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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 165 Research Studies Displayed
Topham EW, Bristol A, Luther B
Caregiver inclusion in IDEAL discharge teaching: implications for transitions from hospital to home.
The purpose of this study was to explore perceptions of caregivers regarding their discharge preparation, focusing particular attention on whether and how they believed discharge preparation impacted post-discharge patient outcomes. Through interviews with four English-speaking caregivers, findings showed that, once home, the caregivers reported gaps in their knowledge of how to care for the patient, suggesting key gaps related to knowledge of warning signs and problems. Two of the four caregiver participants attributed a hospital readmission to post-discharge knowledge gaps. This study of caregiver experiences suggests that AHRQ’s IDEAL discharge planning strategy remains a useful and important framework for case managers to follow when providing discharge services.
Citation: Topham EW, Bristol A, Luther B . Caregiver inclusion in IDEAL discharge teaching: implications for transitions from hospital to home. Prof Case Manag 2022 Jul-Aug;27(4):181-93. doi: 10.1097/ncm.0000000000000563..
Keywords: Hospital Discharge, Transitions of Care, Caregiving
Giesler DL, Krein S, Brancaccio A
Reducing overuse of antibiotics at discharge home: a single-center mixed methods pilot study.
This article described a single-center, controlled pilot study of a pharmacist-facilitated antibiotic timeout prior to hospital discharge. The timeout addressed key elements of duration and was designed and implemented using iterative cycles with rapid feedback. The authors evaluated implementation outcomes related to feasibility, including usability, adherence, and acceptability. The pharmacists conducted 288 antibiotic timeouts with a mean duration of 2.5 minutes. Pharmacists recommended an antibiotic change in 25% of timeouts with 70% of recommended changes accepted by hospitalists. Barriers included unanticipated and weekend discharges. There were no differences in antibiotic use after discharge during the intervention compared to control services.
Citation: Giesler DL, Krein S, Brancaccio A . Reducing overuse of antibiotics at discharge home: a single-center mixed methods pilot study. Am J Infect Control 2022 Jul;50(7):777-86. doi: 10.1016/j.ajic.2021.11.016..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Hospital Discharge, Transitions of Care
May HP, Krauter AK, Finnie DM
Optimising transitions of care for acute kidney injury survivors: protocol for a mixed-methods study of nephrologist and primary care provider recommendations.
Gaps in proper kidney care after acute kidney injury (AKI) in hospital patients can contribute to long term complications for those individuals. The purpose of this study is to provide an in-depth assessment of nephrologists’ and primary care providers’ approaches to follow-up care after in-hospital acute kidney injury (AKI). The researchers will utilize a mixed-methods study to assess provider recommendations and decision-making for post-AKI care.
Citation: May HP, Krauter AK, Finnie DM . Optimising transitions of care for acute kidney injury survivors: protocol for a mixed-methods study of nephrologist and primary care provider recommendations. BMJ Open 2022 Jun 22;12(6):e058613. doi: 10.1136/bmjopen-2021-058613..
Keywords: Kidney Disease and Health, Transitions of Care
Usher MC, Tignanelli CJ, Hilliard B
Responding to COVID-19 through interhospital resource coordination: a mixed-methods evaluation
Researchers sought to describe a novel hospital system approach to managing the COVID-19 pandemic, including multihospital coordination capability and transfer of COVID-19 patients to a single, dedicated hospital. They found that, with standardized communication, interhospital transfers were a safe and effective method of cohorting COVID-19 patients, were well-received by health care providers, and had the potential to improve care quality.
AHRQ-funded; HS026379; HS026732.
Citation: Usher MC, Tignanelli CJ, Hilliard B . Responding to COVID-19 through interhospital resource coordination: a mixed-methods evaluation J Patient Saf 2022 Jun 1;18(4):287-94. doi: 10.1097/pts.0000000000000916..
Keywords: COVID-19, Hospitals, Healthcare Delivery, Public Health, Care Coordination, Transitions of Care
Yu A, Jordan SR, Gilmartin H
"Our hands are tied until your doctor gets here": nursing perspectives on inter-hospital transfers.
