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
51 to 75 of 1110 Research Studies DisplayedCrook S, Dragan K, Woo JL
Long-term health care utilization after cardiac surgery in children covered under Medicaid.
The purpose of this study was to examine the long-term burden of health care expenditures and utilization after pediatric cardiac surgery to improve care and reduce outcome inequities. The study compared children under the age of 18 undergoing cardiac surgery from 2006-2019 to a similar cohort of children without cardiac surgical disease. The research concluded that children after cardiac surgery have substantial long-term health care needs than noncardiac surgical comparators.
AHRQ-funded; HS000055.
Citation: Crook S, Dragan K, Woo JL .
Long-term health care utilization after cardiac surgery in children covered under Medicaid.
J Am Coll Cardiol 2023 Apr 25; 81(16):1605-17. doi: 10.1016/j.jacc.2023.02.021..
Keywords: Children/Adolescents, Healthcare Utilization, Long-Term Care, Cardiovascular Conditions, Medicaid, Surgery
Sun EC, Rishel CA, Waljee JF
Association between state limits on opioid prescribing and the incidence of persistent postoperative opioid use among surgical patients.
The objective of this study was to examine whether laws limiting opioid prescribing were associated with reductions in the incidence of persistent postoperative opioid use. Over identified 950,000 privately insured patients who had undergone one of 10 procedures were identified; researchers then estimated the association between persistent postoperative opioid use and whether state opioid prescribing limits were in effect on the day of surgery. The findings suggested that laws limiting opioid prescriptions were not associated with subsequent reductions in persistent postoperative opioid use.
AHRQ-funded; HS026753.
Citation: Sun EC, Rishel CA, Waljee JF .
Association between state limits on opioid prescribing and the incidence of persistent postoperative opioid use among surgical patients.
Ann Surg 2023 Apr;277(4):e759-e65. doi: 10.1097/sla.0000000000005283.
Keywords: Opioids, Medication, Surgery, Substance Abuse, Practice Patterns
Herb J, Rodriguez-Ormaza N, Cunningham C
Gastrostomy tube outcomes among surgical and non-surgical services: a retrospective review.
The purpose of this retrospective analysis study was to evaluate variations in baseline characteristics, complications, and mortality in patients receiving a gastrostomy tube (GT) by surgical or non-surgical services. The researchers assessed adult patients who underwent GT placement from 2014 to 2017 at a single institution. The study found that of the 1,339 adults who underwent GT placement, surgical and non-surgical services performed 45 percent and 55 percent of procedures, respectively. Gastrostomy tube-related complications were similar with 29.6% surgical vs 28.8% non-surgical. The thirty-day mortality rate of 23.7 percent among non-surgical services than the 16.5 percent rate for surgical services.
AHRQ-funded; HS000032.
Citation: Herb J, Rodriguez-Ormaza N, Cunningham C .
Gastrostomy tube outcomes among surgical and non-surgical services: a retrospective review.
Am Surg 2023 Apr; 89(4):813-20. doi: 10.1177/00031348211047173..
Keywords: Surgery, Digestive Disease and Health, Outcomes
Fernandes-Taylor S, Yang Q, Yang DY
Greater patient sharing between hospitals is associated with better outcomes for transferred emergency general surgery patients.
The availability of emergency surgical services has diminished as the rural workforce has decreased. The growing need for interhospital patient transfers makes care coordination across different settings essential for maintaining high-quality care. The purpose of this study was to investigate the impact of recurrent patient-sharing between hospitals on the outcomes of emergency general surgery (EGS) patient transfers. A multicenter analysis was conducted involving inpatient acute care hospital stays in Wisconsin that required the transfer of EGS patients. Data was sourced from the Wisconsin Hospital Association (WHA), a comprehensive statewide hospital discharge database for the years 2016-2018. We postulated that a higher percentage of patients transferred between hospitals would lead to improved outcomes. The relationship between the proportion of EGS patient transfers and patient outcomes, such as in-hospital morbidity, mortality, and duration of stay, was examined. Additional factors considered were hospital organizational features and patient sociodemographic and clinical attributes. The researchers found that during the two-year study period, 118 hospitals transferred 3,197 EGS patients; 1,131 of these patients experienced in-hospital complications, death, or an extended stay (beyond the 75th percentile). The average patient age was 62 years, with 50% being female and 5% non-white. In the mixed-effects model, the proportion of shared patients between hospitals was linked to a reduced likelihood of in-hospital complications. Specifically, when the proportion of shared patients doubled between two hospitals, the relative odds of any adverse outcome shifted by 0.85.
