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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 1301 Research Studies Displayed
Perl J, Fuller DS, Boudville N
Optimizing peritoneal dialysis-associated peritonitis prevention in the United States: from standardized peritoneal dialysis-associated peritonitis reporting and beyond.
Peritoneal dialysis (PD)-associated peritonitis is the leading cause of permanent transition to hemodialysis among patients receiving PD. Optimizing the prevention of peritonitis in the United States will first require standardization of peritonitis definitions, key data elements, and outcomes in an effort to facilitate nationwide reporting. In this paper, the investigators highlighted considerations and challenges in developing standardized definitions and implementation of national reporting of peritonitis rates by PD facilities.
Citation: Perl J, Fuller DS, Boudville N . Optimizing peritoneal dialysis-associated peritonitis prevention in the United States: from standardized peritoneal dialysis-associated peritonitis reporting and beyond. Clin J Am Soc Nephrol 2020 Dec 31;16(1):154-61. doi: 10.2215/cjn.11280919..
Keywords: Kidney Disease and Health, Quality Improvement, Quality of Care
Navis A, George MC, Nmashie A
Validation of the Safer Opioid Prescribing Evaluation Tool (SOPET) for assessing adherence to the Centers for Disease Control opioid prescribing guidelines.
This study assessed the use of the Safer Opioid Prescribing Evaluation Tool (SOPET) which was designed to improve the implementation of the 2016 Centers for Disease Control Guidelines on the prescription of opioids for chronic pain. Four raters with varying levels of clinical experience were trained to use the SOPET and then used it to evaluate 21 baseline patient scenarios. Inter-rater reliability was measured using intraclass correlation coefficient (ICC) estimates and their 95% confidence intervals for the total SOPET score based on a mean-rating absolute-agreement, two-way random-effects model. Inter-rater reliability was found to be good for the three physician raters (0.92, 0.97, and 0.99). However, inter-rater reliability for the non-physician rater was lower (0.67).
Citation: Navis A, George MC, Nmashie A . Validation of the Safer Opioid Prescribing Evaluation Tool (SOPET) for assessing adherence to the Centers for Disease Control opioid prescribing guidelines. Pain Med 2020 Dec 25;21(12):3655-59. doi: 10.1093/pm/pnaa138..
Keywords: Opioids, Medication, Medication: Safety, Patient Safety, Guidelines, Practice Patterns, Pain, Chronic Conditions, Evidence-Based Practice
Bobo WV, Ryu E, Petterson TM
Bi-directional association between depression and HF: an electronic health records-based cohort study.
This study examined whether heart failure (HF) patients were more likely to be diagnosed with depression, or patients with depression were more likely to be diagnosed with HF. This retrospective cohort study utilized electronic health records (EHRs) from a large healthcare system in 2006 for adults who received primary care services. The EHR identified 10,649 people with depression, and 5,911 people with HF between 2006 to 2018. In the depression cohort there were 2,024 newly diagnosed occurrences of HF, and 944 occurrences of newly diagnosed depression in the HF cohort over 4-6 years of follow-up. There was a significantly higher risk of developing HF in the depression cohort than vice versa.
Citation: Bobo WV, Ryu E, Petterson TM . Bi-directional association between depression and HF: an electronic health records-based cohort study. J Comorb 2020 Jan-Dec;10:2235042x20984059. doi: 10.1177/2235042x20984059..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Depression, Electronic Health Records (EHRs), Health Information Technology (HIT), Chronic Conditions
McGinty EE, Presskreischer R, Anderson KE
Psychological distress and COVID-19-related stressors reported in a longitudinal cohort of US adults in April and July 2020.
The authors investigated how psychological distress has changed over the course of the COVID-19 pandemic. They found that more than 60% of adults with serious distress reported that pandemic-related disruptions to education, employment, and finances negatively affected their mental health. Thirty-five percent of adults with serious distress cited inability to obtain health care as a contributing factor, highlighting the need to facilitate safe and affordable health care access during the pandemic and beyond.
Citation: McGinty EE, Presskreischer R, Anderson KE . Psychological distress and COVID-19-related stressors reported in a longitudinal cohort of US adults in April and July 2020. JAMA 2020 Dec 22;324(24):2555-57. doi: 10.1001/jama.2020.21231..
Keywords: COVID-19, Behavioral Health, Stress
Na A, Middleton A, Haas A
Impact of diabetes on 90-day episodes of care after elective total joint arthroplasty among Medicare beneficiaries.
