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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 597 Research Studies Displayed
Henke RM, Fingar KR, Jiang HJ
AHRQ Author: Jiang HJ, Liang L
Access to obstetric, behavioral health, and surgical inpatient services after hospital mergers in rural areas.
This study examined the influence of rural hospital mergers on changes to inpatient service lines at hospitals and within their catchment areas. The authors used hospital discharge data from 32 HCUP Inpatient Databases from 2007 to 2018. They found that merged hospitals were more likely than independent hospitals to eliminate maternal/neonatal and surgical care. They also found that while the number of mental/substance use disorder-related stays decreased or remained stable at merged hospitals and their catchment areas, it increased for unaffiliated hospitals and their catchment areas. This indicates a potential unmet need in the communities of rural hospitals postmerger.
AHRQ-authored; AHRQ-funded; 290201800001C.
Citation: Henke RM, Fingar KR, Jiang HJ . Access to obstetric, behavioral health, and surgical inpatient services after hospital mergers in rural areas. Health Aff 2021 Oct;40(10):1627-36. doi: 10.1377/hlthaff.2021.00160..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitals, Access to Care, Rural Health
Arntson E, Dimick JB, Nuliyalu U
Changes in hospital-acquired conditions and mortality associated with the hospital-acquired condition reduction program.
This study evaluated changes in Hospital-Acquired Conditions (HACs) and 30-day mortality after the announcement of the Centers for Medicare and Medicare Services’ Hospital-Acquired Condition Reduction Program (HACRP) in August 2013. The authors evaluated models to test for changes in HACs and 30-day mortality before and after the Affordable Care Act (ACA), and after the HACRP. Fee-for-service Medicare claims from 2009 to 2015 were used. The HAC rate declined after the ACA was passed and declined further after the HACRP announcement. However, 30-day mortality rates were unchanged.
Citation: Arntson E, Dimick JB, Nuliyalu U . Changes in hospital-acquired conditions and mortality associated with the hospital-acquired condition reduction program. Ann Surg 2021 Oct 1;274(4):e301-e07. doi: 10.1097/sla.0000000000003641..
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Mortality, Medicare, Payment, Prevention, Patient Safety
Holmgren AJ, Kuznetsova M, Classen D
Assessing hospital electronic health record vendor performance across publicly reported quality measures.
The authors measured hospital performance, stratified by electronic health record (EHR) vendor, across 4 quality metrics. They found that no EHR vendor was associated with higher quality across all measures, and the 2 largest vendors were not associated with the highest scores. Only a small fraction of quality variation was explained by EHR vendor choice. They concluded that top performance on quality measures can be achieved with any EHR vendor, as much of quality performance is driven by the hospital and how it uses the EHR.
Citation: Holmgren AJ, Kuznetsova M, Classen D . Assessing hospital electronic health record vendor performance across publicly reported quality measures. J Am Med Inform Assoc 2021 Sep 18;28(10):2101-07. doi: 10.1093/jamia/ocab120..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Indicators (QIs), Quality Measures, Hospitals, Quality of Care, Provider Performance
Buxbaum JD, Rak S
Equity and the uneven distribution of federal COVID-19 relief funds To US hospitals.
This paper looked at the distribution of federal COVID-19 relief funds among US hospitals. The authors studied the relationship between the relief received by 2,709 hospitals and community- and hospital-level characteristics. Average funding through February 2021 was $25.7 million per hospital. They found that hospitals serving a community with a very high share of Black residents or having a very high ratio of Medicaid revenue to beds were associated with meaningful increased funding. However, hospitals with a very high share of Hispanic residents or a Medically Underserved Area were associated with decreased funding or no difference in funding.
Citation: Buxbaum JD, Rak S . Equity and the uneven distribution of federal COVID-19 relief funds To US hospitals. Health Aff 2021 Sep;40(9):1473-82. doi: 10.1377/hlthaff.2020.02018..
Keywords: COVID-19, Hospitals
Greenberg JK, Olsen MA, Poe J
Administrative data are unreliable for ranking hospital performance based on serious complications after spine fusion.
