National Healthcare Quality and Disparities Report
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Topics
- Anxiety (1)
- Asthma (2)
- Behavioral Health (1)
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- Critical Care (1)
- Depression (1)
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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 DisplayedWaltman A, Konetzka RT, Chia S
Effectiveness of a bundled payments for care improvement program for chronic obstructive pulmonary disease.
This single-site retrospective observational study evaluated the impact of an evidence-based transitions of care program on episode costs and readmission rates, comparing patients hospitalized for COPD exacerbations who received versus those who did not receive the intervention. Between October 2015 and September 2018, 132 received and 161 did not receive the program. Below target mean episode costs were found for six out of eleven quarters for the intervention group, as opposed to only one out of twelve quarters for the control group. Overall, there were non-significant mean savings of $2551 in episode costs relative to target costs for the intervention group, though results varied by index admission diagnosis-related group (DRG). There were additional costs of $4184 per episode for the least-complicated cohort (DRG 192), but savings of $1897 and $1753 for the most complicated index admissions (DRGs 191 and 190, respectively). A significant mean decrease of 0.24 readmissions per episode for intervention was observed in 90-day readmission rates relative to control. Skilled nursing facility readmissions and hospital discharges were factors of higher costs (mean increases of $9098 and $17,095 per episode respectively).
AHRQ-funded; HS027804.
Citation: Waltman A, Konetzka RT, Chia S .
Effectiveness of a bundled payments for care improvement program for chronic obstructive pulmonary disease.
J Gen Intern Med 2023 Sep; 38(12):2662-70. doi: 10.1007/s11606-023-08249-6..
Keywords: Respiratory Conditions, Chronic Conditions, Payment, Quality Improvement, Quality of Care
Campbell JI, Menzies D
Testing and scaling interventions to improve the tuberculosis infection care cascade.
The purpose of this study was to review and summarize current literature on barriers and solutions occurring within the tuberculosis (TB) infection care cascade, focusing on children in high- and low-burden settings, and obtaining data and information from studies on both children and adults. The researchers concluded that identifying and addressing gaps in the TB care cascade requires the utilization of tools both novel and long-standing, and will be facilitated by shared clinical practice with primary care providers, methods of quality improvement, and innovative study designs.
AHRQ-funded; HS000063.
Citation: Campbell JI, Menzies D .
Testing and scaling interventions to improve the tuberculosis infection care cascade.
J Pediatric Infect Dis Soc 2022 Oct 31;11(Suppl 3):S94-s100. doi: 10.1093/jpids/piac070..
Keywords: Respiratory Conditions, Infectious Diseases, Quality Improvement, Quality of Care
Schechter S, Jaladanki S, Rodean J
Sustainability of paediatric asthma care quality in community hospitals after ending a national quality improvement collaborative.
Community hospitals, which care for most hospitalised children in the USA, may be vulnerable to declines in paediatric care quality when quality improvement (QI) initiatives end. In this study, the investigators aimed to evaluate changes in care quality in community hospitals after the end of the Pathways for Improving Paediatric Asthma Care (PIPA) national QI collaborative. The investigators concluded that the end of the paediatric asthma QI collaborative was associated with concerning declines in guideline adherence in community hospitals.
AHRQ-funded; HS027041.
Citation: Schechter S, Jaladanki S, Rodean J .
Sustainability of paediatric asthma care quality in community hospitals after ending a national quality improvement collaborative.
BMJ Qual Saf 2021 Nov;30(11):876-83. doi: 10.1136/bmjqs-2020-012292..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Hospitals, Quality Improvement, Quality of Care
Liu FF, Lew A, Andes E
Implementation strategies for depression and anxiety screening in a pediatric cystic fibrosis center: a quality improvement project.
The objective of this study was to share key strategies that led to successful mental health screening (MHS) implementation in one pediatric cystic fibrosis center and to report implementation and screening outcomes. Results showed that leveraging coproduction to address stakeholder needs led to successful implementation of a sustainable MHS process.
