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AHRQ Research Studies Date
Topics
- Ambulatory Care and Surgery (4)
- Antibiotics (16)
- (-) Antimicrobial Stewardship (16)
- Children/Adolescents (3)
- Community-Acquired Infections (1)
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- Diagnostic Safety and Quality (1)
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- Pneumonia (1)
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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 16 of 16 Research Studies DisplayedRamanathan S, Yan CH, Hubbard C
Changes in antibiotic prescribing by dentists in the United States, 2012-2019.
Dentists are the top specialty prescriber of antibiotics in the United States, prescribing 10% of all outpatient antibiotics. The purpose of this retrospective study was to assess trends in the rates of antibiotic prescribing by dentists. The researchers also evaluated if trends varied by agent, specialty, and patient characteristics. The study found that between 2012 and 2019 dentists wrote more than 216 million antibiotic prescriptions. The annual rate of dental antibiotic prescribing remained steady over time. However, the dental prescribing rate increased in the Northeast, among oral and maxillofacial surgeons, prosthodontists, endodontists, periodontists, and for amoxicillin. The mean days' supply significantly decreased over the study period by 0.023 days per 1,000 dentists per year.
AHRQ-funded; HS025177.
Citation: Ramanathan S, Yan CH, Hubbard C .
Changes in antibiotic prescribing by dentists in the United States, 2012-2019.
Infect Control Hosp Epidemiol 2023 Nov; 44(11):1725-30. doi: 10.1017/ice.2023.151..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Dental and Oral Health
Deshpande A, Walker R, Schulte R
Reducing antimicrobial overuse through targeted therapy for patients with community-acquired pneumonia: a study protocol for a cluster-randomized factorial controlled trial (CARE-CAP).
The authors described a planned cluster-randomized controlled trial in 12 hospitals in the Cleveland Clinic Health System to test two approaches to reducing the use of extended-spectrum antibiotics (ESA) in adult patients with community-acquired pneumonia (CAP): rapid diagnostic assays that provide accurate results within hours, and de-escalation after negative bacterial cultures in clinically stable patients. The purpose will be to establish whether the identification of an etiological agent early and pharmacist-led de-escalation can safely reduce the use of ESA in patients with CAP. The findings may also inform clinical guidelines on the management of CAP.
AHRQ-funded; HS028633.
Citation: Deshpande A, Walker R, Schulte R .
Reducing antimicrobial overuse through targeted therapy for patients with community-acquired pneumonia: a study protocol for a cluster-randomized factorial controlled trial (CARE-CAP).
Trials 2023 Sep 16; 24(1):595. doi: 10.1186/s13063-023-07615-3..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Community-Acquired Infections, Pneumonia, Respiratory Conditions
Laytner LA, Olmeda K, Salinas J
Acculturation and subjective norms impact non-prescription antibiotic use among Hispanic patients in the United States.
The purpose of this study was to explore the effects of acculturation and subjective norms on Hispanic individuals' intentions to use antibiotics without a prescription from the following sources: 1) United States markets (not legal), 2) other countries, 3) leftovers from previous prescriptions, and 4) friends/relatives. The study found that of the 263 patients surveyed, 47% reported previous non-prescription use, and 54% expressed intention to use non-prescription antibiotics if feeling sick. Individuals with lower acculturation (Spanish-speaking preferences) expressed greater intentions to utilize antibiotics from abroad and from any source. Individuals with more friends/relatives who obtain antibiotics abroad were over 2.5 times more likely to intend to utilize non-prescription antibiotics from friends/relatives. Other predictors of intention to utilize non-prescription antibiotics included high costs of doctor visits and perceived language barriers in the clinic.
AHRQ-funded; HS026901.
Citation: Laytner LA, Olmeda K, Salinas J .
Acculturation and subjective norms impact non-prescription antibiotic use among Hispanic patients in the United States.
Antibiotics 2023 Sep 8; 12(9). doi: 10.3390/antibiotics12091419..
Keywords: Racial and Ethnic Minorities, Antibiotics, Medication, Antimicrobial Stewardship
Grigoryan L, Paasche-Orlow MK, Alquicira O
Antibiotic use without a prescription: a multi-site survey of patient, health system, and encounter characteristics.
