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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 25 of 38 Research Studies DisplayedWysham NG, Hochman MJ, Wolf SP
Performance of consultative palliative care model in achieving quality metrics in the ICU.
The purpose of this paper was to assess adherence to proposed quality metrics of ICU-based palliative care by palliative care specialists. The authors found that palliative care consultations in an ICU setting are characterized by variable adherence to candidate ICU palliative care quality metrics. Although symptom management was the foremost reason for palliative care consultation, consultants infrequently documented symptom assessments. The consultants performed better in offering spiritual support and managing documented symptoms.
AHRQ-funded; HS023681.
Citation: Wysham NG, Hochman MJ, Wolf SP .
Performance of consultative palliative care model in achieving quality metrics in the ICU.
J Pain Symptom Manage 2016 Dec;52(6):873-77. doi: 10.1016/j.jpainsymman.2016.05.026.
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Keywords: Critical Care, Intensive Care Unit (ICU), Palliative Care, Quality of Care, Quality Measures
Sakata KK, Stephenson LS, Mulanax A
Professional and interprofessional differences in electronic health records use and recognition of safety issues in critically ill patients.
The authors conducted this study to determine how each professional group - physicians, nurses, and pharmacists - reviews electronic health records (EHR) data in preparation for rounds and their ability to identify patient safety issues. They found significant and non-overlapping differences in individual profession recognition of patient safety issues in the EHR which may be attributed to differences in EHR use.
AHRQ-funded; HS023793; HS021637.
Citation: Sakata KK, Stephenson LS, Mulanax A .
Professional and interprofessional differences in electronic health records use and recognition of safety issues in critically ill patients.
J Interprof Care 2016 Sep;30(5):636-42. doi: 10.1080/13561820.2016.1193479.
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Keywords: Critical Care, Electronic Health Records (EHRs), Provider: Health Personnel, Intensive Care Unit (ICU), Patient Safety
Costa DK, Dammeyer J, White M
Interprofessional team interactions about complex care in the ICU: pilot development of an observational rating tool.
The purpose of this study was to examine the reliability of an observational rating tool to assess team interactions about the awakening and breathing coordination, delirium, and early mobility (ABCDE) bundle in one ICU. It provided pilot evidence of reliability of an observational rating tool to assess interprofessional team interactions about ABCDE.
AHRQ-funded; HS024552.
Citation: Costa DK, Dammeyer J, White M .
Interprofessional team interactions about complex care in the ICU: pilot development of an observational rating tool.
BMC Res Notes 2016 Aug 18;9:408. doi: 10.1186/s13104-016-2213-1.
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Keywords: Healthcare Delivery, Communication, Critical Care, Intensive Care Unit (ICU), Teams
Lyu PF, Hockenberry JM, Gaydos LM
Impact of a sequential intervention on albumin utilization in critical care.
The authors evaluated the effect of a sequential multifaceted intervention on decreasing albumin use in the intensive care unit. They found that a sequential intervention achieved significant reductions in albumin use and cost savings without changes in patient outcomes, supporting the combination of financial and nonfinancial strategies to align providers with evidence-based practices.
AHRQ-funded; HS000055.
Citation: Lyu PF, Hockenberry JM, Gaydos LM .
Impact of a sequential intervention on albumin utilization in critical care.
Crit Care Med 2016 Jul;44(7):1307-13. doi: 10.1097/ccm.0000000000001638.
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Keywords: Critical Care, Healthcare Utilization, Intensive Care Unit (ICU), Patient-Centered Outcomes Research, Practice Patterns
Sjoding MW, Prescott HC, Wunsch H
Longitudinal changes in ICU admissions among elderly patients in the United States.
The researchers sought to describe the changing demographics, diagnoses, and outcomes of patients admitted to critical care units in the U.S. hospitals. They ound that patients with infectious diseases increased from 8.8 percent to 17.2 percent of admissions, and explicitly labeled sepsis moved from the 11th-ranked diagnosis in 1996 to the top-ranked primary discharge diagnosis in 2010.
AHRQ-funded; HS020672.
Citation: Sjoding MW, Prescott HC, Wunsch H .
Longitudinal changes in ICU admissions among elderly patients in the United States.
Crit Care Med 2016 Jul;44(7):1353-60. doi: 10.1097/ccm.0000000000001664.
