National Healthcare Quality and Disparities Report
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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
26 to 50 of 100 Research Studies DisplayedMeagher AD, Lin A, Mandell SP
A comparison of scoring systems for predicting short- and long-term survival after trauma in older adults.
Researchers conducted a retrospective cohort study to identify injured older adults at highest risk for 30-day mortality. They found that older, injured adults transported by EMS to a large variety of trauma and non-trauma hospitals were more likely to die within 30 days if they required emergent airway management or had a higher comorbidity burden. They concluded that identification of an ideal prognostic tool remains elusive.
AHRQ-funded; HS023796.
Citation: Meagher AD, Lin A, Mandell SP .
A comparison of scoring systems for predicting short- and long-term survival after trauma in older adults.
Acad Emerg Med 2019 Jun;26(6):621-30. doi: 10.1111/acem.13727..
Keywords: Elderly, Trauma, Mortality, Injuries and Wounds, Emergency Department
Angraal S, Gupta A, Khera R
Association of access to exercise opportunities and cardiovascular mortality.
The purpose of this study is to examine the patterns of cardiovascular disease (CVD) mortality in varying degrees of access within the U.S. at the county level. The results indicate that access to exercise opportunities has a significant association with adjusted CVD mortality--higher access correlates with lower CVD mortality. Counties that have lower access to exercise facilities show a higher prevalence of obesity and diabetes in comparison with counties that have higher access. States with fewer people living in close proximity to a park have higher percentage of people who do not engage in any leisure physical activity. These results suggest means by which opportunities to increase access may be developed.
AHRQ-funded; HS023000.
Citation: Angraal S, Gupta A, Khera R .
Association of access to exercise opportunities and cardiovascular mortality.
Am Heart J 2019 Jun;212:152-56. doi: 10.1016/j.ahj.2019.02.010..
Keywords: Cardiovascular Conditions, Health Status, Mortality, Social Determinants of Health
Istl AC, Ruck JM, Morris CD
Call for improved design and reporting in soft tissue sarcoma studies: a systematic review and meta-analysis of chemotherapy and survival outcomes in resectable STS.
Researchers completed a meta-analysis of chemotherapy in localized STS, assessing OS, PFS, and local and distant recurrence. They found no benefit of chemotherapy over locoregional therapy alone for all-comers or site-specific STS. Recommendations to improve outcome reporting and quality indices are suggested.
AHRQ-funded; HS024736.
Citation: Istl AC, Ruck JM, Morris CD .
Call for improved design and reporting in soft tissue sarcoma studies: a systematic review and meta-analysis of chemotherapy and survival outcomes in resectable STS.
J Surg Oncol 2019 Jun;119(7):824-35. doi: 10.1002/jso.25401..
Keywords: Cancer, Treatments, Evidence-Based Practice, Mortality, Outcomes, Research Methodologies
Jarman MP, Pollack Porter K, Curriero FC
Factors mediating demographic determinants of injury mortality.
The authors investigated the role of injury characteristics and access to trauma care as mediators of the relationships between race, ethnicity, sex, and injury mortality. They found that distance, injury characteristics, and insurance mediate the effects of demographic characteristics on injury mortality and appear to contribute to disparities in injury mortality.
AHRQ-funded; HS000029.
Citation: Jarman MP, Pollack Porter K, Curriero FC .
Factors mediating demographic determinants of injury mortality.
Ann Epidemiol 2019 Jun;34:58-64.e2. doi: 10.1016/j.annepidem.2019.03.013..
Keywords: Access to Care, Disparities, Injuries and Wounds, Mortality, Racial and Ethnic Minorities, Sex Factors, Social Determinants of Health, Trauma
Pepper DJ, Sun J, Rhee C
Procalcitonin-guided antibiotic discontinuation and mortality in critically ill adults: a systematic review and meta-analysis.