The purpose of this study was to assess the impact of factors of patient, health system, and clinical encounters on intention to utilize antibiotics without a prescription. Use cases included antibiotics that were 1) bought in the United States, 2) provided by relatives or friends, 3) purchased in another country, or 4) from any of these sources. Between January 2020 through June 2021, a survey was administered in 6 publicly funded primary care clinics and 2 private emergency departments in Texas, United States. Study participants included adult patients visiting 1 of the clinical settings. The study found that of the 564 survey respondents 43.6% reported previous use of antibiotics without a prescription, and 31.4% reported intent to take antibiotics without a prescription. Survey respondents reported they would take antibiotics obtained from relatives or friends (22.3%), bought in the United States without a prescription (19.1%), or purchased in another country without a prescription (17.9%). Perceived high cost of doctor visits, lack of health insurance, and younger age were all predictors of intended use of nonprescription antibiotics from any of the sources. Hispanic or Latino ethnicity, being interviewed in Spanish, language barrier to medical care, and lack of transportation for medical appointments.
AHRQ-funded; HS026901.
Citation: Grigoryan L, Paasche-Orlow MK, Alquicira O .
Antibiotic use without a prescription: a multi-site survey of patient, health system, and encounter characteristics.
Clin Infect Dis 2023 Aug 22; 77(4):510-17. doi: 10.1093/cid/ciad241..
Keywords: Antibiotics, Medication, Antimicrobial Stewardship
Brown T, Lee JY, Guzman A
Prevalence and appropriateness of in-person versus not-in-person ambulatory antibiotic prescribing in an integrated academic health system: a cohort study.
This retrospective cohort study examined the prevalence and appropriateness of all ambulatory antibiotic prescribing in an integrated health delivery system in the United States. The authors looked at prescribing at in-person visits and not-in-person visits (e.g. telephone, refills). Prescribing was divided into the following 5 appropriateness groups: 1) chronic antibiotic use; 2) antibiotic-appropriate; 3) potentially antibiotic-appropriate; 4) non-antibiotic-appropriate; and 5) not associated with a diagnosis. Over the 4-year study period, there were 714,057 antibiotic prescriptions ordered for 348,739 unique patients by 2,391 clinicians in 467 clinics with a patient population with a mean age of 41 years, 61% female and 78% White. Clinicians were mostly women (58%); were 78% physicians; and of those physicians were 42% primary care, 39% medical specialists, and 12% surgical specialists. The vast majority (81%) of antibiotics were prescribed at in-person visits, and 19% were not in-person visits (10% telephone, 5% orders only, and 3% refill encounters). Prescribing appropriateness was divided into 16% for chronic use, 15% antibiotic-appropriate, 39% potentially antibiotic-appropriate, 22% non-antibiotic-appropriate, and 8% not associated with a diagnosis. Prescription of antibiotics not-in-person were more likely to be chronic (20% versus 15%); less likely to be associated with appropriate or potentially appropriate diagnoses (30% versus 59%) or non-antibiotic-appropriate diagnoses (8% versus 25%); and more likely to be associated with no diagnosis (42% versus <1%).
AHRQ-funded; HS024930.
Citation: Brown T, Lee JY, Guzman A .
Prevalence and appropriateness of in-person versus not-in-person ambulatory antibiotic prescribing in an integrated academic health system: a cohort study.
PLoS One 2023 Jul 27; 18(7):e0289303. doi: 10.1371/journal.pone.0289303..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Ambulatory Care and Surgery
Cabral SM, Harris AD, Cosgrove SE
Adherence to antimicrobial prophylaxis guidelines for elective surgeries across 825 US hospitals, 2019-2020.
This retrospective cohort study assessed adherence to surgical antimicrobial prophylaxis guidelines for elective surgeries across 825 US hospitals from 2019 to 2020. The authors looked at adults who underwent elective craniotomy, hip replacement, knee replacement, spinal procedure, or hernia repair in 2019-2020 at hospitals in the PINC AI (Premier) Healthcare Database. They evaluated adherence of prophylaxis regimes, with respect to antimicrobial agents endorsed in the American Society of Health-System Pharmacist guidelines, accounting for patient antibiotic allergy and methicillin-resistant Staphylococcus aureus colonization status. They found that across 825 hospitals and 521,091 inpatient elective surgeries, 59% were adherent to prophylaxis guidelines. The most common reason found for nonadherence was unnecessary vancomycin use. Patients receiving cefazolin plus vancomycin had 19% higher odds of acute kidney injury (AKI) compared with patients receiving cefazolin alone.
AHRQ-funded; HS028363.
Citation: Cabral SM, Harris AD, Cosgrove SE .
Adherence to antimicrobial prophylaxis guidelines for elective surgeries across 825 US hospitals, 2019-2020.
