National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Events (2)
- Antibiotics (1)
- Behavioral Health (1)
- Cancer (1)
- Children/Adolescents (4)
- Communication (2)
- Critical Care (5)
- Decision Making (1)
- Depression (1)
- Diagnostic Safety and Quality (2)
- Elderly (2)
- Electronic Health Records (EHRs) (1)
- Emergency Medical Services (EMS) (1)
- Healthcare-Associated Infections (HAIs) (5)
- Health Information Technology (HIT) (2)
- Heart Disease and Health (2)
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- Injuries and Wounds (1)
- (-) Intensive Care Unit (ICU) (19)
- Medicare (1)
- Medication (2)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (1)
- Mortality (1)
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- Outcomes (2)
- Palliative Care (1)
- Patient-Centered Outcomes Research (1)
- Patient and Family Engagement (1)
- Patient Safety (5)
- Practice Patterns (1)
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- Respiratory Conditions (6)
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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 19 of 19 Research Studies DisplayedKruser JM, Rakhra SS, Sacotte RM
Intensive care unit outcomes among patients with cancer after palliative radiation therapy.
To inform goals of care discussions at the time of palliative radiation therapy (RT) consultation, researchers sought to characterize intensive care unit (ICU) outcomes for patients treated with palliative RT compared to all other patients with metastatic cancer admitted to the ICU. They found that prior treatment with palliative RT is associated with increased in-hospital mortality after ICU admission.
AHRQ-funded; HS000078.
Citation: Kruser JM, Rakhra SS, Sacotte RM .
Intensive care unit outcomes among patients with cancer after palliative radiation therapy.
Int J Radiat Oncol Biol Phys 2017 Nov 15;99(4):854-58. doi: 10.1016/j.ijrobp.2017.06.2463.
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Keywords: Cancer, Intensive Care Unit (ICU), Palliative Care, Patient-Centered Outcomes Research
Finn Davis K, Napolitano N, Li S
Promoters and barriers to implementation of tracheal intubation airway safety bundle: a mixed-method analysis.
This study describes promoters and barriers to implementation of an airway safety quality improvement bundle from the perspective of interdisciplinary frontline clinicians and ICU quality improvement leaders. Both early and late adopters identified similar promoter and barrier themes. Early adopter sites customized the quality improvement bundle and had an interdisciplinary quality improvement team approach.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Finn Davis K, Napolitano N, Li S .
Promoters and barriers to implementation of tracheal intubation airway safety bundle: a mixed-method analysis.
Pediatr Crit Care Med 2017 Oct;18(10):965-72. doi: 10.1097/pcc.0000000000001251.
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Keywords: Critical Care, Intensive Care Unit (ICU), Patient Safety, Quality Improvement, Respiratory Conditions
Wang S, Mosher C, Gao S
Antidepressant use and depressive symptoms in intensive care unit survivors.
Nearly 30% of intensive care unit (ICU) survivors have depressive symptoms 2-12 months after hospital discharge. In this study, the investigators examined the prevalence of depressive symptoms and risk factors for depressive symptoms in 204 patients at their initial evaluation in the Critical Care Recovery Center (CCRC), an ICU survivor clinic based at Eskenazi Hospital in Indianapolis, Indiana.
AHRQ-funded; HS024384.
Citation: Wang S, Mosher C, Gao S .
Antidepressant use and depressive symptoms in intensive care unit survivors.
J Hosp Med 2017 Sep;12(9):731-34. doi: 10.12788/jhm.2814..
Keywords: Medication, Depression, Intensive Care Unit (ICU), Behavioral Health
Sinha SS, Sjoding MW, Sukul D
Changes in primary noncardiac diagnoses over time among elderly cardiac intensive care unit patients in the United States.
This study examined changes in primary noncardiac diagnoses among elderly patients admitted to a cardiac intensive care unit (CICU) during the past decade. More than half of all elderly patients with a CICU stay across the United States now have primary noncardiac diagnoses at discharge. These patients receive different types of care and have worse outcomes than patients with primary cardiac diagnoses.
AHRQ-funded; HS020672.
Citation: Sinha SS, Sjoding MW, Sukul D .
Changes in primary noncardiac diagnoses over time among elderly cardiac intensive care unit patients in the United States.
Circ Cardiovasc Qual Outcomes 2017 Aug;10(8):e003616. doi: 10.1161/circoutcomes.117.003616.
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Keywords: Elderly, Heart Disease and Health, Intensive Care Unit (ICU), Outcomes, Respiratory Conditions
Brown SM, Duggal A, Hou PC
Nonlinear imputation of PaO2/FIO2 from SpO2/FIO2 among mechanically ventilated patients in the ICU: a prospective, observational study.