AHRQ-funded; HS025224
Citation: Fernandes-Taylor S, Yang Q, Yang DY .
Greater patient sharing between hospitals is associated with better outcomes for transferred emergency general surgery patients.
J Trauma Acute Care Surg 2023 Apr;94(5):592-98. doi: 10.1097/ta.0000000000003789.
Keywords: Emergency Department, Hospitals, Surgery, Transitions of Care
Mota L, Marcaccio CL, Patel PB
The impact of neighborhood social disadvantage on abdominal aortic aneurysm severity and management.
This study measured the impact of neighborhood social disadvantage on abdominal aortic aneurysm (AAA) severity and management. The authors identified all patients who underwent endovascular or open repair of an AAA in the Vascular Quality Initiative registry between 2003 and 2020. An area deprivation index (ADI) score of 1 to 100 was assigned to each patient based on their residential zip code, with higher ADI scores corresponding with increasing deprivation, which was then divided into quintiles. Outcomes looked at were rates of ruptured AAA (rAAA) repair versus an intact AAA repair and rates of endovascular repair (EVAR) versus the open approach. Among the 55,931 patients who underwent AAA repair, 6649 (12%) were in the lowest ADI quintile, 11,692 (21%) in the second, 15,958 (29%) in the third, 15,035 (27%) in the fourth, and 6597 (12%) in the highest ADI quintile. Patients in the two highest ADI quintiles had a higher proportion of rAAA repair (vs intact repair) compared with those in the lowest ADI quintile (8.8% and 9.1% vs 6.2%). They were also less likely to undergo EVAR (vs open approach) when compared with the lowest ADI quintile (81% and 81% vs 88%). Increasing ADI quintiles trended towards increasing rAAA and decreasing EVAR rates. In adjusted analyses, when compared with patients in the lowest ADI quintile, patients in the highest ADI quintile had higher odds of rAAA repair and lower odds of undergoing EVAR.
AHRQ-funded; HS027285.
Citation: Mota L, Marcaccio CL, Patel PB .
The impact of neighborhood social disadvantage on abdominal aortic aneurysm severity and management.
J Vasc Surg 2023 Apr;77(4):1077-86.e2. doi: 10.1016/j.jvs.2022.10.048.
Keywords: Social Determinants of Health, Cardiovascular Conditions, Surgery, Disparities
Solano QP, Thumma JR, Mullens C
Variation of ventral and incisional hernia repairs in kidney transplant recipients.
Researchers sought to evaluate hospital-level variation of ventral or incisional hernia repair (VIHR) among the kidney transplant population by performing a retrospective review of inpatient Medicare claims to identify patients who underwent kidney transplant, 2007-18. Their findings showed that the overall cumulative incidence of hernia repair varied substantially across hospital tertiles; patient and hospital characteristics also varied across tertile, most notably with diabetes and obesity. They concluded that future research will be needed to understand if program and surgeon level factors contribute to the observed variation in treatment.
AHRQ-funded; HS025778.
Citation: Solano QP, Thumma JR, Mullens C .
Variation of ventral and incisional hernia repairs in kidney transplant recipients.
Surg Endosc 2023 Apr; 37(4):3173-79. doi: 10.1007/s00464-022-09505-2..
Keywords: Kidney Disease and Health, Surgery, Transplantation
Bamdad MC, Vitous CA, Rivard SJ
"You remember those days"-a qualitative study of resident surgeon responses to complications and deaths.