Clin Infect Dis 2023 Jun 16; 76(12):2106-15. doi: 10.1093/cid/ciad077..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Guidelines, Evidence-Based Practice, Surgery
Kakiuchi S, Perencevich EN, Livorsi DJ
Is the number of prescriptions an appropriate metric for outpatient antimicrobial consumption? A comparison between the prescription counts and days supplied.
Monitoring antibiotic use is essential for encouraging the appropriate use of antibiotics. However, defining appropriate metrics presents multiple challenges. The purpose of this study was to compare 2 metrics for antibiotic outpatient consumption at the Veterans Health Administration (VHA) pharmacies: the number of prescriptions in EMRs and the number of dispensed days, or days supplied. During the study period, 13,373,460 clinic visits (5.0%) of the 265,613,607 total clinic visits had an antibiotic prescription, and the total of days supplied was 182,793,572. The study found that the mean days supplied per prescription continued mainly unchanged during the study period. Comparing the number of prescriptions and days supplied normalized by the number of clinic visits, these 2 metrics changed in parallel, with only minor differences from 2010 to 2019. When the researchers focused on short-term prescriptions usually utilized for acute illnesses (14 days or less), prescription number and days supplied reflected an increasing discrepancy. The number of prescriptions underestimated the decline compared to days supplied. Alternatively, long-term prescriptions (15 days or more) reflected the opposite discrepancy. For comparisons between facilities, the researchers found considerable differences in rankings of healthcare systems based on the 2 metrics.
AHRQ-funded; HS027472.
Citation: Kakiuchi S, Perencevich EN, Livorsi DJ .
Is the number of prescriptions an appropriate metric for outpatient antimicrobial consumption? A comparison between the prescription counts and days supplied.
Infect Control Hosp Epidemiol 2023 Jun; 44(6):941-44. doi: 10.1017/ice.2022.189..
Keywords: Medication, Ambulatory Care and Surgery, Antibiotics, Antimicrobial Stewardship
Suzuki H, Heintz BH, Livorsi DJ
Tracking antimicrobial stewardship activities beyond days of therapy (DOT): comparison of days of antibiotic spectrum coverage (DASC) and DOT at a single center.
Researchers evaluated the measurement performance by days of antibiotic spectrum coverage (DASC) versus days of therapy (DOT), the preferred metric for measuring inpatient antimicrobial consumption within the U.S. Their retrospective study analyzed inpatient antimicrobial use at the Iowa City Veterans’ Affairs Healthcare System acute-care hospital. Antimicrobial DOT did not decrease significantly during a period of robust stewardship activities, but a significant downward trend in the antimicrobial spectrum, as measured by DASC was detected. The researchers concluded that the DASC metric may help to monitor the effect of stewardship activities more broadly.
AHRQ-funded; HS027472.
Citation: Suzuki H, Heintz BH, Livorsi DJ .
Tracking antimicrobial stewardship activities beyond days of therapy (DOT): comparison of days of antibiotic spectrum coverage (DASC) and DOT at a single center.
Infect Control Hosp Epidemiol 2023 Jun; 44(6):934-37. doi: 10.1017/ice.2022.312..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication
Laytner L, Chen P, Nash S
Perspectives on non-prescription antibiotic use among Hispanic patients in the Houston Metroplex.
This study examined non-prescription use of antibiotics among Hispanic adults in the Houston area. The study included Hispanic primary care clinic patients with different types of health insurance coverage in the Houston metroplex who endorsed non-prescription use in a previous survey. Semistructured interviews were conducted in English or Spanish with 35 participants primarily female (68.6%) and aged 27 to 66. Participants reported obtaining antibiotics through under-the-counter US markets, trusted persons, and purchased without a prescription abroad. Factors contributing to non-prescription use included beliefs that the doctor visit was unnecessary, limited access to healthcare, and communication difficulties. However, participants expressed confidence in medical recommendations from pharmacists and trusted community members.
AHRQ-funded; HS026901.
Citation: Laytner L, Chen P, Nash S .
Perspectives on non-prescription antibiotic use among Hispanic patients in the Houston Metroplex.
J Am Board Fam Med 2023 May 8; 36(3):390-404. doi: 10.3122/jabfm.2022.220416R1..
Keywords: Racial and Ethnic Minorities, Antibiotics, Medication, Antimicrobial Stewardship
Patel D, Ng T, Madani LS
Antibiotic stewardship to reduce inappropriate antibiotic prescribing in integrated academic health-system urgent care clinics.
