National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Adverse Events (1)
- Alcohol Use (1)
- Antibiotics (2)
- Antimicrobial Stewardship (1)
- Catheter-Associated Urinary Tract Infection (CAUTI) (1)
- Children/Adolescents (4)
- Clinical Decision Support (CDS) (1)
- Clostridium difficile Infections (1)
- (-) Community-Acquired Infections (20)
- Comparative Effectiveness (1)
- Elderly (2)
- Electronic Health Records (EHRs) (1)
- Emergency Department (2)
- Family Health and History (1)
- Healthcare-Associated Infections (HAIs) (3)
- Healthcare Costs (1)
- Home Healthcare (2)
- Hospital Discharge (1)
- Hospitalization (3)
- Hospitals (1)
- Infectious Diseases (11)
- Medication (2)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (5)
- Mortality (1)
- Nursing (1)
- Outcomes (1)
- Patient-Centered Outcomes Research (1)
- Patient Safety (2)
- Pneumonia (7)
- Prevention (2)
- Quality Improvement (1)
- Quality of Care (1)
- Racial and Ethnic Minorities (1)
- Respiratory Conditions (1)
- Risk (4)
- Sepsis (2)
- Shared Decision Making (2)
- Social Determinants of Health (1)
- Stroke (1)
- Substance Abuse (1)
- Urinary Tract Infection (UTI) (3)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 20 of 20 Research Studies DisplayedHaessler S, Lindenauer PK, Zilberberg MD
Blood cultures versus respiratory cultures: 2 different views of pneumonia.
This study examined characteristics and outcomes of patients with positive cultures for pneumonia by site. The authors compared results from blood and respiratory cultures to see if organisms and resistance patterns differed by site. They studied adult patients discharged from July 2010 to June 2015 with principal diagnoses of pneumonia, respiratory failure, acute respiratory distress syndrome, respiratory arrest, or sepsis with a secondary diagnosis of pneumonia. Out of 138,651 hospitalizations of patients with pneumonia, 9.3% yielded positive cultures with 6438 from respiratory culture and 5992 blood cultures, and 45 both respiratory and blood cultures. Isolates from respiratory samples were often more resistant than were isolates from blood. Patients with positive cultures in both sites had higher case-fatality, longer lengths of stay and higher costs than patients who only had one culture site positive. Among respiratory cultures, the most common pathogens identified were Staphylococcus aureus (34%) and Pseudomonas aeruginosa (17%), whereas blood cultures most commonly grew Streptococcus pneumoniae (33%), followed by S. aureus (22%).
AHRQ-funded; HS024277.
Citation: Haessler S, Lindenauer PK, Zilberberg MD .
Blood cultures versus respiratory cultures: 2 different views of pneumonia.
Clin Infect Dis 2020 Oct 23;71(7):1604-12. doi: 10.1093/cid/ciz1049..
Keywords: Pneumonia, Community-Acquired Infections, Respiratory Conditions, Infectious Diseases
Schimmel JJ, Haessler S, Imrey P
Pneumococcal urinary antigen testing in United States hospitals: a missed opportunity for antimicrobial stewardship.
The Infectious Disease Society of America recommends pneumococcal urinary antigen testing (UAT) when identifying pneumococcal infection would allow for antibiotic de-escalation. However, the frequencies of UAT and subsequent antibiotic de-escalation are unknown. The authors conducted this retrospective cohort study of adult patients admitted with community-acquired or healthcare-associated pneumonia to 170 US hospitals in the Premier database from 2010-2015, to describe variation in UAT use, associations of UAT results with antibiotic de-escalation, and associations of de-escalation with outcomes.
AHRQ-funded; HS024277.
Citation: Schimmel JJ, Haessler S, Imrey P .
Pneumococcal urinary antigen testing in United States hospitals: a missed opportunity for antimicrobial stewardship.
Clin Infect Dis 2020 Sep 12;71(6):1427-34. doi: 10.1093/cid/ciz983..
Keywords: Antimicrobial Stewardship, Community-Acquired Infections, Infectious Diseases, Pneumonia
Dowding D, Russell D, Trifilio M
Home care nurses' identification of patients at risk of infection and their risk mitigation strategies: a qualitative interview study.
