National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data & Analytics
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Program
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- National Healthcare Quality and Disparities Report Data Tools
- AHRQ Quality Indicator Tools for Data Analytics
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (18)
- Adverse Drug Events (ADE) (8)
- Adverse Events (68)
- Ambulatory Care and Surgery (9)
- Antibiotics (11)
- Antimicrobial Stewardship (9)
- Asthma (3)
- Back Health and Pain (1)
- Behavioral Health (9)
- Blood Clots (4)
- Blood Thinners (1)
- Brain Injury (1)
- Burnout (5)
- Cancer (15)
- Cancer: Colorectal Cancer (2)
- Cancer: Prostate Cancer (2)
- Cancer: Skin Cancer (1)
- Cardiovascular Conditions (30)
- Care Coordination (17)
- Caregiving (10)
- Care Management (8)
- Catheter-Associated Urinary Tract Infection (CAUTI) (9)
- Central Line-Associated Bloodstream Infections (CLABSI) (11)
- Children/Adolescents (94)
- Chronic Conditions (12)
- Clinical Decision Support (CDS) (11)
- Clinician-Patient Communication (7)
- Clostridium difficile Infections (10)
- Communication (21)
- Community-Acquired Infections (1)
- Comparative Effectiveness (3)
- Complementary and Alternative Medicine (1)
- Comprehensive Unit-based Safety Program (CUSP) (1)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (22)
- COVID-19 (23)
- Critical Care (20)
- Cultural Competence (1)
- Data (9)
- Dementia (1)
- Depression (1)
- Diabetes (1)
- Diagnostic Safety and Quality (19)
- Dialysis (1)
- Digestive Disease and Health (1)
- Disparities (13)
- Education: Continuing Medical Education (5)
- Education: Patient and Caregiver (4)
- Elderly (32)
- Electronic Health Records (EHRs) (39)
- Emergency Department (45)
- Emergency Medical Services (EMS) (7)
- Emergency Preparedness (7)
- Evidence-Based Practice (19)
- Falls (15)
- Guidelines (6)
- Healthcare-Associated Infections (HAIs) (68)
- Healthcare Cost and Utilization Project (HCUP) (57)
- Healthcare Costs (82)
- Healthcare Delivery (50)
- Healthcare Utilization (18)
- Health Information Exchange (HIE) (10)
- Health Information Technology (HIT) (79)
- Health Insurance (19)
- Health Literacy (3)
- Health Promotion (1)
- Health Services Research (HSR) (16)
- Health Systems (19)
- Heart Disease and Health (21)
- Home Healthcare (5)
- Hospital Discharge (40)
- Hospitalization (64)
- Hospital Readmissions (88)
- (-) Hospitals (773)
- Human Immunodeficiency Virus (HIV) (1)
- Imaging (4)
- Implementation (17)
- Infectious Diseases (27)
- Influenza (1)
- Injuries and Wounds (16)
- Inpatient Care (61)
- Intensive Care Unit (ICU) (29)
- Kidney Disease and Health (2)
- Labor and Delivery (9)
- Learning Health Systems (1)
- Long-Term Care (7)
- Low-Income (3)
- Maternal Care (14)
- Medicaid (17)
- Medical Devices (3)
- Medical Errors (13)
- Medical Expenditure Panel Survey (MEPS) (1)
- Medical Liability (2)
- Medicare (92)
- Medication (35)
- Medication: Safety (9)
- Men's Health (1)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (6)
- Mortality (48)
- Neonatal Intensive Care Unit (NICU) (3)
- Neurological Disorders (7)
- Newborns/Infants (12)
- Nursing (10)
- Nursing Homes (16)
- Opioids (5)
- Organizational Change (10)
- Orthopedics (8)
- Outcomes (57)
- Pain (3)
- Palliative Care (2)
- Patient-Centered Healthcare (10)
- Patient-Centered Outcomes Research (27)
- Patient Adherence/Compliance (2)
- Patient and Family Engagement (18)
- Patient Experience (32)
- Patient Safety (158)
- Payment (45)
- Pneumonia (7)
- Policy (28)
- Practice Patterns (9)
- Pregnancy (13)
- Pressure Ulcers (3)
- Prevention (41)
- Primary Care (5)
- Primary Care: Models of Care (1)
