National Healthcare Quality and Disparities Report
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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 25 of 106 Research Studies DisplayedZhou S, Kang H, Yao B
An automated pipeline for analyzing medication event reports in clinical settings.
The article describes and evaluates an automated pipeline that is expected to improve the efficiency of analyzing medication event reports. The pipeline assists clinicians in extracting information from reports and generating feedback using classic machine-learning classifiers to compare three attributes taken from the reports: event originating stages, event types, and event causes. The pipeline identifies these attributes and calculates similarity scores based on them. A strategy to measure similarity was created and evaluated by human subjects using a questionnaire.
AHRQ-funded; HS022895.
Citation: Zhou S, Kang H, Yao B .
An automated pipeline for analyzing medication event reports in clinical settings.
BMC Med Inform Decis Mak 2018 Dec 7;18(Suppl 5):113. doi: 10.1186/s12911-018-0687-6..
Keywords: Adverse Drug Events (ADE), Quality of Care, Medication, Patient Safety
Dowding D, Merrill J, Russell D
Using feedback intervention theory to guide clinical dashboard design.
The provision of feedback to clinicians and organizations on the quality of care they provide is thought to influence clinician and organizational behavior leading to care improvements. Clinical Dashboards use data visualization techniques to provide feedback to individuals on their performance compared to quality metrics. In this paper the authors outline a theoretical approach to the design of a clinical dashboard; Feedback Intervention Theory (FIT).
AHRQ-funded; HS023855.
Citation: Dowding D, Merrill J, Russell D .
Using feedback intervention theory to guide clinical dashboard design.
AMIA Annu Symp Proc 2018 Dec 5;2018:395-403..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider Performance, Quality of Care, Quality Improvement
I Auerbach, M Badaki-Makun, O
AHRQ Author: Barata
A research agenda to advance pediatric emergency care through enhanced collaboration across emergency departments.
In 2018, the Society for Academic Emergency Medicine and the journal Academic Emergency Medicine (AEM) convened a consensus conference entitled, "Academic Emergency Medicine Consensus Conference: Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps." This article is the product of the breakout session, "Emergency Department Collaboration-Pediatric Emergency Medicine in Non-Children's Hospital."
AHRQ-funded; HS026101.
Citation: I Auerbach, M Badaki-Makun, O .
A research agenda to advance pediatric emergency care through enhanced collaboration across emergency departments.
Acad Emerg Med 2018 Dec;25(12):1415-26. doi: 10.1111/acem.13642..
Keywords: Care Coordination, Children/Adolescents, Emergency Department, Evidence-Based Practice, Health Services Research (HSR), Outcomes, Quality of Care, Quality Improvement
Meddings J, Smith SN, Hofer TP
Mixed messages to consumers from Medicare: Hospital Compare grades versus value-based payment penalty.
This study examined the discrepancy of ratings with hospitals with low readmission grades for heart failure (HF) and acute myocardial infarction (AMI) on the Hospital Compare website, yet received penalties for excessive readmissions under the hospital Readmissions Reduction Program. A retrospective data analysis was conducted of 2956 hospitals that had publicly reported HF grades on Hospital Compare. Of those, 92% were graded as “no different” than the national rate for HD readmissions, yet included 48.6% that were scored as having excessive HF admissions and 87% received an overall readmission penalty. Of the 120 hospitals graded as “better”, none were scored as having excessive HF readmissions and 50% were penalized. There were similar results for AMI.
AHRQ-funded; HS018334; HS019767.
Citation: Meddings J, Smith SN, Hofer TP .
Mixed messages to consumers from Medicare: Hospital Compare grades versus value-based payment penalty.
Am J Manag Care 2018 Dec;24(12):e399-e403..
Keywords: Medicare, Hospital Readmissions, Heart Disease and Health, Hospitals, Quality of Care, Cardiovascular Conditions, Provider Performance, Payment
Hornor MA, Liu JY, Hu QL
Surgical technical evidence review for acute appendectomy conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery.
