National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (2)
- (-) Adverse Events (55)
- Ambulatory Care and Surgery (2)
- Blood Clots (3)
- Blood Pressure (1)
- Cardiovascular Conditions (2)
- Care Management (1)
- Children/Adolescents (5)
- Clinical Decision Support (CDS) (1)
- Communication (2)
- Critical Care (2)
- Data (2)
- Decision Making (1)
- Diagnostic Safety and Quality (11)
- Disparities (1)
- Education: Continuing Medical Education (2)
- Elderly (2)
- Electronic Health Records (EHRs) (5)
- Emergency Department (4)
- Evidence-Based Practice (1)
- Guidelines (1)
- Healthcare-Associated Infections (HAIs) (7)
- Healthcare Cost and Utilization Project (HCUP) (4)
- Healthcare Costs (1)
- Healthcare Delivery (2)
- Health Information Technology (HIT) (6)
- Heart Disease and Health (1)
- Hospital Discharge (1)
- Hospitalization (2)
- Hospital Readmissions (3)
- Hospitals (13)
- Imaging (1)
- Infectious Diseases (1)
- Injuries and Wounds (6)
- Inpatient Care (1)
- Intensive Care Unit (ICU) (2)
- Kidney Disease and Health (1)
- Labor and Delivery (2)
- Long-Term Care (2)
- Medical Errors (22)
- Medical Liability (1)
- Medicare (2)
- Medication (2)
- Medication: Safety (1)
- Mortality (2)
- Newborns/Infants (3)
- Nursing (1)
- Nursing Homes (2)
- Orthopedics (1)
- Outcomes (3)
- Patient-Centered Outcomes Research (4)
- Patient Experience (1)
- Patient Safety (37)
- Pregnancy (2)
- Prevention (3)
- Primary Care (2)
- Provider (1)
- Provider: Physician (1)
- Provider Performance (1)
- Public Reporting (3)
- Quality Improvement (27)
- Quality Indicators (QIs) (7)
- Quality Measures (4)
- (-) Quality of Care (55)
- Racial and Ethnic Minorities (1)
- Registries (1)
- Risk (5)
- Sleep Problems (1)
- Social Determinants of Health (1)
- Surgery (15)
- Teams (2)
- TeamSTEPPS (1)
- Tools & Toolkits (1)
- Training (2)
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
26 to 50 of 55 Research Studies DisplayedSchwarzkopf R, Behery OA, Yu H
Patterns and costs of 90-day readmission for surgical and medical complications following total hip and knee arthroplasty.
Unplanned readmissions following elective total hip (THA) and knee (TKA) arthroplasty as a result of surgical complications likely have different quality improvement targets and cost implications than those for nonsurgical readmissions. In this study, the investigators compared payments, timing, and location of unplanned readmissions with Center for Medicare and Medicaid Services (CMS)-defined surgical complications to readmissions without such complications.
AHRQ-funded; HS022882.
Citation: Schwarzkopf R, Behery OA, Yu H .
Patterns and costs of 90-day readmission for surgical and medical complications following total hip and knee arthroplasty.
J Arthroplasty 2019 Oct;34(10):2304-07. doi: 10.1016/j.arth.2019.05.046..
Keywords: Orthopedics, Surgery, Hospital Readmissions, Adverse Events, Quality Improvement, Quality of Care, Medicare, Hospitals
St Hilaire MA, Anderson C, Anwar J
Brief (<4 hour) sleep episodes are insufficient for restoring performance in first-year resident physicians working overnight extended-duration work shifts.
This study examines the impact of reinstating extended duration (24-28) work shifts (EDWS) for postgraduate year 1 resident physicians. The performance of residents was studied for 23 male residents between 2002-2004 during a three-week on-call rotation schedule at the Medical and Intensive Care Units at Brigham and Women’s Hospital in Boston. If the sleep episodes were four hours or less then the odds of >1 attentional failure was 2.72 times higher during post-call compared to matched sessions during non-EDWS.
AHRQ-funded; HS012032.
Citation: St Hilaire MA, Anderson C, Anwar J .
Brief (<4 hour) sleep episodes are insufficient for restoring performance in first-year resident physicians working overnight extended-duration work shifts.
Sleep 2019 May;42(5):pii: zsz041. doi: 10.1093/sleep/zsz041..
