National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (1)
- Adverse Events (3)
- Behavioral Health (3)
- Caregiving (1)
- Case Study (1)
- Children's Health Insurance Program (CHIP) (1)
- (-) Children/Adolescents (20)
- Communication (1)
- Community-Acquired Infections (1)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (2)
- Critical Care (2)
- Dental and Oral Health (1)
- Diagnostic Safety and Quality (1)
- Disabilities (1)
- Disparities (1)
- Emergency Department (1)
- Evidence-Based Practice (1)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (2)
- Health Information Technology (HIT) (2)
- Health Insurance (3)
- Hospitalization (1)
- Hospital Readmissions (2)
- Hospitals (4)
- Inpatient Care (1)
- Intensive Care Unit (ICU) (1)
- Long-Term Care (1)
- Low-Income (2)
- Medicaid (1)
- Medical Errors (1)
- Medication (1)
- Outcomes (2)
- Patient-Centered Outcomes Research (2)
- Patient Experience (2)
- Patient Safety (5)
- Payment (1)
- Pneumonia (1)
- Policy (1)
- Prevention (1)
- Primary Care (1)
- Quality Improvement (7)
- Quality Indicators (QIs) (2)
- Quality Measures (5)
- (-) Quality of Care (20)
- Racial and Ethnic Minorities (3)
- Risk (1)
- Social Determinants of Health (1)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 20 of 20 Research Studies DisplayedNapolitano 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
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
Olin S, Storfer-Isser A, Morden E
Quality measures for managing prescription of antipsychotic medication among youths: factors associated with health plan performance.
This study examined the performance of health plans on two Healthcare Effectiveness Data and Information Set (HEDIS) measures: metabolic monitoring of children and adolescents prescribed an antipsychotic and use of first-line psychosocial care for children and adolescents prescribed an antipsychotic for a nonindicated use. This study then identified key plan characteristics and other contextual factors associated with health plan performance on quality measures related to pediatric antipsychotic prescribing. Findings suggested that quality measures, in conjunction with policies such as prior authorization, can encourage better care delivery to vulnerable populations.
ARHQ-funded; HS020503; HS025296.
Citation: Olin S, Storfer-Isser A, Morden E .
Quality measures for managing prescription of antipsychotic medication among youths: factors associated with health plan performance.
Psychiatr Serv 2019 Nov;70(11):1020-26. doi: 10.1176/appi.ps.201900089..
Keywords: Children/Adolescents, Medication, Behavioral Health, Quality Measures, Quality of Care, Health Insurance
Shenkman E, Tomar S, Manning D
Feasibility and usability of measuring receipt of sealants in 2 states.
In this study, the authors examined the reliability and validity of the Dental Quality Alliance childhood sealant measure under actual use conditions in Texas and Florida. The 2 states provide care for almost 20% of children in Medicaid nationally. They proposed eliminating the caries risk assessment requirement and incorporating a 3-year look-back period to identify already sealed, missing, or restored molars.
AHRQ-funded; U18 HS025298.
Citation: Shenkman E, Tomar S, Manning D .
Feasibility and usability of measuring receipt of sealants in 2 states.
J Am Dent Assoc 2019 Oct;150(10):839-45. doi: 10.1016/j.adaj.2019.05.022..
Keywords: Dental and Oral Health, Children/Adolescents, Quality Measures, Quality of Care
Montalbano A, Quinonez RA, Hall M
Achievable benchmarks of care for pediatric readmissions.
This study’s objective was to calculate mean readmission rates and the Achievable Benchmarks of Care (ABCs) for pediatric diagnoses by different hospital types: metropolitan teaching, metropolitan nonteaching, and nonmetropolitan hospitals. The authors used a cross-sectional retrospective study of 30-day, all-cause same-hospital readmission of patients less than 18 years of age using the 2014 HCUP National Readmission Database. They calculated mean readmission and corresponding ABCs for the 17 most common readmission diagnosis. They found that sickle cell disease (SCD), bipolar and major depressive disorders were the most common reasons for readmission.
AHRQ-funded; HS024554.
Citation: Montalbano A, Quinonez RA, Hall M .
Achievable benchmarks of care for pediatric readmissions.
J Hosp Med 2019 Sep;14(9):534-40. doi: 10.12788/jhm.3201..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Hospital Readmissions, Hospitals, Quality of Care
Desai AD, Starmer AJ
Process metrics and outcomes to inform quality improvement in pediatric hospital medicine.