This study examined the impact of diabetes on 90-day episodes of care after elective total knee arthroplasty (TKA) and total hip arthroplasty (THA) in the United States. Complication (n = 521,230) and readmission (n = 515,691) data was extracted on Medicare beneficiaries using files from 2013 and 2014. Diabetes status was identified with ICD-9 codes. The odds ratio (OR) of TKA complications was significantly higher for patients with uncontrolled diabetes than those with no diabetes. The OR of THA complications was also significantly higher for controlled-complicated diabetes. OR of readmission was significantly higher for all diabetes groups.
Citation: Na A, Middleton A, Haas A . Impact of diabetes on 90-day episodes of care after elective total joint arthroplasty among Medicare beneficiaries. J Bone Joint Surg Am 2020 Dec 16;102(24):2157-65. doi: 10.2106/jbjs.20.00203..
Keywords: Diabetes, Chronic Conditions, Orthopedics, Surgery
Fisher KA, Bloomstone SJ, Walder J
Attitudes toward a potential SARS-CoV-2 vaccine: a survey of U.S. adults.
The authors assessed the intent to be vaccinated against COVID-19 among a representative sample of adults in the United States and identified predictors of and reasons for vaccine hesitancy. They found that approximately 3 in 10 adults were not sure they would accept vaccination and 1 in 10 did not intend to be vaccinated against COVID-19. They recommended targeted and multipronged efforts to increase acceptance of a COVID-19 vaccine.
Citation: Fisher KA, Bloomstone SJ, Walder J . Attitudes toward a potential SARS-CoV-2 vaccine: a survey of U.S. adults. Ann Intern Med 2020 Dec 15;173(12):964-73. doi: 10.7326/m20-3569..
Keywords: COVID-19, Vaccination, Public Health, Patient Adherence/Compliance
Stillman AE, Gatsonis C, Lima JAC
Coronary computed tomography angiography compared with single photon emission computed tomography myocardial perfusion imaging as a guide to optimal medical therapy in patients presenting with stable angina: the RESCUE trial.
Coronary computed tomography angiography compared with single photon emission computed tomography myocardial perfusion imaging as a guide to optimal medical therapy in patients presenting with stable angina: the RESCUE trial.
Citation: Stillman AE, Gatsonis C, Lima JAC . Coronary computed tomography angiography compared with single photon emission computed tomography myocardial perfusion imaging as a guide to optimal medical therapy in patients presenting with stable angina: the RESCUE trial. J Am Heart Assoc 2020 Dec 15;9(24):e017993. doi: 10.1161/jaha.120.017993..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Imaging, Comparative Effectiveness, Evidence-Based Practice
Chou R, Blazina I, Bougatsos C
Screening for hepatitis B virus infection in nonpregnant adolescents and adults: updated evidence report and systematic review for the US Preventive Services Task Force.
The authors updated the 2014 hepatitis B virus (HBV) screening review in nonpregnant adolescents and adults to inform the USPSTF. They found no direct evidence for the clinical benefits and harms of HBV screening vs no screening. Antiviral therapy for HBV infection was associated with improved intermediate outcomes and may improve clinical outcomes.
Citation: Chou R, Blazina I, Bougatsos C . Screening for hepatitis B virus infection in nonpregnant adolescents and adults: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2020 Dec 15;324(23):2423-36. doi: 10.1001/jama.2020.19750..
Keywords: U.S. Preventive Services Task Force (USPSTF), Children/Adolescents, Hepatitis, Chronic Conditions, Screening, Evidence-Based Practice, Prevention
Iribarren S, Lentz C, Sheinfil AZ
Using an HIV self-test kit to test a partner: attitudes and preferences among high-risk populations.
Researchers explored attitudes and preferences among HIV-negative men who have sex with men and HIV-negative transgender women using an HIV self-testing (HIVST) kit to test partners. They found that most preferred gum swab over fingerprick tests, but would prefer a blood test if it gave results for other sexually transmitted infections (STIs). They concluded that efforts to improve HIVST uptake should focus on incorporating testing for other STIs, reducing test kit size, and reducing cost.
Citation: Iribarren S, Lentz C, Sheinfil AZ . Using an HIV self-test kit to test a partner: attitudes and preferences among high-risk populations. AIDS Behav 2020 Nov;24(11):3232-43. doi: 10.1007/s10461-020-02885-3..
