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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
26 to 50 of 12392 Research Studies DisplayedHesgrove 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
Ing C, Silber JH, Lackraj D
Behavioural disorders after prenatal exposure to anaesthesia for maternal surgery.
This study examined the association between prenatal exposure to general anesthesia for maternal surgery during pregnancy and subsequent risk of disruptive or internalizing behavioral disorder diagnosis. The authors used a nationwide sample of pregnant women linked to their liveborn infants was evaluated using the Medicaid Analytic eXtract (MAX, 1999-2013). Multivariate matching was used to match each child prenatally exposed to general anesthesia owing to maternal appendectomy or cholecystectomy during pregnancy with five unexposed children, with primary outcome a diagnosis of a disruptive or internalizing behavioral disorder. They matched 34,271 prenatally exposed children with 171,355 unexposed children in the database. Prenatally exposed children were more likely than unexposed children to receive a diagnosis of a disruptive or internalizing behavioral disorder. For secondary outcomes, increased hazards of disruptive (hazard ratio [HR], 1.32) and internalizing (HR, 1.36) behavioral disorders were identified, and also increased hazards of attention-deficit/hyperactivity disorder (HR, 1.32), behavioral disorders (HR, 1.28), developmental speech or language disorders (HR, 1.16), and autism (HR, 1.31).
AHRQ-funded; HS026493.
Citation: Ing C, Silber JH, Lackraj D .
Behavioural disorders after prenatal exposure to anaesthesia for maternal surgery.
Br J Anaesth 2024 May; 132(5):899-910. doi: 10.1016/j.bja.2024.01.025..
Keywords: Maternal Care, Surgery, Women, Children/Adolescents, Behavioral Health
Martinez MF, Weatherwax C, Piercy K
Benefits of meeting the Healthy People 2030 Youth Sports Participation target.
This study examines the benefits of achieving the Healthy People 2030 target of increasing youth sports participation to 63.3%. The authors used an agent-based model developed in 2023 to represent each person aged 6-17 years in the US. The authors found that increasing the proportion of youth participating in sports from the most recent participation levels (50.7%) to the Healthy People 2030 target (63.3%) could reduce overweight/obesity prevalence by 3.37%, resulting in 1.71 million fewer cases of overweight/obesity. This could avert 352,000 cases of weight-related diseases and gain 1.86 million quality-adjusted life years, saving $22.55 billion in direct medical costs and $25.43 billion in productivity losses. This would also reduce depression/anxiety symptoms, saving $3.61 billion in direct medical costs and $28.38 billion in productivity losses.
AHRQ-funded; HS028165.
Citation: Martinez MF, Weatherwax C, Piercy K .
Benefits of meeting the Healthy People 2030 Youth Sports Participation target.
Am J Prev Med 2024 May; 66(5):760-69. doi: 10.1016/j.amepre.2023.12.018..
Keywords: Children/Adolescents, Lifestyle Changes, Obesity
Thompson MP, Hou H, Fliegner M
Cardiac rehabilitation use after heart failure hospitalization associated with advanced heart failure center status.
The purpose of this retrospective analysis was to associate hospitalization at a center providing advanced heart failure (HF) therapies and subsequent cardiac rehabilitation (CR) participation. Data from a 20% sample of Medicare beneficiaries primarily hospitalized with a heart failure with reduced ejection fraction diagnosis was analyzed. Results showed that the patients were more likely to attend CR after discharge if admitted to an advanced HFC than a nonadvanced HFC.
AHRQ-funded; HS027830.
Citation: Thompson MP, Hou H, Fliegner M .
Cardiac rehabilitation use after heart failure hospitalization associated with advanced heart failure center status.
J Cardiopulm Rehabil Prev 2024 May; 44(3):194-201. doi: 10.1097/hcr.0000000000000846.
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Keywords: Cardiovascular Conditions, Heart Disease and Health, Hospitalization, Medicare
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
Campbell KA, Sternberg SB, Benneyan J
Completion rates and timeliness of diagnostic colonoscopies for rectal bleeding in primary care.
This study looked at the completion rates and timeliness of diagnostic colonoscopies for rectal bleeding in primary care, as rectal bleeding is usually the most common presenting symptom of colorectal cancer. This retrospective cohort study was a medical record review of patients aged ≥ 40 with index diagnosis of rectal bleeding at 2 primary practices-an urban academic practice and affiliated community health center-between January 1, 2018, and December 31, 2020. Primary outcomes were percentages of patient cases classified as having completed recommended follow-up workup ("closed loop") vs. not ("open loop"). A total of 837 patients had been coded with rectal bleeding, with 67 excluded leaving 770 patients included. A total of 172 patients (22.3%) failed to undergo timely recommended workup. Reasons for a failed timely workup included the majority not having a procedure ordered, or the procedure was ordered but never scheduled or cancelled and not kept.
