National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
Topics
- Adverse Events (1)
- Antibiotics (1)
- Antimicrobial Stewardship (1)
- Children/Adolescents (6)
- Clinical Decision Support (CDS) (3)
- Community-Acquired Infections (1)
- Critical Care (2)
- Diabetes (2)
- (-) Diagnostic Safety and Quality (21)
- Elderly (1)
- Emergency Department (2)
- Evidence-Based Practice (1)
- Guidelines (1)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Health Information Technology (HIT) (1)
- Hospital Discharge (1)
- Hospitalization (2)
- Intensive Care Unit (ICU) (1)
- Long-Term Care (1)
- Medical Errors (2)
- Medication (1)
- Newborns/Infants (1)
- Nursing (1)
- Nursing Homes (1)
- Outcomes (2)
- Patient-Centered Outcomes Research (3)
- Patient Safety (1)
- Risk (2)
- Screening (1)
- (-) Sepsis (21)
- Training (1)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 21 of 21 Research Studies DisplayedMichelson KA, Bachur RG, Cruz AT
Multicenter evaluation of a method to identify delayed diagnosis of diabetic ketoacidosis and sepsis in administrative data.
The objectives of this study were to derive a method of automated identification of delayed diagnosis of two serious pediatric conditions in the emergency department (ED). Subjects were patients under the age of 21 who had two EDs encounters within 7 days, the second resulting in a diagnosis of new-onset diabetic ketoacidosis (DKA) or sepsis. The results showed that delayed diagnosis was present in 89 % of DKA patients seen twice within 7 days. 17 % of sepsis patients were deemed to have delayed diagnosis; the authors noted that many children with sepsis delayed diagnosis may be identified using the proposed approach with low specificity, indicating a need for manual case review. The fewer days between ED encounters was the most important characteristic associated with delayed diagnosis.
AHRQ-funded; HS026503.
Citation: Michelson KA, Bachur RG, Cruz AT .
Multicenter evaluation of a method to identify delayed diagnosis of diabetic ketoacidosis and sepsis in administrative data.
Diagnosis 2023 Nov; 10(4):383-89. doi: 10.1515/dx-2023-0019..
Keywords: Diabetes, Diagnostic Safety and Quality, Sepsis
Georgette N, Michelson K, Monuteaux M
A temperature- and age-adjusted shock index for emergency department identification of pediatric sepsis.
The objective of this retrospective cohort study was to derive a temperature- and age-adjusted mean shock index (TAMSI) for early identification of sepsis and septic shock in children with suspected infection. Researchers analyzed data on children who presented with suspected infection to a single emergency department over a 10-year period. Test characteristics for the TAMSI cutoffs were compared with those for the Pediatric Advanced Life Support (PALS) tachycardia or systolic hypotension cutoffs. The results showed that TAMSI achieved a similar negative likelihood ratio and improved positive likelihood ratio compared with PALS vital sign cutoffs for the prediction of septic shock, but did not improve on PALS for sepsis prediction among children with suspected infection.
AHRQ-funded; HS026503.
Citation: Georgette N, Michelson K, Monuteaux M .
A temperature- and age-adjusted shock index for emergency department identification of pediatric sepsis.
Ann Emerg Med 2023 Oct; 82(4):494-502. doi: 10.1016/j.annemergmed.2023.03.026..
Keywords: Children/Adolescents, Emergency Department, Sepsis, Diagnostic Safety and Quality
Michelson KA, Bachur RG, Grubenhoff JA
Outcomes of missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis, and sepsis in five pediatric hospitals.
This study’s objective was to determine 90-day complication rates and hospital utilization after a missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis (DKA), or sepsis. The authors evaluated patients under 21 years of age visiting five pediatric emergency departments (EDs) with a study condition. Case patients included had a preceding ED visit within 7 days of diagnosis and underwent case review to confirm a missed diagnosis. The authors compared complication rates and utilization between case and control patients after adjusting for age, sex, and insurance. They analyzed 29,398 children with appendicitis, 5366 with DKA, and 3622 with sepsis, of whom 429, 33, and 46, respectively, had a missed diagnosis. Patients with a missed appendicitis or DKA diagnosis had more hospital days and readmissions, but there were no significant differences for those with sepsis. Those with missed appendicitis were more likely to have abdominal abscess drainage or perforated appendicitis. Those with missed DKA were more likely to have cerebral edema, mechanical ventilation, or death. Those with missed sepsis were less likely to have mechanical ventilation.
AHRQ-funded; HS026503.
