National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Cardiovascular Conditions (3)
- Catheter-Associated Urinary Tract Infection (CAUTI) (1)
- Central Line-Associated Bloodstream Infections (CLABSI) (1)
- Children/Adolescents (2)
- Clinical Decision Support (CDS) (1)
- Dental and Oral Health (1)
- Education: Continuing Medical Education (1)
- Elderly (1)
- Evidence-Based Practice (1)
- Healthcare-Associated Infections (HAIs) (2)
- Healthcare Delivery (1)
- Health Information Technology (HIT) (1)
- Health Insurance (1)
- Heart Disease and Health (2)
- Hospitalization (1)
- Hospital Readmissions (1)
- Hospitals (5)
- Long-Term Care (1)
- Medicare (3)
- Mortality (1)
- Nursing Homes (3)
- Outcomes (3)
- Patient-Centered Outcomes Research (1)
- Patient Safety (4)
- Payment (1)
- Pneumonia (1)
- Prevention (1)
- Provider (1)
- (-) Provider Performance (22)
- Public Reporting (1)
- Quality Improvement (4)
- Quality Indicators (QIs) (7)
- (-) Quality Measures (22)
- Quality of Care (15)
- Respiratory Conditions (2)
- Surgery (4)
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 22 of 22 Research Studies DisplayedSpatz ES
Fostering a culture to support surgical outcome measures.
This editorial comments on the relationship of surgical skills (referring to the gentleness, tissue exposure, instrument handling, time and motion, and flow of operation) and patient outcomes
AHRQ-funded; HS023000.
Citation: Spatz ES .
Fostering a culture to support surgical outcome measures.
Circ Cardiovasc Qual Outcomes 2016 Jul;9(4):345-7. doi: 10.1161/circoutcomes.116.003038.
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Keywords: Outcomes, Provider Performance, Quality Measures, Surgery
Kaiser SV, Lam R, Joseph GB
Limitations of using pediatric respiratory illness readmissions to compare hospital performance.
Researcher sought to determine if a National Quality Forum (NQF)-endorsed measure for pediatric lower respiratory illness (LRI) 30-day readmission rates can meaningfully identify high- and low-performing hospitals. Subjects were children with LRI (bronchiolitis, influenza, or pneumonia as primary diagnosis, or with an LRI as a secondary diagnosis with a primary diagnosis of respiratory failure, sepsis, bacteremia, or asthma) from all hospital admissions in California from 2012 to 2014. The researchers were unable to identify meaningful variation in hospital performance without broadening the metric definition and merging multiple years of data. They recommend that utilizers of pediatric-quality measures consider modifying metrics to better evaluate the quality of pediatric care at low-volume hospitals.
AHRQ-funded; HS024385; HS022835; HS024592; HS025297.
Citation: Kaiser SV, Lam R, Joseph GB .
Limitations of using pediatric respiratory illness readmissions to compare hospital performance.
J Hosp Med 2018 Nov;13(11):737-42. doi: 10.12788/jhm.2988..
Keywords: Children/Adolescents, Respiratory Conditions, Provider Performance, Hospital Readmissions, Hospitals, Quality Indicators (QIs), Quality Measures, Quality of Care, Quality Improvement
Brauner D, Werner RM, Shippee TP
Does Nursing Home Compare reflect patient safety in nursing homes?
In this study the investigators compared nursing homes' performance on several composite quality measures from Nursing Home Compare, the most prominent recent example of a national policy aimed at improving the quality of nursing home care, to their performance on measures of patient safety in nursing homes such as pressure sores, infections, falls, and medication errors.
AHRQ-funded; HS024967.
Citation: Brauner D, Werner RM, Shippee TP .
Does Nursing Home Compare reflect patient safety in nursing homes?
Health Aff 2018 Nov;37(11):1770-78. doi: 10.1377/hlthaff.2018.0721.
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Keywords: Quality of Care, Nursing Homes, Patient Safety, Provider Performance, Quality Measures
Alexander GL, Madsen R
A national report of nursing home quality and information technology: two-year trends.
The authors sought to answer these two research questions: What are the trends in information technology (IT) adoption in US nursing home facilities over 2 years? How are 2-year trends in IT adoption in US nursing homes related to nationally reported quality measures (QMs)? Using surveys of nursing home administrators and data from Nursing Home Compare, they concluded that multiple dimensions of IT sophistication influence QMs in every health care domain, providing an opportunity to design a reporting system that joins these important variables to be assessed on a national scale.
