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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
1 to 19 of 19 Research Studies DisplayedCardell CF, Knapp L, Cohen ME
Successful implementation of enhanced recovery in elective colorectal surgery is variable and dependent on the local environment.
This study looked at the results of a national colorectal enhanced recovery program (ERP) to improve patient outcomes. A total of 207 hospitals participated between 2017 and 2020. Quantitative (patient-level process and outcome) and qualitative (survey and structured interviews with hospital teams) data were collected and analyzed. Results shows that 62 hospitals were characterized as High Performance, and 52 as High Improvement. High Performance hospitals were larger with more annual colorectal surgeries. Fewer barriers to staff-buy-in and competing priorities, and more experience with standardized perioperative care were also characteristics of High Performance hospitals. High Improvement hospitals had lower baseline process measure (PM) adherence and less experience with perioperative care but had positive trends in annual patient outcomes such as annual morbidity, readmission, and prolonged length of stay compared to Low Improvement Hospitals.
AHRQ-funded; 233201500020I.
Citation: Cardell CF, Knapp L, Cohen ME .
Successful implementation of enhanced recovery in elective colorectal surgery is variable and dependent on the local environment.
Ann Surg 2021 Oct 1;274(4):605-12. doi: 10.1097/sla.0000000000005069..
Keywords: Surgery, Quality Improvement, Quality of Care, Outcomes, Patient-Centered Outcomes Research, Provider Performance
Hu QL, Grant MC, Hornor MA
Technical evidence review for emergency major abdominal operation conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
This technical evidence review focuses on the use of enhanced recovery pathways (ERPs) for emergency major abdominal surgery conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery (ISCR). This national ERP initiative is funded by AHRQ and implemented in 2017 through a collaboration with American College of Surgeons, and Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality. Five common emergency general surgery (EGS) procedures were focused on: perforated peptic ulcer repair, colectomy, lysis of adhesions, small bowel resection, and exploratory laparotomy. The authors identified seventeen candidate components for emergency major abdominal ERP. The components span the continuum of care from preoperative setting to hospital discharge. For every component they conducted a systematic literature review to find relevant studies. Each component was examined for rationale, evidence, and summary and recommendations. Many were supported by evidence and guidelines specific to their particular operation. Key gaps in literature were highlighted, specifically lack of evidence specific to these operations across many ERP processes.
AHRQ-funded; 233201500020I.
Citation: Hu QL, Grant MC, Hornor MA .
Technical evidence review for emergency major abdominal operation conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
J Am Coll Surg 2020 Dec;231(6):743-64.e5. doi: 10.1016/j.jamcollsurg.2020.08.772..
Keywords: Evidence-Based Practice, Surgery, Patient Safety, Quality Improvement, Quality of Care, Patient-Centered Outcomes Research
Tang AB, Childers CP, Dworsky JQ
Surgeon work captured by the National Surgical Quality Improvement Program across specialties.
The National Surgical Quality Improvement Program (NSQIP) database is increasingly used for surgical research. However, it is unclear how well this database represents the breadth of work performed by different specialties. Using the 2017 NSQIP participant use file and the 2017 Medicare Physician/Supplier Procedure Summary file, the investigators evaluated (1) what proportion of surgical work was captured by NSQIP, (2) what procedures and disciplines were undersampled, and (3) the overall concordance between the NSQIP sample and a national sample.
AHRQ-funded; HS000046.
Citation: Tang AB, Childers CP, Dworsky JQ .
Surgeon work captured by the National Surgical Quality Improvement Program across specialties.
Surgery 2020 Mar;167(3):550-55. doi: 10.1016/j.surg.2019.11.013..
Keywords: Surgery, Quality Improvement, Quality of Care, Provider: Physician, Provider, Medicare, Patient-Centered Outcomes Research
Hu QL, Livhits MJ, Ko CY MJ, Ko CY
Same-day discharge is not associated with increased readmissions or complications after thyroid operations.
The purpose of this study was to determine whether same-day discharge following thyroid surgery resulted in increased rehospitalization. Data from the American College of Surgeons National Surgical Quality Improvement Program Targeted Thyroidectomy database was used to identify patients who underwent thyroid resections. Results showed that, in a national cohort of patients undergoing thyroid surgery, same-day discharge was not associated with greater rates of readmission or complications when compared with discharge 1 or 2 days after thyroid surgery.
