National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Events (3)
- Antibiotics (3)
- Antimicrobial Stewardship (4)
- Behavioral Health (1)
- Brain Injury (2)
- Burnout (1)
- Care Management (2)
- Children/Adolescents (15)
- Chronic Conditions (1)
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- Communication (2)
- (-) Critical Care (58)
- Decision Making (4)
- Diagnostic Safety and Quality (2)
- Education: Continuing Medical Education (3)
- Elderly (7)
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- Healthcare-Associated Infections (HAIs) (3)
- Healthcare Cost and Utilization Project (HCUP) (3)
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- Intensive Care Unit (ICU) (24)
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- Medical Errors (1)
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- Medication: Safety (1)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (1)
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- Neonatal Intensive Care Unit (NICU) (1)
- Neurological Disorders (5)
- Newborns/Infants (2)
- Nursing (4)
- Opioids (1)
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- Provider: Nurse (1)
- Provider Performance (1)
- Quality Improvement (2)
- Quality Measures (1)
- Quality of Care (4)
- Quality of Life (1)
- Registries (1)
- Respiratory Conditions (8)
- Risk (2)
- Rural Health (1)
- Simulation (1)
- Stress (1)
- Stroke (1)
- Substance Abuse (1)
- Surgery (2)
- Teams (4)
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- Tools & Toolkits (1)
- Training (3)
- Trauma (2)
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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 58 Research Studies DisplayedCooper Z, Lilley EJ, Bollens-Lund E
High burden of palliative care needs of older adults during emergency major abdominal surgery.
The purpose of this retrospective study was to quantify preoperative illness burden in older adults undergoing emergency major abdominal surgery (EMAS), to examine the association between illness burden and postoperative outcomes, and to describe end-of-life care in the year after discharge. The investigators found that most older adults undergoing EMAS have preexisting high illness burden and experience high mortality and healthcare use in the year after surgery, particularly near the end of life.
AHRQ-funded; HS022763.
Citation: Cooper Z, Lilley EJ, Bollens-Lund E .
High burden of palliative care needs of older adults during emergency major abdominal surgery.
J Am Geriatr Soc 2018 Nov;66(11):2072-78. doi: 10.1111/jgs.15516..
Keywords: Critical Care, Elderly, Palliative Care, Surgery
Daniel VT, Ayturk D, Kiefe CI
The current State of the acute care surgery workforce: a boots on the ground perspective.
Acute care surgery (ACS) was proposed to address a general surgery workforce crisis; however, the ACS workforce composition is unknown. A national survey was conducted to determine the differences in the emergency general surgery (EGS) workforce between ACS and non-ACS hospitals. The investigators concluded that ACS and non-ACS hospitals differ in their surgical workforce. It is clear that ACS hospitals have more human capital, which suggests that ACS hospitals may require more dedicated resources compared to non-ACS hospitals.
AHRQ-funded; HS022694.
Citation: Daniel VT, Ayturk D, Kiefe CI .
The current State of the acute care surgery workforce: a boots on the ground perspective.
Am J Surg 2018 Dec;216(6):1076-81. doi: 10.1016/j.amjsurg.2018.08.023..
Keywords: Critical Care, Emergency Department, Hospitals, Workforce
Williams CN, Piantino J, McEvoy C
The burden of pediatric neurocritical care in the United States.
This article attempts to quantify the burden of pediatric neurocritical care (PNCC) by developing national estimates of disease incidence, evaluating use of critical care interventions (CCI), and examining hospital outcomes. The Kids Inpatient Database (KID) was analyzed to evaluate cohorts with the following conditions: traumatic brain injury, neuro-infection, or inflammatory diseases; status epilepticus; stroke; hypoxic ischemic injury after cardiac arrest; or spinal cord injury.
AHRQ-funded; HS022981.
Citation: Williams CN, Piantino J, McEvoy C .
The burden of pediatric neurocritical care in the United States.
Pediatr Neurol 2018 Dec;89:31-38. doi: 10.1016/j.pediatrneurol.2018.07.013..
