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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 20 of 20 Research Studies Displayed
Chin DL, Wilson MH, Bang H
Comparing patient outcomes of academician-preceptors, hospitalist-preceptors, and hospitalists on internal medicine services in an academic medical center.
The aim of this study was to compare patient outcomes between hospitalist-preceptors and hospitalists working alone, and between hospitalist-preceptors and academician-preceptors. The researchers found that preceptor-led medicine services were associated with more readmissions within 30 days, shorter lengths of stay, and lower index admission-associated costs. However, they also found that when considering cumulative hospitalization costs, patients discharged by academician-preceptors incurred the highest cost and hospitalist-preceptors incurred the lowest cost.
Citation: Chin DL, Wilson MH, Bang H . Comparing patient outcomes of academician-preceptors, hospitalist-preceptors, and hospitalists on internal medicine services in an academic medical center. J Gen Intern Med 2014 Dec;29(12):1672-8. doi: 10.1007/s11606-014-2982-y.
Keywords: Comparative Effectiveness, Hospital Readmissions, Patient-Centered Outcomes Research, Teams
Khazanie P, Hammill BG, Qualls LG
Clinical effectiveness of cardiac resynchronization therapy versus medical therapy alone among patients with heart failure: analysis of the ICD Registry and ADHERE.
The researchers examined associations between cardiac resynchronization therapy with defibrillator (CRT-D) and mortality and readmission among patients with heart failure who received CRT-D in clinical practice, compared with those who received medical therapy alone. They found that CRT-D was associated with lower risks of mortality and readmission than medical therapy alone.
Citation: Khazanie P, Hammill BG, Qualls LG . Clinical effectiveness of cardiac resynchronization therapy versus medical therapy alone among patients with heart failure: analysis of the ICD Registry and ADHERE. Circ Heart Fail. 2014 Nov;7(6):926-34. doi: 10.1161/circheartfailure.113.000838..
Keywords: Comparative Effectiveness, Heart Disease and Health, Medical Devices, Hospital Readmissions, Outcomes
Thomas KS, Rahman M, Mor V
Influence of hospital and nursing home quality on hospital readmissions.
The authors sought to determine whether the quality of the hospital and of the nursing home (NH) to which a patient was discharged were related to the likelihood of rehospitalization. They found that patients discharged from higher-quality hospitals and patients who received care in higher-quality NHs were less likely to be rehospitalized within 30 days. They concluded that the passage of the Affordable Care Act changed the accountability of hospitals for patients' outcomes after discharge, and that their study highlights the joint accountability of hospitals and NHs for rehospitalization of patients.
Citation: Thomas KS, Rahman M, Mor V . Influence of hospital and nursing home quality on hospital readmissions. Am J Manag Care 2014 Nov;20(11):e523-31.
Keywords: Quality of Care, Hospitals, Nursing Homes, Patient-Centered Outcomes Research, Hospital Readmissions
Zhang Y, Kaplan CM, Baik SH
Medication adherence and readmission after myocardial infarction in the Medicare population.
This study examines the relationship between 6-month medication adherence following a hospitalization for heart attack and a subsequent readmission occurring between 6 and 12 months after the heart attack. It found that the probability of having a preventable readmission 6 to 12 months after a heart attack discharge was much lower for Medicare beneficiaries with good adherence to all heart attack-related medications, compared to those with poor adherence.
Citation: Zhang Y, Kaplan CM, Baik SH . Medication adherence and readmission after myocardial infarction in the Medicare population. Am J Manag Care 2014 Nov; 20(11):e498-505..
Keywords: Heart Disease and Health, Medication, Patient Adherence/Compliance, Hospital Readmissions
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
Curtin CM, Hernandez-Boussard T
Readmissions after treatment of distal radius fractures.
The authors assessed the rates and associated diagnoses of readmissions for patients having received an intervention for treatment of distal radius fracture. Using AHRQ data sets, they found that many distal radius fracture patients return to the health care system for pain-related issues, and they recommended implementation of better pain management.
Citation: Curtin CM, Hernandez-Boussard T . Readmissions after treatment of distal radius fractures. J Hand Surg Am 2014 Oct;39(10):1926-32. doi: 10.1016/j.jhsa.2014.07.041.
Keywords: Injuries and Wounds, Quality of Care, Healthcare Cost and Utilization Project (HCUP), Pain, Hospital Readmissions
Regenstein M, Andres E
Reducing hospital readmissions among Medicaid patients: a review of the literature.
This review aims to identify factors related to readmissions that are unique to Medicaid populations to inform efforts to reduce Medicaid readmissions. It concluded that much of the Medicaid readmissions literature focuses on patients with mental health or substance abuse issues, who are often high utilizers of health care within the Medicaid population.
