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
201 to 225 of 267 Research Studies DisplayedWysham NG, Hochman MJ, Wolf SP
Performance of consultative palliative care model in achieving quality metrics in the ICU.
The purpose of this paper was to assess adherence to proposed quality metrics of ICU-based palliative care by palliative care specialists. The authors found that palliative care consultations in an ICU setting are characterized by variable adherence to candidate ICU palliative care quality metrics. Although symptom management was the foremost reason for palliative care consultation, consultants infrequently documented symptom assessments. The consultants performed better in offering spiritual support and managing documented symptoms.
AHRQ-funded; HS023681.
Citation: Wysham NG, Hochman MJ, Wolf SP .
Performance of consultative palliative care model in achieving quality metrics in the ICU.
J Pain Symptom Manage 2016 Dec;52(6):873-77. doi: 10.1016/j.jpainsymman.2016.05.026.
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Keywords: Critical Care, Intensive Care Unit (ICU), Palliative Care, Quality of Care, Quality Measures
Gold JA, Stephenson LE, Gorsuch A
Feasibility of utilizing a commercial eye tracker to assess electronic health record use during patient simulation.
The researchers reported on their use of eye- and screen-tracking technology to understand factors associated with poor error recognition during an intensive care unit-based electronic health record simulation. They concluded that eye tracking can be successfully integrated into electronic health record-based simulation and provides a surrogate measure of cognitive decision making and electronic health record usability.
AHRQ-funded; HS021637.
Citation: Gold JA, Stephenson LE, Gorsuch A .
Feasibility of utilizing a commercial eye tracker to assess electronic health record use during patient simulation.
Health Informatics J 2016 Sep;22(3):744-57. doi: 10.1177/1460458215590250.
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Keywords: Electronic Health Records (EHRs), Intensive Care Unit (ICU), Patient Safety
Valley TS, Sjoding MW, Goldberger ZD
ICU use and quality of care for patients with myocardial infarction and heart failure.
This study evaluated the relationship between a hospital's ICU or coronary care unit (CCU) admission rate and quality of care provided to patients with acute myocardial infarction (AMI) or heart failure (HF). It found that hospitals with the highest rates of ICU admission for patients with either of these conditions delivered lower quality of care and had higher 30-day mortality.
AHRQ-funded; HS020672.
Citation: Valley TS, Sjoding MW, Goldberger ZD .
ICU use and quality of care for patients with myocardial infarction and heart failure.
Chest 2016 Sep;150(3):524-32. doi: 10.1016/j.chest.2016.05.034.
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Keywords: Intensive Care Unit (ICU), Heart Disease and Health, Quality of Care, Elderly
Sakata KK, Stephenson LS, Mulanax A
Professional and interprofessional differences in electronic health records use and recognition of safety issues in critically ill patients.
The authors conducted this study to determine how each professional group - physicians, nurses, and pharmacists - reviews electronic health records (EHR) data in preparation for rounds and their ability to identify patient safety issues. They found significant and non-overlapping differences in individual profession recognition of patient safety issues in the EHR which may be attributed to differences in EHR use.
AHRQ-funded; HS023793; HS021637.
Citation: Sakata KK, Stephenson LS, Mulanax A .
Professional and interprofessional differences in electronic health records use and recognition of safety issues in critically ill patients.
J Interprof Care 2016 Sep;30(5):636-42. doi: 10.1080/13561820.2016.1193479.
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Keywords: Critical Care, Electronic Health Records (EHRs), Provider: Health Personnel, Intensive Care Unit (ICU), Patient Safety
Costa DK, Dammeyer J, White M
Interprofessional team interactions about complex care in the ICU: pilot development of an observational rating tool.
The purpose of this study was to examine the reliability of an observational rating tool to assess team interactions about the awakening and breathing coordination, delirium, and early mobility (ABCDE) bundle in one ICU. It provided pilot evidence of reliability of an observational rating tool to assess interprofessional team interactions about ABCDE.
AHRQ-funded; HS024552.
Citation: Costa DK, Dammeyer J, White M .
Interprofessional team interactions about complex care in the ICU: pilot development of an observational rating tool.
BMC Res Notes 2016 Aug 18;9:408. doi: 10.1186/s13104-016-2213-1.
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Keywords: Healthcare Delivery, Communication, Critical Care, Intensive Care Unit (ICU), Teams
Wheeler DS, Wong HR
Sepsis in pediatric cardiac intensive care.
