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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
1 to 25 of 1001 Research Studies DisplayedBeck AF, Henize AW, Klein MD
A data-driven approach to optimizing medical-legal partnership performance and joint advocacy.
This paper discusses ways that medical-legal partnerships (MLPs) have facilitated advocacy at both patient (client) and population levels. MLPs address health-harming legal needs experienced by low-income families. In particular, the article discusses the work of the MLP Cincinnati Child Health-Law Partnership (Child HeLP), a joint initiative that bridges the primary care clinics at Cincinnati Children’s with the Legal Aid Society of Greater Cincinnati (LASGC). The authors found that Child HeLP referral was associated with a 38% reduction in hospitalizations. They discuss their use of quality improvement (QI) methods and statistical process (SPC) charts to optimize their partnership and facilitate identification of patterns amenable to population-level action and policy change. They also discuss how additional clinical-community partnerships have followed the Child HeLP model. There have been 10,190 referrals to legal partners for 7,801 children since Child HeLP’s inception in 2008. The most common reasons for referral are housing instability/adverse housing quality (~40%), public benefit denials or delays (~25%), and unmet educational needs (~20%). Referrals have resulted in an estimated $1,360,000 in recovered benefits and improvements in housing conditions, educational achievement, and other benefits.
AHRQ-funded; HS027996.
Citation: Beck AF, Henize AW, Klein MD .
A data-driven approach to optimizing medical-legal partnership performance and joint advocacy.
J Law Med Ethics 2023 Winter; 51(4):880-88. doi: 10.1017/jme.2023.158..
Keywords: Quality Improvement, Quality of Care, Policy
Kimpel CC, Myer EA, Cupples A A
Identifying barriers and facilitators to Veterans Affairs Whole Health Integration using the updated consolidated framework for implementation research.
This study examined the Veteran Affairs (VA) Whole Health Integration System initiative across VA sites with approaches to implementation varying by site. The authors used the Consolidated Framework for Implementation Research (CFIR) to synthesize systemic barriers and facilitators to Veteran use with the initiative. Advanced fellows from 11 VA Quality Scholars sites performed the initial data collection. The final report included CFIR-organized results from six sites. Cost, complexity, offerings, and accessibility were key innovation findings. They also found inner setting barriers and facilitators including relational connections and communication, compatibility, structure and resources, learning centeredness, and information and knowledge access. Results regarding individuals included innovation deliverers, implementation leaders and team, and individual capability, opportunity, and motivation to implement and deliver whole health care.
AHRQ-funded; HS026122.
Citation: Kimpel CC, Myer EA, Cupples A A .
Identifying barriers and facilitators to Veterans Affairs Whole Health Integration using the updated consolidated framework for implementation research.
J Healthc Qual 2024 May-Jun; 46(3):137-49. doi: 10.1097/jhq.0000000000000419..
Keywords: Implementation, Quality Improvement, Healthcare Delivery, Quality of Care
Hemmila MR, Neiman PU, Hoppe BL
Improving outcomes in emergency general surgery: construct of a collaborative quality initiative.
This study investigated emergency general surgery outcomes in order to construct a collaborative quality initiative to improve outcomes. The authors collected data at 10 hospitals from July 2019 to December 2022. They defined five different cohorts: acute appendicitis, acute gallbladder disease, small bowel obstruction, emergency laparotomy, and overall aggregate. Processes and inpatient outcomes examined included operative versus nonoperative management, mortality, morbidity (mortality and/or complication), readmissions, and length of stay. The cohorts included 19,956 emergency general surgery patients, of which 56.8% were female and 82.8% were White, and the mean (SD) age was 53.3 (20.8) years. After accounting for patient and disease factors, the adjusted aggregate mortality rate was 3.5%, morbidity rate was 27.6%, and the readmission rate was 15.1%. Operative management rates varied between hospitals from 70.9% to 96.9% for acute appendicitis and 19.8% to 79.4% for small bowel obstruction. Gastrofin challenge use in patients with a small bowel obstruction ranged from 10.7% to 61.4% of patients. A little over half (51.5%) of patients who underwent initial nonoperative management of acute cholecystitis had a cholecystostomy tube placed, with placement rate ranging from 23.5% to 62.1% across hospitals.
