National Healthcare Quality and Disparities Report
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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 164 Research Studies DisplayedSkube SJ, Hu Z, Arsoniadis EG
Characterizing surgical site infection signals in clinical notes.
Building off of previous work for automated and semi-automated surgical site infections (SSIs) detection using expert-derived "strong features" from clinical notes, researchers hypothesized that additional SSI phrases may be contained in clinical notes. They systematically characterized phrases and expressions associated with SSIs. While 83 percent of expert-derived original terms overlapped with new terms and modifiers, an additional 362 modifiers associated with both positive and negative SSI signals were identified.
AHRQ-funded; HS024532.
Citation: Skube SJ, Hu Z, Arsoniadis EG .
Characterizing surgical site infection signals in clinical notes.
Stud Health Technol Inform 2017;245:955-59.
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Keywords: Healthcare-Associated Infections (HAIs), Surgery, Injuries and Wounds, Patient Safety, Adverse Events, Quality Improvement, Quality of Care
Goff SL, Mazor KM, Guhn-Knight H
Factors that matter to low-income and racial/ethnic minority mothers when choosing a pediatric practice: a mixed methods analysis.
The authors sought to understand potential barriers to using quality data by assessing what factors mattered to women when choosing a pediatric practice. They found that pediatrician characteristics and factors related to access to care may be more important to low-income and racial/ethnic minority women than more commonly reported quality metrics.
AHRQ-funded; HS021864.
Citation: Goff SL, Mazor KM, Guhn-Knight H .
Factors that matter to low-income and racial/ethnic minority mothers when choosing a pediatric practice: a mixed methods analysis.
J Racial Ethn Health Disparities 2017 Dec;4(6):1051-60. doi: 10.1007/s40615-016-0309-x.
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Keywords: Access to Care, Quality of Care, Low-Income, Children/Adolescents, Racial and Ethnic Minorities
Wang Y, Spatz ES, Tariq M
Home health agency performance in the United States: 2011-15.
This review’s evaluation of home health agency quality performance included 11,462 Medicare-certified home health agencies that served 92.4 percent of all ZIP codes nationwide, accounting for 315.2 million people. It found that home health agency performance on several quality indicators varied, and many agencies were persistently in the lowest quartile of performance.
AHRQ-funded; HS023000.
Citation: Wang Y, Spatz ES, Tariq M .
Home health agency performance in the United States: 2011-15.
J Am Geriatr Soc 2017 Dec;65(12):2572-79. doi: 10.1111/jgs.14987.
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Keywords: Quality of Care, Home Healthcare, Quality Indicators (QIs), Quality Measures
Khandelwal N, Curtis JR, Freedman VA
How often is end-of-life care in the United States inconsistent with patients' goals of care?
The purpose of this study was to document the proportion of bereaved respondents who reported care inconsistent with patients' wishes and characterize the predictors of end-of-life care associated with inconsistent care. The study found that one in eight respondents stated care in the last months of life was inconsistent with patients' wishes; such care was associated with worse ratings of care, pain management, and communication with clinicians.
AHRQ-funded; HS022982.
Citation: Khandelwal N, Curtis JR, Freedman VA .
How often is end-of-life care in the United States inconsistent with patients' goals of care?
J Palliat Med 2017 Dec;20(12):1400-04. doi: 10.1089/jpm.2017.0065..
Keywords: Care Management, Healthcare Delivery, Elderly, Palliative Care, Patient-Centered Healthcare, Quality of Care
Haynes AB, Edmondson LB, Lipsitz SR
Mortality trends after a voluntary checklist-based surgical safety collaborative.
This study sought to determine whether completion of a voluntary, checklist-based surgical quality improvement program is associated with reduced 30-day postoperative mortality. It It found that, despite similar pre-existing rates and trends of postoperative mortality, hospitals in South Carolina completing a voluntary checklist-based surgical quality improvement program had a reduction in deaths after inpatient surgery over the first 3 years of the collaborative compared with other hospitals in the state.
AHRQ-funded; HS019631.