- Provider (20)
- Provider: Clinician (4)
- Provider: Health Personnel (4)
- Provider: Nurse (15)
- Provider: Pharmacist (1)
- Provider: Physician (15)
- Provider Performance (55)
- Public Health (18)
- Public Reporting (7)
- Quality Improvement (78)
- Quality Indicators (QIs) (32)
- Quality Measures (37)
- Quality of Care (167)
- Racial and Ethnic Minorities (13)
- Registries (4)
- Rehabilitation (2)
- Research Methodologies (3)
- Respiratory Conditions (18)
- Risk (27)
- Rural/Inner-City Residents (4)
- Rural Health (23)
- Sepsis (30)
- Sexual Health (1)
- Shared Decision Making (17)
- Sickle Cell Disease (2)
- Simulation (1)
- Sleep Problems (2)
- Social Determinants of Health (7)
- Stress (1)
- Stroke (9)
- Substance Abuse (7)
- Surgery (111)
- Surveys on Patient Safety Culture (4)
- Teams (21)
- TeamSTEPPS (8)
- Telehealth (9)
- Tools & Toolkits (4)
- Training (6)
- Transitions of Care (44)
- Transplantation (1)
- Trauma (6)
- Treatments (2)
- Uninsured (7)
- Urban Health (3)
- Urinary Tract Infection (UTI) (8)
- Vulnerable Populations (3)
- Web-Based (2)
- Women (16)
- Workflow (3)
- Workforce (16)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 773 Research Studies DisplayedEllenbogen MI, Weiner JP, Zhu Y
Development of a hospital coding intensity measure based on sepsis diagnoses.
This study’s goal was to develop a hospital coding intensity measure based on sepsis diagnoses. The authors hypothesized that coded sepsis rates among patients hospitalized with common infections may serve as a useful surrogate for coding intensity and derived a hospital-level sepsis coding intensity measure using prevalence of "sepsis" primary diagnoses among patients hospitalized with urinary tract infection, cellulitis, and pneumonia. This was well correlated with the hospital mean number of discharge diagnoses, which has historically been used to quantify hospital-level coding intensity. It also has the advantage of inferring hospital coding intensity without the strong association with comorbidity that the mean number of discharge diagnoses has.
AHRQ-funded; HS028673; HS029350.
Citation: Ellenbogen MI, Weiner JP, Zhu Y .
Development of a hospital coding intensity measure based on sepsis diagnoses.
J Hosp Med 2024 Jun; 19(6):505-07. doi: 10.1002/jhm.13351..
Keywords: Sepsis, Hospitals
Hesgrove B, Zebrak K, Yount N
AHRQ Author: Ginsberg C
Associations between patient safety culture and workplace safety culture in hospital settings.
This AHRQ-authored paper examined the relationship between the perceptions of providers and staff on workplace safety culture and patient safety culture. This study used data from a pilot test in 2021 of the Surveys on Patient Safety Culture™ (SOPS®) Hospital Survey 2.0 Workplace Safety Supplemental Item Set, which consisted of 6,684 respondents from 28 hospitals in 16 states. The authors performed multiple regressions to examine the relationships between the 11 patient safety culture measures and the 10 workplace safety culture measures. Sixty-nine (69) of 110 associations were statistically significant. Three workplace safety culture measures had the largest number of associations with patient safety culture measures: (1) overall support from hospital leaders to ensure workplace safety; (2) being able to report workplace safety problems without negative consequences; and, (3) overall rating on workplace safety. The two associations with the strongest magnitude were between the overall rating on workplace safety and hospital management support for patient safety and hospital management support for workplace safety and hospital management support for patient safety.
AHRQ-authored; AHRQ-funded; 233201500026I.
