National Healthcare Quality and Disparities Report
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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
651 to 675 of 757 Research Studies DisplayedSilber JH, Satopaa VA, Mukherjee N
Improving Medicare's Hospital Compare mortality model.
The researchers sought to improve the predictions provided by Medicare's Hospital Compare (HC) to facilitate better informed decisions regarding hospital choice by the public. Their model produces very different predictions from the current HC model, with higher predicted mortality rates at hospitals with lower volume and worse characteristics. The expanded model would advise patients against seeking treatment at the smallest hospitals with worse technology and staffing.
AHRQ-funded; HS021854.
Citation: Silber JH, Satopaa VA, Mukherjee N .
Improving Medicare's Hospital Compare mortality model.
Health Serv Res 2016 Jun;51 Suppl 2:1229-47. doi: 10.1111/1475-6773.12478.
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Keywords: Hospitals, Mortality, Medicare
Brown TT, Robinson JC
Reference pricing with endogenous or exogenous payment limits: impacts on insurer and consumer spending.
The authors extended reference pricing (RP) models to a hospital context focusing on insurer and consumer payments. They found that, for 2 years following RP implementation, insurer payments to high-price and low-price hospitals moved downward, consistent with endogenous RP. When the reference price was not reset to account for changes in market prices, insurer payments to low-price hospitals reverted to pre-implementation levels, consistent with exogenous RP.
AHRQ-funded; HS022098.
Citation: Brown TT, Robinson JC .
Reference pricing with endogenous or exogenous payment limits: impacts on insurer and consumer spending.
Health Econ 2016 Jun;25(6):740-9. doi: 10.1002/hec.3181.
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Keywords: Payment, Healthcare Costs, Health Insurance, Hospitals
Rangachari P
Role of social knowledge networking technology in facilitating meaningful use of electronic health record medication reconciliation.
In this paper, Rangachari 1) conducted a narrative review of the literature on "technology use," to understand how technologies-in-practice may be transformed from limited use to meaningful use; 2) conducted a narrative review of the literature on "organizational change implementation," to understand how changes in technology use could be successfully implemented and sustained in a healthcare organizational context; and 3) applied lessons learned from the narrative literature reviews to identify strategies for the meaningful use and successful implementation of EHR Medication Reconciliation technology.
AHRQ-funded; HS024335.
Citation: Rangachari P .
Role of social knowledge networking technology in facilitating meaningful use of electronic health record medication reconciliation.
J Hosp Adm 2016 Jun;5(3):98-106. doi: 10.5430/jha.v5n3p98.
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Keywords: Health Systems, Medication, Hospitals, Organizational Change, Electronic Health Records (EHRs)
Mishra SR, Haldar S, Pollack AH
"Not just a receiver": understanding patient behavior in the hospital environment.
Through interviews with hospitalized patients and their caregivers, the authors identified ways that patients and caregivers actively participate in their care. They described the different roles patients and caregivers assume in interacting with their hospital care team and then discuss how systems designed to support patient engagement in the hospital setting can promote active participation and help patients achieve better outcomes.
AHRQ-funded; HS022894.
Citation: Mishra SR, Haldar S, Pollack AH .
"Not just a receiver": understanding patient behavior in the hospital environment.
Proc SIGCHI Conf Hum Factor Comput Syst 2016 May 7;2016:3103-14. doi: 10.1145/2858036.2858167.
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Keywords: Health Information Technology (HIT), Hospitals, Patient and Family Engagement, Patient-Centered Outcomes Research
Das A, Norton EC, Miller DC
Adding a spending metric to Medicare's value-based purchasing program rewarded low-quality hospitals.
In fiscal year 2015 the Centers for Medicare and Medicaid Services expanded its Hospital Value-Based Purchasing program by rewarding or penalizing hospitals for their performance on both spending and quality. Using data from 2,679 US hospitals that participated in the program in fiscal years 2014 and 2015, researchers found that the new emphasis on spending rewarded not only low-spending hospitals but some low-quality hospitals as well.
AHRQ-funded; HS020671.
Citation: Das A, Norton EC, Miller DC .
