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Topics
- Adverse Events (3)
- Asthma (5)
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- Care Coordination (1)
- Caregiving (1)
- Care Management (4)
- (-) Children/Adolescents (19)
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- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (2)
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- Patient-Centered Outcomes Research (2)
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- Patient Experience (1)
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- Practice Patterns (2)
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- Provider (1)
- Provider: Physician (1)
- Quality Improvement (2)
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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
1 to 19 of 19 Research Studies DisplayedSosa T, Ferris S, Frese C
Comparing two proximal measures of unrecognized clinical deterioration in children.
Critical deterioration events (CDEs) and emergency transfers (ETs) are two proximal measures to cardiopulmonary arrest, and both aim to evaluate how systems recognize and respond to clinical deterioration in children. This retrospective observational study sought to (1) characterize CDEs and ETs by timing, overlap, and intervention category, and (2) evaluate the performance of the watcher identification system and the pediatric early warning score (PEWS) to identify patients who experience these events.
AHRQ-funded; HS023827.
Citation: Sosa T, Ferris S, Frese C .
Comparing two proximal measures of unrecognized clinical deterioration in children.
J Hosp Med 2020 Nov;15(11):673-76. doi: 10.12788/jhm.3515..
Keywords: Children/Adolescents, Cardiovascular Conditions, Critical Care, Inpatient Care
Soberano BT, Brady P, Yunger T
The effects of care team roles on situation awareness in the pediatric intensive care unit: a prospective cross-sectional study.
Improved situation awareness (SA) decreases rates of clinical deterioration in the pediatric inpatient setting. The investigators used a prospective, cross-sectional, observational study to measure interprofessional care team SA for a pediatric intensive care unit (PICU) patients. The resident, bedside nurse, and respiratory therapist for each patient were surveyed regarding high clinical deterioration risk status as defined by clinical criteria identified by the PICU fellow or attending and mitigation plan.
AHRQ-funded; HS026975.
Citation: Soberano BT, Brady P, Yunger T .
The effects of care team roles on situation awareness in the pediatric intensive care unit: a prospective cross-sectional study.
J Hosp Med 2020 Oct;15(10):594-97. doi: 10.12788/jhm.3449..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Teams, Inpatient Care
Cotter JM, Tyler A, Reese J
Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.
This study looked at pediatric emergency department (ED) inpatient use of dexamethasone versus prednisone by providers for asthma treatment. A survey was distributed to providers who care for inpatient asthmatics. Ninety-two providers completed the survey. When patients received dexamethasone in the ED, 44% continued dexamethasone, 14% switched to prednisone, 2% stopped steroid use, and 40% said it depended on the circumstances. Hospitalists were significantly more likely to continue dexamethasone than pulmonologists (61% versus 15%). Switching to prednisone included factors such as severity of exacerbation (73%) and asthma history (47%). Just over half of providers (5f1%) felt uncomfortable using dexamethasone because of “minimal data to support [its] use inpatient.”
AHRQ-funded; HS026512.
Citation: Cotter JM, Tyler A, Reese J .
Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.
J Asthma 2020 Sep;57(9):942-48. doi: 10.1080/02770903.2019.1622713..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Medication, Inpatient Care, Care Management, Hospitalization, Emergency Department, Practice Patterns, Provider: Physician, Provider
Kaiser SV, Lam Cabana, MD
Best practices in implementing inpatient pediatric asthma pathways: a qualitative study.
The objective of this study was to identify potential best practices in pathway implementation. Building upon a previous observational study in which the researchers identified higher and lower performing children's hospitals based on hospital-level changes in asthma patient length of stay after implementation of a pathway, they conducted semi-structured interviews with a sample of healthcare providers involved in pathway implementation at these hospitals. They identified several potential best practices to support pathway implementation. They recommended that hospitals implementing pathways consider applying these strategies to ensure success in improving quality of asthma care for children.
AHRQ-funded; HS024592.
Citation: Kaiser SV, Lam Cabana, MD .