Keywords: Adverse Events, Education: Continuing Medical Education, Medical Errors, Patient Safety, Provider, Provider: Physician, Quality of Care, Sleep Problems, Training
Bundy DG, Singh H, Stein RE
The design and conduct of Project RedDE: a cluster-randomized trial to reduce diagnostic errors in pediatric primary care.
This paper discusses the results of Project RedDE, which was a virtual collaborative quality improvement study to reduce diagnostic errors in pediatric primary care practices. Forty-three practices were initially recruited, with a total of 31 practices left at the end due to practice dropout and two participating practices merging. This study was a randomized controlled trial targeting three common diagnostic errors (missed diagnoses of adolescent depression, abnormal blood pressure, and lack of followup for abnormal laboratory results). Contamination across study groups was a recurring problem, but risk mitigations were used. Electronic health records contributed to teams’ success.
AHRQ-funded; HS203608.
Citation: Bundy DG, Singh H, Stein RE .
The design and conduct of Project RedDE: a cluster-randomized trial to reduce diagnostic errors in pediatric primary care.
Clin Trials 2019 Apr;16(2):154-64. doi: 10.1177/1740774518820522..
Keywords: Adverse Events, Children/Adolescents, Diagnostic Safety and Quality, Medical Errors, Prevention, Primary Care, Quality of Care, Quality Improvement
Stockwell DC, Landrigan CP, Toomey SL
Racial, ethnic, and socioeconomic disparities in patient safety events for hospitalized children.
Previous studies have revealed racial/ethnic and socioeconomic disparities in quality of care and patient safety. However, these disparities have not been examined in a pediatric inpatient environment by using a measure of clinically confirmed adverse events (AEs). In this study, the investigators do so using the Global Assessment of Pediatric Patient Safety (GAPPS) Trigger Tool. The investigators concluded that the GAPPS analysis revealed racial and/or ethnic and socioeconomic disparities in rates of AEs experienced by hospitalized children across a broad range of geographic and hospital settings.
AHRQ-funded; HS020513; HS025299.
Citation: Stockwell DC, Landrigan CP, Toomey SL .
Racial, ethnic, and socioeconomic disparities in patient safety events for hospitalized children.
Hosp Pediatr 2019 Jan;9(1):1-5. doi: 10.1542/hpeds.2018-0131..
Keywords: Children/Adolescents, Disparities, Racial and Ethnic Minorities, Social Determinants of Health, Hospitalization, Patient Safety, Quality of Care, Adverse Events
Silber JH, Arriaga AF, Niknam BA
Failure-to-rescue after acute myocardial infarction.
The purpose of this study is to develop a failure-to-rescue (FTR) metric modified to analyze acute myocardial infarction (AMI) outcomes. The subjects were older Medicare beneficiaries who were admitted to short-term acute-care hospitals for AMI between 2009 and 2011. Measures included thirty-day mortality and FTR rates, as well as in-hospital complication rates. The study concludes that a modified FTR metric can be created that may aid in studying the quality of care of AMI admissions and has the advantageous properties of surgical FTR.
AHRQ-funded; HS023560.
Citation: Silber JH, Arriaga AF, Niknam BA .
Failure-to-rescue after acute myocardial infarction.
Med Care 2018 May;56(5):416-23. doi: 10.1097/mlr.0000000000000904..
Keywords: Adverse Events, Cardiovascular Conditions, Quality of Care, Mortality, Heart Disease and Health
Muldoon MF, Kronish IM, Shimbo D
Of signal and noise: overcoming challenges in blood pressure measurement to optimize hypertension care.
This paper reviews the manifestations and consequences of BP mismeasurement and misinterpretation in clinical practice and draw on recent research to propose a set of solutions that leverage available technologies to optimize hypertension care.
AHRQ-funded; HS024262.
Citation: Muldoon MF, Kronish IM, Shimbo D .
Of signal and noise: overcoming challenges in blood pressure measurement to optimize hypertension care.
Circ Cardiovasc Qual Outcomes 2018 May;11(5):e004543. doi: 10.1161/circoutcomes.117.004543..
Keywords: Blood Pressure, Diagnostic Safety and Quality, Adverse Events, Medical Errors, Electronic Health Records (EHRs), Health Information Technology (HIT), Quality of Care
Aldina S, Goldhaber-Fiebert SN, Hannenberg AA
Factors associated with the use of cognitive aids in operating room crises: a cross-sectional study of US hospitals and ambulatory surgical centers.
