National Healthcare Quality and Disparities Report
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Topics
- Adverse Drug Events (ADE) (5)
- Adverse Events (8)
- Alcohol Use (1)
- Behavioral Health (1)
- Blood Clots (1)
- Blood Pressure (1)
- Cardiovascular Conditions (1)
- Care Coordination (1)
- Children/Adolescents (6)
- (-) Chronic Conditions (20)
- Communication (1)
- Diabetes (2)
- Elderly (4)
- Electronic Health Records (EHRs) (1)
- Evidence-Based Practice (1)
- Falls (2)
- Family Health and History (2)
- Guidelines (1)
- Healthcare Delivery (1)
- Health Information Technology (HIT) (2)
- Heart Disease and Health (1)
- Home Healthcare (1)
- Hospital Discharge (1)
- Hospitals (1)
- Injuries and Wounds (1)
- Inpatient Care (3)
- Kidney Disease and Health (2)
- Medical Errors (3)
- Medicare (1)
- Medication (12)
- Medication: Safety (8)
- Mortality (1)
- Opioids (5)
- Outcomes (1)
- Pain (5)
- (-) Patient Safety (20)
- Practice Patterns (1)
- Primary Care (1)
- Provider: Physician (1)
- Quality of Care (1)
- Respiratory Conditions (1)
- Risk (3)
- Sleep Problems (1)
- Substance Abuse (2)
- Surgery (1)
- Transitions of Care (2)
- Vulnerable Populations (2)
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 20 of 20 Research Studies DisplayedKieren MQ, Kelly MM, Garcia MA
Parent experiences with the process of sharing inpatient safety concerns for children with medical complexity: a qualitative analysis.
The objective of this study was to describe the process of identifying and reporting inpatient safety concerns from the perspective of parents of children with medical complexity (CMC). Researchers conducted a secondary analysis of qualitative data from semi-structured interviews with English and Spanish-speaking parents of CMC at two tertiary children's hospitals. The parents described a multi-step process of reporting their safety concerns and a spectrum of staff response and validation. The researchers concluded that their findings could inform family-centered interventions that support safety concern reporting in the inpatient setting.
AHRQ-funded; HS025781.
Citation: Kieren MQ, Kelly MM, Garcia MA .
Parent experiences with the process of sharing inpatient safety concerns for children with medical complexity: a qualitative analysis.
Acad Pediatr 2023 Nov-Dec; 23(8):1535-41. doi: 10.1016/j.acap.2023.06.008..
Keywords: Children/Adolescents, Patient Safety, Inpatient Care, Chronic Conditions
Mauskar S, Ngo T, Haskell H
In their own words: safety and quality perspectives from families of hospitalized children with medical complexity.
The purpose of this study was to address the gap of research on inpatient safety/quality experience of Children with medical complexity (CMC) and identify otherwise unrecognized, family-prioritized areas for improving safety/quality of children with medical complexity (CMC). Out of 208 families surveyed, 237 (88%) families completed surveys; 83 families offered 138 free-text safety responses about medications, feeds, cares, and other categories. The study found that themes included unmet expectations of hospital care/environment, lack of consistency, provider-patient communication lapses, families' expertise about care, and the value of transparency.
AHRQ-funded; HS025781.
Citation: Mauskar S, Ngo T, Haskell H .
In their own words: safety and quality perspectives from families of hospitalized children with medical complexity.
J Hosp Med 2023 Sep; 18(9):777-86. doi: 10.1002/jhm.13178..
Keywords: Children/Adolescents, Patient Safety, Quality of Care, Chronic Conditions
Mercer AN, Mauskar S, Baird J
Family safety reporting in hospitalized children with medical complexity.
This prospective cohort study was conducted to evaluate safety concerns from families of hospitalized children with medical complexity (CMC) who are at high risk of medical errors. This survey was done predischarge with English- and Spanish-speaking parents/staff of hospitalized CMC on 5 units caring for complex care patients at a tertiary care children's hospital. A total of 155 parents and 214 staff completed surveys, with 43% (n = 66) having ≥1 hospital safety concerns, totaling 115 concerns (1-6 concerns each). A physician review found that 69% of concerns were medical errors, and 22% nonsafety-related quality issues. Most parents (68%) reported concerns to staff, particularly bedside nurses, but only 32% of parents recalled being told how to report safety concerns. Higher education and longer length of stay were associated with family safety concerns.
