National Healthcare Quality and Disparities Report
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Topics
- Cardiovascular Conditions (1)
- Caregiving (1)
- Central Line-Associated Bloodstream Infections (CLABSI) (1)
- Community-Acquired Infections (1)
- Elderly (7)
- Electronic Health Records (EHRs) (2)
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- Healthcare-Associated Infections (HAIs) (1)
- Health Information Technology (HIT) (2)
- Heart Disease and Health (1)
- (-) Home Healthcare (13)
- (-) Hospitalization (13)
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- Nursing Homes (1)
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- Provider Performance (1)
- Quality of Care (1)
- Risk (6)
- Transitions of Care (2)
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 13 of 13 Research Studies DisplayedLi J
Home health agencies with high quality of patient care star ratings reduced short-term hospitalization rates and increased days independently at home.
Accurate Medicare Quality of Patient Care home health star ratings are crucial to helping patients find high-quality care, yet critics of these ratings indicate that they are not valid. The purpose of this retrospective study was to assess whether using the highest-rated home health agency available in a ZIP code improves outcomes. The researchers included 1,870,080 Medicare fee-for-service beneficiaries using home health care from July 2015 through July 2016 in the United States. The study found that treatment by the highest-rated agencies available decreased risks of hospitalization, emergency department use, and institutionalization during the initial episode, and increased days independently at home by 2.6% or 3.75 days in the 180 days after the end of the initial episode. Treatment effects were stronger for agencies that were above-average, had 1 or more stars than the next-best agency, and nonrural residents. Effects were positive for both postacute and community-entry patients.
AHRQ-funded; HS026836.
Citation: Li J .
Home health agencies with high quality of patient care star ratings reduced short-term hospitalization rates and increased days independently at home.
Med Care 2024 Jan; 62(1):11-20. doi: 10.1097/mlr.0000000000001930..
Keywords: Home Healthcare, Quality of Care, Hospitalization, Provider Performance
Song J, Min SH, Chae S
Uncovering hidden trends: identifying time trajectories in risk factors documented in clinical notes and predicting hospitalizations and emergency department visits during home health care.
The purpose of this study was to characterize risk factor patterns documented in home health care (HHC) clinical notes and explore their relationships with hospitalizations or emergency department (ED) visits. The researchers analyzed data for 73,350 episodes of care from one large HHC organization utilizing dynamic time warping and hierarchical clustering analysis to characterize the patterns of risk factors over time documented in clinical notes. The study found that six temporal clusters emerged, reflecting varying patterns in how risk factors were documented. Patients with a sharp increase in documented risk factors over time had a 3 times greater probability of hospitalization or ED visit than patients with no documented risk factors. The majority of risk factors were found in the physiological domain, and a minority were found in the environmental domain.
AHRQ-funded; HS027742.
Citation: Song J, Min SH, Chae S .
Uncovering hidden trends: identifying time trajectories in risk factors documented in clinical notes and predicting hospitalizations and emergency department visits during home health care.
J Am Med Inform Assoc 2023 Oct 19; 30(11):1801-10. doi: 10.1093/jamia/ocad101..
Keywords: Emergency Department, Hospitalization, Home Healthcare, Risk
Min SH, Song J, Evans L
Home healthcare patients with distinct psychological, cognitive, and behavioral symptom profiles and at-risk subgroup for hospitalization and emergency department visits using latent class analysis.
The purpose of this study was to explore subgroups of older adults receiving home healthcare services with similar psychological, cognitive, and behavioral symptom profiles and an at-risk subgroup for future hospitalization and emergency department visits as an indicator of underdiagnosis or undertreatment. The three-class model applied in the study consisted of Class 1: "Moderate psychological symptoms without behavioral issues," Class 2: "Severe psychological symptoms with behavioral issues," and Class 3: "Mild psychological symptoms without behavioral issues." The study found that Class 1 patients had 1.14 higher odds and Class 2 patients had 1.26 higher odds of being hospitalized or visiting emergency departments compared to Class 3. The researchers discovered significant differences in individual characteristics such as age, gender, race/ethnicity, and insurance.
AHRQ-funded; HS027742.
Citation: Min SH, Song J, Evans L .
Home healthcare patients with distinct psychological, cognitive, and behavioral symptom profiles and at-risk subgroup for hospitalization and emergency department visits using latent class analysis.
Clin Nurs Res 2023 Sep; 32(7):1021-30. doi: 10.1177/10547738231183026..
Keywords: Home Healthcare, Emergency Department, Hospitalization, Elderly
Song J, Chae S, Bowles KH
The identification of clusters of risk factors and their association with hospitalizations or emergency department visits in home health care.
