National Healthcare Quality and Disparities Report
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Topics
- Access to Care (1)
- Antibiotics (1)
- Antimicrobial Stewardship (1)
- Anxiety (1)
- Asthma (4)
- Behavioral Health (1)
- Care Management (1)
- Children/Adolescents (8)
- Chronic Conditions (6)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- Critical Care (1)
- Depression (1)
- Diagnostic Safety and Quality (2)
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- Elderly (1)
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- Health Information Technology (HIT) (1)
- Health Services Research (HSR) (1)
- Hospital Readmissions (3)
- Hospitals (7)
- Implementation (2)
- Infectious Diseases (1)
- Inpatient Care (1)
- Medicaid (1)
- Medication (2)
- Mortality (1)
- Palliative Care (1)
- Patient-Centered Healthcare (1)
- Payment (1)
- Pneumonia (1)
- Practice Patterns (1)
- Primary Care (1)
- Provider Performance (3)
- Quality Improvement (7)
- Quality Indicators (QIs) (3)
- Quality Measures (4)
- (-) Quality of Care (20)
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- Urban Health (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 20 of 20 Research Studies DisplayedWaltman A, Konetzka RT, Chia S
Effectiveness of a bundled payments for care improvement program for chronic obstructive pulmonary disease.
This single-site retrospective observational study evaluated the impact of an evidence-based transitions of care program on episode costs and readmission rates, comparing patients hospitalized for COPD exacerbations who received versus those who did not receive the intervention. Between October 2015 and September 2018, 132 received and 161 did not receive the program. Below target mean episode costs were found for six out of eleven quarters for the intervention group, as opposed to only one out of twelve quarters for the control group. Overall, there were non-significant mean savings of $2551 in episode costs relative to target costs for the intervention group, though results varied by index admission diagnosis-related group (DRG). There were additional costs of $4184 per episode for the least-complicated cohort (DRG 192), but savings of $1897 and $1753 for the most complicated index admissions (DRGs 191 and 190, respectively). A significant mean decrease of 0.24 readmissions per episode for intervention was observed in 90-day readmission rates relative to control. Skilled nursing facility readmissions and hospital discharges were factors of higher costs (mean increases of $9098 and $17,095 per episode respectively).
AHRQ-funded; HS027804.
Citation: Waltman A, Konetzka RT, Chia S .
Effectiveness of a bundled payments for care improvement program for chronic obstructive pulmonary disease.
J Gen Intern Med 2023 Sep; 38(12):2662-70. doi: 10.1007/s11606-023-08249-6..
Keywords: Respiratory Conditions, Chronic Conditions, Payment, Quality Improvement, Quality of Care
Rojas JC, Chokkara S, Zhu M
Care quality for patients with chronic obstructive pulmonary disease in the readmission penalty era.
The purpose of this study was to assess changes in the quality of care for patients hospitalized for Chronic obstructive pulmonary disease (COPD) after the implementation of the Hospital Readmissions Reduction Program (HRRP) which levied financial penalties on hospitals for excessive COPD readmissions. The researchers reviewed the records from 995 U.S. hospitals in the Premier Healthcare Database, evaluating patients older than 40 years of age hospitalized for COPD. The study included 662,842 pre-HRRP (January 2010-September 2014) and 285,508 post-HRRP (October 2014-December 2018) admissions, and found that recommended care increased at a rate of 0.16% per month pre-HRRP and 0.01% per month post-HRRP. Nonrecommended care decreased at a rate of 0.15% per month pre-HRRP and 0.13% per month post-HRRP. Ideal care increased at a rate of 0.24% per month pre-HRRP and 0.11% per month post-HRRP. The researchers concluded that after HRRP implementation, the pre-HRRP trends toward improving care quality for inpatient COPD care slowed.
AHRQ-funded; HS027804.
Citation: Rojas JC, Chokkara S, Zhu M .
Care quality for patients with chronic obstructive pulmonary disease in the readmission penalty era.
Am J Respir Crit Care Med 2023 Jan; 207(1):29-37. doi: 10.1164/rccm.202203-0496OC..
Keywords: Respiratory Conditions, Quality of Care, Hospital Readmissions, Chronic Conditions
Campbell JI, Menzies D
Testing and scaling interventions to improve the tuberculosis infection care cascade.
