National Healthcare Quality and Disparities Report
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Topics
- Adverse Drug Events (ADE) (1)
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- Antimicrobial Stewardship (2)
- Asthma (4)
- Behavioral Health (1)
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- Payment (2)
- Pneumonia (4)
- Practice Patterns (6)
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- Provider: Health Personnel (1)
- Provider Performance (1)
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- Quality Indicators (QIs) (1)
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- Quality of Care (3)
- Racial and Ethnic Minorities (4)
- Rehabilitation (1)
- Research Methodologies (1)
- (-) Respiratory Conditions (74)
- Risk (4)
- Screening (2)
- Sex Factors (1)
- Sleep Problems (6)
- Social Determinants of Health (2)
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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 74 Research Studies DisplayedAlbright K, Hurley LP, Lockhart S
Attitudes about adult vaccines and reminder/recall in a safety net population.
The objective of this study was to determine patient perspectives on adult vaccines generally; attitudes about Tdap, pneumococcal polysaccharide (PPSV-23), and seasonal influenza vaccines specifically; and preferences for adult reminder/recall delivery.
AHRQ-funded; HS022648.
Citation: Albright K, Hurley LP, Lockhart S .
Attitudes about adult vaccines and reminder/recall in a safety net population.
Vaccine 2017 Dec 19;35(52):7292-96. doi: 10.1016/j.vaccine.2017.11.001..
Keywords: Influenza, Pneumonia, Vaccination, Prevention, Respiratory Conditions
Lindenauer PK, Shieh MS, Stefan MS
Hospital procalcitonin testing and antibiotic treatment of patients admitted for chronic obstructive pulmonary disease exacerbation
The purpose of this study was to determine the impact of procalcitonin (PCT) testing on antibiotic treatment of patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD) in routine practice. The study conclude that as currently implemented, PCT testing appears to have had little impact on decisions to initiate antibiotic therapy or on duration of treatment for COPD exacerbations.
AHRQ-funded; HS024596.
Citation: Lindenauer PK, Shieh MS, Stefan MS .
Hospital procalcitonin testing and antibiotic treatment of patients admitted for chronic obstructive pulmonary disease exacerbation
Ann Am Thorac Soc 2017 Dec;14(12):1779-85. doi: 10.1513/AnnalsATS.201702-133OC..
Keywords: Antibiotics, Respiratory Conditions, Hospitalization, Inpatient Care, Patient-Centered Outcomes Research
Parekh TM, Bhatt SP, Westfall AO
Implications of DRG classification in a bundled payment initiative for COPD.
The researchers hypothesized that patients included in a the Medicare Bundled Payments for Care Improvement (BPCI) initiative for chronic obstructive pulmonary disease (COPD) would have less severe illness and decreased hospital utilization compared with those excluded from the bundled payment initiative. They concluded that the use of DRGs to identify patients with COPD for inclusion in the BPCI initiative led to the exclusion of more than one-third of patients with acute exacerbations.
AHRQ-funded; HS013852.
Citation: Parekh TM, Bhatt SP, Westfall AO .
Implications of DRG classification in a bundled payment initiative for COPD.
Am J Accountable Care 2017 Dec;5(4):12-18.
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Keywords: Respiratory Conditions, Healthcare Costs, Payment
Morabito J, Bell MT, Montenij LJ
Perioperative considerations for chylothorax.
This paper presents the case report of a 73 year old man with recurrent right pleural effusions, and a mediastinal mass of indeterminate etiology after a computer tomography-guided biopsy and thoracentesis. It discusses the perioperative considerations for chylothorax.
AHRQ-funded; HS024124.
Citation: Morabito J, Bell MT, Montenij LJ .
Perioperative considerations for chylothorax.
J Cardiothorac Vasc Anesth 2017 Dec;31(6):2277-81. doi: 10.1053/j.jvca.2017.06.001..
Keywords: Case Study, Imaging, Respiratory Conditions, Surgery
Donovan LM, Rise PJ, Carson SS
Sleep disturbance in smokers with preserved pulmonary function and chronic obstructive pulmonary disease.
This study compared the magnitude and correlates of sleep disturbance between smokers with preserved pulmonary function and those with airflow obstruction. It found that among smokers with clinically identified chronic obstructive pulmonary disease (COPD), the severity of sleep disturbance is greater among those with preserved pulmonary function compared to those with airflow obstruction. Non-respiratory symptoms, such as depression, were associated with sleep disturbance in both groups.
AHRQ-funded; HS017894.
Citation: Donovan LM, Rise PJ, Carson SS .
