National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
2826 to 2850 of 12214 Research Studies DisplayedMian HS, Fiala MA, Sanchez L
Renal failure among multiple myeloma patients utilizing carfilzomib and associated factors in the "real world."
Researchers investigated the rate of renal failure and associated risk factors in real-world populations of patients with multiple myeloma taking carfilzomib. Using Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data, they found that renal failure developed in 22% of patients during the study period. The median time to development of renal failure from first carfilzomib administration was 1.6 months. Increasing age, pre-existing heart failure, and pre-existing chronic kidney disease were associated with a higher risk of developing renal failure. As their study could not determine the exact cause and mechanism of renal failure, they recommended future studies to further understand this cause among patients on carfilzomib and to devise strategies to mitigate the risk.
AHRQ-funded; HS019455.
Citation: Mian HS, Fiala MA, Sanchez L .
Renal failure among multiple myeloma patients utilizing carfilzomib and associated factors in the "real world."
Ann Hematol 2021 May;100(5):1261-66. doi: 10.1007/s00277-021-04420-3..
Keywords: Cancer, Kidney Disease and Health, Medication, Adverse Drug Events (ADE), Adverse Events, Risk
Srivastava S, Clark B, Landy-Schmitt C
Repetitive and self-injurious behaviors in children with Cornelia de Lange syndrome.
AHRQ-funded; HS023000.
Citation: Srivastava S, Clark B, Landy-Schmitt C .
Repetitive and self-injurious behaviors in children with Cornelia de Lange syndrome.
J Autism Dev Disord 2021 May;51(5):1748-58. doi: 10.1007/s10803-020-04617-x..
Keywords: Children/Adolescents, Neurological Disorders, Diagnostic Safety and Quality
Allgaier J, Lagu T, Haessler S
Risk factors, management, and outcomes of legionella pneumonia in a large, nationally representative sample.
The authors sought to describe testing, empiric treatment, and outcomes for patients with Legionella pneumonia (LP). They found that LP was an uncommon cause of community-acquired pneumonia, occurring primarily from late spring through early autumn. Further, testing was uncommon, even among patients with risk factors, and many patients with positive test results failed to receive empiric coverage for LP.
AHRQ-funded; HS024277.
Citation: Allgaier J, Lagu T, Haessler S .
Risk factors, management, and outcomes of legionella pneumonia in a large, nationally representative sample.
Chest 2021 May;159(5):1782-92. doi: 10.1016/j.chest.2020.12.013..
Keywords: Respiratory Conditions
Duh-Leong C, Dreyer BP, Huang TT
Social capital as a positive social determinant of health: a narrative review.
This paper frames social capital, or the benefits that a child receives from social relationships, as a positive social determinant of health that helps children exposed to adversity achieve healthy outcomes across the life course. Findings showed that pediatric primary care practices play an important role in fostering social relationships between families, the health care system, and the community. Further research was recommended in order to develop definitional and measurement rigor for social capital, to evaluate interventions that may improve health outcomes through social capital, and to broaden understanding of how social relationships influence health outcomes.
AHRQ-funded; HS022236.
Citation: Duh-Leong C, Dreyer BP, Huang TT .
Social capital as a positive social determinant of health: a narrative review.
Acad Pediatr 2021 May-Jun;21(4):594-99. doi: 10.1016/j.acap.2020.09.013..
Keywords: Social Determinants of Health
Bunting AM, Frank D, Arshonsky J
Socially-supportive norms and mutual aid of people who use opioids: an analysis of Reddit during the initial COVID-19 pandemic.
This study looked at the effect big events like the COVID-19 pandemic can have on transforming social structures, social interactions, and social norms. The social media site Reddit.com was used to collect data on the impact of COVID-19 and opioid use. Posts from March to May 2020 were collected from the two most popular opioid subreddits. Out of 2000 posts, 300 were found to be relevant to the study. The pandemic led to robust social support and mutual aid on Reddit including advice on coping with social isolation, withdrawal, managing cravings, and accessing recovery resources.
AHRQ-funded; HS026120.
Citation: Bunting AM, Frank D, Arshonsky J .