AHRQ-funded; HS025781.
Citation: Mercer AN, Mauskar S, Baird J .
Family safety reporting in hospitalized children with medical complexity.
Pediatrics 2022 Aug 1; 150(2):e2021055098. doi: 10.1542/peds.2021-055098..
Keywords: Children/Adolescents, Family Health and History, Chronic Conditions, Patient Safety, Medical Errors, Adverse Events, Inpatient Care
Khan A, Baird J, Kelly MM
Family safety reporting in medically complex children: parent, staff, and leader perspectives.
This qualitative study examined parent, staff, and hospital leader perspectives about family safety reporting in children with medical complexity (CMC) to inform future interventions. The study was conducted at 2 tertiary care children’s hospitals with dedicated inpatient complex care services. Hour-long semi-structured, individual interviews were conducted with English and Spanish-speaking parents of CMC, physicians, nurses, and hospital leaders. A total of 80 participants (34 parents, 19 nurses and allied health professionals, 11 physicians, and 16 hospital leaders) were interviewed. Four themes related to family safety reporting emerged: (1) unclear, nontransparent, and variable existing processes, (2) a continuum of staff and leadership buy-in, (3) a family decision-making calculus about whether to report, and (4) misaligned staff and parent priorities and expectations. The authors also identified potential strategies for engaging families and staff in family reporting.
AHRQ-funded; HS025781.
Citation: Khan A, Baird J, Kelly MM .
Family safety reporting in medically complex children: parent, staff, and leader perspectives.
Pediatrics 2022 Jun; 149(6). doi: 10.1542/peds.2021-053913..
Keywords: Children/Adolescents, Family Health and History, Chronic Conditions, Provider: Physician, Patient Safety, Medical Errors, Adverse Events, Inpatient Care
Chen C, Winterstein AG, Lo-Ciganic WH
Concurrent use of prescription gabapentinoids with opioids and risk for fall-related injury among older US Medicare beneficiaries with chronic noncancer pain: a population-based cohort study.
This study compared the risk of fall-related injury in two cohorts who used gabapentinoids concurrently with opioid use and those who used opioids only. The authors created 2 cohorts based on whether concurrent users initiated gabapentinoids on the day of opioid initiation (Cohort 1) or after opioid initiation (Cohort 2). Both cohorts were identified from a sample of older Medicare beneficiaries with chronic non-cancer pain (CNCP). Four concurrent users were matched up with 1 opioid-only user. They identified 6,733 concurrent users and 27,092 matched opioid-only users in Cohort 1 and 5,709 concurrent users and 22,388 matched opioid-only users in Cohort 2. Cohort 1’s incidence rate of fall-related injury was 24.5 per 100 person-users during follow-up and was 18.0 per 100-person-years during follow-up for Cohort 2. Concurrent users had had similar risk of fall-related injury as opioid-only users in Cohort 1 but had higher risk for fall-related injury than opioid-only users in Cohort 2.
AHRQ-funded; HS027230.
Citation: Chen C, Winterstein AG, Lo-Ciganic WH .
Concurrent use of prescription gabapentinoids with opioids and risk for fall-related injury among older US Medicare beneficiaries with chronic noncancer pain: a population-based cohort study.
PLoS Med 2022 Mar;19(3):e1003921. doi: 10.1371/journal.pmed.1003921..
Keywords: Elderly, Opioids, Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events, Falls, Patient Safety, Injuries and Wounds, Pain, Chronic Conditions
Wei YJ, Chen C, Lewis MO
Trajectories of prescription opioid dose and risk of opioid-related adverse events among older Medicare beneficiaries in the United States: a nested case-control study.