Adding a spending metric to Medicare's value-based purchasing program rewarded low-quality hospitals.
Health Aff 2016 May;35(5):898-906. doi: 10.1377/hlthaff.2015.1190.
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Keywords: Medicare, Provider Performance, Payment, Hospitals, Healthcare Costs, Quality of Care
Lee SJ, Grobe JE, Tiro JA
Assessing race and ethnicity data quality across cancer registries and EMRs in two hospitals.
The objective of this study was to characterize the quality of race/ethnicity data collection efforts. The authors assessed race and ethnicity data quality across cancer registries and electronic medical records in two hospitals. Their findings suggested that high-quality race/ethnicity data are attainable. Many of the "errors" in race/ethnicity data were caused by missing or "Unknown" data values.
AHRQ-funded; HS022418.
Citation: Lee SJ, Grobe JE, Tiro JA .
Assessing race and ethnicity data quality across cancer registries and EMRs in two hospitals.
J Am Med Inform Assoc 2016 May;23(3):627-34. doi: 10.1093/jamia/ocv156..
Keywords: Cancer, Data, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitals, Racial and Ethnic Minorities, Registries
Berian JR, Paruch JL, Cohen ME
Does performance vary within the same hospital when separately examining different patient subgroups?
The researchers sought to determine whether performance differs within a given hospital for 6 contrasting patient subgroups and to identify the percentage of hospitals with greater than chance differences in performance. They found that overall quality differed for elderly vs nonelderly, renal insufficiency vs normal renal function patients, cancer vs noncancer, and emergency vs nonemergency. They concluded that quality programs can consider separate reports for these subgroups to identify opportunities for quality improvement.
AHRQ-funded; HS021857.
Citation: Berian JR, Paruch JL, Cohen ME .
Does performance vary within the same hospital when separately examining different patient subgroups?
J Am Coll Surg 2016 May;222(5):790-97.e1. doi: 10.1016/j.jamcollsurg.2016.01.057.
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Keywords: Emergency Medical Services (EMS), Hospitals, Outcomes, Quality Improvement, Social Determinants of Health
Yanamadala S, Morrison D, Curtin C
Electronic health records and quality of care: an observational study modeling impact on mortality, readmissions, and complications.
The authors assessed the relationship between electronic health records (EHR) adoption and patient outcomes. Their results indicate that patients receiving medical and surgical care at hospitals with no EHR system have similar outcomes compared to patients seeking care at hospitals with a full EHR system. They concluded that EHRs may play a smaller role than expected in patient outcomes and overall quality of care.
AHRQ-funded; HS024096.
Citation: Yanamadala S, Morrison D, Curtin C .
Electronic health records and quality of care: an observational study modeling impact on mortality, readmissions, and complications.
Medicine (Baltimore) 2016 May;95(19):e3332. doi: 10.1097/md.0000000000003332.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Electronic Health Records (EHRs), Quality of Care, Mortality, Hospitals
Baker AW, Dicks KV, Durkin MJ
Epidemiology of surgical site infection in a community hospital network.
The researchers described the epidemiology of complex surgical site infection (SSI) following commonly performed surgical procedures in community hospitals and to characterize trends of SSI prevalence rates over time for MRSA and other common pathogens. They found that the prevalence of MRSA SSI decreased from 2008 to 2012. This decrease in MRSA SSI prevalence led to an overall decrease in SSI prevalence.
AHRQ-funded; HS023866.
Citation: Baker AW, Dicks KV, Durkin MJ .
Epidemiology of surgical site infection in a community hospital network.
Infect Control Hosp Epidemiol 2016 May;37(5):519-26. doi: 10.1017/ice.2016.13.
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Keywords: Surgery, Healthcare-Associated Infections (HAIs), Methicillin-Resistant Staphylococcus aureus (MRSA), Injuries and Wounds, Adverse Events, Risk, Hospitals
Michelson KA, Monuteaux MC, Neuman MI
Variation and trends in anaphylaxis care in United States children's hospitals.
The authors sought to determine the extent of variation in treatment of children with anaphylaxis. They found that there is substantial variability in the use of common therapies and hospitalization rates for children cared for in U.S. children's hospitals, highlighting the need for research defining optimal care for anaphylaxis.