The purpose of this study was to conceptualize and implement antibiotic stewardship activities in urgent care that targets non-antibiotic-appropriate acute respiratory tract infections (ARIs) that also decreases general antibiotic prescribing and preserves patient satisfaction. The stewardship initiative commenced in fiscal year 2020 and included development of measures, comparative feedback, and education for clinicians and patients. The study measured antibiotic prescribing in fiscal years (FY) 2019, 2020, and 2021 for the stewardship goals, possible diagnosis-shifting visits, and overall prescribing. The researchers also collected patient satisfaction data for ARI visits. The study found that from FY 2019 to FY21, 576,609 patients made 1,358,816 visits to 17 urgent care clinics, including 105,781 visits for which stewardship measures were applied and 149,691 visits for which diagnosis shifting measures were applied. The antibiotic prescribing rate decreased for stewardship-measure visits from 34% in FY 2019 to 12% in FY 2021 The antibiotic prescribing rate decreased for diagnosis-shifting visits from 63% to 35%, and the antibiotic prescribing rate decreased overall from 30% to 10%. The patient satisfaction rate increased from 83% in FY 2019 to 89% in FY 2020 and FY 2021. There was no significant relationship between antibiotic prescribing rates of individual clinicians and ARI visit patient satisfaction.
AHRQ-funded; 233201500020I; HS026506; HS028127.
Citation: Patel D, Ng T, Madani LS .
Antibiotic stewardship to reduce inappropriate antibiotic prescribing in integrated academic health-system urgent care clinics.
Infect Control Hosp Epidemiol 2023 May; 44(5):736-45. doi: 10.1017/ice.2022.164..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication
Keller S, Miller MA, Cosgrove SE
AHRQ Author: Miller MA
The AHRQ Safety Program for Improving Antibiotic Use in Practice.
The Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use was an antibiotic stewardship intervention implemented across the United States in 2020 in 389 primary and urgent care practices. The AHRQ Toolkit to Improve Antibiotic Use in Ambulatory Care has been created based on integration of the educational material used in the AHRQ safety program and the experiences of the participating practices. The toolkit includes presentations on developing, implementing, and maintaining antibiotic stewardship activities; a gap analysis tool; and a guide to accessing and reporting antibiotic prescription data. Practices can use these tools to build their antibiotic stewardship teams and begin working on programs. Improving antibiotic prescribing in ambulatory care is a critical need. Utilizing the AHRQ Toolkit to Improve Antibiotic Use in Ambulatory Care can assist practices in achieving their antibiotic stewardship goals.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Keller S, Miller MA, Cosgrove SE .
The AHRQ Safety Program for Improving Antibiotic Use in Practice.
Am Fam Physician 2023 May; 107(5):456-57..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Ambulatory Care and Surgery, Tools & Toolkits
Thurman Johnson C, Ridge LJ, Hessels AJ
Nurse engagement in antibiotic stewardship programs: a scoping review of the literature.
This scoping review described how nurses are engaged in hospital-based antibiotic stewardship programs (ASPs) and to what extent this overlaps with the CDC framework. The authors concluded that, although hospitals were engaging nurses in antibiotic stewardship programs, their selected approaches did not reflect the full breadth of opportunities identified by the CDC. They noted that more detail as to how precisely nurses were engaged would be a useful addition to the literature; more research was also needed on nurse engagement in culturing or testing and penicillin allergy evaluation.
AHRQ-funded; HS026418.
Citation: Thurman Johnson C, Ridge LJ, Hessels AJ .
Nurse engagement in antibiotic stewardship programs: a scoping review of the literature.
J Healthc Qual 2023 Mar-Apr;45(2):69-82. doi: 10.1097/jhq.0000000000000372.
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Provider: Nurse
Olmeda K, Trautner BW, Laytner L
Prevalence and predictors of using antibiotics without a prescription in a pediatric population in the United States.
This study assessed the prevalence of antibiotic use in children in the previous 12 months, storage of antimicrobials, and intended use of non-prescription antibiotics (professed intention for future non-prescription antibiotic use). A diverse sample of caregivers of children under 18 years were surveyed in English and Spanish at two safety net clinics in Texas from January 2021 to April 2022. There was an 82% response rate, with 17% surveyed in Spanish. Approximately 21% reported storing antibiotics in their home, specifically amoxicillin (n = 52), clindamycin (n = 10), cephalexin (n = 5), penicillin (n = 3), and trimethoprim/sulfamethoxazole (n = 3). Nearly 15% reported intention to give non-prescription antibiotics to their children, with three Spanish-speaking caregivers reporting giving non-prescription antibiotics to their child in the previous 12 months. Younger caregivers were associated with storage and intended use of non-prescription antibiotics.
