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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 16 of 16 Research Studies Displayed
Ingraham AM, Ayturk MD, Kiefe CI
Adherence to 20 emergency general surgery best practices: results of a national survey.
The authors used a hybrid questionnaire to examine national adherence to emergency general surgery (EGS) best practices. They found that there was substantial room for performance improvement, and that adopting an acute care surgery model predicts better performance. They conclude that this novel overview of adherence to EGS best practices will enable surgeons and policymakers to address variations in EGS care nationally.
Citation: Ingraham AM, Ayturk MD, Kiefe CI . Adherence to 20 emergency general surgery best practices: results of a national survey. Ann Surg 2019 Aug;270(2):270-80. doi: 10.1097/sla.0000000000002746..
Keywords: Surgery, Emergency Department, Guidelines, Quality of Care, Quality Improvement, Value
Perraillon MC, Brauner DJ, Konetzka RT
Nursing home response to Nursing Home Compare: the provider perspective.
This paper examined the validity of quality ratings of nursing homes with Nursing Home Compare (NHC) and assessed the views of nursing home administrators and staff. There was a conflict found between improving ratings and competing goals of maximizing profits and avoidance of litigation. Since the NHC is self-reported there is controversy on its validity due to self-reporting bias.
Citation: Perraillon MC, Brauner DJ, Konetzka RT . Nursing home response to Nursing Home Compare: the provider perspective. Med Care Res Rev 2019 Aug;76(4):425-43. doi: 10.1177/1077558717725165..
Keywords: Long-Term Care, Nursing Homes, Provider Performance, Quality of Care, Quality Improvement, Value
Mafi JN, Godoy-Travieso P, Wei E
Evaluation of an intervention to reduce low-value preoperative care for patients undergoing cataract surgery at a safety-net health system.
This study analyzed the effects of an intervention program to reduce preoperative costs for care in patients undergoing cataract surgery. Most surgery centers require a battery of tests before surgery is approved. All patients must undergo primary care visits with chest x-rays, laboratory tests, and electrocardiograms required for many of them depending on age and presence of other conditions. This case-control study was conducted at 2 academic safety-net medical centers, Los Angeles County and University of Southern California (LAC-USC) (intervention, n = 469) and Harbor-UCLA (University of California, Los Angeles) (control, n = 585), from April 13, 2015, through April 12, 2016, with 12 additional months (April 13, 2016, through April 13, 2017) to assess sustainability (intervention, n = 1002; control, n = 511). All preoperative care decreased in the intervention group and mostly decreased in the control group. Financial losses occurred at these centers, but there was an overall savings for patients and society. These findings suggest that this may be a barrier to eliminating low-value care.
Citation: Mafi JN, Godoy-Travieso P, Wei E . Evaluation of an intervention to reduce low-value preoperative care for patients undergoing cataract surgery at a safety-net health system. JAMA Intern Med 2019 May;179(5):648-57. doi: 10.1001/jamainternmed.2018.8358..
Keywords: Healthcare Costs, Surgery, Eye Disease and Health, Value, Quality Improvement, Quality of Care
Maurer M, Carman KL, Yang M
Increasing the use of comparative quality information in maternity care: results from a randomized controlled trial.
The authors tested an intervention to increase uptake of hospital-level maternity care quality reports among 245 pregnant women in North Carolina. They found that intervention participants were significantly more likely to report adopting behaviors to inform care, such as thinking through preferences, talking with their doctor, or creating a birth plan. They concluded that reports designed to put quality information into the larger context of what consumers want and need to know, along with targeted and timely communications, can increase consumer use of quality information and prompt them to talk with providers about care preferences and evidence-based practices.
Citation: Maurer M, Carman KL, Yang M . Increasing the use of comparative quality information in maternity care: results from a randomized controlled trial. Med Care Res Rev 2019 Apr;76(2):208-28. doi: 10.1177/1077558717712290.
Keywords: Maternal Care, Patient and Family Engagement, Quality Improvement, Value, Women, Pregnancy
Ciotoli C, Smith AJ, Keeling RP
Call to action: better care, better health, and greater value in college health.
This report aims to inspire, motivate, and challenge college health professionals and their colleagues, campus leaders, and national entities to take both immediate and sustainable steps to bring quality improvement (QI) to the forefront of college health practice - and, by doing so, to elevate care, health, and value of college health as a key pathway to advancing student success.