This qualitative study examined the impact of complications and deaths on surgery residents to facilitate development of improved support systems. Twenty-eight mid-level and senior residents (PGY3 and above) from 14 different training programs across the US were given semi-structured interviews. The interviewees described an initial emotional response of sadness, frustration, or grief. Simultaneously or soon after went through an examination period where they looked at how and why the outcome occurred with the goal of learning from it. The last phase was having a feeling of ownership, which was strengthened by involved in patient care and length of rotation.
AHRQ-funded; HS026772.
Citation: Bamdad MC, Vitous CA, Rivard SJ .
"You remember those days"-a qualitative study of resident surgeon responses to complications and deaths.
J Surg Educ 2022 Mar-Apr; 79(2):452-62. doi: 10.1016/j.jsurg.2021.09.011..
Keywords: Surgery, Provider: Physician, Adverse Events, Mortality
Bilimoria KY, McGee MF, Williams MV
Development of the Illinois Surgical Quality Improvement Collaborative (ISQIC): implementing 21 components to catalyze statewide improvement in surgical care.
In 2014, a distinctive learning collaborative was established by 56 hospitals in Illinois, known as the Illinois Surgical Quality Improvement Collaborative (ISQIC). The purpose of this study is to present an overview of ISQIC's initial three years, focusing on 1) the formation and financing of the collaborative, 2) the 21 approaches employed for quality improvement (QI) support, 3) maintaining the collaborative, and 4) ISQIC as a foundation for innovative QI research. ISQIC integrates 21 elements that promote QI, targeting the hospital, the surgical QI team, and the perioperative microsystem. These elements were derived from existing evidence, a comprehensive needs assessment of the hospitals, previous experiences from surgical and non-surgical QI collaboratives, and interviews with QI professionals. The elements span five domains: guided implementation (e.g., mentors, coaches, statewide QI projects), education (e.g., process improvement (PI) curriculum), comparative performance reports for hospitals and surgeons (e.g., process, outcomes, costs), networking (e.g., venues for sharing QI experiences and best practices), and financing (e.g., for the overall program, pilot grants, and incentive payments for improvement). The study found that the 21 unique ISQIC components enabled hospitals to utilize their data effectively for the implementation of QI initiatives and enhancement of care. Formal (QI/PI) training, mentorship, and coaching were provided to hospitals as they implemented solutions. Hospitals were funded for the program and collaborated on statewide quality initiatives. Knowledge gained in one hospital was disseminated to all participating hospitals through conferences, webinars, and toolkits, fostering a collective learning environment aimed at improving and ensuring safer care for surgical patients in Illinois. Over the first three years, surgical outcomes in Illinois showed improvement.
AHRQ-funded; HS024516
Citation: Bilimoria KY, McGee MF, Williams MV .
Development of the Illinois Surgical Quality Improvement Collaborative (ISQIC): implementing 21 components to catalyze statewide improvement in surgical care.
Ann Surg Open 2023 Mar;4(1):e258. doi: 10.1097/as9.0000000000000258.
Keywords: Quality Improvement, Surgery, Quality of Care
Ingraham NE, Jones EK, King S
Re-aiming equity evaluation in clinical decision support: a scoping review of equity assessments in surgical decision support systems.
This scoping review explored surgical literature to determine frequency and rigor of clinical decision support (CDS) equity assessments and offer recommendations to improve CDS equity by appending existing frameworks. The authors performed a scoping review of PubMed and Google Scholar and identified 1,415 citations with 229 abstracts meeting criteria for review. A total of 84 papers underwent full review after 145 were excluded if they did not assess outcomes of an electronic CDS tool or have a surgical use case. Only 6% of surgical CDS systems reported equity analyses, suggesting that current methods for optimizing equity in surgical CDS are inadequate. The authors proposed revising the RE-AIM framework to include an Equity element (RE2-AIM) specifying that CDS foundational analyses and algorithms are performed or trained on balanced datasets with sociodemographic characteristics that accurately represent the CDS target population and are assessed by sensitivity analyses focused on vulnerable subpopulations.
AHRQ-funded; HS026379; HS024532.