AHRQ-funded; HS028672.
Citation: Hemmila MR, Neiman PU, Hoppe BL .
Improving outcomes in emergency general surgery: construct of a collaborative quality initiative.
J Trauma Acute Care Surg 2024 May; 96(5):715-26. doi: 10.1097/ta.0000000000004248..
Keywords: Surgery, Outcomes, Quality Improvement, Quality of Care
Zheng H, Ash AS, Yang W
Strengthening quality measurement to predict success for total knee arthroplasty: results from a nationally representative total knee arthroplasty cohort.
In 2027, the Centers for Medicare & Medicaid Services (CMS) will begin mandating Patient-reported outcome measures (PROMs) to assess the quality of total knee arthroplasty (TKA). Using data from a national cohort of primary unilateral TKA patients, the authors developed, tested, and enhanced a model closely following a CMS-proposed measure to predict substantial clinical benefit. Only the enhanced model predicted success accurately across the spectrum of baseline scores. Findings were virtually identical when analyses were replicated on patients over 65. The authors concluded that adding a baseline knee-specific PROM score to a quality measurement model in a nationally representative cohort dramatically improved its predictive power.
AHRQ-funded; HS018910.
Citation: Zheng H, Ash AS, Yang W .
Strengthening quality measurement to predict success for total knee arthroplasty: results from a nationally representative total knee arthroplasty cohort.
J Bone Joint Surg Am 2024 Apr 17; 106(8):708-15. doi: 10.2106/jbjs.23.00602..
Keywords: Quality Measures, Quality of Care, Orthopedics, Surgery, Outcomes, Evidence-Based Practice, Patient-Centered Outcomes Research
Shaller D, Nembhard I, Matta S
Assessing an innovative method to promote learning from patient narratives: Findings from a field experiment in ambulatory care.
The purpose of this study was to evaluate whether an online interactive report developed to help interpretation of patients' narrative feedback results in change in ambulatory staff learning and behavior at the individual staff and practice level, and patient experience survey scores. The researchers studied 22 ambulatory practice sites in an academic medical center utilizing three primary data sources: 333 staff surveys; 20 in-depth interviews with practice leaders and staff; and 9551 modified CG-CAHPS patient experience surveys augmented by open-ended narrative elicitation questions. The study found that interviews reported that the interface helped narrative interpretation and use for improvement. Staff survey analyses reported improved learning from narratives at intervention sites and higher behavior change at staff and practice levels. Patient experience scores for interactions with office staff and wait time information increased significantly at intervention sites, compared to control sites.
AHRQ-funded; HS016978.
Citation: Shaller D, Nembhard I, Matta S .
Assessing an innovative method to promote learning from patient narratives: Findings from a field experiment in ambulatory care.
Health Serv Res 2024 Apr; 59(2):e14245. doi: 10.1111/1475-6773.14245..
Keywords: Ambulatory Care and Surgery, Patient Experience, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Quality Improvement, Quality of Care
Scott HF, Lindberg DM, Brackman S
Pediatric sepsis in general emergency departments: association between pediatric sepsis case volume, care quality, and outcome.
The purpose of this study was to evaluate whether a general emergency department's (ED) annual pediatric sepsis volume increases the odds of delivering care aligned with Surviving Sepsis pediatric guidelines. The researchers included 1,527 ED encounters between January 1, 2015, and September 30, 2021. The study found that care was aligned with the guidelines in 41.1% of encounters, and annual pediatric sepsis volume was minimally related with the probability of guideline-concordant care. Care concordance increased from 23.1% in 2015 to 52.8% in 2021.
AHRQ-funded; HS025696.
Citation: Scott HF, Lindberg DM, Brackman S .
Pediatric sepsis in general emergency departments: association between pediatric sepsis case volume, care quality, and outcome.
