National Healthcare Quality and Disparities Report
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Topics
- Adverse Events (1)
- Ambulatory Care and Surgery (1)
- Antibiotics (1)
- Antimicrobial Stewardship (1)
- Burnout (1)
- Cardiovascular Conditions (1)
- Care Management (1)
- Children/Adolescents (2)
- Clinical Decision Support (CDS) (5)
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- Clostridium difficile Infections (1)
- (-) Decision Making (17)
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- Education: Patient and Caregiver (1)
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- Evidence-Based Practice (1)
- Falls (1)
- Healthcare Cost and Utilization Project (HCUP) (2)
- Healthcare Costs (2)
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- Health Information Technology (HIT) (1)
- Health Literacy (1)
- Heart Disease and Health (1)
- Hospital Discharge (1)
- Hospitalization (2)
- (-) Hospitals (17)
- Injuries and Wounds (1)
- Inpatient Care (2)
- Intensive Care Unit (ICU) (1)
- Medication (2)
- Medication: Safety (1)
- Nursing (1)
- Patient and Family Engagement (1)
- Patient Experience (1)
- Patient Safety (6)
- Pressure Ulcers (1)
- Prevention (2)
- Quality Improvement (3)
- Quality of Care (3)
- Risk (1)
- Surgery (1)
- Teams (1)
- Tools & Toolkits (1)
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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
1 to 17 of 17 Research Studies DisplayedValley 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.
AHRQ-funded; HS028038.
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
Krein SL, Harrod M, Weston LE
Comparing peripherally inserted central catheter-related practices across hospitals with different insertion models: a multisite qualitative study.
Researchers compared peripherally inserted central catheters (PICCs)-related processes across hospitals with different insertion delivery models. They concluded that vascular access nurses play critical roles in all aspects of PICC-related care. Further, there is variation in PICC decision-making, care and maintenance, and patient education across hospitals.
AHRQ-funded; HS025891.
Citation: Krein SL, Harrod M, Weston LE .
Comparing peripherally inserted central catheter-related practices across hospitals with different insertion models: a multisite qualitative study.
BMJ Qual Saf 2021 Aug;30(8):628-38. doi: 10.1136/bmjqs-2020-011987..
Keywords: Inpatient Care, Decision Making, Patient Safety, Hospitals
Manges KA, Wallace AS, Groves PS
Ready to go home? Assessment of shared mental models of the patient and discharging team regarding readiness for hospital discharge.
A critical task of the inpatient interprofessional team is readying patients for discharge. Assessment of shared mental model (SMM) convergence can determine how much team members agree about patient discharge readiness and how their mental models align with the patient's self-assessment. The objective of this study was to determine the convergence of interprofessional team SMMs of hospital discharge readiness and identify factors associated with these assessments.
AHRQ-funded; HS026116.
Citation: Manges KA, Wallace AS, Groves PS .
Ready to go home? Assessment of shared mental models of the patient and discharging team regarding readiness for hospital discharge.
J Hosp Med 2021 Jun;16(6):326-32. doi: 10.12788/jhm.3464..
Keywords: Hospital Discharge, Teams, Care Management, Decision Making, Hospitals
Tamma PD, Miller MA, Dullabh P
AHRQ Author: Miller MA
Association of a safety program for improving antibiotic use with antibiotic use and hospital-onset Clostridioides difficile infection rates among US hospitals.
Regulatory agencies and professional organizations recommend antibiotic stewardship programs (ASPs) in US hospitals. The optimal approach to establish robust, sustainable ASPs across diverse hospitals is unknown. The purpose of this study was to assess whether the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use was associated with reductions in antibiotic use across US hospitals. The investigators concluded that AHRQ Safety Program appeared to enable diverse hospitals to establish ASPs and teach frontline clinicians to self-steward their antibiotic use.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Tamma PD, Miller MA, Dullabh P .
Association of a safety program for improving antibiotic use with antibiotic use and hospital-onset Clostridioides difficile infection rates among US hospitals.
