National Healthcare Quality and Disparities Report
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Topics
- Adverse Drug Events (ADE) (1)
- (-) Adverse Events (20)
- Antibiotics (1)
- Blood Thinners (1)
- Cardiovascular Conditions (1)
- Care Management (1)
- Children/Adolescents (3)
- Communication (1)
- Comparative Effectiveness (2)
- Complementary and Alternative Medicine (1)
- Comprehensive Unit-based Safety Program (CUSP) (1)
- Critical Care (1)
- Digestive Disease and Health (1)
- Emergency Department (1)
- Evidence-Based Practice (2)
- Guidelines (1)
- Healthcare-Associated Infections (HAIs) (5)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Health Insurance (1)
- Heart Disease and Health (1)
- Hospital Readmissions (1)
- Hospitals (4)
- Infectious Diseases (1)
- Injuries and Wounds (2)
- Intensive Care Unit (ICU) (3)
- Labor and Delivery (2)
- Maternal Care (1)
- Medication (3)
- Medication: Safety (1)
- Mortality (3)
- Newborns/Infants (3)
- Obesity (2)
- Obesity: Weight Management (1)
- (-) Outcomes (20)
- Patient-Centered Outcomes Research (5)
- (-) Patient Safety (20)
- Practice Patterns (3)
- Pregnancy (2)
- Prevention (2)
- Provider (1)
- Provider: Physician (1)
- Provider Performance (1)
- Quality Improvement (1)
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- Registries (2)
- Respiratory Conditions (2)
- Risk (3)
- Sepsis (1)
- Simulation (1)
- Surgery (6)
- Surveys on Patient Safety Culture (1)
- Teams (2)
- TeamSTEPPS (1)
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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
1 to 20 of 20 Research Studies DisplayedSlatnick LR, Thornhill D, Deakyne Davies
Disseminated intravascular coagulation is an independent predictor of adverse outcomes in children in the emergency department with suspected sepsis.
The purpose of this study was to evaluate the impact of early disseminated intravascular coagulation (DIC) on illness severity in children using a database of emergency department ED encounters for children with suspected sepsis, in view of similar associations in adults. The investigators concluded that a DIC score of ≥3 was an independent predictor for both vasopressor use and mortality in this pediatric cohort, distinct from the adult overt DIC score cutoff of ≥5.
AHRQ-funded; HS025696.
Citation: Slatnick LR, Thornhill D, Deakyne Davies .
Disseminated intravascular coagulation is an independent predictor of adverse outcomes in children in the emergency department with suspected sepsis.
J Pediatr 2020 Oct;225:198-206.e2. doi: 10.1016/j.jpeds.2020.06.022..
Keywords: Children/Adolescents, Emergency Department, Sepsis, Adverse Events, Mortality, Patient Safety, Outcomes
Villa Zapata L, Hansten PD, Panic J
Risk of bleeding with exposure to warfarin and nonsteroidal anti-inflammatory drugs: a systematic review and meta-analysis.
Warfarin use can trigger the occurrence of bleeding independently or as a result of a drug-drug interaction when used in combination with nonsteroidal anti-inflammatory drugs (NSAIDs). This article examines the risk of bleeding in individuals exposed to concomitant warfarin and NSAID compared with those taking warfarin alone. The investigators concluded that risk of bleeding was significantly increased among persons taking warfarin and a NSAID or COX-2 inhibitor together as compared with taking warfarin alone.
AHRQ-funded; HS025984.
Citation: Villa Zapata L, Hansten PD, Panic J .
Risk of bleeding with exposure to warfarin and nonsteroidal anti-inflammatory drugs: a systematic review and meta-analysis.
Thromb Haemost 2020 Jul;120(7):1066-74. doi: 10.1055/s-0040-1710592..
Keywords: Blood Thinners, Medication, Medication: Safety, Risk, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes
Kanters AE, Shubeck SP, Varban OA
Incidence and efficacy of stent placement in leak management after bariatric surgery: an MBSAQIP analysis.
The goal of this study was to evaluate the rates of use and efficacy of stent placement for postoperative leak following bariatric surgery. Using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, findings showed that the use of stents can be effective; however, such use does not prevent reoperation and is associated with an increased likelihood of readmission. Recommendations included consideration of both technique and resource utilization when choosing a management pathway for leaks.