Citation: Ingraham NE, Jones EK, King S .
Re-aiming equity evaluation in clinical decision support: a scoping review of equity assessments in surgical decision support systems.
Ann Surg 2023 Mar; 277(3):359-64. doi: 10.1097/sla.0000000000005661..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Disparities, Surgery
Logan CD, Feinglass J, Halverson AL
Rural-urban disparities in receipt of surgery for potentially resectable non-small cell lung cancer.
This study examined the reasons there are lower rates of surgical treatment for potentially resectable non-small cell lung cancer (NSCLC) for patients living in rural areas than in urban areas. The National Cancer Database was used to identify patients with clinical stage I-IIIA NSCLC between 2004 and 2018. Reasons for nonreceipt of surgery was evaluated for rural and urban area patients. The study included 328,785 patients with NSCLC with 13% from rural areas. Overall, 62.4% of patients from urban areas and 58.8% of patients from rural areas underwent surgery. Patients from rural areas had increased odds of (1) being recommended primary nonsurgical management, (2) surgery being deemed contraindicated due to risk, (3) surgery being recommended but not performed, and (4) overall failure to receive surgery.
AHRQ-funded; HS026385.
Citation: Logan CD, Feinglass J, Halverson AL .
Rural-urban disparities in receipt of surgery for potentially resectable non-small cell lung cancer.
J Surg Res 2023 Mar;283:1053-63. doi: 10.1016/j.jss.2022.10.097.
Keywords: Cancer: Lung Cancer, Cancer, Disparities, Surgery, Rural Health, Access to Care
Montgomery KB, Gillis A, Ramonell KM
Comparative utility of preoperative imaging in normocalcemic versus hypercalcemic primary hyperparathyroidism.
This retrospective review examined the utility of preoperative imaging in normocalcemic versus hypercalcemic primary hyperparathyroidism (PHPT) patients. The review was conducted on all PHPT patients who underwent parathyroidectomy from 2001 to 2019. The cohort included 2218 patients, with 433 normocalcemic PHPT (19.5%) and 1785 hypercalcemic PHPT (80.5%). Among normocalcemic patients, there were no differences in cure rates in patients with preoperative imaging versus those without (100% vs 99%). There were no differences in postoperative complications except for a slight increase in transient hypocalcemia in patients without imaging. There were equivalent cure and complication rates for normocalcemic PHPT patients with or without preoperative imaging compared to hypercalcemic patients.
AHRQ-funded; HS013852.
Citation: Montgomery KB, Gillis A, Ramonell KM .
Comparative utility of preoperative imaging in normocalcemic versus hypercalcemic primary hyperparathyroidism.
Am J Surg 2023 Feb;225(2):293-97. doi: 10.1016/j.amjsurg.2022.09.042.
Keywords: Imaging, Surgery
Mullens CL, Mead M, Kalata S
Evaluation of prices for surgical procedures within and outside hospital networks in the US.
The authors conducted an economic evaluation to examine variations in prices for surgical procedures under the Hospital Price Transparency Rule at U.S. hospitals in and outside of networks. The results showed that median negotiated prices were significantly higher at hospitals within networks compared with independent hospitals for 15 of the 16 procedures evaluated. The authors noted that these results ought to be interpreted in the context of certain limitations and that it will be important to understand the mechanisms behind these variations in negotiated prices for surgical care in order to identify areas of unwarranted variation.
AHRQ-funded; HS028606; HS000053.
Citation: Mullens CL, Mead M, Kalata S .
Evaluation of prices for surgical procedures within and outside hospital networks in the US.
JAMA Netw Open 2023 Feb; 6(2):e2255849. doi: 10.1001/jamanetworkopen.2022.55849..
Keywords: Surgery, Healthcare Costs, Hospitals
De Roo AC, Ha J, Regenbogen SE
Impact of Medicare eligibility on informal caregiving for surgery and stroke.