AHRQ-funded; HS022497.
Citation: Alexander GL, Madsen R .
A national report of nursing home quality and information technology: two-year trends.
J Nurs Care Qual 2018 Jul/Sep;33(3):200-07. doi: 10.1097/ncq.0000000000000328.
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Keywords: Health Information Technology (HIT), Nursing Homes, Long-Term Care, Quality of Care, Quality Measures, Provider Performance
de la Guardia FH, Hwang J, Adams JL
https://doi.org/10.1007/s10742-018-0179-2
Loss function-based evaluation of physician report cards.
The authors specified loss functions and evaluated the potential cost of misclassification for physician report card designs. They found that misclassification cost depends on how performance information will be used and by whom; selecting the lowest-cost design for a given stakeholder could maximize the usefulness of physician performance data. They conlcuded that misclassification cost could guide report card design, improving the usefulness of a report card for one stakeholder without disadvantaging others.
AHRQ-funded; HS021860.
Citation: de la Guardia FH, Hwang J, Adams JL .
Loss function-based evaluation of physician report cards.
Health Services and Outcomes Research Methodology 2018 Jun;18(2):96-108. doi: 10.1007/s10742-018-0179-2.
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Keywords: Quality of Care, Provider Performance, Quality Measures
Suckow BD, Goodney PP, Columbo JA
National trends in open surgical, endovascular, and branched-fenestrated endovascular aortic aneurysm repair in Medicare patients.
Open repair effectively prevents rupture for patients with abdominal aortic aneurysm (AAA) and is commonly studied as a metric reflecting hospital and surgeon expertise in cardiovascular care. However, given recent advances in endovascular aneurysm repair (EVAR), such as branched-fenestrated EVAR, it is unknown how commonly open surgical repair is still used in everyday practice. This study analyzed trends in open AAA repair, EVAR, and branched-fenestrated EVAR for AAA in Medicare beneficiaries from 2003 to 2013.
AHRQ-funded; HS021581.
Citation: Suckow BD, Goodney PP, Columbo JA .
National trends in open surgical, endovascular, and branched-fenestrated endovascular aortic aneurysm repair in Medicare patients.
J Vasc Surg 2018 Jun;67(6):1690-97.e1. doi: 10.1016/j.jvs.2017.09.046..
Keywords: Cardiovascular Conditions, Medicare, Provider Performance, Quality Measures, Surgery
Niknam BA, Arriaga AF, Rosenbaum PR
Adjustment for atherosclerosis diagnosis distorts the effects of percutaneous coronary intervention and the ranking of hospital performance.
The researchers investigated how adjustment for atherosclerosis affects rankings of hospitals that perform percutaneous coronary intervention (PCI). They found that atherosclerosis is almost always noted in patients with acute myocardial infarction (AMI) who undergo interventional cardiology but less often in medically managed patients, so adjustment for its notation likely removes part of the effect of interventional treatment. Thus, hospitals performing more extensive imaging and more PCIs have higher atherosclerosis diagnosis rates, making their patients appear healthier and artificially reducing the expected mortality rate against which they are benchmarked. The authors concluded that atherosclerosis adjustment is detrimental to hospitals providing more thorough AMI care.
AHRQ-funded; HS023560.
Citation: Niknam BA, Arriaga AF, Rosenbaum PR .
Adjustment for atherosclerosis diagnosis distorts the effects of percutaneous coronary intervention and the ranking of hospital performance.
J Am Heart Assoc 2018 May 25;7(11). doi: 10.1161/jaha.117.008366.
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Keywords: Cardiovascular Conditions, Outcomes, Heart Disease and Health, Provider Performance, Quality Measures
Eze-Ajoku E, Lavoie M, DeCamp M
Exploring the evidence base behind quality measures.
This study examined the strength of evidence behind quality measures used in Medicare’s 2016 Shared Savings Program. These measures apply to more than 430 accountable care organizations (ACOs). Differences existed in the grading systems used and the evidentiary strength. Based on average ACO performance, performance appeared to be lower in the moderate evidence category (overall average, 61 percent) compared to the high evidence category (overall average, 77 percent).
AHRQ-funded; HS023684.
Citation: Eze-Ajoku E, Lavoie M, DeCamp M .
