National Healthcare Quality and Disparities Report
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Search All Research Studies
Topics
- Adverse Drug Events (ADE) (3)
- (-) Adverse Events (13)
- Behavioral Health (1)
- Central Line-Associated Bloodstream Infections (CLABSI) (1)
- Clinical Decision Support (CDS) (1)
- Dementia (1)
- Depression (1)
- Elderly (8)
- Evidence-Based Practice (1)
- Falls (3)
- Healthcare-Associated Infections (HAIs) (1)
- Hospital Discharge (2)
- Hospitalization (3)
- Injuries and Wounds (2)
- Long-Term Care (7)
- Medical Errors (2)
- Medication (3)
- Medication: Safety (1)
- Neurological Disorders (2)
- (-) Nursing Homes (13)
- Patient-Centered Outcomes Research (2)
- Patient Safety (8)
- Quality Improvement (1)
- Quality of Care (2)
- Risk (4)
- Surgery (1)
- Transitions of Care (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 13 of 13 Research Studies DisplayedField TS, Fouayzi H, Crawfo TS, Fouayzi H, Crawford S
The association of nursing home characteristics and quality with adverse events after a hospitalization.
This prospective cohort analysis measured the association of long-stay nursing home residents returning to the facility after a hospitalization and adverse events (AEs). Thirty-two nursing homes in New England states participated with a total of 555 long-stay residents contributing 762 returns from hospitalizations. The authors measured the association between AEs developing in the 45 days following discharge back to long-term care and characteristics of the nursing homes including bed size, ownership, 5-star quality ratings, registered nurse and nursing assistant hours, and the individual Centers for Medicare & Medicaid Services (CMS) quality indicators. They found no association of AEs with most nursing home characteristics. Several individual quality indicators were associated with AEs. The highest tertile of residents with depression had a hazard ratio (HR) of 1.65 and the highest tertile of the percentage taking antipsychotic medications had an HR of 1.58. Residents needing increased assistance with activities of daily living was statistically significant, but not monotonic.
AHRQ-funded; HS024422.
Citation: Field TS, Fouayzi H, Crawfo TS, Fouayzi H, Crawford S .
The association of nursing home characteristics and quality with adverse events after a hospitalization.
J Am Med Dir Assoc 2021 Oct;22(10):2196-200. doi: 10.1016/j.jamda.2021.02.027..
Keywords: Elderly, Nursing Homes, Adverse Events, Hospitalization
Mangrum R, Stewart MD, Gifford DR
Omissions of care in nursing homes: a uniform definition for research and quality improvement.
The goal of this study was to create a uniform definition of omission of care in US nursing homes. Lack of a uniform definition has made efforts to prevent them challenging. Subject matter experts and a broad range of nursing home stakeholders were brought together in iterative rounds of engagement to identify key concepts and aspects of omissions of care and develop a consensus-based definition. The concise definition decided on was: “Omissions of care in nursing homes encompass situations when care–either clinical or nonclinical–is not provided for a resident and results in additional monitoring or intervention or increases the risk of an undesirable or adverse physical, emotional, or psychosocial outcome for the resident."
AHRQ-funded; 233201500014I.
Citation: Mangrum R, Stewart MD, Gifford DR .
Omissions of care in nursing homes: a uniform definition for research and quality improvement.
J Am Med Dir Assoc 2020 Nov;21(11):1587-91.e2. doi: 10.1016/j.jamda.2020.08.016..
Keywords: Elderly, Nursing Homes, Long-Term Care, Quality Improvement, Quality of Care, Medical Errors, Adverse Events, Patient Safety, Risk, Patient-Centered Outcomes Research
Ogletree AM, Mangrum R, Harris Y
AHRQ Author: Bergofsky L Perfetto D
Omissions of care in nursing home settings: a narrative review.
This review aimed to (1) examine existing definitions of omissions of care in the healthcare environment and associated characteristics and (2) outline adverse events that may be attributable to omissions of care among nursing home populations. The investigators concluded that definitions of omissions of care for nursing homes varied in scope and level of detail. Substantial evidence connected omissions of care with an array of adverse events in nursing home populations.
AHRQ-authored; AHRQ-funded; 233201500014I.
Citation: Ogletree AM, Mangrum R, Harris Y .
Omissions of care in nursing home settings: a narrative review.
J Am Med Dir Assoc 2020 May;21(5):604-14. doi: 10.1016/j.jamda.2020.02.016..
Keywords: Nursing Homes, Long-Term Care, Adverse Events, Medical Errors, Patient Safety, Quality of Care
Chatterjee S, Bali V, Carnahan RM
Anticholinergic burden and risk of cognitive impairment in elderly nursing home residents with depression.