The purpose of this study was to characterize the experiences of inpatient floor-level bedside nurses caring for inter-hospital transfer (IHT) patients and to identify care coordination challenges and solutions. Results from this study are mapped to AHRQ’s Care Coordination Measurement Framework domains of communication, assessing needs and goals, and negotiating accountability. Findings showed that three key themes characterized nurses' experiences with IHT related to these domains: challenges with information exchange and team communication during IHT, environmental and information preparation needed to anticipate transfers, and determining responsibility and care plans after the IHT patient has arrived at the accepting facility.
Citation: Yu A, Jordan SR, Gilmartin H . "Our hands are tied until your doctor gets here": nursing perspectives on inter-hospital transfers. J Gen Intern Med 2022 May;37(7):1729-36. doi: 10.1007/s11606-021-07276-5..
Keywords: Transitions of Care, Hospitals, Provider: Nurse
Sharara SL, Arbaje AI, Cosgrove SE
The voice of the patient: patient roles in antibiotic management at the hospital-to-home transition.
The objective of this study was to characterize tasks required for patient-performed antibiotic medication management (MM) at the hospital-to-home transition, as well as barriers to and strategies for patient-led antibiotic MM. The overall goal was to understand patients' role in managing antibiotics at the hospital-to-home transition. The investigators concluded that there are many opportunities to improve patient-led antibiotic MM at the hospital-to-home transition.
Citation: Sharara SL, Arbaje AI, Cosgrove SE . The voice of the patient: patient roles in antibiotic management at the hospital-to-home transition. J Patient Saf 2022 Apr 1;18(3):e633-e39. doi: 10.1097/pts.0000000000000899..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Hospital Discharge, Transitions of Care, Patient Self-Management
Hoonakker PLT, Hose BZ, Carayon P
Scenario-based evaluation of team health information technology to support pediatric trauma care transitions.
This study’s objective was to examine if the Teamwork Transition Technology (T(3)) supports teams and team cognition. Using a scenario-based mock-up methodology with 36 clinicians and staff from the different units and departments who are involved in pediatric trauma to examine T(3), results showed that most participants agreed that the technology helped to achieve the goals set out in the design phase. Respondents thought that T(3) organized and presented information in a different way that was helpful to them. The authors concluded that the results of their evaluation showed that participants agreed that T(3) does support them in their work and increases their situation awareness.
Citation: Hoonakker PLT, Hose BZ, Carayon P . Scenario-based evaluation of team health information technology to support pediatric trauma care transitions. Appl Clin Inform 2022 Jan;13(1):218-29. doi: 10.1055/s-0042-1742368.
Keywords: Children/Adolescents, Transitions of Care, Health Information Technology (HIT), Teams, Trauma
Kennedy EE, Bowles KH, Aryal S
Systematic review of prediction models for postacute care destination decision-making.
This article reported a systematic review of studies containing development and validation of models predicting post-acute care destination after adult inpatient hospitalization, summarized clinical populations and variables, evaluated model performance, assessed risk of bias and applicability, and made recommendations to reduce bias in future models. Findings indicated that prediction modeling studies for post-acute care destinations were becoming more prolific in the literature, but model development and validation strategies were inconsistent, and performance was variable. Most models were developed using regression, but machine learning methods were increasing in frequency.
AHRQ-funded; HS026599; HS027742.
Citation: Kennedy EE, Bowles KH, Aryal S . Systematic review of prediction models for postacute care destination decision-making. J Am Med Inform Assoc 2021 Dec 28;29(1):176-86. doi: 10.1093/jamia/ocab197..
Keywords: Decision Making, Transitions of Care
Brajcich BC, Shallcross ML, Johnson JK
Barriers to post-discharge monitoring and patient-clinician communication: a qualitative study.
This study used semi-structured interviews and focus groups to identify barriers to post-discharge monitoring and patient-clinician communication. Participants were gastrointestinal surgery patients and clinicians, with a total of 15 patients and 17 clinicians. Four themes and four barriers were identified from patient and clinician interviews and focus groups. Patient-identified barriers included education and expectation setting, technology access and literacy, availability of resources and support, and misalignment of communication preferences. Clinician-identified barriers included health education, access to clinical team, healthcare practitioner time constraints, and care team experience and consistency.
Citation: Brajcich BC, Shallcross ML, Johnson JK . Barriers to post-discharge monitoring and patient-clinician communication: a qualitative study. J Surg Res 2021 Dec;268:1-8. doi: 10.1016/j.jss.2021.06.032..
