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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 17 of 17 Research Studies Displayed
Wang Y, Eldridge N, Metersky ML
AHRQ Author: Eldridge N, Rodrick D
Analysis of hospital-level readmission rates and variation in adverse events among patients with pneumonia in the United States.
The purpose of this AHRQ-authored cross-sectional study was to assess whether patients with pneumonia who were admitted to hospitals with higher risk-standardized readmission rates had a higher risk of in-hospital adverse events. The researchers linked patient-level adverse events data from the Medicare Patient Safety Monitoring System (MPSMS) to the hospital-level pneumonia-specific all-cause readmissions data from the Centers for Medicare & Medicaid Services. The MPSMS data included 46,047 patients with pneumonia across 2,590 hospitals discharged from July 1, 2010, through December 31, 2019. For data from 2010 to 2017, analysis was completed from October 2019 through July 2020, and for data from 2018 to 2019 analysis was completed from March through April 2022. The study concluded that readmission rates are associated with the quality of hospital care for pneumonia; patients with pneumonia admitted to hospitals with high all-cause readmission rates had a higher likelihood of developing adverse events during the initial hospitalization.
AHRQ-authored; AHRQ-funded; 290201800005C.
Citation: Wang Y, Eldridge N, Metersky ML . Analysis of hospital-level readmission rates and variation in adverse events among patients with pneumonia in the United States. JAMA Netw Open 2022 May 2;5(5):e2214586. doi: 10.1001/jamanetworkopen.2022.14586..
Keywords: Hospital Readmissions, Hospitals, Adverse Events, Pneumonia, Respiratory Conditions
Jaladanki S, Schechter SB, Genies MC
Strategies for sustaining high-quality pediatric asthma care in community hospitals.
This study’s objective was to identify strategies associated with sustained guideline adherence and high-quality pediatric asthma care in community hospitals. Hospitals who were part of the Pathways for Improving Pediatric Asthma Care (PIPA) national quality improvement (QI) intervention were included. Clinicians (n = 19) involved in clinical care of children hospitalized with asthma were interviewed from five higher- and three lower-performing hospitals. Higher-performing hospitals had dedicated local champions who consistently provided reminders of evidence-based practices and delivered ongoing education. These champions also modified/developed electronic health record (EHR) tools. Lower-performing hospital clinicians described unique barriers, including delays in modifying the EHR and lack of automation of EHR tools. For all hospitals, barriers to sustainability included challenges with quality monitoring, decreasing focus of local champions over time, and ongoing difficulties developing around evidence-based practices.
Citation: Jaladanki S, Schechter SB, Genies MC . Strategies for sustaining high-quality pediatric asthma care in community hospitals. Health Serv Res 2022 Feb;57(1):125-36. doi: 10.1111/1475-6773.13870..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Chronic Conditions, Hospitals, Quality of Care
Schechter S, Jaladanki S, Rodean J
Sustainability of paediatric asthma care quality in community hospitals after ending a national quality improvement collaborative.
Community hospitals, which care for most hospitalised children in the USA, may be vulnerable to declines in paediatric care quality when quality improvement (QI) initiatives end. In this study, the investigators aimed to evaluate changes in care quality in community hospitals after the end of the Pathways for Improving Paediatric Asthma Care (PIPA) national QI collaborative. The investigators concluded that the end of the paediatric asthma QI collaborative was associated with concerning declines in guideline adherence in community hospitals.
Citation: Schechter S, Jaladanki S, Rodean J . Sustainability of paediatric asthma care quality in community hospitals after ending a national quality improvement collaborative. BMJ Qual Saf 2021 Nov;30(11):876-83. doi: 10.1136/bmjqs-2020-012292..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Hospitals, Quality Improvement, Quality of Care
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.
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
Bryan MA, Tyler A, Zhou C
Associations between quality measures and outcomes for children hospitalized with bronchiolitis.
The authors used adherence to the Pediatric Respiratory Illness Measurement System (PRIMES) indicators to evaluate the strength of associations for individual indicators with length of stay (LOS) and cost for bronchiolitis. They found that three indicators were significantly associated with shorter LOS and lower cost, while two underuse indicators were associated with higher cost. They concluded that a subset of PRIMES quality indicators for bronchiolitis were strongly associated with improved outcomes and can serve as important measures for future quality improvement efforts.
