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
1 to 25 of 29 Research Studies DisplayedAbu HO, Anatchkova MD, Erskine NA
Are we "missing the big picture" in transitions of care? Perspectives of healthcare providers managing patients with unplanned hospitalization.
The objective of this qualitative study was to explore the factors that negatively/positively influence care transitions following an unplanned hospitalization from the perspective of healthcare providers. The study identified factors within and outside the discharging healthcare facility that influence care transitions and ultimately affect patient-centered outcomes and provider satisfaction with delivered care.
AHRQ-funded; HS022694.
Citation: Abu HO, Anatchkova MD, Erskine NA .
Are we "missing the big picture" in transitions of care? Perspectives of healthcare providers managing patients with unplanned hospitalization.
Appl Nurs Res 2018 Dec;44:60-66. doi: 10.1016/j.apnr.2018.09.006..
Keywords: Hospital Discharge, Hospitalization, Transitions of Care, Clinician-Patient Communication
Balentine CJ, Kenzik K, Chu DI
Planning post-discharge destination for gastrointestinal surgery patients: room for improvement?
Investigators compared short-term recovery for patients discharged to inpatient rehabilitation versus skilled nursing facilities after gastrointestinal surgery. They found that there was no difference in 30-day readmission rates, but post-discharge mortality was higher for patients discharged to skilled nursing facilities compared to inpatient rehabilitation.
AHRQ-funded; HS023009.
Citation: Balentine CJ, Kenzik K, Chu DI .
Planning post-discharge destination for gastrointestinal surgery patients: room for improvement?
Am J Surg 2018 Nov;216(5):912-18. doi: 10.1016/j.amjsurg.2018.05.004..
Keywords: Hospital Discharge, Surgery, Digestive Disease and Health, Rehabilitation, Nursing Homes, Quality Improvement, Quality of Care, Transitions of Care
Desai AD, Simon TD, Leyenaar JK
Utilizing family-centered process and outcome measures to assess hospital-to-home transition quality.
This commentary describes the success of using 8 new caregiver-reported measures to assess the quality of hospital- and emergency department (ED)-to-home transitions in pediatric patients. This measures were originally created by the national Pediatric Quality Measures Program mandated by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). An original article describing these measures was published 2016 and there have been several follow-up studies. These measures are undergoing further testing.
AHRQ-funded; HS024133; HS024299; HS020506.
Citation: Desai AD, Simon TD, Leyenaar JK .
Utilizing family-centered process and outcome measures to assess hospital-to-home transition quality.
Acad Pediatr 2018 Nov - Dec;18(8):843-46. doi: 10.1016/j.acap.2018.07.013..
Keywords: Hospital Discharge, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Transitions of Care, Quality of Care, Quality Measures, Quality Improvement, Children's Health Insurance Program (CHIP), Evidence-Based Practice
Amin AP, Pinto D, House JA
Association of same-day discharge after elective percutaneous coronary intervention in the United States with costs and outcomes.
The purpose of this study was to examine (1) the incidence and trends in same day discharge (SDD); (2) hospital variation in SDD; (3) the association between SDD and readmissions for bleeding, acute kidney injury (AKI), acute myocardial infarction (AMI), or mortality at 30, 90, and 365 days after PCI; and (4) hospital costs of SDD and its drivers.
AHRQ-funded; HS022418.
Citation: Amin AP, Pinto D, House JA .
Association of same-day discharge after elective percutaneous coronary intervention in the United States with costs and outcomes.
JAMA Cardiol 2018 Nov;3(11):1041-49. doi: 10.1001/jamacardio.2018.3029..
Keywords: Healthcare Costs, Hospital Discharge, Patient-Centered Outcomes Research, Heart Disease and Health
Middleton A, Kuo YF, Graham JE
Readmission patterns over 90-day episodes of care among Medicare fee-for-service beneficiaries discharged to post-acute care.