Keywords: Children/Adolescents, Critical Care, Healthcare Costs, Healthcare Cost and Utilization Project (HCUP), Neurological Disorders, Stroke, Trauma
Barbash IJ
Cognitive impairment, anesthesia, and critical illness: learning from the past to gain perspective on the future.
This study examined the link between cognitive impairment, ICU admission and anesthesia. The author’s hypothesis was that patients with cognitive impairment would be more likely to undergo surgical procedures. However, analysis using data from the Mayo Clinical Study on Aging on 1,977 cognitive normal patients, 387 patients with mild cognitive impairment (MCI), and 72 patients with established dementia found that patients with MCI were more likely to undergo anesthesia and those with dementia were less likely to undergo procedural anesthesia. The author hypothesizes this may be linked to impaired decision-making of the patient and the risk-benefit analysis of performing surgery on patients with established dementia. However, ICU admissions were increased in patients with MCI and dementia.
AHRQ-funded; HS025455.
Citation: Barbash IJ .
Cognitive impairment, anesthesia, and critical illness: learning from the past to gain perspective on the future.
Mayo Clin Proc 2018 Nov;93(11):1537-39. doi: 10.1016/j.mayocp.2018.09.007..
Keywords: Adverse Events, Critical Care, Medication, Intensive Care Unit (ICU), Neurological Disorders
Patel MB, Bednarik J, Lee P
Delirium monitoring in neurocritically ill patients: a systematic review.
In this study, the investigators systematically reviewed Cumulative Index to Nursing and Allied Health Literature, Web of Science, and PubMed to determine whether there are valid and reliable tools to monitor delirium in neurocritically ill patients and whether delirium is associated with relevant clinical outcomes (e.g., survival, length of stay, functional independence, cognition) in this population.
AHRQ-funded; HS023437.
Citation: Patel MB, Bednarik J, Lee P .
Delirium monitoring in neurocritically ill patients: a systematic review.
Crit Care Med 2018 Nov;46(11):1832-41. doi: 10.1097/ccm.0000000000003349..
Keywords: Critical Care, Patient-Centered Outcomes Research
Stolldorf DP, Dietrich MS, Chidume T
Nurse-initiated mobilization practices in 2 community intensive care units: a pilot study.
The purposes of this study were to describe nurse-led mobilization practices in 2 community hospital ICUs and to report differences and similarities between the 2 settings. The investigators found that differences in patient characteristics and nurse-led mobilization activities were observed between ICUs. After controlling for patient characteristics, they found statistically significant differences in nurse-led mobilization activities between the 2 units, suggesting that factors other than patient characteristics may explain differences in nurse-led mobilization practices.
AHRQ-funded; HS025486.
Citation: Stolldorf DP, Dietrich MS, Chidume T .
Nurse-initiated mobilization practices in 2 community intensive care units: a pilot study.
Dimens Crit Care Nurs 2018 Nov/Dec;37(6):318-23. doi: 10.1097/dcc.0000000000000320..
Keywords: Critical Care, Intensive Care Unit (ICU)
Rosen MA, Dietz AS, Lee N
Sensor-based measurement of critical care nursing workload: Unobtrusive measures of nursing activity complement traditional task and patient level indicators of workload to predict perceived exertion.
The purpose of this study was to establish the validity of sensor-based measures of work processes for predicting perceived mental and physical exertion of critical care nurses. Environmental sensors worn by staff in a surgical intensive care unit captured work process data. Nurses rated their mental and physical exertion for each four-hour block, and recorded patient and staffing-level workload factors. Analysis of this data yielded highly predictive models of critical care nursing workload to generate insights into workflow and work design. The researchers conclude that sensor-based measures are a viable complement to traditional task demand measures of workload.
AHRQ-funded; HS023553.
Citation: Rosen MA, Dietz AS, Lee N .
Sensor-based measurement of critical care nursing workload: Unobtrusive measures of nursing activity complement traditional task and patient level indicators of workload to predict perceived exertion.
PLoS One 2018 Oct 12;13(10):e0204819. doi: 10.1371/journal.pone.0204819..