Citation: Hesgrove B, Zebrak K, Yount N .
Associations between patient safety culture and workplace safety culture in hospital settings.
BMC Health Serv Res 2024 May 2; 24(1):568. doi: 10.1186/s12913-024-10984-3..
Keywords: Surveys on Patient Safety Culture, Patient Safety, Hospitals
Meille G, Monnet JN
AHRQ Author: Meille G, Monnet JN
Catholic hospital affiliation and postpartum contraceptive care and subsequent deliveries.
This AHRQ-authored paper assessed whether living in an area in which the closest hospital was Catholic was associated with the probability of postpartum contraception and subsequent deliveries. The study used data from the HCUP State Inpatient Databases, State Emergency Department Databases, and State Ambulatory Surgery and Services Databases for 11 states. Patients were matched based on the county-level percentage of the population affiliated with Catholic churches and urbanicity, and the zip code-level number of hospitals within 5 and 20 miles, median household income, and percentage of the population by race and ethnicity. Main outcomes were probability of delivery at a Catholic hospital, surgical sterilization within 1 year of delivery, receipt of long-acting reversible contraception at delivery, and subsequent delivery within 3 years. The sample consisted of 4,101,443 deliveries (1,301,792 after matching), with 14.5% of patients living in exposed zip codes. Living in exposed zip codes was associated with a 21.26-percentage point (pp) increase in the probability of delivery at a Catholic hospital. Additionally, comparing exposed vs unexposed zip codes, the probability of surgical sterilization at delivery decreased by 0.95 pp and the probability of sterilization in the year after discharge further decreased by 0.21 pp. Subsequent deliveries within 3 years increased 0.47 pp.
AHRQ-authored.
Citation: Meille G, Monnet JN .
Catholic hospital affiliation and postpartum contraceptive care and subsequent deliveries.
JAMA Intern Med 2024 May; 184(5):493-501. doi: 10.1001/jamainternmed.2023.8425..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitals, Maternal Care, Women
Crowley AP, Neville S, Sun C
Differential hospital participation in bundled payments in communities with higher shares of marginalized populations.
This study’s objective was to examine whether communities with higher proportions of marginalized individuals were less likely to be served by a hospital participating in Bundled Payments for Care Improvement Advanced (BPCI-Advanced). Communities with higher shares of dual-eligible Medicare and Medicaid individuals were less likely to be served by a hospital participating in BPCI-Advanced than communities with the lowest quartile of dual-eligible individuals (Q4: -15.1 percentage points [pp] lower than Q1). There was no consistent significant relationship between community proportion of Black beneficiaries and likelihood of having a hospital participating in BPCI-Advanced, however communities with higher shares of Hispanic beneficiaries were more likely to have a hospital participating in BPCI-Advanced than those in the lowest quartile (Q4: 19.2 pp higher than Q1).
AHRQ-funded; HS027595.
Citation: Crowley AP, Neville S, Sun C .
Differential hospital participation in bundled payments in communities with higher shares of marginalized populations.
J Gen Intern Med 2024 May; 39(7):1180-87. doi: 10.1007/s11606-024-08655-4..
Keywords: Payment, Hospitals, Medicare
Eid SM, Press VG, Kato H
Enhancing professional development and promoting collaboration in hospital medicine through the visiting professor exchange program.
The Visiting Professor in Hospital Medicine (ViP) Exchange Program, a pilot initiative across 11 diverse academic institutions, aimed to address the challenges faced by academic hospitalists in career advancement and research collaboration. The program facilitated national speaking engagements, mentorship opportunities, and exposure to innovative programs at host institutions. A survey of participating hospitalists revealed overwhelmingly positive feedback, with most reporting significant career development benefits, increased national recognition, and enhanced networking opportunities. The ViP program not only fosters individual growth but also contributes to the broader pipeline of academic hospitalist advancement. Key considerations for institutions implementing similar programs include careful cohort selection, logistical planning, securing funding, and ongoing evaluation. The expansion of such programs, potentially through virtual platforms, can significantly contribute to the growth and development of the field of hospital medicine.
