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AHRQ Research Studies Date
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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 16 of 16 Research Studies DisplayedHenke RM, Fingar KR, Jiang HJ
AHRQ Author: Jiang HJ, Liang L
Access to obstetric, behavioral health, and surgical inpatient services after hospital mergers in rural areas.
This study examined the influence of rural hospital mergers on changes to inpatient service lines at hospitals and within their catchment areas. The authors used hospital discharge data from 32 HCUP Inpatient Databases from 2007 to 2018. They found that merged hospitals were more likely than independent hospitals to eliminate maternal/neonatal and surgical care. They also found that while the number of mental/substance use disorder-related stays decreased or remained stable at merged hospitals and their catchment areas, it increased for unaffiliated hospitals and their catchment areas. This indicates a potential unmet need in the communities of rural hospitals postmerger.
AHRQ-authored; AHRQ-funded; 290201800001C.
Citation: Henke RM, Fingar KR, Jiang HJ .
Access to obstetric, behavioral health, and surgical inpatient services after hospital mergers in rural areas.
Health Aff 2021 Oct;40(10):1627-36. doi: 10.1377/hlthaff.2021.00160..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitals, Access to Care, Rural Health
Jiang HJ, Fingar KR, Liang L
AHRQ Author: Jiang HJ, Liang L
Quality of care before and after mergers and acquisitions of rural hospitals.
Researchers sought to examine changes in quality of care for patients at rural hospitals that merged compared with those that remained independent. Using HCUP data, they found that rural hospital mergers were associated with better mortality outcomes for acute myocardial infarction, heart failure, stroke, gastrointestinal hemorrhage, hip fracture, and pneumonia. They concluded that their finding is important to enhancing rural health care and reducing urban-rural disparities in quality of care.
AHRQ-authored; AHRQ-funded; 290201800001C.
Citation: Jiang HJ, Fingar KR, Liang L .
Quality of care before and after mergers and acquisitions of rural hospitals.
JAMA Netw Open 2021 Sep;4(9):e2124662. doi: 10.1001/jamanetworkopen.2021.24662..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitals, Rural Health, Quality of Care
Martin BI, Brodke DS, Wilson FA
The impact of halting elective admissions in anticipation of a demand surge due to the coronavirus pandemic (COVID-19).
This study’s objective was to estimate excess demand for hospital beds due to COVID-19 and the net financial impact of eliminating elective admissions to meet demand. An economic simulation was conducted combining epidemiological reports, the US Census, American Hospital Association Annual Survey, and the National Inpatient Sample. The base case used relied on a hospital admission rate reported by the CDC of 137.6 per 100,000, with the highest rates in people aged 65 year and older and 50-64 years. Elective admissions accounted for 20% of total hospital admissions, with an average rate of 30% unoccupied beds across hospitals. Hospitals that restricted elective care due to a COVID surge was only financial favorable if capacity was filled by a high proportion of COVID-19 cases among hospitals with low rates of elective admissions. There is a substantial financial risk to hospitals that restrict elective care.
AHRQ-funded; HS024714.
Citation: Martin BI, Brodke DS, Wilson FA .
The impact of halting elective admissions in anticipation of a demand surge due to the coronavirus pandemic (COVID-19).
Med Care 2021 Mar;59(3):213-19. doi: 10.1097/mlr.0000000000001496..
Keywords: Healthcare Cost and Utilization Project (HCUP), COVID-19, Hospitals, Healthcare Costs, Access to Care, Public Health
Fernandes-Taylor S, Yang DY, Schumacher J
Factors associated with Interhospital transfers of emergency general surgery patients from emergency departments.
This study looked at the factors contributing to transfer of emergency general surgery (EGS) patients to another hospital. Data from the AHRQ Nationwide Emergency Department Sample (NEDS) from 2010-2014 was analyzed. The transfer rate during that time was 1.9%. Patients with Medicare or other insurance had higher odds of transfer compared to patients with private health insurance. Odds of transfer increased with a greater number of comorbid conditions as well as resuscitation, intestinal obstruction, and conditions of the upper gastrointestinal tract. Transfers were more likely to originate from rural hospitals or Level I or II trauma centers.
AHRQ-funded; HS025224.
Citation: Fernandes-Taylor S, Yang DY, Schumacher J .
Factors associated with Interhospital transfers of emergency general surgery patients from emergency departments.
