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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 221 Research Studies DisplayedNanji KC, Seger DL, Slight SP
Medication-related clinical decision support alert overrides in inpatients.
This study examined the use of medical-related clinical decision support alert overrides by clinicians in hospital inpatient settings. Overall, almost three-quarters of alerts were overridden, with 40% of them not being appropriate. The majority of overrides dealing with duplicate drug, patient allergy or formulary substitution alerts were appropriate but very few for renal- or age-based were. The authors concluded that research should be done to optimize alert types and frequencies to reduce alarm fatigue.
AHRQ-funded; HS024764.
Citation: Nanji KC, Seger DL, Slight SP .
Medication-related clinical decision support alert overrides in inpatients.
J Am Med Inform Assoc 2018 May;25(5):476-81. doi: 10.1093/jamia/ocx115..
Keywords: Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT), Inpatient Care, Medication
Wickremasinghe AC, Kuzniewicz MW, McCulloch CE
Efficacy of subthreshold newborn phototherapy during the birth hospitalization in preventing readmission for phototherapy.
The purpose of this study was to estimate the efficacy of subthreshold phototherapy for newborns with total serum bilirubin (TSB) levels from 0.1 to 3.0 mg/dL below the appropriate AAP phototherapy threshold during the birth hospitalization in preventing readmissions for phototherapy, and to identify predictors of readmission for phototherapy. The investigators concluded that subthreshold phototherapy during the birth hospitalization is effective in preventing readmissions for phototherapy; however, for each readmission prevented, many newborns require phototherapy who would otherwise not need it.
AHRQ-funded; HS020618.
Citation: Wickremasinghe AC, Kuzniewicz MW, McCulloch CE .
Efficacy of subthreshold newborn phototherapy during the birth hospitalization in preventing readmission for phototherapy.
JAMA Pediatr 2018 Apr;172(4):378-85. doi: 10.1001/jamapediatrics.2017.5630..
Keywords: Children/Adolescents, Evidence-Based Practice, Hospital Readmissions, Hospitalization, Inpatient Care, Newborns/Infants
Gani F, Enumah ZO, Conca-Cheng AM
Palliative care utilization among patients admitted for gastrointestinal and thoracic cancers.
Although a growing body of literature recommends the early initiation of palliative care (PC), the use of PC remains variable. The current study sought to describe the use of PC and to identify factors associated with the use of inpatient PC. The investigators found that among patients admitted for cancer, PC services were used in 8.5% of patients during their inpatient admission with surgical patients being 79% less likely to receive a PC consultation.
AHRQ-funded; HS024736.
Citation: Gani F, Enumah ZO, Conca-Cheng AM .
Palliative care utilization among patients admitted for gastrointestinal and thoracic cancers.
J Palliat Med 2018 Apr;21(4):428-37. doi: 10.1089/jpm.2017.0295..
Keywords: Cancer, Palliative Care, Healthcare Utilization, Inpatient Care
Parast L, Bardach NS, Burkhart Q
Development of new quality measures for hospital-based care of suicidal youth.
This study researched the value of 4 new quality measures developed to assess hospital-based care for suicidal youth. The four quality measures focused on counseling caregivers about restricting access to lethal means of self-harm, and the benefits and risks of antidepressant medications. They were divided into measures for the emergency department (ED) and inpatient measures. Survey field tests were conducted with caregivers of youth who were admitted to the ED or inpatient care for suicidality at 1 of 2 children’s hospitals between July 2013 and June 2014. Most caregivers did receive counseling about restricting their child’s access to lethal means of self-harm and also reported higher rates of counseling of benefits on antidepressants both in the ED and in the inpatient setting than the risks.
AHRQ-funded; HS020506.
Citation: Parast L, Bardach NS, Burkhart Q .
Development of new quality measures for hospital-based care of suicidal youth.
Acad Pediatr 2018 Apr;18(3):248-55. doi: 10.1016/j.acap.2017.09.017..