The objective of the study was to validate the superiority of nonlinear imputation of PaO2/FIO2 (a clinical indicator of hypoxaemia) among mechanically ventilated patients and understand what factors influence the accuracy of imputation. It concluded that in mechanically ventilated patients, nonlinear imputation of PaO2/FIO2 from SpO2/FIO2 seems accurate, especially for moderate-severe hypoxemia. Linear and log-linear imputations cannot be recommended.
AHRQ-funded; HS021456.
Citation: Brown SM, Duggal A, Hou PC .
Nonlinear imputation of PaO2/FIO2 from SpO2/FIO2 among mechanically ventilated patients in the ICU: a prospective, observational study.
Crit Care Med 2017 Aug;45(8):1317-24. doi: 10.1097/ccm.0000000000002514.
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Keywords: Diagnostic Safety and Quality, Respiratory Conditions, Intensive Care Unit (ICU), Emergency Medical Services (EMS)
Grunwell JR, Kamat PP, Miksa M
Trend and outcomes of video laryngoscope use across PICUs.
The use of video laryngoscopy for tracheal intubation is now common for adult ICUs, but has not been quantified in pediatric ICUs (PICUs). A retrospective review was conducted of PICUs across the US and four other countries. There was a wide variability of use of video laryngoscopy across PICUs. There has been a significant increase in the use of video laryngoscopy versus direct laryngoscopy from 2011 to 2015, which has resulted in a decrease in adverse outcomes.
AHRQ-funded; HS021583; HS022464.
Citation: Grunwell JR, Kamat PP, Miksa M .
Trend and outcomes of video laryngoscope use across PICUs.
Pediatr Crit Care Med 2017 Aug;18(8):741-49. doi: 10.1097/pcc.0000000000001175..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Patient Safety, Practice Patterns, Respiratory Conditions
Rawat N, Yang T, Ali KJ
Two-state collaborative study of a multifaceted intervention to decrease ventilator-associated events.
Given strong national interest in improving ventilated patient care, the National Institute of Health and AHRQ funded a two-state collaborative to reduce ventilator-associated events. The researchers described the collaborative's impact on ventilator-associated event rates in 56 ICUs. They found that compliance with all evidence-based interventions improved over the course of the collaborative. This study is the largest to date affirming that best practices can prevent ventilator-associated events.
AHRQ-funded; 29032002T.
Citation: Rawat N, Yang T, Ali KJ .
Two-state collaborative study of a multifaceted intervention to decrease ventilator-associated events.
Crit Care Med 2017 Jul;45(7):1208-15. doi: 10.1097/ccm.0000000000002463.
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Keywords: Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU), Adverse Events, Patient Safety, Prevention
Sudduth CL, Overton EC, Lyu PF
Filtering authentic sepsis arising in the ICU using administrative codes coupled to a SIRS screening protocol.
Using administrative codes and minimal physiologic and laboratory data, researchers sought a high-specificity identification strategy for patients whose sepsis initially appeared during their ICU stay. They concluded that selected administrative codes coupled to SIRS criteria and applied to patients admitted to ICU can yield up to 94 percent authentic sepsis patients. However, only 1/3 of patients thus identified appeared to become septic during their ICU stay.
AHRQ-funded; HS000055.
Citation: Sudduth CL, Overton EC, Lyu PF .
Filtering authentic sepsis arising in the ICU using administrative codes coupled to a SIRS screening protocol.
J Crit Care 2017 Jun;39:220-24. doi: 10.1016/j.jcrc.2017.01.012.
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Keywords: Diagnostic Safety and Quality, Intensive Care Unit (ICU), Hospitalization, Sepsis
Valley TS, Sjoding MW, Ryan AM
Intensive care unit admission and survival among older patients with chronic obstructive pulmonary disease, heart failure, or myocardial infarction.
The researchers estimated the relationship between ICU admission and outcomes for hospitalized patients with exacerbation of chronic obstructive pulmonary disease (COPD), exacerbation of heart failure (HF), or acute myocardial infarction (AMI). They found that ICU admission did not confer a survival benefit for patients with uncertain ICU needs hospitalized with COPD exacerbation, HF exacerbation, or AMI.
AHRQ-funded; HS020672.
Citation: Valley TS, Sjoding MW, Ryan AM .
Intensive care unit admission and survival among older patients with chronic obstructive pulmonary disease, heart failure, or myocardial infarction.
Ann Am Thorac Soc 2017 Jun;14(6):943-51. doi: 10.1513/AnnalsATS.201611-847OC.
