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
126 to 150 of 220 Research Studies DisplayedJones CD, Burke RE
Inpatient notes - getting past the "black box"-opportunities for hospitalists to improve postacute care transitions.
The care provided after hospital discharge in skilled-nursing facilities and home health care is collectively termed postacute care (PAC). In this article, the authors outline 3 key problems with postacute care transitions and offer potential solutions.
AHRQ-funded; HS024569.
Citation: Jones CD, Burke RE .
Inpatient notes - getting past the "black box"-opportunities for hospitalists to improve postacute care transitions.
Ann Intern Med 2018 May 15;168(10):HO2-HO3. doi: 10.7326/m18-0940..
Keywords: Health Services Research (HSR), Home Healthcare, Hospital Discharge, Long-Term Care, Transitions of Care
Jones CD, Burke RE
Web exclusive. Annals for Hospitalists Inpatient Notes - getting past the "black box"-opportunities for hospitalists to improve postacute care transitions.
In this article, the authors outline 3 key problems in postacute care (PAC) transitions and offer potential solutions. They assert that improving hospitalists' knowledge of PAC, improving communication after hospital discharge, and creating mechanisms for feedback to hospitalists are all possible ways of getting past the PAC “black box.”
AHRQ-funded; HS024569.
Citation: Jones CD, Burke RE .
Web exclusive. Annals for Hospitalists Inpatient Notes - getting past the "black box"-opportunities for hospitalists to improve postacute care transitions.
Ann Intern Med 2018 May 15;168(10):H02 - H03. doi: 10.7326/m18-0940..
Keywords: Communication, Hospital Discharge, Inpatient Care, Transitions of Care
Middleton A, Downer B, Haas A
Functional status is associated with 30-day potentially preventable readmissions following skilled nursing facility discharge among Medicare beneficiaries.
This retrospective cohort study’s objective was to determine the association between patients’ functional status at discharge from skilled nursing facility (SNF) care and 30-day potentially preventable readmissions. Data was used from a national cohort of Medicare fee-for-service beneficiaries discharged from SNF care from July 2013 to July 2014. The average age was 81.4 years, 67% were women, and 86.3% non-Hispanic white. Functional data used from the Minimum Data Set was self-care, mobility, and cognition domains. The overall rate of 30-day potentially preventable readmissions was 5.7%. The 5 most common conditions for readmissions were congestive heart failure, septicemia, urinary tract infection, bacterial pneumonia, and renal failure. Mobility was the most dependent category followed by self-care and cognition.
AHRQ-funded; HS022134.
Citation: Middleton A, Downer B, Haas A .
Functional status is associated with 30-day potentially preventable readmissions following skilled nursing facility discharge among Medicare beneficiaries.
J Am Med Dir Assoc 2018 Apr;19(4):348-54.e4. doi: 10.1016/j.jamda.2017.12.003..
Keywords: Hospital Readmissions, Hospital Discharge, Hospitals, Medicare, Elderly
Statile AM, Unaka N, Auger KA
Preparing from the outside looking in for safely transitioning pediatric inpatients to home.
In this editorial, the authors discuss a paper by Rehm, et al. published in 2018 in Journal of Hospital Medicine entitled “Issues Identified by Post-Discharge Contact after Pediatric Hospitalization: A Multi-site Study.”
AHRQ-funded; HS024735.
Citation: Statile AM, Unaka N, Auger KA .
Preparing from the outside looking in for safely transitioning pediatric inpatients to home.
J Hosp Med 2018 Apr;13(4):287-88. doi: 10.12788/jhm.2935..
Keywords: Children/Adolescents, Hospital Discharge, Hospitalization, Patient Safety, Transitions of Care
Parikh K, Hall M, Kenyon CC
Impact of discharge components on readmission rates for children hospitalized with asthma.
This study described hospital-based asthma-specific discharge components at children's hospitals and determine the association of these discharge components with pediatric asthma readmission rates. No individual or combination discharge components were associated with lower 30-day adjusted readmission rates. The only single-component significantly associated with a lower rate of readmission at 3 months was having comprehensive content of education.
AHRQ-funded; HS024554.
Citation: Parikh K, Hall M, Kenyon CC .
Impact of discharge components on readmission rates for children hospitalized with asthma.
J Pediatr. 2018 Apr;195:175-181.e2. doi: 10.1016/j.jpeds.2017.11.062..
Keywords: Asthma, Children/Adolescents, Hospital Discharge, Hospital Readmissions, Patient-Centered Outcomes Research
Feder SL, Britton MC, Chaudhry SI
"They need to have an understanding of why they're coming here and what the outcomes might be." Clinician perspectives on goals of care for patients discharged from hospitals to skilled nursing facilities.
