National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Events (1)
- Antibiotics (5)
- Antimicrobial Stewardship (2)
- Catheter-Associated Urinary Tract Infection (CAUTI) (8)
- Central Line-Associated Bloodstream Infections (CLABSI) (2)
- Children/Adolescents (1)
- Clinical Decision Support (CDS) (1)
- Communication (1)
- Community-Acquired Infections (1)
- Comprehensive Unit-based Safety Program (CUSP) (1)
- Critical Care (1)
- Decision Making (2)
- Diagnostic Safety and Quality (2)
- Education: Patient and Caregiver (1)
- Elderly (1)
- Electronic Health Records (EHRs) (1)
- Emergency Department (1)
- Healthcare-Associated Infections (HAIs) (11)
- Health Information Technology (HIT) (1)
- Health Literacy (1)
- Home Healthcare (1)
- Hospitals (2)
- Intensive Care Unit (ICU) (2)
- Long-Term Care (2)
- Medication (4)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (1)
- Nursing (1)
- Nursing Homes (2)
- Patient-Centered Outcomes Research (2)
- Patient Safety (4)
- Practice Patterns (1)
- Prevention (4)
- Provider: Nurse (1)
- Quality Improvement (2)
- Quality of Care (3)
- (-) Urinary Tract Infection (UTI) (17)
- Women (1)
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 17 of 17 Research Studies DisplayedClark AW, Durkin MJ, Olsen MA
Rural-urban differences in antibiotic prescribing for uncomplicated urinary tract infection.
This study examined rural-urban differences in temporal trends and risk of inappropriate antibiotic use by agent and duration among women with uncomplicated urinary tract infection (UTI). This observational cohort study identified US commercially insured women aged 18-44 coded for uncomplicated UTI and prescribed an antibiotic from the IBM MarketScan Commercial Database (2010-2015). Of the 670,450 women with uncomplicated UTIs, a large proportion received antibiotic prescriptions for inappropriate agents (46.7%) or durations (76.1%). Rural women were more likely to receive prescriptions with inappropriately long durations than urban women. There was a slight decline in patients who received inappropriate agents and durations from 2011 to 2015. Rural-urban differences varied over time by agent, geographic region, and provider specialty.
AHRQ-funded; HS019455.
Citation: Clark AW, Durkin MJ, Olsen MA .
Rural-urban differences in antibiotic prescribing for uncomplicated urinary tract infection.
Infect Control Hosp Epidemiol 2021 Dec;42(12):1437-44. doi: 10.1017/ice.2021.21..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Urinary Tract Infection (UTI), Practice Patterns
Butler AM, Durkin MJ, Keller MR
Risk of antibiotic treatment failure in premenopausal women with uncomplicated urinary tract infection.
This study compared treatment outcomes for various antibiotics in premenopausal women with uncomplicated urinary tract infections (UTIs). The authors compared treatment with fluoroquinolones (first-line), trimethoprim-sulfamethoxazole (TMP/SMX) (first-line), nitrofurantoin (first-line), narrow-spectrum β-lactams (non-first-line), and amoxicillin/ampicillin (non-recommended). Over 1.1 million patient outcomes were analyzed. The risk of treatment failure differed by the antibiotic type, with higher risk associated with TMP/SMX versus nitrofurantoin, and lower or similar risk associated with broad- versus narrow-spectrum β-lactams.
AHRQ-funded; HS019455.
Citation: Butler AM, Durkin MJ, Keller MR .
Risk of antibiotic treatment failure in premenopausal women with uncomplicated urinary tract infection.
Pharmacoepidemiol Drug Saf 2021 Oct;30(10):1360-70. doi: 10.1002/pds.5237..
Keywords: Antibiotics, Medication, Urinary Tract Infection (UTI), Women
Woo K, Adams V, Wilson P
Identifying urinary tract infection-related information in home care nursing notes.
Urinary tract infection (UTI) is common in home care but not easily captured with standard assessment. This study aimed to examine the value of nursing notes in detecting UTI signs and symptoms in home care. The investigators found that information in nursing notes was often overlooked by stakeholders and not integrated into predictive modeling for decision-making support. They indicate that their findings highlighted the value of nursing notes in early risk identification and care guidance.
AHRQ-funded; R01 HS024723.
Citation: Woo K, Adams V, Wilson P .
Identifying urinary tract infection-related information in home care nursing notes.
J Am Med Dir Assoc 2021 May;22(5):1015-21.e2. doi: 10.1016/j.jamda.2020.12.010..
Keywords: Urinary Tract Infection (UTI), Home Healthcare, Diagnostic Safety and Quality
McAlearney AS, Gaughan AA, DePuccio MJ
Management practices for leaders to promote infection prevention: lessons from a qualitative study.
