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
51 to 75 of 100 Research Studies DisplayedRhee C, Jones TM, Hamad Y
Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals.
The purpose of this study was to estimate the prevalence, underlying causes, and preventability of sepsis-associated mortality in acute care hospitals. A retrospective medical record review was conducted of 568 randomly selected adults admitted to six US academic and community hospitals who died in the hospital or were discharged to hospice and not readmitted. Medical records were reviewed. Sepsis was found to be the most common immediate cause of death; however, most underlying causes were related to severe chronic comorbidities. Most sepsis-associated deaths were unlikely to be preventable through better hospital-based care. The authors conclude that further innovations in the prevention and care of underlying conditions may be necessary before a significant reduction in sepsis-associated deaths can be achieved.
AHRQ-funded; HS025008.
Citation: Rhee C, Jones TM, Hamad Y .
Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals.
JAMA Netw Open 2019 Feb;2(2):e187571. doi: 10.1001/jamanetworkopen.2018.7571..
Keywords: Mortality, Sepsis, Hospitals, Inpatient Care
Haley CA, Brault MA, Mwinga K
Promoting progress in child survival across four African countries: the role of strong health governance and leadership in maternal, neonatal and child health.
The researchers conducted four individual case studies concerning the World Health Organization's African Region Millennium Development Goal #4 (MDG#4) to reduce under-five mortality by two-thirds by 2015. They found that strong health governance and leadership (HGL) was a significant driver of the greater success in Liberia and Zambia compared with Kenya and Zimbabwe. Three aspects of HGL which most consistently contributed to the different progress towards MDG#4 among the four study countries were identified. Although child mortality in sub-Saharan Africa remains high, the authors concluded that comparative study suggests key HGL factors that can facilitate the reduction of child mortality and may prove useful in tackling current Sustainable Development Goals.
AHRQ-funded; HS023000.
Citation: Haley CA, Brault MA, Mwinga K .
Promoting progress in child survival across four African countries: the role of strong health governance and leadership in maternal, neonatal and child health.
Health Policy Plan 2019 Feb 1;34(1):24-36. doi: 10.1093/heapol/czy105..
Keywords: Children/Adolescents, Maternal Care, Mortality, Newborns/Infants, Pregnancy
Holscher CM, Luo X, Massie AB
Better graft outcomes from offspring donor kidneys among living donor kidney transplant recipients in the United States.
This study used Scientific Registry of Transplant Recipients data 2001-2016 to evaluate death-censored graft failure (DCGF) and mortality for recipients of offspring versus nonoffspring living donor kidneys, using Cox regression models with interaction terms. The investigators found that kidneys from offspring donors provided lower graft failure and comparable mortality.
AHRQ-funded; HS024600.
Citation: Holscher CM, Luo X, Massie AB .
Better graft outcomes from offspring donor kidneys among living donor kidney transplant recipients in the United States.
Am J Transplant 2019 Jan;19(1):269-76. doi: 10.1111/ajt.15126..
Keywords: Transplantation, Surgery, Registries, Outcomes, Mortality, Adverse Events
Armstrong MJ, Alliance S, Corsentino P
Cause of death and end-of-life experiences in individuals with dementia with Lewy bodies.
Researchers investigate the natural history, cause of death, and end-of-life experiences of individuals diagnosed with dementia with Lewy bodies (DLB). In the 20-question survey, respondents indicated that physicians rarely discussed what to expect at the end of life and that the caregiver usually initiated such conversations. Failure to thrive was the most common cause of death, followed by pneumonia and swallowing difficulties, other medical conditions, and complications from falling. The researchers conclude that the study results highlight a critical need for better prognostic counseling and education for persons and families living with DLB, and they recommended further study.
AHRQ-funded; HS024159.
Citation: Armstrong MJ, Alliance S, Corsentino P .
Cause of death and end-of-life experiences in individuals with dementia with Lewy bodies.