Citation: Regenstein M, Andres E . Reducing hospital readmissions among Medicaid patients: a review of the literature. Qual Manag Health Care 2014 Oct-Dec;23(4):203-25. doi: 10.1097/qmh.0000000000000043..
Keywords: Hospital Readmissions, Medicaid, Behavioral Health, Substance Abuse, Social Determinants of Health
Lorch SA, Passarella M, Zeigler A
Challenges to measuring variation in readmission rates of neonatal intensive care patients.
The authors examined the viability of a hospital readmission quality metric for infants requiring neonatal intensive care. They found that the California cohort showed significant variation in hospital-level readmission rates, supporting the premise that readmission rates of prematurely born infants may reflect care quality. However, state data did not include term and early term infants requiring neonatal intensive care, and there were extensive missing data in the few states with sufficient information on managed care patients to calculate state-level measures. They concluded that constructing a valid readmission measure for NICU care across diverse states and regions requires improved data collection.
AHRQ-funded; HS018661; HS020508.
Citation: Lorch SA, Passarella M, Zeigler A . Challenges to measuring variation in readmission rates of neonatal intensive care patients. Acad Pediatr 2014 Sep-Oct;14(5 Suppl):S47-53. doi: 10.1016/j.acap.2014.06.010.
Keywords: Neonatal Intensive Care Unit (NICU), Newborns/Infants, Quality Indicators (QIs), Quality Measures, Hospital Readmissions
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.
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.
Keywords: Adverse Events, Hospital Readmissions, Patient Safety, Outcomes, Patient-Centered Outcomes Research, Surgery, Treatments
Nakamura MM, Toomey SL, Zaslavsky AM
Measuring pediatric hospital readmission rates to drive quality improvement.
The investigators sought to describe the importance of readmissions in children and the challenges of developing readmission quality measures. They found that the policy focus on readmissions has motivated widespread efforts by hospitals and outpatient providers to evaluate and reengineer care processes.
AHRQ-funded; HS020513; HS020508.
Citation: Nakamura MM, Toomey SL, Zaslavsky AM . Measuring pediatric hospital readmission rates to drive quality improvement. Acad Pediatr 2014 Sep-Oct;14(5 Suppl):S39-46. doi: 10.1016/j.acap.2014.06.012.
Keywords: Children/Adolescents, Quality Improvement, Quality Indicators (QIs), Quality Measures, Hospital Readmissions
Brown SE, Ratcliffe SJ, Halpern SD
An empirical comparison of key statistical attributes among potential ICU quality indicators.
The researchers assessed the performance of candidate indicators of ICU quality based on face validity, relevance to patients, ability to be measured reliably, sufficient variability to identify poor performers, relative insensitivity to severity adjustment, and the ability to capture what providers do rather than patients' characteristics. They concluded that no indicator performed optimally across assessments and recommended that future research seek to define and operationalize quality in a way that is relevant to both patients and providers.
Citation: Brown SE, Ratcliffe SJ, Halpern SD . An empirical comparison of key statistical attributes among potential ICU quality indicators. Crit Care Med 2014 Aug;42(8):1821-31. doi: 10.1097/ccm.0000000000000334.
Keywords: Quality of Care, Intensive Care Unit (ICU), Patient Safety, Quality Indicators (QIs), Hospital Readmissions
Trudnak T, Kelley D, Zerzan J
AHRQ Author: Jiang HJ
Medicaid admissions and readmissions: understanding the prevalence, payment, and most common diagnoses.
The authors characterized acute care hospital admissions and thirty-day readmissions in the Medicaid population through a retrospective analysis in nineteen states. They found that Medicaid readmissions were both prevalent and costly, and that they represented 12.5 percent of Medicaid payments for all hospitalizations, with the most prevalent diagnostic categories being mental and behavioral disorders and diagnoses related to pregnancy, childbirth, and their complications.
AHRQ-authored; AHRQ-funded; 29020090015C.
Citation: Trudnak T, Kelley D, Zerzan J . Medicaid admissions and readmissions: understanding the prevalence, payment, and most common diagnoses. Health Aff 2014 Aug;33(8):1337-44. doi: 10.1377/hlthaff.2013.0632.
Keywords: Healthcare Costs, Hospitalization, Medicaid, Hospital Readmissions
Schiltz NK, Finkelstein Rosenthal B, Crowley MA
Rehospitalization during the first year of life by insurance status.