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Keywords: Elderly, Intensive Care Unit (ICU), Hospitalization, Diagnostic Safety and Quality, Critical Care
Ishizuka M, Rangarajan V, Sawyer TL
The development of tracheal intubation proficiency outside the operating suite during pediatric critical care medicine fellowship training: a retrospective cohort study using cumulative sum analysis.
The researchers hypothesized that both overall and first-attempt tracheal intubation success rates by pediatric critical care medicine fellows would improve over the course of training. They found that all fellows who completed 3 years of training during the study period achieved an acceptable 90% overall tracheal intubation success rate. They concluded that further investigations on a larger scale across different training programs are necessary to clarify intensity and duration of the training to achieve tracheal intubation procedural competency.
AHRQ-funded; HS021583; HS022464.
Citation: Ishizuka M, Rangarajan V, Sawyer TL .
The development of tracheal intubation proficiency outside the operating suite during pediatric critical care medicine fellowship training: a retrospective cohort study using cumulative sum analysis.
Pediatr Crit Care Med 2016 Jul;17(7):e309-16. doi: 10.1097/pcc.0000000000000774.
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Keywords: Children/Adolescents, Critical Care, Education: Continuing Medical Education, Children/Adolescents, Respiratory Conditions
McConnochie KM, Wood NE, Alarie C
Care offered by an information-rich pediatric acute illness connected care model.
The authors described care provided over a 12-year period by Health-e-Access, an evidence-based, information-rich, connected care model designed to serve children with acute illness. They demonstrated the broad clinical capacity of this care model and key components imparting this capacity. They concluded that Health-e-Access included technology essential for establishing diagnoses, ruling out more serious conditions, and identifying problems beyond its scope.
AHRQ-funded; HS018912; HS016871; HS015165.
Citation: McConnochie KM, Wood NE, Alarie C .
Care offered by an information-rich pediatric acute illness connected care model.
Telemed J E Health 2016 Jun;22(6):465-72. doi: 10.1089/tmj.2015.0161.
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Keywords: Critical Care, Children/Adolescents, Health Services Research (HSR), Children/Adolescents, Telehealth
Freedman S
Capacity and utilization in health care: the effect of empty beds on neonatal intensive care admission.
In this paper, the author exploited short-term variation in Neonatal Intensive Care Unit (NICU) capacity that is unlikely to be correlated with unobserved demand determinants. He found that available NICU beds have little to no effect on NICU utilization for the sickest infants, but do increase utilization for those in the range of birth weights where admission decisions are likely to be more discretionary.
AHRQ-funded; HS018266.
Citation: Freedman S .
Capacity and utilization in health care: the effect of empty beds on neonatal intensive care admission.
Am Econ J Econ Policy 2016 May 1;8(2):154-85. doi: 10.1257/pol.20120393.
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Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Healthcare Utilization, Critical Care, Decision Making
Heid C, Knobloch MJ, Schulz LT
Use of the health belief model to study patient perceptions of antimicrobial stewardship in the acute care setting.
The authors identified themes associated with patient perceptions of antibiotic use and the role of patients in inpatient antimicrobial stewardship. They found that general medicine inpatients receiving at least one anti-infective medication recognized antibiotic resistance as a serious public health threat but expressed low perceived susceptibility to being personally affected by antibiotic resistance. Few participants reported being offered the opportunity to engage in shared decision making while hospitalized. The researchers concluded that the likelihood of patient engagement in stewardship practices is currently limited by low perceived susceptibility and lack of cues to act.
AHRQ-funded; HS023791.
Citation: Heid C, Knobloch MJ, Schulz LT .
Use of the health belief model to study patient perceptions of antimicrobial stewardship in the acute care setting.
Infect Control Hosp Epidemiol 2016 May;37(5):576-82. doi: 10.1017/ice.2015.342.
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Keywords: Critical Care, Antimicrobial Stewardship, Antibiotics, Patient and Family Engagement, Patient Safety
Berry JG, Hall M, Dumas H
Pediatric hospital discharges to home health and postacute facility care: a national study.
The researchers assessed the national prevalence of, characteristics of children discharged to, and variation in use across states of home health care (HHC) and facility-based postacute care (PAC) for children. They found that HHC and PAC use after discharge for hospitalized children is infrequent, even for children with multiple chronic conditions. It varies significantly by race/ethnicity and across states.
