National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (22)
- (-) Adverse Events (52)
- Ambulatory Care and Surgery (1)
- Antibiotics (2)
- Antimicrobial Stewardship (2)
- Behavioral Health (1)
- Blood Clots (1)
- Blood Thinners (6)
- Cancer (1)
- Cardiovascular Conditions (6)
- Case Study (2)
- Catheter-Associated Urinary Tract Infection (CAUTI) (1)
- Children/Adolescents (9)
- Chronic Conditions (1)
- Clinician-Patient Communication (1)
- Colonoscopy (1)
- Communication (1)
- Critical Care (4)
- Decision Making (1)
- Dental and Oral Health (1)
- Depression (1)
- Diagnostic Safety and Quality (6)
- Dialysis (1)
- Digestive Disease and Health (1)
- Education: Continuing Medical Education (1)
- Elderly (4)
- Electronic Health Records (EHRs) (5)
- Emergency Department (4)
- Evidence-Based Practice (2)
- Genetics (1)
- Guidelines (3)
- Healthcare-Associated Infections (HAIs) (2)
- Healthcare Costs (2)
- Health Information Technology (HIT) (5)
- Heart Disease and Health (3)
- Hospitalization (1)
- Hospital Readmissions (1)
- Hospitals (2)
- Imaging (1)
- Implementation (1)
- Inpatient Care (1)
- Intensive Care Unit (ICU) (4)
- Kidney Disease and Health (4)
- Long-Term Care (3)
- Medical Devices (1)
- Medical Errors (16)
- Medicare (1)
- Medication (22)
- Medication: Safety (17)
- Mortality (2)
- Neurological Disorders (2)
- Newborns/Infants (2)
- Nursing Homes (3)
- Obesity (1)
- Obesity: Weight Management (1)
- Opioids (1)
- Outcomes (3)
- Patient-Centered Outcomes Research (3)
- Patient Adherence/Compliance (1)
- (-) Patient Safety (52)
- Pneumonia (1)
- Policy (1)
- Prevention (3)
- Provider (2)
- Provider: Physician (1)
- Provider Performance (1)
- Public Health (1)
- Quality Improvement (4)
- Quality of Care (8)
- Registries (3)
- Risk (5)
- Screening (1)
- Sepsis (1)
- Surgery (7)
- Surveys on Patient Safety Culture (1)
- Training (1)
- Transplantation (1)
- Treatments (1)
- Urinary Tract Infection (UTI) (2)
- Vaccination (1)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 52 Research Studies DisplayedBarnes GD
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
Griffey RT, Schneider RM, Todorov AA
The emergency department trigger tool: validation and testing to optimize yield.
Researchers validated the emergency department trigger tool (EDTT) in an independent sample and compared record selection approaches to optimize yield for quality improvement. In this single-site study of the EDTT, they observed high levels of validity in trigger selection, yield, and representativeness of adverse events, with yields that are superior to estimates for traditional approaches to adverse event detection. Record selection using weighted triggers outperformed a trigger count threshold approach and far outperformed random sampling from records with at least one trigger. They concluded that the EDTT is a promising efficient and high-yield approach for detecting all-cause harm to guide quality improvement efforts in the emergency department.
AHRQ-funded; HS025052.
Citation: Griffey RT, Schneider RM, Todorov AA .
The emergency department trigger tool: validation and testing to optimize yield.
Acad Emerg Med 2020 Dec;27(12):1279-90. doi: 10.1111/acem.14101..
Keywords: Emergency Department, Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Adverse Events, Patient Safety, Quality Improvement, Quality of Care
Branca A, Tellez D, Berkenbosch J
The new trainee effect in tracheal intubation procedural safety across PICUs in North America: a report from National Emergency Airway Registry for Children.
Researchers evaluated the effect of the timing of the PICU fellow academic cycle on tracheal intubation-associated events in a retrospective cohort study of 37 PICUs participating in the National Emergency Airway Registry for Children.. They found that the New Trainee Effect in tracheal intubation safety outcomes was not observed in various types of PICUs. There was a significant improvement in pediatric critical care medicine fellows' first attempt success and a significant decline in tracheal intubation-associated event rates, indicating substantial skills acquisition throughout pediatric critical care medicine fellowship.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Branca A, Tellez D, Berkenbosch J .
The new trainee effect in tracheal intubation procedural safety across PICUs in North America: a report from National Emergency Airway Registry for Children.
Pediatr Crit Care Med 2020 Dec;21(12):1042-50. doi: 10.1097/pcc.0000000000002480..
