National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Blood Clots (1)
- Cardiovascular Conditions (1)
- Catheter-Associated Urinary Tract Infection (CAUTI) (2)
- Central Line-Associated Bloodstream Infections (CLABSI) (2)
- Clostridium difficile Infections (2)
- Communication (1)
- (-) Healthcare-Associated Infections (HAIs) (10)
- Healthcare Costs (2)
- Heart Disease and Health (1)
- (-) Hospitals (10)
- Implementation (1)
- Infectious Diseases (2)
- Medical Devices (1)
- Medicare (2)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (2)
- Mortality (1)
- Patient Safety (4)
- Payment (2)
- Pneumonia (1)
- Policy (1)
- Prevention (3)
- Quality Improvement (2)
- Quality of Care (2)
- Risk (1)
- Sepsis (1)
- Urinary Tract Infection (UTI) (2)
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 10 of 10 Research Studies DisplayedLikosky DS, Yang G, Zhang M
Interhospital variability in health care-associated infections and payments after durable ventricular assist device implant among Medicare beneficiaries.
The purpose of this study was to examine differences in durable ventricular assist device implantation infection rates and associated costs across hospitals. The researchers utilized clinical data for 8,688 patients who received primary durable ventricular assist devices from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) hospitals (n = 120) and merged that data with post-implantation 90-day Medicare claims. The primary outcome included infections within 90 days of implantation and Medicare payments. The study found that 27.8% of patients developed 3982 identified infections. The median adjusted incidence of infections (per 100 patient-months) across hospitals was 14.3 and differed according to hospital. Total Medicare payments from implantation to 90 days were 9.0% more in high versus low infection tercile hospitals. The researchers concluded that health-care-associated infection rates post durable ventricular assist device implantation varied according to hospital and were associated with increased 90-day Medicare expenditures.
AHRQ-funded; HS026003.
Citation: Likosky DS, Yang G, Zhang M .
Interhospital variability in health care-associated infections and payments after durable ventricular assist device implant among Medicare beneficiaries.
J Thorac Cardiovasc Surg 2022 Nov;164(5):1561-68. doi: 10.1016/j.jtcvs.2021.04.074..
Keywords: Healthcare-Associated Infections (HAIs), Medical Devices, Medicare, Heart Disease and Health, Cardiovascular Conditions, Hospitals, Payment, Healthcare Costs
Lee PT, Krecko LK, Savage S
Which hospital-acquired conditions matter the most in trauma? An evidence-based approach for prioritizing trauma program improvement.
The purpose of this study was to quantify and compare the impacts of six different hospital-acquired conditions (HACs) on early clinical outcomes and resource utilization in hospitalized trauma patients. The researchers included 529,856 adult patients from the 2013 to 2016 American College of Surgeons Trauma Quality Improvement Program Participant Use Data Files with 5 days or longer of hospitalization and had an Injury Severity Score of 9 or higher. The study found the incidences of HACs were: pneumonia, 5.2%; urinary tract infection, 3.4%; venous thromboembolism, 3.3%; surgical site infection, 1.3%; pressure ulcer, 1.3%; and central line-associated blood stream infection, 0.2%. The HAC of pneumonia demonstrated the largest association with in-hospital outcomes and resource utilization. The researchers reported that prevention of pneumonia within the study group would have resulted in estimated reductions of: 22.1% for end organ dysfunction, 8.7% for prolonged hospitalization, 7.8% for mortality, 7.1% for prolonged intensive care unit stay, and 6.8% for need for mechanical ventilation. The researchers concluded that pneumonia prevention should be a priority activity in program improvement efforts.
AHRQ-funded; HS025224.
Citation: Lee PT, Krecko LK, Savage S .
Which hospital-acquired conditions matter the most in trauma? An evidence-based approach for prioritizing trauma program improvement.
J Trauma Acute Care Surg 2022 Oct 1;93(4):446-52. doi: 10.1097/ta.0000000000003645..
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Pneumonia, Urinary Tract Infection (UTI), Blood Clots
McAlearney AS, MacEwan SR, Gregory ME
Identifying management practices for promoting infection prevention: perspectives on strategic communication.
The purpose of this study was to better understand the topics and communication strategies used by hospital administrative and clinical leaders to facilitate healthcare-associated infection prevention. Between 2017 and 2019 the researchers interviewed 188 administrative and clinical leaders in 18 U.S. Hospitals and interviewed them about management practices used to promote the prevention of HAI, with a focus on strategic communications. The study found that information sharing regarding infection prevention focused on two main topics: facilitators of success and barriers to success. The researchers also reported that storytelling using examples of real events was useful. The study concluded that the findings provide useful information about how the strategic communication of HAI information can contribute to improvement and advance hospitals’ infection prevention plans and efforts.
