National Healthcare Quality and Disparities Report
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Topics
- Adverse Drug Events (ADE) (1)
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- Ambulatory Care and Surgery (1)
- Burnout (1)
- Cancer (3)
- Cancer: Breast Cancer (2)
- Cardiovascular Conditions (3)
- Care Management (1)
- Catheter-Associated Urinary Tract Infection (CAUTI) (1)
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- Diagnostic Safety and Quality (4)
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- Healthcare-Associated Infections (HAIs) (6)
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- Medicare (9)
- Mortality (3)
- Newborns/Infants (1)
- Nursing Homes (8)
- Organizational Change (3)
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- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (3)
- Patient and Family Engagement (1)
- Patient Experience (6)
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- Payment (10)
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- Pregnancy (1)
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- Provider: Physician (5)
- (-) Provider Performance (77)
- Public Reporting (2)
- Quality Improvement (17)
- Quality Indicators (QIs) (12)
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- Quality of Care (55)
- Racial and Ethnic Minorities (1)
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- Shared Decision Making (1)
- Simulation (2)
- Social Media (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
51 to 75 of 77 Research Studies DisplayedAzari DP, Fraiser LL, Quamme SRP
Modeling surgical technical skill using expert assessment for automated computer rating.
The authors used computer vision to predict expert performance ratings from surgeon hand motions for tying and suturing tasks. Open surgeries were video recorded, and surgeon hands tracked without using sensors or markers. The authors found that the computer algorithm consistently predicted the panel ratings of individual tasks, and were more objective and reliable than individual assessment by surgical experts.
AHRQ-funded; F32 HS022403.
Citation: Azari DP, Fraiser LL, Quamme SRP .
Modeling surgical technical skill using expert assessment for automated computer rating.
Ann Surg 2019 Mar;269(3):574-81. doi: 10.1097/sla.0000000000002478..
Keywords: Surgery, Provider Performance, Provider: Physician, Provider
Schlesinger MJ, Rybowski L, Shaller D
Americans' growing exposure to clinician quality information: insights and implications.
The authors of this article examined the impact of changes in the growth of consumer information seeking and the availability of patient narratives about care on consumer awareness of quality information and sociodemographic differences. Public exposure to quality information of any type doubled between 2010 and 2015, ad exposure to patient narratives and experience surveys tripled. Minority consumers were better informed than whites consistently over this period, although there were differences across subgroups regarding the types of information encountered. An education-related gradient in quality awareness also emerged. The authors conclude that public policy should respond to these emerging trends in information exposure by establishing standards for rigorous elicitation of narratives and assisting consumer learning via a combination of narratives and quantified clinician quality metrics.
AHRQ-funded; HS016978; HS016980; HS021858.
Citation: Schlesinger MJ, Rybowski L, Shaller D .
Americans' growing exposure to clinician quality information: insights and implications.
Health Aff 2019 Mar;38(3):374-82. doi: 10.1377/hlthaff.2018.05006..
Keywords: Policy, Provider Performance, Public Reporting, Quality of Care, Quality Measures
Sheehan FH, McConnaughey S, Freeman R
Formative assessment of performance in diagnostic ultrasound using simulation and quantitative and objective metrics.
The authors of this article describe how they developed simulator-based tools for assessing provider competence in transthoracic echocardiography (TTE) and vascular duplex scanning. Psychomotor skill in TTE image acquisition was calculated using the deviation angle of an acquired image from the anatomically correct view, and this skill metric applied for formative assessment to evaluate curricula and provide feedback to learners. Psychomotor skill in vascular ultrasound was measured in terms of dexterity and image plane location. The skill metric in the TTE simulator enabled immediate feedback, as well as formative assessment of curriculum efficacy and a comparison of curriculum outcomes. The vascular duplex ultrasound simulator also provided feedback. The authors conclude that skill in acquiring diagnostic ultrasound images of organs and vessels can be measured using simulation in an objective, quantitative, and standardized manner. Simulator-based metrics might also be applied to summative assessment.
