National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Events (1)
- Antibiotics (4)
- Antimicrobial Stewardship (2)
- Cancer (1)
- Caregiving (2)
- Care Management (2)
- Catheter-Associated Urinary Tract Infection (CAUTI) (4)
- Children/Adolescents (10)
- Chronic Conditions (3)
- Communication (1)
- Critical Care (1)
- Data (1)
- Dementia (1)
- Diabetes (1)
- Disabilities (2)
- Education: Patient and Caregiver (1)
- Elderly (15)
- Emergency Department (1)
- Evidence-Based Practice (2)
- Healthcare-Associated Infections (HAIs) (9)
- Healthcare Costs (3)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (2)
- Health Insurance (1)
- Health Services Research (HSR) (1)
- Injuries and Wounds (1)
- (-) Long-Term Care (37)
- Medication (6)
- Medication: Safety (1)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (2)
- Neurological Disorders (1)
- Nursing (2)
- Nursing Homes (22)
- Opioids (2)
- Organizational Change (1)
- Pain (2)
- Palliative Care (1)
- Patient-Centered Outcomes Research (1)
- Patient Safety (10)
- Policy (1)
- Practice Patterns (2)
- Prevention (9)
- Primary Care (1)
- Provider (1)
- Provider: Nurse (1)
- Quality Improvement (2)
- Quality Indicators (QIs) (1)
- Quality of Care (2)
- Racial and Ethnic Minorities (2)
- Respiratory Conditions (2)
- Risk (2)
- Telehealth (1)
- Transitions of Care (2)
- Urinary Tract Infection (UTI) (2)
- Vulnerable Populations (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 25 of 37 Research Studies DisplayedKrein SL, Harrod M, Collier S
A national collaborative approach to reduce catheter-associated urinary tract infections in nursing homes: a qualitative assessment.
AHRQ’s Safety Program for Long-term Care: Health Care-Associated Infections/Catheter-Associated Urinary Tract Infection, a national performance improvement program, was designed to promote implementation of a catheter-associated urinary tract infections (CAUTI) prevention program through state-based or regional collaboratives in more than 500 nursing homes across the United States. The observed program success and positive views of those participating suggest that collaboratives are an important strategy for providing nursing homes with enhanced expertise and support.
AHRQ-funded; 290201000025I; 29032008T.
Citation: Krein SL, Harrod M, Collier S .
A national collaborative approach to reduce catheter-associated urinary tract infections in nursing homes: a qualitative assessment.
Am J Infect Control 2017 Dec;45(12):1342-48. doi: 10.1016/j.ajic.2017.07.006.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Long-Term Care, Nursing Homes, Quality Improvement, Patient Safety
Britton MC, Ouellet GM, Minges KE
Care transitions between hospitals and skilled nursing facilities: perspectives of sending and receiving providers.
This study was conducted to identify the perspectives of sending and receiving providers regarding care transitions between the hospital and skilled nursing facilities. Four main themes emerged: increasing patient complexity, identifying an optimal care setting, rising financial pressure, and barriers to effective communication. The investigators indicated that the data highlighted hospital and SNF providers' shared concerns about patient-level risk factors and escalating costs of care.
AHRQ-funded; HS023554.
Citation: Britton MC, Ouellet GM, Minges KE .
Care transitions between hospitals and skilled nursing facilities: perspectives of sending and receiving providers.
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Keywords: Communication, Long-Term Care, Nursing Homes, Risk, Transitions of Care
Katz MJ, Gurses AP, Tamma PD
AHRQ Author: Miller MA
Implementing antimicrobial stewardship in long-term care settings: an integrative review using a human factors approach.
In this integrative review, the authors analyzed published evidence in the context of a human factors engineering approach as well as educational interventions to understand aspects of multimodal interventions associated with the implementation of successful stewardship programs in long term care facilities. The outcomes indicate that effective antimicrobial stewardship in long-term care is supported by incorporating multidisciplinary education, tools integrated into the workflow of nurses and prescribers that facilitate review of antibiotic use, and involvement of infectious disease consultants.
AHRQ-authored; AHRQ-funded; 2332015000201.
Citation: Katz MJ, Gurses AP, Tamma PD .