The purpose of this study was to assess whether the intensity of family and friend care changes after older individuals enroll in Medicare at 65. Researchers used Health and Retirement Study survey data covering a 20-year period to compare informal care received by patients who had been hospitalized for stroke, heart surgery, or joint surgery, and who were stratified into propensity-weighted pre- and post-Medicare eligibility cohorts. Their results showed that onset of Medicare eligibility was associated with a substantial decrease in family and friend caregiving use received by stroke patients, but not in the other acute care cohorts. They concluded that this effect of Medicare coverage on informal caregiving had implications for patient function and caregiver burden, and should be considered in episode-based reimbursement models that alter professional rehabilitative care intensity.
AHRQ-funded; HS000053.
Citation: De Roo AC, Ha J, Regenbogen SE .
Impact of Medicare eligibility on informal caregiving for surgery and stroke.
Health Serv Res 2023 Feb; 58(1):128-39. doi: 10.1111/1475-6773.14019..
Keywords: Medicare, Caregiving, Surgery, Stroke, Cardiovascular Conditions
Bartels K, Howard-Quijano K, Prin M
Meeting report: first Cardiovascular Outcomes Research in Perioperative Medicine conference.
This article summarized the background and objectives of the first Cardiovascular Outcomes Research in Perioperative Medicine (COR-PM) conference. It also described the conduct of the conference and outlined future directions for scientific meetings which are focused on the fostering of high-quality clinical research in the broader perioperative medicine community.
AHRQ-funded; HS027795.
Citation: Bartels K, Howard-Quijano K, Prin M .
Meeting report: first Cardiovascular Outcomes Research in Perioperative Medicine conference.
Anesth Analg 2023 Feb; 136(2):418-20. doi: 10.1213/ane.0000000000006248..
Keywords: Cardiovascular Conditions, Surgery, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Kim KM, Giannitrapani KF, Garcia A
Patient characteristics associated with occurrence of preoperative goals-of-care conversations.
This study’s goal was to evaluate the association between patient risk of hospitalization or death and goals-of-care conversations documented with a completed Life-Sustaining Treatment (LST) Decisions Initiative note among veterans undergoing surgery. This retrospective cross-sectional study included 190,040 veterans who underwent operations between January 2017 and February 2020. The main outcome looked at was preoperative LST note completion (30 days before or on the day of surgery) or no LST note completion within the 30-day preoperative period prior to or on the day of the index operation. Of 190,040 veterans (90.8% men), 3.8% completed an LST note before surgery, and 96.2% did not complete an LST note. In the groups with and without LST note completion before surgery, most were aged between 65 and 84 years, male, and Whites. Compared with patients who completed an LST, patients who did not tended to be female, married, Black, and in better health; to have a lower risk of hospitalization or death; or to undergo neurosurgical or urologic surgical procedures. Over the 3-year study interval, unadjusted rates of LST note completion before surgery increased from 0.1% to 9.6%. High-risk surgery was not associated with increased LST note completion before surgery. Veterans who underwent cardiothoracic surgery had the highest likelihood of LST note completion before surgery.
AHRQ-funded; F32 HS028747.
Citation: Kim KM, Giannitrapani KF, Garcia A .
Patient characteristics associated with occurrence of preoperative goals-of-care conversations.
JAMA Netw Open 2023 Feb;6(2):e2255407. doi: 10.1001/jamanetworkopen.2022.55407.
Keywords: Surgery, Clinician-Patient Communication, Communication
Difazio RL, Shore BJ, Melvin P
Pneumonia after hip surgery in children with neurological complex chronic conditions.
The purpose of this retrospective cohort study was to estimate rates of postoperative pneumonia in children with neurological complex chronic conditions (CCC) undergoing hip surgery, to determine the effect of pneumonia on postoperative hospital resource use, and to identify predictors. Researchers used data from the Pediatric Health Information System for children 4 years and older with a neurological CCC who had undergone hip surgery from 2016 to 2018 in U.S. children's hospitals. Findings indicate that postoperative pneumonia in children with a neurological CCC was associated with longer length-of-stay, readmissions, and higher costs. Children who had undergone pelvic osteotomies and who had multimorbidity needed additional clinical support to prevent postoperative pneumonia and to decrease resource utilization.
