National Healthcare Quality and Disparities Report
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Search All Research Studies
Topics
- Adverse Drug Events (ADE) (1)
- Adverse Events (3)
- Antibiotics (3)
- Antimicrobial Stewardship (1)
- Behavioral Health (1)
- Catheter-Associated Urinary Tract Infection (CAUTI) (1)
- Depression (1)
- (-) Elderly (13)
- Evidence-Based Practice (1)
- Falls (1)
- Healthcare-Associated Infections (HAIs) (2)
- Hospital Discharge (1)
- Hospitalization (1)
- Implementation (1)
- Infectious Diseases (1)
- Injuries and Wounds (4)
- (-) Long-Term Care (13)
- Medical Errors (1)
- Medication (4)
- Medication: Safety (1)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (1)
- Neurological Disorders (1)
- Nursing Homes (11)
- Patient-Centered Outcomes Research (1)
- (-) Patient Safety (13)
- Policy (1)
- Pressure Ulcers (1)
- Prevention (1)
- Quality Improvement (1)
- Quality Measures (1)
- Quality of Care (2)
- Risk (2)
- Transitions of Care (1)
- Urinary Tract Infection (UTI) (1)
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 13 of 13 Research Studies DisplayedTemkin-Greener H, Mao Y, McGarry B
Patient safety culture in assisted living: staff perceptions and association with state regulations.
The purpose this study was to evaluate views on patient safety culture (PSC) among assisted living (AL) administrators and direct care workers (DCWs), and their relationships with state regulations. The researchers utilized the PSC instrument developed by the Agency for Healthcare Research & Quality to conduct a survey of administrators and DCWs working in assisted living communities serving Medicare beneficiary residents. Secondary data on ALs and residents were obtained from the Medicare Master Beneficiary Summary Files. Other data sources included: the Area Health Resource Files, a previous national AL directory, the US census, and a prior study citing AL regulations. 714 administrators and DCWs in 257 The study found that administrators' and DCWs' perspectives on PSC differed significantly across almost all domains. The researchers concluded that PSC is a relevant metric for evaluating organizational performance.
AHRQ-funded; HS026893.
Citation: Temkin-Greener H, Mao Y, McGarry B .
Patient safety culture in assisted living: staff perceptions and association with state regulations.
J Am Med Dir Assoc 2022 Dec;23(12):1997-2022.e3. doi: 10.1016/j.jamda.2022.09.007..
Keywords: Patient Safety, Elderly, Long-Term Care, Policy
Chen Z, Gleason LJ, Sanghavi P
Accuracy of pressure ulcer events in US nursing home ratings.
This study investigated the accuracy of the government website Nursing Home Compare (NHC) pressure ulcer measures, which are chief indicators of nursing home patient safety. The authors identified hospital admissions for pressure ulcers and linked them to the nursing home-reported data at the patient level using Medicare fee-for-service beneficiaries who were nursing home residents between 2011 and 2017. Percentages of pressure ulcers that were appropriately reported by stage, long-stay versus short-stay status, and race was calculated. Reporting rates were low for both short-stay (70.2%) and long-stay (59.7%) for stage 2-4 pressure ulcer hospitalizations. Black residents experienced more severe pressure ulcers than White residents. Correlations between claims-based measures and NHC ratings were found to be poor.
AHRQ-funded; HS026957.
Citation: Chen Z, Gleason LJ, Sanghavi P .
Accuracy of pressure ulcer events in US nursing home ratings.
Med Care 2022 Oct;60(10):775-83. doi: 10.1097/mlr.0000000000001763.
AHRQ-funded; HS026957..
AHRQ-funded; HS026957..
Keywords: Elderly, Nursing Homes, Long-Term Care, Pressure Ulcers, Quality Measures, Quality of Care, Patient Safety
Katz MJ, Tamma PD, Cosgrove SE
Implementation of an antibiotic stewardship program in long-term care facilities across the US.
The purpose of this study was to determine if AHRQ’s Safety Program for Improving Antibiotic Use was associated with reductions in antibiotic use in long-term care (LTC) facilities in the US. Findings showed that participation in the AHRQ safety program was associated with the development of antibiotic stewardship programs (ASPs) that actively engaged clinical staff in the decision-making processes around antibiotic prescriptions in participating LTC facilities. The reduction in days of antibiotic therapy and starts, which was more pronounced in more engaged facilities, indicated that implementation of this multifaceted program may support successful ASPs in LTC settings.
AHRQ-funded; 233201500020I.
Citation: Katz MJ, Tamma PD, Cosgrove SE .
Implementation of an antibiotic stewardship program in long-term care facilities across the US.
JAMA Netw Open 2022 Feb;5(2):e220181. doi: 10.1001/jamanetworkopen.2022.0181..
Keywords: Elderly, Antimicrobial Stewardship, Antibiotics, Long-Term Care, Medication, Implementation, Patient Safety
Mangrum R, Stewart MD, Gifford DR
Omissions of care in nursing homes: a uniform definition for research and quality improvement.
The goal of this study was to create a uniform definition of omission of care in US nursing homes. Lack of a uniform definition has made efforts to prevent them challenging. Subject matter experts and a broad range of nursing home stakeholders were brought together in iterative rounds of engagement to identify key concepts and aspects of omissions of care and develop a consensus-based definition. The concise definition decided on was: “Omissions of care in nursing homes encompass situations when care–either clinical or nonclinical–is not provided for a resident and results in additional monitoring or intervention or increases the risk of an undesirable or adverse physical, emotional, or psychosocial outcome for the resident."
AHRQ-funded; 233201500014I.
Citation: Mangrum R, Stewart MD, Gifford DR .
Omissions of care in nursing homes: a uniform definition for research and quality improvement.