The purpose of this study was to review and summarize current literature on barriers and solutions occurring within the tuberculosis (TB) infection care cascade, focusing on children in high- and low-burden settings, and obtaining data and information from studies on both children and adults. The researchers concluded that identifying and addressing gaps in the TB care cascade requires the utilization of tools both novel and long-standing, and will be facilitated by shared clinical practice with primary care providers, methods of quality improvement, and innovative study designs.
AHRQ-funded; HS000063.
Citation: Campbell JI, Menzies D .
Testing and scaling interventions to improve the tuberculosis infection care cascade.
J Pediatric Infect Dis Soc 2022 Oct 31;11(Suppl 3):S94-s100. doi: 10.1093/jpids/piac070..
Keywords: Respiratory Conditions, Infectious Diseases, Quality Improvement, Quality of Care
Jaladanki S, Schechter SB, Genies MC
Strategies for sustaining high-quality pediatric asthma care in community hospitals.
This study’s objective was to identify strategies associated with sustained guideline adherence and high-quality pediatric asthma care in community hospitals. Hospitals who were part of the Pathways for Improving Pediatric Asthma Care (PIPA) national quality improvement (QI) intervention were included. Clinicians (n = 19) involved in clinical care of children hospitalized with asthma were interviewed from five higher- and three lower-performing hospitals. Higher-performing hospitals had dedicated local champions who consistently provided reminders of evidence-based practices and delivered ongoing education. These champions also modified/developed electronic health record (EHR) tools. Lower-performing hospital clinicians described unique barriers, including delays in modifying the EHR and lack of automation of EHR tools. For all hospitals, barriers to sustainability included challenges with quality monitoring, decreasing focus of local champions over time, and ongoing difficulties developing around evidence-based practices.
AHRQ-funded; HS027041.
Citation: Jaladanki S, Schechter SB, Genies MC .
Strategies for sustaining high-quality pediatric asthma care in community hospitals.
Health Serv Res 2022 Feb;57(1):125-36. doi: 10.1111/1475-6773.13870..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Chronic Conditions, Hospitals, Quality of Care
Schechter S, Jaladanki S, Rodean J
Sustainability of paediatric asthma care quality in community hospitals after ending a national quality improvement collaborative.
Community hospitals, which care for most hospitalised children in the USA, may be vulnerable to declines in paediatric care quality when quality improvement (QI) initiatives end. In this study, the investigators aimed to evaluate changes in care quality in community hospitals after the end of the Pathways for Improving Paediatric Asthma Care (PIPA) national QI collaborative. The investigators concluded that the end of the paediatric asthma QI collaborative was associated with concerning declines in guideline adherence in community hospitals.
AHRQ-funded; HS027041.
Citation: Schechter S, Jaladanki S, Rodean J .
Sustainability of paediatric asthma care quality in community hospitals after ending a national quality improvement collaborative.
BMJ Qual Saf 2021 Nov;30(11):876-83. doi: 10.1136/bmjqs-2020-012292..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Hospitals, Quality Improvement, Quality of Care
Piwnica-Worms K, Staiger B, Ross JS
Effects of forced disruption in Medicaid managed care on children with asthma.
The objective of this study was to evaluate the effect of a forced disruption to Medicaid managed care plans and provider networks on health utilization and outcomes for children with persistent asthma. The investigators concluded that while there was a decrease in the number of outpatient visits associated with forced disruption of Medicaid managed care plans for children with persistent asthma, there were no consistent associations with worse asthma quality performance or higher emergent health care utilization.
AHRQ-funded; HS022882; HS025164.
Citation: Piwnica-Worms K, Staiger B, Ross JS .
Effects of forced disruption in Medicaid managed care on children with asthma.
Health Serv Res 2021 Aug;56(4):668-76. doi: 10.1111/1475-6773.13643..
Keywords: Children/Adolescents, Medicaid, Asthma, Respiratory Conditions, Chronic Conditions, Quality of Care
Liu FF, Lew A, Andes E
Implementation strategies for depression and anxiety screening in a pediatric cystic fibrosis center: a quality improvement project.
The objective of this study was to share key strategies that led to successful mental health screening (MHS) implementation in one pediatric cystic fibrosis center and to report implementation and screening outcomes. Results showed that leveraging coproduction to address stakeholder needs led to successful implementation of a sustainable MHS process.
AHRQ-funded; HS026393.
Citation: Liu FF, Lew A, Andes E .
Implementation strategies for depression and anxiety screening in a pediatric cystic fibrosis center: a quality improvement project.
