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
4876 to 4900 of 12139 Research Studies DisplayedNelson HD, Fu R, Zakher B
Medication use for the risk reduction of primary breast cancer in women: updated evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this paper was to update the 2013 US Preventive Services Task Force systematic review on medications to reduce risk of primary (first diagnosis) invasive breast cancer in women. Investigators abstracted data on methods, participant characteristics, eligibility criteria, outcome ascertainment, and follow-up; individual trial results were combined using a profile likelihood random-effects model. Results showed that tamoxifen, raloxifene, and aromatase inhibitors were associated with lower risk of primary invasive breast cancer in women but also were associated with adverse effects that differed between medications. Risk stratification methods to identify patients with increased breast cancer risk demonstrated low accuracy.
AHRQ-funded; 290201500009I.
Citation: Nelson HD, Fu R, Zakher B .
Medication use for the risk reduction of primary breast cancer in women: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2019 Sep 3;322(9):868-86. doi: 10.1001/jama.2019.5780..
Keywords: Cancer: Breast Cancer, Cancer, Medication, U.S. Preventive Services Task Force (USPSTF), Evidence-Based Practice, Guidelines, Prevention, Primary Care
Bach P, Hartung D
Leveraging the role of community pharmacists in the prevention, surveillance, and treatment of opioid use disorders.
This narrative review explores the literature describing novel programs designed to capitalize on the role of the community pharmacist in helping to reduce opioid-related harms, as well as evaluations of existing practices already in place in the US and elsewhere around the world. Specific approaches examined include strategies to facilitate pharmacist monitoring for problematic opioid use, to increase pharmacy-based harm reduction efforts (including naloxone distribution and needle exchange programs), and to involve community pharmacists in the dispensation of opioid agonist therapy.
AHRQ-funded; HS024227; 2902015000091.
Citation: Bach P, Hartung D .
Leveraging the role of community pharmacists in the prevention, surveillance, and treatment of opioid use disorders.
Addict Sci Clin Pract 2019 Sep 2;14(1):30. doi: 10.1186/s13722-019-0158-0..
Keywords: Medication, Opioids, Provider, Provider: Pharmacist, Substance Abuse
Merritt C, Dietrich AM, Bogie AL
2018 Academic Emergency Medicine Consensus Conference: A Workforce Development Research Agenda for Pediatric Care in the Emergency Department.
Although the number of pediatric emergency medicine specialists continues to rise, the vast majority of children are cared for in general EDs outside of children's hospitals by a diverse workforce of care providers who must possess the knowledge, experience, skills, and systemic support necessary to deliver excellent pediatric emergency care. There is a crucial need to understand the factors that drive the professional development and support systems of this diverse workforce. In this paper the investigators identified five key research themes and prioritized a specific research agenda.
AHRQ-funded; HS026101.
Citation: Merritt C, Dietrich AM, Bogie AL .
2018 Academic Emergency Medicine Consensus Conference: A Workforce Development Research Agenda for Pediatric Care in the Emergency Department.
Acad Emerg Med 2019 Sep;26(9):1063-73. doi: 10.1111/acem.13638..
Keywords: Emergency Department, Research Methodologies, Children/Adolescents
Zhou J, Hodges JS, Suri MFK
A Bayesian hierarchical model estimating CACE in meta-analysis of randomized clinical trials with noncompliance.
Noncompliance to assigned treatment is a common challenge in analysis and interpretation of randomized clinical trials. The complier average causal effect (CACE) approach provides a useful tool for addressing noncompliance, where CACE is defined as the average difference in potential outcomes for the response in the subpopulation of subjects who comply with their assigned treatments. In this article, the investigators present a Bayesian hierarchical model to estimate the CACE in a meta-analysis of randomized clinical trials where compliance may be heterogeneous between studies.
AHRQ-funded; HS024743.
Citation: Zhou J, Hodges JS, Suri MFK .
A Bayesian hierarchical model estimating CACE in meta-analysis of randomized clinical trials with noncompliance.
Biometrics 2019 Sep;75(3):978-87. doi: 10.1111/biom.13028..