Ann Emerg Med 2024 Apr; 83(4):318-26. doi: 10.1016/j.annemergmed.2023.10.011..
Keywords: Children/Adolescents, Sepsis, Emergency Department, Quality of Care, Guidelines, Evidence-Based Practice
Li J
Public reporting and consumer demand in the home health sector.
The author used a natural experiment in the home health sector to assess whether a higher rating under the star ratings program affected patient choice. Findings indicated that higher rated agencies increased their market share by a statistically insignificant amount. No evidence of heterogeneous effects across the rating distribution or over time was discovered. The author concluded that star ratings are unlikely to improve home health quality despite continued policymaker interest.
AHRQ-funded; HS026836.
Citation: Li J .
Public reporting and consumer demand in the home health sector.
AHRQ-funded; HS026836..
Keywords: Home Healthcare, Nursing Homes, Provider Performance, Patient Experience, Quality of Care
Chen VW, Rosen T, Dong Y
Case sampling for evaluating hospital postoperative morbidity in US surgical quality improvement programs.
This study examined whether US surgical quality improvement (QI) programs using case sampling is robust enough for identifying hospitals with higher than expected complications. Eligible patients were 18 years and older who underwent a noncardiac operation at US Department of Veterans Affairs (VA) hospitals with a record in the VA Surgical Quality Improvement Program (systematic sample) and the VA Corporate Data Warehouse surgical domain (100% of surgical cases). Most patients in both samples were men (90.2% vs 91.2%) and White (74.7% vs 74.5%). Overall, 30-day complication rates were 7.6% and 5.3% for the sample and universal review cohorts, respectively. Using over 2145 hospital quarters of data, hospitals were identified as an outlier in 15.0% of quarters using the sample and 18.2% with universal review. Average hospital quarterly complication rates were 4.7% for outliers identified using the sample only, 7.2% for universal only, and 7.4% for concurrent identification in both sources. For nonsampled cases, average hospital quarterly complication rates were 7.0% at outliers and 4.4% at nonoutliers. Among outlier hospital quarters in the sample, 54.2% were concurrently identified with universal review, and for those identified with universal review, 44.6% were concurrently identified using the sample.
AHRQ-funded; HS028560.
Citation: Chen VW, Rosen T, Dong Y .
Case sampling for evaluating hospital postoperative morbidity in US surgical quality improvement programs.
JAMA Surg 2024 Mar; 159(3):315-22. doi: 10.1001/jamasurg.2023.6524..
Keywords: Surgery, Quality Improvement, Quality of Care, Hospitals
Meyers D, Miller T, De La Mare J
AHRQ Author: Meyers D, Miller T, De La Mare J, Makulowich G, Zhan C
What AHRQ learned while working to transform primary care.
The authors summarized the effects and lessons learned from AHRQ’s 3-year EvidenceNOW: Advancing Heart Health initiative. Results from an independent national evaluation demonstrated that the EvidenceNOW model successfully boosted capacity of primary care practices to improve quality of care. EvidenceNOW also showed that lasting practice transformation efforts need to be responsive to anticipated and unanticipated changes, relationship-oriented, and not tied to specific diseases or initiatives. The authors concluded that these results argue for a national primary care extension service that provides ongoing support for practice transformation.
AHRQ-authored; AHRQ-funded; 233201500013I.
Citation: Meyers D, Miller T, De La Mare J .
What AHRQ learned while working to transform primary care.
Ann Fam Med 2024 Mar-Apr; 22(2):161-66. doi: 10.1370/afm.3090..
Keywords: Primary Care, Evidence-Based Practice, Practice Improvement, Quality Improvement, Quality of Care
Auerbach AD, Lee TM, Hubbard CC
Diagnostic errors in hospitalized adults who died or were transferred to intensive care.