AHRQ-funded; HS027869.
Citation: Olmeda K, Trautner BW, Laytner L .
Prevalence and predictors of using antibiotics without a prescription in a pediatric population in the United States.
Antibiotics 2023 Mar;12(3). doi: 10.3390/antibiotics12030491..
Keywords: Children/Adolescents, Antibiotics, Medication, Antimicrobial Stewardship
Chiotos K, Blumenthal J, Boguniewicz J
Antibiotic indications and appropriateness in the pediatric intensive care unit: a 10-center point prevalence study.
The purpose of this study was to describe indications and appropriateness of antibiotic orders in pediatric intensive care unit (PICU) patients. The study found that of 1462 patients admitted to participating PICUs, 58% had at least 1 antibiotic order, with 1277 antibiotic orders being reviewed. Common indications were empiric therapy for suspected bacterial infections without sepsis or septic shock, nonoperative prophylaxis, empiric therapy for sepsis or septic shock, community-acquired pneumonia, and post-operative prophylaxis. Appropriateness was evaluated for 985 orders for which an evidence-based heading for appropriateness could be created. Of these, 34% were categorized as inappropriate. Indications with the most orders classified as inappropriate were empiric therapy for suspected bacterial infection without sepsis or septic shock, sepsis or septic shock, CAP, ventilator-associated infections, and post-operative prophylaxis. The proportion of antibiotics classified as inappropriate differed across institutions.
AHRQ-funded; HS026393.
Citation: Chiotos K, Blumenthal J, Boguniewicz J .
Antibiotic indications and appropriateness in the pediatric intensive care unit: a 10-center point prevalence study.
Clin Infect Dis 2023 Feb 8; 76(3):e1021-e30. doi: 10.1093/cid/ciac698..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Antibiotics, Medication, Antimicrobial Stewardship, Sepsis
Jindai K, Itaya T, Ogawa Y
Decline in oral antimicrobial prescription in the outpatient setting after nationwide implementation of financial incentives and provider education: an interrupted time-series analysis.
Researchers examined the impact of financial incentives to providers and provider education on overall antimicrobial prescription rates. They also analyzed how nationwide outpatient antimicrobial stewardship interventions in cases where antimicrobials were deemed unnecessary for uncomplicated respiratory infections and acute diarrhea affected different age groups before and after their implementation. The results indicated that prescription rates for all age groups showed a downward trend throughout the study period. Substantial reductions in prescription rates were observed among infants under 2 years, while provider education immediately reduced prescription rates in all age groups uniformly. Interventions did not affect the long-term trend for any age group.
AHRQ-funded; HS027472.
Citation: Jindai K, Itaya T, Ogawa Y .
Decline in oral antimicrobial prescription in the outpatient setting after nationwide implementation of financial incentives and provider education: an interrupted time-series analysis.
Infect Control Hosp Epidemiol 2023 Feb; 44(2):253-59. doi: 10.1017/ice.2022.49..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Ambulatory Care and Surgery
Chiotos K, Marshall D, Kellom K
Mixed-methods process evaluation of a respiratory-culture diagnostic stewardship intervention.
The purpose of this study was to perform an evaluation of a diagnostic stewardship initiative for respiratory culture in the healthcare setting within a pediatric intensive care unit (PICU) in a tertiary-care center. The study found that the frequency of culture collection per day of service differed among attending physicians, ranging from 2.2 to 27 cultures per 100 days. A total of 14 interviews were conducted, and 87 clinicians (response rate: 47%) along with 77 nurses or respiratory therapists (response rate: 17%) participated in the survey. There was a variation in clinicians' stated practices concerning culture ordering, which was influenced by both their specialty and their perception of the respiratory culture's usefulness. Additionally, group "default" practices, fear, and hierarchy affected the decision to order cultures. Obstacles to standardization encompassed concerns about missing a diagnosis and the conflict between standardized practices and individual judgment.
AHRQ-funded; HS026393.
Citation: Chiotos K, Marshall D, Kellom K .
Mixed-methods process evaluation of a respiratory-culture diagnostic stewardship intervention.
Infect Control Hosp Epidemiol 2023 Feb; 44(2):191-99. doi: 10.1017/ice.2022.299..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Antibiotics, Medication, Antimicrobial Stewardship, Intensive Care Unit (ICU)