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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 25 of 157 Research Studies Displayed
Cardell 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.
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
Shintani Smith S, Cheng BT, Kern RC
Publicly reported patient satisfaction scores in academic otolaryngology departments.
Despite controversy regarding their impact and validity, there is a rising national focus on patient satisfaction scores (PSS). In this retrospective cross-sectional study the investigators described the landscape of online PSS as posted by academic otolaryngology practices. The investigators concluded that patient satisfaction with otolaryngology providers at academic institutions was consistently high, as demonstrated by high online PSS with little variability.
Citation: Shintani Smith S, Cheng BT, Kern RC . Publicly reported patient satisfaction scores in academic otolaryngology departments. Laryngoscope 2021 Oct;131(10):2204-10. doi: 10.1002/lary.29557..
Keywords: Patient Experience, Quality of Care, Provider Performance
Holmgren AJ, Kuznetsova M, Classen D
Assessing hospital electronic health record vendor performance across publicly reported quality measures.
The authors measured hospital performance, stratified by electronic health record (EHR) vendor, across 4 quality metrics. They found that no EHR vendor was associated with higher quality across all measures, and the 2 largest vendors were not associated with the highest scores. Only a small fraction of quality variation was explained by EHR vendor choice. They concluded that top performance on quality measures can be achieved with any EHR vendor, as much of quality performance is driven by the hospital and how it uses the EHR.
Citation: Holmgren AJ, Kuznetsova M, Classen D . Assessing hospital electronic health record vendor performance across publicly reported quality measures. J Am Med Inform Assoc 2021 Sep 18;28(10):2101-07. doi: 10.1093/jamia/ocab120..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Indicators (QIs), Quality Measures, Hospitals, Quality of Care, Provider Performance
Greenberg JK, Olsen MA, Poe J
Administrative data are unreliable for ranking hospital performance based on serious complications after spine fusion.
The authors evaluated the extent to which a metric of serious complications determined from administrative data can reliably profile hospital performance in spine fusion surgery. They found that a metric of serious complications was unreliable for benchmarking cervical fusion outcomes and only modestly reliable for thoracolumbar fusion. They concluded that, when assessed using administrative datasets, these measures appeared to be inappropriate for high-stakes applications, such as public reporting or pay-for-performance.
AHRQ-funded; HS027075; HS019455.
Citation: Greenberg JK, Olsen MA, Poe J . Administrative data are unreliable for ranking hospital performance based on serious complications after spine fusion. Spine 2021 Sep 1;46(17):1181-90. doi: 10.1097/brs.0000000000004017..
Keywords: Surgery, Provider Performance, Hospitals, Adverse Events, Back Health and Pain
Murray DJ, Boulet JR, Boyle WA
Competence in decision making: setting performance standards for critical care.
Health care professionals must be able to make frequent and timely decisions that can alter the illness trajectory of intensive care patients. A competence standard for this ability is difficult to establish yet assuring practitioners can make appropriate judgments is an important step in advancing patient safety. In this study, the investigators hypothesized that simulation could be used effectively to assess decision-making competence.
Citation: Murray DJ, Boulet JR, Boyle WA . Competence in decision making: setting performance standards for critical care. Anesth Analg 2021 Jul 1;133(1):142-50. doi: 10.1213/ane.0000000000005053..
Keywords: Critical Care, Decision Making, Intensive Care Unit (ICU), Simulation, Provider Performance, Patient Safety, Quality of Care
Greenberg CC, Byrnes ME, Engler TA
Association of a statewide surgical coaching program with clinical outcomes and surgeon perceptions.
Investigators assessed risk-adjusted outcomes and participant perceptions following a statewide coaching program for bariatric surgeons. They found that this surgical coaching program was perceived as valuable and surgeons reported numerous practice changes. Additionally, operative times improved, but there was no significant improvement in risk-adjusted outcomes.
Citation: Greenberg CC, Byrnes ME, Engler TA . Association of a statewide surgical coaching program with clinical outcomes and surgeon perceptions. Ann Surg 2021 Jun;273(6):1034-39. doi: 10.1097/sla.0000000000004800..
Keywords: Surgery, Provider: Physician, Provider Performance, Outcomes
Sinz E, Banerjee A, Steadman R
Reliability of simulation-based assessment for practicing physicians: performance is context-specific.
