National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Ambulatory Care and Surgery (1)
- Antibiotics (1)
- Antimicrobial Stewardship (2)
- Blood Clots (1)
- Brain Injury (1)
- Cancer (1)
- Cardiovascular Conditions (1)
- Care Coordination (1)
- Care Management (1)
- Central Line-Associated Bloodstream Infections (CLABSI) (1)
- Children/Adolescents (7)
- Clinical Decision Support (CDS) (1)
- Communication (2)
- Comparative Effectiveness (2)
- (-) Critical Care (34)
- Decision Making (2)
- Diabetes (1)
- Disparities (1)
- Education: Continuing Medical Education (1)
- Elderly (1)
- Emergency Medical Services (EMS) (4)
- Guidelines (1)
- Healthcare-Associated Infections (HAIs) (6)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (2)
- Healthcare Delivery (2)
- Health Information Technology (HIT) (3)
- Heart Disease and Health (1)
- Hospital Discharge (1)
- Hospitalization (3)
- Hospital Readmissions (1)
- Hospitals (2)
- Influenza (1)
- Injuries and Wounds (1)
- Inpatient Care (1)
- Intensive Care Unit (ICU) (9)
- Long-Term Care (1)
- Medicare (1)
- Medication (4)
- Medication: Safety (1)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (1)
- Mortality (3)
- Neurological Disorders (1)
- Nursing (2)
- Opioids (1)
- Outcomes (1)
- Patient-Centered Healthcare (1)
- Patient Safety (7)
- Pneumonia (1)
- Prevention (2)
- Primary Care (1)
- Quality Improvement (1)
- Quality of Care (8)
- Racial and Ethnic Minorities (1)
- Respiratory Conditions (1)
- Risk (1)
- Sepsis (1)
- Simulation (1)
- Substance Abuse (1)
- Surgery (2)
- Teams (1)
- Telehealth (2)
- Training (2)
- Trauma (1)
- Urinary Tract Infection (UTI) (1)
- Workforce (1)
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 34 Research Studies DisplayedHeslin KC, Owens PL, Karaca Z
AHRQ Author: Heslin KC; Owens PL; Karaca Z; Elixhauser A
Trends in opioid-related inpatient stays shifted after the US transitioned to ICD-10-CM diagnosis coding in 2015.
This study examines how trend analyses of inpatient stays involving opioid diagnoses were affected by the transition to ICD-10-CM. It found a sharp increase in opioid-related stays overall during the transition to ICD-10-CM. This may indicate that the new classification system is capturing stays that were missed by ICD-9-CM data.
AHRQ-authored.
Citation: Heslin KC, Owens PL, Karaca Z .
Trends in opioid-related inpatient stays shifted after the US transitioned to ICD-10-CM diagnosis coding in 2015.
Med Care 2017 Nov;55(11):918-23. doi: 10.1097/mlr.0000000000000805.
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Keywords: Critical Care, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Opioids, Substance Abuse
Finn Davis K, Napolitano N, Li S
Promoters and barriers to implementation of tracheal intubation airway safety bundle: a mixed-method analysis.
This study describes promoters and barriers to implementation of an airway safety quality improvement bundle from the perspective of interdisciplinary frontline clinicians and ICU quality improvement leaders. Both early and late adopters identified similar promoter and barrier themes. Early adopter sites customized the quality improvement bundle and had an interdisciplinary quality improvement team approach.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Finn Davis K, Napolitano N, Li S .
Promoters and barriers to implementation of tracheal intubation airway safety bundle: a mixed-method analysis.
Pediatr Crit Care Med 2017 Oct;18(10):965-72. doi: 10.1097/pcc.0000000000001251.
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Keywords: Critical Care, Intensive Care Unit (ICU), Patient Safety, Quality Improvement, Respiratory Conditions
Williams CN, Kirby A, Piantino J
If you build it, they will come: Initial experience with a multi-disciplinary pediatric neurocritical care follow-up clinic.
To address morbidities in Pediatric Neurocritical Care survivors, collaboration between Pediatric Neurology and Pediatric Critical Care created a multidisciplinary follow-up clinic providing specialized evaluations after discharge. Clinic referrals applied to all Pediatric Neurocritical Care patients regardless of admission severity of illness. Here, the authors report an initial case series, which revealed a population that is heterogenous in age, ranging from 1 month to 18 years, and in diagnoses.
AHRQ-funded; HS022981.
Citation: Williams CN, Kirby A, Piantino J .
If you build it, they will come: Initial experience with a multi-disciplinary pediatric neurocritical care follow-up clinic.
Children 2017 Sep 19;4(9). doi: 10.3390/children4090083.