Keywords: Caregiving, Children/Adolescents, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Education: Patient and Caregiver, Emergency Department, Hospitalization, Hospitals, Inpatient Care, Behavioral Health, Prevention, Quality of Care, Quality Measures
Keohane LM, Trivedi AN, Mor V
The role of Medicare's inpatient cost-sharing in Medicaid entry.
This study sought to isolate the effect of greater inpatient cost-sharing on Medicaid entry among Medicare beneficiaries. It concluded that Increasing Medicare cost-sharing requirements may promote Medicaid enrollment among low-income beneficiaries. Potential savings from an increased cost-sharing in the Medicare program may be offset by increased Medicaid participation.
AHRQ-funded; HS023016.
Citation: Keohane LM, Trivedi AN, Mor V .
The role of Medicare's inpatient cost-sharing in Medicaid entry.
Health Serv Res 2018 Apr;53(2):711-29. doi: 10.1111/1475-6773.12682.
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Keywords: Healthcare Costs, Inpatient Care, Medicaid, Medicare
Dynan L, Goudie A, Brady PW
Pediatric adverse event rates associated with inexperience in teaching hospitals: a multilevel analysis.
In this article, the investigators hypothesize that adverse event rates increase with the availability of more complex services and technologies (transplantation and pediatric open-heart surgery); increase as experience of providers decreases (July effect); and increase with residents per bed, a measure of both average provider inexperience and congestion. Using multilevel analysis, they found empirical evidence in support of their three hypotheses.
AHRQ-funded; HS023827.
Citation: Dynan L, Goudie A, Brady PW .
Pediatric adverse event rates associated with inexperience in teaching hospitals: a multilevel analysis.
J Healthc Qual 2018 Mar/Apr;40(2):69-78. doi: 10.1097/jhq.0000000000000121..
Keywords: Children/Adolescents, Healthcare Cost and Utilization Project (HCUP), Adverse Events, Hospitals, Inpatient Care, Medical Errors, Patient Safety
Chen LM, Levine DA, Hayward R
Relationship between hospital 30-day mortality rates for heart failure and patterns of early inpatient comfort care.
This study describes the use of early comfort care for patients with heart failure (HF), and whether hospitals that more commonly initiate comfort care have higher 30-day mortality rates. It found that hospital use of early comfort care for HF varies, has not increased over time, and on average, is not correlated with 30-day risk-standardized mortality rates.
AHRQ-funded; HS020671.
Citation: Chen LM, Levine DA, Hayward R .
Relationship between hospital 30-day mortality rates for heart failure and patterns of early inpatient comfort care.
J Hosp Med 2018 Mar;13(3):170-76. doi: 10.12788/jhm.2862.
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Keywords: Cardiovascular Conditions, Elderly, Heart Disease and Health, Inpatient Care, Mortality, Palliative Care
Goodwin JS, Salameh H, Zhou J
Association of hospitalist years of experience with mortality in the hospitalized Medicare population.
The purpose of the study is to describe the association of hospitalist years of experience with 30-day mortality and hospital mortality of their patients. The authors noted that patients cared for by hospitalists in their first year of practice experienced higher mortality. The authors asserted that early-career hospitalists may require additional support to ensure optimal outcomes for their patients.
AHRQ-funded; HS022134.
Citation: Goodwin JS, Salameh H, Zhou J .
Association of hospitalist years of experience with mortality in the hospitalized Medicare population.
JAMA Intern Med 2018 Feb;178(2):196-203. doi: 10.1001/jamainternmed.2017.7049..
Keywords: Hospitalization, Inpatient Care, Medicare, Mortality, Provider
Paje D, Conlon A, Kaatz S
Patterns and predictors of short-term peripherally inserted central catheter use: a multicenter prospective cohort study.