Keywords: Human Immunodeficiency Virus (HIV), Diagnostic Safety and Quality, Infectious Diseases, Prevention
Desai AD, Wang G, Wignall J
User-centered design of a longitudinal care plan for children with medical complexity.
This study’s goal was to determine content priorities and design preferences for a longitudinal care plan (LCP) among caregivers and healthcare providers who care for children with complex medical conditions (CMC) in acute care settings. Thirty iterative one-on-one design sessions with 10 caregivers and 20 providers were conducted. There was high within-group variability in content preferences among caregivers compared to provider groups. The authors identified 6 design preferences: a familiar yet customizable layout, a problem-based organization schema, linked content between sections, a table layout for most sections, a balance between unstructured and structured data fields, and use of family-centered terminology.
Citation: Desai AD, Wang G, Wignall J . User-centered design of a longitudinal care plan for children with medical complexity. J Am Med Inform Assoc 2020 Dec 9;27(12):1860-70. doi: 10.1093/jamia/ocaa193..
Keywords: Children/Adolescents, Chronic Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT), Care Coordination, Caregiving
Bakre S, Hollingsworth JM, Yan PL
Accountable care organizations and spending for patients undergoing long-term dialysis.
This study analyzed Medicare data to examine time trends in long-term dialysis beneficiary alignment to Accountable Care Organizations (ACOs) and differences in spending for those who were Accountable Care Organization aligned versus nonaligned. Beneficiaries on long-term dialysis between 2009 and 2016 were identified using a 20% random sample of Medicare beneficiaries. Trends in alignment to an ACO alignment were compared with alignment of the general Medicare population. The cohort included 135,152 beneficiaries during the study period. Alignment to an ACO of long-term dialysis beneficiaries increased from 6% to 23% from 2012 to 2016. In the time series analysis, ACO spending was $143 less per beneficiary-quarter than spending for non-aligned beneficiaries. This savings was limited to care by a primary care physician.
AHRQ-funded; HS024525; HS026908; HS024728.
Citation: Bakre S, Hollingsworth JM, Yan PL . Accountable care organizations and spending for patients undergoing long-term dialysis. Clin J Am Soc Nephrol 2020 Dec 7;15(12):1777-84. doi: 10.2215/cjn.02150220..
Keywords: Healthcare Costs, Dialysis, Kidney Disease and Health, Medicare
Combining antiplatelet and anticoagulant therapy in cardiovascular disease.
The author describes results of a number of randomized clinical trials that have explored different combinations of anticoagulation plus antiplatelet agents aimed at minimizing bleeding risk while preserving low thrombotic event rates. Findings include shorter courses with fewer antithrombotic agents as being effective, particularly when direct oral anticoagulants are combined with clopidogrel. Combined use of very low-dose rivaroxaban plus aspirin also demonstrated benefit in atherosclerotic diseases, including coronary and peripheral artery disease. Use of proton pump inhibitor therapy while patients were taking multiple antithrombotic agents had the potential to further reduce upper gastrointestinal bleeding risk in select populations. The author recommends that applying this evidence to patients with multiple thrombotic conditions will help to avoid costly and life-threatening adverse medication events.
AHRQ-funded; HS026874; HS026322.
Citation: Barnes GD . Combining antiplatelet and anticoagulant therapy in cardiovascular disease. Hematology Am Soc Hematol Educ Program 2020 Dec 4;2020(1):642-48. doi: 10.1182/hematology.2020000151..
Keywords: Blood Thinners, Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Cardiovascular Conditions
Campbell AM, Mattoni M, Yefimov MN
Improving cognitive workload in radiation therapists: a pilot EEG neurofeedback study.
The authors employed an accelerated alpha-theta neurofeedback (NF) protocol to test if 12 radiation therapy therapists (RTTs) could learn the protocol and exhibit behavior and brain performance-related benefits. Following the 3-week protocol, participants showed a decrease in subjective cognitive workload and a decrease in response time during a performance task, as well as a decrease in desynchrony of the alpha electroencephalogram band. The authors concluded that the RTTs successfully learned the protocol and improved in perceived cognitive workload following 3 weeks of neurofeedback.
Citation: Campbell AM, Mattoni M, Yefimov MN . Improving cognitive workload in radiation therapists: a pilot EEG neurofeedback study. Front Psychol 2020 Dec 3;11:571739. doi: 10.3389/fpsyg.2020.571739..
