National Healthcare Quality and Disparities Report
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Topics
- Access to Care (1)
- Adverse Drug Events (ADE) (4)
- Adverse Events (4)
- Ambulatory Care and Surgery (1)
- Antibiotics (5)
- Antimicrobial Stewardship (1)
- Asthma (1)
- Autism (1)
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- Cancer: Lung Cancer (1)
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- Communication (3)
- Critical Care (1)
- Data (2)
- Decision Making (8)
- Depression (1)
- Diabetes (5)
- Diagnostic Safety and Quality (2)
- Dialysis (1)
- Digestive Disease and Health (2)
- Disparities (3)
- Elderly (7)
- Electronic Health Records (EHRs) (5)
- Electronic Prescribing (E-Prescribing) (1)
- Emergency Medical Services (EMS) (4)
- Evidence-Based Practice (4)
- Genetics (2)
- Guidelines (6)
- Healthcare-Associated Infections (HAIs) (2)
- Healthcare Cost and Utilization Project (HCUP) (2)
- Healthcare Costs (2)
- Healthcare Delivery (2)
- Healthcare Utilization (3)
- Health Information Technology (HIT) (7)
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- Health Services Research (HSR) (2)
- Health Systems (1)
- Heart Disease and Health (3)
- Hospitalization (1)
- Hospitals (2)
- Imaging (4)
- Implementation (1)
- Infectious Diseases (2)
- Intensive Care Unit (ICU) (1)
- Kidney Disease and Health (2)
- Labor and Delivery (1)
- Long-Term Care (1)
- Medicaid (1)
- Medical Errors (4)
- Medical Liability (1)
- Medicare (5)
- Medication (20)
- Medication: Safety (2)
- Nursing Homes (2)
- Opioids (1)
- Outcomes (3)
- Pain (1)
- Palliative Care (2)
- Patient-Centered Healthcare (2)
- Patient-Centered Outcomes Research (9)
- Patient and Family Engagement (2)
- Patient Safety (4)
- Payment (1)
- Pneumonia (1)
- Policy (2)
- (-) Practice Patterns (65)
- Primary Care (10)
- Primary Care: Models of Care (1)
- Provider (1)
- Provider: Health Personnel (1)
- Provider: Physician (2)
- Public Health (1)
- Quality Improvement (2)
- Quality of Care (1)
- Racial and Ethnic Minorities (1)
- Respiratory Conditions (5)
- Rural Health (1)
- Screening (1)
- Sexual Health (1)
- Social Determinants of Health (1)
- Substance Abuse (1)
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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
1 to 25 of 65 Research Studies DisplayedHelmchen LA, Lambert BL, McDonald TB
Changes in physician practice patterns after implementation of a communication-and-resolution program.
The researchers tested if a 2006 communication-and-resolution program to address unexpected adverse outcomes was associated with changes in cost and use trajectories. They found that the intervention hospital recorded an increase in the number of patients with a principal diagnosis of chest pain. Among admitted patients, quarterly growth rates of clinical laboratory and radiology charges at the intervention hospital declined by 3.8 and 6.9 percentage points.
AHRQ-funded; HS019565.
Citation: Helmchen LA, Lambert BL, McDonald TB .
Changes in physician practice patterns after implementation of a communication-and-resolution program.
Health Serv Res 2016 Dec;51 Suppl 3:2516-36. doi: 10.1111/1475-6773.12610.
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Keywords: Adverse Events, Communication, Medical Errors, Medical Liability, Practice Patterns
Raji MY, Chen NW, Raji M
Factors associated with seeking physician care by Medicare beneficiaries who receive all their primary care from nurse practitioners.
The authors sought to examine rate and correlates of switching from exclusive nurse practitioner (NP) primary care to receiving some or all primary care from physicians. The study group consisted of Medicare beneficiaries with diabetes, congrestive heart failure, or chronic obstructive pulmonary disease. The researchers found that about half of Medicare patients under exclusive NP primary care switched to physicians for some or all primary care over a 3-year period.