Citation: Bryan MA, Tyler A, Zhou C . Associations between quality measures and outcomes for children hospitalized with bronchiolitis. Hosp Pediatr 2020 Nov;10(11):932-40. doi: 10.1542/hpeds.2020-0175..
Keywords: Children/Adolescents, Respiratory Conditions, Hospitals, Quality Indicators (QIs), Quality Measures, Quality of Care
Steuart R, Tan R, Melink K
Discharge before return to respiratory baseline in children with neurologic impairment.
Children with neurologic impairment (NI) are commonly hospitalized with acute respiratory infections (ARI). These children frequently require respiratory support at baseline and are often discharged before return to respiratory baseline. The purpose of this study was to determine if discharge before return to respiratory baseline was associated with reutilization among children with NI hospitalized with ARI.
Citation: Steuart R, Tan R, Melink K . Discharge before return to respiratory baseline in children with neurologic impairment. J Hosp Med 2020 Sep;15(9):531-37. doi: 10.12788/jhm.3394..
Keywords: Children/Adolescents, Neurological Disorders, Respiratory Conditions, Hospital Readmissions, Hospital Discharge, Hospitals
Kaiser SV, Lam Cabana, MD
Best practices in implementing inpatient pediatric asthma pathways: a qualitative study.
The objective of this study was to identify potential best practices in pathway implementation. Building upon a previous observational study in which the researchers identified higher and lower performing children's hospitals based on hospital-level changes in asthma patient length of stay after implementation of a pathway, they conducted semi-structured interviews with a sample of healthcare providers involved in pathway implementation at these hospitals. They identified several potential best practices to support pathway implementation. They recommended that hospitals implementing pathways consider applying these strategies to ensure success in improving quality of asthma care for children.
Citation: Kaiser SV, Lam Cabana, MD . Best practices in implementing inpatient pediatric asthma pathways: a qualitative study. J Asthma 2020 Jul;57(7):744-54. doi: 10.1080/02770903.2019.1606237..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Hospitals, Inpatient Care, Guidelines, Evidence-Based Practice, Implementation, Quality Improvement, Quality of Care
Law AC, Forbath N, O'Donoghue S
Hospital-level availability of prone positioning in Massachusetts ICUs.
The authors sought to evaluate the institutional availability of prone positioning (PP), for which prior studies have shown its underuse. They found that most hospitals they surveyed in Massachusetts were either unable, or not completely able, to offer PP routinely. They concluded that their finding of low uptake of an evidence-based intervention with a mortality benefit at an institutional level raises multiple questions for future investigation and suggests that attempts to implement PP among eligible patients will need to include consideration of hospital-level barriers.
Citation: Law AC, Forbath N, O'Donoghue S . Hospital-level availability of prone positioning in Massachusetts ICUs. Am J Respir Crit Care Med 2020 Apr 15;201(8):1006-08. doi: 10.1164/rccm.201910-2097LE.
Keywords: Intensive Care Unit (ICU), Inpatient Care, Hospitals, Respiratory Conditions
Myers LC, Faridi MK, Hasegawa K
The hospital readmissions reduction program and readmissions for chronic obstructive pulmonary disease, 2006-2015.
In October 2012, the initial phase of the Hospital Readmission Reduction Program imposed financial penalties on hospitals with higher-than-expected risk-adjusted 30-day readmission rates for Medicare beneficiaries with congestive heart failure, myocardial infarction, and pneumonia. In this study, the investigators hypothesized that these penalties may also be associated with decreased readmissions for chronic obstructive pulmonary disease (COPD) in the general population before COPD became a target condition (October 2014).
Citation: Myers LC, Faridi MK, Hasegawa K . The hospital readmissions reduction program and readmissions for chronic obstructive pulmonary disease, 2006-2015. Ann Am Thorac Soc 2020 Apr;17(4):450-56. doi: 10.1513/AnnalsATS.201909-672OC..