AHRQ-funded; HS000063.
Citation: Michelson KA, Monuteaux MC, Neuman MI .
Variation and trends in anaphylaxis care in United States children's hospitals.
Acad Emerg Med 2016 May;23(5):623-7. doi: 10.1111/acem.12922.
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Keywords: Children/Adolescents, Emergency Department, Hospitals, Care Management, Hospitalization
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
Harrison MI, Paez K, Carman KL
AHRQ Author: Harrison MI
Effects of organizational context on Lean implementation in five hospital systems.
In order to help reduce gaps in knowledge of effects of intraorganizational context, the authors researched Lean implementation initiatives in five organizations and examined 12 of their Lean rapid improvement projects. They identified intraorganizational characteristics including CEO commitment to Lean and active support for it, prior organizational capacity for quality improvement-based performance improvement, and alignment of the Lean initiative with the organizational mission.
AHRQ-authored.
Citation: Harrison MI, Paez K, Carman KL .
Effects of organizational context on Lean implementation in five hospital systems.
Health Care Manage Rev 2016 Apr-Jun;41(2):127-44. doi: 10.1097/hmr.0000000000000049..
Keywords: Organizational Change, Hospitals, Quality Improvement, Quality of Care, Healthcare Delivery, Implementation
McConnell KJ, Lindrooth RC, Wholey DR
Modern management practices and hospital admissions.
The researchers investigated whether the modern management practices and publicly reported performance measures are associated with choice of hospital for patients with acute myocardial infarction (AMI). They found that, overall, a one standard deviation change in management practice scores is associated with an 8% increase in AMI admissions.
AHRQ-funded; HS018466.
Citation: McConnell KJ, Lindrooth RC, Wholey DR .
Modern management practices and hospital admissions.
Health Econ 2016 Apr;25(4):470-85. doi: 10.1002/hec.3171.
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Keywords: Hospitals, Heart Disease and Health, Cardiovascular Conditions, Quality Indicators (QIs), Quality Measures, Quality of Care, Public Reporting, Provider Performance
Sommers BD, Stone J, Kane N
Predictors of payer mix and financial performance among safety net hospitals prior to the Affordable Care Act.
The objective of this study was to use audited hospital financial statements to identify predictors of payer mix and financial performance in safety net hospitals prior to the Affordable Care Act. It found that university governance was the strongest positive predictor of operating margin. Safety net hospital financial performance varied considerably. Academic hospitals had higher operating margins, while more generous Medicaid eligibility and reimbursement policies improved hospitals' ability to recoup costs.
AHRQ-funded; HS021291.
Citation: Sommers BD, Stone J, Kane N .
Predictors of payer mix and financial performance among safety net hospitals prior to the Affordable Care Act.
Int J Health Serv 2016;46(1):166-84. doi: 10.1177/0020731415586408.
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Keywords: Hospitals, Policy, Medicaid, Payment
Leary JC, Schainker EG, Leyenaar JK
The unwritten rules of mentorship: facilitators of and barriers to effective mentorship in pediatric hospital medicine.
This study aimed to characterize successful pediatric hospitalists' past and current mentorship experiences and identify facilitators of and barriers to effective mentorship in pediatric hospital medicine (PHM). They found that several themes emerged regarding facilitators of and barriers to effective mentorship in PHM. These "unwritten rules of mentorship" may serve as a guide to establish and maintain beneficial mentorship relationships and overcome challenges.
AHRQ-funded; HS024133.
Citation: Leary JC, Schainker EG, Leyenaar JK .
The unwritten rules of mentorship: facilitators of and barriers to effective mentorship in pediatric hospital medicine.
Hosp Pediatr 2016 Apr;6(4):219-25. doi: 10.1542/hpeds.2015-0108..
Keywords: Education: Continuing Medical Education, Hospitals, Children/Adolescents, Quality Improvement, Training
Chopra V, Smith S, Swaminathan L
Variations in peripherally inserted central catheter use and outcomes in Michigan hospitals.
