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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 17 of 17 Research Studies Displayed
Topham EW, Bristol A, Luther B
Caregiver inclusion in IDEAL discharge teaching: implications for transitions from hospital to home.
The purpose of this study was to explore perceptions of caregivers regarding their discharge preparation, focusing particular attention on whether and how they believed discharge preparation impacted post-discharge patient outcomes. Through interviews with four English-speaking caregivers, findings showed that, once home, the caregivers reported gaps in their knowledge of how to care for the patient, suggesting key gaps related to knowledge of warning signs and problems. Two of the four caregiver participants attributed a hospital readmission to post-discharge knowledge gaps. This study of caregiver experiences suggests that AHRQ’s IDEAL discharge planning strategy remains a useful and important framework for case managers to follow when providing discharge services.
Citation: Topham EW, Bristol A, Luther B . Caregiver inclusion in IDEAL discharge teaching: implications for transitions from hospital to home. Prof Case Manag 2022 Jul-Aug;27(4):181-93. doi: 10.1097/ncm.0000000000000563..
Keywords: Hospital Discharge, Transitions of Care, Caregiving
Giesler DL, Krein S, Brancaccio A
Reducing overuse of antibiotics at discharge home: a single-center mixed methods pilot study.
This article described a single-center, controlled pilot study of a pharmacist-facilitated antibiotic timeout prior to hospital discharge. The timeout addressed key elements of duration and was designed and implemented using iterative cycles with rapid feedback. The authors evaluated implementation outcomes related to feasibility, including usability, adherence, and acceptability. The pharmacists conducted 288 antibiotic timeouts with a mean duration of 2.5 minutes. Pharmacists recommended an antibiotic change in 25% of timeouts with 70% of recommended changes accepted by hospitalists. Barriers included unanticipated and weekend discharges. There were no differences in antibiotic use after discharge during the intervention compared to control services.
Citation: Giesler DL, Krein S, Brancaccio A . Reducing overuse of antibiotics at discharge home: a single-center mixed methods pilot study. Am J Infect Control 2022 Jul;50(7):777-86. doi: 10.1016/j.ajic.2021.11.016..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Hospital Discharge, Transitions of Care
Vaughn VM, Hersh AL, Spivak ES
Antibiotic overuse and stewardship at hospital discharge: the reducing overuse of antibiotics at discharge home framework.
In this review, the authors discussed what is currently known about antibiotic overuse at hospital discharge, key barriers, and targets for improving antibiotic prescribing at discharge. They introduced an evidence-based framework, the Reducing Overuse of Antibiotics at Discharge Home Framework, for conducting discharge antibiotic stewardship.
Citation: Vaughn VM, Hersh AL, Spivak ES . Antibiotic overuse and stewardship at hospital discharge: the reducing overuse of antibiotics at discharge home framework. Clin Infect Dis 2022 May 3;74(9):1696-702. doi: 10.1093/cid/ciab842..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Hospital Discharge, Hospitals
Sharara SL, Arbaje AI, Cosgrove SE
The voice of the patient: patient roles in antibiotic management at the hospital-to-home transition.
The objective of this study was to characterize tasks required for patient-performed antibiotic medication management (MM) at the hospital-to-home transition, as well as barriers to and strategies for patient-led antibiotic MM. The overall goal was to understand patients' role in managing antibiotics at the hospital-to-home transition. The investigators concluded that there are many opportunities to improve patient-led antibiotic MM at the hospital-to-home transition.
Citation: Sharara SL, Arbaje AI, Cosgrove SE . The voice of the patient: patient roles in antibiotic management at the hospital-to-home transition. J Patient Saf 2022 Apr 1;18(3):e633-e39. doi: 10.1097/pts.0000000000000899..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Hospital Discharge, Transitions of Care, Patient Self-Management
Fierro J, Herrick H, Fregene N
Home pulse oximetry after discharge from a quaternary-care children's hospital: prescriber patterns and perspectives.
Researchers conducted a mixed-methods analysis of pediatric home pulse oximetry orders to determine prescribed alarm parameter limits and recommended interventions. Semi-structured qualitative interviews were conducted with pediatric providers managing patients who received home oxygen and pulse oximetry. Results showed significant variability in home pulse oximetry prescribing practices; provider interviews highlighted the importance of the provider-patient relationship and areas for improvement. The researchers concluded that there is an opportunity to create standardized guidelines that optimize the use of home monitoring devices for patients, families, and pulmonary providers.
Citation: Fierro J, Herrick H, Fregene N . Home pulse oximetry after discharge from a quaternary-care children's hospital: prescriber patterns and perspectives. Pediatr Pulmonol 2022 Jan;57(1):209-16. doi: 10.1002/ppul.25722..