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Keywords: Intensive Care Unit (ICU), Respiratory Conditions, Heart Disease and Health, Outcomes
Metersky ML, Klompas M, Eldridge N
Changes in rates of ventilator-associated pneumonia-reply.
In response to a critical letter, the authors comment that the discordance between ventilator-associated pneumonia (VAP) rates from the Medicare Patient Safety Monitoring System (MPSMS) vs the National Healthcare Safety Network (NHSN)is likely related to differences in data sources, as discussed in their report, including conscious or unconscious bias in VAP rates reported to the NHSN. It is unlikely to be related to differences in denominators or competing risks.
AHRQ-authored.
Citation: Metersky ML, Klompas M, Eldridge N .
Changes in rates of ventilator-associated pneumonia-reply.
JAMA 2017 Apr 18;317(15):1581-82. doi: 10.1001/jama.2017.2431.
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Keywords: Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU), Patient Safety, Respiratory Conditions
Johnson JK, Robinson GL, Pineles LL
Carbapenem MICs in Escherichia coli and Klebsiella species producing extended-spectrum beta-lactamases in critical care patients from 2001 to 2009.
Carbapenem antibiotics are used as a first line of therapy against ESBL-producing Enterobacteriaceae. The researchers examined a cohort of critical care patients for gastrointestinal colonization with carbapenem-resistant ESBL-producing strains (CR-ESBL strains). They found that 10 percent of the isolates were resistant to at least one carbapenem antibiotic.
AHRQ-funded; HS021068.
Citation: Johnson JK, Robinson GL, Pineles LL .
Carbapenem MICs in Escherichia coli and Klebsiella species producing extended-spectrum beta-lactamases in critical care patients from 2001 to 2009.
Antimicrob Agents Chemother 2017 Apr;61(4):e01718-16. doi: 10.1128/aac.01718-16.
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Keywords: Antibiotics, Critical Care, Medication, Intensive Care Unit (ICU)
Cocoros NM, Priebe GP, Logan LK
A pediatric approach to ventilator-associated events surveillance.
The authors propose pediatric ventilator-associated conditions (VAC) for surveillance related to antimicrobial use, with pediatric possible ventilator-associated pneumonia (PVAP) as a subset of adult ventilator-associated conditions (AVAC). Studies on generalizability and responsiveness of these metrics to quality improvement initiatives are needed, as are studies to determine whether lower pediatric ventilator-associated event (VAE) rates are associated with improvements in other outcomes.
AHRQ-funded; HS021636.
Citation: Cocoros NM, Priebe GP, Logan LK .
A pediatric approach to ventilator-associated events surveillance.
Infect Control Hosp Epidemiol 2017 Mar;38(3):327-33. doi: 10.1017/ice.2016.277.
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Keywords: Adverse Events, Children/Adolescents, Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU), Quality Improvement
Hartman ME, Saeed MJ, Bennett T
Readmission and late mortality after critical illness in childhood.
Researchers sought to understand risks for hospital readmission and trends in mortality during the year following ICU discharge. They found that, in multivariate analysis, risk of nonelective readmission for children without cancer was higher with longer index ICU admission length of stay, younger age, and several chronic and acute conditions. Mortality in the year after ICU discharge was low overall.
AHRQ-funded; HS019455.
Citation: Hartman ME, Saeed MJ, Bennett T .
Readmission and late mortality after critical illness in childhood.
Pediatr Crit Care Med 2017 Mar;18(3):e112-e21. doi: 10.1097/pcc.0000000000001062.
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Keywords: Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Mortality, Hospital Readmissions
Artis KA, Dyer E, Mohan V
Accuracy of laboratory data communication on ICU daily rounds using an electronic health record.
The researchers created a robust but simple methodology to measure the prevalence of inaccurately communicated (misrepresented) data and to characterize data communication failures by type. They found that clinician laboratory data retrieval and communication during ICU rounds at their institution was poor, prone to omissions and inaccuracies, yet largely unrecognized by the rounding team.
AHRQ-funded; HS023793.
Citation: Artis KA, Dyer E, Mohan V .
Accuracy of laboratory data communication on ICU daily rounds using an electronic health record.
Crit Care Med 2017 Feb;45(2):179-86. doi: 10.1097/ccm.0000000000002060.
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Keywords: Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Intensive Care Unit (ICU), Teams
Segall N, Bennett-Guerrero E
ICU rounds: "What we've got here is failure to communicate".
Many of the decisions regarding critical care patients are made during patient rounds—approximately nine per patient— based on the premise that the data that inform the decisions are accurate and complete. The study by Artis et al in this issue challenges this premise. The authors discuss the article, its context and implications.
