National Healthcare Quality and Disparities Report
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- Social Determinants of Health (1)
- Stroke (2)
- Surgery (6)
- Teams (4)
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- Transitions of Care (10)
- Trauma (1)
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- Uninsured (1)
- Urban Health (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 25 of 50 Research Studies DisplayedMcCarthy IM, Raval MV
Price spillovers and specialization in health care: the case of children's hospitals.
The purpose of this study was to explore a possible differentiation effect in which patients perceive specialty hospitals as different from other hospitals, so that specialty hospitals effectively compete in a separate market from general acute care hospitals. The researchers examined this effect in the context of routine pediatric procedures offered by both specialty children's hospitals and general acute care hospitals. The study found substantial empirical evidence of a differentiation effect in which competitive forces from non-children's hospitals appear largely irrelevant for specialty children's hospitals.
AHRQ-funded; HS024712.
Citation: McCarthy IM, Raval MV .
Price spillovers and specialization in health care: the case of children's hospitals.
Health Econ 2023 Oct; 32(10):2408-23. doi: 10.1002/hec.4734..
Keywords: Children/Adolescents, Hospitals, Healthcare Delivery
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.
AHRQ-funded; HS024072.
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
Usher MC, Tignanelli CJ, Hilliard B
Responding to COVID-19 through interhospital resource coordination: a mixed-methods evaluation
Researchers sought to describe a novel hospital system approach to managing the COVID-19 pandemic, including multihospital coordination capability and transfer of COVID-19 patients to a single, dedicated hospital. They found that, with standardized communication, interhospital transfers were a safe and effective method of cohorting COVID-19 patients, were well-received by health care providers, and had the potential to improve care quality.
AHRQ-funded; HS026379; HS026732.
Citation: Usher MC, Tignanelli CJ, Hilliard B .
Responding to COVID-19 through interhospital resource coordination: a mixed-methods evaluation
J Patient Saf 2022 Jun 1;18(4):287-94. doi: 10.1097/pts.0000000000000916..
Keywords: COVID-19, Hospitals, Healthcare Delivery, Public Health, Care Coordination, Transitions of Care
Everson J, Adler-Milstein JR, Hollingsworth JM
Dispersion in the hospital network of shared patients is associated with less efficient care.
The purpose of this study was to examine the level of distribution of patient-sharing networks across U.S. hospitals and its relationship with 3 measures of care delivered by hospitals that were likely to relate to coordination. The researchers utilized data from 2016 Medicare Fee-for-Service claims to measure the volume of patients that hospitals treated in common, and then calculated a measure of dispersion for each hospital. The relationship between network dispersion, Medicare spending per beneficiary, readmission rates, and emergency department (ED) throughput rates were then estimated. The study reported that hospitals with more dispersed networks had greater spending rates but not higher admission rates or slower ED processes. Among hospitals with less resources, more dispersion was associated with higher readmission rates and slower ED processes. The researchers concluded that dispersed interhospital networks create difficulties in coordinating patients who are treated at multiple hospitals, and that the structure of patient-sharing networks may be an overlooked factor that influences the delivery of care in health care organizations.
AHRQ-funded; HS026395, HS024525, HS024728, HS024454.
Citation: Everson J, Adler-Milstein JR, Hollingsworth JM .
Dispersion in the hospital network of shared patients is associated with less efficient care.
Health Care Manage Rev 2022 Apr-Jun;47(2):88-99. doi: 10.1097/hmr.0000000000000295..
Keywords: Medicare, Hospitals, Care Coordination, Healthcare Delivery
Post B, Nallamothu BK, Hollenbeck B
Hospital-cardiologist integration often occurs without a practice acquisition.
This study’s objective was to determine how much of the increase in hospital-cardiologist integration comes from acquisition of physician practices compared to individual employment decisions. Data from 2011 to 2018 was used from the American Medical Association Masterfile and Medicare. In 2011 18% of cardiologists were integrated, which rose to 25% in 2016. It was found that 48% of integrations occurred without acquisitions and that physicians who had completed residencies in the past 5 years had higher rates of integration that increased over time. Rates of early career physicians joining hospital systems also rose from 25% to 32% during that time period.