J Am Geriatr Soc 2019 Jan;67(1):67-73. doi: 10.1111/jgs.15608..
Keywords: Dementia, Neurological Disorders, Patient Experience, Palliative Care, Mortality, Elderly
Daniel VT, Ayturk D, Ward DV
The influence of payor status on outcomes associated with surgical repair of upper gastrointestinal perforations due to peptic ulcer disease in the United States.
An association between lack of insurance and inferior outcomes has been well described for a number of surgical emergencies, yet little is known about the relationship of payor status and outcomes of patients undergoing emergent surgical repair for upper gastrointestinal (UGI) perforations. In this study, the investigators evaluated the association of payor status and in-hospital mortality for patients undergoing emergency surgery for UGI perforations in the United States.
AHRQ-funded; HS022694.
Citation: Daniel VT, Ayturk D, Ward DV .
The influence of payor status on outcomes associated with surgical repair of upper gastrointestinal perforations due to peptic ulcer disease in the United States.
Am J Surg 2019 Jan;217(1):121-25. doi: 10.1016/j.amjsurg.2018.06.025..
Keywords: Adverse Events, Digestive Disease and Health, Health Insurance, Healthcare Cost and Utilization Project (HCUP), Mortality, Outcomes, Patient Safety, Surgery, Uninsured
Albrecht JS, Al Kibria G, Gruber-Baldini A
Risk of mortality in individuals with hip fracture and traumatic brain injury.
Researchers estimated the prevalence of TBI (traumatic brain injury) with individuals hospitalized with hip fracture and their all-cause mortality. The population studied were Medicare beneficiaries aged 65 and older from 2006 to 2010. They concluded that there was a higher risk of death with individuals who had TBI than those who had only a hip fracture.
AHRQ-funded; HS024560.
Citation: Albrecht JS, Al Kibria G, Gruber-Baldini A .
Risk of mortality in individuals with hip fracture and traumatic brain injury.
J Am Geriatr Soc 2019 Jan;67(1):124-27. doi: 10.1111/jgs.15661..
Keywords: Brain Injury, Injuries and Wounds, Mortality, Risk, Trauma
Rhee C, Kalil AC
Toward a more nuanced approach to the early administration of intravenous fluids in patients with sepsis.
In this paper the authors discuss an article by Lane et al., published in 2018 in JAMA Network Open, related to the early administration of intravenous fluids in patients with sepsis.
AHRQ-funded; HS025008.
Citation: Rhee C, Kalil AC .
Toward a more nuanced approach to the early administration of intravenous fluids in patients with sepsis.
JAMA Netw Open 2018 Dec 7;1(8):e185844. doi: 10.1001/jamanetworkopen.2018.5844..
Keywords: Emergency Medical Services (EMS), Mortality, Sepsis
Kempker JA, Martin GS
Severity and timing of onset drive economic costs and clinical outcomes with sepsis.
Sepsis disproportionately affects older adults (mean age, 65 yr); is predominantly community acquired (87%); is expensive (mean hospital costs $21,500); and is associated with high hospital mortality (one in eight patients) and high rates of 30-day readmission for survivors (one in eight patients). In this editorial, the authors discuss an article- by Paoli et al, published in 2018 in Volume 46 of Critical Care Medicine- on sepsis epidemiology.
AHRQ-funded; HS025240.
Citation: Kempker JA, Martin GS .
Severity and timing of onset drive economic costs and clinical outcomes with sepsis.
Crit Care Med 2018 Dec;46(12):2043-44. doi: 10.1097/ccm.0000000000003376..
Keywords: Healthcare Costs, Mortality, Outcomes, Sepsis
Huckfeldt P, Escarce J, Wilcock A
HF mortality trends under Medicare readmissions reduction program at penalized and nonpenalized hospitals.
