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
201 to 225 of 2151 Research Studies DisplayedTung EL, Johnson TA, O'Neal Y
Experiences of community violence among adults with chronic conditions: qualitative findings from Chicago.
The purpose of this study was to explore and characterize, using a qualitative study design, self-described experiences of community violence among adults with chronic health conditions. Investigators found that patients often struggled to balance the challenges imposed by community violence with the demands of living with and managing their chronic conditions.
AHRQ-funded; HS023007.
Citation: Tung EL, Johnson TA, O'Neal Y .
Experiences of community violence among adults with chronic conditions: qualitative findings from Chicago.
J Gen Intern Med 2018 Nov;33(11):1913-20. doi: 10.1007/s11606-018-4607-3..
Keywords: Chronic Conditions, Disparities, Social Determinants of Health
Leeds IL, Rosenblum AJ, Wise PE
Eye of the beholder: risk calculators and barriers to adoption in surgical trainees.
This study examined barriers to surgical trainees in using risk calculator tools before surgery. A total of 124 surgical residents responded to a survey and most still favored more traditional methods for risk calculation including direct verbal communication, sketch diagrams, and brochures. Only about half or less were familiar with more contemporary tools such as best-worst case scenario framing, case-specific risk calculators, and all-procedure calculators.
AHRQ-funded; HS024736.
Citation: Leeds IL, Rosenblum AJ, Wise PE .
Eye of the beholder: risk calculators and barriers to adoption in surgical trainees.
Surgery 2018 Nov;164(5):1117-23. doi: 10.1016/j.surg.2018.07.002..
Keywords: Clinical Decision Support (CDS), Decision Making, Education: Continuing Medical Education, Risk, Surgery
Russell D, Dowding DW, McDonald MV
Factors for compliance with infection control practices in home healthcare: findings from a survey of nurses' knowledge and attitudes toward infection control.
This study analyzed survey responses from nurses at 2 large, certified home healthcare agencies to explore levels of compliance with infection control practices and identify associated demographic, knowledge, and attitudinal correlates. The findings suggested that efforts to improve compliance with infection control practices in home healthcare should focus on strategies to alter perceptions about infection risk and other attitudinal factors.
AHRQ-funded; HS024723.
Citation: Russell D, Dowding DW, McDonald MV .
Factors for compliance with infection control practices in home healthcare: findings from a survey of nurses' knowledge and attitudes toward infection control.
Am J Infect Control 2018 Nov;46(11):1211-17. doi: 10.1016/j.ajic.2018.05.005..
Keywords: Healthcare-Associated Infections (HAIs), Home Healthcare, Prevention, Patient Safety
Noureldin M, Hass Z, Abrahamson K
Fall risk, supports and services, and falls following a nursing home discharge.
The purpose of this study was to examine whether the presence of supports and services have an impact on the relationship between fall-related risk factors and fall occurrence following a nursing-home discharge. The study sample was comprised of 1459 participants in the Minnesota Return to Community Initiative, who had been assisted in achieving a community discharge; 15 percent of participants fell within 30 days of nursing-home discharge. A structural equation model was used to determine relationship between emerging latent variables and falls. Results indicated that use of high-risk medications and fall concerns/history had a direct, positive effect on falling. Receiving supports/services did not have a direct effect on falls, but the authors note that it reduced the effect of high-risk medication use on falling.
AHRQ-funded; HS020224.
Citation: Noureldin M, Hass Z, Abrahamson K .
Fall risk, supports and services, and falls following a nursing home discharge.
Gerontologist 2018 Nov 3;58(6):1075-84. doi: 10.1093/geront/gnx133..
Keywords: Adverse Events, Elderly, Falls, Nursing Homes, Risk
Wilmont S, Hessels AJ, Kelly AM
Family experiences and perspectives on infection prevention in pediatric long-term care.
The aims of this qualitative study were to (a) explore perspectives on infection prevention among families visiting children in pediatric long-term care facilities and (b) identify facilitators of and barriers to optimal hand hygiene using semistructured in-depth interviews with 10 family members visiting two New York City metropolitan area facilities.
AHRQ-funded; HS021470.
Citation: Wilmont S, Hessels AJ, Kelly AM .
Family experiences and perspectives on infection prevention in pediatric long-term care.
Children/Adolescents, Healthcare-Associated Infections, Long-term Care, Pediatrics, Prevention Practices.