This study looked at the management practices around prevention of catheter-associated urinary tract infections (CAUTIs) and central line-associated bloodstream infections (CLABSI) that hospital leaders can take to promote healthcare associated infection (HAI) prevention efforts. Interviews were conducted with 420 managers and frontline staff in 18 hospitals across the United States. The three management practices characterized as important facilitators of HAI prevention were 1) engagement of executive leadership; 2) information sharing; and 3) manager coaching.
AHRQ-funded; HS024958.
Citation: McAlearney AS, Gaughan AA, DePuccio MJ .
Management practices for leaders to promote infection prevention: lessons from a qualitative study.
Am J Infect Control 2021 May;49(5):536-41. doi: 10.1016/j.ajic.2020.09.001..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Catheter-Associated Urinary Tract Infection (CAUTI), Urinary Tract Infection (UTI), Healthcare-Associated Infections (HAIs), Prevention, Communication
Hanlon JT, Perera S, Schweon S
Improvements in antibiotic appropriateness for cystitis in older nursing home residents: a quality improvement study with randomized assignment.
This study evaluated the impact of an educational quality improvement initiative on the appropriateness of antibiotic prescribing restricted to uncomplicated cystitis in older noncatheterized nursing home residents. This 1-year case-control study used 25 participating nursing homes that were randomized to the intervention or usual care group by strata that included state, urban/rural status, bed size, and geographic separation. A total of 75 cases of cystitis were found in the intervention groups and 92 in the control groups. The intervention group had a nonsignificant 21% reduction in the risk of antibiotic prescribing. There was a favorable comparison in appropriateness of duration. However, the intervention group had more problems with drug-drug interactions than the control group (8% vs 1%). There were also more problems with dosage in the intervention group. Both groups had similar rates of problems with choice or effectiveness (44% vs 45%). The most common antibiotic class that was prescribed inappropriately was quinolones.
AHRQ-funded; R18 HS023779.
Citation: Hanlon JT, Perera S, Schweon S .
Improvements in antibiotic appropriateness for cystitis in older nursing home residents: a quality improvement study with randomized assignment.
J Am Med Dir Assoc 2021 Jan;22(1):173-77. doi: 10.1016/j.jamda.2020.07.040..
Keywords: Elderly, Nursing Homes, Long-Term Care, Antibiotics, Medication, Quality Improvement, Quality of Care, Urinary Tract Infection (UTI), Decision Making
Beeber AS, Kistler CE, Zimmerman S
Nurse decision-making for suspected urinary tract infections in nursing homes: potential targets to reduce antibiotic overuse.
This study’s goal was to determine what information is most important to registered nurses (RNs) decisions to call clinicians about suspected urinary tract infections (UTIs) in nursing home residents. An online survey was conducted with a convenience sample of 881 RNs recruited from a health care research panel. Clinical scenarios from 10 categories of resident characteristics were used: UTI risk, resident type, functional status, mental status, lower urinary tract status, body temperature, physical exam, urinalysis, antibiotic request, and goals of care. Participants were randomized into 2 deliberation conditions: self-paced (n=437) and forced deliberation (n=444). Painful or difficult urinary, obvious blood in urine and temperature at 101.5° had the highest odds of a RN calling a clinician by the forced-deliberation group. For the self-paced group, painful or difficult urination had the highest odds.
AHRQ-funded; HS024519.
Citation: Beeber AS, Kistler CE, Zimmerman S .
Nurse decision-making for suspected urinary tract infections in nursing homes: potential targets to reduce antibiotic overuse.
J Am Med Dir Assoc 2021 Jan;22(1):156-63. doi: 10.1016/j.jamda.2020.06.053..
Keywords: Urinary Tract Infection (UTI), Antibiotics, Antimicrobial Stewardship, Medication, Nursing Homes, Long-Term Care, Decision Making, Diagnostic Safety and Quality
Anesi JA, Lautenbach E, Nachamkin I
Clinical and molecular characterization of community-onset urinary tract infections due to extended-spectrum cephalosporin-resistant Enterobacteriaceae.
The objective of this paper was to evaluate risk factors for and molecular characteristics of community-onset extended-spectrum cephalosporin-resistant (ESC-R) Enterobacteriaceae (EB) urinary tract infections (UTIs) in a US health system. The investigators found that use of trimethoprim-sulfamethoxazole, older age, diabetes, and presentation to the emergency department were associated with community-onset ESC-R EB UTI, with a high prevalence of CTX-M among their community isolates.
AHRQ-funded; HS020002.
Citation: Anesi JA, Lautenbach E, Nachamkin I .
Clinical and molecular characterization of community-onset urinary tract infections due to extended-spectrum cephalosporin-resistant Enterobacteriaceae.
Infect Control Hosp Epidemiol 2016 Dec;37(12):1433-39. doi: 10.1017/ice.2016.225.
