National Healthcare Quality and Disparities Report
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- Adverse Drug Events (ADE) (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 20 of 20 Research Studies DisplayedPannucci CJ, Fleming KI, Varghese TK
Low anti-factor Xa level predicts 90-day symptomatic venous thromboembolism in surgical patients receiving enoxaparin prophylaxis: a pooled analysis of eight clinical trials.
This study examined whether low anti-factor Xa (aFXa) level predicts 90-day symptomatic venous thromboembolism (VTE) in surgical patients receiving enoxaparin prophylaxis. The authors conducted a pooled analysis of 8 clinical trials from a single institution over a 4-year period. Among 985 patients, 2.3% had symptomatic 90-day VTE, 4.2% had 90-day clinically relevant bleeding, and 2.1% had major bleeding. Patients with initial low aFXa were significantly more likely to have 90-day VTE than patients with adequate or high xFXa (4.2% vs 1.3%). This relationship was significant for patients who received enoxaparin twice daily as opposed to once a day. No association was seen between high xFXa and 90-day clinically relevant bleeding or major bleeding.
AHRQ-funded; HS024326.
Citation: Pannucci CJ, Fleming KI, Varghese TK .
Low anti-factor Xa level predicts 90-day symptomatic venous thromboembolism in surgical patients receiving enoxaparin prophylaxis: a pooled analysis of eight clinical trials.
Ann Surg 2022 Dec 1;276(6):e682-e90. doi: 10.1097/sla.0000000000004589..
Keywords: Blood Thinners, Surgery, Medication, Blood Clots
Weekes AJ, Raper JD, Thomas AM
Electrocardiographic findings associated with early clinical deterioration in acute pulmonary embolism.
Investigators sought to determine associations of early ECG patterns with clinical deterioration (CD) within 5 days and with RV abnormality (abnlRV) by echocardiography in PE. They found that supraventricular tachycardia was an independent predictor of CD, while T-wave inversion, incomplete right bundle branch block, ST-segment elevation aVR, sinus tachycardia, and S1-Q3-T3 were independent predictors of abnlRV. They suggested that finding one or more of these ECG patterns may increase considerations for performance of echocardiography to look for RV abnormalities and, if present, inform concerns for early clinical deterioration.
AHRQ-funded; HS025979.
Citation: Weekes AJ, Raper JD, Thomas AM .
Electrocardiographic findings associated with early clinical deterioration in acute pulmonary embolism.
Acad Emerg Med 2022 Oct;29(10):1185-96. doi: 10.1111/acem.14554..
Keywords: Respiratory Conditions, Blood Clots
Lee PT, Krecko LK, Savage S
Which hospital-acquired conditions matter the most in trauma? An evidence-based approach for prioritizing trauma program improvement.
The purpose of this study was to quantify and compare the impacts of six different hospital-acquired conditions (HACs) on early clinical outcomes and resource utilization in hospitalized trauma patients. The researchers included 529,856 adult patients from the 2013 to 2016 American College of Surgeons Trauma Quality Improvement Program Participant Use Data Files with 5 days or longer of hospitalization and had an Injury Severity Score of 9 or higher. The study found the incidences of HACs were: pneumonia, 5.2%; urinary tract infection, 3.4%; venous thromboembolism, 3.3%; surgical site infection, 1.3%; pressure ulcer, 1.3%; and central line-associated blood stream infection, 0.2%. The HAC of pneumonia demonstrated the largest association with in-hospital outcomes and resource utilization. The researchers reported that prevention of pneumonia within the study group would have resulted in estimated reductions of: 22.1% for end organ dysfunction, 8.7% for prolonged hospitalization, 7.8% for mortality, 7.1% for prolonged intensive care unit stay, and 6.8% for need for mechanical ventilation. The researchers concluded that pneumonia prevention should be a priority activity in program improvement efforts.
AHRQ-funded; HS025224.
Citation: Lee PT, Krecko LK, Savage S .
Which hospital-acquired conditions matter the most in trauma? An evidence-based approach for prioritizing trauma program improvement.
