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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 13 of 13 Research Studies Displayed
Herzig SJ, Anderson TS,, Jung y
Risk factors for opioid-related adverse drug events among older adults after hospital discharge.
This study examined patient- and prescribing-related risk factors for opioid-related adverse drug events (ADEs) after hospital discharge among medical patients. Administrative billing codes and medication claims were used to define potential opioid-related ADEs within 30 days of hospital discharge. Findings showed that potential opioid-related ADEs occurred in 7% of older adults discharged from a medical hospitalization with an opioid prescription. Recommendations included using identified risk factors to inform physician decision-making, having conversations with older adults about risk, and increasing development and targeting of harm reduction strategies.
Citation: Herzig SJ, Anderson TS,, Jung y . Risk factors for opioid-related adverse drug events among older adults after hospital discharge. J Am Geriatr Soc 2022 Jan;70(1):228-34. doi: 10.1111/jgs.17453..
Keywords: Elderly, Opioids, Risk, Adverse Drug Events (ADE), Adverse Events, Medication, Hospital Discharge
Herzig SJ, Anderson TS, Jung Y
Relative risks of adverse events among older adults receiving opioids versus NSAIDs after hospital discharge: a nationwide cohort study.
This retrospective cohort study’s objective was to determine the incidence and risk of post-discharge adverse events among opioid claims in the week after hospital discharge, compared to those with nonsteroidal anti-inflammatory drugs (NSAIDs) claims alone. A national sample of Medicare beneficiaries age 65 and older who were hospitalized in the United States in 2016 was used. Beneficiaries who were admitted from or discharged to a facility were excluded. The authors used 3:1 propensity matching to match beneficiaries with an opioid claim in the week after discharge (13,385) with beneficiaries with NSAID claim alone (4,677). Beneficiaries receiving opioids had a higher incidence of death, healthcare utilization, and any potential adverse effect compared to those with an NSAID claim only. Specific adverse effects included higher relative risk of fall/fracture, nausea/vomiting, and slowed colonic motility.
Citation: Herzig SJ, Anderson TS, Jung Y . Relative risks of adverse events among older adults receiving opioids versus NSAIDs after hospital discharge: a nationwide cohort study. PLoS Med 2021 Sep 27;18(9):e1003804. doi: 10.1371/journal.pmed.1003804..
Keywords: Elderly, Opioids, Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Risk, Hospital Discharge
Siddique SM, Tipton K, Leas B
Interventions to reduce hospital length of stay in high-risk populations: a systematic review.
Many strategies to reduce hospital length of stay (LOS) have been implemented, but few studies have evaluated hospital-led interventions focused on high-risk populations. The Agency for Healthcare Research and Quality (AHRQ) Learning Health System panel commissioned this study to further evaluate system-level interventions for LOS reduction. The objective of this study was to identify and synthesize evidence regarding potential systems-level strategies to reduce LOS for patients at high risk for prolonged LOS.
Citation: Siddique SM, Tipton K, Leas B . Interventions to reduce hospital length of stay in high-risk populations: a systematic review. JAMA Netw Open 2021 Sep;4(9):e2125846. doi: 10.1001/jamanetworkopen.2021.25846..
Keywords: Learning Health Systems, Healthcare Systems, Evidence-Based Practice, Hospital Discharge, Risk, Inpatient Care, Care Management
Ye S, Hiura G, Fleck E
Hospital readmissions after implementation of a discharge care program for patients with COVID-19 illness.
The surge of coronavirus 2019 (COVID-19) hospitalizations in New York City required rapid discharges to maintain hospital capacity. The objective of this study was to determine whether lenient provisional discharge guidelines with remote monitoring after discharge resulted in safe discharges home for patients hospitalized with COVID-19 illness. The investigators found that lenient discharge criteria in conjunction with remote monitoring after discharge were associated with a rate of early readmissions after COVID-related hospitalizations that was comparable to the rate of readmissions after other reasons for hospitalization before the COVID pandemic.
AHRQ-funded; HS024262; HS025198.
Citation: Ye S, Hiura G, Fleck E . Hospital readmissions after implementation of a discharge care program for patients with COVID-19 illness. J Gen Intern Med 2021 Mar;36(3):722-29. doi: 10.1007/s11606-020-06340-w..