After announcement and implementation of the Medicare Hospital Readmissions Reduction Program (HRRP), 30-day readmissions declined rapidly among seniors with heart failure (HF) while 30-day mortality rose. This raised questions about whether the policy was responsible, because lower HF readmission rates have historically been associated with higher mortality. In this study, the investigators compared trends in heart failure (HF) mortality at penalized and nonpenalized hospitals nationally.
AHRQ-funded; HS024284.
Citation: Huckfeldt P, Escarce J, Wilcock A .
HF mortality trends under Medicare readmissions reduction program at penalized and nonpenalized hospitals.
J Am Coll Cardiol 2018 Nov 13;72(20):2539-40. doi: 10.1016/j.jacc.2018.08.2174..
Keywords: Mortality, Heart Disease and Health, Cardiovascular Conditions, Hospital Readmissions, Medicare, Hospitals, Provider Performance, Payment
Smith ME, Wells EE, Friese CR
Interpersonal and organizational dynamics are key drivers of failure to rescue.
This qualitative study of providers from hospitals with high and low rescue rates identified key factors that providers believe influence the successful rescue of surgical patients. These factors are: teamwork, action taking, psychological safety, recognition of complications, and communication. Providers surveyed agreed on two targets for improvement: delayed recognition of developing complications, and poor interprofessional communication and inability to express clinical concerns. The authors conclude that, to improve perioperative outcomes, hospitals and payers should shift their attention to improving early detection and increasing communication effectiveness when major complications occur.
AHRQ-funded; HS023621; HS024403.
Citation: Smith ME, Wells EE, Friese CR .
Interpersonal and organizational dynamics are key drivers of failure to rescue.
Health Aff 2018 Nov;37(11):1870-76. doi: 10.1377/hlthaff.2018.0704..
Keywords: Adverse Events, Communication, Hospitals, Mortality, Organizational Change, Patient Safety, Surgery
Han RH, McKinnon A, CreveCoeur TS
Predictors of mortality for preterm infants with intraventricular hemorrhage: a population-based study.
This study examined the risk factors for mortality in preterm infants with intraventricular hemorrhage (IVH). An overall inpatient mortality occurred in 10% of the cohort of 7437 preterm infants born between 2005 and 2014. Mortality risk was independently associated with a variety of factors including male sex, Asian race, lower gestational age, higher IVH grade, gastrotomy, tracheostomy, and shunt infection.
AHRQ-funded; HS019455.
Citation: Han RH, McKinnon A, CreveCoeur TS .
Predictors of mortality for preterm infants with intraventricular hemorrhage: a population-based study.
Childs Nerv Syst 2018 Nov;34(11):2203-13. Epub ahead of print. doi: 10.1007/s00381-018-3897-4..
Keywords: Healthcare Cost and Utilization Project (HCUP), Mortality, Newborns/Infants, Outcomes
Weir RE, Lyttle CS, Meltzer DO
The relative ability of comorbidity ascertainment methodologies to predict in-hospital mortality among hospitalized community-acquired pneumonia patients.
In this observational study, the investigators sought to compare the relative value of several methodologies by which comorbidities may be ascertained. The authors concluded that although comorbidities derived through administrative data did produce an area under the curve greater than chart review, their analyses suggested a coding bias in several comorbidities with a paradoxically protective effect. They assert that chart review, while labor and resource intensive, may be the ideal method for ascertainment of clinically relevant comorbidities.
AHRQ-funded; HS016948; HS010597.
Citation: Weir RE, Lyttle CS, Meltzer DO .
The relative ability of comorbidity ascertainment methodologies to predict in-hospital mortality among hospitalized community-acquired pneumonia patients.
Med Care 2018 Nov;56(11):950-55. doi: 10.1097/mlr.0000000000000989..
Keywords: Community-Acquired Infections, Hospitalization, Mortality, Pneumonia
Desai NR, Ott LS, George EJ
Variation in and hospital characteristics associated with the value of care for Medicare beneficiaries with acute myocardial infarction, heart failure, and pneumonia.
