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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 44 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
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
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
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
Hsu HE, Wang R, Jentzsch MS
The impact of measurement changes on evaluating hospital performance: the case of catheter-associated urinary tract infections.
Researchers observed that catheter-associated urinary tract infections in 592 hospitals immediately declined after federal value-based incentive program implementation, but found that this was fully attributable to a concurrent surveillance case definition revision. They found that post revision, more hospitals had favorable standardized infection ratios, likely leading to artificial inflation of their performance scores unrelated to changes in patient safety.
AHRQ-funded; HS000063; HS025008; HS018414.
Citation: Hsu HE, Wang R, Jentzsch MS .
The impact of measurement changes on evaluating hospital performance: the case of catheter-associated urinary tract infections.
Infect Control Hosp Epidemiol 2019 Nov;40(11):1269-71. doi: 10.1017/ice.2019.240..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Hospitals, Patient Safety, Provider Performance, Quality Measures, Urinary Tract Infection (UTI)
Wood SJ, Albertson EM, Conrad DA
Accountable care program implementation and effects on participating health care systems in Washington state: a conceptual model.
This study used key informant interviews with health care executives representing 5 large health systems contracted with the Washington State Health Care Authority to provide accountable care network services under the State Innovation Model initiative. Two rounds of semistructured interviews were conducted, and results indicated the need to present a modified conceptual model aligned better with accountable care program (ACP) implementation.
AHRQ-funded; HS013853.
Citation: Wood SJ, Albertson EM, Conrad DA .
Accountable care program implementation and effects on participating health care systems in Washington state: a conceptual model.
J Ambul Care Manage 2019 Oct/Dec;42(4):321-36. doi: 10.1097/jac.0000000000000302..
Keywords: Health Systems, Provider Performance, Organizational Change, Health Services Research (HSR), Payment, Health Insurance, Implementation
White CM, Coleman CI, Jackman K
AHRQ series on improving translation of evidence: linking evidence reports and performance measures to help learning health systems use new information for improvement.
This paper analyzed ways to enhance usability of AHRQ’s Evidence-based Practice Center (EPC) reports. The reports are often lengthy and difficult for users to navigate. A quality measure index was created to allow health systems to more efficiently access relevant information. A test was created where two tables were embedded in an EPC report. The first identified quality measures covered by the report descriptively. The second contained page numbers in the executive summary which hyperlinked to those pages with the quality measures. An exercise with two health system-targeted scenarios was then created. The participants were timed how long it took to find answers to scenario questions and gave feedback. It was found that it took 63.4% less time to find quality measure information with the hyperlinked indexing tables than without. The participants felt that the tables were easy to use and more user friendly to health systems.
Jt Comm J Qual Patient Saf 2019 Oct;45(10):706-10. doi: 10.1016/j.jcjq.2019.05.002.
Citation: White CM, Coleman CI, Jackman K .
AHRQ series on improving translation of evidence: linking evidence reports and performance measures to help learning health systems use new information for improvement.
Jt Comm J Qual Patient Saf 2019 Oct;45(10):706-10. doi: 10.1016/j.jcjq.2019.05.002..
Keywords: Implementation, Evidence-Based Practice, Health Systems, Learning Health Systems, Patient-Centered Outcomes Research, Provider Performance, Quality Measures, Quality Improvement, Quality of Care
Lasater KB, Jarrin OF, Aiken LH
A methodology for studying organizational performance: a multistate survey of front-line providers.
The objective of this study was to describe a novel approach to obtaining a representative sample of organizations using individuals nested within organizations, and demonstrate how resurveying nonrespondents could allay concerns about bias from low response rates at the individual-level. The investigators concluded that surveying organizations via random sampling of front-line providers could avoid the self-selection issues caused by directly sampling organizations.
AHRQ-funded; HS022406.
Citation: Lasater KB, Jarrin OF, Aiken LH .
A methodology for studying organizational performance: a multistate survey of front-line providers.
Med Care 2019 Sep;57(9):742-49. doi: 10.1097/mlr.0000000000001167..
Keywords: Provider Performance, Organizational Change
Kim KL, LI L, Kuang M
Changes in hospital referral patterns to skilled nursing facilities under the Hospital Readmissions Reduction Program.
The objective of this study was to investigate the association between changes in hospital referral patterns to skilled nursing facilities (SNFs) and Hospital Readmissions Reduction Program (HRRP) penalty pressure. Results showed that HRRP did not prompt substantial changes in hospital referral patterns to SNFs, although readmissions for patients referred to SNFs differentially decreased more than for other patients, warranting investigation of other mechanisms underlying readmissions reduction.