The objective of this retrospective cohort study was to determine the prevalence, underlying causes, and harms of diagnostic errors in hospitalized adults who were transferred to an intensive care unit or who died. Data was taken from 29 academic medical centers in the U.S. in a random sample of adults hospitalized with general medical conditions. Errors were found to have contributed to temporary harm, permanent harm, or death in nearly 18% of patients; among patients who died, diagnostic error was judged to have contributed to death in 6.6% of cases. The researchers noted that problems with choosing and interpreting tests and the processes involved with clinician assessment were a high priority for improvement efforts.
AHRQ-funded; HS027369.
Citation: Auerbach AD, Lee TM, Hubbard CC .
Diagnostic errors in hospitalized adults who died or were transferred to intensive care.
JAMA Intern Med 2024 Feb; 184(2):164-73. doi: 10.1001/jamainternmed.2023.7347..
Keywords: Diagnostic Safety and Quality, Medical Errors, Hospitals, Inpatient Care, Quality of Care, Patient Safety, Adverse Events
Dalal AK, Schnipper JL, Raffel K
Identifying and classifying diagnostic errors in acute care across hospitals: early lessons from the Utility of Predictive Systems in Diagnostic Errors (UPSIDE) study.
This paper describes the Utility of Predictive Systems in Diagnostic Errors (UPSIDE) study, whose aim was to define the prevalence and underlying causes of diagnostic errors (DEs) in patients who die in the hospital or are transferred to the intensive care unit (ICU) after the first 48 hours. This study was conducted at 31 hospitals with more than 2500 cases reviewed using electronic health records. The authors identified some insights into key requirements into building a robust DE surveillance program by developing these steps: 1) Develop a shared understanding of what constitutes a diagnostic error; 2) Use validated tools to identify diagnostic errors and classify process failures, but respect your context; 3) Develop a standard approach to using electronic health records for case reviews; 4) Ensure reliability and consistency of the case review process; and 5) Link diagnostic error case reviews to institutional safety programs. They also developed steps to establish a diagnosis error review process at the hospital level with six processes.
AHRQ-funded; HS027369; HS026613.
Citation: Dalal AK, Schnipper JL, Raffel K .
Identifying and classifying diagnostic errors in acute care across hospitals: early lessons from the Utility of Predictive Systems in Diagnostic Errors (UPSIDE) study.
J Hosp Med 2024 Feb; 19(2):140-45. doi: 10.1002/jhm.13136..
Keywords: Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety, Quality of Care, Hospitals
Ali KJ, Goeschel CA, DeLia DM
The PRIDx framework to engage payers in reducing diagnostic errors in healthcare.
The authors conducted a literature review and interviewed subject matter experts to develop a multi-component Payer Relationships for Improving Diagnoses (PRIDx) framework. The PRIDx framework can be used to encourage public and private payers to take specific actions to improve diagnostic safety. The authors noted that implementation of the PRIDx framework will require new types of partnerships, including external support from public and private payer organizations, and also require the creation of strong provider incentives.
AHRQ-funded; 2332015000221.
Citation: Ali KJ, Goeschel CA, DeLia DM .
The PRIDx framework to engage payers in reducing diagnostic errors in healthcare.
https://www.pubmed.ncbi.nlm.nih.gov/37795579.
Keywords: Diagnostic Safety and Quality, Quality of Care, Patient Safety
Newman-Toker DE, Nassery N, Schaffer AC
Burden of serious harms from diagnostic error in the USA.
Americans who experience serious harm from misdiagnosis annually. Serious harm is defined as permanent morbidity or morality. This cross-sectional analysis used nationally representative observational data. The authors estimated annual incident vascular events and infections from 21.5 million (M) sampled US hospital discharges (2012-2014). US-based cancer registries were used to find annual new cancers. They derived diagnostic errors and serious harms by multiplying by literature-based rates for disease-specific incidences for 15 major vascular events, infections and cancers ('Big Three' categories). Extrapolating to all diseases (including non-'Big Three' dangerous disease categories), they estimated total serious harms annually in the USA to be 795,000 (plausible range 598,000-1,023,000). Using more conservative assumptions they estimated 549,000 serious harms. These results were compatible with setting-specific serious harm estimates from inpatient, emergency department and ambulatory care. Fifteen dangerous diseases accounted for 50.7% of total serious harms and the top 5 (stroke, sepsis, pneumonia, venous thromboembolism and lung cancer) accounted for 38.7%.