J Trauma Acute Care Surg 2022 Oct 1;93(4):446-52. doi: 10.1097/ta.0000000000003645..
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Pneumonia, Urinary Tract Infection (UTI), Blood Clots
Raper JD, Thomas AM, Lupez K
Can right ventricular assessments improve triaging of low risk pulmonary embolism?
Researchers sought to determine if right ventricle (RV) assessment variables add prognostic accuracy for 5-day clinical deterioration in patients classified low risk by the Simplified Pulmonary Embolism Severity Index and to determine the prognostic importance of RV assessments compared to other variables and to each other. They found that a pulmonary embolism triaging strategy with RV imaging assessments had superior prognostic performance at classifying low risk for 5-day clinical deterioration versus one without.
AHRQ-funded; HS025979.
Citation: Raper JD, Thomas AM, Lupez K .
Can right ventricular assessments improve triaging of low risk pulmonary embolism?
Acad Emerg Med 2022 Jul;29(7):835-50. doi: 10.1111/acem.14484..
Keywords: Respiratory Conditions, Blood Clots, Risk
Rothberg MB, Hamilton AC, Greene MT
Derivation and validation of a risk factor model to identify medical inpatients at risk for venous thromboembolism.
This study’s objective was to compare multiple risk assessment models for hospitalized patients at high risk for venous thromboembolism (VTE). The authors developed a derivation cohort using 6 years of data from 12 hospitals to identify risk factors associated with developing VTE within 14 days of admission. The cohort included 155,026 patients with a 14-day VTE rate of 0.68%. The final multivariable model contained 13 risk factors and good calibration, and performance was evaluated using the C-statistic. The temporal validation cohort had 53,210 patients with a VTE rate of 0.64% and the external cohort had 23,413 patients and a rate of 0.49%. The Cleveland Clinic Model (CCM) outperformed both the Padua and IMPROVE models in the temporal cohort. In the external cohort the CCM C-statistic was similar to Padua and outperformed IMPROVE.
AHRQ-funded; HS022883.
Citation: Rothberg MB, Hamilton AC, Greene MT .
Derivation and validation of a risk factor model to identify medical inpatients at risk for venous thromboembolism.
Thromb Haemost 2022 Jul;122(7):1231-38. doi: 10.1055/a-1698-6506..
Keywords: Inpatient Care, Risk, Blood Clots
Zhang NJ, Rameau P, Julemis M
Automated pulmonary embolism risk assessment using the Wells criteria: validation study.
The authors sought to create an automated process to calculate the Wells score for pulmonary embolism for emergency department patients, which might reduce unnecessary computed tomography pulmonary angiography (CTPA) testing. They designed the process using electronic health records data elements, including free-text fields, and calculated Wells scores for a sample of adult emergency department visits that resulted in a CTPA study for pulmonary embolism at two tertiary care hospitals in New York. After validation, the authors concluded that the development of the automated process to classify risk for pulmonary embolism in emergency department visits was successful.
AHRQ-funded; HS026196.
Citation: Zhang NJ, Rameau P, Julemis M .
Automated pulmonary embolism risk assessment using the Wells criteria: validation study.
JMIR Form Res 2022 Feb 28;6(2):e32230. doi: 10.2196/32230.
Keywords: Blood Clots, Respiratory Conditions, Risk, Emergency Department
Beckman MG, Abe K, Barnes K
AHRQ Author: Brady PJ
Strategies and partnerships toward prevention of healthcare-associated venous thromboembolism.
This issue of the Journal of Hospital Medicine showcases the initiatives of several of the CDC’s healthcare-associated venous thromboembolism (HA-VTE) prevention champions. The CDC and AHRQ are partnering to disseminate and promote these best practices. In addition to this challenge, the CDC, AHRQ and the Joint Commission Center for Transforming Healthcare are working on activities and programs dedicated to improving prevention of HA-VTE. They are summarized in the article.
AHRQ-authored.
Citation: Beckman MG, Abe K, Barnes K .