AHRQ-funded; HS022882.
Citation: Kim KL, LI L, Kuang M .
Changes in hospital referral patterns to skilled nursing facilities under the Hospital Readmissions Reduction Program.
Med Care 2019 Sep;57(9):695-701. doi: 10.1097/mlr.0000000000001169..
Keywords: Hospitals, Nursing Homes, Hospital Readmissions, Payment, Provider Performance
Parchman ML, Anderson ML, Dorr DA
A randomized trial of external practice support to improve cardiovascular risk factors in primary care.
Researchers conducted a randomized controlled trial to compare the effectiveness of adding various forms of enhanced external support to practice facilitation on primary care practices' clinical quality measure (CQM) performance. They concluded that, although they found no significant differences in CQM performance across study arms, the ability of a practice to reach a target level of performance may be enhanced by adding both educational outreach visits and shared learning to practice facilitation.
AHRQ-funded; HS023908.
Citation: Parchman ML, Anderson ML, Dorr DA .
A randomized trial of external practice support to improve cardiovascular risk factors in primary care.
Ann Fam Med 2019 Aug 12;17(Suppl 1):S40-s49. doi: 10.1370/afm.2407..
Keywords: Cardiovascular Conditions, Primary Care, Quality Improvement, Provider Performance, Quality Measures, Quality of Care, Risk, Evidence-Based Practice, Patient-Centered Healthcare, Chronic Conditions
Barbash IJ, Davis B, Kahn JM
National performance on the Medicare SEP-1 sepsis quality measure.
Researchers characterized national performance on the sepsis measure known as SEP-1. They found that the majority of eligible hospitals reported SEP-1 data, and overall bundle compliance was highly variable. Further, SEP-1 performance was associated with structural hospital characteristics and performance on other measures of hospital quality, providing preliminary support for SEP-1 performance as a marker of timely hospital sepsis care.
AHRQ-funded; HS025455.
Citation: Barbash IJ, Davis B, Kahn JM .
National performance on the Medicare SEP-1 sepsis quality measure.
Crit Care Med 2019 Aug;47(8):1026-32. doi: 10.1097/ccm.0000000000003613..
Keywords: Sepsis, Quality Indicators (QIs), Quality Measures, Quality of Care, Hospitals, Provider Performance
Li Y, Cen X, Cai X
Perceived patient safety culture in nursing homes associated with "Nursing Home Compare" performance indicators.
This study examined the association between the use of “Nursing Home Compare” performance indicators and improved patient safety culture in nursing homes. A survey was conducted in 2017 using AHRQ’s Survey on Patient Safety Culture for Nursing Homes which collects data on 12 core domains of safety culture scores. Out of 2254 nursing homes sampled, there was a response rate of 36%. It was found that for every 10 percentage points increase in overall positive response rate for safety culture, there was an association with 0.56 fewer health care deficiencies, 0.74 fewer substantiated complaints, reduced fines by $2285.20, and 20% increased odds of being designed as 4-star or 5-star.
AHRQ-funded; HS024923.
Citation: Li Y, Cen X, Cai X .
Perceived patient safety culture in nursing homes associated with "Nursing Home Compare" performance indicators.
Med Care 2019 Aug;57(8):641-47. doi: 10.1097/mlr.0000000000001142..
Keywords: Surveys on Patient Safety Culture, Patient Safety, Nursing Homes, Quality Indicators (QIs), Quality Measures, Quality of Care, Provider Performance
Perraillon MC, Brauner DJ, Konetzka RT
Nursing home response to Nursing Home Compare: the provider perspective.
This paper examined the validity of quality ratings of nursing homes with Nursing Home Compare (NHC) and assessed the views of nursing home administrators and staff. There was a conflict found between improving ratings and competing goals of maximizing profits and avoidance of litigation. Since the NHC is self-reported there is controversy on its validity due to self-reporting bias.
AHRQ-funded; HS018718.
Citation: Perraillon MC, Brauner DJ, Konetzka RT .
Nursing home response to Nursing Home Compare: the provider perspective.
Med Care Res Rev 2019 Aug;76(4):425-43. doi: 10.1177/1077558717725165..
Keywords: Long-Term Care, Nursing Homes, Provider Performance, Quality of Care, Quality Improvement
Ahluwalia SC, Damberg CL, Haas A
How are medical groups identified as high-performing? The effect of different approaches to classification of performance.
The researchers examined how different classification approaches influence which providers are designated as "high-performers.” They found that classification of medical groups as high performing is sensitive to the domains of performance included, the classification approach, and the choice of threshold. They further suggest that the absence of a consistently applied approach to identifying high performers impedes efforts to reliably compare, select and reward high-performing providers.