AHRQ-funded; HS024453.
Citation: Difazio RL, Shore BJ, Melvin P .
Pneumonia after hip surgery in children with neurological complex chronic conditions.
Dev Med Child Neurol 2023 Feb; 65(2):232-42. doi: 10.1111/dmcn.15339..
Keywords: Children/Adolescents, Surgery, Neurological Disorders, Pneumonia, Respiratory Conditions, Hospital Readmissions, Adverse Events
Ehlers AP, Howard R, Lai YL
Postacute care utilization and episode of care payments following common elective operations.
The purpose of the cross-sectional study was to analyze post-acute care (PAC) usage and its associated costs for patients undergoing common elective procedures. The researchers examined adult patients in a statewide administrative claims database who underwent elective cholecystectomy, ventral or incisional hernia repair (VIHR), and groin hernia repair between 2012 and 2019. The study found that among the 34,717 patients who underwent elective cholecystectomy, PAC was utilized by 0.7%, resulting in significantly higher payments ($19,047 vs $7,830, P < 0.001). For the 29,826 patients who underwent VIHR, 1.7% utilized PAC, leading to significantly higher payments ($19,766 vs $9,439, P < 0.001). Of the 37,006 patients who underwent groin hernia repair, 0.3% utilized PAC services, incurring significantly higher payments ($14,886 vs $8,062, P < 0.001). The study identified both modifiable and non-modifiable risk factors associated with PAC utilization. Morbid obesity was linked to PAC usage following VIHR. Male gender was associated with reduced odds of PAC utilization for VIHR and groin hernia repair. The researchers concluded that the study identified both modifiable (e.g., obesity) and nonmodifiable (e.g., female gender) patient factors associated with PAC utilization. To optimize patients and minimize PAC usage, it is essential to understand patient risk factors and implement systems and processes that address these factors.
AHRQ-funded; HS025778.
Citation: Ehlers AP, Howard R, Lai YL .
Postacute care utilization and episode of care payments following common elective operations.
Ann Surg 2023 Feb; 277(2):e266-e72. doi: 10.1097/sla.0000000000004814.
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Keywords: Surgery, Healthcare Utilization
Iantorno SE, Ulugia JG, Kastenberg ZJ
Postdischarge racial and ethnic disparities in pediatric appendicitis: a mediation analysis.
This retrospective cohort study sought to explore whether racial and ethnic disparities for children presenting with acute appendicitis persist after initial management and hospital discharge. The cohort included children under 18 years who underwent treatment for acute appendicitis in 47 U.S. Children's Hospitals from 2017 to 2019. Findings showed that children of racial and ethnic minorities were more likely to visit the emergency department after treatment for acute appendicitis, but Hispanic/Latinx patients did not have a corresponding increase in readmission. These differences were mediated mainly by insurance status and urban residence.
AHRQ-funded; HS025776.
Citation: Iantorno SE, Ulugia JG, Kastenberg ZJ .
Postdischarge racial and ethnic disparities in pediatric appendicitis: a mediation analysis.
J Surg Res 2023 Feb;282:174-82. doi: 10.1016/j.jss.2022.09.027..
Keywords: Children/Adolescents, Racial and Ethnic Minorities, Disparities, Hospital Discharge, Surgery
Ervin JN, Vitous CA, Wells EE
Rescue Improvement Conference: a novel tool for addressing failure to rescue.
The objective of this study was to understand the effectiveness of the Rescue Improvement Conference, a forum that addresses failure to rescue (FTR). FTR is the phenomenon where delayed recognition or response to surgical complications leads to a progressive cascade of adverse events culminating in patient death. The authors used 5 indicators of effectiveness: educational value, conference takeaways, discussion time, changes to surgical practice, and opportunities for improvement and conducted semi-structured interviews. The results showed that conference felt that the Rescue Improvement Conference was effective in all five indicators. The authors concluded that the conference has the potential to support other surgical departments in developing system-level strategies to recognize and manage postoperative complications that contribute to FTR.
AHRQ-funded; HS024403; HS023621.
