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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 467 Research Studies DisplayedSmith TC, Davis MF, Heaney CD
Pig movement and antimicrobial use drive transmission of livestock-associated staphylococcus aureus CC398.
Staphylococcus aureus was originally considered a hospital-associated organism, but new classes of methicillin-resistant strains have emerged outside of the hospital setting, including among livestock. This article discusses a recent study which examined the transportation of pigs on over 200 farms; the authors of this article contend that the results of the study demonstrate the importance of cooperation between occupational health services, genomics, veterinary medicine, and farmers in understanding the epidemiology of MRSAs as related to livestock.
AHRQ-funded; HS019966.
Citation: Smith TC, Davis MF, Heaney CD .
Pig movement and antimicrobial use drive transmission of livestock-associated staphylococcus aureus CC398.
MBio 2018 Dec 11;9(6). doi: 10.1128/mBio.02459-18..
Keywords: Antimicrobial Stewardship, Infectious Diseases, Methicillin-Resistant Staphylococcus aureus (MRSA), Patient Safety, Prevention
Kang H, Zhou S, Yao B
A prototype of knowledge-based patient safety event reporting and learning system.
In this study, a hierarchical list of contributing factors for patient falls, based on the key contributing factors defined by AHRQ Common Formats 2.0, was established by expert review and discussion. Using the list as an infrastructure, the investigators designed and developed a novel reporting system, where a strategy to identify contributing factors was intended to provide reporters knowledge support, in the form of similar cases and potential solutions.
AHRQ-funded; HS022895.
Citation: Kang H, Zhou S, Yao B .
A prototype of knowledge-based patient safety event reporting and learning system.
BMC Med Inform Decis Mak 2018 Dec 7;18(Suppl 5):110. doi: 10.1186/s12911-018-0688-5..
Keywords: Adverse Events, Patient Safety, Falls
Zhou S, Kang H, Yao B
An automated pipeline for analyzing medication event reports in clinical settings.
The article describes and evaluates an automated pipeline that is expected to improve the efficiency of analyzing medication event reports. The pipeline assists clinicians in extracting information from reports and generating feedback using classic machine-learning classifiers to compare three attributes taken from the reports: event originating stages, event types, and event causes. The pipeline identifies these attributes and calculates similarity scores based on them. A strategy to measure similarity was created and evaluated by human subjects using a questionnaire.
AHRQ-funded; HS022895.
Citation: Zhou S, Kang H, Yao B .
An automated pipeline for analyzing medication event reports in clinical settings.
BMC Med Inform Decis Mak 2018 Dec 7;18(Suppl 5):113. doi: 10.1186/s12911-018-0687-6..
Keywords: Adverse Drug Events (ADE), Quality of Care, Medication, Patient Safety
Ancker JS, Stabile C, Carter J
Informing, reassuring, or alarming? Balancing patient needs in the development of a postsurgical symptom reporting system in cancer.
After ambulatory surgeries, patients who recover at home have multiple questions about wound healing, symptoms and medication side effects, and recovery expectations. In this study, the investigators conducted user testing and rapid application development of a symptom reporting system that supports home-based recovery by inviting patients to self-report symptoms in the days after surgery and receive an immediate feedback report giving context for their reported symptoms.
AHRQ-funded; HS021531.
Citation: Ancker JS, Stabile C, Carter J .
Informing, reassuring, or alarming? Balancing patient needs in the development of a postsurgical symptom reporting system in cancer.
AMIA Annu Symp Proc 2018 Dec 5;2018:166-74..
Keywords: Adverse Events, Ambulatory Care and Surgery, Cancer, Education: Patient and Caregiver, Health Information Technology (HIT), Patient Safety, Surgery
Khan A, Spector ND, Baird JD
Patient safety after implementation of a coproduced family centered communication programme: multicenter before and after intervention study.
The objective of this prospective, multicenter before and after intervention was to determine whether medical errors, family experience, and communication processes improved after implementation of the intervention to standardize the structure of healthcare provider-family communication on family centered rounds. The investigators concluded that although overall errors were unchanged, harmful medical errors decreased and family experience and communication processes improved.