This study is a systematic review and meta-analysis on survival outcomes of using procalcitonin (PCT)-guided antibiotic discontinuation on critically ill adults. The study quality was assessing with the Cochrane risk of bias tool, and GRADEpro was used to grade evidence. PCT-guided discontinuation was associated with decreased mortality, but there was a high risk of bias in many of the studies reviewed with a low certainty of evidence. The authors suggest properly designed studies with mortality as the primary outcome is needed to further answer this question.
AHRQ-funded; HS025008.
Citation: Pepper DJ, Sun J, Rhee C .
Procalcitonin-guided antibiotic discontinuation and mortality in critically ill adults: a systematic review and meta-analysis.
Chest 2019 Jun;155(6):1109-18. doi: 10.1016/j.chest.2018.12.029..
Keywords: Antibiotics, Critical Care, Evidence-Based Practice, Medication, Mortality, Outcomes, Sepsis
Vanderlaan J, Rochat R, Williams B
Associations between hospital maternal service level and delivery outcomes.
This study explored the associations between delivery hospital self-reported level of maternal service, as defined by the American Hospital Association, and both maternal and neonatal outcomes among women at high maternal risk, as defined by the Obstetric Comorbidity Index. The investigators concluded that for the group of pregnant women in need of maternal transfer, delivery hospital self-reported level of maternal care was not associated with the odds of poor maternal or neonatal outcomes.
AHRQ-funded; HS024655.
Citation: Vanderlaan J, Rochat R, Williams B .
Associations between hospital maternal service level and delivery outcomes.
Womens Health Issues 2019 May - Jun;29(3):252-58. doi: 10.1016/j.whi.2019.02.004..
Keywords: Maternal Care, Labor and Delivery, Pregnancy, Women, Outcomes, Hospitals, Quality of Care, Newborns/Infants, Mortality
Pepper DJ, Demirkale CY, Sun J
Does obesity protect against death in sepsis? A retrospective cohort study of 55,038 adult patients.
The purpose of this study was to estimate the relationship between body mass index and sepsis mortality using detailed clinical data for case detection and risk adjustment. In adults with clinically-defined sepsis, results demonstrated lower short-term mortality in patients with higher body mass indices compared with those with normal body mass indices and higher short-term mortality in those with low body mass indices. Understanding how obesity improves survival in sepsis would inform prognostic and therapeutic strategies.
AHRQ-funded; HS025008.
Citation: Pepper DJ, Demirkale CY, Sun J .
Does obesity protect against death in sepsis? A retrospective cohort study of 55,038 adult patients.
Crit Care Med 2019 May;47(5):643-50. doi: 10.1097/ccm.0000000000003692..
Keywords: Sepsis, Obesity, Mortality
Hadler RA, Goldstein NE, Bekelman DB
"Why would i choose death?": a qualitative study of patient understanding of the role and limitations of cardiac devices.
The aim of this study was to assess perceptions of cardiac devices in patients with heart failure and how these perceptions impacted advance care planning and future expectations. The investigators found that patients, in their sample, with cardiac devices overestimated the impact of their devices on preventing disease progression and death and deprioritized advance care planning as a result.
AHRQ-funded; HS022989.
Citation: Hadler RA, Goldstein NE, Bekelman DB .
"Why would i choose death?": a qualitative study of patient understanding of the role and limitations of cardiac devices.
J Cardiovasc Nurs 2019 May/Jun;34(3):275-82. doi: 10.1097/jcn.0000000000000565..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Mortality, Palliative Care
Liu J, Larson E, Hessels A
Comparison of measures to predict mortality and length of stay in hospitalized patients.
This study compared performance of five measures in order to predict mortality and length of stay (LOS) in hospitalized adults using claims data; the measures included three comorbidity composite scores, 3 M risk of mortality, and 3 M severity of illness subclasses. Binary logistic and zero-truncated negative binomial regression models were applied to a 2-year retrospective dataset of adult inpatient admissions from a large hospital system in New York City. All five measures demonstrated a good to strong model fit for predicting in-hospital mortality. The authors conclude that these measures can guide nurse managers in assigning nursing care and coordinating patient services, as well as administrators in supporting optimal nursing care more effectively and efficiently.
