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
76 to 100 of 178 Research Studies DisplayedVarley AL, Kripalani S, Spain T
Understanding factors influencing quality improvement capacity among ambulatory care practices across the MidSouth region: an exploratory qualitative study.
Success in choosing and implementing quality metrics, necessary in a value-based care model, depends on quality improvement (QI) capacity-the shared knowledge, understanding, and commitment to continuous improvement. In this study, the investigators set out to explore factors influencing QI capacity among ambulatory care practices in the MidSouth Practice Transformation Network. Their findings provide insight into factors influencing the adoption and implementation of QI metrics across a diverse group of ambulatory care practices.
AHRQ-funded; HS013852.
Citation: Varley AL, Kripalani S, Spain T .
Understanding factors influencing quality improvement capacity among ambulatory care practices across the MidSouth region: an exploratory qualitative study.
Qual Manag Health Care 2020 Jul/Sep;29(3):136-41. doi: 10.1097/qmh.0000000000000255..
Keywords: Quality Improvement, Quality of Care, Ambulatory Care and Surgery, Practice Improvement
Homco J, Carabin H, Nagykaldi Z
Validity of medical record abstraction and electronic health record-generated reports to assess performance on cardiovascular quality measures in primary care.
The purpose of this study was to compare observed performance scores measured using 2 imperfect reference standard data sources with misclassification-adjusted performance scores obtained using bayesian latent class analysis. Using aspirin, blood pressure, and smoking performance data from the Healthy Hearts for Oklahoma Project, researchers found that extracting information for the same individuals using different data sources generated different performance score estimates. Recommendations included further research to identify the sources of these differences.
AHRQ-funded; HS023919.
Citation: Homco J, Carabin H, Nagykaldi Z .
Validity of medical record abstraction and electronic health record-generated reports to assess performance on cardiovascular quality measures in primary care.
JAMA Netw Open 2020 Jul;3(7):e209411. doi: 10.1001/jamanetworkopen.2020.9411..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Cardiovascular Conditions, Quality Measures, Quality of Care, Primary Care, Provider Performance, Evidence-Based Practice
Rudin RS, Friedberg MW, Shekelle P
Getting value from electronic health records: research needed to improve practice.
Electronic health records (EHRs) are now widely adopted in the United States, but health systems have barely begun using them to deliver high-value care. This article describes 4 potential benefits of EHR-based research: improving clinical decisions, supporting triage decisions, enabling collaboration among the care team (including patients), and increasing productivity via automation of tasks.
AHRQ-funded; HS024067.
Citation: Rudin RS, Friedberg MW, Shekelle P .
Getting value from electronic health records: research needed to improve practice.
Ann Intern Med 2020 Jun 2;172(11 Suppl):S130-s36. doi: 10.7326/m19-0878..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Improvement, Quality of Care, Healthcare Delivery
Crystal S, Jarrín OF, Rosenthal M
National partnership to improve dementia care in nursing homes campaign: state and facility strategies, impact, and antipsychotic reduction outcomes.
This study examines the success of the national partnership campaign to reduce prescription of antipsychotic medications to elderly nursing home residents with dementia. Antipsychotic medications have been shown to increase mortality. Use of these medications had increased 23.9% in dementia patients by 2011. The campaign reduced use by 40.1% to 14.3% by the second quarter of 2019. The campaign measured progress with public reporting of quality measures, increased regulatory scrutiny, and accompanying state and facility initiatives. Sedative-hypnotic medication use also decreased in tandem with antipsychotic reduction suggesting that the campaign increased attention to the use of other risky psychotropic medications.
AHRQ-funded; HS023464; HS022406; HS023258; HS021112.
Citation: Crystal S, Jarrín OF, Rosenthal M .
National partnership to improve dementia care in nursing homes campaign: state and facility strategies, impact, and antipsychotic reduction outcomes.
Innov Aging 2020 Jun 2;4(3):igaa018. doi: 10.1093/geroni/igaa018..
Keywords: Elderly, Nursing Homes, Long-Term Care, Dementia, Neurological Disorders, Quality Improvement, Quality of Care, Medication, Mortality
Olivieri-Mui B, McGuire J, Griffith J
Assessing the quality of human immunodeficiency virus care in nursing homes.