Pediatr Pulmonol 2020 Dec;55(12):3328-36. doi: 10.1002/ppul.24951..
Keywords: Children/Adolescents, Respiratory Conditions, Chronic Conditions, Depression, Anxiety, Behavioral Health, Screening, Implementation, Quality Improvement, Quality of Care, Diagnostic Safety and Quality
Bryan MA, Tyler A, Zhou C
Associations between quality measures and outcomes for children hospitalized with bronchiolitis.
The authors used adherence to the Pediatric Respiratory Illness Measurement System (PRIMES) indicators to evaluate the strength of associations for individual indicators with length of stay (LOS) and cost for bronchiolitis. They found that three indicators were significantly associated with shorter LOS and lower cost, while two underuse indicators were associated with higher cost. They concluded that a subset of PRIMES quality indicators for bronchiolitis were strongly associated with improved outcomes and can serve as important measures for future quality improvement efforts.
AHRQ-funded; HS026512.
Citation: Bryan MA, Tyler A, Zhou C .
Associations between quality measures and outcomes for children hospitalized with bronchiolitis.
Hosp Pediatr 2020 Nov;10(11):932-40. doi: 10.1542/hpeds.2020-0175..
Keywords: Children/Adolescents, Respiratory Conditions, Hospitals, Quality Indicators (QIs), Quality Measures, Quality of Care
Kaiser SV, Lam Cabana, MD
Best practices in implementing inpatient pediatric asthma pathways: a qualitative study.
The objective of this study was to identify potential best practices in pathway implementation. Building upon a previous observational study in which the researchers identified higher and lower performing children's hospitals based on hospital-level changes in asthma patient length of stay after implementation of a pathway, they conducted semi-structured interviews with a sample of healthcare providers involved in pathway implementation at these hospitals. They identified several potential best practices to support pathway implementation. They recommended that hospitals implementing pathways consider applying these strategies to ensure success in improving quality of asthma care for children.
AHRQ-funded; HS024592.
Citation: Kaiser SV, Lam Cabana, MD .
Best practices in implementing inpatient pediatric asthma pathways: a qualitative study.
J Asthma 2020 Jul;57(7):744-54. doi: 10.1080/02770903.2019.1606237..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Hospitals, Inpatient Care, Guidelines, Evidence-Based Practice, Implementation, Quality Improvement, Quality of Care
Artis KA, Dweik RA, Patel B
Performance measure development, use, and measurement of effectiveness using the guideline on mechanical ventilation in acute respiratory distress syndrome. an official American Thoracic Society workshop report.
This report summarizes the proceedings of a workshop convened to advance the American Thoracic Society’s work in performance measure development and guideline implementation. The example of a low-tidal volume ventilation performance measure created from the 2017 ATS clinical practice guideline is used to illustrate the application of the ATS performance measure development framework, including detailed explanation of the rationale for the specifications chosen, identification of areas in need of further validity testing, and a preliminary strategy for testing the performance measure.
AHRQ-funded; HS024552.
Citation: Artis KA, Dweik RA, Patel B .
Performance measure development, use, and measurement of effectiveness using the guideline on mechanical ventilation in acute respiratory distress syndrome. an official American Thoracic Society workshop report.
Ann Am Thorac Soc 2019 Dec;16(12):1463-72. doi: 10.1513/AnnalsATS.201909-665ST..
Keywords: Respiratory Conditions, Guidelines, Evidence-Based Practice, Quality Measures, Quality of Care, Provider Performance
Pandian V, Zhen G, Stanley S
Management of difficult airway among patients with oropharyngeal angioedema.
This study assessed the impact of a quality improvement program to manage patients with difficult airway associated with oropharyngeal angioedema patients called DART (difficult airway response team). This retrospective review compared patient charges from July 2003 to June 2008 (pre-DART) to charges from July 2008 to June 2013 (post-DART). Patient characteristics, airway evaluation, and interventions were compared. There was a higher incidence of patients requiring intubation in the post-DART cohort (67%) versus the pre-DART cohort (39%). The results showed the approach offers adequate time and resources for airway evaluation prior to intervention and allows fewer numbers of attempts to secure an airway.
AHRQ-funded; HS024547.
Citation: Pandian V, Zhen G, Stanley S .
Management of difficult airway among patients with oropharyngeal angioedema.
Laryngoscope 2019 Jun;129(6):1360-67. doi: 10.1002/lary.27622..
