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
101 to 125 of 142 Research Studies DisplayedDarby 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
Chien AT, Toomey SL, Kuo DZ
Care quality and spending among commercially insured children with disabilities.
Researchers examined the prevalence of children with disabilities (CWD) within a commercially insured population and compared outpatient care quality and annual health plan spending levels for CWD relative to children with complex medical conditions without disabilities; children with chronic conditions that are not complex; and children without disabling, complex, or chronic conditions. The cross-sectional study comprised over 1M person-years of Blue Cross Blue Shield Massachusetts data for beneficiaries aged from 1 to 19 years. The researchers found that CWD were prevalent in the commercially insured population, with these children experiencing suboptimal levels of care which were comparable to non-CWD groups. They concluded that improving the care value for CWD involves a deeper understanding of what higher spending delivers and additional aspects of care quality.
AHRQ-funded; HS025299.
Citation: Chien AT, Toomey SL, Kuo DZ .
Care quality and spending among commercially insured children with disabilities.
Acad Pediatr 2019 Apr;19(3):291-99. doi: 10.1016/j.acap.2018.06.004..
Keywords: Quality of Care, Children/Adolescents, Disabilities, Healthcare Costs, Health Insurance
Hurley VB, Rodriguez HP, Shortell SM
The role of accountable care organization affiliation and ownership in promoting physician practice participation in quality improvement collaboratives.
The goal of this study was to examine organizational influences on physician practices' propensity to participate in quality improvement collaboratives (QICs). Using data from the third wave of the National Study of Physician Organizations, findings showed that 13.6% of practices surveyed participated in a QIC. ACO affiliation, CHC ownership, larger practice size, and health information technology functionality were positively associated with QIC participation. Practice use of QI methods partially mediated the association of ACO affiliation with QIC participation.
AHRQ-funded; HS022241.
Citation: Hurley VB, Rodriguez HP, Shortell SM .
The role of accountable care organization affiliation and ownership in promoting physician practice participation in quality improvement collaboratives.
Health Care Manage Rev 2019 Apr/Jun;44(2):174-82. doi: 10.1097/hmr.0000000000000148.
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Keywords: Quality Improvement, Quality of Care, Provider: Physician, Provider, Community-Based Practice
Xie A, Woods-Hill CZ, Berenholtz SM
Use of human factors and ergonomics to disseminate health care quality improvement programs.
Human factors and ergonomics (HFE) is recognized as a key systems engineering approach to improve health care quality and safety. In this article, the authors suggest that HFE can play an important role in the dissemination of quality improvement programs across diverse health care settings. They suggest that to achieve this, health care organizations need to build capacity by leveraging HFE expertise and develop tools that guide local adaptation of interventions developed for large-scale quality initiatives.
AHRQ-funded; HS025642; HS025238.
Citation: Xie A, Woods-Hill CZ, Berenholtz SM .
Use of human factors and ergonomics to disseminate health care quality improvement programs.
Qual Manag Health Care 2019 Apr/Jun;28(2):117-18. doi: 10.1097/qmh.0000000000000211..
Keywords: Quality Improvement, Quality of Care, Communication, Provider
Machta RM, Maurer KA, Jones DJ
AHRQ Author: Furukawa MF
A systematic review of vertical integration and quality of care, efficiency, and patient-centered outcomes.
This systematic review examined the effects of small independent practices becoming part of larger provider organizations and hospital systems. A literature review was done for studies from 1996 to 2016. Out of 7,559 articles generated, 29 articles were included in this review. Vertical integration was associated with better quality but there were no differences or even lower efficiency than prior to the integration measured by utilization, spending and prices. Patient-centered outcome was measured by only a few studies so was not included.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Machta RM, Maurer KA, Jones DJ .
A systematic review of vertical integration and quality of care, efficiency, and patient-centered outcomes.
Health Care Manage Rev 2019 Apr/Jun;44(2):159-73. doi: 10.1097/hmr.0000000000000197..
Keywords: Evidence-Based Practice, Patient-Centered Outcomes Research, Quality of Care
Hung DY, Harrison MI, Liang SY
AHRQ Author: Harrison MI
Contextual conditions and performance improvement in primary care.