AHRQ-funded; HS026393.
Citation: Liu FF, Lew A, Andes E .
Implementation strategies for depression and anxiety screening in a pediatric cystic fibrosis center: a quality improvement project.
Pediatr Pulmonol 2020 Dec;55(12):3328-36. doi: 10.1002/ppul.24951..
Keywords: Children/Adolescents, Respiratory Conditions, Chronic Conditions, Depression, Anxiety, Behavioral Health, Screening, Implementation, Quality Improvement, Quality of Care, Diagnostic Safety and Quality
Kaiser SV, Lam Cabana, MD
Best practices in implementing inpatient pediatric asthma pathways: a qualitative study.
The objective of this study was to identify potential best practices in pathway implementation. Building upon a previous observational study in which the researchers identified higher and lower performing children's hospitals based on hospital-level changes in asthma patient length of stay after implementation of a pathway, they conducted semi-structured interviews with a sample of healthcare providers involved in pathway implementation at these hospitals. They identified several potential best practices to support pathway implementation. They recommended that hospitals implementing pathways consider applying these strategies to ensure success in improving quality of asthma care for children.
AHRQ-funded; HS024592.
Citation: Kaiser SV, Lam Cabana, MD .
Best practices in implementing inpatient pediatric asthma pathways: a qualitative study.
J Asthma 2020 Jul;57(7):744-54. doi: 10.1080/02770903.2019.1606237..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Hospitals, Inpatient Care, Guidelines, Evidence-Based Practice, Implementation, Quality Improvement, Quality of Care
Pandian V, Zhen G, Stanley S
Management of difficult airway among patients with oropharyngeal angioedema.
This study assessed the impact of a quality improvement program to manage patients with difficult airway associated with oropharyngeal angioedema patients called DART (difficult airway response team). This retrospective review compared patient charges from July 2003 to June 2008 (pre-DART) to charges from July 2008 to June 2013 (post-DART). Patient characteristics, airway evaluation, and interventions were compared. There was a higher incidence of patients requiring intubation in the post-DART cohort (67%) versus the pre-DART cohort (39%). The results showed the approach offers adequate time and resources for airway evaluation prior to intervention and allows fewer numbers of attempts to secure an airway.
AHRQ-funded; HS024547.
Citation: Pandian V, Zhen G, Stanley S .
Management of difficult airway among patients with oropharyngeal angioedema.
Laryngoscope 2019 Jun;129(6):1360-67. doi: 10.1002/lary.27622..
Keywords: Care Management, Quality of Care, Quality Improvement, Respiratory Conditions, Teams
Kaiser SV, Lam R, Joseph GB
Limitations of using pediatric respiratory illness readmissions to compare hospital performance.
Researcher sought to determine if a National Quality Forum (NQF)-endorsed measure for pediatric lower respiratory illness (LRI) 30-day readmission rates can meaningfully identify high- and low-performing hospitals. Subjects were children with LRI (bronchiolitis, influenza, or pneumonia as primary diagnosis, or with an LRI as a secondary diagnosis with a primary diagnosis of respiratory failure, sepsis, bacteremia, or asthma) from all hospital admissions in California from 2012 to 2014. The researchers were unable to identify meaningful variation in hospital performance without broadening the metric definition and merging multiple years of data. They recommend that utilizers of pediatric-quality measures consider modifying metrics to better evaluate the quality of pediatric care at low-volume hospitals.
AHRQ-funded; HS024385; HS022835; HS024592; HS025297.
Citation: Kaiser SV, Lam R, Joseph GB .
Limitations of using pediatric respiratory illness readmissions to compare hospital performance.
J Hosp Med 2018 Nov;13(11):737-42. doi: 10.12788/jhm.2988..
Keywords: Children/Adolescents, Respiratory Conditions, Provider Performance, Hospital Readmissions, Hospitals, Quality Indicators (QIs), Quality Measures, Quality of Care, Quality Improvement
Bavishi A, Boss E, Shah RK
Outcomes after endoscopic dilation of laryngotracheal stenosis: an analysis of ACS-NSQIP.