Investigators sought to understand if and how home care nurses identify patients at high risk of infection and which strategies they use to mitigate that risk. Interviews with fifty nurses were audio recorded and transcribed. Factors identified by the nurses as putting a patient at higher risk of infection included being older, having diabetes, and inadequate nutrition as well as inadequate clinical information available at start of care. The main strategy for infection prevention was patient and caregiver education. Nurses also discussed the importance of their own infection prevention behaviors and the ability to adjust a patient's plan of care according to their infection risk.
AHRQ-funded; HS024723.
Citation: Dowding D, Russell D, Trifilio M .
Home care nurses' identification of patients at risk of infection and their risk mitigation strategies: a qualitative interview study.
Int J Nurs Stud 2020 Jul;107:103617. doi: 10.1016/j.ijnurstu.2020.103617..
Keywords: Home Healthcare, Community-Acquired Infections, Infectious Diseases, Patient Safety, Prevention, Nursing, Shared Decision Making
Hogan PG, Mork RL, Thompson RM
Environmental methicillin-resistant Staphylococcus aureus contamination, persistent colonization, and subsequent skin and soft tissue infection.
This 12-month prospective cohort study examined households contaminated with methicillin-resistant Staphylococcus aureus (MRSA), persistent colonization, and subsequent soft tissue infection (SSTI). Households in St. Louis who had members with community-acquired MRSA SSTI were longitudinally tracked from 2012 to 2015. A baseline visit was conducted at the index patient’s primary home, followed by four quarterly visits over 12 months. With each visit, an interview and serial cultures were collected. Of the 692 participants in 150 households, including 150 children, who completed all 5 samplings; 213 (39%) showed persistent colonization with S. aureus, particularly in the nose. Nine pets (8%) were persistently colonized with S. aureus. Interval SSTI was also associated with MRSA in 76 index patients (53%) and 101 household contacts (19%).
AHRQ-funded; HS021736; HS024269.
Citation: Hogan PG, Mork RL, Thompson RM .
Environmental methicillin-resistant Staphylococcus aureus contamination, persistent colonization, and subsequent skin and soft tissue infection.
JAMA Pediatr 2020 Jun;174(6):552-62. doi: 10.1001/jamapediatrics.2020.0132..
Keywords: Children/Adolescents, Methicillin-Resistant Staphylococcus aureus (MRSA), Community-Acquired Infections
Shang J, Russell D, Dowding D
A predictive risk model for infection-related hospitalization among home healthcare patients.
Infection prevention is a high priority for home healthcare (HHC), but tools are lacking to identify patients at highest risk of developing infections. The purpose of this study was to develop and test a predictive risk model to identify HHC patients at risk of an infection-related hospitalization or emergency department visit. A nonexperimental study using secondary data was conducted.
AHRQ-funded; HS024723.
Citation: Shang J, Russell D, Dowding D .
A predictive risk model for infection-related hospitalization among home healthcare patients.
J Healthc Qual 2020 May/Jun;42(3):136-47. doi: 10.1097/jhq.0000000000000214..
Keywords: Elderly, Home Healthcare, Infectious Diseases, Community-Acquired Infections, Risk, Hospitalization, Emergency Department
Mork RL, Hogan PG, Muenks CE
Longitudinal, strain-specific Staphylococcus aureus introduction and transmission events in households of children with community-associated meticillin-resistant S aureus skin and soft tissue infection: a prospective cohort study.
This prospective cohort study examined methods of transmission for methicillin-resistant Staphylococcus aureus (MRSA) in households with otherwise healthy children who have a MRSA infection. From 2012-2015 households in St. Louis with children who had a community-acquired MRSA skin and soft-tissue infection were longitudinally tracked. Children with other health issues were excluded. A baseline visit was conducted at the index patient’s primary home, followed by four quarterly visits over 12 months. With each visit, an interview and serial cultures were collected. Molecular typing was done of those samples to determine the distinct S aureus strain. MRSA recipients were most likely to live in a rental situation, and were more likely to share a bedroom with a strain-colonised individual. The most likely transmission source was shared bath towels. Pets were often recipients, but rarely the sole transmission source. Frequent handwashing decreased the likelihood of novel strains being introduced into the house and emphasizes the importance of hand hygiene.