AHRQ-funded; HS000053; HS023597.
Citation: Kanters AE, Shubeck SP, Varban OA .
Incidence and efficacy of stent placement in leak management after bariatric surgery: an MBSAQIP analysis.
Ann Surg 2020 Jan;271(1):134-39. doi: 10.1097/sla.0000000000003023..
Keywords: Surgery, Obesity: Weight Management, Obesity, Adverse Events, Patient Safety, Outcomes
Chopra V, Kaatz S, Swaminathan L
Variation in use and outcomes related to midline catheters: results from a multicentre pilot study.
This study examined complication rates from placement of midline vascular catheters. They have become more common in use recently. Complications were analyzed using medical records from hospitalized patients in 12 hospitals from January 2017 to February 2018. Most midline catheters were placed in general ward settings for difficult intravenous access. About half were removed within 5 days of insertion. Major or minor complications occurred in 10.3% of midlines with minor complications accounting for 71% of all adverse events. These minor complications included dislodgement, leaking, and infiltration. Major complications included occlusion, upper-extremity DVT and BSI. Use of midlines and outcomes varied widely across hospitals.
AHRQ-funded; HS025891.
Citation: Chopra V, Kaatz S, Swaminathan L .
Variation in use and outcomes related to midline catheters: results from a multicentre pilot study.
BMJ Qual Saf 2019 Sep;28(9):714-20. doi: 10.1136/bmjqs-2018-008554..
Keywords: Patient Safety, Healthcare-Associated Infections (HAIs), Infectious Diseases, Adverse Events, Practice Patterns, Outcomes, Hospitals
Ozawa Y, Ades A, Foglia EE
Premedication with neuromuscular blockade and sedation during neonatal intubation is associated with fewer adverse events.
This study assessed the impact of using sedation with neuromuscular blockade in non-emergency tracheal intubation of neonates. The retrospective cohort was from infants in neonatal intensive care units (NICUs) participating the National Emergency Airway Registry for Neonates from 2014 to 2017. There was less adverse events associated with use of the neuromuscular blockade premedication.
AHRQ-funded; HS024511.
Citation: Ozawa Y, Ades A, Foglia EE .
Premedication with neuromuscular blockade and sedation during neonatal intubation is associated with fewer adverse events.
J Perinatol 2019 Jun;39(6):848-56. doi: 10.1038/s41372-019-0367-0..
Keywords: Adverse Events, Medication, Newborns/Infants, Outcomes, Patient Safety, Registries
Sanders R, Edwards L, Nishisaki A
Tracheal intubations for critically Ill children outside specialized centers in the United Kingdom-patient, provider, practice factors, and adverse events.
This editorial discusses a research study on outcomes of performing pediatric trachael intubations (TIs) and how the results can be applied to performing intubations on critically ill children in the United Kingdom outside of specialized centers. One of the authors is from a U.S. site that submits its airway management data to the National Emergency Airway Registry for Children (NEAR4KIDS). The results from the registry were compared to the results from the study. A total of 1,051 patients out of 1,237 eligible patients were analyzed. The results came from 47 nonspecialized local hospitals in the North Thames and East Anglia region of the UK. Adverse TI-associated events (TIAEs) occurred in 22.7% of the patients, which is higher than those in PICUs and cardiac ICUs. The majority of intubations were performed by the anesthesiologist in the team. The results were similar to those in the NEAR4KIDS registry. There were more complications with children with a higher grade of airway difficulties and comorbidities. The authors believe that pediatric airway management for acutely ill children would benefit from new strategies. They recommend a system change using Plan, Do, Study, Act (PDSA) cycles.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Sanders R, Edwards L, Nishisaki A .
Tracheal intubations for critically Ill children outside specialized centers in the United Kingdom-patient, provider, practice factors, and adverse events.
Pediatr Crit Care Med 2019 Jun;20(6):572-73. doi: 10.1097/pcc.0000000000001946..
Keywords: Adverse Events, Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Outcomes, Patient Safety, Registries, Respiratory Conditions
Kahwati LC, Sorensen AV, Teixeira-Poit S
AHRQ Author: Mistry KB
Impact of the Agency for Healthcare Research and Quality's Safety Program for Perinatal Care.
