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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
101 to 125 of 178 Research Studies DisplayedSinger SJ, Kerrissey M, Friedberg M
A comprehensive theory of integration.
Efforts to transform health care delivery to improve care have increasingly focused on care integration. However, variation in how integration is defined has complicated efforts to design, synthesize, and compare studies of integration in health care. Drawing on previous work, in this study the investigators presented a comprehensive theoretical model of relationships between types of integration and proposed how to measure them.
AHRQ-funded; HS024067.
Citation: Singer SJ, Kerrissey M, Friedberg M .
A comprehensive theory of integration.
Med Care Res Rev 2020 Apr;77(2):196-207. doi: 10.1177/1077558718767000..
Keywords: Healthcare Delivery, Patient-Centered Healthcare, Quality of Care
Griffey RT, Schneider RM, Todorov AA
Adverse events present on arrival to the emergency department: the ED as a dual safety net.
This study examined the prevalence of adverse events due to medication-related or patient care-related events that present on arrival (POA) to the emergency department (ED). This retrospective observation study tested the ED Trigger Tool from data at an urban academic medical center. Adults who completed an ED visit were eligible (N=92,859). A total of 5,582 visits gave a trigger. The majority of AEs (1,181) identified were from patients who were white and older. In total, POA AEs accounted for an estimated 7.65% of ED visits.
AHRQ-funded; HS025052.
Citation: Griffey RT, Schneider RM, Todorov AA .
Adverse events present on arrival to the emergency department: the ED as a dual safety net.
Jt Comm J Qual Patient Saf 2020 Apr;46(4):192-98. doi: 10.1016/j.jcjq.2019.12.003..
Keywords: Adverse Events, Adverse Drug Events (ADE), Emergency Department, Medication, Patient Safety, Quality of Care
Sanghavi P, Pan S, Caudry D
Assessment of nursing home reporting of major injury falls for quality measurement on Nursing Home Compare.
The purpose of this study was to assess the accuracy of nursing home self-report of major injury falls on the Minimum Data Set (MDS). They linked inpatient claims for major injury falls with MDS assessments. The investigators concluded that the nursing home-reported data used for the Nursing Home Compare (NHC) falls measure may be highly inaccurate.
AHRQ-funded; HS026957.
Citation: Sanghavi P, Pan S, Caudry D .
Assessment of nursing home reporting of major injury falls for quality measurement on Nursing Home Compare.
Health Serv Res 2020 Apr;55(2):201-10. doi: 10.1111/1475-6773.13247..
Keywords: Falls, Nursing Homes, Quality Measures, Quality Indicators (QIs), Quality of Care, Elderly, Public Reporting, Injuries and Wounds
Fisher KA, Gallagher TH, Smith KM
Communicating with patients about breakdowns in care: a national randomised vignette-based survey.
This study examined the impact of an apology when problems occur in patient care breakdowns occur at hospitals. Breakdowns included slow response to call bell, rude aide, and unanswered questions. A national online survey of 1188 adults aged 35 years or older were sampled from an online panel representative of the entire US population, created and maintained by GfK. Twice as many participants receiving an in-depth prompt about care breakdowns would recommend the hospital compared with those receiving no prompt (18.4% vs 8.8%). Almost three times as many participants who received a full apology would probably/definitely recommend the hospital compared with those receiving no apology (34.1% vs 13.6%). The survey also asked whether the respondent would speak up, with feeling upset being a strong determinant of greater intent to speak up.
AHRQ-funded; HS024596; HS022757.
Citation: Fisher KA, Gallagher TH, Smith KM .
Communicating with patients about breakdowns in care: a national randomised vignette-based survey.
BMJ Qual Saf 2020 Apr;29(4):313-19. doi: 10.1136/bmjqs-2019-009712..
Keywords: Clinician-Patient Communication, Communication, Patient Experience, Patient and Family Engagement, Quality Improvement, Quality of Care, Hospitals
Coley RY, Boggs JM, Beck A
Defining success in measurement-based care for depression: a comparison of common metrics.