Exploring the evidence base behind quality measures.
Am J Med Qual 2018 May/Jun;33(3):321-22. doi: 10.1177/1062860617721645.
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Keywords: Evidence-Based Practice, Medicare, Payment, Provider Performance, Quality Measures
Bowen ME, Bhat D, Fish J
Improving performance on preventive health quality measures using clinical decision support to capture care done elsewhere and patient exceptions.
This before-after study was conducted to examine the ability of clinical decision support (CDS) to improve performance on preventive quality measures, capture clinician-reported services completed elsewhere, and patient/medical exceptions and to describe their impact on quality measurement.
AHRQ-funded; HS022418.
Citation: Bowen ME, Bhat D, Fish J .
Improving performance on preventive health quality measures using clinical decision support to capture care done elsewhere and patient exceptions.
Am J Med Qual 2018 May/Jun;33(3):237-45. doi: 10.1177/1062860617732830..
Keywords: Clinical Decision Support (CDS), Prevention, Provider Performance, Quality Improvement, Quality Measures, Quality Measures
Sawyer JM, Anton NE, Korndorffer JR
Time crunch: increasing the efficiency of assessment of technical surgical skill via brief video clips.
Video review for assessment of surgical performance is gaining popularity but is time consuming for busy expert reviewers, making review delays inevitable. The study authors hypothesized that a shorter duration video clip would not affect the quality of expert ratings compared with full-length review. Their hypothesis was rejected as shorter video durations for surgical performance assessment led to inflated reviewer ratings both for expert and novice reviewers. They concluded that shortening duration of the video could not be recommended for accurate performance assessment.
AHRQ-funded; HS022080.
Citation: Sawyer JM, Anton NE, Korndorffer JR .
Time crunch: increasing the efficiency of assessment of technical surgical skill via brief video clips.
Surgery 2018 Apr;163(4):933-37. doi: 10.1016/j.surg.2017.11.011..
Keywords: Surgery, Quality of Care, Provider Performance, Quality Measures
Ryskina KL, Konetzka RT, Werner RM
Association between 5-Star nursing home report card ratings and potentially preventable hospitalizations.
The goal of this study was to test whether the improvements in nursing homes’ 5-star ratings were correlated with reductions in rates of hospitalization; the researchers’ hypothesis was that increased attention to ratings motivated nursing homes to make changes to improve ratings but did not affect hospitalization rate, resulting in a weakened association between ratings and hospitalizations. 2007-2010 Medicare hospital claims and nursing home clinical assessment data were used to compare the correlation between nursing homes’ ratings and hospitalization rates. Correlation weakened slightly after the ratings became publicly available. The researchers conclude that improvements in nursing home ratings after the release of Medicare's 5-star rating system were not accompanied by improvements in a broader measure of outcomes for post-acute care patients and, although this dissociation may be due to additional factors, the 5-star ratings became less meaningful as an indicator of nursing home quality for these patients.
AHRQ-funded; HS021861.
Citation: Ryskina KL, Konetzka RT, Werner RM .
Association between 5-Star nursing home report card ratings and potentially preventable hospitalizations.
Inquiry 2018 Jan-Dec;55:46958018787323. doi: 10.1177/0046958018787323..
Keywords: Elderly, Nursing Homes, Medicare, Quality Indicators (QIs), Provider Performance, Quality Measures, Hospitalization, Quality of Care
Govindan S, Wallace B, Iwashyna TJ
Do experts understand performance measures? A mixed-methods study of infection preventionists.
This study assessed expert interpretation of CLABSI quality data using a cross-sectional survey of members of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN). The investigators found that significant variability in the interpretation of CLABSI data exists among experts. They assert that this finding is likely related to data complexity, particularly with respect to risk-adjusted data. They suggest that improvements appear necessary in data sharing and public policy efforts to account for this complexity.
AHRQ-funded; HS022835.
Citation: Govindan S, Wallace B, Iwashyna TJ .
Do experts understand performance measures? A mixed-methods study of infection preventionists.
Infect Control Hosp Epidemiol 2018 Jan;39(1):71-76. doi: 10.1017/ice.2017.243..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Provider, Provider Performance, Quality of Care, Quality Measures
Masnick M, Morgan DJ, Sorkin JD
Can national healthcare-associated infections (HAIs) data differentiate hospitals in the United States?
