National Healthcare Quality and Disparities Report
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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
101 to 125 of 192 Research Studies DisplayedChase JD, Russell D, Rice M
Caregivers' perceptions managing functional needs among older adults receiving post-acute home health care.
The researchers conducted telephone interviews to explore caregivers’ experiences managing physical functioning (PF) needs of older adults in the post-acute home health care setting. Caregivers depicted the enormity of caregiving tasks needed to manage older patients' PF needs and described their perceived roles and challenges in managing PF deficits, including a sense of isolation when they were the sole caregiver. The researchers conclude that their findings can guide nursing efforts to target caregiver training and support during the critical care transition period.
AHRQ-funded; HS022140.
Citation: Chase JD, Russell D, Rice M .
Caregivers' perceptions managing functional needs among older adults receiving post-acute home health care.
Res Gerontol Nurs 2019 Jul 1;12(4):174-83. doi: 10.3928/19404921-20190319-01..
Keywords: Caregiving, Elderly, Home Healthcare, Transitions of Care
Wyatt DL
AHRQ Author: Wyatt DL
Employing technology to make care transitions safer.
This commentary discusses the potential for errors in patient handoffs; important information about medications and instructions regarding patient care may be overlooked when the patient is referred to special care, moved to a new hospital setting, or discharged. The problem is especially acute for patients with multiple chronic conditions who often undergo frequent transitions to new care settings and healthcare providers. The author describes AHRQ’s funding opportunities for health information technology interventions that aim to improve communication and coordination during care transitions, such as location-based smartphone alerts, a patient-centered discharge toolkit, and a ‘smart pillbox’ electronic medication adherence reporting project.
AHRQ-authored.
Citation: Wyatt DL .
Employing technology to make care transitions safer.
J Nurs Care Qual 2019 Jul/Sep;34(3):185-88. doi: 10.1097/ncq.0000000000000417..
Keywords: Adverse Events, Care Coordination, Chronic Conditions, Communication, Health Information Technology (HIT), Healthcare Delivery, Hospital Discharge, Medical Errors, Medication, Patient Safety, Transitions of Care
Krishnan S, Hay CC, Pappadis MR
Stroke survivors' perspectives on post-acute rehabilitation options, goals, satisfaction, and transition to home.
This study analyzed stroke survivors’ perspectives on post-acute rehabilitation involvement with their care during discharge planning. Researchers interviewed eighteen stroke survivors who were sent to inpatient rehabilitation facilities after a stroke. They were surveyed about their involvement in decisions made in the selection of their rehabilitation facilities, and more than half were not. About two-thirds of patients were not involved in rehabilitation goal setting. However, most patients were satisfied with their rehabilitation stay.
AHRQ-funded; HS022134; HS024711.
Citation: Krishnan S, Hay CC, Pappadis MR .
Stroke survivors' perspectives on post-acute rehabilitation options, goals, satisfaction, and transition to home.
J Neurol Phys Ther 2019 Jul;43(3):160-67. doi: 10.1097/npt.0000000000000281..
Keywords: Hospital Discharge, Rehabilitation, Stroke, Transitions of Care
Fraze TK, Beidler LB, Briggs ADM
'Eyes in the home': ACOs use home visits to improve care management, identify needs, and reduce hospital use.
Researchers used national survey data from physician practices and accountable care organizations (ACOs), paired with qualitative interviews, to learn about home visiting programs. They found that interviewed ACOs reported using home visits as part of care management and care transitions programs as well as to evaluate patients' home environments and identify needs, most often using nonphysician staff. Further, home visit implementation for some types of patients can be challenging because of barriers related to reimbursement, staffing, and resources.
AHRQ-funded; HS024075.
Citation: Fraze TK, Beidler LB, Briggs ADM .
'Eyes in the home': ACOs use home visits to improve care management, identify needs, and reduce hospital use.
Health Aff 2019 Jun;38(6):1021-27. doi: 10.1377/hlthaff.2019.00003..
Keywords: Transitions of Care, Home Healthcare, Healthcare Delivery, Care Management
Parikh K, Hinds PS, Teach SJ
Using stakeholder engagement to develop a hospital-initiated, patient-centered intervention to improve hospital-to-home transitions for children with asthma.
