National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (4)
- Adverse Events (3)
- Antibiotics (1)
- Antimicrobial Stewardship (1)
- Central Line-Associated Bloodstream Infections (CLABSI) (1)
- Chronic Conditions (1)
- Communication (3)
- Comparative Effectiveness (1)
- Data (1)
- Decision Making (1)
- Dementia (5)
- Dental and Oral Health (1)
- Elderly (15)
- Emergency Medical Services (EMS) (1)
- Evidence-Based Practice (1)
- Falls (3)
- Guidelines (1)
- Healthcare-Associated Infections (HAIs) (3)
- Healthcare Costs (3)
- Health Information Technology (HIT) (1)
- Health Insurance (1)
- Home Healthcare (1)
- Hospitalization (3)
- Implementation (1)
- Influenza (1)
- Injuries and Wounds (2)
- Inpatient Care (1)
- Long-Term Care (12)
- Medicaid (2)
- Medicare (7)
- Medication (8)
- Medication: Safety (2)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (1)
- Mortality (1)
- Neurological Disorders (1)
- Nursing (1)
- (-) Nursing Homes (38)
- Nutrition (1)
- Outcomes (2)
- Pain (1)
- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (3)
- Patient Safety (8)
- Payment (2)
- Policy (2)
- Practice Patterns (2)
- Pressure Ulcers (1)
- Prevention (2)
- Provider Performance (2)
- Public Reporting (2)
- Quality Improvement (4)
- Quality Indicators (QIs) (1)
- Quality Measures (2)
- Quality of Care (4)
- Research Methodologies (1)
- Risk (1)
- Surgery (2)
- Tools & Toolkits (1)
- Transitions of Care (2)
- Urinary Tract Infection (UTI) (1)
- Vaccination (1)
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 25 of 38 Research Studies DisplayedLepore M, Leland NE
Nursing homes that increased the proportion of Medicare days saw gains in quality outcomes for long-stay residents.
The authors examined nationwide facility-level nursing home data for the period 2007-2010. They found that increasing the proportion of Medicare-covered patient days in a nursing home was significantly associated with improvements in the quality of daily pain, pressure ulcers, and performing activities of daily living.
AHRQ-funded; HS022907.
Citation: Lepore M, Leland NE .
Nursing homes that increased the proportion of Medicare days saw gains in quality outcomes for long-stay residents.
Health Aff 2015 Dec;34(12):2121-8. doi: 10.1377/hlthaff.2015.0303.
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Keywords: Long-Term Care, Medicare, Nursing Homes, Patient-Centered Outcomes Research, Quality Improvement
Bali V, Chatterjee S, Carnahan RM
Risk of dementia among elderly nursing home patients using paroxetine and other selective serotonin reuptake inhibitors.
This study evaluated the comparative risk of dementia associated with use of paroxetine and other selective serotonin reuptake inhibitors (SSRIs) among elderly nursing home patients. It found that compared with use of other SSRIs, use of paroxetine was not associated with higher risk of dementia among elderly nursing home patients with depression.
AHRQ-funded; HS021264.
Citation: Bali V, Chatterjee S, Carnahan RM .
Risk of dementia among elderly nursing home patients using paroxetine and other selective serotonin reuptake inhibitors.
Psychiatr Serv 2015 Dec;66(12):1333-40. doi: 10.1176/appi.ps.201500011.
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Keywords: Adverse Drug Events (ADE), Dementia, Elderly, Nursing Homes, Medication
Rhodes W, Olsho LE, Ward AS
AHRQ Author: Spector WD
https://link.springer.com/article/10.1007/s10742-015-0138-0
Use of Monte Carlo simulation to inform design decisions for pairwise cluster randomization.
This paper demonstrates the utility of the Monte Carlo approach in the context of a planned evaluation of an intervention to reduce falls among nursing home residents and provides recommendations for researchers on key design questions, including the choice between cluster randomization and pairwise cluster randomization, and selection of parametric or nonparametric estimators.
AHRQ-authored; AHRQ-funded; 290201000031I.
Citation: Rhodes W, Olsho LE, Ward AS .
Use of Monte Carlo simulation to inform design decisions for pairwise cluster randomization.
Health Serv Outcomes Res Method (2015) 15: 182-203. https://doi.org/10.1007/s10742-015-0138-0..
Keywords: Nursing Homes, Research Methodologies, Falls
Simmons SF, Keeler E, An R
Cost-effectiveness of nutrition intervention in long-term care.
The researchers sought to determine the cost-effectiveness of two nutrition interventions on food, beverage, and supplement intake and body weight. They found that oral liquid nutrition supplements and snack offers were efficacious in promoting caloric intake when coupled with assistance to promote consumption and a variety of options, but neither intervention resulted in significant weight gain.
