National Healthcare Quality and Disparities Report
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- Adverse Events (1)
- Cancer (1)
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- Children/Adolescents (1)
- Comparative Effectiveness (2)
- COVID-19 (1)
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- (-) Outcomes (21)
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- Patient-Centered Outcomes Research (5)
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- Quality Indicators (QIs) (1)
- Quality Measures (1)
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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 21 of 21 Research Studies DisplayedSolomon Y, Rastogi V, Marcaccio CL
Outcomes after transcarotid artery revascularization stratified by preprocedural symptom status.
In this study, researchers examined contemporary perioperative outcomes in patients who underwent transcarotid artery revascularization (TCAR) stratified by specific preprocedural symptom status. Using data from the Vascular Quality Initiative, they found that, after TCAR, compared with asymptomatic status, a recent stroke and a recent hemispheric TIA were associated with higher stroke/death rates, whereas a recent ocular TIA was associated with similar stroke/death rates. In addition, a formerly symptomatic status was associated with higher stroke/death rates compared with an asymptomatic status. The researchers concluded that their findings suggested that classifying patients undergoing TCAR as symptomatic versus asymptomatic may be an oversimplification and that patients' specific preoperative neurologic symptoms should instead be used in risk assessment and outcome reporting for TCAR.
AHRQ-funded; HS027285.
Citation: Solomon Y, Rastogi V, Marcaccio CL .
Outcomes after transcarotid artery revascularization stratified by preprocedural symptom status.
J Vasc Surg 2022 Nov;76(5):1307-15.e1. doi: 10.1016/j.jvs.2022.05.024..
Keywords: Cardiovascular Conditions, Surgery, Stroke, Outcomes
Anjorin AC, Marcaccio CL, Patel PB
Racial and ethnic disparities in 3-year outcomes following infrainguinal bypass for chronic limb-threatening ischemia.
This study’s objective was to determine the differences in 3-year outcomes after open infrainguinal bypass for chronic limb-threatening ischemia (CLTI) stratified by race/ethnicity and explored the potential factors contributing to these differences to help determine reasons why outcomes are worse for racial and ethnic minorities. The authors identified all CLTI patients who had undergone primary open infrainguinal bypass in the Vascular Quality Initiative registry from 2003 to 2017 with linkage to Medicare claims through 2018 for the 3-year outcomes. Primary outcomes were the 3-year rates of major amputation, reintervention, and mortality. They also recorded 30-day major adverse limb events (MALE) defined as major amputation or reintervention. Of the 7108 patients with CLTI 79% were non-Hispanic White, 15% were Black, 1% were Asian, and 6% were Hispanic. Compared with White patients, Black patients had higher rates of 3-year major amputation (Black vs White, 32% vs 19%), reintervention (Black vs White, 61% vs 57%), and 30-day MALE (Black vs White, 8.1% vs 4.9%) but lower mortality (Black vs White, 38% vs 42%). Hispanic patients also experienced higher rates of amputation (Hispanic vs White, 27% vs 19%), reintervention (Hispanic vs White, 70% vs 57%), and MALE (Hispanic vs White, 8.7% vs 4.9%). However, mortality was similar between Hispanic vs White groups. A higher presence of comorbidities in Black and Hispanic patients with CLTI is considered the greatest contributing factors to higher amputation and reintervention rates.
AHRQ-funded; HS027285.
Citation: Anjorin AC, Marcaccio CL, Patel PB .
Racial and ethnic disparities in 3-year outcomes following infrainguinal bypass for chronic limb-threatening ischemia.
J Vasc Surg 2022 Nov;76(5):1335-46.e7. doi: 10.1016/j.jvs.2022.06.026..
Keywords: Racial and Ethnic Minorities, Disparities, Outcomes, Surgery, Cardiovascular Conditions
Ko H, Pelt CE, Martin BI
Patient-reported outcomes following cemented versus cementless primary total knee arthroplasty: a comparative analysis based on propensity score matching.