Keywords: Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Adverse Events, Patient Safety, Registries, Education: Continuing Medical Education, Training
Salmasian H, Blanchfield BB, Joyce K
Association of display of patient photographs in the electronic health record with wrong-patient order entry errors.
Wrong-patient order entry (WPOE) errors have a high potential for harm; these errors are particularly frequent wherever workflows are complex and multitasking and interruptions are common, such as in the emergency department (ED). The purpose of this study was to evaluate whether the use of noninterruptive display of patient photographs in the banner of the electronic health record (EHR) is associated with a decreased rate of WPOE errors.
AHRQ-funded; HS024713.
Citation: Salmasian H, Blanchfield BB, Joyce K .
Association of display of patient photographs in the electronic health record with wrong-patient order entry errors.
AMA Netw Open 2020 Nov 2;3(11):e2019652. doi: 10.1001/jamanetworkopen.2020.19652..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Adverse Drug Events (ADE), Adverse Events, Medication, Medication: Safety, Patient Safety, Diagnostic Safety and Quality
Mangrum R, Stewart MD, Gifford DR
Omissions of care in nursing homes: a uniform definition for research and quality improvement.
The goal of this study was to create a uniform definition of omission of care in US nursing homes. Lack of a uniform definition has made efforts to prevent them challenging. Subject matter experts and a broad range of nursing home stakeholders were brought together in iterative rounds of engagement to identify key concepts and aspects of omissions of care and develop a consensus-based definition. The concise definition decided on was: “Omissions of care in nursing homes encompass situations when care–either clinical or nonclinical–is not provided for a resident and results in additional monitoring or intervention or increases the risk of an undesirable or adverse physical, emotional, or psychosocial outcome for the resident."
AHRQ-funded; 233201500014I.
Citation: Mangrum R, Stewart MD, Gifford DR .
Omissions of care in nursing homes: a uniform definition for research and quality improvement.
J Am Med Dir Assoc 2020 Nov;21(11):1587-91.e2. doi: 10.1016/j.jamda.2020.08.016..
Keywords: Elderly, Nursing Homes, Long-Term Care, Quality Improvement, Quality of Care, Medical Errors, Adverse Events, Patient Safety, Risk, Patient-Centered Outcomes Research
Yansane A, Lee JH, Hebballi N
Assessing the patient safety culture in dentistry.
Medical errors are among the leading causes of death within the United States. Studies have shown that patients can be harmed while receiving care, sometimes resulting in permanent injury or, in extreme cases, death. To reduce the risk of patient safety incidents, it is imperative that a robust culture of safety be established. The primary objective of this study was to evaluate the patient safety culture among providers at 4 US dental institutions, comparing the results with their medical counterparts in 2016.
AHRQ-funded; HS024406.
Citation: Yansane A, Lee JH, Hebballi N .
Assessing the patient safety culture in dentistry.
JDR Clin Trans Res 2020 Oct;5(4):399-408. doi: 10.1177/2380084419897614..
Keywords: Surveys on Patient Safety Culture, Patient Safety, Dental and Oral Health, Provider, Medical Errors, Adverse Events
Toce MS, Michelson K, Hudgins J
Association of state-level opioid-reduction policies with pediatric opioid poisoning.
Opioid-reduction policies have been enacted by US states to address the opioid epidemic. Evidence of an association between policy implementation and decreased rates of pediatric opioid poisoning provides further justification for expanded implementation of these policies. The purpose of this study was to examine the association of 3 state-level opioid-reduction policies with the rate of opioid poisoning in children and adolescents.
AHRQ-funded; HS026503.
Citation: Toce MS, Michelson K, Hudgins J .
Association of state-level opioid-reduction policies with pediatric opioid poisoning.
JAMA Pediatr 2020 Oct;174(10):961-68. doi: 10.1001/jamapediatrics.2020.1980..
Keywords: Children/Adolescents, Opioids, Medication: Safety, Medication, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Policy
Slatnick LR, Thornhill D, Deakyne Davies
Disseminated intravascular coagulation is an independent predictor of adverse outcomes in children in the emergency department with suspected sepsis.
The purpose of this study was to evaluate the impact of early disseminated intravascular coagulation (DIC) on illness severity in children using a database of emergency department ED encounters for children with suspected sepsis, in view of similar associations in adults. The investigators concluded that a DIC score of ≥3 was an independent predictor for both vasopressor use and mortality in this pediatric cohort, distinct from the adult overt DIC score cutoff of ≥5.