AHRQ-funded; HS025707.
Citation: Post B, Nallamothu BK, Hollenbeck B .
Hospital-cardiologist integration often occurs without a practice acquisition.
Health Serv Res 2022 Apr;57(2):333-39. doi: 10.1111/1475-6773.13929..
Keywords: Hospitals, Provider: Physician, Healthcare Delivery, Workforce
Bergman ZR, Usher M, Olson A
Comparison of outcomes and process of care for patients treated at hospitals dedicated for COVID-19 care vs other hospitals.
The purpose of this study was to analyze the mortality rate and complications associated with treatment at the COVID-19-dedicated hospitals. Findings showed that, in this cohort study, COVID-19-dedicated hospitals in Minnesota had multiple benefits, including providing high-volume repetitive treatment and isolating patients with the infection. This experience suggests improved in-hospital mortality for patients treated at dedicated hospitals.
AHRQ-funded; HS026732; HS026379.
Citation: Bergman ZR, Usher M, Olson A .
Comparison of outcomes and process of care for patients treated at hospitals dedicated for COVID-19 care vs other hospitals.
JAMA Netw Open 2022 Mar;5(3):e220873. doi: 10.1001/jamanetworkopen.2022.0873..
Keywords: COVID-19, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes, Healthcare Delivery, Hospitals
Barbash IJ, Kahn JM
Fostering hospital resilience-lessons from COVID-19.
This article describes how hospitals can foster organizational resistance using lessons from the COVID-19 pandemic. They describe what resilience would look like including: 1) resilient hospitals would respond to a surge in COVID-19 cases in ways that ensure the delivery of high-quality care for patients with the disease; 2) resilient hospitals would response to COVID-19 surges in ways that preserve standards of care for patients without COVID-19; 3) resilient hospitals would preserve access to care for the entire community of patients they serve, including continuing elective surgeries and mitigating effects of health disparities; and 4) resilient hospitals would do all of this while protecting the well-being of frontline staff. Protection of front-line staff includes ensuring adequate personal protective equipment as well as through clear communication from leaders. Factors that foster resilience are described including well-developed, scalable clinical protocols, flexible electronic health records, and a supportive, interdisciplinary working environment in which all team members feel safe to raise concerns and share new ideas. Resilience might also be fostered among hospitals through their interactions.
AHRQ-funded; HS025455.
Citation: Barbash IJ, Kahn JM .
Fostering hospital resilience-lessons from COVID-19.
JAMA 2021 Aug 24; 326(8):693-94. doi: 10.1001/jama.2021.12484..
Keywords: COVID-19, Hospitals, Healthcare Delivery, Public Health
Fernandes-Taylor S, Yang DY, Schumacher J
Factors associated with Interhospital transfers of emergency general surgery patients from emergency departments.
This study looked at the factors contributing to transfer of emergency general surgery (EGS) patients to another hospital. Data from the AHRQ Nationwide Emergency Department Sample (NEDS) from 2010-2014 was analyzed. The transfer rate during that time was 1.9%. Patients with Medicare or other insurance had higher odds of transfer compared to patients with private health insurance. Odds of transfer increased with a greater number of comorbid conditions as well as resuscitation, intestinal obstruction, and conditions of the upper gastrointestinal tract. Transfers were more likely to originate from rural hospitals or Level I or II trauma centers.
AHRQ-funded; HS025224.
Citation: Fernandes-Taylor S, Yang DY, Schumacher J .
Factors associated with Interhospital transfers of emergency general surgery patients from emergency departments.
Am J Emerg Med 2021 Feb;40:83-88. doi: 10.1016/j.ajem.2020.12.012..
Keywords: Healthcare Cost and Utilization Project (HCUP), Surgery, Emergency Department, Transitions of Care, Hospitals, Healthcare Delivery
Post B, Norton EC, Hollenbeck B
Hospital-physician integration and Medicare's site-based outpatient payments.
