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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results1 to 25 of 722 Research Studies Displayed
Nguyen JK, P P
Comparison of survival outcomes among older adults with major trauma after trauma center versus non-trauma center care in the United States.
This study’s objective was to compare level 1 and 2 trauma centers with similarly sized non-trauma centers on survival after major trauma among older adults. The authors used claims of 100% of 2012-2017 Medicare fee-for-service beneficiaries who received hospital care after major trauma. They assessed the roles of prehospital care, hospital quality, and volume. Thirty-day mortality was higher overall at level 1 versus non-trauma centers by 2.2 percentage points (pp). Thirty-day mortality was higher at level 1 versus non-trauma centers by 2.3 pp for falls and 2.3 pp for motor vehicle crashes. Outcomes were similar at level 1 and 2 trauma centers. The difference was not explained by hospital quality and volume. There were also no statistical differences in the ambulance-transported group, after adjusting for prehospital variables.
Citation: Nguyen JK, P P . Comparison of survival outcomes among older adults with major trauma after trauma center versus non-trauma center care in the United States. Health Serv Res 2023 Aug; 58(4):817-27. doi: 10.1111/1475-6773.14148..
Keywords: Elderly, Trauma, Outcomes, Injuries and Wounds, Emergency Department, Hospitals
Silver CM, Yang AD, Shan Y
Changes in surgical outcomes in a Statewide Quality Improvement Collaborative with introduction of simultaneous, comprehensive interventions.
Researchers investigated whether a comprehensive quality improvement program implemented simultaneously across hospitals at the formation of a quality improvement collaborative (QIC) would improve patient outcomes. They analyzed risk-adjusted rates of postoperative morbidity and mortality for patients who had undergone surgery at hospitals in the Illinois Surgical Quality Improvement Collaborative (ISQIC); analyses compared ISQIC hospitals with hospitals in the NSQIP Participant Use File (PUF). Although complication rates decreased at both ISQIC and PUF hospitals, findings showed that participation in ISQIC was associated with a significantly greater improvement in death or serious morbidity. The researchers concluded that these results emphasize the potential of QICs to improve patient outcomes.
Citation: Silver CM, Yang AD, Shan Y . Changes in surgical outcomes in a Statewide Quality Improvement Collaborative with introduction of simultaneous, comprehensive interventions. J Am Coll Surg 2023 Jul 1; 237(1):128-38. doi: 10.1097/xcs.0000000000000679..
Keywords: Surgery, Outcomes, Quality Improvement, Quality of Care, Hospitals
Smith DC, Phillippi JC, Tilden EL
Comparing cesarean birth utilization between US hospitals: a demonstration of the robson ten-group classification system for use in quality improvement and benchmarking.
The objective of this study was to describe the application and utility of the World Health Organization-endorsed Robson Ten-Group Classification System (TGCS) to compare hospital-level cesarean births rates for use in quality improvement and benchmarking. The authors conducted a descriptive, secondary data analysis of the Consortium on Safe Labor dataset using data from births from 2002-08 at 12 sites across the US. Results showed a variation in use of cesarean birth, labor induction, and trial of labor after cesarean (TOLAC) across the 12 sites. The authors concluded that TGCS provides a method for between-hospital comparisons and adoption of TGCS in the US would provide an effective benchmarking tool to assist in reducing the use of cesarean birth and increasing the support of TOLAC.
Citation: Smith DC, Phillippi JC, Tilden EL . Comparing cesarean birth utilization between US hospitals: a demonstration of the robson ten-group classification system for use in quality improvement and benchmarking. J Perinat Neonatal Nurs 2023 Jul-Sep; 37(3):214-22. doi: 10.1097/jpn.0000000000000670..
Keywords: Hospitals, Healthcare Utilization, Maternal Care, Women, Quality Improvement, Quality Measures, Quality of Care
Wang Y, Eldridge N, Metersky ML
AHRQ Author: Eldridge N and Rodrick D
Relationship between in-hospital adverse events and hospital performance on 30-day all-cause mortality and readmission for patients with heart failure.