This study evaluated whether elderly nursing home residents with mild depression and intact cognition experienced cognitive impairment after using anticholinergic drugs. The study was a population-based nested case-control study using Minimum Data Set (MDS)-linked Medicare data where the base cohort were patients 65 years and older with depression who had intact cognition. Cumulative anticholinergic burden was measured within 30, 60, and 90 days preceding the event (cognitive measurement) date using the Anticholinergic Drug Scale (ADS). The end sample compared 3707 cases with mild-to-moderate cognition to 3707 matched controls with intact cognition. There was no association with cumulative anticholinergic exposure at 30 days with cognitive impairment, but the odds of cognitive impairment increased with exposure 60 and 90 days before the event date. This study concludes there should be concern in using anticholinergic drugs for longer than 30 days with elderly nursing home residents.
AHRQ-funded; HS021264.
Citation: Chatterjee S, Bali V, Carnahan RM .
Anticholinergic burden and risk of cognitive impairment in elderly nursing home residents with depression.
Res Social Adm Pharm 2020 Mar;16(3):329-35. doi: 10.1016/j.sapharm.2019.05.020..
Keywords: Elderly, Nursing Homes, Long-Term Care, Depression, Behavioral Health, Medication, Neurological Disorders, Adverse Drug Events (ADE), Adverse Events, Patient Safety
Kapoor A, Field T, Handler S
Characteristics of long-term care residents that predict adverse events after hospitalization.
This study examined the characteristics of long-term care (LTC) residents that predict adverse events (AEs) after discharge from recent hospitalization. This cohort study looked at AEs that occurred at 32 nursing homes from six New England states. AE incidents involving a total of 555 LTC residents with 762 transitions from the hospital back to LTC were reviewed. The association between all AEs and preventable AEs developing in the 45 days following discharge back to LTC was measured. There were 283 discharges with one or more AEs and 212 with preventable AEs. Characteristics independently associated with higher risk of AEs included hospital length of stay (LOS) 9 or more days, 18 or more regularly scheduled medications, and 19 and above on the dependency in activities of daily living (ADL) scale.
AHRQ-funded; HS024422.
Citation: Kapoor A, Field T, Handler S .
Characteristics of long-term care residents that predict adverse events after hospitalization.
J Am Geriatr Soc 2020 Nov;68(11):2551-57. doi: 10.1111/jgs.16770..
Keywords: Elderly, Long-Term Care, Nursing Homes, Hospitalization, Adverse Events, Transitions of Care, Hospital Discharge, Risk
Kapoor A, Field T, Handler S
Adverse events in long-term care residents transitioning from hospital back to nursing home.
This study looked at adverse event rates of long-term care residents transitioning back to their nursing home after hospitalization. A prospective cohort study of LTC residents discharged from hospital back to LTC from March 1, 2016, to December 31, 2017 was conducted, and residents were followed up for 45 days. A random sample of 32 nursing homes located in 6 New England states was used, and 555 LTC residents were selected, contributing 762 transitions from hospital back to the same LTC facility. Most of the cohort were female (65.5%) and non-Hispanic white (93.7%). The study used trained nurse abstractors to review nursing home records to determine if an adverse event occurred. Out of 762 discharges there were 379 adverse events. The most common adverse events were pressure ulcers, skin tears, and falls followed by health care-acquired infections. 145 adverse events were considered less serious, with 28 life-threatening, and 8 were fatal. Most of the adverse events were considered preventable or ameliorable.
AHRQ-funded; HS024596.
Citation: Kapoor A, Field T, Handler S .
Adverse events in long-term care residents transitioning from hospital back to nursing home.
JAMA Intern Med 2019 Sep;179(9):1254-61. doi: 10.1001/jamainternmed.2019.2005..
Keywords: Adverse Events, Long-Term Care, Nursing Homes, Transitions of Care, Elderly, Patient Safety, Hospital Discharge, Hospitalization
Noureldin M, Hass Z, Abrahamson K
Fall risk, supports and services, and falls following a nursing home discharge.
The purpose of this study was to examine whether the presence of supports and services have an impact on the relationship between fall-related risk factors and fall occurrence following a nursing-home discharge. The study sample was comprised of 1459 participants in the Minnesota Return to Community Initiative, who had been assisted in achieving a community discharge; 15 percent of participants fell within 30 days of nursing-home discharge. A structural equation model was used to determine relationship between emerging latent variables and falls. Results indicated that use of high-risk medications and fall concerns/history had a direct, positive effect on falling. Receiving supports/services did not have a direct effect on falls, but the authors note that it reduced the effect of high-risk medication use on falling.
AHRQ-funded; HS020224.
Citation: Noureldin M, Hass Z, Abrahamson K .
Fall risk, supports and services, and falls following a nursing home discharge.
Gerontologist 2018 Nov 3;58(6):1075-84. doi: 10.1093/geront/gnx133..
Keywords: Adverse Events, Elderly, Falls, Nursing Homes, Risk
Dore DD, Zullo AR, Mor V
Age, sex, and dose effects of nonbenzodiazepine hypnotics on hip fracture in nursing home residents.
This study examined the rate of hip fracture in nursing home residents prescribed nonbenzodiazepine hypnotics. A sample of nursing home residents was used and linked to Medicare and Minimum Data Set (2007-2008) data. The rate of hip fracture was higher in residents aged 90 and above, and lower in residents 70 or below. There was no different by sex.
AHRQ-funded; HS022998.