Keywords: Patient Adherence/Compliance, Research Methodologies
Shen NT, Salajegheh A, Brown RS
A call to standardize definitions, data collection, and outcome assessment to improve care in alcohol-related liver disease.
Alcohol-related liver disease (ALD) is highly prevalent and appears to be increasingly reported with worsening mortality; thus, optimizing care in this patient population is imperative. This requires a multidisciplinary, multifaceted approach that includes recognizing alcohol use disorder (AUD) and existing treatments for AUD. In this paper, the authors call for standardizing definitions, data collection, and outcome assessment to improve care in alcohol-related liver disease.
AHRQ-funded; HS000066.
Citation: Shen NT, Salajegheh A, Brown RS .
A call to standardize definitions, data collection, and outcome assessment to improve care in alcohol-related liver disease.
Hepatology 2019 Sep;70(3):1038-44. doi: 10.1002/hep.30587..
Keywords: Data, Alcohol Use, Outcomes
Rangachari P, Dellsperger KC, Rethemeyer RK
A health system's pilot experience with using Social Knowledge Networking (SKN) technology to enable meaningful use of EHR medication reconciliation technology.
Similar to issues faced in health systems across USA, AU Health, based in Augusta, Georgia, faced a scenario of low physician engagement in, and limited-use of its Electronic Health Record (EHR) Medication Reconciliation (MedRec) technology, which translated to high rates of medication discrepancies and low accuracy of the patient's active medication list, during transitions of care. This paper describes AU Health’s pilot experience with using Social Knowledge Networking (SKN) technology to enable meaningful use of EHR medication reconciliation technology.
AHRQ-funded; HS024335.
Citation: Rangachari P, Dellsperger KC, Rethemeyer RK .
A health system's pilot experience with using Social Knowledge Networking (SKN) technology to enable meaningful use of EHR medication reconciliation technology.
J Hosp Manag Health Policy 2019 Sep;3(22). doi: 10.21037/jhmhp.2019.08.01..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Health Systems
Lasater KB, Jarrin OF, Aiken LH
A methodology for studying organizational performance: a multistate survey of front-line providers.
The objective of this study was to describe a novel approach to obtaining a representative sample of organizations using individuals nested within organizations, and demonstrate how resurveying nonrespondents could allay concerns about bias from low response rates at the individual-level. The investigators concluded that surveying organizations via random sampling of front-line providers could avoid the self-selection issues caused by directly sampling organizations.
AHRQ-funded; HS022406.
Citation: Lasater KB, Jarrin OF, Aiken LH .
A methodology for studying organizational performance: a multistate survey of front-line providers.
Med Care 2019 Sep;57(9):742-49. doi: 10.1097/mlr.0000000000001167..
Keywords: Provider Performance, Organizational Change
Stevens JP, Sheridan AR, Bernstein HB
A multidimensional profile of dyspnea in hospitalized patients.
Dyspnea is prevalent among hospitalized patients but little is known about the experience of dyspnea among inpatients. In this study, the investigators sought to characterize the multiple sensations and associated emotions of dyspnea in patients admitted with dyspnea to a tertiary care hospital. The investigators indicated that this first multidimensional portrait of dyspnea in a general inpatient population characterized the sensations and emotions dyspneic patients endure.
AHRQ-funded; HS024288.
Citation: Stevens JP, Sheridan AR, Bernstein HB .
A multidimensional profile of dyspnea in hospitalized patients.
Chest 2019 Sep;156(3):507-17. doi: 10.1016/j.chest.2019.04.128..
Keywords: Hospitalization, Inpatient Care
Goetz Goldberg D, Haghighat S, Kavalloor S S
A qualitative analysis of implementing EvidenceNOW to improve cardiovascular care.
This study’s objective was to perform a quantitative analysis of the implementation of an EvidenceNOW initiative to assist primary care practices in implementing evidence-based cardiovascular care and building capacity for quality improvement. The Heart of Virginia Health care (HVH) regional cooperative was surveyed to understand HVH team member viewpoints on the initiative’s challenges, strengths, and lessons learned in each phase of the project. The researchers interviewed 22 HVH team members in depth. Positives aspects included diverse team member skills and areas of expertise, a well-received kick-off event, and a comprehensive set of practice improvement resources. Challenges included recruiting primary practices, varying types and capabilities of electronic health records, working with practices at different transformation stages and different objectives for participating and involvement in other government initiatives.