AHRQ-funded; HS022134; HS020642.
Citation: Raji MY, Chen NW, Raji M .
Factors associated with seeking physician care by Medicare beneficiaries who receive all their primary care from nurse practitioners.
J Prim Care Community Health 2016 Oct;7(4):249-57. doi: 10.1177/2150131916659674.
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Keywords: Elderly, Medicare, Primary Care, Practice Patterns
Shay LA, Street RL, Jr., Baldwin AS
Characterizing safety-net providers' HPV vaccine recommendations to undecided parents: a pilot study.
The researchers developed a tool to describe strength and content of provider HPV vaccination recommendations. The tool showed how providers undercut their recommendations through qualifications or support them with a rationale. The authors recommended that providers would benefit from communication skills training on how to make explicit recommendations with an evidence-based rationale.
AHRQ-funded; HS022418.
Citation: Shay LA, Street RL, Jr., Baldwin AS .
Characterizing safety-net providers' HPV vaccine recommendations to undecided parents: a pilot study.
Patient Educ Couns 2016 Sep;99(9):1452-60. doi: 10.1016/j.pec.2016.06.027.
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Keywords: Practice Patterns, Vaccination, Infectious Diseases, Sexual Health, Clinician-Patient Communication, Guidelines, Evidence-Based Practice, Communication
Curtis JR, Harrold LR, Asgari MM
Diagnostic prevalence of ankylosing spondylitis using computerized health care data, 1996 to 2009: underrecognition in a US health care setting.
The authors sought to estimate the prevalence of axial spondyloarthritis (axSpA) and ankylosing spondylitis in Kaiser Permanente Northern California (KPNC). They found that observed prevalence in the KPNC population, compared with national estimates for axSpA and ankylosing spondylitis, suggests underrecognition of these conditions in routine clinical practice. They suggested the use of computerized data to identify true cases of ankylosing spondylitis in order to facilitate population-based research.
AHRQ-funded; HS021589; HS018517.
Citation: Curtis JR, Harrold LR, Asgari MM .
Diagnostic prevalence of ankylosing spondylitis using computerized health care data, 1996 to 2009: underrecognition in a US health care setting.
Perm J 2016 Fall;20(4):4-10. doi: 10.7812/tpp/15-151.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Practice Patterns
Henry MK, Zonfrillo MR, French B
Hospital variation in cervical spine imaging of young children with traumatic brain injury.
The authors sought to identify child-level and hospital-level factors associated with performance of cervical imaging of children with traumatic brain injury from falls and abusive head trauma. They found no association between annual hospital volume of injured children and cervical imaging performance.
AHRQ-funded; HS024194.
Citation: Henry MK, Zonfrillo MR, French B .
Hospital variation in cervical spine imaging of young children with traumatic brain injury.
Acad Pediatr 2016 Sep-Oct;16(7):684-91. doi: 10.1016/j.acap.2016.01.017.
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Keywords: Brain Injury, Children/Adolescents, Imaging, Hospitals, Practice Patterns
Wu AC, Li L, Fung V
Mismatching among guidelines, providers, and parents on controller medication use in children with asthma.
The authors sought to assess provider prescribing patterns for asthma controller medications and to assess how frequently parental reports of children's asthma controller medicine use were mismatched with provider recommendations. They found that mismatches between parental reports and provider intentions regarding how the child was supposed to use inhaled steroids occurred for half of the children. They recommended that efforts focus on ways to reduce these mismatches.
AHRQ-funded; HS019669.
Citation: Wu AC, Li L, Fung V .
Mismatching among guidelines, providers, and parents on controller medication use in children with asthma.
J Allergy Clin Immunol Pract 2016 Sep-Oct;4(5):910-6. doi: 10.1016/j.jaip.2016.04.004.
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Keywords: Asthma, Children/Adolescents, Guidelines, Medication, Practice Patterns
Lavin JM, Boss EF, Brereton J
Responses to errors and adverse events: the need for a systems approach in otolaryngology.