Sleep disturbance in smokers with preserved pulmonary function and chronic obstructive pulmonary disease.
Ann Am Thorac Soc 2017 Dec;14(12):1836-43. doi: 10.1513/AnnalsATS.201706-453OC.
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Keywords: Respiratory Conditions, Sleep Problems, Tobacco Use, Chronic Conditions
Oates GR, Hamby BW, Stepanikova I
Social determinants of adherence to pulmonary rehabilitation for chronic obstructive pulmonary disease.
Adherence to pulmonary rehabilitation (PR) is low. Previous studies have focused on clinical predictors of PR completion. This study aimed to identify social determinants of adherence to PR. The findings showed that, relative to high adherence, low adherence is associated with limited functional capacity and current smoking, while moderate adherence is associated with socioeconomic disadvantage. The distinction highlights different pathways to suboptimal adherence and calls for tailored intervention approaches.
AHRQ-funded; HS023009.
Citation: Oates GR, Hamby BW, Stepanikova I .
Social determinants of adherence to pulmonary rehabilitation for chronic obstructive pulmonary disease.
Copd 2017 Dec;14(6):610-17. doi: 10.1080/15412555.2017.1379070..
Keywords: Respiratory Conditions, Racial and Ethnic Minorities, Patient Adherence/Compliance, Social Determinants of Health
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
Linder JA, Meeker D, Fox CR
Effects of behavioral interventions on inappropriate antibiotic prescribing in primary care 12 months after stopping interventions.
This study examines the persistence of effects 12 months after stopping behavioral interventions on inappropriate antibiotic prescribing. In the 12 months after removing behavioral interventions, inappropriate antibiotic prescribing for acute respiratory infections (ARIs) increased relative to control practices—whose inappropriate prescribing rates continued to decrease.
AHRQ-funded; HS019913.
Citation: Linder JA, Meeker D, Fox CR .
Effects of behavioral interventions on inappropriate antibiotic prescribing in primary care 12 months after stopping interventions.
JAMA 2017 Oct 10;318(14):1391-92. doi: 10.1001/jama.2017.11152.
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Keywords: Antibiotics, Practice Patterns, Primary Care, Comparative Effectiveness, Respiratory Conditions
Badawy J, Nguyen OK, Clark C
Is everyone really breathing 20 times a minute? Assessing epidemiology and variation in recorded respiratory rate in hospitalised adults.
The researchers sought to assess the potential accuracy of respiratory rate (RR) by analyzing the distribution and variation as a proxy, since RR should be normally distributed if recorded accurately. The observed patterns suggest that RR is inaccurately recorded, even among those with cardiopulmonary compromise, and represents a 'spot' estimate with values of 18 and 20 breaths per minute representing 'normal.’
AHRQ-funded; HS022418.
Citation: Badawy J, Nguyen OK, Clark C .
Is everyone really breathing 20 times a minute? Assessing epidemiology and variation in recorded respiratory rate in hospitalised adults.
BMJ Qual Saf 2017 Oct;26(10):832-36. doi: 10.1136/bmjqs-2017-006671.
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Keywords: Hospitalization, Inpatient Care, Patient Safety, Quality Improvement, Respiratory Conditions
Finn Davis K, Napolitano N, Li S
Promoters and barriers to implementation of tracheal intubation airway safety bundle: a mixed-method analysis.
This study describes promoters and barriers to implementation of an airway safety quality improvement bundle from the perspective of interdisciplinary frontline clinicians and ICU quality improvement leaders. Both early and late adopters identified similar promoter and barrier themes. Early adopter sites customized the quality improvement bundle and had an interdisciplinary quality improvement team approach.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Finn Davis K, Napolitano N, Li S .
Promoters and barriers to implementation of tracheal intubation airway safety bundle: a mixed-method analysis.
Pediatr Crit Care Med 2017 Oct;18(10):965-72. doi: 10.1097/pcc.0000000000001251.
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Keywords: Critical Care, Intensive Care Unit (ICU), Patient Safety, Quality Improvement, Respiratory Conditions
Goto T, Faridi MK, Gibo K
Sex and racial/ethnic differences in the reason for 30-day readmission after COPD hospitalization.
This retrospective cohort study used 2006-2012 data from the State Inpatient Database of eight geographically-diverse US states (Arkansas, California, Florida, Iowa, Nebraska, New York, Utah, and Washington) to examine 30-day readmissions in patients hospitalized for chronic obstructive pulmonary disease (COPD). In their analysis of all-payer population-based data, the authors found sex and racial/ethnic differences in the reason for 30-day readmission in patients hospitalized for COPD.
AHRQ-funded; HS023305.