Implementing antimicrobial stewardship in long-term care settings: an integrative review using a human factors approach.
Clin Infect Dis 2017 Nov;65(11):1943-51. doi: 10.1093/cid/cix566.
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Keywords: Antimicrobial Stewardship, Healthcare-Associated Infections (HAIs), Elderly, Long-Term Care, Nursing Homes
Hessels AJ, Darby SW, Simpser E
National testing of the nursing-kids intensity of care survey for pediatric long-term care.
The purpose of this study is to test the Nursing-Kids Intensity of Care, a measure of the intensity of nursing care needs, defined as the quantity and type of direct and indirect care activities performed by caregivers in a national sample. The authors concluded that additional testing to further establish psychometric sufficiency and expanded use to quantify the intensity of nursing care needs of children with complex medical conditions in pediatric long-term care settings is recommended.
AHRQ-funded; HS021470.
AHRQ-funded; HS021470.
AHRQ-funded; HS021470.
Citation: Hessels AJ, Darby SW, Simpser E .
National testing of the nursing-kids intensity of care survey for pediatric long-term care.
J Pediatr Nurs 2017 Nov/Dec;37:86-90. doi: 10.1016/j.pedn.2017.08.026..
Keywords: Children/Adolescents, Health Services Research (HSR), Long-Term Care, Nursing, Children/Adolescents
Banaszak-Holl J, Reichert H, Todd Greene M
Do safety culture scores in nursing homes depend on job role and ownership? Results from a national survey.
Researchers sought to identify facility- and individual-level predictors of nursing home safety culture. Their survey of nursing home staff (N = 14,177) from 170 of 210 participating facilities found that perceptions of safety culture vary widely among nursing home staff, with administrators consistently perceiving better safety culture than clinical staff who spend more time with residents.
AHRQ-funded; 2902010000251.
Citation: Banaszak-Holl J, Reichert H, Todd Greene M .
Do safety culture scores in nursing homes depend on job role and ownership? Results from a national survey.
J Am Geriatr Soc 2017 Oct;65(10):2244-50. doi: 10.1111/jgs.15030.
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Keywords: Patient Safety, Nursing Homes, Long-Term Care
Nothelle SK, Sharma R, Oakes AH
Determinants of potentially inappropriate medication use in long-term and acute care settings: a systematic review.
The authors searched for studies conducted in the United States that described determinants of Potentially inappropriate medications (PIMs) use in adults >/=60 years of age in a nursing home or residential care facility, in the emergency department (ED), or in the hospital. They concluded that among older adults, those who are on many medications are at increased risk for PIM use across multiple settings.
AHRQ-funded; HS000029.
Citation: Nothelle SK, Sharma R, Oakes AH .
Determinants of potentially inappropriate medication use in long-term and acute care settings: a systematic review.
J Am Med Dir Assoc 2017 Sep;18(9):806.e1-06.e17. doi: 10.1016/j.jamda.2017.06.005.
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Keywords: Medication, Medication: Safety, Long-Term Care, Critical Care, Elderly
Saiman L, Maykowski P, Murray M
Incidence, risks, and types of infections in pediatric long-term care facilities.
The researchers described the types of infections diagnosed in residents of pediatric long-term care facilities, calculate infection rates, and identified risk factors for respiratory tract infections (RTIs). RTIs were the most common infections diagnosed, but modifiable risk factors for RTIs were not identified. Also included in the study were skin and soft-tissue infections; chronic comorbid conditions, including neurologic and respiratory disorders; and device use.
AHRQ-funded; HS021470.
Citation: Saiman L, Maykowski P, Murray M .
Incidence, risks, and types of infections in pediatric long-term care facilities.
JAMA Pediatr 2017 Sep;171(9):872-78. doi: 10.1001/jamapediatrics.2017.1482.
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Keywords: Healthcare-Associated Infections (HAIs), Long-Term Care, Patient Safety, Children/Adolescents, Risk
Mody L, Greene MT, Meddings J
AHRQ Author: Burwen DR, Battles J
A national implementation project to prevent catheter-associated urinary tract infection in nursing home residents.