AHRQ-funded; HS027614; HS029350.
Citation: Newman-Toker DE, Nassery N, Schaffer AC .
Burden of serious harms from diagnostic error in the USA.
BMJ Qual Saf 2024 Jan 19; 33(2):109-20. doi: 10.1136/bmjqs-2021-014130..
Keywords: Healthcare Cost and Utilization Project (HCUP), Diagnostic Safety and Quality, Medical Errors, Patient Safety, Quality of Care, Adverse Events
Li 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
Ray M, Zhao S, Wang S
Improving hospital quality risk-adjustment models using interactions identified by hierarchical group lasso regularisation.
This study’s goal was to see if using hierarchical group lasso regularization (HGLR) improved hospital quality risk adjustment (RA) models. The authors analyzed patient discharge de-identified data from 14 State Inpatient Databases, AHRQ Healthcare Cost and Utilization Project, California Department of Health Care Access and Information, and New York State Department of Health. They used HGLR to identify first-order interactions in several AHRQ inpatient quality indicators (IQI) - IQI 09 (Pancreatic Resection Mortality Rate), IQI 11 (Abdominal Aortic Aneurysm Repair Mortality Rate), and Patient Safety Indicator 14 (Postoperative Wound Dehiscence Rate). These RA models were compared with stratum-specific and composite main effects models with covariates selected by least absolute shrinkage and selection operator (LASSO). HGLR identified clinical meaning interactions for all models, with model performance similar or superior for composite models with HGLR-selected features, compared to those with LASSO-selected features. HGLR was found to be scalable to handle a large number of covariates and their interactions and is customizable to use multiple CPU cores to reduce analysis time.
AHRQ-funded; 290201200003I.
Citation: Ray M, Zhao S, Wang S .
Improving hospital quality risk-adjustment models using interactions identified by hierarchical group lasso regularisation.
BMC Health Serv Res 2023 Dec 15; 23(1):1419. doi: 10.1186/s12913-023-10423-9..
Keywords: Quality of Care, Hospitals, Risk
Schnipper JL, Raffel KE, Keniston A
Achieving diagnostic excellence through prevention and teamwork (ADEPT) study protocol: a multicenter, prospective quality and safety program to improve diagnostic processes in medical inpatients.
This paper describes the protocol for a study that will build surveillance for hospital diagnostic errors into usual care, benchmark diagnostic performance across sites, pilot test interventions, and evaluate the program's impact on diagnostic error rates. The authors will test achieving diagnostic excellence through prevention and teamwork (ADEPT), a multicenter, real-world quality and safety program utilizing interrupted time-series techniques to evaluate outcomes. They will use a randomly sampled population of medical patients hospitalized at 16 US hospitals who died, were transferred to intensive care, or had a rapid response during the hospitalization. There will be surveillance for diagnostic errors on 10 events per month per site using a previously established two-person adjudication process. With guidance from national experts in quality and safety, study sites will report and benchmark diagnostic error rates, share lessons regarding underlying causes, and design, implement, and pilot test interventions using both Safety I and Safety II approaches aimed at patients, providers, and health systems. The primary outcome sought after will be the number of diagnostic errors per patient, using segmented multivariable regression to evaluate change in y-intercept and change in slope after initiation of the program.
AHRQ-funded; HS029366.
Citation: Schnipper JL, Raffel KE, Keniston A .
Achieving diagnostic excellence through prevention and teamwork (ADEPT) study protocol: a multicenter, prospective quality and safety program to improve diagnostic processes in medical inpatients.
J Hosp Med 2023 Dec; 18(12):1072-81. doi: 10.1002/jhm.13230..