Citation: Goto T, Faridi MK, Gibo K .
Sex and racial/ethnic differences in the reason for 30-day readmission after COPD hospitalization.
Respir Med 2017 Oct;131:6-10. doi: 10.1016/j.rmed.2017.07.056..
Keywords: Respiratory Conditions, Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities, Hospital Readmissions, Sex Factors
Jolley SE, Hough CL, Clermont G
Relationship between race and the effect of fluids on long-term mortality after acute respiratory distress syndrome. secondary analysis of the National Heart, Lung, and Blood Institute Fluid and Catheter Treatment Trial.
Short-term follow-up in the Fluid and Catheter Treatment Trial (FACTT) suggested differential mortality by race with conservative fluid management, but no significant interaction. A post hoc analysis of FACTT and the Economic Analysis of Pulmonary Artery Catheters (EAPAC) study was performed. The researchers found that in their cohort, conservative fluid management may have improved 1-year mortality for non-Hispanic black patients with ARDS. However, they found no long-term benefit of conservative fluid management in white subjects.
AHRQ-funded; HS011620.
Citation: Jolley SE, Hough CL, Clermont G .
Relationship between race and the effect of fluids on long-term mortality after acute respiratory distress syndrome. secondary analysis of the National Heart, Lung, and Blood Institute Fluid and Catheter Treatment Trial.
Ann Am Thorac Soc 2017 Sep;14(9):1443-49. doi: 10.1513/AnnalsATS.201611-906OC..
Keywords: Racial and Ethnic Minorities, Respiratory Conditions, Mortality
Goto T, Faridi MK, Gibo K
Trends in 30-day readmission rates after COPD hospitalization, 2006-2012.
This study investigated trends in 30-day readmission rates after chronic obstructive pulmonary disease (COPD)-related hospitalization. Overall, the 30-day readmission rate for COPD-related hospitalization decreased modestly from 20.0 percent in 2006 to 19.2 percent in 2012. Similar to the overall population, the readmission rate over the 7-year period remained persistently high in most of AHRQ-defined priority populations.
AHRQ-funded; HS023305.
Citation: Goto T, Faridi MK, Gibo K .
Trends in 30-day readmission rates after COPD hospitalization, 2006-2012.
Respir Med 2017 Sep;130:92-97. doi: 10.1016/j.rmed.2017.07.058.
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Keywords: Respiratory Conditions, Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Social Determinants of Health, Vulnerable Populations
Albrecht JS, Khokhar B, Huang TY
Adherence and healthcare utilization among older adults with COPD and depression.
The researchers quantified the independent effects of adherence to antidepressants and chronic obstructive pulmonary disease (COPD) maintenance medications on healthcare utilization among individuals co-diagnosed with COPD and depression. They found that, compared to no use,higher levels of adherence to COPD maintenance medications were associated with decreased risk of ED visits and hospitalizations. Similarly, higher levels of adherence to antidepressants resulted in decreased risk of ED visits and hospitalization.
AHRQ-funded; HS024560.
Citation: Albrecht JS, Khokhar B, Huang TY .
Adherence and healthcare utilization among older adults with COPD and depression.
Respir Med 2017 Aug;129:53-58. doi: 10.1016/j.rmed.2017.06.002.
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Keywords: Elderly, Healthcare Utilization, Respiratory Conditions, Depression, Patient Adherence/Compliance
Sinha SS, Sjoding MW, Sukul D
Changes in primary noncardiac diagnoses over time among elderly cardiac intensive care unit patients in the United States.
This study examined changes in primary noncardiac diagnoses among elderly patients admitted to a cardiac intensive care unit (CICU) during the past decade. More than half of all elderly patients with a CICU stay across the United States now have primary noncardiac diagnoses at discharge. These patients receive different types of care and have worse outcomes than patients with primary cardiac diagnoses.
AHRQ-funded; HS020672.
Citation: Sinha SS, Sjoding MW, Sukul D .
Changes in primary noncardiac diagnoses over time among elderly cardiac intensive care unit patients in the United States.
Circ Cardiovasc Qual Outcomes 2017 Aug;10(8):e003616. doi: 10.1161/circoutcomes.117.003616.
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Keywords: Elderly, Heart Disease and Health, Intensive Care Unit (ICU), Outcomes, Respiratory Conditions
Costa DK, White MR, Ginier E
Identifying barriers to delivering the awakening and breathing coordination, delirium, and early exercise/mobility bundle to minimize adverse outcomes for mechanically ventilated patients: a systematic review.
