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
151 to 175 of 220 Research Studies DisplayedUnaka NI, Statile A, Haney J
Assessment of readability, understandability, and completeness of pediatric hospital medicine discharge instructions.
A cross-sectional study was conducted at a large urban academic children's hospital to describe readability levels, understandability scores, and completeness of written instructions given to families at hospital discharge. The investigators found that overall, the readability, understandability, and completeness of discharge instructions were subpar. Efforts to improve the content of discharge instructions may promote safe and effective transitions home.
AHRQ-funded; HS023827.
Citation: Unaka NI, Statile A, Haney J .
Assessment of readability, understandability, and completeness of pediatric hospital medicine discharge instructions.
J Hosp Med 2017 Feb;12(2):98-101. doi: 10.12788/jhm.2688..
Keywords: Children/Adolescents, Health Literacy, Hospital Discharge, Children/Adolescents
Nguyen OK, Makam AN, Clark C
Vital signs are still vital: instability on discharge and the risk of post-discharge adverse outcomes.
This study assessed the association between vital sign instability at hospital discharge and post-discharge adverse outcomes. Having two or more vital sign instabilities at discharge had a positive predictive value of 22 percent and positive likelihood ratio of 1.8 for 30-day death or readmission. Vital sign instability on discharge is thus associated with increased risk-adjusted rates of 30-day mortality and readmission.
AHRQ-funded; HS022418.
Citation: Nguyen OK, Makam AN, Clark C .
Vital signs are still vital: instability on discharge and the risk of post-discharge adverse outcomes.
J Gen Intern Med 2017 Jan;32(1):42-48. doi: 10.1007/s11606-016-3826-8.
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Keywords: Hospital Discharge, Hospital Readmissions, Patient-Centered Outcomes Research, Risk
Mukamel DB, Amin A, Weimer DL
Personalizing nursing home compare and the discharge from hospitals to nursing homes.
This study tested whether use of a personalized report card, Nursing Home Compare Plus (NHCPlus), embedded in a reengineered discharge process, can lead to better outcomes than the usual discharge process from hospitals to nursing homes. It found that about 85 percent of users indicated satisfaction with NHCPlus. Compared to controls, intervention patients were more satisfied with the choice process.
AHRQ-funded; R21 HS021844.
Citation: Mukamel DB, Amin A, Weimer DL .
Personalizing nursing home compare and the discharge from hospitals to nursing homes.
Health Serv Res 2016 Dec;51(6):2076-94. doi: 10.1111/1475-6773.12588.
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Keywords: Hospital Discharge, Hospitals, Nursing Homes, Patient Experience, Quality Indicators (QIs)
Broecker M, Ponto K, Tredinnick R
SafeHOME: promoting safe transitions to the home.
This paper introduces the SafeHome Simulator system, a set of immersive Virtual Reality Training tools and display systems to train patients in safe discharge procedures in captured environments of their actual houses. The aim is to lower patient readmission by significantly improving discharge planning and training. The SafeHOME Simulator is a project currently under review.
AHRQ-funded; HS022548.
Citation: Broecker M, Ponto K, Tredinnick R .
SafeHOME: promoting safe transitions to the home.
Stud Health Technol Inform 2016;220:51-4.
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Keywords: Transitions of Care, Health Information Technology (HIT), Patient Safety, Patient Self-Management, Hospital Discharge
Werner NE, Gurses AP, Leff B
Improving care transitions across healthcare settings through a human factors approach.
This article describes how a systems' approach known as Human Factors and Ergonomics can complement and further strengthen efforts to improve care transitions.
AHRQ-funded; HS022916.
Citation: Werner NE, Gurses AP, Leff B .
Improving care transitions across healthcare settings through a human factors approach.
J Healthc Qual 2016 Nov/Dec;38(6):328-43. doi: 10.1097/jhq.0000000000000025.
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Keywords: Healthcare Delivery, Provider, Hospital Discharge, Patient Safety, Transitions of Care
Garfield CF, Simon CD, Rutsohn J
Paternal and maternal testosterone in parents of NICU infants transitioning home.