AHRQ-funded; HS023387.
Citation: Segall N, Bennett-Guerrero E .
ICU rounds: "What we've got here is failure to communicate".
Crit Care Med 2017 Feb;45(2):366-67. doi: 10.1097/ccm.0000000000002125.
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Keywords: Communication, Critical Care, Decision Making, Intensive Care Unit (ICU), Patient Safety
Bunnell KL, Zullo AR, Collins C
Methicillin-resistant staphylococcus aureus pneumonia in critically ill trauma and burn patients: a retrospective cohort study.
The authors sought to determine the incidence of MRSA pneumonia in early-onset and late-onset pneumonia and to identify risk factors for MRSA in the trauma-burn intensive care unit (ICU). They found that the 11.4% overall incidence of MRSA pneumonia in the studied trauma-burn cohort was similar to what has been reported in other trauma populations, although MRSA was equally likely to be identified in early- and late-onset pneumonia. They suggested that risk factors other than duration of hospitalization may be important considerations in the decision to initiate MRSA-active empiric therapy for pneumonia in the trauma-burn ICU.
AHRQ-funded; HS022998.
Citation: Bunnell KL, Zullo AR, Collins C .
Methicillin-resistant staphylococcus aureus pneumonia in critically ill trauma and burn patients: a retrospective cohort study.
Surg Infect 2017 Feb/Mar;18(2):196-201. doi: 10.1089/sur.2016.115.
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Keywords: Critical Care, Healthcare-Associated Infections (HAIs), Injuries and Wounds, Intensive Care Unit (ICU), Methicillin-Resistant Staphylococcus aureus (MRSA)
Musuuza JS, Roberts TJ, Carayon P
Assessing the sustainability of daily chlorhexidine bathing in the intensive care unit of a Veteran's Hospital by examining nurses' perspectives and experiences.
The objective of this project was to describe the process of daily chlorhexidine gluconate (CHG) bathing and identify the barriers and facilitators that can influence its successful adoption and sustainability in an ICU of a Veterans Administration Hospital. Patient bathing in ICUs was largely influenced by scheduling/workload and patient factors such as clinical stability, hypersensitivity to CHG, patient refusal, presence of IV lines and general hygiene.
AHRQ-funded; HS024039.
Citation: Musuuza JS, Roberts TJ, Carayon P .
Assessing the sustainability of daily chlorhexidine bathing in the intensive care unit of a Veteran's Hospital by examining nurses' perspectives and experiences.
BMC Infect Dis 2017 Jan 14;17(1):75. doi: 10.1186/s12879-017-2180-8.
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Keywords: Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU), Prevention
Asan O, Flynn KE, Azam L
Nurses’ perceptions of a novel health information technology: a qualitative study in the pediatric intensive care unit.
The purpose of this study was to evaluate the use of a novel health information technology (HIT), a large customizable interactive monitor (LCIM), implemented in a pediatric intensive care unit (PICU). The study collected and analyzed data from 55 PICU nurses in seven focus groups. Six major themes emerged including familiarity and use routines, positive perceptions with the LCIM, negative perceptions with the LCIM, privacy, training, and suggestions for improvement.
AHRQ-funded; HS023626.
Citation: Asan O, Flynn KE, Azam L .
Nurses’ perceptions of a novel health information technology: a qualitative study in the pediatric intensive care unit.
Int J Hum Comput Interact 2017;33(4):258-64. doi: 10.1080/10447318.2017.1279828.
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Keywords: Health Information Technology (HIT), Intensive Care Unit (ICU), Patient and Family Engagement, Children/Adolescents, Nursing
Admon AJ, Wunsch H, Iwashyna TJ
Hospital contributions to variability in the use of ICUs among elderly Medicare recipients.
Hospitals vary widely in ICU admission rates across numerous medical diagnoses. In This retrospective cohort study examined the extent to which variability in ICU use is specific to individual diagnoses or is a function of the hospital, regardless of disease. The authors concluded that hospitals account for a significant proportion of variation independent of measured patient and hospital characteristics, suggesting the need for further work to evaluate the causes of variation at the hospital level and potential consequences of variation across hospitals.
AHRQ-funded; HS020672.
Citation: Admon AJ, Wunsch H, Iwashyna TJ .
Hospital contributions to variability in the use of ICUs among elderly Medicare recipients.
Crit Care Med 2017 Jan;45(1):75-84. doi: 10.1097/CCM.0000000000002025..
Keywords: Elderly, Hospitalization, Hospitals, Intensive Care Unit (ICU), Medicare