The goal of this study was to identify patient, provider, and device characteristics and the clinical outcomes associated with short-term peripherally inserted central catheters (PICCs). Trained abstractors collected data from the medical records of adults that received PICCs during hospitalization; patients were prospectively followed until PICC removal, death, or 70 days after insertion. Complications associated with short-term use were assessed. Major complications included venous thromboembolism or central line associated bloodstream infection. Common minor complications were catheter occlusion and tip migration.
AHRQ-funded; HS022835.
Citation: Paje D, Conlon A, Kaatz S .
Patterns and predictors of short-term peripherally inserted central catheter use: a multicenter prospective cohort study.
J Hosp Med 2018 Feb;13(2):76-82. doi: 10.12788/jhm.2847..
Keywords: Adverse Events, Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Inpatient Care, Patient Safety, Practice Patterns
Kaiser SV, Rodean J, Bekmezian A
Rising utilization of inpatient pediatric asthma pathways.
The objectives of this study were to: 1) Describe inpatient pediatric asthma pathway design and implementation across a large hospital network and (2) Compare characteristics of hospitals with and without pathways. The investigators concluded that from 2005-2015, there was a dramatic rise in implementation of inpatient pediatric asthma pathways. They found variation in many aspects of pathway design and implementation.
AHRQ-funded; HS024554; HS024592.
Citation: Kaiser SV, Rodean J, Bekmezian A .
Rising utilization of inpatient pediatric asthma pathways.
J Asthma 2018 Feb;55(2):196-207. doi: 10.1080/02770903.2017.1316392..
Keywords: Asthma, Care Coordination, Children/Adolescents, Inpatient Care
Yen PY, Walker DM, Smith JMG
Usability evaluation of a commercial inpatient portal.
The authors aimed to understand how users interact with, learn to use, and communicate with their providers through an inpatient portal. They found that participants frequently made operational errors in navigation and assuming non-existent functionalities; participants' learning styles varied, with age as a potential factor that influenced how they learned MyChart Bedside; and participants preferred to message providers individually and wanted feedback on status. They concluded that, for inpatient portals to be effective in promoting patient engagement, it remains critical for technology developers and hospital administrators to understand how users interact with this technology and the resources that may be necessary to support its use.
AHRQ-funded; HS024091.
Citation: Yen PY, Walker DM, Smith JMG .
Usability evaluation of a commercial inpatient portal.
Int J Med Inform 2018 Feb;110:10-18. doi: 10.1016/j.ijmedinf.2017.11.007.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Inpatient Care, Patient and Family Engagement, Web-Based
Walker DM, Menser T, Yen PY
Optimizing the user experience: identifying opportunities to improve use of an inpatient portal.
This study aimed to evaluate the user experience associated with an inpatient portal. The authors concluded that inpatient portals may be an effective tool to improve the patient experience in the hospital and making this technology available to inpatients may help to foster ongoing use of technology across the care continuum. However, deriving the benefits from the technology requires appropriate support. The investigators identified multiple opportunities for hospital management to intervene.
AHRQ-funded; HS024091; HS024349.
Citation: Walker DM, Menser T, Yen PY .
Optimizing the user experience: identifying opportunities to improve use of an inpatient portal.
Appl Clin Inform 2018 Jan;9(1):105-13. doi: 10.1055/s-0037-1621732..
Keywords: Health Information Technology (HIT), Inpatient Care, Patient Experience, Web-Based
Payne TH, Alonso WD, Markiel JA
Using voice to create hospital progress notes: description of a mobile application and supporting system integrated with a commercial electronic health record.
The authors described the development and design of a smartphone app-based system to create inpatient progress notes using voice, commercial automatic speech recognition software, with text processing to recognize spoken voice commands and format the note, and integration with a commercial EHR. They found the system to be generally very reliable, accepted by physician users, and secure. They concluded that this approach provides an alternative to the use of keyboard and templates to create progress notes and may appeal to physicians who prefer voice to typing.
AHRQ-funded; HS023631.
