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
176 to 200 of 326 Research Studies DisplayedJoyce NR, McGuire TG, Bartels SJ
The impact of dementia special care units on quality of care: an instrumental variables analysis.
The purpose of this study was to compare the quality of care following admission to a nursing home (NH) with and without a dementia special care unit (SCU) for residents with dementia. The investigators found that facilities with an SCU provided better quality of care as measured by several validated quality indicators. The authors suggested that given the aging population, policies to promote the expansion and use of dementia SCUs may be warranted.
AHRQ-funded; HS022998.
Citation: Joyce NR, McGuire TG, Bartels SJ .
The impact of dementia special care units on quality of care: an instrumental variables analysis.
Health Serv Res 2018 Oct;53(5):3657-79. doi: 10.1111/1475-6773.12867..
Keywords: Dementia, Elderly, Quality of Care, Long-Term Care, Nursing Homes
Hong I, Karmarker A, Chan W
Discharge patterns for ischemic and hemorrhagic stroke patients going from acute care hospitals to inpatient and skilled nursing rehabilitation.
Investigators explored variation in acute care use of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation after ischemic and hemorrhagic stroke. They found demographic and clinical differences among stroke patients admitted for post-acute rehabilitation at inpatient rehabilitation facilities and skilled nursing facilities settings. Additionally, examination of variation in ischemic and hemorrhagic stroke discharges suggests acute facility-level differences and indicates a need for careful consideration of patient and facility factors when comparing the effectiveness of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation.
AHRQ-funded; HS022134; HS024711.
Citation: Hong I, Karmarker A, Chan W .
Discharge patterns for ischemic and hemorrhagic stroke patients going from acute care hospitals to inpatient and skilled nursing rehabilitation.
Am J Phys Med Rehabil 2018 Sep;97(9):636-45. doi: 10.1097/phm.0000000000000932..
Keywords: Transitions of Care, Hospital Discharge, Stroke, Cardiovascular Conditions, Nursing Homes, Rehabilitation
Palmer JA, Mor V, Volandes AE
A dynamic application of PRECIS-2 to evaluate implementation in a pragmatic, cluster randomized clinical trial in two nursing home systems.
This report's objective was to apply PRagmatic Explanatory Continuum Indicator Summary-2 (PRECIS-2) in a novel manner during the actual conduct of the PRagmatic trial Of Video Education in Nursing homes (PROVEN) trial to assess how dynamic adaptations shifted implementation to either a more explanatory or a more pragmatic approach.
AHRQ-funded; HS000011.
Citation: Palmer JA, Mor V, Volandes AE .
A dynamic application of PRECIS-2 to evaluate implementation in a pragmatic, cluster randomized clinical trial in two nursing home systems.
Trials 2018 Aug 22;19(1):453. doi: 10.1186/s13063-018-2817-y..
Keywords: Health Services Research (HSR), Nursing Homes, Research Methodologies
Chen LM, Acharya Y, Norton EC
Readmission rates and skilled nursing facility utilization after major inpatient surgery.
The purpose of this observational study was to describe the association between changes in skilled nursing facility (SNF) use and changes in readmission rates after surgery. The investigators looked at fee-for-service Medicare beneficiaries undergoing coronary artery bypass grafting (CABG) or total hip replacement (THR) from 2008 to 2013. They concluded that changes in use of postacute care after THR and CABG were not associated with changes in readmission rates in their study.
AHRQ-funded; HS024698; HS020671.
Citation: Chen LM, Acharya Y, Norton EC .
Readmission rates and skilled nursing facility utilization after major inpatient surgery.
Med Care 2018 Aug;56(8):679-85. doi: 10.1097/mlr.0000000000000941..
Keywords: Hospital Discharge, Hospital Readmissions, Nursing Homes, Surgery
Alexander GL, Madsen R
A national report of nursing home quality and information technology: two-year trends.
The authors sought to answer these two research questions: What are the trends in information technology (IT) adoption in US nursing home facilities over 2 years? How are 2-year trends in IT adoption in US nursing homes related to nationally reported quality measures (QMs)? Using surveys of nursing home administrators and data from Nursing Home Compare, they concluded that multiple dimensions of IT sophistication influence QMs in every health care domain, providing an opportunity to design a reporting system that joins these important variables to be assessed on a national scale.
AHRQ-funded; HS022497.
Citation: Alexander GL, Madsen R .
A national report of nursing home quality and information technology: two-year trends.