The purpose of this study was to describe the Safety Program for Perinatal Care (SPPC) implementation experience and evaluate the short-term impact on labor and delivery (L&D) unit patient safety culture, processes, and adverse events. SPPC implementation by L&D units were supported sing a program toolkit, trainings, and technical assistance. Researchers then evaluated the program using a pre-post, mixed-methods design. Changes in safety and quality were measured using the Modified Adverse Outcome Index (MAOI) and other perinatal care indicators. Findings showed that SPPC had a favorable impact on unit patient safety culture and processes, but mixed short-term impact on maternal and neonatal adverse events.
AHRQ-authored; AHRQ-funded; 2902010000241.
Citation: Kahwati LC, Sorensen AV, Teixeira-Poit S .
Impact of the Agency for Healthcare Research and Quality's Safety Program for Perinatal Care.
Jt Comm J Qual Patient Saf 2019 Apr;45(4):231-40. doi: 10.1016/j.jcjq.2018.11.002..
Keywords: Adverse Events, Communication, Comprehensive Unit-based Safety Program (CUSP), Labor and Delivery, Maternal Care, Newborns/Infants, Outcomes, Patient Safety, Pregnancy, Simulation, Surveys on Patient Safety Culture, Teams, TeamSTEPPS, Training, Women
Daniel VT, Ayturk D, Ward DV
The influence of payor status on outcomes associated with surgical repair of upper gastrointestinal perforations due to peptic ulcer disease in the United States.
An association between lack of insurance and inferior outcomes has been well described for a number of surgical emergencies, yet little is known about the relationship of payor status and outcomes of patients undergoing emergent surgical repair for upper gastrointestinal (UGI) perforations. In this study, the investigators evaluated the association of payor status and in-hospital mortality for patients undergoing emergency surgery for UGI perforations in the United States.
AHRQ-funded; HS022694.
Citation: Daniel VT, Ayturk D, Ward DV .
The influence of payor status on outcomes associated with surgical repair of upper gastrointestinal perforations due to peptic ulcer disease in the United States.
Am J Surg 2019 Jan;217(1):121-25. doi: 10.1016/j.amjsurg.2018.06.025..
Keywords: Adverse Events, Digestive Disease and Health, Health Insurance, Healthcare Cost and Utilization Project (HCUP), Mortality, Outcomes, Patient Safety, Surgery, Uninsured
Lee JH, Nuthall G, Ikeyama T
Tracheal intubation practice and safety across international PICUs: a report from national emergency airway registry for children.
Researchers hypothesized that there would be differences in the process of care and adverse outcomes for tracheal intubation across pediatric ICUs (PICUs) in six different geographical regions: Germany, Japan, Singapore, India, New Zealand, and North America. Adverse tracheal intubation-associated events and desaturation occurrences in PICUS in these regions were evaluated, and the international PICUs compared with those in North America. The proportion of tracheal intubations for endotracheal tube change was greater in international PICUs, and the median age for international tracheal intubations was younger when compared with North America PICUs. Occurrences of adverse tracheal intubation-associated events were slightly lower for international than for North American PICUs, except for Germany and Japan, which were slightly higher.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Lee JH, Nuthall G, Ikeyama T .
Tracheal intubation practice and safety across international PICUs: a report from national emergency airway registry for children.
Pediatr Crit Care Med 2019 Jan;20(1):1-8. doi: 10.1097/pcc.0000000000001782..
Keywords: Adverse Events, Care Management, Children/Adolescents, Intensive Care Unit (ICU), Respiratory Conditions, Outcomes, Patient Safety
Stevens H, Carlin AM, Ross R
Effect of surgeon age on bariatric surgery outcomes.
This study examined the effect of surgeon age on complication rates for bariatric surgery. A retrospective study was done with 71 surgeons in Michigan who participated in a statewide collaborative improvement program. Older surgeons performed more Roux-en Y Gastric Bypass (40%) and less sleeve gastrectomy (38.8%) than younger surgeons. There was not found to be any statistically significant differences in patient outcome between the two age groups.
AHRQ-funded; HS024403.
Citation: Stevens H, Carlin AM, Ross R .