The authors assessed the association of insurance status on infant rehospitalization in a population-based setting. They found that Medicaid coverage and being uninsured were strong predictors of rehospitalizations, with Medicaid bearing a disproportionate share of the economic burden. Normal birth weight infants had the lowest risk. They further found that jaundice and acute bronchiolitis were the leading causes of rehospitalization within 30 days and 1 year, respectively.
Citation: Schiltz NK, Finkelstein Rosenthal B, Crowley MA . Rehospitalization during the first year of life by insurance status. Clin Pediatr 2014 Aug;53(9):845-53. doi: 10.1177/0009922814536924.
Keywords: Health Insurance, Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Newborns/Infants, Medicaid, Newborns/Infants
Santos CA, Brennan DC, Fraser VJ
Delayed-onset cytomegalovirus disease coded during hospital readmission after kidney transplantation.
The researchers sought to expand understanding of the scope, risk factors and outcomes associated with delayed-onset cytomegalovirus (CMV) disease among kidney transplant reci
Citation: Santos CA, Brennan DC, Fraser VJ . Delayed-onset cytomegalovirus disease coded during hospital readmission after kidney transplantation. Transplantation. 2014 Jul 27;98(2):187-94. doi: 10.1097/TP.0000000000000030..
Keywords: Transplantation, Hospital Readmissions, Risk, Outcomes
Daiello LA, Gardner R, Epstein-Lubow G
Association of dementia with early rehospitalization among Medicare beneficiaries.
This study examined the question of whether dementia was associated with a greater likelihood of Medicare patients being readmitted to the hospital within 30 days. Using a group of 25,839 hospitalizations, including 3,908 admissions of Me.icare beneficiaries with dementia, it found that those with a dementia diagnosis were more likely (17.8 percent vs. 14.5 percent) to be readmitted within 30 days.
Citation: Daiello LA, Gardner R, Epstein-Lubow G . Association of dementia with early rehospitalization among Medicare beneficiaries. Arch Gerontol Geriatr. 2014 Jul-Aug;59(1):162-8. doi: 10.1016/j.archger.2014.02.010..
Keywords: Medicare, Elderly, Dementia, Hospital Readmissions
Black JT, Romano PS, Sadeghi B
A remote monitoring and telephone nurse coaching intervention to reduce readmissions among patients with heart failure: study protocol for the Better
The objective of this randomized controlled comparative effectiveness study was to evaluate the effectiveness of a care transition intervention that included pre-discharge education about heart failure and post-discharge telephone nurse coaching combined with home telemonitoring of weight, blood pressure, heart rate, and symptoms in reducing all-cause 180-day hospital readmissions for older adults hospitalized with heart failure.
Citation: Black JT, Romano PS, Sadeghi B . A remote monitoring and telephone nurse coaching intervention to reduce readmissions among patients with heart failure: study protocol for the Better Trials 2014 Apr 13;15:124. doi: 10.1186/1745-6215-15-124..
Keywords: Cardiovascular Conditions, Comparative Effectiveness, Health Information Technology (HIT), Heart Disease and Health, Hospital Readmissions, Telehealth, Transitions of Care
Albrecht JS, Gruber-Baldini AL, Hirshon JM
Depressive symptoms and hospital readmission in older adults.
The purpose of this study was to quantify the risk of 30-day unplanned hospital readmission in adults aged 65 and older with depressive symptoms. The investigators concluded that, although not associated with hospital readmission, depressive symptoms were associated with other poor outcomes and may be underdiagnosed in hospitalized older adults. They asserted that hospitals interested in reducing readmission should focus on older adults with more comorbid illness and recent hospitalizations.
Citation: Albrecht JS, Gruber-Baldini AL, Hirshon JM . Depressive symptoms and hospital readmission in older adults. J Am Geriatr Soc 2014 Mar;62(3):495-9. doi: 10.1111/jgs.12686..
Keywords: Depression, Elderly, Emergency Department, Hospital Readmissions, Risk
Ottenbacher KJ, Karmarkar A, Graham JE
Thirty-day hospital readmission following discharge from postacute rehabilitation in fee-for-service Medicare patients.
This study sought to determine 30-day readmission rates and factors related to readmission for patients receiving postacute inpatient rehabilitation. It found that among postacute rehabilitation facilities providing services to Medicare fee-for-service beneficiaries, 30-day readmission rates ranged from 5.8 percent to 18.8 percent for selected impairment groups.
Citation: Ottenbacher KJ, Karmarkar A, Graham JE . Thirty-day hospital readmission following discharge from postacute rehabilitation in fee-for-service Medicare patients. JAMA 2014 Feb 12;311(6):604-14. doi: 10.1001/jama.2014.8..
Keywords: Hospital Readmissions, Medicare, Rehabilitation, Elderly, Quality Indicators (QIs)
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