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 15 of 15 Research Studies DisplayedBrown CS, Albright J, Henke PK
Modeling the elective vascular surgery recovery after coronavirus disease 2019: implications for moving forward.
This study looked at the impact of delays in elective vascular surgery caused by the coronavirus pandemic. Data from a 35-hospital regional vascular surgical collaborative consisting of all hospitals performing vascular surgery in the state of Michigan was used to estimate the number of delayed surgical cases for adults undergoing carotid endarterectomy, carotid stenting, endovascular and open abdominal aortic aneurysm repair, and lower extremity bypass. Median statewide monthly vascular surgical volume before the pandemic was 439 procedures, with a maximum statewide monthly case volume of 519 procedures. For the month of April 2020, elective vascular surgery procedure volume decreased by ~90%. Modelling estimated it would take approximately 8 months to catch up with the backlog. The authors suggest that if hospitals across the collaborative shared the burden of backlogged cases, the recovery should be shortened to ~3 months.
AHRQ-funded; HS000053.
Citation: Brown CS, Albright J, Henke PK .
Modeling the elective vascular surgery recovery after coronavirus disease 2019: implications for moving forward.
J Vasc Surg 2021 Jun;73(6):1876-80.e1. doi: 10.1016/j.jvs.2020.11.025..
Keywords: COVID-19, Infectious Diseases, Cardiovascular Conditions, Surgery
Byrnes ME, Brown CS, De Roo A
Elective surgical delays due to COVID-19: the patient lived experience.
This study looked at the effects of the COVID-19 pandemic on scheduling of elective cardiac and vascular surgery. The authors interviewed 47 individuals who experienced a postponement of surgery due to coronavirus. Patients described 3 key issues around their postponement: 1) surgery as part of a “return to normal”; 2) postponement took a toll on their physical health and mental wellbeing; and 3) many patients in their study said they would “rather die from a heart attack” than be exposed to the coronavirus.
AHRQ-funded; HS000053.
Citation: Byrnes ME, Brown CS, De Roo A .
Elective surgical delays due to COVID-19: the patient lived experience.
Med Care 2021 Apr;59(4):288-94. doi: 10.1097/mlr.0000000000001503..
Keywords: COVID-19, Surgery, Public Health, Patient Experience, Infectious Diseases
Aasen DM, Bronsert Rozeboom, PD
Relationships between predischarge and postdischarge infectious complications, length of stay, and unplanned readmissions in the ACS NSQIP database.
This study looked at the relationships between predischarge and postdischarge infectious complications, length of stay, and unplanned hospital readmissions after surgery. Data from the American College of Surgeons National Surgical Quality Improvement database from 2012 to 2017 across nine surgical specialties was used to analyze 30-day postoperative infectious complications including sepsis, surgical site infections, pneumonia, and urinary tract infections. Postoperative infectious complications were identified in 5.2% of cases, of which 59.8% were postdischarge. The specific postdischarge complications identified were 73.4% of surgical site infections, 34.9% of sepsis cases, 26.5% of pneumonia cases, and 53.2% of urinary tract infections. These postoperative infections were associated with an increased risk of readmission. Most infections were diagnosed postdischarge. The trend towards shorter length of stays postoperation also contribute to the increase in infections detected after discharge and the rate of unplanned related postoperative readmissions.
AHRQ-funded; HS026019.
Citation: Aasen DM, Bronsert Rozeboom, PD .
Relationships between predischarge and postdischarge infectious complications, length of stay, and unplanned readmissions in the ACS NSQIP database.
Surgery 2021 Feb;169(2):325-32. doi: 10.1016/j.surg.2020.08.009..
Keywords: Hospital Readmissions, Adverse Events, Healthcare-Associated Infections (HAIs), Infectious Diseases, Quality Improvement, Quality of Care, Surgery
Byrnes ME, Varlamos CJ, Rivard SJ
"You're used to being the one that can fix things…": a qualitative snapshot of colorectal surgeons during COVID-19.
This viewpoint article reflects the narratives of 58 colorectal surgeons who engaged in an in-depth qualitative interview during the COVID-19 shutdown of elective surgeries. The goal for reporting these findings is to offer a snapshot of surgeon perspectives on the delays of elective surgeries and to give voice to surgeons who were unable to perform most or all their duties as a surgeon.