AHRQ-funded; HS00063.
Citation: Khan A, Spector ND, Baird JD .
Patient safety after implementation of a coproduced family centered communication programme: multicenter before and after intervention study.
BMJ 2018 Dec 5;363:k4764. doi: 10.1136/bmj.k4764..
Keywords: Adverse Events, Clinician-Patient Communication, Communication, Medical Errors, Patient and Family Engagement, Patient Safety
Keller SC, Williams D, Rock C
A new frontier: central line-associated bloodstream infection surveillance in home infusion therapy.
As more home infusion agencies consider ways to perform surveillance for central line–associated bloodstream infection (CLABSI), an understanding of the assorted challenges is necessary. The authors discussed these challenges, which include a lack of a widely accepted standard definition of CLABSIs in home infusion therapy, the lack of a reporting platform, the absence of a reporting requirement, and barriers in obtaining the needed information to identify the presence of a potential CLABSI and adjudicate whether it meets a CLABSI definition. The 21st Century Cures Act will expand Medicare coverage for home infusion therapy services by 2021, likely leading to increased pressure for home infusion therapy CLABSI surveillance. Benchmarking of CLABSI data can usher in informed work to reduce CLABSIs and enhance patient safety in home infusion therapy.
AHRQ-funded; HS025782.
Citation: Keller SC, Williams D, Rock C .
A new frontier: central line-associated bloodstream infection surveillance in home infusion therapy.
Am J Infect Control 2018 Dec;46(12):1419-21. doi: 10.1016/j.ajic.2018.05.016..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Home Healthcare, Patient Safety, Sepsis, Infectious Diseases, Prevention
Anesi JA, Lautenbach E, Nachamkin I
Poor clinical outcomes associated with community-onset urinary tract infections due to extended-spectrum cephalosporin-resistant Enterobacteriaceae.
In this retrospective cohort study, the investigators sought to determine the clinical outcomes associated with community-onset ESC-resistant (ESC-R) EB urinary tract infections (UTIs) in a US health system. The authors found that community-onset UTI due to an ESC-R EB organism was significantly associated with clinical failure, which may be due in part to inappropriate initial antibiotic therapy. They indicate that further studies are needed to determine which patients in the community are at high risk for drug-resistant infection to help inform prompt diagnosis and appropriate antibiotic prescribing for ESC-R EB.
AHRQ-funded; HS020002.
Citation: Anesi JA, Lautenbach E, Nachamkin I .
Poor clinical outcomes associated with community-onset urinary tract infections due to extended-spectrum cephalosporin-resistant Enterobacteriaceae.
Infect Control Hosp Epidemiol 2018 Dec;39(12):1431-35. doi: 10.1017/ice.2018.254..
Keywords: Antibiotics, Community-Acquired Infections, Medication, Outcomes, Patient Safety, Urinary Tract Infection (UTI)
Hornor MA, Liu JY, Hu QL
Surgical technical evidence review for acute appendectomy conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery.
This evidence review uses enhanced recovery pathways (ERPs) protocols developed for the AHRQ-funded Safety Program for Improving Surgical Care and Recovery (ISCR Program) to develop ERPs for acute appendectomy surgery. The authors classified appendicitis into uncomplicated (nonperforated) and complicated (perforated or gangrenous) to help with risk stratification. They identified 13 components for appendectomy for review. The processes are organized by perioperative phase, and each phase includes the rationale, evidence review, summary of guidelines, and a recommendation summary of the evidence for or against inclusion in the ERP. Preoperative management components included: education and counseling; preoperative antibiotics; initial nonsurgical management for perforated appendicitis with abscess or phlegmon, venous thromboembolism prophylaxis, delay for operation for 12-24 hours for uncomplicated appendicitis. Intraoperative management components include: laparoscopic surgical technique, peritoneal drain placement, urinary catheter placement, and prophylactic nasogastric tube insertion. Postoperative management components include same-day surgery discharge for uncomplicated appendicitis, antibiotics, early oral alimentation, and early mobilization. Of the ERPs reviewed: there was no evidence to support the routine use of abdominal drainage in patients undergoing appendectomies, urinary catheter insertion for laparoscopic surgery, use of prophylactic nasogastric tube placement, postoperative antibiotic use for uncomplicated appendicitis, and early oral alimentation for uncomplicated appendicitis.