Quality of human immunodeficiency virus (HIV) care in nursing homes (NHs) has never been measured. In this cross-sectional study, the investigators assessed the quality of human immunodeficiency virus care in nursing homes. This study provides previously unknown baseline metrics on NH HIV care quality and highlights significant challenges when measuring HIV care in NHs.
AHRQ-funded; HS025662.
Citation: Olivieri-Mui B, McGuire J, Griffith J .
Assessing the quality of human immunodeficiency virus care in nursing homes.
J Am Geriatr Soc 2020 Jun;68(6):1226-34. doi: 10.1111/jgs.16359..
Keywords: Elderly, Human Immunodeficiency Virus (HIV), Nursing Homes, Long-Term Care, Quality of Care
Khaneki S, Bronsert MR, Henderson WG
Comparison of accuracy of prediction of postoperative mortality and morbidity between a new, parsimonious risk calculator (SURPAS) and the ACS Surgical Risk Calculator.
The purpose of this study was to compare the accuracy of the Surgical Risk Preoperative Assessment System (SURPAS) to that of the American College of Surgeons Surgical Risk Calculator (ACS-SRC). Data from 1006 selected ACS National Surgical Quality Improvement Program (NSQIP) patients with known outcomes were used to calculate predicted risk of postoperative mortality and morbidity. Findings showed that the SURPAS risk predictions were more accurate than the ACS-SRC's for overall morbidity, particularly for high risk patients.
AHRQ-funded; HS024124.
Citation: Khaneki S, Bronsert MR, Henderson WG .
Comparison of accuracy of prediction of postoperative mortality and morbidity between a new, parsimonious risk calculator (SURPAS) and the ACS Surgical Risk Calculator.
Am J Surg 2020 Jun;219(6):1065-72. doi: 10.1016/j.amjsurg.2019.07.036..
Keywords: Surgery, Risk, Adverse Events, Quality Improvement, Quality of Care
Campbell Britton M, Petersen-Pickett J, Hodshon B
Mapping the care transition from hospital to skilled nursing facility.
Researchers used process mapping to illustrate the sequence of events involved with hospital discharge and admission to a skilled nursing facility (SNF). These transitions are often associated with breakdowns in communication that may place patients at risk for adverse events. A quality improvement (QI) team worked with frontline staff at an academic medical center and two local SNFs in the northeastern United States. The final process map included care management, medicine, nursing, admissions and physical therapy service staff. The process map showed numerous activities that need to be coordinated between care teams, and highlighted specific opportunities for improving communication between different teams.
AHRQ-funded; HS023554.
Citation: Campbell Britton M, Petersen-Pickett J, Hodshon B .
Mapping the care transition from hospital to skilled nursing facility.
J Eval Clin Pract 2020 Jun;26(3):786-90. doi: 10.1111/jep.13238..
Keywords: Transitions of Care, Care Coordination, Quality Improvement, Communication, Hospital Discharge, Hospitals, Nursing Homes, Quality of Care
Rodríguez HP, Fulton BD, Phillips AZ
The early impact of the Centers for Medicare & Medicaid Services State Innovation Models Initiative on 30-day hospital readmissions among adults with diabetes.
The Centers for Medicare & Medicaid Services (CMS) State Innovation Models (SIM) Initiative funds states to accelerate delivery system and payment reforms. All SIM states focus on improving diabetes care, but SIM's effect on 30-day readmissions among adults with diabetes remains unclear. In this study, the investigators found no evidence that SIM reduced 30-day readmission rates among adults with diabetes during the first 2 years of round 1 implementation, even among CMS beneficiaries.
AHRQ-funded; HS022241.
Citation: Rodríguez HP, Fulton BD, Phillips AZ .
The early impact of the Centers for Medicare & Medicaid Services State Innovation Models Initiative on 30-day hospital readmissions among adults with diabetes.
Med Care 2020 Jun;58(6 Suppl 1):S22-s30. doi: 10.1097/mlr.0000000000001276..
Keywords: Diabetes, Chronic Conditions, Hospital Readmissions, Quality Improvement, Quality of Care
Spatz ES, Suter LG, George E
An instrument for assessing the quality of informed consent documents for elective procedures: development and testing.