Keywords: Children/Adolescents, Healthcare-Associated Infections (HAIs), Long-Term Care, Prevention, Patient Safety
Murray KS, Prunty M, Henderson A
Functional status in patients requiring nursing home stay after radical cystectomy.
The objective of this study was to evaluate the ability to perform activities of daily living (ADLs) in patients who required nursing home (NH) care after radical cystectomy (RC), as this surgery can impair patients' ability to perform ADLs in the post-operative period. The investigators found that ADLs, as measured by the Minimum Data Set (MDS)-ADL Long Form score, worsen after RC. They suggest this should be an important part of the risks and benefits conversation with patients, their families, and caregivers.
AHRQ-funded; HS022140.
Citation: Murray KS, Prunty M, Henderson A .
Functional status in patients requiring nursing home stay after radical cystectomy.
Urology 2018 Nov;121:39-43. doi: 10.1016/j.urology.2018.07.030..
Keywords: Cancer, Nursing Homes, Outcomes, Patient-Centered Outcomes Research
Wolf ER, Hochheimer CJ, Sabo RT
Gaps in well-child care attendance among primary care clinics serving low-income families.
This retrospective cohort study of children 0 to 6 years old between 2011 and 2016 within 2 health networks spanning 20 states, sought to determine which specific well-child visits (WCVs) are most frequently missed and whether age-specific patterns of attendance differ by race or insurance type. The investigators found that the 15- and 18-month WCVs as well as the 4-year WCV are the least frequently attended WCVs.
AHRQ-funded; HS024270.
Citation: Wolf ER, Hochheimer CJ, Sabo RT .
Gaps in well-child care attendance among primary care clinics serving low-income families.
Pediatrics 2018 Nov;142(5). doi: 10.1542/peds.2017-4019..
Keywords: Children/Adolescents, Low-Income, Children/Adolescents, Primary Care
Overstreet DS, Penn TM, Cable ST
Higher habitual dietary caffeine consumption is related to lower experimental pain sensitivity in a community-based sample.
The primary objective of this observational study was to determine whether caffeine consumed habitually as part of a daily diet was associated with experimental pain sensitivity using noxious stimuli in a non-clinical sample of 62 community-dwelling adults between 19 and 77 years old. The investigators indicated that results revealed individuals who habitually consume greater amounts of caffeine as part of their daily diets demonstrated diminished sensitivity to painful stimuli in a laboratory setting.
AHRQ-funded; HS013852.
Citation: Overstreet DS, Penn TM, Cable ST .
Higher habitual dietary caffeine consumption is related to lower experimental pain sensitivity in a community-based sample.
Psychopharmacology (Berl) 2018 Nov;235(11):3167-76. doi: 10.1007/s00213-018-5016-3..
Keywords: Nutrition, Pain
Gonzalez CM, Garba RJ, Liguori A
How to make or break implicit bias instruction: implications for curriculum development.
The purpose of this study was to analyze faculty experiences regarding facilitating discussions as part of the institution's curriculum on racial and ethnic implicit bias recognition and management. The investigators conducted 21 in-depth interviews with faculty who had experience teaching in implicit bias instruction or were interested in facilitating discussions related to implicit bias and the Implicit Association Test. Grounded theory methodology was used to analyze interview transcripts.
AHRQ-funded; HS023199.
Citation: Gonzalez CM, Garba RJ, Liguori A .
How to make or break implicit bias instruction: implications for curriculum development.
Sessions):S74-s81. doi: 10.1097/acm.0000000000002386..
Keywords: Education: Continuing Medical Education
Ratwani RM, Savage E, Will A
Identifying electronic health record usability and safety challenges in pediatric settings.
To understand specific usability issues and medication errors in the care of children, the investigators analyzed 9,000 patient safety reports, made in the period 2012-17, from three different health care institutions that were likely related to EHR use. They found: the general pattern of usability challenges and medication errors were the same across the three sites; the most common usability challenges were associated with system feedback and the visual display; and the most common medication error was improper dosing.
AHRQ-funded; HS023701.
Citation: Ratwani RM, Savage E, Will A .
Identifying electronic health record usability and safety challenges in pediatric settings.
Health Aff 2018 Nov;37(11):1752-59. doi: 10.1377/hlthaff.2018.0699..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Medication, Medication: Safety, Patient Safety, Children/Adolescents
Wang A, Pollack T, Kadziel LA
Impact of practice facilitation in primary care on chronic disease care processes and outcomes: a systematic review.