This study examined how clinicians view goals of care (GoC) for hospitalized patients discharged to skilled nursing facilities (SNFs). A variety of clinicians were interviewed: 22% were nurses, 20% physicians, 15% from care management, and 15% from social services. Many respondents felt that patients and their families had unrealistic GoCs. However, conversations on GoCs were infrequent during hospitalizations which contribute to unrealistic expectations for SNF care and poor patient outcomes. The researchers recommend interventions to ensure that GoC conversations and are held regularly and in a timely manner before transfer occurs.
AHRQ-funded; HS023554.
Citation: Feder SL, Britton MC, Chaudhry SI .
"They need to have an understanding of why they're coming here and what the outcomes might be." Clinician perspectives on goals of care for patients discharged from hospitals to skilled nursing facilities.
J Pain Symptom Manage 2018 Mar;55(3):930-37. doi: 10.1016/j.jpainsymman.2017.10.013..
Keywords: Care Coordination, Clinician-Patient Communication, Communication, Hospital Discharge, Nursing Homes, Patient and Family Engagement, Provider: Clinician, Provider: Nurse, Provider: Physician
Sorkin DH, Amin A, Weimer DL
Hospital discharge and selecting a skilled nursing facility: a comparison of experiences and perspectives of patients and their families.
This article seeks to examine and compare the experiences and perspectives of patients and others involved in the selection of the nursing home (predominately adult children and spouses). It found that patients were the primary decision makers about 23 percent of the time but were often involved in the decision even when family members/involved others were primarily making decisions in the discharge process.
AHRQ-funded; HS021844.
Citation: Sorkin DH, Amin A, Weimer DL .
Hospital discharge and selecting a skilled nursing facility: a comparison of experiences and perspectives of patients and their families.
Prof Case Manag 2018 Mar/Apr;23(2):50-59. doi: 10.1097/ncm.0000000000000252.
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Keywords: Decision Making, Hospital Discharge, Long-Term Care, Nursing Homes, Patient Experience
Sills MR, Macy ML, Kocher KE
Return visit admissions may not indicate quality of emergency department care for children.
The goal of this retrospective analysis was to test the hypothesis that in-hospital outcomes are worse among children admitted during a return ED visit than among those admitted during an index visit. Children who were hospitalized in Florida and New York hospitals during a return visit within 7 days were classified as "ED return admissions" or "readmissions"; in-hospital outcomes for ED return admissions and readmissions were compared to "index admissions without return admission". The results indicate that children who are initially discharged from the ED and then have a return admission had lower severity but similar cost in comparison with children who experienced an index admission without a return admission. The authors conclude that this suggests that ED return visit admissions do not involve worse outcomes than index admissions.
AHRQ-funded; HS024160; HS016418.
Citation: Sills MR, Macy ML, Kocher KE .
Return visit admissions may not indicate quality of emergency department care for children.
Acad Emerg Med 2018 Mar;25(3):283-92. doi: 10.1111/acem.13324..
Keywords: Children/Adolescents, Emergency Department, Hospital Discharge, Hospital Readmissions, Hospitals, Quality of Care, Outcomes
Lacson R, Desai S, Landman A
Impact of a health information technology intervention on the follow-up management of pulmonary nodules.
Recommendations to improve care for patients with pulmonary nodules require follow-up management. However, transitions in care can exacerbate failures in follow-up testing and compromise patient safety. The study authors evaluated the impact of a discharge module that included follow-up recommendations for further management of pulmonary nodules on the study outcome and follow-up management of patients with pulmonary nodules within 1 year after discharge.
AHRQ-funded; HS022586.
Citation: Lacson R, Desai S, Landman A .
Impact of a health information technology intervention on the follow-up management of pulmonary nodules.
J Digit Imaging 2018 Feb;31(1):19-25. doi: 10.1007/s10278-017-9989-y..
Keywords: Cancer: Lung Cancer, Health Information Technology (HIT), Hospital Discharge, Transitions of Care
Kerstenetzky L, Birschbach MJ, Beach KF
Improving medication information transfer between hospitals, skilled-nursing facilities, and long-term-care pharmacies for hospital discharge transitions of care: a targeted needs assessment using the Intervention Mapping framework.
The authors of this study report on the development of a logic model that will be used to explore methods for minimizing patient care medication delays and errors while further improving handoff communication to skilled nurse facilities and long term care pharmacy staff.