Citation: Ciotoli C, Smith AJ, Keeling RP . Call to action: better care, better health, and greater value in college health. J Am Coll Health 2018 Oct;66(7):625-39. doi: 10.1080/07448481.2018.1431908..
Keywords: Education, Quality of Care, Quality Improvement, Value
Nuckols TK, Keeler E, Anderson LJ
Economic evaluation of quality improvement interventions designed to improve glycemic control in diabetes: a systematic review and weighted regression analysis.
This study systematically reviewed economic evaluations of quality improvement (QI) interventions for glycemic control among adults with type 1 or type 2 diabetes. Using English-language studies from high-income countries that evaluated organizational changes and reported program and utilization-related costs, the researchers extracted data regarding intervention, study design, change in HbA1c, time horizon, perspective, incremental net cost, incremental cost-effectiveness ratio, and study quality. They conclude that diverse and multifaceted QI interventions which lower HbA1c appear to be a fair-to-good value, relative to usual care.
Citation: Nuckols TK, Keeler E, Anderson LJ . Economic evaluation of quality improvement interventions designed to improve glycemic control in diabetes: a systematic review and weighted regression analysis. Diabetes Care 2018 May;41(5):985-93. doi: 10.2337/dc17-1495..
Keywords: Diabetes, Healthcare Costs, Quality of Care, Quality Improvement, Value
McMahon LF, Jr., Howell JD
The hospital: still the doctors' workplace(s) - a cautionary note for approaches to safety and value improvement.
The authors discuss a study by Shahian et al. exploring an important concept: What is the relationship between global hospital safety indicators and specific hospital-level clinical outcomes? They insist that studies assessing hospital quality, safety, and outcomes also address the multiproduct nature of hospital outcomes, operations, safety, and quality.
Citation: McMahon LF, Jr., Howell JD . The hospital: still the doctors' workplace(s) - a cautionary note for approaches to safety and value improvement. Health Serv Res 2018 Apr;53(2):601-07. doi: 10.1111/1475-6773.12780.
Keywords: Hospitals, Outcomes, Quality Indicators (QIs), Quality Improvement, Value
Paddock SM, Damberg CL, Yanagihara D
What role does efficiency play in understanding the relationship between cost and quality in physician organizations?
Previous studies demonstrate overuse of a narrow set of services, suggesting provider inefficiency, but existing studies neither quantify inefficiency more broadly nor assess its variation across physician organizations (POs). This study found that POs had substantial variation in efficiency, producing widely differing levels of quality for the same cost.
Citation: Paddock SM, Damberg CL, Yanagihara D . What role does efficiency play in understanding the relationship between cost and quality in physician organizations? Med Care 2017 Dec;55(12):1039-45. doi: 10.1097/mlr.0000000000000823.
Keywords: Value, Practice Patterns, Healthcare Costs, Quality of Care, Quality Improvement, Payment, Provider Performance
Abrahamson K, Davila H, Rehkamp N
Is there a business case for nursing home quality improvement?
The objective of this study was to investigate the economic or business perspective surrounding QI participation by exploring nursing home leader perceptions regarding market-based motivations for improvements, or a business case for engaging in a quality improvement project.
Citation: Abrahamson K, Davila H, Rehkamp N . Is there a business case for nursing home quality improvement? Nurs Econ 2016 Sep-Oct;34(5):224-9, 35..
Keywords: Long-Term Care, Nursing Homes, Quality Improvement, Value
Kronick R, Casalino LP, Bindman AB
AHRQ Author: Kronick R
Apple pickers or federal judges: strong versus weak incentives in physician payment.
The authors provide an introduction for five papers commissioned by AHRQ focusing on incentives for physicians that are featured in this special issue of Health Services Research. These papers concentrate on suggesting a conceptual framework for the use of financial incentives in health care, key implications of the evidence to date on pay for performance and public reporting in health care and several related topics.
Citation: Kronick R, Casalino LP, Bindman AB . Apple pickers or federal judges: strong versus weak incentives in physician payment. Health Serv Res 2015 Dec;50 Suppl 2:2049-56. doi: 10.1111/1475-6773.12424.
Keywords: Payment, Provider Performance, Policy, Health Services Research (HSR), Quality of Care, Value, Healthcare Costs, Quality Improvement
Berenson RA, Rice T
Beyond measurement and reward: methods of motivating quality improvement and accountability.