The goal of this systematic review was to evaluate the impact of practice facilitation on chronic disease outcomes in the primary care setting. Researchers extracted and assessed the quality of the data on chronic disease process and clinical outcome measures from U.S. studies that implemented practice facilitation and reported quantifiable care processes and chronic disease outcomes. The results of this evaluation suggest that practice facilitation may improve chronic disease care measures; practices across all studies were aware of practice facilitation. The authors conclude that the results support the potential expansion of practice facilitation in primary care, but that future work will need to investigate potential opportunities to improve chronic disease outcomes in other health care settings.
AHRQ-funded; HS000084.
Citation: Wang A, Pollack T, Kadziel LA .
Impact of practice facilitation in primary care on chronic disease care processes and outcomes: a systematic review.
J Gen Intern Med 2018 Nov;33(11):1968-77. doi: 10.1007/s11606-018-4581-9.
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Keywords: Care Management, Chronic Conditions, Primary Care, Quality of Care, Quality Improvement
Jaime MCD, McCauley HL, Tancredi DJ
Implementing a coach-delivered dating violence prevention program with high school athletes.
This paper describes the implementation of a coach-delivered dating violence prevention program with high school athletes. The program, Coaching Boys Into Men (CBIM), is an evidence-based, athletic coach-delivered dating violence prevention program that has been shown to increase positive bystander behaviors and reduce abuse perpetration among high school male athletes.
AHRQ-funded; HS022236.
Citation: Jaime MCD, McCauley HL, Tancredi DJ .
Implementing a coach-delivered dating violence prevention program with high school athletes.
Prev Sci 2018 Nov;19(8):1113-22. doi: 10.1007/s11121-018-0909-2..
Keywords: Children/Adolescents, Domestic Violence, Education
Misra-Hebert AD, Perzynski A, Rothberg MB
Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system.
This mixed-methods comparative case study examined the implementation of team-based primary care models in a large integrated health system. Field observations of 9 practices were conducted along with 75 interviews and provider and staff surveys. The 9 practices were categorized into 3 groups: high, partial, and low update of the new models. Ability of the practices to implement the new team-based model depended on their ability to adapt to change and to adapt team roles in workflow.
AHRQ-funded; HS024128.
Citation: Misra-Hebert AD, Perzynski A, Rothberg MB .
Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system.
J Gen Intern Med 2018 Nov;33(11):1928-36. doi: 10.1007/s11606-018-4611-7..
Keywords: Case Study, Health Systems, Patient-Centered Healthcare, Primary Care, Primary Care: Models of Care, Teams
Brennan MB, Guihan M, Budiman-Mak E
Increasing SBP variability is associated with an increased risk of developing incident diabetic foot ulcers.
This study evaluated the relationship between increased systolic blood pressure (SBP) variability and risk of incident diabetic foot ulceration using a nested case-control design. The investigators found a graded relationship between SBP variability and risk of diabetic foot ulceration, providing a potential new and modifiable target to reduce this common complication.
AHRQ-funded; HS018542.
Citation: Brennan MB, Guihan M, Budiman-Mak E .
Increasing SBP variability is associated with an increased risk of developing incident diabetic foot ulcers.
J Hypertens 2018 Nov;36(11):2177-84. doi: 10.1097/hjh.0000000000001783..
Keywords: Adverse Events, Diabetes, Risk
Smith ME, Wells EE, Friese CR
Interpersonal and organizational dynamics are key drivers of failure to rescue.
This qualitative study of providers from hospitals with high and low rescue rates identified key factors that providers believe influence the successful rescue of surgical patients. These factors are: teamwork, action taking, psychological safety, recognition of complications, and communication. Providers surveyed agreed on two targets for improvement: delayed recognition of developing complications, and poor interprofessional communication and inability to express clinical concerns. The authors conclude that, to improve perioperative outcomes, hospitals and payers should shift their attention to improving early detection and increasing communication effectiveness when major complications occur.
AHRQ-funded; HS023621; HS024403.
Citation: Smith ME, Wells EE, Friese CR .
Interpersonal and organizational dynamics are key drivers of failure to rescue.
Health Aff 2018 Nov;37(11):1870-76. doi: 10.1377/hlthaff.2018.0704..
Keywords: Adverse Events, Communication, Hospitals, Mortality, Organizational Change, Patient Safety, Surgery
Giardina TD, Haskell H, Menon S
Learning from patients' experiences related to diagnostic errors is essential for progress in patient safety.