The authors demonstrated that multidisciplinary stakeholder engagement can meaningfully influence intervention design. They presented a model of efficient yet substantive engagement of parents and health professionals in developing a hospital-to-home transition intervention for children hospitalized with asthma. Their results suggest that multidimensional stakeholder engagement can meaningfully shape intervention development, and they hope that these tools can be used or adapted to other hospital-based quality improvement, education, or research efforts.
AHRQ-funded; HS024554.
Citation: Parikh K, Hinds PS, Teach SJ .
Using stakeholder engagement to develop a hospital-initiated, patient-centered intervention to improve hospital-to-home transitions for children with asthma.
Hosp Pediatr 2019 Jun;9(6):460-63. doi: 10.1542/hpeds.2018-0261.
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Keywords: Children/Adolescents, Patient-Centered Healthcare, Patient and Family Engagement, Hospital Discharge, Transitions of Care, Asthma, Respiratory Conditions
Hass Z, Woodhouse M, Grabowski DC
Assessing the impact of Minnesota's return to community initiative for newly admitted nursing home residents.
This study evaluated the Minnesota Return to Community Initiative (RTCI) program which facilitates community discharge of non-Medicaid nursing home residents. It was implemented statewide without a control group. The program assists with discharge planning, transitioning to the community, and postdischarge follow-up. Results showed the program increased discharge rates by an estimated 11 percent. Success increased with time as nursing home facilities increased their participation.
AHRQ-funded; HS020224.
Citation: Hass Z, Woodhouse M, Grabowski DC .
Assessing the impact of Minnesota's return to community initiative for newly admitted nursing home residents.
Health Serv Res 2019 Jun;54(3):555-63. doi: 10.1111/1475-6773.13118..
Keywords: Care Coordination, Long-Term Care, Nursing Homes, Transitions of Care
Lauerman MH, Herrera AV, Albrecht JS
Interhospital transfers with wide variability in emergency general surgery.
This study examined modern hospital practices for interhospital transfers of emergency general surgery patients. A retrospective review of the Maryland Health Services Cost Review Commission database was conducted from 2013 to 2015. The majority of patients (94.1%) were not transferred with only 3.2% transferred to a hospital and 2.7% transferred from a hospital. For individual hospitals, there was a range of 0-30.5% of encounters transferred to a hospital, 0.02-14.62% transferred from a hospital and 69.25-99.95% not transferred.
AHRQ-funded; HS024560.
Citation: Lauerman MH, Herrera AV, Albrecht JS .
Interhospital transfers with wide variability in emergency general surgery.
Am Surg 2019 Jun;85(6):595-600..
Keywords: Emergency Department, Healthcare Delivery, Hospitalization, Hospitals, Outcomes, Quality of Care, Surgery, Transitions of Care
Mueller SK, Schnipper JL
Physician perspectives on interhospital transfers.
This study examined physician perspectives of the common problems that occur during acute care hospital interhospital transfers. The process tends to be nonstandardized which creates a number of issues. These issues include: patients sometimes, frequently, or always arriving without required specialized care (56% of the time), arriving with unrealistic expectations of care (77.2% of responses), arrived more than 24 hours after accepted transfer in 80.1% of responses, and arrived without necessary transfer records 86.9% of the time. The last issue and also time of day of arrival many physicians felt posed a risk to the transferred patients.
AHRQ-funded; HS023331.
Citation: Mueller SK, Schnipper JL .
Physician perspectives on interhospital transfers.
J Patient Saf 2019 Jun;15(2):86-89. doi: 10.1097/pts.0000000000000312..
Keywords: Healthcare Delivery, Hospitals, Patient Safety, Provider, Provider: Physician, Transitions of Care
Fabius CD, Robison J
Differences in living arrangements among older adults transitioning into the community: examining the impact of race and choice.
The federal Money Follows the Person Rebalancing Demonstration program allows nursing home residents to use Medicaid funds for home and community-based services rather than institutional care. Race, choice in housing, and challenges faced prior to transitioning may impact living arrangements following a discharge into the community. This study examined the influence of these factors on living arrangements for 659 program participants age 65 or older.