J Nurs Care Qual 2018 Jul/Sep;33(3):200-07. doi: 10.1097/ncq.0000000000000328.
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Keywords: Health Information Technology (HIT), Nursing Homes, Long-Term Care, Quality of Care, Quality Measures, Provider Performance
Krein SL, Greene MT, King B
Assessing a national collaborative program to prevent catheter-associated urinary tract infection in a Veterans Health Administration nursing home cohort.
Collaborative programs have helped reduce catheter-associated urinary tract infection (CAUTI) rates in community-based nursing homes. This study assessed whether collaborative participation produced similar benefits among Veterans Health Administration (VHA) nursing homes. The researchers found that no changes in CAUTI rates, catheter use, or urine culture orders were found during the program period. One potential reason was the relatively low baseline CAUTI rate, as compared with a cohort of community-based nursing homes.
AHRQ-funded; 290201000025I.
Citation: Krein SL, Greene MT, King B .
Assessing a national collaborative program to prevent catheter-associated urinary tract infection in a Veterans Health Administration nursing home cohort.
Infect Control Hosp Epidemiol 2018 Jul;39(7):820-25. doi: 10.1017/ice.2018.99..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Long-Term Care, Nursing Homes, Patient Safety, Prevention, Urinary Tract Infection (UTI)
Pulia M, Kern M, Schwei RJ
Comparing appropriateness of antibiotics for nursing home residents by setting of prescription initiation: a cross-sectional analysis.
The objective of this study was to characterize antibiotic therapy for nursing home (NH) residents and compare appropriateness based on setting of prescription initiation. The study concluded that antibiotics initiated out-of-facility for NH residents constituted a small but not trivial percent of all prescriptions and inappropriate use was high in these settings.
AHRQ-funded; HS024342; HS022465.
Citation: Pulia M, Kern M, Schwei RJ .
Comparing appropriateness of antibiotics for nursing home residents by setting of prescription initiation: a cross-sectional analysis.
Antimicrob Resist Infect Control 2018 Jun 14;7:74. doi: 10.1186/s13756-018-0364-7..
Keywords: Elderly, Nursing Homes, Patient Safety, Practice Patterns
Sloane PD, Ward K, Weber DJ
Can sepsis be detected in the nursing home prior to the need for hospital transfer?
The purpose of this study was to determine whether and to what extent simple screening tools might identify nursing home (NH) residents who are at high risk of becoming septic. The authors concluded that NHs need better systems to monitor NH residents whose status is changing, and to present that information to medical providers in real time, either through rapid medical response programs or telemetry.
AHRQ-funded; HS022846.
Citation: Sloane PD, Ward K, Weber DJ .
Can sepsis be detected in the nursing home prior to the need for hospital transfer?
J Am Med Dir Assoc 2018 Jun;19(6):492-96.e1. doi: 10.1016/j.jamda.2018.02.001..
Keywords: Sepsis, Nursing Homes, Long-Term Care, Diagnostic Safety and Quality, Elderly
Buttke D, Cooke V, Abrahamson K
A statewide model for assisting nursing home residents to transition successfully to the community.
Minnesota's Return to Community Initiative (RTCI) is a novel, statewide initiative to assist private paying nursing home residents to return to the community and to remain in that setting without converting to Medicaid. The objective of this manuscript was to describe in detail RTCI's development and design, its key operational components, and characteristics of its clients and their care outcomes.
AHRQ-funded; HS020224.
Citation: Buttke D, Cooke V, Abrahamson K .
A statewide model for assisting nursing home residents to transition successfully to the community.
Geriatrics 2018 Jun;3(2):18. doi: 10.3390/geriatrics3020018..
Keywords: Elderly, Nursing Homes, Transitions of Care
Smith SN, Greene MT, Mody L
Evaluation of the association between Nursing Home Survey on Patient Safety culture (NHSOPS) measures and catheter-associated urinary tract infections: results of a national collaborative.
The investigators examined the association between nursing home safety culture, measured with the Nursing Home Survey on Patient Safety Culture (NHSOPS), and catheter-associated urinary tract infection rates (CAUTI) using data from a recent national collaborative for preventing healthcare-associated infections in nursing homes. They found that this large national collaborative of nursing homes saw declining CAUTI rates as well as improvements in several NHSOPS domains. However, no association was found between initial or over-time NHSOPS scores and CAUTI rates.
AHRQ-funded; 290201000025I.
Citation: Smith SN, Greene MT, Mody L .