AHRQ-funded; HS018580.
Citation: Simmons SF, Keeler E, An R .
Cost-effectiveness of nutrition intervention in long-term care.
J Am Geriatr Soc 2015 Nov;63(11):2308-16. doi: 10.1111/jgs.13709..
Keywords: Elderly, Long-Term Care, Nursing Homes, Nutrition, Comparative Effectiveness
He D, Konetzka RT
Public reporting and demand rationing: evidence from the nursing home industry.
The authors examined a consequence of public reporting: the potential for demand rationing. They found that high-quality nursing homes facing capacity constraints reduced admissions of less profitable Medicaid residents while increasing the more profitable Medicare and private-pay admissions, relative to low-quality nursing homes facing no capacity constraints.
AHRQ-funded; HS021877.
Citation: He D, Konetzka RT .
Public reporting and demand rationing: evidence from the nursing home industry.
Health Econ 2015 Nov;24(11):1437-51. doi: 10.1002/hec.3097.
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Keywords: Public Reporting, Medicare, Nursing Homes
Rahman M, Keohane L, Trivedi AN
High-cost patients had substantial rates of leaving Medicare Advantage and joining traditional Medicare.
The investigators examined the rates at which participants who used three high-cost services switched between Medicare Advantage and traditional Medicare. They found that the switching rate from 2010 to 2011 away from Medicare Advantage and to traditional Medicare exceeded the switching rate in the opposite direction for participants who used long-term nursing home care, short-term nursing home care, and home health care. These results were magnified among people who were enrolled in both Medicare and Medicaid.
AHRQ-funded; HS000011.
Citation: Rahman M, Keohane L, Trivedi AN .
High-cost patients had substantial rates of leaving Medicare Advantage and joining traditional Medicare.
Health Aff 2015 Oct;34(10):1675-81. doi: 10.1377/hlthaff.2015.0272.
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Keywords: Healthcare Costs, Home Healthcare, Long-Term Care, Medicare, Nursing Homes
Konetzka RT, Brauner DJ, Coca Perraillon M
The role of severe dementia in nursing home report cards.
This article examined the intended and unintended effects of quality reporting for nursing home residents with severe dementia relative to other residents, using a difference-in-differences design to examine selected reported and unreported quality measures. The results indicate that prior to public reporting, nursing home residents with severe dementia were at significantly higher risk of poor outcomes on most reported quality measures.
AHRQ-funded; HS018718.
Citation: Konetzka RT, Brauner DJ, Coca Perraillon M .
The role of severe dementia in nursing home report cards.
Med Care Res Rev 2015 Oct;72(5):562-79. doi: 10.1177/1077558715588436.
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Keywords: Dementia, Nursing Homes, Long-Term Care, Quality Measures
Culley CM, Perera S, Marcum ZA
Using a clinical surveillance system to detect drug-associated hypoglycemia in nursing home residents.
The authors determined whether a clinical surveillance system could be used to detect drug-associated hypoglycemia events and determine their incidence in nursing home (NH) residents. Their evaluation found a high incidence of drug-associated hypoglycemia in a general NH population.
AHRQ-funded; HS018721.
Citation: Culley CM, Perera S, Marcum ZA .
Using a clinical surveillance system to detect drug-associated hypoglycemia in nursing home residents.
J Am Geriatr Soc 2015 Oct;63(10):2125-9. doi: 10.1111/jgs.13648.
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Keywords: Adverse Drug Events (ADE), Elderly, Medication: Safety, Medication, Nursing Homes
Pop-Vicas A, Rahman M, Gozalo PL
Estimating the effect of influenza vaccination on nursing home residents' morbidity and mortality.
This study estimated the effect of influenza vaccination on hospitalization and mortality in nursing home (NH) residents. It found that the association between vaccine match and reduction in overall mortality and pneumonia and influenza hospitalizations was strongest for A/H3N2, the influenza strain typically responsible for the most-severe influenza cases.
AHRQ-funded; HS018462.
Citation: Pop-Vicas A, Rahman M, Gozalo PL .
Estimating the effect of influenza vaccination on nursing home residents' morbidity and mortality.
J Am Geriatr Soc 2015 Sep;63(9):1798-804. doi: 10.1111/jgs.13617..
Keywords: Influenza, Nursing Homes, Vaccination, Hospitalization
Beffa LR, Petroski GF, Kruse RL
Functional status of nursing home residents before and after abdominal aortic aneurysm repair.