This evidence review uses enhanced recovery pathways (ERPs) protocols developed for the AHRQ-funded Safety Program for Improving Surgical Care and Recovery (ISCR Program) to develop ERPs for acute appendectomy surgery. The authors classified appendicitis into uncomplicated (nonperforated) and complicated (perforated or gangrenous) to help with risk stratification. They identified 13 components for appendectomy for review. The processes are organized by perioperative phase, and each phase includes the rationale, evidence review, summary of guidelines, and a recommendation summary of the evidence for or against inclusion in the ERP. Preoperative management components included: education and counseling; preoperative antibiotics; initial nonsurgical management for perforated appendicitis with abscess or phlegmon, venous thromboembolism prophylaxis, delay for operation for 12-24 hours for uncomplicated appendicitis. Intraoperative management components include: laparoscopic surgical technique, peritoneal drain placement, urinary catheter placement, and prophylactic nasogastric tube insertion. Postoperative management components include same-day surgery discharge for uncomplicated appendicitis, antibiotics, early oral alimentation, and early mobilization. Of the ERPs reviewed: there was no evidence to support the routine use of abdominal drainage in patients undergoing appendectomies, urinary catheter insertion for laparoscopic surgery, use of prophylactic nasogastric tube placement, postoperative antibiotic use for uncomplicated appendicitis, and early oral alimentation for uncomplicated appendicitis.
AHRQ-funded.
Citation: Hornor MA, Liu JY, Hu QL .
Surgical technical evidence review for acute appendectomy conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery.
J Am Coll Surg 2018 Dec;227(6):605-17.e2. doi: 10.1016/j.jamcollsurg.2018.09.024..
Keywords: Surgery, Quality Improvement, Quality of Care, Patient Safety, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes
Kranz AM, Dalton S, Damberg C
Using health IT to coordinate care and improve quality in safety-net clinics.
Health centers provide care to vulnerable and high-need populations. Recent investments have promoted use of health information technology (HIT) capabilities for improving care coordination and quality of care in health centers. This study examined factors associated with use of these HIT capabilities and the association between these capabilities and quality of care in a census of health centers in the United States.
AHRQ-funded; HS024067.
Citation: Kranz AM, Dalton S, Damberg C .
Using health IT to coordinate care and improve quality in safety-net clinics.
Jt Comm J Qual Patient Saf 2018 Dec;44(12):731-40. doi: 10.1016/j.jcjq.2018.03.006..
Keywords: Health Information Technology (HIT), Care Coordination, Patient-Centered Healthcare, Quality Improvement, Quality of Care, Vulnerable Populations, Care Management
Fink JT, Magnan EM, Johnson HM
Blood pressure control and other quality of care metrics for patients with obesity and diabetes: a population-based cohort study.
In this observational population-based cohort study, the investigators sought to examine the relationship between the extent of obesity and the achievement of guideline-recommended blood pressure goals and other quality of care metrics among patients with diabetes. The investigators suggest that although the cardiovascular risk for patients with obesity and diabetes is greater than for non-obese patients with diabetes, they found that patients with obesity are even further behind in achieving blood pressure control.
AHRQ-funded; HS021899.
Citation: Fink JT, Magnan EM, Johnson HM .
Blood pressure control and other quality of care metrics for patients with obesity and diabetes: a population-based cohort study.
High Blood Press Cardiovasc Prev 2018 Dec;25(4):391-99. doi: 10.1007/s40292-018-0284-x..
Keywords: Blood Pressure, Diabetes, Quality of Care, Obesity
Swietek KE, Domino ME, Beadles C
Do medical homes improve quality of care for persons with multiple chronic conditions?
The purpose of this study was to examine the association between medical home enrollment and receipt of recommended care for Medicaid beneficiaries with multiple chronic conditions (MCC). The investigators found that patient-centered medical home enrollment was associated with an increased likelihood of receiving eight recommended mental and physical health services, including A1C testing for persons with diabetes, lipid profiles for persons with diabetes and/or hyperlipidemia, and psychotherapy for persons with major depression and persons with schizophrenia.
AHRQ-funded; HS019659.
Citation: Swietek KE, Domino ME, Beadles C .