The authors reviewed risk factors for developing sepsis; the role of biomarkers; and the pathophysiology and management of severe sepsis and septic shock. They concluded that while scientific advances in the diagnosis and clinical staging of sepsis offer tremendous promise for the future, it is also evident that sepsis mortality has not improved enough, even with progress in our understanding of the molecular pathophysiology of sepsis.
AHRQ-funded; HS020455.
Citation: Wheeler DS, Wong HR .
Sepsis in pediatric cardiac intensive care.
Pediatr Crit Care Med 2016 Aug;17(8 Suppl 1):S266-71. doi: 10.1097/pcc.0000000000000796.
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Keywords: Cardiovascular Conditions, Children/Adolescents, Intensive Care Unit (ICU), Children/Adolescents, Sepsis
Asan O, Holden RJ, Flynn KE
Provider use of a novel EHR display in the pediatric intensive care unit. Large Customizable Interactive Monitor (LCIM).
The purpose of this study was to explore providers' perspectives on the use of a novel technology, "Large Customizable Interactive Monitor" (LCIM), a novel application of the electronic health record system implemented in a Pediatric Intensive Care Unit. The study revealed this next generation HIT might have great potential for family-centered rounds, team education during rounds, and family education/engagement in their child's health in the patient room.
AHRQ-funded; HS023626.
Citation: Asan O, Holden RJ, Flynn KE .
Provider use of a novel EHR display in the pediatric intensive care unit. Large Customizable Interactive Monitor (LCIM).
Appl Clin Inform 2016 Jul 20;7(3):682-92. doi: 10.4338/aci-2016-02-ra-0030.
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Keywords: Children/Adolescents, Electronic Health Records (EHRs), Intensive Care Unit (ICU), Patient and Family Engagement, Children/Adolescents
Dicks KV, Lofgren E, Lewis SS
A multicenter pragmatic interrupted time series analysis of chlorhexidine gluconate bathing in community hospital intensive care units.
This study sought to determine whether daily chlorhexidine gluconate (CHG) bathing of intensive care unit (ICU) patients leads to a decrease in hospital-acquired infections (HAIs), particularly infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). It concluded that hospitals that implemented CHG bathing attained a decrease in ICU central-line-associated bloodstream infections (CLABSIs), ICU primary BSIs, and VRE central-line-associated bloodstream infections.
AHRQ-funded; HS023866.
Citation: Dicks KV, Lofgren E, Lewis SS .
A multicenter pragmatic interrupted time series analysis of chlorhexidine gluconate bathing in community hospital intensive care units.
Infect Control Hosp Epidemiol 2016 Jul;37(7):791-7. doi: 10.1017/ice.2016.23.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Central Line-Associated Bloodstream Infections (CLABSI), Intensive Care Unit (ICU), Methicillin-Resistant Staphylococcus aureus (MRSA), Prevention, Patient Safety, Healthcare-Associated Infections (HAIs)
Clark BJ, Rubinsky AD, Ho PM
Alcohol screening scores and the risk of intensive care unit admission and hospital readmission.
This study sought to determine whether alcohol misuse was associated with admission to an intensive care unit (ICU) among patients receiving outpatient care. Among 486,115 veterans receiving outpatient care, the adjusted probability of ICU admission within 1 year was 2.0 percent for abstinent patients, 1.6 percent for patients with lower-risk alcohol use, 1.8 percent for patients with moderate alcohol misuse, and 2.5 percent for patients with severe alcohol misuse.
AHRQ-funded; HS022800.
Citation: Clark BJ, Rubinsky AD, Ho PM .
Alcohol screening scores and the risk of intensive care unit admission and hospital readmission.
Subst Abus 2016 Jul-Sep;37(3):466-73. doi: 10.1080/08897077.2015.1137259.
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Keywords: Alcohol Use, Hospital Readmissions, Intensive Care Unit (ICU), Ambulatory Care and Surgery, Screening, Substance Abuse
Humble SS, Wilson LD, Leath TC
ICU sedation with dexmedetomidine after severe traumatic brain injury.
This study describes the dexmedetomidine dosage and infusion times, as well as the physiological parameters, neurological status and daily narcotic requirements before, during and after dexmedetomidine infusion. Its findings demonstrate that initiation of dexmedetomidine infusion is not associated with a decline in neurological functioning in adults with severe TBI.
AHRQ-funded; HS013833.
Citation: Humble SS, Wilson LD, Leath TC .
ICU sedation with dexmedetomidine after severe traumatic brain injury.