This retrospective cohort study’s objective was to examine readmission patterns over 90-day episodes of care in patients discharged from hospitals to skilled nursing facilities (SNFs). Data was used from a national cohort of Medicare fee-for-service beneficiaries discharged from SNF care from July 2013 to July 2014. The cohort studied were adults 65 years and older who were hospitalized for stroke, joint replacement, or hip fracture, and had survived 90 days post-discharge. Patients with hemorrhagic stroke were more likely than those with ischemic stroke to be rehospitalized over the first 30 days after discharge. For patients receiving nonelective joint replacements, readmissions increased from the 30 to 90-day period post-acute discharge.
AHRQ-funded; HS022134.
Citation: Middleton A, Kuo YF, Graham JE .
Readmission patterns over 90-day episodes of care among Medicare fee-for-service beneficiaries discharged to post-acute care.
J Am Med Dir Assoc 2018 Oct;19(10):896-901. doi: 10.1016/j.jamda.2018.03.006..
Keywords: Hospital Readmissions, Hospital Discharge, Medicare, Hospitals, Elderly
Hong I, Karmarker A, Chan W
Discharge patterns for ischemic and hemorrhagic stroke patients going from acute care hospitals to inpatient and skilled nursing rehabilitation.
Investigators explored variation in acute care use of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation after ischemic and hemorrhagic stroke. They found demographic and clinical differences among stroke patients admitted for post-acute rehabilitation at inpatient rehabilitation facilities and skilled nursing facilities settings. Additionally, examination of variation in ischemic and hemorrhagic stroke discharges suggests acute facility-level differences and indicates a need for careful consideration of patient and facility factors when comparing the effectiveness of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation.
AHRQ-funded; HS022134; HS024711.
Citation: Hong I, Karmarker A, Chan W .
Discharge patterns for ischemic and hemorrhagic stroke patients going from acute care hospitals to inpatient and skilled nursing rehabilitation.
Am J Phys Med Rehabil 2018 Sep;97(9):636-45. doi: 10.1097/phm.0000000000000932..
Keywords: Transitions of Care, Hospital Discharge, Stroke, Cardiovascular Conditions, Nursing Homes, Rehabilitation
Auger KA, Shah SS, Tubbs-Cooley HL
Effects of a 1-time nurse-led telephone call after pediatric discharge: the H2O II randomized clinical trial.
The purpose of this study was to determine whether a single nurse-led telephone call after pediatric discharge decreased the 30-day reutilization rate for urgent care services and enhanced overall transition success. The investigators concluded that although postdischarge nurse contact did not decrease the reutilization rate of postdischarge urgent health care services, the method showed promise to bolster postdischarge education.
AHRQ-funded; HS024735.
Citation: Auger KA, Shah SS, Tubbs-Cooley HL .
Effects of a 1-time nurse-led telephone call after pediatric discharge: the H2O II randomized clinical trial.
JAMA Pediatr 2018 Sep;172(9):e181482. doi: 10.1001/jamapediatrics.2018.1482..
Keywords: Care Coordination, Children/Adolescents, Health Information Technology (HIT), Health Services Research (HSR), Healthcare Delivery, Healthcare Utilization, Hospital Discharge, Outcomes, Provider, Provider: Nurse, Telehealth, Transitions of Care
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
Krishnan N, Li B, Jacobs BL
The fate of radical cystectomy patients after hospital discharge: understanding the black box of the pre-readmission interval.
This study looked at reasons why bladder cancer patients who had undergone radical cystectomy surgery were readmitted to the hospital within 30 days. A retrospective cohort study was conducted for patients from 2005 to 2012. Researchers found that fever or difficulty with eating or maintaining their weight had the highest chance of being readmitted. Patients who had a higher pain tolerance or had noninfectious wounds or urinary concerns were less likely to be readmitted.
AHRQ-funded; HS018726.
Citation: Krishnan N, Li B, Jacobs BL .