AHRQ-funded.
Citation: Eid SM, Press VG, Kato H .
Enhancing professional development and promoting collaboration in hospital medicine through the visiting professor exchange program.
J Hosp Med 2024 May; 19(5):424-28. doi: 10.1002/jhm.13191..
Keywords: Hospitals, Education: Continuing Medical Education
Jiang HJ, Henke RM, Fingar KR
AHRQ Author: Jiang J, Liang L, Roemer MI
Rural hospitals experienced more patient volume variability than urban hospitals during the COVID-19 pandemic, 2020-21.
This AHRQ-authored paper examined hospital discharge data from the Healthcare Cost and Utilization Project State Inpatient Databases to compare data from the COVID-19 pandemic period (March 8, 2020-December 31, 2021) with data from the prepandemic period (January 1, 2017-March 7, 2020). There was a dose-response relationship with community COVID-19 burden, ranging from a 13.2 percent decrease in patient volume in periods of low transmission to a 16.5 percent increase in volume in periods of high transmission. About 35 percent of rural hospitals experienced fluctuations exceeding 20 percent (in either direction) in average daily total volume, in contrast to only 13 percent of urban hospitals experiencing similar magnitudes of changes. Rural hospitals with larger average daily volume changes were more likely to be smaller, government-owned, and critical access hospitals and to have significantly lower operating margins.
AHRQ-authored.
Citation: Jiang HJ, Henke RM, Fingar KR .
Rural hospitals experienced more patient volume variability than urban hospitals during the COVID-19 pandemic, 2020-21.
Health Affairs 2024 May; 43(5):641-50. doi: 10.1377/hlthaff.2023.00678..
Keywords: Healthcare Cost and Utilization Project (HCUP), COVID-19, Rural Health, Hospitals
Harlan EA, Venkatesh S, Morrison J
Rural-urban differences in mortality among mechanically ventilated patients in intensive and intermediate care.
Antibiotic misuse in treating urinary tract infections (UTIs) in outpatients is widespread, contributing significantly to antibiotic overuse. While multifaceted interventions involving pre- or post-design strategies have shown promise in improving antibiotic use for UTIs, the long-term sustainability of audit and feedback, a common approach, remains uncertain. Future investigations into outpatient antibiotic stewardship for UTIs should focus on assessing both the effectiveness of interventions and the feasibility of their implementation.
AHRQ-funded; HS028038.
Citation: Harlan EA, Venkatesh S, Morrison J .
Rural-urban differences in mortality among mechanically ventilated patients in intensive and intermediate care.
Ann Am Thorac Soc 2024 May; 21(5):774-81. doi: 10.1513/AnnalsATS.202308-684OC..
Keywords: Rural/Inner-City Residents, Rural Health, Urban Health, Mortality, Critical Care, Intensive Care Unit (ICU), Hospitals
Ramadan OI, Rosenbaum PR, Reiter JG
Impact of hospital affiliation with a flagship hospital system on surgical outcomes.
The purpose of this study was to compare general surgery outcomes at flagship systems, flagship hospitals, and flagship hospital affiliates with matched controls. The researchers utilized Medicare claims data from 2018 and 2019 to match patients undergoing inpatient general surgery in flagship system hospitals to controls who underwent the same procedure at hospitals outside the system but within the same region. 32,228 closely matched pairs were formed across 35 regions. The study found that patients at flagship system hospitals had lower 30-day mortality than matched control patients, and patients at flagship hospitals had lower mortality than control patients. Patients at flagship hospital affiliates had similar mortality to matched controls, and flagship hospitals had lower mortality than affiliate hospitals.
AHRQ-funded; HS026116.
Citation: Ramadan OI, Rosenbaum PR, Reiter JG .
Impact of hospital affiliation with a flagship hospital system on surgical outcomes.
Ann Surg 2024 Apr; 279(4):631-39. doi: 10.1097/sla.0000000000006132..