The researchers developed, implemented, and evaluated an intervention to reduce catheter-associated urinary tract infection (UTI). They found that in a large-scale, national implementation project involving community-based nursing homes, combined technical and socioadaptive catheter-associated UTI prevention interventions successfully reduced the incidence of catheter-associated UTIs.
AHRQ-authored; AHRQ-funded; 290201000025I; HS019767; HS024385; HS018334.
Citation: Mody L, Greene MT, Meddings J .
A national implementation project to prevent catheter-associated urinary tract infection in nursing home residents.
JAMA Intern Med 2017 Aug;177(8):1154-62. doi: 10.1001/jamainternmed.2017.1689.
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Keywords: Antibiotics, Catheter-Associated Urinary Tract Infection (CAUTI), Elderly, Long-Term Care, Nursing Homes, Prevention, Urinary Tract Infection (UTI)
Jutkowitz E, Kuntz KM, Dowd B
Effects of cognition, function, and behavioral and psychological symptoms on out-of-pocket medical and nursing home expenditures and time spent caregiving for persons with dementia.
This study used cross-sectional data (Aging, Demographics, and Memory Study) to estimate probabilities of experiencing outcomes by clinical features. It found that no clinical feature predicted the probability of having out-of-pocket medical expenditures. For those with medical expenditures, higher cognition and poorer function were associated with more spending.
AHRQ-funded; HS024165.
Citation: Jutkowitz E, Kuntz KM, Dowd B .
Effects of cognition, function, and behavioral and psychological symptoms on out-of-pocket medical and nursing home expenditures and time spent caregiving for persons with dementia.
Alzheimers Dement 2017 Jul;13(7):801-09. doi: 10.1016/j.jalz.2016.12.011.
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Keywords: Caregiving, Dementia, Elderly, Healthcare Costs, Long-Term Care, Neurological Disorders, Nursing Homes
Goodwin JS, Li S, Zhou J
Comparison of methods to identify long term care nursing home residence with administrative data.
Researchers compared different methods for identifying a long term care (LTC) nursing home stay, distinct from stays in skilled nursing facilities (SNFs), to the method currently used by the Center for Medicare and Medicaid Services (CMS). They concluded that using both Medicare and Minimum Data Set (MDS), data to identify LTC stays will lead to more accurate attribution of CMS nursing home quality indicators.
AHRQ-funded; HS022134.
Citation: Goodwin JS, Li S, Zhou J .
Comparison of methods to identify long term care nursing home residence with administrative data.
BMC Health Serv Res 2017 May 30;17(1):376. doi: 10.1186/s12913-017-2318-9.
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Keywords: Data, Long-Term Care, Nursing Homes, Quality Indicators (QIs)
Hessels AJ, Agarwal M, Saiman L
Measuring patient safety culture in pediatric long-term care.
The purpose of this study was to test the reliability, feasibility and utility of a modified patient safety survey for use in pediatric long term care (pLTC) settings and describe patient safety culture in a sample of providers from pLTC facilities. Highest ratings were given to overall perceptions of safety, feedback and incident communication, supervisors' expectations and actions and management support.
AHRQ-funded; HS021470.
Citation: Hessels AJ, Agarwal M, Saiman L .
Measuring patient safety culture in pediatric long-term care.
J Pediatr Rehabil Med 2017 May 17;10(2):81-87. doi: 10.3233/prm-170432.
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Keywords: Children/Adolescents, Long-Term Care, Patient Safety, Quality of Care
Meddings J, Saint S, Krein SL
Systematic review of interventions to reduce urinary tract infection in nursing home residents.
This paper is a systematic literature review of strategies to reduce urinary tract infections (UTIs) in nursing home residents. It concludes that several practices, often implemented in bundles, such as improving hand hygiene, reducing and improving catheter use, managing incontinence without catheters, and enhanced barrier precautions, appear to reduce UTI or catheter-associated UTI in nursing home residents.
AHRQ-funded; HS019767; HS018334; 290201000025I.
Citation: Meddings J, Saint S, Krein SL .
Systematic review of interventions to reduce urinary tract infection in nursing home residents.
J Hosp Med 2017 May;12(5):356-68. doi: 10.12788/jhm.2724.