AHRQ-funded; HS024915.
Citation: Liu J, Larson E, Hessels A .
Comparison of measures to predict mortality and length of stay in hospitalized patients.
Nurs Res 2019 May/Jun;68(3):200-09. doi: 10.1097/nnr.0000000000000350..
Keywords: Hospitalization, Mortality, Nursing, Patient Safety, Risk
Hannan EL, Barrett SC, Samadashvili Z
Retooling of paper-based outcome measures to electronic format: comparison of the NY State public risk model and EHR-derived risk models for CABG mortality.
This study assessed the feasibility of retooling the paper-based New York State coronary artery bypass graft (CABG) surgery statistical model for mortality and readmission into a model for electronic health records (EHRs). Researchers found that only 6 data elements could be extracted from the EHR, and outlier hospitals differed for readmission but was usable for mortality. They concluded that the EHR model was inferior to the NYS model, and that simplifying the EHR risk model couldn’t capture most of the risk factors in the NYS model.
AHRQ-funded; HS022647.
Citation: Hannan EL, Barrett SC, Samadashvili Z .
Retooling of paper-based outcome measures to electronic format: comparison of the NY State public risk model and EHR-derived risk models for CABG mortality.
Med Care 2019 May;57(5):377-84. doi: 10.1097/mlr.0000000000001104..
Keywords: Surgery, Electronic Health Records (EHRs), Health Information Technology (HIT), Mortality, Outcomes, Risk, Cardiovascular Conditions
McClellan CB
Disparities in opioid related mortality between United States counties from 2000 to 2014.
This study examines disparities in opioid related mortality between United States counties from 2000 to 2014. Unfortunately, counties that had lower rates in 2000 had caught up by 2014. The authors suggest that prevention measures need to be broader in scope and be implemented in areas where the opioid crisis doesn’t seem as prevalent.
AHRQ-authored.
Citation: McClellan CB .
Disparities in opioid related mortality between United States counties from 2000 to 2014.
Drug Alcohol Depend 2019 Apr 25;199:151-58. doi: 10.1016/j.drugalcdep.2019.03.005..
Keywords: Disparities, Medication, Mortality, Opioids, Substance Abuse
Darby JL, Davis BS, Barbash IJ
An administrative model for benchmarking hospitals on their 30-day sepsis mortality.
The goal of this study was to develop an administrative risk-adjustment model suitable for profiling hospitals on their 30-day mortality rates for patients with sepsis. The investigators concluded that a novel claims-based risk-adjustment model demonstrated wide variation in risk-standardized 30-day sepsis mortality rates across hospitals. Individual hospitals' performance rankings were stable across years and after the addition of laboratory data. They assert that this model provides a robust way to rank hospitals on sepsis mortality while adjusting for patient risk.
AHRQ-funded; HS025455.
Citation: Darby JL, Davis BS, Barbash IJ .
An administrative model for benchmarking hospitals on their 30-day sepsis mortality.
BMC Health Serv Res 2019 Apr 11;19(1):221. doi: 10.1186/s12913-019-4037-x..
Keywords: Hospitals, Mortality, Quality of Care, Sepsis
Shen NT, Londono C, Gold S
Systematic review with meta-analysis on transplantation for alcohol-related liver disease: very low evidence of improved outcomes.
Under the hypothesis that, while liver transplantation for patients with alcohol-related liver disease (ALD) may improve mortality and relapse, findings will be limited by pre-specified causes of heterogeneity, researchers conducted a systematic review. Data from 10 studies comparing use of liver transplant in ALD to no-transplant was analyzed. Primary outcome of both was short- and long-term mortality and relapse. The results of the review indicate that liver transplantation for ALD patients suggests reduced mortality and relapse in heterogeneous, institution-specific populations. The authors note that, to understand efficacy of transplanting ALD, their research approach must change.