The article examines public policies designed to improve quality and accountability that do not rely on financial incentives and public reporting of provider performance. It concludes that public policies related to quality improvement should focus more on methods of enhancing professional intrinsic motivation, while recognizing the potential role of organizations to actively promote and facilitate that motivation.
Citation: Berenson RA, Rice T . Beyond measurement and reward: methods of motivating quality improvement and accountability. Health Serv Res 2015 Dec;50 Suppl 2:2155-86. doi: 10.1111/1475-6773.12413.
Keywords: Quality Improvement, Policy, Provider Performance, Quality of Care, Value, Payment
Layton TJ, Ryan AM
Higher incentive payments in Medicare Advantage's pay-for-performance program did not improve quality but did increase plan offerings.
The researchers evaluated the effects of the size of financial bonuses on quality of care and the number of plan offerings in the Medicare Advantage Quality Bonus Payment Demonstration. They concluded that at great expense to Medicare, double bonuses in the Medicare Advantage Quality Bonus Payment Demonstration were not associated with improved quality but were associated with more plan offerings.
Citation: Layton TJ, Ryan AM . Higher incentive payments in Medicare Advantage's pay-for-performance program did not improve quality but did increase plan offerings. Health Serv Res 2015 Dec;50(6):1810-28. doi: 10.1111/1475-6773.12409..
Keywords: Medicare, Payment, Provider Performance, Value, Health Services Research (HSR), Quality Improvement, Quality of Care
Schlesinger M, Grob R, Shaller D
Using patient-reported information to improve clinical practice.
The purposes of this study were to assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient-valued outcomes in health systems with strong financial incentives. It concluded that unless public policies are attentive to patients' perspectives, stronger financial incentives for clinicians can threaten aspects of care that patients most value.
Citation: Schlesinger M, Grob R, Shaller D . Using patient-reported information to improve clinical practice. Health Serv Res 2015 Dec;50 Suppl 2:2116-54. doi: 10.1111/1475-6773.12420.
Keywords: Quality Improvement, Quality of Care, Patient Experience, Provider Performance, Policy, Value, Payment, Public Reporting
Ryan AM, Burgess JF, Pesko MF
The early effects of Medicare's mandatory hospital pay-for-performance program.
This study evaluated the impact of hospital value-based purchasing (HVBP) on clinical quality and patient experience during its initial implementation period. It found that hospitals that were exposed to HVBP did not show greater improvement for either the clinical process or patient experience measures during the program’s initial implementation period.
Citation: Ryan AM, Burgess JF, Pesko MF . The early effects of Medicare's mandatory hospital pay-for-performance program. Health Serv Res. 2015 Feb;50(1):81-97. doi: 10.1111/1475-6773.12206..
Keywords: Medicare, Provider Performance, Payment, Hospitals, Value, Quality Improvement, Quality of Care, Patient Experience
Arling PA, Abrahamson K, Miech EJ
Communication and effectiveness in a US nursing home quality-improvement collaborative.
The investigators explored the relationship between changes in resident health outcomes, practitioner communication patterns, and practitioner perceptions of group effectiveness within a quality-improvement collaborative of nursing home clinicians. They found that reductions in fall rates were highest in facilities where respondents experienced the highest levels of communication with collaborative members outside of scheduled meetings. Clinician and practitioner observations were discussed.
Citation: Arling PA, Abrahamson K, Miech EJ . Communication and effectiveness in a US nursing home quality-improvement collaborative. Nurs Health Sci 2014 Sep;16(3):291-7. doi: 10.1111/nhs.12098.
Keywords: Communication, Falls, Nursing Homes, Quality of Care, Prevention, Quality Improvement, Value
DeVoe JE, Stenger R
Aligning provider incentives to improve primary healthcare delivery in the United States.
This critical review uses a theoretical framework from game-theory models to discuss some of the dominant primary care provider payment models and how they create 'prisoner's dilemmas' that have stalled past reform efforts, then illustrates an escape from the dilemma. It concludes that a blend of guaranteed payment and selective incentives designed to encourage primary care providers to deliver high quality care, efficient and equitable care and to eliminate incentives towards over-servicing could reach outcomes leading to shared benefits for everyone involved.
AHRQ-funded; HS014645; HS016181.
Citation: DeVoe JE, Stenger R . Aligning provider incentives to improve primary healthcare delivery in the United States. OA Fam Med 2013 Jun 1;1(1):7.
Keywords: Healthcare Delivery, Payment, Primary Care, Quality Improvement, Value