Endoscopic management of pediatric subglottic stenosis (SGS) is common, however no multi-institutional studies have assessed its perioperative outcomes. This study examined outcomes after endoscopic dilation of laryngotracheal stenosis. The study found that open airway reconstruction is associated with longer length of stay and increased reintubations and reoperations, suggesting a possible opportunity to improve value in healthcare in the appropriately selected patient. Reoperations and readmissions following endoscopic dilation are more prevalent in children less than one year.
AHRQ-funded; HS022932.
Citation: Bavishi A, Boss E, Shah RK .
Outcomes after endoscopic dilation of laryngotracheal stenosis: an analysis of ACS-NSQIP.
J Clin Outcomes Manag 2018 Mar;25(3):111-16..
Keywords: Children/Adolescents, Patient-Centered Outcomes Research, Quality Improvement, Respiratory Conditions, Surgery
Badawy J, Nguyen OK, Clark C
Is everyone really breathing 20 times a minute? Assessing epidemiology and variation in recorded respiratory rate in hospitalised adults.
The researchers sought to assess the potential accuracy of respiratory rate (RR) by analyzing the distribution and variation as a proxy, since RR should be normally distributed if recorded accurately. The observed patterns suggest that RR is inaccurately recorded, even among those with cardiopulmonary compromise, and represents a 'spot' estimate with values of 18 and 20 breaths per minute representing 'normal.’
AHRQ-funded; HS022418.
Citation: Badawy J, Nguyen OK, Clark C .
Is everyone really breathing 20 times a minute? Assessing epidemiology and variation in recorded respiratory rate in hospitalised adults.
BMJ Qual Saf 2017 Oct;26(10):832-36. doi: 10.1136/bmjqs-2017-006671.
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Keywords: Hospitalization, Inpatient Care, Patient Safety, Quality Improvement, Respiratory Conditions
Finn Davis K, Napolitano N, Li S
Promoters and barriers to implementation of tracheal intubation airway safety bundle: a mixed-method analysis.
This study describes promoters and barriers to implementation of an airway safety quality improvement bundle from the perspective of interdisciplinary frontline clinicians and ICU quality improvement leaders. Both early and late adopters identified similar promoter and barrier themes. Early adopter sites customized the quality improvement bundle and had an interdisciplinary quality improvement team approach.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Finn Davis K, Napolitano N, Li S .
Promoters and barriers to implementation of tracheal intubation airway safety bundle: a mixed-method analysis.
Pediatr Crit Care Med 2017 Oct;18(10):965-72. doi: 10.1097/pcc.0000000000001251.
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Keywords: Critical Care, Intensive Care Unit (ICU), Patient Safety, Quality Improvement, Respiratory Conditions
Bhatt SP, Wells JM, Iyer AS
Results of a Medicare bundled payments for care improvement initiative for chronic obstructive pulmonary disease readmissions.
This study evaluated whether a comprehensive chronic obstructive pulmonary disease (COPD) multidisciplinary intervention focusing on inpatient, transitional, and outpatient care as part of an institution's Bundled Payments for Care Improvement (BPCI) participation would reduce 30-day all-cause readmission rates for COPD exacerbations and reduce overall costs. It concluded that a Medicare BPCI intervention did not reduce 30-day all-cause readmission rates or overall costs after hospitalization for acute exacerbation of COPD.
AHRQ-funded; HS013852.
Citation: Bhatt SP, Wells JM, Iyer AS .
Results of a Medicare bundled payments for care improvement initiative for chronic obstructive pulmonary disease readmissions.
Ann Am Thorac Soc 2017 May;14(5):643-48. doi: 10.1513/AnnalsATS.201610-775BC.
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Keywords: Respiratory Conditions, Payment, Hospital Readmissions, Medicare, Quality Improvement