The authors evaluated the extent to which a metric of serious complications determined from administrative data can reliably profile hospital performance in spine fusion surgery. They found that a metric of serious complications was unreliable for benchmarking cervical fusion outcomes and only modestly reliable for thoracolumbar fusion. They concluded that, when assessed using administrative datasets, these measures appeared to be inappropriate for high-stakes applications, such as public reporting or pay-for-performance.
AHRQ-funded; HS027075; HS019455.
Citation: Greenberg JK, Olsen MA, Poe J . Administrative data are unreliable for ranking hospital performance based on serious complications after spine fusion. Spine 2021 Sep 1;46(17):1181-90. doi: 10.1097/brs.0000000000004017..
Keywords: Surgery, Provider Performance, Hospitals, Adverse Events, Back Health and Pain
Jiang HJ, Fingar KR, Liang L
AHRQ Author: Jiang HJ, Liang L
Quality of care before and after mergers and acquisitions of rural hospitals.
Researchers sought to examine changes in quality of care for patients at rural hospitals that merged compared with those that remained independent. Using HCUP data, they found that rural hospital mergers were associated with better mortality outcomes for acute myocardial infarction, heart failure, stroke, gastrointestinal hemorrhage, hip fracture, and pneumonia. They concluded that their finding is important to enhancing rural health care and reducing urban-rural disparities in quality of care.
AHRQ-authored; AHRQ-funded; 290201800001C.
Citation: Jiang HJ, Fingar KR, Liang L . Quality of care before and after mergers and acquisitions of rural hospitals. JAMA Netw Open 2021 Sep;4(9):e2124662. doi: 10.1001/jamanetworkopen.2021.24662..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitals, Rural Health, Quality of Care
Apathy NC, Holmgren AJ, Adler-Milstein J
A decade post-HITECH: critical access hospitals have electronic health records but struggle to keep up with other advanced functions.
This study compared electronic health record (EHR) adoption and advanced use over time at critical access hospitals (CAHs) and non-CAHs. Data used was 2008 to 2018 American Hospital Information Technology survey data to update national EHR adoption statistics. In 2018, almost 100% (98.3%) of hospitals had adopted EHRs with no difference by CAH status. More than half had adopted advanced patient engagement (PE) and clinical data analytics (CDA). CAHs were less likely to adopt both advanced uses. This digital divide prevents CAH patients from benefitting from a fully digitized healthcare system.
Citation: Apathy NC, Holmgren AJ, Adler-Milstein J . A decade post-HITECH: critical access hospitals have electronic health records but struggle to keep up with other advanced functions. J Am Med Inform Assoc 2021 Aug 13;28(9):1947-54. doi: 10.1093/jamia/ocab102..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitals
Pylypchuk Y, Barker W, Encinosa W
AHRQ Author: Encinosa W
Impact of the 2015 Health Information Technology Certification Edition on interoperability among hospitals.
Most nonfederal acute care hospitals use electronic health records (EHRs) certified by the Office of the National Coordinator for Health Information Technology. In 2015, the Office of the National Coordinator for Health Information Technology finalized the 2015 Health IT Certification Edition and adoption by hospitals began in 2016. In this study, the investigators examined the impact of the 2015 Edition on rates of interoperable exchange among nonfederal acute hospitals.
Citation: Pylypchuk Y, Barker W, Encinosa W . Impact of the 2015 Health Information Technology Certification Edition on interoperability among hospitals. J Am Med Inform Assoc 2021 Aug 13;28(9):1866-73. doi: 10.1093/jamia/ocab083..
Keywords: Health Information Exchange (HIE), Health Information Technology (HIT), Hospitals
Santos T, Lee SD, East C
Can collaboration between nonprofit hospitals and local health departments influence population health investments by nonprofit hospitals?
The Patient Protection and Affordable Care Act (ACA) sought to improve population health by requiring nonprofit hospitals (NFPs) to conduct triennial community health needs assessments and address the identified needs. In this context, some states have encouraged collaboration between hospitals and local health department (LHD) to increase the focus of community benefit spending onto population health. The aim of the study was to examine whether a 2012 state law that required NFPs to collaborate with LHDs in local health planning influenced hospital population health improvement spending.
AHRQ-funded; HS024959; HS026116.