AHRQ-funded; HS023092.
Citation: Berry JG, Hall M, Dumas H .
Pediatric hospital discharges to home health and postacute facility care: a national study.
JAMA Pediatr 2016 Apr;170(4):326-33. doi: 10.1001/jamapediatrics.2015.4836.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Home Healthcare, Children/Adolescents, Children/Adolescents, Critical Care
Sanders RC, Jr., Nett ST, Davis KF
Family presence during pediatric tracheal intubations.
The researchers described the current practice of family presence (FP) during tracheal intubation (TI) and evaluated the association with procedural and clinician (including physician, respiratory therapist, and nurse practitioner) outcomes across multiple pediatric intensive care units (PICUs). They found that FP was not associated with first attempt success, adverse TI-associated events, oxygen desaturation (<80%), or higher team stress level.
AHRQ-funded; HS022464; HS022469; HS021583.
Citation: Sanders RC, Jr., Nett ST, Davis KF .
Family presence during pediatric tracheal intubations.
JAMA Pediatr 2016 Mar 7;170(3):e154627. doi: 10.1001/jamapediatrics.2015.4627.
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Keywords: Newborns/Infants, Children/Adolescents, Critical Care, Adverse Events, Patient-Centered Outcomes Research
Baird J, Rehm RS, Hinds PS
Do you know my child? Continuity of nursing care in the pediatric intensive care unit.
The objective of this analysis was to explore the delivery of continuity of nursing care in the pediatric intensive care unit (PICU), from the perspective of both parents and nurses. Parents repeatedly endorsed a desire for continuity of nursing care, wanting to ensure that the bedside nurse valued their child as an individual and understood the complexities of the child's care regimen.
AHRQ-funded; HS000063.
Citation: Baird J, Rehm RS, Hinds PS .
Do you know my child? Continuity of nursing care in the pediatric intensive care unit.
Nurs Res 2016 Mar-Apr;65(2):142-50. doi: 10.1097/nnr.0000000000000135.
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Keywords: Care Management, Children/Adolescents, Critical Care, Healthcare Delivery, Intensive Care Unit (ICU), Nursing
Collinsworth AW, Priest EL, Campbell CR
A review of multifaceted care approaches for the prevention and mitigation of delirium in intensive care units.
The objective of this review was to examine the effectiveness, implementation, and costs of multifaceted care approaches, including care bundles, for the prevention and mitigation of delirium in patients hospitalized in intensive care units (ICUs). It concluded that although multifaceted care approaches may reduce delirium and improve patient outcomes, greater improvements may be achieved by deploying a comprehensive bundle of care practices.
AHRQ-funded; HS021459.
Citation: Collinsworth AW, Priest EL, Campbell CR .
A review of multifaceted care approaches for the prevention and mitigation of delirium in intensive care units.
J Intensive Care Med 2016 Feb;31(2):127-41. doi: 10.1177/0885066614553925.
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Keywords: Intensive Care Unit (ICU), Prevention, Evidence-Based Practice, Critical Care, Quality of Care
Hakkarainen TW, Arbabi S, Willis MM
Outcomes of patients discharged to skilled nursing facilities after acute care hospitalizations.
This study evaluated previously independent older patients discharged to skilled nursing facilities (SNFs) and identified risk factors for failure to return home and death and development of a predictive tool to determine likelihood of adverse outcome. It found that a large proportion of older patients discharging to SNFs never return home.
AHRQ-funded; HS020025.
Citation: Hakkarainen TW, Arbabi S, Willis MM .
Outcomes of patients discharged to skilled nursing facilities after acute care hospitalizations.
Ann Surg 2016 Feb;263(2):280-5. doi: 10.1097/sla.0000000000001367..
Keywords: Critical Care, Hospitalization, Risk, Elderly, Mortality
Hasvold J, Sjoding M, Pohl K
The role of human metapneumovirus in the critically ill adult patient.
The purpose of the study is to describe the role of human metapneumovirus (hMPV) infection in critical illness and acute respiratory distress syndrome (ARDS). It concluded that although most patients hospitalized with hMPV had chronic cardiac or pulmonary disease, hMPV can also be associated with serious respiratory illness and ARDS in adult patients without significant comorbidities or immunosuppression.
