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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 20 of 20 Research Studies DisplayedScott JW, Knowlton LM, Murphy P
Financial toxicity after trauma and acute care surgery: from understanding to action.
The negative impact of major injuries and surgical emergencies on patients’ long-term financial wellbeing is a factor that is often overlooked by clinicians and researchers. The concept of financial toxicity includes the objective financial repercussions of illness and medical care and also subjective financial concerns of patients. The purpose of this review was to 1) provide a conceptual overview of financial toxicity after trauma or emergency surgery, 2) outline what is known about the long-term economic outcomes among trauma and emergency surgery patients, 3) examine the relationship between financial toxicity and long-term physical and mental health outcomes, 4) describe policies and programs that may mitigate financial toxicity, and 5) identify the current knowledge gaps and urgent next steps for clinicians and researchers engaged in this area of work.
AHRQ-funded; HS028672.
Citation: Scott JW, Knowlton LM, Murphy P .
Financial toxicity after trauma and acute care surgery: from understanding to action.
J Trauma Acute Care Surg 2023 Nov 1; 95(5):800-05. doi: 10.1097/ta.0000000000003979..
Keywords: Healthcare Costs, Trauma, Surgery
Held P, Splaine CC, Smith DL
Examining trauma cognition change trajectories among initial PTSD treatment non-optimal responders: a potential avenue to guide subsequent treatment selection.
The purpose of this study was to examine negative post-trauma cognitions (NPCs) change trajectories in individuals who were determined to be non-optimally responsive to intensive PTSD treatment. The researchers utilized a 3-week Cognitive Processing Therapy-based intensive PTSD treatment (ITP) sample of 243 participants. Analyses were replicated in a separate 2-week ITP sample of 215 participants. The study found that in both non-optimal responder samples, two trajectories emerged; a no NPC change group which represented those with an overall lack of NPC change throughout treatment and an NPC change group which represented those with an overall reduction of NPCs occurring primarily later in treatment. Changes in PTSD symptom severity during treatment was the only consistent predictor of NPC change trajectory group membership among treatment non-optimal responders across ITPs.
AHRQ-funded; HS028511.
Citation: Held P, Splaine CC, Smith DL .
Examining trauma cognition change trajectories among initial PTSD treatment non-optimal responders: a potential avenue to guide subsequent treatment selection.
Eur J Psychotraumatol 2023; 14(2):2237361. doi: 10.1080/20008066.2023.2237361..
Keywords: Trauma, Behavioral Health, Stress
Jones EK, Ninkovic I, Bahr M
A novel, evidence-based, comprehensive clinical decision support system improves outcomes for patients with traumatic rib fractures.
This study’s objective to investigate if a traumatic rib fracture clinical decision support system (CDSS) reduced hospital length of stay (LOS), 90-day and 1-year mortality, unplanned ICU transfer, and the need for mechanical ventilation. The CDSS included an admission evidence-based (EB) order set and a pain-inspiratory-cough (PIC) score early warning system (EWS). The CDSS was implemented at 9 US trauma centers, with 3,279 patients meeting inclusion criteria. Hospital LOS pre vs post-intervention was unchanged but unplanned transfer to the ICU was reduced, as was 1-year mortality. Provider utilization was associated with significantly reduced LOS. The EWS triggered on 34.4% of patients; however, it was not associated with a significant reduction in hospital LOS.
AHRQ-funded; HS026379.
Citation: Jones EK, Ninkovic I, Bahr M .
A novel, evidence-based, comprehensive clinical decision support system improves outcomes for patients with traumatic rib fractures.
J Trauma Acute Care Surg 2023 Aug 1; 95(2):161-71. doi: 10.1097/ta.0000000000003866..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Evidence-Based Practice, Injuries and Wounds, Trauma
Nguyen JK, P P
Comparison of survival outcomes among older adults with major trauma after trauma center versus non-trauma center care in the United States.
This study’s objective was to compare level 1 and 2 trauma centers with similarly sized non-trauma centers on survival after major trauma among older adults. The authors used claims of 100% of 2012-2017 Medicare fee-for-service beneficiaries who received hospital care after major trauma. They assessed the roles of prehospital care, hospital quality, and volume. Thirty-day mortality was higher overall at level 1 versus non-trauma centers by 2.2 percentage points (pp). Thirty-day mortality was higher at level 1 versus non-trauma centers by 2.3 pp for falls and 2.3 pp for motor vehicle crashes. Outcomes were similar at level 1 and 2 trauma centers. The difference was not explained by hospital quality and volume. There were also no statistical differences in the ambulance-transported group, after adjusting for prehospital variables.