AHRQ-funded; HS000066.
Citation: Shen NT, Londono C, Gold S .
Systematic review with meta-analysis on transplantation for alcohol-related liver disease: very low evidence of improved outcomes.
World J Gastroenterol 2019 Apr 7;25(13):1628-39. doi: 10.3748/wjg.v25.i13.1628..
Keywords: Alcohol Use, Evidence-Based Practice, Mortality, Outcomes, Patient-Centered Outcomes Research, Surgery, Transplantation
Spees LP, Martin PL, Kurtzberg J
Reduction in mortality after umbilical cord blood transplantation in children over a 20-year period (1995-2014).
Infections and graft-versus-host disease (GVHD) have historically resulted in high mortality among children undergoing umbilical cord blood transplantation (UCBT). However, recent advances in clinical practice have likely improved outcomes of these patients. In this paper, the authors report on a retrospective cohort study, they conducted, of children (<18years of age) undergoing UCBT at Duke University between January 1, 1995 and December 31, 2014.
AHRQ-funded; HS000032.
Citation: Spees LP, Martin PL, Kurtzberg J .
Reduction in mortality after umbilical cord blood transplantation in children over a 20-year period (1995-2014).
Biol Blood Marrow Transplant 2019 Apr;25(4):756-63. doi: 10.1016/j.bbmt.2018.11.018..
Keywords: Children/Adolescents, Mortality, Outcomes
Shah S, Xian Y, Sheng S
Use, temporal trends, and outcomes of endovascular therapy after interhospital transfer in the United States.
This study examined the use, trends and outcomes of endovascular therapy (EVT) after interhospital transfer in the United Sates. This cohort study analyzed trends from over 1.8 million patients with ischemic stroke admitted to 2143 Get With The Guidelines-Stroke participating hospitals between 2012 and 2017. There were differences in mortality for interhospital transfer patients, although those differences disappeared after adjusting for delay in EVT initiation.
AHRQ-funded; HS024561.
Citation: Shah S, Xian Y, Sheng S .
Use, temporal trends, and outcomes of endovascular therapy after interhospital transfer in the United States.
Circulation 2019 Mar 26;139(13):1568-77. doi: 10.1161/circulationaha.118.036509..
Keywords: Stroke, Cardiovascular Conditions, Transitions of Care, Outcomes, Healthcare Delivery, Hospitals, Mortality, Quality of Care
Huckfeldt P, Escarce J, Sood N
Thirty-day postdischarge mortality among black and white patients 65 years and older in the Medicare Hospital Readmissions Reduction Program.
The goal of this cohort study was to determine whether short-term mortality rates increased among black and white adults 65 years and older after initiation of the Medicare Hospital Readmissions Reduction Program (HRRP) and whether trends differed by race. Using an interrupted time-series analysis, the researchers found that short-term post-discharge mortality did not appear to increase for black patients under the HRRP, suggesting that certain value-based payment policies can be implemented without harming black populations. However, mortality seemed to increase for white patients with heart failure; this situation warrants investigation.
AHRQ-funded; HS025394.
Citation: Huckfeldt P, Escarce J, Sood N .
Thirty-day postdischarge mortality among black and white patients 65 years and older in the Medicare Hospital Readmissions Reduction Program.
JAMA Netw Open 2019 Mar;2(3):e190634. doi: 10.1001/jamanetworkopen.2019.0634..
Keywords: Medicare, Elderly, Mortality, Heart Disease and Health, Cardiovascular Conditions, Hospital Discharge
Kim D, Funk RJ, Yan P
Informal clinical integration in Medicare accountable care organizations and mortality following coronary artery bypass graft surgery.
Researchers looked at national Medicare data from 2008-2014 to determine if informal clinical integration in accountable care organizations (ACOs) made a difference in mortality rates in patients undergoing coronary artery bypass grafting (CABG). The cohort used were Medicare beneficiaries age 66 and older undergoing CABG. Results from ACO-participating health systems were compared with nonparticipating systems. Informal clinical integration made a difference in mortality, however there was no difference based on ACO participation for health systems on the low to moderate range.