Citation: Ervin JN, Vitous CA, Wells EE .
Rescue Improvement Conference: a novel tool for addressing failure to rescue.
Ann Surg 2023 Feb; 277(2):233-37. doi: 10.1097/sla.0000000000004832..
Keywords: Surgery, Adverse Events, Patient Safety, Quality of Care, Quality Improvement
Carey K, Lin MY
Safety-net hospital performance under comprehensive care for joint replacement.
The objective of this study was to investigate the relative progress of safety-net hospitals (SNHs) under Medicare's Comprehensive Care for Joint Replacement (CJR) mandatory bundled payment model and to identify contributors to SNHs' realization of success under the CJR program. Secondary data on all CJR hospitals from 2016-2020 were taken from CMS public use files and from the American Hospital Association. The findings indicated that SNHs were less successful in meeting spending targets when compared to CJR hospitals overall. The authors concluded that the formula used by CMS to determine spending targets may not be sufficient to address disparities in SNH financial performances under mandatory bundled payment.
AHRQ-funded; HS027786.
Citation: Carey K, Lin MY .
Safety-net hospital performance under comprehensive care for joint replacement.
Health Serv Res 2023 Feb; 58(1):101-06. doi: 10.1111/1475-6773.14042..
Keywords: Hospitals, Surgery, Orthopedics, Provider Performance
Tsou AY, Kessler SK, Wu M
Surgical treatments for epilepsies in children aged 1-36 months: a systematic review.
The purpose of this article was to summarize the findings of a systematic review commissioned by the American Epilepsy Society to evaluate evidence and describe evidence gaps for surgical treatments for epilepsy in children aged 1 to 36 months without infantile spasms. The researchers searched EMBASE, MEDLINE, PubMed, and the Cochrane Library for studies published from 1/1/1999 to 8/19/21 and included studies reporting data on children aged 1 month to 36 months or less enrolled in surgical interventions or neurostimulation for epilepsy. Eighteen studies met inclusion criteria. The review found that seizure freedom for infants undergoing hemispherectomy/hemispherotomy ranged from 7% to 76% at 1 year after surgery. For non-hemispheric surgeries seizure freedom ranged from 40% to 70%. Over half of infants undergoing hemispherectomy/hemispherotomy achieved a favorable outcome (Engel I or II, ILAE I to IV, or >50% seizure reduction) at follow-up of over 1 year. The researchers note that the studies had important limitations. The researchers concluded that while evidence remains sparse and low quality, some infants achieve seizure freedom after surgery and 50% or greater achieve favorable outcomes.
AHRQ-funded; 75Q80120D00002.
Citation: Tsou AY, Kessler SK, Wu M .
Surgical treatments for epilepsies in children aged 1-36 months: a systematic review.
Neurology 2023 Jan 3;100(1):e1-e15. doi: 10.1212/wnl.0000000000201012..
Keywords: Children/Adolescents, Newborns/Infants, Surgery, Treatments, Evidence-Based Practice
Diaz A, Lindau ST, Obeng-Gyasi S
Association of hospital quality and neighborhood deprivation with mortality after inpatient surgery among Medicare beneficiaries.
The purpose of this cross-sectional study was to compare postoperative mortality among Medicare beneficiaries based on the level of neighborhood deprivation where they live and the hospital quality where they received care. The researchers examined outcomes among Medicare beneficiaries undergoing one of five common surgical procedures (colon resection, coronary artery bypass, cholecystectomy, appendectomy, or incisional hernia repair) between 2014 and 2018. Hospital quality was assigned using the Centers for Medicare & Medicaid Services Star Rating. Each beneficiary's neighborhood was identified at the census tract level and sorted into quintiles based on its Area Deprivation Index score. A risk matrix across hospital quality and neighborhood deprivation was created to determine the relative contribution of each to mortality after surgery. Data were analyzed from June 1 to December 31, 2021. The study included 1,898,829 Medicare beneficiaries. Patients from all neighborhood deprivation group quintiles sought care at hospitals across hospital quality levels. Thirty-day risk-adjusted mortality varied across high- and low-quality hospitals and across the least and most deprived neighborhoods. When combined, comparing patients from the least deprived neighborhoods going to high-quality hospitals vs patients from the most deprived neighborhoods going to low-quality hospitals, the variation increased further. The researchers concluded that both a patient's neighborhood and the hospital where they received treatment were associated with the risk of death after commonly performed inpatient surgical procedures. The associations of these factors on mortality may be additive. Efforts to address variation in postoperative mortality should include both hospital quality improvement and addressing drivers of neighborhood deprivation.