Keywords: Hospital Discharge, Clinician-Patient Communication, Care Management, Transitions of Care
Chhatre S, Malkowicz SB, Jayadevappa R
Continuity of care in acute survivorship phase, and short and long-term outcomes in prostate cancer patients.
This study examined the association between continuity of care and outcomes in Medicare beneficiaries with localized prostate cancer, and the moderating effect of race using SEER – Medicare data between 2000 and 2016. Continuity of care was defined as visits dispersion and density in the acute survivorship phase. Outcomes measured were emergency room visits, hospitalizations, and cost during the acute survivorship phase and mortality over the follow-up phase. Higher continuity of care was associated with improved outcomes. The interaction between race and continuity of care was significant.
Citation: Chhatre S, Malkowicz SB, Jayadevappa R . Continuity of care in acute survivorship phase, and short and long-term outcomes in prostate cancer patients. Prostate 2021 Dec;81(16):1310-19. doi: 10.1002/pros.24228..
Keywords: Cancer: Prostate Cancer, Cancer, Transitions of Care
Burden A, Potestio C, Pukenas E
Influence of perioperative handoffs on complications and outcomes.
The authors describe the perioperative environment, calling it dynamic and complex, and indicate that there are multiple distractions that can interfere with effective communication and safe patient care. They discuss various aspects involved in handoffs, concluding that an institutional culture that highlights the importance of patient safety and that encourages team collaboration has demonstrated that harm can be decreased and patient safety can be improved.
Citation: Burden A, Potestio C, Pukenas E . Influence of perioperative handoffs on complications and outcomes. Adv Anesth 2021 Dec;39:133-48. doi: 10.1016/j.aan.2021.07.008..
Keywords: Patient Safety, Transitions of Care, Workflow
Mueller SK, Shannon E, Dalal A
Patient and physician experience with interhospital transfer: a qualitative study.
This qualitative study explored patients’ and involved physicians’ experience with interhospital transfer (IHT) to understand specific factors that may impact the quality and safety of this care transition. Individual interviews were conducted with adult patients transferred to cardiology, general medicine, and oncology services at a tertiary care academic medical center, as well as their transferring physician, accepting attending physician, and accepting/admitting resident physician. Participants included 10 adults (6 cardiology, 2 medicine, and 2 oncology), 9 accepting attending physicians, 12 accepting and/or admitting resident physicians, and 5 transferring physicians. Emergent themes demonstrated that participants held a shared understanding for the reason for the transfer and relayed a general dissatisfaction regarding the timing and lack of advanced notification of transfer. The authors found distinct differences in IHT experience by stakeholder group - with physicians relaying discontent on intrahospital chains of communication and interhospital information exchange, and patient participants focused more readily on the physical aspects of IHT.
Citation: Mueller SK, Shannon E, Dalal A . Patient and physician experience with interhospital transfer: a qualitative study. J Patient Saf 2021 Dec 1;17(8):e752-e57. doi: 10.1097/pts.0000000000000501..
Keywords: Transitions of Care, Hospitals, Hospitalization, Provider: Physician, Patient Experience
Kunz SN, Helkey D, Zitnik M
Quantifying the variation in neonatal transport referral patterns using network analysis.
This retrospective study evaluated the association of neonatal patient characteristics with quantitative differences in neonatal transport networks. Data was analyzed for infants <28 days of age acutely transported within California from 2008 to 2012. The authors analyzed 34,708 acute transfers, representing 1594 unique transfer routes between 271 hospitals. They found greater degrees of regionalization for preterm and surgical patients compared to term infants and those transported for medical reasons.
Citation: Kunz SN, Helkey D, Zitnik M . Quantifying the variation in neonatal transport referral patterns using network analysis. J Perinatol 2021 Dec;41(12):2795-803. doi: 10.1038/s41372-021-01091-w..
Keywords: Newborns/Infants, Hospitals, Transitions of Care
Limes J, Callister C, Young E
A cross-sectional survey of internal medicine residents' knowledge, attitudes, and current practices regarding patient transitions to post-acute care.