AHRQ-funded; HS027044.
Citation: Post B, Norton EC, Hollenbeck B .
Hospital-physician integration and Medicare's site-based outpatient payments.
Health Serv Res 2021 Feb;56(1):7-15. doi: 10.1111/1475-6773.13613..
Keywords: Hospitals, Payment, Medicare, Ambulatory Care and Surgery, Healthcare Delivery
Kohn R, Harhay MO, Bayes B
Influence of bedspacing on outcomes of hospitalised medicine service patients: a retrospective cohort study.
The objective of this cohort study was to assess the association of bedspacing with patient-centered outcomes among United States patients admitted to general medicine services. The study compared internal medicine, family medicine and geriatric service patients who were bedspaced versus cohorted for the entirety of their hospital stay within three large, urban hospitals. Findings showed that bedspacing was associated with adverse patient-centered outcomes. Recommendations for future work included a need to confirm these findings, to understand mechanisms contributing to adverse outcomes, and to identify factors that mitigate these adverse effects in order to provide high-value, patient-centered care to hospitalized patients.
AHRQ-funded; HS026372.
Citation: Kohn R, Harhay MO, Bayes B .
Influence of bedspacing on outcomes of hospitalised medicine service patients: a retrospective cohort study.
BMJ Qual Saf 2021 Feb;30(2):116-22. doi: 10.1136/bmjqs-2019-010675..
Keywords: Patient-Centered Outcomes Research, Outcomes, Inpatient Care, Hospitals, Healthcare Delivery, Care Management, Adverse Events
Anesi GL, Chelluri J, Qasim ZA
Association of an emergency department-embedded critical care unit with hospital outcomes and intensive care unit use.
The purpose of this study was to evaluate the potential impact of an emergency department-embedded critical care unit (CCU) at the Hospital of the University of Pennsylvania among patients with sepsis and acute respiratory failure (ARF) admitted from the emergency department to a medical ward or ICU from January 2016 to December 2017. Findings showed that the emergency department-embedded CCU was not associated with clinical outcomes among patients admitted with sepsis or ARF. Among less sick patients with sepsis, the emergency department-embedded CCU was initially associated with reduced rates of direct ICU admission from the emergency department. Further research was recommended to further evaluate the impact and utility of the emergency department-embedded CCU model.
AHRQ-funded; HS026372.
Citation: Anesi GL, Chelluri J, Qasim ZA .
Association of an emergency department-embedded critical care unit with hospital outcomes and intensive care unit use.
Ann Am Thorac Soc 2020 Dec;17(12):1599-609. doi: 10.1513/AnnalsATS.201912-912OC..
Keywords: Emergency Department, Critical Care, Intensive Care Unit (ICU), Hospitals, Sepsis, Respiratory Conditions, Outcomes, Patient-Centered Outcomes Research, Healthcare Delivery
Graves JA, Nshuti L, Everson J
Breadth and exclusivity of hospital and physician networks in US insurance markets.
The goal of this study was to quantify network breadth and overlap among primary care physician (PCP), cardiology, and general acute care hospital networks for employer-based (large group and small group), individually purchased (marketplace), Medicare Advantage (MA), and Medicaid managed care (MMC) plans. The main outcomes measured were percentage of in-network physicians and/or hospitals within a 60-minute drive from a hypothetical patient in a given zip code (breadth), and the number of physicians and/or hospitals within each network that overlapped with other insurers' networks, expressed as a percentage of the total possible number of shared connections (exclusivity). Networks were categorized by network breadth size and analyzed by insurance type, state, and insurance, physician, and/or hospital market concentration level, as measured by the Hirschman-Herfindahl index. Markets with concentrated primary care and insurance markets had the broadest and least exclusive primary care networks among large-group commercial plans. Markets with the least concentration had the narrowest and most exclusive networks. Rising levels of insurer and market concentration were associated with broader and less exclusive healthcare networks. The authors suggest that this means that patients could switch to a lower-cost, narrow network plan without losing-in-network coverage to their PCP.
AHRQ-funded; HS025976; HS026395.