AHRQ-funded; HS027282.
Citation: Campbell KA, Sternberg SB, Benneyan J .
Completion rates and timeliness of diagnostic colonoscopies for rectal bleeding in primary care.
J Gen Intern Med 2024 May; 39(6):985-91. doi: 10.1007/s11606-023-08513-9..
Keywords: Diagnostic Safety and Quality, Screening, Cancer: Colorectal Cancer, Primary Care, Prevention, Cancer
Michelson KA, Bucher BT, Neuman MI
Cost and late hospital care of publicly insured children after appendectomy.
This study examined the cost and late hospital care of publicly-insured children in the US after an appendectomy. The authors studied all publicly-insured children in the US with uncomplicated or complicated appendicitis in 2018-2019 using administrative claims, with the main outcome hospitalization or abdominal procedure within 180 days of an appendicitis discharge. They evaluated health-care expenditures arising from appendicitis episodes. Among 95,942 children with appendicitis, 6.0% had late hospital care, with 5062 requiring rehospitalization and 2.1% surgery. Median time to late hospital care was 10 days. Age under 5 y (compared with >14 y), complex chronic conditions, and complicated appendicitis were each associated with time to late hospital care. Expenditures over 180 days were a median $6553 and $19,589 respectively in those requiring no late hospital care versus those requiring it.
AHRQ-funded; HS025776; HS026503.
Citation: Michelson KA, Bucher BT, Neuman MI .
Cost and late hospital care of publicly insured children after appendectomy.
J Surg Res 2024 May; 297:41-46. doi: 10.1016/j.jss.2024.02.003..
Keywords: Children/Adolescents, Surgery, Medicaid
Parikh NR, Francisco LS, Balikai SC
Development and evaluation of I-PASS-to-PICU: a standard electronic template to improve referral communication for interfacility transfers to the pediatric ICU.
The objective of this study was to develop and evaluate a standard electronic referral template (I-PASS-to-PICU) to improve communication for interfacility pediatric ICU (PICU) transfers. I-PASS-to-PICU was developed in a single PICU, designed with an electronic health record-supported clinical note template by adapting elements from an evidence-based handoff program, to support information exchange between referring clinicians and receiving PICU physicians. Usability testing with receiving PICU physicians using simulated and actual calls revealed good usability on the System Usability Scale. The authors planned further evaluation of the template’s effectiveness in improving information exchange during real-time PICU practice.
AHRQ-funded; HS026965.
Citation: Parikh NR, Francisco LS, Balikai SC .
Development and evaluation of I-PASS-to-PICU: a standard electronic template to improve referral communication for interfacility transfers to the pediatric ICU.
Jt Comm J Qual Patient Saf 2024 May; 50(5):338-47. doi: 10.1016/j.jcjq.2024.01.010..
Keywords: Children/Adolescents, Transitions of Care, Intensive Care Unit (ICU), Electronic Health Records (EHRs), Health Information Technology (HIT), Communication, Critical Care
Tokede B, Brandon R, Lee CT
Development and validation of a rule-based algorithm to identify periodontal diagnosis using structured electronic health record data.
This article describes the development and validation of an automated electronic health record (EHR) based algorithm to suggest a periodontal diagnosis. It was based on materials from the 2017 World Workshop on the Classification of Periodontal Diseases and Conditions. Findings suggested that a rule-based algorithm using EHR data can be implemented with moderate accuracy in support of chairside clinical diagnostic decision making, and may be particularly useful for inexperienced clinicians. The authors noted that grey-zone cases where clinical judgement will be required still exist and that future applications of similar algorithms will depend upon the quality of EHR data.
AHRQ-funded; HS027938.
Citation: Tokede B, Brandon R, Lee CT .
Development and validation of a rule-based algorithm to identify periodontal diagnosis using structured electronic health record data.
J Clin Periodontol 2024 May; 51(5):547-57. doi: 10.1111/jcpe.13938..
Keywords: Dental and Oral Health, Electronic Health Records (EHRs), Health Information Technology (HIT), Diagnostic Safety and Quality
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
Bruce KE, Busse CE, Tully KP
Hemoglobin on admission for childbirth and postpartum acute care use in a southeastern health care system.