The purpose of this study was to compare baseline and early post-operative global and condition-specific patient reported outcomes (PROs) between patients undergoing cemented versus cementless total knee arthroplasty (TKA). The researchers prospectively collected PROs through the Comparative Effectiveness Pulmonary Embolism Prevention After Hip and Knee Replacement (PEPPER) trial using the short-form of the Knee Injury and Osteoarthritis Outcome Score (KOOS-Jr.), the Patient-Reported Outcomes Measurement Information System Physical Health (PROMIS-PH), and the Numeric Pain Rating Scale (NPRS). Pre- and post-operative outcomes in 5,961 patients undergoing primary TKA between December 2016 and August 2021 were examined. The study found that significant pre to- post-operative were observed in both groups. The researchers concluded that patients with cemented TKA reported early benefit in KOOS-Jr. over those with cementless TKA.
AHRQ-funded; HS024714.
Citation: Ko H, Pelt CE, Martin BI .
Patient-reported outcomes following cemented versus cementless primary total knee arthroplasty: a comparative analysis based on propensity score matching.
BMC Musculoskelet Disord 2022 Oct 27;23(1):934. doi: 10.1186/s12891-022-05899-1..
Keywords: Orthopedics, Surgery, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Graber J, Kittelson A, Juarez-Colunga E
Comparing "people-like-me" and linear mixed model predictions of functional recovery following knee arthroplasty.
This study compared the relative strengths and weaknesses of 2 prediction model approaches for predicting functional recovery after knee arthroplasty: a neighbors-based "people-like-me" (PLM) approach and a linear mixed model (LMM) approach. The authors used 2 distinct datasets to train and then test PLM and LMM prediction approaches. They used the Timed Up and Go (TUG)-a common test of mobility-to operationalize physical function. Both approaches use patient characteristics and baseline postoperative TUG values to predict TUG recovery from days 1-425 following surgery. They then compared the accuracy and precision of the two approaches. A total of 317 patient records with 1379 TUG observations were used to train approaches, and 456 patient records with 1244 TUG observations were used to test the predictions. Both approaches performed similarly in terms of mean squared error and bias, but the PLM approach provided more accurate and precise estimates of prediction uncertainty.
AHRQ-funded; HS025692.
Citation: Graber J, Kittelson A, Juarez-Colunga E .
Comparing "people-like-me" and linear mixed model predictions of functional recovery following knee arthroplasty.
J Am Med Inform Assoc 2022 Oct 7;29(11):1899-907. doi: 10.1093/jamia/ocac123..
Keywords: Orthopedics, Surgery, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Outcomes
Fritz B, King C, Chen Y
Protocol for the perioperative outcome risk assessment with computer learning enhancement (Periop ORACLE) randomized study.
This paper describes a protocol for an ongoing study that hypothesizes that anesthesiology clinicians can predict postoperative complications more accurately with machine learning assistance than without machine learning assistance. This investigation is a sub-study nested within the TECTONICS randomized clinical trial. Study team members who are anesthesiology clinicians working in a telemedicine setting are currently reviewing ongoing surgical cases and documenting how likely they feel the patient is to experience 30-day in-hospital death or acute kidney injury. These case reviews will be randomized to be performed with access to a display showing machine learning predictions for the postoperative complications or without access to the display, and the accuracy of the predictions will be compared across these two groups.
AHRQ-funded; HS024581.
Citation: Fritz B, King C, Chen Y .
Protocol for the perioperative outcome risk assessment with computer learning enhancement (Periop ORACLE) randomized study.
F1000Res 2022; 11:653. doi: 10.12688/f1000research.122286.2..
Keywords: Surgery, Risk, Outcomes, Health Information Technology (HIT)
Taylor K, Diaz A, Nuliyalu U
Association of dual Medicare and Medicaid eligibility with outcomes and spending for cancer surgery in high-quality hospitals.