Even physicians who routinely work in complex, dynamic practices may be unprepared to optimally manage challenging critical events. High-fidelity simulation can realistically mimic critical clinically relevant events, however the reliability and validity of simulation-based assessment scores for practicing physicians has not been established. In this study, standardised complex simulation scenarios were developed and administered to board-certified, practicing anesthesiologists who volunteered to participate in an assessment study during formative maintenance of certification activities.
Citation: Sinz E, Banerjee A, Steadman R . Reliability of simulation-based assessment for practicing physicians: performance is context-specific. BMC Med Educ 2021 Apr 12;21(1):207. doi: 10.1186/s12909-021-02617-8..
Keywords: Simulation, Education: Continuing Medical Education, Training, Provider Performance
Shekelle PG, Pane JD, Agniel D
Assessment of variation in electronic health record capabilities and reported clinical quality performance in ambulatory care clinics, 2014-2017.
This study’s objective was to assess the association between electronic health records (EHRs) with different degrees of capabilities and publicly reported ambulatory quality measures in at least 3 clinical domains of care. This cross-sectional and longitudinal study was conducted using survey responses from 1141 ambulatory clinics in Minnesota, Washington, and Wisconsin affiliated with a health system and reported performance measures in 2014 to 2017. A composite measure of EHR capability that considered 50 EHR capabilities was created using 7 functional domains: no functional EHR, EHR underuser, EHR, neither underuser nor superuser, and EHR superuser; as well as a standardized composite of ambulatory clinical measures that included a median of 13 individual measures (3 to 25). The proportion of clinics that were EHR superusers increased from 51% in 2014 to 61% in 2017. In all survey years EHR superusers had better clinical quality performance than other clinics. This difference in scores translated into an approximately 9% difference in a clinic’s rank order in clinical quality.
Citation: Shekelle PG, Pane JD, Agniel D . Assessment of variation in electronic health record capabilities and reported clinical quality performance in ambulatory care clinics, 2014-2017. JAMA Netw Open 2021 Apr;4(4):e217476. doi: 10.1001/jamanetworkopen.2021.7476..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Ambulatory Care and Surgery, Provider Performance, Quality of Care
Mazur LM, Adams R, Mosaly PR
Effect of simulation-based training and neurofeedback interventions on radiation technologists' workload, situation awareness, and performance.
The purpose of this study was to assess the effect of a combined intervention - simulation-based training supported by neurofeedback sessions - on radiation technologists' (RTs') workload, situation awareness, and performance during routine quality assurance and treatment delivery tasks. The investigators found that RTs randomized to simulation-based training followed by neurofeedback sessions demonstrated no significant changes in perceived workload or situation awareness scores but did have better performance compared with other study groups (P < .01).
Citation: Mazur LM, Adams R, Mosaly PR . Effect of simulation-based training and neurofeedback interventions on radiation technologists' workload, situation awareness, and performance. Pract Radiat Oncol 2021 Mar-Apr;11(2):e124-e33. doi: 10.1016/j.prro.2020.08.005..
Keywords: Simulation, Training, Provider Performance, Provider: Health Personnel
Chhabra KR, Thumma JR, Varban OA
Associations between video evaluations of surgical technique and -outcomes of laparoscopic sleeve gastrectomy.
The authors examined associations between technique and outcomes in laparoscopic sleeve gastrectomy. Technical approaches to five controversial aspects of laparoscopic sleeve gastrectomy were studied: dissection of the proximal stomach, sleeve caliber, sleeve anatomy, staple line reinforcement, and leak testing. The authors found that variations in surgical technique can be measured by video review and are associated with differences in patient outcomes.
AHRQ-funded; HS023597; HS025365.
Citation: Chhabra KR, Thumma JR, Varban OA . Associations between video evaluations of surgical technique and -outcomes of laparoscopic sleeve gastrectomy. JAMA Surg 2021 Feb;156(2):e205532. doi: 10.1001/jamasurg.2020.5532..
Keywords: Surgery, Obesity, Provider Performance, Provider: Physician, Provider, Quality of Care
Meyers DJ, Trivedi AN, Wilson IB, DJ, Trivedi AN, Wilson IB
Higher Medicare Advantage Star Ratings are associated with improvements In patient outcomes.
