National Healthcare Quality and Disparities Report
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Topics
- Adverse Events (3)
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- Cardiovascular Conditions (1)
- Children/Adolescents (1)
- Chronic Conditions (1)
- Elderly (1)
- Evidence-Based Practice (2)
- Falls (1)
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- (-) Quality Improvement (12)
- Quality Indicators (QIs) (1)
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- Quality of Care (9)
- (-) Risk (12)
- Stroke (1)
- Surgery (8)
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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 12 of 12 Research Studies DisplayedLiao JM, Wang E, Isidro U
The association between bundled payment participation and changes in medical episode outcomes among high-risk patients.
This research evaluated whether the association between participation in bundled payments for medical conditions and episode outcomes differed for clinically high-risk versus other patients in regard to length of stay (LOS) at skilled nursing facilities (SNFs). Participants included 471,421 Medicare patients hospitalized at bundled payment and propensity-matched non-participating hospitals. Primary outcomes were SNF LOS and 90-day unplanned readmissions. SNF length of stay was differentially lower among frail patients, patients with advanced age (>85 years), and those with prior institutional post-acute care provider utilization compared to non-frail, younger, and patients without prior utilization, respectively. Bundled payment participation was also associated with differentially greater SNF LOS among disabled patients. It was not associated with differential changes in readmissions in any high-risk group but was associated with changes in quality, utilization, and spending measures for some groups.
AHRQ-funded; HS027595.
Citation: Liao JM, Wang E, Isidro U .
The association between bundled payment participation and changes in medical episode outcomes among high-risk patients.
Healthcare 2022 Dec 12; 10(12). doi: 10.3390/healthcare10122510..
Keywords: Payment, Quality Improvement, Quality of Care, Risk, Policy
Delaney LD, Howard R, Palazzolo K
Outcomes of a presurgical optimization program for elective hernia repairs among high-risk patients.
The authors evaluated the feasibility of evidence-based patient optimization before surgery by implementing a low-cost preoperative optimization clinic. They found that a hernia optimization clinic safely improved management of high-risk patients and increased operative yield for the institution. They concluded that their results represented an opportunity to create sustainable and scalable models that provide longitudinal care and optimize patients to improve outcomes of hernia repair.
AHRQ-funded; HS025778.
Citation: Delaney LD, Howard R, Palazzolo K .
Outcomes of a presurgical optimization program for elective hernia repairs among high-risk patients.
JAMA Netw Open 2021 Nov;4(11):e2130016. doi: 10.1001/jamanetworkopen.2021.30016..
Keywords: Surgery, Risk, Evidence-Based Practice, Quality Improvement, Quality of Care, Outcomes
Brajcich BC, Bentrem DJ, Yang AD
Short-term risk of performing concurrent procedures with hepatic artery infusion pump placement.
This study’s objective was to characterize the short-term outcomes of concurrent surgery with hepatic artery infusion pump (HAIP) placement using data from the 2005-2017 ACS NSQIP dataset. Findings showed that HAIP placement is not associated with additional morbidity when performed with hepatic and/or colorectal surgery. Decisions regarding HAIP placement should consider the risks of concurrent operations as well as patient- and disease-specific factors.
AHRQ-funded; HS026385.
Citation: Brajcich BC, Bentrem DJ, Yang AD .
Short-term risk of performing concurrent procedures with hepatic artery infusion pump placement.
Ann Surg Oncol 2020 Dec;27(13):5098-106. doi: 10.1245/s10434-020-08938-0..
Keywords: Quality Improvement, Quality of Care, Surgery, Risk, Cancer, Outcomes
Mangrum R, Stewart MD, Gifford DR
Omissions of care in nursing homes: a uniform definition for research and quality improvement.
The goal of this study was to create a uniform definition of omission of care in US nursing homes. Lack of a uniform definition has made efforts to prevent them challenging. Subject matter experts and a broad range of nursing home stakeholders were brought together in iterative rounds of engagement to identify key concepts and aspects of omissions of care and develop a consensus-based definition. The concise definition decided on was: “Omissions of care in nursing homes encompass situations when care–either clinical or nonclinical–is not provided for a resident and results in additional monitoring or intervention or increases the risk of an undesirable or adverse physical, emotional, or psychosocial outcome for the resident."
AHRQ-funded; 233201500014I.