Am J Emerg Med 2021 Feb;40:83-88. doi: 10.1016/j.ajem.2020.12.012..
Keywords: Healthcare Cost and Utilization Project (HCUP), Surgery, Emergency Department, Transitions of Care, Hospitals, Healthcare Delivery
Jacobs PD, Basu J
AHRQ Author: Jacobs PD, Basu J
Medicare Advantage and postdischarge quality: evidence from hospital readmissions.
This study compared relative readmission rates for beneficiaries enrolled in Medicare Advantage (MA) and traditional Medicare (TM). HCUP State Inpatient Databases data for 4 states was used from 2009 and 2014. The outcome compared was the probability of a hospital readmission within 30 days of an index admission. There were significantly lower all-cause readmission rates among MA enrollees relative to those in TM in both 2009 and 2014, but MA enrollment was not associated with an increased reduction in readmission rates relative to TM during that time period.
AHRQ-authored
Citation: Jacobs PD, Basu J .
Medicare Advantage and postdischarge quality: evidence from hospital readmissions.
Am J Manag Care 2020 Dec;26(12):524-29. doi: 10.37765/ajmc.2020.88540..
Keywords: Healthcare Cost and Utilization Project (HCUP), Elderly, Medicare, Hospital Readmissions, Hospitals, Quality of Care, Provider Performance
Boggs KM, Teferi MM, Espinola JA
Consolidating emergency department-specific data to enable linkage with large administrative datasets.
This paper looks at the challenges and opportunities presented by consolidating hospital-level data with patient-level data to create better analyses of hospital-based specialties, units, or departments, and patient outcomes. The American Hospital Association (AHA) has hospital-level data, while the Centers for Medicare & Medicaid Services (CMS) has patient-level data which can be used to study emergency departments (EDs). A distinct database discussed in this paper is the Nationwide Emergency Department Inventory (NEDI). However, the NEDI database lists EDs individually while the AHA and CMS databases list EDs individually or by group if they are part of a larger network. A test set using EDs from New England was conducted using individually matched NEDI EDs with corresponding EDs in the AHA and CMS. A “group match” was assigned when more than one NEDI ED was matched to a single AHA or CMS facility ID number. Of the 195 EDs in the test set, 169 (87%) completed the NEDI survey. Of those, 77% EDs were individually listed in AHA and CMS while 39 were part of groups consisting of 2-3 EDs with one facility ID. The grouped EDs had a larger number of annual visits and beds, were more likely to be freestanding and were less likely to be rural. The consolidated dataset with 171 EDS yielded similar results to the 169 responding EDs which provides a more representative sample for studies.
AHRQ-funded; HS024561.
Citation: Boggs KM, Teferi MM, Espinola JA .
Consolidating emergency department-specific data to enable linkage with large administrative datasets.
West J Emerg Med 2020 Oct 27;21(6):141-45. doi: 10.5811/westjem.2020.8.48305..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Hospitals, Health Information Technology (HIT)
Bourne DS, Davis BS, Gigli KH
Economic analysis of mandated protocolized sepsis care in New York hospitals.
Investigators evaluated the effects of the 2013 New York State sepsis regulations on the costs of care for patients hospitalized with sepsis. They found that mandated protocolized sepsis care was not associated with significant changes in hospital costs in patients hospitalized with sepsis in New York State.
AHRQ-funded; HS025146.
Citation: Bourne DS, Davis BS, Gigli KH .
Economic analysis of mandated protocolized sepsis care in New York hospitals.
Crit Care Med 2020 Oct;48(10):1411-18. doi: 10.1097/ccm.0000000000004514..
Keywords: Healthcare Cost and Utilization Project (HCUP), Sepsis, Healthcare Costs, Hospitalization, Hospitals
Philip JL, Yang DY, Wang X
Effect of transfer status on outcomes of emergency general surgery patients.
This study looked at outcomes of transferred (TRAN) versus directly admitted (DA) emergency general surgery (EGS) patients. Patients with a diagnosis of EGS were identified from the 2008-2011 Nationwide Inpatient Sample (NIS). Outcomes included were in-hospital mortality and morbidity. They identified 274,145 TRAN and 10,456,100 DA encounters. Morbidity and mortality were both higher in TRAN patients than DA. TRAN patients were more likely to have greater comorbidity scores, have Medicare insurance, and reside in an area with a lesser median household income compared to DA patients. Morbidity among TRAN patients were primarily due urinary-, gastrointestinal-, and pulmonary-related complications. Median stay and median cost at the hospital were greater for TRAN patients.