This study was designed to determine whether patients using the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website can use nationally reported healthcare-associated infection (HAI) data to differentiate hospitals. The authors concluded that HAI data generally are reported by enough hospitals to meet minimal criteria for useful comparisons in many geographic locations, though this varies by type of HAI.
AHRQ-funded; HS018111.
Citation: Masnick M, Morgan DJ, Sorkin JD .
Can national healthcare-associated infections (HAIs) data differentiate hospitals in the United States?
Infect Control Hosp Epidemiol 2017 Oct;38(10):1167-71. doi: 10.1017/ice.2017.179..
Keywords: Quality of Care, Healthcare-Associated Infections (HAIs), Hospitals, Provider Performance, Quality Measures
DeLancey JO, Softcheck J, Chung JW
Associations between hospital characteristics, measure reporting, and the Centers for Medicare & Medicaid Services Overall Hospital Quality Star Ratings.
This study evaluated associations between hospital characteristics, number and types of measures reported, and the star ratings. Of 3,591 hospitals receiving a star rating,4 or 5 stars were awarded to 15.8 percent of major teaching hospitals, 18.8 percent of other teaching hospitals, 30.2 percent of community hospitals, 33.3 percent of critical access hospitals, and 87.3 percent of specialty hospitals.
AHRQ-funded; HS021857.
Citation: DeLancey JO, Softcheck J, Chung JW .
Associations between hospital characteristics, measure reporting, and the Centers for Medicare & Medicaid Services Overall Hospital Quality Star Ratings.
JAMA 2017 May 16;317(19):2015-17. doi: 10.1001/jama.2017.3148.
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Keywords: Hospitals, Quality of Care, Quality Measures, Provider Performance, Patient Safety
Encinosa W, Hsiao CJ, Firminger K
AHRQ Author: Encinosa W, Hsiao CJ
What performance measures do consumers find useful when selecting marketplace health plans?
This study explored consumers’ ability to use measures from eValue8, the leading tool that large employers use to compare and select health plans. It found that consumers have different views of health plan measures compared with employers. For example, consumers care most about measures indicating how well plans support long-term patient–physician relationships—many plan measures were seen to be intrusive in this relationship.
AHRQ-authored.
Citation: Encinosa W, Hsiao CJ, Firminger K .
What performance measures do consumers find useful when selecting marketplace health plans?
Am J Accountable Care 2016 Jun;4(2):10-16.
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Keywords: Health Insurance, Provider Performance, Quality Measures
McConnell KJ, Lindrooth RC, Wholey DR
Modern management practices and hospital admissions.
The researchers investigated whether the modern management practices and publicly reported performance measures are associated with choice of hospital for patients with acute myocardial infarction (AMI). They found that, overall, a one standard deviation change in management practice scores is associated with an 8% increase in AMI admissions.
AHRQ-funded; HS018466.
Citation: McConnell KJ, Lindrooth RC, Wholey DR .
Modern management practices and hospital admissions.
Health Econ 2016 Apr;25(4):470-85. doi: 10.1002/hec.3171.
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Keywords: Hospitals, Heart Disease and Health, Cardiovascular Conditions, Quality Indicators (QIs), Quality Measures, Quality of Care, Public Reporting, Provider Performance
Walkey AJ, Weinberg J, Wiener RS
Association of do-not-resuscitate orders and hospital mortality rate among patients with pneumonia.
The researchers evaluated the effect of analytic approaches accounting for do-not-resuscitate (DNR) status on risk-adjusted hospital mortality rates and performance rankings. They found that after accounting for patient DNR status and between-hospital variation in the association between DNR status and mortality, hospitals with higher DNR rates had lower mortality.
AHRQ-funded; HS020672.
Citation: Walkey AJ, Weinberg J, Wiener RS .
Association of do-not-resuscitate orders and hospital mortality rate among patients with pneumonia.
JAMA Intern Med 2016 Jan;176(1):97-104. doi: 10.1001/jamainternmed.2015.6324.
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Keywords: Hospitals, Mortality, Quality of Care, Quality Indicators (QIs), Quality Measures, Pneumonia, Provider Performance, Respiratory Conditions
Bevans KB, Moon J, Carle AC
Patient reported outcomes as indicators of pediatric health care quality.