The authors reported otolaryngologists' reactions to errors and adverse events and determined if temporal changes in physician efforts to assume responsibility; ameliorate patients' conditions; or change personal, group-wide, or hospital practices have occurred. Members of the American Academy of Otolaryngology-Head and Neck Surgery were surveyed. The undertaking of corrective actions was reported, and these events led to changes in personal, group/departmental, and hospital practice. The authors found that efforts to change personal practice were much more common than efforts to improve systems.
AHRQ-funded; HS022932.
Citation: Lavin JM, Boss EF, Brereton J .
Responses to errors and adverse events: the need for a systems approach in otolaryngology.
Laryngoscope 2016 Sep;126(9):1999-2002. doi: 10.1002/lary.25837.
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Keywords: Adverse Events, Medical Errors, Patient Safety, Practice Patterns
Govani SM, Wiitala WL, Stidham RW
Age disparities in the use of steroid-sparing therapy for inflammatory bowel disease.
The investigators compared the use of steroids and steroid-sparing therapies and rates of complications among elderly and younger patients in a national cohort of veterans with inflammatory bowel disease (IBD). They found that, after starting steroids, fracture rates increased in the elderly patients with IBD, whereas increases in venous thromboembolism and infections after starting steroids affected both age groups. Additonally, elderly veterans were less likely to receive steroids and steroid-sparing medications than younger veterans.
AHRQ-funded; HS024122.
Citation: Govani SM, Wiitala WL, Stidham RW .
Age disparities in the use of steroid-sparing therapy for inflammatory bowel disease.
Inflamm Bowel Dis 2016 Aug;22(8):1923-8. doi: 10.1097/mib.0000000000000817.
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Keywords: Digestive Disease and Health, Disparities, Elderly, Medication, Practice Patterns
Fleischman W, Ross JS, Melnick ER
Financial ties between emergency physicians and industry: insights from open payments data.
The authors sought to describe nonresearch, nonroyalty Open Payments made to emergency physicians in the United States. They found that nearly a third of emergency physicians received such payments from industry in 2014, and that most payments were of small monetary value and for activities related to the marketing of antithrombotic drugs.
AHRQ-funded; HS021271.
Citation: Fleischman W, Ross JS, Melnick ER .
Financial ties between emergency physicians and industry: insights from open payments data.
Ann Emerg Med 2016 Aug;68(2):153-58.e4. doi: 10.1016/j.annemergmed.2016.01.014.
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Keywords: Emergency Medical Services (EMS), Medication, Policy, Practice Patterns, Provider: Physician
Mehta AB, Cooke CR, Wiener RS
Hospital variation in early tracheostomy in the United States: a population-based study.
The researchers determined between-hospital variation in early tracheostomy utilization and the association of early tracheostomy with patient outcomes using hierarchical regression. They concluded that early tracheostomy is potentially overused among mechanically ventilated trauma patients, with nearly half of tracheostomies performed within the first week of mechanical ventilation and large unexplained hospital variation, without clear benefits.
AHRQ-funded; HS020672.
Citation: Mehta AB, Cooke CR, Wiener RS .
Hospital variation in early tracheostomy in the United States: a population-based study.
Crit Care Med 2016 Aug;44(8):1506-14. doi: 10.1097/ccm.0000000000001674.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Practice Patterns, Respiratory Conditions, Respiratory Conditions, Outcomes
Melnick ER, O'Brien EG, Kovalerchik O
The association between physician empathy and variation in imaging use.
This paper's objective was to describe empathy in a cohort of emergency physicians and evaluate its association with CT utilization. The authors found that, on the four psychometric scales used, performance was not predictive of risk-adjusted CT utilization in the emergency department. They concluded that the underlying physician-based factors that mediate interphysician variation remain to be clearly identified.
AHRQ-funded; HS021271.
Citation: Melnick ER, O'Brien EG, Kovalerchik O .
The association between physician empathy and variation in imaging use.
Acad Emerg Med 2016 Aug;23(8):895-904. doi: 10.1111/acem.13017.