The fate of radical cystectomy patients after hospital discharge: understanding the black box of the pre-readmission interval.
Eur Urol Focus 2018 Sep;4(5):711-17. doi: 10.1016/j.euf.2016.07.004..
Keywords: Adverse Events, Cancer, Hospital Discharge, Hospital Readmissions, Surgery
Gupta A, Lacson R, Balthazar PC
Assessing documentation of critical imaging result follow-up recommendations in emergency department discharge instructions.
The purpose of this study was to facilitate follow-up of critical test results across transitions in patient care settings, the investigators implemented an electronic discharge module that enabled care providers to include follow-up recommendations in the discharge instructions. Implementation of a discharge module was associated with increased documentation of critical imaging finding follow-up recommendations in ED discharge instructions. However, one in four patients still did not receive adequate follow-up recommendations, suggesting further opportunities for performance improvement exist.
AHRQ-funded; HS022586.
Citation: Gupta A, Lacson R, Balthazar PC .
Assessing documentation of critical imaging result follow-up recommendations in emergency department discharge instructions.
J Digit Imaging 2018 Aug;31(4):562-67. doi: 10.1007/s10278-017-0039-6..
Keywords: Emergency Department, Health Information Technology (HIT), Hospital Discharge, Imaging, Transitions of Care
Henke RM, Karaca Z, Gibson TB
AHRQ Author: Karaca Z, Wong HS
Medicare Advantage and traditional Medicare hospitalization intensity and readmissions.
This study uses 2013 Healthcare Cost and Utilization Project hospital discharge data from 22 states to compare hospital cost, length of stay, and readmissions for Traditional Medicare and Medicare Advantage. The authors found that Medicare Advantage hospitalizations were substantially less expensive and shorter for mental health stays but costlier and longer for injury and surgical stays.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Henke RM, Karaca Z, Gibson TB .
Medicare Advantage and traditional Medicare hospitalization intensity and readmissions.
Med Care Res Rev 2018 Aug;75(4):434-53. doi: 10.1177/1077558717692103..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospital Discharge, Hospital Readmissions, Hospitalization, Medicare
Chen LM, Acharya Y, Norton EC
Readmission rates and skilled nursing facility utilization after major inpatient surgery.
The purpose of this observational study was to describe the association between changes in skilled nursing facility (SNF) use and changes in readmission rates after surgery. The investigators looked at fee-for-service Medicare beneficiaries undergoing coronary artery bypass grafting (CABG) or total hip replacement (THR) from 2008 to 2013. They concluded that changes in use of postacute care after THR and CABG were not associated with changes in readmission rates in their study.
AHRQ-funded; HS024698; HS020671.
Citation: Chen LM, Acharya Y, Norton EC .
Readmission rates and skilled nursing facility utilization after major inpatient surgery.
Med Care 2018 Aug;56(8):679-85. doi: 10.1097/mlr.0000000000000941..
Keywords: Hospital Discharge, Hospital Readmissions, Nursing Homes, Surgery
Doupnik SK, Lawlor J, Zima BT
Mental health conditions and unplanned hospital readmissions in children.
Mental health conditions (MHCs) are prevalent among hospitalized children and could influence the success of hospital discharge. The objective of this retrospective cross-sectional study was to assess the relationship between MHCs and 30-day readmissions. The investigators concluded that MHCs were associated with a higher likelihood of hospital readmission in children admitted for medical conditions and procedures. They suggest that understanding the influence of MHCs on readmissions could guide strategic planning to reduce unplanned readmissions for children with co-occurring physical and mental health conditions.
AHRQ-funded; HS023292.
Citation: Doupnik SK, Lawlor J, Zima BT .
Mental health conditions and unplanned hospital readmissions in children.
J Hosp Med 2018 Jul;13(7):445-52. doi: 10.12788/jhm.2910..