The purpose of this retrospective cohort study was to identify risk factor clusters in home health care and assess whether the clusters are related with hospitalizations or emergency department visits. The researchers included 61,454 patients associated with 79,079 episodes receiving home health care from one of the largest home health care organizations in the U.S. The study found that a total of 11.6% of home health episodes resulted in hospitalizations or emergency department visits. Three clusters were formed by the risk factors: 1) Cluster 1- a combination of risk factors related to situations where patients may experience increased pain ("impaired physical comfort with pain"). 2) Cluster 2 - characterized by multiple comorbidities or other risks for hospitalization (e.g., prior falls, called "high comorbidity burden"). 3) Cluster 3 - "impaired cognitive/psychological and skin integrity" which includes dementia or skin ulcer. The risk of hospitalizations or emergency department visits increased by 1.95 times for Cluster 2 and by 2.12 times for Cluster 3 when compared to cluster 1. The study concluded that Varying combinations of risk factors affected the likelihood of negative outcomes.
AHRQ-funded; HS027742.
Citation: Song J, Chae S, Bowles KH .
The identification of clusters of risk factors and their association with hospitalizations or emergency department visits in home health care.
J Adv Nurs 2023 Feb; 79(2):593-604. doi: 10.1111/jan.15498..
Keywords: Emergency Department, Hospitalization, Home Healthcare, Risk
Hobensack M, Ojo M, Barrón Y
Documentation of hospitalization risk factors in electronic health records (EHRs): a qualitative study with home healthcare clinicians.
The objectives of this study were to identify risk factors that home healthcare clinicians associate with patient deterioration and to understand clinicians’ response to and documentation of these risk factors. The authors interviewed multidisciplinary home healthcare clinicians and used directed content analysis to identify risk factors for deterioration. A total of 79 risk factors were identified by the clinicians, who responded most often by communicating with the prescribing provider or following up with patients and caregivers. Clinicians also acknowledged that social factors played a role in deterioration risk. The authors noted that, since most risk factors were documented in clinical notes, methods such as natural language processing are needed to extract them. They concluded that by providing a comprehensive list of risk factors grounded in clinician expertise and mapped to standardized terminologies, the results of their study supported the development of an early warning system for patient deterioration.
AHRQ-funded; HS027742.
Citation: Hobensack M, Ojo M, Barrón Y .
Documentation of hospitalization risk factors in electronic health records (EHRs): a qualitative study with home healthcare clinicians.
J Am Med Inform Assoc 2022 Apr 13;29(5):805-12. doi: 10.1093/jamia/ocac023..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Home Healthcare, Risk, Hospitalization
Song J, Woo K, Shang J
Predictive risk models for wound infection-related hospitalization or ED visits in home health care using machine-learning algorithms.
Wound infection is prevalent in home healthcare (HHC) and often leads to hospitalizations. However, none of the previous studies of wounds in HHC have used data from clinical notes. Therefore, in this paper, the authors created a more accurate description of a patient's condition by extracting risk factors from clinical notes to build predictive models to identify a patient's risk of wound infection in HHC.
AHRQ-funded; HS024915.
Citation: Song J, Woo K, Shang J .
Predictive risk models for wound infection-related hospitalization or ED visits in home health care using machine-learning algorithms.
Adv Skin Wound Care 2021 Aug;34(8):1-12. doi: 10.1097/01.Asw.0000755928.30524.22..
Keywords: Home Healthcare, Injuries and Wounds, Risk, Hospitalization
Wang J, Ying M, Temkin-Greener H
Care-partner support and hospitalization in assisted living during transitional home health care.
This study examined the impact of care-partner support on outcomes among assisted living (AL) residents. Variation in care-partner and its impact on hospitalizations among AL residents receiving Medicare home health (HH) services was investigated. Analysis of national data from various databases was used and a total of 741,926 participants were identified with Medicare HH admissions in 2017. Care-partner support during the HH admission was measured in seven domains: activity of daily living (ADLs), instrumental activities of ADLs), medication administration, treatment, medical equipment, home safety, and transportation. Care-partner support was categorized as assistance not needed, care-partner currently providing assistance, care-partner needs additional training/support to provide assistance, and care-partner is unavailable/unlikely to provide assistance. Among the cohort, inadequate care-partner support was identified for all seven domains ranging from 13.1% for transportation to 49.8% for treatment and was unavailable for 0.9% for transportation to 11.0% for treatment. Having inadequate or unavailable care-partner support was related to increased risk of hospitalization by 8.9% for treatment to 41.3% for medication administration.
AHRQ-funded; HS026893.
Citation: Wang J, Ying M, Temkin-Greener H .
Care-partner support and hospitalization in assisted living during transitional home health care.
J Am Geriatr Soc 2021 May;69(5):1231-39. doi: 10.1111/jgs.17005..
Keywords: Elderly, Transitions of Care, Caregiving, Hospitalization, Home Healthcare, Long-Term Care
Topaz M, Woo K, Ryvicker M
Home healthcare clinical notes predict patient hospitalization and emergency department visits.
About 30% of home healthcare patients are hospitalized or visit an emergency department (ED) during a home healthcare (HHC) episode. Novel data science methods are increasingly used to improve identification of patients at risk for negative outcomes. The aim of the study was to identify patients at heightened risk hospitalization or ED visits using HHC narrative data (clinical notes).