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Keywords: Decision Making, Emergency Medical Services (EMS), Healthcare Utilization, Imaging, Practice Patterns
Gidengil CA, Mehrotra A, Beach S
What drives variation in antibiotic prescribing for acute respiratory infections?
This study sought to identify the underlying factors driving variation in antibiotic prescribing across clinicians and settings. The investigators concluded that poor-quality antibiotic prescribing was associated with feeling rushed, believing less strongly that antibiotics were overused, and believing that patient demand was not an issue, factors that can be assessed and addressed in future interventions.
AHRQ-funded; HS018419.
Citation: Gidengil CA, Mehrotra A, Beach S .
What drives variation in antibiotic prescribing for acute respiratory infections?
J Gen Intern Med 2016 Aug;31(8):918-24. doi: 10.1007/s11606-016-3643-0..
Keywords: Antibiotics, Medication, Respiratory Conditions, Practice Patterns
Morrato EH, Brewer SE, Campagna EJ
Glucose testing for adults receiving Medicaid and antipsychotics: a population-based prescriber survey on behaviors, attitudes, and barriers.
The authors aimed to assess provider attitudes about glucose testing for adults prescribed second-generation antipsychotic medication. They concluded that establishing organizational priority across all treatment settings is important for achieving population-based diabetes screening goals for all Medicaid patients receiving antipsychotics.
AHRQ-funded; HS019464.
Citation: Morrato EH, Brewer SE, Campagna EJ .
Glucose testing for adults receiving Medicaid and antipsychotics: a population-based prescriber survey on behaviors, attitudes, and barriers.
Psychiatr Serv 2016 Jul 1;67(7):798-802. doi: 10.1176/appi.ps.201500181.
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Keywords: Diabetes, Medication, Behavioral Health, Practice Patterns, Screening
Lyu PF, Hockenberry JM, Gaydos LM
Impact of a sequential intervention on albumin utilization in critical care.
The authors evaluated the effect of a sequential multifaceted intervention on decreasing albumin use in the intensive care unit. They found that a sequential intervention achieved significant reductions in albumin use and cost savings without changes in patient outcomes, supporting the combination of financial and nonfinancial strategies to align providers with evidence-based practices.
AHRQ-funded; HS000055.
Citation: Lyu PF, Hockenberry JM, Gaydos LM .
Impact of a sequential intervention on albumin utilization in critical care.
Crit Care Med 2016 Jul;44(7):1307-13. doi: 10.1097/ccm.0000000000001638.
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Keywords: Critical Care, Healthcare Utilization, Intensive Care Unit (ICU), Patient-Centered Outcomes Research, Practice Patterns
Penti B, Liebschutz JM, Kopcza B
Novel peer review method for improving controlled substance prescribing in primary care.
The authors sought to determine if peer feedback through a chart review tool (CRT) can impact opioid prescribing for patients with chronic noncancer pain in an outpatient family medicine clinic at an urban, safety-net teaching hospital. They reviewed 99 patient charts from 14 physicians over 1 year. They found that the mean dose of opioids decreased 2.6 mg morphine equivalent dose (MED)/day from time of chart review until the end of the project, compared to a 6.9 mg MED/day increase that occurred from 12 months prior to chart review to the time of chart review, and 14 patients were taken off of opioids after the chart review.
AHRQ-funded; HS022242.
Citation: Penti B, Liebschutz JM, Kopcza B .
Novel peer review method for improving controlled substance prescribing in primary care.
J Opioid Manag 2016 Jul-Aug;12(4):269-79. doi: 10.5055/jom.2016.0342.
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Keywords: Adverse Drug Events (ADE), Medication, Opioids, Primary Care, Practice Patterns
Rizvi RF, Harder KA, Hultman GM
A comparative observational study of inpatient clinical note-entry and reading/retrieval styles adopted by physicians.
The researchers sought to understand physicians' usage of inpatient notes in two Electronic Health Record (EHR) systems. They found that the highest variability was observed with progress notes and the least variability was within discharge summaries, while note-writing styles were most consistent for history and physical notes. Physician preference for adopting a certain reading/retrieval order appeared to be a function of what best fits their workflow while fulfilling the stimulus demands. They also found that time spent entering history and physical, discharge summaries, and progress notes were similar in both EHRs.