AHRQ-funded; HS021984.
Citation: Kerstenetzky L, Birschbach MJ, Beach KF .
Improving medication information transfer between hospitals, skilled-nursing facilities, and long-term-care pharmacies for hospital discharge transitions of care: a targeted needs assessment using the Intervention Mapping framework.
Res Social Adm Pharm 2018 Feb;14(2):138-45. doi: 10.1016/j.sapharm.2016.12.013..
Keywords: Adverse Drug Events (ADE), Hospital Discharge, Hospitals, Long-Term Care, Medical Errors, Medication, Medication: Safety, Nursing Homes, Patient Safety, Transitions of Care
Middleton A, Li S, Kuo YF
New institutionalization in long-term care after hospital discharge to skilled nursing facility.
Approximately half of individuals newly admitted to long-term care (LTC) nursing homes (NHs) experienced a prior hospitalization followed by discharge to a skilled nursing facility (SNF). The objective of this study was to examine characteristics associated with new institutionalizations of older adults on this care trajectory. Associations between risk factors and new LTC institutionalizations varied according to race and ethnicity, age, and level of cognitive function.
AHRQ-funded; HS022134.
Citation: Middleton A, Li S, Kuo YF .
New institutionalization in long-term care after hospital discharge to skilled nursing facility.
J Am Geriatr Soc 2018 Jan;66(1):56-63. doi: 10.1111/jgs.15131..
Keywords: Long-Term Care, Nursing Homes, Hospital Discharge, Elderly, Hospitalization, Medicare
Psoinos CM, Collins CE, Ayturk MD
Post-hospitalization treatment regimen and readmission for C. difficile colitis in Medicare beneficiaries.
C. difficile (CDI) has surpassed methicillin-resistant staph aureus as the most common nosocomial infection with recurrence reaching 30% and the elderly being disproportionately affected. The authors hypothesized that post-discharge antibiotic therapy for continued CDI treatment reduces readmissions. The study concluded that patients discharged with single-drug therapy for CDI had lower readmission rates compared to patients discharged on no ongoing CDI treatment suggesting that short-term monotherapy may be beneficial in inducing eradication and preventing relapse.
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AHRQ-funded; HS022694
Citation: Psoinos CM, Collins CE, Ayturk MD .
Post-hospitalization treatment regimen and readmission for C. difficile colitis in Medicare beneficiaries.
World J Surg 2018 Jan;42(1):246-53. doi: 10.1007/s00268-017-4139-8..
Keywords: Antibiotics, Clostridium difficile Infections, Elderly, Hospital Discharge, Hospital Readmissions
Ellimoottil C, Syrjamaki JD, Volt JD
Validation of a claims-based algorithm to characterize episodes of care.
The Michigan Value Collaborative (MVC) developed a claims-based algorithm to provide hospitals with data on events that occur to patients beyond the hospitalization. In this article, the investigators discuss the validation of MVC's claims-based algorithm. They indicate that their findings suggest that the MVC claims-based algorithm identifies and classifies claims with high fidelity and outperforms medical records in the identification of postdischarge events.
AHRQ-funded; HS024193.
Citation: Ellimoottil C, Syrjamaki JD, Volt JD .
Validation of a claims-based algorithm to characterize episodes of care.
Am J Manag Care 2017 Nov;23(11):e382-e86..
Keywords: Hospital Discharge, Hospital Readmissions, Hospitalization, Hospitals, Quality of Care, Quality Improvement
Jones CD, Jones J, RIchard A
"Connecting the Dots": a qualitative study of home health nurse perspectives on coordinating care for recently discharged patients.
This study described home health care (HHC) nurse perspectives about challenges and solutions to coordinating care for recently discharged patients. HHC nurses described challenges and solutions within domains of Accountability, Communication, Assessing Needs & Goals, and Medication Management. One additional domain of Safety, for both patients and HHC nurses, emerged from the analysis.
AHRQ-funded; HS024569.
Citation: Jones CD, Jones J, RIchard A .
"Connecting the Dots": a qualitative study of home health nurse perspectives on coordinating care for recently discharged patients.
J Gen Intern Med 2017 Oct;32(10):1114-21. doi: 10.1007/s11606-017-4104-0.
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Keywords: Care Coordination, Elderly, Home Healthcare, Health Services Research (HSR), Hospital Discharge
Quinn JM, Sparks M, Gephart SM
Discharge criteria for the late preterm infant: a review of the literature.
The purpose of this literature review was to examine differences in late preterm infant (LPI) discharge criteria between the well newborn setting and the NICU by answering the clinical questions, "What are the recommended discharge criteria for the LPI and do they differ if admitted to the well newborn setting versus the NICU?"
AHRQ-funded; HS022908.
Citation: Quinn JM, Sparks M, Gephart SM .
Discharge criteria for the late preterm infant: a review of the literature.
Adv Neonatal Care 2017 Oct;17(5):362-71. doi: 10.1097/anc.0000000000000406..
Keywords: Hospital Discharge, Newborns/Infants, Newborns/Infants
Tedesco D, Asch SM, Curtin C
Opioid abuse and poisoning: trends in inpatient and emergency department discharges.
This study analyzed national trends in inpatient and emergency department (ED) discharges for opioid abuse, dependence, and poisoning using Healthcare Cost and Utilization Project data.
AHRQ-funded; HS024096.
Citation: Tedesco D, Asch SM, Curtin C .
Opioid abuse and poisoning: trends in inpatient and emergency department discharges.
Health Aff 2017 Oct;36(10):1748-53. doi: 10.1377/hlthaff.2017.0260..
Keywords: Emergency Department, Healthcare Cost and Utilization Project (HCUP), Hospital Discharge, Opioids, Substance Abuse
Sobotka SA, Agarwal RK, Msall ME
Prolonged hospital discharge for children with technology dependency: a source of health care disparities.
As the population of children who use medical technology such as long-term ventilation increases, it is important to critically evaluate the systems for preparing families for home life. The authors discuss the complication of hospital discharge and how it contributes to health and developmental disparities. They also describe a hospital-to-home transitional care model, which presents a home-like environment to provide developmental support while focusing on parental training, home nursing, and public-funding arrangements.
AHRQ-funded; HS023007.
Citation: Sobotka SA, Agarwal RK, Msall ME .
Prolonged hospital discharge for children with technology dependency: a source of health care disparities.
Pediatr Ann 2017 Oct;46(10):e365-e70. doi: 10.3928/19382359-20170919-01.
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Keywords: Children/Adolescents, Disparities, Home Healthcare, Hospital Discharge, Medical Devices
Chavez LJ, Liu CF, Tefft N
The association between unhealthy alcohol use and acute care expenditures in the 30 days following hospital discharge among older Veterans Affairs patients with a medical condition.
Heavy alcohol use could predict increased risk for post-discharge acute care. This study assessed 30-day acute care utilization and expenditures for different categories of alcohol use, using VA and Medicare health care utilization data.
AHRQ-funded; HS022800.
Citation: Chavez LJ, Liu CF, Tefft N .
The association between unhealthy alcohol use and acute care expenditures in the 30 days following hospital discharge among older Veterans Affairs patients with a medical condition.
J Behav Health Serv Res 2017 Oct;44(4):602-24. doi: 10.1007/s11414-016-9529-4..
Keywords: Alcohol Use, Hospital Discharge
Holland DE, Brandt C, Targonski PV
Validating performance of a hospital discharge planning decision tool in community hospitals.
The researchers aimed to determine the predictive performance of the Early Screen for Discharge Planning (ESDP) in a rural regional community hospital practice setting. Patients with high ESDP scores reported more problems after discharge, reported lower quality of life, had longer length of stays, and used post-acute care services more than patients with low ESDP scores.
AHRQ-funded; HS022923.
Citation: Holland DE, Brandt C, Targonski PV .
Validating performance of a hospital discharge planning decision tool in community hospitals.
Prof Case Manag 2017 Sep/Oct;22(5):204-13. doi: 10.1097/ncm.0000000000000233.
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Keywords: Decision Making, Hospital Discharge, Outcomes, Rural Health, Tools & Toolkits
Dharmarajan K, Qin L, Bierlein M
Outcomes after observation stays among older adult Medicare beneficiaries in the USA: retrospective cohort study.
This study characterized rates and trends over time of emergency department treatment-and-discharge stays, repeat observation stays, inpatient stays, any hospital revisit, and death within 30 days of discharge from observation stays. Hospital revisits are common after discharge from observation stays, frequently result in inpatient hospitalizations, and have increased over time among Medicare beneficiaries.
AHRQ-funded; HS023000.
Citation: Dharmarajan K, Qin L, Bierlein M .
Outcomes after observation stays among older adult Medicare beneficiaries in the USA: retrospective cohort study.
BMJ 2017 Jun 20;357:j2616. doi: 10.1136/bmj.j2616.
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Keywords: Elderly, Emergency Department, Hospital Discharge, Hospital Readmissions, Medicare
Henke RM, Karaca Z, Jackson P
AHRQ Author: Karaca Z; Wong HS
Discharge planning and hospital readmissions.
This study examines the association between the quality of hospital discharge planning and all-cause 30-day readmissions and same-hospital readmissions. Discharge-planning quality was associated with (a) lower rates of 30-day hospital readmissions and (b) higher rates of same-hospital readmissions for heart failure, pneumonia, and total hip or joint replacement. These results suggest that by improving inpatient discharge planning, hospitals may be able to influence their 30-day readmissions.
AHRQ-authored; AHRQ-funded.
Citation: Henke RM, Karaca Z, Jackson P .
Discharge planning and hospital readmissions.
Med Care Res Rev 2017 Jun;74(3):345-68. doi: 10.1177/1077558716647652.
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Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Hospital Discharge, Hospital Readmissions, Hospitals, Hospitalization
Middleton A, Zhou J, Ottenbacher KJ
Hospital variation in rates of new institutionalizations within 6 months of discharge.
The primary objective of this study was to examine the hospital-level variation in rates of new institutionalizations among Medicare beneficiaries. The overall observed rate of new institutionalizations was 3.6 percent (N = 173,998). Older age, white race, Medicaid eligibility, longer hospitalization, and having a skilled nursing facility stay over the 6 months before hospitalization were associated with higher adjusted odds. Observed rates ranged from 0.9 percent to 5.9 percent across states.
AHRQ-funded; HS022134.
Citation: Middleton A, Zhou J, Ottenbacher KJ .
Hospital variation in rates of new institutionalizations within 6 months of discharge.
J Am Geriatr Soc 2017 Jun;65(6):1206-13. doi: 10.1111/jgs.14760.
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Keywords: Hospitalization, Elderly, Nursing Homes, Hospital Discharge
Regenbogen SE, Cain-Nielsen AH, Norton EC
Costs and consequences of early hospital discharge after major inpatient surgery in older adults.
This study evaluated the association between early postoperative discharge practices and overall surgical episode spending and expenditures for postdischarge care use and readmissions. It concluded that early routine postoperative discharge after major inpatient surgery is associated with lower total surgical episode payments. There is no evidence that savings from shorter postsurgical hospitalization are offset by higher postdischarge care spending.
AHRQ-funded; HS024698.
Citation: Regenbogen SE, Cain-Nielsen AH, Norton EC .
Costs and consequences of early hospital discharge after major inpatient surgery in older adults.
JAMA Surg 2017 May 17;152(5):e170123. doi: 10.1001/jamasurg.2017.0123.
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Keywords: Elderly, Surgery, Hospital Discharge, Healthcare Costs, Outcomes
Attanasio LB, Kozhimannil KB, Srinivas SK
Concordance between women's self-reported reasons for cesarean delivery and hospital discharge records.
Researchers compared women's self-reported reasons for cesarean with their hospital discharge records and examined correlates of variability in agreement between sources. Ninety-one percent of women reported a reason for their cesarean that was present in the discharge data. Positive predictive value (PPV), the probability that women's self-reported reasons for cesarean varied by reason for cesarean, with high PPV for dystocia, macrosomia, and cephalopelvic disproportion (91.1 percent), and lower PPV for malposition (81.7 percent).
AHRQ-funded; HS024215.
Citation: Attanasio LB, Kozhimannil KB, Srinivas SK .
Concordance between women's self-reported reasons for cesarean delivery and hospital discharge records.
Womens Health Issues 2017 May - Jun;27(3):329-35. doi: 10.1016/j.whi.2016.12.006.
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Keywords: Hospital Discharge, Labor and Delivery, Pregnancy, Women
Buys DR, Campbell AD, Godfryd A
Meals enhancing nutrition after discharge: findings from a pilot randomized controlled trial.
This pilot study's objective was to evaluate the feasibility of conducting a randomized controlled trial assessing a post-discharge home-delivered meal program's impact on older adults' nutritional intake and hospital readmissions and to assess patient acceptability and satisfaction with the program. It found that participants were overwhelmingly satisfied (82 percent to 100 percent satisfied or very satisfied) with staff performance, meal quality, and delivery processes.
AHRQ-funded; HS013852.
Citation: Buys DR, Campbell AD, Godfryd A .
Meals enhancing nutrition after discharge: findings from a pilot randomized controlled trial.
J Acad Nutr Diet 2017 Apr;117(4):599-608. doi: 10.1016/j.jand.2016.11.005.
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Keywords: Nutrition, Patient Experience, Elderly, Home Healthcare, Hospital Discharge