Strategies and partnerships toward prevention of healthcare-associated venous thromboembolism.
J Hosp Med 2016 Dec;11 Suppl 2:S5-s7. doi: 10.1002/jhm.2659.
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Keywords: Prevention, Blood Clots, Quality Improvement, Guidelines, Adverse Events
Lau BD, Haut ER, Hobson DB
ICD-9 code-based venous thromboembolism performance targets fail to measure up.
Suboptimal prevention practices have prompted payers to consider hospital-associated Venous thromboembolism (VTE) as a potentially preventable condition for which financial incentives or penalties exist to drive practice improvement. The authors reviewed a subset of hospital-associated VTE that were identified by ICD-9 codes used by a state-run pay-for-performance quality improvement program and discuss their findings.
AHRQ-funded; HS017952.
Citation: Lau BD, Haut ER, Hobson DB .
ICD-9 code-based venous thromboembolism performance targets fail to measure up.
Am J Med Qual 2016 Sep;31(5):448-53. doi: 10.1177/1062860615583547.
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Keywords: Healthcare-Associated Infections (HAIs), Quality Indicators (QIs), Prevention, Hospitals, Quality Improvement, Blood Clots, Payment, Provider Performance
Farrow NE, Lau BD, JohnBull EA
Is the meaningful use venous thromboembolism VTE-6 measure meaningful? A retrospective analysis of one hospital's VTE-6 cases.
The researchers assessed the validity of the Meaningful Use VTE-6 measure by reviewing the quality of venous thromboembolism (VTE) prophylaxis provided to patients. Sixty percent of the patients identified as having sustained potentially preventable VTE were false positives. For the remaining forty percent, VTE was considered to be truly potentially preventable and those patients therefore provided targets for quality improvement measures.
AHRQ-funded; HS017952.
Citation: Farrow NE, Lau BD, JohnBull EA .
Is the meaningful use venous thromboembolism VTE-6 measure meaningful? A retrospective analysis of one hospital's VTE-6 cases.
Jt Comm J Qual Patient Saf 2016 Sep;42(9):410-6.
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Keywords: Blood Clots, Quality Improvement, Quality Measures, Quality Measures, Electronic Health Records (EHRs)
Poonawalla IB, Piller LB, Lairson DR
Use of hematopoietic growth factors and risk of thromboembolic and pulmonary toxicities in elderly patients with advanced ovarian cancer.
This study evaluated the risk of thromboembolic and pulmonary toxicities associated with hematopoietic growth factor (HGF) use (i.e., erythropoietin-stimulating agent [ESA] and/or colony-stimulating factor [CSF]) in a community-dwelling cohort of elderly patients with advanced ovarian cancer. An increased risk of thromboembolic events was observed in elderly patients with ovarian cancer who received ESA + CSF.
AHRQ-funded; HS018956.
Citation: Poonawalla IB, Piller LB, Lairson DR .
Use of hematopoietic growth factors and risk of thromboembolic and pulmonary toxicities in elderly patients with advanced ovarian cancer.
Womens Health Issues 2016 Sep-Oct;26(5):574-83. doi: 10.1016/j.whi.2016.05.007.
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Keywords: Adverse Events, Blood Clots, Elderly, Cancer: Ovarian Cancer, Risk
Wang SV, Franklin JM, Glynn RJ
Prediction of rates of thromboembolic and major bleeding outcomes with dabigatran or warfarin among patients with atrial fibrillation: new initiator cohort study.
The authors compared stratified event rates from randomized controlled trials with predicted event rates from models developed in observational data and assessed their ability to accurately capture observed rates of thromboembolism and major bleeding for patients treated with dabigatran or warfarin as part of routine care. They found that estimated rates of thromboembolism under dabigatran or warfarin treatment in randomized controlled trials were close to observed rates in routine care patients, but that rates of major bleeding were underestimated. They concluded that models developed in routine care patients can provide accurate, tailored estimates of risk and benefit under alternative treatment to enhance patient centered care.