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Keywords: Brain Injury, Critical Care, Neurological Disorders, Patient-Centered Healthcare, Children/Adolescents
Nothelle SK, Sharma R, Oakes AH
Determinants of potentially inappropriate medication use in long-term and acute care settings: a systematic review.
The authors searched for studies conducted in the United States that described determinants of Potentially inappropriate medications (PIMs) use in adults >/=60 years of age in a nursing home or residential care facility, in the emergency department (ED), or in the hospital. They concluded that among older adults, those who are on many medications are at increased risk for PIM use across multiple settings.
AHRQ-funded; HS000029.
Citation: Nothelle SK, Sharma R, Oakes AH .
Determinants of potentially inappropriate medication use in long-term and acute care settings: a systematic review.
J Am Med Dir Assoc 2017 Sep;18(9):806.e1-06.e17. doi: 10.1016/j.jamda.2017.06.005.
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Keywords: Medication, Medication: Safety, Long-Term Care, Critical Care, Elderly
Fehr JJ, McBride ME, Boulet JR
The simulation-based assessment of pediatric rapid response teams.
The researchers created scenarios of simulated decompensating pediatric patients to train pediatric rapid response teams (RRTs) and to determine whether the scenario scores provide a valid assessment of RRT performance with the hypothesis that RRTs led by intensivists-in-training would be better prepared to manage the scenarios than teams led by nurse practitioners. The greater scores achieved by intensivist-in-training-led teams provides some evidence to support the validity of the assessment.
AHRQ-funded; HS018734.
Citation: Fehr JJ, McBride ME, Boulet JR .
The simulation-based assessment of pediatric rapid response teams.
J Pediatr 2017 Sep;188:258-62.e1. doi: 10.1016/j.jpeds.2017.03.030.
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Keywords: Critical Care, Education: Continuing Medical Education, Children/Adolescents, Teams, Training
Boltey E, Yakusheva O, Costa DK
5 nursing strategies to prevent ventilator-associated pneumonia.
This article reviews the top five evidence-based nursing practices for reducing ventilator-associated pneumonia (VAP) risk in critically ill adults.
AHRQ-funded; HS024552.
Citation: Boltey E, Yakusheva O, Costa DK .
5 nursing strategies to prevent ventilator-associated pneumonia.
Am Nurse Today 2017 Jun;12(6):42-43..
Keywords: Critical Care, Healthcare-Associated Infections (HAIs), Nursing, Prevention, Pneumonia
Johnson JK, Robinson GL, Pineles LL
Carbapenem MICs in Escherichia coli and Klebsiella species producing extended-spectrum beta-lactamases in critical care patients from 2001 to 2009.
Carbapenem antibiotics are used as a first line of therapy against ESBL-producing Enterobacteriaceae. The researchers examined a cohort of critical care patients for gastrointestinal colonization with carbapenem-resistant ESBL-producing strains (CR-ESBL strains). They found that 10 percent of the isolates were resistant to at least one carbapenem antibiotic.
AHRQ-funded; HS021068.
Citation: Johnson JK, Robinson GL, Pineles LL .
Carbapenem MICs in Escherichia coli and Klebsiella species producing extended-spectrum beta-lactamases in critical care patients from 2001 to 2009.
Antimicrob Agents Chemother 2017 Apr;61(4):e01718-16. doi: 10.1128/aac.01718-16.
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Keywords: Antibiotics, Critical Care, Medication, Intensive Care Unit (ICU)
Corrado MM, Shi J, Wheeler KK
Emergency medical services (EMS) versus non-EMS transport among injured children in the United States.
This study assessed the proportions of injured children transported to trauma centers by different transportation modes and evaluated the effect of transportation mode on inter-facility transfer rates using the US national trauma registry. Over one third of US pediatric trauma patients used non-EMS transport to arrive at trauma centers. Moderate to severely injured children benefit from EMS transport and professional field triage.
AHRQ-funded; HS024263.
Citation: Corrado MM, Shi J, Wheeler KK .
Emergency medical services (EMS) versus non-EMS transport among injured children in the United States.
Am J Emerg Med 2017 Mar;35(3):475-78. doi: 10.1016/j.ajem.2016.11.059.
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Keywords: Emergency Medical Services (EMS), Children/Adolescents, Trauma, Critical Care
Dunn Lopez K, Gephart SM, Raszewski R
Integrative review of clinical decision support for registered nurses in acute care settings.
To report on the state of the science of clinical decision support (CDS) for hospital bedside nurses, the researchers performed an integrative review of qualitative and quantitative peer-reviewed original research studies. They concluded that clinical support systems targeting bedside nurses have positive effects on outcomes and hold promise for improving care quality.