Keywords: Respiratory Conditions, Hospital Readmissions, Hospitals, Chronic Conditions, Medicare
Ji W, McKenna C, Ochoa A
Development and assessment of objective surveillance definitions for nonventilator hospital-acquired pneumonia.
The authors sought to propose and assess potentially objective, efficient, and reproducible surveillance definitions for non-ventilator hospital-acquired pneumonia (NV-HAP) using routine clinical data stored in electronic health record systems. They found that objective surveillance for NV-HAP using electronically computable definitions that incorporate common clinical criteria is feasible and generates incidence, mortality, and adjusted odds ratios for hospital mortality similar to estimates from manual surveillance. They concluded that these definitions have the potential to facilitate widespread, automated surveillance for NV-HAP and thus inform the development and evaluation of prevention programs.
Citation: Ji W, McKenna C, Ochoa A . Development and assessment of objective surveillance definitions for nonventilator hospital-acquired pneumonia. JAMA Netw Open 2019 Oct 2;2(10):e1913674. doi: 10.1001/jamanetworkopen.2019.13674..
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Respiratory Conditions, Public Health, Electronic Health Records (EHRs), Health Information Technology (HIT)
Kenyon CC, Gruschow SM, Haaland WL
Kenyon CC, Gruschow SM, Haaland WL, Desai AD, Adams SA, Hitt TA, Williams DJ, et al. Perceived access to outpatient care and hospital reutilization following acute respiratory illnesses.
The authors’ goal was to assess the relationship between perceived access to timely office-based care and subsequent 30-day pediatric revisits following hospital discharge for asthma, bronchiolitis, croup, and pneumonia. They found that perceived access to timely office-based care was associated with significantly greater odds of subsequent emergency department revisit. They concluded that focusing solely on enhancing timely access to care following discharge for common respiratory illnesses may be insufficient to prevent repeat utilization.
Citation: Kenyon CC, Gruschow SM, Haaland WL . Kenyon CC, Gruschow SM, Haaland WL, Desai AD, Adams SA, Hitt TA, Williams DJ, et al. Perceived access to outpatient care and hospital reutilization following acute respiratory illnesses. Acad Pediatr 2019 May - Jun;19(4):370-77. doi: 10.1016/j.acap.2018.07.001..
Keywords: Children/Adolescents, Respiratory Conditions, Ambulatory Care and Surgery, Emergency Department, Access to Care, Hospitals
Kaiser SV, Lam R, Joseph GB
Limitations of using pediatric respiratory illness readmissions to compare hospital performance.
Researcher sought to determine if a National Quality Forum (NQF)-endorsed measure for pediatric lower respiratory illness (LRI) 30-day readmission rates can meaningfully identify high- and low-performing hospitals. Subjects were children with LRI (bronchiolitis, influenza, or pneumonia as primary diagnosis, or with an LRI as a secondary diagnosis with a primary diagnosis of respiratory failure, sepsis, bacteremia, or asthma) from all hospital admissions in California from 2012 to 2014. The researchers were unable to identify meaningful variation in hospital performance without broadening the metric definition and merging multiple years of data. They recommend that utilizers of pediatric-quality measures consider modifying metrics to better evaluate the quality of pediatric care at low-volume hospitals.
AHRQ-funded; HS024385; HS022835; HS024592; HS025297.
Citation: Kaiser SV, Lam R, Joseph GB . Limitations of using pediatric respiratory illness readmissions to compare hospital performance. J Hosp Med 2018 Nov;13(11):737-42. doi: 10.12788/jhm.2988..
Keywords: Children/Adolescents, Respiratory Conditions, Provider Performance, Hospital Readmissions, Hospitals, Quality Indicators (QIs), Quality Measures, Quality of Care, Quality Improvement
Mittal M, Wang CE, Goben AH
Proprietary management and higher readmission rates: a correlation.
This study examined readmission rates of patients for six diseases including acute myocardial infarction, heart failure, coronary artery bypass graft, pneumonia, COPD, and total hip or total knee arthroplasty from the Center for Medicare and Medicaid Readmissions Reduction Production (HRRP) for 2012 to 2015. The type of hospital ownership was the variable that was being studied. There were statistically higher readmission rates in proprietary (for profit) hospitals compared to government and non-profit hospitals. This was true regardless of their location.