AHRQ-funded; HS025224; HS022694.
Citation: Philip JL, Yang DY, Wang X .
Effect of transfer status on outcomes of emergency general surgery patients.
Surgery 2020 Aug;168(2):280-86. doi: 10.1016/j.surg.2020.01.005..
Keywords: Healthcare Cost and Utilization Project (HCUP), Surgery, Transitions of Care, Mortality, Outcomes, Healthcare Costs, Hospitals
Oslock WM, Ricci KB, Ingraham AM
Role of interprofessional teams in emergency general surgery patient outcomes.
This paper discusses the results of a 2015 survey of acute care hospitals, which asked whether residents and advanced practice providers participate in emergency general surgery care. The data was then linked to patient data from 17 State Inpatient Databases using American Hospital Association identifiers to determine if that was associated with better management of patients, mortality, or complications. Eighty-three hospitals and 49,271 unique emergency general surgery admissions were included in the dataset. Hospitals with residents had reduced odds of systemic complications compared with hospitals without them or other clinical support. Hospitals with only residents had the lowest odds of operative complication.
AHRQ-funded; HS022694.
Citation: Oslock WM, Ricci KB, Ingraham AM .
Role of interprofessional teams in emergency general surgery patient outcomes.
Surgery 2020 Aug;168(2):347-53. doi: 10.1016/j.surg.2020.04.046..
Keywords: Healthcare Cost and Utilization Project (HCUP), Teams, Surgery, Adverse Events, Hospitals, Healthcare Delivery
Bucholz EM,, Schuster MA, Toomey SL
Trends in 30-day readmission for Medicaid and privately insured pediatric patients: 2010-2017.
This study examined trends in 30-day readmission rates for Medicaid and privately insured pediatric patients from 2010 to 2017. The HCUP Nationwide Readmissions Database was used to compare hospital-level risk-adjusted readmission rates. Higher readmission rates were found for Medicaid beneficiaires compared to privately insured pediatric patients during the time period.
AHRQ-funded; HS020513; HS025299.
Citation: Bucholz EM,, Schuster MA, Toomey SL .
Trends in 30-day readmission for Medicaid and privately insured pediatric patients: 2010-2017.
Pediatrics 2020 Aug;146(2). doi: 10.1542/peds.2020-0270..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Hospital Readmissions, Health Insurance, Medicaid, Hospitals
Gigli KH, Davis BS, Yabes JG
Pediatric outcomes after regulatory mandates for sepsis care.
The authors used hospital discharge data from 2011 to 2015 to compare changes in pediatric sepsis outcomes in New York and four control states following New York’s 2013 regulations mandating that hospitals develop pediatric-specific protocols for sepsis recognition and treatment. They found that implementation of statewide sepsis regulations was generally associated with improved mortality trends in New York State, particularly in prespecified subpopulations of patients, suggesting that the regulations were successful in affecting sepsis outcomes.
AHRQ-funded; HS025146.
Citation: Gigli KH, Davis BS, Yabes JG .
Pediatric outcomes after regulatory mandates for sepsis care.
Pediatrics 2020 Jul;146(1). doi: 10.1542/peds.2019-3353.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Sepsis, Outcomes, Hospitals
Martsolf GR, Nuckols TK, Fingar KR
AHRQ Author: Stocks C, Owens PL
Nonspecific chest pain and hospital revisits within 7 days of care: variation across emergency department, observation and inpatient visits.
The purpose of this study was to compare the rate at which patients with nonspecific chest pain return to the hospital within 7 days after index observation visits versus after index emergency department and inpatient visits. Findings showed that up to 1 in 10 patients discharged with nonspecific chest pain returned to the hospital within 1week. Compared with emergency department and inpatient care, observation visits were associated with lower revisit rates. Recommendations include further research to refine clinical standards of care for nonspecific chest pain as well as to investigate the healthcare delivery and patient factors that influence 7-day revisit rates.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Martsolf GR, Nuckols TK, Fingar KR .
Nonspecific chest pain and hospital revisits within 7 days of care: variation across emergency department, observation and inpatient visits.
