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
526 to 550 of 551 Research Studies DisplayedBrown JR, Solomon RJ, Sarnak MJ
Reducing contrast-induced acute kidney injury using a regional multicenter quality improvement intervention.
The researchers sought to determine whether a 6-year regional multicenter quality improvement intervention could reduce contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary interventions. They found that benchmark hospitals had no significant changes in CI-AKI, while rates of CI-AKI were significantly reduced in hospitals receiving the intervention. Key qualitative system factors associated with improvement included multidisciplinary teams, limiting contrast volume, standardized fluid orders, intravenous fluid bolus, and patient education about oral hydration.
AHRQ-funded; HS018443.
Citation: Brown JR, Solomon RJ, Sarnak MJ .
Reducing contrast-induced acute kidney injury using a regional multicenter quality improvement intervention.
Circ Cardiovasc Qual Outcomes 2014 Sep;7(5):693-700. doi: 10.1161/circoutcomes.114.000903.
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Keywords: Adverse Drug Events (ADE), Injuries and Wounds, Patient Safety, Heart Disease and Health, Quality Improvement
Maggard-Gibbons M
The use of report cards and outcome measurements to improve the safety of surgical care: the American College of Surgeons National Surgical Quality Improvement Program.
This review summarized the history of American College of Surgeons National Surgical Quality Improvement Project and its components, and described the evidence that feeding outcomes back to providers, along with real-time comparisons with other hospital rates, leads to quality improvement, better patient outcomes, cost savings and overall improved patient safety.
AHRQ-funded; 2902007100621.
Citation: Maggard-Gibbons M .
The use of report cards and outcome measurements to improve the safety of surgical care: the American College of Surgeons National Surgical Quality Improvement Program.
BMJ Qual Saf 2014 Jul;23(7):589-99. doi: 10.1136/bmjqs-2013-002223..
Keywords: Quality Improvement, Quality Indicators (QIs), Quality Measures, Quality of Care, Surgery, Patient Safety, Outcomes, Patient-Centered Outcomes Research, Provider Performance
Zhang R, Lee JY, Jean-Jacques M
Factors influencing the increasing disparity in LDL cholesterol control between white and black patients with diabetes in a context of active quality improvement.
The authors conducted a retrospective analysis of black and white patients treated continuously between 2008 and 2010 in order to examine possible causes of an increased disparity in low-density lipoprotein (LDL) cholesterol control following a multifaceted physician-directed quality improvement (QI) initiative. They found that physician-facing, general QI interventions may be insufficient to produce equity in LDL cholesterol control, and that helping patients maintain prior success controlling cholesterol appears as important in addressing this disparity as is helping uncontrolled patients achieve control.
AHRQ-funded; HS021141.
Citation: Zhang R, Lee JY, Jean-Jacques M .
Factors influencing the increasing disparity in LDL cholesterol control between white and black patients with diabetes in a context of active quality improvement.
Am J Med Qual 2014 Jul-Aug;29(4):308-14. doi: 10.1177/1062860613498112.
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Keywords: Heart Disease and Health, Diabetes, Disparities, Quality Improvement, Racial and Ethnic Minorities
Arora VM, Berhie S, Horwitz LI
Using standardized videos to validate a measure of handoff quality: the handoff mini-clinical examination exercise.
The researchers report the results of the development of a shorter Handoff Mini-Clinical Examination Exercise (CEX), along with the formal establishment of its construct validity, namely its ability to distinguish between levels of performance in 3 domains of handoff quality. They were able to demonstrate evidence that the Handoff Mini-CEX can draw reliable and valid conclusions regarding handoff performance by physicians in U.S. hospitals.
AHRQ-funded; HS018278
Citation: Arora VM, Berhie S, Horwitz LI .
Using standardized videos to validate a measure of handoff quality: the handoff mini-clinical examination exercise.
J Hospital Med. 2014 Jul;9(7):441-6. doi: 10.1002/jhm.2185.
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Keywords: Provider Performance, Quality Measures, Quality Improvement, Quality of Care, Education: Continuing Medical Education, Patient Safety
Padula WV, Mishra MK, Makic MB
A framework of quality improvement interventions to implement evidence-based practices for pressure ulcer prevention.