This study’s aim was to assess internal medicine residents’ knowledge, attitudes, and current practice regarding patient transitions to post-acute care (PAC). The authors conducted a multi-site cross-sectional 36-question survey at 3 university-based Internal Medicine training programs in the United States. Of 482 residents, almost half (49%) responded. Only 31% of residents know how often patients received skilled therapists at skilled nursing facilities (SNFs) and 23% knew how frequently nursing services are provided. The majority of residents (79%) identified the discharge summary as the main way to communicate care instructions to the SNF, but only 55% reported always completing it prior to discharge. Upper-level residents were more likely to know how much therapy patients received at an SNF, but other resident knowledge about PAC did not vary by residency year. Residents who experienced a clinical rotation at a SNF had higher levels of knowledge compared to those who did not.
Citation: Limes J, Callister C, Young E . A cross-sectional survey of internal medicine residents' knowledge, attitudes, and current practices regarding patient transitions to post-acute care. J Am Med Dir Assoc 2021 Nov;22(11):2344-49. doi: 10.1016/j.jamda.2021.02.011..
Keywords: Transitions of Care, Education: Continuing Medical Education, Provider: Physician
Werner NE, Rutkowski RA, Krause S
Disparate perspectives: exploring healthcare professionals' misaligned mental models of older adults' transitions of care between the emergency department and skilled nursing facility.
Care transitions that occur across healthcare system boundaries represent a unique challenge for maintaining high quality care and patient safety, as these systems are typically not aligned to perform the care transition process. In this article, the investigators explored healthcare professionals' mental models of older adults' transitions between the emergency department (ED) and skilled nursing facility (SNF).
Citation: Werner NE, Rutkowski RA, Krause S . Disparate perspectives: exploring healthcare professionals' misaligned mental models of older adults' transitions of care between the emergency department and skilled nursing facility. Appl Ergon 2021 Oct;96:103509. doi: 10.1016/j.apergo.2021.103509..
Keywords: Elderly, Transitions of Care, Emergency Department, Nursing Homes, Healthcare Delivery
Parikh K, Richmond M, Lee M
Outcomes from a pilot patient-centered hospital-to-home transition program for children hospitalized with asthma.
The purpose of this study was to evaluate a multi-component hospital-to-home (H2H) transition program for children hospitalized with an asthma exacerbation. A pilot prospective randomized clinical trial of guideline-based asthma care with and without a patient-centered multi-component H2H program was conducted among children enrolled in K-8(th) grade on Medicaid hospitalized for an asthma exacerbation. The investigators concluded that the pilot data suggested that comprehensive care coordination initiated during the inpatient stay was feasible and acceptable.
Citation: Parikh K, Richmond M, Lee M . Outcomes from a pilot patient-centered hospital-to-home transition program for children hospitalized with asthma. J Asthma 2021 Oct;58(10):1384-94. doi: 10.1080/02770903.2020.1795877..
Keywords: Children/Adolescents, Patient-Centered Healthcare, Transitions of Care, Asthma, Hospital Discharge, Care Coordination, Chronic Conditions
Manges KA, Ayele R, Leonard C
Differences in transitional care processes among high-performing and low-performing hospital-SNF pairs: a rapid ethnographic approach.
This study’s objective was to explore differences between low- and high-performing hospitals and skilled nursing facilities (SNFs) pairs and postacute care outcomes. The authors used flow maps and thematic analysis to describe the process of hospitals discharging patients to SNFs and to identify differences in subprocesses used by high-performing and low-performing hospitals. Hospitals were classified based on their 30-day readmission rates from SNFs. The final sample included 148 hours of observations with 30 clinicians across four hospitals and five corresponding SNFs. High-performing sites differed in each stage from low-performing sites by focusing on 1) earlier, ongoing, systematic identification of high-risk patients; 2) discussing the decision to go to an SNF as an iterative team-based process and 3) anticipating barriers with knowledge of transitional and SNF care processes.
Citation: Manges KA, Ayele R, Leonard C . Differences in transitional care processes among high-performing and low-performing hospital-SNF pairs: a rapid ethnographic approach. BMJ Qual Saf 2021 Aug;30(8):648-57. doi: 10.1136/bmjqs-2020-011204..