AHRQ-funded; HS000011.
Citation: Fabius CD, Robison J .
Differences in living arrangements among older adults transitioning into the community: examining the impact of race and choice.
J Appl Gerontol 2019 Apr;38(4):454-78. doi: 10.1177/0733464816687496..
Keywords: Elderly, Transitions of Care, Racial and Ethnic Minorities, Medicaid, Nursing Homes, Home Healthcare, Healthcare Delivery
Jones CD, Jones J, Bowles KH
Quality of hospital communication and patient preparation for home health care: results from a statewide survey of home health care nurses and staff.
The purpose of this study was to evaluate the quality of communication between hospitals and home health care (HHC) clinicians and patient preparedness to receive HHC in a statewide sample of HHC nurses and staff. The authors concluded that communication between hospitals and HHC was suboptimal, and patients were often not prepared to receive HHC. They suggest that providing EHR access for HHC clinicians is a promising solution to improve the quality of communication.
AHRQ-funded; HS024569.
Citation: Jones CD, Jones J, Bowles KH .
Quality of hospital communication and patient preparation for home health care: results from a statewide survey of home health care nurses and staff.
J Am Med Dir Assoc 2019 Apr;20(4):487-91. doi: 10.1016/j.jamda.2019.01.004..
Keywords: Transitions of Care, Home Healthcare, Hospital Discharge, Hospitals, Communication
Shah S, Xian Y, Sheng S
Use, temporal trends, and outcomes of endovascular therapy after interhospital transfer in the United States.
This study examined the use, trends and outcomes of endovascular therapy (EVT) after interhospital transfer in the United Sates. This cohort study analyzed trends from over 1.8 million patients with ischemic stroke admitted to 2143 Get With The Guidelines-Stroke participating hospitals between 2012 and 2017. There were differences in mortality for interhospital transfer patients, although those differences disappeared after adjusting for delay in EVT initiation.
AHRQ-funded; HS024561.
Citation: Shah S, Xian Y, Sheng S .
Use, temporal trends, and outcomes of endovascular therapy after interhospital transfer in the United States.
Circulation 2019 Mar 26;139(13):1568-77. doi: 10.1161/circulationaha.118.036509..
Keywords: Stroke, Cardiovascular Conditions, Transitions of Care, Outcomes, Healthcare Delivery, Hospitals, Mortality, Quality of Care
Jones CD, Jones J, Bowles KH
Patient, caregiver, and clinician perspectives on expectations for home healthcare after discharge: a qualitative case study.
The objective of this study was to evaluate and compare expectations for skilled home health care (HHC) from the patient, caregiver, and HHC perspectives after hospital discharge. Results showed that unclear expectations occurred when the patient and/or caregiver expectations were uncertain or misaligned with the services received; in most such cases, the patient and caregiver did not have prior experience with HHC. Recommendations to improve HHC transitions included actively engaging both patients and caregivers in the hospital and HHC settings to provide education about HHC services and assess and address additional care needs.
AHRQ-funded; HS024569.
Citation: Jones CD, Jones J, Bowles KH .
Patient, caregiver, and clinician perspectives on expectations for home healthcare after discharge: a qualitative case study.
J Hosp Med 2019 Feb;14(2):90-95. doi: 10.12788/jhm.3140..
Keywords: Caregiving, Health Services Research (HSR), Home Healthcare, Patient Experience, Provider, Provider: Clinician, Transitions of Care
Xiao Y, Abebe E, Gurses AP
Engineering a foundation for partnership to improve medication safety during care transitions.
Current approaches to safe, self-medication management for patients and caregivers after hospital discharge tend to focus on adding isolated strategies. Positing the concept that medication safety during care transition and at patient homes is the property of a "work system," in which the patient and caregivers are in collaboration with health professionals, this article argues that system thinking can enable a fundamental transformation that redesigns professionals' interactions with patients and caregivers, with the explicit goal of developing patients and caregivers into true partners with targeted roles. The authors describe a set of recommendations based on human factors principles that creates an engineering partnership with patients and their caregivers at different stages during a care episode, to enable productive interactions.
AHRQ-funded; HS024436.
Citation: Xiao Y, Abebe E, Gurses AP .