The purpose of this paper is to enhance the learner’s competence with knowledge about a framework of quality improvement (QI) interventions to implement evidence-based practices for pressure ulcer (PrU) prevention. The best-practice framework offers a reference point to initiating a bundle of QI interventions in support of evidence-based practices. Hospitals and clinicians tasked with quality improvement efforts can use this framework to problem-solve PrU prevention and other critical issues.
AHRQ-funded; HS023710.
Citation: Padula WV, Mishra MK, Makic MB .
A framework of quality improvement interventions to implement evidence-based practices for pressure ulcer prevention.
Adv Skin Wound Care 2014 Jun;27(6):280-4; quiz 85-6. doi: 10.1097/01.ASW.0000450703.87099.5b..
Keywords: Quality Improvement, Patient Safety, Evidence-Based Practice, Pressure Ulcers, Guidelines
Mutter R, Clancy C
AHRQ Author: Mutter R, Clancy C
Investing in emergency medicine to improve health care for all Americans: the role of the Agency for Healthcare Research and Quality.
This article provides a description of the portfolio of emergency care-related activities that AHRQ sponsors. The discussion includes these areas: conduct of research; tool development; quality indicators; data and analytic capacity; and training of young investigators.
AHRQ-authored.
Citation: Mutter R, Clancy C .
Investing in emergency medicine to improve health care for all Americans: the role of the Agency for Healthcare Research and Quality.
Ann Emerg Med 2014 May;63(5):580-3. doi: 10.1016/j.annemergmed.2013.06.021.
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Keywords: Emergency Department, Quality of Care, Health Services Research (HSR), Quality Improvement, TeamSTEPPS
Glance LG, Mukamel DB, Osler TM
Ranking trauma center quality: can past performance predict future performance?
This study investigated whether hospital quality metrics based on prior years of data reliably predict future performance. It found that although the future performance of individual trauma centers can be predicted using 2-year-old data, the performance of individual trauma centers cannot be reliably predicted using performance reports based on data that is 3, 4, or 5 years old.
AHRQ-funded; HS016737.
Citation: Glance LG, Mukamel DB, Osler TM .
Ranking trauma center quality: can past performance predict future performance?
Ann Surg 2014 Apr;259(4):682-6. doi: 10.1097/sla.0000000000000334..
Keywords: Quality Improvement, Quality Measures, Hospitals
Meddings J, Rogers MA, Krein SL
Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review.
The authors updated a prior systematic review and a meta-analysis regarding interventions prompting urinary catheter (UC) removal by reminders or stop orders. They found that UC reminders and stop orders appear to reduce catheter-associated urinary tract infection rates and should be used to improve patient safety.
AHRQ-funded; 290200710062I; HS019767; HS018344.
Citation: Meddings J, Rogers MA, Krein SL .
Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review.
BMJ Qual Saf 2014 Apr;23(4):277-89. doi: 10.1136/bmjqs-2012-001774.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Patient Safety, Patient-Centered Outcomes Research, Prevention, Quality Improvement, Urinary Tract Infection (UTI)
Dahlke AR, Chung JW, Holl JL
Evaluation of initial participation in public reporting of American College of Surgeons NSQIP surgical outcomes on Medicare's Hospital Compare website.
The objective of this paper was to compare CMS-National Surgical Quality Improvement Program (CMS-NSQIP) participating hospitals with American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) hospitals that elected not to participate in Hospital Compare. The researchers found few measurable differences between CMS-NSQIP participating and nonparticipating hospitals.
AHRQ-funded; HS021857.
Citation: Dahlke AR, Chung JW, Holl JL .
Evaluation of initial participation in public reporting of American College of Surgeons NSQIP surgical outcomes on Medicare's Hospital Compare website.
J Am Coll Surg 2014 Mar;218(3):374-80, 80.e1-5. doi: 10.1016/j.jamcollsurg.2013.11.022.
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Keywords: Hospitals, Outcomes, Public Reporting, Quality Improvement, Surgery
Martinez KA, Aslakson RA, Wilson RF
A systematic review of health care interventions for pain in patients with advanced cancer.
The authors sought to synthesize the evidence on the effectiveness of pain-focused interventions in patients with advanced cancer. In nineteen studies, they found moderate strength of evidence that pain management in advanced cancer can be improved using health care interventions, particularly nurse-led patient-centered interventions.
AHRQ-funded; 290200710061.
Citation: Martinez KA, Aslakson RA, Wilson RF .