This study’s objective was to evaluate whether hemoglobin on admission for childbirth is associated with postpartum acute care use (ACU). The authors conducted a retrospective cohort study of patients giving birth at a southeastern quaternary care hospital from January 2018 through June 2021 using electronic health records. They categorized predelivery hemoglobin as <9, 9- < 10, 10- < 11, 11- < 12, and ≥12 g/dL, and acute care was defined as a visit to obstetric triage, the emergency department, or inpatient admission within 90 days postpartum. Among 8,677 pregnancies, 17% used acute care in the system within 90 days postpartum. In unadjusted models, those with predelivery hemoglobin <9 had twice the risk of postpartum ACU compared to those with hemoglobin ≥12, with a decrease in risk for each increase in hemoglobin category. The adjusted model showed a similar trend with smaller effect estimates.
AHRQ-funded; HS027260.
Citation: Bruce KE, Busse CE, Tully KP .
Hemoglobin on admission for childbirth and postpartum acute care use in a southeastern health care system.
Am J Perinatol 2024 May. doi: 10.1055/a-2223-6292..
Keywords: Maternal Care, Women
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
Chien AT, Spence SJ, Okumura MJ
Impairment types and combinations among adolescents and young adults with disabilities: Colorado 2014-2018.
A study using Colorado's All Payer Claims Dataset from 2014-2018 reveals a higher prevalence of disability among adolescents and young adults (AYA) insured by Medicaid (11.9%) compared to those with commercial insurance (4.3%). The majority of AYA with disabilities (AYA-WD) had a single impairment, but those with Medicaid were more likely to have multiple impairments. Significant differences were also found in the prevalence of specific impairment types, with Medicaid-insured AYA-WD having higher rates of physical, developmental, psychiatric, and intellectual impairments. The study utilized validated algorithms to identify and categorize disabilities, demonstrating their effectiveness in understanding the prevalence and types of impairments in this population.
AHRQ-funded; HS025299.
Citation: Chien AT, Spence SJ, Okumura MJ .
Impairment types and combinations among adolescents and young adults with disabilities: Colorado 2014-2018.
Acad Pediatr 2024 May-Jun; 24(4):587-95. doi: 10.1016/j.acap.2023.10.010..
Keywords: Children/Adolescents, Young Adults, Disabilities
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
Shi M, M
Monitoring for waste: evidence from Medicare audits.
This paper examined tradeoffs of monitoring for wasteful public spending. The author studied a large Medicare program that monitored for unnecessary healthcare spending and considered its effect on government savings, provider behavior, and patient health. Findings indicated that every Medicare dollar spent on monitoring generated $24-29 in government savings; the majority of savings stemmed from the deterrence of future care. No evidence was found that the health of the marginal patient is harmed, indicating that monitoring primarily deters low-value care. The author concluded that while monitoring increased provider administrative costs, these costs were incurred upfront and included investments in technology to assess the medical necessity of care.
AHRQ-funded; HS027715.
Citation: Shi M, M .
Monitoring for waste: evidence from Medicare audits.
Q J Econ 2024 May; 139(2):993-1049. doi: 10.1093/qje/qjad049..
Keywords: Medicare, Healthcare Costs, Healthcare Cost and Utilization Project (HCUP)
Hughes PM, Graaf G, Gigli KH
Pediatric mental health care and scope-of-practice expansions.
This study investigated the relationship between scope-of-practice (SoP) regulations for psychologists and nurse practitioners and access to pediatric mental health services. The researchers analyzed data from the National Survey of Children's Health spanning 2016 to 2020, focusing on a nationally representative sample of children with mental health needs. The study examined two primary outcomes: unmet mental health care needs and receipt of mental health medication. The analysis revealed that children living in states with expanded psychologist SoP had a 5.4 percentage point lower probability of having unmet mental health needs. Additionally, these children had a 2.0 percentage point higher probability of receiving mental health medication. In contrast, nurse practitioner SoP expansion showed no significant association with unmet mental health needs. However, children in states with expanded nurse practitioner SoP had a 1.5 percentage point lower probability of receiving mental health medication. To assess these associations, the researchers employed logistic regression models, adjusting for multiple covariates. The expanded SoP for both psychologists and nurse practitioners was determined based on the child's state of residence and the year of the survey. The study's findings suggest that expanded SoP for psychologists is associated with improved access to pediatric mental health care, both in terms of addressing unmet needs and increasing medication access. However, the impact of expanded SoP for nurse practitioners appears to be less clear, with no significant effect on unmet needs and a slight decrease in medication receipt.