This study examined organizational features of primary care clinics that had gone through Lean redesigns and had experienced the greatest performance improvements. They surveyed 1333 physicians and staff in 43 primary care clinics across a large primary care system. They found that clinics with prior experience with quality improvement had the highest increases in efficiency. Clinics reporting the highest levels of burnout and work stress before the redesign also made efficiency gains. Physician productivity gains was associated with a history of change, staff participation and leadership support. The greatest improvements in patient satisfaction occurred where there was the lowest stress levels with highest levels of teamwork, staff engagement and leadership support.
AHRQ-authored; AHRQ-funded; 2902010000221.
Citation: Hung DY, Harrison MI, Liang SY .
Contextual conditions and performance improvement in primary care.
Qual Manag Health Care 2019 Apr/Jun;28(2):70-77. doi: 10.1097/qmh.0000000000000198..
Keywords: Organizational Change, Healthcare Delivery, Primary Care, Provider Performance, Quality Improvement, Quality of Care, Workflow
Wu SS, Chan KS, Bae J
Electronic clinical reminder and quality of primary diabetes care.
The goal of this retrospective cohort study was to examine the association of EMR's clinical reminder use with a comprehensive set of diabetes quality metrics in office-based physicians and within solo- versus multi-physician practices. Data on visits made by adults with diabetes were identified from the National Ambulatory Medical Care Survey and a multiple logistic regression was used to test for associations between clinical reminder use and recommended services by the American Diabetes Association. The researchers found no statistically significant relationship that suggests clinical reminder use improves diabetes process guidelines for solo practices, and they conclude that other resource efforts are needed to reduce gaps in primary diabetes care.
AHRQ-funded; HS000029.
Citation: Wu SS, Chan KS, Bae J .
Electronic clinical reminder and quality of primary diabetes care.
Prim Care Diabetes 2019 Apr;13(2):150-57. doi: 10.1016/j.pcd.2018.08.007..
Keywords: Care Management, Chronic Conditions, Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Quality of Care
Cefalu MS, Elliott MN, Setodji CM
Hospital quality indicators are not unidimensional: a reanalysis of Lieberthal and Comer.
The objective of this study was to evaluate the dimensionality of hospital quality indicators treated as unidimensional in a prior publication. The investigators found that there were four underlying dimensions of hospital quality: patient experience, mortality, and two clinical process dimensions. They concluded that hospital quality should be measured using a variety of indicators reflecting different dimensions of quality.
AHRQ-funded; HS016980; HS016978.
Citation: Cefalu MS, Elliott MN, Setodji CM .
Hospital quality indicators are not unidimensional: a reanalysis of Lieberthal and Comer.
Health Serv Res 2019 Apr;54(2):502-08. doi: 10.1111/1475-6773.13056..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Hospitals, Patient Experience, Provider Performance, Quality of Care, Quality Indicators (QIs), Quality Measures
Colborn KL, Bronsert M, Hammermeister K
Identification of urinary tract infections using electronic health record data.
Using the American College of Surgeons National Surgical Quality Improvement Program UTI status of patients who underwent an operation at the University of Colorado Hospital, the investigators sought to develop an algorithm for identifying UTIs using data from the electronic health record. The investigators concluded that a model with 14 predictors from the electronic health record identifies UTIs well, and it could be used to scale up UTI surveillance or to estimate the impact of large-scale interventions on UTI rates.
AHRQ-funded; HS026019.
Citation: Colborn KL, Bronsert M, Hammermeister K .
Identification of urinary tract infections using electronic health record data.
Am J Infect Control 2019 Apr;47(4):371-75. doi: 10.1016/j.ajic.2018.10.009..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Quality of Care, Quality Improvement, Surgery, Urinary Tract Infection (UTI)
Bundy DG, Singh H, Stein RE
The design and conduct of Project RedDE: a cluster-randomized trial to reduce diagnostic errors in pediatric primary care.
This paper discusses the results of Project RedDE, which was a virtual collaborative quality improvement study to reduce diagnostic errors in pediatric primary care practices. Forty-three practices were initially recruited, with a total of 31 practices left at the end due to practice dropout and two participating practices merging. This study was a randomized controlled trial targeting three common diagnostic errors (missed diagnoses of adolescent depression, abnormal blood pressure, and lack of followup for abnormal laboratory results). Contamination across study groups was a recurring problem, but risk mitigations were used. Electronic health records contributed to teams’ success.
AHRQ-funded; HS203608.
Citation: Bundy DG, Singh H, Stein RE .
The design and conduct of Project RedDE: a cluster-randomized trial to reduce diagnostic errors in pediatric primary care.
Clin Trials 2019 Apr;16(2):154-64. doi: 10.1177/1740774518820522..