Keywords: Diagnostic Safety and Quality, Patient Safety, Quality of Care, Hospitals, Inpatient Care
Watnick S, Blake PG, Mehrotra R
System-level strategies to improve home dialysis: policy levers and quality initiatives.
This article discusses trends in home dialysis use, reviews the evolving understanding of what constitutes high quality care for the home dialysis population (as well as how this can be measured), and discusses policy and advocacy efforts that continue to shape the care of US patients, and compares with experiences in other countries. The authors conclude by discussing future directions for quality and advocacy efforts.
AHRQ-funded; HS028684.
Citation: Watnick S, Blake PG, Mehrotra R .
System-level strategies to improve home dialysis: policy levers and quality initiatives.
Clin J Am Soc Nephrol 2023 Dec; 18(12):1616-25. doi: 10.2215/cjn.0000000000000299..
Keywords: Home Healthcare, Kidney Disease and Health, Policy, Quality Improvement, Quality of Care
Bingham CA, Harris JG, Qui T
Pediatric Rheumatology Care and Outcomes Improvement Network's quality measure set to improve care of children with juvenile idiopathic arthritis.
The objective of this study was to describe the selection, development, and implementation of quality measures for juvenile idiopathic arthritis (JIA) by the Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), a multihospital learning health network. Clinicians in PR-COIN and parents of children with JIA collaboratively selected outcome quality measures and a committee of rheumatologists and data analysts developed operational definitions. Initial measures were clinical inactive disease, low pain score, and optimal physical functioning; the revised set included additional measures of disease activity, data quality, and a balancing measure. The authors concluded that PR-COIN's set of JIA quality measures is the first comprehensive set used at the point-of-care for a large cohort of JIA patients in a variety of pediatric rheumatology practice settings.
AHRQ-funded; HS021114.
Citation: Bingham CA, Harris JG, Qui T .
Pediatric Rheumatology Care and Outcomes Improvement Network's quality measure set to improve care of children with juvenile idiopathic arthritis.
Arthritis Care Res 2023 Dec; 75(12):2442-52. doi: 10.1002/acr.25168.
Keywords: Children/Adolescents, Arthritis, Quality Measures, Quality Improvement, Quality of Care, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Pak TR, Young J, McKenna CS
Risk of misleading conclusions in observational studies of time-to-antibiotics and mortality in suspected sepsis.
Important studies indicate that every hour of sepsis that elapses until antibiotics are administered increases mortality. The researchers of this study found determined that analyses in the influential studies often adjusted for limited covariates, included patients with long delays until antibiotic administration, combined sepsis and septic shock, and used linear models presuming each hour of delay has equal impact on the sepsis and the patient. The purpose of this study was to assess the effect of the analytic decisions on the relationships between time-to-antibiotics and mortality. The researchers retrospectively identified 104,248 adults admitted from 2015-2022 to five hospitals with suspected infection. The patients included 25,990 with suspected septic shock and 23,619 with sepsis without shock. The study found that changing covariates, maximum time-to-antibiotics, and severity stratification altered the magnitude, direction, and significance of observed relationships between time-to-antibiotics and mortality. In a fully adjusted model of patients treated within 6 hours, every hour related with higher mortality for septic shock, but not sepsis without shock or suspected infection alone. Modeling every hour independently confirmed that every hour delay was related with greater mortality for septic shock, but only delays of greater than 6 hours were related with greater mortality for sepsis without shock.
AHRQ-funded; HS027170.
Citation: Pak TR, Young J, McKenna CS .
Risk of misleading conclusions in observational studies of time-to-antibiotics and mortality in suspected sepsis.
Clin Infect Dis 2023 Nov 30; 77(11):1534-43. doi: 10.1093/cid/ciad450..
Keywords: Antibiotics, Medication, Sepsis, Mortality, Quality of Care
Goldberg DG, Owens-Jasey C, Haghighat S
Implementation strategies for large scale quality improvement initiatives in primary care settings: a qualitative assessment.