AHRQ-funded; HS024219.
Citation: Sheehan FH, McConnaughey S, Freeman R .
Formative assessment of performance in diagnostic ultrasound using simulation and quantitative and objective metrics.
Mil Med 2019 Mar 1;184(Supplement_1):386-91. doi: 10.1093/milmed/usy388.
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Keywords: Diagnostic Safety and Quality, Education: Continuing Medical Education, Imaging, Provider Performance, Training
Cerully JL, Parker AM, Rybowski L
Improving patients' choice of clinician by including roll-up measures in public healthcare quality reports: an online experiment.
The purpose of this paper was to determine how presenting quality scores at different levels of aggregation affects patients' clinician choices. A simulated clinician-choice experiment with 550 panelists was employed. The results suggested that roll-ups in healthcare quality reports, alone or as a complement to drill-downs, can help patients make better decisions.
AHRQ-funded; HS016978.
Citation: Cerully JL, Parker AM, Rybowski L .
Improving patients' choice of clinician by including roll-up measures in public healthcare quality reports: an online experiment.
J Gen Intern Med 2019 Feb;34(2):243-49. doi: 10.1007/s11606-018-4725-y..
Keywords: Shared Decision Making, Quality of Care, Provider Performance
Chukmaitov A, Harless DW, Bazzoli GJ
Preventable hospital admissions and 30-day all-cause readmissions: does hospital participation in accountable care organizations improve quality of care?
This study evaluates quality performance of hospitals participating in Medicare Shared Savings and Pioneer Accountable Care Organization (ACO) programs relative to nonparticipating hospitals. The authors studied preventable hospitalizations for conditions sensitive to high-quality ambulatory care and 30-day all-cause readmissions potentially influenced by hospital care. A decrease was found in preventable hospitalizations for COPD and asthma and for diabetes complications for ACO participating hospitals, but no significant differences for preventable chronic heart failure hospitalizations and 30-day readmissions.
AHRQ-funded; HS023332.
Citation: Chukmaitov A, Harless DW, Bazzoli GJ .
Preventable hospital admissions and 30-day all-cause readmissions: does hospital participation in accountable care organizations improve quality of care?
Am J Med Qual 2019 Jan/Feb;34(1):14-22. doi: 10.1177/1062860618778786..
Keywords: Hospital Readmissions, Hospitals, Quality of Care, Provider Performance, Hospitalization
Zuckerman RB, Wu S, Chen LM
The five-star skilled nursing facility rating system and care of disadvantaged populations.
AHRQ-funded; HS000029.
Citation: Zuckerman RB, Wu S, Chen LM .
The five-star skilled nursing facility rating system and care of disadvantaged populations.
J Am Geriatr Soc 2019 Jan;67(1):108-14. doi: 10.1111/jgs.15629..
Keywords: Nursing Homes, Vulnerable Populations, Medicare, Elderly, Provider Performance, Quality of Care, Hospital Discharge, Disparities
Catchpole K, Neyens DM, Abernathy J
Framework for direct observation of performance and safety in healthcare.
This viewpoint paper discusses non-participant direct observation of healthcare processes as a rich method for understanding safety and performance improvement. The authors suggest that as a prospective method for error prediction and modelling, observation can capture a broad range of performance issues that can be related to higher aspects of the system.
AHRQ-funded; HS024380.
Citation: Catchpole K, Neyens DM, Abernathy J .
Framework for direct observation of performance and safety in healthcare.
BMJ Qual Saf 2017 Dec;26(12):1015-21. doi: 10.1136/bmjqs-2016-006407..
Keywords: Healthcare Delivery, Patient Safety, Provider Performance, Quality Improvement
Paddock SM, Damberg CL, Yanagihara D
What role does efficiency play in understanding the relationship between cost and quality in physician organizations?
