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
1 to 25 of 54 Research Studies DisplayedBauer TM, Yaser JM, Daramola T
Cardiac rehabilitation reduces two-year mortality after coronary artery bypass grafting.
This study analyzed the outcome of cardiac rehabilitation (CR) use for patients who have undergone coronary revascularization procedures. The study looked at Medicare fee-for-service claims linked to surgical data patients discharged alive following isolated coronary artery bypass grafting (CABG) from January 2015 to October 2019. A total of 3,848/6,412 (60.0%) of patients were enrolled in CR for an average of 23.2 sessions with 770/6,412 (12.0%) completing all recommended 36 sessions. Predictors of post-discharge CR use included increasing age, discharge to home (vs extended care facility), and shorter length of stay. Unadjusted and inverse probability treatment weighting (IPTW) analyses showed significant reduction in 2-year mortality in CR users as compared to CR non-users (unadjusted 9.4%).
AHRQ-funded; HS027830.
Citation: Bauer TM, Yaser JM, Daramola T .
Cardiac rehabilitation reduces two-year mortality after coronary artery bypass grafting.
Ann Thorac Surg 2023 Nov; 116(5):1099-105. doi: 10.1016/j.athoracsur.2023.05.044..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Surgery, Mortality, Outcomes
Zhou S, Yang G, Zhang M
Mortality following durable left ventricular assist device implantation by timing and type of first infection.
Researchers examined the relationship between timing and type of first infection regarding mortality following left ventricular assist device implantation. The study cohort included nearly 13,000 Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support patients at 166 centers. The results showed that patients with any post-implantation infection had an increased risk of death; ventricular assist device-related infections and infections occurring in the intermediate interval (91-180 days after implantation) were associated with the largest increase in risk. The researchers recommended that infection prevention strategies should target non-ventricular assist device infections in the first 90 days, then shift to surveillance/prevention of driveline infections after 90 days.
AHRQ-funded; HS026003.
Citation: Zhou S, Yang G, Zhang M .
Mortality following durable left ventricular assist device implantation by timing and type of first infection.
J Thorac Cardiovasc Surg 2023 Aug; 166(2):570-79.e4. doi: 10.1016/j.jtcvs.2021.10.056..
Keywords: Mortality, Cardiovascular Conditions, Medical Devices, Heart Disease and Health
Tan MS, Heise CW, Gallo T
Relationship between a risk score for QT interval prolongation and mortality across rural and urban inpatient facilities.
The objectives of this retrospective observational study were to evaluate the relationship between a modified Tisdale QTc-risk score (QTc-RS), inpatient mortality, and length of stay in a broad inpatient population with an order for a medication with a known risk of torsades de pointes (TdP). Inpatient data from 28 healthcare facilities in the western US were used. The results indicated that there is a strong relationship between increased mortality as well as longer duration of hospitalization with an increasing QTc-RS.
AHRQ-funded; HS026662.
Citation: Tan MS, Heise CW, Gallo T .
Relationship between a risk score for QT interval prolongation and mortality across rural and urban inpatient facilities.
J Electrocardiol 2023 Mar;77:4-9. doi: 10.1016/j.jelectrocard.2022.11.008.
Keywords: Heart Disease and Health, Cardiovascular Conditions, Mortality, Rural Health, Urban Health, Risk
Hollingsworth JM, Yu X, Yan PL
Provider care team segregation and operative mortality following coronary artery bypass grafting.
The purpose of this study was to examine whether provider care team segregation within hospitals contributes to the higher mortality rate of Black patients following coronary artery bypass grafting compared to their White counterparts. Using national Medicare data, findings showed that Black patients who undergo coronary artery bypass grafting at a hospital with a higher level of provider care team segregation die more frequently after surgery than Black patients treated at a hospital with a lower level.
AHRQ-funded; HS026908.
Citation: Hollingsworth JM, Yu X, Yan PL .
Provider care team segregation and operative mortality following coronary artery bypass grafting.