Citation: Santos T, Lee SD, East C . Can collaboration between nonprofit hospitals and local health departments influence population health investments by nonprofit hospitals? Med Care 2021 Aug;59(8):687-93. doi: 10.1097/mlr.0000000000001561..
Keywords: Hospitals, Public Health
Cabral SM, Goodman KE, Blanco N
Comorbidity and severity-of-illness risk adjustment for hospital-onset Clostridioides difficile infection using data from the electronic medical record.
This study’s objective was to determine whether electronically available comorbidities and laboratory values on admission are risk factors for hospital-onset Clostridioides difficile infection (HO-CDI) across multiple institutions and whether they could be used to improve risk adjustment. Adult patients admitted to 3 hospitals in Maryland from 2016 to 2018 were included. Patients with comorbid conditions were assigned using the Elixhauser comorbidity index. Standardized infection rates (SIRs) were computed using current CDC risk adjustment methodology and included the addition of Elixhauser score and individual comorbidities. Hospital 1 had 314 (0.65%) of patients with a HO-CDI, Hospital 2 had 41 (0.47%) with a HO-CDI, and Hospital 3 had 75 (0.26%) with a HO-CDI. Elixhauser score in multivariable regression was a significant risk factor for HO-CDI at all hospitals when controlling for age, antibiotic user, and antacid use. Abnormal leukocyte level at hospital admission was a significant risk factor at hospitals 1 and 2. Including the Elixhauser score in the risk adjustment model was statistically significant.
Citation: Cabral SM, Goodman KE, Blanco N . Comorbidity and severity-of-illness risk adjustment for hospital-onset Clostridioides difficile infection using data from the electronic medical record. Infect Control Hosp Epidemiol 2021 Aug;42(8):955-61. doi: 10.1017/ice.2020.1344..
Keywords: Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Hospitals, Risk
Do Medicare's facility fees incentivize hospitals to vertically integrate with oncologists?
Within the past decade, the U.S. health care market has undergone massive vertical integration, prompting economists to study the underlying causes and consequences of hospital-physician integration. This paper examined whether or not hospitals strategically chose to vertically integrate with clinical oncologists in order to capture facility fees, a commonly cited reason for increased consolidation in the health care market.
Citation: Valdez S . Do Medicare's facility fees incentivize hospitals to vertically integrate with oncologists? Inquiry 2021 Jan-Dec;58:469580211022968. doi: 10.1177/00469580211022968..
Keywords: Medicare, Hospitals, Provider: Physician
Goodman KE, Cosgrove SE, Pineles L
Significant regional differences in antibiotic use across 576 US hospitals
This study’s objective was to examine adult antibiotic use across 576 hospitals and nearly 12 million encounters in 2016-2017. Findings showed that adult inpatient antibiotic use remained high, driven predominantly by broad-spectrum agents. Recommendations included better understanding of the reasons for interhospital usage differences, including by region and teaching status, in order to inform efforts to reduce inappropriate antibiotic prescribing.
Citation: Goodman KE, Cosgrove SE, Pineles L . Significant regional differences in antibiotic use across 576 US hospitals Significant regional differences in antibiotic use across 576 US hospitals and 11 701 326 adult admissions, 2016-2017..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Hospitals
Lasater KB, Sloane DM, McHugh MD
Evaluation of hospital nurse-to-patient staffing ratios and sepsis bundles on patient outcomes.
Despite nurses' responsibilities in recognition and treatment of sepsis, little evidence documents whether patient-to-nurse staffing ratios are associated with clinical outcomes for patients with sepsis. Using linked data sources from 2017 including MEDPAR patient claims, Hospital Compare, American Hospital Association, and a large survey of nurses, the investigators estimated the effect of hospital patient-to-nurse staffing ratios and adherence to the Early Management Bundle for patients with Severe Sepsis/Septic Shock SEP-1 sepsis bundles on patients' odds of in-hospital and 60-day mortality, readmission, and length of stay.
Citation: Lasater KB, Sloane DM, McHugh MD . Evaluation of hospital nurse-to-patient staffing ratios and sepsis bundles on patient outcomes. Am J Infect Control 2021 Jul;49(7):868-73. doi: 10.1016/j.ajic.2020.12.002..
