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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 25 of 220 Research Studies DisplayedCE Kranz, AM DeYoreo, M
Access, quality, and financial performance of rural hospitals following health system affiliation.
This study examined the effect of a rural hospital affiliating itself with a health system. The comparison study used data from 2008 to 2017. A propensity score-weighted set of twelve measures were used on structure, utilization, financial performance, and quality. The rural hospitals that affiliated themselves with a health system experienced a significant reduction in on-site diagnostic imaging technologies, the availability of obstetric and primary care services, and outpatient nonemergency visits as well as a significant increase in operating margins. While these affiliations may help to keep a rural hospital open, it may also reduce access to services in these rural areas.
AHRQ-funded; HS024067.
Citation: CE Kranz, AM DeYoreo, M .
Access, quality, and financial performance of rural hospitals following health system affiliation.
Health Aff 2019 Dec;38(12):2095-104. doi: 10.1377/hlthaff.2019.00918..
Keywords: Provider Performance, Quality of Care, Hospitals, Rural Health
Napolitano N, Laverriere EK, Craig N
Apneic oxygenation as a quality improvement intervention in an academic PICU.
The objective of this prospective pre/post observational study was to evaluate if the use of apneic oxygenation during tracheal intubation in children is feasible and would decrease the occurrence of oxygen desaturation. The investigators concluded that implementation of apneic oxygenation in PICU was feasible, and was associated with significant reduction in moderate and severe oxygen desaturation. They suggest that use of apneic oxygenation should be considered when intubating critically ill children.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Napolitano N, Laverriere EK, Craig N .
Apneic oxygenation as a quality improvement intervention in an academic PICU.
Pediatr Crit Care Med 2019 Dec;20(12):e531-e37. doi: 10.1097/pcc.0000000000002123..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Quality Improvement, Quality of Care, Patient Safety, Adverse Events
Stoops C, Stone S, Evans E
Baby NINJA (Nephrotoxic Injury Negated by Just-in-Time Action): reduction of nephrotoxic medication-associated acute kidney injury in the neonatal intensive care unit.
The purpose of this study was to test if acute kidney injury (AKI) is preventable in patients in the neonatal intensive care unit and if infants at high-risk of nephrotoxic medication-induced AKI can be identified using a systematic surveillance program previously used in the pediatric non-intensive care unit setting. The authors concluded that a systematic surveillance program to identify high-risk infants can prevent nephrotoxic-induced AKI and has the potential to prevent short and long-term consequences of AKI in critically ill infants.
AHRQ-funded; HS023763.
Citation: Stoops C, Stone S, Evans E .
Baby NINJA (Nephrotoxic Injury Negated by Just-in-Time Action): reduction of nephrotoxic medication-associated acute kidney injury in the neonatal intensive care unit.
J Pediatr 2019 Dec;215:223-28.e6. doi: 10.1016/j.jpeds.2019.08.046..
Keywords: Newborns/Infants, Medication, Medication: Safety, Patient Safety, Kidney Disease and Health, Intensive Care Unit (ICU), Critical Care, Quality Improvement, Quality of Care, Prevention, Adverse Drug Events (ADE), Adverse Events
Sheetz KH, Dimick JB, Nathan H
Centralization of high-risk cancer surgery within existing hospital systems.
Centralization is often proposed as a strategy to improve the quality of certain high-risk health care services. In this study, the investigators evaluated the extent to which existing hospital systems centralize high-risk cancer surgery and whether centralization is associated with short-term clinical outcomes. The investigators concluded that greater centralization of complex cancer surgery within existing hospital systems was associated with better outcomes.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Dimick JB, Nathan H .
Centralization of high-risk cancer surgery within existing hospital systems.
J Clin Oncol 2019 Dec 1;37(34):3234-42. doi: 10.1200/jco.18.02035..
Keywords: Surgery, Cancer, Risk, Hospitals, Health Systems, Quality Improvement, Quality Indicators (QIs), Quality of Care, Outcomes
Mafi JN, May FP, Kahn KL
Low-value proton pump inhibitor prescriptions among older adults at a large academic health system.