Keywords: Transitions of Care, Hospitals, Nursing Homes, Hospital Readmissions, Hospital Discharge
De Oliveira GS, Castro-Alves LJ, Kendall MC
Effectiveness of pharmacist intervention to reduce medication errors and health-care resources utilization after transitions of care: a meta-analysis of randomized controlled trials.
The main objective of the current investigation was to examine the effectiveness of pharmacist-based transition-of-care interventions on the reduction of medication errors after hospital discharge. Findings showed that pharmacist transition-of-care intervention is an effective strategy to reduce medication errors after hospital discharge and also reduces subsequent emergency room visits.
Citation: De Oliveira GS, Castro-Alves LJ, Kendall MC . Effectiveness of pharmacist intervention to reduce medication errors and health-care resources utilization after transitions of care: a meta-analysis of randomized controlled trials. J Patient Saf 2021 Aug 1;17(5):375-80. doi: 10.1097/pts.0000000000000283..
Keywords: Medication: Safety, Medication, Adverse Drug Events (ADE), Adverse Events, Medical Errors, Patient Safety, Provider: Pharmacist, Transitions of Care
Chilakamarri P, Finn EB, Sather J
Failure mode and effect analysis: engineering safer neurocritical care transitions.
Investigators presented failure mode and effect analysis (FMEA) as a systems-engineering methodology to be applied to neurocritical care transitions to reduce failures in communication and improve patient safety. They described their local implementation of FMEA to improve the safety of inter-hospital transfer for patients with intracerebral and subarachnoid hemorrhage as evidence of success. They found that application of the FMEA approach yielded meaningful and sustained process change for patients with neurocritical care needs.
Citation: Chilakamarri P, Finn EB, Sather J . Failure mode and effect analysis: engineering safer neurocritical care transitions. Neurocrit Care 2021 Aug;35(1):232-40. doi: 10.1007/s12028-020-01160-6..
Keywords: Patient Safety, Transitions of Care, Critical Care, Communication, Quality Improvement, Quality of Care
Hou Y, Bushnell CD, Duncan PW
Hospital to home transition for patients with stroke under bundled payments.
In this paper, the authors describe COMprehensive Post-Acute Stroke Services (COMPASS), a comprehensive transitional care intervention focused on discharge from the acute care setting to home. The COMPASS care model is aligned with the incentive structures and essential components of bundled payments in terms of care coordination, patient assessment, patient and family involvement, and continuity of care. They concluded that ongoing evaluation will inform the design of incorporating COMPASS-like transitional care interventions into a stroke bundle.
AHRQ-funded; R01 HS025723.
Citation: Hou Y, Bushnell CD, Duncan PW . Hospital to home transition for patients with stroke under bundled payments. Arch Phys Med Rehabil 2021 Aug;102(8):1658-64. doi: 10.1016/j.apmr.2021.03.010..
Keywords: Transitions of Care, Stroke, Cardiovascular Conditions, Rehabilitation, Care Coordination
Naderi R, Oberndorfer TA, Jordan SR
Resident perspectives on the value of interdisciplinary conference calls for geriatric patients.
The University of Colorado implemented a virtual interdisciplinary conference call, TEAM (Transitions Expectation and Management), between providers on the inpatient Acute Care of the Elder (ACE) unit and the outpatient Seniors Clinic at the University of Colorado Hospital. This study highlighted learner perspectives of the benefit of interdisciplinary conference calls between inpatient and outpatient providers to enhance transitions of care, which provided meaningful feedback and served as a vehicle for residents to recognize the impact of their care decisions in the broader spectrum of patients' experience during hospital discharge.
Citation: Naderi R, Oberndorfer TA, Jordan SR . Resident perspectives on the value of interdisciplinary conference calls for geriatric patients. BMC Med Educ 2021 Jun 3;21(1):314. doi: 10.1186/s12909-021-02750-4..
Keywords: Elderly, Education: Continuing Medical Education, Transitions of Care
Wang J, Ying M, Temkin-Greener H
Care-partner support and hospitalization in assisted living during transitional home health care.