Researchers sought to evaluate the association between hospital performance on mortality and readmission with hospital performance on safety adverse event rates. Their cross-sectional study linked patient-level adverse events data from the Medicare Patient Safety Monitoring System to hospital-level, heart failure (HF)-specific, 30-day, all-cause mortality and readmissions data from CMS. The study included data on over 39,000 patients with HF from over 3000 hospitals. Patients admitted with HF to hospitals with high 30-day, all-cause mortality and readmission rates had a higher risk of in-hospital adverse events. The researchers concluded that there might be common quality issues among the measure concepts in these hospitals that produce poor performance for patients with HF.
AHRQ-funded; AHRQ-authored; 290201800005C.
Citation: Wang Y, Eldridge N, Metersky ML . Relationship between in-hospital adverse events and hospital performance on 30-day all-cause mortality and readmission for patients with heart failure. Circ Cardiovasc Qual Outcomes 2023 Jul; 16(7):e009573. doi: 10.1161/circoutcomes.122.009573..
Keywords: Hospitals, Hospital Readmissions, Heart Disease and Health, Cardiovascular Conditions, Adverse Events, Provider Performance
Arbaje AI, Woodman S, Keita Fakeye MB
Senior services in US hospitals and readmission risk or mortality among Medicare beneficiaries since the Affordable Care Act.
This study examined whether there was an association between readmission risk or mortality among Medicare beneficiaries and passage of the Affordable Care Act. The study updated the Senior Care Services Scale (SCSS) which describes hospital provision of older adult services before the passage of the Affordable Care Act. The authors conducted a retrospective cohort analysis of older adults ≥65 years (n = 1,416,669), admitted to 2570 US acute-care hospitals from 2014 to 2015. Outcomes were hospital readmission, or death, within 30 and 90 days of discharge. The updated SCSS included three service groups: Inpatient Specialty Care, Post-Acute Community Care, and Home Care and Hospice. Older adults admitted to high Inpatient-Specialty-Care-scoring hospitals had lower risk of death within 30 days, and 90 days. There was no significant association between the other two groups and study outcomes.
Citation: Arbaje AI, Woodman S, Keita Fakeye MB . Senior services in US hospitals and readmission risk or mortality among Medicare beneficiaries since the Affordable Care Act. J Appl Gerontol 2023 Jul; 42(7):1424-32. doi: 10.1177/07334648231161925..
Keywords: Elderly, Hospitals, Hospital Readmissions, Medicare
MacEwan SR, Gaughan AA, Beal EW
Concerns and frustrations about the public reporting of device-related healthcare-associated infections: perspectives of hospital leaders and staff.
The purpose of this study was to explore the specific concerns of hospital leaders and staff regarding the identification and public reporting of healthcare-associated infections (HAIs). Between 2017 and 2019 the researchers conducted interviews with 471 participants including hospitals leaders and hospital staff across 18 United States hospitals. The study found that interviewees discussed concerns about public reporting of HAI data, including a lack of trust in the data and unintended consequences of its public reporting, as well as particular frustrations with the identification and accountability for publicly-reported HAIs.
Citation: MacEwan SR, Gaughan AA, Beal EW . Concerns and frustrations about the public reporting of device-related healthcare-associated infections: perspectives of hospital leaders and staff. Am J Infect Control 2023 Jun; 51(6):633-37. doi: 10.1016/j.ajic.2022.08.003..
Keywords: Medical Devices, Healthcare-Associated Infections (HAIs), Hospitals, Provider: Health Personnel
Trenaman L, Harrison M, Hoch JS
Medicare beneficiaries' perspectives on the quality of hospital care and their implications for value-based payment.
The objective of this study was to estimate the relative importance of the 4 quality domains in the Medicare's Hospital Value-Based Purchasing (HVBP) program from the perspective of Medicare beneficiaries and the impact of using beneficiary value weights on incentive payments for hospitals enrolled in FY 2019. A nationally representative sample of 1025 Medicare beneficiaries was recruited through Ipsos KnowledgePanel for an online survey. Hospital performance on clinical outcomes was most highly valued by beneficiaries, followed by safety, patient experience, and efficiency. The authors concluded that current HVBP program value weights do not reflect beneficiary preferences, suggesting that the use of beneficiary value weights may exacerbate disparities by rewarding larger, high-volume hospitals.
Citation: Trenaman L, Harrison M, Hoch JS . Medicare beneficiaries' perspectives on the quality of hospital care and their implications for value-based payment. JAMA Netw Open 2023 Jun; 6(6):e2319047. doi: 10.1001/jamanetworkopen.2023.19047..