A systematic review of health care interventions for pain in patients with advanced cancer.
Am J Hosp Palliat Care 2014 Feb;31(1):79-86. doi: 10.1177/1049909113476129.
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Keywords: Cancer, Comparative Effectiveness, Pain, Palliative Care, Quality Improvement
Battles JB, Farr SL, Weinberg DA
AHRQ Author: Battles JB
From research to nationwide implementation: the impact of AHRQ's HAI prevention program.
The authors sought to provide insight to AHRQ's healthcare-associated infection (HAI) prevention strategies by: first, discussing the context and structure of AHRQ's HAI research portfolio and funding decisions; secondly, describing the process of prevention practice implementation and lessons learned; and third, explaining the outcomes and national impact of the AHRQ program. Their paper described major contributions that have emerged from AHRQ-funded HAI projects.
AHRQ-authored.
Citation: Battles JB, Farr SL, Weinberg DA .
From research to nationwide implementation: the impact of AHRQ's HAI prevention program.
Med Care 2014 Feb;52(2 Suppl 1):S91-6. doi: 10.1097/mlr.0000000000000037.
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Keywords: Quality of Care, Healthcare-Associated Infections (HAIs), Quality Improvement, Patient Safety, Prevention
Rangachari P, Madaio M, Rethemeyer RK
Role of communication content and frequency in enabling evidence-based practices.
The study sought to promote central line bundle (CLB) implementation in a medical ICU and a pediatric ICU through periodic quality improvement (QI) interventions over a 52-week period. It found that proactive communications increased by 68 percent in the MICU and 61 percent in the PICU. During the same timeframe, both units increased CLB adherence to 100 percent. Both units also demonstrated statistically significant declines in catheter days.
AHRQ-funded; HS019785.
Citation: Rangachari P, Madaio M, Rethemeyer RK .
Role of communication content and frequency in enabling evidence-based practices.
Qual Manag Health Care 2014 Jan-Mar;23(1):43-58. doi: 10.1097/qmh.0000000000000017..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Communication, Evidence-Based Practice, Guidelines, Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU), Quality of Care, Quality Improvement
Zurovac J, Moreno L, Crosson J
Using multifactorial experiments for comparative effectiveness research in physician practices with electronic health record.
This paper identifies the opportunities for using efficient multifactorial designs and electronic health records (EHR) data to evaluate quality-improvement efforts in physician practices. It concludes that the use of efficient multifactor experimental designs, especially coupled with EHR data, has great promise for helping physician practices, hospitals, and other stakeholders conduct rapid-cycle comparative effectiveness research in order to assess alternative ways of implementing various aspects of care.
AHRQ-funded; HS022789.
Citation: Zurovac J, Moreno L, Crosson J .
Using multifactorial experiments for comparative effectiveness research in physician practices with electronic health record.
eGEMS 2013 Dec 30;1(3):1037. doi: 10.13063/2327-9214.1037..
Keywords: Patient-Centered Outcomes Research, Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Improvement, Comparative Effectiveness
Taliani CA, Bricker PL, Adelman AM
Implementing effective care management in the patient-centered medical home.
The investigators explored how a disparate group of patient-centered medical homes (PCMHs) embedded care management in their team care environment to identify best practices. They concluded that PCMHs may want to ensure that care managers are available to meet with patients during visits, support patient self-management, fully leverage the electronic medical record for team messaging and patient tracking, and ensure integration into the care team with office huddles and ongoing communication.
AHRQ-funded; HS019150.
Citation: Taliani CA, Bricker PL, Adelman AM .
Implementing effective care management in the patient-centered medical home.
Am J Manag Care 2013 Dec;19(12):957-64.
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Keywords: Care Management, Diabetes, Healthcare Delivery, Patient-Centered Healthcare, Quality Improvement, Teams
Mukamel DB, Harrington C
Resident satisfaction surveys and clinical quality of care in nursing homes: two sides of the same coin?
The authors of this article believe that quality of nursing homes is a complex, multidimensional construct. Unlike acute care hospitals, where patients are typically treated for one specific condition and stay for a short period of time, the length of stays in nursing homes varies widely. They argue that neither the individual assessment of clinical quality nor evaluation of hotel services are sufficient.
AHRQ-funded; HS021844.
Citation: Mukamel DB, Harrington C .
Resident satisfaction surveys and clinical quality of care in nursing homes: two sides of the same coin?