AHRQ-funded; 233201500020I.
Citation: Hu QL, Livhits MJ, Ko CY MJ, Ko CY .
Same-day discharge is not associated with increased readmissions or complications after thyroid operations.
Surgery 2020 Jan;167(1):117-23. doi: 10.1016/j.surg.2019.06.054..
Keywords: Surgery, Ambulatory Care and Surgery, Hospital Readmissions, Hospital Discharge, Adverse Events, Patient-Centered Outcomes Research, Quality Improvement, Quality of Care
Grant MC, Gibbons MM, Ko CY
Evidence review conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery: focus on anesthesiology for gynecologic surgery.
This paper is an evidence review of enhanced recovery after surgery (ERAS) protocols for gynecologic surgery that will be used as part of AHRQ’s Safety Program for Improving Surgical Care and Recovery. This initiative was developed in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality. The authors conducted a literature review of the various anesthesia components which may influence outcomes and facilitate recovery after gynecological surgery. They included interventions for preoperative, intraoperative, and postoperative phases of care and then summarized the best available evidence for ERAS for gynecological surgery. The best evidence was summarized for recommendations to be used in the initiative.
Citation: Grant MC, Gibbons MM, Ko CY .
Evidence review conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery: focus on anesthesiology for gynecologic surgery.
AHRQ-funded; 233201500020I..
Keywords: Patient Safety, Surgery, Quality Improvement, Quality of Care, Evidence-Based Practice, Patient-Centered Outcomes Research, Women
Grant MC, Gibbons M M, Ko CY
Evidence review conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery: focus on anesthesiology for bariatric surgery.
The authors conducted an evidence review to select anesthetic interventions that positively influence outcomes and facilitate recovery after bariatric surgery. They summarize the best available evidence to recommend the anesthetic components of care for enhanced recovery after bariatric surgery. The concluded that there is evidence in the literature, and from society guidelines, to support AHRQ’s Safety Program for Improving Surgical Care and Recovery goals for bariatric surgery.
AHRQ-funded; 233201500020I.
Citation: Grant MC, Gibbons M M, Ko CY .
Evidence review conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery: focus on anesthesiology for bariatric surgery.
Anesth Analg 2019 Jul;129(1):51-60. doi: 10.1213/ane.0000000000003696..
Keywords: Evidence-Based Practice, Medication, Obesity, Outcomes, Patient-Centered Outcomes Research, Patient Safety, Quality Improvement, Surgery
Soffin EM, Gibbons MM, Wick EC
Evidence review conducted for the Agency for Healthcare Research and Quality Safety Program for I
This evidence review was conducted as part of AHRQ’s Safety Program for Improving Surgical Care and Recovery. An evidence review of interventions was conducted to create an enhanced recovery after surgery (ERAS) protocol for anesthesiology for hip fracture repair surgery. The researchers identified anesthesiology components of care and evaluated them across the perioperative continuum. They created ERAS protocols for the preoperative, intraoperative, and postoperative phases.
AHRQ-funded; 233201500020I.
Citation: Soffin EM, Gibbons MM, Wick EC .
Evidence review conducted for the Agency for Healthcare Research and Quality Safety Program for I
Anesth Analg 2019 Jun;128(6):1107-17. doi: 10.1213/ane.0000000000003925..
Keywords: Evidence-Based Practice, Patient-Centered Outcomes Research, Surgery, Orthopedics, Quality Improvement, Quality of Care, Outcomes, Care Management
Ban KA, Gibbons MM, Ko CY
Evidence review conducted for the Agency for Healthcare Research and Quality Safety Program for Improving
This evidence review was conducted for AHRQ in partnership with the American College of Surgeons and the Johns Hopkins Armstrong Institute for Patient Safety and Quality who have developed the Safety Program for Improving Surgical Care and Recovery (ISCR). This national effort will disseminate best practices in perioperative care to more than 750 hospitals across multiple procedures in the next 5 years. This evidence-based review is focused on improving patient safety of anesthesiology for colorectal (CR) surgery. Components reviewed included carbohydrate loading, reduced fasting, multimodal preanesthesia medicine, antibiotic prophylaxis, normothermia, blood transfusion, intraoperative fluid management/goal-directed fluid therapy, a standardized intraoperative anesthesia pathway, and standard postoperative multimodal analgesic regiments. The results of this review will be used to develop an evidence-based CR protocol for implementation.