Effect of surgeon age on bariatric surgery outcomes.
Ann Surg 2018 May;267(5):905-09. doi: 10.1097/sla.0000000000002297..
Keywords: Adverse Events, Obesity, Outcomes, Patient Safety, Provider, Provider: Physician, Provider Performance
Spatz ES, Wang Y, Beckman AL
Traditional Chinese medicine for acute myocardial infarction in western medicine hospitals in China.
This study examined the use of traditional Chinese medicine (TCM) in patients admitted for acute myocardial infarction (AMI) in China during the first 24 hours of hospitalization. The data came from the China Patient-centered Evaluative Assessment of Cardiac Events Retrospective Study of Acute Myocardial Infarction. A chart review was done of randomly sampled patients in 2001, 2006 and 2011 in 162 Western medicine hospitals across China. Nearly all (99%) hospitals used some form of TCM, with Salvia miltiorrhiza being the most commonly prescribed. This TCM treatment (and others) was used intravenously and use has increased over the span of the study, despite lack of evidence of benefit or harm.
AHRQ-funded; HS023000.
Citation: Spatz ES, Wang Y, Beckman AL .
Traditional Chinese medicine for acute myocardial infarction in western medicine hospitals in China.
Circ Cardiovasc Qual Outcomes 2018 Mar;11(3):e004190. doi: 10.1161/circoutcomes.117.004190..
Keywords: Adverse Events, Cardiovascular Conditions, Complementary and Alternative Medicine, Heart Disease and Health, Hospitals, Mortality, Outcomes, Patient-Centered Outcomes Research, Patient Safety, Practice Patterns, Risk
Shaw CA, Steelman VM, DeBerg J
Effectiveness of active and passive warming for the prevention of inadvertent hypothermia in patients receiving neuraxial anesthesia: a systematic review and meta-analysis of randomized controlled trials.
The purpose of this review is to answer the question: Does the type of warming intervention influence the frequency or severity of inadvertent perioperative hypothermia (IPH) in surgical patients receiving neuraxial anesthesia? The review concluded that during neuraxial anesthesia, active warming (AW) reduces IPH more effectively than passive warming. Even with AW, IPH persists in some patients.
AHRQ-funded; HS021422.
Citation: Shaw CA, Steelman VM, DeBerg J .
Effectiveness of active and passive warming for the prevention of inadvertent hypothermia in patients receiving neuraxial anesthesia: a systematic review and meta-analysis of randomized controlled trials.
J Clin Anesth 2017 May;38:93-104. doi: 10.1016/j.jclinane.2017.01.005.
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Keywords: Comparative Effectiveness, Prevention, Outcomes, Adverse Events, Patient Safety
Obremskey WT, Schmidt AH, O'Toole RV
A prospective randomized trial to assess oral versus intravenous antibiotics for the treatment of postoperative wound infection after extremity fractures (POvIV study).
The POvIV study is a prospective, multicenter, randomized trial to compare oral (PO) with intravenous (IV) antibiotic therapy in patients with postoperative wound infections after extremity fractures. This study will be the largest prospective randomized trial to evaluate the safety and effectiveness of PO antibiotic use for treatment of postoperative wound infections. Results will inform clinician decisions on antibiotic delivery in patients with postoperative wound infections.
AHRQ-funded; HS000029.
Citation: Obremskey WT, Schmidt AH, O'Toole RV .
A prospective randomized trial to assess oral versus intravenous antibiotics for the treatment of postoperative wound infection after extremity fractures (POvIV study).
J Orthop Trauma 2017 Apr;31 Suppl 1:S32-s38. doi: 10.1097/bot.0000000000000802.
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Keywords: Antibiotics, Surgery, Injuries and Wounds, Healthcare-Associated Infections (HAIs), Comparative Effectiveness, Medication, Patient Safety, Adverse Events, Prevention, Patient-Centered Outcomes Research, Outcomes
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
McElroy LM, Khorzad R, Nannicelli AP
Failure mode and effects analysis: a comparison of two common risk prioritisation methods.
The investigators compared a simplified scoring method with the traditional scoring method to determine the degree of congruence in identifying high-risk failures. They found that the simplified method did not result in the same degree of discrimination in the ranking of failures offered by the traditional method.