The purpose of this review was to identify and catalog the barriers to the Awakening and Breathing Coordination, Delirium, and Early exercise/mobility bundle (ABCDE) delivery based on a widely used implementation framework, and to provide a resource to guide clinicians in overcoming barriers to implementation. It provides the first, to the authors’ knowledge, systematic differential diagnosis of barriers to ABCDE delivery, moving beyond the conventional focus on patient-level factors.
AHRQ-funded; HS024552.
Citation: Costa DK, White MR, Ginier E .
Identifying barriers to delivering the awakening and breathing coordination, delirium, and early exercise/mobility bundle to minimize adverse outcomes for mechanically ventilated patients: a systematic review.
Chest 2017 Aug;152(2):304-11. doi: 10.1016/j.chest.2017.03.054.
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Keywords: Respiratory Conditions, Adverse Events, Prevention, Outcomes
Brown SM, Duggal A, Hou PC
Nonlinear imputation of PaO2/FIO2 from SpO2/FIO2 among mechanically ventilated patients in the ICU: a prospective, observational study.
The objective of the study was to validate the superiority of nonlinear imputation of PaO2/FIO2 (a clinical indicator of hypoxaemia) among mechanically ventilated patients and understand what factors influence the accuracy of imputation. It concluded that in mechanically ventilated patients, nonlinear imputation of PaO2/FIO2 from SpO2/FIO2 seems accurate, especially for moderate-severe hypoxemia. Linear and log-linear imputations cannot be recommended.
AHRQ-funded; HS021456.
Citation: Brown SM, Duggal A, Hou PC .
Nonlinear imputation of PaO2/FIO2 from SpO2/FIO2 among mechanically ventilated patients in the ICU: a prospective, observational study.
Crit Care Med 2017 Aug;45(8):1317-24. doi: 10.1097/ccm.0000000000002514.
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Keywords: Diagnostic Safety and Quality, Respiratory Conditions, Intensive Care Unit (ICU), Emergency Medical Services (EMS)
Grunwell JR, Kamat PP, Miksa M
Trend and outcomes of video laryngoscope use across PICUs.
The use of video laryngoscopy for tracheal intubation is now common for adult ICUs, but has not been quantified in pediatric ICUs (PICUs). A retrospective review was conducted of PICUs across the US and four other countries. There was a wide variability of use of video laryngoscopy across PICUs. There has been a significant increase in the use of video laryngoscopy versus direct laryngoscopy from 2011 to 2015, which has resulted in a decrease in adverse outcomes.
AHRQ-funded; HS021583; HS022464.
Citation: Grunwell JR, Kamat PP, Miksa M .
Trend and outcomes of video laryngoscope use across PICUs.
Pediatr Crit Care Med 2017 Aug;18(8):741-49. doi: 10.1097/pcc.0000000000001175..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Patient Safety, Practice Patterns, Respiratory Conditions
Berry J, Wilson K, Dumas H
Use of post-acute facility care in children hospitalized with acute respiratory illness.
In this retrospective analysis, the investigators assessed which children hospitalized with respiratory illness (RI) were the most likely to use post-acute facility care (PAC) for recovery. The investigators found that children with RI who were most likely to use PAC had a high prevalence of multiple chronic conditions, multiple medications, and medical technology.
AHRQ-funded; HS023092.
Citation: Berry J, Wilson K, Dumas H .
Use of post-acute facility care in children hospitalized with acute respiratory illness.
J Hosp Med 2017 Aug;12(8):626-31. doi: 10.12788/jhm.2780..
Keywords: Children/Adolescents, Hospitalization, Respiratory Conditions, Transitions of Care
Rinne ST, Castaneda J, Lindenauer PK
Chronic obstructive pulmonary disease readmissions and other measures of hospital quality.
This study examined the association between COPD readmissions and other quality measures. There were modest correlations between COPD readmission rates and readmission rates for other medical conditions, including heart failure , acute myocardial infarction, pneumonia, and stroke . In contrast, it also found low correlations between COPD readmission rates and readmission rates for surgical conditions, as well as mortality rates for all measured conditions.
AHRQ-funded; HS016978.
Citation: Rinne ST, Castaneda J, Lindenauer PK .
Chronic obstructive pulmonary disease readmissions and other measures of hospital quality.
Am J Respir Crit Care Med 2017 Jul 1;196(1):47-55. doi: 10.1164/rccm.201609-1944OC.
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Keywords: Respiratory Conditions, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Quality of Care, Hospital Readmissions, Hospitals
McGrath SP, Pyke J, Taenzer AH
Assessment of continuous acoustic respiratory rate monitoring as an addition to a pulse oximetry-based patient surveillance system.