Researchers sought to characterize the prevalence of potentially low-value proton pump inhibitor (PPI) prescriptions among older adults to inform a quality improvement intervention. Subjects were patients, aged 65 years or older, receiving primary care at a large academic health system in 2018. The researchers found that one in eight older adults were prescribed a PPI, and over one-third of prescriptions were potentially low-value. They conclude that, with most potentially low-value prescribing concentrated among a small subset of primary care physicians, interventions targeting them and/or applying EHR-based automatic stopping rules may protect older adults from harm.
AHRQ-funded; HS024067.
Citation: Mafi JN, May FP, Kahn KL .
Low-value proton pump inhibitor prescriptions among older adults at a large academic health system.
J Am Geriatr Soc 2019 Dec;67(12):2600-05. doi: 10.1111/jgs.16117..
Keywords: Elderly, Medication, Quality Improvement, Quality of Care, Primary Care
Singh H, Graber ML, Hofer TP
Measures to improve diagnostic safety in clinical practice.
In this paper, the investigators discuss how the need to develop measures to improve diagnostic performance could move forward at a time when the scientific foundation needed to inform measurement is still evolving. They highlight challenges and opportunities for developing potential measures of "diagnostic safety" related to clinical diagnostic errors and associated preventable diagnostic harm. In doing so, they propose a starter set of measurement concepts for initial consideration that seem reasonably related to diagnostic safety and call for these to be studied and further refined.
AHRQ-funded; HS022087.
Citation: Singh H, Graber ML, Hofer TP .
Measures to improve diagnostic safety in clinical practice.
J Patient Saf 2019 Dec;15(4):311-16. doi: 10.1097/pts.0000000000000338.
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Keywords: Patient Safety, Diagnostic Safety and Quality, Healthcare Delivery, Quality Improvement, Quality of Care, Medical Errors, Adverse Events
Ailabouni NJ, Marcum ZA, Schmader KE
Medication use quality and safety in older adults: 2018 update.
This study identified four key articles from 2018 that address medication use quality and safety for older adults. The first study highlighted a cluster-randomized trial that utilized a pharmacist-led education-based intervention delivered to both patients and doctors to deprescribe four types of inappropriate medications. The second study from the UK examined the association between anticholinergic exposure, overall and by medication class, and dementia risk in 40,770 older adults. The third study was a Swedish longitudinal cohort study examining the association between antihypertensive medications and incident dementia. The fourth and last study was a randomized, double-blind, placebo-controlled trial and examined the effect of daily low-dose aspirin for primary prevention of cardiac events and hemorrhage in 19,144 community-dwelling older adults.
AHRQ-funded; HS022982.
Citation: Ailabouni NJ, Marcum ZA, Schmader KE .
Medication use quality and safety in older adults: 2018 update.
J Am Geriatr Soc 2019 Dec;67(12):2458-62. doi: 10.1111/jgs.16243..
Keywords: Elderly, Medication, Medication: Safety, Patient Safety, Quality of Care, Provider: Pharmacist, Provider
Artis KA, Dweik RA, Patel B
Performance measure development, use, and measurement of effectiveness using the guideline on mechanical ventilation in acute respiratory distress syndrome. an official American Thoracic Society workshop report.
This report summarizes the proceedings of a workshop convened to advance the American Thoracic Society’s work in performance measure development and guideline implementation. The example of a low-tidal volume ventilation performance measure created from the 2017 ATS clinical practice guideline is used to illustrate the application of the ATS performance measure development framework, including detailed explanation of the rationale for the specifications chosen, identification of areas in need of further validity testing, and a preliminary strategy for testing the performance measure.
AHRQ-funded; HS024552.
Citation: Artis KA, Dweik RA, Patel B .
Performance measure development, use, and measurement of effectiveness using the guideline on mechanical ventilation in acute respiratory distress syndrome. an official American Thoracic Society workshop report.