This study examined organizational context and implementation process factors influencing the use of cognitive aids for OR crises. It found that small facility size was associated with a fourfold increase in the odds of a facility reporting more successful implementation. Completing more implementation steps was also significantly associated with more successful implementation.
AHRQ-funded; HS024235.
Citation: Aldina S, Goldhaber-Fiebert SN, Hannenberg AA .
Factors associated with the use of cognitive aids in operating room crises: a cross-sectional study of US hospitals and ambulatory surgical centers.
Implement Sci 2018 Mar 26;13(1):50. doi: 10.1186/s13012-018-0739-4.
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Keywords: Adverse Events, Ambulatory Care and Surgery, Patient Safety, Quality Improvement, Quality of Care, Hospitals, Decision Making, Clinical Decision Support (CDS)
McArdle J, Sorensen A, Fowler CI
Strategies to improve management of shoulder dystocia under the AHRQ Safety Program for Perinatal Care.
The purpose of this study using TeamSTEPPS was to assess the implementation of safety strategies to improve management of births complicated by shoulder dystocia in labor and delivery units. Results suggested that successful management of shoulder dystocia requires a rapid, standardized, and coordinated response. The Safety Program for Perinatal Care strategies to increase safety of shoulder dystocia management are scalable, replicable, and adaptable to unit needs and circumstances.
AHRQ-funded; 2902010000241.
Citation: McArdle J, Sorensen A, Fowler CI .
Strategies to improve management of shoulder dystocia under the AHRQ Safety Program for Perinatal Care.
J Obstet Gynecol Neonatal Nurs 2018 Mar;47(2):191-201. doi: 10.1016/j.jogn.2017.11.014.
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Keywords: Labor and Delivery, Newborns/Infants, Pregnancy, Adverse Events, TeamSTEPPS, Injuries and Wounds, Care Management, Education: Continuing Medical Education, Training, Tools & Toolkits, Patient Safety, Nursing, Communication, Quality of Care
Bhise V, Sittig DF, Vaghani V
An electronic trigger based on care escalation to identify preventable adverse events in hospitalised patients.
Researchers refined the methods of the Institute of Healthcare Improvement's Global Trigger Tool application and leveraged electronic health record data to improve detection of preventable adverse events, including diagnostic errors. In the studied sample, preventable adverse events were identified, including adverse drug events, patient falls, procedure-related complications, and hospital-associated infections. The authors concluded that such e-triggers can help overcome limitations of currently available methods to detect preventable harm in hospitalized patients.
AHRQ-funded; HS022087; HS023602.
Citation: Bhise V, Sittig DF, Vaghani V .
An electronic trigger based on care escalation to identify preventable adverse events in hospitalised patients.
BMJ Qual Saf 2018 Mar;27(3):241-46. doi: 10.1136/bmjqs-2017-006975..
Keywords: Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitalization, Hospitals, Patient Safety, Prevention, Quality of Care, Quality Improvement, Quality Indicators (QIs)
Skube SJ, Hu Z, Arsoniadis EG
Characterizing surgical site infection signals in clinical notes.
Building off of previous work for automated and semi-automated surgical site infections (SSIs) detection using expert-derived "strong features" from clinical notes, researchers hypothesized that additional SSI phrases may be contained in clinical notes. They systematically characterized phrases and expressions associated with SSIs. While 83 percent of expert-derived original terms overlapped with new terms and modifiers, an additional 362 modifiers associated with both positive and negative SSI signals were identified.
AHRQ-funded; HS024532.
Citation: Skube SJ, Hu Z, Arsoniadis EG .
Characterizing surgical site infection signals in clinical notes.
Stud Health Technol Inform 2017;245:955-59.
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Keywords: Healthcare-Associated Infections (HAIs), Surgery, Injuries and Wounds, Patient Safety, Adverse Events, Quality Improvement, Quality of Care
Hu Z, Melton GB, Arsoniadis EG
Strategies for handling missing clinical data for automated surgical site infection detection from the electronic health record.
Proper handling of missing data is important for many secondary uses of electronic health record (EHR) data. Data imputation methods can be used to handle missing data, but their use for postoperative complication detection is unclear. Overall, models with missing data imputation almost always outperformed reference models without imputation that included only cases with complete data for detection of SSI overall achieving very good average area under the curve values.
AHRQ-funded; HS024532.
Citation: Hu Z, Melton GB, Arsoniadis EG .