Keywords: Adverse Events, Children/Adolescents, Diagnostic Safety and Quality, Medical Errors, Prevention, Primary Care, Quality of Care, Quality Improvement
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
Kempker JA, Kramer MR, Waller LA
State-level hospital compliance with and performance in the Centers for Medicaid & Medicare Services' Early Management Severe Sepsis and Septic Shock Bundle.
This research letter discusses a study that measured state-level hospital compliance and performance in the Centers for Medicaid & Medicare Services’(CMS) Early Management Severe Sepsis and Septic Shock Bundle (SEP-1) inpatient quality measure. There was a wide range of compliance from 97% (New Jersey) to North Dakota (15.9%). There was a state average of 48%.
AHRQ-funded; HS025240.
Citation: Kempker JA, Kramer MR, Waller LA .
State-level hospital compliance with and performance in the Centers for Medicaid & Medicare Services' Early Management Severe Sepsis and Septic Shock Bundle.
Crit Care 2019 Mar 18;23(1):92. doi: 10.1186/s13054-019-2382-0..
Keywords: Hospitals, Inpatient Care, Quality of Care, Quality Measures, Sepsis
Simon KC, Yucus C, Castle J
Building of EMR tools to support quality and research in a memory disorders clinic.
This article describes the development of a customized EMR toolkit that standardizes patient data collection with hundreds of discrete fields, supports Best Practices for treating patients with memory disorders, and also supports practice-based research. The toolkit was successfully implemented to support Best Practices in the care of patients with memory disorders. Applications are also discussed. Data collection is ongoing, but the authors anticipate that the toolkit will generate data that allows for descriptive and hypothesis-driven research as well as quality improvement among patients seen in memory clinics.
AHRQ-funded; HS024057.
Citation: Simon KC, Yucus C, Castle J .
Building of EMR tools to support quality and research in a memory disorders clinic.
Front Neurol 2019 Mar 7;10:161. doi: 10.3389/fneur.2019.00161..
Keywords: Dementia, Electronic Health Records (EHRs), Health Information Technology (HIT), Neurological Disorders, Quality of Care, Quality Improvement, Tools & Toolkits
Hysong SJ, Amspoker AB, Hughes AM
Impact of team configuration and team stability on primary care quality.
This paper discusses an upcoming study on the impact of team configurations on primary care effectiveness in clinics in the Veterans Health Administration (VHA). Recommendations are based on the Patient-Centered Medical Home (PCMH) model. Researchers plan to extract data from over 7000 primary care teams in the VHA’s Team Assignment Reports (TAR).
AHRQ-funded; HS025982.
Citation: Hysong SJ, Amspoker AB, Hughes AM .
Impact of team configuration and team stability on primary care quality.
Implement Sci 2019 Mar 6;14(1):22. doi: 10.1186/s13012-019-0864-8..
Keywords: Primary Care, Primary Care: Models of Care, Quality of Care, Teams
Perraillon MC, Konetzka RT, He D
Consumer response to composite ratings of nursing home quality.
Health care report cards are intended to address information asymmetries and enable consumers to choose providers of better quality. This study examined whether the form of the information mattered to consumers. The investigators concluded that the form of quality reporting mattered to consumers, and that the increased use of composite ratings was likely to increase consumer response.
AHRQ-funded; HS021877; HS021861; HS000084.
Citation: Perraillon MC, Konetzka RT, He D .
Consumer response to composite ratings of nursing home quality.
Am J Health Econ 2019 Spring;5(2):165-90. doi: 10.1162/ajhe_a_00115..
Keywords: Nursing Homes, Long-Term Care, Quality of Care, Provider Performance, Quality Measures
Blay E, Huang R, Chung JW
Evaluating the impact of the venous thromboembolism outcome measure on the PSI 90 composite quality metric.
Patient Safety Indicator (PSI) 90 is a composite measure widely used in federal pay-for-performance and public reporting programs. A component metric of PSI 90, venous thromboembolism (VTE) rate, has been shown to be subject to surveillance bias and not a valid measure for hospital quality comparisons. A study was conducted to examine how hospital PSI 90 scores would change if the VTE measure were removed from calculation of this composite measure.
AHRQ-funded; HS021857.
Citation: Blay E, Huang R, Chung JW .
Evaluating the impact of the venous thromboembolism outcome measure on the PSI 90 composite quality metric.
Jt Comm J Qual Patient Saf 2019 Mar;45(3):148-55. doi: 10.1016/j.jcjq.2018.08.009..