AHRQ-funded; HS021736; HS024269
Citation: Mork RL, Hogan PG, Muenks CE .
Longitudinal, strain-specific Staphylococcus aureus introduction and transmission events in households of children with community-associated meticillin-resistant S aureus skin and soft tissue infection: a prospective cohort study.
Lancet Infect Dis 2020 Feb;20(2):188-98. doi: 10.1016/s1473-3099(19)30570-5..
Keywords: Methicillin-Resistant Staphylococcus aureus (MRSA), Infectious Diseases, Community-Acquired Infections, Prevention, Children/Adolescents, Family Health and History
Turner NA, Grambow SC, Woods CW
Epidemiologic trends in Clostridioides difficile infections in a regional community hospital network.
Clostridioides difficile infection (CDI) remains a leading cause of health care facility-associated infection. A greater understanding of the regional epidemiologic profile of CDI could inform targeted prevention strategies. The objectives of this study was to assess trends in incidence of health care facility-associated and community-acquired CDI among hospitalized patients over time and to conduct a subanalysis of trends in the NAP1 strain of CDI over time.
AHRQ-funded; HS023866.
Citation: Turner NA, Grambow SC, Woods CW .
Epidemiologic trends in Clostridioides difficile infections in a regional community hospital network.
JAMA Netw Open 2019 Oct 2;2(10):e1914149. doi: 10.1001/jamanetworkopen.2019.14149..
Keywords: Clostridium difficile Infections, Community-Acquired Infections, Infectious Diseases, Hospitals
Parrish KL, Wylie KM, Reich PJ
Carriage of the toxic shock syndrome toxin gene by contemporary community-associated Staphylococcus aureus isolates.
J Pediatric Infect Dis Soc 2019 Nov 6;8(5):470-73. doi: 10.1093/jpids/piy098.
In this study, the investigators report the prevalence of the tst-1 gene among 252 methicillin-susceptible Staphylococcus aureus (MSSA) isolates and 458 methicillin-resistant S aureus (MRSA) isolates collected from 531 subjects between 2008 and 2017.
In this study, the investigators report the prevalence of the tst-1 gene among 252 methicillin-susceptible Staphylococcus aureus (MSSA) isolates and 458 methicillin-resistant S aureus (MRSA) isolates collected from 531 subjects between 2008 and 2017.
AHRQ-funded; HS024269.
Citation: Parrish KL, Wylie KM, Reich PJ .
Carriage of the toxic shock syndrome toxin gene by contemporary community-associated Staphylococcus aureus isolates.
Carriage of the toxic shock syndrome toxin gene by contemporary community-associated Staphylococcus aureus isolates.
.
.
Keywords: Methicillin-Resistant Staphylococcus aureus (MRSA), Infectious Diseases, Community-Acquired Infections, Sepsis, Patient Safety
Obodozie-Ofoegbu OO, Teng C, Mortensen EM
Antipseudomonal monotherapy or combination therapy for older adults with community-onset pneumonia and multidrug-resistant risk factors: a retrospective cohort study.
Infectious Diseases Society of America guidelines recommend empiric antipseudomonal combination therapy when Pseudomonas is suspected. However, combination antipseudomonal therapy is controversial. This population-based retrospective cohort study compared all-cause 30-day mortality in older patients who received antipseudomonal monotherapy (PMT) or antipseudomonal combination therapy (PCT) for the treatment of community-onset pneumonia. The investigators found that older adults who received combination antipseudomonal therapy for community-onset pneumonia fared worse than those who received monotherapy.
AHRQ-funded; HS022418.
Citation: Obodozie-Ofoegbu OO, Teng C, Mortensen EM .
Antipseudomonal monotherapy or combination therapy for older adults with community-onset pneumonia and multidrug-resistant risk factors: a retrospective cohort study.