Ann Am Thorac Soc 2019 Dec;16(12):1463-72. doi: 10.1513/AnnalsATS.201909-665ST..
Keywords: Respiratory Conditions, Guidelines, Evidence-Based Practice, Quality Measures, Quality of Care, Provider Performance
Rosenthal M, Shortell S, Shah ND
Physician practices in Accountable Care Organizations are more likely to collect and use physician performance information, yet base only a small proportion of compensation on performance data.
The purpose of this study was to characterize the strategies that physician practices use to improve clinician performance and determine their association with accountable care organizations (ACOs) and other payment reforms. The investigators concluded that ACO-affiliated practices are using more performance improvement strategies than other practices, but base only a small fraction of compensation on quality or cost.
AHRQ-funded; HS024075.
Citation: Rosenthal M, Shortell S, Shah ND .
Physician practices in Accountable Care Organizations are more likely to collect and use physician performance information, yet base only a small proportion of compensation on performance data.
Health Serv Res 2019 Dec;54(6):1214-22. doi: 10.1111/1475-6773.13238..
Keywords: Provider Performance, Payment, Quality Improvement, Quality of Care
Barbash IJ, Kahn JM
Sepsis quality in safety-net hospitals: an analysis of Medicare's SEP-1 performance measure.
Researchers studied the relationship between hospital safety-net status and performance on Medicare's SEP-1 quality measure. Data from 2827 hospitals were analyzed. They found that existing sepsis policies may harm safety-net hospitals and widen health disparities. They suggest that strategies to promote collaboration among hospitals may be an avenue for sepsis performance improvement in these hospitals.
AHRQ-funded; HS025455.
Citation: Barbash IJ, Kahn JM .
Sepsis quality in safety-net hospitals: an analysis of Medicare's SEP-1 performance measure.
J Crit Care 2019 Dec;54:88-93. doi: 10.1016/j.jcrc.2019.08.009.
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Keywords: Sepsis, Quality Measures, Quality of Care, Hospitals, Provider Performance, Quality Improvement
King CR, Abraham J, Kannampallil TG
Protocol for the effectiveness of an anesthesiology control tower system in improving perioperative quality metrics and clinical outcomes: the TECTONICS randomized, pragmatic trial.
The primary objective of this trial was to determine whether an anesthesiology control tower (ACT) prevents clinically relevant adverse postoperative outcomes including 30-day mortality, delirium, respiratory failure, and acute kidney injury. Clinicians in operating rooms randomized to ACT support receive decision support from clinicians in the ACT. In operating rooms randomized to no intervention, the current standard of anesthesia care is delivered. The intention-to-treat principle will be followed for all analyses.
AHRQ-funded; HS024581.
Citation: King CR, Abraham J, Kannampallil TG .
Protocol for the effectiveness of an anesthesiology control tower system in improving perioperative quality metrics and clinical outcomes: the TECTONICS randomized, pragmatic trial.
F1000Res 2019 Nov 29;8:2032. doi: 10.12688/f1000research.21016.1.
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Keywords: Quality Measures, Quality Improvement, Quality of Care, Surgery, Telehealth, Health Information Technology (HIT)
Schuttner L, Wong ES, Rosland AM
Association of the patient-centered medical home implementation with chronic disease quality in patients with multimorbidity.
The purpose of this retrospective cohort study was to examine the association of Patient-Aligned Care Team (PACT) implementation, the Veterans Health Administration (VA) PCMH model, and care quality for multimorbid patients enrolled in VA primary care from 2012 to 2014. The investigators found that for one-third of metrics (5/15), greater implementation of PACT in 2012 was associated with higher predicted probability of meeting the quality metric in 2013-2014. This association persisted for only two metrics among patients with > 5 chronic diseases.
AHRQ-funded; HS026369.
Citation: Schuttner L, Wong ES, Rosland AM .
Association of the patient-centered medical home implementation with chronic disease quality in patients with multimorbidity.
J Gen Intern Med 2020 Oct;35(10):2932-38. doi: 10.1007/s11606-020-06076-7..