Keywords: COVID-19, Hospital Discharge, Hospital Readmissions, Hospitals, Public Health, Hospitalization, Risk
Arbaje AI, Werner NE, Kasda EM
Learning from lawsuits: using malpractice claims data to develop care transitions planning tools.
This study used malpractice claims data to evaluate safety risks during care transitions from hospital to home and to help develop care transitions planning tools and pilot test them. The authors analyzed closed malpractice claims for 230 adult patients discharged from 4 hospital sites. Two structured focus groups were also conducted for stakeholders to review concerns. This led to the development of two care transitions planning tools – one for patients/caregivers and one for healthcare providers. Feasibility on 53 patient discharges were tested for both tools. A total of 33 risk factors corresponding to hospital work system elements, care transitions processes, and care outcomes were found using qualitative analysis. Providers found the tool easy to use and patients felt the length and response of the tool was acceptable.
AHRQ-funded; HS022916; HS019519.
Citation: Arbaje AI, Werner NE, Kasda EM . Learning from lawsuits: using malpractice claims data to develop care transitions planning tools. J Patient Saf 2020 Mar;16(1):52-57. doi: 10.1097/pts.0000000000000238.
Keywords: Medical Liability, Transitions of Care, Risk, Hospital Discharge, Hospitals, Patient Safety
Schlick CJR, Liu JY, Yang AD
Pre-operative, intra-operative, and post-operative factors associated with post-discharge venous thromboembolism following colorectal cancer resection.
Venous thromboembolism (VTE) is the most common preventable cause of 30-day post-operative mortality, with many events occurring after hospital discharge. High-level evidence supports post-discharge VTE chemoprophylaxis following abdominal/pelvic cancer resection; however, some studies support a more tailored approach. The objectives of this study were to (1) identify risk factors associated with post-discharge VTE in a large cohort of patients undergoing colorectal cancer resection and (2) develop a post-discharge VTE risk calculator.
AHRQ-funded; HS024516; HS026385.
Citation: Schlick CJR, Liu JY, Yang AD . Pre-operative, intra-operative, and post-operative factors associated with post-discharge venous thromboembolism following colorectal cancer resection. J Gastrointest Surg 2020 Jan;24(1):144-54. doi: 10.1007/s11605-019-04354-2..
Keywords: Cancer: Colorectal Cancer, Cancer, Surgery, Blood Clots, Adverse Events, Risk, Hospital Discharge
Kapoor A, Field T, Handler S
Characteristics of long-term care residents that predict adverse events after hospitalization.
This study examined the characteristics of long-term care (LTC) residents that predict adverse events (AEs) after discharge from recent hospitalization. This cohort study looked at AEs that occurred at 32 nursing homes from six New England states. AE incidents involving a total of 555 LTC residents with 762 transitions from the hospital back to LTC were reviewed. The association between all AEs and preventable AEs developing in the 45 days following discharge back to LTC was measured. There were 283 discharges with one or more AEs and 212 with preventable AEs. Characteristics independently associated with higher risk of AEs included hospital length of stay (LOS) 9 or more days, 18 or more regularly scheduled medications, and 19 and above on the dependency in activities of daily living (ADL) scale.
Citation: Kapoor A, Field T, Handler S . Characteristics of long-term care residents that predict adverse events after hospitalization. J Am Geriatr Soc 2020 Nov;68(11):2551-57. doi: 10.1111/jgs.16770..
Keywords: Elderly, Long-Term Care, Nursing Homes, Hospitalization, Adverse Events, Transitions of Care, Hospital Discharge, Risk
Lewkowitz AK, Rosenbloom JI , Keller M
Association between severe maternal morbidity and psychiatric illness within 1 year of hospital discharge after delivery.
The purpose of this study was to estimate whether severe maternal morbidity is associated with increased risk of psychiatric illness in the year after delivery hospital discharge. Results showed that although absolute numbers were modest, severe maternal morbidity was associated with increased risk of severe postpartum psychiatric morbidity and substance use disorder. The highest period of risk extended to 4 months after hospital discharge.
Citation: Lewkowitz AK, Rosenbloom JI , Keller M . Association between severe maternal morbidity and psychiatric illness within 1 year of hospital discharge after delivery. Obstet Gynecol 2019 Oct;134(4):695-707. doi: 10.1097/aog.0000000000003434..