Keywords: Medicare, Inpatient Care, Hospitals
Hansen CJ, Rayo MF, Patterson ES
Perceptually discriminating the highest priority alarms reduces response time: a retrospective pre-post study at four hospitals.
Emergency alarms are the most urgent of hospital alarms, necessitating immediate attention and action to address a dangerous situation. These alarms are triggered by clinicians and have greater positive predictive value (PPV). High-priority alarms are different from emergency alarms, are automatically triggered, and have lower PPV. The purpose of this retrospective pre-post study was to decrease nurse response time for emergency alarms and high-priority alarms by improving the discernability between emergency alarms and all other alarms, as well as by suppressing redundant and false alarms in a secondary alarm notification system (SANS). The researchers analyzed data 15 months prior to and 25 months after a SANS redesign was implemented in four hospitals. For emergency alarms, the researchers integrated digitized human speech features to distinguish the emergency alarms from the automatically triggered alarms, leaving their onset and escalation pathways unaltered. The researchers suppressed some of the automatically triggered alarms by delaying their initial onset and escalation by 20 seconds. The study found that response time for emergency alarms decreased at all hospitals ad the improvements were sustained. The use of automatically triggered alarms decreased 25.0%. Response time for the three automatically triggered cardiac alarms increased at the four hospitals.
Citation: Hansen CJ, Rayo MF, Patterson ES . Perceptually discriminating the highest priority alarms reduces response time: a retrospective pre-post study at four hospitals. Hum Factors 2023 Jun; 65(4):636-50. doi: 10.1177/00187208211032870..
Keywords: Hospitals, Nursing
Auerbach AD, Astik GJ, O'Leary KJ
Prevalence and causes of diagnostic errors in hospitalized patients under investigation for COVID-19.
During the COVID-19 pandemic, clinicians were required to address a disease with continuously changing traits while simultaneously complying with changes in care (e.g., physical distancing) that could contribute to diagnostic errors (DEs). The purpose of this study was to examine the frequency of DEs and their causes in patients hospitalized under investigation (PUI) for COVID-19. The researchers randomly selected up to 8 cases per site per month for evaluation, with each case evaluated by two clinicians to determine whether a DE occurred, and whether any diagnostic process faults took place. The study found that wo hundred and fifty-seven patient charts were evaluated, of which 14% contained a DE. Patients with and without DE were statistically similar in socioeconomic factors, comorbidities, risk factors for COVID-19, and COVID-19 test turnaround time and eventual positivity. The most common diagnostic process issues contributing to DE were problems with clinical assessment, testing choices, history taking, and physical examination. Diagnostic process issues related with COVID-19 policies and procedures were not related with DE risk. 35.9% of patients with errors and 5.4% of patients overall suffered harm or death due to diagnostic error.
Citation: Auerbach AD, Astik GJ, O'Leary KJ . Prevalence and causes of diagnostic errors in hospitalized patients under investigation for COVID-19. J Gen Intern Med 2023 Jun; 38(8):1902-10. doi: 10.1007/s11606-023-08176-6..
Keywords: COVID-19, Diagnostic Safety and Quality, Hospitals, Inpatient Care, Quality of Care
Ye S, Li D, Yu T
The impact of surgical volume on hospital ranking using the standardized infection ratio.
Researchers investigated the effect of surgical volume on the accuracy of identifying poorly performing hospitals. Their research was based on the standardized infection ratio, and they applied their proposed method to data from HCA Healthcare from 2014-2016 on surgical site infections in colon surgery patients. They concluded that minimum surgical volumes and predicted events criteria are required to make hospital evaluation reliable, and that these criteria may vary by overall prevalence and between-hospital variability.
Citation: Ye S, Li D, Yu T . The impact of surgical volume on hospital ranking using the standardized infection ratio. Sci Rep 2023 May 10; 13(1):7624. doi: 10.1038/s41598-023-33937-y..
Keywords: Hospitals, Surgery, Healthcare-Associated Infections (HAIs), Provider Performance, Quality of Care
Kannan S, Song Z
Changes in out-of-pocket costs for US hospital admissions between December and January every year.