JAMA Netw Open 2021 Feb;4(2):e210235. doi: 10.1001/jamanetworkopen.2021.0235..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Decision Making, Clostridium difficile Infections, Patient Safety, Quality Improvement, Quality of Care, Hospitals
Ruhnke GW, Tak HJ, Meltzer DO
Association of preferences for participation in decision-making with care satisfaction among hospitalized patients.
The purpose of this study was to investigate the association of hospitalized patients' desire to delegate decisions to their physician with care dissatisfaction. The investigators indicated that the findings suggested that patient preferences to participate in medical decision-making were statistically significantly associated with dissatisfaction of hospitalized patients. The authors assert that clinicians should individualize their encouragement of patient participation in diagnostic and management decisions to maximize patient satisfaction.
AHRQ-funded; HS016967.
Citation: Ruhnke GW, Tak HJ, Meltzer DO .
Association of preferences for participation in decision-making with care satisfaction among hospitalized patients.
JAMA Netw Open 2020 Oct;3(10):e2018766. doi: 10.1001/jamanetworkopen.2020.18766..
Keywords: Decision Making, Patient and Family Engagement, Patient Experience, Hospitalization, Hospitals
Co Z, Holmgren AJ, Classen DC
The tradeoffs between safety and alert fatigue: data from a national evaluation of hospital medication-related clinical decision support.
This study evaluated the overall performance of hospitals that used the Computerized Physician Order Entry Evaluation Tool in 2017 and 2018 and compared performances for fatal orders and nuisance orders each year. The authors evaluated 1599 hospitals that took the test by using their overall percentage scores along with the percentage of fatal orders appropriately alerted on and the percentage of nuisance orders incorrectly alerted on. Overall hospital scores improved from 58.1% in 2017 to 66.2% in 2018. Fatal order performance improved slightly from 78.8% to 83.0%, but there no very little change in nuisance order performance (89.0% to 89.7%). Conclusions were that perhaps hospitals are not targeting the deadliest orders first and some hospitals may be achieving higher scores by over-alerting. This has the potential to cause clinician burnout and even worsen patient safety.
AHRQ-funded; HS023696.
Citation: Co Z, Holmgren AJ, Classen DC .
The tradeoffs between safety and alert fatigue: data from a national evaluation of hospital medication-related clinical decision support.
J Am Med Inform Assoc 2020 Aug;27(8):1252-58. doi: 10.1093/jamia/ocaa098..
Keywords: Medication: Safety, Medication, Patient Safety, Clinical Decision Support (CDS), Decision Making, Burnout, Hospitals, Health Information Technology (HIT), Quality of Care
Ingraham A, Wang X, Havlena J
Factors associated with the interhospital transfer of emergency general surgery patients.
Researchers used data from the Nationwide Inpatient Sample to determine patient- and hospital-level factors associated with interhospital emergency general surgery (EGS) transfers. They identified that hospital-level characteristics more strongly predicted the need for transfer than patient-related factors. They recommended considering these factors in order to facilitate transfer decision-making.
AHRQ-funded; HS025224.
Citation: Ingraham A, Wang X, Havlena J .
Factors associated with the interhospital transfer of emergency general surgery patients.
J Surg Res 2019 Aug;240:191-200. doi: 10.1016/j.jss.2018.11.053..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Surgery, Decision Making, Hospitals, Healthcare Delivery, Transitions of Care
Shoemaker SJ, Brach C, Edwards A
AHRQ Author: Brach C
Opportunities to improve informed consent with AHRQ training modules.
Patients often do not understand the risks, benefits, and alternatives of undergoing specific interventions, even after signing a consent form. This paper describes a mixed-methods pilot test of two Agency for Healthcare Research and Quality (AHRQ) informed consent training modules that was implemented in four hospitals. The study concluded that many opportunities exist for hospitals to improve their informed consent practices.
AHRQ-authored; AHRQ-funded; 290201000031I.
Citation: Shoemaker SJ, Brach C, Edwards A .
Opportunities to improve informed consent with AHRQ training modules.
Jt Comm J Qual Patient Saf 2018 Jun;44(6):343-52. doi: 10.1016/j.jcjq.2017.11.010..