Previous studies demonstrate overuse of a narrow set of services, suggesting provider inefficiency, but existing studies neither quantify inefficiency more broadly nor assess its variation across physician organizations (POs). This study found that POs had substantial variation in efficiency, producing widely differing levels of quality for the same cost.
AHRQ-funded; HS021860.
Citation: Paddock SM, Damberg CL, Yanagihara D .
What role does efficiency play in understanding the relationship between cost and quality in physician organizations?
Med Care 2017 Dec;55(12):1039-45. doi: 10.1097/mlr.0000000000000823.
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Keywords: Practice Patterns, Healthcare Costs, Quality of Care, Quality Improvement, Payment, Provider Performance
Masnick M, Morgan DJ, Sorkin JD
Can national healthcare-associated infections (HAIs) data differentiate hospitals in the United States?
This study was designed to determine whether patients using the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website can use nationally reported healthcare-associated infection (HAI) data to differentiate hospitals. The authors concluded that HAI data generally are reported by enough hospitals to meet minimal criteria for useful comparisons in many geographic locations, though this varies by type of HAI.
AHRQ-funded; HS018111.
Citation: Masnick M, Morgan DJ, Sorkin JD .
Can national healthcare-associated infections (HAIs) data differentiate hospitals in the United States?
Infect Control Hosp Epidemiol 2017 Oct;38(10):1167-71. doi: 10.1017/ice.2017.179..
Keywords: Quality of Care, Healthcare-Associated Infections (HAIs), Hospitals, Provider Performance, Quality Measures
Adams JL, Paddock SM
Misclassification risk of tier-based physician quality performance systems.
The authors estimated misclassification rates for two-category high-quality physician identification systems. They found that current methods for profiling physicians on quality may produce misleading results, and that misclassification is a policy-relevant measure of the potential impact of tiering on providers, payers, and patients. They concluded that quantifying misclassification rates should inform the construction of high-performance networks and quality improvement initiatives.
AHRQ-funded; HS021860.
Citation: Adams JL, Paddock SM .
Misclassification risk of tier-based physician quality performance systems.
Health Serv Res 2017 Aug;52(4):1277-96. doi: 10.1111/1475-6773.12561.
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Keywords: Provider Performance, Quality of Care, Payment
Smith SN, Reichert HA, Ameling JM
Dissecting Leapfrog: how well do Leapfrog safe practices scores correlate with Hospital Compare ratings and penalties, and how much do they matter?
Voluntary Leapfrog Safe Practices Score (SPS) measures were among the first public reports of hospital performance. Recently, Medicare's Hospital Compare website has reported compulsory measures. Leapfrog's Hospital Safety Score (HSS) grades incorporate SPS and Medicare measures. The researchers evaluated associations between Leapfrog SPS and Medicare measures. They found that voluntary Leapfrog SPS measures skew toward positive self-report and bear little association with compulsory Medicare outcomes and penalties.
AHRQ-funded; HS019767; HS024385; HS018334.
Citation: Smith SN, Reichert HA, Ameling JM .
Dissecting Leapfrog: how well do Leapfrog safe practices scores correlate with Hospital Compare ratings and penalties, and how much do they matter?
Med Care 2017 Jun;55(6):606-14. doi: 10.1097/mlr.0000000000000716.
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Keywords: Patient Safety, Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Hospitals, Provider Performance
DeLancey JO, Softcheck J, Chung JW
Associations between hospital characteristics, measure reporting, and the Centers for Medicare & Medicaid Services Overall Hospital Quality Star Ratings.
This study evaluated associations between hospital characteristics, number and types of measures reported, and the star ratings. Of 3,591 hospitals receiving a star rating,4 or 5 stars were awarded to 15.8 percent of major teaching hospitals, 18.8 percent of other teaching hospitals, 30.2 percent of community hospitals, 33.3 percent of critical access hospitals, and 87.3 percent of specialty hospitals.