Keywords: Critical Care, Nursing, Provider: Nurse, Patient Safety, Workflow
Murray DJ, Boyle WA, Beyatte MB
Decision-making skills improve with critical care training: using simulation to measure progress.
Health care professionals are expected to acquire decision-making skills during their training, but few methods are available to assess progress in acquiring these essential skills. The purpose of this study was to determine whether a simulation methodology could be used to assess whether decision-making skills improve during critical care training. The investigators indicate that their findings provide evidence to support the validity of a simulation-based method to assess progress in decision-making skills.
AHRQ-funded; HS022265.
Citation: Murray DJ, Boyle WA, Beyatte MB .
Decision-making skills improve with critical care training: using simulation to measure progress.
J Crit Care 2018 Oct;47:133-38. doi: 10.1016/j.jcrc.2018.06.021..
Keywords: Critical Care, Education: Continuing Medical Education, Decision Making, Simulation, Teams, Training
Gajic O, Ahmad SR, Wilson ME
Outcomes of critical illness: what is meaningful?
In this review, the investigators discuss efforts and challenges in understanding and developing meaningful outcomes of critical care research, quality improvement and policy, which are patient-centered and goal concordant, rather than mortality alone. They discuss different aspects of what could constitute outcomes of critical illness as meaningful to the patients and other stakeholders, including families and providers.
AHRQ-funded; HS026609.
Citation: Gajic O, Ahmad SR, Wilson ME .
Outcomes of critical illness: what is meaningful?
Curr Opin Crit Care 2018 Oct;24(5):394-400. doi: 10.1097/mcc.0000000000000530..
Keywords: Critical Care, Patient-Centered Outcomes Research
Doernberg SB, Aboo LM, Burdette SD
Essential resources and strategies for antibiotic stewardship programs in the acute care setting.
This study measured the success of antibiotic stewardship programs to rates of antibiotic resistant disease. A survey was conducted of US stewardship programs using a cross-section of members of 3 infectious diseases subspecialty societies. Two-hundred forty-four respondents from a variety of acute care settings filled out the survey. Eighty-five percent of surveyed programs demonstrated at least 1 improved outcome in the prior 2 years. Every 0.50 increase in pharmacist and physician full-time equivalent (FTE) support predicted a 1.48-fold increase in demonstration effectiveness.
AHRQ-funded; HS023866.
Citation: Doernberg SB, Aboo LM, Burdette SD .
Essential resources and strategies for antibiotic stewardship programs in the acute care setting.
Clin Infect Dis 2018 Sep 28;67(8):1168-74. doi: 10.1093/cid/ciy255..
Keywords: Antimicrobial Stewardship, Antibiotics, Critical Care, Medication
Bergl PA, Nanchal RS, Singh H
Diagnostic error in the critically ill: defining the problem and exploring next steps to advance intensive care unit safety.
Despite progress in ICU safety, diagnostic errors remain largely unexplored and under-studied in critical care. Compared to other safety problems, diagnostic errors are more difficult to identify and, due to the intricacies of the diagnostic process, are more difficult to unravel. This paper discusses diagnostic error in critically ill patients, defines the problem and explores next steps to advance ICU safety.
AHRQ-funded; HS022087.
Citation: Bergl PA, Nanchal RS, Singh H .
Diagnostic error in the critically ill: defining the problem and exploring next steps to advance intensive care unit safety.
Ann Am Thorac Soc 2018 Aug;15(8):903-07. doi: 10.1513/AnnalsATS.201801-068PS..
Keywords: Adverse Events, Critical Care, Diagnostic Safety and Quality, Intensive Care Unit (ICU), Medical Errors, Patient Safety
Sobotka SA, Peters S, Pinto NP
Neurodevelopmental disorders in the PICU population.
Attention deficit hyperactivity disorder (ADHD), affecting 11% of children and adolescents, increases risk for injury and may predispose children to illness. However, the prevalence of ADHD and other developmental disorders in the pediatric intensive care unit (PICU) has not been previously studied. In this study, the investigators performed a single-center, prospective cohort study of children aged 6 to 12 years who were hospitalized in the PICU from May through August 2016.