Socially-supportive norms and mutual aid of people who use opioids: an analysis of Reddit during the initial COVID-19 pandemic.
Drug Alcohol Depend 2021 May 1;222:108672. doi: 10.1016/j.drugalcdep.2021.108672..
Keywords: Opioids, Medication, Substance Abuse, COVID-19, Infectious Diseases, Social Media
Javalkar K, Robson VK, Gaffney L
Socioeconomic and racial and/or ethnic disparities in multisystem inflammatory syndrome.
Researchers characterized the socioeconomic and racial and/or ethnic disparities impacting the diagnosis and outcomes of multisystem inflammatory syndrome in children (MIS-C). They found that lower socioeconomic status or higher social vulnerability index, Hispanic ethnicity, and Black race independently increased risk for MIS-C. They recommended additional studies to target interventions to improve health equity for children.
AHRQ-funded; HS000063.
Citation: Javalkar K, Robson VK, Gaffney L .
Socioeconomic and racial and/or ethnic disparities in multisystem inflammatory syndrome.
Pediatrics 2021 May;147(5). doi: 10.1542/peds.2020-039933..
Keywords: Children/Adolescents, Social Determinants of Health, Disparities, Racial and Ethnic Minorities, Risk
Evans E, Gutman R, Resnik L
Successful community discharge among older adults with traumatic brain injury in skilled nursing facilities.
The purpose of this retrospective cohort study was to identify patient, injury, and functional status characteristics associated with successful discharge to the community following a skilled nursing facility (SNF) stay among older adults hospitalized following traumatic brain injury (TBI). Participants were Medicare fee-for-service beneficiaries admitted to an SNF after hospitalization for TBI. Findings showed that among older adults with TBI who discharge to an SNF, sociodemographic and functional status characteristics are associated with successful discharge and may be useful to clinicians for discharge planning.
AHRQ-funded; HS000011.
Citation: Evans E, Gutman R, Resnik L .
Successful community discharge among older adults with traumatic brain injury in skilled nursing facilities.
J Head Trauma Rehabil 2021 May-Jun;36(3):E186-e98. doi: 10.1097/htr.0000000000000638..
Keywords: Elderly, Brain Injury, Transitions of Care, Nursing Homes
Bongiovanni T, Lancaster E, Ledesma Y
Systematic review and meta-analysis of the association between non-steroidal anti-inflammatory drugs and operative bleeding in the perioperative period.
Investigators sought to understand the risk of bleeding caused by NSAIDs in the perioperative period. They performed a systematic review of articles on the use of NSAIDs and outcomes of interest such as surgical complications and bleeding, then conducted a meta-analysis of the data. They concluded that NSAIDs were unlikely to be the cause of postoperative bleeding complications. The literature studied covered a large number of patients and remained consistent across types of NSAIDs and operations.
AHRQ-funded; HS027369; HS026383; 233201500020I.
Citation: Bongiovanni T, Lancaster E, Ledesma Y .
Systematic review and meta-analysis of the association between non-steroidal anti-inflammatory drugs and operative bleeding in the perioperative period.
J Am Coll Surg 2021 May;232(5):765-90.e1. doi: 10.1016/j.jamcollsurg.2021.01.005..
Keywords: Adverse Drug Events (ADE), Adverse Events, Medication, Surgery, Medication: Safety
Bartsch SM, O'Shea KJ, Wedlock PT
The benefits of vaccinating with the first available COVID-19 coronavirus vaccine.
This study’s objective was to determine quantitatively the benefits of early vaccination for COVID-19 even if later on in the pandemic a latter vaccine has substantially higher efficacy. The team developed this model in 2020 before vaccinations became available. For example if a vaccine with 50% efficacy becomes available when 10% of the population has already been infected, waiting until 40% of the population are infected for a vaccine with 80% efficacy results in 15.6 million additional cases and 1.5 million additional hospitalizations, costing $20.6 billion more in direct medical costs and $12.4 billion more in productivity losses.
AHRQ-funded; HS028165.
Citation: Bartsch SM, O'Shea KJ, Wedlock PT .
The benefits of vaccinating with the first available COVID-19 coronavirus vaccine.
Am J Prev Med 2021 May;60(5):605-13. doi: 10.1016/j.amepre.2021.01.001..