AHRQ-funded; HS022908.
Citation: Dunn Lopez K, Gephart SM, Raszewski R .
Integrative review of clinical decision support for registered nurses in acute care settings.
J Am Med Inform Assoc 2017 Mar 1;24(2):441-50. doi: 10.1093/jamia/ocw084.
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Keywords: Critical Care, Clinical Decision Support (CDS), Health Information Technology (HIT), Nursing, Patient Safety
Hartman ME, Saeed MJ, Bennett T
Readmission and late mortality after critical illness in childhood.
Researchers sought to understand risks for hospital readmission and trends in mortality during the year following ICU discharge. They found that, in multivariate analysis, risk of nonelective readmission for children without cancer was higher with longer index ICU admission length of stay, younger age, and several chronic and acute conditions. Mortality in the year after ICU discharge was low overall.
AHRQ-funded; HS019455.
Citation: Hartman ME, Saeed MJ, Bennett T .
Readmission and late mortality after critical illness in childhood.
Pediatr Crit Care Med 2017 Mar;18(3):e112-e21. doi: 10.1097/pcc.0000000000001062.
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Keywords: Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Mortality, Hospital Readmissions
Moehring RW, Anderson DJ, Cochran RL
Expert consensus on metrics to assess the impact of patient-level antimicrobial stewardship interventions in acute-care settings.
Antimicrobial stewardship programs (ASPs) positively impact patient care, but metrics to assess ASP impact are poorly defined. Researchers used a modified Delphi approach to select relevant metrics for assessing patient-level interventions in acute-care settings for the purposes of internal program decision making. On a 9-point Likert scale, six metrics were rated >6 in all criteria and fourteen metrics rated >6 in all criteria except feasibility.
AHRQ-funded; HS023866.
Citation: Moehring RW, Anderson DJ, Cochran RL .
Expert consensus on metrics to assess the impact of patient-level antimicrobial stewardship interventions in acute-care settings.
Clin Infect Dis 2017 Feb 1;64(3):377-83. doi: 10.1093/cid/ciw787.
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Keywords: Critical Care, Antimicrobial Stewardship, Healthcare-Associated Infections (HAIs), Patient Safety, Prevention
Segall N, Bennett-Guerrero E
ICU rounds: "What we've got here is failure to communicate".
Many of the decisions regarding critical care patients are made during patient rounds—approximately nine per patient— based on the premise that the data that inform the decisions are accurate and complete. The study by Artis et al in this issue challenges this premise. The authors discuss the article, its context and implications.
AHRQ-funded; HS023387.
Citation: Segall N, Bennett-Guerrero E .
ICU rounds: "What we've got here is failure to communicate".
Crit Care Med 2017 Feb;45(2):366-67. doi: 10.1097/ccm.0000000000002125.
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Keywords: Communication, Critical Care, Decision Making, Intensive Care Unit (ICU), Patient Safety
Bunnell KL, Zullo AR, Collins C
Methicillin-resistant staphylococcus aureus pneumonia in critically ill trauma and burn patients: a retrospective cohort study.
The authors sought to determine the incidence of MRSA pneumonia in early-onset and late-onset pneumonia and to identify risk factors for MRSA in the trauma-burn intensive care unit (ICU). They found that the 11.4% overall incidence of MRSA pneumonia in the studied trauma-burn cohort was similar to what has been reported in other trauma populations, although MRSA was equally likely to be identified in early- and late-onset pneumonia. They suggested that risk factors other than duration of hospitalization may be important considerations in the decision to initiate MRSA-active empiric therapy for pneumonia in the trauma-burn ICU.
AHRQ-funded; HS022998.
Citation: Bunnell KL, Zullo AR, Collins C .
Methicillin-resistant staphylococcus aureus pneumonia in critically ill trauma and burn patients: a retrospective cohort study.
Surg Infect 2017 Feb/Mar;18(2):196-201. doi: 10.1089/sur.2016.115.
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Keywords: Critical Care, Healthcare-Associated Infections (HAIs), Injuries and Wounds, Intensive Care Unit (ICU), Methicillin-Resistant Staphylococcus aureus (MRSA)
Scott KW, Orav EJ, Cutler DM
Changes in hospital-physician affiliations in U.S. hospitals and their effect on quality of care.
This study examined changes in U.S. acute care hospitals that reported employment relationships with their physicians and to determine whether quality of care improved after the hospitals switched to this integration model. It concluded that during the past decade, hospitals have increasingly become employers of physicians. The study's findings suggest that physician employment alone probably is not a sufficient tool for improving hospital care.