AHRQ-funded; HS024525; HS024728.
Citation: Kim D, Funk RJ, Yan P .
Informal clinical integration in Medicare accountable care organizations and mortality following coronary artery bypass graft surgery.
Med Care 2019 Mar;57(3):194-201. doi: 10.1097/mlr.0000000000001052..
Keywords: Cardiovascular Conditions, Medicare, Mortality, Outcomes, Surgery
Martinez DA, Zhang H, Bastias M
Prolonged wait time is associated with increased mortality for Chilean waiting list patients with non-prioritized conditions.
This study looked at mortality rates of Chilean patients on waiting lists for non-prioritized medical treatment within their universal healthcare system. There was a statistically significant association between waiting time and mortality for patients observed in the study. The study used data from 987,497 patients at 77 medical centers from 2008 to 2015. Three geographically distant regions were studied and there was a large region-to-region variation in mortality rates.
AHRQ-funded.
Citation: Martinez DA, Zhang H, Bastias M .
Prolonged wait time is associated with increased mortality for Chilean waiting list patients with non-prioritized conditions.
BMC Public Health 2019 Feb 26;19(1):233. doi: 10.1186/s12889-019-6526-6..
Keywords: Access to Care, Mortality
Alapati V, Tang F, Charlap E
Discharge heart rate after hospitalization for myocardial infarction and long-term mortality in 2 US registries.
In this study, researchers evaluated the association of discharge and admission heart rates with 3-year mortality. They concluded that a higher discharge heart rate after AMI was more strongly associated with 3-year mortality than a high heart rate at admissions.
AHRQ-funded; HS011282.
Citation: Alapati V, Tang F, Charlap E .
Discharge heart rate after hospitalization for myocardial infarction and long-term mortality in 2 US registries.
J Am Heart Assoc 2019 Feb 5;8(3):e010855. doi: 10.1161/jaha.118.010855..
Keywords: Cardiovascular Conditions, Hospital Discharge, Mortality, Heart Disease and Health, Registries
Wey A, Gustafson SK, Salkowski N
Association of pretransplant and posttransplant program ratings with candidate mortality after listing.
The Scientific Registry of Transplant Recipients (SRTR) is responsible for understandable reporting of program metrics, including transplant rate, waitlist mortality, and posttransplant outcomes. SRTR developed five-tier systems for each metric to improve accessibility for the public. In this study, the researchers investigated the associations of the five-tier assignments at listing with all-cause candidate mortality after listing, for candidates listed July 12, 2011-June 16, 2014.
AHRQ-funded; HS024527.
Citation: Wey A, Gustafson SK, Salkowski N .
Association of pretransplant and posttransplant program ratings with candidate mortality after listing.
Am J Transplant 2019 Feb;19(2):399-406. doi: 10.1111/ajt.15032..
Keywords: Transplantation, Surgery, Mortality, Registries
Wey A, Salkowski N, Kasiske BL
Comparing Scientific Registry of Transplant Recipients posttransplant program-specific outcome ratings at listing with subsequent recipient outcomes after transplant.
To improve accessibility of program-specific reports to patients, the Scientific Registry of Transplant Recipients released a 5-tier system for categorizing 1-year posttransplant program evaluations. Whether this system predicts subsequent posttransplant outcomes at the time patients are waitlisted has been questioned. IN this study, researchers investigated the association of tier at listing and the corresponding continuous score used for tier assignment, which ranges from 0 (poor outcomes) to 1 (good outcomes), with eventual 1-year posttransplant graft survival.
AHRQ-funded; HS024527.
Citation: Wey A, Salkowski N, Kasiske BL .
Comparing Scientific Registry of Transplant Recipients posttransplant program-specific outcome ratings at listing with subsequent recipient outcomes after transplant.