This study used a sample of older patients who are Medicare beneficiaries who were newly prescribed opioids to determine rates of 4 prescription opioid dose trajectories and the risk of opioid-related adverse events (ORAEs). A 5% random sample of Medicare beneficiaries from 2011 to 2018 was used to conduct a nested case-control study of patients age 65 and older who were newly diagnosed with chronic noncancer pain (CNCP). Among the cases and controls, 2,192 (70.6%) were women and mean age was 77.1 years. Four prescribed opioid trajectories before the incident ORAE diagnosis or matched date emerged: gradual dose discontinuation (from ≤3 to 0 daily morphine milligram equivalent (MME), 1,456 [23.5%]), gradual dose increase (from 0 to >3 daily MME, 1,878 [30.3%]), consistent low dose (between 3 and 5 daily MME, 1,510 [24.3%]), and consistent moderate dose (>20 daily MME, 1,362 [22.0%]). Less than 5% were prescribed a mean daily dose of ≥90 daily MME during 6 months before diagnosis or matched date. Patients with gradual dose discontinuation versus those with a consistent low or moderate dose, and increase dose were more likely to be 65 to 74 years, Midwest US residents, and receiving no low-income subsidy. Those with gradual dose increase and consistent moderate dose had a higher risk of ORAE, after adjustment for covariates.
AHRQ-funded; HS027230.
Citation: Wei YJ, Chen C, Lewis MO .
Trajectories of prescription opioid dose and risk of opioid-related adverse events among older Medicare beneficiaries in the United States: a nested case-control study.
PLoS Med 2022 Mar;19(3):e1003947. doi: 10.1371/journal.pmed.1003947..
Keywords: Elderly, Opioids, Medication, Adverse Drug Events (ADE), Adverse Events, Risk, Chronic Conditions, Pain, Substance Abuse, Behavioral Health, Medication: Safety, Patient Safety
Horton DB, Xie F, Chen L
Oral glucocorticoids and incident treatment of diabetes mellitus, hypertension, and venous thromboembolism in children.
The purpose of this study was to quantify rates of incident treatment for diabetes mellitus, hypertension, and venous thromboembolism (VTE) associated with oral glucocorticoid exposure in children aged 1-18 years. Participants were identified using US Medicaid claims data and included more than 930,000 children diagnosed with autoimmune diseases or a nonimmune comparator condition. Findings showed strong dose-dependent relationships between current glucocorticoid exposure and all outcomes, suggesting strong relative risks, but low absolute risks, of newly-treated VTE, diabetes, and especially hypertension in children taking high-dose oral glucocorticoids.
AHRQ-funded; HS021110.
Citation: Horton DB, Xie F, Chen L .
Oral glucocorticoids and incident treatment of diabetes mellitus, hypertension, and venous thromboembolism in children.
Am J Epidemiol 2021 Feb 1;190(3):403-12. doi: 10.1093/aje/kwaa197..
Keywords: Children/Adolescents, Diabetes, Chronic Conditions, Blood Clots, Medication: Safety, Medication, Adverse Drug Events (ADE), Adverse Events, Risk, Patient Safety, Blood Pressure
Wyse J, Simmons A, Ramachandran B
"I don't mind doing what it takes to be safe." Patient perspectives of urine drug testing for pain.
This study sought to uncover patients’ beliefs regarding UDT and its implications for the patient–clinician relationship. Urine drug testing (UDT) is a standard recommendation for those prescribed long-term opioid therapy (LTOT) for pain but remains underutilized. Clinician fears regarding negative patient perceptions have been identified as a barrier to conducting UDT; however, little is known about patient perspectives of UDT.
AHRQ-funded; HS026370.
Citation: Wyse J, Simmons A, Ramachandran B .
"I don't mind doing what it takes to be safe." Patient perspectives of urine drug testing for pain.
J Gen Intern Med 2021 Jan;36(1):243-44. doi: 10.1007/s11606-020-05688-3..
Keywords: Pain, Chronic Conditions, Opioids, Medication, Medication: Safety, Patient Safety, Substance Abuse
Navis A, George MC, Nmashie A
Validation of the Safer Opioid Prescribing Evaluation Tool (SOPET) for assessing adherence to the Centers for Disease Control opioid prescribing guidelines.