Strategies for handling missing clinical data for automated surgical site infection detection from the electronic health record.
J Biomed Inform 2017 Apr;68:112-20. doi: 10.1016/j.jbi.2017.03.009.
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Keywords: Data, Electronic Health Records (EHRs), Healthcare-Associated Infections (HAIs), Registries, Surgery, Injuries and Wounds, Health Information Technology (HIT), Quality Improvement, Quality of Care, Adverse Events
Kang H, Gong Y
A novel schema to enhance data quality of patient safety event reports.
In this study, the researchers designed a patient safety event (PSE) similarity searching model based on semantic similarity measures, and proposed a novel schema of PSE reporting system which can effectively learn from previous experiences and timely inform the subsequent actions. Their system will not only help promote the report qualities but also serve as a knowledge base and education tool to guide healthcare providers in terms of preventing the recurrence of PSEs.
AHRQ-funded; HS022895.
Citation: Kang H, Gong Y .
A novel schema to enhance data quality of patient safety event reports.
AMIA Annu Symp Proc 2017 Feb 10;2016:1840-49.
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Keywords: Quality of Care, Patient Safety, Data, Adverse Events, Medical Errors
Calderwood MS, Kleinman K, Huang SS
Surgical site infections: volume-outcome relationship and year-to-year stability of performance rankings.
The researchers evaluated the volume-outcome relationship as well as the year-to-year stability of performance rankings following coronary artery bypass graft (CABG) surgery and hip arthroplasty. They concluded that aggregate surgical site infection risk is highest in hospitals with low annual procedure volumes. Even for higher volume hospitals, year-to-year random variation makes past experience an unreliable estimator of current performance.
AHRQ-funded; HS021424.
Citation: Calderwood MS, Kleinman K, Huang SS .
Surgical site infections: volume-outcome relationship and year-to-year stability of performance rankings.
Med Care 2017 Jan;55(1):79-85. doi: 10.1097/mlr.0000000000000620.
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Keywords: Surgery, Healthcare-Associated Infections (HAIs), Adverse Events, Injuries and Wounds, Hospitals, Provider Performance, Quality Indicators (QIs), Quality of Care, Patient Safety, Elderly
Burstein PD, Zalenski DM, Edwards JL
Changing labor and delivery practice: focus on achieving practice and documentation standardization with the goal of improving neonatal outcomes.
The researchers established a multifactorial shoulder dystocia response and management protocol to promote sustainable practice change. In the first year, there was a threefold increase in shoulder dystocia reporting, which continued in years 2 and 3. In the first year, 96 percent of clinicians completed all training elements. Overall teams reached a 99 percent adoption rate of the shoulder dystocia protocol.
AHRQ-funded; HS019608.
Citation: Burstein PD, Zalenski DM, Edwards JL .
Changing labor and delivery practice: focus on achieving practice and documentation standardization with the goal of improving neonatal outcomes.
Health Serv Res 2016 Dec;51 Suppl 3:2472-86. doi: 10.1111/1475-6773.12589.
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Keywords: Labor and Delivery, Newborns/Infants, Adverse Events, Quality Improvement, Quality of Care, Patient Safety, Patient-Centered Outcomes Research, Outcomes, Guidelines, Evidence-Based Practice, Pregnancy, Teams
Gallagher TH, Farrell ML, Karson H
Collaboration with regulators to support quality and accountability following medical errors: The Communication and Resolution Program Certification Pilot.
The Medical Quality Assurance Commission (MQAC, board of medicine) in Washington State has collaborated with the Foundation for Health Care Quality (FHCQ) on the CRP Certification pilot. A panel of physicians, risk managers, and patient advocates at FHCQ will review cases for use of the CRP key elements. After describing the process, the authors concluded that the CRP Certification program is a promising example of collaboration among institutions, insurers, and regulators to promote patient-centered accountability and learning following adverse events.
AHRQ-funded; HS019531.
Citation: Gallagher TH, Farrell ML, Karson H .
Collaboration with regulators to support quality and accountability following medical errors: The Communication and Resolution Program Certification Pilot.
Health Serv Res 2016 Dec;51 Suppl 3:2569-82. doi: 10.1111/1475-6773.12557.
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Keywords: Adverse Events, Communication, Medical Errors, Medical Liability, Patient Safety, Quality of Care
Minami CA, Dahlke AR, Barnard C
Association between hospital characteristics and performance on the new hospital-acquired condition reduction program's surgical site infection measures.
