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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 10 of 10 Research Studies Displayed
Tamma PD, Miller MA, Dullabh P
AHRQ Author: Miller MA
Association of a safety program for improving antibiotic use with antibiotic use and hospital-onset Clostridioides difficile infection rates among US hospitals.
Regulatory agencies and professional organizations recommend antibiotic stewardship programs (ASPs) in US hospitals. The optimal approach to establish robust, sustainable ASPs across diverse hospitals is unknown. The purpose of this study was to assess whether the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use was associated with reductions in antibiotic use across US hospitals. The investigators concluded that AHRQ Safety Program appeared to enable diverse hospitals to establish ASPs and teach frontline clinicians to self-steward their antibiotic use.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Tamma PD, Miller MA, Dullabh P . Association of a safety program for improving antibiotic use with antibiotic use and hospital-onset Clostridioides difficile infection rates among US hospitals. JAMA Netw Open 2021 Feb;4(2):e210235. doi: 10.1001/jamanetworkopen.2021.0235..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Decision Making, Clostridium difficile Infections, Patient Safety, Quality Improvement, Quality of Care, Hospitals
Hanlon JT, Perera S, Schweon S
Improvements in antibiotic appropriateness for cystitis in older nursing home residents: a quality improvement study with randomized assignment.
This study evaluated the impact of an educational quality improvement initiative on the appropriateness of antibiotic prescribing restricted to uncomplicated cystitis in older noncatheterized nursing home residents. This 1-year case-control study used 25 participating nursing homes that were randomized to the intervention or usual care group by strata that included state, urban/rural status, bed size, and geographic separation. A total of 75 cases of cystitis were found in the intervention groups and 92 in the control groups. The intervention group had a nonsignificant 21% reduction in the risk of antibiotic prescribing. There was a favorable comparison in appropriateness of duration. However, the intervention group had more problems with drug-drug interactions than the control group (8% vs 1%). There were also more problems with dosage in the intervention group. Both groups had similar rates of problems with choice or effectiveness (44% vs 45%). The most common antibiotic class that was prescribed inappropriately was quinolones.
AHRQ-funded; R18 HS023779.
Citation: Hanlon JT, Perera S, Schweon S . Improvements in antibiotic appropriateness for cystitis in older nursing home residents: a quality improvement study with randomized assignment. J Am Med Dir Assoc 2021 Jan;22(1):173-77. doi: 10.1016/j.jamda.2020.07.040..
Keywords: Elderly, Nursing Homes, Long-Term Care, Antibiotics, Medication, Quality Improvement, Quality of Care, Urinary Tract Infection (UTI), Decision Making
Blecker S, Austrian JS, Horwitz LI
Interrupting providers with clinical decision support to improve care for heart failure.
The goal of this study was to develop a clinical decision support (CDS) system to recommend an angiotenson converting enzyme (ACE) inhibitor during hospitalization so it could be promoted for continuation at discharge. Patients who were hospitalized with reduced ejection fraction were pseudo-randomized to deliver interruptive or non-interruptive CDS alerts to providers based on the patients’ even or odd medical record number. The utilization rate was higher for interruptive alert versus non-interruptive alert hospitalizations for a sample of 958. This resulted in improved quality of care for heart failure patients.
Citation: Blecker S, Austrian JS, Horwitz LI . Interrupting providers with clinical decision support to improve care for heart failure. Int J Med Inform 2019 Nov;131:103956. doi: 10.1016/j.ijmedinf.2019.103956..
Keywords: Clinical Decision Support (CDS), Decision Making, Heart Disease and Health, Cardiovascular Conditions, Medication, Medication: Safety, Patient Safety, Quality Improvement, Quality of Care
Cochon LR, Kapoor N, Carrodeguas E
Variation in follow-up imaging recommendations in radiology reports: patient, modality, and radiologist predictors.