This article provides an overview of the selection, development, and use of process and outcome measures for pediatric hospital medicine quality improvement initiatives. It reviews commonly used categories of process and outcome measures, provides a list of common sources and repositories of previously validated measures, and provides a blueprint for the development of novel measures.
AHRQ-funded; HS024299.
Citation: Desai AD, Starmer AJ .
Process metrics and outcomes to inform quality improvement in pediatric hospital medicine.
Pediatr Clin North Am 2019 Aug;66(4):725-37. doi: 10.1016/j.pcl.2019.03.002..
Keywords: Children/Adolescents, Hospitals, Quality of Care, Quality Improvement, Quality Measures, Outcomes, Patient-Centered Outcomes Research
Nakamura MM, Toomey SL, Zaslavsky AM
Potential impact of initial clinical data on adjustment of pediatric readmission rates.
This study investigated whether the addition of adding initial clinical data to adjust for case-mix (differences in patient populations) improved prediction of pediatric readmissions. Thirty-day readmissions were examined using claims and electronic records for patients aged 18 and younger who were admitted to 3 children’s hospitals from February 2011 to February 2014. The Pediatric All-Condition Readmission Measure was used and started with a model including age, gender, chronic conditions, and primary diagnosis. Initial vital sign and laboratory data was added to see if it improved model performance. Greater readmission risk was found if there was a low red blood cell count and mean corpuscular hemoglobin concentration and high red cell distribution risk. However, it did not provide more than minimal improvement in performance.
AHRQ-funded; HS020513; HS025299.
Citation: Nakamura MM, Toomey SL, Zaslavsky AM .
Potential impact of initial clinical data on adjustment of pediatric readmission rates.
Acad Pediatr 2019 Jul;19(5):589-98. doi: 10.1016/j.acap.2018.09.006..
Keywords: Children/Adolescents, Hospital Readmissions, Risk, Quality Indicators (QIs), Quality Measures, Quality of Care
Toomey SL, Elliott MN, Zaslavsky AM
Improving response rates and representation of hard-to-reach groups in family experience surveys.
This study examined the use of an audio-enabled tablet to survey parents of children discharged from 4 units of a children’s hospital. Normal mail survey response rates are very low, especially for black, Latino, and low-income respondents. This survey was done day of discharge at the hospital and there was a response rate of 71.1% via tablet versus 16.3% for mail only. The Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was used. Tablet response rates were highest with fathers, those more likely to have a high school education or less, less likely to be white, and more likely to be publicly insured. The results are promising for future surveys using tablet administration.
AHRQ-funded; HS020513; HS025299.
Citation: Toomey SL, Elliott MN, Zaslavsky AM .
Improving response rates and representation of hard-to-reach groups in family experience surveys.
Acad Pediatr 2019 May - Jun;19(4):446-53. doi: 10.1016/j.acap.2018.07.007..
Keywords: Caregiving, Children/Adolescents, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Health Information Technology (HIT), Hospitals, Low-Income, Patient Experience, Quality of Care, Quality Improvement, Racial and Ethnic Minorities
Chien AT, Toomey SL, Kuo DZ
Care quality and spending among commercially insured children with disabilities.
Researchers examined the prevalence of children with disabilities (CWD) within a commercially insured population and compared outpatient care quality and annual health plan spending levels for CWD relative to children with complex medical conditions without disabilities; children with chronic conditions that are not complex; and children without disabling, complex, or chronic conditions. The cross-sectional study comprised over 1M person-years of Blue Cross Blue Shield Massachusetts data for beneficiaries aged from 1 to 19 years. The researchers found that CWD were prevalent in the commercially insured population, with these children experiencing suboptimal levels of care which were comparable to non-CWD groups. They concluded that improving the care value for CWD involves a deeper understanding of what higher spending delivers and additional aspects of care quality.
AHRQ-funded; HS025299.
Citation: Chien AT, Toomey SL, Kuo DZ .
Care quality and spending among commercially insured children with disabilities.
Acad Pediatr 2019 Apr;19(3):291-99. doi: 10.1016/j.acap.2018.06.004..
Keywords: Quality of Care, Children/Adolescents, Disabilities, Healthcare Costs, Health Insurance
Bundy DG, Singh H, Stein RE
The design and conduct of Project RedDE: a cluster-randomized trial to reduce diagnostic errors in pediatric primary care.