AHRQ-funded; 233201500020I.
Citation: Ban KA, Gibbons MM, Ko CY .
Evidence review conducted for the Agency for Healthcare Research and Quality Safety Program for Improving
Anesth Analg 2019 May;128(5):879-89. doi: 10.1213/ane.0000000000003366..
Keywords: Evidence-Based Practice, Surgery, Quality Improvement, Quality of Care, Patient Safety, Patient-Centered Outcomes Research, Antibiotics, Medication, Medication: Safety
Soffin EM, Gibbons MM, Ko CY
Evidence review conducted for the Agency for Healthcare Research and Quality Safety program for improving surgical care and recovery: focus on anesthesiology for total hip arthroplasty.
Successes using enhanced recovery after surgery (ERAS) protocols for total hip arthroplasty (THA) are increasingly being reported. The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, has developed the Safety Program for Improving Surgical Care and Recovery. In this study, the investigators conducted an evidence review to select anesthetic interventions that positively influence outcomes and facilitate recovery after total hip arthroplasty (THA).
AHRQ-funded; 233201500020I.
Citation: Soffin EM, Gibbons MM, Ko CY .
Evidence review conducted for the Agency for Healthcare Research and Quality Safety program for improving surgical care and recovery: focus on anesthesiology for total hip arthroplasty.
Anesth Analg 2019 Mar;128(3):454-65. doi: 10.1213/ane.0000000000003663..
Keywords: Evidence-Based Practice, Patient-Centered Outcomes Research, Surgery, Patient Safety, Quality Improvement, Quality of Care
Hsu YJ, Kosinski AS, Wallace AS
Using a society database to evaluate a patient safety collaborative: the Cardiovascular Surgical Translational Study.
The authors assessed the utility of using external databases for quality improvement (QI) evaluations in the context of an innovative QI collaborative aimed to reduce three infections and improve patient safety across the cardiac surgery service line. They compared changes in each outcome between 15 intervention hospitals and 52 propensity score-matched hospitals, and found that improvement trends in several outcomes among the studied intervention hospitals were not statistically different from those in comparison hospitals. They conclude that using external databases may permit comparative effectiveness assessment by providing concurrent comparison groups, additional outcome measures, and longer follow-up.
AHRQ-funded; HS019934.
Citation: Hsu YJ, Kosinski AS, Wallace AS .
Using a society database to evaluate a patient safety collaborative: the Cardiovascular Surgical Translational Study.
J Comp Eff Res 2019 Jan;8(1):21-32. doi: 10.2217/cer-2018-0051..
Keywords: Patient Safety, Quality Improvement, Quality Indicators (QIs), Quality of Care, Surgery, Cardiovascular Conditions, Comparative Effectiveness, Data, Hospitals, Research Methodologies, Patient-Centered Outcomes Research
Hornor MA, Liu JY, Hu QL
Surgical technical evidence review for acute appendectomy conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery.
This evidence review uses enhanced recovery pathways (ERPs) protocols developed for the AHRQ-funded Safety Program for Improving Surgical Care and Recovery (ISCR Program) to develop ERPs for acute appendectomy surgery. The authors classified appendicitis into uncomplicated (nonperforated) and complicated (perforated or gangrenous) to help with risk stratification. They identified 13 components for appendectomy for review. The processes are organized by perioperative phase, and each phase includes the rationale, evidence review, summary of guidelines, and a recommendation summary of the evidence for or against inclusion in the ERP. Preoperative management components included: education and counseling; preoperative antibiotics; initial nonsurgical management for perforated appendicitis with abscess or phlegmon, venous thromboembolism prophylaxis, delay for operation for 12-24 hours for uncomplicated appendicitis. Intraoperative management components include: laparoscopic surgical technique, peritoneal drain placement, urinary catheter placement, and prophylactic nasogastric tube insertion. Postoperative management components include same-day surgery discharge for uncomplicated appendicitis, antibiotics, early oral alimentation, and early mobilization. Of the ERPs reviewed: there was no evidence to support the routine use of abdominal drainage in patients undergoing appendectomies, urinary catheter insertion for laparoscopic surgery, use of prophylactic nasogastric tube placement, postoperative antibiotic use for uncomplicated appendicitis, and early oral alimentation for uncomplicated appendicitis.