This study examined testosterone levels for parents of very low-birth-weight infants, including links between salivary testosterone and infant factors (such as breast-feeding), psychosocial stress, and changes over time. Using multilevel modeling approaches, the researchers reported significant associations between paternal testosterone by time and psychosocial adjustment and between both paternal and maternal testosterone and infant feeding mode.
AHRQ-funded; R21 HS020316.
Citation: Garfield CF, Simon CD, Rutsohn J .
Paternal and maternal testosterone in parents of NICU infants transitioning home.
J Perinat Neonatal Nurs 2016 Oct/Dec;30(4):349-58. doi: 10.1097/jpn.0000000000000218.
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Keywords: Newborns/Infants, Stress, Caregiving, Hospital Discharge
Jones CE, Hollis RH, Wahl TS
Transitional care interventions and hospital readmissions in surgical populations: a systematic review.
The researchers performed a systematic review of transitional care interventions and their effect on hospital readmissions after surgery. Discharge planning programs reduced readmissions by 11.5 percent , 12.5 percent, and 23 percent . Patient education interventions reduced readmissions by 14 percent and 23.5 percent . Primary care follow-up reduced readmissions by 8.3 percent for patients after high-risk surgeries . Home visits reduced readmissions by 7.7 percent and 4 percent, respectively.
AHRQ-funded; HS013852.
Citation: Jones CE, Hollis RH, Wahl TS .
Transitional care interventions and hospital readmissions in surgical populations: a systematic review.
Am J Surg 2016 Aug;212(2):327-35. doi: 10.1016/j.amjsurg.2016.04.004.
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Keywords: Education: Patient and Caregiver, Hospital Discharge, Hospital Readmissions, Transitions of Care
Kavalieratos D, Rollman BL, Arnold RM
Homeward Bound, not hospital rebound: how transitional palliative care can reduce readmission.
Comment on a study concerning heart failure palliative care interventions.
AHRQ-funded; HS022989.
Citation: Kavalieratos D, Rollman BL, Arnold RM .
Homeward Bound, not hospital rebound: how transitional palliative care can reduce readmission.
Heart 2016 Jul 15;102(14):1079-80. doi: 10.1136/heartjnl-2016-309385.
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Keywords: Heart Disease and Health, Hospital Discharge, Hospital Readmissions, Palliative Care
Smith KJ, Handler SM, Kapoor WN
Automated communication tools and computer-based medication reconciliation to decrease hospital discharge medication errors.
This study examines a health care system’s implementation of a broader set of automated primary care physician communication tools, including computerized medication reconciliation, and its impact on discharge medication errors. It found that implementation of automated health system–based tools, including computerized discharge medication reconciliation, decreased hospital discharge medication errors in medically complex patients.
AHRQ-funded; HS018151.
Citation: Smith KJ, Handler SM, Kapoor WN .
Automated communication tools and computer-based medication reconciliation to decrease hospital discharge medication errors.
Am J Med Qual 2016 Jul;31(4):315-22. doi: 10.1177/1062860615574327..
Keywords: Health Information Technology (HIT), Communication, Medication, Medical Errors, Hospital Discharge
Blecker S, Gavin NP, Park H
Observation units as substitutes for hospitalization or home discharge.
The purpose of this study is to determine the effect of the availability of observation units on hospitalizations and discharges to home for emergency department (ED) patients. The authors concluded that half of ED visits for chest pain that resulted in an observation unit admission were made by patients who may have been discharged home had the observation unit not been available.
AHRQ-funded; HS023683.
Citation: Blecker S, Gavin NP, Park H .
Observation units as substitutes for hospitalization or home discharge.
Ann Emerg Med 2016 Jun;67(6):706-13.e2. doi: 10.1016/j.annemergmed.2015.10.025.
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Keywords: Hospitalization, Hospital Discharge, Emergency Department, Emergency Medical Services (EMS)
Shy BD, Kim EY, Genes NG
Increased identification of emergency department 72-hour returns using multihospital health information exchange.
The authors tested the use of a health information exchange (HIE) to improve identification of 72-hour return visits compared to individual hospitals' site-specific data. They found that HIE increased the identification ability of 72-hour ED return analyses by a mean of 11.16% compared with site-specific (no HIE) analyses. They concluded that their analysis demonstrates incremental improvements in the ability to identify early ED returns using increasing levels of HIE data aggregation.
AHRQ-funded; HS021261.
Citation: Shy BD, Kim EY, Genes NG .
Increased identification of emergency department 72-hour returns using multihospital health information exchange.
Acad Emerg Med 2016 May;23(5):645-9. doi: 10.1111/acem.12954.
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Keywords: Emergency Department, Health Information Exchange (HIE), Hospital Discharge, Hospital Readmissions
Garfield CF, Lee YS, Kim HN
Supporting parents of premature infants transitioning from the NICU to home: a pilot randomized control trial of a smartphone application.
This study determined whether parents of Very Low Birth Weight (VLBW) infants in the Neonatal Intensive Care Unit (NICU) transitioning home with the NICU-2-Home smartphone application have greater parenting self-efficacy, are better prepared for discharge and have shorter length of stay (LOS) than control parents. It found that a smartphone application can improve parenting self-efficacy, discharge preparedness, and LOS with improved benefits based on usage.
AHRQ-funded; HS020316.
Citation: Garfield CF, Lee YS, Kim HN .
Supporting parents of premature infants transitioning from the NICU to home: a pilot randomized control trial of a smartphone application.
Internet Interv 2016 May;4(Pt 2):131-37. doi: 10.1016/j.invent.2016.05.004.
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Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Health Information Technology (HIT), Home Healthcare, Hospital Discharge
Faridi KF, Peterson ED, McCoy LA
Timing of first postdischarge follow-up and medication adherence after acute myocardial infarction.
The investigators sought to determine whether earlier outpatient follow-up after acute myocardial infarction (AMI) is associated with higher rates of medication adherence. They found that delayed outpatient follow-up beyond the first 6 weeks after AMI is associated with worse short-term and long-term patient medication adherence. They concluded that medication adherence is modifiable via improved care transitions.
AHRQ-funded; HS021092.
Citation: Faridi KF, Peterson ED, McCoy LA .
Timing of first postdischarge follow-up and medication adherence after acute myocardial infarction.
JAMA Cardiol 2016 May 1;1(2):147-55. doi: 10.1001/jamacardio.2016.0001.
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Keywords: Hospital Discharge, Medication, Heart Disease and Health, Patient Adherence/Compliance, Patient-Centered Healthcare
Vora AN, Peterson ED, Hellkamp AS
Care transitions after acute myocardial infarction for transferred-in versus direct-arrival patients.
Many patients in the United States require transfer from one hospital to another for acute myocardial infarction (MI) care. How well these transferred-in patients are transitioned back to their local community is unknown. This study found that transferred-in patients with acute MI are less likely to have outpatient clinic follow-up within 30 days and more likely to be readmitted within the first 30 days post discharge compared with direct-arrival patients.
AHRQ-funded; HS021092.
Citation: Vora AN, Peterson ED, Hellkamp AS .
Care transitions after acute myocardial infarction for transferred-in versus direct-arrival patients.
Circ Cardiovasc Qual Outcomes 2016 Mar;9(2):109-16. doi: 10.1161/circoutcomes.115.002108.
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Keywords: Transitions of Care, Hospital Readmissions, Cardiovascular Conditions, Patient-Centered Outcomes Research, Hospital Discharge
Ong MK, Romano PS, Edgington S
Effectiveness of remote patient monitoring after discharge of hospitalized patients with heart failure: the better effectiveness after transition-heart failure (BEAT-HF) randomized clinical trial.
The researchers evaluated the effectiveness of a care transition intervention using remote patient monitoring in reducing 180-day all-cause readmissions among a broad population of older adults hospitalized with HF. Theyn found that intervention and usual care groups did not differ significantly in readmissions for any cause 180 days after discharge.
AHRQ-funded; HS019311.
Citation: Ong MK, Romano PS, Edgington S .
Effectiveness of remote patient monitoring after discharge of hospitalized patients with heart failure: the better effectiveness after transition-heart failure (BEAT-HF) randomized clinical trial.
JAMA Intern Med 2016 Mar;176(3):310-8. doi: 10.1001/jamainternmed.2015.7712.
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Keywords: Heart Disease and Health, Hospital Readmissions, Telehealth, Quality of Life, Hospital Discharge
Mitchell SE, Martin J, Holmes S
AHRQ Author: Brach C
How hospitals reengineer their discharge processes to reduce readmissions.
The Re-Engineered Discharge (RED) program is a hospital-based initiative shown to decrease hospital reutilization. Researchers implemented the RED in 10 hospitals to study the implementation process. They found wide variability in the fidelity of the RED intervention. Engaged leadership and multidisciplinary implementation teams were keys to success of the program. Eight out of 10 hospitals reported improvement in 30-day readmission rates after RED implementation.
AHRQ-authored; AHRQ-funded; 290200600012I.
Citation: Mitchell SE, Martin J, Holmes S .
How hospitals reengineer their discharge processes to reduce readmissions.
J Healthc Qual 2016 Mar-Apr;38(2):116-26. doi: 10.1097/jhq.0000000000000005..
Keywords: Hospital Discharge, Hospital Readmissions, Quality Improvement
Dharmarajan K, Chaudhry SI
New approaches to reduce readmissions in patients with heart failure.
The authors discuss a study by Ong and colleagues that presents the results of Better Effectiveness After Transition–Heart Failure (BEATHF), a randomized clinical trial of a combined telemonitoring and care transitions intervention to prevent readmission in patients with heart failure. The BEAT-HF intervention did not lower readmissions after hospitalization for heart failure.
AHRQ-funded; HS023554.
Citation: Dharmarajan K, Chaudhry SI .
New approaches to reduce readmissions in patients with heart failure.
JAMA Intern Med 2016 Mar;176(3):318-20. doi: 10.1001/jamainternmed.2015.7993.
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Keywords: Heart Disease and Health, Hospital Discharge, Hospital Readmissions, Quality of Life, Transitions of Care
Kansagara D, Chiovaro JC, Kagen D
So many options, where do we start? An overview of the care transitions literature.
The purpose of this paper is to summarize the health and utilization effects of transitional care interventions, and to identify common themes about intervention types, patient populations, or settings that modify these effects. The authors found evidence that enhanced discharge planning and hospital-at-home interventions reduced readmissions. They further found that transitional care interventions reduced readmission in patients with congestive heart failure and general medical populations.
AHRQ-funded; HS022981.
Citation: Kansagara D, Chiovaro JC, Kagen D .
So many options, where do we start? An overview of the care transitions literature.
J Hosp Med 2016 Mar;11(3):221-30. doi: 10.1002/jhm.2502.
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Keywords: Caregiving, Hospital Discharge, Hospital Readmissions, Transitions of Care
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
Wong EG, Parker AM, Leung DG
Association of severity of illness and intensive care unit readmission: a systematic review.
This study sought to determine whether ICU readmission is associated with higher severity of illness scores in adult patients. In most of the 31 studies included in the analysis, severity of illness scores were higher in patients readmitted to the ICU. Readmission was also associated with higher mortality and longer ICU and hospital stays.
AHRQ-funded; HS022916.
Citation: Wong EG, Parker AM, Leung DG .
Association of severity of illness and intensive care unit readmission: a systematic review.
Heart Lung 2016 Jan-Feb;45(1):3-9.e2. doi: 10.1016/j.hrtlng.2015.10.040.
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Keywords: Intensive Care Unit (ICU), Hospital Readmissions, Hospital Discharge, Outcomes
Jubelt LE, Goldfeld KS, Chung WY
Changes in discharge location and readmission rates under Medicare bundled payment.
To control costs, NYU Langone Medical Center attempted to shift referrals from facility-based to home-based postacute care. In the context of this shift in referrals, the researchers examined the change in hospital readmission rates. Their findings suggest that institutions may be able to shift some patients from facility-based to home-based postacute care without adversely affecting hospital readmission rates or the length of hospital stay.
AHRQ-funded; HS023683; HS022882.
Citation: Jubelt LE, Goldfeld KS, Chung WY .
Changes in discharge location and readmission rates under Medicare bundled payment.
JAMA Intern Med 2016 Jan;176(1):115-7. doi: 10.1001/jamainternmed.2015.6265.
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Keywords: Medicare, Hospital Discharge, Hospital Readmissions, Home Healthcare, Healthcare Costs
Parriott AM, Arah OA
Patient volumes and pre- and postdischarge postpartum infection: a retrospective cohort study.
The researchers examined the association between hospital and clinician obstetric volume and postpartum infection risk in the pre- and postdischarge periods. They found that hospital obstetric volume is positively associated with predischarge postpartum infections, whereas clinician volume may be negatively associated with those predischarge infections.
AHRQ-funded; HS000046.
Citation: Parriott AM, Arah OA .
Patient volumes and pre- and postdischarge postpartum infection: a retrospective cohort study.
Am J Infect Control 2016 Jan;44(1):30-5. doi: 10.1016/j.ajic.2015.08.018.
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Keywords: Healthcare-Associated Infections (HAIs), Hospital Discharge, Labor and Delivery, Maternal Care, Patient Safety
Mitchell SE, Martin JM, Krizman K
Design and rationale for a randomized controlled trial to reduce readmissions among patients with depressive symptoms.
This study aims to examine the effectiveness of RED-D, a modified brief Cognitive behavioral therapy (CBT) protocol delivered as a post-discharge extension of the Re-Engineered Discharge (RED), in reducing 30-day readmissions rates and emergency department use as well as depressive symptoms for medical patients with comorbid depressive symptoms.
AHRQ-funded; HS019700.
Citation: Mitchell SE, Martin JM, Krizman K .
Design and rationale for a randomized controlled trial to reduce readmissions among patients with depressive symptoms.
Contemp Clin Trials 2015 Nov;45(Pt B):151-6. doi: 10.1016/j.cct.2015.08.016.
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Keywords: Depression, Emergency Department, Hospital Discharge, Hospital Readmissions, Behavioral Health
Gabayan GZ, Derose SF, Chiu VY
Emergency department crowding and outcomes after emergency department discharge.
The researchers assess whether a panel of emergency department (ED) crowding measures, including 2 reported by the Centers for Medicare & Medicaid Services (CMS), is associated with inpatient admission and death within 7 days of ED discharge. Their findings suggest that ED length of stay is a proxy for unmeasured differences in case mix and challenge the validity of the CMS metric as a safety measure for discharged patients.
AHRQ-funded; HS018098.
Citation: Gabayan GZ, Derose SF, Chiu VY .
Emergency department crowding and outcomes after emergency department discharge.
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Keywords: Emergency Department, Emergency Medical Services (EMS), Hospital Discharge, Outcomes, Hospitalization
Blecker S, Goldfeld K, Park H
Impact of an intervention to improve weekend hospital care at an academic medical center: an observational study.
The purpose of this study was to evaluate the impact of a weekend hospital intervention on processes of care and clinical outcomes. The multifaceted intervention included expanded weekend diagnostic services, improved weekend discharge processes, and increased physician and care management services on weekends. The intervention was associated with a reduction in length of stay and an increase in weekend discharges.
AHRQ-funded; HS023683.
Citation: Blecker S, Goldfeld K, Park H .
Impact of an intervention to improve weekend hospital care at an academic medical center: an observational study.
J Gen Intern Med 2015 Nov;30(11):1657-64. doi: 10.1007/s11606-015-3330-6.
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Keywords: Quality Improvement, Quality of Care, Hospitals, Hospital Discharge, Hospital Readmissions, Healthcare Delivery, Outcomes, Patient-Centered Outcomes Research