Do medical homes improve quality of care for persons with multiple chronic conditions?
Health Serv Res 2018 Dec;53(6):4667-81. doi: 10.1111/1475-6773.13024..
Keywords: Chronic Conditions, Quality of Care, Patient-Centered Healthcare, Quality Improvement
Kalogera E, Nelson G
Surgical technical evidence review for gynecologic surgery conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
The objective of this study was to review the enhanced recovery pathways (ERPs) literature in gynecologic surgery (GS) and provide the framework for Improving Surgical Care and Recovery (ISCR) pathway for GS. The investigators concluded that evidence and existing guidelines supported 29 protocol elements for the AHRQ Safety Program for ISCR in GS.
AHRQ-funded; 23337004T.
Citation: Kalogera E, Nelson G .
Surgical technical evidence review for gynecologic surgery conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
Am J Obstet Gynecol 2018 Dec;219(6):563.e1-63.e19. doi: 10.1016/j.ajog.2018.07.014..
Keywords: Evidence-Based Practice, Quality of Care, Patient Safety, Quality Improvement
Gray SL, Marcum ZA, Schmader KE
Update on medication use quality and safety in older adults, 2017.
Improving the quality of medication use and medication safety in older adults is an important public health priority and is of paramount importance for clinicians who care for them. In this paper, the investigators selected four important articles (from 2017), that address these issues, to annotate and critique. In addition, they discuss the broader implications for optimizing medication use.
AHRQ-funded; HS023779; HS022982.
Citation: Gray SL, Marcum ZA, Schmader KE .
Update on medication use quality and safety in older adults, 2017.
J Am Geriatr Soc 2018 Dec;66(12):2254-58. doi: 10.1111/jgs.15665..
Keywords: Elderly, Quality of Care, Medication, Medication: Safety, Patient Safety
Rolnick JA, Ryskina KL
The use of individual provider performance reports by US Hospitals.
In this study, the investigators examined overall trends in how hospitals use the electronic health record to track and provide feedback on provider performance. They used data from 2013 to 2015 from the American Hospital Association (AHA) Annual Survey Information Technology Supplement, which asked hospitals if they have used electronic data to create performance profiles. They linked these data to AHA Annual Survey responses for all general adult and pediatric hospitals and used Multivariable logistic regression to model the odds of use as a function of hospital characteristics.
AHRQ-funded; HS022198.
Citation: Rolnick JA, Ryskina KL .
The use of individual provider performance reports by US Hospitals.
J Hosp Med 2018 Aug;13(8):562-65. doi: 10.12788/jhm.2922..
Keywords: Provider Performance, Quality of Care, Provider, Hospitals, Electronic Health Records (EHRs), Health Information Technology (HIT)
Kaiser SV, Lam R, Joseph GB
Limitations of using pediatric respiratory illness readmissions to compare hospital performance.
Researcher sought to determine if a National Quality Forum (NQF)-endorsed measure for pediatric lower respiratory illness (LRI) 30-day readmission rates can meaningfully identify high- and low-performing hospitals. Subjects were children with LRI (bronchiolitis, influenza, or pneumonia as primary diagnosis, or with an LRI as a secondary diagnosis with a primary diagnosis of respiratory failure, sepsis, bacteremia, or asthma) from all hospital admissions in California from 2012 to 2014. The researchers were unable to identify meaningful variation in hospital performance without broadening the metric definition and merging multiple years of data. They recommend that utilizers of pediatric-quality measures consider modifying metrics to better evaluate the quality of pediatric care at low-volume hospitals.
AHRQ-funded; HS024385; HS022835; HS024592; HS025297.
Citation: Kaiser SV, Lam R, Joseph GB .
Limitations of using pediatric respiratory illness readmissions to compare hospital performance.
J Hosp Med 2018 Nov;13(11):737-42. doi: 10.12788/jhm.2988..
Keywords: Children/Adolescents, Respiratory Conditions, Provider Performance, Hospital Readmissions, Hospitals, Quality Indicators (QIs), Quality Measures, Quality of Care, Quality Improvement
Balentine CJ, Kenzik K, Chu DI
Planning post-discharge destination for gastrointestinal surgery patients: room for improvement?