This research letter evaluated the association between hospital characteristics and surgical site infection (SSI) measures. The authors found that hospitals with higher hospital quality summary scores were more frequently poor performers for SSI and had higher standardized infection ratios. Hospitals were more likely to be poor performers for colon SSI and hysterectomy SSI if they were a teaching hospital, safety-net hospital, or level I trauma center. Teaching hospitals were more likely to be poor performers for colorectal SSI, but the association was not as consistent for hysterectomy.
AHRQ-funded; HS021857.
Citation: Minami CA, Dahlke AR, Barnard C .
Association between hospital characteristics and performance on the new hospital-acquired condition reduction program's surgical site infection measures.
JAMA Surg 2016 Aug;151(8):777-9. doi: 10.1001/jamasurg.2016.0408.
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Keywords: Healthcare-Associated Infections (HAIs), Surgery, Injuries and Wounds, Adverse Events, Quality Measures, Hospitals, Quality of Care
Hernandez-Boussard TM, McDonald KM, Morrison DE
Risks of adverse events in colorectal patients: population-based study.
The authors sought to assess adverse events in colorectal surgical patients. They found important differential rates of adverse events by diagnostic category, with the highest odds ratio occurring in patients undergoing surgery for ischemic colitis.
AHRQ-funded; HS018558.
Citation: Hernandez-Boussard TM, McDonald KM, Morrison DE .
Risks of adverse events in colorectal patients: population-based study.
J Surg Res 2016 May 15;202(2):328-34. doi: 10.1016/j.jss.2016.01.013.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Adverse Events, Surgery, Patient Safety, Risk, Quality Indicators (QIs), Quality of Care, Quality Measures
Southern DA, Pincus HA, Romano PS
Enhanced capture of healthcare-related harms and injuries in the 11th revision of the International Classification of Diseases (ICD-11).
The authors presented recommendations made to the World Health Organization (WHO) by the ICD revision's Quality and Safety Topic Advisory Group (Q&S TAG) for a new conceptual approach to capturing healthcare-related harms and injuries in ICD-coded data. They concluded that this new framework for coding healthcare-related harm has great potential to improve the clinical detail of adverse event descriptions and the overall quality of coded health data.
AHRQ-funded; HS020543.
Citation: Southern DA, Pincus HA, Romano PS .
Enhanced capture of healthcare-related harms and injuries in the 11th revision of the International Classification of Diseases (ICD-11).
Int J Qual Health Care 2016 Feb;28(1):136-42. doi: 10.1093/intqhc/mzv099.
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Keywords: Adverse Events, Quality of Care, Patient Safety, Quality Indicators (QIs)
Fernandez R, Grand JA
Leveraging social science-healthcare collaborations to improve teamwork and patient safety.
This article highlights guiding team science principles from the organizational psychology literature that can be applied to the study of teams in healthcare. The authors' goal is to provide some common language and understanding around teams and teamwork. Additionally, they hope to impart an appreciation for the potential synergy present within clinician-social scientist collaborations.
AHRQ-funded; HS020295; HS022458.
Citation: Fernandez R, Grand JA .
Leveraging social science-healthcare collaborations to improve teamwork and patient safety.
Curr Probl Pediatr Adolesc Health Care 2015 Dec;45(12):370-7. doi: 10.1016/j.cppeds.2015.10.005.
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Keywords: Patient Safety, Teams, Quality Improvement, Quality of Care, Medical Errors, Adverse Events
Okafor NG, Doshi PB, Miller SK
Voluntary medical incident reporting tool to improve physician reporting of medical errors in an emergency department.
A web-based, password-protected tool was developed by members of a quality assurance committee for ED providers to report incidents that they believe could impact patient safety. The researchers found that the utilization of this system in one residency program with two academic sites resulted in an increase from 81 reported incidents in 2009, the first year of use, to 561 reported incidents in 2012.
AHRQ-funded; HS017586.
Citation: Okafor NG, Doshi PB, Miller SK .
Voluntary medical incident reporting tool to improve physician reporting of medical errors in an emergency department.
West J Emerg Med 2015 Dec;16(7):1073-8. doi: 10.5811/westjem.2015.8.27390.
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Keywords: Emergency Department, Adverse Events, Medical Errors, Patient Safety, Public Reporting, Quality of Care
Healy MA, Krell RW, Abdelsattar ZM
Pancreatic resection results in a statewide surgical collaborative.