AHRQ-funded; HS023913.
Citation: Goetz Goldberg D, Haghighat S, Kavalloor S S .
A qualitative analysis of implementing EvidenceNOW to improve cardiovascular care.
J Am Board Fam Med 2019 Sep-Oct;32(5):705-14. doi: 10.3122/jabfm.2019.05.190084..
Keywords: Cardiovascular Conditions, Primary Care, Quality Improvement, Quality of Care, Evidence-Based Practice, Implementation
Montalbano A, Quinonez RA, Hall M
Achievable benchmarks of care for pediatric readmissions.
This study’s objective was to calculate mean readmission rates and the Achievable Benchmarks of Care (ABCs) for pediatric diagnoses by different hospital types: metropolitan teaching, metropolitan nonteaching, and nonmetropolitan hospitals. The authors used a cross-sectional retrospective study of 30-day, all-cause same-hospital readmission of patients less than 18 years of age using the 2014 HCUP National Readmission Database. They calculated mean readmission and corresponding ABCs for the 17 most common readmission diagnosis. They found that sickle cell disease (SCD), bipolar and major depressive disorders were the most common reasons for readmission.
AHRQ-funded; HS024554.
Citation: Montalbano A, Quinonez RA, Hall M .
Achievable benchmarks of care for pediatric readmissions.
J Hosp Med 2019 Sep;14(9):534-40. doi: 10.12788/jhm.3201..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Hospital Readmissions, Hospitals, Quality of Care
Oates GR, Niranjan SJ, Ott C
Adherence to pulmonary rehabilitation in COPD: a qualitative exploration of patient perspectives on barriers and facilitators.
Adherence to pulmonary rehabilitation (PR) is low. This qualitative study used the PRECEDE model to identify predisposing (intrapersonal), reinforcing (interpersonal), and enabling (structural) factors acting as barriers or facilitators of adherence to PR, and elicit recommendations for solutions from patients with chronic obstructive pulmonary disease (COPD). The investigators concluded that health limitations, social support, transportation and financial difficulties, and program features impact ability of patients to attend PR.
AHRQ-funded; HS023009.
Citation: Oates GR, Niranjan SJ, Ott C .
Adherence to pulmonary rehabilitation in COPD: a qualitative exploration of patient perspectives on barriers and facilitators.
J Cardiopulm Rehabil Prev 2019 Sep;39(5):344-49. doi: 10.1097/hcr.0000000000000436..
Keywords: Respiratory Conditions, Rehabilitation, Patient Adherence/Compliance, Chronic Conditions
Caram MEV, Kaufman SR, Modi PK
Adoption of abiraterone and enzalutamide by urologists.
The purpose of this study was to investigate the adoption of abiraterone and enzalutamide by urologists. Abiraterone and enzalutamide are oral therapies approved for the treatment of metastatic castration-resistant prostate cancer, a disease most commonly treated by medical oncologists. The investigators found that urologists are increasingly prescribing oral therapies for metastatic castration-resistant prostate cancer. They suggest that understanding the distribution of urologists specializing in castration-resistant prostate cancer therapeutics will help guide future interventions to optimize the care for this important patient population.
AHRQ-funded; HS025707.
Citation: Caram MEV, Kaufman SR, Modi PK .
Adoption of abiraterone and enzalutamide by urologists.
Urology 2019 Sep;131:176-83. doi: 10.1016/j.urology.2019.05.012..
Keywords: Cancer, Cancer: Prostate Cancer, Care Management, Medication, Men's Health
Kapoor A, Field T, Handler S
Adverse events in long-term care residents transitioning from hospital back to nursing home.
This study looked at adverse event rates of long-term care residents transitioning back to their nursing home after hospitalization. A prospective cohort study of LTC residents discharged from hospital back to LTC from March 1, 2016, to December 31, 2017 was conducted, and residents were followed up for 45 days. A random sample of 32 nursing homes located in 6 New England states was used, and 555 LTC residents were selected, contributing 762 transitions from hospital back to the same LTC facility. Most of the cohort were female (65.5%) and non-Hispanic white (93.7%). The study used trained nurse abstractors to review nursing home records to determine if an adverse event occurred. Out of 762 discharges there were 379 adverse events. The most common adverse events were pressure ulcers, skin tears, and falls followed by health care-acquired infections. 145 adverse events were considered less serious, with 28 life-threatening, and 8 were fatal. Most of the adverse events were considered preventable or ameliorable.