AHRQ-funded.
Citation: Hornor MA, Liu JY, Hu QL .
Surgical technical evidence review for acute appendectomy conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery.
J Am Coll Surg 2018 Dec;227(6):605-17.e2. doi: 10.1016/j.jamcollsurg.2018.09.024..
Keywords: Surgery, Quality Improvement, Quality of Care, Patient Safety, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes
Devine EB, Van Eaton E, Zadworny ME
Automating electronic clinical data capture for quality improvement and research: The CERTAIN Validation Project of Real World Evidence.
Washington State's Surgical Care Outcomes and Assessment Program (SCOAP) is a network of hospitals participating in quality improvement (QI) registries wherein data are manually abstracted from EHRs. To create the Comparative Effectiveness Research and Translation Network (CERTAIN), researchers semi-automated SCOAP data abstraction using a centralized federated data model, created a central data repository (CDR), and assessed whether these data could be used as real world evidence for QI and research. They concluded that semi-automated data abstraction may be useful, although raw data collected as a byproduct of health care delivery is not immediately available for use as real world evidence. New approaches to gathering and analyzing extant data are required.
AHRQ-funded; HS020025.
Citation: Devine EB, Van Eaton E, Zadworny ME .
Automating electronic clinical data capture for quality improvement and research: The CERTAIN Validation Project of Real World Evidence.
eGEMS 2018 May 22;6(1):8. doi: 10.5334/egems.211..
Keywords: Patient-Centered Outcomes Research, Quality Improvement, Registries, Surgery, Electronic Health Records (EHRs)
Martin BI, Lurie JD, Farrokhi FR
Early effects of Medicare's Bundled Payment For Care Improvement program for lumbar fusion.
The purpose of this study was to describe the early effects of Bundled Payment for Care Improvement (BPCI) program participation for lumbar fusion on 90-day reimbursement, procedure volume, reoperation, and readmission. The investigators included 89,605 beneficiaries undergoing lumbar fusion, finding that the mean age was 73.4 years, with 59% women, 92% White, and 22% with a Charlson Comorbidity Index of 2 or more. Participant hospitals had greater procedure volume, bed size, and total discharges. Relative to nonparticipants, risk-bearing hospitals had a slightly increased fusion procedure volume from 2012 to 2013, did not reduce 90-day episode of care costs, increased 90-day readmission rate, and increased repeat surgery rates.
AHRQ-funded; HS024714; HS024075; HS021695.
Citation: Martin BI, Lurie JD, Farrokhi FR .
Early effects of Medicare's Bundled Payment For Care Improvement program for lumbar fusion.
Spine 2018 May 15;43(10):705-11. doi: 10.1097/brs.0000000000002404.
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Keywords: Payment, Medicare, Quality Improvement, Patient-Centered Outcomes Research, Surgery
Bavishi A, Boss E, Shah RK
Outcomes after endoscopic dilation of laryngotracheal stenosis: an analysis of ACS-NSQIP.
Endoscopic management of pediatric subglottic stenosis (SGS) is common, however no multi-institutional studies have assessed its perioperative outcomes. This study examined outcomes after endoscopic dilation of laryngotracheal stenosis. The study found that open airway reconstruction is associated with longer length of stay and increased reintubations and reoperations, suggesting a possible opportunity to improve value in healthcare in the appropriately selected patient. Reoperations and readmissions following endoscopic dilation are more prevalent in children less than one year.
AHRQ-funded; HS022932.
Citation: Bavishi A, Boss E, Shah RK .
Outcomes after endoscopic dilation of laryngotracheal stenosis: an analysis of ACS-NSQIP.
J Clin Outcomes Manag 2018 Mar;25(3):111-16..