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Keywords: Antibiotics, Community-Acquired Infections, Patient Safety, Urinary Tract Infection (UTI)
Saint S, Greene MT, Krein SL
AHRQ Author: Battles J
A program to prevent catheter-associated urinary tract infection in acute care.
The national Comprehensive Unit-based Safety Program, funded by AHRQ, aimed to reduce catheter-associated UTI in intensive care units (ICUs) and non-ICUs. The main program features were dissemination of information to sponsor organizations and hospitals, data collection, and guidance on key technical and socioadaptive factors in the prevention of catheter-associated UTI. Among the findings: in an adjusted analysis, catheter-associated UTI rates decreased from 2.40 to 2.05 infections per 1000 catheter-days.
AHRQ-authored; AHRQ-funded; 290201000025I; 29032001T.
Citation: Saint S, Greene MT, Krein SL .
A program to prevent catheter-associated urinary tract infection in acute care.
N Engl J Med 2016 Jun 2;374(22):2111-9. doi: 10.1056/NEJMoa1504906.
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Keywords: Comprehensive Unit-based Safety Program (CUSP), Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU), Prevention, Urinary Tract Infection (UTI)
Jones K, Sibai J, Battjes R
How and when nurses collect urine cultures on catheterized patients: a survey of 5 hospitals.
Obtaining a specimen for urine culture is a key element in evaluating for catheter-associated urinary tract infections (CAUTIs). Nurses at 5 hospitals completed a survey regarding their knowledge, training, and practices of appropriate reasons for obtaining urine cultures. The researchers concluded that important opportunities exist for nurses to optimize the decisions to obtain urine cultures and the process for obtaining them.
AHRQ-funded; 290201000025I; 29032001T.
Citation: Jones K, Sibai J, Battjes R .
How and when nurses collect urine cultures on catheterized patients: a survey of 5 hospitals.
Am J Infect Control 2016 Feb;44(2):173-6. doi: 10.1016/j.ajic.2015.09.003.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Hospitals, Nursing, Provider: Nurse, Urinary Tract Infection (UTI)
Masnick M, Morgan DJ, Sorkin JD
Lack of patient understanding of hospital-acquired infection data published on the Centers for Medicare and Medicaid Services Hospital Compare Website.
This study assessed the interpretability of hospital-acquired infection (HAI) data as presented on the Centers for Medicare and Medicaid Services Hospital Compare website among patients who might benefit from access to these data. It concluded that current public HAI data presentation methods may be inadequate. When presented with numeric HAI data, study participants incorrectly compared hospitals on the basis of HAI data in more than 40% of the responses.
AHRQ-funded; HS018111.
Citation: Masnick M, Morgan DJ, Sorkin JD .
Lack of patient understanding of hospital-acquired infection data published on the Centers for Medicare and Medicaid Services Hospital Compare Website.
Infect Control Hosp Epidemiol 2016 Feb;37(2):182-7. doi: 10.1017/ice.2015.260.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Education: Patient and Caregiver, Health Literacy, Healthcare-Associated Infections (HAIs), Hospitals, Urinary Tract Infection (UTI)
Huang SS, Septimus E, Hayden MK
Effect of body surface decolonisation on bacteriuria and candiduria in intensive care units: an analysis of a cluster-randomised trial.
The researchers aimed to assess the effect of decolonization on bacteriuria and candiduria in patients admitted to ICUs. They concluded that universal decolonization of patients in the ICU with once a day chlorhexidine baths and short-course nasal mupirocin could be a potential preventive strategy in male patients because it significantly decreases candiduria and any bacteriuria, but not for women.
AHRQ-funded; 290201000008I; 29032007T.
Citation: Huang SS, Septimus E, Hayden MK .
Effect of body surface decolonisation on bacteriuria and candiduria in intensive care units: an analysis of a cluster-randomised trial.
Lancet Infect Dis 2016 Jan;16(1):70-9. doi: 10.1016/s1473-3099(15)00238-8.
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Keywords: Intensive Care Unit (ICU), Healthcare-Associated Infections (HAIs), Urinary Tract Infection (UTI), Methicillin-Resistant Staphylococcus aureus (MRSA), Prevention
Manojlovich M, Saint S, Meddings J
Indwelling urinary catheter insertion practices in the emergency department: an observational study.
The researchers sought (1) to determine how frequently major breaks in aseptic insertion technique occur, and (2) to identify the number of patients who developed bacteriuria after catheter placement in the ED. They found that major breaks in aseptic insertion technique occurred in 48 of 81 insertion attempts. Of the 7 patients with bacteriuria after insertion, 5 had experienced a major break in technique.
AHRQ-funded; HS019767; 290201000025I; 29032001T.
Citation: Manojlovich M, Saint S, Meddings J .
Indwelling urinary catheter insertion practices in the emergency department: an observational study.