The researchers examined the use of peripherally inserted central catheters (PICCs) by conducting a prospective study at 10 hospitals through the Michigan Hospital Medicine Safety Consortium. Their multicenter study found substantial variation in PICC indications, patterns of use, and outcomes at the 10 Michigan hospitals included in the study.
AHRQ-funded; HS022835.
Citation: Chopra V, Smith S, Swaminathan L .
Variations in peripherally inserted central catheter use and outcomes in Michigan hospitals.
JAMA Intern Med 2016 Apr;176(4):548-51. doi: 10.1001/jamainternmed.2015.8402.
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Keywords: Patient Safety, Practice Patterns, Healthcare-Associated Infections (HAIs), Hospitals, Outcomes, Adverse Events
Brown JR, Rezaee ME, Nichols EL
Incidence and in-hospital mortality of acute kidney injury (AKI) and dialysis-requiring AKI (AKI-D) after cardiac catheterization in the National Inpatient Sample.
This study examined cardiac catheterization or percutaneous coronary intervention (PCI) hospital discharges from the nationally representative National Inpatient Sample to determine annual population incidence rates for AKI and AKI-D in the United States from 2001 to 2011. It found that the incidence of AKI among cardiac catheterization and PCI patients has increased sharply in the United States; however, mortality has significantly declined.
AHRQ-funded; HS018443.
Citation: Brown JR, Rezaee ME, Nichols EL .
Incidence and in-hospital mortality of acute kidney injury (AKI) and dialysis-requiring AKI (AKI-D) after cardiac catheterization in the National Inpatient Sample.
J Am Heart Assoc 2016 Mar 15;5(3):e002739. doi: 10.1161/jaha.115.002739.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Adverse Events, Mortality, Patient Safety, Surgery, Heart Disease and Health, Cardiovascular Conditions, Kidney Disease and Health, Dialysis, Hospitals
Farra S, Miller ET, Gneuhs M
Evacuation performance evaluation tool.
The authors described the development and implications of a disaster evacuation performance tool that measures one portion of the very complex process of evacuation. The tool was pilot tested with an administrative, medical, and nursing leadership group and then implemented with a group of healthcare workers during a disaster exercise. The authors found that the Delphi process based on the conceptual framework of DeVellis yielded a psychometrically sound evacuation performance evaluation tool for a neonatal intensive care unit.
AHRQ-funded; HS023149.
Citation: Farra S, Miller ET, Gneuhs M .
Evacuation performance evaluation tool.
Am J Disaster Med 2016 Spring;11(2):131-36. doi: 10.5055/ajdm.2016.0232.
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Keywords: Emergency Preparedness, Hospitals, Neonatal Intensive Care Unit (NICU), Children/Adolescents, Training
Schondelmeyer AC, Brady PW, Landrigan CP
Alarm fatigue: clearing the air.
The authors discuss an article in the same issue of the Journal of Hospital Medicine by Paine and colleagues that sets out to review the small but growing body of literature addressing physiologic monitor alarms and interventions that have tried to address alarm fatigue. They conclude that the review demonstrates that the great majority of alarms do not help clinicians and likely contribute to alarm fatigue.
AHRQ-funded; HS023827.
Citation: Schondelmeyer AC, Brady PW, Landrigan CP .
Alarm fatigue: clearing the air.
J Hosp Med 2016 Feb;11(2):153-4. doi: 10.1002/jhm.2521.
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Keywords: Patient Safety, Nursing, Adverse Events, Hospitals
Jones K, Sibai J, Battjes R
How and when nurses collect urine cultures on catheterized patients: a survey of 5 hospitals.
Obtaining a specimen for urine culture is a key element in evaluating for catheter-associated urinary tract infections (CAUTIs). Nurses at 5 hospitals completed a survey regarding their knowledge, training, and practices of appropriate reasons for obtaining urine cultures. The researchers concluded that important opportunities exist for nurses to optimize the decisions to obtain urine cultures and the process for obtaining them.
AHRQ-funded; 290201000025I; 29032001T.
Citation: Jones K, Sibai J, Battjes R .
How and when nurses collect urine cultures on catheterized patients: a survey of 5 hospitals.