The objectives of this study were to investigate the association between hospital-level 30-day risk-standardized mortality rates (RSMRs) and 30-day risk-standardized payments (RSPs) for acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PNA); to characterize patterns of value in care; and to identify hospital characteristics associated with high-value care (defined by having lower than median RSMRs and RSPs).
AHRQ-funded; HS023000.
Citation: Desai NR, Ott LS, George EJ .
Variation in and hospital characteristics associated with the value of care for Medicare beneficiaries with acute myocardial infarction, heart failure, and pneumonia.
JAMA Netw Open 2018 Oct 5;1(6):e183519. doi: 10.1001/jamanetworkopen.2018.3519..
Keywords: Cardiovascular Conditions, Elderly, Hospitalization, Hospitals, Heart Disease and Health, Inpatient Care, Medicare, Mortality, Pneumonia
Leyenaar JK, Bogetz JF
Child mortality in the United States: bridging palliative care and public health perspectives.
This commentary discusses the findings of the article by Trowbridge et al in this same issue of Pediatrics, which examines modes of death rather than causes of death at a freestanding children’s hospital. Five distinct categories were created: withdrawal of life-sustaining technology; non-escalation of care; failed resuscitation; code then withdrawal; death by neurological criteria. More than 60% of the deaths were infants. The authors of this commentary note that conceptualizing the findings of this study from a public health perspective raises important questions about how causes of death are associated with end-of-life care in hospitals.
AHRQ-funded; HS024133.
Citation: Leyenaar JK, Bogetz JF .
Child mortality in the United States: bridging palliative care and public health perspectives.
Pediatrics 2018 Oct;142(4). doi: 10.1542/peds.2018-1927..
Keywords: Children/Adolescents, Hospitals, Mortality, Palliative Care, Patient-Centered Outcomes Research, Public Health
Kundi H, Valsdottir LR, Popma JJ
Impact of a claims-based frailty indicator on the prediction of long-term mortality after transcatheter aortic valve replacement in Medicare beneficiaries.
In this study, the investigators sought to characterize the prognostic importance of frailty factors as identified in healthcare billing records in comparison to validated measures of frailty for the prediction of long-term mortality after transcatheter aortic valve replacement (TAVR). The authors suggest that risk prediction models that include frailty as identified in claims data can be used to predict long-term mortality risk after TAVR.
AHRQ-funded; HS024520.
Citation: Kundi H, Valsdottir LR, Popma JJ .
Impact of a claims-based frailty indicator on the prediction of long-term mortality after transcatheter aortic valve replacement in Medicare beneficiaries.
Circ Cardiovasc Qual Outcomes 2018 Oct;11(10):e005048. doi: 10.1161/circoutcomes.118.005048..
Keywords: Medicare, Mortality, Surgery, Outcomes
Bindman AB, Cox DF
AHRQ Author: Bindman AB
Changes in health care costs and mortality associated with transitional care management services after a discharge among Medicare beneficiaries.
Medicare adopted transitional care management (TCM) payment codes in 2013 to encourage clinicians to furnish TCM services after beneficiaries were discharged to the community from medical facilities. The purpose of this study was to investigate whether the receipt of TCM services was associated with the subsequent health care costs and mortality of the beneficiaries in the month after the service was provided. The study concluded that despite the apparent benefits of TCM services for Medicare beneficiaries, the use of this service remains low.
AHRQ-authored.
Citation: Bindman AB, Cox DF .
Changes in health care costs and mortality associated with transitional care management services after a discharge among Medicare beneficiaries.
JAMA Intern Med 2018 Sep;178(9):1165-71. doi: 10.1001/jamainternmed.2018.2572..
Keywords: Healthcare Costs, Hospital Discharge, Medicare, Mortality, Transitions of Care
Nelson DB, Moniz MH, Davis MM
Population-level factors associated with maternal mortality in the United States, 1997-2012.