This study assessed the use of the Safer Opioid Prescribing Evaluation Tool (SOPET) which was designed to improve the implementation of the 2016 Centers for Disease Control Guidelines on the prescription of opioids for chronic pain. Four raters with varying levels of clinical experience were trained to use the SOPET and then used it to evaluate 21 baseline patient scenarios. Inter-rater reliability was measured using intraclass correlation coefficient (ICC) estimates and their 95% confidence intervals for the total SOPET score based on a mean-rating absolute-agreement, two-way random-effects model. Inter-rater reliability was found to be good for the three physician raters (0.92, 0.97, and 0.99). However, inter-rater reliability for the non-physician rater was lower (0.67).
AHRQ-funded; HS025641.
Citation: Navis A, George MC, Nmashie A .
Validation of the Safer Opioid Prescribing Evaluation Tool (SOPET) for assessing adherence to the Centers for Disease Control opioid prescribing guidelines.
Pain Med 2020 Dec 25;21(12):3655-59. doi: 10.1093/pm/pnaa138..
Keywords: Opioids, Medication, Medication: Safety, Patient Safety, Guidelines, Practice Patterns, Pain, Chronic Conditions, Evidence-Based Practice
Kurani S, Jeffery MM, Thorsteinsdottir B
Use of potentially nephrotoxic medications by U.S. adults with chronic kidney disease: NHANES, 2011-2016.
This study looked at the prevalence of potentially inappropriate medication (PIM) use by US adults by chronic kidney disease (CKD) stage and self-reported CKD awareness. A cross-sectional analysis of National Health and Nutrition Examination Surveys, 2011-2016 was conducted using a cohort of non-pregnant CKD adults with stages 3a, 3b, or 4-5 CKD. Analyses were adjusted for sex, age, race/ethnicity, education, comorbidities, and insurance type. More than 50% of US adults were taking PIM(s) for all CKD stages and awareness categories, but rates were highest among CKD-unaware patients with stages 4-5 CKD. Proton pump inhibitors, opioids, metformin, sulfonylureas, and NSAIDS were used frequently in all CKD stages. NSAIDS were used less frequently when the patient was CKD-aware.
AHRQ-funded; HS025164; HS025402; HS025517.
Citation: Kurani S, Jeffery MM, Thorsteinsdottir B .
Use of potentially nephrotoxic medications by U.S. adults with chronic kidney disease: NHANES, 2011-2016.
J Gen Intern Med 2020 Apr;35(4):1092-101. doi: 10.1007/s11606-019-05557-8..
Keywords: Medication: Safety, Medication, Adverse Drug Events (ADE), Adverse Events, Kidney Disease and Health, Chronic Conditions, Patient Safety
Mueller S, Zheng J, Orav EJ
Inter-hospital transfer and patient outcomes: a retrospective cohort study.
Inter-hospital transfer (IHT, the transfer of patients between hospitals) occurs regularly and exposes patients to risks of discontinuity of care, though outcomes of transferred patients remains largely understudied. The purpose of this retrospective cohort study was to evaluate the association between IHT and healthcare utilisation and clinical outcomes. The investigators concluded that IHT was associated with higher costs, longer LOS and lower odds of discharge home, but was differentially associated with odds of early death and 30 -day mortality depending on patients' disease category.
AHRQ-funded; HS023331.
Citation: Mueller S, Zheng J, Orav EJ .
Inter-hospital transfer and patient outcomes: a retrospective cohort study.
BMJ Qual Saf 2019 Nov;28(11):e1. doi: 10.1136/bmjqs-2018-008087..
Keywords: Transitions of Care, Hospitals, Patient Safety, Elderly, Outcomes, Chronic Conditions, Mortality, Medicare
Wyatt DL
AHRQ Author: Wyatt DL
Employing technology to make care transitions safer.
This commentary discusses the potential for errors in patient handoffs; important information about medications and instructions regarding patient care may be overlooked when the patient is referred to special care, moved to a new hospital setting, or discharged. The problem is especially acute for patients with multiple chronic conditions who often undergo frequent transitions to new care settings and healthcare providers. The author describes AHRQ’s funding opportunities for health information technology interventions that aim to improve communication and coordination during care transitions, such as location-based smartphone alerts, a patient-centered discharge toolkit, and a ‘smart pillbox’ electronic medication adherence reporting project.
AHRQ-authored.
Citation: Wyatt DL .