Keywords: Children/Adolescents, Patient-Centered Outcomes Research, Quality Improvement, Respiratory Conditions, Surgery
Childers CP, Siletz AE, Singer ES
Surgical technical evidence review for elective total joint replacement conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
AHRQ, the American College of Surgeons, and the Johns Hopkins Medicine Armstrong Institute for Patent Safety and Quality have developed the Safety Program for Improving Surgical Care and Recovery - a national effort to catalyze implementation of practices to improve perioperative care and enhance recovery of surgical patients. This review synthesizes evidence that can be used to develop a protocol for elective total knee arthroplasty and total hip arthroplasty.
AHRQ-funded; 233201500020I.
Citation: Childers CP, Siletz AE, Singer ES .
Surgical technical evidence review for elective total joint replacement conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
Geriatr Orthop Surg Rehabil 2018 Feb 12;9:2151458518754451. doi: 10.1177/2151458518754451.
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Keywords: Evidence-Based Practice, Orthopedics, Patient Safety, Surgery, Quality Improvement, Quality of Care, Patient-Centered Outcomes Research
Franklin PD
Research priorities for optimal use of patient-reported outcomes in quality and outcome improvement for total knee arthroplasty.
This paper uses the traditional quality management's framework of inputs (patients), processes (clinical care), and outcomes to outline priority research questions to learn how clinicians, hospital managers, and patients can interpret patient-reported outcomes to improve total knee arthroplasty care and outcomes. It concludes that research should identify best practices to minimize variation in a patient's health status before surgery.
AHRQ-funded; HS018910.
Citation: Franklin PD .
Research priorities for optimal use of patient-reported outcomes in quality and outcome improvement for total knee arthroplasty.
J Am Acad Orthop Surg 2017 Feb;25 Suppl 1:S51-s54. doi: 10.5435/jaaos-d-16-00632.
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Keywords: Patient-Centered Outcomes Research, Surgery, Quality Improvement, Patient Experience, Evidence-Based Practice
Dimou FM, Riall TS
Pancreatic resection results in a statewide surgical collaborative.
The authors believe that participation in a regional quality improvement collaborative may provide an alternative model to improving outcomes for patients undergoing pancreatic resection. Furthermore, they argue that a procedure-specific collaborative could help hospitals and physicians improve outcomes for complex procedures such as pancreatic resection.
AHRQ-funded; HS022134.
Citation: Dimou FM, Riall TS .
Pancreatic resection results in a statewide surgical collaborative.
Ann Surg Oncol 2015 Aug;22(8):2462-3. doi: 10.1245/s10434-015-4536-x..
Keywords: Surgery, Patient-Centered Outcomes Research, Quality Improvement, Quality of Care
Shah RK, Stey AM, Jantana KR
Identification of opportunities for quality improvement and outcome measurement in pediatric otolaryngology.
This study evaluated perioperative outcomes in pediatric otolaryngology through analysis of records residing in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (ACS-NSQIP) database. It found that although the overall rate of major postoperative morbidity in pediatric otolaryngology is low, the following areas may be targeted for targeted quality-improvement interventions: tracheostomy, airway reconstruction, mastoidectomy, and abscess drainage.
AHRQ-funded; HS022932
Citation: Shah RK, Stey AM, Jantana KR .
Identification of opportunities for quality improvement and outcome measurement in pediatric otolaryngology.
JAMA Otolaryngol Head Neck Surg. 2014 Nov;140(11):1019-26. doi: 10.1001/jamaoto.2014.2067..
Keywords: Surgery, Children/Adolescents, Quality Improvement, Outcomes, Patient-Centered Outcomes Research
Maggard-Gibbons M
The use of report cards and outcome measurements to improve the safety of surgical care: the American College of Surgeons National Surgical Quality Improvement Program.
This review summarized the history of American College of Surgeons National Surgical Quality Improvement Project and its components, and described the evidence that feeding outcomes back to providers, along with real-time comparisons with other hospital rates, leads to quality improvement, better patient outcomes, cost savings and overall improved patient safety.
AHRQ-funded; 2902007100621.
Citation: Maggard-Gibbons M .
The use of report cards and outcome measurements to improve the safety of surgical care: the American College of Surgeons National Surgical Quality Improvement Program.
BMJ Qual Saf 2014 Jul;23(7):589-99. doi: 10.1136/bmjqs-2013-002223..
Keywords: Quality Improvement, Quality Indicators (QIs), Quality Measures, Quality of Care, Surgery, Patient Safety, Outcomes, Patient-Centered Outcomes Research, Provider Performance