Evaluation of the association between Nursing Home Survey on Patient Safety culture (NHSOPS) measures and catheter-associated urinary tract infections: results of a national collaborative.
BMJ Qual Saf 2018 Jun;27(6):464-73. doi: 10.1136/bmjqs-2017-006610.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Long-Term Care, Nursing Homes, Patient Safety, Quality Measures, Urinary Tract Infection (UTI)
Berry SD, Zullo AR, Lee Y
Fracture Risk Assessment in Long-term Care (FRAiL): development and validation of a prediction model.
This paper’s objective was to develop and validate a model, Fracture Risk Assessment in Long-term Care (FRAiL) to predict the 2-year risk of hip fracture in nursing home (NH) residents using readily available clinical characteristics. The FRAiL model was developed specifically to identify NH residents at greatest risk for hip fracture, and results identified a different pattern of risk factors compared with community models. This practical model could be used to screen NH residents for fracture risk and to target intervention strategies.
AHRQ-funded; HS022998.
Citation: Berry SD, Zullo AR, Lee Y .
Fracture Risk Assessment in Long-term Care (FRAiL): development and validation of a prediction model.
J Gerontol A Biol Sci Med Sci 2018 May 9;73(6):763-69. doi: 10.1093/gerona/glx147.
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Keywords: Elderly, Injuries and Wounds, Long-Term Care, Nursing Homes, Risk
Ogarek JA, McCreedy EM, Thomas KS
Minimum data set changes in health, end-stage disease and symptoms and signs scale: a revised measure to predict mortality in nursing home residents.
The purpose of this study was to revise the Minimum Data Set (MDS) Changes in Health, End-stage disease and Symptoms and Signs (CHESS) scale, an MDS 2.0-based measure widely used to predict mortality in institutional settings, in response to the release of MDS 3.0. The MDS-CHESS 3.0 predicts mortality in newly admitted and long-stay nursing home populations. The additional relationship to hospitalizations and successful discharges to community increases the utility of this scale as a potential risk adjustment tool.
AHRQ-funded; HS000011.
Citation: Ogarek JA, McCreedy EM, Thomas KS .
Minimum data set changes in health, end-stage disease and symptoms and signs scale: a revised measure to predict mortality in nursing home residents.
J Am Geriatr Soc 2018 May;66(5):976-81. doi: 10.1111/jgs.15305..
Keywords: Decision Making, Elderly, Health Status, Mortality, Nursing Homes
McCreedy E, Loomer L, Palmer JA
Representation in the care planning process for nursing home residents with dementia.
This study examined the participation of residents, family members, or representatives in nursing home (NH) long-term care planning for residents with cognitive impairment. A large for-profit NH system was used to recruit study participants. A sample of 18,552 long-stay NH residents in 2016 were surveyed. Of residents with no cognitive impairment, 8% had family or representative participation in care planning, compared with 26% of residents with severe impairments. Family participation was greater in NHs with more social workers.
AHRQ-funded; HS000011.
Citation: McCreedy E, Loomer L, Palmer JA .
Representation in the care planning process for nursing home residents with dementia.
J Am Med Dir Assoc 2018 May;19(5):415-21. doi: 10.1016/j.jamda.2018.01.004..
Keywords: Dementia, Nursing Homes, Long-Term Care, Patient and Family Engagement, Neurological Disorders
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
McCreedy EM, Weinstein BE, Chodosh J
Hearing loss: why does it matter for nursing homes?
This paper examines the impact of hearing loss on residents in nursing home settings and provides an estimate of prevalence using the Minimum Data Set (MDS v.3.0). They outline steps to mitigate hearing loss and discuss solutions that may be inexpensive and low-tech.
AHRQ-funded; HS000011.
Citation: McCreedy EM, Weinstein BE, Chodosh J .
Hearing loss: why does it matter for nursing homes?
J Am Med Dir Assoc 2018 Apr;19(4):323-27. doi: 10.1016/j.jamda.2017.12.007..
Keywords: Nursing Homes, Elderly, Quality of Life, Depression, Behavioral Health
Li S, Middleton A, Ottenbacher KJ
Trajectories over the first year of long-term care nursing home residence.
This retrospective cohort study examined changes in situation for Medicare fee-for-service beneficiaries newly admitted to long-term nursing homes from July 2012 to December 2013 for the first year after admission. Data was used from the Minimum Data Set and Medicare Provider and Analysis Reviews claims data. Median length of stay in long-term care was 127 days, and for any institution 158 days. At 12 months post admission, 35% had died, 36.9% remained in long-term care, 23.4% were in the community, and 4.7% were in acute care hospitals or other institutions.