Investigators compared short-term recovery for patients discharged to inpatient rehabilitation versus skilled nursing facilities after gastrointestinal surgery. They found that there was no difference in 30-day readmission rates, but post-discharge mortality was higher for patients discharged to skilled nursing facilities compared to inpatient rehabilitation.
AHRQ-funded; HS023009.
Citation: Balentine CJ, Kenzik K, Chu DI .
Planning post-discharge destination for gastrointestinal surgery patients: room for improvement?
Am J Surg 2018 Nov;216(5):912-18. doi: 10.1016/j.amjsurg.2018.05.004..
Keywords: Hospital Discharge, Surgery, Digestive Disease and Health, Rehabilitation, Nursing Homes, Quality Improvement, Quality of Care, Transitions of Care
Desai AD, Simon TD, Leyenaar JK
Utilizing family-centered process and outcome measures to assess hospital-to-home transition quality.
This commentary describes the success of using 8 new caregiver-reported measures to assess the quality of hospital- and emergency department (ED)-to-home transitions in pediatric patients. This measures were originally created by the national Pediatric Quality Measures Program mandated by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). An original article describing these measures was published 2016 and there have been several follow-up studies. These measures are undergoing further testing.
AHRQ-funded; HS024133; HS024299; HS020506.
Citation: Desai AD, Simon TD, Leyenaar JK .
Utilizing family-centered process and outcome measures to assess hospital-to-home transition quality.
Acad Pediatr 2018 Nov - Dec;18(8):843-46. doi: 10.1016/j.acap.2018.07.013..
Keywords: Hospital Discharge, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Transitions of Care, Quality of Care, Quality Measures, Quality Improvement, Children's Health Insurance Program (CHIP), Evidence-Based Practice
Carayon P, Wooldridge A, Hose BZ
Challenges and opportunities for improving patient safety through human factors and systems engineering.
In this paper, the authors provide an overview of human factors and systems engineering (HF/SE), its demonstrated value to a wide range of patient safety problems and challenges to its broader implementation across health care. In addition, they make a variety of recommendations to maximize the spread of HF/SE.
AHRQ-funded; HS024453.
Citation: Carayon P, Wooldridge A, Hose BZ .
Challenges and opportunities for improving patient safety through human factors and systems engineering.
Health Aff 2018 Nov;37(11):1862-69. doi: 10.1377/hlthaff.2018.0723..
Keywords: Quality of Care, Patient Safety, Quality Improvement, System Design
Likosky DS, Harrington SD, Cabrera L
Collaborative quality improvement reduces postoperative pneumonia after isolated coronary artery bypass grafting surgery.
This study examined post cardiac surgery pneumonia rates associated with participation in a statewide, quality improvement collaborative relative to a national physician reporting program. The investigators concluded that participation in a physician-led collaborative was associated with significant reductions in pneumonia relative to a national quality reporting program. They suggest that interventions including collaborative learning may yield superior outcomes relative to solely using physician feedback reporting.
AHRQ-funded; HS022535.
Citation: Likosky DS, Harrington SD, Cabrera L .
Collaborative quality improvement reduces postoperative pneumonia after isolated coronary artery bypass grafting surgery.
Circ Cardiovasc Qual Outcomes 2018 Nov;11(11):e004756. doi: 10.1161/circoutcomes.118.004756..
Keywords: Outcomes, Patient Safety, Pneumonia, Quality of Care, Quality Improvement, Surgery
Brauner D, Werner RM, Shippee TP
Does Nursing Home Compare reflect patient safety in nursing homes?
In this study the investigators compared nursing homes' performance on several composite quality measures from Nursing Home Compare, the most prominent recent example of a national policy aimed at improving the quality of nursing home care, to their performance on measures of patient safety in nursing homes such as pressure sores, infections, falls, and medication errors.
AHRQ-funded; HS024967.
Citation: Brauner D, Werner RM, Shippee TP .
Does Nursing Home Compare reflect patient safety in nursing homes?