AHRQ-funded; HS021857.
Citation: DeLancey JO, Softcheck J, Chung JW .
Associations between hospital characteristics, measure reporting, and the Centers for Medicare & Medicaid Services Overall Hospital Quality Star Ratings.
JAMA 2017 May 16;317(19):2015-17. doi: 10.1001/jama.2017.3148.
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Keywords: Hospitals, Quality of Care, Quality Measures, Provider Performance, Patient Safety
Fernandez R, Shah S, Rosenman ED
Developing team cognition: a role for simulation.
Evidence from team science research demonstrates a strong relationship between team cognition and team performance and suggests a role for simulation in the development of this team-level construct. In this article, the researchers synthesize research from the broader team science literature to provide foundational knowledge regarding team cognition and highlight best practices for using simulation to target team cognition.
AHRQ-funded; HS020295; HS022458.
Citation: Fernandez R, Shah S, Rosenman ED .
Developing team cognition: a role for simulation.
Simul Healthc 2017 Apr;12(2):96-103. doi: 10.1097/sih.0000000000000200.
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Keywords: Teams, Training, Provider Performance, Patient Safety
Mendelson A, Kondo K, Damberg C
The effects of pay-for-performance programs on health, health care use, and processes of care: a systematic review.
This review updated and expanded a prior review examining the effects of P4P programs targeted at the physician, group, managerial, or institutional level on process-of-care and patient outcomes in ambulatory and inpatient settings. It found that pay-for-performance programs may be associated with improved processes of care in ambulatory settings, but consistently positive associations with improved health outcomes have not been demonstrated in any setting.
AHRQ-funded; HS022981.
Citation: Mendelson A, Kondo K, Damberg C .
The effects of pay-for-performance programs on health, health care use, and processes of care: a systematic review.
Ann Intern Med 2017 Mar 7;166(5):341-53. doi: 10.7326/m16-1881.
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Keywords: Payment, Provider Performance, Healthcare Utilization, Quality of Care
Lewis VA, Fraze T, Fisher ES
ACOs serving high proportions of racial and ethnic minorities lag in quality performance.
Researchers analyzed racial and ethnic disparities in health care outcomes among accountable care organizations (ACOs). Their findings suggest that ACOs with a high share of minority patients may struggle with quality performance under ACO contracts, especially during their early years of participation-maintaining or potentially exacerbating current inequities.
AHRQ-funded; HS024075.
Citation: Lewis VA, Fraze T, Fisher ES .
ACOs serving high proportions of racial and ethnic minorities lag in quality performance.
Health Aff 2017 Jan;36(1):57-66. doi: 10.1377/hlthaff.2016.0626.
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Keywords: Disparities, Racial and Ethnic Minorities, Provider Performance, Quality Indicators (QIs), Quality of Care
Davis JD, Olsen MA, Bommarito K
All-payer analysis of heart failure hospitalization 30-day readmission: comorbidities matter.
In this study, the researchers investigated readmission characteristics and the magnitude of 30-day hospital readmissions after hospital discharge for heart failure using the Healthcare Cost and Utilization Project State Inpatient Databases (SID). They found in this large all-payer cohort, ∼70% of 30-day readmissions were for non-heart failure causes, and the median time to readmission was 12 days.
AHRQ-funded; HS019455.
Citation: Davis JD, Olsen MA, Bommarito K .
All-payer analysis of heart failure hospitalization 30-day readmission: comorbidities matter.
Am J Med 2017 Jan;130(1):93.e9-93.e28. doi: 10.1016/j.amjmed.2016.07.030..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Hospitalization, Hospitals, Provider Performance
Govindan S, Chopra V, Iwashyna TJ
Do clinicians understand quality metric data? An evaluation in a Twitter-derived sample.