Out-of-pocket costs for ICU care may be large at the beginning of the year due to high insurance deductibles that reset every year for US patients, and the expensive nature of ICU care. The purpose of this cross-sectional study was to explore cost-sharing changes from December to January for ICU admissions and non -ICU admissions among adults with employer-sponsored insurance. Among aggregate ICU hospitalizations, total cost-sharing averaged $1079 in December and $1871 in January, a 73.4% increase. Among non-ICU hospitalizations, total cost-sharing averaged $1043 in December and $1683 in January, a 61.3% increase. These increases and differences between ICU and non-ICU hospitalizations were greater among patients with high deductible health plans (HDHPs). For patients with HDHPs requiring an ICU stay, cost-sharing averaged $3093 per hospitalization in January vs $1301 in December.
Citation: Kannan S, Song Z . Changes in out-of-pocket costs for US hospital admissions between December and January every year. JAMA Health Forum 2023 May 5; 4(5):e230784. doi: 10.1001/jamahealthforum.2023.0784..
Keywords: Healthcare Costs, Hospitals, Hospitalization, Intensive Care Unit (ICU)
Simpson KR, Spetz J, Gay CL
Hospital characteristics associated with nurse staffing during labor and birth: Inequities for the most vulnerable maternity patients.
The objective of this study was to estimate the relationship between hospital characteristics and adherence with Association of Women's Health, Obstetric and Neonatal Nurses nurse staffing guidelines. Registered nurses were enrolled in a cross-sectional survey; hospital characteristics were obtained from the 2018 American Hospital Association Annual Survey. The findings indicated that, overall, nurses reported strong adherence to staffing guidelines within their hospitals. Higher birth volume, teaching status, higher percentage of Medicaid-paid births, and presence of a neonatal intensive care unit were all associated with lower mean adherence scores.
Citation: Simpson KR, Spetz J, Gay CL . Hospital characteristics associated with nurse staffing during labor and birth: Inequities for the most vulnerable maternity patients. Nurs Outlook 2023 May; 71(3):101960. doi: 10.1016/j.outlook.2023.101960..
Keywords: Hospitals, Maternal Care, Provider: Nurse, Workforce, Vulnerable Populations
Valley TS, Schutz A, Miller J
Hospital factors that influence ICU admission decision-making: a qualitative study of eight hospitals.
In order to understand factors influencing how intensive care unit (ICU) admission decisions are made, researchers conducted qualitative analysis of eight U.S. hospitals. Semi-structured, one-on-one interviews with 87 participants were supplemented by site visits and clinical observations. Four hospital-level factors were identified which influenced ICU admission decisionmaking. The researchers concluded that healthcare systems should evaluate use of ICU care and establish institutional patterns to ensure that ICU admission decisions are patient-centered as well as account for resources and hospital-specific constraints.
Citation: Valley TS, Schutz A, Miller J . Hospital factors that influence ICU admission decision-making: a qualitative study of eight hospitals. Intensive Care Med 2023 May; 49(5):505-16. doi: 10.1007/s00134-023-07031-w..
Keywords: Intensive Care Unit (ICU), Hospitals, Decision Making, Hospitalization
Desai AD, Tolpadi A, Parast L
Improving the quality of written discharge instructions: a multisite collaborative project.
This study assessed the association between participation in an Institute for Healthcare Improvement Virtual Breakthrough Series collaborative and the quality of pediatric written discharge instructions across 8 US hospitals. The authors conducted a multicenter, interrupted time-series analysis of a medical records-based quality measure focused on written discharge instruction content (0-100 scale, higher scores reflect better quality). They obtained data from a random sample of pediatric patients (n = 5739) discharged from participating hospitals between September 2015 and August 2016, and between December 2017 and January 2020. The study periods consisted of 3 phases: 1) a 14-month pre-collaborative phase; 2) a 12-month quality improvement collaborative phase when hospitals implemented multiple rapid cycle tests of change and shared improvement strategies; and 3) a 12-month postcollaborative phase. Among hospitals with high baseline performance, measure scores improved beyond expected for the precollaborative trend, but hospitals with low baseline performance, measure scores increased at a lower than expected rate.
Citation: Desai AD, Tolpadi A, Parast L . Improving the quality of written discharge instructions: a multisite collaborative project. Pediatrics 2023 May; 151(5):e2022059452. doi: 10.1542/peds.2022-059452..
Keywords: Hospital Discharge, Transitions of Care, Hospitals
Burden M, Keniston A, Gundareddy VP
Discharge in the A.M.: a randomized controlled trial of physician rounding styles to improve hospital throughput and length of stay.