This study compared response and remission measures with effect size and severity-adjusted effect size (SAES) measures and examined the relationship between baseline symptom severity and treatment success for depression. Electronic records from two large integrated health systems were used to identify new psychotherapy episodes. Findings showed that response was preferable for comparing treatment outcomes, as it did not favor more or less baseline symptom severity, indicated clinically meaningful improvement, and was transparent and easy to calculate.
AHRQ-funded; HS026369.
Citation: Coley RY, Boggs JM, Beck A .
Defining success in measurement-based care for depression: a comparison of common metrics.
Psychiatr Serv 2020 Apr;71(4):312-18. doi: 10.1176/appi.ps.201900295..
Keywords: Depression, Behavioral Health, Patient-Centered Outcomes Research, Outcomes, Quality of Care, Quality Measures
Stangenes SR, Painter IS, Rea TD
Delays in recognition of the need for telephone-assisted CPR due to caller descriptions of chief complaint.
The objective of this study was to test if caller descriptions of chief complaint delays emergency medical dispatchers' (EMDs) recognition of the need for telephone-assisted CPR (T-CPR). The investigators conducted an analysis of N = 433 cardiac arrest calls from six large call centers in the United States. They concluded that caller chief complaint description affected the time to recognition of the need for T-CPR.
AHRQ-funded; HS021658.
Citation: Stangenes SR, Painter IS, Rea TD .
Delays in recognition of the need for telephone-assisted CPR due to caller descriptions of chief complaint.
Resuscitation 2020 Apr;149:82-86. doi: 10.1016/j.resuscitation.2020.02.013..
Keywords: Emergency Medical Services (EMS), Cardiovascular Conditions, Patient Safety, Quality of Care, Telehealth, Health Information Technology (HIT), Communication
Persell SD, Liss DT, Walunas TL
Effects of 2 forms of practice facilitation on cardiovascular prevention in primary care: a practice-randomized, comparative effectiveness trial.
Effective quality improvement (QI) strategies are needed for small practices. The objective of this study was to compare practice facilitation implementing point-of-care (POC) QI strategies alone versus facilitation implementing point-of-care plus population management (POC+PM) strategies on preventive cardiovascular care. The investigators concluded that facilitator-led QI promoting population management approaches plus POC improvement strategies was not clearly superior to POC strategies alone.
AHRQ-funded; HS023921.
Citation: Persell SD, Liss DT, Walunas TL .
Effects of 2 forms of practice facilitation on cardiovascular prevention in primary care: a practice-randomized, comparative effectiveness trial.
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Keywords: Cardiovascular Conditions, Prevention, Primary Care: Models of Care, Primary Care, Comparative Effectiveness, Patient-Centered Outcomes Research, Evidence-Based Practice, Quality Improvement, Quality of Care, Care Management, Healthcare Delivery
Smith ME, Nuliyalu U, Dimick JB
Local referral of high-risk pancreatectomy patients to improve surgical outcomes and minimize travel burden.
Referring patients to high-quality hospitals for complex procedures may improve outcomes. This is most feasible within small geographic areas. However, access to specialized surgical procedures may be an implementation barrier. In this study, the investigators sought to determine the availability of high-quality hospitals performing pancreatectomy and the potential benefit and travel burden of referral within small geographic areas.
AHRQ-funded; HS024763.
Citation: Smith ME, Nuliyalu U, Dimick JB .
Local referral of high-risk pancreatectomy patients to improve surgical outcomes and minimize travel burden.
J Gastrointest Surg 2020 Apr;24(4):882-89. doi: 10.1007/s11605-019-04245-6..
Keywords: Surgery, Hospitals, Outcomes, Quality of Care
Fahrenbach J, Chin MH, Huang ES
Neighborhood disadvantage and hospital quality ratings in the Medicare Hospital Compare Program.
This study examined the relationship between neighborhood social risk factors (SRFs) and hospital ratings in Medicare's Hospital Compare Program. Results showed that lower hospital summary scores were associated with caring for neighborhoods with higher social risk. Associations between neighborhood SRFs and hospital ratings were largest in the timeliness of care, patient experience, and hospital readmission groups and smallest in the safety, efficiency, and effectiveness of care groups. Failing to account for neighborhood social risk in hospital rating systems may reinforce hidden disincentives to care for medically underserved areas in the United States.