Best practices in implementing inpatient pediatric asthma pathways: a qualitative study.
J Asthma 2020 Jul;57(7):744-54. doi: 10.1080/02770903.2019.1606237..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Hospitals, Inpatient Care, Guidelines, Evidence-Based Practice, Implementation, Quality Improvement, Quality of Care
Coon ER, Stoddard G, Brady PW
Intensive care unit utilization after adoption of a ward-based high-flow nasal cannula protocol.
This study examined whether the adoption of ward-based high-flow nasal cannula (HFNC) protocol in pediatric intensive care units (ICUs) reduced ICU utilization. This retrospective cohort study included infants aged 3 to 24 months hospitalized with bronchiolitis at hospitals in the Pediatric Health Information System database. There was a 93% response rate with the 44 hospitals contacted for the survey, of which 18 were categorized as non-adopting hospitals and 12 were categorized as adopting hospitals. Ward-based HFNC protocol data were included from the 2010-2011 and 2015-2016 respiratory seasons. Early protocols were paradoxically associated with increased ICU utilization.
AHRQ-funded; HS023827.
Citation: Coon ER, Stoddard G, Brady PW .
Intensive care unit utilization after adoption of a ward-based high-flow nasal cannula protocol.
J Hosp Med 2020 Jun;15(6):325-30. doi: 10.12788/jhm.3417..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Respiratory Conditions, Healthcare Utilization, Newborns/Infants, Inpatient Care
Kaiser SV, Jennings B, Rodean J
Pathways for improving inpatient pediatric asthma care (PIPA): a multicenter, national study.
This study examined whether implementation of a pathway strategy for inpatient pediatric asthma patients improve outcomes for these patients. Outcomes measured included length of stay (LOS), early administration of metered-dose inhalers, screening for secondhand tobacco exposure and referral to cessation resources, and 7-day hospital readmissions or emergency revisits. Eighty-five hospitals were enrolled and 68 completed the study with (n=12,013) admissions. Pathways were associated with increases in early administration of metered-dose inhalers, and referral to smoking cessation resources, but no statistically significant changes in the other outcomes were observed. Most hospitals did improve in at least one outcome.
AHRQ-funded; HS024592; HS024554.
Citation: Kaiser SV, Jennings B, Rodean J .
Pathways for improving inpatient pediatric asthma care (PIPA): a multicenter, national study.
Pediatrics 2020 Jun;145(6):e20193026. doi: 10.1542/peds.2019-3026..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Inpatient Care, Patient-Centered Outcomes Research, Outcomes, Hospitalization, Care Management
Wooldridge AR, Carayon P, Hoonakker P
Work system barriers and facilitators in inpatient care transitions of pediatric trauma patients.
Hospital-based care of pediatric trauma patients includes transitions between units that are critical for quality of care and patient safety. Using a macroergonomics approach, the investigators identified work system barriers and facilitators in care transitions. They interviewed eighteen healthcare professionals involved in transitions from emergency department (ED) to operating room (OR), OR to pediatric intensive care unit (PICU) and ED to PICU.
AHRQ-funded; HS023837.
Citation: Wooldridge AR, Carayon P, Hoonakker P .
Work system barriers and facilitators in inpatient care transitions of pediatric trauma patients.
Appl Ergon 2020 May;85:103059. doi: 10.1016/j.apergo.2020.103059..
Keywords: Children/Adolescents, Inpatient Care, Transitions of Care, Healthcare Delivery, Trauma, Hospitals
Bonafide CP, Xiao R, Brady PW
Prevalence of continuous pulse oximetry monitoring in hospitalized children with bronchiolitis not requiring supplemental oxygen.
This study examined the use of continuous pulse oximetry monitoring in hospitalized children with bronchiolitis who do not require supplemental oxygen. US national guidelines discourage the use but the practice was found to be still fairly widespread. The researchers conducted a multicenter, cross-sectional study of pediatric wards in 56 US and Canadian hospitals in the Pediatric Research in Inpatient Settings Network from December 2018 through March 2019. Patients aged 8 weeks through 23 months were included as a convenience sample. Overall usage was found to be 46% ranging from 6% to 82%.