Citation: Haynes AB, Edmondson LB, Lipsitz SR .
Mortality trends after a voluntary checklist-based surgical safety collaborative.
Annals of Surgery 2017 Dec;266(6):923-29. doi: 10.1097/SLA.0000000000002249.
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Keywords: Mortality, Patient Safety, Surgery, Quality Improvement, Quality of Care
Childers CP, Childers KK, Maggard-Gibbons M
National estimates of genetic testing in women with a history of breast or ovarian cancer.
In the United States, 3.8 million women have a history of breast (BC) or ovarian cancer (OC). Up to 15 percent of cases are attributable to heritable mutations, which, if identified, provide critical knowledge for treatment and preventive care. This study found that fewer than one in five individuals with a history of BC or OC meeting select National Cancer Comprehensive Network criteria have undergone genetic testing.
AHRQ-funded; HS025079.
Citation: Childers CP, Childers KK, Maggard-Gibbons M .
National estimates of genetic testing in women with a history of breast or ovarian cancer.
J Clin Oncol 2017 Dec 1;35(34):3800-06. doi: 10.1200/jco.2017.73.6314.
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Keywords: Cancer, Cancer: Breast Cancer, Cancer: Ovarian Cancer, Family Health and History, Genetics, Quality of Care, Screening, Women
Sarkar U, McDonald K, Motala A
Pragmatic insights on patient safety priorities and intervention strategies in ambulatory settings.
In this article, the investigators (1) reviewed the methods and results for the key informant input process for a Technical Brief on ambulatory safety commissioned by the Agency for Healthcare Research and Quality (AHRQ), (2) summarized the key informant perspectives on ambulatory safety, (3) expanded on key informant input with specific recommendations for an ambulatory safety agenda, (4) reported on existing initiatives and progress related to key informant perspectives and our recommendations, and (5) proposed specific research and policy activities that would advance ambulatory safety.
AHRQ-funded; 290201500010I.
Citation: Sarkar U, McDonald K, Motala A .
Pragmatic insights on patient safety priorities and intervention strategies in ambulatory settings.
Jt Comm J Qual Patient Saf 2017 Dec;43(12):661-70. doi: 10.1016/j.jcjq.2017.06.009..
Keywords: Ambulatory Care and Surgery, Patient Safety, Quality of Care
Cole MB, Wilson IB, Trivedi AN
State variation in quality outcomes and disparities in outcomes in community health centers.
The researchers estimated between-state variation in hypertension, diabetes, and pregnancy outcomes and racial/ethnic disparities in these outcomes for health center patients. They found wide variation in both outcomes and racial/ethnic disparities in outcomes between states for patients seen at health centers..
AHRQ-funded; HS024652.
Citation: Cole MB, Wilson IB, Trivedi AN .
State variation in quality outcomes and disparities in outcomes in community health centers.
Med Care 2017 Dec;55(12):1001-07. doi: 10.1097/mlr.0000000000000818.
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Keywords: Community-Based Practice, Disparities, Quality of Care, Outcomes, Racial and Ethnic Minorities
Joyce NR, Huskamp HA, Hadland SE
The alternative quality contract: impact on service use and spending for children with ADHD.
The authors used Blue Cross-Blue Shield of Massachusetts (BCBSMA) claims for 2006-2011 to compare youths enrolled in provider organizations participating in the alternative quality contract (AQC) with those not participating. They found that the AQC was associated with small increases in the probability of any outpatient visits and in the probability and number of medication management visits among children with attention-deficit hyperactivity disorder (ADHD). Further, spending did not change, and there was no evidence of reductions in service utilization or spending for children with ADHD in the first three years of AQC implementation.
AHRQ-funded; HS022998.
Citation: Joyce NR, Huskamp HA, Hadland SE .
The alternative quality contract: impact on service use and spending for children with ADHD.
Psychiatr Serv 2017 Dec;68(12):1210-12. doi: 10.1176/appi.ps.201700143.