AHRQ-funded; HS025696.
Citation: Slatnick LR, Thornhill D, Deakyne Davies .
Disseminated intravascular coagulation is an independent predictor of adverse outcomes in children in the emergency department with suspected sepsis.
J Pediatr 2020 Oct;225:198-206.e2. doi: 10.1016/j.jpeds.2020.06.022..
Keywords: Children/Adolescents, Emergency Department, Sepsis, Adverse Events, Mortality, Patient Safety, Outcomes
Emeriaud G, Napolitano N, Polikoff P
Impact of failure of noninvasive ventilation on the safety of pediatric tracheal intubation.
This prospective multicenter cohort study’s objective was to assess whether noninvasive ventilation failure in critically ill children was associated with severe tracheal intubation-associated events and severe oxygen desaturation during tracheal intubation. Data from the National Emergency Airway Registry for Children was used to examine data from thirteen PICUs (in 12 institutions) in the United States and Canada. The study included 956 tracheal intubation encounters, with 424 (44%) occurring after noninvasive ventilation failure with a median of 13 hours of noninvasive ventilation. The failure group included more infants (47% vs 33%) and patients with a respiratory diagnosis (56% vs 30%). Noninvasive ventilation failure was not associated with severe tracheal intubation-associated events without noninvasive ventilation but was associated with severe desaturation (15% vs 9%) without noninvasive ventilation.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Emeriaud G, Napolitano N, Polikoff P .
Impact of failure of noninvasive ventilation on the safety of pediatric tracheal intubation.
Crit Care Med 2020 Oct;48(10):1503-12. doi: 10.1097/ccm.0000000000004500..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Patient Safety, Adverse Events
Feldman AG, Parsons JA, Dutmer CM
Subacute liver failure following gene replacement therapy for spinal muscular atrophy type 1.
This paper reports on two cases of transient, drug-induced liver failure after gene replacement therapy using an adeno-associated virus vector containing the survival motor neuron 1 gene.
AHRQ-funded; HS026510.
Citation: Feldman AG, Parsons JA, Dutmer CM .
Subacute liver failure following gene replacement therapy for spinal muscular atrophy type 1.
J Pediatr 2020 Oct;225:252-58.e1. doi: 10.1016/j.jpeds.2020.05.044..
Keywords: Newborns/Infants, Neurological Disorders, Genetics, Treatments, Adverse Drug Events (ADE), Adverse Events, Medication, Medication: Safety, Patient Safety, Case Study
Barnes GD, Sippola E, Dorsch M
Applying population health approaches to improve safe anticoagulant use in the outpatient setting: the DOAC Dashboard multi-cohort implementation evaluation study protocol.
This paper discusses the study protocol that is being used in the ongoing multi-cohort implementation evaluation study on applying population health approaches to improve safe use of direct oral anticoagulants (DOAC) for treatment of atrial fibrillation and venous thromboembolism. It is hoped that these approaches will help prevent incorrect dosing which is common and puts patients at risk of adverse events. Population health tools, including interactive dashboards built into the electronic health record (EHR), are being evaluated as a way to improve safe prescribing. A three-phase project is being conducted at the Veterans Health Administration (VHA) using both quantitative and qualitative methods. The DOAC Dashboard will be implemented in four new health systems. Quantitative evaluation of the implementation will follow the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Stakeholders will be interviewed as part of the qualitative evaluation using the Consolidated Framework for Implementation Research and Technology Acceptance Models. The goals of the study are to evaluate the implementation of the EHR-based population health tool, guide the adoption in four new health systems, and evaluate the multi-center implementation effort.
AHRQ-funded; HS026874.
Citation: Barnes GD, Sippola E, Dorsch M .
Applying population health approaches to improve safe anticoagulant use in the outpatient setting: the DOAC Dashboard multi-cohort implementation evaluation study protocol.
Implement Sci 2020 Sep 21;15(1):83. doi: 10.1186/s13012-020-01044-5.
.
.
Keywords: Blood Thinners, Medication, Patient Safety, Implementation, Adverse Drug Events (ADE), Adverse Events, Medical Errors
Zachariah P, Sanabria E, Liu J
Novel strategies for predicting healthcare-associated infections at admission: implications for nursing care.
Accurate, real-time models to predict hospital adverse events could facilitate timely and targeted interventions to improve patient outcomes. Advances in computing enable the use of supervised machine learning (SML) techniques to predict hospital-onset infections. The purpose of this study was to trial SML methods to predict urinary tract infections (UTIs) during inpatient hospitalization at the time of admission.