Diagnostic error research has largely focused on individual clinicians' decision making and system design, while overlooking information from patients. In this paper, the authors analyzed patient- and family-reported error narratives to explore factors that contribute to diagnostic errors. The authors suggest that health systems should develop and implement formal programs to collect patients' experiences with the diagnostic process and use these data to promote an organizational culture that strives to reduce harm from diagnostic error.
AHRQ-funded; HS022087; HS017820; HS023558.
Citation: Giardina TD, Haskell H, Menon S .
Learning from patients' experiences related to diagnostic errors is essential for progress in patient safety.
Health Aff 2018 Nov;37(11):1821-27. doi: 10.1377/hlthaff.2018.0698..
Keywords: Diagnostic Safety and Quality, Patient Experience, Patient Safety, Quality Improvement
Makam AN, Nguyen OK, Xuan L
Long-term acute care hospital use of non-mechanically ventilated hospitalized older adults.
In this observational cohort study, the investigators sought to determine why non-mechanically ventilated hospitalized older adults are transferred to long-term acute care (LTAC) hospitals rather than remaining in the hospital. The authors found that nearly half of the variation in LTAC use is independent of illness severity and is explained by which hospital and what region the individual was hospitalized in.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Xuan L .
Long-term acute care hospital use of non-mechanically ventilated hospitalized older adults.
J Am Geriatr Soc 2018 Nov;66(11):2112-19. doi: 10.1111/jgs.15564..
Keywords: Elderly, Hospitalization, Long-Term Care, Respiratory Conditions
Bettenhausen JL, Richardson TE, Shah SS
Medicaid expenditures among children with noncomplex chronic diseases.
This study analyzed Medicaid use by children with noncomplex chronic diseases (NC-CDs). The objective was to describe patient characteristics, expenditures, and use patterns. The researchers used the 2014 Truven Medicaid MarketScan Database to analyze claims from 11 states. Mental health conditions accounted for half of the inpatient diagnosis, with the expenditures high as well. One-percent of children with the highest expenditures accounted for 20% of the total Medicaid expenditures.
AHRQ-funded; HS024735.
Citation: Bettenhausen JL, Richardson TE, Shah SS .
Medicaid expenditures among children with noncomplex chronic diseases.
Pediatrics 2018 Nov;142(5). doi: 10.1542/peds.2018-0286..
Keywords: Children/Adolescents, Chronic Conditions, Healthcare Costs, Medicaid
Rice WS, Turan B, White K
Norms and stigma around unintended pregnancy in Alabama: associations with recent contraceptive use and dual method use among young women.
This study investigated the role of unintended pregnancy norms and stigma in contraceptive use among young women in Alabama. A total of 390 women aged 18-24 were surveyed from November 2014 to October 2015 at university and public health clinics. These women were considered at risk for unintended pregnancy and sexually transmitted diseases. Compared to nonusers, users of contraceptives were more likely to be White, nulliparous, from the university and had higher income. Disapproval of unintended pregnancy by close family and friends was associated with greater contraceptive use.
AHRQ-funded; HS013852.
Citation: Rice WS, Turan B, White K .
Norms and stigma around unintended pregnancy in Alabama: associations with recent contraceptive use and dual method use among young women.
Women Health 2018 Nov-Dec;58(10):1151-66. doi: 10.1080/03630242.2017.1414099.
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Keywords: Sexual Health, Pregnancy, Social Stigma, Women, Young Adults
Stolldorf DP, Dietrich MS, Chidume T
Nurse-initiated mobilization practices in 2 community intensive care units: a pilot study.
The purposes of this study were to describe nurse-led mobilization practices in 2 community hospital ICUs and to report differences and similarities between the 2 settings. The investigators found that differences in patient characteristics and nurse-led mobilization activities were observed between ICUs. After controlling for patient characteristics, they found statistically significant differences in nurse-led mobilization activities between the 2 units, suggesting that factors other than patient characteristics may explain differences in nurse-led mobilization practices.
AHRQ-funded; HS025486.
Citation: Stolldorf DP, Dietrich MS, Chidume T .
Nurse-initiated mobilization practices in 2 community intensive care units: a pilot study.
Dimens Crit Care Nurs 2018 Nov/Dec;37(6):318-23. doi: 10.1097/dcc.0000000000000320..
Keywords: Critical Care, Intensive Care Unit (ICU)
Aiken LH, Sloane DM, Barnes H
Nurses' and patients' appraisals show patient safety in hospitals remains a concern.
