National Healthcare Quality and Disparities Report
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Search All Research Studies
Topics
- Antibiotics (2)
- Antimicrobial Stewardship (1)
- Asthma (4)
- Care Management (4)
- Children/Adolescents (6)
- COVID-19 (1)
- Education: Patient and Caregiver (1)
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- (-) Inpatient Care (13)
- Intensive Care Unit (ICU) (2)
- Medication (2)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (1)
- Newborns/Infants (2)
- Outcomes (2)
- Patient-Centered Outcomes Research (2)
- Patient Safety (2)
- Pneumonia (1)
- Practice Patterns (1)
- Provider (1)
- Provider: Physician (1)
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- Quality of Care (1)
- (-) Respiratory Conditions (13)
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 13 of 13 Research Studies DisplayedVolerman A, Balachandran U, Zhu M
Evaluating inhaler education interventions for hospitalized children with asthma: a randomized controlled trial.
The objective of this study was to evaluate whether the technology-based intervention-Virtual Teach-to-Goal (V-TTG) could lead to less inhaler misuse among children hospitalized with asthma. A single-center randomized controlled trial of V-TTG vs brief intervention was conducted with children aged 5-10 with asthma. At baseline, nearly all children misused inhalers; inhaler misuse decreased significantly in both V-TTG and brief intervention. The researchers suggested that future studies evaluate V-TTG intervention across diverse populations and disease severities to identify its greatest impact.
AHRQ-funded; HS027804.
Citation: Volerman A, Balachandran U, Zhu M .
Evaluating inhaler education interventions for hospitalized children with asthma: a randomized controlled trial.
Ann Allergy Asthma Immunol 2023 Aug; 131(2):217-23.e1. doi: 10.1016/j.anai.2023.02.023..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Education: Patient and Caregiver, Inpatient Care
Rasooly IR, Makeneni S, Khan AN
The alarm burden of excess continuous pulse oximetry monitoring among patients with bronchiolitis.
This study’s objective was to quantify alarm burden of excess continuous pulse oximetry monitoring among hospitalized infants with bronchiolitis who are not receiving supplemental oxygen. The authors evaluated admissions of 201 children (aged 0-24 months) with bronchiolitis. They categorized time ≥60 minutes following discontinuation of supplemental oxygen as "continuously monitored (guideline-discordant)," "intermittently measured (guideline-concordant)," or "unable to classify." Among 4402 classifiable hours, 77% of alarms occurred during periods of guideline-discordant monitoring. Patients experienced a median of 35 alarms during guideline-discordant, continuously monitored time, representing a rate of 6.7 alarms per hour. When the monitoring was guideline-concordant, median hourly alarm rate was 0.5 alarms per hour.
AHRQ-funded; HS026620.
Citation: Rasooly IR, Makeneni S, Khan AN .
The alarm burden of excess continuous pulse oximetry monitoring among patients with bronchiolitis.
J Hosp Med 2021 Dec;16(12):727-29. doi: 10.12788/jhm.3731..
Keywords: Newborns/Infants, Respiratory Conditions, Inpatient Care
Deshpande A, Richter SS, Haessler S
De-escalation of empiric antibiotics following negative cultures in hospitalized patients with pneumonia: rates and outcomes.
This study assessed antibiotic de-escalation practices across hospitals and their associations with outcomes in hospitalized patients diagnosed with pneumonia with negative cultures. The authors included 14,170 adults admitted with pneumonia in 2010-2015 to 164 US hospitals if they had negative blood and/or respiratory cultures and received both anti-MRSA and antipseudomonal agents other than quinolones. If empiric drugs were stopped on day 4 while continuing another antibiotic it was defined at de-escalation. Patients were propensity adjusted for de-escalation and compared on in-hospital 14-day mortality, late deterioration with ICU transfer, length-of-stay (LOS) and costs. Thirteen percent (1924 patients) had both initial empiric drugs stopped by hospital day 4. De-escalation rates at hospitals ranged from 2-35% and the established rate quartiles were not significantly associated with outcomes. Even at hospitals in the top quartile of de-escalation, the de-escalation rates were lower than 50%.
AHRQ-funded; HS025026; HS024277.
Citation: Deshpande A, Richter SS, Haessler S .
De-escalation of empiric antibiotics following negative cultures in hospitalized patients with pneumonia: rates and outcomes.
Clin Infect Dis 2021 Apr 26;72(8):1314-22. doi: 10.1093/cid/ciaa212..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Pneumonia, Respiratory Conditions, Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Inpatient Care
Soares WE, Schoenfeld EM, Visintainer P
Safety assessment of a noninvasive respiratory protocol for adults with COVID-19.
