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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 16 of 16 Research Studies Displayed
Bourgoin A, Balaban R, Hochman M
AHRQ Author: Perfetto D, Hogan EM
Improving quality and safety for patients after hospital discharge: primary care as the lead integrator in postdischarge care transitions.
The purpose of this study was to explain primary care-based transition workflow processes for hospitalized patients. The researchers conducted interviews with primary care thought leaders, staff at 9 primary care sites, community agency staff, and recently discharged patients. The researchers found that primary care postdischarge workflows vary across the different settings, rarely include communications with the patient or the inpatient team during the hospitalization and vary widely across settings. The researchers recommended the use of principles for primary care practices to encourage active participation in the full spectrum of postdischarge care, from admission through the first postdischarge visit to primary care.
AHRQ-authored; AHRQ-funded; 233201500019I/HHSP23337002T.
Citation: Bourgoin A, Balaban R, Hochman M . Improving quality and safety for patients after hospital discharge: primary care as the lead integrator in postdischarge care transitions. J Ambul Care Manage 2022 Oct-Dec;45(4):310-20. doi: 10.1097/jac.0000000000000433..
Keywords: Quality of Care, Patient Safety, Hospital Discharge, Transitions of Care, Hospitals, Workflow
Gonzalez MR, Junge-Maughan L, Lipsitz LA
ECHO-CT: an interdisciplinary videoconference model for identifying potential postdischarge transition-of-care events.
In this paper, data collected through the Extension for Community Health Outcomes- Care Transitions (ECHO-CT) model were used to identify and classify transition-of-care events (TCEs). Findings showed that the TCEs identified highlight areas in which providers can work to reduce issues arising during the course of discharge to post-acute care facilities. Recommendations included standardized processes to identify, record, and report TCEs in order to provide high-quality, safe care for patients as they move across care settings.
Citation: Gonzalez MR, Junge-Maughan L, Lipsitz LA . ECHO-CT: an interdisciplinary videoconference model for identifying potential postdischarge transition-of-care events. J Hosp Med 2021 Feb;16(2):93-96. doi: 10.12788/jhm.3523..
Keywords: Transitions of Care, Hospital Discharge, Quality Improvement, Quality of Care
Mohr NM, Zebrowski AM, Gaieski DF
Inpatient hospital performance is associated with post-discharge sepsis mortality.
The objective of this study was to test the hypothesis that hospitals with high risk-adjusted inpatient sepsis mortality also have high post-discharge mortality, readmissions, and discharge to nursing homes. Sepsis hospitalization survivors among age-qualifying Medicare beneficiaries were followed for 180 days post-discharge; mortality, readmissions, and new admission to skilled nursing facilities were measured. Findings showed that hospitals with the highest risk-adjusted sepsis inpatient mortality also had higher post-discharge mortality and increased readmissions, suggesting that post-discharge complications were a modifiable risk that may be affected during inpatient care. Recommendations for future work include seeking to elucidate inpatient and healthcare practices that can reduce sepsis post-discharge complications.
AHRQ-funded; HS023614; HS025753.
Citation: Mohr NM, Zebrowski AM, Gaieski DF . Inpatient hospital performance is associated with post-discharge sepsis mortality. Crit Care 2020 Oct 27;24(1):626. doi: 10.1186/s13054-020-03341-3..
Keywords: Sepsis, Mortality, Hospital Discharge, Hospitals, Provider Performance, Quality of Care, Inpatient Care, Hospital Readmissions
Campbell Britton M, Petersen-Pickett J, Hodshon B
Mapping the care transition from hospital to skilled nursing facility.
Researchers used process mapping to illustrate the sequence of events involved with hospital discharge and admission to a skilled nursing facility (SNF). These transitions are often associated with breakdowns in communication that may place patients at risk for adverse events. A quality improvement (QI) team worked with frontline staff at an academic medical center and two local SNFs in the northeastern United States. The final process map included care management, medicine, nursing, admissions and physical therapy service staff. The process map showed numerous activities that need to be coordinated between care teams, and highlighted specific opportunities for improving communication between different teams.