Citation: Michelson KA, Bachur RG, Grubenhoff JA .
Outcomes of missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis, and sepsis in five pediatric hospitals.
J Emerg Med 2023 Jul; 65(1):e9-e18. doi: 10.1016/j.jemermed.2023.04.006..
Keywords: Children/Adolescents, Sepsis, Diabetes, Diagnostic Safety and Quality
Dhudasia MB, Benitz WE, Flannery DD
Diagnostic performance and patient outcomes with c-reactive protein use in early-onset sepsis evaluations.
This study’s objective was to determine performance of C-reactive protein (CRP) in the diagnosis of early-onset sepsis, and to assess patient outcomes with and without routine use of CRP in infants in the neonatal intensive care unit (NICU). This retrospective cohort study looked at infants admitted to 2 NICUs from 2009 to 2014. During the time period, 10,134 infants were admitted, 89.9% had CRP, and 74.5% had blood culture obtained within 3 days of birth. CRP obtained plus/minus 4 hours had a sensitivity of 41.7%, specificity 89.9%, and positive likelihood ratio 4.12 in diagnosis of early-onset sepsis. When obtained 24-72 hours after blood culture, sensitivity of CRP increased significantly (89.5%), but specificity (55.7%) and positive likelihood ratio (2.02) decreased. Comparing the periods with (n = 4977) and without (n = 5135) routine use of CRP, the authors observed lower rates of early-onset sepsis evaluation (74.5% vs 50.5%), antibiotic initiation (65.0% vs 50.8%), and antibiotic prolongation in the absence of early-onset sepsis (17.3% vs 7.2%) in the later period.
AHRQ-funded; HS027468.
Citation: Dhudasia MB, Benitz WE, Flannery DD .
Diagnostic performance and patient outcomes with c-reactive protein use in early-onset sepsis evaluations.
J Pediatr 2023 May; 256:98-104.e6. doi: 10.1016/j.jpeds.2022.12.007..
Keywords: Newborns/Infants, Sepsis, Diagnostic Safety and Quality
Woods-Hill CZ, Colantuoni EA, Koontz DW
Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.
The purpose of this AHRQ-funded prospective study was to assess the relationship between a 14-site PICU blood culture collaborative, the Bright STAR (Testing Stewardship for Antibiotic Reduction) collaborative, and culture rates, antibiotic use, and patient outcomes. The researchers collected data from each participating PICU across the United States and from the Children’s Hospital Association Pediatric Health Information System. The main outcome was blood culture rates, with secondary outcomes including: broad-spectrum antibiotic use and PICU rates of central line-associated bloodstream infection (CLABSI), Clostridioides difficile infection, readmission, length of stay, sepsis, severe sepsis/septic shock, and mortality. The study found that the blood culture rate preimplementation across the 14 PICUs was 149.4 per 1000 patient days per month, and the rate postimplementation was 100.5 for a 33% relative reduction postimplementation. For those same periods, the rate of antibiotic use decreased from 506 days per 1000 patient-days per month preimplementation to 440 days per 1000 patient-days per month postimplementation, which reflects a 13% relative reduction. Rates of CLABSI decreased from 1.8 to 1.1 per 1000 central venous line days per month, a 36% relative reduction. The variables of length of stay, readmission, sepsis, severe sepsis/septic shock, and mortality were similar before and after implementation. The researchers concluded that collaborative interventions can reduce blood culture and antibiotic use in the PICU.
AHRQ-funded; HS025642.
Citation: Woods-Hill CZ, Colantuoni EA, Koontz DW .
Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.
JAMA Pediatr 2022 Jul;176(7):690-98. doi: 10.1001/jamapediatrics.2022.1024..
Keywords: Children/Adolescents, Sepsis, Critical Care, Antibiotics, Medication, Diagnostic Safety and Quality, Antimicrobial Stewardship
Cifra CL, Westlund E, Ten Eyck P
An estimate of missed pediatric sepsis in the emergency department.
AHRQ-funded; HS025753.
Citation: Cifra CL, Westlund E, Ten Eyck P .
An estimate of missed pediatric sepsis in the emergency department.
Diagnosis 2021;8(2):193-98. doi: 10.1515/dx-2020-0023..
Keywords: Children/Adolescents, Sepsis, Emergency Department, Diagnostic Safety and Quality, Medical Errors, Risk
Michelson KA, Williams DN, Dart AH
Development of a rubric for assessing delayed diagnosis of appendicitis, diabetic ketoacidosis and sepsis.
