Hanauer DA, Branford GL, Greenberg G
Two-year longitudinal assessment of physicians' perceptions after replacement of a longstanding homegrown electronic health record: does a J-curve of satisfaction really exist?
This report describes a 2-year prospective, longitudinal survey of attending physicians in 3 clinical areas (family medicine, general pediatrics, internal medicine) who experienced a transition from a homegrown electronic health record (EHR) to a vendor EHR. The primary goal was to determine if perceptions followed a J-curve pattern in which they initially dropped but eventually surpassed baseline measures. A J-curve was not found for any measures, including workflow, safety, communication, and satisfaction.
AHRQ-funded; HS023613.
Citation: Hanauer DA, Branford GL, Greenberg G .
Two-year longitudinal assessment of physicians' perceptions after replacement of a longstanding homegrown electronic health record: does a J-curve of satisfaction really exist?
J Am Med Inform Assoc 2017 Apr 1;24(e1):e157-e65. doi: 10.1093/jamia/ocw077.
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Keywords: Electronic Health Records (EHRs), Provider: Health Personnel, Ambulatory Care and Surgery, Patient Safety, Workflow
Goldman JL, Richardson T, Newland JG
Outpatient parenteral antimicrobial therapy in pediatric Medicaid enrollees.
The study’s objective was to characterize outpatient parenteral antimicrobial therapy (OPAT) use and clinical outcomes for a large population of pediatric Medicaid enrollees treated with OPAT. It found that ceftriaxone and vancomycin were the most commonly prescribed antimicrobials. An emergency department visit or hospital admission occurred during 38 percent of OPAT episodes, among which 61 percent were OPAT-related.
AHRQ-funded; HS023320.
Citation: Goldman JL, Richardson T, Newland JG .
Outpatient parenteral antimicrobial therapy in pediatric Medicaid enrollees.
J Pediatric Infect Dis Soc 2017 Mar 1;6(1):65-71. doi: 10.1093/jpids/piv106.
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Keywords: Antibiotics, Children/Adolescents, Medicaid, Ambulatory Care and Surgery, Patient-Centered Outcomes Research
Predmore Z, Nie X, Main R
Anesthesia service use during outpatient gastroenterology procedures continued to increase from 2010 to 2013 and potentially discretionary spending remained high.
Previous studies have identified an increasing number of gastroenterology (GI) procedures using anesthesia services to provide sedation, with a majority of these services delivered to low-risk patients. The aim of this study was to update these trends with the most recent years of data. It found that during 2010 to 2013, anesthesia service use in GI procedures continued to increase and the proportion of these services rendered for low-risk patients remained high.
AHRQ-funded; HS000029.
Citation: Predmore Z, Nie X, Main R .
Anesthesia service use during outpatient gastroenterology procedures continued to increase from 2010 to 2013 and potentially discretionary spending remained high.
Am J Gastroenterol 2017 Feb;112(2):297-302. doi: 10.1038/ajg.2016.266.
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Keywords: Digestive Disease and Health, Ambulatory Care and Surgery, Healthcare Costs
Ducoffe AR, York A, Hu DJ
AHRQ Author: Perfetto D
National action plan for adverse drug event prevention: recommendations for safer outpatient opioid use.
This article focuses on recommendations from the Adverse Drug Events (ADE) Action Plan to help guide safer opioid use in healthcare delivery settings. Its aim is to discuss current federal methods in place to prevent opioid ADEs while also providing evidence to encourage providers and hospitals to innovate new systems and practices to increase prevention.
AHRQ-authored.
Citation: Ducoffe AR, York A, Hu DJ .
National action plan for adverse drug event prevention: recommendations for safer outpatient opioid use.
Pain Med 2016 Dec;17(12):2291-304. doi: 10.1093/pm/pnw106.
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Keywords: Prevention, Opioids, Patient Safety, Ambulatory Care and Surgery, Adverse Drug Events (ADE)
Michaelidis CI, Fine MJ, Lin CJ
The hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States: an exploratory analysis.
This study estimated the hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States. It concluded that each ambulatory antibiotic prescription is associated with a hidden societal cost of antibiotic resistance (SCAR) that substantially increases the cost of an antibiotic prescription in the United States. This finding raises concerns regarding the magnitude of misalignment between individual and societal antibiotic costs.
AHRQ-funded; HS024930.
Citation: Michaelidis CI, Fine MJ, Lin CJ .
The hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States: an exploratory analysis.
BMC Infect Dis 2016 Nov 8;16(1):655. doi: 10.1186/s12879-016-1990-4.
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Keywords: Medication, Primary Care, Hospitalization, Healthcare Costs, Ambulatory Care and Surgery
Cunha CB, D'Agata EM
Implementing an antimicrobial stewardship program in out-patient dialysis units.
The purpose of this review is to highlight the key elements and interventions of antimicrobial stewardship programs (ASP). The Infectious Disease Society of America and the Society of Healthcare Epidemiology of America have provided evidence-based guidelines for the development and implementation of an ASP. Many of their recommendations can be adapted to the out-patient dialysis setting.
AHRQ-funded; HS021666.
Citation: Cunha CB, D'Agata EM .
Implementing an antimicrobial stewardship program in out-patient dialysis units.
Curr Opin Nephrol Hypertens 2016 Nov;25(6):551-55. doi: 10.1097/mnh.0000000000000281.
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Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Ambulatory Care and Surgery, Kidney Disease and Health, Chronic Conditions