National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
Topics
- Care Coordination (1)
- Children/Adolescents (1)
- Communication (1)
- Decision Making (1)
- Elderly (1)
- (-) Emergency Department (16)
- Emergency Medical Services (EMS) (3)
- Healthcare Cost and Utilization Project (HCUP) (3)
- Healthcare Delivery (6)
- Health Information Technology (HIT) (1)
- Hospital Discharge (2)
- Hospitalization (3)
- Hospitals (8)
- Imaging (1)
- Intensive Care Unit (ICU) (1)
- Medicaid (1)
- Medicare (1)
- Mortality (1)
- Nursing Homes (1)
- Outcomes (2)
- Patient-Centered Outcomes Research (1)
- Patient Safety (2)
- Policy (1)
- Primary Care (1)
- Provider (1)
- Provider: Clinician (1)
- Quality of Care (1)
- Sepsis (1)
- Surgery (5)
- (-) Transitions of Care (16)
- Trauma (1)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
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 DisplayedFernandes-Taylor S, Yang Q, Yang DY
Greater patient sharing between hospitals is associated with better outcomes for transferred emergency general surgery patients.
The availability of emergency surgical services has diminished as the rural workforce has decreased. The growing need for interhospital patient transfers makes care coordination across different settings essential for maintaining high-quality care. The purpose of this study was to investigate the impact of recurrent patient-sharing between hospitals on the outcomes of emergency general surgery (EGS) patient transfers. A multicenter analysis was conducted involving inpatient acute care hospital stays in Wisconsin that required the transfer of EGS patients. Data was sourced from the Wisconsin Hospital Association (WHA), a comprehensive statewide hospital discharge database for the years 2016-2018. We postulated that a higher percentage of patients transferred between hospitals would lead to improved outcomes. The relationship between the proportion of EGS patient transfers and patient outcomes, such as in-hospital morbidity, mortality, and duration of stay, was examined. Additional factors considered were hospital organizational features and patient sociodemographic and clinical attributes. The researchers found that during the two-year study period, 118 hospitals transferred 3,197 EGS patients; 1,131 of these patients experienced in-hospital complications, death, or an extended stay (beyond the 75th percentile). The average patient age was 62 years, with 50% being female and 5% non-white. In the mixed-effects model, the proportion of shared patients between hospitals was linked to a reduced likelihood of in-hospital complications. Specifically, when the proportion of shared patients doubled between two hospitals, the relative odds of any adverse outcome shifted by 0.85.
AHRQ-funded; HS025224
Citation: Fernandes-Taylor S, Yang Q, Yang DY .
Greater patient sharing between hospitals is associated with better outcomes for transferred emergency general surgery patients.
J Trauma Acute Care Surg 2023 Apr;94(5):592-98. doi: 10.1097/ta.0000000000003789.
Keywords: Emergency Department, Hospitals, Surgery, Transitions of Care
Zhang A, Spiegel T, Bundy A
Evaluation of a transitions clinic to bridge emergency department and primary care.
This paper evaluated the outcomes of using a clinical transition clinic (CTC) to bridge emergency department (ED) and primary care. Main outcomes were 30-day ED revisits and hospital readmissions. From March 2021 to March 2022, 373 patients were referred to the CTC totaling 405 appointments, with half (53%) completed with a median follow-up time of 4 days. The most common care types provided were wound care (44%) and clinical problem management (33%). Patients who completed their CTC appointment were 50% less likely to return to the ED in 30 days compared with those who did not complete their appointment. The same effect was not seen for CTC appointment completion on hospital readmission.
AHRQ-funded; HS027804.
Citation: Zhang A, Spiegel T, Bundy A .
Evaluation of a transitions clinic to bridge emergency department and primary care.
J Hosp Med 2023 Mar; 18(3):217-23. doi: 10.1002/jhm.13056..
Keywords: Transitions of Care, Emergency Department, Primary Care
Werner NE, Rutkowski RA, Krause S
Disparate perspectives: exploring healthcare professionals' misaligned mental models of older adults' transitions of care between the emergency department and skilled nursing facility.