Employing technology to make care transitions safer.
J Nurs Care Qual 2019 Jul/Sep;34(3):185-88. doi: 10.1097/ncq.0000000000000417..
Keywords: Adverse Events, Care Coordination, Chronic Conditions, Communication, Health Information Technology (HIT), Healthcare Delivery, Hospital Discharge, Medical Errors, Medication, Patient Safety, Transitions of Care
Assimon MM, Brookhart MA, Flythe JE
Comparative cardiac safety of selective serotonin reuptake inhibitors among individuals receiving maintenance hemodialysis.
This retrospective cohort study compared cardiac safety of selective serotonin reuptake inhibitors (SSRIs) among individuals receiving maintenance hemodialysis. These individuals may be particularly susceptible to lethal cardiac consequences of drug-induced QT prolongation due to a substantial cardiovascular disease burden and their use of many medications. Data from a cohort of Medicare beneficiaries receiving hemodialysis included in the US Renal Data system registry from 2007-2014 was used. Researchers compared the 1-year risk of death among hemodialysis patients taking different SSRIs. Use of higher QT-prolonging potential SSRIs (citalopram, escitalopram) was associated with a higher risk of sudden cardiac death than patients taking lower risk SSRIs (fluoxetine, fluvoxamine, paroxetine, sertraline). The association was higher among elderly individuals, females, patients with conduction disorders, and those treated with other non-SSRI QT-prolonging medications.
AHRQ-funded; HS026801.
Citation: Assimon MM, Brookhart MA, Flythe JE .
Comparative cardiac safety of selective serotonin reuptake inhibitors among individuals receiving maintenance hemodialysis.
J Am Soc Nephrol 2019 Apr;30(4):611-23. doi: 10.1681/asn.2018101032..
Keywords: Medication, Medication: Safety, Patient Safety, Adverse Drug Events (ADE), Adverse Events, Kidney Disease and Health, Cardiovascular Conditions, Chronic Conditions
Weitzman ER, Magane KM, Wisk LE
Alcohol use and alcohol-interactive medications among medically vulnerable youth.
Information about the prevalence of alcohol use among youth with chronic medical conditions (YCMCs) who take alcohol-interactive (AI) medications is scant. This study attempts to address gaps and inform interventions by quantifying simultaneous exposure to alcohol use and AI medications among YCMCs. Participants were adolescents with a variety of chronic conditions: type 1 diabetes, juvenile idiopathic arthritis, moderate persistent asthma, cystic fibrosis, attention-deficit/hyperactivity disorder, inflammatory bowel disease. Participants completed an electronic survey designed to measure prevalence of exposure to AI medications and associations with alcohol usage in the past year. Many of the participants reported alcohol use, but drinking was less likely among those who took AI medications. The authors conclude that perceptions about alcohol-medication interference mediated the association between drinking and AI medication exposure.
AHRQ-funded; HS022986.
Citation: Weitzman ER, Magane KM, Wisk LE .
Alcohol use and alcohol-interactive medications among medically vulnerable youth.
Pediatrics 2018 Oct;142(4). doi: 10.1542/peds.2017-4026..
Keywords: Alcohol Use, Children/Adolescents, Chronic Conditions, Medication, Medication: Safety, Patient Safety, Vulnerable Populations
Ratanawongsa N, Chan LL, Fouts MM
The challenges of electronic health records and diabetes electronic prescribing: implications for safety net care for diverse populations.
This review highlights how the EHR electronic prescribing transformation has affected diabetes care for vulnerable patients and offers recommendations for improving patient safety through EHR electronic prescribing design, implementation, policy, and research. Specifically, it presents evidence for the adoption of RxNorm and standardized naming and picklist options for high alert medications such as insulin.
AHRQ-funded; HS022561; HS023558.
Citation: Ratanawongsa N, Chan LL, Fouts MM .
The challenges of electronic health records and diabetes electronic prescribing: implications for safety net care for diverse populations.
J Diabetes Res 2017;2017:8983237. doi: 10.1155/2017/8983237.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Vulnerable Populations, Diabetes, Patient Safety, Chronic Conditions
Naples JG, Gellad WF, Hanlon JT
The role of opioid analgesics in geriatric pain management.