Keywords: Children/Adolescents, Healthcare Cost and Utilization Project (HCUP), Hospital Discharge, Hospital Readmissions, Hospitalization, Risk, Young Adults
Auger KA, Simmons JM, Tubbs-Cooley HL
Postdischarge Nurse Home Visits and Reuse: the Hospital to Home Outcomes (H2O) Trial.
In this study, the investigators evaluated the effects of a pediatric transition intervention, specifically a single nurse home visit, on postdischarge outcomes in a randomized controlled trial. The investigators concluded that children randomly assigned to the intervention had higher rates of 30-day postdischarge unplanned health care reuse. They also noted that parents in the intervention group recalled more clinical warning signs 2 weeks after discharge.
AHRQ-funded; HS024735.
Citation: Auger KA, Simmons JM, Tubbs-Cooley HL .
Postdischarge Nurse Home Visits and Reuse: the Hospital to Home Outcomes (H2O) Trial.
Pediatrics 2018 Jul;142(1). doi: 10.1542/peds.2017-3919..
Keywords: Children/Adolescents, Home Healthcare, Hospital Discharge, Nursing, Transitions of Care
Graham KL, Auerbac AD, Schnipper JL
Preventability of early versus late hospital readmissions in a national cohort of general medicine patients.
The purpose of this study was to determine whether readmissions within 7 days of discharge differed from those between 8 and 30 days after discharge with respect to preventability. The investigators found that early readmissions were more likely to be preventable and amenable to hospital-based interventions. Late readmissions were less likely to be preventable and were more amenable to ambulatory and home-based interventions.
AHRQ-funded; HS022241.
Citation: Graham KL, Auerbac AD, Schnipper JL .
Preventability of early versus late hospital readmissions in a national cohort of general medicine patients.
Ann Intern Med 2018 Jun 5;168(11):766-74. doi: 10.7326/m17-1724..
Keywords: Hospital Discharge, Hospital Readmissions, Hospitals, Hospitalization, Prevention
Middleton A, Graham JE, Ottenbacher KJ
Functional status is associated with 30-day potentially preventable hospital readmissions after inpatient rehabilitation among aged Medicare fee-for-service beneficiaries.
This study has two purposes: Determine the association between functional status of patients at discharge following inpatient rehabilitation and their potentially preventable readmission; Examine conditions that result in potentially preventable readmissions. The study examined inpatient rehabilitation facilities that submitted claims to Medicare, and concluded that functional status is associated with readmission and this may help to identify at-risk patients.
AHRQ-funded; HS022134.
Citation: Middleton A, Graham JE, Ottenbacher KJ .
Functional status is associated with 30-day potentially preventable hospital readmissions after inpatient rehabilitation among aged Medicare fee-for-service beneficiaries.
Arch Phys Med Rehabil 2018 Jun;99(6):1067-76. doi: 10.1016/j.apmr.2017.05.001..
Keywords: Elderly, Quality of Care, Hospital Discharge, Hospital Readmissions, Medicare
Toth M, Holmes M, Toles M
Impact of postdischarge follow-up care on Medicare expenditures: does rural make a difference?
Reducing postdischarge Medicare expenditures is a key focus for hospitals. Early follow-up care is an important piece of this focus, but it is unclear whether there are rural-urban differences in the impact of follow-up care on Medicare expenditures. To assess this difference, the study authors used Medicare Current Beneficiary Survey, Cost and Use Files, 2000-2010 to conduct a retrospective analysis of 30-day postdischarge Medicare expenditures using two-stage residual inclusion with a quantile regression, where the receipt of 7-day follow-up care was the main independent variable.
AHRQ-funded; HS000032.
Citation: Toth M, Holmes M, Toles M .
Impact of postdischarge follow-up care on Medicare expenditures: does rural make a difference?
Med Care Res Rev 2018 Jun;75(3):327-53. doi: 10.1177/1077558716687499.