AHRQ-funded; HS022134.
Citation: Li S, Middleton A, Ottenbacher KJ .
Trajectories over the first year of long-term care nursing home residence.
J Am Med Dir Assoc 2018 Apr;19(4):333-41. doi: 10.1016/j.jamda.2017.09.021.
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Keywords: Long-Term Care, Nursing Homes, Elderly, Medicare, Patient-Centered Outcomes Research, Outcomes
Jump RLP, Crnich CJ, Mody L
Infectious diseases in older adults of long-term care facilities: update on approach to diagnosis and management.
The diagnosis, treatment, and prevention of infectious diseases in older adults in long-term care facilities (LTCFs), particularly nursing facilities, remains a challenge for all health providers who care for this population. This review provides updated information on the currently most important challenges of infectious diseases in LTCFs. With the increasing prescribing of antibiotics in older adults, particularly in LTCFs, the topic of antibiotic stewardship is presented in this review.
AHRQ-funded; HS022465.
Citation: Jump RLP, Crnich CJ, Mody L .
Infectious diseases in older adults of long-term care facilities: update on approach to diagnosis and management.
J Am Geriatr Soc 2018 Apr;66(4):789-803. doi: 10.1111/jgs.15248.
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Keywords: Elderly, Healthcare-Associated Infections (HAIs), Infectious Diseases, Nursing Homes, Long-Term Care, Antimicrobial Stewardship, Antibiotics, Medication, Evidence-Based Practice, Guidelines
Berridge C, Tyler DA, Miller SC
Staff empowerment practices and CNA retention: findings from a nationally representative nursing home culture change survey.
This article examines whether staff empowerment practices common to nursing home culture change are associated with certified nursing assistant (CNA) retention. It concluded that after adjustment for covariates, a greater staff empowerment practice score was positively associated with greater retention. Compared with the low empowerment category, nursing homes with scores in the medium category had a 44 percent greater likelihood of having higher CNA retention.
AHRQ-funded; HS000011.
Citation: Berridge C, Tyler DA, Miller SC .
Staff empowerment practices and CNA retention: findings from a nationally representative nursing home culture change survey.
J Appl Gerontol 2018 Apr;37(4):419-34. doi: 10.1177/0733464816665204.
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Keywords: Long-Term Care, Nursing Homes, Provider, Provider: Health Personnel, Workforce
Zullo AR, Zhang T, Banerjee G
Facility and state variation in hip fracture in U.S. nursing home residents.
The purpose of this study was to quantify the variation in hip fracture incidence across U.S. nursing home (NH) facilities and states and examine how hip fracture incidence varies according to facility- and state-level characteristics. The investigators concluded that much of the variation in hip fracture incidence remained unexplained. They suggested that their findings indicated that potentially modifiable state and facility characteristics such as psychoactive drug prescribing and minimum staffing requirements could be addressed to help reduce the rate of hip fracture in U.S. NHs.
AHRQ-funded; HS022998.
Citation: Zullo AR, Zhang T, Banerjee G .
Facility and state variation in hip fracture in U.S. nursing home residents.
J Am Geriatr Soc 2018 Mar;66(3):539-45. doi: 10.1111/jgs.15264..
Keywords: Elderly, Injuries and Wounds, Long-Term Care, Nursing Homes, Patient Safety
Feder SL, Britton MC, Chaudhry SI
"They need to have an understanding of why they're coming here and what the outcomes might be." Clinician perspectives on goals of care for patients discharged from hospitals to skilled nursing facilities.
This study examined how clinicians view goals of care (GoC) for hospitalized patients discharged to skilled nursing facilities (SNFs). A variety of clinicians were interviewed: 22% were nurses, 20% physicians, 15% from care management, and 15% from social services. Many respondents felt that patients and their families had unrealistic GoCs. However, conversations on GoCs were infrequent during hospitalizations which contribute to unrealistic expectations for SNF care and poor patient outcomes. The researchers recommend interventions to ensure that GoC conversations and are held regularly and in a timely manner before transfer occurs.
AHRQ-funded; HS023554.
Citation: Feder SL, Britton MC, Chaudhry SI .
"They need to have an understanding of why they're coming here and what the outcomes might be." Clinician perspectives on goals of care for patients discharged from hospitals to skilled nursing facilities.
J Pain Symptom Manage 2018 Mar;55(3):930-37. doi: 10.1016/j.jpainsymman.2017.10.013..