AHRQ-funded; HS022085.
Citation: Rizvi RF, Harder KA, Hultman GM .
A comparative observational study of inpatient clinical note-entry and reading/retrieval styles adopted by physicians.
Int J Med Inform 2016 Jun;90:1-11. doi: 10.1016/j.ijmedinf.2016.02.011.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Health Personnel, Practice Patterns
Erickson KF, Winkelmayer WC, Chertow GM
Effects of physician payment reform on provision of home dialysis.
The investigators evaluated whether Medicare payment reform influenced dialysis modality assignment. They concluded that transition from a capitated to a tiered fee-for-service payment model for in-center hemodialysis care resulted in fewer patients receiving home dialysis.
AHRQ-funded; HS019178.
Citation: Erickson KF, Winkelmayer WC, Chertow GM .
Effects of physician payment reform on provision of home dialysis.
Am J Manag Care 2016 Jun;22(6):e215-23.
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Keywords: Dialysis, Healthcare Costs, Kidney Disease and Health, Payment, Practice Patterns
Renati S, Linder JA
Necessity of office visits for acute respiratory infections in primary care.
The researchers measured the proportion of primary care acute respiratory infection (ARI) visits that may not require an office visit. They concluded that about two-thirds of primary care ARI visits may not be necessary for appropriate antibiotic management.
AHRQ-funded; HS018419.
Citation: Renati S, Linder JA .
Necessity of office visits for acute respiratory infections in primary care.
Fam Pract 2016 Jun;33(3):312-7. doi: 10.1093/fampra/cmw019.
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Keywords: Decision Making, Medication, Primary Care, Practice Patterns, Respiratory Conditions
Chung S, Zhao B, Lauderdale D
Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.
The researchers examined patterns and predictors of initiation of treatment for incident diabetes in an ambulatory care setting in the US. They found that only half of patients were treated during the first year following diabetes incidence, and only 20% of patients received both medication prescription and lifestyle modification interventions.
AHRQ-funded; HS019815.
Citation: Chung S, Zhao B, Lauderdale D .
Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.
Prim Care Diabetes 2015 Feb;9(1):23-30. doi: 10.1016/j.pcd.2014.04.005..
Keywords: Ambulatory Care and Surgery, Care Management, Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Practice Patterns
Gidengil CA, Linder JA, Beach S
Using clinical vignettes to assess quality of care for acute respiratory infections.
Overprescribing of antibiotics for acute respiratory infections (ARIs) is common. The objective of this study was to develop and validate a vignette-based method to estimate clinician ARI antibiotic prescribing. The researchers concluded that responses to 3 clinical vignettes can identify clinicians with relatively poor quality ARI antibiotic prescribing. Vignettes may be a mechanism to target clinicians for quality improvement efforts.
AHRQ-funded; HS018419.
Citation: Gidengil CA, Linder JA, Beach S .
Using clinical vignettes to assess quality of care for acute respiratory infections.
Inquiry 2016 Apr 20;53:pii: 0046958016636531. doi: 10.1177/0046958016636531..
Keywords: Antibiotics, Antimicrobial Stewardship, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR), Medication, Practice Patterns, Primary Care, Quality of Care, Respiratory Conditions
Kenzik K, Pisu M, Fouad MN
Are long-term cancer survivors and physicians discussing health promotion and healthy behaviors?
This study aimed to (1) describe the proportion of survivors reporting that a physician discussed strategies to improve health and (2) identify which groups are more likely to report these discussions. It concluded that the frequency of health promotion discussions varied across survivor characteristics. Discussions were more frequently reported by some groups, e.g., survivors with diabetes, or among individuals less likely to engage in healthy behaviors.
AHRQ-funded; HS013852.
Citation: Kenzik K, Pisu M, Fouad MN .