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Keywords: Antibiotics, Catheter-Associated Urinary Tract Infection (CAUTI), Elderly, Evidence-Based Practice, Long-Term Care, Nursing Homes, Patient Safety, Prevention, Urinary Tract Infection (UTI)
Mody L, Greene MT, Saint S
Comparing catheter-associated urinary tract infection prevention programs between Veterans Affairs nursing homes and non-Veterans Affairs nursing homes.
Nursing homes provided baseline information about their infection prevention programs to assess strengths and gaps related to catheter-associated urinary tract infection (CAUTI) prevention via a needs assessment questionnaire. Among nursing homes participating in an AHRQ-funded collaborative, VA and non-VA nursing homes differed in their approach to CAUTI prevention. Best practices from both settings should be applied universally to create an optimal infection prevention program within emerging integrated healthcare systems.
AHRQ-funded; 290201000025I; HS019767; HS024385; HS018334.
Citation: Mody L, Greene MT, Saint S .
Comparing catheter-associated urinary tract infection prevention programs between Veterans Affairs nursing homes and non-Veterans Affairs nursing homes.
Infect Control Hosp Epidemiol 2017 Mar;38(3):287-93. doi: 10.1017/ice.2016.279.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Long-Term Care, Nursing Homes, Prevention
Fain KM, Alexander GC, Dore DD
Frequency and predictors of analgesic prescribing in U.S. nursing home residents with persistent pain.
The purpose of this study was to quantify prescription analgesic use of elderly nursing home (NH) residents with persistent noncancer pain and to identify individual and facility traits associated with no treatment. The investigators concluded that through 2008, pain remained undertreated in NHs, especially in certain subpopulations, including cognitively impaired and older residents. The authors suggest that changes in pain management practice and policies may be necessary to target these vulnerable residents.
AHRQ-funded; HS022998.
Citation: Fain KM, Alexander GC, Dore DD .
Frequency and predictors of analgesic prescribing in U.S. nursing home residents with persistent pain.
J Am Geriatr Soc 2017 Feb;65(2):286-93. doi: 10.1111/jgs.14512..
Keywords: Care Management, Chronic Conditions, Elderly, Long-Term Care, Medication, Nursing Homes, Opioids, Pain, Practice Patterns
Fain KM, Castillo-Salgado C, Dore DD
Inappropriate fentanyl prescribing among nursing home residents in the United States.
In this cross-sectional study, the investigators quantified transdermal fentanyl prescribing in elderly nursing home residents without prior opioid use or persistent pain, and the association of individual and facility traits with opioid-naive prescribing. The investigators concluded that most nursing home residents initiating transdermal fentanyl did not have persistent pain and many were opioid-naive. They suggest that changes in prescribing practices may be necessary to ensure Food and Drug Administration warnings are followed, particularly for vulnerable subgroups, such as the cognitively impaired.
AHRQ-funded; HS018960.
Citation: Fain KM, Castillo-Salgado C, Dore DD .
Inappropriate fentanyl prescribing among nursing home residents in the United States.
J Am Med Dir Assoc 2017 Feb;18(2):138-44. doi: 10.1016/j.jamda.2016.08.015..
Keywords: Care Management, Chronic Conditions, Elderly, Long-Term Care, Medication, Nursing Homes, Opioids, Pain, Practice Patterns
Albrecht JS, Croft L, Morgan DJ
Perceptions of gown and glove use to prevent methicillin-resistant staphylococcus aureus transmission in nursing homes.
This qualitative study explored current use and perceptions of glove and gown use in nursing homes. Analysis of recordings of three focus group discussions revealed that direct care staff reported using gowns and gloves primarily as self-protection against contact with bodily fluids, not to prevent MRSA transmission. Glove use was described as common and more acceptable to staff and residents than gown use.
AHRQ-funded; HS024560; HS022135.
Citation: Albrecht JS, Croft L, Morgan DJ .
Perceptions of gown and glove use to prevent methicillin-resistant staphylococcus aureus transmission in nursing homes.
J Am Med Dir Assoc 2017 Feb;18(2):158-61. doi: 10.1016/j.jamda.2016.08.016.