The purpose of this study was to assess whether treatment at high-quality hospitals mitigates dual-eligibility-associated disparities in outcomes and spending for cancer surgery. Medicare beneficiaries 65 years or older who underwent colectomy, rectal resection, lung resection, or pancreatectomy were evaluated. The findings indicate that, even among the highest-quality hospitals, dual-eligibility patients had poorer outcomes and higher spending. Dually eligible patients were more likely to be discharged to a facility and thus incurred higher post-acute care costs. Although treatment at high-quality hospitals is associated with reduced differences in outcomes, dual-eligibility patients remain at high risk for adverse post-operative outcomes as well as increased readmissions and post-acute care use.
AHRQ-funded; HS024763.
Citation: Taylor K, Diaz A, Nuliyalu U .
Association of dual Medicare and Medicaid eligibility with outcomes and spending for cancer surgery in high-quality hospitals.
JAMA Surg 2022 Apr;157(4):e217586. doi: 10.1001/jamasurg.2021.7586..
Keywords: Cancer, Surgery, Medicare, Medicaid, Outcomes, Hospitals
Kanters AE, Evilsizer SK, Regenbogen SE
Correlation of colorectal surgical skill with patient outcomes: a cautionary tale.
Some have proposed that video-based skill assessments be used as a way to measure technical skills, quality improvement, and credentialing in colorectal surgeons and other practitioners. However, it must first be determined whether video-based assessments can accurately predict patient outcomes. The researchers assembled a panel of 10 peer surgeons to evaluate videos of minimally invasive colectomy procedures submitted by 21 surgeons. Each surgeon submitted one video, and the videos were edited to highlight key steps in the procedure. The panel and the surgeon participants were all associated with the Michigan Surgical Quality Collaborative. The panel used a validated American Society of Colon and Rectal Surgeons assessment instrument to rate the surgeon’s skills. The surgeon’s ratings were then linked to a validated registry of surgical outcomes, and the researchers assessed the relationship between skill level and risk-adjusted complication rates. The researchers found that after risk-adjustment there was no statistically significant difference in complication rates between the bottom (17.5%) and top (16.8%) quartile surgeons (p=0.41). The study concluded that there was no correlation between video-based peer rating of minimally invasive colectomy and postoperative complications among specialty surgeons, and that caution should be used when utilizing video review in credentialing.
AHRQ-funded; HS025365.
Citation: Kanters AE, Evilsizer SK, Regenbogen SE .
Correlation of colorectal surgical skill with patient outcomes: a cautionary tale.
Dis Colon Rectum 2022 Mar;65(3):444-51. doi: 10.1097/dcr.0000000000002124..
Keywords: Surgery, Provider: Physician, Provider Performance, Digestive Disease and Health, Outcomes
Shao CC, McLeod MC, Gleason L
Effect of COVID-19 pandemic restructuring on surgical volume and outcomes of non-COVID patients undergoing surgery.
The authors sought to assess changes in surgical case mix and outcomes due to restructuring during the pandemic. Institutional ACS-NSQIP data was used to identify patients undergoing surgery at a single tertiary care institution in the Deep South. They found that surgeries during the COVID-19 pandemic were more often outpatient without differences in post-operative outcomes. They recommended additional analysis to determine the impact of duration of operative delay on surgical outcomes with restructuring focusing more on outpatient surgeries.
AHRQ-funded; HS013852.
Citation: Shao CC, McLeod MC, Gleason L .
Effect of COVID-19 pandemic restructuring on surgical volume and outcomes of non-COVID patients undergoing surgery.
Am Surg 2022 Mar;88(3):489-97. doi: 10.1177/00031348211054528..
Keywords: COVID-19, Surgery, Public Health, Outcomes
Chhabra KR, Ghaferi AA, Yang J
Relationship between health care spending and clinical outcomes in bariatric surgery: implications for Medicare bundled payments.