Keywords: Children/Adolescents, Hospital Discharge
Herzig SJ, Anderson TS,, Jung y
Risk factors for opioid-related adverse drug events among older adults after hospital discharge.
This study examined patient- and prescribing-related risk factors for opioid-related adverse drug events (ADEs) after hospital discharge among medical patients. Administrative billing codes and medication claims were used to define potential opioid-related ADEs within 30 days of hospital discharge. Findings showed that potential opioid-related ADEs occurred in 7% of older adults discharged from a medical hospitalization with an opioid prescription. Recommendations included using identified risk factors to inform physician decision-making, having conversations with older adults about risk, and increasing development and targeting of harm reduction strategies.
Citation: Herzig SJ, Anderson TS,, Jung y . Risk factors for opioid-related adverse drug events among older adults after hospital discharge. J Am Geriatr Soc 2022 Jan;70(1):228-34. doi: 10.1111/jgs.17453..
Keywords: Elderly, Opioids, Risk, Adverse Drug Events (ADE), Adverse Events, Medication, Hospital Discharge
Sanger PC, Hartzler A, Han SM
Patient perspectives on post-discharge surgical site infections: towards a patient-centered mobile health solution.
This study explored patient experience of surgical site infections (SSI) and openness to a mobile health (mHealth) wound monitoring ‘‘app’’ as a novel solution to address the problem of patient perceptions about barriers experienced while seeking care for post-discharge SSI. It found that patients are dissatisfied with the current standard post-hospitalization care practice and were accepting of the concept of a patient-centered wound monitoring application.
Citation: Sanger PC, Hartzler A, Han SM . Patient perspectives on post-discharge surgical site infections: towards a patient-centered mobile health solution. PLoS One 2014 Dec;9(12):e114016. doi: 10.1371/journal.pone.0114016..
Keywords: Surgery, Health Information Technology (HIT), Adverse Events, Patient Experience, Hospital Discharge
Sanger P, Hartzler A, Lober WB
Design considerations for post-acute care mHealth: patient perspectives.
The authors are developing an mHealth platform to engage patients in wound tracking to identify and manage surgical site infections (SSI) after hospital discharge. Their key design qualities include: meeting basic accessibility, usability and security needs; encouraging patient-centeredness; facilitating better, more predictable communication; and supporting personalized management by providers. In this article, they illustrated their application of these guiding design considerations and proposed a new framework for mHealth design based on illness duration and intensity.
Citation: Sanger P, Hartzler A, Lober WB . Design considerations for post-acute care mHealth: patient perspectives. AMIA Annu Symp Proc 2014 Nov 14;2014:1920-9.
Keywords: Telehealth, Patient Self-Management, Surgery, Injuries and Wounds, Healthcare-Associated Infections (HAIs), Hospital Discharge, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Adverse Events
Albrecht JS, Gruber-Baldini AL, Hirshon JM
Hospital discharge instructions: comprehension and compliance among older adults.
The purpose of this prospective cohort study was to quantify the prevalence of non-comprehension and non-compliance with discharge instructions and to identify associated patient characteristics. The investigators concluded that non-comprehension of discharge instructions among older adults was prevalent, multi-factorial, and varies by domain.
Citation: Albrecht JS, Gruber-Baldini AL, Hirshon JM . Hospital discharge instructions: comprehension and compliance among older adults. J Gen Intern Med 2014 Nov;29(11):1491-8. doi: 10.1007/s11606-014-2956-0..
Keywords: Elderly, Health Literacy, Hospital Discharge, Patient Adherence/Compliance
Goldman LE, Sarkar U, Kessell E
Support from hospital to home for elders: a randomized trial.
The researchers studied a peridischarge, nurse-led intervention combined with telephone follow-up designed to reduce readmissions among patients who were 55 or older. They found that the nurse-led, in-hospital discharge support intervention did not show a reduction in readmissions or ED visits among 700 diverse, low-income older adults at a safety-net hospital.
Citation: Goldman LE, Sarkar U, Kessell E . Support from hospital to home for elders: a randomized trial. Ann Intern Med 2014 Oct 7;161(7):472-81. doi: 10.7326/m14-0094..
Keywords: Hospital Discharge, Hospital Readmissions, Emergency Department, Elderly, Social Determinants of Health, Nursing
Garfield CF, Lee Y, Kim HN
Paternal and maternal concerns for their very low-birth-weight infants transitioning from the NICU to home.
The authors examined the concerns and coping mechanisms of fathers and mothers of very low-birth-weight neonatal intensive care unit (NICU) infants as they transition to home from the NICU. They found that overriding concerns included pervasive uncertainty, lingering medical concerns, and partner-related adjustment concerns that differed by gender. They concluded that many parental concerns can be addressed with improved discharge information exchanges and anticipatory guidance.