This study sought to investigate changes over time in adverse outcomes after pancreatectomy across hospitals with different caseloads in a statewide surgical collaborative. It concluded that participation in regional quality collaboratives by lower-volume hospitals can attenuate the volume–outcome relationship for pancreatic surgery.
AHRQ-funded; HS20937; HS000053.
Citation: Healy MA, Krell RW, Abdelsattar ZM .
Pancreatic resection results in a statewide surgical collaborative.
Ann Surg Oncol 2015 Aug;22(8):2468-74. doi: 10.1245/s10434-015-4529-9..
Keywords: Surgery, Patient Safety, Adverse Events, Hospitals, Quality Improvement, Quality of Care
Durkin MJ, Dicks KV, Baker AW
Postoperative infection in spine surgery: does the month matter?
The authors evaluated for seasonal variation of surgical site infection (SSI) following spine surgery in a network of nonteaching community hospitals. They found that the rate of SSI following fusion or spinal laminectomy/laminoplasty was higher during the summer in this network of community hospitals, most likely due to S. aureus rather than the July effect.
AHRQ-funded; HS023866.
Citation: Durkin MJ, Dicks KV, Baker AW .
Postoperative infection in spine surgery: does the month matter?
J Neurosurg Spine 2015 Jul;23(1):128-34. doi: 10.3171/2014.10.spine14559.
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Keywords: Surgery, Healthcare-Associated Infections (HAIs), Injuries and Wounds, Adverse Events, Patient Safety, Hospitals, Outcomes, Quality of Care
Crane S, Sloane PD, Elder N
Reporting and using near-miss events to improve patient safety in diverse primary care practices: a collaborative approach to learning from our mistakes.
This study assessed the feasibility of a near-miss reporting system in primary care practices and to describe initial reports and practice responses to them. It found that all 7 practices successfully implemented the system, reporting 632 near-miss events in 9 months and initiating 32 quality improvement projects based on the reports.
AHRQ-funded; HS019558.
Citation: Crane S, Sloane PD, Elder N .
Reporting and using near-miss events to improve patient safety in diverse primary care practices: a collaborative approach to learning from our mistakes.
J Am Board Fam Med 2015 Jul-Aug;28(4):452-60. doi: 10.3122/jabfm.2015.04.140050..
Keywords: Adverse Events, Medical Errors, Patient Safety, Primary Care, Public Reporting, Quality Improvement, Quality of Care
Singh JA, Ramachandran R
Does hospital volume predict outcomes and complications after total shoulder arthroplasty in the US?
The researchers assessed the association of hospital procedure volume for total shoulder arthroplasty (TSA) with patient outcomes and complications. They found that, compared to low volume hospitals (<5, 5–9, or 10–14 procedures annually), patients receiving TSA at higher volume hospitals (15–24 or ‡25 procedures annually) had significantly lower likelihood of being discharged to an inpatient medical facility.
AHRQ-funded; HS021110.
Citation: Singh JA, Ramachandran R .
Does hospital volume predict outcomes and complications after total shoulder arthroplasty in the US?
Arthritis Care Res 2015 May;67(6):885-90. doi: 10.1002/acr.22507..
Keywords: Patient-Centered Outcomes Research, Adverse Events, Patient Safety, Quality of Care, Healthcare Cost and Utilization Project (HCUP)
Chung JW, Ju MH, Kinnier CV
Postoperative venous thromboembolism outcomes measure: analytic exploration of potential misclassification of hospital quality due to surveillance bias.
The authors discuss problems associated with AHRQ’s Patient Safety Indicator (PS112), Postoperative Venous Thromboembolism such as identifying truly poor-quality hospitals from those that only seem to be poor-quality because of hospital-to-hospital variations in imaging rates for venous thromboembolism (VTE). They call for the development of administrative codes that enable reliable identification and exclusion of sub-clinical VTE from the measure numerator.
AHRQ-funded; HS021857
Citation: Chung JW, Ju MH, Kinnier CV .
Postoperative venous thromboembolism outcomes measure: analytic exploration of potential misclassification of hospital quality due to surveillance bias.
Ann Surg. 2015 Mar;261(3):443-4. doi: 10.1097/sla.0000000000000850..
Keywords: Quality Indicators (QIs), Blood Clots, Quality of Care, Adverse Events