AHRQ-funded; HS024915.
Citation: Zachariah P, Sanabria E, Liu J .
Novel strategies for predicting healthcare-associated infections at admission: implications for nursing care.
Nurs Res 2020 Sep/Oct;69(5):399-403. doi: 10.1097/nnr.0000000000000449..
Keywords: Urinary Tract Infection (UTI), Healthcare-Associated Infections (HAIs), Adverse Events, Patient Safety, Risk
Bacon O, Hoffman L
System-level patient safety practices that aim to reduce medication errors associated with infusion pumps: an evidence review.
This literature review looked at studies that discuss 2 system-level patient safety practices (PSPs) that aim to reduce medication errors associated with infusion pumps. The first practice focuses on implementing structured process changes and redesigning workflows to improve efficiencies with pump use; and the other focuses on investing in initial and ongoing staff training on the correct use, maintenance, and monitoring of infusion pumps. Two databases were searched, with only four studies reporting medication administration errors, procedural errors, or deviations from hospital policy. Mixed results were found on examining process outcomes related to pump handling. Two studies found an increase in nurses’ adherence to using the medication safety software library because of education, with a resulting decrease in medication errors and adverse safety events.
AHRQ-funded; HHSP233201500013I.
Citation: Bacon O, Hoffman L .
System-level patient safety practices that aim to reduce medication errors associated with infusion pumps: an evidence review.
J Patient Saf 2020 Sep;16(3S Suppl 1):S42-s47. doi: 10.1097/pts.0000000000000722..
Keywords: Adverse Drug Events (ADE), Adverse Events, Patient Safety, Medication: Safety, Medication
De Roo AC, Hendren S, Ameling JM
Using appropriateness criteria to identify opportunities to improve perioperative urinary catheter use.
Researchers applied Michigan Appropriate Perioperative criteria to statewide registry data to identify improvement targets for urinary catheter use. They found that perioperative urinary catheter use was appropriate for most simple abdominal procedures, but duration of use varied in all categories.
AHRQ-funded; HS019767; HS024385; HS018334; HS000053.
Citation: De Roo AC, Hendren S, Ameling JM .
Using appropriateness criteria to identify opportunities to improve perioperative urinary catheter use.
Am J Surg 2020 Sep;220(3):706-13. doi: 10.1016/j.amjsurg.2020.01.008..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Urinary Tract Infection (UTI), Healthcare-Associated Infections (HAIs), Patient Safety, Surgery, Prevention, Adverse Events
Earl TR, Katapodis ND, Schneiderman SR
Using deprescribing practices and the screening tool of older persons' potentially inappropriate prescriptions criteria to reduce harm and preventable adverse drug events in older adults.
This paper is a systematic review of the literature published between 2008 to 2018 that studies the effect of interventions to reduce preventable adverse drug effects (ADEs) for adults who are prescribed multiple medications. Two safety practices were examined: 1) deprescribing interventions to reduce polypharmacy; and 2) use of the Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions (STOPP) to reduce potentially inappropriate medications (PIMS). A total of 26 studies and 1 systematic review were included (14 for deprescribing and 12 for STOPP). Deprescribing interventions included decision support tools, educational interventions, and medication reviews. The STOPP tool most reported changes in PIMS, as well as some economic outcomes. Both methods were found to be effective.
AHRQ-funded; HHSP233201500013I.
Citation: Earl TR, Katapodis ND, Schneiderman SR .
Using deprescribing practices and the screening tool of older persons' potentially inappropriate prescriptions criteria to reduce harm and preventable adverse drug events in older adults.
J Patient Saf 2020 Sep;16(3S Suppl 1):S23-s35. doi: 10.1097/pts.0000000000000747..
Keywords: Elderly, Medication: Safety, Medication, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Screening, Prevention
Abraham NS, Yang EH, Noseworthy PA
Fewer gastrointestinal bleeds with ticagrelor and prasugrel compared with clopidogrel in patients with acute coronary syndrome following percutaneous coronary intervention.
The goal of this study was to compare gastrointestinal bleeding (GIB) rates associated with clopidogrel, prasugrel, and ticagrelor using national medical and pharmacy claims data from privately insured and Medicare Advantage enrollees. Findings showed that, in the first year following percutaneous coronary intervention for acute coronary syndrome, ticagrelor and prasugrel were associated with fewer GIB events compared with clopidogrel.
AHRQ-funded; HS025402.
Citation: Abraham NS, Yang EH, Noseworthy PA .
