National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Events (1)
- Cardiovascular Conditions (1)
- (-) Care Coordination (9)
- Care Management (1)
- Chronic Conditions (2)
- Communication (2)
- Healthcare Delivery (1)
- Health Information Technology (HIT) (1)
- Heart Disease and Health (1)
- Home Healthcare (1)
- Hospital Discharge (3)
- Hospital Readmissions (2)
- Hospitals (4)
- Long-Term Care (1)
- Medical Errors (1)
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- Neonatal Intensive Care Unit (NICU) (1)
- Newborns/Infants (1)
- Nursing Homes (3)
- Patient-Centered Healthcare (1)
- Patient Safety (2)
- Quality Indicators (QIs) (1)
- Quality Measures (1)
- Quality of Care (1)
- Social Determinants of Health (1)
- Stroke (1)
- (-) Transitions of Care (9)
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 9 of 9 Research Studies DisplayedCampbell Britton M, Hodshon B, Chaudhry SI
Implementing a warm handoff between hospital and skilled nursing facility clinicians.
This study focused on increasing better communication during transfers from hospitals and skilled nursing facilities (SNFs). Warm handoffs between hospital and SNF physicians was implemented. Participation in warm handoffs gradually increased – starting at 15.78% in stage 1 and increasing to 46.89% in stage 3. A total of 2417 patient discharges were included in this study.
AHRQ-funded; HS023554.
Citation: Campbell Britton M, Hodshon B, Chaudhry SI .
Implementing a warm handoff between hospital and skilled nursing facility clinicians.
J Patient Saf 2019 Sep;15(3):198-204. doi: 10.1097/pts.0000000000000529..
Keywords: Communication, Patient Safety, Hospital Discharge, Transitions of Care, Care Coordination, Hospitals, Nursing Homes
Zachrison KS, Dhand A, Schwamm LH
A network approach to stroke systems of care.
This study provided a network analysis of stroke systems of care. Stroke patients are increasing transferred between hospitals to receive higher levels of care, but coordination and triage of these patients remains a challenge. The network analysis provides an understanding of the central hubs, the change of network structure over time, and the dissemination of innovations.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Dhand A, Schwamm LH .
A network approach to stroke systems of care.
Circ Cardiovasc Qual Outcomes 2019 Aug;12(8):e005526. doi: 10.1161/circoutcomes.119.005526..
Keywords: Stroke, Care Coordination, Transitions of Care, Care Management, Cardiovascular Conditions, Hospitals
Wyatt DL
AHRQ Author: Wyatt DL
Employing technology to make care transitions safer.
This commentary discusses the potential for errors in patient handoffs; important information about medications and instructions regarding patient care may be overlooked when the patient is referred to special care, moved to a new hospital setting, or discharged. The problem is especially acute for patients with multiple chronic conditions who often undergo frequent transitions to new care settings and healthcare providers. The author describes AHRQ’s funding opportunities for health information technology interventions that aim to improve communication and coordination during care transitions, such as location-based smartphone alerts, a patient-centered discharge toolkit, and a ‘smart pillbox’ electronic medication adherence reporting project.
AHRQ-authored.
Citation: Wyatt DL .
Employing technology to make care transitions safer.
J Nurs Care Qual 2019 Jul/Sep;34(3):185-88. doi: 10.1097/ncq.0000000000000417..
Keywords: Adverse Events, Care Coordination, Chronic Conditions, Communication, Health Information Technology (HIT), Healthcare Delivery, Hospital Discharge, Medical Errors, Medication, Patient Safety, Transitions of Care
Hass Z, Woodhouse M, Grabowski DC
Assessing the impact of Minnesota's return to community initiative for newly admitted nursing home residents.
This study evaluated the Minnesota Return to Community Initiative (RTCI) program which facilitates community discharge of non-Medicaid nursing home residents. It was implemented statewide without a control group. The program assists with discharge planning, transitioning to the community, and postdischarge follow-up. Results showed the program increased discharge rates by an estimated 11 percent. Success increased with time as nursing home facilities increased their participation.
AHRQ-funded; HS020224.
Citation: Hass Z, Woodhouse M, Grabowski DC .
Assessing the impact of Minnesota's return to community initiative for newly admitted nursing home residents.
Health Serv Res 2019 Jun;54(3):555-63. doi: 10.1111/1475-6773.13118..