Keywords: Patient-Centered Healthcare, Implementation, Chronic Conditions, Primary Care: Models of Care, Primary Care, Quality Improvement, Quality of Care
Evensen CT, Yost KJ, Keller S
Development and testing of the CAHPS Cancer Care Survey.
In order to develop the CAHPS Cancer Care Survey instrument, the authors conducted cognitive tests of the instrument as well as field tests at six cancer centers and four community oncology practices; the survey was then finalized and obtained the CAHPS trademark. The authors recommend mail-only, mail-telephone mixed-mode, and Web-mail mixed-mode data collection methods.
AHRQ-funded; 290200600019I.
Citation: Evensen CT, Yost KJ, Keller S .
Development and testing of the CAHPS Cancer Care Survey.
J Oncol Pract 2019 Nov;15(11):e969-e78. doi: 10.1200/jop.19.00039..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Cancer, Patient Experience, Quality of Care
Grant MC, Gibbons MM, Ko CY
Evidence review conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery: focus on anesthesiology for gynecologic surgery.
This paper is an evidence review of enhanced recovery after surgery (ERAS) protocols for gynecologic surgery that will be used as part of AHRQ’s Safety Program for Improving Surgical Care and Recovery. This initiative was developed in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality. The authors conducted a literature review of the various anesthesia components which may influence outcomes and facilitate recovery after gynecological surgery. They included interventions for preoperative, intraoperative, and postoperative phases of care and then summarized the best available evidence for ERAS for gynecological surgery. The best evidence was summarized for recommendations to be used in the initiative.
Citation: Grant MC, Gibbons MM, Ko CY .
Evidence review conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery: focus on anesthesiology for gynecologic surgery.
AHRQ-funded; 233201500020I..
Keywords: Patient Safety, Surgery, Quality Improvement, Quality of Care, Evidence-Based Practice, Patient-Centered Outcomes Research, Women
Davis MM, Gunn R, Kenzie E
Integration of improvement and implementation science in practice-based research networks: a longitudinal, comparative case study.
This study’s goal was to systematically examine implementation science (IS), quality improvement (QI), and IS/QI projects conducted within a practice-based research network (PBRN) over time to identify similarities, differences, and synergies. Documents were reviewed and staff interviews were conducted in the Oregon Rural Practice-based Research Network (ORPRN) from January 2007 to January 2019. Almost 30% of ORPRN’s projects (26/99) included IS or QI elements, and 54% were classified as IS/QI. All 26 projects used an evidence-based intervention and shared many similarities in relation to objective and settings. Randomized designs and theoretical frameworks were used by over half of the IS and IS/QI projects, while no QI projects did. Projects used a similar number of practice change strategies.
AHRQ-funded; HS027080.
Citation: Davis MM, Gunn R, Kenzie E .
Integration of improvement and implementation science in practice-based research networks: a longitudinal, comparative case study.
J Gen Intern Med 2021 Jun;36(6):1503-13. doi: 10.1007/s11606-021-06610-1..
Keywords: Implementation, Quality Improvement, Quality of Care
Leary JC, Walsh KE, Morin RA
Quality and safety of pediatric inpatient care in community hospitals: a scoping review.
This study’s aim was to conduct a scoping review and synthesize literature on the quality and safety of pediatric inpatient care in nonpediatric hospitals in the United States. A systematic literature review was performed in October 2016 to identify pediatric studies that reported on safety, effectiveness, efficiency, timeliness, patient-centeredness, or equity set. A total of 44 articles were included using inclusion criteria. There was a moderate or high risk of bias for 72% of the studies. This study shows there is very limited research currently and would benefit from more multicenter collaborations.
AHRQ-funded; HS024133.
Citation: Leary JC, Walsh KE, Morin RA .
Quality and safety of pediatric inpatient care in community hospitals: a scoping review.
J Hosp Med 2019 Nov 1;14(10):694-703. doi: 10.12788/jhm.3268..
