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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 14 of 14 Research Studies Displayed
Mackie TI, Kovacs KM, Simmel C
A best-worst scaling experiment to identify patient-centered claims-based outcomes for evaluation of pediatric antipsychotic monitoring programs.
This study utilized a best-worst scaling (BWS) experiment to identify the claims-based outcomes that matter most to patients and other relevant parties when evaluating pediatric antipsychotic monitoring programs, specifically in foster care children. Relevant parties included policymakers (n = 31), foster care alumni (n = 28), caseworkers (n=23), prescribing clinicians (n = 32), and caregivers (n = 18). Participants received surveys with a scenario on antipsychotic monitoring programs and ranked 11 candidate claims-based outcomes as most and least important. Safety indicators ranked among the top three candidate outcomes across respondent groups. Foster care alumni put “antipsychotic treatment reduction” and “increased psychosocial treatment” as the highest ranking. Caseworkers, prescribers, and caregivers gave top priority to “increased follow-up after treatment initiation”. Potential unintended consequences ranked lowest, including increased use of other psychotropic medication classes, increased psychiatric hospital stays, and increased emergency room utilization.
Citation: Mackie TI, Kovacs KM, Simmel C . A best-worst scaling experiment to identify patient-centered claims-based outcomes for evaluation of pediatric antipsychotic monitoring programs. Health Serv Res 2021 Jun;56(3):418-31. doi: 10.1111/1475-6773.13610..
Keywords: Children/Adolescents, Medication, Medication: Safety, Patient Safety, Policy
Tedesco D, Moghavem N, Weng Y
Improvement in patient safety may precede policy changes: trends in patient safety indicators in the United States, 2000-2013.
This study’s aim was to assess changes in national patient safety trends that corresponded to U.S. pay-for-performance reforms. The study analyzed 13 patient safety indicators (PSIs) that were developed by AHRQ. PSI trends, Center for Medicaid and Medicare Services payment policy changes, and Inpatient Prospective Payment System regulations and notices between 2000 and 2013 were analyzed. Twelve of the thirteen PSIs had decreasing or stable trends in the last 5 years of the study. Central-line bloodstream infections had the greatest annual decrease (-31.1 annual percent change between 2006 and 2013) whereas postoperative respiratory failure had the smallest annual percent change (-3.5 between 2005 and 2013). Significant decreases in trends preceded federal payment reform initiatives in all but postoperative hip fracture. These findings suggest that intense public discourses targeting patient safety may drive national policy reforms.
Citation: Tedesco D, Moghavem N, Weng Y . Improvement in patient safety may precede policy changes: trends in patient safety indicators in the United States, 2000-2013. J Patient Saf 2021 Jun 1;17(4):e327-e34. doi: 10.1097/pts.0000000000000615..
Keywords: Patient Safety, Quality Improvement, Quality Indicators (QIs), Quality Measures, Quality of Care, Policy
Vsevolozhskaya OA, Manz KC, Zephyr PM
Measurement matters: changing penalty calculations under the Hospital Acquired Condition Reduction Program (HACRP) cost hospitals millions.
Since October 2014, the Centers for Medicare and Medicaid Services has penalized 25% of U.S. hospitals with the highest rates of hospital-acquired conditions under the Hospital Acquired Conditions Reduction Program (HACRP). While early evaluations of the HACRP program reported cumulative reductions in hospital-acquired conditions, more recent studies have not found a clear association between receipt of the HACRP penalty and hospital quality of care. In this article, the authors posit that some of this disconnect may be driven by frequent scoring updates.
Citation: Vsevolozhskaya OA, Manz KC, Zephyr PM . Measurement matters: changing penalty calculations under the Hospital Acquired Condition Reduction Program (HACRP) cost hospitals millions. BMC Health Serv Res 2021 Feb 10;21(1):131. doi: 10.1186/s12913-021-06108-w..
Keywords: Healthcare-Associated Infections (HAIs), Infectious Diseases, Hospitals, Policy, Quality Improvement, Quality of Care, Patient Safety
Toce MS, Michelson K, Hudgins J
Association of state-level opioid-reduction policies with pediatric opioid poisoning.