In an effort to alleviate hospital capacity constraints, medical facilities frequently promote the prioritization of early morning discharges, which could potentially lead to unintended repercussions. The purpose of this study was to investigate the impact of hospitalist physicians focusing on discharging patients before attending to other tasks in comparison to their customary rounding practices. This prospective, multi-center randomized controlled trial involved three major academic hospitals. Participants included Hospital Medicine attending-level physicians and the patients under their care during the study, who were at least 18 years old, admitted to a Medicine service, and assigned to a hospitalist team through routine procedures. Physicians were randomized into two groups: 1) giving precedence to discharging patients as care permitted or 2) maintaining their usual practice. The primary outcome measure was the time of discharge order. Secondary outcomes encompassed actual discharge time, length of stay (LOS), and order timings for procedures, consultations, and imaging. The study found that between February 9, 2021, and July 31, 2021, 59 physicians were randomized to prioritize patient discharges or maintain their usual rounding practice, resulting in the discharge of 4,437 patients. In the primary adjusted analysis (intention-to-treat), there was no significant difference in discharge order time or actual discharge time between physicians who prioritized discharging patients first and those who followed their usual rounding style. Additionally, LOS and order times for other physician orders remained unchanged.
Citation: Burden M, Keniston A, Gundareddy VP . Discharge in the A.M.: a randomized controlled trial of physician rounding styles to improve hospital throughput and length of stay. J Hosp Med 2023 Apr;18(4):302-15. doi: 10.1002/jhm.13060.
Keywords: Hospital Discharge, Hospitals
Fernandes-Taylor S, Yang Q, Yang DY
Greater patient sharing between hospitals is associated with better outcomes for transferred emergency general surgery patients.
The availability of emergency surgical services has diminished as the rural workforce has decreased. The growing need for interhospital patient transfers makes care coordination across different settings essential for maintaining high-quality care. The purpose of this study was to investigate the impact of recurrent patient-sharing between hospitals on the outcomes of emergency general surgery (EGS) patient transfers. A multicenter analysis was conducted involving inpatient acute care hospital stays in Wisconsin that required the transfer of EGS patients. Data was sourced from the Wisconsin Hospital Association (WHA), a comprehensive statewide hospital discharge database for the years 2016-2018. We postulated that a higher percentage of patients transferred between hospitals would lead to improved outcomes. The relationship between the proportion of EGS patient transfers and patient outcomes, such as in-hospital morbidity, mortality, and duration of stay, was examined. Additional factors considered were hospital organizational features and patient sociodemographic and clinical attributes. The researchers found that during the two-year study period, 118 hospitals transferred 3,197 EGS patients; 1,131 of these patients experienced in-hospital complications, death, or an extended stay (beyond the 75th percentile). The average patient age was 62 years, with 50% being female and 5% non-white. In the mixed-effects model, the proportion of shared patients between hospitals was linked to a reduced likelihood of in-hospital complications. Specifically, when the proportion of shared patients doubled between two hospitals, the relative odds of any adverse outcome shifted by 0.85.
Citation: Fernandes-Taylor S, Yang Q, Yang DY . Greater patient sharing between hospitals is associated with better outcomes for transferred emergency general surgery patients. J Trauma Acute Care Surg 2023 Apr;94(5):592-98. doi: 10.1097/ta.0000000000003789.
Keywords: Emergency Department, Hospitals, Surgery, Transitions of Care
Carroll C, Euhus R, Beaulieu N
Hospital survival in rural markets: closures, mergers, and profitability.
This study investigated how the decline in profitability has affected rural hospital survival, either independently or with a merger. The authors assessed the rate of hospital closures and mergers in predominantly rural markets during the period 2010-18, focusing on hospitals that were unprofitable at baseline. A minority (7%) closed, with a larger share (17%) merged, most commonly with organizations from outside of their local geographic market. Most unprofitable hospitals (77%) continued to operate through 2018 without closure or merger. About half returned to profitability. Their analysis suggested that although rural hospital markets are experiencing meaningful rates of closures and mergers, many hospitals have survived despite their poor financial performance.
Citation: Carroll C, Euhus R, Beaulieu N . Hospital survival in rural markets: closures, mergers, and profitability. Health Aff 2023 Apr; 42(4):498-507. doi: 10.1377/hlthaff.2022.01191..