AHRQ-funded; HS028606.
Citation: Diaz A, Lindau ST, Obeng-Gyasi S .
Association of hospital quality and neighborhood deprivation with mortality after inpatient surgery among Medicare beneficiaries.
JAMA Netw Open 2023 Jan; 6(1):e2253620. doi: 10.1001/jamanetworkopen.2022.53620..
Keywords: Hospitals, Quality of Care, Surgery, Mortality, Social Determinants of Health
Theiss LM, Wood L, Shao C
Disparities in perioperative use of patient engagement technologies - not all use is equal.
The objective of this retrospective cohort study was to determine the association of patient-level characteristics and the use of a patient engagement technology during the perioperative period. Patients who had undergone elective colorectal surgery were enrolled in a patient engagement technology at a single institution and received educational content, healthcare reminders, patient reported outcome surveys, and health checks. Findings indicated that use of a patient engagement technology in the perioperative period differs significantly by sex, race/ethnicity, and insurance status. The authors concluded that this diverse usage should be considered during implementation of interventions to improve surgical outcomes.
AHRQ-funded; HS023009.
Citation: Theiss LM, Wood L, Shao C .
Disparities in perioperative use of patient engagement technologies - not all use is equal.
Ann Surg 2023 Jan;277(1):e218-e25. doi: 10.1097/sla.0000000000004970.
Keywords: Patient and Family Engagement, Disparities, Surgery, Hospital Discharge
Ko H, Martin BI, Nelson RE
How does the effect of the comprehensive Care for Joint Replacement model vary based on surgical volume and costs of care?
This article described differences in costs, quality, and patient selection between hospitals that continued to participate in the comprehensive Care for Joint Replacement (CJR) program after the CMS policy revision and those that withdrew from CJR before and after the implementation of CJR. Study subjects were Medicare beneficiaries who had undergone elective lower extremity joint replacement from 2013 to 2017. The results indicated that hospitals that continued to participate in CJR achieved a greater cost reduction. The authors noted that these the cost reductions were partly attributable to the avoidance of potential higher-cost patients.
AHRQ-funded; HS024714.
Citation: Ko H, Martin BI, Nelson RE .
How does the effect of the comprehensive Care for Joint Replacement model vary based on surgical volume and costs of care?
Med Care 2023 Jan;61(1):20-26. doi: 10.1097/mlr.0000000000001785..
Keywords: Orthopedics, Surgery, Healthcare Costs, Medicare, Payment
Likosky DS, Strobel RJ, Wu X
Interhospital failure to rescue after coronary artery bypass grafting.
Researchers conducted an observational study to evaluate whether interhospital variation in mortality rates for coronary artery bypass grafting was driven by complications and failure to rescue. Subjects were patients undergoing grafting surgery across 90 hospitals between 2011 and 2017. Results indicated the predicted mortality risk was similar across hospital observed:expected mortality terciles. Observed and expected failure to rescue rates were positively correlated among patients with major and overall complications. The researchers concluded that interhospital variability in successful rescue after coronary artery bypass grafting supports the importance of identifying best practices at high-performing hospitals; this includes early recognition and management of complications.
AHRQ-funded; HS026003.
Citation: Likosky DS, Strobel RJ, Wu X .
Interhospital failure to rescue after coronary artery bypass grafting.
J Thorac Cardiovasc Surg 2023 Jan;165(1):134-43.e3. doi: 10.1016/j.jtcvs.2021.01.064..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Surgery, Hospitals, Adverse Events