Keywords: Provider, Burnout, Stress, Workforce
Davoudi A, Lee NS, Chivers C
Patient interaction phenotypes with an automated remote hypertension monitoring program and their association with blood pressure control: observational study.
Researchers explored the unique phenotypes of patient interactions with an automated text messaging platform for blood pressure (BP) monitoring and to estimate associations between interaction phenotypes and BP control. Through a secondary analysis of data from a randomized controlled trial for adults with poorly controlled hypertension, they identified unique interaction phenotypes among patients engaging with an automated text message platform for remote BP monitoring; only the minimalist communication style was associated with achieving target BP. They recommended identifying and understanding interaction phenotypes to tailor future automated texting interactions and design future interventions to achieve better BP control.
Citation: Davoudi A, Lee NS, Chivers C . Patient interaction phenotypes with an automated remote hypertension monitoring program and their association with blood pressure control: observational study. J Med Internet Res 2020 Dec 3;22(12):e22493. doi: 10.2196/22493..
Keywords: Telehealth, Health Information Technology (HIT), Hypertension, Blood Pressure
Myong C, Hull P, Price M
The impact of funding for federally qualified health centers on utilization and emergency department visits in Massachusetts.
This retrospective study examined the impact of funding for federally qualified health centers (FQHCs) on utilization and emergency department (ED) visits in Massachusetts. The authors theorized that greater funding for FQHCs could increase the local availability of clinic-based care and reduce more costly resource use, such as ED visits. Data from the Massachusetts All Payer Claims Database (APCD) 2010-2013 was used that included enrollees in 559 Massachusetts ZIP codes (2010 numbers 6,173,563). They calculated shift-share predictions of changes in FQHC funding at the ZIP code-level for FQHCs that received Community Health Center funds in any year. They found that a standard deviation increase in prior year FQHC funding (31%) was associated with a 2.3% increase in enrollees with FQHC visits and a 1.3% decrease in enrollees at EDs. However, there were no significant changes in emergent ED visit rates.
Citation: Myong C, Hull P, Price M . The impact of funding for federally qualified health centers on utilization and emergency department visits in Massachusetts. PLoS One 2020 Dec 3;15(12):e0243279. doi: 10.1371/journal.pone.0243279..
Keywords: State Data, Healthcare Utilization, Emergency Department, Healthcare Costs, Access to Care, Vulnerable Populations, Policy
Bogetz JF, Revette A, Rosenberg AR
"I could never prepare for something like the death of my own child": parental perspectives on preparedness at end of life for children with complex chronic conditions.
This study’s goal was to elucidate aspects important to preparedness at end of life (EOL) among bereaved parents of children with complex chronic conditions (CCCs). Participants answered 21 open-response queries on communication, decision-making, and EOL experiences as part of the Survey of Caring for Children with CCCs. Findings showed that most bereaved parents of children with CCCs described feeling unprepared for their child's EOL, despite palliative care and advance care planning, suggesting preparedness is a nuanced concept beyond "readiness." Recommendations included more research to identify supportive elements among parents facing their child's EOL.
Citation: Bogetz JF, Revette A, Rosenberg AR . "I could never prepare for something like the death of my own child": parental perspectives on preparedness at end of life for children with complex chronic conditions. J Pain Symptom Manage 2020 Dec;60(6):1154-62.e1. doi: 10.1016/j.jpainsymman.2020.06.035..
Keywords: Children/Adolescents, Caregiving, Mortality, Chronic Conditions, Palliative Care
Byrnes ME, Varlamos CJ, Rivard SJ
"You're used to being the one that can fix things…": a qualitative snapshot of colorectal surgeons during COVID-19.
This viewpoint article reflects the narratives of 58 colorectal surgeons who engaged in an in-depth qualitative interview during the COVID-19 shutdown of elective surgeries. The goal for reporting these findings is to offer a snapshot of surgeon perspectives on the delays of elective surgeries and to give voice to surgeons who were unable to perform most or all their duties as a surgeon.
AHRQ-funded; HS025365; HS000053.
Citation: Byrnes ME, Varlamos CJ, Rivard SJ . "You're used to being the one that can fix things…": a qualitative snapshot of colorectal surgeons during COVID-19. Dis Colon Rectum 2020 Dec;63(12):1575-78. doi: 10.1097/dcr.0000000000001818..