AHRQ-funded; HS024596.
Citation: Kapoor A, Field T, Handler S .
Adverse events in long-term care residents transitioning from hospital back to nursing home.
JAMA Intern Med 2019 Sep;179(9):1254-61. doi: 10.1001/jamainternmed.2019.2005..
Keywords: Adverse Events, Long-Term Care, Nursing Homes, Transitions of Care, Elderly, Patient Safety, Hospital Discharge, Hospitalization
Adam GP, Balk EM, Jap J
AHRQ EPC series on improving translation of evidence: web-based interactive presentation of systematic review reports.
In this study, an open-source Web-based interactive report presentation of a systematic review was developed to allow users to generate their own "reports" from the information produced by the review. Data from a broad-scope systematic review were used with network meta-analysis conducted on nonsurgical treatments of urinary incontinence (UI) in women. Stakeholders informed and piloted the tool and assessed its usefulness.
AHRQ-funded; 290201500002I.
Citation: Adam GP, Balk EM, Jap J .
AHRQ EPC series on improving translation of evidence: web-based interactive presentation of systematic review reports.
Jt Comm J Qual Patient Saf 2019 Sep;45(9):629-38. doi: 10.1016/j.jcjq.2019.05.001..
Keywords: Evidence-Based Practice, Patient-Centered Outcomes Research, Implementation
Long S, Thomas GW, Anderson DD
An extensible orthopaedic wire navigation simulation platform.
The demand for simulation-based skills training in orthopaedics is steadily growing. Wire navigation, or the ability to use 2D images to place an implant through a specified path in bone, is an area of training that has been difficult to simulate given its reliance on radiation based fluoroscopy. The investigators group previously presented on the development of a wire navigation simulator for a hip fracture module. In this paper, they present a new methodology for extending the simulator to other surgical applications of wire navigation.
AHRQ-funded; HS022077; HS025353.
Citation: Long S, Thomas GW, Anderson DD .
An extensible orthopaedic wire navigation simulation platform.
J Med Device 2019 Sep;13(3):031001-310017. doi: 10.1115/1.4043461..
Keywords: Orthopedics, Simulation, Training, Surgery, Education: Continuing Medical Education
Obodozie-Ofoegbu OO, Teng C, Mortensen EM
Antipseudomonal monotherapy or combination therapy for older adults with community-onset pneumonia and multidrug-resistant risk factors: a retrospective cohort study.
Infectious Diseases Society of America guidelines recommend empiric antipseudomonal combination therapy when Pseudomonas is suspected. However, combination antipseudomonal therapy is controversial. This population-based retrospective cohort study compared all-cause 30-day mortality in older patients who received antipseudomonal monotherapy (PMT) or antipseudomonal combination therapy (PCT) for the treatment of community-onset pneumonia. The investigators found that older adults who received combination antipseudomonal therapy for community-onset pneumonia fared worse than those who received monotherapy.
AHRQ-funded; HS022418.
Citation: Obodozie-Ofoegbu OO, Teng C, Mortensen EM .
Antipseudomonal monotherapy or combination therapy for older adults with community-onset pneumonia and multidrug-resistant risk factors: a retrospective cohort study.
Am J Infect Control 2019 Sep;47(9):1053-58. doi: 10.1016/j.ajic.2019.02.018..
Keywords: Antibiotics, Community-Acquired Infections, Elderly, Infectious Diseases, Medication, Pneumonia, Risk
Zhang AD, Schwartz JL, Ross JS
Association between Food and Drug Administration Advisory Committee recommendations and agency actions, 2008-2015.
In this paper, the authors examined the association between Food and Drug Administration Advisory Committee Recommendations and agency actions for a time period of 2008-2015. The investigators concluded that the FDA disagrees with the recommendations of its advisory committees a minority of the time, and in these cases it tends to be less likely to approve new products or supplemental indications and take safety actions.