AHRQ-funded; HS022193.
Citation: Wang SV, Franklin JM, Glynn RJ .
Prediction of rates of thromboembolic and major bleeding outcomes with dabigatran or warfarin among patients with atrial fibrillation: new initiator cohort study.
BMJ 2016 May 24;353:i2607. doi: 10.1136/bmj.i2607.
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Keywords: Blood Thinners, Adverse Drug Events (ADE), Blood Clots, Patient Safety, Medication
Jindai K, Sterkel AK, Reed KD
Limb embolism in a 52-year-old woman.
In response to a photo quiz, the authors make the following diagnosis: arterial thrombus caused by Histoplasma capsulatum deriving from native valve endocarditis caused by the same organism. Various aspects of the case are discussed.
AHRQ-funded; HS022465; HS023779.
Citation: Jindai K, Sterkel AK, Reed KD .
Limb embolism in a 52-year-old woman.
Clin Infect Dis 2016 May 15;62(10):1320-1. doi: 10.1093/cid/ciw081.
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Keywords: Blood Clots, Care Management, Case Study, Diagnostic Safety and Quality, Patient Safety
Grant PJ, Greene MT, Chopra V
Assessing the Caprini score for risk assessment of venous thromboembolism in hospitalized medical patients.
The authors examined how well the Caprini risk assessment model predicts venous thromboembolism in hospitalized medical patients. They concluded that the Caprini risk assessment model was unable to identify a subset of medical patients who benefit from pharmacologic prophylaxis.
AHRQ-funded; HS022835.
Citation: Grant PJ, Greene MT, Chopra V .
Assessing the Caprini score for risk assessment of venous thromboembolism in hospitalized medical patients.
Am J Med 2016 May;129(5):528-35. doi: 10.1016/j.amjmed.2015.10.027.
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Keywords: Adverse Events, Blood Clots, Hospitalization, Risk, Patient Safety
Du XL, Zhang Y, Hardy D
Associations between hematopoietic growth factors and risks of venous thromboembolism, stroke, ischemic heart disease and myelodysplastic syndrome: findings from a large population-based cohort of women with breast cancer.
The researchers sought to determine the risk of venous thromboembolism (VTE), stroke, ischemic heart disease, and myelodysplastic syndrome (MDS) in association with the receipt of colony-stimulating factors (CSFs) and/or erythropoiesis-stimulating agents (ESAs) in women with breast cancer. They found that receipts of CSFs and ESAs were significantly associated with an increased risk of VTE in women with breast cancer.
AHRQ-funded; HS018956.
Citation: Du XL, Zhang Y, Hardy D .
Associations between hematopoietic growth factors and risks of venous thromboembolism, stroke, ischemic heart disease and myelodysplastic syndrome: findings from a large population-based cohort of women with breast cancer.
Cancer Causes Control 2016 May;27(5):695-707. doi: 10.1007/s10552-016-0742-5.
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Keywords: Blood Clots, Cancer: Breast Cancer, Cardiovascular Conditions, Risk, Stroke
Yen J, Van Arendonk KJ, Streiff MB
Risk factors for venous thromboembolism in pediatric trauma patients and validation of a novel scoring system: the risk of clots in kids with trauma score.
The researchers identified risk factors for venous thromboembolism and developed venous thromboembolism risk assessment models for pediatric trauma patients. They found that venous thromboembolism is infrequent after trauma in pediatric patients, and they developed weighted scoring systems to stratify pediatric trauma patients at risk.
AHRQ-funded; HS017952.
Citation: Yen J, Van Arendonk KJ, Streiff MB .
Risk factors for venous thromboembolism in pediatric trauma patients and validation of a novel scoring system: the risk of clots in kids with trauma score.
Pediatr Crit Care Med 2016 May;17(5):391-9. doi: 10.1097/pcc.0000000000000699.
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Keywords: Blood Clots, Children/Adolescents, Risk, Risk, Trauma
Admon AJ, Seymour CW, Gershengorn HB
Hospital-level variation in ICU admission and critical care procedures for patients hospitalized for pulmonary embolism.