Citation: Mangrum R, Stewart MD, Gifford DR .
Omissions of care in nursing homes: a uniform definition for research and quality improvement.
J Am Med Dir Assoc 2020 Nov;21(11):1587-91.e2. doi: 10.1016/j.jamda.2020.08.016..
Keywords: Elderly, Nursing Homes, Long-Term Care, Quality Improvement, Quality of Care, Medical Errors, Adverse Events, Patient Safety, Risk, Patient-Centered Outcomes Research
De la Garza Ramos R, Gelfand Y, Benton JA
Rates, risk factors, and complications of red blood cell transfusion in metastatic spinal tumor surgery: an analysis of a prospective multicenter surgical database.
The goal of this study was to identify rates, risks, and complications of red blood cell (RBC) transfusion in metastatic spinal tumor surgery. The multicenter prospective American College of Surgeons National Quality Improvement Program database was used to identify adult patients with disseminated cancer who underwent metastatic spinal tumor surgery from 2012-2016. A patient was included if at least 1 intraoperative/postoperative RBC transfusion was received within the first 72 hours of surgery start time. Out of 1601 patients included, 623 (38.9%) received a RBC transfusion. There was an overall higher complication rate in patients who received a transfusion compared to those who didn’t. These complications included sepsis (3.5% vs. 1.9%), deep vein thrombosis (6.1% vs. 3.3%), and prolonged ventilation (3.9% vs. 1.3%). Future research into complication prevention was recommended.
https://www.pubmed.ncbi.nlm.nih.gov/32298819
Citation: De la Garza Ramos R, Gelfand Y, Benton JA .
Rates, risk factors, and complications of red blood cell transfusion in metastatic spinal tumor surgery: an analysis of a prospective multicenter surgical database.
World Neurosurg 2020 Jul;139:e308-e15. doi: 10.1016/j.wneu.2020.03.202..
Keywords: Quality Improvement, Quality of Care, Surgery, Risk, Cancer
Khaneki S, Bronsert MR, Henderson WG
Comparison of accuracy of prediction of postoperative mortality and morbidity between a new, parsimonious risk calculator (SURPAS) and the ACS Surgical Risk Calculator.
The purpose of this study was to compare the accuracy of the Surgical Risk Preoperative Assessment System (SURPAS) to that of the American College of Surgeons Surgical Risk Calculator (ACS-SRC). Data from 1006 selected ACS National Surgical Quality Improvement Program (NSQIP) patients with known outcomes were used to calculate predicted risk of postoperative mortality and morbidity. Findings showed that the SURPAS risk predictions were more accurate than the ACS-SRC's for overall morbidity, particularly for high risk patients.
AHRQ-funded; HS024124.
Citation: Khaneki S, Bronsert MR, Henderson WG .
Comparison of accuracy of prediction of postoperative mortality and morbidity between a new, parsimonious risk calculator (SURPAS) and the ACS Surgical Risk Calculator.
Am J Surg 2020 Jun;219(6):1065-72. doi: 10.1016/j.amjsurg.2019.07.036..
Keywords: Surgery, Risk, Adverse Events, Quality Improvement, Quality of Care
Sheetz KH, Dimick JB, Nathan H
Centralization of high-risk cancer surgery within existing hospital systems.
Centralization is often proposed as a strategy to improve the quality of certain high-risk health care services. In this study, the investigators evaluated the extent to which existing hospital systems centralize high-risk cancer surgery and whether centralization is associated with short-term clinical outcomes. The investigators concluded that greater centralization of complex cancer surgery within existing hospital systems was associated with better outcomes.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Dimick JB, Nathan H .
Centralization of high-risk cancer surgery within existing hospital systems.
J Clin Oncol 2019 Dec 1;37(34):3234-42. doi: 10.1200/jco.18.02035..
Keywords: Surgery, Cancer, Risk, Hospitals, Health Systems, Quality Improvement, Quality Indicators (QIs), Quality of Care, Outcomes
Jones KJ, Skinner A, Venema D
Evaluating the use of multiteam systems to manage the complexity of inpatient falls in rural hospitals.
Researchers evaluated the implementation and outcomes of evidence-based fall-risk-reduction processes when those processes are implemented using a multiteam system (MTS) structure. They found that multiteam systems that effectively coordinate fall-risk-reduction processes may improve the capacity of hospitals to manage the complex patient, environmental, and system factors that result in falls.