Are long-term cancer survivors and physicians discussing health promotion and healthy behaviors?
J Cancer Surviv 2016 Apr;10(2):271-9. doi: 10.1007/s11764-015-0473-8.
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Keywords: Behavioral Health, Cancer, Health Promotion, Patient and Family Engagement, Practice Patterns
Wang RC, Rodriguez RM, Moghadassi M
External validation of the STONE score, a clinical prediction rule for ureteral stone: an observational multi-institutional study.
The STONE score is a clinical decision rule that classifies patients with suspected nephrolithiasis into low-, moderate-, and high-score groups, with corresponding probabilities of ureteral stone. The researchers evaluated the STONE score compared with physician gestalt. They concluded that in its present form, the STONE score lacks sufficient accuracy to allow clinicians to defer CT scan for suspected ureteral stone.
AHRQ-funded; HS021281; HS019312.
Citation: Wang RC, Rodriguez RM, Moghadassi M .
External validation of the STONE score, a clinical prediction rule for ureteral stone: an observational multi-institutional study.
Ann Emerg Med 2016 Apr;67(4):423-32.e2. doi: 10.1016/j.annemergmed.2015.08.019.
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Keywords: Decision Making, Diagnostic Safety and Quality, Imaging, Kidney Disease and Health, Practice Patterns
Beeler PE, Orav EJ, Seger DL
Provider variation in responses to warnings: do the same providers run stop signs repeatedly?
Variation in the use of tests and treatments has been demonstrated to be substantial between providers and geographic regions. This study assessed variation between outpatient providers in overriding electronic prescribing warnings. It concluded that the decision to override prescribing warnings shows variation between providers, and the magnitude of variation differs among the clinical domains of the warnings; more variation was observed in areas with more inappropriate overrides.
AHRQ-funded; HS021094.
Citation: Beeler PE, Orav EJ, Seger DL .
Provider variation in responses to warnings: do the same providers run stop signs repeatedly?
J Am Med Inform Assoc 2016 Apr;23(e1):e93-8. doi: 10.1093/jamia/ocv117.
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Keywords: Adverse Drug Events (ADE), Electronic Prescribing (E-Prescribing), Medication: Safety, Medical Errors, Practice Patterns
Dimou FM, Adhikari D, Mehta HB
Trends in follow-up of patients presenting to the emergency department with symptomatic cholelithiasis.
To better understand underuse of cholecystectomy, the researchers examined physician follow-up patterns after emergency department (ED) visits for symptomatic gallstones. They found that fewer than half of patients were evaluated by a surgeon after an initial ED visit for symptomatic gallstones. Patients who did not have physician follow-up were most likely to require emergent cholecystectomy, suggesting inappropriate ED discharge and highlighting the need for timely follow-up.
AHRQ-funded; HS022134.
Citation: Dimou FM, Adhikari D, Mehta HB .
Trends in follow-up of patients presenting to the emergency department with symptomatic cholelithiasis.
J Am Coll Surg 2016 Apr;222(4):377-84. doi: 10.1016/j.jamcollsurg.2015.12.011.
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Keywords: Elderly, Emergency Medical Services (EMS), Patient-Centered Outcomes Research, Practice Patterns
Chopra V, Smith S, Swaminathan L
Variations in peripherally inserted central catheter use and outcomes in Michigan hospitals.
The researchers examined the use of peripherally inserted central catheters (PICCs) by conducting a prospective study at 10 hospitals through the Michigan Hospital Medicine Safety Consortium. Their multicenter study found substantial variation in PICC indications, patterns of use, and outcomes at the 10 Michigan hospitals included in the study.
AHRQ-funded; HS022835.
Citation: Chopra V, Smith S, Swaminathan L .
Variations in peripherally inserted central catheter use and outcomes in Michigan hospitals.
JAMA Intern Med 2016 Apr;176(4):548-51. doi: 10.1001/jamainternmed.2015.8402.
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Keywords: Patient Safety, Practice Patterns, Healthcare-Associated Infections (HAIs), Hospitals, Outcomes, Adverse Events