BMC Health Serv Res 2020 Jun 8;20(1):516. doi: 10.1186/s12913-020-05200-x..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Pain, Healthcare Utilization, Hospitals, Heart Disease and Health, Cardiovascular Conditions
Basu J
AHRQ Author: Basu J
Multilevel risk factors for hospital readmission among patients with opioid use disorder in selected US States: role of socioeconomic characteristics of patients and their community.
This study examined the association of socioeconomic characteristics of individuals hospitalized with a principal diagnosis of opioid use disorder and their all-cause 30-day readmission risks. Discharge data from the 2014 HCUP Survey was used and was linked to community and hospital characteristics using data from HRSA and the American Hospital Association. Medicare is associated with the highest readmission risk followed by Medicaid covered patients. Self-pay or covered by other payers had a similar risk to private insurance coverage. Urban patients also had a higher readmission rate than rural patients.
AHRQ-authored.
Citation: Basu J .
Multilevel risk factors for hospital readmission among patients with opioid use disorder in selected US States: role of socioeconomic characteristics of patients and their community.
Health Serv Res Manag Epidemiol 2020 Jan-Dec;7:2333392820904240. doi: 10.1177/2333392820904240..
Keywords: Healthcare Cost and Utilization Project (HCUP), Opioids, Medication, Substance Abuse, Hospital Readmissions, Hospitals, Social Determinants of Health
Hsuan C, Carr BG, Hsia RY
Assessment of hospital readmissions from the emergency department after implementation of Medicare's hospital readmissions reduction program.
The purpose of this study was to examine whether the Medicare Hospital Readmissions Reduction Program (HRRP) was associated with changes in the probability of readmission at emergency department (ED) visits after hospital discharge (ED revisits) overall and depending on whether admission is typically indicated for the patient's condition at the ED revisit. Using hospital and ED discharge data from California, Florida, and New York, findings suggested that implementation of the HRRP was associated with a lower likelihood of readmission for recently discharged patients presenting to the ED, specifically for congestive heart failure. These findings highlighted the critical role of the ED in readmission reduction under the HRRP and suggested that patient outcomes after HRRP implementation merit further study.
AHRQ-funded; HS025838.
Citation: Hsuan C, Carr BG, Hsia RY .
Assessment of hospital readmissions from the emergency department after implementation of Medicare's hospital readmissions reduction program.
JAMA Netw Open 2020 May;3(5):e203857. doi: 10.1001/jamanetworkopen.2020.3857..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Hospital Readmissions, Hospital Discharge, Hospitals, Medicare
Dworsky JQ, Childers CP, Gornbein J
Hospital experience predicts outcomes after high-risk geriatric surgery.
This study examined if there an association between a hospital’s annual volume of high-risk geriatric surgery and their risk of inpatient mortality, postoperative length of stay, and discharge to nursing facility. Using the 2014 National Inpatient Sample, older adults were identified who had undergone high-risk geriatric surgery. There were an estimated 514,950 hospital encounters at 3,115 hospitals undergoing surgery. A higher proportion of high-risk geriatric surgery patients was associated with decreased mortality and shorter postoperative length of stay. Higher volume hospitals were not associated with mortality but was associated with longer length of stay and decreased discharge to nursing facilities.
AHRQ-funded; HS000046; HS025079.
Citation: Dworsky JQ, Childers CP, Gornbein J .
Hospital experience predicts outcomes after high-risk geriatric surgery.
Surgery 2020 Feb;167(2):468-74. doi: 10.1016/j.surg.2019.07.026..
Keywords: Healthcare Cost and Utilization Project (HCUP), Elderly, Surgery, Risk, Hospitals, Outcomes, Mortality
Strobel RJ, Likosky DS, Brescia AA
The effect of hospital market competition on the adoption of transcatheter aortic valve replacement.
The use of transcatheter aortic valve replacement (TAVR) has grown rapidly. The purpose of this study was to assess whether hospital market competition was associated with the use of TAVR. The investigators concluded that market competition was positively associated with a hospital's adoption of TAVR and indicated that future studies should further examine the impact of competition on quality and appropriateness.
AHRQ-funded; HS026003.
Citation: Strobel RJ, Likosky DS, Brescia AA .
The effect of hospital market competition on the adoption of transcatheter aortic valve replacement.
Ann Thorac Surg 2020 Feb;109(2):473-79. doi: 10.1016/j.athoracsur.2019.06.025..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitals, Cardiovascular Conditions, Heart Disease and Health, Surgery