Am J Infect Control 2019 Sep;47(9):1053-58. doi: 10.1016/j.ajic.2019.02.018..
Keywords: Antibiotics, Community-Acquired Infections, Elderly, Infectious Diseases, Medication, Pneumonia, Risk
Asti L, Bartsch SM, Umscheid CA
The potential economic value of sputum culture use in patients with community-acquired pneumonia and healthcare-associated pneumonia.
Researchers developed a decision model to determine the economic and clinical value of using sputum cultures in the treatment of community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP) from the hospital perspective under various conditions. They found that, overall, obtaining sputum cultures does not provide significant clinical or economic benefits for CAP or HCAP patients; however, it can reduce costs and shorten overall length of stay under some circumstances. They recommended that clinicians consider their local conditions when making decisions about sputum culture use.
AHRQ-funded; HS023317.
Citation: Asti L, Bartsch SM, Umscheid CA .
The potential economic value of sputum culture use in patients with community-acquired pneumonia and healthcare-associated pneumonia.
Clin Microbiol Infect 2019 Aug;25(8):1038.e1-38.e9. doi: 10.1016/j.cmi.2018.11.031..
Keywords: Pneumonia, Community-Acquired Infections, Healthcare-Associated Infections (HAIs), Infectious Diseases, Healthcare Costs, Clinical Decision Support (CDS), Shared Decision Making
Elman MR, Williams CD, Bearden DT
Healthcare-associated urinary tract infections with onset post hospital discharge.
The objective of this study was to measure the incidence of potentially healthcare-associated (HA), community-onset (CO) urinary tract infection (UTI) in a retrospective cohort of hospitalized patients. Among 3,273 patients at risk for potentially HA-CO UTI, results found that the incidence of HA-CO UTI in the 30 days post discharge was 29.8 per 1,000 patients; independent risk factors included paraplegia, quadriplegia, indwelling catheter during index hospitalization, prior piperacillin-tazobactam prescription, prior penicillin class prescription, and private insurance. The authors conclude that HA-CO UTI may be common within 30 days following hospital discharge, and that their data suggests that surveillance efforts may need to be expanded to capture the full burden to patients and to better inform antibiotic prescribing decisions for patients with a history of hospitalization.
AHRQ-funded; HS020970.
Citation: Elman MR, Williams CD, Bearden DT .
Healthcare-associated urinary tract infections with onset post hospital discharge.
Infect Control Hosp Epidemiol 2019 Aug;40(8):863-71. doi: 10.1017/ice.2019.148..
Keywords: Adverse Events, Catheter-Associated Urinary Tract Infection (CAUTI), Community-Acquired Infections, Healthcare-Associated Infections (HAIs), Hospital Discharge, Hospitalization, Urinary Tract Infection (UTI)
Gupta NM, Lindenauer PK, Yu PC
Association between alcohol use disorders and outcomes of patients hospitalized with community-acquired pneumonia.
The purpose of this study was to compare the causes, treatment, and outcomes of pneumonia in patients with and without alcohol use disorder (AUD). Results suggest that, compared with hospitalized patients with community-acquired pneumonia but without AUD, those with AUD less often harbor resistant organisms. The authors conclude that higher age-adjusted risk of death among patients with AUD appears to be largely attributable to differences in comorbidities, whereas greater use of health care resources may be attributable to alcohol withdrawal.
AHRQ-funded; HS024277; HS025026.
Citation: Gupta NM, Lindenauer PK, Yu PC .
Association between alcohol use disorders and outcomes of patients hospitalized with community-acquired pneumonia.
JAMA Netw Open 2019 Jun 5;2(6):e195172. doi: 10.1001/jamanetworkopen.2019.5172..
Keywords: Alcohol Use, Community-Acquired Infections, Hospitalization, Outcomes, Pneumonia, Substance Abuse
Kempker JA, Panwar B, Judd SE
Plasma 25-hydroxyvitamin d and the longitudinal risk of sepsis in the REGARDS cohort..