Keywords: COVID-19, Vaccination, Healthcare Costs, Prevention, Infectious Diseases
Gleason K, Harkless G, Stanley J
The critical need for nursing education to address the diagnostic process.
In this paper, the authors reviewed the history and current state of diagnostic education in pre-licensure registered nurse preparation, introduced interprofessional individual- and team-based competencies to improve diagnostic safety, and discussed the next steps for nursing education.
AHRQ-funded; HS027198.
Citation: Gleason K, Harkless G, Stanley J .
The critical need for nursing education to address the diagnostic process.
Nurs Outlook 2021 May-Jun;69(3):362-69. doi: 10.1016/j.outlook.2020.12.005..
Keywords: Diagnostic Safety and Quality, Provider: Nurse, Education: Curriculum
Krah NM, Jones TW, Lake J
The impact of antibiotic allergy labels on antibiotic exposure, clinical outcomes, and healthcare costs: a systematic review.
In this systematic review, the authors aimed to determine how antibiotic allergy labels influenced three domains. They found that antibiotic allergy labels have negative effects on antibiotic use and exposure, clinical outcomes, and economic outcomes in a variety of clinical settings and populations.
AHRQ-funded; HS023320.
Citation: Krah NM, Jones TW, Lake J .
The impact of antibiotic allergy labels on antibiotic exposure, clinical outcomes, and healthcare costs: a systematic review.
Infect Control Hosp Epidemiol 2021 May;42(5):530-48. doi: 10.1017/ice.2020.1229..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Healthcare Costs
Baillargeon J, Polychronopoulou E, Kuo YF
The impact of substance use disorder on COVID-19 outcomes.
The goal of this study was to examine the impact of substance use disorder on the risk of hospitalization, complications, and mortality among adult patients diagnosed as having COVID-19. Using data from the TriNetX Research Network database, primary analysis showed that substance use disorder was associated with an increased risk of hospitalization, ventilator use, and mortality. These findings suggest that COVID-19 patients with substance use disorders are at increased risk for adverse outcomes.
AHRQ-funded; HS026133.
Citation: Baillargeon J, Polychronopoulou E, Kuo YF .
The impact of substance use disorder on COVID-19 outcomes.
Psychiatr Serv 2021 May;72(5):578-81. doi: 10.1176/appi.ps.202000534..
Keywords: COVID-19, Substance Abuse, Hospitalization, Mortality, Risk
Narla S, Silverberg JI
The inpatient burden and comorbidities of pyoderma gangrenosum in adults in the United States.
The objective of this study was to determine the prevalence, predictors, outcomes, and costs of hospitalization for pyoderma gangrenosum (PG) in United States adults. Data from the 2002-2012 National Inpatient Sample were analyzed. Findings showed that PG admissions were more likely at teaching and medium or large hospitals. The majority of inpatients with PG were classified with minor or moderate likelihood of dying, but moderate and major loss of function. PG was associated with numerous other health disorders. This study demonstrated a substantial and increasing inpatient burden of PG in the United States, with considerable disability and mortality risk, multiple comorbid health disorders, and costs.
AHRQ-funded; HS023011.
Citation: Narla S, Silverberg JI .
The inpatient burden and comorbidities of pyoderma gangrenosum in adults in the United States.
Arch Dermatol Res 2021 May;313(4):245-53. doi: 10.1007/s00403-020-02098-7..
Keywords: Healthcare Cost and Utilization Project (HCUP), Skin Conditions, Injuries and Wounds, Hospitalization, Healthcare Costs
Asti L, Hopley C, Avelis C
The potential clinical and economic value of a human papillomavirus primary screening test that additionally identifies genotypes 31, 45, 51, and 52 individually.
This study looked at the potential clinical and economic value of a human papillomavirus (HPV) primary screening test that additionally identified genotypes 31,45,51, and 52 along with genotypes 16 and 18. The authors developed a Markov model of the HPV disease course and evaluated the clinical and economic value of HPV primary screening with Onclarity. Currently HPV primary screening results in 25,194 invasive procedures and 48 invasive cervical cancer (ICC) cases per 100,000 women. Screening with extended genotyping and later screening women with certain genotypes averted 903 to 3163 invasive procedures and results in 0 to 3 more ICC cases compared with current primary screening tests. Extended genotyping was cost effective when costing $75 and cost saving when costing $43. When the probabilities of disease progression increased 2-4 times, it was not cost-effective because it resulted in more ICC cases and accrued fewer quality-adjusted life-years.