This study examined the impact of care-partner support on outcomes among assisted living (AL) residents. Variation in care-partner and its impact on hospitalizations among AL residents receiving Medicare home health (HH) services was investigated. Analysis of national data from various databases was used and a total of 741,926 participants were identified with Medicare HH admissions in 2017. Care-partner support during the HH admission was measured in seven domains: activity of daily living (ADLs), instrumental activities of ADLs), medication administration, treatment, medical equipment, home safety, and transportation. Care-partner support was categorized as assistance not needed, care-partner currently providing assistance, care-partner needs additional training/support to provide assistance, and care-partner is unavailable/unlikely to provide assistance. Among the cohort, inadequate care-partner support was identified for all seven domains ranging from 13.1% for transportation to 49.8% for treatment and was unavailable for 0.9% for transportation to 11.0% for treatment. Having inadequate or unavailable care-partner support was related to increased risk of hospitalization by 8.9% for treatment to 41.3% for medication administration.
Citation: Wang J, Ying M, Temkin-Greener H . Care-partner support and hospitalization in assisted living during transitional home health care. J Am Geriatr Soc 2021 May;69(5):1231-39. doi: 10.1111/jgs.17005..
Keywords: Elderly, Transitions of Care, Caregiving, Hospitalization, Home Healthcare, Long-Term Care
Champion C, Sockolow PS, Bowles KH
Getting to complete and accurate medication lists during the transition to home health care.
This observational field study looked at the work that home health care (HHC) admissions nurses complete related to medication reconciliation tasks, explored the impact of shared electronic medication data (interoperability), and highlight opportunities to enhance medication reconciliation with respect to transition in care to HHC agencies. Three diverse Pennsylvania HHC agencies participated, with each using different electronic health record systems. Six nurses per site admitted 2 patients each (36 patients total) and their tasks were examined in depth. Medication reconciliation tasks included changes in number of medications and change types and calls to the health provider (doctor or pharmacy) to resolve medication-related issues. A high percentage of patients used multiple medications (more than 12 medications on average), and were high-risk (on average more than 8 medications per patient). Medication reconciliation decreased the number of prescriptions between pre- and post-reconciliation for 91% of patients with 41% of the medications requiring changes. Two-thirds of the nurses called a provider to facilitate medication changes. Interoperability reduced the number of changes required but did not eliminate changes or calls to providers.
AHRQ-funded; R01 HS024537.
Citation: Champion C, Sockolow PS, Bowles KH . Getting to complete and accurate medication lists during the transition to home health care. J Am Med Dir Assoc 2021 May;22(5):1003-08. doi: 10.1016/j.jamda.2020.06.024..
Keywords: Medication, Medication: Safety, Transitions of Care, Home Healthcare, Patient Safety
Evans E, Gutman R, Resnik L
Successful community discharge among older adults with traumatic brain injury in skilled nursing facilities.
The purpose of this retrospective cohort study was to identify patient, injury, and functional status characteristics associated with successful discharge to the community following a skilled nursing facility (SNF) stay among older adults hospitalized following traumatic brain injury (TBI). Participants were Medicare fee-for-service beneficiaries admitted to an SNF after hospitalization for TBI. Findings showed that among older adults with TBI who discharge to an SNF, sociodemographic and functional status characteristics are associated with successful discharge and may be useful to clinicians for discharge planning.
Citation: Evans E, Gutman R, Resnik L . Successful community discharge among older adults with traumatic brain injury in skilled nursing facilities. J Head Trauma Rehabil 2021 May-Jun;36(3):E186-e98. doi: 10.1097/htr.0000000000000638..
Keywords: Elderly, Brain Injury, Transitions of Care, Nursing Homes
Fekieta R, Rosenberg A, Jenq GY
A new tool to assess clinician experience with patient care transitions.
The authors developed a brief survey to gauge clinician experience with patient care transfers that occur within a hospital. They found that, overall, the survey was feasible to implement and was built to optimize content, construct, and response process validity. Survey results drove practical improvement work, such as informing a verbal transfer protocol to improve nursing preparedness to receive patients on general medicine units. They concluded that, as a practical tool, the survey and its results can help hospital administrators to focus on categories of transfer activities that are most problematic for clinicians and to track trends for quality improvement.
Citation: Fekieta R, Rosenberg A, Jenq GY . A new tool to assess clinician experience with patient care transitions. Qual Manag Health Care 2021 Apr-Jun;30(2):87-96. doi: 10.1097/qmh.0000000000000290..
Keywords: Transitions of Care, Quality Improvement, Quality of Care, Provider: Clinician, Provider