Keywords: Care Management, Quality of Care, Quality Improvement, Respiratory Conditions, Teams
Kaiser SV, Lam R, Joseph GB
Limitations of using pediatric respiratory illness readmissions to compare hospital performance.
Researcher sought to determine if a National Quality Forum (NQF)-endorsed measure for pediatric lower respiratory illness (LRI) 30-day readmission rates can meaningfully identify high- and low-performing hospitals. Subjects were children with LRI (bronchiolitis, influenza, or pneumonia as primary diagnosis, or with an LRI as a secondary diagnosis with a primary diagnosis of respiratory failure, sepsis, bacteremia, or asthma) from all hospital admissions in California from 2012 to 2014. The researchers were unable to identify meaningful variation in hospital performance without broadening the metric definition and merging multiple years of data. They recommend that utilizers of pediatric-quality measures consider modifying metrics to better evaluate the quality of pediatric care at low-volume hospitals.
AHRQ-funded; HS024385; HS022835; HS024592; HS025297.
Citation: Kaiser SV, Lam R, Joseph GB .
Limitations of using pediatric respiratory illness readmissions to compare hospital performance.
J Hosp Med 2018 Nov;13(11):737-42. doi: 10.12788/jhm.2988..
Keywords: Children/Adolescents, Respiratory Conditions, Provider Performance, Hospital Readmissions, Hospitals, Quality Indicators (QIs), Quality Measures, Quality of Care, Quality Improvement
Harris VC, Links AR, Kim JM
Follow-up and time to treatment in an urban cohort of children with sleep-disordered breathing.
The purpose of this study was to evaluate follow-up and timing of sleep-disordered breathing diagnosis and treatment in urban children referred from primary care. Researchers found that half of the children referred for sleep-disordered breathing evaluation are lost to follow-up from primary care. Obstructive sleep apnea severity did not predict follow-up or timeliness of treatment. They conclude that these findings suggest social determinants may pose barriers to care in addition to the clinical burden of sleep-disordered breathing.
AHRQ-funded; HS022932.
Citation: Harris VC, Links AR, Kim JM .
Follow-up and time to treatment in an urban cohort of children with sleep-disordered breathing.
Otolaryngol Head Neck Surg 2018 Aug;159(2):371-78. doi: 10.1177/0194599818772035..
Keywords: Access to Care, Children/Adolescents, Disparities, Healthcare Delivery, Patient-Centered Healthcare, Quality of Care, Respiratory Conditions, Sleep Problems, Urban Health
Iyer AS, Benzo RP, Bakitas MA
Easing the tension between palliative care and intensive care in chronic obstructive pulmonary disease.
This editorial discusses palliative care and intensive care in chronic obstructive pulmonary disease and comments on an article by Shen, et al., published, in 2018, in the Journal of Palliative Care, entitled “Life-sustaining procedures, palliative care consultation, and do-not resuscitate status in dying patients with COPD in US hospitals: 2010-2014.”
AHRQ-funded; HS023009.
Citation: Iyer AS, Benzo RP, Bakitas MA .
Easing the tension between palliative care and intensive care in chronic obstructive pulmonary disease.
J Palliat Care 2018 Jul;33(3):123-24. doi: 10.1177/0825859718782505..
Keywords: Chronic Conditions, Respiratory Conditions, Critical Care, Elderly, Palliative Care, Quality of Care
Sjoding MW, Hofer TP, Co I
Interobserver reliability of the Berlin ARDS definition and strategies to improve the reliability of ARDS diagnosis.
This study sought to examine the interobserver reliability of the Berlin acute respiratory distress syndrome (ARDS) definition and examine strategies for improving the reliability of ARDS diagnosis. It concluded that the reliability of the Berlin ARDS definition is moderate. Combining independent reviews by multiple clinicians or improving methods to identify bilateral infiltrates on chest imaging are important strategies for improving the reliability of ARDS diagnosis.
AHRQ-funded; HS020672.
Citation: Sjoding MW, Hofer TP, Co I .
Interobserver reliability of the Berlin ARDS definition and strategies to improve the reliability of ARDS diagnosis.
Chest 2018 Feb;153(2):361-67. doi: 10.1016/j.chest.2017.11.037.
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Keywords: Diagnostic Safety and Quality, Quality of Care, Respiratory Conditions
Rinne ST, Castaneda J, Lindenauer PK
Chronic obstructive pulmonary disease readmissions and other measures of hospital quality.