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Keywords: Healthcare Costs, Hospital Discharge, Medicare, Rural Health
Jones CD, Burke RE
Inpatient notes - getting past the "black box"-opportunities for hospitalists to improve postacute care transitions.
The care provided after hospital discharge in skilled-nursing facilities and home health care is collectively termed postacute care (PAC). In this article, the authors outline 3 key problems with postacute care transitions and offer potential solutions.
AHRQ-funded; HS024569.
Citation: Jones CD, Burke RE .
Inpatient notes - getting past the "black box"-opportunities for hospitalists to improve postacute care transitions.
Ann Intern Med 2018 May 15;168(10):HO2-HO3. doi: 10.7326/m18-0940..
Keywords: Health Services Research (HSR), Home Healthcare, Hospital Discharge, Long-Term Care, Transitions of Care
Jones CD, Burke RE
Web exclusive. Annals for Hospitalists Inpatient Notes - getting past the "black box"-opportunities for hospitalists to improve postacute care transitions.
In this article, the authors outline 3 key problems in postacute care (PAC) transitions and offer potential solutions. They assert that improving hospitalists' knowledge of PAC, improving communication after hospital discharge, and creating mechanisms for feedback to hospitalists are all possible ways of getting past the PAC “black box.”
AHRQ-funded; HS024569.
Citation: Jones CD, Burke RE .
Web exclusive. Annals for Hospitalists Inpatient Notes - getting past the "black box"-opportunities for hospitalists to improve postacute care transitions.
Ann Intern Med 2018 May 15;168(10):H02 - H03. doi: 10.7326/m18-0940..
Keywords: Communication, Hospital Discharge, Inpatient Care, Transitions of Care
Middleton A, Downer B, Haas A
Functional status is associated with 30-day potentially preventable readmissions following skilled nursing facility discharge among Medicare beneficiaries.
This retrospective cohort study’s objective was to determine the association between patients’ functional status at discharge from skilled nursing facility (SNF) care and 30-day potentially preventable readmissions. Data was used from a national cohort of Medicare fee-for-service beneficiaries discharged from SNF care from July 2013 to July 2014. The average age was 81.4 years, 67% were women, and 86.3% non-Hispanic white. Functional data used from the Minimum Data Set was self-care, mobility, and cognition domains. The overall rate of 30-day potentially preventable readmissions was 5.7%. The 5 most common conditions for readmissions were congestive heart failure, septicemia, urinary tract infection, bacterial pneumonia, and renal failure. Mobility was the most dependent category followed by self-care and cognition.
AHRQ-funded; HS022134.
Citation: Middleton A, Downer B, Haas A .
Functional status is associated with 30-day potentially preventable readmissions following skilled nursing facility discharge among Medicare beneficiaries.
J Am Med Dir Assoc 2018 Apr;19(4):348-54.e4. doi: 10.1016/j.jamda.2017.12.003..
Keywords: Hospital Readmissions, Hospital Discharge, Hospitals, Medicare, Elderly
Statile AM, Unaka N, Auger KA
Preparing from the outside looking in for safely transitioning pediatric inpatients to home.
In this editorial, the authors discuss a paper by Rehm, et al. published in 2018 in Journal of Hospital Medicine entitled “Issues Identified by Post-Discharge Contact after Pediatric Hospitalization: A Multi-site Study.”
AHRQ-funded; HS024735.
Citation: Statile AM, Unaka N, Auger KA .
Preparing from the outside looking in for safely transitioning pediatric inpatients to home.
J Hosp Med 2018 Apr;13(4):287-88. doi: 10.12788/jhm.2935..
Keywords: Children/Adolescents, Hospital Discharge, Hospitalization, Patient Safety, Transitions of Care
Parikh K, Hall M, Kenyon CC
Impact of discharge components on readmission rates for children hospitalized with asthma.