AHRQ-funded; HS026763.
Citation: Bonafide CP, Xiao R, Brady PW .
Prevalence of continuous pulse oximetry monitoring in hospitalized children with bronchiolitis not requiring supplemental oxygen.
JAMA 2020 Apr 21;323(15):1467-77. doi: 10.1001/jama.2020.2998..
Keywords: Children/Adolescents, Respiratory Conditions, Inpatient Care, Hospitalization, Care Management, Evidence-Based Practice
Feng JY, Toomey SL, Elliott MN
Factors associated with family experience in pediatric inpatient care.
Researchers assessed which aspects of pediatric inpatient experience have the strongest relationships with parents' willingness to recommend a hospital. Their cross-sectional study examined surveys completed by parents of children hospitalized at hospitals using the Child Hospital Consumer Assessment of Healthcare Providers and Systems Survey. They found that child comfort and nurse-parent communication showed the strongest relationships with willingness to recommend, followed by preparing to leave the hospital, doctor-parent communication, and keeping parents informed. They recommended improvement efforts focusing on creating an age-appropriate environment, improving the effectiveness of provider interactions, and engaging parents to share their values and concerns.
AHRQ-funded; HS020513; HS025299.
Citation: Feng JY, Toomey SL, Elliott MN .
Factors associated with family experience in pediatric inpatient care.
Pediatrics 2020 Mar;145(3): e20191264. doi: 10.1542/peds.2019-1264..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Children/Adolescents, Quality Measures, Quality of Care, Inpatient Care, Patient Experience, Hospitals, Hospitalization, Patient and Family Engagement, Clinician-Patient Communication
Lifland B, Wright DR, Mangione-Smith R
The impact of an adolescent depressive disorders clinical pathway on healthcare utilization.
The purpose of this study was to examine the association between level of adherence to an adolescent depressive disorders inpatient clinical pathway with psychiatric patients’ length of stay (LOS), cost, and readmissions. Patients in the high-adherence category were found to have significantly longer LOS and higher costs when compared to those in the low-adherence category. The authors conclude that understanding which of the care processes within the pathway are most cost-effective for improving patient-centered outcomes requires further investigation.
AHRQ-funded; HS024299.
Citation: Lifland B, Wright DR, Mangione-Smith R .
The impact of an adolescent depressive disorders clinical pathway on healthcare utilization.
Adm Policy Ment Health 2018 Nov;45(6):979-87. doi: 10.1007/s10488-018-0878-6..
Keywords: Care Management, Children/Adolescents, Depression, Healthcare Costs, Healthcare Utilization, Hospital Readmissions, Hospitalization, Inpatient Care, Behavioral Health, Outcomes, Patient-Centered Outcomes Research
Hessels AJ, Liu J, Cohen B
Severity of illness measures for pediatric inpatients.
The purpose of this study was to (1) identify severity of illness (SOI) measures used for pediatric patients admitted to acute care hospitals and (2) compare the ability of two SOI measures to predict mortality and length of stay (LOS). The authors concluded that the chronic complex condition may be preferable for predicting outcomes among pediatric inpatients.
AHRQ-funded; HS024915.
Citation: Hessels AJ, Liu J, Cohen B .
Severity of illness measures for pediatric inpatients.
J Healthc Qual 2018 Sep/Oct;40(5):e77-e89. doi: 10.1097/jhq.0000000000000135..
Keywords: Children/Adolescents, Inpatient Care, Children/Adolescents
Rosenberg RE, Abzug JM, Rappaport DI
Collaborations with pediatric hospitalists: national surveys of pediatric surgeons and orthopedic surgeons.
In this study, to understand characteristics of pediatric hospitalist (PH) involvement in the care of children admitted to surgical services and explore surgeons' perspectives of PH effectiveness, the investigators conducted a cross-sectional, web-based survey of pediatric surgical (PS) and pediatric orthopedic subspecialists (OS) from professional organizations.