Keywords: Care Coordination, Long-Term Care, Nursing Homes, Transitions of Care
Gupta S, Zengul FD, Davlyatov GK
Reduction in hospitals' readmission rates: role of hospital-based skilled nursing facilities.
The purpose of this study was to examine the association between hospital-based skilled nursing facilities (HBSNFs) and hospitals' readmission rates. Data sources included the American Hospital Association Annual Survey, Area Health Resources Files, CMS Medicare cost reports and Hospital Compare. Results showed that the presence of HBSNFs was associated with lower readmission rates for acute myocardial infarction and pneumonia. Further, higher skilled nursing facilities to hospitals ratio were associated with lower readmission rates.
AHRQ-funded; HS023345.
Citation: Gupta S, Zengul FD, Davlyatov GK .
Reduction in hospitals' readmission rates: role of hospital-based skilled nursing facilities.
Inquiry 2019 Jan-Dec;56:46958018817994. doi: 10.1177/0046958018817994..
Keywords: Hospital Readmissions, Transitions of Care, Care Coordination, Hospitals, Quality Indicators (QIs), Quality Measures, Quality of Care
McHugh JP, Foster A, Mor V JP, Foster A, Mor V
Reducing hospital readmissions through preferred networks of skilled nursing facilities.
This study used a concurrent mixed-methods approach to examine changes in rehospitalization rates and differences in practices between hospitals that did and did not develop formal skilled nursing facilities (SNF) networks.
AHRQ-funded; HS023961.
Citation: McHugh JP, Foster A, Mor V JP, Foster A, Mor V .
Reducing hospital readmissions through preferred networks of skilled nursing facilities.
Health Aff 2017 Sep;36(9):1591-98. doi: 10.1377/hlthaff.2017.0211..
Keywords: Care Coordination, Hospital Readmissions, Hospitals, Nursing Homes, Transitions of Care
Hewner S, Casucci S, Sullivan S
Integrating social determinants of health into primary care clinical and informational workflow during care transitions.
Care continuity during transitions between the hospital and home requires reliable communication between providers and settings and an understanding of social determinants that influence recovery. This paper describes the coordinating transitions intervention which uses real time alerts, delivered directly to the primary care practice for complex chronically ill patients discharged from an acute care setting, to facilitate nurse care coordinator led telephone outreach.
AHRQ-funded; HS022575.
Citation: Hewner S, Casucci S, Sullivan S .
Integrating social determinants of health into primary care clinical and informational workflow during care transitions.
eGEMS 2017 Jul 4;5(2):2. doi: 10.13063/2327-9214.1282..
Keywords: Care Coordination, Chronic Conditions, Patient-Centered Healthcare, Social Determinants of Health, Transitions of Care
Jones CD, Bowles KH, Richard A
High-value home health care for patients with heart failure: an opportunity to optimize transitions from hospital to home.
Providing home health nursing and therapy could promote recovery in vulnerable HF patients with post-hospital syndrome and potentially reduce readmissions. The authors argue that understanding the characteristics of effective post-acute HHC for patients with HF will inform best practices, optimal outcomes for cost, and ultimately high-value care.
AHRQ-funded; HS024569.
Citation: Jones CD, Bowles KH, Richard A .
High-value home health care for patients with heart failure: an opportunity to optimize transitions from hospital to home.
Circ Cardiovasc Qual Outcomes 2017 May;10(5). doi: 10.1161/circoutcomes.117.003676.
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Keywords: Home Healthcare, Heart Disease and Health, Transitions of Care, Care Coordination, Medicare
Garfield CF, Lee Y, Kim HN
Paternal and maternal concerns for their very low-birth-weight infants transitioning from the NICU to home.
The authors examined the concerns and coping mechanisms of fathers and mothers of very low-birth-weight neonatal intensive care unit (NICU) infants as they transition to home from the NICU. They found that overriding concerns included pervasive uncertainty, lingering medical concerns, and partner-related adjustment concerns that differed by gender. They concluded that many parental concerns can be addressed with improved discharge information exchanges and anticipatory guidance.
AHRQ-funded; HS020316.
Citation: Garfield CF, Lee Y, Kim HN .
Paternal and maternal concerns for their very low-birth-weight infants transitioning from the NICU to home.
J Perinat Neonatal Nurs 2014 Oct-Dec;28(4):305-12. doi: 10.1097/jpn.0000000000000021.
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Keywords: Care Coordination, Hospital Discharge, Neonatal Intensive Care Unit (NICU), Newborns/Infants, Transitions of Care