This study described hospital-based asthma-specific discharge components at children's hospitals and determine the association of these discharge components with pediatric asthma readmission rates. No individual or combination discharge components were associated with lower 30-day adjusted readmission rates. The only single-component significantly associated with a lower rate of readmission at 3 months was having comprehensive content of education.
AHRQ-funded; HS024554.
Citation: Parikh K, Hall M, Kenyon CC .
Impact of discharge components on readmission rates for children hospitalized with asthma.
J Pediatr. 2018 Apr;195:175-181.e2. doi: 10.1016/j.jpeds.2017.11.062..
Keywords: Asthma, Children/Adolescents, Hospital Discharge, Hospital Readmissions, Patient-Centered Outcomes Research
Feder SL, Britton MC, Chaudhry SI
"They need to have an understanding of why they're coming here and what the outcomes might be." Clinician perspectives on goals of care for patients discharged from hospitals to skilled nursing facilities.
This study examined how clinicians view goals of care (GoC) for hospitalized patients discharged to skilled nursing facilities (SNFs). A variety of clinicians were interviewed: 22% were nurses, 20% physicians, 15% from care management, and 15% from social services. Many respondents felt that patients and their families had unrealistic GoCs. However, conversations on GoCs were infrequent during hospitalizations which contribute to unrealistic expectations for SNF care and poor patient outcomes. The researchers recommend interventions to ensure that GoC conversations and are held regularly and in a timely manner before transfer occurs.
AHRQ-funded; HS023554.
Citation: Feder SL, Britton MC, Chaudhry SI .
"They need to have an understanding of why they're coming here and what the outcomes might be." Clinician perspectives on goals of care for patients discharged from hospitals to skilled nursing facilities.
J Pain Symptom Manage 2018 Mar;55(3):930-37. doi: 10.1016/j.jpainsymman.2017.10.013..
Keywords: Care Coordination, Clinician-Patient Communication, Communication, Hospital Discharge, Nursing Homes, Patient and Family Engagement, Provider: Clinician, Provider: Nurse, Provider: Physician
Sorkin DH, Amin A, Weimer DL
Hospital discharge and selecting a skilled nursing facility: a comparison of experiences and perspectives of patients and their families.
This article seeks to examine and compare the experiences and perspectives of patients and others involved in the selection of the nursing home (predominately adult children and spouses). It found that patients were the primary decision makers about 23 percent of the time but were often involved in the decision even when family members/involved others were primarily making decisions in the discharge process.
AHRQ-funded; HS021844.
Citation: Sorkin DH, Amin A, Weimer DL .
Hospital discharge and selecting a skilled nursing facility: a comparison of experiences and perspectives of patients and their families.
Prof Case Manag 2018 Mar/Apr;23(2):50-59. doi: 10.1097/ncm.0000000000000252.
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Keywords: Decision Making, Hospital Discharge, Long-Term Care, Nursing Homes, Patient Experience
Sills MR, Macy ML, Kocher KE
Return visit admissions may not indicate quality of emergency department care for children.
The goal of this retrospective analysis was to test the hypothesis that in-hospital outcomes are worse among children admitted during a return ED visit than among those admitted during an index visit. Children who were hospitalized in Florida and New York hospitals during a return visit within 7 days were classified as "ED return admissions" or "readmissions"; in-hospital outcomes for ED return admissions and readmissions were compared to "index admissions without return admission". The results indicate that children who are initially discharged from the ED and then have a return admission had lower severity but similar cost in comparison with children who experienced an index admission without a return admission. The authors conclude that this suggests that ED return visit admissions do not involve worse outcomes than index admissions.
AHRQ-funded; HS024160; HS016418.
Citation: Sills MR, Macy ML, Kocher KE .
Return visit admissions may not indicate quality of emergency department care for children.
Acad Emerg Med 2018 Mar;25(3):283-92. doi: 10.1111/acem.13324..
Keywords: Children/Adolescents, Emergency Department, Hospital Discharge, Hospital Readmissions, Hospitals, Quality of Care, Outcomes