AHRQ-funded; HS000032.
Citation: Hughes PM, Graaf G, Gigli KH .
Pediatric mental health care and scope-of-practice expansions.
Adm Policy Ment Health 2024 May; 51(3):384-92. doi: 10.1007/s10488-024-01342-w..
Keywords: Children/Adolescents, Behavioral Health, Access to Care
Kelly MM, Kieren MQ, Coller RJ
Pediatric open notes: caregiver experiences since the 21st Century Cures Act.
This progress report discusses the impact of the 2020 21st Century Cures Act Final Rule, which mandates that patients and their caregivers have free, secure, and immediate access to their electronic health information, including clinical notes. The authors discuss the results of a study where they surveyed parents who were offered access to clinical notes during their child’s hospital stay. The benefit most frequently cited by parents was the ability to recapitulate their child’s care plan, while the most mentioned challenge was confusion caused by misunderstanding note content. Policy implications are discussed that might mitigate challenges including sociodemographic disparities as well as language barriers and limited health literacy. They present technological solutions such as use of AI algorithms to identify and filter confidential, potentially sensitive, information to different tiers of access that would allow adolescents a greater degree of control over their personal information. The use of natural language processing also has the potential to automatically translate medical language into more patient and family-friendly terms.
AHRQ-funded; HS027214; HS027894.
Citation: Kelly MM, Kieren MQ, Coller RJ .
Pediatric open notes: caregiver experiences since the 21st Century Cures Act.
Acad Pediatr 2024 May-Jun; 24(4):556-58. doi: 10.1016/j.acap.2023.10.001..
Keywords: Children/Adolescents, Caregiving, Electronic Health Records (EHRs), Health Information Technology (HIT), Policy
Feyman Y, Griffith KN, Dorneo A
Physicians and specialties in the Veterans Health Administration's Community Care Network.
This study examined the availability of services provided through US Veterans Health Administration (VHA) community care networks by specialty and clinical characteristics. Just over half (57.6%) of the 768,254 physicians who submitted a Medicare claim in 2019 participated in the VHA community care network. The two groups had similar years since medical school graduation. However, community care physician participants were more often male, practiced in nonmetropolitan areas, or health care professional short areas, had larger Medicare patient panels, and higher Merit-Based Inventive Payment System (MIPS) scores. Their Medicare beneficiaries were similar in terms of proportions of male beneficiaries, age, hierarchical condition category risk adjustment score, and Medicare payments per beneficiary. Network participation was highest among oncologists (77.6%), urologists (77.3%), and cardiologists (76.3%). Participation was lowest among nutrition (31.0%), speech pathology (31.3%), and emergency medicine (34.1%) specialties.
AHRQ-funded; HS026395.
Citation: Feyman Y, Griffith KN, Dorneo A .
Physicians and specialties in the Veterans Health Administration's Community Care Network.
JAMA Netw Open 2024 May; 7(5):e2410841. doi: 10.1001/jamanetworkopen.2024.10841..
Keywords: Community-Based Practice
Freed K, Taylor MG, Toledo P
Readability, content, and quality of online patient education materials on anesthesia and neurotoxicity in the pediatric population.
This study’s aim was to evaluate readability, content, and quality of Internet-based patient education materials (PEMs) on anesthesia in the pediatric population and neurotoxicity. In 2016 the FDA released a warning statement against use of general anesthetic drugs in children and pregnant women due to concerns about neurotoxicity, and a number of websites of US medical centers with pediatric anesthesia fellowship programs had posted PEMs on the effects of anesthesia in the pediatric population and neurotoxicity. The quality of the PEMs was assessed with the Patient Education Material Assessment Tool for Print. Readability of the PEMs to the recommended sixth-grade reading level was compared using a one-sample t-test. The authors identified 27 PEMs pertaining to pediatric anesthesia and eight to neurotoxicity. Mean readability of all PEMs was greater than a sixth-grade reading level. While only 13% of PEMs on anesthesia for pediatric patients mentioned the FDA warning, all of the neurotoxicity materials did. The materials had good understandability (83%) but poor actionability (60%).
AHRQ-funded; HS025267.
Citation: Freed K, Taylor MG, Toledo P .