Health Aff 2018 Nov;37(11):1770-78. doi: 10.1377/hlthaff.2018.0721.
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Keywords: Quality of Care, Nursing Homes, Patient Safety, Provider Performance, Quality Measures
Wang A, Pollack T, Kadziel LA
Impact of practice facilitation in primary care on chronic disease care processes and outcomes: a systematic review.
The goal of this systematic review was to evaluate the impact of practice facilitation on chronic disease outcomes in the primary care setting. Researchers extracted and assessed the quality of the data on chronic disease process and clinical outcome measures from U.S. studies that implemented practice facilitation and reported quantifiable care processes and chronic disease outcomes. The results of this evaluation suggest that practice facilitation may improve chronic disease care measures; practices across all studies were aware of practice facilitation. The authors conclude that the results support the potential expansion of practice facilitation in primary care, but that future work will need to investigate potential opportunities to improve chronic disease outcomes in other health care settings.
AHRQ-funded; HS000084.
Citation: Wang A, Pollack T, Kadziel LA .
Impact of practice facilitation in primary care on chronic disease care processes and outcomes: a systematic review.
J Gen Intern Med 2018 Nov;33(11):1968-77. doi: 10.1007/s11606-018-4581-9.
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Keywords: Care Management, Chronic Conditions, Primary Care, Quality of Care, Quality Improvement
Aiken LH, Sloane DM, Barnes H
Nurses' and patients' appraisals show patient safety in hospitals remains a concern.
This study analyzed if there is a positive correlation between improvements of work environments for nurses and improvements in patient safety. A total of 535 hospitals in four large states at two points in time between 2005 and 2016 were studied. Survey data showed an improvement of work environment with 21% of study hospitals, and 7% had worse scores. For the hospitals with improved work environments, patients and nurses both reported high scores for patient safety indicators. For work environments which deteriorated, favorable patient safety grades went down 21%.
AHRQ-funded; HS022406.
Citation: Aiken LH, Sloane DM, Barnes H .
Nurses' and patients' appraisals show patient safety in hospitals remains a concern.
Health Aff 2018 Nov;37(11):1744-51. doi: 10.1377/hlthaff.2018.0711..
Keywords: Burnout, Hospitals, Patient Experience, Patient Safety, Provider: Nurse, Quality of Care, Quality Improvement
Berenson R, Singh H
Payment innovations to improve diagnostic accuracy and reduce diagnostic error.
Researchers examined ways that payment innovations could be used to improve diagnostic accuracy and reduce diagnostic error among Medicare patients. They recommended three different approaches: 1) coding changes in the Medicare Physician Fee schedule; new Alternative Payment Models (APMs) that could improve accuracy in challenging cases and even provide second or third opinions; and 3) have a method that accurate diagnoses would trigger APM payments and establish payment amounts.
AHRQ-funded; HS022087; HS017820.
Citation: Berenson R, Singh H .
Payment innovations to improve diagnostic accuracy and reduce diagnostic error.
Health Aff 2018 Nov;37(11):1828-35. doi: 10.1377/hlthaff.2018.0714..
Keywords: Diagnostic Safety and Quality, Payment, Medical Errors, Medicare, Patient Safety, Quality of Care
Brimhall KC, Mor Barak ME
The critical role of workplace inclusion in fostering innovation, job satisfaction, and quality of care in a diverse human service organization.
Using a sample of 213 participants within 21 departmental units in a diverse human service organization, the authors performed multilevel path analysis to examine the critical role of workplace inclusion in fostering innovation, job satisfaction, and quality of care in a diverse human service organization.
AHRQ-funded; HS024650.
Citation: Brimhall KC, Mor Barak ME .
The critical role of workplace inclusion in fostering innovation, job satisfaction, and quality of care in a diverse human service organization.
Hum Serv Organ Manag Leadersh Gov 2018 Nov/Dec;42(5):474-92..
Keywords: Quality of Care, Workforce, Organizational Change
Admon AJ, Gupta A, Williams M
Appraising the evidence supporting Choosing Wisely(R) recommendations.