Keywords: Surgery, Provider: Physician, Provider, COVID-19, Public Health, Infectious Diseases
Cykert S, Keyserling TC, Pignone M
A controlled trial of dissemination and implementation of a cardiovascular risk reduction strategy in small primary care practices.
Researchers assessed the effect of dissemination and implementation of an intervention consisting of practice facilitation and a risk-stratified, population management dashboard on cardiovascular risk reduction for patients at high risk in small, primary care practices. They found that a risk-stratified, population management dashboard combined with practice facilitation led to substantial reductions of 10-year atherosclerotic cardiovascular disease risk for patients at high risk. They recommended utilizing similar approaches to lead to effective dissemination and implementation of other new evidence, especially in rural and other under-resourced practices.
Citation: Cykert S, Keyserling TC, Pignone M . A controlled trial of dissemination and implementation of a cardiovascular risk reduction strategy in small primary care practices. Health Serv Res 2020 Dec;55(6):944-53. doi: 10.1111/1475-6773.13571..
Keywords: Cardiovascular Conditions, Risk, Prevention, Primary Care, Implementation, Evidence-Based Practice, Patient-Centered Healthcare, Patient-Centered Outcomes Research
O'Leary KJ, Manojlovich M, Johnson JK
A multisite study of interprofessional teamwork and collaboration on general medical services.
This multisite study of four mid-sized hospitals measured teamwork climate of nurses, nurse assistants, and physicians working on general medical services. Teamwork climate scores for 380 participants (80 hospitalists, 13 resident physicians, 193 nurses, and 94 nurses) were measured using the Safety Attitudes Questionnaire. Hospitalists had the highest median teamwork climate score and nurses had the lowest, but it was not a statistically significant difference. A higher percentage of hospitalists (63.3%) rated the quality of collaboration with nurses as high or very high, but only 48.7% of nurses rated the collaboration with hospitalists as high or very high. There were significant differences in perceptions of teamwork climate across sites and across professional categories.
Citation: O'Leary KJ, Manojlovich M, Johnson JK . A multisite study of interprofessional teamwork and collaboration on general medical services. Jt Comm J Qual Patient Saf 2020 Dec;46(12):667-72. doi: 10.1016/j.jcjq.2020.09.009..
Keywords: Teams, Hospitals, Patient Safety, Provider: Clinician, Provider: Physician, Provider: Nurse, Provider
Groetzinger LM, Rivosecchi RM, McVerry BJ
A quality improvement evaluation of a primary as-needed light sedation protocol in mechanically ventilated adults.
This study assessed outcomes of using a light-sedation protocol as needed compared to the more usual continuous infusion sedation in mechanically ventilated adults in medical intensive care units (ICUs). This retrospective review compared patients who received the as needed sedation protocol to similar patients treated initially with continuous infusion sedation at a 32-bed medical ICU in a large academic center. Over a 2-year period, 254 total mechanically ventilated patients were evaluated. Of the evaluable patients, 114 received the prioritizing as-needed sedation protocol, and 140 received the continuous infusion approach. In the as-needed group, 42% of patients never received continuous infusion sedation. The group also received significantly less opioid, propofol, and benzodiazepine; and experienced less delirium, shorter duration of mechanical ventilation, and shorter ICU length of stay compared to the continuous infusion sedation group.
Citation: Groetzinger LM, Rivosecchi RM, McVerry BJ . A quality improvement evaluation of a primary as-needed light sedation protocol in mechanically ventilated adults. Crit Care Explor 2020 Dec;2(12):e0264. doi: 10.1097/cce.0000000000000264..
Keywords: Quality Improvement, Quality of Care, Intensive Care Unit (ICU), Critical Care, Implementation
Hong MR, Lei D, Yousaf M
A real-world study of the longitudinal course of adult atopic dermatitis severity in clinical practice.
This study examined the longitudinal course of adult atopic dermatitis (AD) severity in clinical practice. Dermatology patients were assessed at approximately 6,12, 18, and 24 months by the scoring systems Eczema Area and Severity Index (EASI) and objective-Scoring Atopic Dermatitis (objective-SCORAD). At any visit, 36.2% of cases were scored as moderate, and 18.2% were severe. Among those patients, 25% and 18.6% continued to have moderate or severe scores at 1 or more follow-up visits for EASI, and 22.6% and 24.5% moderate or severe objective-SCORAD scores respectively. Many patients had fluctuating severity scores over time and a minority had persistently moderate or severe lesions over time, and most of those patients were unable to achieve persistent lesional clearance.