Keywords: Hospitals, Surgery, Outcomes
Lin SC, Adler-Milstein J, Hollingsworth JM
Alternative payment models and patient-reported quality of preparation for discharge: a retrospective longitudinal study.
This study’s objective was to assess patient-reported preparation for posthospital care was associated with reduced readmissions, and whether alternative payment model (APM) participation was associated with improved preparation for posthospital care. The authors used mixed-effects regression on observational data for 2685 US hospitals. They measured patient-reported preparation for posthospital care using the 3-Item Care Transition Measure and readmission using 30-day all-cause risk-adjusted readmissions from Hospital Compare. They obtained participation data in accountable care organizations (ACOs), Medical Homes, and Medicare's Bundled Payments for Care Improvement program from Medicare, the American Hospital Association's Annual Survey, and Leavitt Partner's ACO database. They found that APMs are not associated with improved preparation for posthospital care, even though it was associated with reduced readmissions (Marginal Effect: -0.012 percentage points).
AHRQ-funded; HS026908; HS025875.
Citation: Lin SC, Adler-Milstein J, Hollingsworth JM .
Alternative payment models and patient-reported quality of preparation for discharge: a retrospective longitudinal study.
J Patient Exp 2024 Mar 22; 11:23743735241240926. doi: 10.1177/23743735241240926..
Keywords: Payment, Hospital Discharge, Hospital Readmissions, Hospitals
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
Mullens Hernandez, JA JA, Murthy J
Understanding the impacts of rural hospital closures: a scoping review.
Researchers conducted a scoping literature review to understand the impact of rural hospital closure in order to inform ongoing federal policy debates and research. Key categories of adverse impacts that emerged included: emergency medical service transport; availability of emergency care, hospital services, and outpatient services; changes in quality of care: effects on workforce and community members and the local economy. The researchers concluded that a synthesis of their findings will permit policymakers and researchers to understand, and mitigate, the harms of rural hospital closure. They also recommended a tailored approach and discussed crucial knowledge gaps in the evidence base.
AHRQ-funded; HS028672; HS027788; HS028606; HS028963.
Citation: Mullens Hernandez, JA JA, Murthy J .
Understanding the impacts of rural hospital closures: a scoping review.
J Rural Health 2024 Mar; 40(2):227-37. doi: 10.1111/jrh.12801..
Keywords: Rural Health, Rural/Inner-City Residents, Hospitals, Access to Care
Parikh K, Hall M, Tieder JS
Disparities in racial, ethnic, and payer groups for pediatric safety events in US hospitals.
A retrospective cohort study using the 2019 Kids' Inpatient Database found disparities in pediatric safety events. Black and Hispanic children had significantly higher odds in 5 of 7 safety indicators compared to white children, especially in postoperative sepsis and respiratory failure. Medicaid-covered children also showed higher odds in 4 of 7 indicators compared to privately insured children, highlighting the need for targeted interventions to enhance hospital patient safety, particularly among minority and Medicaid-covered populations.
AHRQ-funded; HS028484.
Citation: Parikh K, Hall M, Tieder JS .
Disparities in racial, ethnic, and payer groups for pediatric safety events in US hospitals.
Pediatrics 2024 Mar; 153(3):e2023063714. doi: 10.1542/peds.2023-063714.
Keywords: Healthcare Cost and Utilization Project (HCUP), Disparities, Racial and Ethnic Minorities, Children/Adolescents, Patient Safety, Hospitals
Bui LN, Knox M, Miller-Rosales C
Hospital capabilities associated with behavioral health integration within emergency departments.
The objective of this study was to identify hospital capabilities associated with behavioral health processes in emergency departments. Responses to the National Survey of Healthcare Organizations and Systems were linked American Hospital Association Annual Survey data. Most hospitals reported screening for behavioral health conditions and provided direct referrals to community-based clinicians. Approximately half the hospitals used team approaches to behavioral health. Hospitals that reported more barriers to care delivery innovations also reported less screening and usage of a team approach. The authors concluded that research and interventions which focus on removing barriers or adding processes to disseminate best practices offer a path to accelerate behavioral health integration in emergency departments.