Citation: Graves JA, Nshuti L, Everson J .
Breadth and exclusivity of hospital and physician networks in US insurance markets.
JAMA Netw Open 2020 Dec;3(12):e2029419. doi: 10.1001/jamanetworkopen.2020.29419..
Keywords: Health Insurance, Learning Health Systems, Health Systems, Primary Care, Hospitals, Healthcare Delivery
Tameron AM, Ricci KB, Oslock WM
The association between self-declared acute care surgery services and critical care resources: results from a national survey.
In this study, the investigators examined differences in critical care structures and processes between hospitals with Acute Care Surgery (ACS) versus general surgeon on call (GSOC) models for emergency general surgery (EGS) care. The investigators concluded that while harnessing of critical care structures and processes varied across hospitals that had implemented ACS, overall ACS models of care appeared to have more robust critical care practices.
AHRQ-funded; HS022694.
Citation: Tameron AM, Ricci KB, Oslock WM .
The association between self-declared acute care surgery services and critical care resources: results from a national survey.
J Crit Care 2020 Dec;60:84-90. doi: 10.1016/j.jcrc.2020.04.002..
Keywords: Surgery, Critical Care, Emergency Department, Healthcare Delivery, Hospitals
Anesi GL, Chowdhury M, Small DS GL, Chowdhury M, Small DS
Association of a novel index of hospital capacity strain with admission to intensive care units.
Researchers sought to develop a novel composite strain index and measure its association with intensive care unit (ICU) admission decisions and hospital outcomes.
AHRQ-funded; HS026372.
Citation: Anesi GL, Chowdhury M, Small DS GL, Chowdhury M, Small DS .
Association of a novel index of hospital capacity strain with admission to intensive care units.
Ann Am Thorac Soc 2020 Nov;17(11):1440-47. doi: 10.1513/AnnalsATS.202003-228OC.
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Keywords: Intensive Care Unit (ICU), Hospitals, Healthcare Delivery
Chien AT, Pandey A, Lu S
Pediatric hospital services within a one-hour drive: a national study.
Researchers determined the proportion of US counties whose 0- to 19-year-old patients could reach pediatric hospital services within one hour of driving; then, among counties within a one-hour drive, they determined each county’s beds per 100,000 pediatric-aged population to provide a sense of hospital capacity relative to the size of their pediatric population. They concluded that the need to drive more than one hour to reach hospital-based pediatric services is more the rule than the exception.
AHRQ-funded; HS024072; HS025299.
Citation: Chien AT, Pandey A, Lu S .
Pediatric hospital services within a one-hour drive: a national study.
Pediatrics 2020 Nov;146(5). doi: 10.1542/peds.2020-1724..
Keywords: Children/Adolescents, Hospitals, Access to Care, Healthcare Delivery
de Cordova PB, Jones T, Riman KA
Staffing trends in magnet and non-magnet hospitals after state legislation.
This study examined whether there was a difference in staffing of registered nurses in Magnet and non-Magnet hospitals using unit-level, publicly available data in New Jersey. This secondary analysis of longitudinal RN staffing data was conducted using 64 hospitals representing 12 nursing specialties during the time span of 2008 to 2015. There was a slight increase in staffing at Magnet hospitals compared to non-Magnet hospitals, but RN staffing improved in all hospitals. No meaningful difference in staffing for all 12 specialties was found.
AHRQ-funded; HS024339.
Citation: de Cordova PB, Jones T, Riman KA .
Staffing trends in magnet and non-magnet hospitals after state legislation.
J Nurs Care Qual 2020 Oct/Dec;35(4):323-28. doi: 10.1097/ncq.0000000000000479..
Keywords: Hospitals, Policy, Healthcare Delivery, Workforce
Fisher ES, Shortell SM, O'Malley AJ
Financial integration's impact on care delivery and payment reforms: a survey of hospitals and physician practices. Health Aff 2020 Aug;39(8):1302-11. doi: 10.1377/hlthaff.2019.01813.