Citation: Campbell Britton M, Petersen-Pickett J, Hodshon B . Mapping the care transition from hospital to skilled nursing facility. J Eval Clin Pract 2020 Jun;26(3):786-90. doi: 10.1111/jep.13238..
Keywords: Transitions of Care, Care Coordination, Quality Improvement, Communication, Hospital Discharge, Hospitals, Nursing Homes, Quality of Care
Desai AD, Zhou C, Simon TD
Validation of a parent-reported hospital-to-home transition experience measure.
This study examined the validity of the Pediatric Transition Experience Measure (P-TEM), which is an 8-item, parent-reported measure that globally assesses hospital-to-home transition quality from discharge through follow-up compared to other validation measures. The other measures it was compared to included the 1) Child Hospital Consumer Assessment of Healthcare Providers and Systems Discharge Composite, 2) Center of Excellence on Quality of Care Measures for Children with Complex Needs parent-reported measures, 3) change in health-related quality of life from admission to postdischarge, and 4) 30-day emergency department revisits or readmissions. The P-TEM measure compared favorably with the Child Hospital Consumer Assessment of Healthcare Providers and Systems Discharge Composite measure and the other measures as well.
Citation: Desai AD, Zhou C, Simon TD . Validation of a parent-reported hospital-to-home transition experience measure. Pediatrics 2020 Feb;145(2):pii: e20192150. doi: 10.1542/peds.2019-2150..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Children/Adolescents, Patient Experience, Transitions of Care, Hospital Discharge, Quality Improvement, Quality of Care, Quality Measures
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.
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
Bain AM, Werner RM, Yuan Y
Do hospitals participating in accountable care organizations discharge patients to higher quality nursing homes?
This study examined whether hospitals participating in Medicare's Shared Saving Program increased use of highly rated skilled nursing facilities (SNFs) or decreased the use of low-rated SNFs after initiation of accountable care organization (ACO) contracts, compared with non-ACO hospitals. The findings indicate that, after joining an ACO, the percentage of hospital discharges going to a high-quality SNF increased slightly; the probability of discharge from ACO-participating hospitals to low-quality SNFs did not change significantly in comparison with non-ACO hospitals.
Citation: Bain AM, Werner RM, Yuan Y . Do hospitals participating in accountable care organizations discharge patients to higher quality nursing homes? J Hosp Med 2019 May;14(5):288-89. doi: 10.12788/jhm.3147..
Keywords: Elderly, Hospital Discharge, Hospitals, Medicare, Nursing Homes, Quality of Care, Value
Zuckerman RB, Wu S, Chen LM
The five-star skilled nursing facility rating system and care of disadvantaged populations.
Citation: Zuckerman RB, Wu S, Chen LM . The five-star skilled nursing facility rating system and care of disadvantaged populations. J Am Geriatr Soc 2019 Jan;67(1):108-14. doi: 10.1111/jgs.15629..
Keywords: Nursing Homes, Vulnerable Populations, Medicare, Elderly, Provider Performance, Quality of Care, Hospital Discharge, Disparities
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.
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
Middleton A, Graham JE, Ottenbacher KJ
Functional status is associated with 30-day potentially preventable hospital readmissions after inpatient rehabilitation among aged Medicare fee-for-service beneficiaries.
This study has two purposes: Determine the association between functional status of patients at discharge following inpatient rehabilitation and their potentially preventable readmission; Examine conditions that result in potentially preventable readmissions. The study examined inpatient rehabilitation facilities that submitted claims to Medicare, and concluded that functional status is associated with readmission and this may help to identify at-risk patients.
Citation: Middleton A, Graham JE, Ottenbacher KJ . Functional status is associated with 30-day potentially preventable hospital readmissions after inpatient rehabilitation among aged Medicare fee-for-service beneficiaries. Arch Phys Med Rehabil 2018 Jun;99(6):1067-76. doi: 10.1016/j.apmr.2017.05.001..
Keywords: Elderly, Quality of Care, Hospital Discharge, Hospital Readmissions, Medicare
Sills MR, Macy ML, Kocher KE
Return visit admissions may not indicate quality of emergency department care for children.