AHRQ-funded; HS024075.
Citation: Bui LN, Knox M, Miller-Rosales C .
Hospital capabilities associated with behavioral health integration within emergency departments.
Med Care 2024 Mar; 62(3):170-74. doi: 10.1097/mlr.0000000000001973.
Keywords: Behavioral Health, Emergency Department, Hospitals, Substance Abuse, Teams, Telehealth, Health Information Technology (HIT)
Wu J, Yuan CT, Moyal-Smith R
Electronic health record-supported implementation of an evidence-based pathway for perioperative surgical care.
This study examines the role of electronic health records (EHRs) in implementing enhanced recovery pathways (ERPs) for perioperative surgical care. Interviews with informaticians and clinicians from eight US hospitals revealed three thematic clusters: "EHR difficulties," "EHR enablers," and "EHR barriers." Researchers concluded that high performers and improvers successfully integrated ERPs into EHRs with dedicated multidisciplinary teams, while others faced challenges. Early involvement of informatics expertise benefited ERP implementation and sustainability.
AHRQ-funded; 2332015000201.
Citation: Wu J, Yuan CT, Moyal-Smith R .
Electronic health record-supported implementation of an evidence-based pathway for perioperative surgical care.
J Am Med Inform Assoc 2024 Feb 16; 31(3):591-99. doi: 10.1093/jamia/ocad237.
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Surgery, Evidence-Based Practice, Hospitals
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
Kalata S, Schaefer SL, Nuliyahu U
Low-volume elective surgery and outcomes in Medicare beneficiaries treated at hospital networks.
This cross-sectional study’s objective was to quantify low-volume surgery and associated outcomes within hospital networks. This study used Medicare Provider Analysis and Review data to examine fee-for-service beneficiaries aged 66 to 99 years who underwent 1 of 10 elective surgical procedures (abdominal aortic aneurysm repair, carotid endarterectomy, mitral valve repair, hip or knee replacement, bariatric surgery, or resection for lung, esophageal, pancreatic, or rectal cancers) in a network hospital from 2016 to 2018. Hospital volume for each procedure (calculated with the use of National Inpatient Sample data) was compared with yearly hospital volume standards for that procedure recommended by The Leapfrog Group. The authors analyzed primary outcomes which were postoperative complications, 30-day readmission, and 30-day mortality, stratified by the volume status of the hospital and network type. Secondary outcome was the availability of a different high-volume hospital within the same network or outside the network and its proximity to the patient (based on hospital referral region and zip code). In all, data were analyzed for 950,079 Medicare fee-for-service beneficiaries (average age 74.4 years; 621,138 females and 427,931 males) who underwent 1,049,069 procedures at 2469 hospitals within 382 networks. Of these networks, almost 100% [380 (99.5%)] had at least 1 low-volume hospital performing the elective procedure of interest. In 79.8% of procedures that were performed at low-volume hospitals, there was a hospital that met volume standards within the same network and hospital referral region located a median (IQR) distance of 29 (12-60) miles from the patient's home. In adjusted analyses, postoperative outcomes were inferior at low-volume hospitals compared with hospitals meeting volume standards, with a 30-day mortality of 8.1% at low-volume hospitals vs 5.5% at hospitals that met volume standards.
AHRQ-funded; HS028606.
Citation: Kalata S, Schaefer SL, Nuliyahu U .
Low-volume elective surgery and outcomes in Medicare beneficiaries treated at hospital networks.
JAMA Surg 2024 Feb; 159(2):203-10. doi: 10.1001/jamasurg.2023.6542.
Keywords: Surgery, Medicare, Hospitals, Outcomes
Nash KA, Weerahandi H, Yu H
Measuring equity in readmission as a distinct assessment of hospital performance.