Researchers examined CMS' five-star rating system for the overall quality of Medicare Advantage (MA) contracts. They found that enrollees experiencing a one-star MA rating increase were 20.8 percent less likely to leave their plan voluntarily to enroll in another plan or traditional Medicare. When hospitalized, enrollees were 3.4 percent more likely to use a higher-quality hospital and 2.6 percent less likely to be readmitted within ninety days. These findings suggest that MA star ratings may capture key domains of an MA plan's quality.
Citation: Meyers DJ, Trivedi AN, Wilson IB, DJ, Trivedi AN, Wilson IB . Higher Medicare Advantage Star Ratings are associated with improvements In patient outcomes. Health Aff 2021 Feb;40(2):243-50. doi: 10.1377/hlthaff.2020.00845..
Keywords: Patient Experience, Provider Performance, Medicare, Quality Improvement, Quality of Care, Outcomes
Griffey RT, Schneider RM, Sharp BR
Description and yield of current quality and safety review in selected US academic emergency departments.
This study examined the impact of current quality and safety reviews used in US academic emergency departments (EDs). The authors hypothesized that current protocols are decades old and inefficient with low yield for identifying patient harm. They conducted a prospective observational study at five academic EDs for a 12-month procedure. Sites used the Institute for Healthcare Improvement’s definition in defining an adverse event and a modified National Coordinating Council for Medication Error Reporting and Prevention (MERP) Index for severity grading of events. They reviewed a total of 4735 cases and identified 381 events, of which 287 were near-misses, and 94 had adverse events (AEs). The overall AE rate was 1.99% (1.24-3.47%) across all sites. Quality concern rate (events without harms) was 6.06% (5.42-6.78%). Forty-seven percent of cases used 72 hour returns as their referral source but with only a 0.81% yield in identifying harm. Other referral sources also had similar low yields. External referrals in the 94 AE cases accounted for 41.49% of cases. The authors concluded that new approaches to quality and safety review in the ED are needed to optimize yield and efficiency for identifying harms and areas for improvement.
Citation: Griffey RT, Schneider RM, Sharp BR . Description and yield of current quality and safety review in selected US academic emergency departments. J Patient Saf 2020 Dec;16(4):e245-e49. doi: 10.1097/pts.0000000000000379..
Keywords: Emergency Department, Patient Safety, Quality Improvement, Quality of Care, Provider Performance
Heinze K, Suwanabol PA, Vitous CA
A survey of patient perspectives on approach to health care: focus on physician competency and compassion.
This study is a cross-sectional survey of 764 patients to gain insight into perceptions of physician qualities of compassion and competence. The participants response rate was 85%, with mean age 52.4, 70.8% female, and 84% identified as white. Predictors of compassion over competence included female gender and whether the respondent had a personal connection to the vignette used. Preferences were found to be influenced by: 1) explicit beliefs regarding the value of physician compassion and competence; 2) impact of emotional and mental health on medical experiences; 3) type and frequency of health care exposure, and; 4) perceived role of the physician in various clinical vignettes.
Citation: Heinze K, Suwanabol PA, Vitous CA . A survey of patient perspectives on approach to health care: focus on physician competency and compassion. J Patient Exp 2020 Dec;7(6):1044-53. doi: 10.1177/2374373520968447..
Keywords: Provider: Physician, Provider, Patient Experience, Provider Performance, Quality of Care
Short MN, Ho V
Weighing the effects of vertical integration versus market concentration on hospital quality.
Provider organizations are increasing in complexity, as hospitals acquire physician practices and physician organizations grow in size. At the same time, hospitals are merging with each other to improve bargaining power with insurers. In this study, the investigators analyzed 29 quality measures reported to the Center for Medicare and Medicaid Services' Hospital Compare database for 2008 to 2015 to test whether vertical integration between hospitals and physicians or increases in hospital market concentration influenced patient outcomes.
Citation: Short MN, Ho V . Weighing the effects of vertical integration versus market concentration on hospital quality. Med Care Res Rev 2020 Dec;77(6):538-48. doi: 10.1177/1077558719828938.
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Quality of Care, Patient Experience, Hospitals, Medicare, Provider Performance, Healthcare Systems
Jacobs PD, Basu J
AHRQ Author: Jacobs PD, Basu J
Medicare Advantage and postdischarge quality: evidence from hospital readmissions.