Citation: Garfield CF, Lee Y, Kim HN . Paternal and maternal concerns for their very low-birth-weight infants transitioning from the NICU to home. J Perinat Neonatal Nurs 2014 Oct-Dec;28(4):305-12. doi: 10.1097/jpn.0000000000000021.
Keywords: Care Coordination, Hospital Discharge, Neonatal Intensive Care Unit (NICU), Newborns/Infants, Transitions of Care
Mixon AS, Neal E, Bell S
Care transitions: a leverage point for safe and effective medication use in older adults--a mini-review.
The authors discuss medication adherence in older adults across the continuum of care, describing reasons for nonadherence, methods to assess adherence, and tools to improve adherence, with particular focus on emerging techniques and technologies.
Citation: Mixon AS, Neal E, Bell S . Care transitions: a leverage point for safe and effective medication use in older adults--a mini-review. Gerontology 2015;61(1):32-40. doi: 10.1159/000363765.
Keywords: Elderly, Hospital Discharge, Medication: Safety, Medication, Patient Adherence/Compliance
Gadzinski AJ, Dimick JB, Ye Z
Transfer rates and use of post-acute care after surgery at critical access vs non-critical access hospitals.
This study evaluated discharge practice patterns and use of post-acute care after surgical admissions at critical access hospitals (CAHs). It found that for each of six common surgical procedures, a greater proportion of patients was transferred to another hospital. However, the proportion of patients at CAHs using post-acute care is equal to or less than that of patients treated in non-CAHs.
Citation: Gadzinski AJ, Dimick JB, Ye Z . Transfer rates and use of post-acute care after surgery at critical access vs non-critical access hospitals. JAMA Surg. 2014 Jul;149(7):671-7. doi: 10.1001/jamasurg.2013.5694..
Keywords: Surgery, Critical Care, Hospital Discharge, Quality of Care
Wang CY, Graham JE, Karmarkar AM
FIM motor scores for classifying community discharge after inpatient rehabilitation for hip fracture.
A major goal of this study was to identify which discharge functional independence measure (FIM)--total, motor, or cognition--best discriminates community versus institutional discharges. It found that the FIM motor scale yields the best overall discrimination of patients discharged to the community versus those discharged to an institution after inpatient rehabilitation for hip fracture.
Citation: Wang CY, Graham JE, Karmarkar AM . FIM motor scores for classifying community discharge after inpatient rehabilitation for hip fracture. PM & R : the journal of injury, function, and rehabilitation 2014 Jun;6(6):493-7. doi: 10.1016/j.pmrj.2013.12.008..
Keywords: Hospital Discharge, Rehabilitation, Injuries and Wounds, Elderly
Liao JM, Roy CL, Eibensteiner K
Lost in transition: discrepancies in how physicians perceive the actionability of the results of tests pending at discharge.
Effective communication of pending hospital test results between inpatient and primary care physicians is sometimes challenging or nonexistent. This communication is essential for safe, quality transactions at discharge. Health information technology (such as email and fax) is an effective strategy for improving and reporting test-result management.
Citation: Liao JM, Roy CL, Eibensteiner K . Lost in transition: discrepancies in how physicians perceive the actionability of the results of tests pending at discharge. J Hospital Med. 2014 Jun;9(6):407-9. doi: 10.1002/jhm.2177..
Keywords: Communication, Care Coordination, Health Information Technology (HIT), Hospital Discharge, Patient Safety
Carey K, Lin MY
Hospital length of stay and readmission: an early investigation.
This study is a retrospective examination of the association between length of stay in an index hospitalization and readmission within 7 days and within 30 days of discharge. It found negative associations between length of stay and readmission probability, particularly for heart attack patients; however, the magnitude of the effect was modest for heart attack.
Citation: Carey K, Lin MY . Hospital length of stay and readmission: an early investigation. Med Care Res Rev 2014 Feb;71(1):99-111. doi: 10.1177/1077558713504998..
Keywords: Healthcare Cost and Utilization Project (HCUP), Heart Disease and Health, Hospital Readmissions, Hospitalization, Hospital Discharge
Mitchell SE, Gardiner PM, Sadikova E
Patient activation and 30-day post-discharge hospital utilization.
This study examining the role of patient activation in the rate of hospital readmission within 30 days of discharge found that adult medical patients in an urban academic safety net hospital with lower levels of patient activation had a higher rate of post-discharge 30-day hospital utilization.
Citation: Mitchell SE, Gardiner PM, Sadikova E . Patient activation and 30-day post-discharge hospital utilization. J Gen Intern Med. 2014 Feb;29(2):349-55. doi: 10.1007/s11606-013-2647-2..
Keywords: Emergency Department, Hospital Discharge, Hospital Readmissions, Hospitalization