This paper discusses the results of Project RedDE, which was a virtual collaborative quality improvement study to reduce diagnostic errors in pediatric primary care practices. Forty-three practices were initially recruited, with a total of 31 practices left at the end due to practice dropout and two participating practices merging. This study was a randomized controlled trial targeting three common diagnostic errors (missed diagnoses of adolescent depression, abnormal blood pressure, and lack of followup for abnormal laboratory results). Contamination across study groups was a recurring problem, but risk mitigations were used. Electronic health records contributed to teams’ success.
AHRQ-funded; HS203608.
Citation: Bundy DG, Singh H, Stein RE .
The design and conduct of Project RedDE: a cluster-randomized trial to reduce diagnostic errors in pediatric primary care.
Clin Trials 2019 Apr;16(2):154-64. doi: 10.1177/1740774518820522..
Keywords: Adverse Events, Children/Adolescents, Diagnostic Safety and Quality, Medical Errors, Prevention, Primary Care, Quality of Care, Quality Improvement
Leyenaar JK, Andrews CB, Tyksinski ER
Facilitators of interdepartmental quality improvement: a mixed-methods analysis of a collaborative to improve pediatric community-acquired pneumonia management.
This study examined the relationship between emergency room (ER) physicians and hospital pediatricians in the use of narrow-spectrum antibiotics to treat children hospitalized with pneumonia. There were eight inter-related domains that were identified that contribute to successful quality improvement efforts. These domains include hospital leadership and support; quality improvement champions, and interdepartmental relationships.
AHRQ-funded; HS024133; HS024554.
Citation: Leyenaar JK, Andrews CB, Tyksinski ER .
Facilitators of interdepartmental quality improvement: a mixed-methods analysis of a collaborative to improve pediatric community-acquired pneumonia management.
BMJ Qual Saf 2019 Mar;28(3):215-22. doi: 10.1136/bmjqs-2018-008065..
Keywords: Children/Adolescents, Community-Acquired Infections, Emergency Department, Pneumonia, Quality of Care, Quality Improvement
Berrens ZJ, Gosdin CH, Brady PW
Efficacy and safety of pediatric critical care physician telemedicine involvement in rapid response team and code response in a satellite facility.
This study compared response rates at satellite inpatient facilities of larger children’s hospitals using telemedicine to response rates at main campus. Through the use of telemedicine, there was no difference in critical care response and rate of transfer to intensive-care units.
AHRQ-funded; HS023827.
Citation: Berrens ZJ, Gosdin CH, Brady PW .
Efficacy and safety of pediatric critical care physician telemedicine involvement in rapid response team and code response in a satellite facility.
Pediatr Crit Care Med 2019 Feb;20(2):172-77. doi: 10.1097/pcc.0000000000001796.
.
.
Keywords: Children/Adolescents, Critical Care, Quality of Care, Health Information Technology (HIT), Patient Safety
Stockwell DC, Landrigan CP, Toomey SL
Racial, ethnic, and socioeconomic disparities in patient safety events for hospitalized children.
Previous studies have revealed racial/ethnic and socioeconomic disparities in quality of care and patient safety. However, these disparities have not been examined in a pediatric inpatient environment by using a measure of clinically confirmed adverse events (AEs). In this study, the investigators do so using the Global Assessment of Pediatric Patient Safety (GAPPS) Trigger Tool. The investigators concluded that the GAPPS analysis revealed racial and/or ethnic and socioeconomic disparities in rates of AEs experienced by hospitalized children across a broad range of geographic and hospital settings.
AHRQ-funded; HS020513; HS025299.
Citation: Stockwell DC, Landrigan CP, Toomey SL .
Racial, ethnic, and socioeconomic disparities in patient safety events for hospitalized children.
Hosp Pediatr 2019 Jan;9(1):1-5. doi: 10.1542/hpeds.2018-0131..
Keywords: Children/Adolescents, Disparities, Racial and Ethnic Minorities, Social Determinants of Health, Hospitalization, Patient Safety, Quality of Care, Adverse Events
Goff SL, Mazor KM, Guhn-Knight H
Factors that matter to low-income and racial/ethnic minority mothers when choosing a pediatric practice: a mixed methods analysis.
The authors sought to understand potential barriers to using quality data by assessing what factors mattered to women when choosing a pediatric practice. They found that pediatrician characteristics and factors related to access to care may be more important to low-income and racial/ethnic minority women than more commonly reported quality metrics.
AHRQ-funded; HS021864.
Citation: Goff SL, Mazor KM, Guhn-Knight H .
Factors that matter to low-income and racial/ethnic minority mothers when choosing a pediatric practice: a mixed methods analysis.
J Racial Ethn Health Disparities 2017 Dec;4(6):1051-60. doi: 10.1007/s40615-016-0309-x.