The objective of this mixed qualitative-quantitative study was to develop a nationally applicable tool for assessing the quality of informed consent documents for elective procedures. The investigators identified key quality elements of an informed consent document and operationalised the highest-priority elements to define a minimum standard for informed consent documents. They assert that this tool is a starting point that can enable hospitals and other providers to evaluate and improve the quality of informed consent.
AHRQ-funded; HS023000.
Citation: Spatz ES, Suter LG, George E .
An instrument for assessing the quality of informed consent documents for elective procedures: development and testing.
BMJ Open 2020 May 19;10(5):e033297. doi: 10.1136/bmjopen-2019-033297..
Keywords: Surgery, Quality Measures, Quality of Care
Spatz ES, Bao H, Herrin J
Quality of informed consent documents among US. hospitals: a cross-sectional study.
The purpose of this study was to determine whether informed consent for surgical procedures performed in US hospitals met a minimum standard of quality. The investigators developed and tested a quality measure of informed consent documents. The investigators concluded that all hospitals performed poorly on a measure of informed consent document quality, though there was some variation across hospitals. They indicated that measuring the quality of hospital's informed consent documents can serve as a first step in driving attention to gaps in quality.
AHRQ-funded; HS023000.
Citation: Spatz ES, Bao H, Herrin J .
Quality of informed consent documents among US. hospitals: a cross-sectional study.
BMJ Open 2020 May 19;10(5):e033299. doi: 10.1136/bmjopen-2019-033299..
Keywords: Hospitals, Surgery, Quality Measures, Quality of Care
Hansen JE, Brown DW, Hanke SP
Angiotensin-converting enzyme inhibitor prescription for patients with single ventricle physiology enrolled in the NPC-QIC registry.
This study examined trends in the routine use of angiotension-converting enzyme inhibitors (ACEI) during palliation of hypoplastic left heart syndrome, which is considered controversial. The authors used patients enrolled in the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) registry from 2008 to 2016 who had been prescribed ACEI between stage 1 palliation (stage I Norwood procedure) discharge and stage 2 palliation (stage II superior cavopulmonary anastomosis procedure) admission. ACEI prescriptions declined from 45% in the pre-2010 period to 36.8% from 2011 to 2016. No difference was found in interstage mortality, change in atrioventricular valve regurgitation, or change in ventricular dysfunction between groups. Atrioventricular septal defect, and preoperative mechanical ventilation were associated with increased ACEI prescription.
AHRQ-funded; HS021114.
Citation: Hansen JE, Brown DW, Hanke SP .
Angiotensin-converting enzyme inhibitor prescription for patients with single ventricle physiology enrolled in the NPC-QIC registry.
J Am Heart Assoc 2020 May 18;9(10):e014823. doi: 10.1161/jaha.119.014823..
Keywords: Newborns/Infants, Medication, Heart Disease and Health, Cardiovascular Conditions, Practice Patterns, Registries, Quality Improvement, Quality of Care
Panchal AR, Finnegan G, Way DP
Assessment of paramedic performance on difficult airway simulation.
The purpose of this study was to assess paramedic comprehensive airway management practices during a difficult airway simulation through which paramedics were obligated to consider alternatives to endotracheal intubation (ETI). The investigators concluded that in a difficult airway management scenario designed for low ETI success rates, even experienced paramedics were challenged with comprehensive airway management. This was exemplified by difficulties with the use of backup airway devices.
AHRQ-funded; HS021456.
Citation: Panchal AR, Finnegan G, Way DP .
Assessment of paramedic performance on difficult airway simulation.
Prehosp Emerg Care 2020 May-Jun;24(3):411-20. doi: 10.3109/10903127.2015.1102993..
Keywords: Simulation, Emergency Medical Services (EMS), Training, Quality of Care, Care Management, Provider Performance
Ryskina KL, Andy AU, Manges KA
Association of online consumer reviews of skilled nursing facilities with patient rehospitalization rates.
The purpose of this study was to: 1.) assess the association between rehospitalization rates and online ratings of skilled nursing facility (SNFs); 2.) Compare the association of rehospitalization with ratings from a review website vs Medicare Nursing Home Compare (NHC) ratings; and 3.) Identify specific topics consistently reported in reviews of SNFs with the highest vs lowest rehospitalization rates using natural language processing.