AHRQ-funded.
Citation: Hornor MA, Liu JY, Hu QL .
Surgical technical evidence review for acute appendectomy conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery.
J Am Coll Surg 2018 Dec;227(6):605-17.e2. doi: 10.1016/j.jamcollsurg.2018.09.024..
Keywords: Surgery, Quality Improvement, Quality of Care, Patient Safety, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes
Burgermaster M, Murray M, Saiman L
Associations between enteral nutrition and acute respiratory infection among patients in New York metropolitan region pediatric long-term care facilities.
This study investigated the outcomes of children and a subsample of infants in pediatric long-term care facilities are need enteral nutrition (EN). Those patients who need EN had a higher risk of acute pediatric infection (ARI) and a lower odds of discharge than those who did not. Infants had a particular higher risk of comorbidities and infections when they were fed using percutaneous feeding tubes.
AHRQ-funded; HS021470.
Citation: Burgermaster M, Murray M, Saiman L .
Associations between enteral nutrition and acute respiratory infection among patients in New York metropolitan region pediatric long-term care facilities.
Nutr Clin Pract 2018 Dec;33(6):865-71. doi: 10.1002/ncp.10017..
Keywords: Children/Adolescents, Healthcare-Associated Infections (HAIs), Nutrition, Outcomes, Patient-Centered Outcomes Research, Patient Safety, Respiratory Conditions, Long-Term Care
Bardossy AC, Williams T, Jones K
Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections: the tale of two teaching hospitals.
This study compared 2 teaching hospitals’ intervention programs for preventing catheter-associated urinary tract infections (CAUTI). The comparisons were done in their adult intensive care units.
AHRQ-funded; 290201000025I; 29032001T.
Citation: Bardossy AC, Williams T, Jones K .
Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections: the tale of two teaching hospitals.
Infect Control Hosp Epidemiol 2018 Dec;39(12):1494-96. doi: 10.1017/ice.2018.251..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU), Patient-Centered Outcomes Research, Patient Safety, Urinary Tract Infection (UTI)
Medford-Davis LN, Singh H, Mahajan P
Diagnostic decision-making in the emergency department.
Emergency providers must often diagnose from undifferentiated symptoms, without previous knowledge of the patient. Failure to provide an accurate assessment of the problem or to communicate the problem to the patient is diagnostic error. This article considers methods to monitor diagnostic error in emergency departments.
AHRQ-funded; HS024953.
Citation: Medford-Davis LN, Singh H, Mahajan P .
Diagnostic decision-making in the emergency department.
Pediatr Clin North Am 2018 Dec;65(6):1097-105. doi: 10.1016/j.pcl.2018.07.003..
Keywords: Emergency Department, Diagnostic Safety and Quality, Decision Making, Medical Errors, Patient Safety
Bateni SB, Olson JL, Hoch JS
Drivers of cost for pancreatic surgery: it's not about hospital volume.
Researchers compared healthcare costs of pancreatic surgery between high- and low-volume centers. They found there was no significant difference in costs, however high-volume centers have better outcomes for morbidity and mortality.
AHRQ-funded; HS022236.
Citation: Bateni SB, Olson JL, Hoch JS .
Drivers of cost for pancreatic surgery: it's not about hospital volume.
Ann Surg Oncol 2018 Dec;25(13):3804-11. doi: 10.1245/s10434-018-6758-1..
Keywords: Healthcare Costs, Hospitals, Outcomes, Patient Safety, Surgery
Schnipper JL, Mixon A, Stein J
Effects of a multifaceted medication reconciliation quality improvement intervention on patient safety: final results of the MARQUIS study.