AHRQ-funded; HS022198.
Citation: Rosenberg RE, Abzug JM, Rappaport DI .
Collaborations with pediatric hospitalists: national surveys of pediatric surgeons and orthopedic surgeons.
J Hosp Med 2018 Aug;13(8):566-69. doi: 10.12788/jhm.2921..
Keywords: Children/Adolescents, Orthopedics, Surgery, Hospitals, Inpatient Care
Stockwell DC, Landrigan CP, Toomey SL
Adverse events in hospitalized pediatric patients.
Patient safety concerns over the past 2 decades have prompted widespread efforts to reduce adverse events (AEs). This study used a validated safety surveillance tool, the Global Assessment of Pediatric Patient Safety, to measure temporal trends (2007-2012) in AE rates among hospitalized children. The study concluded that AE rates in pediatric inpatients are high and did not improve from 2007 to 2012. Pediatric AE rates were substantially higher in teaching hospitals as well as in patients with more chronic conditions.
AHRQ-funded; HS020513
Citation: Stockwell DC, Landrigan CP, Toomey SL .
Adverse events in hospitalized pediatric patients.
Pediatrics 2018 Aug;142(2). doi: 10.1542/peds.2017-3360..
Keywords: Children/Adolescents, Adverse Events, Patient Safety, Inpatient Care, Medical Errors
Sun SA, Ma X, Li G
Epidemiologic patterns of in-hospital anaphylaxis in pediatric surgical patients.
This research letter looks into epidemiologic patterns of in-hospital anaphylaxis in pediatric surgical patients. Data from the study came from the Kids’ Inpatient Database (KIDS), which is released every 3 years. The data came from the 2003, 2006, 2009 and 2012 KID data sets. Children were included if they had a surgical admission for anaphylaxis which is interpreted as an in-hospital event. Overall in-hospital mortality for all children was 0.38% but for in-hospital anaphylaxis was 2.47%. The most common reason children were in the hospital before the event was hematological and myeloproliferative disorders, with the largest percentage undergoing bone marrow transplant procedures. Although the exact cause of the reaction was not known, hypersensitivity to chemotherapeutic agents and more recent mAb treatments have been identified as reasons for the in-hospital anaphylaxis.
AHRQ-funded; HS022941.
Citation: Sun SA, Ma X, Li G .
Epidemiologic patterns of in-hospital anaphylaxis in pediatric surgical patients.
J Allergy Clin Immunol 2018 May;141(5):1904-05.e2. doi: 10.1016/j.jaci.2017.11.030..
Keywords: Adverse Events, Children/Adolescents, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Hospitals, Inpatient Care, Practice Patterns, Surgery
Parikh K, Keller S, Ralston S
Inpatient quality improvement interventions for asthma: a meta-analysis.
This article reviewed interventional studies of inpatient-initiated asthma quality improvement (QI) to synthesize its impact on health care utilization. Thirty articles were included; 12 provided data on health care reutilization outcomes. The selected studies were categorized by intervention type and outcome. Risk ratios for readmissions were examined and a subanalyis of multimodal interventions conducted; the latter suggested lower readmission rates. A subanalysis of education and discharge planning interventions did not show an effect. The authors did not identify any inpatient strategies that impacted health care reutilization within 30 days of index hospitalization, but note that multimodal interventions demonstrated impact over the longer interval.
AHRQ-funded; HS024554.
Citation: Parikh K, Keller S, Ralston S .
Inpatient quality improvement interventions for asthma: a meta-analysis.
Pediatrics 2018 May;141(5). doi: 10.1542/peds.2017-3334.
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Keywords: Asthma, Children/Adolescents, Hospitalization, Inpatient Care, Quality Improvement
Wickremasinghe AC, Kuzniewicz MW, McCulloch CE
Efficacy of subthreshold newborn phototherapy during the birth hospitalization in preventing readmission for phototherapy.