AHRQ-funded; HS022882.
Citation: Zhang AD, Schwartz JL, Ross JS .
Association between Food and Drug Administration Advisory Committee recommendations and agency actions, 2008-2015.
Milbank Q 2019 Sep;97(3):796-819. doi: 10.1111/1468-0009.12403..
Keywords: Medical Devices, Policy, Patient Safety
Chatterjee P, Qi M, Coe NB
Association between high discharge rates of vulnerable patients and skilled nursing facility copayments.
The authors sought to determine whether patterns of skilled nursing facility (SNF) discharge are associated with the change in Medicare payment responsibility on day 20. They found that Medicare beneficiaries were more often discharged from SNFs on benefit day 20 than on benefit days 19 or 21. Those discharged on day 20 were more likely to be racial/ethnic minorities and to live in areas of lower socioeconomic status compared with those discharged before or after day 20. Their findings suggested an association between disproportionately high SNF discharge rates of vulnerable patients and existing Medicare payment policies. The authors recommended that payment policies be designed with consideration of the potential for such unintended consequences, and that any potential consequences be mitigated by balancing existing payment structures with incentives to provide optimal patient care.
AHRQ-funded; HS024266.
Citation: Chatterjee P, Qi M, Coe NB .
Association between high discharge rates of vulnerable patients and skilled nursing facility copayments.
JAMA Intern Med 2019 Sep;179(9):1296-98. doi: 10.1001/jamainternmed.2019.1209.
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Keywords: Vulnerable Populations, Nursing Homes, Medicare, Payment, Policy, Social Determinants of Health
Turer CB, Barlow SE, Sarwer DB
Association of clinician behaviors and weight change in school-aged children.
This study used clinical practice data to determine whether recommended weight management clinician behaviors were associated with weight status improvement in children aged 6-12 years who are overweight or obese. Electronic health record data (2009-2014) from 52 clinics were used. Weight status was examined from 1 visit to the next as dichotomous improvement (versus worsening or no change) and change in percentage overweight (over sex/age-specific BMI95).
AHRQ-funded; HS022418.
Citation: Turer CB, Barlow SE, Sarwer DB .
Association of clinician behaviors and weight change in school-aged children.
Am J Prev Med 2019 Sep;57(3):384-93. doi: 10.1016/j.amepre.2019.04.029..
Keywords: Children/Adolescents, Obesity, Obesity: Weight Management, Outcomes, Patient-Centered Outcomes Research
Bath J, Smith JB, Kruse RL
Association of neutrophil-to-lymphocyte ratio with outcomes after elective abdominal aortic aneurysm repair.
This study investigated postoperative outcomes from elective abdominal aortic aneurysm surgery (AAA) repair using neutrophil-to-lymphocyte ratio as the predictor. Inpatients from the Cerner Health Facts database undergoing elective AAA repair from 2008 to 2015 were selected using ICD-9 procedure codes. Patients with a high postoperative NLR experienced longer hospital stays; higher rates of in-hospital death; high rates of renal failure, cardiac problems, respiratory problems, and infection compared to patients with a low postoperative NLR. The authors recommend future study of NLR to help provide clinically important risk profiles.
AHRQ-funded; HS022140.
Citation: Bath J, Smith JB, Kruse RL .
Association of neutrophil-to-lymphocyte ratio with outcomes after elective abdominal aortic aneurysm repair.
J Vasc Nurs 2019 Sep;37(3):213-20. doi: 10.1016/j.jvn.2019.06.001..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Surgery, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Sobotka SA, Foster C, Lynch E
Attributable delay of discharge for children with long-term mechanical ventilation.
The purpose of this study was to assess the reasons for discharge delays for children with long-term mechanical ventilation. The investigators found that over one-half of children discharged to the community from a large inpatient pediatric long-term mechanical ventilation program had a nonmedical delay of discharge home, most commonly because of home nurse staffing.
AHRQ-funded; HS023007.
Citation: Sobotka SA, Foster C, Lynch E .
Attributable delay of discharge for children with long-term mechanical ventilation.