AHRQ-funded; HS000055.
Citation: Scott KW, Orav EJ, Cutler DM .
Changes in hospital-physician affiliations in U.S. hospitals and their effect on quality of care.
Ann Intern Med 2017 Jan 3;166(1):1-8. doi: 10.7326/m16-0125.
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Keywords: Hospitals, Quality of Care, Critical Care, Workforce
Michelson KA, Bachur RG, Levy JA
The impact of critically ill children on paediatric ED medication timeliness.
The presence of critically ill patients may impact care for other ED patients. The researchers evaluated whether the presence of a critically ill child was associated with the time to (1) receipt of the first medication among other patients, and (2) administration of diagnosis-specific medications. They concluded that the presence of critically ill patients was associated with a delay in medication administration to others.
AHRQ-funded; HS000063.
Citation: Michelson KA, Bachur RG, Levy JA .
The impact of critically ill children on paediatric ED medication timeliness.
Emerg Med J 2017 Jan;34(1):8-12. doi: 10.1136/emermed-2016-205989.
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Keywords: Children/Adolescents, Critical Care, Medication, Emergency Medical Services (EMS), Healthcare Delivery
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
Patrick SW, Kawai AT, Kleinman K
Health care-associated infections among critically ill children in the US, 2007-2012.
The researchers examined trends in central line-associated blood stream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and ventilator-associated pneumonia (VAP) incidence rates between 2007 and 2012 based on standardized surveillance data from pediatric intensive care units (PICUs) and neonatal intensive care units (NICUs) in the United States. They found that incidence rates of CLABSIs and VAPs decreased among critically ill neonates and children during this period.
AHRQ-funded; HS018414.
Citation: Patrick SW, Kawai AT, Kleinman K .
Health care-associated infections among critically ill children in the US, 2007-2012.
Pediatrics 2014 Oct;134(4):705-12. doi: 10.1542/peds.2014-0613..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Urinary Tract Infection (UTI), Critical Care, Children/Adolescents, Healthcare-Associated Infections (HAIs)
Bakullari A, Metersky ML, Wang Y
Racial and ethnic disparities in healthcare-associated infections in the United States, 2009-2011.
This study examined racial and ethnic disparities in the occurrence of healthcare-associated infections (HAIs) in 79,019 Medicare patients hospitalized with acute cardiovascular disease, pneumonia, and major surgery. It found that Asian and Hispanic patients, but not non-Hispanic blacks, had significantly higher rates of HAIs than white non-Hispanic patients.
AHRQ-funded; 290201200003C
Citation: Bakullari A, Metersky ML, Wang Y .
Racial and ethnic disparities in healthcare-associated infections in the United States, 2009-2011.
Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S10-6. doi: 10.1086/677827..
Keywords: Healthcare-Associated Infections (HAIs), Disparities, Racial and Ethnic Minorities, Critical Care, Patient Safety
Brown SE, Rey MM, Pardo D
The allocation of intensivists' rounding time under conditions of intensive care unit capacity strain.
This single-center study of 566 patients provides the first description of how ICU physicians allocate time spent on patient rounds and how this allocation changes as ICUs become strained. Daily rounding time increased with increases in census and admissions, but less time was spent per patient, primarily affecting new admissions and nonblack follow-up patients. Neither patient age, sex, acuity, and severity of illness nor the presence of family on rounds affected the allocation of rounding time.
AHRQ-funded; HS018406
Citation: Brown SE, Rey MM, Pardo D .
The allocation of intensivists' rounding time under conditions of intensive care unit capacity strain.
Am J Respir Crit Care Med. 2014 Oct 1;190(7):831-4. doi: 10.1164/rccm.201406-1127LE..
Keywords: Intensive Care Unit (ICU), Critical Care, Care Coordination
Eckenrode S, Bakullari A, Metersky ML
The association between age, sex, and hospital-acquired infection rates: results from the 2009-2011 National Medicare Patient Safety Monitoring System.
The researchers, using six different measures of hospital-acquired infections (HAIs), analyzed data from a large national sample of patients admitted to the hospital with acute cardiovascular disease, pneumonia, and major surgery to determine to determine age- and sex-related differences in HAI rates. They found that there are no simple ways to focus HAI-prevention efforts based solely on age or sex.
AHRQ-funded; 290201200003C
Citation: Eckenrode S, Bakullari A, Metersky ML .
The association between age, sex, and hospital-acquired infection rates: results from the 2009-2011 National Medicare Patient Safety Monitoring System.
Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S3-9. doi: 10.1086/677831..
Keywords: Healthcare-Associated Infections (HAIs), Patient Safety, Medicare, Critical Care