This study compared relative readmission rates for beneficiaries enrolled in Medicare Advantage (MA) and traditional Medicare (TM). HCUP State Inpatient Databases data for 4 states was used from 2009 and 2014. The outcome compared was the probability of a hospital readmission within 30 days of an index admission. There were significantly lower all-cause readmission rates among MA enrollees relative to those in TM in both 2009 and 2014, but MA enrollment was not associated with an increased reduction in readmission rates relative to TM during that time period.
Citation: Jacobs PD, Basu J . Medicare Advantage and postdischarge quality: evidence from hospital readmissions. Am J Manag Care 2020 Dec;26(12):524-29. doi: 10.37765/ajmc.2020.88540..
Keywords: Healthcare Cost and Utilization Project (HCUP), Elderly, Medicare, Hospital Readmissions, Hospitals, Quality of Care, Provider Performance
Geng F, Mansouri S, Stevenson DG
Evolution of the home health care market: the expansion and quality performance of multi-agency chains.
This study examined the growth and quality performance of multi-agency home health agency (HHA) chains from 2005 to 2018. All Medicare-certified HHAs were included. Over the time period, the number of HHAs increased from 7899 to 10,818 and the number of chain-owned HHAs more than doubled from 903 to 1841. In 2018, for-profit nonchain agencies were still the largest category - both in the number of agencies (67.8%) and number of Medicare enrollees served (40.7%). Non-chain for-profit HHAs served the highest proportion of dual eligible beneficiaries and African Americans among all agency types.
Citation: Geng F, Mansouri S, Stevenson DG . Evolution of the home health care market: the expansion and quality performance of multi-agency chains. Health Serv Res 2020 Dec;55(Suppl 3):1073-84. doi: 10.1111/1475-6773.13597..
Keywords: Home Healthcare, Provider Performance, Quality of Care
Auger KA, Ponti-Zins MC, Statile AM
Performance of pediatric readmission measures.
Investigators sought to assess how four different measures of pediatric readmission compare with assessment of both preventable and unplanned readmission. The four measures were: all-cause readmission, unplanned readmission/time flag classification, pediatric all-condition readmission, and potentially preventable readmission. They found that none of the existing pediatric readmission measures can reliably determine preventability. The unplanned readmission/time flag measure performed best in identifying unplanned readmissions.
Citation: Auger KA, Ponti-Zins MC, Statile AM . Performance of pediatric readmission measures. J Hosp Med 2020 Dec;15(12):723-26. doi: 10.12788/jhm.3521..
Keywords: Children/Adolescents, Hospital Readmissions, Provider Performance, Quality Measures, Quality of Care
Agniel D, Haviland A, Shekelle P
Distinguishing high-performing health systems using a composite of publicly reported measures of ambulatory care.
The purpose of this study was to develop and evaluate a measure that ranks health care systems by ambulatory care quality. The authors concluded that their measure, using publicly reported data to produce valid, reliable, and stable ranks of ambulatory care quality for health care systems in Minnesota and California, could also be used in other applications.
Citation: Agniel D, Haviland A, Shekelle P . Distinguishing high-performing health systems using a composite of publicly reported measures of ambulatory care. Ann Intern Med 2020 Nov 17;173(10):791-98. doi: 10.7326/m20-0718..
Keywords: Healthcare Systems, Ambulatory Care and Surgery, Quality Indicators (QIs), Quality Measures, Quality of Care, Provider Performance, Healthcare Delivery
Jin B, Nembhard IM
Voluntary hospital reporting of performance in cancer care: does volume make a difference?
The authors hypothesized that patient volume is positively associated with both reporting and performance in cancer care. Studying 72 Pennsylvania hospitals accredited by the Commission on Cancer, they found that hospitals that publicly reported their performance had higher patient volumes than hospitals that did not release performance. Among reporting hospitals, no association was found between patient volume and performance on process of care metrics, suggesting that volume is not a predictor of performance for reporting hospitals. They recommended further research to identify other factors that differentiate performance within and across reporting and nonreporting hospitals.
Citation: Jin B, Nembhard IM . Voluntary hospital reporting of performance in cancer care: does volume make a difference? J Healthc Qual 2020 Nov/Dec;42(6):e75-e82. doi: 10.1097/jhq.0000000000000225..