Circ Cardiovasc Qual Outcomes 2021 May;14(5):e007778. doi: 10.1161/circoutcomes.120.007778..
Keywords: Surgery, Heart Disease and Health, Cardiovascular Conditions, Mortality, Teams, Healthcare Delivery, Racial and Ethnic Minorities
Li K, Ferguson T, Embil J
Risk of kidney failure, death, and cardiovascular events after lower limb complications in patients with CKD.
Investigators sought to determine how interim lower limb complications modify the subsequent risk of progression to kidney failure, all-cause mortality before kidney failure, and cardiovascular events in a cohort of patients with chronic kidney disease (CKD) stages G3 to G5. Patient-level data obtained from several administrative databases from Manitoba, Canada, were analyzed. They found that interim lower limb complications were associated with an increased risk of kidney failure, all-cause mortality before kidney failure, and cardiovascular-related hospitalization. They stated that clinical trials of screening and treatment strategies for patients with CKD at risk for lower limb complications may help determine optimal strategies to manage this risk.
AHRQ-funded; HS018574.
Citation: Li K, Ferguson T, Embil J .
Risk of kidney failure, death, and cardiovascular events after lower limb complications in patients with CKD.
Kidney Int Rep 2021 Feb;6(2):381-88. doi: 10.1016/j.ekir.2020.11.010..
Keywords: Kidney Disease and Health, Cardiovascular Conditions, Chronic Conditions, Risk, Adverse Events, Mortality, Outcomes
Brescia AA, Watt TMF, Pagani FD
Assessment of mortality among durable left ventricular assist device recipients ineligible for clinical trials.
This study compared the mortality of heart patients undergoing durable left ventricular assist device (LVAD) implantation who were enrolled in a clinical trial called Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Therapy With HeartMate 3 (MOMENTUM 3) to general population LVAD recipients from 181 North American centers from January 1, 2012, to June 30, 2017, identified in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). Among 14,679 recipients, a total of 6429 recipients (43.8%) would have been ineligible for enrollment in the MOMENTUM 3 study. Estimated mortality for recipients who were trial-ineligible was higher than for recipients who were trial-eligible (25.3% versus 16.2% for 1-year mortality, 42.8% versus 36.4% for 3-year mortality). The authors concluded that a better representation of the patient population would reflect real-world experience better than the trial eligibility criteria that was used.
AHRQ-funded; HS026003.
Citation: Brescia AA, Watt TMF, Pagani FD .
Assessment of mortality among durable left ventricular assist device recipients ineligible for clinical trials.
JAMA Netw Open 2021 Jan 4;4(1):e2032865. doi: 10.1001/jamanetworkopen.2020.32865..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Mortality, Medical Devices
Bath J, Smith JB, Woodard J
Complex relationship between low albumin level and poor outcome after lower extremity procedures for peripheral artery disease.
Researchers sought to examine the association of low albumin level with outcomes in patients undergoing open and endovascular lower extremity procedures for peripheral artery disease. Subjects were patients with peripheral artery disease undergoing lower extremity procedures, selected from Cerner Health Facts database using ICD-9 diagnosis and procedure codes. They found that low preoperative albumin levels were associated with in-hospital death, prolonged length of stay, and severe morbidity after open and endovascular lower extremity procedures. They recommended that elective procedures be deferred until albumin levels have been optimized.
Citation: Bath J, Smith JB, Woodard J .
Complex relationship between low albumin level and poor outcome after lower extremity procedures for peripheral artery disease.
J Vasc Surg 2021 Jan;73(1):200-09. doi: 10.1016/j.jvs.2020.04.524..
Keywords: Cardiovascular Conditions, Surgery, Outcomes, Mortality, Risk
Khodneva Y, Richman J, Kertesz S
Gender differences in association of prescription opioid use and mortality: a propensity-matched analysis from the REasons for Geographic And Racial Differences in Stroke (REGARDS) prospective cohort.