AHRQ-funded; HS024067.
Citation: Ahluwalia SC, Damberg CL, Haas A .
How are medical groups identified as high-performing? The effect of different approaches to classification of performance.
BMC Health Serv Res 2019 Jul 18;19(1):500. doi: 10.1186/s12913-019-4293-9..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Provider Performance, Quality of Care, Quality Measures
Sankaran R, Sukul D, Nuliyalu U
Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction Program: retrospective cohort study.
This study evaluated the association between hospital penalization in the US Hospital Acquired Condition Reduction Program (HACRP) and changes in clinical outcomes. Out of the total of 724 hospitals were penalized in fiscal year 2015, 708 were included in the study. The majority of the penalized hospitals were large teaching institutions and have a greater share of low-income patients than non-penalized hospitals. After penalization, there was a non-significant change in hospital acquired conditions, 30-day readmission rates, and 30-day mortality. This might mean that disparities in care could be exacerbated.
AHRQ-funded; HS026244.
Citation: Sankaran R, Sukul D, Nuliyalu U .
Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction Program: retrospective cohort study.
BMJ 2019 Jul 3;366:l4109. doi: 10.1136/bmj.l4109..
Keywords: Health Insurance, Healthcare-Associated Infections (HAIs), Hospitals, Medicare, Patient Safety, Provider Performance, Payment, Quality of Care, Quality Indicators (QIs)
Chen PG, Harrison MI, Bergofsky LR
Use of internal performance measurement to guide improvement within medical groups.
The purpose of this study was to investigate how medical groups use measures of quality, cost, and patient experience of care for performance improvement. Through interviews, findings showed that strategies for using internal measurement for quality improvement included taking a gradual, iterative approach and setting clear goals with high priority, finding workable approaches to data sharing, and fostering engagement by focusing on actionable measures. Measurement was also used to check accuracy of external performance reports, clarify and manage conflicting external measurement requirements, and prepare for anticipated external measurement requirements. Most respondents did not report a need to assess costs of internal measurement or the capacity to do so.
AHRQ-authored; AHRQ-funded; 233201500026I.
Citation: Chen PG, Harrison MI, Bergofsky LR .
Use of internal performance measurement to guide improvement within medical groups.
Jt Comm J Qual Patient Saf 2019 Jul;45(7):487-94. doi: 10.1016/j.jcjq.2019.02.009..
Keywords: Quality Measures, Quality Improvement, Provider Performance, Patient Experience, Quality of Care
Anton NE, Mizota T, Whiteside JA
Mental skills training limits the decay in operative technical skill under stressful conditions: results of a multisite, randomized controlled study.
The authors hypothesize that surgery residents trained on mental skills would outperform controls under increased stress conditions in the simulated operating room. They find that their comprehensive mental skills curriculum implemented with surgery residents at two institutions was effective at minimizing the deterioration of resident technical performance under stressful conditions compared with controls. They conclude that their results provide further evidence for the effectiveness of mental skills training to optimize surgery trainees' technical performance during challenging clinical situations.
AHRQ-funded; R18 HS022080.
Citation: Anton NE, Mizota T, Whiteside JA .
Mental skills training limits the decay in operative technical skill under stressful conditions: results of a multisite, randomized controlled study.
Surgery 2019 Jun;165(6):1059-64. doi: 10.1016/j.surg.2019.01.011..
Keywords: Surgery, Education: Continuing Medical Education, Stress, Provider Performance, Training, Provider: Physician, Provider
Martin JR, Anton N, Timsina L
Performance variability during training on simulators is associated with skill transfer.
Researchers looked at performance variability during training on simulators for performing laparoscopic surgery. Their hypothesis was that participants (surgery residents and medical students) who had consistent scores were most likely to have the most expertise and be capable of training others. The trainees first used the Fundamentals of Laparoscopic Surgery (FLS) simulator to learn laparoscopic suturing and then were transfer tested on a live, anesthetized porcine model. Their hypothesis was proven true and those with decreased practice variability was associated with greater scores in posttests and transfer tests.
AHRQ-funded; R18 HS022080.
Citation: Martin JR, Anton N, Timsina L .
Performance variability during training on simulators is associated with skill transfer.
Surgery 2019 Jun;165(6):1065-68. doi: 10.1016/j.surg.2019.01.013..
Keywords: Simulation, Training, Surgery, Education: Continuing Medical Education, Provider Performance, Provider: Physician, Provider
Sheetz KH, Ibrahim AM, Nathan H
Variation in surgical outcomes across networks of the highest-rated US hospitals.