The purpose of this study was to estimate the efficacy of subthreshold phototherapy for newborns with total serum bilirubin (TSB) levels from 0.1 to 3.0 mg/dL below the appropriate AAP phototherapy threshold during the birth hospitalization in preventing readmissions for phototherapy, and to identify predictors of readmission for phototherapy. The investigators concluded that subthreshold phototherapy during the birth hospitalization is effective in preventing readmissions for phototherapy; however, for each readmission prevented, many newborns require phototherapy who would otherwise not need it.
AHRQ-funded; HS020618.
Citation: Wickremasinghe AC, Kuzniewicz MW, McCulloch CE .
Efficacy of subthreshold newborn phototherapy during the birth hospitalization in preventing readmission for phototherapy.
JAMA Pediatr 2018 Apr;172(4):378-85. doi: 10.1001/jamapediatrics.2017.5630..
Keywords: Children/Adolescents, Evidence-Based Practice, Hospital Readmissions, Hospitalization, Inpatient Care, Newborns/Infants
Parast L, Bardach NS, Burkhart Q
Development of new quality measures for hospital-based care of suicidal youth.
This study researched the value of 4 new quality measures developed to assess hospital-based care for suicidal youth. The four quality measures focused on counseling caregivers about restricting access to lethal means of self-harm, and the benefits and risks of antidepressant medications. They were divided into measures for the emergency department (ED) and inpatient measures. Survey field tests were conducted with caregivers of youth who were admitted to the ED or inpatient care for suicidality at 1 of 2 children’s hospitals between July 2013 and June 2014. Most caregivers did receive counseling about restricting their child’s access to lethal means of self-harm and also reported higher rates of counseling of benefits on antidepressants both in the ED and in the inpatient setting than the risks.
AHRQ-funded; HS020506.
Citation: Parast L, Bardach NS, Burkhart Q .
Development of new quality measures for hospital-based care of suicidal youth.
Acad Pediatr 2018 Apr;18(3):248-55. doi: 10.1016/j.acap.2017.09.017..
Keywords: Caregiving, Children/Adolescents, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Education: Patient and Caregiver, Emergency Department, Hospitalization, Hospitals, Inpatient Care, Behavioral Health, Prevention, Quality of Care, Quality Measures
Dynan L, Goudie A, Brady PW
Pediatric adverse event rates associated with inexperience in teaching hospitals: a multilevel analysis.
In this article, the investigators hypothesize that adverse event rates increase with the availability of more complex services and technologies (transplantation and pediatric open-heart surgery); increase as experience of providers decreases (July effect); and increase with residents per bed, a measure of both average provider inexperience and congestion. Using multilevel analysis, they found empirical evidence in support of their three hypotheses.
AHRQ-funded; HS023827.
Citation: Dynan L, Goudie A, Brady PW .
Pediatric adverse event rates associated with inexperience in teaching hospitals: a multilevel analysis.
J Healthc Qual 2018 Mar/Apr;40(2):69-78. doi: 10.1097/jhq.0000000000000121..
Keywords: Children/Adolescents, Healthcare Cost and Utilization Project (HCUP), Adverse Events, Hospitals, Inpatient Care, Medical Errors, Patient Safety
Kaiser SV, Rodean J, Bekmezian A
Rising utilization of inpatient pediatric asthma pathways.
The objectives of this study were to: 1) Describe inpatient pediatric asthma pathway design and implementation across a large hospital network and (2) Compare characteristics of hospitals with and without pathways. The investigators concluded that from 2005-2015, there was a dramatic rise in implementation of inpatient pediatric asthma pathways. They found variation in many aspects of pathway design and implementation.
AHRQ-funded; HS024554; HS024592.
Citation: Kaiser SV, Rodean J, Bekmezian A .
Rising utilization of inpatient pediatric asthma pathways.
J Asthma 2018 Feb;55(2):196-207. doi: 10.1080/02770903.2017.1316392..
Keywords: Asthma, Care Coordination, Children/Adolescents, Inpatient Care