This study examined the association between COPD readmissions and other quality measures. There were modest correlations between COPD readmission rates and readmission rates for other medical conditions, including heart failure , acute myocardial infarction, pneumonia, and stroke . In contrast, it also found low correlations between COPD readmission rates and readmission rates for surgical conditions, as well as mortality rates for all measured conditions.
AHRQ-funded; HS016978.
Citation: Rinne ST, Castaneda J, Lindenauer PK .
Chronic obstructive pulmonary disease readmissions and other measures of hospital quality.
Am J Respir Crit Care Med 2017 Jul 1;196(1):47-55. doi: 10.1164/rccm.201609-1944OC.
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Keywords: Respiratory Conditions, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Quality of Care, Hospital Readmissions, Hospitals
Gidengil CA, Linder JA, Beach S
Using clinical vignettes to assess quality of care for acute respiratory infections.
Overprescribing of antibiotics for acute respiratory infections (ARIs) is common. The objective of this study was to develop and validate a vignette-based method to estimate clinician ARI antibiotic prescribing. The researchers concluded that responses to 3 clinical vignettes can identify clinicians with relatively poor quality ARI antibiotic prescribing. Vignettes may be a mechanism to target clinicians for quality improvement efforts.
AHRQ-funded; HS018419.
Citation: Gidengil CA, Linder JA, Beach S .
Using clinical vignettes to assess quality of care for acute respiratory infections.
Inquiry 2016 Apr 20;53:pii: 0046958016636531. doi: 10.1177/0046958016636531..
Keywords: Antibiotics, Antimicrobial Stewardship, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR), Medication, Practice Patterns, Primary Care, Quality of Care, Respiratory Conditions
Walkey AJ, Weinberg J, Wiener RS
Association of do-not-resuscitate orders and hospital mortality rate among patients with pneumonia.
The researchers evaluated the effect of analytic approaches accounting for do-not-resuscitate (DNR) status on risk-adjusted hospital mortality rates and performance rankings. They found that after accounting for patient DNR status and between-hospital variation in the association between DNR status and mortality, hospitals with higher DNR rates had lower mortality.
AHRQ-funded; HS020672.
Citation: Walkey AJ, Weinberg J, Wiener RS .
Association of do-not-resuscitate orders and hospital mortality rate among patients with pneumonia.
JAMA Intern Med 2016 Jan;176(1):97-104. doi: 10.1001/jamainternmed.2015.6324.
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Keywords: Hospitals, Mortality, Quality of Care, Quality Indicators (QIs), Quality Measures, Pneumonia, Provider Performance, Respiratory Conditions
Linares-Perdomo O, East TD, Brower R
Standardizing predicted body weight equations for mechanical ventilation tidal volume settings.
Predicted body weight (PBW) equations use height, age, and sex as input variables. The researchers compared National Institutes of Health (NIH) ARDS Network (ARDSNet), actuarial table (ACTUARIAL), and Stewart (STEWART) PBW equations used in clinical trials, across physiologic ranges for age and height. They concluded that significant differences between PBW equations for both men and women could be important sources of interstudy variation. Studies should adopt a standard PBW equation.
AHRQ-funded; HS006594.
Citation: Linares-Perdomo O, East TD, Brower R .
Standardizing predicted body weight equations for mechanical ventilation tidal volume settings.
Chest 2015 Jul;148(1):73-8. doi: 10.1378/chest.14-2843..
Keywords: Research Methodologies, Respiratory Conditions, Quality of Care
Gidengil CA, Linder JA, Hunter G
The volume-quality relationship in antibiotic prescribing: when more isn't better.
The researchers examined the impact of volume on more common medical conditions such as acute respiratory infections (ARIs). They found that higher ARI volume physicians had lower quality across a number of domains, including higher antibiotic prescribing rates, higher broad-spectrum antibiotic prescribing, and lower guideline concordance. When they prescribed an antibiotic for a diagnosis for which an antibiotic may be indicated, they were less likely to prescribe guideline-concordant antibiotics.
AHRQ-funded; HS018419.
Citation: Gidengil CA, Linder JA, Hunter G .
The volume-quality relationship in antibiotic prescribing: when more isn't better.
Inquiry 2015 Feb 10;52. doi: 10.1177/0046958015571130..
Keywords: Quality of Care, Medication, Respiratory Conditions, Guidelines