Citation: Hong MR, Lei D, Yousaf M . A real-world study of the longitudinal course of adult atopic dermatitis severity in clinical practice. Ann Allergy Asthma Immunol 2020 Dec;125(6):686-92.e3. doi: 10.1016/j.anai.2020.07.005.
Keywords: Skin Conditions, Patient-Centered Outcomes Research, Evidence-Based Practice
Heinze K, Suwanabol PA, Vitous CA
A survey of patient perspectives on approach to health care: focus on physician competency and compassion.
This study is a cross-sectional survey of 764 patients to gain insight into perceptions of physician qualities of compassion and competence. The participants response rate was 85%, with mean age 52.4, 70.8% female, and 84% identified as white. Predictors of compassion over competence included female gender and whether the respondent had a personal connection to the vignette used. Preferences were found to be influenced by: 1) explicit beliefs regarding the value of physician compassion and competence; 2) impact of emotional and mental health on medical experiences; 3) type and frequency of health care exposure, and; 4) perceived role of the physician in various clinical vignettes.
Citation: Heinze K, Suwanabol PA, Vitous CA . A survey of patient perspectives on approach to health care: focus on physician competency and compassion. J Patient Exp 2020 Dec;7(6):1044-53. doi: 10.1177/2374373520968447..
Keywords: Provider: Physician, Provider, Patient Experience, Provider Performance, Quality of Care
Caram MEV, Oerline MK, Dusetzina S
Adherence and out-of-pocket costs among Medicare beneficiaries who are prescribed oral targeted therapies for advanced prostate cancer.
The authors investigated coping and material measures of the financial hardship of abiraterone and enzalutamide among patients with advanced prostate cancer with Medicare Part D coverage. They found substantial variations in the adherence rate and out-of-pocket payments, with sociodemographic patient and regional factors found to be associated with both aspects.
Citation: Caram MEV, Oerline MK, Dusetzina S . Adherence and out-of-pocket costs among Medicare beneficiaries who are prescribed oral targeted therapies for advanced prostate cancer. Cancer 2020 Dec 1;126(23):5050-59. doi: 10.1002/cncr.33176..
Keywords: Patient Adherence/Compliance, Medicare, Cancer: Prostate Cancer, Cancer, Medication, Healthcare Costs
Scanlon DP, Harvey JB, Wolf LJ
Are health systems redesigning how health care is delivered?
The purpose of this study was to explore why and how health systems are engaging in care delivery redesign (CDR)-defined as the variety of tools and organizational change processes health systems use to pursue the Triple Aim. The investigators concluded that the ability to validly and reliably measure CDR activities-particularly across varying organizational contexts and markets-was currently limited but is key to better understanding CDR's impact on intended outcomes, which is important for guiding both health system decision making and policy making.
Citation: Scanlon DP, Harvey JB, Wolf LJ . Are health systems redesigning how health care is delivered? Health Serv Res 2020 Dec;55(Suppl 3):1129-43. doi: 10.1111/1475-6773.13585..
Keywords: Healthcare Systems, Healthcare Delivery
Hsuan C, Braun TM, Ponce NA
Are improvements still needed to the modified hospital readmissions reduction program: a health and retirement study (2000-2014)?
This study examined whether modifications to the Medicare Hospital Readmissions Reduction Program (HRRP) addressed concerns that it unfairly penalized safety net hospitals treating patients with high social and functional risks. Data from 2000-2014 Medicare hospital discharge, Health and Retirement Study, and other community-level data was used. The authors estimated risk-standardized readmission rates (RSRRs) for peer groups and by safety net status using four hierarchical logistic regression models. Patient data used was from 20,255 fee-for-service Medicare beneficiaries (65+) with eligible index hospitalizations. Hospitals were categorized by peer group, with 1 having the lowest number of at-risk patients, and 5 categorized as a safety-net hospital. Under the modifications fewer safety-net hospitals were penalized, but worsened for those in peer groups 1,2, and 3.
Citation: Hsuan C, Braun TM, Ponce NA . Are improvements still needed to the modified hospital readmissions reduction program: a health and retirement study (2000-2014)? J Gen Intern Med 2020 Dec;35(12):3564-71. doi: 10.1007/s11606-020-06222-1..
Keywords: Hospital Readmissions, Hospitals, Medicare, Safety Net