Prescription opioids (PO) have been widely used for chronic non-cancer pain, with commensurate concerns for overdose. The long-term effect of these medications on non-overdose mortality in the general population remains poorly understood. This study's objective was to examine the association of prescription opioid use and mortality in a large cohort, accounting for gender differences and concurrent benzodiazepine use, and using propensity score matching.
AHRQ-funded; HS013852.
Citation: Khodneva Y, Richman J, Kertesz S .
Gender differences in association of prescription opioid use and mortality: a propensity-matched analysis from the REasons for Geographic And Racial Differences in Stroke (REGARDS) prospective cohort.
Subst Abus 2021;42(1):94-103. doi: 10.1080/08897077.2019.1702609..
Keywords: Stroke, Cardiovascular Conditions, Sex Factors, Opioids, Medication, Mortality
Kostelanetz S, Di Gravio C, Schildcrout JS
Should we implement geographic or patient-reported social determinants of health measures in cardiovascular patients.
The authors compared patient-reported social determinants of health (SDOH) to the Brokamp Area Deprivation Index (ADI) and then evaluated the association of patient-reported SDOH and ADI with mortality in patients with cardiovascular disease (CVD). They found that the Brokamp ADI is associated with mortality in hospitalized patients with CVD. They recommended that, in the absence of available patient-reported data, hospitals implement the Brokamp ADI as an approximation for patient-reported data to enhance risk stratification of patients with CVD.
AHRQ-funded; HS026122.
Citation: Kostelanetz S, Di Gravio C, Schildcrout JS .
Should we implement geographic or patient-reported social determinants of health measures in cardiovascular patients.
Ethn Dis 2021 Winter;31(1):9-22. doi: 10.18865/ed.31.1.9..
Keywords: Social Determinants of Health, Cardiovascular Conditions, Mortality, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Patel SA, Krasnow M, Long K
Excess 30-day heart failure readmissions and mortality in black patients increases with neighborhood deprivation.
Researchers examined whether neighborhood environment modifies the disparity in 30-day heart failure (HF) readmissions and mortality between Black and White patients in the Southeastern United States. They created a geocoded retrospective cohort of patients hospitalized for acute HF from 2010-2018 within Emory Healthcare. They found that excess 30-day HF readmissions and mortality were present among Black patients in every neighborhood strata and increased with progressive neighborhood socioeconomic deprivation.
AHRQ-funded; HS026081.
Citation: Patel SA, Krasnow M, Long K .
Excess 30-day heart failure readmissions and mortality in black patients increases with neighborhood deprivation.
Circ Heart Fail 2020 Dec;13(12):e007947. doi: 10.1161/circheartfailure.120.007947..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Hospital Readmissions, Racial and Ethnic Minorities, Mortality, Social Determinants of Health, Low-Income, Disparities
Khera R, Kondamudi N, Zhong L
Temporal trends in heart failure incidence among Medicare
This retrospective, national cohort study looked at temporal trends in heart failure (HF) incidence among Medicare beneficiaries from 2011 to 2016. There had been a decline in claims during that time period. Five percent of all fee-for-service Medicare beneficiaries with no prior HF diagnosis were followed up from 2011-2016. Annual trends were examined in HF incidence among groups with and without primary HF risk factors (hypertension, diabetes, and obesity) and predisposing cardiovascular conditions (acute myocardial infarction (MI) and atrial fibrillation (AF). Of the approximately 1.8 million Medicare beneficiaries at risk for HF, 249,832 had a new diagnosis of HF. The prevalence of all 5 risk factors had increased during the 5-year study period. There was a relative decline in HF incidence among beneficiaries with primary HF risk factors, but incidence increased among individuals with acute MI and AF.
AHRQ-funded; HS022418.
Citation: Khera R, Kondamudi N, Zhong L .
Temporal trends in heart failure incidence among Medicare
JAMA Netw Open 2020 Oct;3(10):e2022190. doi: 10.1001/jamanetworkopen.2020.22190.