Am J Infect Control 2016 Feb;44(2):173-6. doi: 10.1016/j.ajic.2015.09.003.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Hospitals, Nursing, Provider: Nurse, Urinary Tract Infection (UTI)
Masnick M, Morgan DJ, Sorkin JD
Lack of patient understanding of hospital-acquired infection data published on the Centers for Medicare and Medicaid Services Hospital Compare Website.
This study assessed the interpretability of hospital-acquired infection (HAI) data as presented on the Centers for Medicare and Medicaid Services Hospital Compare website among patients who might benefit from access to these data. It concluded that current public HAI data presentation methods may be inadequate. When presented with numeric HAI data, study participants incorrectly compared hospitals on the basis of HAI data in more than 40% of the responses.
AHRQ-funded; HS018111.
Citation: Masnick M, Morgan DJ, Sorkin JD .
Lack of patient understanding of hospital-acquired infection data published on the Centers for Medicare and Medicaid Services Hospital Compare Website.
Infect Control Hosp Epidemiol 2016 Feb;37(2):182-7. doi: 10.1017/ice.2015.260.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Education: Patient and Caregiver, Health Literacy, Healthcare-Associated Infections (HAIs), Hospitals, Urinary Tract Infection (UTI)
Sjoding MW, Valley TS, Prescott HC
Rising billing for intermediate intensive care among hospitalized Medicare bbetween 1996 and 2010.
This study characterized trends in intermediate care use among U.S. hospitals. Only 8.2 percent of Medicare hospitalizations in 1996 were billed for intermediate care, but billing steadily increased to 22.8 percent by 2010, whereas the percentage billed for ICU care and ward-only care declined. Patients billed for intermediate care had more acute organ failures diagnoses codes compared with general ward patients.
AHRQ-funded; HS020672.
Citation: Sjoding MW, Valley TS, Prescott HC .
Rising billing for intermediate intensive care among hospitalized Medicare bbetween 1996 and 2010.
Am J Respir Crit Care Med 2016 Jan 15;193(2):163-70. doi: 10.1164/rccm.201506-1252OC.
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Keywords: Payment, Hospitals, Intensive Care Unit (ICU), Healthcare Costs, Medicare
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.
AHRQ-funded; HS020672.
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.
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Keywords: Hospitals, Mortality, Quality of Care, Quality Indicators (QIs), Quality Measures, Pneumonia, Provider Performance, Respiratory Conditions
Das A, Norton EC, Miller DC
Association of postdischarge spending and performance on new episode-based spending measure.
The Centers for Medicare and Medicaid Services recently added the Medicare Spending per Beneficiary (MSPB) metric to its Hospital Value-Based Purchasing (HVBP) program. The researchers evaluated whether hospital performance was driven by spending before, during, or after hospitalization. They found that compared with low-cost hospitals, high-cost hospitals had significantly higher preadmission and index admission spending, but the largest differences were in postdischarge spending.
AHRQ-funded; HS020671.
Citation: Das A, Norton EC, Miller DC .
Association of postdischarge spending and performance on new episode-based spending measure.
JAMA Intern Med 2016 Jan;176(1):117-9. doi: 10.1001/jamainternmed.2015.6261.
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Keywords: Healthcare Costs, Medicare, Hospitals, Provider Performance, Hospitalization, Payment, Hospital Discharge
Khatri N, Gupta V
Effective implementation of health information technologies in U.S. hospitals.
Two issues pertaining to the effective implementation of health information technologies (HITs) in U.S. hospitals are examined. First, which information technology (IT) system is better--a homegrown or an outsourced one? In the second issue, the critical role of in-house IT expertise/capabilities in the effective implementation of HITs is investigated. It concluded that a homegrown HIT system achieves better quality of patient care than an outsourced one.
AHRQ-funded; HS017549.
Citation: Khatri N, Gupta V .
Effective implementation of health information technologies in U.S. hospitals.
Health Care Manage Rev 2016 Jan-Mar;41(1):11-21. doi: 10.1097/hmr.0000000000000039.
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Keywords: Health Information Technology (HIT), Hospitals, Implementation