AHRQ-funded; HS023007.
Citation: Sobotka SA, Peters S, Pinto NP .
Neurodevelopmental disorders in the PICU population.
Clin Pediatr 2018 Jul;57(8):913-19. doi: 10.1177/0009922817737080..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Behavioral Health
Iyer AS, Benzo RP, Bakitas MA
Easing the tension between palliative care and intensive care in chronic obstructive pulmonary disease.
This editorial discusses palliative care and intensive care in chronic obstructive pulmonary disease and comments on an article by Shen, et al., published, in 2018, in the Journal of Palliative Care, entitled “Life-sustaining procedures, palliative care consultation, and do-not resuscitate status in dying patients with COPD in US hospitals: 2010-2014.”
AHRQ-funded; HS023009.
Citation: Iyer AS, Benzo RP, Bakitas MA .
Easing the tension between palliative care and intensive care in chronic obstructive pulmonary disease.
J Palliat Care 2018 Jul;33(3):123-24. doi: 10.1177/0825859718782505..
Keywords: Chronic Conditions, Respiratory Conditions, Critical Care, Elderly, Palliative Care, Quality of Care
Costa DK, Moss M
The cost of caring: emotion, burnout, and psychological distress in critical care clinicians.
This paper comments on emotion, burnout, and psychological distress in critical care clinicians. It stresses that the current management approaches for burnout and other forms of psychological distress are insufficient and discusses possibilities for improvement.
AHRQ-funded; HS024552.
Citation: Costa DK, Moss M .
The cost of caring: emotion, burnout, and psychological distress in critical care clinicians.
Ann Am Thorac Soc 2018 Jul;15(7):787-90. doi: 10.1513/AnnalsATS.201804-269PS..
Keywords: Burnout, Critical Care, Provider, Workforce
Kojima T, Harwayne-Gidansky I, Shenoi AN
Cricoid pressure during induction for tracheal intubation in critically ill children: a report from National Emergency Airway Registry for Children.
The objective of this retrospective cohort study was to evaluate the association between cricoid pressure use and the occurrence of regurgitation during tracheal intubation for critically ill children in pediatric intensive care unit (PICU). The investigators found that cricoid pressure during induction and mask ventilation before tracheal intubation in the current ICU practice was not associated with a lower regurgitation rate after adjusting for previously reported confounders.
AHRQ-funded; HS024511.
Citation: Kojima T, Harwayne-Gidansky I, Shenoi AN .
Cricoid pressure during induction for tracheal intubation in critically ill children: a report from National Emergency Airway Registry for Children.
Pediatr Crit Care Med 2018 Jun;19(6):528-37. doi: 10.1097/pcc.0000000000001531.
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Keywords: Children/Adolescents, Critical Care, Children/Adolescents, Registries, Respiratory Conditions
Khandelwal N, Hough CL, Downey L
Prevalence, risk factors, and outcomes of financial stress in survivors of critical illness.
The objective was to describe the prevalence of financial stress among critically ill patients and their families and explore associations between financial stress and psychologic distress. It found that factors associated with financial stress included female sex, young children at home, and baseline financial discomfort. Also, financial stress after critical illness was common and associated with symptoms of anxiety and depression.
AHRQ-funded; HS022982.
Citation: Khandelwal N, Hough CL, Downey L .
Prevalence, risk factors, and outcomes of financial stress in survivors of critical illness.
Crit Care Med 2018 Jun;46(6):e530-e39. doi: 10.1097/ccm.0000000000003076.
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Keywords: Critical Care, Healthcare Costs, Risk, Patient-Centered Outcomes Research, Stress
Boyle WA, Murray DJ, Beyatte MB
Simulation-based assessment of critical care "front-line" providers.
The researchers developed a standardized simulation method to assess clinical skills of ICU providers. Their simulation assessments yielded reasonably reliable measures of Critical Care Medicine decision-making skills. Despite a wide range of performance, those with more ICU training and experience performed better, providing evidence to support the validity of the scores.