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Keywords: Heart Disease and Health, Cardiovascular Conditions, Medicare, Risk, Elderly, Mortality
Jannat-Khah DP, Khodneva Y, Bryant K
Depressive symptoms do not discriminate: racial and economic influences between time-varying depressive symptoms and mortality among REGARDS participants.
This study examined whether time-varying depressive symptoms (TVDS) predict mortality and if racial and income differences moderate the association in a large cohort. The cohort from the REGARDS study was used to look at that determination. The REGARDS study used community-dwelling U.S. adults aged 45 years or older. They found that there was similar and statistically significant differences with white, black, and low-income ($35,000 or less) participants for the association between TVDS and mortality. High-income participants were found to have a lower hazard.
AHRQ-funded; HS025198.
Citation: Jannat-Khah DP, Khodneva Y, Bryant K .
Depressive symptoms do not discriminate: racial and economic influences between time-varying depressive symptoms and mortality among REGARDS participants.
Ann Epidemiol 2020 Jun;46:31-40.e2. doi: 10.1016/j.annepidem.2020.04.004..
Keywords: Depression, Behavioral Health, Racial and Ethnic Minorities, Cardiovascular Conditions, Cancer, Low-Income, Social Determinants of Health, Mortality
Basciotta M, Zhou W, Ngo L
Antipsychotics and the risk of mortality or cardiopulmonary arrest in hospitalized adults.
Investigators sought to evaluate the risk of death or nonfatal cardiopulmonary arrest in hospitalized adults exposed to antipsychotics. They found that, in hospitalized adults, typical antipsychotics were associated with increased mortality or cardiopulmonary arrest, whereas atypical antipsychotics were only associated with increased risk among adults age 65 years and older. They recommended that providers be thoughtful when prescribing antipsychotic medications, especially to older adults in settings where data regarding benefit are lacking.
AHRQ-funded; HS026215.
Citation: Basciotta M, Zhou W, Ngo L .
Antipsychotics and the risk of mortality or cardiopulmonary arrest in hospitalized adults.
J Am Geriatr Soc 2020 Mar;68(3):544-50. doi: 10.1111/jgs.16246..
Keywords: Medication, Risk, Hospitalization, Cardiovascular Conditions, Mortality, Elderly
Dhruva SS, Ross JS, Mortazavi BJ
Association of use of an intravascular microaxial left ventricular assist device vs intra-aortic balloon pump with in-hospital mortality and major bleeding among patients with acute myocardial infarction complicated by cardiogenic shock.
This study examines outcomes among patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) complicated by cardiogenic shock. Two interventions are compared: intravascular microaxial left ventricular assist devices (LVADs) versus intra-aortic balloon pumps (IABPs). The American College of Cardiology’s National Cardiovascular Data Registry was used to identify patients with AMI complicated by cardiogenic shock from hospitals participating in the CathPCI and Chest Pain-MI registries and identified 28,304 patients. Over the study period (2015 to 2017), LVAD was used in 6.2% of patients and IABP in 29.9%. LVAD was shown to have higher rates of in-hospital death and major bleeding complications compared to IABP.
AHRQ-funded; HS022882; HS025402; HS025517; HS026379.
Citation: Dhruva SS, Ross JS, Mortazavi BJ .
Association of use of an intravascular microaxial left ventricular assist device vs intra-aortic balloon pump with in-hospital mortality and major bleeding among patients with acute myocardial infarction complicated by cardiogenic shock.
JAMA 2020 Feb 25;323(8):734-45. doi: 10.1001/jama.2020.0254..
Keywords: Medical Devices, Heart Disease and Health, Cardiovascular Conditions, Mortality, Adverse Events, Registries, Patient Safety, Patient-Centered Outcomes Research, Evidence-Based Practice
Angraal S, Mortazavi BJ, Gupta A
Machine learning prediction of mortality and hospitalization in heart failure with preserved ejection fraction.