AHRQ-funded; HS026116.
Citation: Ryskina KL, Andy AU, Manges KA .
Association of online consumer reviews of skilled nursing facilities with patient rehospitalization rates.
JAMA Netw Open 2020 May;3(5):e204682. doi: 10.1001/jamanetworkopen.2020.4682..
Keywords: Nursing Homes, Hospital Readmissions, Provider Performance, Quality of Care, Medicare, Elderly
McHugh M, Brown T, Walunas TL
Contrasting perspectives of practice leaders and practice facilitators may be common in quality improvement initiatives.
The authors sought to identify patterns of contrasting perspectives on implementation issues between practice leaders and their practice facilitators as well as factors that may contribute to them. Through individual interviews, they found that turnover of staff was frequently reported in dyads with contrasting perspectives. They recommended that planners of quality improvement initiatives using practice facilitation consider taking steps to minimize contrasting perspectives by addressing turnover challenges and encouraging opportunities to share perspectives.
AHRQ-funded; HS023921.
Citation: McHugh M, Brown T, Walunas TL .
Contrasting perspectives of practice leaders and practice facilitators may be common in quality improvement initiatives.
J Healthc Qual 2020 May/Jun;42(3):e32-e38. doi: 10.1097/jhq.0000000000000223..
Keywords: Primary Care, Quality Improvement, Quality of Care, Implementation, Communication, Provider
Dadlez NM, Adelman J, Bundy DG
Contributing factors for pediatric ambulatory diagnostic process errors: Project RedDE.
This study examined root causes of three common pediatric diagnostic errors by having 31 practices enrolled in a national QI collaborative perform monthly “mini-RCAs” (mini root cause analyses). The diagnoses errors studied were missed adolescent depression, missed elevated blood pressure, and missed actionable laboratory values. Twenty-eight practices submitted 184 mini-RCAs with the most common causes being patient volume (adolescent depression and elevated BP), inadequate staffing (adolescent depression), clinic milieu (elevated BP), written communication and provider knowledge (actionable laboratory values), and electronic health records (EHRs) – (elevated BP and actionable laboratory values). The median number of mini-RCAs submitted was 6.
AHRQ-funded; HS024538; HS024713; HS026121.
Citation: Dadlez NM, Adelman J, Bundy DG .
Contributing factors for pediatric ambulatory diagnostic process errors: Project RedDE.
Pediatr Qual Saf 2020 May-Jun;5(3):e299. doi: 10.1097/pq9.0000000000000299..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Quality Improvement, Quality of Care, Medical Errors, Adverse Events, Patient Safety
Silverberg JI, Lai JS, Kantor RW
Development, validation, and interpretation of the PROMIS Itch Questionnaire: a patient-reported outcome measure for the quality of life impact of itch.
Current patient-reported outcome measures for itch are limited and may not capture its full impact on health-related quality of life. In this study, the investigators sought to develop, calibrate, and validate banks of questions assessing the health-related quality of life impact of itch as part of the Patient-Reported Outcomes Measurement Information System. A systematic process of literature review, content-expert review, qualitative research, testing in a sample of 600 adults, classical test theory methods, and item response theory analyses were applied.
AHRQ-funded; HS023011.
Citation: Silverberg JI, Lai JS, Kantor RW .
Development, validation, and interpretation of the PROMIS Itch Questionnaire: a patient-reported outcome measure for the quality of life impact of itch.
J Invest Dermatol 2020 May;140(5):986-94.e6. doi: 10.1016/j.jid.2019.08.452..
Keywords: Quality of Life, Quality of Care
Baernholdt M, Yan G, Hinton ID
Effect of preventive care interventions on pressure ulcer rates in a national sample of rural and urban nursing units: Longitudinal associations over 4 years.