AHRQ-funded; HS020672.
Citation: Hasvold J, Sjoding M, Pohl K .
The role of human metapneumovirus in the critically ill adult patient.
J Crit Care 2016 Feb;31(1):233-7. doi: 10.1016/j.jcrc.2015.09.035.
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Keywords: Critical Care, Respiratory Conditions, Intensive Care Unit (ICU), Hospitalization
Dalal AK, Dykes PC, Collins S
A web-based, patient-centered toolkit to engage patients and caregivers in the acute care setting: a preliminary evaluation.
The researchers implemented a web-based, patient-centered toolkit that engages patients/caregivers in the hospital plan of care by facilitating education and patient-provider communication. Of the 585 eligible patients approached on medical intensive care and oncology units, 239 were enrolled (119 patients, 120 caregivers). They found that the average system usability scores and satisfaction ratings of a sample of surveyed enrollees were favorable.
AHRQ-funded; HS023535.
Citation: Dalal AK, Dykes PC, Collins S .
A web-based, patient-centered toolkit to engage patients and caregivers in the acute care setting: a preliminary evaluation.
J Am Med Inform Assoc 2016 Jan;23(1):80-7. doi: 10.1093/jamia/ocv093.
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Keywords: Critical Care, Patient and Family Engagement, Clinician-Patient Communication, Tools & Toolkits, Web-Based
Kelesidis T, Braykov N, Uslan DZ
Indications and types of antibiotic agents used in 6 acute care hospitals, 2009-2010: a pragmatic retrospective observational study.
This study characterized the indications for antibiotic therapy, agents used, duration, combinations, and microbiological justification in 6 acute-care US facilities with varied location, size, and type of antimicrobial stewardship programs. It concluded that the use of broad-spectrum empirical therapy was prevalent in 6 US acute care facilities. Fluoroquinolones, vancomycin, and antipseudomonal penicillins were the most frequently used antibiotics, particularly for respiratory indications
AHRQ-funded; HS021188.
Citation: Kelesidis T, Braykov N, Uslan DZ .
Indications and types of antibiotic agents used in 6 acute care hospitals, 2009-2010: a pragmatic retrospective observational study.
Infect Control Hosp Epidemiol 2016 Jan;37(1):70-9. doi: 10.1017/ice.2015.226.
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Keywords: Antimicrobial Stewardship, Critical Care, Hospitals, Medication, Respiratory Conditions
Nagendran M, Dimick JB, Gonzalez AA
Mortality among older adults before versus after hospital transition to intensivist staffing.
The researchers sought to determine whether hospitals can reduce their mortality by adopting an intensivist staffing model. Adoption of an intensivist staffing model was not associated with improved mortality in Medicare beneficiaries. These findings suggest that the lower mortality rates previously observed at hospitals with intensivist staffing may be attributable to other factors.
AHRQ-funded; HS023621; HS024403.
Citation: Nagendran M, Dimick JB, Gonzalez AA .
Mortality among older adults before versus after hospital transition to intensivist staffing.
Med Care 2016 Jan;54(1):67-73. doi: 10.1097/mlr.0000000000000446.
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Keywords: Mortality, Elderly, Intensive Care Unit (ICU), Hospitalization, Critical Care
Hernandez M, Hojman N, Sadorra C
Pediatric critical care telemedicine program: a single institution review.
The researchers conducted a retrospective review of a pediatric critical care telemedicine program at a single university children's hospital between 2000 and 2014. They concluded that their review demonstrated that a pediatric critical care telemedicine program used to provide consultations to seriously ill children in rural and community emergency departments is feasible, sustainable, and used relatively infrequently, most typically for the sickest pediatric patients.
AHRQ-funded; HS019712.
Citation: Hernandez M, Hojman N, Sadorra C .
Pediatric critical care telemedicine program: a single institution review.
Telemed J E Health 2016 Jan;22(1):51-5. doi: 10.1089/tmj.2015.0043.
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Keywords: Children/Adolescents, Critical Care, Emergency Department, Telehealth
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)
Berner ES, Burkhardt JH, Panjamapirom A
Cost implications of human and automated follow-up in ambulatory care.