Aging Health 2013 Dec;9(6):607-9. doi: 10.2217/ahe.13.63..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Long-Term Care, Nursing Homes, Patient Experience, Quality of Care, Quality Improvement, Quality Measures
Begum R, Smith Ryan M, Winther CH
Small practices' experience with EHR, quality measurement, and incentives.
The researchers surveyed clinicians participating in Health eHearts, a cluster-randomized trial of the effect of a financial incentive and quality improvement (QI) assistance program on measures of cardiovascular care compared with the effect of providing quality reports and QI assistance. No differences were detected between groups regarding agreement with selected clinical measures or their relevance to the patient population.
AHRQ-funded; HS019164; HS018275.
Citation: Begum R, Smith Ryan M, Winther CH .
Small practices' experience with EHR, quality measurement, and incentives.
Am J Manag Care 2013 Nov;19(10 Spec No):eSP12-8..
Keywords: Health Information Technology (HIT), Electronic Health Records (EHRs), Quality Improvement, Primary Care, Practice Patterns
Henriksen K, Brady J
AHRQ Author: Henriksen K, Brady J
The pursuit of better diagnostic performance: a human factors perspective.
Improving diagnostic performance is increasingly recognised as a multifaceted challenge. This paper addresses a few of these challenges, including questions that focus on who owns the problem, treating cognitive and system shortcomings as separate issues, why knowledge in the head is not enough, and what we are learning from health information technology and the use of checklists. The authors propose a systems engineering approach making use of rapid-cycle prototyping and simulation, and they call for the formation of substantive partnerships with those in disciplines beyond the clinical domain.
AHRQ-authored.
Citation: Henriksen K, Brady J .
The pursuit of better diagnostic performance: a human factors perspective.
BMJ Qual Saf 2013 Oct;22 Suppl 2:ii1-ii5. doi: 10.1136/bmjqs-2013-001827.
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Keywords: Diagnostic Safety and Quality, Health Information Technology (HIT), Medical Errors, Health Information Technology (HIT), Quality Improvement
Clancy CM
AHRQ Author: Clancy CM
Children's electronic health records: has the tipping point arrived?
This article describes an electronic health record (EHR) format developed by AHRQ and CMS in consultation with experts from the American Academy of Pediatrics and the American Academy of Family Physicians. Organized around 22 topic areas, this format includes information about needed functionality, best practices, and applicable data standards that can be used as a starting point for EHR developers.
AHRQ-authored.
Citation: Clancy CM .
Children's electronic health records: has the tipping point arrived?
J Comp Eff Res 2013 Jul;2(4):359-61. doi: 10.2217/cer.13.44.
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Keywords: Children/Adolescents, Electronic Health Records (EHRs), Children/Adolescents, Quality Improvement
Werner RM, Konetzka RT, Kim MM
Quality improvement under nursing home compare: the association between changes in process and outcome measures.
The researchers tested the extent to which improvements in outcomes of care are explained by changes in nursing home processes. Of the 5 outcome measures examined, they found that only improvements in the percentage of nursing home residents in moderate or severe pain were associated with changes in nursing home processes of care. They concluded that understanding the mechanism behind improvements in nursing home outcomes may be key to successfully achieving broad quality improvements across nursing homes.
AHRQ-funded; HS021861.
Citation: Werner RM, Konetzka RT, Kim MM .
Quality improvement under nursing home compare: the association between changes in process and outcome measures.
Med Care 2013 Jul;51(7):582-8. doi: 10.1097/MLR.0b013e31828dbae4.
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Keywords: Nursing Homes, Long-Term Care, Quality Improvement, Quality Measures, Quality of Care, Provider Performance, Outcomes
DeVoe JE, Stenger R
Aligning provider incentives to improve primary healthcare delivery in the United States.
This critical review uses a theoretical framework from game-theory models to discuss some of the dominant primary care provider payment models and how they create 'prisoner's dilemmas' that have stalled past reform efforts, then illustrates an escape from the dilemma. It concludes that a blend of guaranteed payment and selective incentives designed to encourage primary care providers to deliver high quality care, efficient and equitable care and to eliminate incentives towards over-servicing could reach outcomes leading to shared benefits for everyone involved.
AHRQ-funded; HS014645; HS016181.
Citation: DeVoe JE, Stenger R .
Aligning provider incentives to improve primary healthcare delivery in the United States.