This study’s objective was to create a guide for objectively grading the likelihood of delayed diagnosis of appendicitis, new-onset diabetic ketoacidosis (DKA), and sepsis. Case vignettes were constructed for each condition and then presented to expert Delphi panels for review. In each vignette, the patient had a previous emergency department visit within 7 days of the delayed diagnosis. The panels graded the likelihood of a delayed diagnosis on a five-point scale. Consensus was achieved within three Delphi rounds for all appendicitis and sepsis vignettes, and 77% of DKA vignettes. The authors created a case review guide from the consensus scores that will aid researchers and quality improvement specialists in objective case review to determine if delayed diagnosis had occurred for those three conditions.
AHRQ-funded; HS026503.
Citation: Michelson KA, Williams DN, Dart AH .
Development of a rubric for assessing delayed diagnosis of appendicitis, diabetic ketoacidosis and sepsis.
Diagnosis 2021;8(2):219-25. doi: 10.1515/dx-2020-0035..
Keywords: Diagnostic Safety and Quality, Sepsis, Medical Errors, Adverse Events, Patient Safety
Wayne MT, Molling D, Wang XQ
Measurement of sepsis in a national cohort using three different methods to define baseline organ function.
In 2017, the U.S. Centers for Disease Control and Prevention (CDC) developed a new surveillance definition of sepsis, the adult sepsis event (ASE), to better track sepsis epidemiology. The objective of this study was to understand how sepsis identification and outcomes differed when using the best laboratory values during hospitalization versus methods that used historical lookbacks to define baseline organ function.
AHRQ-funded; HS026725.
Citation: Wayne MT, Molling D, Wang XQ .
Measurement of sepsis in a national cohort using three different methods to define baseline organ function.
Ann Am Thorac Soc 2021 Apr;18(4):648-55. doi: 10.1513/AnnalsATS.202009-1130OC..
Keywords: Sepsis, Diagnostic Safety and Quality
Jordan Kempker A, Rudd KE, Wang HE
https://www.pubmed.ncbi.nlm.nih.gov/33009097
Sepsis epidemiology across the International Classification of Diseases, 9th Edition, to International Classification of Diseases, 10th Edition, chasm-a direct application of the Institute for Health Metrics and Evaluation case definition to hospital disc
The objective of this study was to describe the epidemiology of sepsis across the transition from the International Classification of Diseases (ICD), 9th Edition and ICD, 10th Edition, coding systems, evaluating estimates of two previously published ICD 10th Edition, coding strategies. The investigators concluded that The Institute for Health Metrics and Evaluation ICD, 10th Edition, coding strategy for identifying sepsis may capture a larger patient population within administrative datasets that are different from those identified with previously deployed ICD-based methods.
Citation: Jordan Kempker A, Rudd KE, Wang HE .
Sepsis epidemiology across the International Classification of Diseases, 9th Edition, to International Classification of Diseases, 10th Edition, chasm-a direct application of the Institute for Health Metrics and Evaluation case definition to hospital disc
Crit Care Med 2020 Dec;48(12):1881-84. doi: 10.1097/ccm.0000000000004577..
Keywords: Healthcare Cost and Utilization Project (HCUP), Sepsis, Diagnostic Safety and Quality
Gale BM, Hall KK
The use of patient monitoring systems to improve sepsis recognition and outcomes: a systematic review.
This systematic review’s aim was to determine the impact of automated patient monitoring systems (PMSs) on sepsis recognition and outcomes. The review was conducted using articles published from 2008 through 2018. Nineteen articles were identified for inclusion with 4 systematic reviews and 15 individual studies. Study results for outcome measures were mixed, with more than half the studies showing a significant improvement in at least one outcome measure (eg mortality, intensive care unit length of stay, ICU transfer). Evidence for process measure improvement was of moderate strength across multiple hospital units.
AHRQ-funded; 233201500013I.
Citation: Gale BM, Hall KK .
The use of patient monitoring systems to improve sepsis recognition and outcomes: a systematic review.
J Patient Saf 2020 Sep;16(3S Suppl 1):S8-s11. doi: 10.1097/pts.0000000000000750..
Keywords: Clinical Decision Support (CDS), Sepsis, Diagnostic Safety and Quality, Screening, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Klompas M, Osborn TM, Rhee C
Who owns sepsis?
In this Ideas and Opinions article, the authors discuss applying to sepsis guidelines that are already in place for other conditions. They indicate that other time-critical diagnoses have evolved triaging systems to inform the urgency and intensity of therapy, and that sepsis can evolve similarly, where potentially infected patients with worrisome signs or comorbidities, such as hypotension, altered mental status, or immunosuppression, are managed with one level of urgency and intensity and less severely ill patients are managed with another.