AHRQ-funded; HS023007.
Citation: Fahrenbach J, Chin MH, Huang ES .
Neighborhood disadvantage and hospital quality ratings in the Medicare Hospital Compare Program.
Med Care 2020 Apr;58(4):376-83. doi: 10.1097/mlr.0000000000001283..
Keywords: Quality of Care, Hospitals, Medicare, Quality Indicators (QIs), Patient Experience, Social Determinants of Health
Poghosyan L, Ghaffari A, Liu J
Physician-nurse practitioner teamwork in primary care practices in New York: a cross-sectional survey.
Primary care practices increasingly rely on the growing workforce of nurse practitioners (NPs) to meet primary care demand. Understanding teamwork between NPs and physicians in primary care practices is critically important. In this study, the investigators assessed teamwork between NPs and physicians practicing within the same primary care practice and determined how teamwork affected their job satisfaction, intent to leave their current job, and quality of care.
AHRQ-funded; HS024758.
Citation: Poghosyan L, Ghaffari A, Liu J .
Physician-nurse practitioner teamwork in primary care practices in New York: a cross-sectional survey.
J Gen Intern Med 2020 Apr;35(4):1021-28. doi: 10.1007/s11606-019-05509-2..
Keywords: Primary Care: Models of Care, Primary Care, Provider: Clinician, Provider: Physician, Provider, Workforce, Quality of Care
Kranz AM, Mahmud A, Agniel D
Provision of social services and health care quality in US community health centers, 2017.
The authors describe the types of social services provided at community health centers (CHCs), characteristics of CHCs providing these services, and the association between on-site provision and health care quality. Their findings indicate that CHCs most often offered on-site assistance for needs related to food or nutriion, interpersonal violence, and housing. Participation in projects with community-based organizations was associated with providing services on-site. On-site provision was associated with better performance on measures of health care quality. They conclude that some CHCs provide social services on-site, and this was associated with better performance on measures of health care quality.
AHRQ-funded; HS024067.
Citation: Kranz AM, Mahmud A, Agniel D .
Provision of social services and health care quality in US community health centers, 2017.
Am J Public Health 2020 Apr;110(4):567-73. doi: 10.2105/ajph.2019.305519..
Keywords: Community Partnerships, Quality of Care, Domestic Violence, Nutrition
Grembowsk D, Conrad DA, Naranjo D
RE-AIM Evaluation Plan for Washington State Innovation Models Project.
The authors sought to present the state-level evaluation methods for Washington State's State Innovation Models (SIM). They applied the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) evaluation framework to structure their evaluation, then created a conceptual model and plan to use multiple and mixed methods to study SIM performance in the RE-AIM components from a statewide, population-based perspective.
AHRQ-funded; HS013853.
Citation: Grembowsk D, Conrad DA, Naranjo D .
RE-AIM Evaluation Plan for Washington State Innovation Models Project.
Qual Manag Health Care 2020 Apr/Jun;29(2):81-94. doi: 10.1097/qmh.0000000000000246..
Keywords: Healthcare Delivery, Quality of Care
Alfred M, Catchpole K, Huffer E
Work systems analysis of sterile processing: decontamination.
This study examined the work of sterile processing departments (SPDs) from a systems perspective. This paper reports the results of a work systems analysis that sought to identify the complex multilevel interdependencies that create performance variation and identify potential improvement interactions. The analysis was conducted at a 700-bed academic hospital with two reprocessing facilities decontaminating approximately 23,000 units each month. Mixed methods, including 56 hours of observations of work was done, as well as formal and informal interviews with relevant stakeholders and analysis of data collected about the system. The authors identified 21 different performance shaping factors, 30 potential failures, 16 types of process variance, and 10 outcome variances in decontamination. Approximately 2% of trays were returned to decontamination from assembly with 1% of surgical cases having decontamination problems.