AHRQ-funded; HS024958.
Citation: McAlearney AS, MacEwan SR, Gregory ME .
Identifying management practices for promoting infection prevention: perspectives on strategic communication.
Am J Infect Control 2022 Jun;50(6):593-97. doi: 10.1016/j.ajic.2021.11.025..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Hospitals, Prevention, Communication
McCleskey SG, Shek L, Grein J
Economic evaluation of quality improvement interventions to prevent catheter-associated urinary tract infections in the hospital setting: a systematic review.
This systematic review looked at economic evaluations of quality improvement (QI) interventions to reduce rates of catheter-associated urinary tract infections (CAUTIs). A literature review was conducted for conference abstracts and studies from January 2000 to October 2020. Dual reviewers assessed study design, effectiveness, costs and study quality for eligibility. The reviewers performed a cost-consequence analysis from the hospital perspective, estimating the incidence rate ratio and increment net cost/savings per hospital over 3 years for each eligible study. Fifteen unique economic evaluations were eligible, and 12 studies were amenable to standardization. QI interventions were associated with a 43% decline in infections and wide ranges of net costs relative to usual care.
AHRQ-funded; HS022644.
Citation: McCleskey SG, Shek L, Grein J .
Economic evaluation of quality improvement interventions to prevent catheter-associated urinary tract infections in the hospital setting: a systematic review.
BMJ Qual Saf 2022 Apr;31(4):308-21. doi: 10.1136/bmjqs-2021-013839..
Keywords: Quality Improvement, Quality of Care, Urinary Tract Infection (UTI), Healthcare-Associated Infections (HAIs), Hospitals, Healthcare Costs
Arntson E, Dimick JB, Nuliyalu U
Changes in hospital-acquired conditions and mortality associated with the hospital-acquired condition reduction program.
This study evaluated changes in Hospital-Acquired Conditions (HACs) and 30-day mortality after the announcement of the Centers for Medicare and Medicare Services’ Hospital-Acquired Condition Reduction Program (HACRP) in August 2013. The authors evaluated models to test for changes in HACs and 30-day mortality before and after the Affordable Care Act (ACA), and after the HACRP. Fee-for-service Medicare claims from 2009 to 2015 were used. The HAC rate declined after the ACA was passed and declined further after the HACRP announcement. However, 30-day mortality rates were unchanged.
AHRQ-funded; HS026244.
Citation: Arntson E, Dimick JB, Nuliyalu U .
Changes in hospital-acquired conditions and mortality associated with the hospital-acquired condition reduction program.
Ann Surg 2021 Oct 1;274(4):e301-e07. doi: 10.1097/sla.0000000000003641..
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Mortality, Medicare, Payment, Prevention, Patient Safety
Page B, Klompas M, Chan C
Surveillance for healthcare-associated infections: hospital-onset adult sepsis events versus current reportable conditions.
US hospitals are required by the Centers for Medicare and Medicaid Services to publicly report central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), Clostridioidesdiffficile, methicillin-resistant Staphylococcus aureus bacteremia, and selected surgical site infections for benchmarking and pay-for-performance programs. In this study the investigators retrospectively assessed the overlap between HO-ASEs and reportable HAIs among adults hospitalized between June 2015-June 2018 in 3 hospitals.
AHRQ-funded; HS025008.
Citation: Page B, Klompas M, Chan C .
Surveillance for healthcare-associated infections: hospital-onset adult sepsis events versus current reportable conditions.
Clin Infect Dis 2021 Sep 15;73(6):1013-19. doi: 10.1093/cid/ciab217..
Keywords: Sepsis, Healthcare-Associated Infections (HAIs), Hospitals, Clostridium difficile Infections, Catheter-Associated Urinary Tract Infection (CAUTI), Methicillin-Resistant Staphylococcus aureus (MRSA), Central Line-Associated Bloodstream Infections (CLABSI)
Pakyz AL, Wang H, Ozcan YA
Leapfrog Hospital Safety Score, magnet designation, and healthcare-associated infections in United States hospitals.
The goal of this study was to determine whether Magnet designation and hospitals with better Leapfrog Hospital Safety Scores have fewer healthcare-associated infections (HAIs). Findings showed that “A” hospitals performed better on clostridium difficile infection (CDI) but not methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections, while Magnet designation was associated with fewer than expected MRSA infections but more than expected CDIs. These mixed results show that hospital global assessments of safety and workplace quality differentially and imperfectly predict its level of HAIs.