Keywords: Blood Clots, Patient Safety, Quality Measures, Quality Indicators (QIs), Quality of Care
Soffin EM, Gibbons MM, Ko CY
Evidence review conducted for the Agency for Healthcare Research and Quality Safety program for improving surgical care and recovery: focus on anesthesiology for total hip arthroplasty.
Successes using enhanced recovery after surgery (ERAS) protocols for total hip arthroplasty (THA) are increasingly being reported. The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, has developed the Safety Program for Improving Surgical Care and Recovery. In this study, the investigators conducted an evidence review to select anesthetic interventions that positively influence outcomes and facilitate recovery after total hip arthroplasty (THA).
AHRQ-funded; 233201500020I.
Citation: Soffin EM, Gibbons MM, Ko CY .
Evidence review conducted for the Agency for Healthcare Research and Quality Safety program for improving surgical care and recovery: focus on anesthesiology for total hip arthroplasty.
Anesth Analg 2019 Mar;128(3):454-65. doi: 10.1213/ane.0000000000003663..
Keywords: Evidence-Based Practice, Patient-Centered Outcomes Research, Surgery, Patient Safety, Quality Improvement, Quality of Care
Dworsky JQ, Castle SC, Lee CC
Gerofit prehabilitation pilot program: preparing frail older veterans for surgery.
Older Veterans are increasingly undergoing surgery and are at particularly high risk of postoperative morbidity and mortality. Prehabilitation has emerged as a method to improve postoperative outcomes by enhancing the patient's preoperative condition. IN this paper, the authors present data from their prehabilitation pilot project and plans for expansion and dissemination of a nationwide quality improvement effort.
Citation: Dworsky JQ, Castle SC, Lee CC .
Gerofit prehabilitation pilot program: preparing frail older veterans for surgery.
J Healthc Qual 2019 Mar/Apr;41(2):91-98. doi: 10.1097/jhq.0000000000000185..
Keywords: Elderly, Patient Safety, Quality of Care, Quality Improvement, Surgery
Milla C, Guo M, Chang A
Patient perspectives in comparing hospitals for childbirth: insights from Hawai'i.
Childbirth is a national priority area for healthcare quality improvement. Patient perspectives are increasingly valued in healthcare, yet Asian American and Pacific Islander (AAPI) perspectives of healthcare quality are often understudied, particularly from individuals with limited English proficiency (LEP). In this study, the goal was to understand factors that consumers in Hawai'i, including AAPI and those with LEP, used to compare patient care in hospitals, especially for childbirth.
AHRQ-funded; HS021903.
Citation: Milla C, Guo M, Chang A .
Patient perspectives in comparing hospitals for childbirth: insights from Hawai'i.
Hawaii J Med Public Health 2019 Mar;78(3):89-97..
Keywords: Labor and Delivery, Pregnancy, Hospitals, Quality Improvement, Quality of Care, Cultural Competence, Women
Liu LH, Choden S, Yazdany J
Quality improvement initiatives in rheumatology: an integrative review of the last 5 years.
Researchers reviewed recent quality improvement initiatives in the field of rheumatology to identify common strategies and themes leading to measurable change. Their review demonstrated common solutions, particularly involving leveraging health IT and workflow redesign. Electronic health record (EHR)-based interventions were most successful when reinforced with provider education, reminders, and performance feedback. Structured models such as the learning collaborative may help disseminate successful initiatives across practices.
AHRQ-funded; HS025638.
Citation: Liu LH, Choden S, Yazdany J .
Quality improvement initiatives in rheumatology: an integrative review of the last 5 years.
Curr Opin Rheumatol 2019 Mar;31(2):98-108. doi: 10.1097/bor.0000000000000586..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Quality of Care, Quality Improvement
Hanlon JT, Perera S, Drinka PJ
The IOU consensus recommendations for empirical therapy of cystitis in nursing home residents.
A 19-member panel of clinical pharmacists was convened for the Improving Outcomes of UTI Management in Long-Term Care Project (IOU) funded by the Agency for Healthcare Research and Quality. The objective is to reach consensus on a set of recommendations for the empirical treatment of cystitis in older nursing home residents with oral anti-infective medications. A comprehensive literature search was conducted and out of that 31 recommendations were created. There were two Delphi Survey rounds conducted and those recommendations were rated on a 5-point Likert scale. In the first round three recommendations reached consensus and in the second round an additional eight recommendations were agreed on.