Readability, content, and quality of online patient education materials on anesthesia and neurotoxicity in the pediatric population.
Am J Perinatol 2024 May; 41(S 01):e341-e47. doi: 10.1055/s-0042-1754408..
Keywords: Children/Adolescents, Education: Patient and Caregiver, Medication, Medication: Safety, Patient Safety, Health Information Technology (HIT)
Manojlovich M, Bettencourt AP, Mangus CW
Refining a framework to enhance communication in the emergency department during the diagnostic process: an edelphi approach.
This study’s goal was to examine the entire diagnostic process in the emergency department (ED) using eDelphi methodology to achieve consensus among an expert panel of 18 clinicians, patients, family members, and other participants on a refined ED-based diagnostic decision-making framework that integrates several potential opportunities for communication to enhance diagnostic quality. The authors developed a final framework that positioned communication more prominently in the diagnostic process in the ED and enhances the original National Academies of Sciences, Engineering, and Medicine (NASEM) and ED-adapted NASEM frameworks. The process identified two specific types of communication-information exchange and shared understanding̲-as high priority for optimal outcomes. There were three categories identified for ideas for communication-focused interviews to prevent diagnosis error in the ED: patient-facing, clinician-facing, and system-facing interventions.
AHRQ-funded; HS028375.
Citation: Manojlovich M, Bettencourt AP, Mangus CW .
Refining a framework to enhance communication in the emergency department during the diagnostic process: an edelphi approach.
Jt Comm J Qual Patient Saf 2024 May; 50(5):348-56. doi: 10.1016/j.jcjq.2024.01.013..
Keywords: Emergency Department, Clinician-Patient Communication, Communication, Diagnostic Safety and Quality
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
Kirkendall ES, Brady PW, Corathers SD
Safer type 1 diabetes care at home: SEIPS-based process mapping with parents and clinicians.
This study used the Systems Engineering Initiative for Patient Safety (SEIPS) based process mapping method to identify failures and potential solutions associated with medication errors and treatment delays among outpatient children with type 1 diabetes (T1D). A transdisciplinary team of parents, safety researchers, and clinicians used SEIPS based process mapping to collect data on in-home medication review, observation of administration, chart reviews, parent surveys, and failure modes and effects analysis (FMEA). Eight of the 14 children who had home visits experienced 18 errors (31 per 100 medications). Four errors in two children resulted in harm, and 13 errors had the potential for harm. Two injuries occurred when parents failed to treat severe hypoglycemia and lethargy, and two had injuries due to repeated failures to administer insulin at home properly. The SEIPS-based process maps found that high-risk errors occurred during communication between the clinic and home or in management at home. Two FMEAs identified interventions to better communicate with families and support home care.
AHRQ-funded; HS026644.
Citation: Kirkendall ES, Brady PW, Corathers SD .
Safer type 1 diabetes care at home: SEIPS-based process mapping with parents and clinicians.
Pediatr Qual Saf 2023 May-Jun; 8(3):e649. doi: 10.1097/pq9.0000000000000649..
Keywords: Patient Safety, Diabetes, Home Healthcare, Adverse Drug Events (ADE), Adverse Events, Medication: Safety, Medication, Medical Errors
Temkin-Greener H, Guo W, McGarry B
Serious mental illness in assisted living communities: association with nursing home placement.
The objectives of this retrospective cohort study were to assess prevalence of serious mental illness (SMI) alone and co-occurring with Alzheimer disease and related dementias (ADRD), and to examine association between permanent nursing home (NH) placement and SMI among residents with and without ADRD. Medicare beneficiaries in assisted living were followed to track NH placement. Data was taken from the Medicare Enrollment Database, Beneficiary Summary File, Minimum Data Set, and a national directory of state-licensed assisted living communities. More than half the residents had a diagnosis of SMI. Individuals with schizophrenia and bipolar disorder had significantly lower probability of NH placement. Placement risk was greater for residents with ADRD, increasing for those who also had schizophrenia or bipolar disorder. The authors concluded that these finding suggested that assisted living facilities may not be well prepared to care for residents with schizophrenia or bipolar disorder.
AHRQ-funded; HS026893.
Citation: Temkin-Greener H, Guo W, McGarry B .
Serious mental illness in assisted living communities: association with nursing home placement.
J Am Med Dir Assoc 2024 May; 25(5):917-22. doi: 10.1016/j.jamda.2024.02.015..
Keywords: Elderly, Behavioral Health, Nursing, Long-Term Care