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Keywords: Children/Adolescents, Behavioral Health, Payment, Quality of Care, Healthcare Costs
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
Qiu J, Harold Li H, Zhang T
Automatic x-ray image contrast enhancement based on parameter auto-optimization.
Insufficient image contrast associated with radiation therapy daily setup x-ray images could negatively affect accurate patient treatment setup. The study authors developed a method to perform automatic and user-independent contrast enhancement on 2D kilo voltage (kV) and megavoltage (MV) x-ray images. The study concluded that the proposed method is able to outperform the standard image contrast adjustment procedures that are currently used in the commercial clinical systems.
AHRQ-funded; HS022888.
Citation: Qiu J, Harold Li H, Zhang T .
Automatic x-ray image contrast enhancement based on parameter auto-optimization.
J Appl Clin Med Phys 2017 Nov;18(6):218-23. doi: 10.1002/acm2.12172..
Keywords: Diagnostic Safety and Quality, Quality of Care, Imaging, Patient Safety
Colla CH, Mainor AJ
Choosing Wisely Campaign: valuable for providers who knew about it, but awareness remained constant, 2014-17.
The Choosing Wisely campaign has codified recommendations of which health care services' use should be questioned and discussed with patients. The ABIM Foundation administered surveys in 2014 and 2017 to examine physicians' attitudes toward and awareness of the use of low-value care. There were no significant changes between 2014 and 2017 in awareness of the campaign among physicians or physician-reported difficulty in talking to patients about avoiding a low-value service.
AHRQ-funded; HS023812.
Citation: Colla CH, Mainor AJ .
Choosing Wisely Campaign: valuable for providers who knew about it, but awareness remained constant, 2014-17.
Health Aff 2017 Nov;36(11):2005-11. doi: 10.1377/hlthaff.2017.0945.
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Keywords: Decision Making, Guidelines, Quality of Care, Health Services Research (HSR), Clinician-Patient Communication
Hefele JG, Ritter GA, Bishop CE
Examining racial and ethnic differences in nursing home quality.
The authors measured within-facility differences for a range of publicly reported nursing home quality measures. They found that, on average, care is delivered equally across all racial/ethnic groups in the same nursing home. They concluded that nursing home providers should attempt to identify racial/ethnic within-facility differences in care.
AHRQ-funded; HS021891.
Citation: Hefele JG, Ritter GA, Bishop CE .
Examining racial and ethnic differences in nursing home quality.
Jt Comm J Qual Patient Saf 2017 Nov;43(11):554-64. doi: 10.1016/j.jcjq.2017.06.003.
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Keywords: Disparities, Quality of Care, Nursing Homes, Racial and Ethnic Minorities, Public Reporting
Kamal AH, Nicolla JM, Power S
Quality improvement pearls for the palliative care and hospice professional.
In this article, the authors provide a prioritized list of 10 tips specifically aimed to palliative care and hospice professionals, using their experience in both failures and successes in performing quality improvement. They aim to demystify quality improvement, highlight areas where rigor and a systematic approach are needed for success, and offer their own lessons learned and mistakes made to promote success for others.
AHRQ-funded; HS023681.
Citation: Kamal AH, Nicolla JM, Power S .
Quality improvement pearls for the palliative care and hospice professional.
J Pain Symptom Manage 2017 Nov;54(5):758-65. doi: 10.1016/j.jpainsymman.2017.07.040..
Keywords: Palliative Care, Quality of Care, Quality Improvement
Rogith D, Iyengar MS, Singh H
Using fault trees to advance understanding of diagnostic errors.
In this study, the investigators used fault trees to advance understanding of diagnostic errors. A team of three experts reviewed 10 published cases of diagnostic error and constructed fault trees. The fault trees were modeled according to currently available conceptual frameworks characterizing diagnostic error. The 10 trees were then synthesized into a single fault tree to identify common contributing factors and pathways leading to diagnostic error. The investigators indicate that fault trees might provide a useful framework for both quantitative and qualitative analysis of diagnostic errors.
AHRQ-funded; HS022087; HS023602.
Citation: Rogith D, Iyengar MS, Singh H .