This longitudinal analysis of 87 hospitals in 1 of 16 networks who were affiliated with the US News & World Report Honor Roll hospitals discusses variation in surgical outcomes compared with their network affiliates. Data was used from Medicare beneficiaries who underwent colectomy, coronary artery bypass graft, or hip replacement between 2005 and 2014. Thirty-day postoperative complications, mortality, failure to rescue and readmissions were compared. Outcomes were not consistently better at Honor Roll hospitals compared with their network affiliates. Honor Roll hospitals had lower failure to rescue rates but higher complication rates.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Ibrahim AM, Nathan H .
Variation in surgical outcomes across networks of the highest-rated US hospitals.
JAMA Surg 2019 Jun;154(6):510-15. doi: 10.1001/jamasurg.2019.0090..
Keywords: Surgery, Outcomes, Provider Performance, Hospitals, Quality of Care
Campbell KH, Illuzzi JL, Lee HC
Optimal maternal and neonatal outcomes and associated hospital characteristics.
The goal of this study was to examine hospital variation in both maternal and neonatal morbidities and to identify institutional characteristics associated with hospital performance in a combined measure of maternal and neonatal outcomes. The authors found that hospitals with low maternal morbidity rates may not have low neonatal morbidity rates and vice versa, highlighting the importance of assessing joint maternal-newborn outcomes in order to fully characterize a hospital's obstetrical performance.
AHRQ-funded; HS023801.
Citation: Campbell KH, Illuzzi JL, Lee HC .
Optimal maternal and neonatal outcomes and associated hospital characteristics.
Birth 2019 Jun;46(2):289-99. doi: 10.1111/birt.12400.
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Keywords: Hospitals, Newborns/Infants, Outcomes, Pregnancy, Provider Performance, Quality of Care, Women
Hung DY, Harrison MI, Liang SY
Contextual conditions and performance improvement in primary care.
This study examined organizational features of primary care clinics that had gone through Lean redesigns and had experienced the greatest performance improvements. They surveyed 1333 physicians and staff in 43 primary care clinics across a large primary care system. They found that clinics with prior experience with quality improvement had the highest increases in efficiency. Clinics reporting the highest levels of burnout and work stress before the redesign also made efficiency gains. Physician productivity gains was associated with a history of change, staff participation and leadership support. The greatest improvements in patient satisfaction occurred where there was the lowest stress levels with highest levels of teamwork, staff engagement and leadership support.
AHRQ-authored; AHRQ-funded; 2902010000221.
Citation: Hung DY, Harrison MI, Liang SY .
Contextual conditions and performance improvement in primary care.
Qual Manag Health Care 2019 Apr/Jun;28(2):70-77. doi: 10.1097/qmh.0000000000000198..
Keywords: Organizational Change, Healthcare Delivery, Primary Care, Provider Performance, Quality Improvement, Quality of Care, Workflow
Cefalu MS, Elliott MN, Setodji CM
Hospital quality indicators are not unidimensional: a reanalysis of Lieberthal and Comer.
The objective of this study was to evaluate the dimensionality of hospital quality indicators treated as unidimensional in a prior publication. The investigators found that there were four underlying dimensions of hospital quality: patient experience, mortality, and two clinical process dimensions. They concluded that hospital quality should be measured using a variety of indicators reflecting different dimensions of quality.
AHRQ-funded; HS016980; HS016978.
Citation: Cefalu MS, Elliott MN, Setodji CM .
Hospital quality indicators are not unidimensional: a reanalysis of Lieberthal and Comer.
Health Serv Res 2019 Apr;54(2):502-08. doi: 10.1111/1475-6773.13056..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Hospitals, Patient Experience, Provider Performance, Quality of Care, Quality Indicators (QIs), Quality Measures
Perraillon MC, Konetzka RT, He D
Consumer response to composite ratings of nursing home quality.
Health care report cards are intended to address information asymmetries and enable consumers to choose providers of better quality. This study examined whether the form of the information mattered to consumers. The investigators concluded that the form of quality reporting mattered to consumers, and that the increased use of composite ratings was likely to increase consumer response.
AHRQ-funded; HS021877; HS021861; HS000084.
Citation: Perraillon MC, Konetzka RT, He D .
Consumer response to composite ratings of nursing home quality.
Am J Health Econ 2019 Spring;5(2):165-90. doi: 10.1162/ajhe_a_00115..
Keywords: Nursing Homes, Long-Term Care, Quality of Care, Provider Performance, Quality Measures