Brain Inj 2016;30(10):1266-70. doi: 10.1080/02699052.2016.1187289.
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Keywords: Adverse Drug Events (ADE), Brain Injury, Intensive Care Unit (ICU), Medication, Trauma
Lyu PF, Hockenberry JM, Gaydos LM
Impact of a sequential intervention on albumin utilization in critical care.
The authors evaluated the effect of a sequential multifaceted intervention on decreasing albumin use in the intensive care unit. They found that a sequential intervention achieved significant reductions in albumin use and cost savings without changes in patient outcomes, supporting the combination of financial and nonfinancial strategies to align providers with evidence-based practices.
AHRQ-funded; HS000055.
Citation: Lyu PF, Hockenberry JM, Gaydos LM .
Impact of a sequential intervention on albumin utilization in critical care.
Crit Care Med 2016 Jul;44(7):1307-13. doi: 10.1097/ccm.0000000000001638.
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Keywords: Critical Care, Healthcare Utilization, Intensive Care Unit (ICU), Patient-Centered Outcomes Research, Practice Patterns
Sjoding MW, Prescott HC, Wunsch H
Longitudinal changes in ICU admissions among elderly patients in the United States.
The researchers sought to describe the changing demographics, diagnoses, and outcomes of patients admitted to critical care units in the U.S. hospitals. They ound that patients with infectious diseases increased from 8.8 percent to 17.2 percent of admissions, and explicitly labeled sepsis moved from the 11th-ranked diagnosis in 1996 to the top-ranked primary discharge diagnosis in 2010.
AHRQ-funded; HS020672.
Citation: Sjoding MW, Prescott HC, Wunsch H .
Longitudinal changes in ICU admissions among elderly patients in the United States.
Crit Care Med 2016 Jul;44(7):1353-60. doi: 10.1097/ccm.0000000000001664.
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Keywords: Elderly, Intensive Care Unit (ICU), Hospitalization, Diagnostic Safety and Quality, Critical Care
Saint S, Greene MT, Krein SL
AHRQ Author: Battles J
A program to prevent catheter-associated urinary tract infection in acute care.
The national Comprehensive Unit-based Safety Program, funded by AHRQ, aimed to reduce catheter-associated UTI in intensive care units (ICUs) and non-ICUs. The main program features were dissemination of information to sponsor organizations and hospitals, data collection, and guidance on key technical and socioadaptive factors in the prevention of catheter-associated UTI. Among the findings: in an adjusted analysis, catheter-associated UTI rates decreased from 2.40 to 2.05 infections per 1000 catheter-days.
AHRQ-authored; AHRQ-funded; 290201000025I; 29032001T.
Citation: Saint S, Greene MT, Krein SL .
A program to prevent catheter-associated urinary tract infection in acute care.
N Engl J Med 2016 Jun 2;374(22):2111-9. doi: 10.1056/NEJMoa1504906.
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Keywords: Comprehensive Unit-based Safety Program (CUSP), Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU), Prevention, Urinary Tract Infection (UTI)
Harrison AM, Gajic O, Pickering BW
Development and implementation of sepsis alert systems.
Development and implementation of sepsis alert systems is challenging, particularly outside the monitored intensive care unit (ICU) setting. Current evidence does not support routine use of sepsis alert systems in clinical practice. Continuous improvement in the afferent and efferent aspects will help translate theoretic advantages into measurable patient benefit.
AHRQ-funded; HS022799.
Citation: Harrison AM, Gajic O, Pickering BW .
Development and implementation of sepsis alert systems.
Clin Chest Med 2016 Jun;37(2):219-29. doi: 10.1016/j.ccm.2016.01.004..
Keywords: Intensive Care Unit (ICU), Sepsis, Outcomes, Adverse Events
Dai D, Feinstein JA, Morrison W
Epidemiology of polypharmacy and potential drug-drug interactions among pediatric patients in ICUs of U.S. children's hospitals.
The authors studied the characteristics and prevalence of exposure of pediatric patients to polypharmacy and potential drug-drug interactions in pediatric intensive care units (PICUs). They found that many PICU patients are exposed to substantial polypharmacy and potential drug-drug interactions. Future research should identify the risk of adverse drug events following specific potential drug-drug interaction exposures.
AHRQ-funded; HS018425.
Citation: Dai D, Feinstein JA, Morrison W .
Epidemiology of polypharmacy and potential drug-drug interactions among pediatric patients in ICUs of U.S. children's hospitals.