This study analyzed state-level maternal mortality for the years 1997-2012 using multilevel mixed-effects regression grouped by state, using publicly available data. The study concluded that, in addition to better case ascertainment of maternal deaths, adverse changes in chronic diseases, insufficient healthcare access, and social determinants of health represent identifiable risks for maternal mortality that merit prompt attention in population-directed interventions and health policies.
AHRQ-funded; HS025465.
Citation: Nelson DB, Moniz MH, Davis MM .
Population-level factors associated with maternal mortality in the United States, 1997-2012.
BMC Public Health 2018 Aug 13;18(1):1007. doi: 10.1186/s12889-018-5935-2..
Keywords: Health Services Research (HSR), Labor and Delivery, Mortality, Pregnancy, Social Determinants of Health
Beg MS, Gupta A, Sher D
Impact of concurrent medication use on pancreatic cancer survival-SEER-Medicare analysis.
Researchers examined the association of several medication classes on pancreatic cancer survival, using data from the Surveillance, Epidemiology, and End Results-Medicare database. They found that the use of beta-blockers, heparin, insulin, and warfarin were associated with improved survival in patients with pancreatic cancer, whereas metformin, thiazolidinedione, statin, and combination therapies were not. The authors recommended additional studies to validate these findings in the clinical setting.
AHRQ-funded; HS022418.
Citation: Beg MS, Gupta A, Sher D .
Impact of concurrent medication use on pancreatic cancer survival-SEER-Medicare analysis.
Impact of concurrent medication use on pancreatic cancer survival-SEER-Medicare analysis..
Keywords: Cancer, Medication, Mortality, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Wey A, Valapour M, Skeans
Heart and lung organ offer acceptance practices of transplant programs are associated with waitlist mortality and organ yield.
Variation in heart and lung offer acceptance practices may affect numbers of transplanted organs and create variability in waitlist mortality. In this study, the authors examined offered acceptance ratios, or adjusted odds ratios, for heart and lung transplant programs individually and for all programs within donation service areas (DSAs) using offers from donors recovered July 1, 2016, and June 30, 2017.
AHRQ-funded; HS024527.
Citation: Wey A, Valapour M, Skeans .
Heart and lung organ offer acceptance practices of transplant programs are associated with waitlist mortality and organ yield.
Am J Transplant 2018 Aug;18(8):2061-67. doi: 10.1111/ajt.14885..
Keywords: Transplantation, Health Services Research (HSR), Mortality
Shi J, Shen J, Caupp S
A new weighted injury severity scoring system: Better predictive power for pediatric trauma mortality.
The objective of this study was to develop a weighted Injury Severity Score (wISS) system for pediatric blunt trauma patients with better predictive power than ISS. The authors suggest that by weighting the Abbreviated Injury Scale from different body regions, the wISS had significantly better predictive power for mortality than the ISS, especially in critically injured children.
AHRQ-funded; HS024263.
Citation: Shi J, Shen J, Caupp S .
A new weighted injury severity scoring system: Better predictive power for pediatric trauma mortality.
J Trauma Acute Care Surg 2018 Aug;85(2):334-40. doi: 10.1097/ta.0000000000001943..
Keywords: Children/Adolescents, Injuries and Wounds, Mortality, Children/Adolescents, Trauma
Olfson M, Crystal S, Wall M
Causes of death after nonfatal opioid overdose.
The purpose of this study was to describe all-cause mortality rates, selected cause-specific mortality rates, and standardized mortality rate ratios (SMRs) of adults during their first year after nonfatal opioid overdose. In a US national cohort of adults who had experienced a nonfatal opioid overdose, a marked excess of deaths was attributable to a wide range of substance use-associated, mental health, and medical conditions, underscoring the importance of closely coordinating the substance use, mental health, and medical care of this patient population.
AHRQ-funded; HS021112.
Citation: Olfson M, Crystal S, Wall M .
Causes of death after nonfatal opioid overdose.