This study developed models to predict the risk of death and hospitalization in patients with heart failure (HF) with preserved ejection fraction (HFpEF). Data was used from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) clinical trial. Five methods: logistic regression with a forward selection of variables; logistic regression with a lasso regularization for variable selection; random forest (RF); gradient descent boosting; and support vector machine, were used to train models for assessing risks of mortality and HF hospitalization through 3 years of follow-up and were validated using 5-fold cross-validation. RF was found to be the best performing model for predicting mortality and HF hospitalization. Blood urea nitrogen levels, body mass index, and Kansas City Cardiomyopathy Questionnaire (KCCQ) subscale scores were strongly associated with mortality, while hemoglobin level, blood urea nitrogen, time since previous HF hospitalization, and KCCQ scores were the most significant predictors of HF hospitalization.
AHRQ-funded; HS023000.
Citation: Angraal S, Mortazavi BJ, Gupta A .
Machine learning prediction of mortality and hospitalization in heart failure with preserved ejection fraction.
JACC Heart Fail 2020 Jan;8(1):12-21. doi: 10.1016/j.jchf.2019.06.013..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Mortality, Hospitalization, Risk, Health Status, Health Information Technology (HIT)
Patel DK, Duncan MS, Shah AS
Association of cardiac rehabilitation with decreased hospitalization and mortality risk after cardiac valve surgery.
Investigators sought to characterize cardiac rehabilitation (CR) enrollment after cardiac valve surgery and its association with outcomes, including hospitalizations and mortality. Subjects were all fee-for-service Medicare beneficiaries undergoing open cardiac valve surgery in 2014, identified by inpatient diagnosis codes for open aortic, mitral, tricuspid, and pulmonary valve surgery. They found that fewer than half of Medicare beneficiaries undergoing cardiac valve surgery enrolled in CR programs, and there were marked racial/ethnic disparities among those who do. They recommend further study on barriers to CR enrollment in this population.
AHRQ-funded; HS022990.
Citation: Patel DK, Duncan MS, Shah AS .
Association of cardiac rehabilitation with decreased hospitalization and mortality risk after cardiac valve surgery.
JAMA Cardiol 2019 Dec;4(12):11887-1301. doi: 10.1001/jamacardio.2019.4032..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Rehabilitation, Hospitalization, Surgery, Mortality, Risk, Elderly
Goldstone AB, Chiu P, Baiocchi M
Interfacility transfer of Medicare beneficiaries with acute type a aortic dissection and regionalization of care in the United States.
Researchers investigated the hypothesis that regionalizing care at high-volume hospitals for acute type A aortic dissections will lower mortality. Operative mortality and long-term survival were compared for Medicare beneficiaries diagnosed with an acute type A aortic dissection who were transferred versus not transferred, underwent surgery at high-volume versus low-volume hospitals, and were rerouted versus not rerouted to a high-volume hospital for treatment. The researchers found that, despite delaying surgery, a regionalization policy that transfers patients to high-volume hospitals was associated with a 7.2% absolute risk reduction in operative mortality. They recommended that policymakers evaluate the feasibility and benefits of regionalizing the surgical treatment of acute type A aortic dissection in the United States.
AHRQ-funded; HS022192.
Citation: Goldstone AB, Chiu P, Baiocchi M .
Interfacility transfer of Medicare beneficiaries with acute type a aortic dissection and regionalization of care in the United States.
Circulation 2019 Oct 8;140(15):1239-50. doi: 10.1161/circulationaha.118.038867..
Keywords: Transitions of Care, Medicare, Heart Disease and Health, Cardiovascular Conditions, Patient-Centered Outcomes Research, Risk, Evidence-Based Practice, Mortality, Hospitals
Kundi H, Popma JJ, Valsdottir LR
The value of claims-based nontraditional risk factors in predicting long-term mortality after MitraClip procedure.