.
.
Keywords: Access to Care, Quality of Care, Low-Income, Children/Adolescents, Racial and Ethnic Minorities
Joyce NR, Huskamp HA, Hadland SE
The alternative quality contract: impact on service use and spending for children with ADHD.
The authors used Blue Cross-Blue Shield of Massachusetts (BCBSMA) claims for 2006-2011 to compare youths enrolled in provider organizations participating in the alternative quality contract (AQC) with those not participating. They found that the AQC was associated with small increases in the probability of any outpatient visits and in the probability and number of medication management visits among children with attention-deficit hyperactivity disorder (ADHD). Further, spending did not change, and there was no evidence of reductions in service utilization or spending for children with ADHD in the first three years of AQC implementation.
AHRQ-funded; HS022998.
Citation: Joyce NR, Huskamp HA, Hadland SE .
The alternative quality contract: impact on service use and spending for children with ADHD.
Psychiatr Serv 2017 Dec;68(12):1210-12. doi: 10.1176/appi.ps.201700143.
.
.
Keywords: Children/Adolescents, Behavioral Health, Payment, Quality of Care, Healthcare Costs
Forman-Hoffman VL, Middleton JC, McKeeman JL
Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review.
The researchers describe the process by which they created an online interactive community resources map for use in the Connect for Health randomized controlled trial. The trial was conducted in the 6 pediatric practices that cared for the highest percentage of children with overweight or obesity. Parents and community partners identified several community resources that could help support behavior change.
AHRQ-funded; 290201200008I.
Citation: Forman-Hoffman VL, Middleton JC, McKeeman JL .
Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review.
Implement Sci 2017 Jul 24;12(1):93. doi: 10.1186/s13012-017-0626-4.
.
.
Keywords: Children/Adolescents, Communication, Behavioral Health, Quality of Care, Quality Improvement
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.
.
.
Keywords: Children/Adolescents, Long-Term Care, Patient Safety, Quality of Care
Toomey SL, Elliott MN, Zaslavsky AM
Variation in family experience of pediatric inpatient care as measured by child HCAHPS.
Making national comparisons of family experience of inpatient pediatric care has been limited by the lack of a publicly available survey. A new survey developed by AHRQ and the Centers for Medicare & Medicaid Services makes use of 18 measures. It found that family experience of pediatric inpatient care shows substantial room for improvement and varies considerably across hospitals and measures.
AHRQ-funded; HS020513.
Citation: Toomey SL, Elliott MN, Zaslavsky AM .
Variation in family experience of pediatric inpatient care as measured by child HCAHPS.
Pediatrics 2017 Apr;139(4):e20163372. doi: 10.1542/peds.2016-3372.
.
.
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Children/Adolescents, Patient Experience, Patient Experience, Quality of Care
Adirim T, Meade K, Mistry K
AHRQ Author: Mistry K
A new era in quality measurement: The development and application of quality measures.
Numerous national organizations focus on the development and application of quality measures, including the Pediatric Quality Measures Program, which is focused solely on the development and implementation of pediatric-specific measures. This policy statement provides an overview of quality measurement and describes the opportunities for pediatric health care providers to apply quality measures to improve clinical quality and performance in the delivery of pediatric health care services.
AHRQ-authored.
Citation: Adirim T, Meade K, Mistry K .
A new era in quality measurement: The development and application of quality measures.
Pediatrics 2017 Jan;139(1). doi: 10.1542/peds.2016-3442.
.
.
Keywords: Quality Indicators (QIs), Quality Improvement, Outcomes, Children/Adolescents, Quality of Care
Christensen AL, Petersen DM, Burton RA
What factors influence states' capacity to report children's health care quality measures? A multiple-case study.
The objective of this study was to describe factors that influence the ability of state Medicaid agencies to report the Centers for Medicare & Medicaid Services' (CMS) core set of children's health care quality measures . Reporting capacity was influenced by a state's Medicaid data availability, ability to link to other state data systems, past experience with quality measurement, staff time and technical expertise, and demand for the measures.
AHRQ-funded; 290200900019I; 29032004T.
Citation: Christensen AL, Petersen DM, Burton RA .
What factors influence states' capacity to report children's health care quality measures? A multiple-case study.
Matern Child Health J 2017 Jan;21(1):187-98. doi: 10.1007/s10995-016-2108-8.
.
.
Keywords: Quality Measures, Quality of Care, Children's Health Insurance Program (CHIP), Children/Adolescents, Medicaid, Health Insurance, Policy, Case Study