AHRQ-funded; HS023317.
Citation: Asti L, Hopley C, Avelis C .
The potential clinical and economic value of a human papillomavirus primary screening test that additionally identifies genotypes 31, 45, 51, and 52 individually.
Sex Transm Dis 2021 May;48(5):370-80. doi: 10.1097/olq.0000000000001327.
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Keywords: Sexual Health, Infectious Diseases, Screening, Diagnostic Safety and Quality, Genetics, Cancer: Cervical Cancer, Cancer, Women
Sockolow PS, Bowles KH, Le NB
There's a problem with the problem list: incongruence of patient problem information across the home care admission.
The purpose of this observational field study was to illustrate patterns of patient problem information received and documented across the home health care (HHC) admission process and offer practice, policy, and health information technology recommendations to improve information transfer. The investigators concluded that diagnosis or problem information transferred from the referral source or gathered during an in-home assessment did not appear in the plan of care. Because of the EHR structure, clinicians could not identify inactive problem or problem priority.
AHRQ-funded; HS024537.
Citation: Sockolow PS, Bowles KH, Le NB .
There's a problem with the problem list: incongruence of patient problem information across the home care admission.
J Am Med Dir Assoc 2021 May;22(5):1009-14. doi: 10.1016/j.jamda.2020.06.032..
Keywords: Home Healthcare, Electronic Health Records (EHRs), Health Information Technology (HIT)
Colman N, Newman JW, Nishisaki A
Translational simulation improves compliance with the NEAR4KIDS Airway Safety Bundle in a single-center PICU.
This single-center retrospective review discusses a translational simulation conducted to improve compliance with the National Emergency Airway Registry for Children (NEAR4KIDS) Airway Safety Quality Improvement (QI) bundle to improve the safety of tracheal intubations. The simulation was implemented between March and December 2018. Bundle adherence was assessed 12 months before simulation and 9 months after. Primary outcomes measures were compliance with the bundle and utilization of apneic oxygenation and secondary outcomes was the occurrence of adverse tracheal intubation-associated events. Preintervention bundle compliance was 66%, which increased to 93.7% after the simulation intervention. Adherence to apneic oxygenation was 27.9% before the intervention and increased to 77.9% after. There was no difference in the occurrence of tracheal intubation events.
AHRQ-funded; HS024511.
Citation: Colman N, Newman JW, Nishisaki A .
Translational simulation improves compliance with the NEAR4KIDS Airway Safety Bundle in a single-center PICU.
Pediatr Qual Saf 2021 May-Jun;6(3):e409. doi: 10.1097/pq9.0000000000000409..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Registries, Simulation, Patient Safety, Quality Improvement, Quality of Care
Hua CL, Cornell PY, Zimmerman S
Trends in serious mental illness in US assisted living compared to nursing homes and the community: 2007-2017.
This study examined trends in the prevalence of serious mental illness (SMI) in assisted living (AL) communities in the United States over time and in relationship to characteristics such as dual eligibility and health conditions. Using Medicare data, findings showed that the prevalence of SMI in AL increased by 54% from 2007 to 2017. Residents with SMI were more likely to be dually eligible for Medicare and Medicaid than residents without SMI. Approximately 10% of AL communities had over half of the sample's AL residents with SMI.
AHRQ-funded; HS000011.
Citation: Hua CL, Cornell PY, Zimmerman S .
Trends in serious mental illness in US assisted living compared to nursing homes and the community: 2007-2017.
Am J Geriatr Psychiatry 2021 May;29(5):434-44. doi: 10.1016/j.jagp.2020.09.011..
Keywords: Elderly, Behavioral Health, Nursing Homes, Long-Term Care, Medicare
Reistetter TA, Eschbach K K, Prochaska J
Understanding variation in postacute care: developing rehabilitation service areas through geographic mapping.