AHRQ-funded; HS025008.
Citation: Klompas M, Osborn TM, Rhee C .
Who owns sepsis?
Ann Intern Med 2020 Feb 4;172(3):210-11. doi: 10.7326/m19-2966..
Keywords: Sepsis, Guidelines, Diagnostic Safety and Quality, Critical Care
Anand V, Zhang Z, Kadri SS
Epidemiology of quick sequential organ failure assessment criteria in undifferentiated patients and association with suspected infection and sepsis.
In this study, researchers examined the epidemiology and prognostic value of Quick Sequential Organ Failure Assessment (qSOFA) in undifferentiated patients. They found that only one in three patients who were qSOFA-positive on admission had suspected infection, and one in six had sepsis. They further found that qSOFA had low sensitivity for identifying suspected infection and sepsis, and its prognostic significance was not specific to infection. They recommended a need for more sensitive and specific tools for sepsis screening and risk stratification.
AHRQ-funded; HS025008.
Citation: Anand V, Zhang Z, Kadri SS .
Epidemiology of quick sequential organ failure assessment criteria in undifferentiated patients and association with suspected infection and sepsis.
Chest 2019 Aug;156(2):289-97. doi: 10.1016/j.chest.2019.03.032..
Keywords: Sepsis, Diagnostic Safety and Quality
Sloane PD, Ward K, Weber DJ
Can sepsis be detected in the nursing home prior to the need for hospital transfer?
The purpose of this study was to determine whether and to what extent simple screening tools might identify nursing home (NH) residents who are at high risk of becoming septic. The authors concluded that NHs need better systems to monitor NH residents whose status is changing, and to present that information to medical providers in real time, either through rapid medical response programs or telemetry.
AHRQ-funded; HS022846.
Citation: Sloane PD, Ward K, Weber DJ .
Can sepsis be detected in the nursing home prior to the need for hospital transfer?
J Am Med Dir Assoc 2018 Jun;19(6):492-96.e1. doi: 10.1016/j.jamda.2018.02.001..
Keywords: Sepsis, Nursing Homes, Long-Term Care, Diagnostic Safety and Quality, Elderly
Geis GL, Wheeler DS, Bunger A
A validation argument for a simulation-based training course centered on assessment, recognition, and early management of pediatric sepsis.
The aim of this study was to create a validity argument for the use of a simulation-based training course centered on assessment, recognition, and early management of sepsis in a laboratory-based setting. The authors concluded that, although incomplete, evidence from initial testing suggests that the simulations of pediatric sepsis were sufficiently valid to justify their use in training novice pediatric physicians in the assessment, recognition, and management of pediatric sepsis.
AHRQ-funded; HS020455.
Citation: Geis GL, Wheeler DS, Bunger A .
A validation argument for a simulation-based training course centered on assessment, recognition, and early management of pediatric sepsis.
Simul Healthc 2018 Feb;13(1):16-26. doi: 10.1097/sih.0000000000000271..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Sepsis, Training
Donnelly JP, Safford MM, Shapiro NI
Application of the Third International Consensus Definitions for Sepsis (Sepsis-3) Classification: a retrospective population-based cohort study.
The Consensus Definitions present clinical criteria for the classification of patients with sepsis. Researchers investigated incidence and long-term outcomes of patients diagnosed with these classifications, which are currently unknown. Their findings support the use of the elevated sepsis-related organ failure assessment (SOFA) score from Sepsis-3, and elevated quick SOFA (qSOFA) score from Sepsis-3 classifications to identify patients with infection who are at elevated risk of poor outcomes.
AHRQ-funded; HS013852.
Citation: Donnelly JP, Safford MM, Shapiro NI .
Application of the Third International Consensus Definitions for Sepsis (Sepsis-3) Classification: a retrospective population-based cohort study.
Lancet Infect Dis 2017 Jun;17(6):661-70. doi: 10.1016/s1473-3099(17)30117-2.
.
.
Keywords: Sepsis, Diagnostic Safety and Quality, Patient-Centered Outcomes Research, Outcomes
Sudduth CL, Overton EC, Lyu PF
Filtering authentic sepsis arising in the ICU using administrative codes coupled to a SIRS screening protocol.
Using administrative codes and minimal physiologic and laboratory data, researchers sought a high-specificity identification strategy for patients whose sepsis initially appeared during their ICU stay. They concluded that selected administrative codes coupled to SIRS criteria and applied to patients admitted to ICU can yield up to 94 percent authentic sepsis patients. However, only 1/3 of patients thus identified appeared to become septic during their ICU stay.