Keywords: Sepsis, Nursing, Provider: Nurse, Inpatient Care, Hospitals
Burris HH, Passarella M, Handley SC
Black-white disparities in maternal in-hospital mortality according to teaching and black-serving hospital status.
This study’s objective was to determine whether black-white disparities in maternal in-hospital mortality during delivery vary across hospital types (black-serving vs non-black and teaching vs non-teaching) and whether overall maternal mortality differs across hospital types. The authors performed a population-based, retrospective cohort study of 5,679,044 deliveries among black (14.2%) and white patients (85.8%) in 3 states (California, Missouri, and Pennsylvania) from 1995 to 2009. Examination of black-white disparities found that after risk adjustment, black patients had significantly greater risk of death and that the disparity was similar within each of the hospital types. At teaching hospitals, mortality was similar in black-serving and nonblack-serving hospitals. Among non-teaching hospitals, mortality was significantly higher in black-serving vs nonblack-serving hospitals. Over half (53%) of black patients delivered in nonteaching black-serving hospitals compared with just 19% of white patients.
Citation: Burris HH, Passarella M, Handley SC . Black-white disparities in maternal in-hospital mortality according to teaching and black-serving hospital status. Am J Obstet Gynecol 2021 Jul;225(1):83.e1-83.e9. doi: 10.1016/j.ajog.2021.01.004..
Keywords: Maternal Care, Pregnancy, Mortality, Women, Racial / Ethnic Minorities, Disparities, Hospitals
Masonbrink AR, Harris M, Hall M
Safety events in children's hospitals during the COVID-19 pandemic.
The coronavirus disease 2019 (COVID-19) pandemic has impacted hospitals, potentially affecting quality and safety. The objective of this study was to compare pediatric hospitalization safety events during the pandemic versus previous years. The investigators concluded that postoperative sepsis rates increased among children hospitalized during COVID-19. They suggest that efforts are needed to improve safety of postoperative care for hospitalized children.
AHRQ-funded; HS024554; HS024592.
Citation: Masonbrink AR, Harris M, Hall M . Safety events in children's hospitals during the COVID-19 pandemic. Hosp Pediatr 2021 Jun;11(6):e95-e100. doi: 10.1542/hpeds.2020-004937..
Keywords: Children/Adolescents, COVID-19, Patient Safety, Sepsis, Adverse Events, Hospitalization, Hospitals, Inpatient Care, Infectious Diseases, Public Health
Popejoy LL, Vogelsmeier AA, Wang Y
Testing re-engineered discharge program implementation strategies in SNFs.
This paper describes a trial of the redesigned Re-Engineered Discharge (RED) program, which was originally designed for hospitals, for use at skilled nursing facilities (SNFs). This tool’s objective is to reduce rehospitalizations after discharge. Two different RED implementation strategies (Enhanced and Standard) were compared pretest-posttest. The Standard group had higher odds of being readmitted in the pre-intervention versus post-intervention program. After adjusting coefficients using Poisson regression, the adjusted number of hospitalizations in the Standard group was 45% higher at 30 days, 50% higher at 60 days, and 39% higher at 180 days.
Citation: Popejoy LL, Vogelsmeier AA, Wang Y . Testing re-engineered discharge program implementation strategies in SNFs. Clin Nurs Res 2021 Jun;30(5):644-53. doi: 10.1177/1054773820982612..
Keywords: Hospital Discharge, Hospital Readmissions, Implementation, Hospitals
Shortell SM, Gottlieb DJ, Martinez Camblor P
Hospital-based health systems 20 years later: a taxonomy for policy research and analysis.
Building on the original taxonomy of hospital-based health systems from 20 years ago, the investigators developed a new taxonomy to inform emerging public policy and practice developments. The study design included a cluster analysis of the 2016 AHA Annual Survey data to derive measures of differentiation, centralization, and integration to create categories or types of hospital-based health systems.
Citation: Shortell SM, Gottlieb DJ, Martinez Camblor P . Hospital-based health systems 20 years later: a taxonomy for policy research and analysis. Health Serv Res 2021 Jun;56(3):453-63. doi: 10.1111/1475-6773.13621..