This article reviews the epidemiology of opioid use and their effectiveness for chronic noncancer pain (CNCP) in older adults and summarizes important age-related changes in opioid pharmacokinetics and pharmacodynamics that increase the risks of adverse effects in the elderly. Finally, to assist clinicians with selecting appropriate therapy, the article concludes with an evidence-based approach to optimize opioid prescribing in older adults with CNCP.
AHRQ-funded; HS023779.
Citation: Naples JG, Gellad WF, Hanlon JT .
The role of opioid analgesics in geriatric pain management.
Clin Geriatr Med 2016 Nov;32(4):725-35. doi: 10.1016/j.cger.2016.06.006.
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Keywords: Chronic Conditions, Elderly, Medication, Opioids, Pain, Patient Safety
Walley AY, Green TC
Mainstreaming naloxone through coprescription to patients receiving long-term opioid therapy for chronic pain.
This editorial comments on the Coffin and colleagues' report of the Naloxone for Opioid Safety Evaluation (NOSE) study. The authors concluded that the NOSE study is a substantial step forward in demonstrating the feasibility of coprescription of rescue kits in primary care settings. (Coffin et al., Ann Intern Med. 2016 Aug 16;165(4):245-52.)
AHRQ-funded; HS024021.
Citation: Walley AY, Green TC .
Mainstreaming naloxone through coprescription to patients receiving long-term opioid therapy for chronic pain.
Ann Intern Med 2016 Aug 16;165(4):292-3. doi: 10.7326/m16-1348.
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Keywords: Chronic Conditions, Medication, Patient Safety, Primary Care
Abdelsattar ZM, Hendren S, Wong SL
The impact of untreated obstructive sleep apnea on cardiopulmonary complications in general and vascular surgery: a cohort study.
The purpose of this study was to determine whether preoperatively untreated obstructive sleep apnea (OSA) affects postoperative outcomes. It found that compared with treated OSA, untreated OSA was independently associated with more cardiopulmonary complications (risk-adjusted rates 6.7 percent versus 4.0 percent; particularly unplanned reintubations and myocardial infarction.
AHRQ-funded; HS000053.
Citation: Abdelsattar ZM, Hendren S, Wong SL .
The impact of untreated obstructive sleep apnea on cardiopulmonary complications in general and vascular surgery: a cohort study.
Sleep 2015 Aug;38(8):1205-10. doi: 10.5665/sleep.4892..
Keywords: Sleep Problems, Surgery, Patient Safety, Risk, Heart Disease and Health, Respiratory Conditions, Chronic Conditions
Goldberg DS, Forde KA, Carbonari DM
Population-representative incidence of drug-induced acute liver failure based on an analysis of an integrated health care system.
The researchers conducted an assessment of the incidence and outcomes of acute drug-induced liver failure within a large, integrated healthcare system that approximates a population-representative cohort. They found the incident of acute drug-induced liver failure to be 1.61 per million person years with the overwhelming majority being due to over-the-counter medications or products.
AHRQ-funded; HS018372.
Citation: Goldberg DS, Forde KA, Carbonari DM .
Population-representative incidence of drug-induced acute liver failure based on an analysis of an integrated health care system.
Gastroenterology 2015 Jun;148(7):1353-61.e3. doi: 10.1053/j.gastro.2015.02.050..
Keywords: Medication, Chronic Conditions, Patient Safety
Smucker DR, Regan S, Elder NC
Patient safety incidents in home hospice care: the experiences of hospice interdisciplinary team members.
The study objective was to explore the types and characteristics of patient safety incidents in home hospice care from the experiences of hospice interdisciplinary team members. Based on interviews of 19 experienced hospice leaders, the most commonly described categories of patient harm were injuries from falls and inadequate symptom control.
AHRQ-funded; HS018245
Citation: Smucker DR, Regan S, Elder NC .
Patient safety incidents in home hospice care: the experiences of hospice interdisciplinary team members.
J Palliat Med. 2014 May;17(5):540-4. doi: 10.1089/jpm.2013.0111..
Keywords: Patient Safety, Home Healthcare, Falls, Chronic Conditions