AHRQ-funded; HS025720.
Citation: Nguyen JK, P P .
Comparison of survival outcomes among older adults with major trauma after trauma center versus non-trauma center care in the United States.
Health Serv Res 2023 Aug; 58(4):817-27. doi: 10.1111/1475-6773.14148..
Keywords: Elderly, Trauma, Outcomes, Injuries and Wounds, Emergency Department, Hospitals
Morrow EL, Mayberry LS, Duff MC
The growing gap: a study of sleep, encoding, and consolidation of new words in chronic traumatic brain injury.
Evidence from neuroscience emphasizes sleep as a crucial support for longitudinal memory and word learning. In numerous lab-based word learning experiments, participants encode and then retrieve new words within the same session. Single session designs are not adequate for capturing the full word learning process. Single session studies also inhibit exploration of the role of behavioral and lifestyle factors such as sleep in supporting longitudinal word learning. Adults with a history of traumatic brain injury (TBI), who experience challenges in the memory systems that support word learning and report related sleep disturbance, provide a unique opportunity to explore linkages between memory, sleep, and word learning. The purpose of this study was to evaluate longitudinal word learning and the influence of sleep on short- and long-term word recall in 50 adults with chronic moderate-severe traumatic brain injury (TBI) and 50 demographically matched neurotypical peers. Participants took part in the study over a two week period in their homes in an attempt to capture the process of real-world word learning and to measure sleep within normal living conditions. The study found that participants with TBI demonstrated a deficit in word learning that started at encoding, continued across time, and increased over the course of the week. The gap in performance between groups was greater at the 1-week post-test than the immediate post-test. Participants with and without TBI recalled more words when they slept after learning.
AHRQ-funded; HS026122.
Citation: Morrow EL, Mayberry LS, Duff MC .
The growing gap: a study of sleep, encoding, and consolidation of new words in chronic traumatic brain injury.
Neuropsychologia 2023 Jun 6; 184:108518. doi: 10.1016/j.neuropsychologia.2023.108518..
Keywords: Brain Injury, Chronic Conditions, Sleep Problems, Trauma
Stonko DP, Weller JH, Gonzalez Salazar AJ
A pilot machine learning study using trauma admission data to identify risk for high length of stay.
The purpose of this study was to design a tool that used only data available at time of admission for trauma to predict prolonged hospital length of stay (LOS). Data was collected from the trauma registry at an urban level-one adult trauma center. Single layer and deep artificial neural networks were trained to identify patients in the top quartile of LOS and optimized under the receiver operator characteristic curve. The results indicated that machine learning can predict which trauma patients will have prolonged LOS with physiologic and demographic data available at the time of admission. The authors concluded these patients may benefit from additional disposition planning resources at the time of admission.
AHRQ-funded; HS026640; HS024547; HS027793.
Citation: Stonko DP, Weller JH, Gonzalez Salazar AJ .
A pilot machine learning study using trauma admission data to identify risk for high length of stay.
Surg Innov 2023 Jun; 30(3):356-65. doi: 10.1177/15533506221139965..
Keywords: Trauma, Hospitalization, Health Information Technology (HIT)
Goldstein E, King C, Crits-Cristoph P
The association between trauma and interpersonal problems in a United States community mental health setting.
Prior studies have established connections between traumatic experiences and issues in interpersonal relationships. The purpose of this study was to explore the influence of trauma on interpersonal difficulties in depressed individuals seeking assistance within a community mental health framework. The study included 453 patients who sought treatment and were screened for a comparative effectiveness analysis of depression therapies. The relationship between the 32-item Inventory of Interpersonal Problems (IIP-32) and trauma indicators was investigated. The study found that a staggering 99.1% of participants had undergone a traumatic event. Notable correlations were identified between the total count of traumas, the number of sexually and physically abusive traumas, and factors such as gender and ethnicity. The number of sexually abusive traumas demonstrated a significant connection to the IIP-32 "excessively nurturing" subscale. After adjusting for demographic variables and other IIP-32 subscales, the overall number of traumas retained a significant association with the IIP-32 "excessively nurturing" category.
AHRQ-funded; HS018440
Citation: Goldstein E, King C, Crits-Cristoph P .
The association between trauma and interpersonal problems in a United States community mental health setting.
J Clin Psychol 2023 Apr;79(4):1192-207. doi: 10.1002/jclp.23467.
Keywords: Trauma, Behavioral Health, Community-Based Practice
Kaufman EJ, Khatri U, Hall EC
Law enforcement in the trauma bay: a survey of members of the American Academy for the Surgery of Trauma.