Keywords: Patient-Centered Outcomes Research, Evidence-Based Practice, Children/Adolescents, Inpatient Care, Hospitals, Patient Safety, Quality of Care
Sharma H, Konetzka RT, Smieliauskas F
The relationship between reported staffing and expenditures in nursing homes.
AHRQ-funded; HS024967.
Citation: Sharma H, Konetzka RT, Smieliauskas F .
The relationship between reported staffing and expenditures in nursing homes.
Med Care Res Rev 2019 Dec 1;76(6):758-83. doi: 10.1177/1077558717739214..
Keywords: Nursing Homes, Long-Term Care, Quality Improvement, Quality of Care, Provider Performance, Medicare
Ellis RJ, Zhang LM, Ko CY
Variation in hospital utilization of minimally invasive distal pancreatectomy for localized pancreatic neoplasms.
The objectives of this study were to identify factors associated with use of minimally invasive distal pancreatectomy (MIDP) for localized neoplasms and to assess hospital variation in MIDP utilization. Results showed that utilization of MIDP for localized pancreatic neoplasms is highly variable; while some patient-level factors are associated with MIDP use, hospital adoption of MIDP appears to be the primary driver of utilization. Monitoring hospital-level use of MIDP may be a useful quality measure to monitor uptake of emerging techniques in pancreatic surgery.
AHRQ-funded; HS026385; HS000078.
Citation: Ellis RJ, Zhang LM, Ko CY .
Variation in hospital utilization of minimally invasive distal pancreatectomy for localized pancreatic neoplasms.
J Gastrointest Surg 2020 Dec;24(12):2780-88. doi: 10.1007/s11605-019-04414-7..
Keywords: Cancer, Surgery, Hospitals, Quality of Care
McWilliams JM, Barnett ML, Roberts ET
Did hospital readmissions fall because per capita admission rates fell?
In this study examining the cause of falling hospital readmission rates, the investigators found that the probability of an admission occurring soon after another was lower when there were fewer admissions per patient. The authors indicate that the reduction in admission rates may explain much of the reduction in readmission rates.
AHRQ-funded; HS026727.
Citation: McWilliams JM, Barnett ML, Roberts ET .
Did hospital readmissions fall because per capita admission rates fell?
Health Aff 2019 Nov;38(11):1840-44. doi: 10.1377/hlthaff.2019.00411..
Keywords: Hospital Readmissions, Hospitals, Hospitalization, Quality of Care, Medicare
Ray X, Bojechko C, Moore KL
Evaluating the sensitivity of Halcyon's automatic transit image acquisition for treatment error detection: a phantom study using static IMRT.
The Varian Halcyon electronic portal imaging detector is always in-line with the beam and automatically acquires transit images for every patient with full-field coverage. These images could be used for "every patient, every monitor unit" quality assurance (QA) and eventually adaptive radiotherapy. This study evaluated the imager's sensitivity to potential clinical errors and day-to-day variations from clinical exit images.
AHRQ-funded; HS025440.
Citation: Ray X, Bojechko C, Moore KL .
Evaluating the sensitivity of Halcyon's automatic transit image acquisition for treatment error detection: a phantom study using static IMRT.
J Appl Clin Med Phys 2019 Nov;20(11):131-43. doi: 10.1002/acm2.12749..
Keywords: Imaging, Quality of Care
Sheetz KH, Dimick JB, Englesbe MJ
Hospital-acquired condition reduction program is not associated with additional patient safety improvement.
In 2013 the Centers for Medicare and Medicaid Services announced that it would begin levying penalties against hospitals with the highest rates of hospital-acquired conditions through the Hospital-Acquired Condition Reduction Program. This study evaluates whether the program has been successful in improving patient safety or not. The investigators concluded that the program did not improve patient safety in Michigan beyond existing trends.
AHRQ-funded; HS000053; HS026244.
Citation: Sheetz KH, Dimick JB, Englesbe MJ .
Hospital-acquired condition reduction program is not associated with additional patient safety improvement.
Health Aff 2019 Nov;38(11):1858-65. doi: 10.1377/hlthaff.2018.05504..