This study explored the technical and logistical aspects of augmenting pulse oximetry-based patient surveillance systems with continuous respiratory rate monitoring and offers some insight into the impact on patient deterioration detection that may result.
AHRQ-funded; HS024403.
Citation: McGrath SP, Pyke J, Taenzer AH .
Assessment of continuous acoustic respiratory rate monitoring as an addition to a pulse oximetry-based patient surveillance system.
J Clin Monit Comput 2017 Jun;31(3):561-69. doi: 10.1007/s10877-016-9884-y..
Keywords: Diagnostic Safety and Quality, Respiratory Conditions
Bostwick D, Wolf S, Samsa G
Comparing the palliative care needs of those with cancer to those with common non-cancer serious illness.
Researchers compared functionality, advanced care planning, hospital admissions, prognosis, quality of life, pain, dyspnea, fatigue, and depression between patients with cancer and three non-cancer diagnoses-end-stage renal disease (ESRD), heart failure (HF), and chronic obstructive pulmonary disease (COPD). Patients with COPD, ESRD, and HF were less functional and more likely to be hospitalized at time of referral to palliative care than cancer patients.
AHRQ-funded; HS022763.
Citation: Bostwick D, Wolf S, Samsa G .
Comparing the palliative care needs of those with cancer to those with common non-cancer serious illness.
J Pain Symptom Manage 2017 Jun;53(6):1079-84.e1. doi: 10.1016/j.jpainsymman.2017.02.014.
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Keywords: Cancer, Respiratory Conditions, Kidney Disease and Health, Heart Disease and Health, Palliative Care
Niles DE, Cines C, Insley E
Incidence and characteristics of positive pressure ventilation delivered to newborns in a US tertiary academic hospital.
The Neonatal Resuscitation Program (NRP) guidelines recommend positive pressure ventilation (PPV) in the first 60s of life to support perinatal transition in non-breathing newborns. The aim of this study was to describe the incidence and characteristics of newborn PPV using real-time observation in the delivery unit. The authors suggest that compliance with current NRP guidelines is difficult, and assert that it's not clear whether it is the recommendations or the training to achieve PPV recommendations that should be modified.
AHRQ-funded; HS022469.
Citation: Niles DE, Cines C, Insley E .
Incidence and characteristics of positive pressure ventilation delivered to newborns in a US tertiary academic hospital.
Resuscitation 2017 Jun;115:102-09. doi: 10.1016/j.resuscitation.2017.03.035..
Keywords: Guidelines, Newborns/Infants, Respiratory Conditions
Valley TS, Sjoding MW, Ryan AM
Intensive care unit admission and survival among older patients with chronic obstructive pulmonary disease, heart failure, or myocardial infarction.
The researchers estimated the relationship between ICU admission and outcomes for hospitalized patients with exacerbation of chronic obstructive pulmonary disease (COPD), exacerbation of heart failure (HF), or acute myocardial infarction (AMI). They found that ICU admission did not confer a survival benefit for patients with uncertain ICU needs hospitalized with COPD exacerbation, HF exacerbation, or AMI.
AHRQ-funded; HS020672.
Citation: Valley TS, Sjoding MW, Ryan AM .
Intensive care unit admission and survival among older patients with chronic obstructive pulmonary disease, heart failure, or myocardial infarction.
Ann Am Thorac Soc 2017 Jun;14(6):943-51. doi: 10.1513/AnnalsATS.201611-847OC.
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Keywords: Intensive Care Unit (ICU), Respiratory Conditions, Heart Disease and Health, Outcomes
Bhatt SP, Wells JM, Iyer AS
Results of a Medicare bundled payments for care improvement initiative for chronic obstructive pulmonary disease readmissions.
This study evaluated whether a comprehensive chronic obstructive pulmonary disease (COPD) multidisciplinary intervention focusing on inpatient, transitional, and outpatient care as part of an institution's Bundled Payments for Care Improvement (BPCI) participation would reduce 30-day all-cause readmission rates for COPD exacerbations and reduce overall costs. It concluded that a Medicare BPCI intervention did not reduce 30-day all-cause readmission rates or overall costs after hospitalization for acute exacerbation of COPD.
AHRQ-funded; HS013852.
Citation: Bhatt SP, Wells JM, Iyer AS .
Results of a Medicare bundled payments for care improvement initiative for chronic obstructive pulmonary disease readmissions.
Ann Am Thorac Soc 2017 May;14(5):643-48. doi: 10.1513/AnnalsATS.201610-775BC.
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Keywords: Respiratory Conditions, Payment, Hospital Readmissions, Medicare, Quality Improvement