Opioid-reduction policies have been enacted by US states to address the opioid epidemic. Evidence of an association between policy implementation and decreased rates of pediatric opioid poisoning provides further justification for expanded implementation of these policies. The purpose of this study was to examine the association of 3 state-level opioid-reduction policies with the rate of opioid poisoning in children and adolescents.
Citation: Toce MS, Michelson K, Hudgins J . Association of state-level opioid-reduction policies with pediatric opioid poisoning. JAMA Pediatr 2020 Oct;174(10):961-68. doi: 10.1001/jamapediatrics.2020.1980..
Keywords: Children/Adolescents, Opioids, Medication: Safety, Medication, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Policy
Zhang AD, Schwartz JL, Ross JS
Association between Food and Drug Administration Advisory Committee recommendations and agency actions, 2008-2015.
In this paper, the authors examined the association between Food and Drug Administration Advisory Committee Recommendations and agency actions for a time period of 2008-2015. The investigators concluded that the FDA disagrees with the recommendations of its advisory committees a minority of the time, and in these cases it tends to be less likely to approve new products or supplemental indications and take safety actions.
Citation: Zhang AD, Schwartz JL, Ross JS . Association between Food and Drug Administration Advisory Committee recommendations and agency actions, 2008-2015. Milbank Q 2019 Sep;97(3):796-819. doi: 10.1111/1468-0009.12403..
Keywords: Medical Devices, Policy, Patient Safety
de Cordova PB, Rogowski J, Riman KA
Effects of public reporting legislation of nurse staffing: a trend analysis.
The authors examined nurse staffing trends after the New Jersey enactment of P.L.1971, c.136 (C.26:2 H-13) on January 24, 2005, mandating that all health care facilities compile, post, and report staffing information. They found that the number of patients per registered nurse decreased for ten specialties, and conclude that this indicates the importance of public reporting in improving patient safety.
Citation: de Cordova PB, Rogowski J, Riman KA . Effects of public reporting legislation of nurse staffing: a trend analysis. Policy Polit Nurs Pract 2019 May;20(2):92-104. doi: 10.1177/1527154419832112..
Keywords: Hospitals, Patient Safety, Workforce, Policy, Provider, Provider: Nurse
Law AC, Stevens JP, Hohmann S
Patient outcomes after the introduction of statewide ICU nurse staffing regulations.
The objective of this study was to assess whether Massachusetts legislation directed at ICU nurse staffing was associated with improvements in patient outcomes. The investigators found that state regulation of patient-to-nurse staffing with the aid of patient complexity scores in intensive care was not associated with either increased nurse staffing or changes in patient outcomes.
Citation: Law AC, Stevens JP, Hohmann S . Patient outcomes after the introduction of statewide ICU nurse staffing regulations. Crit Care Med 2018 Sep 4;46(10):1563-69. doi: 10.1097/ccm.0000000000003286..
Keywords: Intensive Care Unit (ICU), Policy, Nursing, Outcomes, Patient Safety
Savage EL, Fairbanks RJ, Ratwani RM
Are informed policies in place to promote safe and usable EHRs? A cross-industry comparison.
This study sought to compare government policies on usability and safety, and methods of examining compliance to those policies, across 3 federal agencies: the Office of the National Coordinator (ONC) and EHRs, the Federal Aviation Administration (FAA) and avionics, and the Food and Drug Administration (FDA) and medical devices. The goal was to identify whether differences in policies exist and, if they do exist, how policies and enforcement mechanisms from other industries might be applied to optimize EHR usability.
Citation: Savage EL, Fairbanks RJ, Ratwani RM . Are informed policies in place to promote safe and usable EHRs? A cross-industry comparison. J Am Med Inform Assoc 2017 Jul 1;24(4):769-75. doi: 10.1093/jamia/ocw185.
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety, Policy
Whicher D, Wu AW
Ethics review of survey research: a mandatory requirement for publication?
The authors provided guidance for journals to consider when making determinations about the necessity of ethical review for survey research projects. They stated that in situations where there is greater than minimal risk of informational or psychological harms, the survey research should have received institutional ethics oversight. They also specified that survey research projects that enroll vulnerable individuals with diminished autonomy should receive institutional ethics oversight.