AHRQ-funded; HS025365; HS000053.
Citation: Byrnes ME, Varlamos CJ, Rivard SJ .
"You're used to being the one that can fix things…": a qualitative snapshot of colorectal surgeons during COVID-19.
Dis Colon Rectum 2020 Dec;63(12):1575-78. doi: 10.1097/dcr.0000000000001818..
Keywords: Surgery, Provider: Physician, Provider, COVID-19, Public Health, Infectious Diseases
Anderson DJ, Ilieş I, Foy K
Early recognition and response to increases in surgical site infections using optimized statistical process control charts-the Early 2RIS Trial: a multicenter cluster randomized controlled trial with stepped wedge design.
This paper discusses the study protocol that was used to conduct the Early 2RIS Trial, which was a multicenter cluster randomized controlled trial from 2016 to 2020 to reduce surgical site infection (SSI) rates. The trial was performed in 29 hospitals in the Duke Infection Control Outreach Network (DICON) and 105 clusters over 4 years. All patients who underwent one of 13 targeted procedures at study hospitals were included. Six clusters were identified: cardiac, orthopedic, gastrointestinal, OB-GYN, vascular, and spinal. Clusters were randomized to intervention, and also underwent surveillance and feedback using optimized SPC charts. Surveillance data feedback was provided to all clusters, regardless of allocation or type of surveillance. The goal was to lower SSI through SPC intervention compared to traditional surveillance and feedback alone.
AHRQ-funded; HS023821.
Citation: Anderson DJ, Ilieş I, Foy K .
Early recognition and response to increases in surgical site infections using optimized statistical process control charts-the Early 2RIS Trial: a multicenter cluster randomized controlled trial with stepped wedge design.
Trials 2020 Oct 28;21(1):894. doi: 10.1186/s13063-020-04802-4..
Keywords: Surgery, Healthcare-Associated Infections (HAIs), Infectious Diseases, Patient Safety
Sheetz KH, Ryan A
Accuracy of quality measurement for the hospital acquired conditions reduction program.
Accuracy of quality measurement for the hospital acquired conditions reduction program.
AHRQ-funded; HS026244; HS000053.
Citation: Sheetz KH, Ryan A .
Accuracy of quality measurement for the hospital acquired conditions reduction program.
BMJ Qual Saf 2020 Jul;29(7):605-07. doi: 10.1136/bmjqs-2019-009747..
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Quality Measures, Quality Improvement, Quality of Care, Surgery, Infectious Diseases
Ilieş I, Anderson DJ, Salem J
Large-scale empirical optimisation of statistical control charts to detect clinically relevant increases in surgical site infection rates.
Researchers sought to determine which statistical process control chart types and design parameters maximized the detection of clinically relevant surgical site infection (SSI) rate increases while minimizing false alarms. Statistically significant SSI rate increases (signals) at individual hospitals were identified using 50 different statistical process control chart variations; blinded epidemiologists evaluated the clinical significance of 2709 representative signals of potential outbreaks and rated them as requiring action or no action. The researchers concluded that an optimized combination of two moving average charts had the best performance for identifying clinically relevant small but sustained above-network SSI rates and large short-term individual hospital increases.
AHRQ-funded; HS023821.
Citation: Ilieş I, Anderson DJ, Salem J .
Large-scale empirical optimisation of statistical control charts to detect clinically relevant increases in surgical site infection rates.
BMJ Qual Saf 2020 Jun;29(6):472-81. doi: 10.1136/bmjqs-2018-008976..
Keywords: Surgery, Healthcare-Associated Infections (HAIs), Infectious Diseases, Hospitals, Patient Safety
Baker AW, Nehls N, Ilies I
Use of optimised dual statistical process control charts for early detection of surgical site infection outbreaks.
This study analyzed the use of optimized dual statistical process control (SPC) charts to predict surgical site infection (SSI) outbreaks. The researchers retrospectively applied an optimized pair of moving average (MA) SPC charts to all 30 SSI outbreaks previously identified and investigated from 2007 to 2015 in the Duke Infection Control Outreach Network (DICON), which is a network of more than 50 community hospitals. The dual MA SPC chart approach detected all 30 outbreaks at a median of 16 months prior to traditional surveillance detection.
AHRQ-funded; HS23821.
Citation: Baker AW, Nehls N, Ilies I .
Use of optimised dual statistical process control charts for early detection of surgical site infection outbreaks.
BMJ Qual Saf 2020 Jun;29(6):517-20. doi: 10.1136/bmjqs-2019-010586..
Keywords: Healthcare-Associated Infections (HAIs), Surgery, Patient Safety, Hospitals, Public Health, Infectious Diseases
Feldman AG, Atkinson K, Wilson K
Underimmunization of the solid organ transplant population: An urgent problem with potential digital health solutions.
This paper describes ways that digital health technologies may help solid organ transplant recipients stay free from vaccine-preventable infections so they are not underimmunized at the time of transplant and thereafter. Due to vaccine hesitancy and refusal in the general population, recipients can no longer rely on herd immunity to protect them. Digital health technologies can provide accurate information about vaccine safety, efficacy and timing in the pre- and post-transplant periods; make complete immunization records universally available and easily accessible; enable communication between patients and multiple providers; and provide automated vaccine reminders to both patients and providers.
AHRQ-funded; HS026510.
Citation: Feldman AG, Atkinson K, Wilson K .
Underimmunization of the solid organ transplant population: An urgent problem with potential digital health solutions.
Am J Transplant 2020 Jan;20(1):34-39. doi: 10.1111/ajt.15605..
Keywords: Transplantation, Surgery, Healthcare Utilization, Infectious Diseases, Telehealth, Health Information Technology (HIT), Vaccination
Tourani R, Murphree DH, Melton-Meaux G
The value of aggregated high-resolution intraoperative data for predicting post-surgical infectious complications at two independent sites.
Surgical procedures carry the risk of postoperative infectious complications, which can be severe, expensive, and morbid. A growing body of evidence indicates that high-resolution intraoperative data can be predictive of these complications. However, these studies are often contradictory in their findings. In this work, data and models from two independent institutions, Mayo Clinic and University of Minnesota-affiliated Fairview Health Services, were directly compared using a common set of definitions for the variables and outcomes.
AHRQ-funded; HS024532.
Citation: Tourani R, Murphree DH, Melton-Meaux G .
The value of aggregated high-resolution intraoperative data for predicting post-surgical infectious complications at two independent sites.
Stud Health Technol Inform 2019 Aug 21;264:398-402. doi: 10.3233/shti190251..
Keywords: Surgery, Adverse Events, Risk, Infectious Diseases, Healthcare-Associated Infections (HAIs)
Kline SE, Sanstead EC, Johnson JR
Cost-effectiveness of pre-operative Staphylococcus aureus screening and decolonization.
In this study, the investigators developed a decision analytic model to evaluate the impact of a preoperative Staphylococcus aureus decolonization bundle on surgical site infections (SSIs), health-care-associated costs (HCACs), and deaths due to SSI. The investigators predict that the treat-all strategy would be the most effective and cost-saving strategy for preventing SSIs. However, they concluded that because this strategy might select more extensively for mupirocin-resistant S. aureus and cause more medication adverse effects than the test-and-treat approach or the SOC, additional studies are needed to define its comparative benefits and harms.
AHRQ-funded; HS022912.
Citation: Kline SE, Sanstead EC, Johnson JR .
Cost-effectiveness of pre-operative Staphylococcus aureus screening and decolonization.
Infect Control Hosp Epidemiol 2018 Nov;39(11):1340-46. doi: 10.1017/ice.2018.228..
Keywords: Surgery, Antibiotics, Antimicrobial Stewardship, Healthcare-Associated Infections (HAIs), Infectious Diseases, Patient Safety, Prevention, Healthcare Costs
Yokoe DS, Avery TR, Platt R
Ranking hospitals based on colon surgery and abdominal hysterectomy surgical site infection outcomes: impact of limiting surveillance to the operative hospital.
This study examined how hospitals are ranked based on colon surgery and abdominal surgical site infection (SSI) outcomes. This ranking can impact how financial penalties are determined. Currently SSI surveillance focuses mainly on the operative hospital, but patients sometimes go to a different hospital after an SSI as opposed to readmission in the operative hospital. The authors used data from a California statewide hospital registry to assess for evidence of SSI for surgeries performed from March 2011 through November 2013. This analysis showed show that operational hospital surveillance alone would have missed 7.2% of colon surgery and 13.4% of abdominal hysterectomy SSIs. This leads to an inaccurate assignment or avoidance of financial penalties for approximately 1 in 11-16 hospitals.
AHRQ-funded; HS021424.
Citation: Yokoe DS, Avery TR, Platt R .
Ranking hospitals based on colon surgery and abdominal hysterectomy surgical site infection outcomes: impact of limiting surveillance to the operative hospital.
Clin Infect Dis 2018 Sep 14;67(7):1096-102. doi: 10.1093/cid/ciy223..
Keywords: Surgery, Healthcare-Associated Infections (HAIs), Infectious Diseases, Injuries and Wounds, Adverse Events, Hospitals, Payment, Patient Safety, Provider Performance
Kline SE, Neaton JD, Lynfield R
Randomized controlled trial of a self-administered five-day antiseptic bundle versus usual disinfectant soap showers for preoperative eradication of Staphylococcus aureus colonization.
The objective of this study was to determine the efficacy in eradicating Staphylococcus aureus (SA) carriage of a 5-day preoperative decolonization bundle compared to 2 disinfectant soap showers, with both regimens self-administered at home. The investigators concluded that an outpatient preoperative antiseptic decolonization bundle aimed at 4 body sites was significantly more effective in eradicating SA than the usual disinfectant showers (ie, the control).
AHRQ-funded; HS022912.
Citation: Kline SE, Neaton JD, Lynfield R .
Randomized controlled trial of a self-administered five-day antiseptic bundle versus usual disinfectant soap showers for preoperative eradication of Staphylococcus aureus colonization.
Infect Control Hosp Epidemiol 2018 Sep;39(9):1049-57. doi: 10.1017/ice.2018.151..
Keywords: Antimicrobial Stewardship, Infectious Diseases, Patient Self-Management, Prevention, Surgery, Patient Safety
Johnson SP, Zhong L, Chung KC
Perioperative antibiotics for clean hand surgery: a national study.
This research is a national study on the use of prophylactic antibiotics in soft tissue hand surgery when antimicrobials are not indicated. Insurance claims from the Truven MarketScan Databases were used to identify patients who had 1 of 5 outpatient surgery procedures including: open or endoscopic carpal tunnel release; trigger finger release; de Ouervain release, and wrist ganglion excision between 2009 and 2015. An increase of 72.5% in prophylactic intravenous antibiotics was shown from 2009 to 2015. Patients with a younger age, male sex, lower income, or obesity had higher odds of receiving antibiotics. Total charge for these antibiotics equaled $1.6 million.
AHRQ-funded; HS023313.
Citation: Johnson SP, Zhong L, Chung KC .
Perioperative antibiotics for clean hand surgery: a national study.
J Hand Surg Am 2018 May;43(5):407-16.e1. doi: 10.1016/j.jhsa.2017.11.018..
Keywords: Antibiotics, Antimicrobial Stewardship, Healthcare-Associated Infections (HAIs), Infectious Diseases, Medication, Patient Safety, Surgery
Ferrada P, Callcut R, Zielinski MD
Loop ileostomy versus total colectomy as surgical treatment for Clostridium difficile-associated disease: an Eastern Association for the Surgery of Trauma multicenter trial.
The objective of this study was to compare loop ileostomy (LI) and total colectomy (TC) procedures in a multicentric approach to help the surgeon decide what procedure was best suited for the patient in need. In this study, the investigators found that LI carried less mortality than TC.
AHRQ-funded; HS024547.
Citation: Ferrada P, Callcut R, Zielinski MD .
Loop ileostomy versus total colectomy as surgical treatment for Clostridium difficile-associated disease: an Eastern Association for the Surgery of Trauma multicenter trial.
J Trauma Acute Care Surg 2017 Jul;83(1):36-40. doi: 10.1097/ta.0000000000001498..
Keywords: Clostridium difficile Infections, Comparative Effectiveness, Infectious Diseases, Surgery, Treatments