This study focused on gaining a comprehensive understanding of perspectives from research participants and research team members on the value of implementation strategies and factors that influenced the AHRQ-funded EvidenceNOW initiative in Virginia. The goal of EvidenceNOW’s Advancing Heart Health in Primary Care initiative is to assist primary care practices in the US in implementing evidence-based practices in cardiovascular care and building capacity for quality improvement. In 2018, the authors conducted 25 focus groups with clinicians and staff at participating practices, including 80 physicians, advanced practice clinicians, practice managers, and other practice staff. They also conducted face-to-face and telephone interviews with 22 research team members, including lead investigators, practice facilitators, physician expert consultants, and evaluators. They used the integrated-Promoting Action on Research Implementation in the Health Services (i-PARIHS) framework in their qualitative data analysis and organization of themes. Implementation strategies that were valued by both practice representatives and research team members included the kick-off event, on-site practice facilitation, and interaction with physician expert consults. Day-to-day activities often overwhelmed clinicians and staff, which hindered their ability to fully participate in the EvidenceNOW initiative.
AHRQ-funded; HS023913.
Citation: Goldberg DG, Owens-Jasey C, Haghighat S .
Implementation strategies for large scale quality improvement initiatives in primary care settings: a qualitative assessment.
BMC Prim Care 2023 Nov 17; 24(1):242. doi: 10.1186/s12875-023-02200-8..
Keywords: Quality Improvement, Primary Care, Quality of Care, Implementation
O'Leary KJ, Johnson JK, Williams MV
Effect of complementary interventions to redesign care on teamwork and quality for hospitalized medical patients: a pragmatic controlled trial.
The objective of this pragmatic controlled trial was to evaluate the effect of interventions to redesign hospital care delivery on teamwork and patient outcomes. Survey participants were healthcare professionals and hospitalized medical patients in medical units at four U.S. hospitals. The results showed that the median teamwork climate score was higher after the intervention among nurses, but that interventions to redesign care for hospitalized patients were not associated with improved patient outcomes.
AHRQ-funded; HS02564.
Citation: O'Leary KJ, Johnson JK, Williams MV .
Effect of complementary interventions to redesign care on teamwork and quality for hospitalized medical patients: a pragmatic controlled trial.
Ann Intern Med 2023 Nov; 176(11):1456-64. doi: 10.7326/m23-0953..
Keywords: Teams, Inpatient Care, Hospitals, Quality of Care, Outcomes
Chen VW, Chidi AP, Dong Y
Risk-adjusted cumulative sum for early detection of hospitals with excess perioperative mortality.
This study’s goal was to compare the risk-adjusted cumulative sum (CUSUM) with episodic evaluation for early detection of hospitals with excess perioperative mortality. The study cohort included 697,566 patients treated at 104 Veterans’ Affairs hospitals across 24 quarters with a mean age of 60.9 years and 91.4% male. These patients underwent a noncardiac operation at a Veterans Affairs hospital, had a record in the Veterans Affairs Surgical Quality Improvement Program (January 1, 2011, through December 31, 2016), and were aged 18 years or older. For each hospital, the median number of quarters detected with observed to expected ratios, at least 1 CUSUM signal, and more than 1 CUSUM signal was 2 quarters (IQR, 1-4 quarters), 8 quarters (IQR, 4-11 quarters), and 3 quarters (IQR, 1-4 quarters). Outlier hospitals were identified 33.3% of the time (830 quarters) with at least 1 CUSUM signal within a quarter, 12.5% (311 quarters) with more than 1 CUSUM signal, and 11.0% (274 quarters) with observed to expected ratios at the end of the quarter. The CUSUM detection occurred a median of 49 days (IQR, 25-63 days) before observed to expected ratio reporting (1 signal, 35 days [IQR, 17-54 days]; 2 signals, 49 days [IQR, 26-61 days]; 3 signals, 58 days [IQR, 44-69 days]; ≥4 signals, 49 days [IQR, 42-69 days]. Of 274 hospital quarters detected with observed to expected ratios, 72.6% were concurrently detected by at least 1 CUSUM signal vs 42.7% by more than 1 CUSUM signal. There was a dose-response relationship between the number of CUSUM signals in a quarter and the median observed to expected ratio (0 signals, 0.63; 1 signal, 1.28; 2 signals, 1.58; 3 signals, 2.08; ≥4 signals, 2.49).