Keywords: Hospitals, Healthcare Systems, Health Services Research (HSR), Policy
Chatterjee P, Qi M, Werner RM
Association of Medicaid expansion with quality in safety-net hospitals.
The authors compared changes in quality from 2012 to 2018 between safety net hospitals (SNHs) in states that expanded Medicaid vs those in states that did not. They found that, despite reductions in uncompensated care and improvements in operating margins, there appeared to be little evidence of quality improvement among SNHs in states that expanded Medicaid compared with those in states that did not.
Citation: Chatterjee P, Qi M, Werner RM . Association of Medicaid expansion with quality in safety-net hospitals. JAMA Intern Med 2021 May;181(5):590-97. doi: 10.1001/jamainternmed.2020.9142..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Safety Net, Hospitals, Medicaid, Quality Improvement, Quality of Care
Anesi GL, Jablonski J, Harhay MO
Characteristics, outcomes, and trends of patients with COVID-19-related critical illness at a learning health system in the United States.
This study’s objective is to describe the epidemiology of COVID-19-related critical illness, including trends in outcomes and care delivery, using five hospitals within the University of Pennsylvania Health System as a setting. Findings showed that, among patients with COVID-19-related critical illness admitted to ICUs of a learning health system in the United States, mortality seemed to decrease over time despite stable patient characteristics. Recommendations included further studies to confirm this result and to investigate causal mechanisms.
Citation: Anesi GL, Jablonski J, Harhay MO . Characteristics, outcomes, and trends of patients with COVID-19-related critical illness at a learning health system in the United States. Ann Intern Med 2021 May;174(5):613-21. doi: 10.7326/m20-5327..
Keywords: COVID-19, Critical Care, Intensive Care Unit (ICU), Mortality, Hospitals, Outcomes, Infectious Diseases
McGrath SP, Perreard IM, MacKenzie T
Patterns in continuous pulse oximetry data prior to pulseless electrical activity arrest in the general care setting.
This study’s objective was to understand if features derived from continuous pulse oximetry data can provide advanced warning of pulseless electrical activity arrest in general care inpatients. A retrospective analysis of SpO2 and pulse rate data derived from continuous pulse oximetry was performed for patients with electrical pulseless activity (n = 38) and control patients (n = 42). The pulseless electrical activity arrest group tended to have lower mean SpO2 and higher mean pulse rates over time intervals ranging from 1 minute to 1 hour. Several hours to the rescue event changes in variability were observed. Up to 20 minutes before rescue events, pulse rate features were significantly different from feature values for the preceding 30-minute interval. Similar results were found at 10 minutes before the event. These differences might be useful for predicting and preventing rescue events.
Citation: McGrath SP, Perreard IM, MacKenzie T . Patterns in continuous pulse oximetry data prior to pulseless electrical activity arrest in the general care setting. J Clin Monit Comput 2021 May;35(3):537-45. doi: 10.1007/s10877-020-00509-8..
Keywords: Patient Safety, Inpatient Care, Hospitals, Prevention, Cardiovascular Conditions
Legler S, Diehl M, Hilliard B
Evaluation of an intrahospital telemedicine program for patients admitted with COVID-19: mixed methods study.
This pilot study’s objective was to evaluate an intrahospital telemedicine program along with its impact on exposure risk and communication for patients admitted with COVID-19. Virtual care was the main primary exposure variable and patient characteristics, PPE use rates, and their association with virtual care were assessed. Out of 137 total patients in their primary analysis, 43 patients used virtual care. There were 82 inpatient days of use, and 401 inpatient days without use. Surveys of 41 patients and clinicians showed high rates of recommendation for further use. A significant reduction in PPE use and physical exam rate was associated with virtual care. However, there are limitations in usability, medical assessment, and empathetic communication.
Citation: Legler S, Diehl M, Hilliard B . Evaluation of an intrahospital telemedicine program for patients admitted with COVID-19: mixed methods study. J Med Internet Res 2021 Apr 29;23(4):e25987. doi: 10.2196/25987..