Keywords: Decision Making, Education: Continuing Medical Education, Health Literacy, Hospitals, Clinician-Patient Communication, Training
Tchou MJ, Tang Girdwood S, Wormser B
Reducing electrolyte testing in hospitalized children by using quality improvement methods.
This article describes a project which aimed to reduce electrolyte testing within a hospital medicine service. Six hospital medicine teams at an academic children's hospital system were targeted by using the Model for Improvement, employing interventions that included standardized communication about electrolyte testing plans and education regarding costs and risks associated with the overuse of electrolyte testing. The primary outcome measure was the number of electrolyte tests per patient day. The authors report that their intervention was associated with significant, rapid reduction in electrolyte testing and was not associated with unintended adverse events.
AHRQ-funded; HS023827.
Citation: Tchou MJ, Tang Girdwood S, Wormser B .
Reducing electrolyte testing in hospitalized children by using quality improvement methods.
Pediatrics 2018 May;141(5). doi: 10.1542/peds.2017-3187..
Keywords: Children/Adolescents, Decision Making, Hospitals, Quality Improvement
Aldina S, Goldhaber-Fiebert SN, Hannenberg AA
Factors associated with the use of cognitive aids in operating room crises: a cross-sectional study of US hospitals and ambulatory surgical centers.
This study examined organizational context and implementation process factors influencing the use of cognitive aids for OR crises. It found that small facility size was associated with a fourfold increase in the odds of a facility reporting more successful implementation. Completing more implementation steps was also significantly associated with more successful implementation.
AHRQ-funded; HS024235.
Citation: Aldina S, Goldhaber-Fiebert SN, Hannenberg AA .
Factors associated with the use of cognitive aids in operating room crises: a cross-sectional study of US hospitals and ambulatory surgical centers.
Implement Sci 2018 Mar 26;13(1):50. doi: 10.1186/s13012-018-0739-4.
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Keywords: Adverse Events, Ambulatory Care and Surgery, Patient Safety, Quality Improvement, Quality of Care, Hospitals, Decision Making, Clinical Decision Support (CDS)
Wong H, Karaca Z, Gibson TB
AHRQ Author: Wong H, Karaca Z
A quantitative observational study of physician influence on hospital costs.
Physicians serve as the nexus of treatment decision-making in hospitalized patients; however, little empirical evidence describes the influence of individual physicians on hospital costs. In this study, the extent to which hospital costs vary across physicians and physician characteristics is examined. Among other findings, the investigators observed sizable variation in average costs of hospital inpatient stays across medical specialties.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Wong H, Karaca Z, Gibson TB .
A quantitative observational study of physician influence on hospital costs.
Inquiry 2018 Jan-Dec;55:46958018800906. doi: 10.1177/0046958018800906..
Keywords: Decision Making, Healthcare Costs, Healthcare Cost and Utilization Project (HCUP), Hospitals
Wang J, Gong Y
Potential of decision support in preventing pressure ulcers in hospitals.
The development of hospital-acquired pressure ulcers signals low quality of care. To meet the challenges of consistently translating best practices into effective clinical practices and promote effective teamwork communication and interprofessional collaboration, the authors consider the failure of consistent care delivery as loss of information and reveal the opportunities of informatics methods to reinforce information delivery, evidenced by typical cases. They then explain and summarize information-related issues existing at the initial assessment upon hospital admission, routine treatments, and team communication.
AHRQ-funded; HS022895.
Citation: Wang J, Gong Y .
Potential of decision support in preventing pressure ulcers in hospitals.
Stud Health Technol Inform 2017;241:15-20.
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Keywords: Clinical Decision Support (CDS), Decision Making, Hospitals, Patient Safety, Pressure Ulcers, Prevention
Dykes PC, Duckworth M, Cunningham S
Pilot testing Fall TIPS (Tailoring Interventions for Patient Safety): a patient-centered fall prevention toolkit.