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Patient Safety, Provider Performance, Quality Improvement, Quality of Care, Infectious Diseases, Payment
Keshvani N, Berger K, Gupta A
Improving respiratory rate accuracy in the hospital: a quality improvement initiative.
Researchers initiated a quality improvement (QI) initiative in hospitals to improve respiratory rate measurement accuracy. Time-keeping devices were added to vital sign carts and patient care assistants were retrained on a newly modified workflow that included concomitant respiratory rate (RR) measurement during automated blood pressure measurement. The median RR measurement rate increased postintervention. This intervention was associated with a 7.8% reduced incidence of tachypnea-specific systemic inflammatory response syndrome. This QI initiative was interdisciplinary, low-cost, and low-tech.
AHRQ-funded; HS022418.
Citation: Keshvani N, Berger K, Gupta A .
Improving respiratory rate accuracy in the hospital: a quality improvement initiative.
J Hosp Med 2019 Nov 1;14(10):673-77. doi: 10.12788/jhm.3232..
Keywords: Patient-Centered Outcomes Research, Quality Improvement, Inpatient Care, Diagnostic Safety and Quality, Hospitals, Quality of Care, Outcomes
Blecker S, Austrian JS, Horwitz LI
Interrupting providers with clinical decision support to improve care for heart failure.
The goal of this study was to develop a clinical decision support (CDS) system to recommend an angiotenson converting enzyme (ACE) inhibitor during hospitalization so it could be promoted for continuation at discharge. Patients who were hospitalized with reduced ejection fraction were pseudo-randomized to deliver interruptive or non-interruptive CDS alerts to providers based on the patients’ even or odd medical record number. The utilization rate was higher for interruptive alert versus non-interruptive alert hospitalizations for a sample of 958. This resulted in improved quality of care for heart failure patients.
AHRQ-funded; HS023683.
Citation: Blecker S, Austrian JS, Horwitz LI .
Interrupting providers with clinical decision support to improve care for heart failure.
Int J Med Inform 2019 Nov;131:103956. doi: 10.1016/j.ijmedinf.2019.103956..
Keywords: Clinical Decision Support (CDS), Decision Making, Heart Disease and Health, Cardiovascular Conditions, Medication, Medication: Safety, Patient Safety, Quality Improvement, Quality of Care
Kang SK, Garry K, Chung R
Natural language processing for identification of incidental pulmonary nodules in radiology reports.
The authors developed natural language processing (NLP) to identify incidental lung nodules (ILNs) in radiology reports for assessment of management recommendations using the electronic health records for patients who underwent chest CT before and after implementation of a department-wide dictation macro of the Fleischner Society recommendations. They concluded that NLP reliably automates identification of ILNs in unstructured reports, pertinent to quality improvement efforts for ILN management.
AHRQ-funded; HS024376.
Citation: Kang SK, Garry K, Chung R .
Natural language processing for identification of incidental pulmonary nodules in radiology reports.
J Am Coll Radiol 2019 Nov;16(11):1587-94. doi: 10.1016/j.jacr.2019.04.026..
Keywords: Imaging, Diagnostic Safety and Quality, Health Information Technology (HIT), Electronic Health Records (EHRs), Quality Improvement, Quality of Care
Hempel S, Miake-Lye I, Brega AG
Quality improvement toolkits: recommendations for development.
The authors convened a panel of health care stakeholders informed by a literature review that analyzed 44 publications and 27 toolkits. The panel formed 12 recommendations for content and 1 recommendation for toolkit development methods. The authors then established a set of key recommendations and suggestions addressing the content, development, and evaluation methods of quality improvement toolkits, together with a ready-to-use checklist.
AHRQ-authored.
Citation: Hempel S, Miake-Lye I, Brega AG .
Quality improvement toolkits: recommendations for development.
Am J Med Qual 2019 Nov/Dec;34(6):538-44. doi: 10.1177/1062860618822102..
Keywords: Quality Improvement, Quality of Care, Tools & Toolkits