AHRQ-funded; HS025538.
Citation: Alfred M, Catchpole K, Huffer E .
Work systems analysis of sterile processing: decontamination.
BMJ Qual Saf 2020 Apr;29(4):320-28. doi: 10.1136/bmjqs-2019-009422..
Keywords: Patient Safety, Quality Improvement, Quality of Care, Prevention, Surgery, Healthcare-Associated Infections (HAIs)
Ho V, Metcalfe L, Vu L
Annual spending per patient and quality in hospital-owned versus physician-owned organizations: an observational study.
This study examined whether there are patient spending differences between practices owned by hospitals versus independent physician practices. The study used data from patients aged 19 to 64 enrolled in a Blue Cross Blue Shield Preferred Provider organization in the four largest metropolitan areas in Texas. Spending was found to be significantly higher for durable medical equipment, imaging, unclassified services, and outpatient care in hospital-owned practices. Estimates were that expenses were 5.8% higher in those practices.
AHRQ-funded; HS024727.
Citation: Ho V, Metcalfe L, Vu L .
Annual spending per patient and quality in hospital-owned versus physician-owned organizations: an observational study.
J Gen Intern Med 2020 Mar;35(3):649-55. doi: 10.1007/s11606-019-05312-z..
Keywords: Hospitals, Healthcare Costs, Quality of Care
LaHue SC, Albers K, Goldman S
Cervical dystonia incidence and diagnostic delay in a multiethnic population.
This study examined rates of diagnostic delay of cervical dystonia (CD) and the population of CD patients. Cases were identified from electronic medical records and multistage screening of more than 3 million Kaiser Permanente Northern California members from 2003-2007. CD incidence is greater in women and increases with age. About half of CD patients had a diagnostic delay. They were first given diagnoses of essential tremor, cervical disc disease, neck sprain/strain, anxiety and depression. Adverse effects are associated with diagnostic delay.
AHRQ-funded; HS018413.
Citation: LaHue SC, Albers K, Goldman S .
Cervical dystonia incidence and diagnostic delay in a multiethnic population.
Mov Disord 2020 Mar;35(3):450-56. doi: 10.1002/mds.27927..
Keywords: Neurological Disorders, Diagnostic Safety and Quality, Patient Safety, Quality of Care
Sweeney SM, Hemler JR, Baron AN
Dedicated workforce required to support large-scale practice improvement.
Facilitation is an effective approach for helping practices implement sustainable evidence-based practice improvements. Few studies examine the facilitation infrastructure and support needed for large-scale dissemination and implementation initiatives. In this paper, the authors discuss a project by the Agency for Health care Research and Quality in which it funded 7 Cooperatives, each of which worked with over 200 primary care practices to rapidly disseminate and implement improvements in cardiovascular preventive care.
AHRQ-funded; HS023940.
Citation: Sweeney SM, Hemler JR, Baron AN .
Dedicated workforce required to support large-scale practice improvement.
J Am Board Fam Med 2020 Mar-Apr;33(2):230-39. doi: 10.3122/jabfm.2020.02.190261..
Keywords: Practice Improvement, Primary Care, Cardiovascular Conditions, Healthcare Delivery, Quality Improvement, Quality of Care, Prevention, Implementation, Evidence-Based Practice
Feng JY, Toomey SL, Elliott MN
Factors associated with family experience in pediatric inpatient care.
Researchers assessed which aspects of pediatric inpatient experience have the strongest relationships with parents' willingness to recommend a hospital. Their cross-sectional study examined surveys completed by parents of children hospitalized at hospitals using the Child Hospital Consumer Assessment of Healthcare Providers and Systems Survey. They found that child comfort and nurse-parent communication showed the strongest relationships with willingness to recommend, followed by preparing to leave the hospital, doctor-parent communication, and keeping parents informed. They recommended improvement efforts focusing on creating an age-appropriate environment, improving the effectiveness of provider interactions, and engaging parents to share their values and concerns.
AHRQ-funded; HS020513; HS025299.