Citation: Payne TH, Alonso WD, Markiel JA .
Using voice to create hospital progress notes: description of a mobile application and supporting system integrated with a commercial electronic health record.
J Biomed Inform 2018 Jan;77:91-96. doi: 10.1016/j.jbi.2017.12.004.
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Keywords: Health Information Technology (HIT), Inpatient Care, Electronic Health Records (EHRs)
Huerta TR, McAlearney AS, Rizer MK
Introducing a patient portal and electronic tablets to inpatient care.
The researchers implemented a pilot inpatient portal (MyChart Bedside [Epic Systems]) using Android tablets to provide patients and their families and caregivers with an expected care plan each day, a roster of the care team, the ability to exchange secure messages with the care team, a way to write and save notes, and access to health information. They conducted the 90-day pilot program in 15 rooms on 1 patient unit in each of 2 hospitals and gave tablets to 179 patients. They found that patients wanted immediate access to laboratory results, that patients admitted for 1-2 days found the tablets less important, that those readmitted insisted on having a tablet, and that those with their own electronic devices were less likely to accept the tablet.
AHRQ-funded; HS024091.
Citation: Huerta TR, McAlearney AS, Rizer MK .
Introducing a patient portal and electronic tablets to inpatient care.
Ann Intern Med 2017 Dec 5;167(11):816-17. doi: 10.7326/m17-1766.
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Keywords: Health Information Technology (HIT), Hospitalization, Inpatient Care, Web-Based, Electronic Health Records (EHRs)
Bowen ME, Rumana U, Kilgore EA
A user-centered glucose-insulin data display for the inpatient setting.
Researchers sought to develop a set of user-centered displays of capillary glucose data and insulin dose to improve inpatient management of insulin-dependent diabetes. Their proposed conceptual data display prototype is designed to simplify the presentation and visualization of key information needed for treatment decisions. The goal is also to enhance clinician's ability to identify opportunities to optimize insulin dosing and decrease end users' cognitive load and error rates.
AHRQ-funded; HS022895.
Citation: Bowen ME, Rumana U, Kilgore EA .
A user-centered glucose-insulin data display for the inpatient setting.
Stud Health Technol Inform 2017;245:684-88.
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Keywords: Care Management, Diabetes, Health Information Technology (HIT), Inpatient Care, Patient Safety
Lindenauer PK, Shieh MS, Stefan MS
Hospital procalcitonin testing and antibiotic treatment of patients admitted for chronic obstructive pulmonary disease exacerbation
The purpose of this study was to determine the impact of procalcitonin (PCT) testing on antibiotic treatment of patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD) in routine practice. The study conclude that as currently implemented, PCT testing appears to have had little impact on decisions to initiate antibiotic therapy or on duration of treatment for COPD exacerbations.
AHRQ-funded; HS024596.
Citation: Lindenauer PK, Shieh MS, Stefan MS .
Hospital procalcitonin testing and antibiotic treatment of patients admitted for chronic obstructive pulmonary disease exacerbation
Ann Am Thorac Soc 2017 Dec;14(12):1779-85. doi: 10.1513/AnnalsATS.201702-133OC..
Keywords: Antibiotics, Respiratory Conditions, Hospitalization, Inpatient Care, Patient-Centered Outcomes Research
Badawy J, Nguyen OK, Clark C
Is everyone really breathing 20 times a minute? Assessing epidemiology and variation in recorded respiratory rate in hospitalised adults.
The researchers sought to assess the potential accuracy of respiratory rate (RR) by analyzing the distribution and variation as a proxy, since RR should be normally distributed if recorded accurately. The observed patterns suggest that RR is inaccurately recorded, even among those with cardiopulmonary compromise, and represents a 'spot' estimate with values of 18 and 20 breaths per minute representing 'normal.’
AHRQ-funded; HS022418.
Citation: Badawy J, Nguyen OK, Clark C .