Keywords: Care Coordination, Clinician-Patient Communication, Communication, Hospital Discharge, Nursing Homes, Patient and Family Engagement, Provider: Clinician, Provider: Nurse, Provider: Physician
Makam AN, Nguyen OK, Xuan L
Factors associated with variation in long-term acute care hospital vs skilled nursing facility use among hospitalized older adults.
This study examined factors associated with variation in long-term acute care hospitals (LTACs) vs less costly skilled nursing facilities (SNFs) transfer among hospitalized older adults. It concluded that half of the variation in LTAC vs SNF transfer is independent of patients' illness severity or clinical complexity, and is explained by where the patient was hospitalized and in what region, with far greater use in the South.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Xuan L .
Factors associated with variation in long-term acute care hospital vs skilled nursing facility use among hospitalized older adults.
JAMA Intern Med 2018 Mar;178(3):399-405. doi: 10.1001/jamainternmed.2017.8467.
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Keywords: Elderly, Long-Term Care, Hospitals, Nursing Homes, Transitions of Care
Sorkin DH, Amin A, Weimer DL
Hospital discharge and selecting a skilled nursing facility: a comparison of experiences and perspectives of patients and their families.
This article seeks to examine and compare the experiences and perspectives of patients and others involved in the selection of the nursing home (predominately adult children and spouses). It found that patients were the primary decision makers about 23 percent of the time but were often involved in the decision even when family members/involved others were primarily making decisions in the discharge process.
AHRQ-funded; HS021844.
Citation: Sorkin DH, Amin A, Weimer DL .
Hospital discharge and selecting a skilled nursing facility: a comparison of experiences and perspectives of patients and their families.
Prof Case Manag 2018 Mar/Apr;23(2):50-59. doi: 10.1097/ncm.0000000000000252.
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Keywords: Decision Making, Hospital Discharge, Long-Term Care, Nursing Homes, Patient Experience
Ye L, Richards KC
Sleep and long-term care.
This review describes the nature and consequences of sleep disturbances in long-term care (LTC), clinical assessment and management of sleep disturbances in LTC, and implications for future research and clinical practice.
AHRQ-funded; HS024330.
Citation: Ye L, Richards KC .
Sleep and long-term care.
Sleep Med Clin 2018 Mar;13(1):117-25. doi: 10.1016/j.jsmc.2017.09.011..
Keywords: Quality of Care, Long-Term Care, Nursing Homes, Sleep Problems
Zullo AR, Zhang T, Beudoin FL
Pain treatments after hip fracture among older nursing home residents.
In this retrospective cohort study the investigators examined the association between use of opioids versus other analgesics with death and functioning after hip fracture in older nursing home (NH) residents. The investigators concluded that a rigorous study addressing the limitations of their study is critical to validate their preliminary findings and provide evidence about the effect of using opioid versus nonopioid analgesics to optimize acute pain in NH residents with a hip fracture.
AHRQ-funded; HS022998.
Citation: Zullo AR, Zhang T, Beudoin FL .
Pain treatments after hip fracture among older nursing home residents.
J Am Med Dir Assoc 2018 Feb;19(2):174-76. doi: 10.1016/j.jamda.2017.11.008..
Keywords: Opioids, Pain, Nursing Homes, Long-Term Care, Elderly, Medication, Injuries and Wounds, Patient-Centered Outcomes Research, Healthcare Utilization
Kerstenetzky L, Birschbach MJ, Beach KF
Improving medication information transfer between hospitals, skilled-nursing facilities, and long-term-care pharmacies for hospital discharge transitions of care: a targeted needs assessment using the Intervention Mapping framework.
The authors of this study report on the development of a logic model that will be used to explore methods for minimizing patient care medication delays and errors while further improving handoff communication to skilled nurse facilities and long term care pharmacy staff.
AHRQ-funded; HS021984.
Citation: Kerstenetzky L, Birschbach MJ, Beach KF .
Improving medication information transfer between hospitals, skilled-nursing facilities, and long-term-care pharmacies for hospital discharge transitions of care: a targeted needs assessment using the Intervention Mapping framework.
Res Social Adm Pharm 2018 Feb;14(2):138-45. doi: 10.1016/j.sapharm.2016.12.013..
Keywords: Adverse Drug Events (ADE), Hospital Discharge, Hospitals, Long-Term Care, Medical Errors, Medication, Medication: Safety, Nursing Homes, Patient Safety, Transitions of Care