This study looked at whether financial integration of hospitals and physician practices was associated with greater quality. A total of 739 hospitals and 2,189 physician practices were included in the nationally representative survey. They were stratified by whether they were independent or owned by complex systems, simple systems, or medical groups. Nine scales were used to measure the level of adoption of diverse, quality-focused care delivery and payment reforms. While quality scores favored financially integrated systems for 4 of 9 hospital measures and one of 9 practice measures, none of them favored complex systems. Better quality was generally not associated with greater financial integration.
AHRQ-funded; U19 HS024075.
Citation: Fisher ES, Shortell SM, O'Malley AJ .
Financial integration's impact on care delivery and payment reforms: a survey of hospitals and physician practices. Health Aff 2020 Aug;39(8):1302-11. doi: 10.1377/hlthaff.2019.01813.
Health Aff 2020 Aug;39(8):1302-11. doi: 10.1377/hlthaff.2019.01813..
Keywords: Healthcare Delivery, Payment, Hospitals, Health Systems, Quality of Care
Auerbach A, O'Leary KJ, Greysen SR
Hospital ward adaptation during the COVID-19 pandemic: a national survey of academic medical centers.
The authors sought to characterize inpatient adaptations to care for non-ICU COVID-19 patients. They found that the COVID-19 pandemic has required medical wards to rapidly adapt with expanding use of respiratory isolation units and use of technology emerging as critical approaches. Reports of unrecognized or delayed diagnoses highlight how such adaptations may produce potential adverse effects on care.
AHRQ-funded; HS026383; HS026215; HS027369.
Citation: Auerbach A, O'Leary KJ, Greysen SR .
Hospital ward adaptation during the COVID-19 pandemic: a national survey of academic medical centers.
J Hosp Med 2020 Aug;15(8):483-88. doi: 10.12788/jhm.3476..
Keywords: COVID-19, Emergency Preparedness, Hospitals, Public Health, Healthcare Delivery, Inpatient Care
Furukawa MF, Machta RM, Barrett KA
AHRQ Author: Furukawa MF
Landscape of health systems in the United States.
This paper describes AHRQ’s development of the Compendium of U.S. Health Systems to help identify and describe health systems. This data resource supports research on comparative health system performance. The authors describe the methods used to create the compendium and create a picture of vertical integration. They identified 626 health systems in 2016, which accounted for 70% of nonfederal general acute care hospitals. The systems varied by key structural attributes, including size, ownership, and geographic prevalence.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Furukawa MF, Machta RM, Barrett KA .
Landscape of health systems in the United States.
Med Care Res Rev 2020 Aug;77(4):357-66. doi: 10.1177/1077558718823130..
Keywords: Health Systems, Healthcare Delivery, Hospitals
Oslock WM, Ricci KB, Ingraham AM
Role of interprofessional teams in emergency general surgery patient outcomes.
This paper discusses the results of a 2015 survey of acute care hospitals, which asked whether residents and advanced practice providers participate in emergency general surgery care. The data was then linked to patient data from 17 State Inpatient Databases using American Hospital Association identifiers to determine if that was associated with better management of patients, mortality, or complications. Eighty-three hospitals and 49,271 unique emergency general surgery admissions were included in the dataset. Hospitals with residents had reduced odds of systemic complications compared with hospitals without them or other clinical support. Hospitals with only residents had the lowest odds of operative complication.
AHRQ-funded; HS022694.
Citation: Oslock WM, Ricci KB, Ingraham AM .
Role of interprofessional teams in emergency general surgery patient outcomes.
Surgery 2020 Aug;168(2):347-53. doi: 10.1016/j.surg.2020.04.046..
Keywords: Healthcare Cost and Utilization Project (HCUP), Teams, Surgery, Adverse Events, Hospitals, Healthcare Delivery
White EM, Kosar CM, Rahman M
Trends in hospitals and skilled nursing facilities sharing medical providers, 2008-16.