The authors evaluated the effects of elective open AAA repair (OAR) and endovascular AAA repair (EVAR) and evaluated comorbidities for their impact on functional trajectories after discharge. They found that procedure type was not significantly related to postoperative function or to the subsequent rate of improvement. OAR and EVAR were associated with similar initial declines and comparable postoperative trajectories, suggesting that less invasive EVAR was not associated with improved functional preservation compared with OAR. Longer stays were associated with poorer functional trajectories.
AHRQ-funded; HS022140.
Citation: Beffa LR, Petroski GF, Kruse RL .
Functional status of nursing home residents before and after abdominal aortic aneurysm repair.
J Vasc Nurs 2015 Sep;33(3):106-11. doi: 10.1016/j.jvn.2015.02.003.
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Keywords: Adverse Events, Elderly, Nursing Homes, Patient-Centered Outcomes Research, Surgery
Crnich CJ, Jump R, Trautner B
Optimizing antibiotic stewardship in nursing homes: a narrative review and recommendations for improvement.
This review summarizes the findings of research on ways to improve antibiotic prescribing practices in nursing homes and presents ways in which antibiotic stewardship can be implemented and optimized in the nursing home setting. It concludes that implementing and sustaining antibiotic stewardship in nursing homes requires an organizational commitment and a strategy based on goal setting.
AHRQ-funded; 290201000018I; 2902010000251; HS022298; HS022465; HS019979; HS022846.
Citation: Crnich CJ, Jump R, Trautner B .
Optimizing antibiotic stewardship in nursing homes: a narrative review and recommendations for improvement.
Drugs Aging 2015 Sep;32(9):699-716. doi: 10.1007/s40266-015-0292-7..
Keywords: Patient Safety, Nursing Homes, Medication
Chopra V, Montoya A, Joshi D
Peripherally inserted central catheter use in skilled nursing facilities: a pilot study.
The purpose of this study was to describe patterns of use, care practices, and outcomes related to peripherally inserted central catheter (PICC) use in skilled nursing facilities (SNFs). The most common indication for PICC use was intravenous antibiotic delivery. The average PICC dwell time was 43 days, and most devices were single-lumen PICCs. Major and minor complications were common and occurred in 11 (20 percent) and 18 (32 percent) participants, respectively.
AHRQ-funded; HS022835; HS019979.
Citation: Chopra V, Montoya A, Joshi D .
Peripherally inserted central catheter use in skilled nursing facilities: a pilot study.
J Am Geriatr Soc 2015 Sep;63(9):1894-9. doi: 10.1111/jgs.13600..
Keywords: Adverse Events, Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Nursing Homes, Patient Safety
Roghmann MC, Johnson JK, Sorkin JD
Transmission of methicillin-resistant Staphylococcus aureus (MRSA) to healthcare worker gowns and gloves during care of nursing home residents.
This study estimated the frequency of methicillin-resistant Staphylococcus aureus (MRSA) transmission to gowns and gloves worn by healthcare workers (HCWs) interacting with nursing home residents to better inform infection prevention policies in this setting. It found that MRSA transmission from MRSA-positive residents to health care worker gown and gloves is substantial; high-contact activities of daily living confer the highest risk.
AHRQ-funded; HS019979.
Citation: Roghmann MC, Johnson JK, Sorkin JD .
Transmission of methicillin-resistant Staphylococcus aureus (MRSA) to healthcare worker gowns and gloves during care of nursing home residents.
Infect Control Hosp Epidemiol 2015 Sep;36(9):1050-7. doi: 10.1017/ice.2015.119..
Keywords: Methicillin-Resistant Staphylococcus aureus (MRSA), Patient Safety, Nursing Homes, Prevention
Leland NE, Gozalo P, Bynum J
What happens to patients when they fracture their hip during a skilled nursing facility stay?
This study characterized outcomes of patients experiencing a fall and subsequent hip fracture while in a nursing home receiving skilled nursing facility (SNF) services. In the first 90 days following hospitalization for surgical repair of the hip fracture, 24.1 percent of patients died, 7.3 percent were discharged to the community but remained fewer than 30 days, and 14.0 percent achieved successful community discharge.
AHRQ-funded; HS000011.
Citation: Leland NE, Gozalo P, Bynum J .
What happens to patients when they fracture their hip during a skilled nursing facility stay?
J Am Med Dir Assoc 2015 Sep;16(9):767-74. doi: 10.1016/j.jamda.2015.03.026..
Keywords: Nursing Homes, Falls, Injuries and Wounds, Outcomes
Mukamel DB, Ye Z, Glance LG
Does mandating nursing home participation in quality reporting make a difference? Evidence from Massachusetts.