The goals of this study were to identify nontraditional risk factors coded in administrative claims data and to evaluate their ability to improve prediction of long-term mortality in patients undergoing percutaneous mitral valve repair. Patients undergoing transcatheter mitral valve repair using MitraClip implantation were identified among Medicare fee-for-service beneficiaries; researchers used nested Cox regression models to identify claims codes predictive of long-term mortality. Four groups of variables were introduced: cardiac, noncardiac, and nontraditional risk factors, and presentation characteristics. The authors conclude that risk-prediction models, which include nontraditional risk factors as identified in claims data, can be used to predict long-term mortality risk more accurately in patients who have undergone MitraClip procedures.
AHRQ-funded; HS024520.
Citation: Kundi H, Popma JJ, Valsdottir LR .
The value of claims-based nontraditional risk factors in predicting long-term mortality after MitraClip procedure.
Can J Cardiol 2018 Dec;34(12):1648-54. doi: 10.1016/j.cjca.2018.10.002..
Keywords: Cardiovascular Conditions, Elderly, Mortality, Heart Disease and Health, Medicare, Risk, Surgery
Reeder HT, Shen C, Buxton AE
Joint shock/death risk prediction model for patients considering implantable cardioverter-defibrillators.
This study’s goal was to develop a joint shock/death risk prediction tool for patients who received implantable cardioverter-defibrillators (ICDs). Secondary analysis of patients was conducted as part of the SCD-HeFT trial (Sudden Cardiac Death in Heart Failure Trial). An illness-death regression model was applied for both ICD shocks and deaths. Among 803 ICD recipients, 430 (53.5%) did not receive an ICD shock or die, 206 (25.7%) received at least 1 shock but did not die, 113 (14.1%) died before receiving a shock, and 54 (6.7%) received at least 1 shock but still died. This predictive performance can be used as a tool for individualized counseling for patients contemplating an ICD.
AHRQ-funded; HS024520.
Citation: Reeder HT, Shen C, Buxton AE .
Joint shock/death risk prediction model for patients considering implantable cardioverter-defibrillators.
Circ Cardiovasc Qual Outcomes 2019 Aug;12(8):e005675. doi: 10.1161/circoutcomes.119.005675..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Medical Devices, Risk, Shared Decision Making, Mortality
Angraal S, Gupta A, Khera R
Association of access to exercise opportunities and cardiovascular mortality.
The purpose of this study is to examine the patterns of cardiovascular disease (CVD) mortality in varying degrees of access within the U.S. at the county level. The results indicate that access to exercise opportunities has a significant association with adjusted CVD mortality--higher access correlates with lower CVD mortality. Counties that have lower access to exercise facilities show a higher prevalence of obesity and diabetes in comparison with counties that have higher access. States with fewer people living in close proximity to a park have higher percentage of people who do not engage in any leisure physical activity. These results suggest means by which opportunities to increase access may be developed.
AHRQ-funded; HS023000.
Citation: Angraal S, Gupta A, Khera R .
Association of access to exercise opportunities and cardiovascular mortality.
Am Heart J 2019 Jun;212:152-56. doi: 10.1016/j.ahj.2019.02.010..
Keywords: Cardiovascular Conditions, Health Status, Mortality, Social Determinants of Health
Hadler RA, Goldstein NE, Bekelman DB
"Why would i choose death?": a qualitative study of patient understanding of the role and limitations of cardiac devices.
The aim of this study was to assess perceptions of cardiac devices in patients with heart failure and how these perceptions impacted advance care planning and future expectations. The investigators found that patients, in their sample, with cardiac devices overestimated the impact of their devices on preventing disease progression and death and deprioritized advance care planning as a result.
AHRQ-funded; HS022989.
Citation: Hadler RA, Goldstein NE, Bekelman DB .
"Why would i choose death?": a qualitative study of patient understanding of the role and limitations of cardiac devices.
J Cardiovasc Nurs 2019 May/Jun;34(3):275-82. doi: 10.1097/jcn.0000000000000565..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Mortality, Palliative Care
Hannan EL, Barrett SC, Samadashvili Z
Retooling of paper-based outcome measures to electronic format: comparison of the NY State public risk model and EHR-derived risk models for CABG mortality.