In this paper, researchers studied low baseline plasma 25-hydroxyvitamin D (25(OH)D) and its association with long-term risk of sepsis. Data from the Reasons for Geographic and Racial Differences in Stroke study was used. Findings reveals that, among community-dwelling US adults, low plasma 25(OH)D measured at a time of relative health was independently associated with increased risk of sepsis.
AHRQ-funded; HS025240.
Citation: Kempker JA, Panwar B, Judd SE .
Plasma 25-hydroxyvitamin d and the longitudinal risk of sepsis in the REGARDS cohort..
Clin Infect Dis 2019 May 17;68(11):1926-31. doi: 10.1093/cid/ciy794..
Keywords: Community-Acquired Infections, Racial and Ethnic Minorities, Risk, Sepsis, Stroke
Randad PR, Dillen CA, Ortines RV
Comparison of livestock-associated and community-associated Staphylococcus aureus pathogenicity in a mouse model of skin and soft tissue infection.
The goal of this study was to determine the degree to which livestock-associated (LA) Staphylococcus aureus strains contracted by industrial hog-operation (IHO) workers cause disease relative to a representative CA-MRSA strain in a mouse model of skin and soft tissue infection (SSTI). Mice infected with LA-S. aureus strains developed larger lesions with a higher bacterial burden than the CA-MRSA infected mice; the largest lesion size and bacterial burden were observed with a CC398 LA-S. aureus strain which had produced a recurrent SSTI in an IHO worker. The researchers conclude that more attention should be placed on the prevention of spreading LA-S. aureus into human populations.
AHRQ-funded; HS019966.
Citation: Randad PR, Dillen CA, Ortines RV .
Comparison of livestock-associated and community-associated Staphylococcus aureus pathogenicity in a mouse model of skin and soft tissue infection.
Sci Rep 2019 May 1;9(1):6774. doi: 10.1038/s41598-019-42919-y..
Keywords: Community-Acquired Infections, Comparative Effectiveness, Infectious Diseases
Weinstein EJ, Han JH, Lautenbach E
A clinical prediction tool for extended-spectrum cephalosporin resistance in community-onset Enterobacterales urinary tract infection.
Researchers sought to create a clinical prediction tool for community-onset urinary tract infections (UTIs) due to extended-spectrum cephalosporin-resistant (ESC-R) Enterobacterales (EB). Study participants included patients who presented to an emergency department or outpatient practice with an EB UTI; case patients had ESC-R EB UTIs and control patients had ESC-susceptible EB UTIs. The predictive model was develop by performing a multivariable conditional logistic regression. The researchers found after multivariable analysis that presentation with an ESC-R EB community-onset UTI could be predicted by the following factors: history of malignancy, history of diabetes, recent skilled nursing facility or hospital stay, recent trimethoprim-sulfamethoxazole exposure, pyelonephritis at the time of presentation. They conclude that community-onset ESC-R EB UTI can be predicted by using the proposed scoring system, which can be helpful to guide diagnostic and therapeutic interventions.
AHRQ-funded; HS020002.
Citation: Weinstein EJ, Han JH, Lautenbach E .
A clinical prediction tool for extended-spectrum cephalosporin resistance in community-onset Enterobacterales urinary tract infection.
Open Forum Infect Dis 2019 Apr;6(4):ofz164. doi: 10.1093/ofid/ofz164..
Keywords: Community-Acquired Infections, Risk, Urinary Tract Infection (UTI)
Leyenaar JK, Andrews CB, Tyksinski ER
Facilitators of interdepartmental quality improvement: a mixed-methods analysis of a collaborative to improve pediatric community-acquired pneumonia management.
This study examined the relationship between emergency room (ER) physicians and hospital pediatricians in the use of narrow-spectrum antibiotics to treat children hospitalized with pneumonia. There were eight inter-related domains that were identified that contribute to successful quality improvement efforts. These domains include hospital leadership and support; quality improvement champions, and interdepartmental relationships.
AHRQ-funded; HS024133; HS024554.
Citation: Leyenaar JK, Andrews CB, Tyksinski ER .
Facilitators of interdepartmental quality improvement: a mixed-methods analysis of a collaborative to improve pediatric community-acquired pneumonia management.