This study’s objective was to evaluate sources of 90-day episode spending variation in Medicare patients undergoing bariatric surgery and whether spending variation was related to quality of care. A retrospective analysis of fee-for-service Medicare claims data from 761 acute care hospitals providing inpatient bariatric surgery was conducted between January 1, 2011 and September 30, 2016. Of 64,537 bariatric patients, 46% went sleeve gastrectomy, 22% revisited the emergency department (ED) within 90 days, and 12.5% were readmitted. Average 90-day payments were $14,124, ranging from $12,220 to $16,887. The largest components of spending variation were readmissions (44% of variation), post-acute care (19%), and index professional fees (15%). The lowest spending hospitals had the lowest complication, ED visit, post-acute utilization, and readmission rates.
AHRQ-funded; HS024403; HS023597.
Citation: Chhabra KR, Ghaferi AA, Yang J .
Relationship between health care spending and clinical outcomes in bariatric surgery: implications for Medicare bundled payments.
Ann Surg 2022 Feb;275(2):356-62. doi: 10.1097/sla.0000000000003979..
Keywords: Healthcare Costs, Surgery, Obesity, Outcomes
Shah RK, Stey AM, Jantana KR
Identification of opportunities for quality improvement and outcome measurement in pediatric otolaryngology.
This study evaluated perioperative outcomes in pediatric otolaryngology through analysis of records residing in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (ACS-NSQIP) database. It found that although the overall rate of major postoperative morbidity in pediatric otolaryngology is low, the following areas may be targeted for targeted quality-improvement interventions: tracheostomy, airway reconstruction, mastoidectomy, and abscess drainage.
AHRQ-funded; HS022932
Citation: Shah RK, Stey AM, Jantana KR .
Identification of opportunities for quality improvement and outcome measurement in pediatric otolaryngology.
JAMA Otolaryngol Head Neck Surg. 2014 Nov;140(11):1019-26. doi: 10.1001/jamaoto.2014.2067..
Keywords: Surgery, Children/Adolescents, Quality Improvement, Outcomes, Patient-Centered Outcomes Research
Duffy RP, Adams JE, Callas PW
The influence of gender on functional outcomes of lower extremity bypass.
The researchers aimed to evaluate the effect of gender on early and late procedural and functional outcomes of lower extremity bypass (LEB). They found that women have complication rates similar to men with inferior early and late functional outcomes after LEB. The reduced patency rates in women with critical limb ischemia did not translate into differences in limb salvage.
AHRQ-funded; HS021581.
Citation: Duffy RP, Adams JE, Callas PW .
The influence of gender on functional outcomes of lower extremity bypass.
J Vasc Surg 2014 Nov;60(5):1282-90, 90.e1. doi: 10.1016/j.jvs.2014.05.008.
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Keywords: Cardiovascular Conditions, Outcomes, Sex Factors, Surgery
Goode AP, Richardson WJ, Schectman RM
Complications, revision fusions, readmissions, and utilization over a 1-year period after bone morphogenetic protein use during primary cervical spine fusions.
The authors sought to determine the 1-year risk of complications, cervical revision fusions, hospital readmissions, and health care services utilization after bone morphogenetic protein (BMP) use with cervical spine fusions. They found that patients receiving BMP were 29% more likely to have a complication and a nervous system complication; cervical revision fusions were more likely among patients receiving BMP; the risk of 30-day readmission was greater with BMP use; and readmission occurred 27.4% sooner on an average. Additionally, patients receiving BMP were more likely to receive computed tomography scans and epidurals with anterior surgical approaches.
AHRQ-funded; HS019479.
Citation: Goode AP, Richardson WJ, Schectman RM .
Complications, revision fusions, readmissions, and utilization over a 1-year period after bone morphogenetic protein use during primary cervical spine fusions.
Spine J 2014 Sep;14(9):2051-9. doi: 10.1016/j.spinee.2013.11.042.
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Keywords: Adverse Events, Hospital Readmissions, Patient Safety, Outcomes, Patient-Centered Outcomes Research, Surgery, Treatments
Abdelsattar ZM, Krell RW, Campbell Jr DA
Differences in hospital performance for noncancer vs cancer colorectal surgery.