The researchers examined the relationship between intensive care unit (ICU) use for patients with pulmonary embolism (PE) and cost, mortality, readmission, and procedure use in 263 hospitals. They found wide variations in ICU admission rates for acute PE without a detectable impact on mortality, cost, or readmission.
AHRQ-funded; HS020672
Citation: Admon AJ, Seymour CW, Gershengorn HB .
Hospital-level variation in ICU admission and critical care procedures for patients hospitalized for pulmonary embolism.
Chest. 2014 Dec;146(6):1452-61. doi: 10.1378/chest.14-0059..
Keywords: Blood Clots, Care Management, Critical Care, Healthcare Delivery, Intensive Care Unit (ICU)
Ju MH, Chung JW, Kinnier CV
Association between hospital imaging use and venous thromboembolism events rates based on clinical data.
This study assessed the presence and extent of venous thromboembolism (VTE) surveillance bias using high-quality clinical data from 208 hospitals. It concluded that hospitals may be unfairly deemed poor performers for the outcome VTE measure if they have increased vigilance for VTE by performing more VTE imaging studies that result in higher VTE event rates.
AHRQ-funded; HS021857
Citation: Ju MH, Chung JW, Kinnier CV .
Association between hospital imaging use and venous thromboembolism events rates based on clinical data.
Ann Surg. 2014 Sep; 260(3):558-64; discussion 64-6. doi: 10.1097/sla.0000000000000897..
Keywords: Blood Clots, Public Reporting, Adverse Events, Outcomes, Quality of Care
Chopra V, Ratz D, Kuhn L
Peripherally inserted central catheter-related deep vein thrombosis: contemporary patterns and predictors.
This study was designed to determine patient, provider, and device outcome of deep vein thrombosis (DVT) associated with peripherally inserted central catheters (PICCs). Larger PICC gauge, especially in the use of recently diagnosed cancer patients, increases the likelihood of DVT.
AHRQ-funded; HS022835
Citation: Chopra V, Ratz D, Kuhn L .
Peripherally inserted central catheter-related deep vein thrombosis: contemporary patterns and predictors.
J Thromb Haemost 2014 Jun;12(6):847-54. doi: 10.1111/jth.12549..
Keywords: Adverse Events, Blood Clots, Patient Safety, Risk
Streiff MB, Brady JP, Grant AM
AHRQ Author: Brady JP
CDC Grand Rounds: preventing hospital-associated venous thromboembolism.
Approximately half of new venous thromboembolism (VTE) cases occur during a hospital stay or within 90 days of an inpatient admission or surgical procedure, and many are not diagnosed until after discharge. Prevention of VTE can be complicated as physicians must balance the risk for thrombosis with the risk for bleeding from anticoagulants. A collaborative, team-based approach to care is needed for significant and sustained improvement, and it also offers efficiency and capacity to tackle other patient safety problems.
AHRQ-authored.
Citation: Streiff MB, Brady JP, Grant AM .
CDC Grand Rounds: preventing hospital-associated venous thromboembolism.
MMWR Morb Mortal Wkly Rep 2014 Mar 7;63(9):190-3.
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Keywords: Blood Clots, Healthcare-Associated Infections (HAIs), Hospitalization, Prevention, Teams
Lau BD, Haut ER
Practices to prevent venous thromboembolism: a brief review.
The purpose of this review is to provide an update on the most effective interventions aimed at improving adherence to guidelines on the use of venous thromboembolism (VTE) prevention strategies. After reviewing sixteen studies, the researchers concluded that the greatest and most sustained improvements were those that combined education with computerised tools.
AHRQ-funded; 290200710.
Citation: Lau BD, Haut ER .
Practices to prevent venous thromboembolism: a brief review.
BMJ Qual Saf 2014 Mar;23(3):187-95. doi: 10.1136/bmjqs-2012-001782..
Keywords: Comparative Effectiveness, Blood Clots, Prevention, Decision Making, Guidelines