AHRQ-funded; HS027742.
Citation: Topaz M, Woo K, Ryvicker M .
Home healthcare clinical notes predict patient hospitalization and emergency department visits.
Nurs Res 2020 Nov/Dec;69(6):448-54. doi: 10.1097/nnr.0000000000000470..
Keywords: Elderly, Home Healthcare, Emergency Department, Hospitalization, Risk, Electronic Health Records (EHRs), Health Information Technology (HIT)
Shang J, Russell D, Dowding D
A predictive risk model for infection-related hospitalization among home healthcare patients.
Infection prevention is a high priority for home healthcare (HHC), but tools are lacking to identify patients at highest risk of developing infections. The purpose of this study was to develop and test a predictive risk model to identify HHC patients at risk of an infection-related hospitalization or emergency department visit. A nonexperimental study using secondary data was conducted.
AHRQ-funded; HS024723.
Citation: Shang J, Russell D, Dowding D .
A predictive risk model for infection-related hospitalization among home healthcare patients.
J Healthc Qual 2020 May/Jun;42(3):136-47. doi: 10.1097/jhq.0000000000000214..
Keywords: Elderly, Home Healthcare, Infectious Diseases, Community-Acquired Infections, Risk, Hospitalization, Emergency Department
Weerahandi H, Bao H, Herrin J
Home health care after skilled nursing facility discharge following heart failure hospitalization.
Heart failure (HF) readmission rates have plateaued despite scrutiny of hospital discharge practices. Many HF patients are discharged to skilled nursing facility (SNF) after hospitalization before returning home. Home healthcare (HHC) services received during the additional transition from SNF to home may affect readmission risk. In this study, the investigators examined whether receipt of HHC affects readmission risk during the transition from SNF to home following HF hospitalization.
AHRQ-funded; HS022882.
Citation: Weerahandi H, Bao H, Herrin J .
Home health care after skilled nursing facility discharge following heart failure hospitalization.
J Am Geriatr Soc 2020 Jan;68(1):96-102. doi: 10.1111/jgs.16179..
Keywords: Home Healthcare, Nursing Homes, Heart Disease and Health, Cardiovascular Conditions, Hospitalization, Hospital Readmissions, Transitions of Care, Elderly
Leeman H, Cosgrove SE, Williams D
Assessing burden of central line-associated bloodstream infections present on hospital admission.
Investigators described patients presenting to an academic medical center with central line-associated bloodstream infection present on hospital admission over 1 year. Of the 130 admissions, they found that about half presented from home infusion, followed by oncology clinic, hemodialysis, and skilled nursing facility. They concluded that efforts to reduce such infections should address patients across the entire health care system.
AHRQ-funded; HS025782.
Citation: Leeman H, Cosgrove SE, Williams D .
Assessing burden of central line-associated bloodstream infections present on hospital admission.
Am J Infect Control 2020 Feb;48(2):216-18. doi: 10.1016/j.ajic.2019.08.010..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Hospitalization, Home Healthcare, Hospitals, Infectious Diseases
Wang SY, Dang W, Aldridge MD
Associations of hospice disenrollment and hospitalization with continuous home care provision.
The researchers examined rates of hospice disenrollment and posthospice hospitalization among patients who are enrolled in hospices that provide continuous home care (CHC) (CHC hospices) compared with patients who are enrolled in hospices that do not offer CHC (non-CHC hospices). They concluded that CHC hospices had significantly lower rates of hospice disenrollment and posthospice hospitalization, suggesting CHC service available may enable higher quality of end-of-life care.
AHRQ-funded; HS023900.
Citation: Wang SY, Dang W, Aldridge MD .
Associations of hospice disenrollment and hospitalization with continuous home care provision.
Med Care 2017 Sep;55(9):848-55. doi: 10.1097/mlr.0000000000000776.
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Keywords: Elderly, Home Healthcare, Hospitalization, Palliative Care
Wang SY, Aldridge MD, Canavan M
Continuous home care reduces hospice disenrollment and hospitalization after hospice enrollment.
The purpose of this paper is to identify hospice and patient characteristics associated with the use of continuous home care (CHC) and to examine the associations between CHC utilization and hospice disenrollment or hospitalization after hospice enrollment. The researchers found that patients who were white, had cancer, and had more comorbidities were more likely to use CHC and that patients who used CHC were less likely to have hospice disenrollment and less likely to be hospitalized after hospice enrollment.
AHRQ-funded; HS023900.
Citation: Wang SY, Aldridge MD, Canavan M .
Continuous home care reduces hospice disenrollment and hospitalization after hospice enrollment.
J Pain Symptom Manage 2016 Dec;52(6):813-21. doi: 10.1016/j.jpainsymman.2016.05.031.
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Keywords: Elderly, Home Healthcare, Hospitalization, Palliative Care