Am J Transplant 2019 Feb;19(2):391-98. doi: 10.1111/ajt.15038..
Keywords: Transplantation, Surgery, Mortality, Registries, Adverse Events, Risk
Warsame F, Haugen CE, Ying H
Limited health literacy and adverse outcomes among kidney transplant candidates.
More than one-third of US adults have limited health literacy, putting them at risk of adverse clinical outcomes. In this study the investigators evaluated the prevalence of limited health literacy among 1578 adult kidney transplant (KT) candidates (May 2014-November 2017) and examined its association with listing for transplant and waitlist mortality in this pilot study. The investigators concluded that limited health literacy may be a salient mechanism in access to KT; programs to aid candidates with limited health literacy may improve outcomes and reduce disparities.
AHRQ-funded; HS024600.
Citation: Warsame F, Haugen CE, Ying H .
Limited health literacy and adverse outcomes among kidney transplant candidates.
Am J Transplant 2019 Feb;19(2):457-65. doi: 10.1111/ajt.14994..
Keywords: Health Literacy, Transplantation, Adverse Events, Patient-Centered Outcomes Research, Outcomes, Surgery, Mortality, Kidney Disease and Health
Rees DI, Sabia JJ, Argys LM
With a little help from my friends: the effects of good samaritan and naloxone access laws on opioid-related deaths.
This study examined the effect of good Samaritan and naxolone access laws (NALs) on opioid-related mortality. Most states have adopted these laws, and the early adopters had the most negative association between NALs and overdose deaths. There was a negative but not statistically significant effect on opioid-related deaths for states with Good Samaritan laws.
AHRQ-funded; HS025014.
Citation: Rees DI, Sabia JJ, Argys LM .
With a little help from my friends: the effects of good samaritan and naloxone access laws on opioid-related deaths.
J Law Econ 2019 Feb;62(1). doi: 10.1086/700703..
Keywords: Opioids, Mortality, Policy, Medication
Nguyen OK, Vazquez MA, Charles MA
Association of scheduled vs emergency-only dialysis with health outcomes and costs in undocumented immigrants with end-stage renal disease.
This paper discusses costs and mortality associated with undocumented immigrants with end-stage renal disease (ESRD). If the patient has insurance, the costs and mortality rates are much lower than those who receive emergency-only dialysis.
AHRQ-funded; HS022418.
Citation: Nguyen OK, Vazquez MA, Charles MA .
Association of scheduled vs emergency-only dialysis with health outcomes and costs in undocumented immigrants with end-stage renal disease.
JAMA Intern Med 2019 Feb;179(2):175-83. doi: 10.1001/jamainternmed.2018.5866..
Keywords: Dialysis, Kidney Disease and Health, Healthcare Costs, Mortality, Patient-Centered Outcomes Research
Yuo TH, Wallace JR, Fish L
Editor's choice - comparison of outcomes after open surgical and endovascular lower extremity revascularisation among end stage renal disease patients on dialysis.
This study compared outcomes of different revascularization surgeries among end stage renal disease (ESRD) patients with peripheral arterial disease (PAD). There is a high risk of complications for this surgery. Outcomes of endovascular revascularization (ER) and open surgical revascularisation (OSR) were compared. Outcomes measured included mortality and major amputation. There is a lower mortality risk for ER versus OSR. OSR has better 30-day limb salvage although there are similar long-term outcomes.
AHRQ-funded; HS019486.
Citation: Yuo TH, Wallace JR, Fish L .
Editor's choice - comparison of outcomes after open surgical and endovascular lower extremity revascularisation among end stage renal disease patients on dialysis.
Eur J Vasc Endovasc Surg 2019 Feb;57(2):248-57. doi: 10.1016/j.ejvs.2018.09.008..
Keywords: Adverse Events, Cardiovascular Conditions, Comparative Effectiveness, Dialysis, Evidence-Based Practice, Kidney Disease and Health, Mortality, Outcomes, Patient-Centered Outcomes Research, Risk, Surgery