Pediatr Crit Care Med 2016 May;17(5):e218-28. doi: 10.1097/pcc.0000000000000684.
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Keywords: Adverse Drug Events (ADE), Children/Adolescents, Intensive Care Unit (ICU), Medication, Medication: Safety
McElroy LM, Khorzad R, Nannicelli AP
Failure mode and effects analysis: a comparison of two common risk prioritisation methods.
The investigators compared a simplified scoring method with the traditional scoring method to determine the degree of congruence in identifying high-risk failures. They found that the simplified method did not result in the same degree of discrimination in the ranking of failures offered by the traditional method.
AHRQ-funded; HS000078.
Citation: McElroy LM, Khorzad R, Nannicelli AP .
Failure mode and effects analysis: a comparison of two common risk prioritisation methods.
BMJ Qual Saf 2016 May;25(5):329-36. doi: 10.1136/bmjqs-2015-004130.
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Keywords: Adverse Events, Intensive Care Unit (ICU), Outcomes, Patient Safety, Risk
Wysham NG, Kamal AH
Integrating palliative care in the intensive care unit. evidence gaps and quality gaps.
The authors discuss Mularski and colleagues in the same issue, stating that this study provides an important advancement in measuring palliative care quality in the ICU. They commend Mularski and colleagues for advancing the candidate measures of ICU-based palliative care and conclude that this report draws attention to important and persistent deficiencies in comprehensive, patient-centered critical care delivery that needs to be addressed in research and in practice.
AHRQ-funded; HS023681.
Citation: Wysham NG, Kamal AH .
Integrating palliative care in the intensive care unit. evidence gaps and quality gaps.
Ann Am Thorac Soc 2016 May;13(5):595-7. doi: 10.1513/AnnalsATS.201601-061ED.
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Keywords: Evidence-Based Practice, Intensive Care Unit (ICU), Palliative Care, Patient-Centered Outcomes Research, Quality of Care
Popoola VO, Colantuoni E, Suwantarat N
Active surveillance cultures and decolonization to reduce staphylococcus aureus infections in the neonatal intensive care unit.
The researchers examined the impact of methicillin-susceptible S. aureus (MSSA) decolonization on the incidence of MSSA infection and to measure the prevalence of mupirocin resistance. They found that active surveillance cultures and decolonization may be effective in decreasing S. aureus infections in NICUs.
AHRQ-funded; HS022872.
Citation: Popoola VO, Colantuoni E, Suwantarat N .
Active surveillance cultures and decolonization to reduce staphylococcus aureus infections in the neonatal intensive care unit.
Infect Control Hosp Epidemiol 2016 Apr;37(4):381-7. doi: 10.1017/ice.2015.316..
Keywords: Healthcare-Associated Infections (HAIs), Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU), Methicillin-Resistant Staphylococcus aureus (MRSA), Newborns/Infants
Baird J, Rehm RS, Hinds PS
Do you know my child? Continuity of nursing care in the pediatric intensive care unit.
The objective of this analysis was to explore the delivery of continuity of nursing care in the pediatric intensive care unit (PICU), from the perspective of both parents and nurses. Parents repeatedly endorsed a desire for continuity of nursing care, wanting to ensure that the bedside nurse valued their child as an individual and understood the complexities of the child's care regimen.
AHRQ-funded; HS000063.
Citation: Baird J, Rehm RS, Hinds PS .
Do you know my child? Continuity of nursing care in the pediatric intensive care unit.
Nurs Res 2016 Mar-Apr;65(2):142-50. doi: 10.1097/nnr.0000000000000135.
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Keywords: Care Management, Children/Adolescents, Critical Care, Healthcare Delivery, Intensive Care Unit (ICU), Nursing
Collinsworth AW, Priest EL, Campbell CR
A review of multifaceted care approaches for the prevention and mitigation of delirium in intensive care units.
The objective of this review was to examine the effectiveness, implementation, and costs of multifaceted care approaches, including care bundles, for the prevention and mitigation of delirium in patients hospitalized in intensive care units (ICUs). It concluded that although multifaceted care approaches may reduce delirium and improve patient outcomes, greater improvements may be achieved by deploying a comprehensive bundle of care practices.
AHRQ-funded; HS021459.
Citation: Collinsworth AW, Priest EL, Campbell CR .
A review of multifaceted care approaches for the prevention and mitigation of delirium in intensive care units.
J Intensive Care Med 2016 Feb;31(2):127-41. doi: 10.1177/0885066614553925.