AHRQ-funded; HS018578.
Citation: Pakyz AL, Wang H, Ozcan YA .
Leapfrog Hospital Safety Score, magnet designation, and healthcare-associated infections in United States hospitals.
J Patient Saf 2021 Sep 1;17(6):445-50. doi: 10.1097/pts.0000000000000378..
Keywords: Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Hospitals, Patient Safety
Cabral SM, Goodman KE, Blanco N
Comorbidity and severity-of-illness risk adjustment for hospital-onset Clostridioides difficile infection using data from the electronic medical record.
This study’s objective was to determine whether electronically available comorbidities and laboratory values on admission are risk factors for hospital-onset Clostridioides difficile infection (HO-CDI) across multiple institutions and whether they could be used to improve risk adjustment. Adult patients admitted to 3 hospitals in Maryland from 2016 to 2018 were included. Patients with comorbid conditions were assigned using the Elixhauser comorbidity index. Standardized infection rates (SIRs) were computed using current CDC risk adjustment methodology and included the addition of Elixhauser score and individual comorbidities. Hospital 1 had 314 (0.65%) of patients with a HO-CDI, Hospital 2 had 41 (0.47%) with a HO-CDI, and Hospital 3 had 75 (0.26%) with a HO-CDI. Elixhauser score in multivariable regression was a significant risk factor for HO-CDI at all hospitals when controlling for age, antibiotic user, and antacid use. Abnormal leukocyte level at hospital admission was a significant risk factor at hospitals 1 and 2. Including the Elixhauser score in the risk adjustment model was statistically significant.
AHRQ-funded; HS022291.
Citation: Cabral SM, Goodman KE, Blanco N .
Comorbidity and severity-of-illness risk adjustment for hospital-onset Clostridioides difficile infection using data from the electronic medical record.
Infect Control Hosp Epidemiol 2021 Aug;42(8):955-61. doi: 10.1017/ice.2020.1344..
Keywords: Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Hospitals, Risk
Lee BY, Bartsch SM, Lin MY
How long-term acute care hospitals can play an important role in controlling carbapenem-resistant Enterobacteriaceae in a region: a simulation modeling study.
Researchers investigated how implementing control measures in long-term acute care hospitals (LTACHs) can impact carbapenem-resistant Enterobacteriaceae (CRE) spread regionwide. They used their own Chicago metropolitan region agent-based model to simulate CRE spread and control. They found that a prevention bundle in only LTACHs decreased prevalence and averted new carriers, infections, and deaths over 3 years compared with no CRE control measures. When LTACHs and intensive care units intervened, prevalence decreased further. They concluded that LTACHs may be more important than other acute care settings for controlling CRE, and regional efforts to control drug-resistant organisms should start with LTACHs as a centerpiece.
AHRQ-funded; HS023317.
Citation: Lee BY, Bartsch SM, Lin MY .
How long-term acute care hospitals can play an important role in controlling carbapenem-resistant Enterobacteriaceae in a region: a simulation modeling study.
Am J Epidemiol 2021 Feb 1;190(3):448-58. doi: 10.1093/aje/kwaa247..
Keywords: Healthcare-Associated Infections (HAIs), Infectious Diseases, Prevention, Hospitals, Patient Safety, Implementation
Vsevolozhskaya OA, Manz KC, Zephyr PM
Measurement matters: changing penalty calculations under the Hospital Acquired Condition Reduction Program (HACRP) cost hospitals millions.
Since October 2014, the Centers for Medicare and Medicaid Services has penalized 25% of U.S. hospitals with the highest rates of hospital-acquired conditions under the Hospital Acquired Conditions Reduction Program (HACRP). While early evaluations of the HACRP program reported cumulative reductions in hospital-acquired conditions, more recent studies have not found a clear association between receipt of the HACRP penalty and hospital quality of care. In this article, the authors posit that some of this disconnect may be driven by frequent scoring updates.
AHRQ-funded; HS025148.
Citation: Vsevolozhskaya OA, Manz KC, Zephyr PM .
Measurement matters: changing penalty calculations under the Hospital Acquired Condition Reduction Program (HACRP) cost hospitals millions.
BMC Health Serv Res 2021 Feb 10;21(1):131. doi: 10.1186/s12913-021-06108-w..
Keywords: Healthcare-Associated Infections (HAIs), Infectious Diseases, Hospitals, Policy, Quality Improvement, Quality of Care, Patient Safety