The researchers investigated the differences in hospital performance for noncancer and cancer colorectal resections at 52 Michigan hospitals. They found that hospital performance ranking in risk-adjusted outcomes (mortality, morbidity, length of stay) after noncancer colorectal resections does not correlate with performance for cancer-related colorectal resections.
AHRQ-funded; HS000053; HS20937
Citation: Abdelsattar ZM, Krell RW, Campbell Jr DA .
Differences in hospital performance for noncancer vs cancer colorectal surgery.
J Am Coll Surg. 2014 Sep;219(3):450-9. doi: 10.1016/j.jamcollsurg.2014.02.034..
Keywords: Outcomes, Surgery, Quality of Care
Huesch MD
The impact of short breaks from cardiac surgery on mortality and stay length in California.
In this small, exploratory study, the researchers sought to investigate potential surgical “forgetting” among cardiac surgeons taking a break from performing isolated coronary artery bypass graft (CABG) surgery in a large state-wide study in California. Patients operated on by surgeons who had not performed isolated CABG in the prior calendar month stayed in hospital 0.5 day longer.
AHRQ-funded; HS021868.
Citation: Huesch MD .
The impact of short breaks from cardiac surgery on mortality and stay length in California.
J Healthc Qual 2014 Sep-Oct;36(5):42-9. doi: 10.1111/jhq.12018..
Keywords: Surgery, Outcomes, Mortality, Risk
Antonescu I, Scott S, Tran TT
Measuring postoperative recovery: what are clinically meaningful differences?
This paper's objective was to generate minimal clinically important difference (MCID) estimates for three postoperative recovery metrics. On the data analyzed, MCIDs were consistently smaller for patients rating their health as "excellent" or "very good" compared with those for patients rating their health as "fair" or "poor." The authors provided MCIDs and ranges around each estimate and recommended that these values be considered when planning and interpreting abdominal surgery clinical trials where patient-reported outcomes are assessed.
AHRQ-funded; HS021857.
Citation: Antonescu I, Scott S, Tran TT .
Measuring postoperative recovery: what are clinically meaningful differences?
Surgery 2014 Aug;156(2):319-27. doi: 10.1016/j.surg.2014.03.005.
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Keywords: Outcomes, Surgery
Maggard-Gibbons M
The use of report cards and outcome measurements to improve the safety of surgical care: the American College of Surgeons National Surgical Quality Improvement Program.
This review summarized the history of American College of Surgeons National Surgical Quality Improvement Project and its components, and described the evidence that feeding outcomes back to providers, along with real-time comparisons with other hospital rates, leads to quality improvement, better patient outcomes, cost savings and overall improved patient safety.
AHRQ-funded; 2902007100621.
Citation: Maggard-Gibbons M .
The use of report cards and outcome measurements to improve the safety of surgical care: the American College of Surgeons National Surgical Quality Improvement Program.
BMJ Qual Saf 2014 Jul;23(7):589-99. doi: 10.1136/bmjqs-2013-002223..
Keywords: Quality Improvement, Quality Indicators (QIs), Quality Measures, Quality of Care, Surgery, Patient Safety, Outcomes, Patient-Centered Outcomes Research, Provider Performance
Cox CL, Huston LJ, Dunn WR
Are articular cartilage lesions and meniscus tears predictive of IKDC, KOOS, and Marx activity level outcomes after anterior cruciate ligament reconstruction? A 6-year multicenter cohort study.
This study of 1,512 ACLR patients who were followed for 6 years found that both articular cartilage injury and meniscus tears/treatment at the time of ACLR were significant predictors of International Knee Documentation Center (IKDC) and Knee injury Osteoarthritis Outcome Score (KOOS) scores after ACLR. Having a grade 4 medial femoral condyle lesion significantly reduced a patient’s Marx activity level score at 6 years.
AHRQ-funded; HS016075
Citation: Cox CL, Huston LJ, Dunn WR .