This study assessed the feasibility of retooling the paper-based New York State coronary artery bypass graft (CABG) surgery statistical model for mortality and readmission into a model for electronic health records (EHRs). Researchers found that only 6 data elements could be extracted from the EHR, and outlier hospitals differed for readmission but was usable for mortality. They concluded that the EHR model was inferior to the NYS model, and that simplifying the EHR risk model couldn’t capture most of the risk factors in the NYS model.
AHRQ-funded; HS022647.
Citation: Hannan EL, Barrett SC, Samadashvili Z .
Retooling of paper-based outcome measures to electronic format: comparison of the NY State public risk model and EHR-derived risk models for CABG mortality.
Med Care 2019 May;57(5):377-84. doi: 10.1097/mlr.0000000000001104..
Keywords: Surgery, Electronic Health Records (EHRs), Health Information Technology (HIT), Mortality, Outcomes, Risk, Cardiovascular Conditions
Shah S, Xian Y, Sheng S
Use, temporal trends, and outcomes of endovascular therapy after interhospital transfer in the United States.
This study examined the use, trends and outcomes of endovascular therapy (EVT) after interhospital transfer in the United Sates. This cohort study analyzed trends from over 1.8 million patients with ischemic stroke admitted to 2143 Get With The Guidelines-Stroke participating hospitals between 2012 and 2017. There were differences in mortality for interhospital transfer patients, although those differences disappeared after adjusting for delay in EVT initiation.
AHRQ-funded; HS024561.
Citation: Shah S, Xian Y, Sheng S .
Use, temporal trends, and outcomes of endovascular therapy after interhospital transfer in the United States.
Circulation 2019 Mar 26;139(13):1568-77. doi: 10.1161/circulationaha.118.036509..
Keywords: Stroke, Cardiovascular Conditions, Transitions of Care, Outcomes, Healthcare Delivery, Hospitals, Mortality, Quality of Care
Huckfeldt P, Escarce J, Sood N
Thirty-day postdischarge mortality among black and white patients 65 years and older in the Medicare Hospital Readmissions Reduction Program.
The goal of this cohort study was to determine whether short-term mortality rates increased among black and white adults 65 years and older after initiation of the Medicare Hospital Readmissions Reduction Program (HRRP) and whether trends differed by race. Using an interrupted time-series analysis, the researchers found that short-term post-discharge mortality did not appear to increase for black patients under the HRRP, suggesting that certain value-based payment policies can be implemented without harming black populations. However, mortality seemed to increase for white patients with heart failure; this situation warrants investigation.
AHRQ-funded; HS025394.
Citation: Huckfeldt P, Escarce J, Sood N .
Thirty-day postdischarge mortality among black and white patients 65 years and older in the Medicare Hospital Readmissions Reduction Program.
JAMA Netw Open 2019 Mar;2(3):e190634. doi: 10.1001/jamanetworkopen.2019.0634..
Keywords: Medicare, Elderly, Mortality, Heart Disease and Health, Cardiovascular Conditions, Hospital Discharge
Kim D, Funk RJ, Yan P
Informal clinical integration in Medicare accountable care organizations and mortality following coronary artery bypass graft surgery.
Researchers looked at national Medicare data from 2008-2014 to determine if informal clinical integration in accountable care organizations (ACOs) made a difference in mortality rates in patients undergoing coronary artery bypass grafting (CABG). The cohort used were Medicare beneficiaries age 66 and older undergoing CABG. Results from ACO-participating health systems were compared with nonparticipating systems. Informal clinical integration made a difference in mortality, however there was no difference based on ACO participation for health systems on the low to moderate range.
AHRQ-funded; HS024525; HS024728.
Citation: Kim D, Funk RJ, Yan P .
Informal clinical integration in Medicare accountable care organizations and mortality following coronary artery bypass graft surgery.
Med Care 2019 Mar;57(3):194-201. doi: 10.1097/mlr.0000000000001052..
Keywords: Cardiovascular Conditions, Medicare, Mortality, Outcomes, Surgery