This study analyzed if there is a positive correlation between improvements of work environments for nurses and improvements in patient safety. A total of 535 hospitals in four large states at two points in time between 2005 and 2016 were studied. Survey data showed an improvement of work environment with 21% of study hospitals, and 7% had worse scores. For the hospitals with improved work environments, patients and nurses both reported high scores for patient safety indicators. For work environments which deteriorated, favorable patient safety grades went down 21%.
AHRQ-funded; HS022406.
Citation: Aiken LH, Sloane DM, Barnes H .
Nurses' and patients' appraisals show patient safety in hospitals remains a concern.
Health Aff 2018 Nov;37(11):1744-51. doi: 10.1377/hlthaff.2018.0711..
Keywords: Burnout, Hospitals, Patient Experience, Patient Safety, Provider: Nurse, Quality of Care, Quality Improvement
Yan C, Rose S, Rothberg M
Patient perspectives on clinical scribes in primary care.
This study surveyed patients in order to quantitatively describe their opinions and perspectives regarding clinical scribes in primary care. A 16-item questionnaire was administered on-site after completion of the patient’s visit. While nearly 70 percent of patients expressed no preference regarding the scribe’s presence during their visit, slightly more were comfortable with a scribe of a different gender. Almost a third preferred the presence of a scribe and all patients reported that they would visit the physician again if the scribe was present. Patients were comfortable discussing most topics in front of the scribe, except sexual history, which the authors conclude has implications for clinical practice. The authors also note that only patients who agreed to a scribe being present during the visit were available for sampling, and that this may lead to selection bias in their findings.
AHRQ-funded; HS024128.
Citation: Yan C, Rose S, Rothberg M .
Patient perspectives on clinical scribes in primary care.
J Gen Intern Med 2018 Nov;33(11):1859-61. doi: 10.1007/s11606-018-4573-9..
Keywords: Patient Experience, Primary Care
Berenson R, Singh H
Payment innovations to improve diagnostic accuracy and reduce diagnostic error.
Researchers examined ways that payment innovations could be used to improve diagnostic accuracy and reduce diagnostic error among Medicare patients. They recommended three different approaches: 1) coding changes in the Medicare Physician Fee schedule; new Alternative Payment Models (APMs) that could improve accuracy in challenging cases and even provide second or third opinions; and 3) have a method that accurate diagnoses would trigger APM payments and establish payment amounts.
AHRQ-funded; HS022087; HS017820.
Citation: Berenson R, Singh H .
Payment innovations to improve diagnostic accuracy and reduce diagnostic error.
Health Aff 2018 Nov;37(11):1828-35. doi: 10.1377/hlthaff.2018.0714..
Keywords: Diagnostic Safety and Quality, Payment, Medical Errors, Medicare, Patient Safety, Quality of Care
Anand V, Carroll AE, Biondich PG
Pediatric decision support using adapted Arden Syntax.
This study reviewed the use of a medical logic module (MLM) called the Arden Syntax in pediatrics. The Arden Syntax was adapted for the Child Health Improvement through Computer Automation System (CHICA) in waiting rooms. This system is used in pediatrician’s offices to screen patient families and alert physicians during office visits. It has been used in 7 pediatric clinics and has served over 44,000 patients in the last decade. The researchers concluded that it is an effective system for use in routine care and only needs some minor modifications.
AHRQ-funded; HS017939; HS018453.
Citation: Anand V, Carroll AE, Biondich PG .
Pediatric decision support using adapted Arden Syntax.
Artif Intell Med 2018 Nov;92:15-23. doi: 10.1016/j.artmed.2015.09.006..
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Health Information Technology (HIT)
Hessels AJ, Murray MT, Cohen B
Perception of patient safety culture in pediatric long-term care settings.
Patient safety culture (PSC) is an emerging construct in adult long-term care settings. No measures are validated to quantify PSC in pediatric long-term care (pLTC) settings despite the importance of safety for this vulnerable population. The objectives of this study were to (1) describe PSC in pLTC; (2) assess the relationship of PSC to facility recommendation and overall safety rating; and (3) test the stability and reliability of the PSC survey over time.
AHRQ-funded; HS021470.
Citation: Hessels AJ, Murray MT, Cohen B .
Perception of patient safety culture in pediatric long-term care settings.
J Healthc Qual 2018 Nov/Dec;40(6):384-91. doi: 10.1097/jhq.0000000000000134..
Keywords: Children/Adolescents, Long-Term Care, Patient Safety, Children/Adolescents