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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 12 of 12 Research Studies Displayed
Catchpole K, Neyens DM, Abernathy J
Framework for direct observation of performance and safety in healthcare.
This viewpoint paper discusses non-participant direct observation of healthcare processes as a rich method for understanding safety and performance improvement. The authors suggest that as a prospective method for error prediction and modelling, observation can capture a broad range of performance issues that can be related to higher aspects of the system.
Citation: Catchpole K, Neyens DM, Abernathy J . Framework for direct observation of performance and safety in healthcare. BMJ Qual Saf 2017 Dec;26(12):1015-21. doi: 10.1136/bmjqs-2016-006407..
Keywords: Healthcare Delivery, Patient Safety, Provider Performance, Quality Improvement
Paddock SM, Damberg CL, Yanagihara D
What role does efficiency play in understanding the relationship between cost and quality in physician organizations?
Previous studies demonstrate overuse of a narrow set of services, suggesting provider inefficiency, but existing studies neither quantify inefficiency more broadly nor assess its variation across physician organizations (POs). This study found that POs had substantial variation in efficiency, producing widely differing levels of quality for the same cost.
Citation: Paddock SM, Damberg CL, Yanagihara D . What role does efficiency play in understanding the relationship between cost and quality in physician organizations? Med Care 2017 Dec;55(12):1039-45. doi: 10.1097/mlr.0000000000000823.
Keywords: Value, Practice Patterns, Healthcare Costs, Quality of Care, Quality Improvement, Payment, Provider Performance
Masnick M, Morgan DJ, Sorkin JD
Can national healthcare-associated infections (HAIs) data differentiate hospitals in the United States?
This study was designed to determine whether patients using the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website can use nationally reported healthcare-associated infection (HAI) data to differentiate hospitals. The authors concluded that HAI data generally are reported by enough hospitals to meet minimal criteria for useful comparisons in many geographic locations, though this varies by type of HAI.
Citation: Masnick M, Morgan DJ, Sorkin JD . Can national healthcare-associated infections (HAIs) data differentiate hospitals in the United States? Infect Control Hosp Epidemiol 2017 Oct;38(10):1167-71. doi: 10.1017/ice.2017.179..
Keywords: Quality of Care, Healthcare-Associated Infections (HAIs), Hospitals, Provider Performance, Quality Measures
Adams JL, Paddock SM
Misclassification risk of tier-based physician quality performance systems.
The authors estimated misclassification rates for two-category high-quality physician identification systems. They found that current methods for profiling physicians on quality may produce misleading results, and that misclassification is a policy-relevant measure of the potential impact of tiering on providers, payers, and patients. They concluded that quantifying misclassification rates should inform the construction of high-performance networks and quality improvement initiatives.
Citation: Adams JL, Paddock SM . Misclassification risk of tier-based physician quality performance systems. Health Serv Res 2017 Aug;52(4):1277-96. doi: 10.1111/1475-6773.12561.
Keywords: Provider Performance, Quality of Care, Payment
Smith SN, Reichert HA, Ameling JM
Dissecting Leapfrog: how well do Leapfrog safe practices scores correlate with Hospital Compare ratings and penalties, and how much do they matter?
Voluntary Leapfrog Safe Practices Score (SPS) measures were among the first public reports of hospital performance. Recently, Medicare's Hospital Compare website has reported compulsory measures. Leapfrog's Hospital Safety Score (HSS) grades incorporate SPS and Medicare measures. The researchers evaluated associations between Leapfrog SPS and Medicare measures. They found that voluntary Leapfrog SPS measures skew toward positive self-report and bear little association with compulsory Medicare outcomes and penalties.
AHRQ-funded; HS019767; HS024385; HS018334.
Citation: Smith SN, Reichert HA, Ameling JM . Dissecting Leapfrog: how well do Leapfrog safe practices scores correlate with Hospital Compare ratings and penalties, and how much do they matter? Med Care 2017 Jun;55(6):606-14. doi: 10.1097/mlr.0000000000000716.
Keywords: Patient Safety, Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Hospitals, Provider Performance
DeLancey JO, Softcheck J, Chung JW
Associations between hospital characteristics, measure reporting, and the Centers for Medicare & Medicaid Services Overall Hospital Quality Star Ratings.
This study evaluated associations between hospital characteristics, number and types of measures reported, and the star ratings. Of 3,591 hospitals receiving a star rating,4 or 5 stars were awarded to 15.8 percent of major teaching hospitals, 18.8 percent of other teaching hospitals, 30.2 percent of community hospitals, 33.3 percent of critical access hospitals, and 87.3 percent of specialty hospitals.
Citation: DeLancey JO, Softcheck J, Chung JW . Associations between hospital characteristics, measure reporting, and the Centers for Medicare & Medicaid Services Overall Hospital Quality Star Ratings. JAMA 2017 May 16;317(19):2015-17. doi: 10.1001/jama.2017.3148.