Keywords: Telehealth, Health Information Technology (HIT), Hospitals, Hospitalization, Communications, COVID-19
Moniz MH, Bonawitz K, Wetmore MK
Implementing immediate postpartum contraception: a comparative case study at 11 hospitals.
Researchers examined how organizational context and implementation strategies drive successful implementation of immediate postpartum long-acting reversible contraception services, with a goal of informing the design of future implementation interventions. Semi-structured interviews were conducted with clinicians, nurses, residents, pharmacy and revenue cycle staff, and hospital administrators. They found that implementation efforts in maternity settings may be more successful if they select strategies to optimize local conditions for success. They recommended future research to evaluate whether these strategies effectively optimize local conditions for successful implementation in a variety of settings.
AHRQ-funded; HS025465; HS023784.
Citation: Moniz MH, Bonawitz K, Wetmore MK . Implementing immediate postpartum contraception: a comparative case study at 11 hospitals. Implement Sci Commun 2021 Apr 12;2(1):42. doi: 10.1186/s43058-021-00136-7..
Keywords: Contraception, Maternal Care, Women, Hospitals, Implementation
Lipsett SC, Haines L, Monuteaux MC
Variation in oophorectomy rates for children with ovarian torsion across US children's hospitals.
A multicenter study of 1783 children diagnosed with ovarian torsion from 2012 to 2017 undergoing oophorectomy was conducted. Four-hundred and two children (22.5%) underwent oophorectomy. Odds of oophorectomy were higher in children under 11 years of age, children with public insurance, and children with complex chronic conditions.
Citation: Lipsett SC, Haines L, Monuteaux MC . Variation in oophorectomy rates for children with ovarian torsion across US children's hospitals. J Pediatr 2021 Apr;231:269-72.e1. doi: 10.1016/j.jpeds.2020.12.019..
Keywords: Children/Adolescents, Chronic Conditions, Surgery, Hospitals
Baloh J, Zhu X, Ward MM
What influences sustainment and nonsustainment of facilitation activities in implementation? Analysis of organizational factors in hospitals implementing TeamSTEPPS.
This study looked at the influences on sustainment of internal facilitation activities. For two years the authors followed 10 small rural hospitals implementing TeamSTEPPS, a patient safety program. Factors the authors examined were the influence of senior management support (SMS), middle management support (MMS), facilitator team time availability (TIME), and team continuity (CONTINUITY). Five hospitals sustained facilitation activities and they found that the combination of SMS, MMS, and CONTINUITY was a sufficient condition for sustainment. The five other hospitals that did not sustain facilitation activities either lacked MMS or lacked both TIME and CONTINUITY. They also discussed the implications for research and practice.
AHRQ-funded; HS024112; HS018396.
Citation: Baloh J, Zhu X, Ward MM . What influences sustainment and nonsustainment of facilitation activities in implementation? Analysis of organizational factors in hospitals implementing TeamSTEPPS. Med Care Res Rev 2021 Apr;78(2):146-56. doi: 10.1177/1077558719848267..
Keywords: TeamSTEPPS, Teams, Implementation, Hospitals, Patient Safety, Rural Health, Organization and Administration
Ye S, Hiura G, Fleck E
Hospital readmissions after implementation of a discharge care program for patients with COVID-19 illness.
The surge of coronavirus 2019 (COVID-19) hospitalizations in New York City required rapid discharges to maintain hospital capacity. The objective of this study was to determine whether lenient provisional discharge guidelines with remote monitoring after discharge resulted in safe discharges home for patients hospitalized with COVID-19 illness. The investigators found that lenient discharge criteria in conjunction with remote monitoring after discharge were associated with a rate of early readmissions after COVID-related hospitalizations that was comparable to the rate of readmissions after other reasons for hospitalization before the COVID pandemic.
AHRQ-funded; HS024262; HS025198.
Citation: Ye S, Hiura G, Fleck E . Hospital readmissions after implementation of a discharge care program for patients with COVID-19 illness. J Gen Intern Med 2021 Mar;36(3):722-29. doi: 10.1007/s11606-020-06340-w..
Keywords: COVID-19, Hospital Discharge, Hospital Readmissions, Hospitals, Public Health, Hospitalization, Risk