Fewer gastrointestinal bleeds with ticagrelor and prasugrel compared with clopidogrel in patients with acute coronary syndrome following percutaneous coronary intervention.
Aliment Pharmacol Ther 2020 Aug;52(4):646-54. doi: 10.1111/apt.15790..
Keywords: Medication: Safety, Medication, Blood Thinners, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Cardiovascular Conditions, Surgery
Griffey RT, Schneider RM, Todorov AA
The emergency department trigger tool: a novel approach to screening for quality and safety events.
The goal of this study was to develop an automated version of a previously developed emergency department (ED) trigger tool to track the likelihood of an adverse event. Thirty triggers were associated with risk of harm. The authors identified 1,726 records out of 76,894 ED visits with greater than or equal to 1 trigger. They compared the results of the automated tool to the previous version and found it performed well. They began with a broad set of candidate triggers and validated a computerized query that eliminates the need for manual screening of triggers and also identified a refined set of triggers associated with adverse events in the ED.
AHRQ-funded; HS025052.
Citation: Griffey RT, Schneider RM, Todorov AA .
The emergency department trigger tool: a novel approach to screening for quality and safety events.
Ann Emerg Med 2020 Aug;76(2):230-40. doi: 10.1016/j.annemergmed.2019.07.032..
Keywords: Emergency Department, Patient Safety, Adverse Events, Medical Errors, Quality of Care, Risk
Miller J, Vitous CA, Boothman RC
Medical error professionals' perspectives on Inter-system medical error discovery (IMED): consensus, divergence, and uncertainty.
Best practices for how to respond are unclear when a medical error is discovered in a different system (inter-system medical error discovery or IMED). This qualitative study explored medical error professionals' views on disclosure, feedback, and reporting in these scenarios. The investigators found that while medical error professionals expressed consensus regarding obligations to disclose obvious errors, they differed on particulars.
AHRQ-funded; HS026030.
Citation: Miller J, Vitous CA, Boothman RC .
Medical error professionals' perspectives on Inter-system medical error discovery (IMED): consensus, divergence, and uncertainty.
Medicine 2020 Jul 31;99(31):e21425. doi: 10.1097/md.0000000000021425..
Keywords: Medical Errors, Adverse Events, Patient Safety, Guidelines
Villa Zapata L, Hansten PD, Horn JR
Evidence of clinically meaningful drug-drug interaction with concomitant use of colchicine and clarithromycin.
Colchicine is currently approved for the treatment of gout and familial Mediterranean fever, among other conditions. Clarithromycin, a strong inhibitor of CYP3A4 and P-glycoprotein, dramatically increases colchicine's half-life, augmenting the risk of a life-threatening adverse reaction when used inadvertently with colchicine. The aim of this study was to examine the evidence and clinical implications of concomitant use of colchicine and clarithromycin.
AHRQ-funded; HS025984.
Citation: Villa Zapata L, Hansten PD, Horn JR .
Evidence of clinically meaningful drug-drug interaction with concomitant use of colchicine and clarithromycin.
Drug Saf 2020 Jul;43(7):661-68. doi: 10.1007/s40264-020-00930-7..
Keywords: Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events, Patient Safety
Liberman JS, Slagle JM, Whitney G
Incidence and classification of nonroutine events during anesthesia care.
A nonroutine event is any aspect of clinical care perceived by clinicians or trained observers as a deviation from optimal care based on the context of the clinical situation. The authors sought to delineate the incidence and nature of intraoperative nonroutine events during anesthesia care. The investigators concluded that nonroutine event-containing cases were commonly associated with patient impact and injury. They indicated that nonroutine event monitoring in conjunction with traditional error reporting may enhance understanding of potential intraoperative failure modes to guide prospective safety interventions.
AHRQ-funded; HS011375.
Citation: Liberman JS, Slagle JM, Whitney G .
Incidence and classification of nonroutine events during anesthesia care.
Anesthesiology 2020 Jul;133(1):41-52. doi: 10.1097/aln.0000000000003336..
Keywords: Medication: Safety, Medication, Patient Safety, Adverse Drug Events (ADE), Adverse Events, Surgery
Villa Zapata L, Hansten PD, Panic J
Risk of bleeding with exposure to warfarin and nonsteroidal anti-inflammatory drugs: a systematic review and meta-analysis.