The goal of this retrospective analysis was to test the hypothesis that in-hospital outcomes are worse among children admitted during a return ED visit than among those admitted during an index visit. Children who were hospitalized in Florida and New York hospitals during a return visit within 7 days were classified as "ED return admissions" or "readmissions"; in-hospital outcomes for ED return admissions and readmissions were compared to "index admissions without return admission". The results indicate that children who are initially discharged from the ED and then have a return admission had lower severity but similar cost in comparison with children who experienced an index admission without a return admission. The authors conclude that this suggests that ED return visit admissions do not involve worse outcomes than index admissions.
AHRQ-funded; HS024160; HS016418.
Citation: Sills MR, Macy ML, Kocher KE . Return visit admissions may not indicate quality of emergency department care for children. Acad Emerg Med 2018 Mar;25(3):283-92. doi: 10.1111/acem.13324..
Keywords: Children/Adolescents, Emergency Department, Hospital Discharge, Hospital Readmissions, Hospitals, Quality of Care, Outcomes
Ellimoottil C, Syrjamaki JD, Volt JD
Validation of a claims-based algorithm to characterize episodes of care.
The Michigan Value Collaborative (MVC) developed a claims-based algorithm to provide hospitals with data on events that occur to patients beyond the hospitalization. In this article, the investigators discuss the validation of MVC's claims-based algorithm. They indicate that their findings suggest that the MVC claims-based algorithm identifies and classifies claims with high fidelity and outperforms medical records in the identification of postdischarge events.
Citation: Ellimoottil C, Syrjamaki JD, Volt JD . Validation of a claims-based algorithm to characterize episodes of care. Am J Manag Care 2017 Nov;23(11):e382-e86..
Keywords: Hospital Discharge, Hospital Readmissions, Hospitalization, Hospitals, Quality of Care, Quality Improvement
Blecker S, Goldfeld K, Park H
Impact of an intervention to improve weekend hospital care at an academic medical center: an observational study.
The purpose of this study was to evaluate the impact of a weekend hospital intervention on processes of care and clinical outcomes. The multifaceted intervention included expanded weekend diagnostic services, improved weekend discharge processes, and increased physician and care management services on weekends. The intervention was associated with a reduction in length of stay and an increase in weekend discharges.
Citation: Blecker S, Goldfeld K, Park H . Impact of an intervention to improve weekend hospital care at an academic medical center: an observational study. J Gen Intern Med 2015 Nov;30(11):1657-64. doi: 10.1007/s11606-015-3330-6.
Keywords: Quality Improvement, Quality of Care, Hospitals, Hospital Discharge, Hospital Readmissions, Healthcare Delivery, Outcomes, Patient-Centered Outcomes Research
Zingmond DS, Parikh P, Louie R
Improving hospital reporting of patient race and ethnicity--approaches to data auditing.
This study investigated new metrics to improve the reporting of patient race and ethnicity (R/E) by hospitals. It examined agreement between hospital reported R/E versus self-report among mothers delivering babies and a cancer cohort in California. It concluded that comparison between reported R/E and R/E estimates using zip code level data may be a reasonable first approach to evaluate and track hospital R/E reporting.
Citation: Zingmond DS, Parikh P, Louie R . Improving hospital reporting of patient race and ethnicity--approaches to data auditing. Health Serv Res 2015 Aug;50 Suppl 1:1372-89. doi: 10.1111/1475-6773.12324..
Keywords: Racial / Ethnic Minorities, Hospitals, Hospital Discharge, Health Services Research (HSR), Registries, Quality Improvement, Quality of Care, Data
Gadzinski AJ, Dimick JB, Ye Z
Transfer rates and use of post-acute care after surgery at critical access vs non-critical access hospitals.
This study evaluated discharge practice patterns and use of post-acute care after surgical admissions at critical access hospitals (CAHs). It found that for each of six common surgical procedures, a greater proportion of patients was transferred to another hospital. However, the proportion of patients at CAHs using post-acute care is equal to or less than that of patients treated in non-CAHs.
Citation: Gadzinski AJ, Dimick JB, Ye Z . Transfer rates and use of post-acute care after surgery at critical access vs non-critical access hospitals. JAMA Surg. 2014 Jul;149(7):671-7. doi: 10.1001/jamasurg.2013.5694..
Keywords: Surgery, Critical Care, Hospital Discharge, Quality of Care