The authors of this paper conducted a pragmatic quality improvement (QI) study at five US hospitals, two of which included concurrent controls. The investigators found that a mentored implementation of a multifaceted medication reconciliation QI initiative was associated with a reduction in total, but not potentially harmful, medication discrepancies. They suggest that the effect of EHR implementation on medication discrepancies warrants further study.
AHRQ-funded; HS019598.
Citation: Schnipper JL, Mixon A, Stein J .
Effects of a multifaceted medication reconciliation quality improvement intervention on patient safety: final results of the MARQUIS study.
BMJ Qual Saf 2018 Dec;27(12):954-64. doi: 10.1136/bmjqs-2018-008233..
Keywords: Hospitals, Medication, Medication: Safety, Patient Safety, Quality Improvement
Bath J, Dombrovskiy VY, Vogel TR
Impact of patient safety indicators on readmission after abdominal aortic surgery.
This analysis evaluated whether Patient Safety Indicator (PSI) events after open surgical repair or endovascular aneurysm repair of abdominal aortic aneurysm (AAA) were associated with increased risk of readmission. The investigators concluded that Agency for Healthcare Quality and Research PSI events may be used to identify patients at the greatest risk for readmission after AAA repair. The risk for 30-day readmission was 71% higher when a PSI event occurred and was not associated with the type of repair.
AHRQ-funded; HS022140.
Citation: Bath J, Dombrovskiy VY, Vogel TR .
Impact of patient safety indicators on readmission after abdominal aortic surgery.
J Vasc Nurs 2018 Dec;36(4):189-95. doi: 10.1016/j.jvn.2018.08.002..
Keywords: Patient Safety, Quality Indicators (QIs), Surgery
Govindan S, Snyder A, Flanders SA
Peripherally inserted central catheters in the ICU: a retrospective study of adult medical patients in 52 hospitals.
This study quantified use of peripherally inserted central catheters in the ICU versus the general ward in 52 Michigan hospitals. Variation in complications and outcomes of use were compared. Use in the ICU produced worse outcomes than those inserted in the general ward.
AHRQ-funded; HS022835.
Citation: Govindan S, Snyder A, Flanders SA .
Peripherally inserted central catheters in the ICU: a retrospective study of adult medical patients in 52 hospitals.
Crit Care Med 2018 Dec;46(12):e1136-e44. doi: 10.1097/ccm.0000000000003423..
Keywords: Adverse Events, Healthcare-Associated Infections (HAIs), Inpatient Care, Intensive Care Unit (ICU), Patient Safety
Felix HC, Bradway C, Bird TM
Safety of obese persons in nursing homes.
This paper discusses the emergence of obese persons as a vulnerable group in the nursing home community. The authors discuss the special needs of this population including that obese residents require special protocols, trained staff, and appropriately sized equipment to prevent and treat skin breakdown.
AHRQ-funded; HS025703.
Citation: Felix HC, Bradway C, Bird TM .
Safety of obese persons in nursing homes.
Med Care 2018 Dec;56(12):1032-34. doi: 10.1097/mlr.0000000000000997..
Keywords: Long-Term Care, Obesity, Nursing Homes, Patient Safety, Skin Conditions
Kalogera E, Nelson G
Surgical technical evidence review for gynecologic surgery conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
The objective of this study was to review the enhanced recovery pathways (ERPs) literature in gynecologic surgery (GS) and provide the framework for Improving Surgical Care and Recovery (ISCR) pathway for GS. The investigators concluded that evidence and existing guidelines supported 29 protocol elements for the AHRQ Safety Program for ISCR in GS.
AHRQ-funded; 23337004T.
Citation: Kalogera E, Nelson G .
Surgical technical evidence review for gynecologic surgery conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
Am J Obstet Gynecol 2018 Dec;219(6):563.e1-63.e19. doi: 10.1016/j.ajog.2018.07.014..