Warfarin use can trigger the occurrence of bleeding independently or as a result of a drug-drug interaction when used in combination with nonsteroidal anti-inflammatory drugs (NSAIDs). This article examines the risk of bleeding in individuals exposed to concomitant warfarin and NSAID compared with those taking warfarin alone. The investigators concluded that risk of bleeding was significantly increased among persons taking warfarin and a NSAID or COX-2 inhibitor together as compared with taking warfarin alone.
AHRQ-funded; HS025984.
Citation: Villa Zapata L, Hansten PD, Panic J .
Risk of bleeding with exposure to warfarin and nonsteroidal anti-inflammatory drugs: a systematic review and meta-analysis.
Thromb Haemost 2020 Jul;120(7):1066-74. doi: 10.1055/s-0040-1710592..
Keywords: Blood Thinners, Medication, Medication: Safety, Risk, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes
Nanji KC, Merry AF, Shaikh SD KC, Merry AF, Shaikh SD
Global PRoMiSe (Perioperative Recommendations for Medication Safety): protocol for a mixed-methods study.
Medication errors (MEs), which occur commonly in the perioperative period, have the potential to cause patient harm or death. Many published recommendations exist for preventing perioperative MEs; however, many of these recommendations conflict and are often not applicable to middle-income and low-income countries. The goal of this study was to develop and disseminate consensus-based recommendations for perioperative medication safety that were tailored to country income level.
AHRQ-funded; HS024764.
Citation: Nanji KC, Merry AF, Shaikh SD KC, Merry AF, Shaikh SD .
Global PRoMiSe (Perioperative Recommendations for Medication Safety): protocol for a mixed-methods study.
BMJ Open 2020 Jun 30;10(6):e038313. doi: 10.1136/bmjopen-2020-038313..
Keywords: Medication, Medication: Safety, Patient Safety, Adverse Drug Events (ADE), Adverse Events, Medical Errors
Vyles D, Antoon JW, Norton A
Children with reported penicillin allergy: public health impact and safety of delabeling.
The objectives of this study were to: 1.) Review the relevant literature related to children with reported penicillin allergy 2.) Highlight the different ways in which children could be delabeled and 3.) Evaluate the public health impact that a penicillin allergy has for children. The investigators concluded that penicillin allergy was overdiagnosed, often incorrectly, and the label was frequently first applied during childhood.
AHRQ-funded; HS026395.
Citation: Vyles D, Antoon JW, Norton A .
Children with reported penicillin allergy: public health impact and safety of delabeling.
Ann Allergy Asthma Immunol 2020 Jun;124(6):558-65. doi: 10.1016/j.anai.2020.03.012..
Keywords: Children/Adolescents, Medication, Medication: Safety, Patient Safety, Adverse Drug Events (ADE), Adverse Events, Public Health
Furukawa MF, Eldridge N, Wang Y
AHRQ Author: Furukawa MF, Eldridge N
Electronic health record adoption and rates of in-hospital adverse events.
Researchers examined the association of hospitals' electronic health record (EHR) adoption and occurrence rates of adverse events among exposed patients. The study included patients hospitalized for acute cardiovascular disease, pneumonia, or conditions requiring surgery. The researchers found that patients exposed to a fully electronic EHR were less likely to experience in-hospital adverse events.
AHRQ-authored.
Citation: Furukawa MF, Eldridge N, Wang Y .
Electronic health record adoption and rates of in-hospital adverse events.
J Patient Saf 2020 Jun;16(2):137-42. doi: 10.1097/pts.0000000000000257..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Adverse Events, Inpatient Care, Hospitals, Patient Safety
Yang AD, Hewitt DB, Blay E
Multi-institution evaluation of adherence to comprehensive postoperative VTE chemoprophylaxis.
The aims of this study were to: (1) measure the rate of failure to provide defect-free postoperative venous thromboembolism (VTE) chemoprophylaxis, (2) identify reasons for failure to provide defect-free VTE chemoprophylaxis, and (3) examine patient- and hospital-level factors associated with failure. The investigators concluded that in contrast to SCIP-VTE-2, their novel quality measure unmasked VTE chemoprophylaxis failures in 18% of colectomies. They found that most failures were due to patient refusals or ordering errors.
AHRQ-funded; HS024516.
Citation: Yang AD, Hewitt DB, Blay E .
Multi-institution evaluation of adherence to comprehensive postoperative VTE chemoprophylaxis.
Ann Surg 2020 Jun;271(6):1072-79. doi: 10.1097/sla.0000000000003124..
Keywords: Patient Adherence/Compliance, Guidelines, Blood Clots, Blood Thinners, Medication, Medication: Safety, Patient Safety, Adverse Events