This study investigated one of the mechanisms that may detract from the effectiveness of quality report cards: voluntary versus mandatory participation of nursing homes in public quality reporting. It found that once reporting became mandatory, nonvolunteers improved more than volunteers in all but 2 staffing measures.
AHRQ-funded; HS021844.
Citation: Mukamel DB, Ye Z, Glance LG .
Does mandating nursing home participation in quality reporting make a difference? Evidence from Massachusetts.
Med Care 2015 Aug;53(8):713-9. doi: 10.1097/mlr.0000000000000390..
Keywords: Nursing Homes, Long-Term Care, Public Reporting, Provider Performance, Quality Improvement, Quality of Care, Quality Indicators (QIs), Quality Measures, Elderly
Mody L, Crnich C
Effects of excessive antibiotic use in nursing homes.
This research commentary discussed effects of excessive antibiotic use in nursing homes (NH), including Clostridium difficile infection, adverse drug reactions, and an increased risk of colonization and infection with multidrug-resistant organisms. The authors recommended that antibiotic improvement teams tailor their improvement efforts based on a locally generated needs assessment.
AHRQ-funded; HS022465.
Citation: Mody L, Crnich C .
Effects of excessive antibiotic use in nursing homes.
JAMA Intern Med 2015 Aug;175(8):1339-41. doi: 10.1001/jamainternmed.2015.2774.
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Keywords: Adverse Drug Events (ADE), Antibiotics, Practice Patterns, Nursing Homes, Healthcare-Associated Infections (HAIs)
Grebla RC, Keohane L, Lee Y
Waiving the three-day rule: admissions and length-of-stay at hospitals and skilled nursing facilities did not increase.
The authors compared hospital and postacute skilled nursing facility utilization among Medicare Advantage enrollees in matched plans that did or did not eliminate that requirement in 2006-10. Among hospitalized enrollees with a skilled nursing facility admission, the mean hospital length-of-stay declined for those no longer subject to the qualifying stay but increased among those still subject to it. The elimination of the three-day-stay requirement was not associated with more hospital or skilled nursing facility admissions or with longer lengths-of-stay in a skilled nursing facility.
AHRQ-funded; HS000011.
Citation: Grebla RC, Keohane L, Lee Y .
Waiving the three-day rule: admissions and length-of-stay at hospitals and skilled nursing facilities did not increase.
Health Aff 2015 Aug;34(8):1324-30. doi: 10.1377/hlthaff.2015.0054.
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Keywords: Elderly, Hospitalization, Long-Term Care, Nursing Homes, Patient-Centered Outcomes Research
Tjia J, Field T, Mazor K
Dissemination of evidence-based antipsychotic prescribing guidelines to nursing homes: a cluster randomized trial.
This study evaluated the effectiveness of efforts to translate and disseminate evidence-based guidelines about atypical antipsychotic use to nursing homes (NHs). It found that RE-AIM indicators suggest some success in disseminating the toolkit and differences in reach, adoption, and implementation according to dissemination strategy but no measurable effect on antipsychotic prescribing trends.
AHRQ-funded; HS019351.
Citation: Tjia J, Field T, Mazor K .
Dissemination of evidence-based antipsychotic prescribing guidelines to nursing homes: a cluster randomized trial.
J Am Geriatr Soc 2015 Jul;63(7):1289-98. doi: 10.1111/jgs.13488..
Keywords: Communication, Evidence-Based Practice, Guidelines, Long-Term Care, Medication, Nursing Homes, Practice Patterns, Tools & Toolkits, Implementation
Mody L, Meddings J, Edson BS
Enhancing resident safety by preventing healthcare-associated infection: a national initiative to reduce catheter-associated urinary tract infections in nursing homes.
The authors describe a new initiative based on lessons learned from a recent multimodal Targeted Infection Prevention program in a group of nursing homes as well as a national initiative to prevent catheter-associated urinary tract infections in over 950 acute care hospitals. This initiative will now be implemented in nearly 500 nursing homes through a project funded by AHRQ. It will emphasize professional development in catheter utilization, catheter care and maintenance, and antimicrobial stewardship.
AHRQ-funded; 2902010000251; HS019979; HS019767.
Citation: Mody L, Meddings J, Edson BS .
Enhancing resident safety by preventing healthcare-associated infection: a national initiative to reduce catheter-associated urinary tract infections in nursing homes.
Clin Infect Dis 2015 Jul 1;61(1):86-94. doi: 10.1093/cid/civ236..
Keywords: Nursing Homes, Healthcare-Associated Infections (HAIs), Urinary Tract Infection (UTI), Patient Safety, Inpatient Care
Abrahamson K, DeCrane S, Mueller C
Implementation of a nursing home quality improvement project to reduce resident pain: a qualitative case study.