This study’s objective was to appraise the evidence supporting the Choosing Wisely® campaign initiated by the American Board of Internal Medicine (ABIM) Foundation to advance dialogue on prevention of unnecessary medical tests, treatments, and procedures. The authors extracted all 320 recommendations that were published through August 2014. The recommendations were then categorized by evidence strength and then a sample of referenced clinical practice guidelines (CPGs) using the validated Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Overall, 70.3% of recommendations cited CPGs, whereas 22.2% cited primary research as their highest evidence level. Hospital medicine recommendations cited CPGs 90% of the time. However, the median overall score using AGREE II was 54.2% and even for hospital medicine-referenced CPGs was 58.3%.
AHRQ-funded; HS020672.
Citation: Admon AJ, Gupta A, Williams M .
Appraising the evidence supporting Choosing Wisely(R) recommendations.
J Hosp Med 2018 Oct;13(10):688-91. doi: 10.12788/jhm.2964..
Keywords: Decision Making, Evidence-Based Practice, Guidelines, Prevention, Quality of Care, Quality Improvement
Ciotoli C, Smith AJ, Keeling RP
Call to action: better care, better health, and greater value in college health.
This report aims to inspire, motivate, and challenge college health professionals and their colleagues, campus leaders, and national entities to take both immediate and sustainable steps to bring quality improvement (QI) to the forefront of college health practice - and, by doing so, to elevate care, health, and value of college health as a key pathway to advancing student success.
AHRQ-funded; HS022520.
Citation: Ciotoli C, Smith AJ, Keeling RP .
Call to action: better care, better health, and greater value in college health.
J Am Coll Health 2018 Oct;66(7):625-39. doi: 10.1080/07448481.2018.1431908..
Keywords: Education, Quality of Care, Quality Improvement
Baldwin LM, Fischer MA, Powell J
Virtual educational outreach intervention in primary care based on the principles of academic detailing.
This paper describes the efforts of the Healthy Hearts Northwest (H2N) EvidenceNOW cooperative in providing virtual outreach intervention in primary care based on the principles of academic detailing (AD). EvidenceNOW is AHRQ’s initiative to fund seven regional cooperatives to identify and implement effective strategies to improve the quality of cardiovascular care in communities across the United States. The H2N network covers three states: Oregon, Washington, and Idaho. For this initiative they recruited 259 primary care practices that had 10 full-time or fewer providers and met stage 1 electronic health record meaningful use criteria. The aim was to increase adoption of the four ABCS of heart disease prevention: Aspirin use by high-risk individuals, Blood pressure control, Cholesterol management, and Smoking cessation. Due to the long distances and staffing limitations H2N decided to develop an educational outreach program using virtual visits instead of the traditional AD program structure. The findings and outcomes of this program is described in detail in this paper.
AHRQ-funded; HS023236; HS023908.
Citation: Baldwin LM, Fischer MA, Powell J .
Virtual educational outreach intervention in primary care based on the principles of academic detailing.
J Contin Educ Health Prof 2018 Fall;38(4):269-75. doi: 10.1097/ceh.0000000000000224..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Evidence-Based Practice, Primary Care, Quality Improvement, Quality of Care, Patient-Centered Outcomes Research, Outcomes, Prevention
Carpenter D, Hassell S, Mardon R
Ambulatory Surgery, Cost-Effectiveness, Health Care Costs, Evidence-based Practice, Organization and Administration
This paper describes the concept of using learning communities to support adoption of health care innovations. The authors assert that the learning community model of group learning can serve as an effective method to support dissemination and implementation of innovations, and to achieve desired outcomes in local settings.
AHRQ-funded; 290201100001C.
Citation: Carpenter D, Hassell S, Mardon R .
Ambulatory Surgery, Cost-Effectiveness, Health Care Costs, Evidence-based Practice, Organization and Administration
Jt Comm J Qual Patient Saf 2018 Oct;44(10):566-73. doi: 10.1016/j.jcjq.2018.03.010..
Keywords: Organizational Change, Patient-Centered Healthcare, Quality Improvement, Quality of Care