Keywords: Hospitals, Rural Health, Rural/Inner-City Residents
Meille G, Post B
AHRQ Author: Meille G
The effects of the Medicaid expansion on hospital utilization, employment, and capital.
This AHRQ-authored paper describes the effect of the Affordable Care Act Medicaid expansion on hospital utilization, employment, and capital. The authors conducted a difference-in-differences analysis that compared changes to hospital demand and supply in Medicaid expansion and nonexpansion states. They used 2010-2016 data from the American Hospital Association and the Healthcare Cost Report Information System to quantify changes to hospital utilization and characterize how hospitals adjusted labor and capital inputs. Medicaid expansion was associated with increases in emergency department visits and other outpatient hospital visits. They found strong evidence that hospitals met increases in demand by hiring nursing staff and weaker evidence that they increased hiring of technicians and investments in equipment. They found no evidence that hospitals adjusted hiring of physicians, support staff, or investments in other capital inputs.
Citation: Meille G, Post B . The effects of the Medicaid expansion on hospital utilization, employment, and capital. Med Care Res Rev 2023 Apr;80(2):165-74. doi: 10.1177/10775587221133165.
Keywords: Medicaid, Hospitals, Healthcare Utilization, Health Insurance, Policy, Access to Care, Uninsured
Leyenaar JK, Hill V, Lam V
Direct admission to hospital for children in the United States.
The purpose of this paper is to develop a policy statement to present recommendations to optimize the quality and safety of this hospital admission approach for children, as one in four unscheduled hospital admissions for children and adolescents in the United States occurs via direct admission, defined as hospital admission without first receiving care in the hospital's emergency department. Recommendations in the proposed policy statement provide guidance related to: (i) direct admission written guidelines, (ii) clear systems of communication between members of the health care team and with families of children requiring admission, (iii) triage systems to identify patient acuity and disease severity, (iv) identification of hospital resources needed to support direct admission systems of care, (v) consideration of patient populations that may be at increased risk of adverse outcomes during the hospital admission process, (vi) addressing the relevance of local factors and resources, and (vii) ongoing evaluation of direct admission processes and outcomes. The recommendations are intended to support the implementation of safe direct admission processes and to foster awareness of outcomes associated with this common portal of hospital admission.
Citation: Leyenaar JK, Hill V, Lam V . Direct admission to hospital for children in the United States. Pediatrics 2023 Mar;151(3):e2022060973. doi: 10.1542/peds.2022-060973.
Keywords: Children/Adolescents, Hospitals, Hospitalization
Mullens CL, Mead M, Kalata S
Evaluation of prices for surgical procedures within and outside hospital networks in the US.
The authors conducted an economic evaluation to examine variations in prices for surgical procedures under the Hospital Price Transparency Rule at U.S. hospitals in and outside of networks. The results showed that median negotiated prices were significantly higher at hospitals within networks compared with independent hospitals for 15 of the 16 procedures evaluated. The authors noted that these results ought to be interpreted in the context of certain limitations and that it will be important to understand the mechanisms behind these variations in negotiated prices for surgical care in order to identify areas of unwarranted variation.
AHRQ-funded; HS028606; HS000053.
Citation: Mullens CL, Mead M, Kalata S . Evaluation of prices for surgical procedures within and outside hospital networks in the US. JAMA Netw Open 2023 Feb; 6(2):e2255849. doi: 10.1001/jamanetworkopen.2022.55849..
Keywords: Surgery, Healthcare Costs, Hospitals
Wolf RM, Hall M, Williams DJ
Pharmacologic restraint use for children experiencing mental health crises in pediatric hospitals.
This study’s objective was to determine hospital-level incidence and variation of pharmacologic restraint use among children admitted for mental health conditions in children's hospitals. The authors examined data for children (5 to ≤18 years) admitted to children's hospitals with a primary mental health condition from 2018 to 2020 using the Pediatric Health Information System database. Of 29,834 included encounters, 12.6% had pharmacologic restraint use, with three hospitals the highest utilizers of all drug classes. Adjusted hospital rates ranged from 35 to 389 pharmacologic restraint use days per 1000 mental health bed days with a mean of 175. There were no significant differences in pharmacologic restraint use found in the hospital-level analysis.