Using fault trees to advance understanding of diagnostic errors.
Jt Comm J Qual Patient Saf 2017 Nov;43(11):598-605. doi: 10.1016/j.jcjq.2017.06.007..
Keywords: Diagnostic Safety and Quality, Patient Safety, Quality of Care, Quality Improvement
Ellimoottil C, Syrjamaki JD, Volt JD
Validation of a claims-based algorithm to characterize episodes of care.
The Michigan Value Collaborative (MVC) developed a claims-based algorithm to provide hospitals with data on events that occur to patients beyond the hospitalization. In this article, the investigators discuss the validation of MVC's claims-based algorithm. They indicate that their findings suggest that the MVC claims-based algorithm identifies and classifies claims with high fidelity and outperforms medical records in the identification of postdischarge events.
AHRQ-funded; HS024193.
Citation: Ellimoottil C, Syrjamaki JD, Volt JD .
Validation of a claims-based algorithm to characterize episodes of care.
Am J Manag Care 2017 Nov;23(11):e382-e86..
Keywords: Hospital Discharge, Hospital Readmissions, Hospitalization, Hospitals, Quality of Care, Quality Improvement
Ndumele CD, Cohen MS, Cleary PD
Association of state access standards with accessibility to specialists for Medicaid managed care enrollees.
The researchers compared ratings of access to specialists for adult Medicaid and commercial enrollees before and after the implementation of specialty access standards. Overall, there was no significant improvement in timely access to specialty services for Medicaid managed care enrollees in the period following implementation of standard(s) nor was there any impact of access standards on insurance-based disparities in access.
AHRQ-funded; HS016978; HS017589.
Citation: Ndumele CD, Cohen MS, Cleary PD .
Association of state access standards with accessibility to specialists for Medicaid managed care enrollees.
JAMA Intern Med 2017 Oct;177(10):1445-51. doi: 10.1001/jamainternmed.2017.3766.
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Keywords: Access to Care, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Quality of Care, Health Insurance, Patient Experience
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
Schmajuk G, Yazdany J
Leveraging the electronic health record to improve quality and safety in rheumatology.
In the coming years, developing and leveraging tools within the electronic health record (EHR) will be the key to making the next big strides in improving the health of patients with rheumatoid arthritis and other rheumatic diseases, including building EHR infrastructure to capture patient outcomes and developing automated methods to retrieve information from free text of clinical notes.
AHRQ-funded; HS024412.
Citation: Schmajuk G, Yazdany J .
Leveraging the electronic health record to improve quality and safety in rheumatology.
Rheumatol Int 2017 Oct;37(10):1603-10. doi: 10.1007/s00296-017-3804-4.
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Keywords: Electronic Health Records (EHRs), Quality of Care, Patient Safety, Quality Improvement, Arthritis
Kamal AH, Taylor DH, Neely B
One size does not fit all: disease profiles of serious illness patients receiving specialty palliative care.
This study was one of the first to describe symptom burden and functional scores by diagnostic categories and care settings across a community-based interdisciplinary specialty palliative care program. Results demonstrated statistically significant and clinically relevant differences among settings of care, functional status, and symptom profiles between patients with various serious illnesses.
AHRQ-funded; HS023681.
Citation: Kamal AH, Taylor DH, Neely B .
One size does not fit all: disease profiles of serious illness patients receiving specialty palliative care.
J Pain Symptom Manage 2017 Oct;54(4):476-83. doi: 10.1016/j.jpainsymman.2017.07.035..
Keywords: Quality of Care, Palliative Care, Quality Improvement
Fisher KA, Mazor KM
Patient and family complaints in cancer care: what can we learn from the tip of the iceberg?
This paper comments on the Mack et al. article “Evaluation of Patient and Family Outpatient Complaints as a Strategy to Prioritize Efforts to Improve Cancer Care Delivery”, published in 2017 in The Joint Commission Journal on Quality and Patient Safety, in which Mack et al. categorized all complaints filed at a large outpatient cancer center during a two-year period, put forth a preliminary rating system for assessing complaint severity, and catalogued the actions taken in response to the complaints.