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Keywords: Healthcare-Associated Infections (HAIs), Long-Term Care, Methicillin-Resistant Staphylococcus aureus (MRSA), Nursing Homes, Prevention, Patient Safety
Lindquist LA, Miller RK, Saltsman WS
SGIM-AMDA-AGS consensus best practice recommendations for transitioning patients' healthcare from skilled nursing facilities to the community.
The authors assembled a cross-cutting team of experts representing primary care physicians (PCPs), home care physicians, physicians who see patients in skilled nursing facilities (SNF physicians), skilled nursing facility medical directors, human factors engineers, transitional care researchers, geriatricians, internists, family practitioners, and three major organizations: AMDA, SGIM, and AGS. This team identified issues and developed best practices perceived as feasible for SNF physician and PCP practices to accomplish.
AHRQ-funded; HS022916.
Citation: Lindquist LA, Miller RK, Saltsman WS .
SGIM-AMDA-AGS consensus best practice recommendations for transitioning patients' healthcare from skilled nursing facilities to the community.
J Gen Intern Med 2017 Feb;32(2):199-203. doi: 10.1007/s11606-016-3850-8.
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Keywords: Quality of Care, Long-Term Care, Nursing Homes, Primary Care, Transitions of Care
Scales K, Zimmerman S, Reed D
Nurse and medical provider perspectives on antibiotic stewardship in nursing homes.
The objective of this cross sectional survey was to examine perspectives on antibiotic use and antibiotic stewardship of nurses and medical providers in nursing homes ( NHs). The investigators concluded that nursing staff and medical providers share a commitment to reducing unnecessary antibiotic use. Antibiotic stewardship interventions should foster cooperation and build competency to implement alternative management approaches and to educate residents and families. Nurse leaders and medical providers with long-term care training may be especially effective champions for antibiotic stewardship.
AHRQ-funded; HS22846.
Citation: Scales K, Zimmerman S, Reed D .
Nurse and medical provider perspectives on antibiotic stewardship in nursing homes.
J Am Geriatr Soc 2017 Jan;65(1):165-71. doi: 10.1111/jgs.14504..
Keywords: Elderly, Antimicrobial Stewardship, Antibiotics, Medication, Nursing Homes, Long-Term Care, Provider: Nurse, Provider
Cohen B, Murray M, Jia H
Is hand hygiene frequency associated with the onset of outbreaks in pediatric long-term care?
The authors studied the possibility of a correlation between hand hygiene and viral outbreak reduction in pediatric long-term care facilities. Contrary to findings in adult long-term care facilities, they found no association between hand hygiene frequency and subsequent outbreak onset in pediatric long-term care facilities.
AHRQ-funded; HS021470.
Citation: Cohen B, Murray M, Jia H .
Is hand hygiene frequency associated with the onset of outbreaks in pediatric long-term care?
Am J Infect Control 2016 Dec;44(12):1492-94. doi: 10.1016/j.ajic.2016.06.022.
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Keywords: Prevention, Children/Adolescents, Long-Term Care, Healthcare-Associated Infections (HAIs), Patient Safety, Children/Adolescents
Peterson LR, Boehm S, Beaumont JL
Reduction of methicillin-resistant Staphylococcus aureus infection in long-term care is possible while maintaining patient socialization: a prospective randomized clinical trial.
The researchers sought to demonstrate that a novel, minimally invasive program not interfering with activities of daily living or socialization could lower methicillin-resistant Staphylococcus aureus (MRSA) disease in long-term care facilities (LTCFs). They found that the MRSA infection rate decreased 65% between baseline and year 2, with a significant reduction observed at each of the three participating LTCFs. They concluded that on-site MRSA surveillance with targeted decolonization resulted in a significant decrease in clinical MRSA infection among LTCF residents.
AHRQ-funded; HS019968.
Citation: Peterson LR, Boehm S, Beaumont JL .
Reduction of methicillin-resistant Staphylococcus aureus infection in long-term care is possible while maintaining patient socialization: a prospective randomized clinical trial.
Am J Infect Control 2016 Dec;44(12):1622-27. doi: 10.1016/j.ajic.2016.04.251.
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Keywords: Healthcare-Associated Infections (HAIs), Long-Term Care, Methicillin-Resistant Staphylococcus aureus (MRSA), Patient Safety, Prevention
Coyle CE, Putman M, Kramer J
The role of aging and disability resource centers in serving adults aging with intellectual disabilities and their families: findings from seven states.