AHRQ-funded; HS013853.
Citation: Chen VW, Chidi AP, Dong Y .
Risk-adjusted cumulative sum for early detection of hospitals with excess perioperative mortality.
JAMA Surg 2023 Nov; 158(11):1176-83. doi: 10.1001/jamasurg.2023.3673..
Keywords: Quality Improvement, Surgery, Hospitals, Patient Safety, Mortality, Quality of Care
Woods-Hill CZ, Koontz DW, Colantuoni EA
Sustainability of the Bright STAR diagnostic stewardship program to reduce blood culture rates among critically ill children.
From 2017 to2020, 14 pediatric intensive care units (PICUs) participated in the Bright STAR (Testing Stewardship for Antibiotic Reduction) QI collaborative to reduce unnecessary blood cultures for PICU patients. The collaborative project found that 4 sites demonstrated a 33% decrease in blood culture rates and a 13% decrease in broad spectrum antibiotic use. The purpose of this current study was to assess whether sites sustained reduced blood culture rates after completion of the formal project. The study found that all sites had lower blood culture rates during the sustainability period when compared with the pre-implementation period. The blood culture rate increased 8% during the sustainability period compared with the postimplementation period but was 27% lower than during the pre-implementation period.
AHRQ-funded; HS025642.
Citation: Woods-Hill CZ, Koontz DW, Colantuoni EA .
Sustainability of the Bright STAR diagnostic stewardship program to reduce blood culture rates among critically ill children.
JAMA Pediatr 2023 Nov; 177(11):1234-37. doi: 10.1001/jamapediatrics.2023.3229..
Keywords: Children/Adolescents, Critical Care, Quality Improvement, Diagnostic Safety and Quality, Quality of Care
Silva GC, Gutman R
Reformulating provider profiling by grouping providers treating similar patients prior to evaluating performance.
The purpose of this study was to explore a novel approach to comparing health providers' performance that identifies groups of providers treating similar populations of patients and then assesses providers' performance within each group. To compare the performance of the proposed approach, the researchers utilized patient-level data from 119 Massachusetts skilled nursing facilities. Simulated and observed outcome data were utilized to examine the performance of the methods in different settings. In simulations, the proposed method classified providers to groups with the admission attributes of similar patients. In the presence of limited overlap in patient attributes across providers and misspecifications of the outcome model, the provider-level estimates created utilizing the novel approach identified providers that under- and overperformed when compared to the existing approaches.
AHRQ-funded; HS026830.
Citation: Silva GC, Gutman R .
Reformulating provider profiling by grouping providers treating similar patients prior to evaluating performance.
Biostatistics 2023 Oct 18; 24(4):962-84. doi: 10.1093/biostatistics/kxac019..
Keywords: Provider Performance, Quality of Care, Healthcare Delivery
Agniel D, Cabreros I, Damberg CL
A formal framework for incorporating equity into health care quality measurement.
This paper examines how tying incentives on the basis of stratification or disparities in quality measurement may have unintended consequences or limited effects. Addressing one aspect of equity may be in competition with addressing others. The authors proposed equity weighting, a new measurement framework to advance equity on multiple fronts that addresses the shortcomings of existing approaches and explicitly calibrates incentives to align with equity goals. They used colorectal cancer screening data derived from 2017 Medicare claims to illustrate how equity weighting fixes unintended consequences in other methods and how it can be adapted to policy goals.
AHRQ-funded; HS024067.
Citation: Agniel D, Cabreros I, Damberg CL .
A formal framework for incorporating equity into health care quality measurement.
Health Aff 2023 Oct; 42(10):1383-91. doi: 10.1377/hlthaff.2022.01483..
Keywords: Quality Measures, Quality Improvement, Quality of Care, Disparities