This study examined the measure of equitable readmissions in hospitals as developed by the Centers for Medicare & Medicaid Services (CMS). Objectives were to define a measure of equitable readmissions; identify hospitals with equitable readmissions by insurance (dual eligible vs non-dual eligible) or patient race (Black vs White); and compare hospitals with and without equitable readmissions by hospital characteristics and performance on accountability measures (quality, cost, and value). The authors used data from a cross-section of hospitals who were eligible for the CMS Hospital-Wide Readmission measure using Medicare data from July 2018 through June 2019. Of 4638 hospitals, they found that 74% served a sufficient number of dual-eligible patients, and 42% served a sufficient number of Black patients to apply CMS Disparity Methods by insurance and race. Of these eligible hospitals, 17% had equitable readmission rates by insurance and 30% by race. Hospitals with equitable readmissions by insurance or race cared for a lower percentage of Black patients (insurance, 1.9% vs 3.3%, race, 7.6% vs 9.3%), and differed from nonequitable hospitals in multiple domains (teaching status, geography, size. In examining equity by insurance, hospitals with low costs were more likely to have equitable readmissions, and there was no relationship between quality and value, and equity. In examining equity by race, hospitals with high overall quality were more likely to have equitable readmissions, and there was no relationship between cost and value, and equity.
AHRQ-funded; HS022882.
Citation: Nash KA, Weerahandi H, Yu H .
Measuring equity in readmission as a distinct assessment of hospital performance.
JAMA 2024 Jan 9; 331(2):111-23. doi: 10.1001/jama.2023.24874..
Keywords: Hospital Readmissions, Hospitals, Provider Performance, Disparities
Wolf RM, Hall M, Williams DJ
Disparities in pharmacologic restraint for children hospitalized in mental health crisis.
This retrospective cohort study examined associations between pharmacologic restraint use and race and ethnicity among children (aged 5-≤18 years) admitted for mental health conditions to acute care nonpsychiatric children's hospitals. Study period was 2018 to 2022 and was conducted at 41 US children’s hospitals and included a cohort of 61,503 hospitalizations. Compared with non-Hispanic Black children, children of non-Hispanic White (adjusted odds ratio [aOR], 0.81), Asian (aOR, 0.82), or other race and ethnicity (aOR, 0.68) were less likely to receive pharmacologic restraint, with no significant difference with Hispanic children. When stratified by sex, racial/ethnic differences were magnified in males, except for Hispanic males, and not found in females. Sensitivity analysis revealed amplified disparities for all racial/ethnic groups, including Hispanic youth.
AHRQ-funded; HS026122.
Citation: Wolf RM, Hall M, Williams DJ .
Disparities in pharmacologic restraint for children hospitalized in mental health crisis.
Pediatrics 2024 Jan; 153(1). doi: 10.1542/peds.2023-061353..
Keywords: Disparities, Children/Adolescents, Behavioral Health, Inpatient Care, Hospitals, Medication
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
Mueller SK, Garabedian P, Goralnick E
Advancing health information during interhospital transfer: an interrupted time series.
The researchers report that health information exchange (HIE) during the interhospital transfer (IHT) of patients between acute care hospitals is subject to fragmented communication and unreliable access to clinical information. This proposed study will design, implement, and rigorously evaluate the implementation of a HIE platform to improve data access during IHT. The four-fold purposes of this study are to: 1) optimize clinician workflow, data visualization, and interoperability through user-centered design sessions for HIE platform development; 2) evaluate the impact of the intervention on clinician-reported medical errors among 500 pre- and 500 postintervention IHT patients using interrupted time series methodology; 3) evaluate intervention fidelity, use, and perceived usability of the platform, and barriers and facilitators of implementation from interprofessional stakeholder input, using mixed-methods evaluation; and 4) combine primary findings to develop a toolkit for spread and sustainability.
AHRQ-funded; HS028982.
Citation: Mueller SK, Garabedian P, Goralnick E .
Advancing health information during interhospital transfer: an interrupted time series.
J Hosp Med 2023 Dec; 18(12):1063-71. doi: 10.1002/jhm.13221..