Infect Control Hosp Epidemiol 2016 Jan;37(1):117-9. doi: 10.1017/ice.2015.238.
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Keywords: Adverse Events, Catheter-Associated Urinary Tract Infection (CAUTI), Emergency Department, Healthcare-Associated Infections (HAIs), Urinary Tract Infection (UTI)
Patrick SW, Kawai AT, Kleinman K
Health care-associated infections among critically ill children in the US, 2007-2012.
The researchers examined trends in central line-associated blood stream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and ventilator-associated pneumonia (VAP) incidence rates between 2007 and 2012 based on standardized surveillance data from pediatric intensive care units (PICUs) and neonatal intensive care units (NICUs) in the United States. They found that incidence rates of CLABSIs and VAPs decreased among critically ill neonates and children during this period.
AHRQ-funded; HS018414.
Citation: Patrick SW, Kawai AT, Kleinman K .
Health care-associated infections among critically ill children in the US, 2007-2012.
Pediatrics 2014 Oct;134(4):705-12. doi: 10.1542/peds.2014-0613..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Urinary Tract Infection (UTI), Critical Care, Children/Adolescents, Healthcare-Associated Infections (HAIs)
Greene MT, Fakih MG, Fowler KE
Regional variation in urinary catheter use and catheter-associated urinary tract infection: results from a national collaborative.
The researchers explored nationwide variation in the use of urinary catheters and catheter-associated urinary tract infections (CAUTI) across a diverse set of units within acute care U.S. hospitals. Using data from 1,101 units in 726 hospitals across 34 States, they found regional differences in catheter use, appropriateness, and CAUTI rates, with possibly 30-40 percent of urinary catheters placed in non-ICU settings lacking an appropriate indication.
AHRQ-funded; HS018334; HS019767; 290201000025I; 29032001T
Citation: Greene MT, Fakih MG, Fowler KE .
Regional variation in urinary catheter use and catheter-associated urinary tract infection: results from a national collaborative.
Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S99-S106. doi: 10.1086/677825..
Keywords: Urinary Tract Infection (UTI), Healthcare-Associated Infections (HAIs), Patient Safety, Quality of Care, Catheter-Associated Urinary Tract Infection (CAUTI)
Greene MT, Kiyoshi-Teo H, Reichert H
Urinary catheter indications in the United States: results from a national survey of acute care hospitals.
The researchers sought to determine how often various indications for catheter use were reported among a nationally representative sample of acute care hospitals. They found that many hospitals were using several indications deemed in appropriated by CAUTI prevention guidelines such as urinary incontinence without outlet obstruction and patient/family request.
AHRQ-funded; 290201000025I; 29032001T
Citation: Greene MT, Kiyoshi-Teo H, Reichert H .
Urinary catheter indications in the United States: results from a national survey of acute care hospitals.
Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S96-8. doi: 10.1086/677823..
Keywords: Urinary Tract Infection (UTI), Patient Safety, Healthcare-Associated Infections (HAIs), Quality of Care, Catheter-Associated Urinary Tract Infection (CAUTI)
Baillie CA, Epps M, Hanish A
Usability and impact of a computerized clinical decision support intervention designed to reduce urinary catheter utilization and catheter-associated urinary tract infections.
The researchers evaluated the usability and effectiveness of a computerized clinical decision support (CDS) intervention aimed at reducing the duration of urinary tract catheterizations. They found that usability improved to 15% with the revised reminder. The catheter utilization ratio declined over the 3 time periods, as did CAUTIs per 1,000 patient-days. They concluded that the usability of the reminder was highly dependent on its user interface, with a homegrown version of the reminder resulting in higher impact than a stock reminder.
AHRQ-funded; HS016946.
Citation: Baillie CA, Epps M, Hanish A .
Usability and impact of a computerized clinical decision support intervention designed to reduce urinary catheter utilization and catheter-associated urinary tract infections.
Infect Control Hosp Epidemiol 2014 Sep;35(9):1147-55. doi: 10.1086/677630.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Clinical Decision Support (CDS), Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare-Associated Infections (HAIs), Patient-Centered Outcomes Research, Urinary Tract Infection (UTI)
Meddings J, Rogers MA, Krein SL
Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review.
The authors updated a prior systematic review and a meta-analysis regarding interventions prompting urinary catheter (UC) removal by reminders or stop orders. They found that UC reminders and stop orders appear to reduce catheter-associated urinary tract infection rates and should be used to improve patient safety.
AHRQ-funded; 290200710062I; HS019767; HS018344.
Citation: Meddings J, Rogers MA, Krein SL .
Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review.
BMJ Qual Saf 2014 Apr;23(4):277-89. doi: 10.1136/bmjqs-2012-001774.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Patient Safety, Patient-Centered Outcomes Research, Prevention, Quality Improvement, Urinary Tract Infection (UTI)