Citation: Wolf RM, Hall M, Williams DJ . Pharmacologic restraint use for children experiencing mental health crises in pediatric hospitals. J Hosp Med 2023 Feb; 18(2):120-29. doi: 10.1002/jhm.13009..
Keywords: Children/Adolescents, Behavioral Health, Hospitals, Medication
Carey K, Lin MY
Safety-net hospital performance under comprehensive care for joint replacement.
The objective of this study was to investigate the relative progress of safety-net hospitals (SNHs) under Medicare's Comprehensive Care for Joint Replacement (CJR) mandatory bundled payment model and to identify contributors to SNHs' realization of success under the CJR program. Secondary data on all CJR hospitals from 2016-2020 were taken from CMS public use files and from the American Hospital Association. The findings indicated that SNHs were less successful in meeting spending targets when compared to CJR hospitals overall. The authors concluded that the formula used by CMS to determine spending targets may not be sufficient to address disparities in SNH financial performances under mandatory bundled payment.
Citation: Carey K, Lin MY . Safety-net hospital performance under comprehensive care for joint replacement. Health Serv Res 2023 Feb; 58(1):101-06. doi: 10.1111/1475-6773.14042..
Keywords: Hospitals, Surgery, Orthopedics, Provider Performance
Aswani MS, Roberts ET
Social risk adjustment in the hospital readmission reduction program: pitfalls of peer grouping, measurement challenges, and potential solutions.
The objective of this study was to investigate the limitations of peer grouping and associated challenges in the measurement of social risk in Medicare's Hospital Readmission Reduction Program (HRRP). Public data on hospitals in the HRRP were used to examine the relationship between hospital dual share and readmission rates within peer groups as well as changes in hospital peer group assignments, readmission rates, and penalties, and the relationship between state Medicaid eligibility rules and peer groups. The findings indicated that peer grouping is limited in the extent to which it accounts for differences in hospitals' patient populations. The authors concluded that problems arise from the construction of peer groups and the measure of social risk used to define them.
Citation: Aswani MS, Roberts ET . Social risk adjustment in the hospital readmission reduction program: pitfalls of peer grouping, measurement challenges, and potential solutions. Health Serv Res 2023 Feb; 58(1):51-59. doi: 10.1111/1475-6773.13969..
Keywords: Hospital Readmissions, Hospitals, Risk
Westley L, Manworren RCB, Griffith DM
Using hospital incident command systems to respond to the pediatric mental and behavioral health crisis of the COVID-19 pandemic.
The purpose of this study was to quantify issues related to hospital incident command systems (HICS) implemented to expand mental and behavioral healthcare (MBHC) services during the COVID-19 pandemic, and track progress toward HICS goals. The researchers analyzed data on patient census, nurse vacancies, staff injuries, and staff perceptions and resources were developed. The study found that after HICS implementation, 84% of nurses reported confidence in providing care to youth with acute MBHC needs.
Citation: Westley L, Manworren RCB, Griffith DM . Using hospital incident command systems to respond to the pediatric mental and behavioral health crisis of the COVID-19 pandemic. J Nurs Adm 2023 Feb; 53(2):96-103. doi: 10.1097/nna.0000000000001254..
Keywords: COVID-19, Children/Adolescents, Behavioral Health, Hospitals
Beaulieu ND, Chernew ME, McWilliams JM
Organization and performance of US health systems.
The objectives of this evidence review were to identify and describe health systems in the US, to assess differences between physicians and hospitals in and outside of health systems, and to compare quality and cost of care delivered by physicians and hospitals in and outside of health systems. A total of 580 health systems in a great variety of sizes were identified; prices for physician, hospital services, and total spending were assessed in 2018 commercial claims data. Health system physicians and hospitals were shown to deliver a large portion of medical services. Clinical quality performance and patient experience measures were slightly better in systems; however, spending and prices were significantly higher, especially in small practices. The authors concluded that slight quality differentials in combination with large price differentials suggested that health systems have not realized their potential for better care at equal or lower cost.
Citation: Beaulieu ND, Chernew ME, McWilliams JM . Organization and performance of US health systems. JAMA 2023 Jan 24; 329(4):325-35. doi: 10.1001/jama.2022.24032..
Keywords: Health Systems, Healthcare Delivery, Provider Performance, Quality Measures, Quality of Care, Hospitals