This study surveyed members of the American Association for the Surgery of Trauma (AAST) to assess their perspectives on frequency, circumstances, and implications of law enforcement officer (LEO) presence in trauma bays nationwide. The survey was distributed electronically to AAST members in September and October 2020, with 234 responding. Of those respondents, 189 (80.7%) were attending surgeons, 169 (72.2%) identified as white, and 144 (61.5%) as male. 187 respondents (79.9%) observed LEO presence at least weekly. Respondents found LEOs helpful for public safety, followed by clinical care, and then for patients. Older respondents rated LEO presence as helpful more often than younger respondents. Respondents assessed severity of the patient's condition, the safety of emergency department staff, the safety of LEOs, and a patient's potential role as a threat to public safety when determining LEO access.
AHRQ-funded; HS026372.
Citation: Kaufman EJ, Khatri U, Hall EC .
Law enforcement in the trauma bay: a survey of members of the American Academy for the Surgery of Trauma.
Trauma Surg Acute Care Open 2023 Mar 13;8(1):e001022. doi: 10.1136/tsaco-2022-001022.
Keywords: Trauma, Emergency Department
Wells KB, Skrine Jeffers K, Mango J
Integration of arts and health sciences in developing an opera on veteran resilience and recovery.
This case study describes development of an opera on veteran resilience and recovery that integrated arts and health sciences. The opera libretto was developed using themes informed from deidentified interviews from 280 adults with a history of depression at 10-year follow-up to a randomized trial. The opera was written using the following key themes: a) resilience in the face of stress; b) post-Vietnam depression or anxiety; c) pathways to recovery; and d) a “collage” of coping strategies. Three main lead characters were developed including a lead veteran, the veteran’s wife, and a second veteran.
AHRQ-funded; HS008349.
Citation: Wells KB, Skrine Jeffers K, Mango J .
Integration of arts and health sciences in developing an opera on veteran resilience and recovery.
Health Promot Pract 2023 Mar; 24(2):207-13. doi: 10.1177/15248399211065402..
Keywords: Social Stigma, Trauma, Behavioral Health
Johnson BN, McKernan L
Co-occurring trauma and non-suicidal self-injury among people with chronic pain: a systematic review.
The authors conducted a systematic review on the intersection of trauma, chronic pain, and non-suicidal self-injury (NSSI). They found that self-harm rates varied across studies, though appeared elevated among patients with chronic pain, and childhood trauma was linked to this co-occurrence. Further, causal links between trauma, NSSI, and pain were proposed, highlighting the need for a comprehensive theoretical model. They recommended assessing for childhood trauma when treating patients with chronic pain and querying regarding NSSI when patients present with indicators of NSSI risk and to treat or refer such patients to specialized treatment.
AHRQ-funded; HS022990.
Citation: Johnson BN, McKernan L .
Co-occurring trauma and non-suicidal self-injury among people with chronic pain: a systematic review.
Curr Pain Headache Rep 2021 Nov 11;25(11):70. doi: 10.1007/s11916-021-00984-x..
Keywords: Trauma, Behavioral Health, Chronic Conditions
Holler E, Meagher AD, Ortiz D
Preinjury functional independence is not associated with discharge location in older trauma patients.
This study’s purpose was to evaluate the association between pre-injury Katz Index of Independence in Activities of Daily Living (Katz ADL) functional status and discharge to a facility in non-neurologically injured trauma patients. Data from 207 subjects in the Trauma Medical Home study cohort was obtained. Patients were predominantly white (89.4%) and female (52.2%). The most common trauma injury was a fall (48.3%), followed by automobile crash (41.1%). There was no relationship between pre-injury independence and the likelihood of discharge home. Over half of patients (51.7%) were discharged home, 37.7% to subacute rehabilitation., 10.1% to acute rehabilitation, and 0.5% to long-term acute care. Patients who self-reported depression and anxiety who weren’t sent home was associated with age, being single, and being female.
AHRQ-funded; HS026390.
Citation: Holler E, Meagher AD, Ortiz D .
Preinjury functional independence is not associated with discharge location in older trauma patients.
J Surg Res 2021 Oct;266:413-20. doi: 10.1016/j.jss.2021.04.029..
Keywords: Elderly, Trauma, Hospital Discharge
Bongiovanni T, Hernandez S, Ledesma Y
Surviving traumatic injury, only to die of acute drug poisoning: should trauma centers be a path for intervention?