AHRQ-funded; HS000055.
Citation: Sudduth CL, Overton EC, Lyu PF .
Filtering authentic sepsis arising in the ICU using administrative codes coupled to a SIRS screening protocol.
J Crit Care 2017 Jun;39:220-24. doi: 10.1016/j.jcrc.2017.01.012.
.
.
Keywords: Diagnostic Safety and Quality, Intensive Care Unit (ICU), Hospitalization, Sepsis
Bhattacharjee P, Churpek MM, Snyder A
Detecting sepsis: are two opinions better than one?
Researchers conducted a study to characterize the agreement between different providers' suspicion of infection and the correlation with patient outcomes using prospective data from a general medicine ward. They concluded that provider disagreement regarding suspected infection is common, with RNs suspecting infection more often, suggesting that a collaborative model for sepsis detection may improve timing and accuracy.
AHRQ-funded; HS000078.
Citation: Bhattacharjee P, Churpek MM, Snyder A .
Detecting sepsis: are two opinions better than one?
J Hosp Med 2017 Apr;12(4):256-58. doi: 10.12788/jhm.2721.
.
.
Keywords: Diagnostic Safety and Quality, Nursing, Risk, Sepsis
Bhattacharjee P, Edelson DP, Churpek MM
Identifying patients with sepsis on the hospital wards.
The goal of this review was to discuss recent advances in the detection of sepsis in patients on the hospital wards. The investigators discuss data highlighting the benefits and limitations of the systemic inflammatory response syndrome (SIRS) criteria for screening patients with sepsis, such as its low specificity, as well as newly described scoring systems, including the proposed role of the quick sepsis-related organ failure assessment (qSOFA) score.
AHRQ-funded; HS000078.
Citation: Bhattacharjee P, Edelson DP, Churpek MM .
Identifying patients with sepsis on the hospital wards.
Chest 2017 Apr;151(4):898-907. doi: 10.1016/j.chest.2016.06.020..
Keywords: Clinical Decision Support (CDS), Diagnostic Safety and Quality, Hospitalization, Sepsis
Balamuth F, Weiss SL, Hall M
Identifying pediatric severe sepsis and septic shock: accuracy of diagnosis codes.
The purpose of this study was to evaluate accuracy of 2 established administrative methods of identifying children with sepsis using a medical record review reference standard. It concluded that sepsis specific International Classification of Diseases, Ninth Revision, Clinical Modification codes identify pediatric patients with severe sepsis in administrative data more accurately than a combination of codes for infection plus organ dysfunction.
AHRQ-funded; K08-HS023827.
Citation: Balamuth F, Weiss SL, Hall M .
Identifying pediatric severe sepsis and septic shock: accuracy of diagnosis codes.
J Pediatr 2015 Dec;167(6):1295-300.e4. doi: 10.1016/j.jpeds.2015.09.027.
.
.
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Sepsis
Makam AN, Nguyen OK, Auerbach AD
Diagnostic accuracy and effectiveness of automated electronic sepsis alert systems: a systematic review.
This review aimed to determine whether automated real-time electronic sepsis alerts can: (1) accurately identify sepsis and (2) improve process measures and outcomes. It found that automated sepsis alerts derived from electronic health data may improve care processes but tend to have poor positive predictive value and do not improve mortality or length of stay.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Auerbach AD .
Diagnostic accuracy and effectiveness of automated electronic sepsis alert systems: a systematic review.
J Hosp Med 2015 Jun;10(6):396-402. doi: 10.1002/jhm.2347..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Sepsis, Diagnostic Safety and Quality, Patient-Centered Outcomes Research
Wang HE, Addis DR, Donnelly JP
Discharge diagnoses versus medical record review in the identification of community-acquired sepsis.
The researchers evaluated the accuracy of hospital discharge diagnoses in the identification of community-acquired sepsis and severe sepsis. They found that hospital discharge diagnoses show good specificity but poor sensitivity for detecting community-acquired sepsis and severe sepsis.
AHRQ-funded; HS013852.
Citation: Wang HE, Addis DR, Donnelly JP .
Discharge diagnoses versus medical record review in the identification of community-acquired sepsis.
Crit Care 2015 Feb 16;19:42. doi: 10.1186/s13054-015-0771-6.
.
.
Keywords: Community-Acquired Infections, Diagnostic Safety and Quality, Hospital Discharge, Sepsis