This study’s goal was to demonstrate a method for developing rehabilitation service areas for post-acute care. A secondary analysis of 2013-2014 Medicare records for older patients in Texas (n = 469,172) was conducted. The analysis included admission records for inpatient rehabilitation facilities, skilled nursing facilities, and long-term care hospitals. The authors used Ward’s algorithm to cluster patient ZIP code tabulation areas based on which facilities patients were admitted to for rehabilitation. They set the number of rehabilitation clusters to 22 to allow for comparison to the 22 hospital referral regions. Interclass Correlation Coefficient (ICC) and variance in the number of rehabilitation beds across areas were the methods used to evaluate rehabilitation service areas. The service areas had a higher ICC and variance in beds than the hospital referral regions.
AHRQ-funded; HS024711.
Citation: Reistetter TA, Eschbach K K, Prochaska J .
Understanding variation in postacute care: developing rehabilitation service areas through geographic mapping.
Am J Phys Med Rehabil 2021 May;100(5):465-72. doi: 10.1097/phm.0000000000001577..
Keywords: Elderly, Rehabilitation, Medicare, Nursing Homes, Long-Term Care, Home Healthcare, Access to Care
Korach ZT, Gradwohl S, Messinger A
Unsupervised clinical relevancy ranking of structured medical records to retrieve condition-specific information in the emergency department.
Investigators compared knowledge-based and unsupervised statistical methods for ranking electronic health record (EHR) information by relevancy to a chief complaint of chest or back pain among emergency department patients. They found that a fully unsupervised statistical method can provide a reasonably accurate, low-effort, and scalable means for situation-specific ranking of clinical information within the EHR.
AHRQ-funded; HS024541.
Citation: Korach ZT, Gradwohl S, Messinger A .
Unsupervised clinical relevancy ranking of structured medical records to retrieve condition-specific information in the emergency department.
Int J Med Inform 2021 May;149:104410. doi: 10.1016/j.ijmedinf.2021.104410.
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Keywords: Emergency Department, Electronic Health Records (EHRs), Health Information Technology (HIT)
Hill JR, Visweswaran S, Ning X
Use, impact, weaknesses, and advanced features of search functions for clinical use in electronic health records: a scoping review.
The purpose of this study was to conduct a scoping review of the literature on the use of EHR search functions within a single patient's record in clinical settings to characterize the current state of research on the topic and identify areas for future study. The review found that search functions generally facilitated patient information retrieval by clinicians and were positively received by users. A limited number of articles described the use of EHR search functions in a clinical setting, despite evidence that they benefit clinician workflow and productivity.
AHRQ-funded; HS027185.
Citation: Hill JR, Visweswaran S, Ning X .
Use, impact, weaknesses, and advanced features of search functions for clinical use in electronic health records: a scoping review.
Appl Clin Inform 2021 May;12(3):417-28. doi: 10.1055/s-0041-1730033..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT)
Silverberg JI, Lei D, Yousaf M
What are the best endpoints for eczema area and severity index and scoring atopic dermatitis in clinical practice? A prospective observational study.
This prospective observational study’s objective was to determine the minimal important changes (MICs) of the Eczema Area and Severity Index (EASI) and Scoring Atopic Dermatitis (SCORAD) across all severities of atopic dermatitis (AD). Questionnaires and evaluation by a dermatologist (n =826) were used to determine the MIC of percentage and absolute improvement of EASI and SCORAD scores in adults and children. Absolute MICs for EASI, SCORAD, and O-SCORAD varied by baseline severity and EASI 50, SCORAD 35 and O-SCORAD 35 were meaningful percentage MICs regardless of baseline AD severity.
AHRQ-funded; HS023011.
Citation: Silverberg JI, Lei D, Yousaf M .
What are the best endpoints for eczema area and severity index and scoring atopic dermatitis in clinical practice? A prospective observational study.
Br J Dermatol 2021 May;184(5):888-95. doi: 10.1111/bjd.19457..
Keywords: Skin Conditions, Patient-Centered Outcomes Research, Evidence-Based Practice
Kanji F, Catchpole K, Choi E
Work-system interventions in robotic-assisted surgery: a systematic review exploring the gap between challenges and solutions.