Keywords: Healthcare Cost and Utilization Project (HCUP), Maternal Care, Pregnancy, Behavioral Health, Hospital Discharge, Risk, Women
Paredes AZ, Malik AT, Cluse M
Discharge disposition to skilled nursing facility after emergent general surgery predicts a poor prognosis.
Emergency general surgery can have a profound impact on the functional status of even previously independent patients. In this study, the investigators examined the role and influence of discharging a patient to a skilled nursing facility. They concluded that after accounting for patient severity and perioperative course, discharge to a skilled nursing facility was an independent risk factor for death, readmission, and postdischarge complications.
Citation: Paredes AZ, Malik AT, Cluse M . Discharge disposition to skilled nursing facility after emergent general surgery predicts a poor prognosis. Surgery 2019 Oct;166(4):489-95. doi: 10.1016/j.surg.2019.04.034..
Keywords: Nursing Homes, Hospital Discharge, Elderly, Ambulatory Care and Surgery, Emergency Department, Outcomes, Hospital Readmissions, Outcomes, Risk
Huang SS, Singh R, McKinnell JA
Decolonization to reduce postdischarge infection risk among MRSA carriers.
This study compared postdischarge methicillin-resistant Staphylococcus aureus (MRSA) rates in study participant who received education alone versus decolonization and education. Decolonization was done with chlorhexidine mouthwash and showers, and nasal sprays. Decolonization with education resulted in a 30% reduction in MRSA infection versus education alone.
Citation: Huang SS, Singh R, McKinnell JA . Decolonization to reduce postdischarge infection risk among MRSA carriers. N Engl J Med 2019 Feb 14;380(7):638-50. doi: 10.1056/NEJMoa1716771..
Keywords: Education: Patient and Caregiver, Healthcare-Associated Infections (HAIs), Hospital Discharge, Methicillin-Resistant Staphylococcus aureus (MRSA), Prevention, Risk
Doupnik SK, Lawlor J, Zima BT
Mental health conditions and unplanned hospital readmissions in children.
Mental health conditions (MHCs) are prevalent among hospitalized children and could influence the success of hospital discharge. The objective of this retrospective cross-sectional study was to assess the relationship between MHCs and 30-day readmissions. The investigators concluded that MHCs were associated with a higher likelihood of hospital readmission in children admitted for medical conditions and procedures. They suggest that understanding the influence of MHCs on readmissions could guide strategic planning to reduce unplanned readmissions for children with co-occurring physical and mental health conditions.
Citation: Doupnik SK, Lawlor J, Zima BT . Mental health conditions and unplanned hospital readmissions in children. J Hosp Med 2018 Jul;13(7):445-52. doi: 10.12788/jhm.2910..
Keywords: Children/Adolescents, Healthcare Cost and Utilization Project (HCUP), Hospital Discharge, Hospital Readmissions, Hospitalization, Risk, Young Adults
Nguyen OK, Makam AN, Clark C
Vital signs are still vital: instability on discharge and the risk of post-discharge adverse outcomes.
This study assessed the association between vital sign instability at hospital discharge and post-discharge adverse outcomes. Having two or more vital sign instabilities at discharge had a positive predictive value of 22 percent and positive likelihood ratio of 1.8 for 30-day death or readmission. Vital sign instability on discharge is thus associated with increased risk-adjusted rates of 30-day mortality and readmission.
Citation: Nguyen OK, Makam AN, Clark C . Vital signs are still vital: instability on discharge and the risk of post-discharge adverse outcomes. J Gen Intern Med 2017 Jan;32(1):42-48. doi: 10.1007/s11606-016-3826-8.
Keywords: Hospital Discharge, Hospital Readmissions, Patient-Centered Outcomes Research, Risk
Tsilimingras D, Schnipper J, Duke A
Post-discharge adverse events among urban and rural patients of an urban community hospital: a prospective cohort study.
The researchers aimed to determine the rate of postdischarge adverse events (AEs), classify the types of post-discharge AEs, and identify risk factors for post-discharge AEs in urban and rural patients. They found that post-discharge AEs were common in both urban and rural patients and many were preventable or ameliorable.
Citation: Tsilimingras D, Schnipper J, Duke A . Post-discharge adverse events among urban and rural patients of an urban community hospital: a prospective cohort study. J Gen Intern Med 2015 Aug;30(8):1164-71. doi: 10.1007/s11606-015-3260-3..
Keywords: Adverse Events, Hospital Discharge, Outcomes, Risk, Rural Health