Engineering a foundation for partnership to improve medication safety during care transitions.
J Patient Saf Risk Manag 2019 Feb 1;24(1):30-36. doi: 10.1177/2516043518821497..
Keywords: Medication, Medication: Safety, Patient and Family Engagement, Patient Safety, Transitions of Care
Arbaje AI, Hughes A, Werner N
Information management goals and process failures during home visits for middle-aged and older adults receiving skilled home healthcare services after hospital discharge: a multisite, qualitative study.
The goal of this study was to identify information management (IM) process failures made during home health visits to middle-aged and older adults after hospital discharge. Communication risks included information overload, information underload, information scatter, information conflict, and erroneous information.
AHRQ-funded; HS022916.
Citation: Arbaje AI, Hughes A, Werner N .
Information management goals and process failures during home visits for middle-aged and older adults receiving skilled home healthcare services after hospital discharge: a multisite, qualitative study.
BMJ Qual Saf 2019 Feb;28(2):111-20. doi: 10.1136/bmjqs-2018-008163..
Keywords: Elderly, Home Healthcare, Hospital Discharge, Patient Safety, Transitions of Care
Nijhawan AE, Higashi RT, Marks EG
Patient and provider perspectives on 30-day readmissions, preventability, and strategies for improving transitions of care for patients with HIV at a safety net hospital.
Researchers assessed perceived causes of 30-day hospital readmissions, factors associated with preventability, and strategies to reduce preventable readmissions and improve continuity of care for HIV-positive individuals. Using semi-structured interviews, they found that the 30-day metric should be adjusted for safety net institutions and patients with AIDS; that participants disagreed about preventability; and that various stakeholders proposed readmission reduction strategies that spanned the inpatient to outpatient care continuum. They then outlined multiple interventions which could substantially decrease hospital readmissions in this underserved population.
AHRQ-funded; HS022418.
Citation: Nijhawan AE, Higashi RT, Marks EG .
Patient and provider perspectives on 30-day readmissions, preventability, and strategies for improving transitions of care for patients with HIV at a safety net hospital.
J Int Assoc Provid AIDS Care 2019 Jan-Dec;18:2325958219827615. doi: 10.1177/2325958219827615..
Keywords: Human Immunodeficiency Virus (HIV), Transitions of Care, Hospital Readmissions, Hospitals
Gupta S, Zengul FD, Davlyatov GK
Reduction in hospitals' readmission rates: role of hospital-based skilled nursing facilities.
The purpose of this study was to examine the association between hospital-based skilled nursing facilities (HBSNFs) and hospitals' readmission rates. Data sources included the American Hospital Association Annual Survey, Area Health Resources Files, CMS Medicare cost reports and Hospital Compare. Results showed that the presence of HBSNFs was associated with lower readmission rates for acute myocardial infarction and pneumonia. Further, higher skilled nursing facilities to hospitals ratio were associated with lower readmission rates.
AHRQ-funded; HS023345.
Citation: Gupta S, Zengul FD, Davlyatov GK .
Reduction in hospitals' readmission rates: role of hospital-based skilled nursing facilities.
Inquiry 2019 Jan-Dec;56:46958018817994. doi: 10.1177/0046958018817994..
Keywords: Hospital Readmissions, Transitions of Care, Care Coordination, Hospitals, Quality Indicators (QIs), Quality Measures, Quality of Care
Kayle M, Docherty SL, Sloane R
Transition to adult care in sickle cell disease: a longitudinal study of clinical characteristics and disease severity.
Researchers conducted a longitudinal analysis of medical records of adolescents and young adults (AYAs) with sickle cell disease (SCD) to describe the clinical course among AYAs during transition to adult care. They found that, whereas most AYAs had stable severity, nearly a quarter had increasing severity over time. AYAs with increasing severity had more complications, were more likely to transfer to adult care, and demonstrated higher and longer adult SCD care utilization compared with AYAs with stable severity.
AHRQ-funded; HS023989.
Citation: Kayle M, Docherty SL, Sloane R .
Transition to adult care in sickle cell disease: a longitudinal study of clinical characteristics and disease severity.