As evidence emerged supporting noninvasive strategies for coronavirus disease 2019 (COVID-19)-related respiratory distress, the investigators implemented a noninvasive COVID-19 respiratory protocol (NCRP) that encouraged high-flow nasal cannula (HFNC) and self-proning across our healthcare system. To assess safety, the investigators conducted a retrospective chart review evaluating mortality and other patient safety outcomes after implementation of the NCRP protocol (April 3, 2020, to April 15, 2020) for adult patients hospitalized with COVID-19, compared with preimplementation outcomes (March 15, 2020, to April 2, 2020).
AHRQ-funded; HS025701.
Citation: Soares WE, Schoenfeld EM, Visintainer P .
Safety assessment of a noninvasive respiratory protocol for adults with COVID-19.
J Hosp Med 2020 Dec;15(12):734-38. doi: 10.12788/jhm.3548..
Keywords: Patient Safety, COVID-19, Respiratory Conditions, Inpatient Care, Infectious Diseases
Cotter JM, Tyler A, Reese J
Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.
This study looked at pediatric emergency department (ED) inpatient use of dexamethasone versus prednisone by providers for asthma treatment. A survey was distributed to providers who care for inpatient asthmatics. Ninety-two providers completed the survey. When patients received dexamethasone in the ED, 44% continued dexamethasone, 14% switched to prednisone, 2% stopped steroid use, and 40% said it depended on the circumstances. Hospitalists were significantly more likely to continue dexamethasone than pulmonologists (61% versus 15%). Switching to prednisone included factors such as severity of exacerbation (73%) and asthma history (47%). Just over half of providers (5f1%) felt uncomfortable using dexamethasone because of “minimal data to support [its] use inpatient.”
AHRQ-funded; HS026512.
Citation: Cotter JM, Tyler A, Reese J .
Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.
J Asthma 2020 Sep;57(9):942-48. doi: 10.1080/02770903.2019.1622713..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Medication, Inpatient Care, Care Management, Hospitalization, Emergency Department, Practice Patterns, Provider: Physician, Provider
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
Coon ER, Stoddard G, Brady PW
Intensive care unit utilization after adoption of a ward-based high-flow nasal cannula protocol.
This study examined whether the adoption of ward-based high-flow nasal cannula (HFNC) protocol in pediatric intensive care units (ICUs) reduced ICU utilization. This retrospective cohort study included infants aged 3 to 24 months hospitalized with bronchiolitis at hospitals in the Pediatric Health Information System database. There was a 93% response rate with the 44 hospitals contacted for the survey, of which 18 were categorized as non-adopting hospitals and 12 were categorized as adopting hospitals. Ward-based HFNC protocol data were included from the 2010-2011 and 2015-2016 respiratory seasons. Early protocols were paradoxically associated with increased ICU utilization.
AHRQ-funded; HS023827.
Citation: Coon ER, Stoddard G, Brady PW .
Intensive care unit utilization after adoption of a ward-based high-flow nasal cannula protocol.
J Hosp Med 2020 Jun;15(6):325-30. doi: 10.12788/jhm.3417..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Respiratory Conditions, Healthcare Utilization, Newborns/Infants, Inpatient Care
Kaiser SV, Jennings B, Rodean J
Pathways for improving inpatient pediatric asthma care (PIPA): a multicenter, national study.
This study examined whether implementation of a pathway strategy for inpatient pediatric asthma patients improve outcomes for these patients. Outcomes measured included length of stay (LOS), early administration of metered-dose inhalers, screening for secondhand tobacco exposure and referral to cessation resources, and 7-day hospital readmissions or emergency revisits. Eighty-five hospitals were enrolled and 68 completed the study with (n=12,013) admissions. Pathways were associated with increases in early administration of metered-dose inhalers, and referral to smoking cessation resources, but no statistically significant changes in the other outcomes were observed. Most hospitals did improve in at least one outcome.
AHRQ-funded; HS024592; HS024554.
Citation: Kaiser SV, Jennings B, Rodean J .
Pathways for improving inpatient pediatric asthma care (PIPA): a multicenter, national study.
Pediatrics 2020 Jun;145(6):e20193026. doi: 10.1542/peds.2019-3026..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Inpatient Care, Patient-Centered Outcomes Research, Outcomes, Hospitalization, Care Management
Bonafide CP, Xiao R, Brady PW
Prevalence of continuous pulse oximetry monitoring in hospitalized children with bronchiolitis not requiring supplemental oxygen.
This study examined the use of continuous pulse oximetry monitoring in hospitalized children with bronchiolitis who do not require supplemental oxygen. US national guidelines discourage the use but the practice was found to be still fairly widespread. The researchers conducted a multicenter, cross-sectional study of pediatric wards in 56 US and Canadian hospitals in the Pediatric Research in Inpatient Settings Network from December 2018 through March 2019. Patients aged 8 weeks through 23 months were included as a convenience sample. Overall usage was found to be 46% ranging from 6% to 82%.