AHRQ-funded; HS023779.
Citation: Hanlon JT, Perera S, Drinka PJ .
The IOU consensus recommendations for empirical therapy of cystitis in nursing home residents.
J Am Geriatr Soc 2019 Mar;67(3):539-45. doi: 10.1111/jgs.15726..
Keywords: Elderly, Nursing Homes, Long-Term Care, Medication, Quality Improvement, Quality of Care, Evidence-Based Practice
Schlesinger MJ, Rybowski L, Shaller D
Americans' growing exposure to clinician quality information: insights and implications.
The authors of this article examined the impact of changes in the growth of consumer information seeking and the availability of patient narratives about care on consumer awareness of quality information and sociodemographic differences. Public exposure to quality information of any type doubled between 2010 and 2015, ad exposure to patient narratives and experience surveys tripled. Minority consumers were better informed than whites consistently over this period, although there were differences across subgroups regarding the types of information encountered. An education-related gradient in quality awareness also emerged. The authors conclude that public policy should respond to these emerging trends in information exposure by establishing standards for rigorous elicitation of narratives and assisting consumer learning via a combination of narratives and quantified clinician quality metrics.
AHRQ-funded; HS016978; HS016980; HS021858.
Citation: Schlesinger MJ, Rybowski L, Shaller D .
Americans' growing exposure to clinician quality information: insights and implications.
Health Aff 2019 Mar;38(3):374-82. doi: 10.1377/hlthaff.2018.05006..
Keywords: Policy, Provider Performance, Public Reporting, Quality of Care, Quality Measures
Artis KA, Bordley J, Mohan V
Data omission by physician trainees on ICU rounds.
This observational study measured how frequently physician trainees omitted data from prerounding notes ("artifacts") and verbal presentations during daily rounds. The authors concluded that in an academic rounding model reliant on trainees to preview and select data for presentation during ICU rounds, verbal appraisal of patient data was highly incomplete. They assert that additional trainee oversight and education, improved electronic health record tools, and novel academic rounding paradigms are needed to address this potential source of medical error.
AHRQ-funded; HS023793.
Citation: Artis KA, Bordley J, Mohan V .
Data omission by physician trainees on ICU rounds.
Crit Care Med 2019 Mar;47(3):403-09. doi: 10.1097/ccm.0000000000003557..
Keywords: Education: Continuing Medical Education, Intensive Care Unit (ICU), Medical Errors, Patient Safety, Quality of Care
Leyenaar JK, Andrews CB, Tyksinski ER
Facilitators of interdepartmental quality improvement: a mixed-methods analysis of a collaborative to improve pediatric community-acquired pneumonia management.
This study examined the relationship between emergency room (ER) physicians and hospital pediatricians in the use of narrow-spectrum antibiotics to treat children hospitalized with pneumonia. There were eight inter-related domains that were identified that contribute to successful quality improvement efforts. These domains include hospital leadership and support; quality improvement champions, and interdepartmental relationships.
AHRQ-funded; HS024133; HS024554.
Citation: Leyenaar JK, Andrews CB, Tyksinski ER .
Facilitators of interdepartmental quality improvement: a mixed-methods analysis of a collaborative to improve pediatric community-acquired pneumonia management.
BMJ Qual Saf 2019 Mar;28(3):215-22. doi: 10.1136/bmjqs-2018-008065..
Keywords: Children/Adolescents, Community-Acquired Infections, Emergency Department, Pneumonia, Quality of Care, Quality Improvement
Kwan BM, Fernald D, Ferrarone P
Implementation and evaluation of a laboratory safety process improvement toolkit.
This study evaluated the quality and usefulness of the revised version of the AHRQ toolkit “Improving Your Office Testing Process”. The toolkit is designed to help primary care practices standardize their laboratory testing processes. Researchers evaluated 2 primary practices. Nineteen clinicians and staff provided survey data. The toolkit was given a positive rating by staff who thought it was easy to use and helped improve the quality improvement (QI) infrastructure.
AHRQ-funded; 233201500025I.
Citation: Kwan BM, Fernald D, Ferrarone P .
Implementation and evaluation of a laboratory safety process improvement toolkit.
J Am Board Fam Med 2019 Mar-Apr;32(2):136-45. doi: 10.3122/jabfm.2019.02.180109..
Keywords: Primary Care, Tools & Toolkits, Diagnostic Safety and Quality, Quality Improvement, Quality of Care