Citation: Whicher D, Wu AW . Ethics review of survey research: a mandatory requirement for publication? Patient 2015 Dec;8(6):477-82. doi: 10.1007/s40271-015-0141-0.
Keywords: Evidence-Based Practice, Policy, Patient Safety, Research Methodologies
Remembering the benefits of vaccination.
This commentary discussed the issue of vaccination and tightening exemptions for school entry. The author pointed out that events show that the success of vaccines can be fragile, as the measles cases associated with Disneyland were preceded by 644 cases in 2014. And 2012 saw more than 40,000 cases of pertussis, the largest number since 1960. These events provided a dramatic reminder that vaccines remain an important and necessary public health tool.
Citation: Feemster KA . Remembering the benefits of vaccination. JAMA Pediatr 2015 Jul;169(7):624-6. doi: 10.1001/jamapediatrics.2015.0647.
Keywords: Children/Adolescents, Infectious Diseases, Patient Safety, Policy, Vaccination
Padula WV, Makic MB, Wald HL
Hospital-acquired pressure ulcers at academic medical centers in the United States, 2008-2012: tracking changes since the CMS nonpayment policy.
This study was conducted to define changes in hospital-acquired pressure ulcers (HAPU) incidence and variance since 2008. It found that HAPU incidence rates decreased significantly among 210 University HealthSystems Consortium academic medical centers after the enactment of the CMS nonpayment policy. This suggests that governmental policy was a significant driver of change in clinical practice for wound care and created incentives for preventive efforts on the part of hospitals.
Citation: Padula WV, Makic MB, Wald HL . Hospital-acquired pressure ulcers at academic medical centers in the United States, 2008-2012: tracking changes since the CMS nonpayment policy. Jt Comm J Qual Patient Saf 2015 Jun;41(6):257-63..
Keywords: Healthcare-Associated Infections (HAIs), Patient Safety, Policy, Pressure Ulcers, Prevention, Quality Improvement
Hwang TJ, Avorn J, Carpenter D
Quantifying the Food And Drug Administration's rulemaking delays highlights the need for transparency.
In order to better understand the FDA’s rulemaking process, the authors examined the evolution of significant rules that the agency published during 2000–12 for drugs, devices, and other medical products. They found that the rules’ median time to finalization was 7.3 years. Longer review times were significantly associated with a reduction in the stringency of final rules, compared to the originally proposed versions.
Citation: Hwang TJ, Avorn J, Carpenter D . Quantifying the Food And Drug Administration's rulemaking delays highlights the need for transparency. Health Aff 2014 Feb;33(2):309-15. doi: 10.1377/hlthaff.2013.0564..
Keywords: Patient Safety, Policy, Decision Making, Medication
Kronick R, McKinney M
AHRQ Author: Kronick R
Ready to provide evidence for ‘making adjustments’ in Obamacare.
In this interview with Modern Healthcare, Richard Kronick, director of the Agency for Healthcare Research and Quality (AHRQ), states that his main objective for AHRQ is to produce evidence to improve the quality, safety, accessibility, and affordability of health care. He discusses several AHRQ programs and places them in the context of changes in the healthcare system triggered by Affordable Care Act.
Citation: Kronick R, McKinney M . Ready to provide evidence for ‘making adjustments’ in Obamacare. Mod Healthc. 2014 Jan 6;44(1):28-9..
Keywords: Healthcare Costs, Quality of Care, Policy, Patient Safety
Kachalia A, Little A, Isavoran M
Greatest impact of safe harbor rule may be to improve patient safety, not reduce liability claims paid by physicians.
The Oregon Health Authority analyzed the potential for safe harbors to improve patient safety and the performance of the medical liability system, as well as legal challenges and stakeholder concerns that might arise with legislation enacting safe harbors. They found that such legislation would have changed the liability outcome in favor of the physician defendant in only 1 percent of 266 claims from the period 2002–09 that were reviewed.
Citation: Kachalia A, Little A, Isavoran M . Greatest impact of safe harbor rule may be to improve patient safety, not reduce liability claims paid by physicians. Health Aff 2014 Jan;33(1):59-66. doi: 10.1377/hlthaff.2013.0834..
Keywords: Patient Safety, Medical Liability, Medical Errors, Quality of Care, Policy