Keywords: Cancer, Provider Performance, Hospitals, Quality Indicators (QIs), Quality Measures, 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
Spatz ES, Bernheim SM, Horwitz LI
Community factors and hospital wide readmission rates: does context matter?
The purpose of this study was to estimate the influence of community factors on the Centers for Medicare & Medicaid Services risk-standardized hospital-wide readmission measure (HWR)-a quality performance measure in the U.S. The investigators concluded that readmissions for a wide range of clinical conditions were influenced by factors relating to the communities in which patients reside.
Citation: Spatz ES, Bernheim SM, Horwitz LI . Community factors and hospital wide readmission rates: does context matter? PLoS One 2020 Oct 23;15(10):e0240222. doi: 10.1371/journal.pone.0240222..
Keywords: Hospital Readmissions, Hospitals, Provider Performance, Quality Measures, Quality of Care
Robbins j, McAlearney AS
Toward a high-performance management system in health care, part 5: how high-performance work practices facilitate speaking up in health care organizations.
Employees' reluctance to speak up about problems and/or make suggestions for improvement is a noted barrier to quality and patient safety improvement in health care organizations. High-performance work practices (HPWPs) offer a framework for considering how management practices can encourage speaking up in these organizations. In this study, the investigators aimed to explore how implementation of HPWPs in U.S. health care organizations could facilitate or remove barriers to speaking up.
Citation: Robbins j, McAlearney AS . Toward a high-performance management system in health care, part 5: how high-performance work practices facilitate speaking up in health care organizations. Health Care Manage Rev 2020 Oct/Dec;45(4):278-89. doi: 10.1097/hmr.0000000000000228..
Keywords: Quality Improvement, Quality of Care, Patient Safety, Provider Performance
Ganguli I, Lupo C, Mainor AJ
Association between specialist compensation and Accountable Care Organization performance.
This study’s objective was to determine whether Medicare Shared Savings Program Accountable Care Organizations (ACOs) using cost reduction measures in specialist compensation demonstrated better performance. National cross-sectional survey data on ACOs from 2013-2015 was linked to public-use data on ACO performance from 2014-2016. Out of 160 ACOs surveys, 26% reported using cost reduction measures to help determine specialist compensation. However, these ACOs did not have savings in the short term.
Citation: Ganguli I, Lupo C, Mainor AJ . Association between specialist compensation and Accountable Care Organization performance. Health Serv Res 2020 Oct;55(5):722-28. doi: 10.1111/1475-6773.13323..
Keywords: Provider Performance, Healthcare Costs, Value, Payment, Medicare
Costar DM, Hall KK
Improving team performance and patient safety on the job through team training and performance support tools: a systematic review.
This systematic review’s objective was to identify recent studies that implemented practices to improve teamwork in health care and were associated with positive improvements on the job. Two databases were searched to identify relevant articles published between 2008 and 2018. Twenty articles were selected for inclusion. Across studies, measures assessing teamwork skills on the job were most often collected and sustained improvements were shown for up to 12 months. Evidence of improved clinical practices and increased patient safety was found in both studies team training interventions, as well as those that introduced performance support tools. All studies were conducted in hospitals with very few studies found in other health care settings such as office-based care.
Citation: Costar DM, Hall KK . Improving team performance and patient safety on the job through team training and performance support tools: a systematic review. J Patient Saf 2020 Sep;16(3S Suppl 1):S48-s56. doi: 10.1097/pts.0000000000000746..
Keywords: Teams, Patient Safety, Training, Patient Safety, Provider Performance, Quality Improvement, Quality of Care
Sprague BL, Miglioretti DL, Lee CI
New mammography screening performance metrics based on the entire screening episode.
Established mammography screening performance metrics use the initial screening mammography assessment because they were developed for radiologist performance auditing, yet these metrics are frequently used to inform health policy and screening decision making. The authors developed new performance metrics based on the final assessment that consider the entire screening episode, including diagnostic workup. They concluded that established screening performance metrics underestimated the interval cancer rate of a mammography screening episode, particularly for women with dense breasts or an elevated breast cancer risk.
Citation: Sprague BL, Miglioretti DL, Lee CI . New mammography screening performance metrics based on the entire screening episode. Cancer 2020 Jul 15;126(14):3289-96. doi: 10.1002/cncr.32939..
Keywords: Mammogram, Screening, Cancer: Breast Cancer, Cancer, Prevention, Women, Provider Performance