The researchers assessed clinician comprehension of central line-associated blood stream infection (CLABSI) quality metric data. It found that the mean percentage of correct answers was 61 percent. Overall, doctor performance was better than performance by nurses and other respondents. In basic numeracy, mean percent correct was 82 percent. For risk-adjustment numeracy, the mean percent correct was 70 percent.
AHRQ-funded; HS022835.
Citation: Govindan S, Chopra V, Iwashyna TJ .
Do clinicians understand quality metric data? An evaluation in a Twitter-derived sample.
J Hosp Med 2017 Jan;12(1):18-22.
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Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Data, Quality of Care, Provider Performance, Social Media
George EI, Ročková V, Rosenbaum PR
Mortality rate estimation and standardization for public reporting: Medicare’s Hospital Compare.
The authors calibrated Bayesian recommendation systems by checking, out of sample, whether predictions aggregate to give correct general advice derived from another sample. Their process leads to substantial revisions in the Hospital Compare model for acute myocardial infarction mortality. They found that indirect standardization, as currently used by Hospital Compare, fails to adequately control for differences in patient risk factors and systematically underestimates mortality rates at the low volume hospitals. They proposed direct standardization instead.
AHRQ-funded; HS021854.
Citation: George EI, Ročková V, Rosenbaum PR .
Mortality rate estimation and standardization for public reporting: Medicare’s Hospital Compare.
Journal of the American Statistical Association 2017;112(519):933-47. doi: 10.1080/01621459.2016.1276021.
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Keywords: Hospitals, Medicare, Mortality, Provider Performance
Calderwood MS, Kleinman K, Huang SS
Surgical site infections: volume-outcome relationship and year-to-year stability of performance rankings.
The researchers evaluated the volume-outcome relationship as well as the year-to-year stability of performance rankings following coronary artery bypass graft (CABG) surgery and hip arthroplasty. They concluded that aggregate surgical site infection risk is highest in hospitals with low annual procedure volumes. Even for higher volume hospitals, year-to-year random variation makes past experience an unreliable estimator of current performance.
AHRQ-funded; HS021424.
Citation: Calderwood MS, Kleinman K, Huang SS .
Surgical site infections: volume-outcome relationship and year-to-year stability of performance rankings.
Med Care 2017 Jan;55(1):79-85. doi: 10.1097/mlr.0000000000000620.
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Keywords: Surgery, Healthcare-Associated Infections (HAIs), Adverse Events, Injuries and Wounds, Hospitals, Provider Performance, Quality Indicators (QIs), Quality of Care, Patient Safety, Elderly
Dill JS, Morgan JC, Weiner B
Frontline health care workers and perceived career mobility: do high-performance work practices make a difference?
This study examined how high-performance work practices (HPWPs) that focus on career development are related to an individuals' perceived mobility with their current employer, and also examined the relationships between perceived mobility, job satisfaction, and turnover intent. The findings suggest that tuition remission and educational release time positively predict perceived mobility, while measures of perceived organizational support in one's current position and perceived supervisor support for career development are also significant predictors of perceived mobility. Additionally, perceived mobility is a significant predictor of job satisfaction and intent to stay with current employer.
AHRQ-funded; HS000032.
Citation: Dill JS, Morgan JC, Weiner B .
Frontline health care workers and perceived career mobility: do high-performance work practices make a difference?
Health Care Manage Rev 2014 Oct-Dec;39(4):318-28. doi: 10.1097/HMR.0b013e31829fcbfd.
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Keywords: Provider: Health Personnel, Provider Performance, Workforce
Hussey PS, Luft HS, McNamara P
AHRQ Author: McNamara P
Public reporting of provider performance at a crossroads in the United States: summary of current barriers and recommendations on how to move forward.
The authors presented a vision statement and 10 recommendations for public reports to achieve their potential for engaging and informing consumers.
AHRQ-authored; AHRQ-funded.
Citation: Hussey PS, Luft HS, McNamara P .
Public reporting of provider performance at a crossroads in the United States: summary of current barriers and recommendations on how to move forward.