Patient falls during an acute hospitalization cause injury, reduced mobility, and increased costs. The laminated paper Fall TIPS Toolkit (Fall TIPS) provides clinical decision support at the bedside by linking each patient's fall risk assessment with evidence-based interventions. The investigators examined strategies to integrate this evidence into clinical practice. They concluded that engaging hospital and clinical leadership is critical in translating evidence-based care into clinical practice. They address and detail barriers to adoption of the protocol to provide guidance for spread to other institutions.
AHRQ-funded; HS025128.
Citation: Dykes PC, Duckworth M, Cunningham S .
Pilot testing Fall TIPS (Tailoring Interventions for Patient Safety): a patient-centered fall prevention toolkit.
Jt Comm J Qual Patient Saf 2017 Aug;43(8):403-13. doi: 10.1016/j.jcjq.2017.05.002..
Keywords: Clinical Decision Support (CDS), Decision Making, Evidence-Based Practice, Falls, Hospitals, Injuries and Wounds, Inpatient Care, Patient Safety, Prevention, Risk, Tools & Toolkits
Grundy Q
"Whether something cool is good enough": the role of evidence, sales representatives and nurses' expertise in hospital purchasing decisions.
The author analyzed the ways that committee members constructed and evaluated a case for a product's value, concluding that purchasing committees need unique support that emphasizes local contexts and expertise, while maintaining rigor and minimizing bias. Grundy proposed a guiding framework to support this decision-making.
AHRQ-funded; HS022383.
Citation: Grundy Q .
"Whether something cool is good enough": the role of evidence, sales representatives and nurses' expertise in hospital purchasing decisions.
Soc Sci Med 2016 Sep;165:82-91. doi: 10.1016/j.socscimed.2016.07.042.
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Keywords: Decision Making, Healthcare Costs, Hospitals, Nursing
Bonafide CP, Roland D, Brady PW
Rapid response systems 20 years later: new approaches, old challenges.
In this article, the authors propose a set of recommendations for a research agenda aimed at pursuing the work of optimizing the identification of deteriorating children. They recommend that the second generation of pediatric rapid response systems continue to build on past achievements while further optimizing use of the data, tools, and people available at the bedside to take the next leap forward.
AHRQ-funded; HS023827.
Citation: Bonafide CP, Roland D, Brady PW .
Rapid response systems 20 years later: new approaches, old challenges.
JAMA Pediatr 2016 Aug;170(8):729-30. doi: 10.1001/jamapediatrics.2016.0398.
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Keywords: Children/Adolescents, Clinical Decision Support (CDS), Decision Making, Emergency Medical Services (EMS), Hospitals
Sadeghi B, Walling AM, Romano PS
A hospital-based advance care planning intervention for patients with heart failure: a feasibility study.
The purpose of this study was to evaluate the feasibility of implementing a multiple-component hospital-based intervention on completion of advance care planning (ACP) forms among heart failure (HF) patients. It concluded that a hospital-based ACP intervention using nonclinician health educators is feasible to implement and has the potential to facilitate the ACP process.
AHRQ-funded HS019311.
Citation: Sadeghi B, Walling AM, Romano PS .
A hospital-based advance care planning intervention for patients with heart failure: a feasibility study.
J Palliat Med 2016 Apr;19(4):451-5. doi: 10.1089/jpm.2015.0269.
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Keywords: Cardiovascular Conditions, Decision Making, Education: Patient and Caregiver, Heart Disease and Health, Hospitals
Ricci KA, Griffin AR, Heslin KC
AHRQ Author: Heslin KC
Evacuate or shelter-in-place? The role of corporate memory and political environment in hospital-evacuation decision making.
This study was conducted to identify factors that most heavily influenced the decisions to evacuate the Manhattan Veterans Administration Medical Center before Hurricane Irene in 2011 and Hurricane Sandy in 2012. The researchers conducted semi-structured interviews with 11 senior leaders on the processes and factors that influenced their evacuation decisions.
AHRQ-authored
Citation: Ricci KA, Griffin AR, Heslin KC .
Evacuate or shelter-in-place? The role of corporate memory and political environment in hospital-evacuation decision making.
Prehosp Disaster Med. 2015 Jun;30(3):233-8. doi: 10.1017/s1049023x15000229..
Keywords: Emergency Preparedness, Decision Making, Hospitals