Citation: Feng JY, Toomey SL, Elliott MN .
Factors associated with family experience in pediatric inpatient care.
Pediatrics 2020 Mar;145(3): e20191264. doi: 10.1542/peds.2019-1264..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Children/Adolescents, Quality Measures, Quality of Care, Inpatient Care, Patient Experience, Hospitals, Hospitalization, Patient and Family Engagement, Clinician-Patient Communication
Nguyen AM, Cuthel A, Padgett DK
How practice facilitation strategies differ by practice context.
The purpose of this study was to identify contextual factors that drive facilitators' strategies to meet practice improvement goals, and how these strategies are tailored to practice context. This study was conducted as part of a larger study, HealthyHearts New York City, which evaluated the impact of practice facilitation on adoption of cardiovascular disease prevention and treatment guidelines.
AHRQ-funded; HS023922.
Citation: Nguyen AM, Cuthel A, Padgett DK .
How practice facilitation strategies differ by practice context.
J Gen Intern Med 2020 Mar;35(3):824-31. doi: 10.1007/s11606-019-05350-7..
Keywords: Quality Improvement, Evidence-Based Practice, Heart Disease and Health, Cardiovascular Conditions, Primary Care, Quality of Care, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care: Models of Care
White EM, Aiken LH, Sloane DM
Nursing home work environment, care quality, registered nurse burnout and job dissatisfaction.
The objective of this cross-sectional study was to examine the relationships between work environment, care quality, registered nurse (RN) burnout, and job dissatisfaction in nursing homes. In this study, the investigators linked 2015 RN4CAST-US nurse survey data with LTCfocus and Nursing Home Compare. They indicate that their results suggest that the work environment is an important area to target for interventions to improve care quality and nurse retention in nursing homes.
AHRQ-funded; HS000011.
Citation: White EM, Aiken LH, Sloane DM .
Nursing home work environment, care quality, registered nurse burnout and job dissatisfaction.
Geriatr Nurs 2020 Mar-Apr;41(2):158-64. doi: 10.1016/j.gerinurse.2019.08.007..
Keywords: Elderly, Nursing Homes, Burnout, Provider: Nurse, Provider, Quality of Care, Provider Performance
Tang AB, Childers CP, Dworsky JQ
Surgeon work captured by the National Surgical Quality Improvement Program across specialties.
The National Surgical Quality Improvement Program (NSQIP) database is increasingly used for surgical research. However, it is unclear how well this database represents the breadth of work performed by different specialties. Using the 2017 NSQIP participant use file and the 2017 Medicare Physician/Supplier Procedure Summary file, the investigators evaluated (1) what proportion of surgical work was captured by NSQIP, (2) what procedures and disciplines were undersampled, and (3) the overall concordance between the NSQIP sample and a national sample.
AHRQ-funded; HS000046.
Citation: Tang AB, Childers CP, Dworsky JQ .
Surgeon work captured by the National Surgical Quality Improvement Program across specialties.
Surgery 2020 Mar;167(3):550-55. doi: 10.1016/j.surg.2019.11.013..
Keywords: Surgery, Quality Improvement, Quality of Care, Provider: Physician, Provider, Medicare, Patient-Centered Outcomes Research
Liu JY, Hu QL, Lamaina M
Surgical technical evidence review for acute cholecystectomy conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery.
In this study, the authors identified 13 overall components to consider for a nonelective laparoscopic cholecystectomy for acute cholecystitis enhanced recovery pathways. They indicated that hospitals participating in AHRQ’s Safety Program for Improving Surgical Care and Recovery will be supported in carrying out practices that enhance care for patients and in gathering data to support continuous quality improvement around the enhanced recovery pathways.
AHRQ-funded; 233201500020I.
Citation: Liu JY, Hu QL, Lamaina M .
Surgical technical evidence review for acute cholecystectomy conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery.
J Am Coll Surg 2020 Mar;230(3):354.e1. doi: 10.1016/j.jamcollsurg.2019.11.014..
Keywords: Surgery, Quality Improvement, Quality of Care, Patient Safety, Evidence-Based Practice
Than C, Chuang E, Washington DL
Understanding gender sensitivity of the health care workforce at the Veterans Health Administration.
Gender sensitivity of providers and staff has assumed increasing importance in closing historical gender disparities in health care quality and outcomes. The Department of Veterans Affairs (VA) has implemented several initiatives intended to improve gender sensitivity of its health care workforce. The current study examined practice- and individual-level characteristics associated with gender sensitivity of primary care providers (PCPs) and staff.
AHRQ-funded; HS000046.
Citation: Than C, Chuang E, Washington DL .
Understanding gender sensitivity of the health care workforce at the Veterans Health Administration.
Womens Health Issues 2020 Mar-Apr;30(2):120-27. doi: 10.1016/j.whi.2020.01.001..
Keywords: Workforce, Provider, Primary Care, Disparities, Quality of Care
Williams AR, Samples H, Crystal S
AHRQ Author: H
Acute care, prescription opioid use, and overdose following discontinuation of long-term buprenorphine treatment for opioid use disorder.
Although buprenorphine treatment reduces risk of overdose and death in opioid use disorder, most patients discontinue treatment within a few weeks or months. In this study, adverse health outcomes following buprenorphine discontinuation were compared among patients who were successfully retained beyond 6 months of continuous treatment, a minimum treatment duration recently endorsed by the National Quality Forum.
AHRQ-funded; HS021112; HS023258.
Citation: Williams AR, Samples H, Crystal S .
Acute care, prescription opioid use, and overdose following discontinuation of long-term buprenorphine treatment for opioid use disorder.
Am J Psychiatry 2020 Feb;177(2):117-24. doi: 10.1176/appi.ajp.2019.19060612..
Keywords: Opioids, Medication, Substance Abuse, Medication, Quality of Care
Kocher KE, Arora R, Bassin BS
Baseline performance of real-world clinical practice within a statewide emergency medicine quality network: the Michigan Emergency Department Improvement Collaborative (MEDIC).
The Michigan Emergency Department Improvement Collaborative (MEDIC) has baseline performance data to identify practice variation across 15 diverse emergency departments on key emergency care quality indicators. The authors assessed MEDIC quality measures and found that performance varied greatly, with demonstrated opportunity for improvement. They conclude that MEDIC provides a robust platform for emergency physician engagement across emergency department practice settings to improve care and is a model for other states.
AHRQ-funded; HS024160.
Citation: Kocher KE, Arora R, Bassin BS .
Baseline performance of real-world clinical practice within a statewide emergency medicine quality network: the Michigan Emergency Department Improvement Collaborative (MEDIC).
Ann Emerg Med 2020 Feb;75(2):192-205. doi: 10.1016/j.annemergmed.2019.04.033..
Keywords: Emergency Department, Quality Improvement, Quality Indicators (QIs), Quality Measures, Quality of Care, Imaging, Diagnostic Safety and Quality
Colton K, Richards CT, Pruitt PB
Early stroke recognition and time-based emergency care performance metrics for intracerebral hemorrhage.
This study compared time for early stroke recognition for intracerebral hemorrhage for hospitals with and without stroke teams. An observational cohort study was conducted at an urban comprehensive stroke center from 2009 to 2017 with 204 cases included. Stroke team activation resulted in faster emergency care compared to no activation. This process resulted in shorter onset-to-arrival times, higher NIH Stroke Scale scores, and higher Glasgow Coma Scale scores.
AHRQ-funded; HS023437.
Citation: Colton K, Richards CT, Pruitt PB .
Early stroke recognition and time-based emergency care performance metrics for intracerebral hemorrhage.
J Stroke Cerebrovasc Dis 2020 Feb;29(2):104552. doi: 10.1016/j.jstrokecerebrovasdis.2019.104552..
Keywords: Stroke, Emergency Department, Provider Performance, Diagnostic Safety and Quality, Quality Improvement, Quality Indicators (QIs), Patient-Centered Outcomes Research, Outcomes, Quality of Care, Evidence-Based Practice, Hospitals