The purpose of this project was to assess the activities of aging and disability resource centers (ADRCs) as they seek to serve older adults with intellectual disabilities and their family caregivers. Results of this qualitative analysis indicate that ADRCs are not focusing explicitly on adults aging with intellectual and developmental disabilities and their family caregivers.
AHRQ-funded; HS017589.
Citation: Coyle CE, Putman M, Kramer J .
The role of aging and disability resource centers in serving adults aging with intellectual disabilities and their families: findings from seven states.
J Aging Soc Policy 2016;28(1):1-14. doi: 10.1080/08959420.2015.1096142.
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Keywords: Caregiving, Disabilities, Elderly, Long-Term Care
Murray MT, Heitkempber E, Jackson O
Direct costs of acute respiratory infections in a pediatric long-term care facility.
Acute respiratory tract infections (ARI) are a major burden in pediatric long-term care. The researchers analyzed the financial impact of ARI in 2012-2013. Costs associated with ARI during the respiratory viral season were ten times greater than during the non-respiratory viral season, $31,224 and $3,242 per 1000 patient-days, respectively.
AHRQ-funded; HS021470.
Citation: Murray MT, Heitkempber E, Jackson O .
Direct costs of acute respiratory infections in a pediatric long-term care facility.
Influenza Other Respir Viruses 2016 Jan;10(1):34-6. doi: 10.1111/irv.12350.
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Keywords: Children/Adolescents, Respiratory Conditions, Long-Term Care, Healthcare Costs, Children/Adolescents
Berry SD, Lee Y, Zullo AR
Incidence of hip fracture in U.S. nursing homes.
The researchers described the incidence rate (IR) of hip fracture according to age, sex, and race in a nationwide sample of long-stay nursing home residents. They found that the mean age was 84 years, 74.5% were women, 83.9% were white, and 12.0% were black. The overall IR of hip fracture was 2.3/100 person years, which was similar in men and women across age groups. The IR of hip fracture was highest in Native Americans aged 85 years or older, in whites, and during the first 100 days of institutionalization, while the.IRs of hip fracture were lowest in blacks.
AHRQ-funded; HS022998.
Citation: Berry SD, Lee Y, Zullo AR .
Incidence of hip fracture in U.S. nursing homes.
J Gerontol A Biol Sci Med Sci 2016 Sep;71(9):1230-4. doi: 10.1093/gerona/glw034.
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Keywords: Elderly, Injuries and Wounds, Long-Term Care, Nursing Homes, Racial and Ethnic Minorities
Abrahamson K, Davila H, Rehkamp N
Is there a business case for nursing home quality improvement?
The objective of this study was to investigate the economic or business perspective surrounding QI participation by exploring nursing home leader perceptions regarding market-based motivations for improvements, or a business case for engaging in a quality improvement project.
AHRQ-funded; HS018464.
Citation: Abrahamson K, Davila H, Rehkamp N .
Is there a business case for nursing home quality improvement?
Nurs Econ 2016 Sep-Oct;34(5):224-9, 35..
Keywords: Long-Term Care, Nursing Homes, Quality Improvement
McGarry BE, Temkin-Greener H, Chapman BP
The impact of consumer numeracy on the purchase of long-term care insurance.
The researchers sought to determine the effect of consumers' numeric abilities on the likelihood of owning private long-term care insurance (LTCI). Using the 2010 wave of the Health and Retirement Study, they found that each additional correct answer on a numeracy scale was associated with a 13% increase in the likelihood of holding LTCI. They recommended that policy efforts aimed at increasing consumer decision support or restructuring the marketplace for long-term care insurance may be needed to increase older adults' ability to prepare for future long-term care expenses.
AHRQ-funded; HS023714.
Citation: McGarry BE, Temkin-Greener H, Chapman BP .
The impact of consumer numeracy on the purchase of long-term care insurance.
Health Serv Res 2016 Aug;51(4):1612-31. doi: 10.1111/1475-6773.12439.
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Keywords: Education: Patient and Caregiver, Healthcare Costs, Health Insurance, Long-Term Care