AHRQ-funded; HS024596; HS022757.
Citation: Fisher KA, Mazor KM .
Patient and family complaints in cancer care: what can we learn from the tip of the iceberg?
Jt Comm J Qual Patient Saf 2017 Oct;43(10):495-97. doi: 10.1016/j.jcjq.2017.07.003..
Keywords: Cancer, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Patient Experience, Patient Safety, Quality of Care, Quality Improvement
Ban KA, Gibbons MM, Ko CY
Surgical technical evidence review for colorectal surgery conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
The objective of this article is to provide a comprehensive review of the evidence supporting the surgical components of the Improving Surgical Care and Recovery (ISCR) colorectal (CR) pathway. This review will evaluate the evidence supporting CR pathways and develop an evidence-based CR protocol to help hospitals participating in the ISCR program implement evidence-based practices.
AHRQ-funded; 233201500020I.
Citation: Ban KA, Gibbons MM, Ko CY .
Surgical technical evidence review for colorectal surgery conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
J Am Coll Surg 2017 Oct;225(4):548-57.e3. doi: 10.1016/j.jamcollsurg.2017.06.017.
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Keywords: Evidence-Based Practice, Hospitals, Patient Safety, Quality Improvement, Surgery, Quality of Care, Guidelines
Ehlers AP, Khor S, Cizik AM
Use of patient-reported outcomes and satisfaction for quality assessments.
This study investigated the relationship between PROs and satisfaction among spine surgery patients. The authors hypothesized that there would be significant disparities between patient satisfaction and PROs at the 1-year postoperative time point. The study found that overall, patients undergoing elective lumbar spine surgery reported being satisfied with outcomes, but the reported responses in PROs were much more variable.
AHRQ-funded; HS020025.
Citation: Ehlers AP, Khor S, Cizik AM .
Use of patient-reported outcomes and satisfaction for quality assessments.
Am J Manag Care 2017 Oct;23(10):618-22..
Keywords: Patient-Centered Outcomes Research, Patient Experience, Quality of Care, Surgery, Outcomes, Orthopedics
Teppala S, Ottenbacher KJ, Eschbach K
Variation in functional status after hip fracture: facility and regional influence on mobility and self-care.
Little is known about variation in functional outcomes after postacute rehabilitation for patients with hip fracture. The researchers examined variation in mobility and self-care after hip fracture rehabilitation across inpatient rehabilitation facilities (IRFs), hospital referral regions (HRRs) and states. Variation in functional status following postacute hip fracture rehabilitation appears to occur primarily at the level of facilities rather than geographic location.
AHRQ-funded; HS022134.
Citation: Teppala S, Ottenbacher KJ, Eschbach K .
Variation in functional status after hip fracture: facility and regional influence on mobility and self-care.
J Gerontol A Biol Sci Med Sci 2017 Oct;72(10):1376-82. doi: 10.1093/gerona/glw249.
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Keywords: Injuries and Wounds, Quality of Care, Health Status, Rehabilitation, Patient Self-Management
Pranaat R, Mohan V, O'Reilly M
Use of simulation based on an electronic health records environment to evaluate the structure and accuracy of notes generated by medical scribes: Proof-of-concept study.
The objective of the researchers was to develop a virtual video-based simulation to demonstrate and quantify the variability and accuracy of scribes' transcribed notes in the EHR. Their high-fidelity, video-based EHR simulation was able to assess multiple performance indicators in medical scribes and demonstrate significant variability both in terms of structure and accuracy in clinical documentation.
AHRQ-funded; HS025141.
Citation: Pranaat R, Mohan V, O'Reilly M .
Use of simulation based on an electronic health records environment to evaluate the structure and accuracy of notes generated by medical scribes: Proof-of-concept study.
JMIR Med Inform 2017 Sep 20;5(3):e30. doi: 10.2196/medinform.7883.
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Keywords: Electronic Health Records (EHRs), Quality of Care, Patient Safety, Training