BMJ Qual Saf 2019 Mar;28(3):215-22. doi: 10.1136/bmjqs-2018-008065..
Keywords: Children/Adolescents, Community-Acquired Infections, Emergency Department, Pneumonia, Quality of Care, Quality Improvement
Hogan PG, Mork RL, Boyle MG
Interplay of personal, pet, and environmental colonization in households affected by community-associated methicillin-resistant Staphylococcus aureus.
In this study, the investigators sought to determine the prevalence, molecular epidemiology, and factors associated with Staphylococcus aureus environmental surface and pet colonization in households of children with community-associated methicillin-resistant S. aureus (CA-MRSA) infection. The investigators found that household environments and pet dogs and cats serve as reservoirs of MRSA. Household member MRSA colonization burden predicts environmental MRSA contamination. The authors indicated that longitudinal studies will inform the directionality of household transmission.
AHRQ-funded; HS021736; HS024269.
Citation: Hogan PG, Mork RL, Boyle MG .
Interplay of personal, pet, and environmental colonization in households affected by community-associated methicillin-resistant Staphylococcus aureus.
J Infect 2019 Mar;78(3):200-07. doi: 10.1016/j.jinf.2018.11.006..
Keywords: Community-Acquired Infections, Infectious Diseases, Methicillin-Resistant Staphylococcus aureus (MRSA)
Immergluck LC, Leong T, Matthews K
Geographic surveillance of community associated MRSA infections in children using electronic health record data.
This study conducted a geographic surveillance of community-associated methicillin resistant Staphylococcus aureas (CA-MRSA) incidence in children from 2000 to 2010 in the Atlanta Metropolitan area. Census tract data was filtered to create maps of antibiotic resistant and non-resistant forms of CA-MRSA infection. Black children and children under the age of 4 were found to have increased risk for CA-MRSA. Poverty also made a difference in the rate of CA-MRSA with neighborhoods with larger households having a higher rate.
AHRQ-funded; HS024338.
Citation: Immergluck LC, Leong T, Matthews K .
Geographic surveillance of community associated MRSA infections in children using electronic health record data.
BMC Infect Dis 2019 Feb 18;19(1):170. doi: 10.1186/s12879-019-3682-3..
Keywords: Children/Adolescents, Community-Acquired Infections, Electronic Health Records (EHRs), Methicillin-Resistant Staphylococcus aureus (MRSA), Social Determinants of Health
Anesi JA, Lautenbach E, Nachamkin I
The role of extended-spectrum cephalosporin-resistance in recurrent community-onset
This study found an association between the use of extended-spectrum cephalosporin-resistance (ESC-R) and recurring Enterobacteriacaea urinary tract infections (EB UTIs). There was a significant increase in emergency room visits within 12 months after the first UTI visit.
AHRQ-funded; HS020002.
Citation: Anesi JA, Lautenbach E, Nachamkin I .
The role of extended-spectrum cephalosporin-resistance in recurrent community-onset
BMC Infect Dis 2019 Feb 14;19(1):163. doi: 10.1186/s12879-019-3804-y..
Keywords: Antibiotics, Community-Acquired Infections, Medication, Urinary Tract Infection (UTI)
Rothberg MB, Haessler S, Lagu T
Outcomes of patients with healthcare-associated pneumonia: worse disease or sicker patients?
The researchers sought to determine the contribution of healthcare-associated pneumonia (HCAP) criteria to case-fatality rate. They found that, after adjustment for differences in patient characteristics, HCAP was associated with greater case-fatality rate than community-acquired pneumonia, possibly due to HCAP organisms or to HCAP criteria themselves.
AHRQ-funded; HS018723.
Citation: Rothberg MB, Haessler S, Lagu T .
Outcomes of patients with healthcare-associated pneumonia: worse disease or sicker patients?
Infect Control Hosp Epidemiol 2014 Oct;35 Suppl 3:S107-15. doi: 10.1086/677829.
.
.
Keywords: Community-Acquired Infections, Healthcare-Associated Infections (HAIs), Mortality, Patient-Centered Outcomes Research, Pneumonia