AHRQ-funded; HS026763.
Citation: Bonafide CP, Xiao R, Brady PW .
Prevalence of continuous pulse oximetry monitoring in hospitalized children with bronchiolitis not requiring supplemental oxygen.
JAMA 2020 Apr 21;323(15):1467-77. doi: 10.1001/jama.2020.2998..
Keywords: Children/Adolescents, Respiratory Conditions, Inpatient Care, Hospitalization, Care Management, Evidence-Based Practice
Law AC, Forbath N, O'Donoghue S
Hospital-level availability of prone positioning in Massachusetts ICUs.
The authors sought to evaluate the institutional availability of prone positioning (PP), for which prior studies have shown its underuse. They found that most hospitals they surveyed in Massachusetts were either unable, or not completely able, to offer PP routinely. They concluded that their finding of low uptake of an evidence-based intervention with a mortality benefit at an institutional level raises multiple questions for future investigation and suggests that attempts to implement PP among eligible patients will need to include consideration of hospital-level barriers.
AHRQ-funded; HS024288.
Citation: Law AC, Forbath N, O'Donoghue S .
Hospital-level availability of prone positioning in Massachusetts ICUs.
Am J Respir Crit Care Med 2020 Apr 15;201(8):1006-08. doi: 10.1164/rccm.201910-2097LE.
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Keywords: Intensive Care Unit (ICU), Inpatient Care, Hospitals, Respiratory Conditions
Semenkovich TR, Olsen MA, Puri V
Current state of empyema management.
The goal of this study was to examine current treatment practices and outcomes for inpatient treatment of empyema. A comprehensive, longitudinal data set from the New York State Inpatient Database, encompassing an entire state cohort of hospitalized patients, was used. The cohort included 4,095 patients who were undergoing intervention for primary empyema and were discharged 2009 to 2014 with chest tube, video-assisted thoracoscopic surgery (VATS) decortication and drainage, or open drainage and decortication. Patients were categorized into these three groups by definitive treatment during their initial hospitalization. The findings indicate that patients who were managed with chest tubes showed higher readmission and reintervention rates, suggesting that some of these patients may benefit from earlier definitive surgical intervention.
AHRQ-funded; HS019455.
Citation: Semenkovich TR, Olsen MA, Puri V .
Current state of empyema management.
Ann Thorac Surg 2018 Jun;105(6):1589-96. doi: 10.1016/j.athoracsur.2018.02.027..
Keywords: Care Management, Healthcare Cost and Utilization Project (HCUP), Inpatient Care, Outcomes, Respiratory Conditions
Lindenauer PK, Shieh MS, Stefan MS
Hospital procalcitonin testing and antibiotic treatment of patients admitted for chronic obstructive pulmonary disease exacerbation
The purpose of this study was to determine the impact of procalcitonin (PCT) testing on antibiotic treatment of patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD) in routine practice. The study conclude that as currently implemented, PCT testing appears to have had little impact on decisions to initiate antibiotic therapy or on duration of treatment for COPD exacerbations.
AHRQ-funded; HS024596.
Citation: Lindenauer PK, Shieh MS, Stefan MS .
Hospital procalcitonin testing and antibiotic treatment of patients admitted for chronic obstructive pulmonary disease exacerbation
Ann Am Thorac Soc 2017 Dec;14(12):1779-85. doi: 10.1513/AnnalsATS.201702-133OC..
Keywords: Antibiotics, Respiratory Conditions, Hospitalization, Inpatient Care, Patient-Centered Outcomes Research
Badawy J, Nguyen OK, Clark C
Is everyone really breathing 20 times a minute? Assessing epidemiology and variation in recorded respiratory rate in hospitalised adults.
The researchers sought to assess the potential accuracy of respiratory rate (RR) by analyzing the distribution and variation as a proxy, since RR should be normally distributed if recorded accurately. The observed patterns suggest that RR is inaccurately recorded, even among those with cardiopulmonary compromise, and represents a 'spot' estimate with values of 18 and 20 breaths per minute representing 'normal.’
AHRQ-funded; HS022418.
Citation: Badawy J, Nguyen OK, Clark C .
Is everyone really breathing 20 times a minute? Assessing epidemiology and variation in recorded respiratory rate in hospitalised adults.
BMJ Qual Saf 2017 Oct;26(10):832-36. doi: 10.1136/bmjqs-2017-006671.
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Keywords: Hospitalization, Inpatient Care, Patient Safety, Quality Improvement, Respiratory Conditions