This study looked at the effects of nursing care interventions aimed at preventing pressure ulcers in rural and urban hospitals over a 4-year period. This longitudinal study used unit-level data from the National Database of Nursing Quality Indicators 2010-2013. The authors analyzed 5761 units (332 rural and 5429 urban) in 772 hospitals (89 rural and 683 urban) that reported ulcer rates in two or more quarters. Outcomes from use of a three-care intervention combination was measured with decreases in pressure ulcers shown from any of those interventions (patients receiving skin assessment on admission, receiving risk assessment on admission, and receiving any risk assessment before the pressure ulcer). An increase in RN skill mix and two nurse outcomes (increase in job satisfaction and intent-to-stay) also led to decreases in ulcer rates.
AHRQ-funded; HS023147.
Citation: Baernholdt M, Yan G, Hinton ID .
Effect of preventive care interventions on pressure ulcer rates in a national sample of rural and urban nursing units: Longitudinal associations over 4 years.
Int J Nurs Stud 2020 May;105:103455. doi: 10.1016/j.ijnurstu.2019.103455..
Keywords: Pressure Ulcers, Prevention, Skin Conditions, Nursing, Practice Patterns, Provider: Nurse, Provider, Quality Indicators (QIs), Quality Measures, Quality of Care
Giardina TD, Royse KE, Khanna A
Health care provider factors associated with patient-reported adverse events and harm.
This research examined associations between patient-reported contributory factors and patient-related harms experienced after an adverse event (AE). A secondary analysis was conducted of a national sample of patient-reported AEs gathered from an online questionnaire from 2010 to February 2016. Harms were categorized as nonphysical harm only, physical harm only, physical harm and emotional or financial harm, or all three harms. One third (32.6%) of patients reported experiencing all three harms, 25.5% physical harms only, and 14.7% reported nonphysical harms only. Patients reporting all three harms were 2.5 times more likely to have filed a report with authorities and 3.3 times more likely to also have experienced a surgical complication. Odds were also 13% higher of reporting problems related to communication between clinician and patients/families or clinician-related behavioral issues with patients experiencing all three harms.
AHRQ-funded; HS025474.
Citation: Giardina TD, Royse KE, Khanna A .
Health care provider factors associated with patient-reported adverse events and harm.
Jt Comm J Qual Patient Saf 2020 May;46(5):282-90. doi: 10.1016/j.jcjq.2020.02.004.
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Keywords: Adverse Events, Medical Errors, Patient Safety, Quality of Care
Herrick HM, Lorch S, Hsu JY
Impact of flow disruptions in the delivery room.
The goal of this study was to identify the impact of flow disruptions during neonatal resuscitation and to determine their association with key process and outcome measures. Delivery-room resuscitations of neonates less 32 weeks gestational age were video recorded for observation. Results showed that flow disruptions occurred frequently during neonatal resuscitation and recommendations included measuring flow disruptions as a feasible method to assess the impact of human factors in the delivery room and to identify modifiable factors and practices to improve patient care.
AHRQ-funded; HS023538; HS026491; HS026625; HS023806.
Citation: Herrick HM, Lorch S, Hsu JY .
Impact of flow disruptions in the delivery room.
Resuscitation 2020 May;150:29-35. doi: 10.1016/j.resuscitation.2020.02.037.
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Keywords: Workflow, Labor and Delivery, Newborns/Infants, Patient Safety, Healthcare Delivery, Quality Improvement, Quality of Care
Tignanelli CJ, Silverman GM, Lindemann EA
Natural language processing of prehospital emergency medical services trauma records allows for automated characterization of treatment appropriateness.
Incomplete prehospital trauma care is a significant contributor to preventable deaths. Current databases lack timelines easily constructible of clinical events. Temporal associations and procedural indications are critical to characterize treatment appropriateness. Natural language processing (NLP) methods present a novel approach to bridge this gap. In this study, the investigators sought to evaluate the efficacy of a novel and automated NLP pipeline to determine treatment appropriateness from a sample of prehospital EMS motor vehicle crash records.
AHRQ-funded; HS026379.
Citation: Tignanelli CJ, Silverman GM, Lindemann EA .
Natural language processing of prehospital emergency medical services trauma records allows for automated characterization of treatment appropriateness.
J Trauma Acute Care Surg 2020 May;88(5):607-14. doi: 10.1097/ta.0000000000002598.
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Keywords: Trauma, Injuries and Wounds, Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Improvement, Quality of Care
Ogletree AM, Mangrum R, Harris Y
AHRQ Author: Bergofsky L Perfetto D
Omissions of care in nursing home settings: a narrative review.