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Keywords: Intensive Care Unit (ICU), Prevention, Evidence-Based Practice, Critical Care, Quality of Care
Abraham J, Kannampallil T, Brenner C
Characterizing the structure and content of nurse handoffs: a Sequential Conversational Analysis approach.
This paper describes Sequential Conversational Analysis (SCA) - a mixed-method approach integrating qualitative conversational analysis with quantitative sequential pattern analysis. This approach allows characterization of the nature of nurse handoff communication, highlighting the relationships underlying verbal content. The authors also discuss how SCA can help in understanding the dynamics of communication in other settings.
AHRQ-funded; HS017586.
Citation: Abraham J, Kannampallil T, Brenner C .
Characterizing the structure and content of nurse handoffs: a Sequential Conversational Analysis approach.
J Biomed Inform 2016 Feb;59:76-88. doi: 10.1016/j.jbi.2015.11.009.
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Keywords: Communication, Quality of Care, Intensive Care Unit (ICU), Nursing, Workflow
Hasvold J, Sjoding M, Pohl K
The role of human metapneumovirus in the critically ill adult patient.
The purpose of the study is to describe the role of human metapneumovirus (hMPV) infection in critical illness and acute respiratory distress syndrome (ARDS). It concluded that although most patients hospitalized with hMPV had chronic cardiac or pulmonary disease, hMPV can also be associated with serious respiratory illness and ARDS in adult patients without significant comorbidities or immunosuppression.
AHRQ-funded; HS020672.
Citation: Hasvold J, Sjoding M, Pohl K .
The role of human metapneumovirus in the critically ill adult patient.
J Crit Care 2016 Feb;31(1):233-7. doi: 10.1016/j.jcrc.2015.09.035.
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Keywords: Critical Care, Respiratory Conditions, Intensive Care Unit (ICU), Hospitalization
Sjoding MW, Valley TS, Prescott HC
Rising billing for intermediate intensive care among hospitalized Medicare bbetween 1996 and 2010.
This study characterized trends in intermediate care use among U.S. hospitals. Only 8.2 percent of Medicare hospitalizations in 1996 were billed for intermediate care, but billing steadily increased to 22.8 percent by 2010, whereas the percentage billed for ICU care and ward-only care declined. Patients billed for intermediate care had more acute organ failures diagnoses codes compared with general ward patients.
AHRQ-funded; HS020672.
Citation: Sjoding MW, Valley TS, Prescott HC .
Rising billing for intermediate intensive care among hospitalized Medicare bbetween 1996 and 2010.
Am J Respir Crit Care Med 2016 Jan 15;193(2):163-70. doi: 10.1164/rccm.201506-1252OC.
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Keywords: Payment, Hospitals, Intensive Care Unit (ICU), Healthcare Costs, Medicare
Wong EG, Parker AM, Leung DG
Association of severity of illness and intensive care unit readmission: a systematic review.
This study sought to determine whether ICU readmission is associated with higher severity of illness scores in adult patients. In most of the 31 studies included in the analysis, severity of illness scores were higher in patients readmitted to the ICU. Readmission was also associated with higher mortality and longer ICU and hospital stays.
AHRQ-funded; HS022916.
Citation: Wong EG, Parker AM, Leung DG .
Association of severity of illness and intensive care unit readmission: a systematic review.
Heart Lung 2016 Jan-Feb;45(1):3-9.e2. doi: 10.1016/j.hrtlng.2015.10.040.
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Keywords: Intensive Care Unit (ICU), Hospital Readmissions, Hospital Discharge, Outcomes
Li S, Rehder KJ, Giuliano JS, Jr.
Development of a quality improvement bundle to reduce tracheal intubation-associated events in pediatric ICUs.
This paper described a methodology to develop a bundle to improve quality and safety of tracheal intubations in the pediatric intensive care unit. The Airway Bundle Checklist consists of four parts: a risk factor assessment, a plan generation, a preprocedure time-out, and a postprocedure huddle to identify improvement opportunities.
AHRQ-funded; HS021583.
Citation: Li S, Rehder KJ, Giuliano JS, Jr. .
Development of a quality improvement bundle to reduce tracheal intubation-associated events in pediatric ICUs.
Am J Med Qual 2016 Jan-Feb;31(1):47-55. doi: 10.1177/1062860614547259.
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Keywords: Adverse Events, Intensive Care Unit (ICU), Quality Improvement, Patient Safety, Children/Adolescents