AHRQ-funded; HS024630; HS021429.
Citation: Jones KJ, Skinner A, Venema D .
Evaluating the use of multiteam systems to manage the complexity of inpatient falls in rural hospitals.
Health Serv Res 2019 Oct;54(5):994-1006. doi: 10.1111/1475-6773.13186..
Keywords: Falls, Hospitals, Inpatient Care, Quality of Care, Quality Improvement, Patient Safety, Prevention, Risk
Parchman ML, Anderson ML, Dorr DA
A randomized trial of external practice support to improve cardiovascular risk factors in primary care.
Researchers conducted a randomized controlled trial to compare the effectiveness of adding various forms of enhanced external support to practice facilitation on primary care practices' clinical quality measure (CQM) performance. They concluded that, although they found no significant differences in CQM performance across study arms, the ability of a practice to reach a target level of performance may be enhanced by adding both educational outreach visits and shared learning to practice facilitation.
AHRQ-funded; HS023908.
Citation: Parchman ML, Anderson ML, Dorr DA .
A randomized trial of external practice support to improve cardiovascular risk factors in primary care.
Ann Fam Med 2019 Aug 12;17(Suppl 1):S40-s49. doi: 10.1370/afm.2407..
Keywords: Cardiovascular Conditions, Primary Care, Quality Improvement, Provider Performance, Quality Measures, Quality of Care, Risk, Evidence-Based Practice, Patient-Centered Healthcare, Chronic Conditions
Lambert-Kerzner A, Ford KL, Hammermeister KE
Assessment of attitudes towards future implementation of the "Surgical Risk Preoperative Assessment System" (SURPAS) tool: a pilot survey among patients, surgeons, and hospital administrators.
Implementation of the Surgical Risk Preoperative Assessment System (SURPAS), an innovative real time, universal, preoperative tool providing individualized risk assessment, may enhance informed consent and reduce adverse outcomes. To ensure optimal development and implementation of SURPAS the study authors performed an in-depth pre-implementation evaluation of SURPAS at an academic tertiary referral center in Colorado.
AHRQ-funded; HS024124.
Citation: Lambert-Kerzner A, Ford KL, Hammermeister KE .
Assessment of attitudes towards future implementation of the "Surgical Risk Preoperative Assessment System" (SURPAS) tool: a pilot survey among patients, surgeons, and hospital administrators.
Patient Saf Surg 2018 Jun 4;12:12. doi: 10.1186/s13037-018-0159-z..
Keywords: Health Information Technology (HIT), Quality Improvement, Risk, Surgery, Tools & Toolkits
Cramer JD, Patel UA, Maas MB
Is neck dissection associated with an increased risk of postoperative stroke?
The researchers investigated whether neck dissection is an independent risk factor for postoperative stroke. They found that the rate of postoperative stroke was greater with neck dissection than without it and concluded that stroke is a rare but highly morbid complication after head and neck surgery. Compared with other head and neck surgery, neck dissection in patients at risk for carotid artery stenosis is associated with an increased risk of postoperative stroke.
AHRQ-funded; HS023011.
Citation: Cramer JD, Patel UA, Maas MB .
Is neck dissection associated with an increased risk of postoperative stroke?
Otolaryngol Head Neck Surg 2017 Aug;157(2):226-32. doi: 10.1177/0194599817698414.
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Keywords: Orthopedics, Quality Improvement, Risk, Stroke, Surgery
Roxbury CR, Li L, Rhee D
Safety and perioperative adverse events in pediatric endoscopic sinus surgery: an ACS-NSQIP-P analysis.
This study describes safety outcomes of pediatric endoscopic sinus surgery (ESS) to identify risk factors for 30-day postoperative adverse events using the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database. It concluded that urgent/emergent procedures carry the greatest risk of postoperative adverse events, and black children are significantly more likely to undergo higher acuity surgery than white children.
AHRQ-funded; HS022932.
Citation: Roxbury CR, Li L, Rhee D .
Safety and perioperative adverse events in pediatric endoscopic sinus surgery: an ACS-NSQIP-P analysis.
Int Forum Allergy Rhinol 2017 Aug;7(8):827-36. doi: 10.1002/alr.21954.
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Keywords: Adverse Events, Children/Adolescents, Quality Improvement, Risk, Surgery