This study’s objective was to determine the incidence and characteristics of and risk factors for trauma patients suffering death by unintentional drug overdose. This retrospective chart review was conducted on all admitted trauma patients 18 years or older at the only level-1 trauma center in the San Francisco area from 2012 to 2012, matched with unintentional overdose decedents from the California death registry. Of 9,860 patients residing in San Francisco at the time of their trauma during the study period 1,418 died, 107 (0.3/100 person-years) from unintentional overdose. Overdose decedents were 84% male, 50% white, with a mean age of 48 years. Twenty percent of deaths occurred within 3 months of hospitalization, and 40% were attributed to a prescription opioid.
AHRQ-funded; HS026383; 233201500020I.
Citation: Bongiovanni T, Hernandez S, Ledesma Y .
Surviving traumatic injury, only to die of acute drug poisoning: should trauma centers be a path for intervention?
Surgery 2021 Oct;170(4):1249-54. doi: 10.1016/j.surg.2021.03.003.
AHRQ-funded; HS026383; 233201500020I..
AHRQ-funded; HS026383; 233201500020I..
Keywords: Trauma, Medication, Risk, Mortality
Bradbury KR, Williams C, Leonard S
Emotional aspects of pediatric post-intensive care syndrome following traumatic brain injury.
This study assessed parent-reported emotional functioning in children with traumatic brain injury (TBI) and identified risk factors for emotional sequelae in the acute recovery phase. Results from logistic regression indicated that only elevated parent PTSD symptoms were a significant predictor for child anxiety and depressive symptoms. Anxiety and depressive symptoms were prevalent in the acute recovery phase of TBI. Consistent with previous research, elevations in anxiety and depressive symptoms were more related to psychosocial factors than to injury severity.
AHRQ-funded; HS022981.
Citation: Bradbury KR, Williams C, Leonard S .
Emotional aspects of pediatric post-intensive care syndrome following traumatic brain injury.
J Child Adolesc Trauma 2021 Jun;14(2):177-87. doi: 10.1007/s40653-020-00332-y..
Keywords: Children/Adolescents, Brain Injury, Trauma, Neurological Disorders
Anderson MC, Evans E, Zonfrillo MR
Rural/urban differences in discharge from rehabilitation in older adults with traumatic brain injury.
This study compared differences in outcomes for older adults with traumatic brain injury (TBI) in rural and urban settings by 1) comparing the rates of successful community discharge; and 2) reasons for not achieving successful discharge. This retrospective national cohort study looked at skilled nursing facility (SNF) patients aged 66 and older using Medicare inpatient claims with Minimum Data Set assessments. A total of 11,771 SNFs were identified with a total population of 61,021 Medicare beneficiaries discharged to a SNF following hospitalization for TBI between 2011 and 2015. Patients in rural settings had lower rates of successful discharge compared with patients in urban settings (52.1% vs 58.5%). Reasons for unsuccessful discharge differed between rural and urban settings with rural patients less likely to discharged from SNF within 100 days although they were less likely to be rehospitalized within 30 days of SNF discharge.
AHRQ-funded; HS000011.
Citation: Anderson MC, Evans E, Zonfrillo MR .
Rural/urban differences in discharge from rehabilitation in older adults with traumatic brain injury.
J Am Geriatr Soc 2021 Jun;69(6):1601-08. doi: 10.1111/jgs.17065..
Keywords: Elderly, Brain Injury, Trauma, Rural Health, Urban Health, Rehabilitation, Nursing Homes
Piantino JA, Lin A, Luther M
Simultaneous heart rate variability and electroencephalographic monitoring in children in the emergency department.
This study’s objective was to determine the clinical value of using changes in heart rate variability (HRV) and electroencephalographic (EEG) background in children with acute trauma seen in the Emergency Department (ED) as early predictors of outcome. A novel wireless monitoring device was piloted in 17 patients with 15 patients having EEG data rated as appropriate for clinical interpretation. This was compared to EEG and HRV data successfully collected in 167 subjects. Results showed recording early HRV and EEG is feasible in children with acute injury. This new tool may offer an early, non-invasive marker for injury stratification and prognosis in children.
AHRQ-funded; HS022981.
Citation: Piantino JA, Lin A, Luther M .
Simultaneous heart rate variability and electroencephalographic monitoring in children in the emergency department.
J Child Adolesc Trauma 2021 Jun;14(2):165-75. doi: 10.1007/s40653-020-00313-1..
Keywords: Children/Adolescents, Emergency Department, Trauma, Outcomes
Rosenman ED, Misisco A, Olenick J
Does team leader gender matter? A Bayesian reconciliation of leadership and patient care during trauma resuscitations.