Citation: Mittal M, Wang CE, Goben AH . Proprietary management and higher readmission rates: a correlation. PLoS One 2018 Sep 18;13(9):e0204272. doi: 10.1371/journal.pone.0204272..
Keywords: Cardiovascular Conditions, Hospital Readmissions, Hospitals, Orthopedics, Respiratory Conditions
Fisher KA, Mazor KM, Goff S
Successful use of noninvasive ventilation in chronic obstructive pulmonary disease. how do high-performing hospitals do it?
To identify approaches used by hospitals that have been successful in implementing Noninvasive ventilation (NIV) to treat patients with severe exacerbations of chronic obstructive pulmonary disease (COPD). The authors identified factors, such as respiratory therapist autonomy, that facilitated essential processes (e.g., timely initiation) of NIV use at high-performing hospitals.
Citation: Fisher KA, Mazor KM, Goff S . Successful use of noninvasive ventilation in chronic obstructive pulmonary disease. how do high-performing hospitals do it? Ann Am Thorac Soc 2017 Nov;14(11):1674-81. doi: 10.1513/AnnalsATS.201612-1005OC..
Keywords: Respiratory Conditions, Hospitals, Patient-Centered Outcomes Research
Rinne ST, Castaneda J, Lindenauer PK
Chronic obstructive pulmonary disease readmissions and other measures of hospital quality.
This study examined the association between COPD readmissions and other quality measures. There were modest correlations between COPD readmission rates and readmission rates for other medical conditions, including heart failure , acute myocardial infarction, pneumonia, and stroke . In contrast, it also found low correlations between COPD readmission rates and readmission rates for surgical conditions, as well as mortality rates for all measured conditions.
Citation: Rinne ST, Castaneda J, Lindenauer PK . Chronic obstructive pulmonary disease readmissions and other measures of hospital quality. Am J Respir Crit Care Med 2017 Jul 1;196(1):47-55. doi: 10.1164/rccm.201609-1944OC.
Keywords: Respiratory Conditions, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Quality of Care, Hospital Readmissions, Hospitals
Walkey AJ, Weinberg J, Wiener RS
Association of do-not-resuscitate orders and hospital mortality rate among patients with pneumonia.
The researchers evaluated the effect of analytic approaches accounting for do-not-resuscitate (DNR) status on risk-adjusted hospital mortality rates and performance rankings. They found that after accounting for patient DNR status and between-hospital variation in the association between DNR status and mortality, hospitals with higher DNR rates had lower mortality.
Citation: Walkey AJ, Weinberg J, Wiener RS . Association of do-not-resuscitate orders and hospital mortality rate among patients with pneumonia. JAMA Intern Med 2016 Jan;176(1):97-104. doi: 10.1001/jamainternmed.2015.6324.
Keywords: Hospitals, Mortality, Quality of Care, Quality Indicators (QIs), Quality Measures, Pneumonia, Provider Performance, Respiratory Conditions
Kelesidis T, Braykov N, Uslan DZ
Indications and types of antibiotic agents used in 6 acute care hospitals, 2009-2010: a pragmatic retrospective observational study.
This study characterized the indications for antibiotic therapy, agents used, duration, combinations, and microbiological justification in 6 acute-care US facilities with varied location, size, and type of antimicrobial stewardship programs. It concluded that the use of broad-spectrum empirical therapy was prevalent in 6 US acute care facilities. Fluoroquinolones, vancomycin, and antipseudomonal penicillins were the most frequently used antibiotics, particularly for respiratory indications
Citation: Kelesidis T, Braykov N, Uslan DZ . Indications and types of antibiotic agents used in 6 acute care hospitals, 2009-2010: a pragmatic retrospective observational study. Infect Control Hosp Epidemiol 2016 Jan;37(1):70-9. doi: 10.1017/ice.2015.226.
Keywords: Antimicrobial Stewardship, Critical Care, Hospitals, Medication, Respiratory Conditions