Keywords: Hospitals, Quality of Care, Quality Measures, Provider Performance, Patient Safety
Fernandez R, Shah S, Rosenman ED
Developing team cognition: a role for simulation.
Evidence from team science research demonstrates a strong relationship between team cognition and team performance and suggests a role for simulation in the development of this team-level construct. In this article, the researchers synthesize research from the broader team science literature to provide foundational knowledge regarding team cognition and highlight best practices for using simulation to target team cognition.
AHRQ-funded; HS020295; HS022458.
Citation: Fernandez R, Shah S, Rosenman ED . Developing team cognition: a role for simulation. Simul Healthc 2017 Apr;12(2):96-103. doi: 10.1097/sih.0000000000000200.
Keywords: Teams, Training, Provider Performance, Patient Safety
Mendelson A, Kondo K, Damberg C
The effects of pay-for-performance programs on health, health care use, and processes of care: a systematic review.
This review updated and expanded a prior review examining the effects of P4P programs targeted at the physician, group, managerial, or institutional level on process-of-care and patient outcomes in ambulatory and inpatient settings. It found that pay-for-performance programs may be associated with improved processes of care in ambulatory settings, but consistently positive associations with improved health outcomes have not been demonstrated in any setting.
Citation: Mendelson A, Kondo K, Damberg C . The effects of pay-for-performance programs on health, health care use, and processes of care: a systematic review. Ann Intern Med 2017 Mar 7;166(5):341-53. doi: 10.7326/m16-1881.
Keywords: Payment, Provider Performance, Healthcare Utilization, Quality of Care
Lewis VA, Fraze T, Fisher ES
ACOs serving high proportions of racial and ethnic minorities lag in quality performance.
Researchers analyzed racial and ethnic disparities in health care outcomes among accountable care organizations (ACOs). Their findings suggest that ACOs with a high share of minority patients may struggle with quality performance under ACO contracts, especially during their early years of participation-maintaining or potentially exacerbating current inequities.
Citation: Lewis VA, Fraze T, Fisher ES . ACOs serving high proportions of racial and ethnic minorities lag in quality performance. Health Aff 2017 Jan;36(1):57-66. doi: 10.1377/hlthaff.2016.0626.
Keywords: Disparities, Racial / Ethnic Minorities, Provider Performance, Quality Indicators (QIs), Quality of Care
Davis JD, Olsen MA, Bommarito K
All-payer analysis of heart failure hospitalization 30-day readmission: comorbidities matter.
In this study, the researchers investigated readmission characteristics and the magnitude of 30-day hospital readmissions after hospital discharge for heart failure using the Healthcare Cost and Utilization Project State Inpatient Databases (SID). They found in this large all-payer cohort, ∼70% of 30-day readmissions were for non-heart failure causes, and the median time to readmission was 12 days.
Citation: Davis JD, Olsen MA, Bommarito K . All-payer analysis of heart failure hospitalization 30-day readmission: comorbidities matter. Am J Med 2017 Jan;130(1):93.e9-93.e28. doi: 10.1016/j.amjmed.2016.07.030..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Hospitalization, Hospitals, Provider Performance
Govindan S, Chopra V, Iwashyna TJ
Do clinicians understand quality metric data? An evaluation in a Twitter-derived sample.
The researchers assessed clinician comprehension of central line-associated blood stream infection (CLABSI) quality metric data. It found that the mean percentage of correct answers was 61 percent. Overall, doctor performance was better than performance by nurses and other respondents. In basic numeracy, mean percent correct was 82 percent. For risk-adjustment numeracy, the mean percent correct was 70 percent.
Citation: Govindan S, Chopra V, Iwashyna TJ . Do clinicians understand quality metric data? An evaluation in a Twitter-derived sample. J Hosp Med 2017 Jan;12(1):18-22.
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Data, Quality of Care, Provider Performance, Social Media
Calderwood MS, Kleinman K, Huang SS
Surgical site infections: volume-outcome relationship and year-to-year stability of performance rankings.
The researchers evaluated the volume-outcome relationship as well as the year-to-year stability of performance rankings following coronary artery bypass graft (CABG) surgery and hip arthroplasty. They concluded that aggregate surgical site infection risk is highest in hospitals with low annual procedure volumes. Even for higher volume hospitals, year-to-year random variation makes past experience an unreliable estimator of current performance.
Citation: Calderwood MS, Kleinman K, Huang SS . Surgical site infections: volume-outcome relationship and year-to-year stability of performance rankings. Med Care 2017 Jan;55(1):79-85. doi: 10.1097/mlr.0000000000000620.
Keywords: Surgery, Healthcare-Associated Infections (HAIs), Adverse Events, Injuries and Wounds, Hospitals, Provider Performance, Quality Indicators (QIs), Quality of Care, Patient Safety, Elderly