The purpose of this review was to identify the gap between identified Robotic Assisted Surgery (RAS) work-system barriers and interventions developed to address those barriers. This review identified a significant gap between issues and solutions in RAS. Improving RAS-associated non-technical skills, task management, and technology management may lead to improved operating room dynamics associated with greater efficiency, reduced costs, and better systems-level outcomes.
AHRQ-funded; HS026491.
Citation: Kanji F, Catchpole K, Choi E .
Work-system interventions in robotic-assisted surgery: a systematic review exploring the gap between challenges and solutions.
Surg Endosc 2021 May;35(5):1976-89. doi: 10.1007/s00464-020-08231-x..
Keywords: Surgery, Communication
Fareed N, Jonnalagadda P, MacEwan SR
Differential effects of outpatient portal user status on inpatient portal use: observational study.
This study’s objective was to understand how patients' use of an inpatient portal is influenced by outpatient portal use. Findings showed that patients' use of an inpatient portal during their hospital stay appeared to be influenced by a combination of factors, including prior outpatient portal use. For new users, hospitalization itself may have influenced portal use. In contrast, nonusers might have lower self-efficacy in their ability to use technology to manage their health, contributing to their lower portal use.
AHRQ-funded; HS024379; HS024091.
Citation: Fareed N, Jonnalagadda P, MacEwan SR .
Differential effects of outpatient portal user status on inpatient portal use: observational study.
J Med Internet Res 2021 Apr 30;23(4):e23866. doi: 10.2196/23866..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT)
Legler S, Diehl M, Hilliard B
Evaluation of an intrahospital telemedicine program for patients admitted with COVID-19: mixed methods study.
This pilot study’s objective was to evaluate an intrahospital telemedicine program along with its impact on exposure risk and communication for patients admitted with COVID-19. Virtual care was the main primary exposure variable and patient characteristics, PPE use rates, and their association with virtual care were assessed. Out of 137 total patients in their primary analysis, 43 patients used virtual care. There were 82 inpatient days of use, and 401 inpatient days without use. Surveys of 41 patients and clinicians showed high rates of recommendation for further use. A significant reduction in PPE use and physical exam rate was associated with virtual care. However, there are limitations in usability, medical assessment, and empathetic communication.
AHRQ-funded; HS026732.
Citation: Legler S, Diehl M, Hilliard B .
Evaluation of an intrahospital telemedicine program for patients admitted with COVID-19: mixed methods study.
J Med Internet Res 2021 Apr 29;23(4):e25987. doi: 10.2196/25987..
Keywords: Telehealth, Health Information Technology (HIT), Hospitals, Hospitalization, Communication, COVID-19
Deshpande A, Richter SS, Haessler S
De-escalation of empiric antibiotics following negative cultures in hospitalized patients with pneumonia: rates and outcomes.
This study assessed antibiotic de-escalation practices across hospitals and their associations with outcomes in hospitalized patients diagnosed with pneumonia with negative cultures. The authors included 14,170 adults admitted with pneumonia in 2010-2015 to 164 US hospitals if they had negative blood and/or respiratory cultures and received both anti-MRSA and antipseudomonal agents other than quinolones. If empiric drugs were stopped on day 4 while continuing another antibiotic it was defined at de-escalation. Patients were propensity adjusted for de-escalation and compared on in-hospital 14-day mortality, late deterioration with ICU transfer, length-of-stay (LOS) and costs. Thirteen percent (1924 patients) had both initial empiric drugs stopped by hospital day 4. De-escalation rates at hospitals ranged from 2-35% and the established rate quartiles were not significantly associated with outcomes. Even at hospitals in the top quartile of de-escalation, the de-escalation rates were lower than 50%.
AHRQ-funded; HS025026; HS024277.
Citation: Deshpande A, Richter SS, Haessler S .
De-escalation of empiric antibiotics following negative cultures in hospitalized patients with pneumonia: rates and outcomes.
Clin Infect Dis 2021 Apr 26;72(8):1314-22. doi: 10.1093/cid/ciaa212..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Pneumonia, Respiratory Conditions, Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Inpatient Care