This study assessed and compared team leadership and patient care in trauma resuscitations led by male and female physicians. A secondary analysis of data from a larger randomized controlled trial using video recordings of resuscitations at a Level 1 trauma center from April 2016 to December 2017 was conducted. A total of 60 participants and 120 video observations were included in the analysis. There was a weak positive effect for female leaders for both patient care and team leadership. Gender-based advantages to team leadership and clinical care were not conclusive with the exception of rejecting a strong male advantage to team leadership.
AHRQ-funded; HS022458.
Citation: Rosenman ED, Misisco A, Olenick J .
Does team leader gender matter? A Bayesian reconciliation of leadership and patient care during trauma resuscitations.
J Am Coll Emerg Physicians Open 2021 Feb;2(1):e12348. doi: 10.1002/emp2.12348..
Keywords: Teams, Trauma, Critical Care, Provider: Physician, Provider
Azadani EN, Townsend J, Peng J
The association between traumatic dental and brain injuries in American children.
This study examined the association between dento-alveolar trauma (DAT) and traumatic brain injuries (TBIs) among children ages 0-18 years. The Nationwide Emergency Department Sample (NEDS), an HCUP dataset, was analyzed using ICD-9-CM codes for the 2010-2014 NEDS data. Out of 6,281,658 emergency department (ED) visits, DAT was recorded in 93,408 (1.5%) visits and TBI was recorded in 996,334 (15.9%) visits. Of the DAT-positive encounters, 7.5% had codes associated with TBI. Patients with DAT had 0.20 odds of having TBI compared with patients who did not DAT when all confounding variables were kept constant. Multiple injuries, being involved in motor vehicle crashes, and injuries due to assault were associated with higher odds of concomitant TBI in patients who sustained DAT.
AHRQ-funded; HS24263.
Citation: Azadani EN, Townsend J, Peng J .
The association between traumatic dental and brain injuries in American children.
Dent Traumatol 2021 Feb;37(1):114-22. doi: 10.1111/edt.12611..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department, Trauma, Neurological Disorders, Dental and Oral Health
Cook JM, Newman E
A consensus statement on trauma mental health: the New Haven Competency Conference process and major findings.
The purpose of this article was to state the need for a comprehensive model of trauma-focused, empirically informed competencies for psychiatrists, and describe the work resulting from the New Haven Competencies consensus conference. The 60 participating experts outlined 5 broad foundational and functional competencies in the areas of trauma-focused and trauma-informed scientific knowledge, psychosocial assessment, psychosocial interventions, professionalism, and relational and systems. Eight cross-cutting competencies were voted into the resulting consensus statement.
AHRQ-funded; HS021602.
Citation: Cook JM, Newman E .
A consensus statement on trauma mental health: the New Haven Competency Conference process and major findings.
Psychol Trauma 2014 Jul;6(4):300-07. doi: 10.1037/a0036747..
Keywords: Trauma, Behavioral Health, Evidence-Based Practice, Education: Continuing Medical Education, Training
Cleveland N, Colwell C, Douglass E
Motor vehicle crash severity estimations by physicians and prehospital personnel.
The purpose of this study was to determine whether emergency physicians (EPs) and EMS personnel differ in their assessment of motor vehicle collision severity and the potential for serious injury when viewing crash scene photographs. They found excellent crash and injury agreement at both ends of the severity spectrum but only modest agreement, and therefore greater variability, in the middle of the severity spectrum.
AHRQ-funded; HS017526
Citation: Cleveland N, Colwell C, Douglass E .
Motor vehicle crash severity estimations by physicians and prehospital personnel.
Prehosp Emerg Care. 2014 Jul-Sep;18(3):402-7. doi: 10.3109/10903127.2014.891065..
Keywords: Emergency Medical Services (EMS), Trauma, Injuries and Wounds, Provider: Health Personnel, Diagnostic Safety and Quality
Band RA, Salhi RA, Holena DN
Severity-adjusted mortality in trauma patients transported by police.
Two decades ago, Philadelphia began allowing police transport of patients with penetrating trauma. In this retrospective cohort study, the investigators conduct a large, multiyear, citywide analysis of this policy. They examine the association between mode of out-of-hospital transport (police department versus emergency medical services [EMS]) and mortality among patients with penetrating trauma in Philadelphia.
AHRQ-funded; HS017960.
Citation: Band RA, Salhi RA, Holena DN .
Severity-adjusted mortality in trauma patients transported by police.
Ann Emerg Med 2014 May;63(5):608-14.e3. doi: 10.1016/j.annemergmed.2013.11.008..
Keywords: Injuries and Wounds, Mortality, Patient-Centered Outcomes Research, Trauma