Care transitions that occur across healthcare system boundaries represent a unique challenge for maintaining high quality care and patient safety, as these systems are typically not aligned to perform the care transition process. In this article, the investigators explored healthcare professionals' mental models of older adults' transitions between the emergency department (ED) and skilled nursing facility (SNF).
AHRQ-funded; HS026624.
Citation: Werner NE, Rutkowski RA, Krause S .
Disparate perspectives: exploring healthcare professionals' misaligned mental models of older adults' transitions of care between the emergency department and skilled nursing facility.
Appl Ergon 2021 Oct;96:103509. doi: 10.1016/j.apergo.2021.103509..
Keywords: Elderly, Transitions of Care, Emergency Department, Nursing Homes, Healthcare Delivery
Fernandes-Taylor S, Yang DY, Schumacher J
Factors associated with Interhospital transfers of emergency general surgery patients from emergency departments.
This study looked at the factors contributing to transfer of emergency general surgery (EGS) patients to another hospital. Data from the AHRQ Nationwide Emergency Department Sample (NEDS) from 2010-2014 was analyzed. The transfer rate during that time was 1.9%. Patients with Medicare or other insurance had higher odds of transfer compared to patients with private health insurance. Odds of transfer increased with a greater number of comorbid conditions as well as resuscitation, intestinal obstruction, and conditions of the upper gastrointestinal tract. Transfers were more likely to originate from rural hospitals or Level I or II trauma centers.
AHRQ-funded; HS025224.
Citation: Fernandes-Taylor S, Yang DY, Schumacher J .
Factors associated with Interhospital transfers of emergency general surgery patients from emergency departments.
Am J Emerg Med 2021 Feb;40:83-88. doi: 10.1016/j.ajem.2020.12.012..
Keywords: Healthcare Cost and Utilization Project (HCUP), Surgery, Emergency Department, Transitions of Care, Hospitals, Healthcare Delivery
Terp S, Seabury SA, Axeen S
The association between hospital characteristics and Emergency Medical Treatment and Labor Act citation events.
The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law enacted in 1986 prohibiting patient dumping (refusing or transferring patients with emergency medical conditions without appropriate stabilization), and discrimination based upon ability to pay. In this study, the investigators evaluated hospital-level features associated with citation for EMTALA violation. They concluded that for-profit ownership was associated with increased odds of EMTALA citations after adjusting for other characteristics.
AHRQ-funded; HS025281.
Citation: Terp S, Seabury SA, Axeen S .
The association between hospital characteristics and Emergency Medical Treatment and Labor Act citation events.
Med Care 2020 Sep;58(9):793-99. doi: 10.1097/mlr.0000000000001360..
Keywords: Emergency Department, Hospitals, Policy, Transitions of Care
Zhu W, Patterson BW, Smith M
A Markov chain model for transient analysis of handoff process in emergency departments.
Transfer of care between multiple units or facilities is of significant importance for patient safety, care quality, and operation efficiency. Such transfers are often referred to as handoffs in hospitals, which need to be carried out timely, safely, and smoothly with accurate information. This paper introduced a Markov chain model to study the transients of handoff process in hospital emergency departments.
AHRQ-funded; HS026624.
Citation: Zhu W, Patterson BW, Smith M .
A Markov chain model for transient analysis of handoff process in emergency departments.
IEEE Robot Autom Lett 2020 Jul;5(3):4360-67. doi: 10.1109/lra.2020.2996066..
Keywords: Emergency Department, Hospitals, Transitions of Care, Healthcare Delivery, Patient Safety
Arulraja MD, Swanson MB, NM
Double inter-hospital transfer in sepsis patients presenting to the ED does not worsen mortality compared to single inter-hospital transfer.
This study investigated whether double inter-hospital transfer in sepsis patients presenting to the emergency department (ED) worsens mortality compared to single inter-hospital transfer. A retrospective cohort study was conducted using 2005-2014 administrative claims data in Iowa. Hospital length-of-stay and cost data was also collected. Compared to non-transfers, single transfers did not have higher mortality rates than double transfers of Iowa sepsis patients.
AHRQ-funded; HS025753.