AHRQ-funded; HS018734; HS022265.
Citation: Boyle WA, Murray DJ, Beyatte MB .
Simulation-based assessment of critical care "front-line" providers.
Crit Care Med 2018 Jun;46(6):e516-e22. doi: 10.1097/ccm.0000000000003073.
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Keywords: Critical Care, Decision Making, Intensive Care Unit (ICU), Provider Performance, Training
Mahmoud L, Zullo AR, Thompson BB
Outcomes of protocolised analgesia and sedation in a neurocritical care unit.
Researchers conducted a retrospective cohort study of 1197 mechanically ventilated patients admitted to a 12-bed neurocritical care unit (NCCU) over four years in order to evaluate the effect of an analgesia-based sedation protocol on medication use and costs in the NCCU. The protocol resulted in increased in fentanyl use and decreased in propofol use, but their findings indicate no effect on healthcare utilization, healthcare costs, or in-hospital mortality. Based on these results, the researchers suggest that similar NCCUs should consider using population-specific protocols to manage analgesia and sedation.
AHRQ-funded; HS022998.
Citation: Mahmoud L, Zullo AR, Thompson BB .
Outcomes of protocolised analgesia and sedation in a neurocritical care unit.
Brain Inj 2018;32(7):941-47. doi: 10.1080/02699052.2018.1469167..
Keywords: Care Management, Brain Injury, Critical Care, Healthcare Costs, Intensive Care Unit (ICU), Medication, Neurological Disorders, Outcomes, Patient-Centered Outcomes Research
Costa DK, Valley TS, Miller MA
AHRQ Author: Miller MA
ICU team composition and its association with ABCDE implementation in a quality collaborative.
Awakening, Breathing Coordination, Delirium, and Early Mobility bundle (ABCDE) should involve an interprofessional team, yet no studies describe what team composition supports implementation. This study found that ABCDE implementation was associated with frequent involvement of team members, suggesting a need for role articulation and coordination.
AHRQ-authored; AHRQ-funded; HS024552.
Citation: Costa DK, Valley TS, Miller MA .
ICU team composition and its association with ABCDE implementation in a quality collaborative.
J Crit Care 2018 Apr;44:1-6. doi: 10.1016/j.jcrc.2017.09.180.
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Keywords: Critical Care, Intensive Care Unit (ICU), Patient Safety, Quality Improvement, Teams
Grossman LV, Choi SW, Collins S
Implementation of acute care patient portals: recommendations on utility and use from six early adopters.
This paper provides recommendations on how to most effectively implement advanced features of acute care patient portals, including: (1) patient-provider communication, (2) care plan information, (3) clinical data viewing, (4) patient education, (5) patient safety, (6) caregiver access, and (7) hospital amenities. One specific recommendation was that stakeholders in acute care patient portals should consider the benefits and challenges of generic and structured electronic care team messaging.
AHRQ-funded; HS021816; HS023613; HS023535; HS024349.
Citation: Grossman LV, Choi SW, Collins S .
Implementation of acute care patient portals: recommendations on utility and use from six early adopters.
J Am Med Inform Assoc 2018 Apr;25(4):370-79. doi: 10.1093/jamia/ocx074.
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Keywords: Critical Care, Electronic Health Records (EHRs), Patient Safety, Clinician-Patient Communication, Web-Based
Wang S, Hammes J, Khan S
Improving Recovery and Outcomes Every Day after the ICU (IMPROVE): study protocol for a randomized controlled trial.
The Improving Recovery and Outcomes Every Day after the ICU (IMPROVE) trial is an ongoing clinical trial which evaluates the efficacy of a combined physical exercise and cognitive training on cognitive function among ICU survivors 50 years and older who experienced delirium during an ICU stay. This article describes the study protocol for IMPROVE.
AHRQ-funded; HS024384.
Citation: Wang S, Hammes J, Khan S .
Improving Recovery and Outcomes Every Day after the ICU (IMPROVE): study protocol for a randomized controlled trial.