This article describes the experiences of staff members working within nursing homes that successfully implemented a quality improvement project aimed at reducing resident pain. Findings from the interviews were organized using the Consolidated Framework for Implementation Research. Interdisciplinary communication, supportive leadership, training, and nursing assistant participation facilitated implementation. Increased documentation, resistance to change, and difficulty measuring outcomes were perceived challenges.
AHRQ-funded; HS018464.
Citation: Abrahamson K, DeCrane S, Mueller C .
Implementation of a nursing home quality improvement project to reduce resident pain: a qualitative case study.
J Nurs Care Qual 2015 Jul-Sep;30(3):261-8. doi: 10.1097/ncq.0000000000000099..
Keywords: Nursing Homes, Quality Improvement, Pain, Chronic Conditions
Alexander GL
Nurse assistant communication strategies about pressure ulcers in nursing homes.
The author explored strategies nursing assistants use to communicate pressure ulcer prevention practices in nursing homes with variable information technology sophistication measures. Three major themes emerged: Passing on Information, Keeping Track of Needs, and Information Access.
AHRQ-funded; HS016862.
Citation: Alexander GL .
Nurse assistant communication strategies about pressure ulcers in nursing homes.
West J Nurs Res 2015 Jul;37(7):984-1004. doi: 10.1177/0193945914555201.
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Keywords: Communication, Health Information Technology (HIT), Nursing Homes, Pressure Ulcers, Prevention
Wysocki A, Thomas KS, Mor V
Functional improvement among short-stay nursing home residents in the MDS 3.0.
This study examined the completeness of the activities of daily living (ADL) items on admission and discharge assessments and the improvement in ADL performance among short-stay residents in the newly adopted Minimum Data Set (MDS) 3.0. It found that the ADL self-performance items are complete at both admission and discharge, with less than 1 percent missing for any item.
AHRQ-funded; HS000011.
Citation: Wysocki A, Thomas KS, Mor V .
Functional improvement among short-stay nursing home residents in the MDS 3.0.
J Am Med Dir Assoc 2015 Jun;16(6):470-4. doi: 10.1016/j.jamda.2014.11.018..
Keywords: Nursing Homes, Elderly, Data
Keohane LM, Grebla RC, Mor V
Medicare Advantage members' expected out-of-pocket spending for inpatient and skilled nursing facility services.
In 2011, new federal regulations restricted inpatient and skilled nursing facility cost sharing and mandated limits on out-of-pocket spending in Medicare Advantage (MA) plans. The authors found that some MA beneficiaries may still have difficulty affording acute and postacute care despite greater regulation of cost sharing.
AHRQ-funded; HS000011.
Citation: Keohane LM, Grebla RC, Mor V .
Medicare Advantage members' expected out-of-pocket spending for inpatient and skilled nursing facility services.
Health Aff 2015 Jun;34(6):1019-27. doi: 10.1377/hlthaff.2014.1146.
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Keywords: Healthcare Costs, Hospitalization, Policy, Medicare, Nursing Homes
Marcum ZA, Hardy SE
Medication management skills in older skilled nursing facility residents transitioning home.
The objective of this pilot study was to describe potential medication management deficiencies of older SNF residents transitioning home. It found that medication management deficiencies were found to be common in a high-risk group of elderly adults making this important transition.
AHRQ-funded; HS020831.
Citation: Marcum ZA, Hardy SE .
Medication management skills in older skilled nursing facility residents transitioning home.
J Am Geriatr Soc 2015 Jun;63(6):1266-8. doi: 10.1111/jgs.13469..
Keywords: Patient Safety, Nursing Homes, Elderly, Medication, Transitions of Care
Daly JM, Bay CP, Levy BT
Caring for people with dementia and challenging behaviors in nursing homes: a needs assessment geriatric nursing.
The authors conducted a needs assessment of directors of nursing (DON) in Iowa nursing homes in relation to caring for patients with Behavioral and Psychological Symptoms of Dementia. They found that facilities with a larger proportion of patients with challenging behaviors being treated with non-drug approaches instead of antipsychotics had DONs who were more likely to be confident in non-drug management strategies and have knowledge about the FDA antipsychotic medications risks.
AHRQ-funded; HS019355.
Citation: Daly JM, Bay CP, Levy BT .
Caring for people with dementia and challenging behaviors in nursing homes: a needs assessment geriatric nursing.
Geriatr Nurs 2015 May-Jun;36(3):182-91. doi: 10.1016/j.gerinurse.2015.01.001.
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Keywords: Elderly, Dementia, Nursing Homes, Long-Term Care, Nursing