Is everyone really breathing 20 times a minute? Assessing epidemiology and variation in recorded respiratory rate in hospitalised adults.
BMJ Qual Saf 2017 Oct;26(10):832-36. doi: 10.1136/bmjqs-2017-006671.
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Keywords: Hospitalization, Inpatient Care, Patient Safety, Quality Improvement, Respiratory Conditions
Parker MW, Carroll M, Bolser B
Implementation of a communication bundle for high-risk patients.
This study occurs in a large pediatric hospital with a history of success in decreasing unrecognized deterioration, in which patients at higher risk of deterioration are termed "watchers." Because communication errors often contribute to unrecognized deterioration, clear and timely communication of watcher status to all team members and contingency planning was desired. The researchers sought to increase the percentage of eligible watchers with a complete communication, teamwork, and planning bundle within 2 hours of identification from 28% to 80%.
AHRQ-funded; HS023827.
Citation: Parker MW, Carroll M, Bolser B .
Implementation of a communication bundle for high-risk patients.
Hosp Pediatr 2017 Sep;7(9):523-29. doi: 10.1542/hpeds.2016-0170..
Keywords: Children/Adolescents, Communication, Healthcare Delivery, Hospitals, Inpatient Care
Berger ZD, Boss EF, Beach MC
Communication behaviors and patient autonomy in hospital care: a qualitative study.
Researchers conducted an observational study of patient-doctor communication on an inpatient medicine service among 18 hospitalized patients and 9 physicians. They concluded that shared decision-making may not be the norm in hospital care. Although physicians do explain treatment plans, many hospitalized patients do not understand enough to share in decisions. When patients do assert their opinion, it can result in conflict.
AHRQ-funded; HS022932.
Citation: Berger ZD, Boss EF, Beach MC .
Communication behaviors and patient autonomy in hospital care: a qualitative study.
Patient Educ Couns 2017 Aug;100(8):1473-81. doi: 10.1016/j.pec.2017.03.006.
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Keywords: Communication, Decision Making, Inpatient Care, Clinician-Patient Communication
Luxenberg A, Chan B, Khanna R
Efficiency and interpretability of text paging communication for medical inpatients: a mixed-methods analysis.
The purpose of this analysis was to investigate text page message content and structure, focusing on efficiency and safety. The authors analyzed the messages generated at an academic tertiary care hospital sent or received by hospital staff via an internal service, including those relating to the care of specific patients. While most messages were nonurgent, those that were lacked consistent language to indicate urgency. The authors conclude that text paging has significant limitations for real-time communication in acute-care settings, and their data should be a basis to inform the development of guidelines on the effective, efficient use of text paging.
AHRQ-funded; HS023558.
Citation: Luxenberg A, Chan B, Khanna R .
Efficiency and interpretability of text paging communication for medical inpatients: a mixed-methods analysis.
JAMA Intern Med 2017 Aug;177(8):1218-20. doi: 10.1001/jamainternmed.2017.2133..
Keywords: Communication, Inpatient Care, Hospitals, Patient Safety
Dykes PC, Duckworth M, Cunningham S
Pilot testing Fall TIPS (Tailoring Interventions for Patient Safety): a patient-centered fall prevention toolkit.
Patient falls during an acute hospitalization cause injury, reduced mobility, and increased costs. The laminated paper Fall TIPS Toolkit (Fall TIPS) provides clinical decision support at the bedside by linking each patient's fall risk assessment with evidence-based interventions. The investigators examined strategies to integrate this evidence into clinical practice. They concluded that engaging hospital and clinical leadership is critical in translating evidence-based care into clinical practice. They address and detail barriers to adoption of the protocol to provide guidance for spread to other institutions.
AHRQ-funded; HS025128.
Citation: Dykes PC, Duckworth M, Cunningham S .
Pilot testing Fall TIPS (Tailoring Interventions for Patient Safety): a patient-centered fall prevention toolkit.