JAMA Psychiatry 2018 Aug;75(8):820-27. doi: 10.1001/jamapsychiatry.2018.1471..
Keywords: Behavioral Health, Mortality, Opioids, Patient-Centered Healthcare, Substance Abuse
Lin MY, Kressin NR, Paasche-Orlow MK
Is 30-day posthospitalization mortality lower among racial/ethnic minorities?: A reexamination.
This study’s objective was to verify other studies that showed that risk-adjusted rates of 30-day mortality after hospitalization for an acute condition was lower among blacks than whites. Inpatient discharge and vital status data was used for patients 18 and older hospitalized in California from January 2010 to June 30, 2011 for a variety of acute conditions. Their analysis verified lower risk of mortality among blacks. Factors for this may be associated with a higher rate of hospitalization with an 80% risk and inpatient mortality was also 30% higher with whites than blacks.
AHRQ-funded; HS022242.
Citation: Lin MY, Kressin NR, Paasche-Orlow MK .
Is 30-day posthospitalization mortality lower among racial/ethnic minorities?: A reexamination.
Med Care 2018 Aug;56(8):665-72. doi: 10.1097/mlr.0000000000000938..
Keywords: Hospitalization, Mortality, Racial and Ethnic Minorities
Bush M, Simpson RJ, Kucharska-Newton A
Approaches to address premature death of patients when assessing patterns of use of health care services after an index event.
In this study, the investigators compared different approaches for cohort definition (restriction by survival time vs. comorbidity score) and analysis method [Kaplan-Meier (KM) vs. competing risk] when assessing patterns of guideline adoption in elderly patients. They found that the KM method consistently overestimated the competing risk method. They suggest that competing risk approaches avoid unrealistic mortality assumptions and lead to interpretations of estimates that are more meaningful.
AHRQ-funded; HS000032.
Citation: Bush M, Simpson RJ, Kucharska-Newton A .
Approaches to address premature death of patients when assessing patterns of use of health care services after an index event.
Med Care 2018 Jul;56(7):619-25. doi: 10.1097/mlr.0000000000000923..
Keywords: Elderly, Healthcare Utilization, Mortality
Jarman MP, Haut ER, Curriero FC
Mapping areas with concentrated risk of trauma mortality: a first step toward mitigating geographic and socioeconomic disparities in trauma.
This study sought to classify injury event locations based on features of the built and social environment at the injury scene, and to examine patterns in individual patient demographics, injury characteristics, and mortality by location class. The investigators concluded identification of location classes may be useful for targeted primary prevention and treatment interventions, both by identifying geographic areas with the highest risk of injury mortality and by identifying patterns of individual risk within location classes.
AHRQ-funded; HS000029.
Citation: Jarman MP, Haut ER, Curriero FC .
Mapping areas with concentrated risk of trauma mortality: a first step toward mitigating geographic and socioeconomic disparities in trauma.
J Trauma Acute Care Surg 2018 Jul;85(1):54-61. doi: 10.1097/ta.0000000000001883..
Keywords: Disparities, Injuries and Wounds, Mortality, Social Determinants of Health, Trauma
Sakran JV, Mehta A, Fransman R
Nationwide trends in mortality following penetrating trauma: are we up for the challenge?
This study analyzed contemporary trends in pre-hospital mortality from penetrating trauma in the past decade using The National Trauma Data Bank. The authors concluded the odds of pre-hospital mortality has increased over 4-fold for gunshot wounds and almost 9-fold for stab wounds. Examining violence intensity, along with improvements in hospital care and data collection, may explain these findings.
AHRQ-funded; HS024547.
Citation: Sakran JV, Mehta A, Fransman R .
Nationwide trends in mortality following penetrating trauma: are we up for the challenge?
J Trauma Acute Care Surg 2018 Jul;85(1):160-66. doi: 10.1097/ta.0000000000001907..
Keywords: Injuries and Wounds, Mortality, Outcomes, Trauma