Med Care Res Rev 2014 Oct;71(5 Suppl):5s-16s. doi: 10.1177/1077558714535980.
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Keywords: Education: Patient and Caregiver, Quality of Care, Provider: Health Personnel, Provider Performance, Public Reporting
Bevans KB, Moon J, Carle AC
Patient reported outcomes as indicators of pediatric health care quality.
The authors described and illustrated in case examples the functions, benefits, and challenges of patient-reported outcomes applications. They concluded that pediatric patient-reported outcomes are increasingly recognized as valuable indicators of health care quality in the clinical environment and as measures of organization- and provider-level performance.
AHRQ-funded; HS020408.
Citation: Bevans KB, Moon J, Carle AC .
Patient reported outcomes as indicators of pediatric health care quality.
Acad Pediatr 2014 Sep-Oct;14(5 Suppl):S90-6. doi: 10.1016/j.acap.2014.06.002..
Keywords: Children/Adolescents, Quality of Care, Children/Adolescents, Quality Indicators (QIs), Quality Measures, Provider Performance
Hockenberry JM, Helmchen LA
The nature of surgeon human capital depreciation.
The authors estimated how temporal breaks affect surgeons' performance of coronary artery bypass grafting (CABG). They found that a surgeon's additional day away from the operating room raised patients' inpatient mortality by up to 0.067 percentage points but reduced total hospitalization costs by up to 0.59 percentage points, and among emergent patients treated by high-volume providers, an additional day away raised mortality risk by 0.398 percentage points but reduced cost by up to 1.4 percentage points. They concluded that their results are consistent with the hypothesis that as temporal distance increases, surgeons are less likely to recognize and address life-threatening complications.
AHRQ-funded; HS019743.
Citation: Hockenberry JM, Helmchen LA .
The nature of surgeon human capital depreciation.
J Health Econ 2014 Sep;37:70-80. doi: 10.1016/j.jhealeco.2014.06.001.
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Keywords: Healthcare Costs, Mortality, Provider Performance, Surgery
Maggard-Gibbons M
The use of report cards and outcome measurements to improve the safety of surgical care: the American College of Surgeons National Surgical Quality Improvement Program.
This review summarized the history of American College of Surgeons National Surgical Quality Improvement Project and its components, and described the evidence that feeding outcomes back to providers, along with real-time comparisons with other hospital rates, leads to quality improvement, better patient outcomes, cost savings and overall improved patient safety.
AHRQ-funded; 2902007100621.
Citation: Maggard-Gibbons M .
The use of report cards and outcome measurements to improve the safety of surgical care: the American College of Surgeons National Surgical Quality Improvement Program.
BMJ Qual Saf 2014 Jul;23(7):589-99. doi: 10.1136/bmjqs-2013-002223..
Keywords: Quality Improvement, Quality Indicators (QIs), Quality Measures, Quality of Care, Surgery, Patient Safety, Outcomes, Patient-Centered Outcomes Research, Provider Performance
Arora VM, Berhie S, Horwitz LI
Using standardized videos to validate a measure of handoff quality: the handoff mini-clinical examination exercise.
The researchers report the results of the development of a shorter Handoff Mini-Clinical Examination Exercise (CEX), along with the formal establishment of its construct validity, namely its ability to distinguish between levels of performance in 3 domains of handoff quality. They were able to demonstrate evidence that the Handoff Mini-CEX can draw reliable and valid conclusions regarding handoff performance by physicians in U.S. hospitals.
AHRQ-funded; HS018278
Citation: Arora VM, Berhie S, Horwitz LI .
Using standardized videos to validate a measure of handoff quality: the handoff mini-clinical examination exercise.
J Hospital Med. 2014 Jul;9(7):441-6. doi: 10.1002/jhm.2185.
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Keywords: Provider Performance, Quality Measures, Quality Improvement, Quality of Care, Education: Continuing Medical Education, Patient Safety