Citation: Arulraja MD, Swanson MB, NM .
Double inter-hospital transfer in sepsis patients presenting to the ED does not worsen mortality compared to single inter-hospital transfer.
J Crit Care 2020 Apr;56:49-57. doi: 10.1016/j.jcrc.2019.11.018..
Keywords: Sepsis, Transitions of Care, Mortality, Hospitals, Emergency Department, Outcomes
Ingraham A, Wang X, Havlena J
Factors associated with the interhospital transfer of emergency general surgery patients.
Researchers used data from the Nationwide Inpatient Sample to determine patient- and hospital-level factors associated with interhospital emergency general surgery (EGS) transfers. They identified that hospital-level characteristics more strongly predicted the need for transfer than patient-related factors. They recommended considering these factors in order to facilitate transfer decision-making.
AHRQ-funded; HS025224.
Citation: Ingraham A, Wang X, Havlena J .
Factors associated with the interhospital transfer of emergency general surgery patients.
J Surg Res 2019 Aug;240:191-200. doi: 10.1016/j.jss.2018.11.053..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Surgery, Decision Making, Hospitals, Healthcare Delivery, Transitions of Care
Hoonakker PLT, Wooldridge AR, Hose BZ
Information flow during pediatric trauma care transitions: things falling through the cracks.
In order to investigate information flow during pediatric trauma care transitions, researchers interviewed 18 clinicians about communication and coordination between the emergency department, operating room, and pediatric intensive care unit, then surveyed the clinicians about patient safety during these transitions. They found that, despite the fact that the many services and units involved in pediatric trauma cooperate well together during trauma cases, important patient care information is often lost when transitioning patients between units. To manage the transition of this fragile and complex population better, they recommend finding ways to manage the information flow during these transitions better by, for instance, providing technological support to ensure shared mental models.
AHRQ-funded; HS023837.
Citation: Hoonakker PLT, Wooldridge AR, Hose BZ .
Information flow during pediatric trauma care transitions: things falling through the cracks.
Intern Emerg Med 2019 Aug;14(5):797-805. doi: 10.1007/s11739-019-02110-7..
Keywords: Children/Adolescents, Communication, Emergency Department, Healthcare Delivery, Intensive Care Unit (ICU), Patient Safety, Provider, Provider: Clinician, Surgery, Transitions of Care, Trauma
Lauerman MH, Herrera AV, Albrecht JS
Interhospital transfers with wide variability in emergency general surgery.
This study examined modern hospital practices for interhospital transfers of emergency general surgery patients. A retrospective review of the Maryland Health Services Cost Review Commission database was conducted from 2013 to 2015. The majority of patients (94.1%) were not transferred with only 3.2% transferred to a hospital and 2.7% transferred from a hospital. For individual hospitals, there was a range of 0-30.5% of encounters transferred to a hospital, 0.02-14.62% transferred from a hospital and 69.25-99.95% not transferred.
AHRQ-funded; HS024560.
Citation: Lauerman MH, Herrera AV, Albrecht JS .
Interhospital transfers with wide variability in emergency general surgery.
Am Surg 2019 Jun;85(6):595-600..
Keywords: Emergency Department, Healthcare Delivery, Hospitalization, Hospitals, Outcomes, Quality of Care, Surgery, Transitions of Care
Gupta A, Lacson R, Balthazar PC
Assessing documentation of critical imaging result follow-up recommendations in emergency department discharge instructions.
The purpose of this study was to facilitate follow-up of critical test results across transitions in patient care settings, the investigators implemented an electronic discharge module that enabled care providers to include follow-up recommendations in the discharge instructions. Implementation of a discharge module was associated with increased documentation of critical imaging finding follow-up recommendations in ED discharge instructions. However, one in four patients still did not receive adequate follow-up recommendations, suggesting further opportunities for performance improvement exist.
AHRQ-funded; HS022586.
Citation: Gupta A, Lacson R, Balthazar PC .
Assessing documentation of critical imaging result follow-up recommendations in emergency department discharge instructions.
J Digit Imaging 2018 Aug;31(4):562-67. doi: 10.1007/s10278-017-0039-6..