Keywords: Evidence-Based Practice, Quality of Care, Patient Safety, Quality Improvement
Gray SL, Marcum ZA, Schmader KE
Update on medication use quality and safety in older adults, 2017.
Improving the quality of medication use and medication safety in older adults is an important public health priority and is of paramount importance for clinicians who care for them. In this paper, the investigators selected four important articles (from 2017), that address these issues, to annotate and critique. In addition, they discuss the broader implications for optimizing medication use.
AHRQ-funded; HS023779; HS022982.
Citation: Gray SL, Marcum ZA, Schmader KE .
Update on medication use quality and safety in older adults, 2017.
J Am Geriatr Soc 2018 Dec;66(12):2254-58. doi: 10.1111/jgs.15665..
Keywords: Elderly, Quality of Care, Medication, Medication: Safety, Patient Safety
Amin AP, Miller S, Rahn B
Reversing the "risk-treatment paradox" of bleeding in patients undergoing percutaneous coronary intervention: risk-concordant use of bleeding avoidance strategies is associated with reduced bleeding and lower costs.
Bleeding avoidance strategies (BAS) are effective, but are paradoxically used less often with patients at high risk of bleeding. This article describes the implementation of an intervention in a St. Louis, MO, hospital intended to reverse the bleeding risk-treatment paradox. Temporal trends in BAS use and the association of risk-concordant BAS use with bleeding as well as hospital costs of percutaneous coronary intervention were examined. Patient-centered care that aimed directly toward making treatment-related decisions based on predicted risk of bleeding led to a more risk-concordant use of BAS and a reversal of the risk-treatment paradox. The authors conclude that larger multicentered studies will be needed to corroborate these results.
AHRQ-funded; HS022481.
Citation: Amin AP, Miller S, Rahn B .
Reversing the "risk-treatment paradox" of bleeding in patients undergoing percutaneous coronary intervention: risk-concordant use of bleeding avoidance strategies is associated with reduced bleeding and lower costs.
J Am Heart Assoc 2018 Nov 6;7(21):e008551. doi: 10.1161/jaha.118.008551..
Keywords: Adverse Events, Patient Safety, Heart Disease and Health, Risk, Surgery, Cardiovascular Conditions, Healthcare Costs
Jayadevappa R, Chhatre S, Newman DK
Association between overactive bladder treatment and falls among older adults.
The purpose of this study was to analyze the risk of falls associated with overactive bladder (OAB) and the effects of OAB treatment on falls among older adult Medicare fee-for-service enrollees. Results showed that a diagnosis of OAB was associated with higher odds of falls compared to those without OAB and that treatment for OAB was associated with lower odds of falls compared to those untreated.
AHRQ-funded; HS024106.
Citation: Jayadevappa R, Chhatre S, Newman DK .
Association between overactive bladder treatment and falls among older adults.
Neurourol Urodyn 2018 Nov;37(8):2688-94. doi: 10.1002/nau.23719..
Keywords: Falls, Elderly, Patient Safety
Kline SE, Sanstead EC, Johnson JR
Cost-effectiveness of pre-operative Staphylococcus aureus screening and decolonization.
In this study, the investigators developed a decision analytic model to evaluate the impact of a preoperative Staphylococcus aureus decolonization bundle on surgical site infections (SSIs), health-care-associated costs (HCACs), and deaths due to SSI. The investigators predict that the treat-all strategy would be the most effective and cost-saving strategy for preventing SSIs. However, they concluded that because this strategy might select more extensively for mupirocin-resistant S. aureus and cause more medication adverse effects than the test-and-treat approach or the SOC, additional studies are needed to define its comparative benefits and harms.
AHRQ-funded; HS022912.
Citation: Kline SE, Sanstead EC, Johnson JR .
Cost-effectiveness of pre-operative Staphylococcus aureus screening and decolonization.
Infect Control Hosp Epidemiol 2018 Nov;39(11):1340-46. doi: 10.1017/ice.2018.228..