The authors described and illustrated in case examples the functions, benefits, and challenges of patient-reported outcomes applications. They concluded that pediatric patient-reported outcomes are increasingly recognized as valuable indicators of health care quality in the clinical environment and as measures of organization- and provider-level performance.
AHRQ-funded; HS020408.
Citation: Bevans KB, Moon J, Carle AC .
Patient reported outcomes as indicators of pediatric health care quality.
Acad Pediatr 2014 Sep-Oct;14(5 Suppl):S90-6. doi: 10.1016/j.acap.2014.06.002..
Keywords: Children/Adolescents, Quality of Care, Children/Adolescents, Quality Indicators (QIs), Quality Measures, Provider Performance
Maggard-Gibbons M
The use of report cards and outcome measurements to improve the safety of surgical care: the American College of Surgeons National Surgical Quality Improvement Program.
This review summarized the history of American College of Surgeons National Surgical Quality Improvement Project and its components, and described the evidence that feeding outcomes back to providers, along with real-time comparisons with other hospital rates, leads to quality improvement, better patient outcomes, cost savings and overall improved patient safety.
AHRQ-funded; 2902007100621.
Citation: Maggard-Gibbons M .
The use of report cards and outcome measurements to improve the safety of surgical care: the American College of Surgeons National Surgical Quality Improvement Program.
BMJ Qual Saf 2014 Jul;23(7):589-99. doi: 10.1136/bmjqs-2013-002223..
Keywords: Quality Improvement, Quality Indicators (QIs), Quality Measures, Quality of Care, Surgery, Patient Safety, Outcomes, Patient-Centered Outcomes Research, Provider Performance
Arora VM, Berhie S, Horwitz LI
Using standardized videos to validate a measure of handoff quality: the handoff mini-clinical examination exercise.
The researchers report the results of the development of a shorter Handoff Mini-Clinical Examination Exercise (CEX), along with the formal establishment of its construct validity, namely its ability to distinguish between levels of performance in 3 domains of handoff quality. They were able to demonstrate evidence that the Handoff Mini-CEX can draw reliable and valid conclusions regarding handoff performance by physicians in U.S. hospitals.
AHRQ-funded; HS018278
Citation: Arora VM, Berhie S, Horwitz LI .
Using standardized videos to validate a measure of handoff quality: the handoff mini-clinical examination exercise.
J Hospital Med. 2014 Jul;9(7):441-6. doi: 10.1002/jhm.2185.
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Keywords: Provider Performance, Quality Measures, Quality Improvement, Quality of Care, Education: Continuing Medical Education, Patient Safety
Paddock SM
Statistical benchmarks for health care provider performance assessment: a comparison of standard approaches to a hierarchical Bayesian histogram-based method.
The author compares histogram-based statistical benchmarking to other more widely used statistical benchmarking methods to demonstrate whether and how their performance differs, both in terms of setting a performance benchmark and also in terms of which providers are identified as exceeding the performance benchmark. Her study uses publicly available data from 3,240 hospitals on two process-of-care measures.
AHRQ-funded; HS021860
Citation: Paddock SM .
Statistical benchmarks for health care provider performance assessment: a comparison of standard approaches to a hierarchical Bayesian histogram-based method.
Health Serv Res. 2014 Jun;49(3):1056-73. doi: 10.1111/1475-6773.12149..
Keywords: Quality of Care, Quality Measures, Provider Performance
Gibson G, Jurasic MM, Wehler CJ
Longitudinal outcomes of using a fluoride performance measure for adults at high risk of experiencing caries.
In this paper, the authors hypothesized that after the implementation of a performance measure regarding appropriate fluoride use, veterans at high risk of experiencing caries would require fewer new dental restorations than in the past. They found that, after use of the performance measure for four years, there were 8.6 percent fewer patients needing two or more restorations, a 10.8 percent decrease in the mean number of restorations, and a modest 3.4 percent fewer patients at high risk of experiencing caries who required new restorations after the initial 12-month period.
AHRQ-funded; HS019527.
Citation: Gibson G, Jurasic MM, Wehler CJ .
Longitudinal outcomes of using a fluoride performance measure for adults at high risk of experiencing caries.
J Am Dent Assoc 2014 May;145(5):443-51. doi: 10.14219/jada.2013.53.
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Keywords: Dental and Oral Health, Healthcare Delivery, Provider Performance, Quality Indicators (QIs), Quality Measures