OA Fam Med 2013 Jun 1;1(1):7.
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Keywords: Healthcare Delivery, Payment, Primary Care, Quality Improvement
McNellis RJ, Genevro JL, Meyers DS
AHRQ Author: McNellis RJ, Genevro JL, Meyers DS
Lessons learned from the study of primary care transformation.
This article discusses the patient-centered medical home (PCMH) model. The authors conclude that the transformation of primary care is essential to achieving the triple aim of better outcomes, better value, and better experience of care, and that the PCMH may be the most viable solution in the current health care environment.
AHRQ-authored.
Citation: McNellis RJ, Genevro JL, Meyers DS .
Lessons learned from the study of primary care transformation.
Ann Fam Med 2013 May-Jun;11 Suppl 1:S1-5. doi: 10.1370/afm.1548.
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Keywords: Patient-Centered Healthcare, Primary Care: Models of Care, Primary Care, Healthcare Delivery, Organizational Change, Quality Improvement, Quality of Care
Merkow RP, Kmiecik TE, Bentrem DJ
Effect of including cancer-specific variables on models examining short-term outcomes.
The objectives of this paper were 1) to examine differences between existing American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) variables and cancer registry variables, and 2) to determine whether the addition of cancer-specific variables improves modeling of short-term outcomes. The researchers found that, although advanced disease stage and neoadjuvant therapy variables were predictors of short-term outcomes, their inclusion did not improve the models.
AHRQ-funded; HS021857.
Citation: Merkow RP, Kmiecik TE, Bentrem DJ .
Effect of including cancer-specific variables on models examining short-term outcomes.
Cancer 2013 Apr 1;119(7):1412-9. doi: 10.1002/cncr.27891.
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Keywords: Cancer: Colorectal Cancer, Outcomes, Quality Improvement, Registries
Kleinman LC, Dougherty D
AHRQ Author: Dougherty D
Assessing quality improvement in health care: theory for practice.
The authors reviewed the role of theory as a means to enhance the practice of quality improvement (QI) research and to propose a novel conceptual model focused on the operations of health care. They concluded that such a theory can promote opportunities for moving the field forward and organizing the planning and interpretation of comparable studies.
AHRQ-authored.
Citation: Kleinman LC, Dougherty D .
Assessing quality improvement in health care: theory for practice.
Pediatrics 2013 Mar;131 Suppl 1:S110-9. doi: 10.1542/peds.2012-1427n.
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Keywords: Quality Improvement, Healthcare Delivery, Organizational Change, Quality of Care, Health Services Research (HSR)
Sharkey S, Hudak S, Horn SD
AHRQ Author: Spector W
Exploratory study of nursing home factors associated with successful implementation of clinical decision support tools for pressure ulcer prevention.
The researchers determined those factors that are associated with nursing homes' success in implementing the On-Time quality improvement (QI) for pressure ulcer prevention program and integrating health information technology (HIT) tools into practice at the unit level. They found that after at least 9 months of implementation effort, 36% of the nursing homes achieved level III of the On-Time QI-HIT program. They concluded that the learning from On-Time QI offers several lessons associated with facility factors that contribute to high level of implementation of a QI-HIT program in a nursing home.
AHRQ-authored; AHRQ-funded; 29020050020.
Citation: Sharkey S, Hudak S, Horn SD .
Exploratory study of nursing home factors associated with successful implementation of clinical decision support tools for pressure ulcer prevention.
Adv Skin Wound Care 2013 Feb;26(2):83-92; quiz p.93-4. doi: 10.1097/01.ASW.0000426718.59326.bb.
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Keywords: Health Information Technology (HIT), Nursing Homes, Pressure Ulcers, Prevention, Quality Improvement
Dixon BE, Rosenman M, Xia Y
A vision for the systematic monitoring and improvement of the quality of electronic health data.
In order to more systematically define, characterize and improve electronic health data quality, the authors propose a novel framework for health data stewardship. Their framework is adapted from prior data quality research outside of health, but it has been reshaped to apply a systems approach to data quality with an emphasis on health outcomes.
AHRQ-funded; HS020909.
Citation: Dixon BE, Rosenman M, Xia Y .
A vision for the systematic monitoring and improvement of the quality of electronic health data.
Stud Health Technol Inform 2013;192:884-8..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Improvement, Quality of Care