Keywords: Surgery, Antibiotics, Antimicrobial Stewardship, Healthcare-Associated Infections (HAIs), Infectious Diseases, Patient Safety, Prevention, Healthcare Costs
Jurewicz KA, Neyens DM, Catchpole K
Developing a 3D gestural interface for anesthesia-related human-computer interaction tasks using both experts and novices.
The purpose of this research was to compare gesture-function mappings for experts and novices using a 3D, vision-based, gestural input system when exposed to the same context of anesthesia tasks in the operating room (OR). Results showed that although domain expertise is influential when creating gesture-function mappings, both experts and novices should be able to use a gesture system intuitively, so development methods need to be refined for considering the needs of different user groups. Recommendations include the development of a touchless interface for perioperative anesthesia in order to reduce bacterial contamination.
AHRQ-funded; HS024380.
Citation: Jurewicz KA, Neyens DM, Catchpole K .
Developing a 3D gestural interface for anesthesia-related human-computer interaction tasks using both experts and novices.
Hum Factors 2018 Nov;60(7):992-1007. doi: 10.1177/0018720818780544..
Keywords: Health Information Technology (HIT), Healthcare-Associated Infections (HAIs), Patient Safety
Colborn KL, Bronsert M, Amioka E
Identification of surgical site infections using electronic health record data.
The objective of this study was to develop an algorithm for identifying surgical site infections (SSIs) using independent variables from electronic health record data and outcomes from the American College of Surgeons National Surgical Quality Improvement Program to supplement manual chart review. The investigators concluded that they identified a model that accurately identified SSIs. They indicated that the framework presented can be easily implemented by other American College of Surgeons National Surgical Quality Improvement Program-participating hospitals to develop models for enhancing surveillance of SSIs.
AHRQ-funded; HS026019.
Citation: Colborn KL, Bronsert M, Amioka E .
Identification of surgical site infections using electronic health record data.
Am J Infect Control 2018 Nov;46(11):1230-35. doi: 10.1016/j.ajic.2018.05.011..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare-Associated Infections (HAIs), Injuries and Wounds, Patient Safety, Surgery
Ratwani RM, Moscovitch B, Rising JP
Improving pediatric electronic health record usability and safety through certification: seize the day.
In this paper, the authors discuss the unique needs of pediatric patients and the differences between care for them and adults as it relates to electronic health records (EHR) and other healthcare technology. Given the centrality of EHRs to modern medicine, inadequate usability (the design, customization, and use of systems) can have serious ramifications on pediatric care, including patient harm, when technology is not optimized for the treatment of children.
AHRQ-funded; HS023701.
Citation: Ratwani RM, Moscovitch B, Rising JP .
Improving pediatric electronic health record usability and safety through certification: seize the day.
JAMA Pediatr 2018 Nov;172(11):1007-08. doi: 10.1001/jamapediatrics.2018.2784..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Wright A, Aaron S, Seger DL
Reduced effectiveness of interruptive drug-drug interaction alerts after conversion to a commercial electronic health record.
This study examined the effects of conversion from a homegrown electronic health record (EHR) system to a commercial system on the effectiveness of drug-drug interaction (DDI) alert. The EHR system included 3277 clinicians in the before and after studies. There was a marked decrease in the acceptance rate (100 to 8.4% for severe alerts, 29.3 to 7.5% for medium severity) at first. The least severe alerts were then disabled, which lowered the alert burden by 50.5% which rose the acceptance of Tier 1 alerts to 12.7%. However, there was no clear explanation after that why the acceptance rate remained so much lower. The authors believe that workflow factors were probably the predominant reasons.
AHRQ-funded; HS016970.
Citation: Wright A, Aaron S, Seger DL .
Reduced effectiveness of interruptive drug-drug interaction alerts after conversion to a commercial electronic health record.
J Gen Intern Med 2018 Nov;33(11):1868-76. doi: 10.1007/s11606-018-4415-9..
Keywords: Adverse Drug Events (ADE), Medication, Adverse Events, Medical Errors, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety