National Healthcare Quality and Disparities Report
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Search All Research Studies
Topics
- Decision Making (1)
- Emergency Department (1)
- Healthcare-Associated Infections (HAIs) (2)
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- Health Services Research (HSR) (1)
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- Patient Safety (3)
- Payment (6)
- (-) Policy (11)
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- (-) Quality Improvement (11)
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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 11 of 11 Research Studies DisplayedWatnick S, Blake PG, Mehrotra R
System-level strategies to improve home dialysis: policy levers and quality initiatives.
This article discusses trends in home dialysis use, reviews the evolving understanding of what constitutes high quality care for the home dialysis population (as well as how this can be measured), and discusses policy and advocacy efforts that continue to shape the care of US patients, and compares with experiences in other countries. The authors conclude by discussing future directions for quality and advocacy efforts.
AHRQ-funded; HS028684.
Citation: Watnick S, Blake PG, Mehrotra R .
System-level strategies to improve home dialysis: policy levers and quality initiatives.
Clin J Am Soc Nephrol 2023 Dec; 18(12):1616-25. doi: 10.2215/cjn.0000000000000299..
Keywords: Home Healthcare, Kidney Disease and Health, Policy, Quality Improvement, Quality of Care
Liao JM, Wang E, Isidro U
The association between bundled payment participation and changes in medical episode outcomes among high-risk patients.
This research evaluated whether the association between participation in bundled payments for medical conditions and episode outcomes differed for clinically high-risk versus other patients in regard to length of stay (LOS) at skilled nursing facilities (SNFs). Participants included 471,421 Medicare patients hospitalized at bundled payment and propensity-matched non-participating hospitals. Primary outcomes were SNF LOS and 90-day unplanned readmissions. SNF length of stay was differentially lower among frail patients, patients with advanced age (>85 years), and those with prior institutional post-acute care provider utilization compared to non-frail, younger, and patients without prior utilization, respectively. Bundled payment participation was also associated with differentially greater SNF LOS among disabled patients. It was not associated with differential changes in readmissions in any high-risk group but was associated with changes in quality, utilization, and spending measures for some groups.
AHRQ-funded; HS027595.
Citation: Liao JM, Wang E, Isidro U .
The association between bundled payment participation and changes in medical episode outcomes among high-risk patients.
Healthcare 2022 Dec 12; 10(12). doi: 10.3390/healthcare10122510..
Keywords: Payment, Quality Improvement, Quality of Care, Risk, Policy
Tedesco D, Moghavem N, Weng Y
Improvement in patient safety may precede policy changes: trends in patient safety indicators in the United States, 2000-2013.
This study’s aim was to assess changes in national patient safety trends that corresponded to U.S. pay-for-performance reforms. The study analyzed 13 patient safety indicators (PSIs) that were developed by AHRQ. PSI trends, Center for Medicaid and Medicare Services payment policy changes, and Inpatient Prospective Payment System regulations and notices between 2000 and 2013 were analyzed. Twelve of the thirteen PSIs had decreasing or stable trends in the last 5 years of the study. Central-line bloodstream infections had the greatest annual decrease (-31.1 annual percent change between 2006 and 2013) whereas postoperative respiratory failure had the smallest annual percent change (-3.5 between 2005 and 2013). Significant decreases in trends preceded federal payment reform initiatives in all but postoperative hip fracture. These findings suggest that intense public discourses targeting patient safety may drive national policy reforms.
AHRQ-funded; HS018558.
Citation: Tedesco D, Moghavem N, Weng Y .
Improvement in patient safety may precede policy changes: trends in patient safety indicators in the United States, 2000-2013.
J Patient Saf 2021 Jun 1;17(4):e327-e34. doi: 10.1097/pts.0000000000000615..
Keywords: Patient Safety, Quality Improvement, Quality Indicators (QIs), Quality Measures, Quality of Care, Policy
Vsevolozhskaya OA, Manz KC, Zephyr PM
Measurement matters: changing penalty calculations under the Hospital Acquired Condition Reduction Program (HACRP) cost hospitals millions.
Since October 2014, the Centers for Medicare and Medicaid Services has penalized 25% of U.S. hospitals with the highest rates of hospital-acquired conditions under the Hospital Acquired Conditions Reduction Program (HACRP). While early evaluations of the HACRP program reported cumulative reductions in hospital-acquired conditions, more recent studies have not found a clear association between receipt of the HACRP penalty and hospital quality of care. In this article, the authors posit that some of this disconnect may be driven by frequent scoring updates.
AHRQ-funded; HS025148.
Citation: Vsevolozhskaya OA, Manz KC, Zephyr PM .
Measurement matters: changing penalty calculations under the Hospital Acquired Condition Reduction Program (HACRP) cost hospitals millions.
BMC Health Serv Res 2021 Feb 10;21(1):131. doi: 10.1186/s12913-021-06108-w..
Keywords: Healthcare-Associated Infections (HAIs), Infectious Diseases, Hospitals, Policy, Quality Improvement, Quality of Care, Patient Safety
Kronick R, Casalino LP, Bindman AB
AHRQ Author: Kronick R
Apple pickers or federal judges: strong versus weak incentives in physician payment.
The authors provide an introduction for five papers commissioned by AHRQ focusing on incentives for physicians that are featured in this special issue of Health Services Research. These papers concentrate on suggesting a conceptual framework for the use of financial incentives in health care, key implications of the evidence to date on pay for performance and public reporting in health care and several related topics.
AHRQ-authored.
Citation: Kronick R, Casalino LP, Bindman AB .
Apple pickers or federal judges: strong versus weak incentives in physician payment.
Health Serv Res 2015 Dec;50 Suppl 2:2049-56. doi: 10.1111/1475-6773.12424.
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Keywords: Payment, Provider Performance, Policy, Health Services Research (HSR), Quality of Care, Healthcare Costs, Quality Improvement
Berenson RA, Rice T
Beyond measurement and reward: methods of motivating quality improvement and accountability.
The article examines public policies designed to improve quality and accountability that do not rely on financial incentives and public reporting of provider performance. It concludes that public policies related to quality improvement should focus more on methods of enhancing professional intrinsic motivation, while recognizing the potential role of organizations to actively promote and facilitate that motivation.
AHRQ-funded
Citation: Berenson RA, Rice T .
Beyond measurement and reward: methods of motivating quality improvement and accountability.
Health Serv Res 2015 Dec;50 Suppl 2:2155-86. doi: 10.1111/1475-6773.12413.
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Keywords: Quality Improvement, Policy, Provider Performance, Quality of Care, Payment
Berdahl C, Schuur JD, Fisher NL
Policy measures and reimbursement for emergency medical imaging in the era of payment reform: proceedings from a panel discussion of the 2015 Academic Emergency Medicine Consensus Conference.
In May 2015, Academic Emergency Medicine convened a consensus conference titled "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization." As part of the conference, a panel of health care policy leaders and emergency physicians discussed the effect of the Affordable Casre Act and other quality programs on ED diagnostic imaging. This article discusses the content of the panel's presentations.
AHRQ-funded; HS023498.
Citation: Berdahl C, Schuur JD, Fisher NL .
Policy measures and reimbursement for emergency medical imaging in the era of payment reform: proceedings from a panel discussion of the 2015 Academic Emergency Medicine Consensus Conference.
Acad Emerg Med 2015 Dec;22(12):1393-9. doi: 10.1111/acem.12829.
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Keywords: Emergency Department, Healthcare Costs, Payment, Policy, Imaging, Policy, Quality Improvement
Schlesinger M, Grob R, Shaller D
Using patient-reported information to improve clinical practice.
The purposes of this study were to assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient-valued outcomes in health systems with strong financial incentives. It concluded that unless public policies are attentive to patients' perspectives, stronger financial incentives for clinicians can threaten aspects of care that patients most value.
AHRQ-funded.
Citation: Schlesinger M, Grob R, Shaller D .
Using patient-reported information to improve clinical practice.
Health Serv Res 2015 Dec;50 Suppl 2:2116-54. doi: 10.1111/1475-6773.12420.
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Keywords: Quality Improvement, Quality of Care, Patient Experience, Provider Performance, Policy, Payment, Public Reporting
Padula WV, Makic MB, Wald HL
Hospital-acquired pressure ulcers at academic medical centers in the United States, 2008-2012: tracking changes since the CMS nonpayment policy.
This study was conducted to define changes in hospital-acquired pressure ulcers (HAPU) incidence and variance since 2008. It found that HAPU incidence rates decreased significantly among 210 University HealthSystems Consortium academic medical centers after the enactment of the CMS nonpayment policy. This suggests that governmental policy was a significant driver of change in clinical practice for wound care and created incentives for preventive efforts on the part of hospitals.
AHRQ-funded; HS023710.
Citation: Padula WV, Makic MB, Wald HL .
Hospital-acquired pressure ulcers at academic medical centers in the United States, 2008-2012: tracking changes since the CMS nonpayment policy.
Jt Comm J Qual Patient Saf 2015 Jun;41(6):257-63..
Keywords: Healthcare-Associated Infections (HAIs), Patient Safety, Policy, Pressure Ulcers, Prevention, Quality Improvement
Abrahamson K, Miech E, Davila HW
Pay-for-performance policy and data-driven decision making within nursing homes: a qualitative study.
The researchers explored ways in which data were collected, thought about and used by nursing home employees as a result of participation in a pay-for-performance (P4P) program. Their findings indicated that participants in the Minnesota Performance-based Incentive Payment Program’s quality improvement (QI) projects perceived a change in the rate and manner in which they gathered, used, and considered data in their QI decisions.
AHRQ-funded; HS018464
Citation: Abrahamson K, Miech E, Davila HW .
Pay-for-performance policy and data-driven decision making within nursing homes: a qualitative study.
BMJ Qual Saf. 2015 May;24(5):311-7. doi: 10.1136/bmjqs-2014-003362..
Keywords: Nursing Homes, Long-Term Care, Payment, Provider Performance, Decision Making, Policy, Quality Improvement, Quality of Care
Sjoding MW, Cooke CR
The importance of rigorous evaluation of quality measurement programs.
The authors comment on a study evaluating a California program to determine whether public reporting of ICU mortality rates improved patient outcomes. They argue that as these programs move from public reporting to pay-for-performance as a primary mechanism for incentivizing improvement, the research community must ensure they are both fair and effective.
AHRQ-funded; HS020672.
Citation: Sjoding MW, Cooke CR .
The importance of rigorous evaluation of quality measurement programs.
Ann Am Thorac Soc 2015 Jan;12(1):107-8. doi: 10.1513/AnnalsATS.201412-588ED..
Keywords: Quality Improvement, Public Reporting, Intensive Care Unit (ICU), Policy, Outcomes