The purpose of this study was to determine the incidence and to identify factors associated with follow-up recommendations in radiology reports from multiple modalities, patient care settings, and imaging divisions. A trained algorithm classified 318,366 report; the findings indicate that substantial interradiologist variation exists in the probability of recommending a follow-up examination in a radiology report.
Citation: Cochon LR, Kapoor N, Carrodeguas E . Variation in follow-up imaging recommendations in radiology reports: patient, modality, and radiologist predictors. Radiology 2019 Jun;291(3):700-07. doi: 10.1148/radiol.2019182826..
Keywords: Decision Making, Diagnostic Safety and Quality, Imaging, Patient Safety, Quality of Care, Quality Improvement
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%.
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
Tchou MJ, Tang Girdwood S, Wormser B
Reducing electrolyte testing in hospitalized children by using quality improvement methods.
This article describes a project which aimed to reduce electrolyte testing within a hospital medicine service. Six hospital medicine teams at an academic children's hospital system were targeted by using the Model for Improvement, employing interventions that included standardized communication about electrolyte testing plans and education regarding costs and risks associated with the overuse of electrolyte testing. The primary outcome measure was the number of electrolyte tests per patient day. The authors report that their intervention was associated with significant, rapid reduction in electrolyte testing and was not associated with unintended adverse events.
Citation: Tchou MJ, Tang Girdwood S, Wormser B . Reducing electrolyte testing in hospitalized children by using quality improvement methods. Pediatrics 2018 May;141(5). doi: 10.1542/peds.2017-3187..
Keywords: Children/Adolescents, Decision Making, Hospitals, Quality Improvement
Aldina S, Goldhaber-Fiebert SN, Hannenberg AA
Factors associated with the use of cognitive aids in operating room crises: a cross-sectional study of US hospitals and ambulatory surgical centers.
This study examined organizational context and implementation process factors influencing the use of cognitive aids for OR crises. It found that small facility size was associated with a fourfold increase in the odds of a facility reporting more successful implementation. Completing more implementation steps was also significantly associated with more successful implementation.
Citation: Aldina S, Goldhaber-Fiebert SN, Hannenberg AA . Factors associated with the use of cognitive aids in operating room crises: a cross-sectional study of US hospitals and ambulatory surgical centers. Implement Sci 2018 Mar 26;13(1):50. doi: 10.1186/s13012-018-0739-4.
Keywords: Adverse Events, Ambulatory Care and Surgery, Patient Safety, Quality Improvement, Quality of Care, Hospitals, Decision Making, Clinical Decision Support (CDS)
Lavallee DC, Chenok KE, Love RM
Incorporating patient-reported outcomes into health care to engage patients and enhance care.
The authors examine the opportunities for using patient-reported outcomes to enhance care delivery and outcomes as health care information needs and technology platforms change. They highlight emerging practices in which patient-reported outcomes provide value to patients and clinicians and improve care delivery. Finally, they examine present and future challenges to maximizing the use of patient-reported outcomes in the clinic.
Citation: Lavallee DC, Chenok KE, Love RM . Incorporating patient-reported outcomes into health care to engage patients and enhance care. Health Aff 2016 Apr;35(4):575-82. doi: 10.1377/hlthaff.2015.1362.
Keywords: Healthcare Delivery, Decision Making, Patient-Centered Outcomes Research, Patient and Family Engagement, Quality Improvement
Blackmore CC, Castro A
Improving the quality of imaging in the emergency department.
The six-tier efficacy hierarchy of Fryback and Thornbury enables understanding of the value of imaging on multiple levels, ranging from technical efficacy to medical decision-making and higher-level patient and societal outcomes. In this article, the authors elucidate the Fryback and Thornbury framework to define the value of imaging in the ED and to relate emergency imaging to the IOM quality domains.
Citation: Blackmore CC, Castro A . Improving the quality of imaging in the emergency department. Acad Emerg Med 2015 Dec;22(12):1385-92. doi: 10.1111/acem.12816.
Keywords: Decision Making, Emergency Department, Imaging, 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.
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