J Pediatr 2019 Sep;212:166-71. doi: 10.1016/j.jpeds.2019.04.034..
Keywords: Children/Adolescents, Respiratory Conditions, Hospital Discharge, Home Healthcare
Mogul DB, Lee J, Purnell TS
Barriers to access in pediatric living-donor liver transplantation.
This study examined knowledge and attitudes about living donor liver transplantation (LDLT) among patients/caregivers for children awaiting or having received a liver transplant. LDLT is only used for 10% of transplant recipients, but has a much better outcome. A survey was conducted among 217 respondents. While 97% of respondents knew an individual could donate a portion of their kidney, only 72% knew evaluation steps, and 69% knew the donor surgery was covered by the recipient’s insurance. Individuals receiving public insurance and without a college degree were less likely to know someone who had been a living donor. This gap in knowledge can create barriers to increasing LDLT for children.
AHRQ-funded; HS023876; HS024600.
Citation: Mogul DB, Lee J, Purnell TS .
Barriers to access in pediatric living-donor liver transplantation.
Pediatr Transplant 2019 Sep;23(6):e13513. doi: 10.1111/petr.13513..
Keywords: Children/Adolescents, Access to Care, Transplantation
Sukul D, Ryan AM, Yan P
Cardiologist participation in accountable care organizations and changes in spending and quality for Medicare patients with cardiovascular disease.
Despite widespread adoption of Medicare accountable care organizations (ACOs), healthcare spending reductions have been modest. This may relate to variable participation in ACOs by specialist physicians, who disproportionately drive spending. In this study, the investigators analyzed national Medicare data to examine whether specialist participation in Medicare ACOs was associated with changes in healthcare spending and clinical quality.
AHRQ-funded; HS024728; HS025615; HS024525.
Citation: Sukul D, Ryan AM, Yan P .
Cardiologist participation in accountable care organizations and changes in spending and quality for Medicare patients with cardiovascular disease.
Circ Cardiovasc Qual Outcomes 2019 Sep;12(9):e005438. doi: 10.1161/circoutcomes.118.005438..
Keywords: Cardiovascular Conditions, Healthcare Costs, Heart Disease and Health, Medicare, Quality of Care
Symer MM, Sedrakyan A, Yeo HL
Case sequence analysis of the robotic colorectal resection learning curve.
This study examined trends in the increasing rate of resection surgery for colorectal cancer using robots. It has a major learning curve so investigators wanted to see if complication rates went down as the technology become more common. The cohort included adults undergoing colorectal section from 2008 through 2016 from data in the New York Statewide Planning and Research Cooperative database. The number of procedures started at 76 cases in 2010 and increased to 702 cases in 2015. Findings were that major complications (myocardial infarction, pulmonary embolism, shock, and death) did not decrease but iatrogenic complications were reduced. The odds of prolonged length of stay also decreased over time.
AHRQ-funded; HS000066.
Citation: Symer MM, Sedrakyan A, Yeo HL .
Case sequence analysis of the robotic colorectal resection learning curve.
Dis Colon Rectum 2019 Sep;62(9):1071-78. doi: 10.1097/dcr.0000000000001437..
Keywords: Cancer: Colorectal Cancer, Cancer, Surgery, Education: Continuing Medical Education, Outcomes
Kim KL, LI L, Kuang M
Changes in hospital referral patterns to skilled nursing facilities under the Hospital Readmissions Reduction Program.
The objective of this study was to investigate the association between changes in hospital referral patterns to skilled nursing facilities (SNFs) and Hospital Readmissions Reduction Program (HRRP) penalty pressure. Results showed that HRRP did not prompt substantial changes in hospital referral patterns to SNFs, although readmissions for patients referred to SNFs differentially decreased more than for other patients, warranting investigation of other mechanisms underlying readmissions reduction.
AHRQ-funded; HS022882.
Citation: Kim KL, LI L, Kuang M .
Changes in hospital referral patterns to skilled nursing facilities under the Hospital Readmissions Reduction Program.
Med Care 2019 Sep;57(9):695-701. doi: 10.1097/mlr.0000000000001169..
Keywords: Hospitals, Nursing Homes, Hospital Readmissions, Payment, Provider Performance