AHRQ-funded; HS000078.
Citation: McElroy LM, Khorzad R, Nannicelli AP .
Failure mode and effects analysis: a comparison of two common risk prioritisation methods.
BMJ Qual Saf 2016 May;25(5):329-36. doi: 10.1136/bmjqs-2015-004130.
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Keywords: Adverse Events, Intensive Care Unit (ICU), Outcomes, Patient Safety, Risk
Chopra V, Smith S, Swaminathan L
Variations in peripherally inserted central catheter use and outcomes in Michigan hospitals.
The researchers examined the use of peripherally inserted central catheters (PICCs) by conducting a prospective study at 10 hospitals through the Michigan Hospital Medicine Safety Consortium. Their multicenter study found substantial variation in PICC indications, patterns of use, and outcomes at the 10 Michigan hospitals included in the study.
AHRQ-funded; HS022835.
Citation: Chopra V, Smith S, Swaminathan L .
Variations in peripherally inserted central catheter use and outcomes in Michigan hospitals.
JAMA Intern Med 2016 Apr;176(4):548-51. doi: 10.1001/jamainternmed.2015.8402.
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Keywords: Patient Safety, Practice Patterns, Healthcare-Associated Infections (HAIs), Hospitals, Outcomes, Adverse Events
Pierce RA, Lessler J, Milstone AM
Expanding the statistical toolbox: analytic approaches for cohort studies with healthcare-associated infectious outcomes.
This review intends to convey the scope of available statistical methodology to better understand the process of pathogen acquisition or HAI development. It determined that despite the range of methods available, logistic regression remains the dominant statistical approach in use. Poisson regression, survival methods, and mechanistic (mathematical) models remain underutilized.
AHRQ-funded; HS022872.
Citation: Pierce RA, Lessler J, Milstone AM .
Expanding the statistical toolbox: analytic approaches for cohort studies with healthcare-associated infectious outcomes.
Curr Opin Infect Dis 2015 Aug;28(4):384-91. doi: 10.1097/qco.0000000000000179..
Keywords: Healthcare-Associated Infections (HAIs), Adverse Events, Outcomes, Patient Safety
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
Abdelsattar ZM, Hendren S, Wong SL
Variation in transfusion practices and the effect on outcomes after noncardiac surgery.
The researchers assessed the hospital-level variation in transfusion practices for packed red blood cells and the patient-level effects on outcomes after noncardiac general or vascular surgery, using population-based prospectively collected data. They found that postoperative transfusions after noncardiac surgery are associated with increased adverse postoperative outcomes, with the exception of postoperative myocardial infarction.
AHRQ-funded; HS000053.
Citation: Abdelsattar ZM, Hendren S, Wong SL .
Variation in transfusion practices and the effect on outcomes after noncardiac surgery.
Ann Surg 2015 Jul;262(1):1-6. doi: 10.1097/sla.0000000000001264..
Keywords: Patient Safety, Surgery, Outcomes, Adverse Events
Goode AP, Richardson WJ, Schectman RM
Complications, revision fusions, readmissions, and utilization over a 1-year period after bone morphogenetic protein use during primary cervical spine fusions.
The authors sought to determine the 1-year risk of complications, cervical revision fusions, hospital readmissions, and health care services utilization after bone morphogenetic protein (BMP) use with cervical spine fusions. They found that patients receiving BMP were 29% more likely to have a complication and a nervous system complication; cervical revision fusions were more likely among patients receiving BMP; the risk of 30-day readmission was greater with BMP use; and readmission occurred 27.4% sooner on an average. Additionally, patients receiving BMP were more likely to receive computed tomography scans and epidurals with anterior surgical approaches.
AHRQ-funded; HS019479.
Citation: Goode AP, Richardson WJ, Schectman RM .
Complications, revision fusions, readmissions, and utilization over a 1-year period after bone morphogenetic protein use during primary cervical spine fusions.
Spine J 2014 Sep;14(9):2051-9. doi: 10.1016/j.spinee.2013.11.042.
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Keywords: Adverse Events, Hospital Readmissions, Patient Safety, Outcomes, Patient-Centered Outcomes Research, Surgery, Treatments