This study tracked costs associated with using nurse-initiated telephone calls or interactive voice response (IVR) over the first two years of followup for a practice assumed to have 4800 acute care patient visits per year. For the first two years, costs were approximately the same but, in subsequent years, IVR followup is approximately $9000 per year less expensive than nurse followup.
AHRQ-funded; HS017060
Citation: Berner ES, Burkhardt JH, Panjamapirom A .
Cost implications of human and automated follow-up in ambulatory care.
Am J Manag Care. 2014 Nov;20(11 Spec No. 17):SP531-40..
Keywords: Healthcare Costs, Primary Care, Quality of Care, Critical Care
Balamuth F, Weiss SL, Neuman MI
Pediatric severe sepsis in U.S. children's hospitals.
The objective of this study was to compare epidemiological trends in the prevalence, resource utilization, and mortality of pediatric patients with severe sepsis and septic shock. The researchers found that the prevalence of severe sepsis/septic shock has increased in the studied U.S. children’s hospitals between 2004 and 2012, whereas resource utilization and mortality have decreased over that time period.
AHRQ-funded; HS021114
Citation: Balamuth F, Weiss SL, Neuman MI .
Pediatric severe sepsis in U.S. children's hospitals.
Pediatr Crit Care Med. 2014 Nov;15(9):798-805. doi: 10.1097/pcc.0000000000000225..
Keywords: Hospitals, Children/Adolescents, Critical Care
Cooke CR, Iwashyna TJ
Sepsis mandates: improving inpatient care while advancing quality improvement.
In light of improvements in the care of the acutely ill hospitalized patients and changes in the epidemiology of hospital care, the authors recommend new quality mandates focused on sepsis. These mandates should: (1) address the reality that sepsis is frequently underdiagnosed, (2) focus on catalyzing and aggregating local efforts for quality improvements, and (3) plan for a phased implementation, improving measures in select sites prior to national roll-out.
AHRQ-funded; HS020672
Citation: Cooke CR, Iwashyna TJ .
Sepsis mandates: improving inpatient care while advancing quality improvement.
JAMA. 2014 Oct 8;312(14):1397-8. doi: 10.1001/jama.2014.11350..
Keywords: Quality of Care, Hospitalization, Inpatient Care, Critical Care, Sepsis
Ramnath VR, Khazeni N
Centralized monitoring and virtual consultant models of tele-ICU care: a side-by-side review.
This side-by-side review directly compares the Centralized Monitoring and Virtual Consultant tele-ICU Models. The Centralized Monitoring tele-ICU Model showed improved mortality and/or length of stay and staff acceptance, particularly in rural or specific patient populations, but with high costs and unclear savings. The Virtual Consultant Model could not be adequately evaluated for effects on clinical outcomes or staff acceptance given minimal data; however, it can be both portable and implemented at a lower cost profile. Improved compliance with clinical practice guidelines was seen in both models. Further study is recommended.
AHRQ-funded; HS019816.
Citation: Ramnath VR, Khazeni N .
Centralized monitoring and virtual consultant models of tele-ICU care: a side-by-side review.
Telemed J E Health 2014 Oct;20(10):962-71. doi: 10.1089/tmj.2014.0024.
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Keywords: Critical Care, Comparative Effectiveness, Quality of Care, Intensive Care Unit (ICU), Telehealth
Ramnath VR, Ho L, Maggio LA
Centralized monitoring and virtual consultant models of tele-ICU care: a systematic review.
This systematic literature review compares the Centralized Monitoring and Virtual Consultant tele-ICU Models. Compared with the Virtual Consultant tele-ICU Model, studies addressing the Centralized Monitoring Model of tele-ICU care were greater in quantity and sample size, with qualitative conclusions of clinical outcomes, staff satisfaction and workload, and financial sustainability largely consistent with past systematic reviews.
AHRQ-funded; HS019816.
Citation: Ramnath VR, Ho L, Maggio LA .
Centralized monitoring and virtual consultant models of tele-ICU care: a systematic review.
Telemed J E Health 2014 Oct;20(10):936-61. doi: 10.1089/tmj.2013.0352.
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Keywords: Critical Care, Comparative Effectiveness, Quality of Care, Intensive Care Unit (ICU), Telehealth