Are articular cartilage lesions and meniscus tears predictive of IKDC, KOOS, and Marx activity level outcomes after anterior cruciate ligament reconstruction? A 6-year multicenter cohort study.
Am J Sports Med. 2014 May;42(5):1058-67. doi: 10.1177/0363546514525910..
Keywords: Outcomes, Surgery, Risk
Martin BI, Lurie JD, Tosteson AN
Indications for spine surgery: validation of an administrative coding algorithm to classify degenerative diagnoses.
The Spine Patient Outcomes Research Trial (SPORT) provided a unique opportunity to examine the validity of a claims-based algorithm for grouping patients by surgical indication. SPORT enrolled patients for lumbar disc herniation, spinal stenosis, and degenerative spondylolisthesis. The researchers found that their claims-based hierarchical coding algorithm of spine-related medical encounters correctly classified more than 90 percent of Medicare patients into their respective SPORT cohorts.
AHRQ-funded; HS018405
Citation: Martin BI, Lurie JD, Tosteson AN .
Indications for spine surgery: validation of an administrative coding algorithm to classify degenerative diagnoses.
Spine. 2014 Apr 20;39(9):769-79. doi: 10.1097/brs.0000000000000275..
Keywords: Comparative Effectiveness, Surgery, Outcomes, Medicare
Jones WS, Dolor RJ, Hasselblad V
Comparative effectiveness of endovascular and surgical revascularization for patients with peripheral artery disease and critical limb ischemia: systematic review of revascularization in critical limb ischemia.
This systematic review found that there is no difference in clinical outcomes for patients with critical limb ischemia treated with endovascular or surgical revascularization. This review of 23 studies found no differences in overall death, amputation, or amputation-free survival at 2 or more years following treatment.
AHRQ-funded; 290200710066I
Citation: Jones WS, Dolor RJ, Hasselblad V .
Comparative effectiveness of endovascular and surgical revascularization for patients with peripheral artery disease and critical limb ischemia: systematic review of revascularization in critical limb ischemia.
Am Heart J. 2014 Apr;167(4):489-498.e7. doi: 10.1016/j.ahj.2013.12.012..
Keywords: Comparative Effectiveness, Outcomes, Surgery, Mortality
Kim DH, Lin Y, Goytizolo EA
Adductor canal block versus femoral nerve block for total knee arthroplasty: a prospective, randomized, controlled trial.
In a study of pain relief for patients recovering from a total knee arthroplasty, researchers found that adductor canal block (ACB) results in less motor impairment for quadriceps muscles after surgery than femoral nerve block (FNB) and it provides a comparable level of pain relief. The prospective, randomized, controlled study included 46 patients receiving ACB and 47 receiving FNB.
AHRQ-funded; HS021734
Citation: Kim DH, Lin Y, Goytizolo EA .
Adductor canal block versus femoral nerve block for total knee arthroplasty: a prospective, randomized, controlled trial.
Anesthesiology. 2014 Mar;120(3):540-50. doi: 10.1097/ALN.0000000000000119..
Keywords: Medication, Opioids, Outcomes, Pain, Surgery
Dahlke AR, Chung JW, Holl JL
Evaluation of initial participation in public reporting of American College of Surgeons NSQIP surgical outcomes on Medicare's Hospital Compare website.
The objective of this paper was to compare CMS-National Surgical Quality Improvement Program (CMS-NSQIP) participating hospitals with American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) hospitals that elected not to participate in Hospital Compare. The researchers found few measurable differences between CMS-NSQIP participating and nonparticipating hospitals.
AHRQ-funded; HS021857.
Citation: Dahlke AR, Chung JW, Holl JL .
Evaluation of initial participation in public reporting of American College of Surgeons NSQIP surgical outcomes on Medicare's Hospital Compare website.
J Am Coll Surg 2014 Mar;218(3):374-80, 80.e1-5. doi: 10.1016/j.jamcollsurg.2013.11.022.
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Keywords: Hospitals, Outcomes, Public Reporting, Quality Improvement, Surgery