Pediatr Blood Cancer 2019 Jan;66(1):e27463. doi: 10.1002/pbc.27463..
Keywords: Children/Adolescents, Patient-Centered Healthcare, Sickle Cell Disease, Transitions of Care, Young Adults
Abu HO, Anatchkova MD, Erskine NA
Are we "missing the big picture" in transitions of care? Perspectives of healthcare providers managing patients with unplanned hospitalization.
The objective of this qualitative study was to explore the factors that negatively/positively influence care transitions following an unplanned hospitalization from the perspective of healthcare providers. The study identified factors within and outside the discharging healthcare facility that influence care transitions and ultimately affect patient-centered outcomes and provider satisfaction with delivered care.
AHRQ-funded; HS022694.
Citation: Abu HO, Anatchkova MD, Erskine NA .
Are we "missing the big picture" in transitions of care? Perspectives of healthcare providers managing patients with unplanned hospitalization.
Appl Nurs Res 2018 Dec;44:60-66. doi: 10.1016/j.apnr.2018.09.006..
Keywords: Hospital Discharge, Hospitalization, Transitions of Care, Clinician-Patient Communication
Balentine CJ, Kenzik K, Chu DI
Planning post-discharge destination for gastrointestinal surgery patients: room for improvement?
Investigators compared short-term recovery for patients discharged to inpatient rehabilitation versus skilled nursing facilities after gastrointestinal surgery. They found that there was no difference in 30-day readmission rates, but post-discharge mortality was higher for patients discharged to skilled nursing facilities compared to inpatient rehabilitation.
AHRQ-funded; HS023009.
Citation: Balentine CJ, Kenzik K, Chu DI .
Planning post-discharge destination for gastrointestinal surgery patients: room for improvement?
Am J Surg 2018 Nov;216(5):912-18. doi: 10.1016/j.amjsurg.2018.05.004..
Keywords: Hospital Discharge, Surgery, Digestive Disease and Health, Rehabilitation, Nursing Homes, Quality Improvement, Quality of Care, Transitions of Care
Desai AD, Simon TD, Leyenaar JK
Utilizing family-centered process and outcome measures to assess hospital-to-home transition quality.
This commentary describes the success of using 8 new caregiver-reported measures to assess the quality of hospital- and emergency department (ED)-to-home transitions in pediatric patients. This measures were originally created by the national Pediatric Quality Measures Program mandated by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). An original article describing these measures was published 2016 and there have been several follow-up studies. These measures are undergoing further testing.
AHRQ-funded; HS024133; HS024299; HS020506.
Citation: Desai AD, Simon TD, Leyenaar JK .
Utilizing family-centered process and outcome measures to assess hospital-to-home transition quality.
Acad Pediatr 2018 Nov - Dec;18(8):843-46. doi: 10.1016/j.acap.2018.07.013..
Keywords: Hospital Discharge, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Transitions of Care, Quality of Care, Quality Measures, Quality Improvement, Children's Health Insurance Program (CHIP), Evidence-Based Practice
Klueh MP, Hu HM, Howard RA
Transitions of care for postoperative opioid prescribing in previously opioid-naive patients in the USA: a retrospective review.
The purpose of this study was to identify specialties prescribing opioids to surgical patients who develop new persistent opioid use. Results showed that, among surgical patients who developed new persistent opioid use, surgeons provided the majority of opioid prescriptions during the first 3 months after surgery, but by 9 to 12 months after surgery, the majority of opioid prescriptions were provided by primary care physicians. Recommendations included enhanced care coordination between surgeons and primary care physicians to allow earlier identification of patients at risk for new persistent opioid use in order to prevent misuse and dependence.
AHRQ-funded; HS023313.
Citation: Klueh MP, Hu HM, Howard RA .
Transitions of care for postoperative opioid prescribing in previously opioid-naive patients in the USA: a retrospective review.
J Gen Intern Med 2018 Oct;33(10):1685-91. doi: 10.1007/s11606-018-4463-1..
Keywords: Transitions of Care, Opioids, Substance Abuse, Surgery, Pain, Medication, Patient-Centered Outcomes Research
Hong I, Karmarker A, Chan W
Discharge patterns for ischemic and hemorrhagic stroke patients going from acute care hospitals to inpatient and skilled nursing rehabilitation.