Trials 2018 Mar 27;19(1):196. doi: 10.1186/s13063-018-2569-8.
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Keywords: Critical Care, Elderly, Intensive Care Unit (ICU), Neurological Disorders, Patient-Centered Outcomes Research
Khan S, Biju A, Wang S
Mobile critical care recovery program (m-CCRP) for acute respiratory failure survivors: study protocol for a randomized controlled trial.
The Mobile Critical Care Recovery Program (m-CCRP) study is a two arm, randomized clinical trial. The researchers will randomize 620 patients admitted to the ICU with acute respiratory failure requiring mechanical ventilation to one of two arms - m-CCRP intervention versus attention control. Their primary aim is to assess the efficacy of m-CCRP in improving the quality of life of acute respiratory failure survivors at 12 months
AHRQ-funded; HS024384.
Citation: Khan S, Biju A, Wang S .
Mobile critical care recovery program (m-CCRP) for acute respiratory failure survivors: study protocol for a randomized controlled trial.
Trials 2018 Feb 7;19(1):94. doi: 10.1186/s13063-018-2449-2.
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Keywords: Critical Care, Intensive Care Unit (ICU), Quality of Life, Respiratory Conditions, Respiratory Conditions
Kojima T, Laverriere EK, Owen EB
Clinical impact of external laryngeal manipulation during laryngoscopy on tracheal intubation success in critically ill children.
In this retrospective observational study, the objective was to evaluate the association between external laryngeal manipulation use and initial tracheal intubation attempt success in pediatric ICUs. The investigators found that external laryngeal manipulation during direct laryngoscopy was associated with lower initial tracheal intubation attempt success in critically ill children, even after adjusting for underlying differences in patient factors and provider levels. They asserted that the indiscriminate use of external laryngeal manipulation cannot be recommended.
AHRQ-funded; HS024511.
Citation: Kojima T, Laverriere EK, Owen EB .
Clinical impact of external laryngeal manipulation during laryngoscopy on tracheal intubation success in critically ill children.
Pediatr Crit Care Med 2018 Feb;19(2):106-14. doi: 10.1097/pcc.0000000000001373..
Keywords: Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Children/Adolescents, Respiratory Conditions
Khubchandani JA, Ingraham AM, Daniel VT
Geographic diffusion and implementation of acute care surgery: an uneven solution to the national emergency general surgery crisis.
Researchers investigated geographic diffusion of acute care surgery (ACS) models of care and characterized the communities in which ACS implementation is lagging. They found that acute care surgery implementation has not been uniform. Rural regions have limited ACS access, with hospitals in counties with greater than the 75th percentile population having 5.4 times higher odds of implementing ACS than hospitals in counties with less than 25th percentile population.
AHRQ-funded; HS022694.
Citation: Khubchandani JA, Ingraham AM, Daniel VT .
Geographic diffusion and implementation of acute care surgery: an uneven solution to the national emergency general surgery crisis.
JAMA Surg 2018 Feb;153(2):150-59. doi: 10.1001/jamasurg.2017.3799.
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Keywords: Critical Care, Rural Health, Surgery
Heslin KC, Owens PL, Karaca Z
AHRQ Author: Heslin KC; Owens PL; Karaca Z; Elixhauser A
Trends in opioid-related inpatient stays shifted after the US transitioned to ICD-10-CM diagnosis coding in 2015.
This study examines how trend analyses of inpatient stays involving opioid diagnoses were affected by the transition to ICD-10-CM. It found a sharp increase in opioid-related stays overall during the transition to ICD-10-CM. This may indicate that the new classification system is capturing stays that were missed by ICD-9-CM data.
AHRQ-authored.
Citation: Heslin KC, Owens PL, Karaca Z .
Trends in opioid-related inpatient stays shifted after the US transitioned to ICD-10-CM diagnosis coding in 2015.
Med Care 2017 Nov;55(11):918-23. doi: 10.1097/mlr.0000000000000805.
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Keywords: Critical Care, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Opioids, Substance Abuse