Jt Comm J Qual Patient Saf 2017 Aug;43(8):403-13. doi: 10.1016/j.jcjq.2017.05.002..
Keywords: Clinical Decision Support (CDS), Decision Making, Evidence-Based Practice, Falls, Hospitals, Injuries and Wounds, Inpatient Care, Patient Safety, Prevention, Risk, Tools & Toolkits
Fisher K, Smith K, Gallagher T
We want to know: eliciting hospitalized patients' perspectives on breakdowns in care.
Researchers interviewed a broad sample of patients during hospitalization and postdischarge to elicit patient perspectives on breakdowns in care. When asked directly, almost 4 out of 10 hospitalized patients reported a breakdown in their care. Patient- perceived breakdowns in care are frequently associated with perceived harm, illustrating the importance of detecting and addressing these events.
AHRQ-funded; HS024596; HS022757.
Citation: Fisher K, Smith K, Gallagher T .
We want to know: eliciting hospitalized patients' perspectives on breakdowns in care.
J Hosp Med 2017 Aug;12(8):603-09. doi: 10.12788/jhm.2783.
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Keywords: Communication, Quality of Care, Inpatient Care, Patient Experience, Patient-Centered Outcomes Research
Roosan D, Weir C, Samore M
Identifying complexity in infectious diseases inpatient settings: an observation study.
This study sought to identify specific complexity-contributing factors in the infectious disease domain and the relationship with the complexity perceived by clinicians. Its factor analysis revealed three factors explaining 47 percent of total variance, namely task interaction and goals, urgency and acuity, and psychosocial behavior. A linear regression analysis showed no statistically significant association between complexity perceived by the physicians and objective complexity.
AHRQ-funded; HS023349.
Citation: Roosan D, Weir C, Samore M .
Identifying complexity in infectious diseases inpatient settings: an observation study.
J Biomed Inform 2017 Jul;71s:S13-s21. doi: 10.1016/j.jbi.2016.10.018.
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Keywords: Clinical Decision Support (CDS), Infectious Diseases, Inpatient Care, Patient Safety
Le P, Martinez KA, Pappas MA
A decision model to estimate a risk threshold for venous thromboembolism prophylaxis in hospitalized medical patients.
To determine a threshold for prophylaxis based on risk of venous thromboembolism, the researchers constructed a decision model with a decision-tree following patients for 3 months after hospitalization, and a lifetime Markov model with 3-month cycles. They found that the prophylaxis threshold was relatively insensitive to low-molecular-weight heparin cost and bleeding risk, but very sensitive to patient age and life expectancy.
AHRQ-funded; HS022883.
Citation: Le P, Martinez KA, Pappas MA .
A decision model to estimate a risk threshold for venous thromboembolism prophylaxis in hospitalized medical patients.
J Thromb Haemost 2017 Jun;15(6):1132-41. doi: 10.1111/jth.13687.
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Keywords: Adverse Events, Clinical Decision Support (CDS), Inpatient Care, Patient Safety, Risk
Eriksson CO, Stoner RC, Eden KB
The association between hospital capacity strain and inpatient outcomes in highly developed countries: a systematic review.
This systematic literature review sought to understand whether hospital capacity strain is associated with worse health outcomes for hospitalized patients and to evaluate benefits and harms of health system interventions to improve care quality during times of hospital capacity strain. It concluded that in highly developed countries, hospital capacity strain is associated with increased mortality and worsened health outcomes.
AHRQ-funded; HS022981.
Citation: Eriksson CO, Stoner RC, Eden KB .
The association between hospital capacity strain and inpatient outcomes in highly developed countries: a systematic review.
J Gen Intern Med 2017 Jun;32(6):686-96. doi: 10.1007/s11606-016-3936-3.
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Keywords: Hospitalization, Hospitals, Inpatient Care, Patient-Centered Outcomes Research, Patient Safety