Investigators explored variation in acute care use of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation after ischemic and hemorrhagic stroke. They found demographic and clinical differences among stroke patients admitted for post-acute rehabilitation at inpatient rehabilitation facilities and skilled nursing facilities settings. Additionally, examination of variation in ischemic and hemorrhagic stroke discharges suggests acute facility-level differences and indicates a need for careful consideration of patient and facility factors when comparing the effectiveness of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation.
AHRQ-funded; HS022134; HS024711.
Citation: Hong I, Karmarker A, Chan W .
Discharge patterns for ischemic and hemorrhagic stroke patients going from acute care hospitals to inpatient and skilled nursing rehabilitation.
Am J Phys Med Rehabil 2018 Sep;97(9):636-45. doi: 10.1097/phm.0000000000000932..
Keywords: Transitions of Care, Hospital Discharge, Stroke, Cardiovascular Conditions, Nursing Homes, Rehabilitation
Auger KA, Shah SS, Tubbs-Cooley HL
Effects of a 1-time nurse-led telephone call after pediatric discharge: the H2O II randomized clinical trial.
The purpose of this study was to determine whether a single nurse-led telephone call after pediatric discharge decreased the 30-day reutilization rate for urgent care services and enhanced overall transition success. The investigators concluded that although postdischarge nurse contact did not decrease the reutilization rate of postdischarge urgent health care services, the method showed promise to bolster postdischarge education.
AHRQ-funded; HS024735.
Citation: Auger KA, Shah SS, Tubbs-Cooley HL .
Effects of a 1-time nurse-led telephone call after pediatric discharge: the H2O II randomized clinical trial.
JAMA Pediatr 2018 Sep;172(9):e181482. doi: 10.1001/jamapediatrics.2018.1482..
Keywords: Care Coordination, Children/Adolescents, Health Information Technology (HIT), Health Services Research (HSR), Healthcare Delivery, Healthcare Utilization, Hospital Discharge, Outcomes, Provider, Provider: Nurse, Telehealth, Transitions of Care
Naylor MD, Hirschman KB, Toles MP
Adaptations of the evidence-based Transitional Care Model in the U.S.
The goal of this study was to describe and classify common local adaptations of the evidence-based intervention Transitional Care Model (TCM); this model is comprised of 10 components that have been proven in multiple clinical trials to improve care and outcomes for chronically ill older adults who are transitioning home from hospitals. 582 U.S.-based transitional care clinicians in health systems and community-based organizations were asked to complete a survey, then researchers interviewed a subset of survey respondents regarding implementation of TCM in their distinct organizations. The results suggest hypotheses that can be used to guide rigorous examination of the association between adaptations of TCM components and desired outcomes, and reinforce a need for investment in adaptation science.
AHRQ-funded; HS022406.
Citation: Naylor MD, Hirschman KB, Toles MP .
Adaptations of the evidence-based Transitional Care Model in the U.S.
Soc Sci Med 2018 Sep;213:28-36. doi: 10.1016/j.socscimed.2018.07.023..
Keywords: Elderly, Chronic Conditions, Evidence-Based Practice, Transitions of Care
Bindman AB, Cox DF
AHRQ Author: Bindman AB
Changes in health care costs and mortality associated with transitional care management services after a discharge among Medicare beneficiaries.
Medicare adopted transitional care management (TCM) payment codes in 2013 to encourage clinicians to furnish TCM services after beneficiaries were discharged to the community from medical facilities. The purpose of this study was to investigate whether the receipt of TCM services was associated with the subsequent health care costs and mortality of the beneficiaries in the month after the service was provided. The study concluded that despite the apparent benefits of TCM services for Medicare beneficiaries, the use of this service remains low.
AHRQ-authored.
Citation: Bindman AB, Cox DF .
Changes in health care costs and mortality associated with transitional care management services after a discharge among Medicare beneficiaries.
JAMA Intern Med 2018 Sep;178(9):1165-71. doi: 10.1001/jamainternmed.2018.2572..
Keywords: Healthcare Costs, Hospital Discharge, Medicare, Mortality, Transitions of Care