Keywords: Health Information Exchange (HIE), Health Information Technology (HIT), Hospitals, Transitions of Care
Meille G, Decker SL, Owens PL
AHRQ Author: Meille G, Decker SL, Owens PL
COVID-19 admission rates and changes in US hospital inpatient and intensive care unit occupancy.
The objective of this cross-sectional study was to measure the relationship between COVID-19 admission rates and hospital occupancy in different US areas at different time periods during 2020. Data were taken from the HCUP State Inpatient Databases for patients in nonfederal acute care hospitals. The results showed that hospital occupancy decreased during weeks with low COVID-19 admissions and increased during weeks with high COVID-19 admissions; the largest changes occurred early in the pandemic. The authors concluded that their findings suggest that COVID-19 surges strained intensive care unit capacity and were associated with decreases in the number of surgical patients. These occupancy fluctuations may have affected quality of care and hospital finances.
AHRQ-authored.
Citation: Meille G, Decker SL, Owens PL .
COVID-19 admission rates and changes in US hospital inpatient and intensive care unit occupancy.
JAMA Health Forum 2023 Dec; 4(12):e234206. doi: 10.1001/jamahealthforum.2023.4206..
Keywords: COVID-19, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Hospitals
Danilack VA, Siegel-Reamer L, Lum L
From "disappointing" to "fantastic": women's experiences with labor induction in a U.S. tertiary hospital.
This study examined women’s expectations and experiences regarding labor induction. Labor induction patients were recruited in a US tertiary care hospital's postpartum mother-baby unit and invited to participate in semi-structured qualitative interviews. From April to September 2018, 26 women were interviewed about expectations and experiences of the labor induction process, side effects and health outcomes of concern, reflections on personal tolerance of different interventions, and thoughts about an ideal process. A wide range of experiences were described- with characterizations from horrible, frustrating, and terrifying to simple, fast and smooth. The Foley balloon catheter was the most polarizing induction method. Other concerns centered on the health of their baby, and an ideal induction involved fewer interventions.
AHRQ-funded; HS025013.
Citation: Danilack VA, Siegel-Reamer L, Lum L .
From "disappointing" to "fantastic": women's experiences with labor induction in a U.S. tertiary hospital.
Birth 2023 Dec; 50(4):959-67. doi: 10.1111/birt.12750..
Keywords: Women, Maternal Care, Hospitals, Patient Experience
Hasegawa S, Livorsi DJ, Perencevich EN S, Livorsi DJ, Perencevich EN
Diagnostic accuracy of hospital antibiograms in predicting the risk of antimicrobial resistance in enterobacteriaceae isolates: a nationwide multicenter evaluation at the Veterans Health Administration.
This study examined the effectiveness of an antibiogram to predict antimicrobial resistance (AMR) at the patient-level for Escherichia coli and Klebsiella spp. The authors retrospectively generated hospital antibiograms for the nationwide Veterans Health Administration (VHA) facilities from 2000 to 2019 using all clinical culture specimens positive for E. coli and Klebsiella spp., then assessed the diagnostic accuracy of an antibiogram to predict resistance for isolates in the following calendar year using logistic regression models and predefined 5-step interpretation thresholds. At 127 VHA facilities, the discrimination abilities of hospital-level antibiograms in predicting individual patient AMR were mostly poor, with the areas under the receiver operating curve at 0.686 and 0.715 for ceftriaxone, 0.637 and 0.675 for fluoroquinolones, and 0.576 and 0.624 for trimethoprim-sulfamethoxazole, respectively.
AHRQ-funded; HS027472.
Citation: Hasegawa S, Livorsi DJ, Perencevich EN S, Livorsi DJ, Perencevich EN .
Diagnostic accuracy of hospital antibiograms in predicting the risk of antimicrobial resistance in enterobacteriaceae isolates: a nationwide multicenter evaluation at the Veterans Health Administration.
Clin Infect Dis 2023 Nov 30; 77(11):1492-500. doi: 10.1093/cid/ciad467..
Keywords: Diagnostic Safety and Quality, Hospitals