This review aimed to (1) examine existing definitions of omissions of care in the healthcare environment and associated characteristics and (2) outline adverse events that may be attributable to omissions of care among nursing home populations. The investigators concluded that definitions of omissions of care for nursing homes varied in scope and level of detail. Substantial evidence connected omissions of care with an array of adverse events in nursing home populations.
AHRQ-authored; AHRQ-funded; 233201500014I.
Citation: Ogletree AM, Mangrum R, Harris Y .
Omissions of care in nursing home settings: a narrative review.
J Am Med Dir Assoc 2020 May;21(5):604-14. doi: 10.1016/j.jamda.2020.02.016..
Keywords: Nursing Homes, Long-Term Care, Adverse Events, Medical Errors, Patient Safety, Quality of Care
Mathews SC, Stoll RA, Sternberger WI
Prioritizing health care solutions for pressure ulcers using the quality function deployment process.
Reducing the incidence and morbidity of pressure ulcers remains a leading national priority in patient safety. A detailed and practical application of quality function deployment is presented, in this paper, that demonstrates the value of applying engineering practices for prioritizing solutions for pressures ulcers specifically and can easily be adapted to other conditions.
AHRQ-funded; HS023553.
Citation: Mathews SC, Stoll RA, Sternberger WI .
Prioritizing health care solutions for pressure ulcers using the quality function deployment process.
Am J Med Qual 2020 May/Jun;35(3):197-204. doi: 10.1177/1062860619869990..
Keywords: Pressure Ulcers, Patient Safety, Quality of Care
Marcin JP, Romano PS, Dayal P
Provider-level and hospital-level factors and process measures of quality care delivered in pediatric emergency departments.
The objective of this study was to determine whether process measures of quality of care delivered to patients receiving care in children's hospital emergency departments were associated with physician-level or hospital-level factors. Subjects were children under 18 years old who presented to any of the 12 emergency departments that participated in the Pediatric Emergency Care Applied Research Network (PECARN).he researchers found that process measures of quality of care delivered to children was higher among patients treated at freestanding children's hospitals but lower among patients treated at higher volume emergency departments.
AHRQ-funded; HS019712.
Citation: Marcin JP, Romano PS, Dayal P .
Provider-level and hospital-level factors and process measures of quality care delivered in pediatric emergency departments.
Acad Pediatr 2020 May-Jun;20(4):524-31. doi: 10.1016/j.acap.2019.11.007..
Keywords: Children/Adolescents, Emergency Department, Hospitals, Quality Measures, Quality of Care
Peahl AF, Gourevitch RA, Luo EM
Right-sizing prenatal care to meet patients' needs and improve maternity care value.
In this manuscript, investigators present a new conceptual model for prenatal care that incorporates both patients' medical and social needs into four phenotypes, and use human-centered design methods to describe how better matching patient needs with prenatal services can increase the use of high-value services and decrease the use of low-value services. They also address some of the key challenges to implementing right-sized prenatal care, including capturing outcomes through research and payment.
AHRQ-funded; HS000055; HS025465.
Citation: Peahl AF, Gourevitch RA, Luo EM .
Right-sizing prenatal care to meet patients' needs and improve maternity care value.
Obstet Gynecol 2020 May;135(5):1027-37. doi: 10.1097/aog.0000000000003820..
Keywords: Maternal Care, Pregnancy, Women, Quality Improvement, Quality of Care
Sheetz KH, Chhabra K, Nathan H
The quality of surgical care at hospitals associated with America's highest-rated medical centers.
The objective of this study was to assess whether the quality of surgical care changes as hospitals form networks with established, high-quality medical centers. The investigators concluded that network formation was not associated with a significant improvement in quality or reduction in Medicare expenditures across all procedures studied for hospitals joining the networks of America’s highest rated medical centers.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Chhabra K, Nathan H .
The quality of surgical care at hospitals associated with America's highest-rated medical centers.
Ann Surg 2020 May;271(5):862-67. doi: 10.1097/sla.0000000000003195..
Keywords: Surgery, Hospitals, Quality of Care, Medicare, Health Systems