Hospitals and skilled nursing facilities (SNFs) face increasing pressure to improve care coordination and reduce unnecessary readmissions. One strategy to accomplish this is to share physicians and advanced practice clinicians, so that the same providers see patients in both settings. Using 2008-16 Medicare claims, the investigators found that as SNFs moved increasingly toward using SNF specialists, there was a steady decline in the number of facilities sharing medical providers and in the proportion of SNF primary care delivered by provider practices with both hospital and SNF clinicians (hospital-SNF practices).
AHRQ-funded; T32 HS000011.
Citation: White EM, Kosar CM, Rahman M .
Trends in hospitals and skilled nursing facilities sharing medical providers, 2008-16.
Health Aff 2020 Aug;39(8):1312-20. doi: 10.1377/hlthaff.2019.01502..
Keywords: Hospitals, Nursing Homes, Care Coordination, Healthcare Delivery
Zhu W, Patterson BW, Smith M
A Markov chain model for transient analysis of handoff process in emergency departments.
Transfer of care between multiple units or facilities is of significant importance for patient safety, care quality, and operation efficiency. Such transfers are often referred to as handoffs in hospitals, which need to be carried out timely, safely, and smoothly with accurate information. This paper introduced a Markov chain model to study the transients of handoff process in hospital emergency departments.
AHRQ-funded; HS026624.
Citation: Zhu W, Patterson BW, Smith M .
A Markov chain model for transient analysis of handoff process in emergency departments.
IEEE Robot Autom Lett 2020 Jul;5(3):4360-67. doi: 10.1109/lra.2020.2996066..
Keywords: Emergency Department, Hospitals, Transitions of Care, Healthcare Delivery, Patient Safety
Zachrison KS, Boggs KM, Hayden EM
A national survey of telemedicine use by US emergency departments.
Telemedicine has the potential to improve the delivery of emergency medical care: however, the extent of its adoption in United States (US) emergency departments is not known. The objectives of this study were to characterise the prevalence of telemedicine use among all US emergency departments, describe clinical applications for which it is most commonly used, and identify emergency department characteristics associated with its use.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Boggs KM, Hayden EM .
A national survey of telemedicine use by US emergency departments.
J Telemed Telecare 2020 Jun;26(5):278-84. doi: 10.1177/1357633x18816112..
Keywords: Telehealth, Health Information Technology (HIT), Emergency Department, Healthcare Delivery, Hospitals
Wooldridge AR, Carayon P, Hoonakker P
Work system barriers and facilitators in inpatient care transitions of pediatric trauma patients.
Hospital-based care of pediatric trauma patients includes transitions between units that are critical for quality of care and patient safety. Using a macroergonomics approach, the investigators identified work system barriers and facilitators in care transitions. They interviewed eighteen healthcare professionals involved in transitions from emergency department (ED) to operating room (OR), OR to pediatric intensive care unit (PICU) and ED to PICU.
AHRQ-funded; HS023837.
Citation: Wooldridge AR, Carayon P, Hoonakker P .
Work system barriers and facilitators in inpatient care transitions of pediatric trauma patients.
Appl Ergon 2020 May;85:103059. doi: 10.1016/j.apergo.2020.103059..
Keywords: Children/Adolescents, Inpatient Care, Transitions of Care, Healthcare Delivery, Trauma, Hospitals
Sharma R, Zachrison KS, Viswanathan A
Trends in telestroke care delivery: a 15-year experience of an academic hub and its network of spokes.
Telestroke provides access to vascular neurology expertise for hospitals lacking stroke coverage, and its use has risen rapidly in the past decade. In this study the investigators aimed to characterize consultations, spoke behavior, and the relationship between spoke telestroke utilization (number of telestroke consults per year) and spoke alteplase treatment metrics in an academic telestroke network.
AHRQ-funded; HS024561.
Citation: Sharma R, Zachrison KS, Viswanathan A .
Trends in telestroke care delivery: a 15-year experience of an academic hub and its network of spokes.
Circ Cardiovasc Qual Outcomes 2020 Mar;13(3):e005903. doi: 10.1161/circoutcomes.119.005903..
Keywords: Telehealth, Health Information Technology (HIT), Stroke, Healthcare Delivery, Care Management, Hospitals