Keywords: Emergency Department, Health Information Technology (HIT), Hospital Discharge, Imaging, Transitions of Care
Leyenaar JK, Lagu T, Lindenauer PK
Direct admission to the hospital: an alternative approach to hospitalization.
The authors discussed the role of hospital medicine in the changing epidemiology of hospital admissions, the potential risks and benefits of direct admission to the hospital, and the need for research to evaluate the safety and effectiveness of this admission approach. They proposed that transitions of care research and quality improvement be expanded to address transitions into the hospital.
AHRQ-funded; HS024133.
Citation: Leyenaar JK, Lagu T, Lindenauer PK .
Direct admission to the hospital: an alternative approach to hospitalization.
J Hosp Med 2016 Apr;11(4):303-5. doi: 10.1002/jhm.2512.
.
.
Keywords: Emergency Department, Emergency Medical Services (EMS), Hospitalization, Transitions of Care
Desai AD, Popalisky J, Simon TD
The effectiveness of family-centered transition processes from hospital settings to home: a review of the literature.
The objective of this study was to conduct a targeted literature review of studies examining the effectiveness of family-centered transition processes from hospital-and emergency department (ED)-to-home for improving patient health outcomes and health care utilization. It determined that patient-tailored discharge education is associated with improved patient health outcomes in pediatric ED patients.
AHRQ-funded; HS020506.
Citation: Desai AD, Popalisky J, Simon TD .
The effectiveness of family-centered transition processes from hospital settings to home: a review of the literature.
Hosp Pediatr 2015 Apr;5(4):219-31. doi: 10.1542/hpeds.2014-0097..
Keywords: Patient-Centered Outcomes Research, Hospital Discharge, Emergency Department, Emergency Medical Services (EMS), Transitions of Care
Kindermann DR, Mutter RL, Houchens RL
Emergency department transfers and transfer relationships in United States hospitals.
The study objective was to describe transfers out of hospital-based emergency departments (EDs) in a total of 97,021 ED transfer encounters. Among the 50 highest transfer rate disease categories, in U.S. EDs, patients are often transported great distances, more commonly to large teaching hospitals with greater resources.
AHRQ-funded; 290201300002C
Citation: Kindermann DR, Mutter RL, Houchens RL .
Emergency department transfers and transfer relationships in United States hospitals.
Acad Emerg Med. 2015 Feb;22(2):157-65. doi: 10.1111/acem.12586..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Transitions of Care, Hospitals
Hilligoss B, Vogus TJ
Navigating care transitions: a process model of how doctors overcome organizational barriers and create awareness.
Using interviews and observations of doctors, the researchers examined transitions from an emergency department to inpatient units through a 2-year study of an academic medical center. They describe and document 3 challenges to between-unit transitions of care and identify the adaptive workarounds that doctors employ to resolve these challenges, thus addressing a significant gap in the literature on high-reliability healthcare organizations.
AHRQ-funded; HS018758
Citation: Hilligoss B, Vogus TJ .
Navigating care transitions: a process model of how doctors overcome organizational barriers and create awareness.
Med Care Res Rev. 2015 Feb;72(1):25-48. doi: 10.1177/1077558714563170..
Keywords: Transitions of Care, Emergency Department, Hospitalization, Care Coordination
Kindermann DR, Mutter RL, Houchens RL
AHRQ Author: Mutter RL
The transfer instability index: a novel metric of emergency department transfer relationships.
The researchers developed the “transfer instability index” to describe sending hospitals’ relationships with receiving hospitals. They found that emergency departments with a greater share of publicly insured patients had a greater transfer instability index, which may indicate less stable, protocolized, and regionalized transfer relationships.
AHRQ-funded; 290201300002C.
Citation: Kindermann DR, Mutter RL, Houchens RL .
The transfer instability index: a novel metric of emergency department transfer relationships.
Acad Emerg Med 2015 Feb;22(2):166-71. doi: 10.1111/acem.12589..
Keywords: Emergency Medical Services (EMS), Emergency Department, Transitions of Care, Medicaid, Medicare