Citation: Dore DD, Zullo AR, Mor V .
Age, sex, and dose effects of nonbenzodiazepine hypnotics on hip fracture in nursing home residents.
J Am Med Dir Assoc 2018 Apr;19(4):328-32.e2. doi: 10.1016/j.jamda.2017.09.015..
Keywords: Injuries and Wounds, Medication, Nursing Homes, Long-Term Care, Adverse Drug Events (ADE), Adverse Events, Falls, Risk, Patient Safety
Simmons SF, Schnelle JF, Sathe NA
Defining safety in the nursing home setting: Implications for future research.
AHRQ’s Common Format for nursing homes (NHs) accommodates voluntary reporting for 4 adverse events: falls with injury, pressure ulcers, medication errors, and infections. In 2015, AHRQ funded a technical brief to describe the state of the science related to safety in the NH setting to inform a research agenda. Thirty-six recent systematic reviews evaluated NH safety-related interventions to address these 4 adverse events and reported mostly mixed evidence about effective approaches to ameliorate them.
AHRQ-funded; 290201500003I.
Citation: Simmons SF, Schnelle JF, Sathe NA .
Defining safety in the nursing home setting: Implications for future research.
J Am Med Dir Assoc 2016 Jun;17(6):473-81. doi: 10.1016/j.jamda.2016.03.005..
Keywords: Nursing Homes, Long-Term Care, Adverse Events, Patient Safety, Evidence-Based Practice
Beffa LR, Petroski GF, Kruse RL
Functional status of nursing home residents before and after abdominal aortic aneurysm repair.
The authors evaluated the effects of elective open AAA repair (OAR) and endovascular AAA repair (EVAR) and evaluated comorbidities for their impact on functional trajectories after discharge. They found that procedure type was not significantly related to postoperative function or to the subsequent rate of improvement. OAR and EVAR were associated with similar initial declines and comparable postoperative trajectories, suggesting that less invasive EVAR was not associated with improved functional preservation compared with OAR. Longer stays were associated with poorer functional trajectories.
AHRQ-funded; HS022140.
Citation: Beffa LR, Petroski GF, Kruse RL .
Functional status of nursing home residents before and after abdominal aortic aneurysm repair.
J Vasc Nurs 2015 Sep;33(3):106-11. doi: 10.1016/j.jvn.2015.02.003.
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Keywords: Adverse Events, Elderly, Nursing Homes, Patient-Centered Outcomes Research, Surgery
Chopra V, Montoya A, Joshi D
Peripherally inserted central catheter use in skilled nursing facilities: a pilot study.
The purpose of this study was to describe patterns of use, care practices, and outcomes related to peripherally inserted central catheter (PICC) use in skilled nursing facilities (SNFs). The most common indication for PICC use was intravenous antibiotic delivery. The average PICC dwell time was 43 days, and most devices were single-lumen PICCs. Major and minor complications were common and occurred in 11 (20 percent) and 18 (32 percent) participants, respectively.
AHRQ-funded; HS022835; HS019979.
Citation: Chopra V, Montoya A, Joshi D .
Peripherally inserted central catheter use in skilled nursing facilities: a pilot study.
J Am Geriatr Soc 2015 Sep;63(9):1894-9. doi: 10.1111/jgs.13600..
Keywords: Adverse Events, Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Nursing Homes, Patient Safety
Aspinall SL, Zhao X, Semia TP
Epidemiology of drug-disease interactions in older veteran nursing home residents.
The objective of this study was to assess the prevalence of and factors associated with potentially inappropriate drug– disease combinations according to the AGS 2012 Beers criteria that are clinically important in elderly adults residing in Veterans Affairs Community Living Centers. It found that drug-disease interactions were common in older residents with dementia or cognitive impairment or a history of falls or hip fracture.
AHRQ-funded; HS018721.
Citation: Aspinall SL, Zhao X, Semia TP .
Epidemiology of drug-disease interactions in older veteran nursing home residents.
J Am Geriatr Soc 2015 Jan;63(1):77-84. doi: 10.1111/jgs.13197..
Keywords: Adverse Drug Events (ADE), Adverse Events, Dementia, Elderly, Falls, Injuries and Wounds, Medication, Medication: Safety, Neurological Disorders, Nursing Homes, Patient Safety
Boyce RD, Perera S, Nace DA
A survey of nursing home physicians to determine laboratory monitoring adverse drug event alert preferences.
The researchers conducted a survey to learn about the laboratory value thresholds that clinical event monitors should use to generate alerts about potential adverse drug events (ADEs). They found that the majority of physicians surveyed prefer alerting thresholds that would generally lead to fewer alerts than if widely accepted standardized laboratory ranges were used.
AHRQ-funded; HS019461; HS018721.
Citation: Boyce RD, Perera S, Nace DA .
A survey of nursing home physicians to determine laboratory monitoring adverse drug event alert preferences.
Appl Clin Inform 2014 Oct 29;5(4):895-906. doi: 10.4338/aci-2014-06-ra-0053..
Keywords: Nursing Homes, Clinical Decision Support (CDS), Adverse Events