J Am Med Dir Assoc 2020 Nov;21(11):1587-91.e2. doi: 10.1016/j.jamda.2020.08.016..
Keywords: Elderly, Nursing Homes, Long-Term Care, Quality Improvement, Quality of Care, Medical Errors, Adverse Events, Patient Safety, Risk, Patient-Centered Outcomes Research
Chatterjee S, Bali V, Carnahan RM
Anticholinergic burden and risk of cognitive impairment in elderly nursing home residents with depression.
This study evaluated whether elderly nursing home residents with mild depression and intact cognition experienced cognitive impairment after using anticholinergic drugs. The study was a population-based nested case-control study using Minimum Data Set (MDS)-linked Medicare data where the base cohort were patients 65 years and older with depression who had intact cognition. Cumulative anticholinergic burden was measured within 30, 60, and 90 days preceding the event (cognitive measurement) date using the Anticholinergic Drug Scale (ADS). The end sample compared 3707 cases with mild-to-moderate cognition to 3707 matched controls with intact cognition. There was no association with cumulative anticholinergic exposure at 30 days with cognitive impairment, but the odds of cognitive impairment increased with exposure 60 and 90 days before the event date. This study concludes there should be concern in using anticholinergic drugs for longer than 30 days with elderly nursing home residents.
AHRQ-funded; HS021264.
Citation: Chatterjee S, Bali V, Carnahan RM .
Anticholinergic burden and risk of cognitive impairment in elderly nursing home residents with depression.
Res Social Adm Pharm 2020 Mar;16(3):329-35. doi: 10.1016/j.sapharm.2019.05.020..
Keywords: Elderly, Nursing Homes, Long-Term Care, Depression, Behavioral Health, Medication, Neurological Disorders, Adverse Drug Events (ADE), Adverse Events, Patient Safety
Kapoor A, Field T, Handler S
Adverse events in long-term care residents transitioning from hospital back to nursing home.
This study looked at adverse event rates of long-term care residents transitioning back to their nursing home after hospitalization. A prospective cohort study of LTC residents discharged from hospital back to LTC from March 1, 2016, to December 31, 2017 was conducted, and residents were followed up for 45 days. A random sample of 32 nursing homes located in 6 New England states was used, and 555 LTC residents were selected, contributing 762 transitions from hospital back to the same LTC facility. Most of the cohort were female (65.5%) and non-Hispanic white (93.7%). The study used trained nurse abstractors to review nursing home records to determine if an adverse event occurred. Out of 762 discharges there were 379 adverse events. The most common adverse events were pressure ulcers, skin tears, and falls followed by health care-acquired infections. 145 adverse events were considered less serious, with 28 life-threatening, and 8 were fatal. Most of the adverse events were considered preventable or ameliorable.
AHRQ-funded; HS024596.
Citation: Kapoor A, Field T, Handler S .
Adverse events in long-term care residents transitioning from hospital back to nursing home.
JAMA Intern Med 2019 Sep;179(9):1254-61. doi: 10.1001/jamainternmed.2019.2005..
Keywords: Adverse Events, Long-Term Care, Nursing Homes, Transitions of Care, Elderly, Patient Safety, Hospital Discharge, Hospitalization
Libertucci J, Bassis CM, Cassone M
Bacteria detected in both urine and open wounds in nursing home residents: a pilot study.
Researchers sought to determine if bacterial species colonizing open wounds are also found in the urine. Their pilot study of nursing home residents provided evidence that bacterial species identified within the urine can also be identified in open wounds in the same patient at one point in time. They recommended further studies to investigate if these species are of the same lineage and if the urinary microbiota are able to seed colonization of open wounds below the umbilicus.
AHRQ-funded; HS019767.
Citation: Libertucci J, Bassis CM, Cassone M .
Bacteria detected in both urine and open wounds in nursing home residents: a pilot study.
mSphere 2019 Aug 28;4(4). doi: 10.1128/mSphere.00463-19..
Keywords: Elderly, Nursing Homes, Long-Term Care, Healthcare-Associated Infections (HAIs), Injuries and Wounds, Patient Safety
Aspinall SL, Springer SP, Zhao X
Central nervous system medication burden and risk of recurrent serious falls and hip fractures in Veterans Affairs nursing home residents.
This study investigated the association between taking central nervous system (CNS) medications with the risk of serious falls and hip fractures. Study participants were residents at a Veterans Health Administration (VHA) Community Living Center (CLC) between July 1, 2005 and June 30, 2009. This was a nested case-control study. The investigators concluded that there was a higher risk in those residents receiving 3.0 or more daily CNS medications.
AHRQ-funded; HS023779.
Citation: Aspinall SL, Springer SP, Zhao X .
Central nervous system medication burden and risk of recurrent serious falls and hip fractures in Veterans Affairs nursing home residents.
J Am Geriatr Soc 2019 Jan;67(1):74-80. doi: 10.1111/jgs.15603..
Keywords: Elderly, Falls, Injuries and Wounds, Long-Term Care, Medication, Nursing Homes, Patient Safety, Risk
Jackson SS, Lydecker AD, Magder LS
Development and validation of a clinical prediction rule to predict transmission of methicillin-resistant Staphylococcus aureus in nursing homes.
This study’s goal was to develop and validate a clinical prediction rule that can predict transmission of methicillin-resistant Staphylococcus aureus (MRSA) in nursing homes. The researchers wanted to identify residents who were most likely to transmit MRSA to health-care workers (HCWs) on their hands or clothing during clinical care. Demographic and clinical characteristic data was used from residents of community nursing homes in Maryland and Michigan from 2012 to 2014. The clinical prediction rule that was developed was then externally validated in a cohort of Department of Veterans Affairs nursing home residents from 7 states between 2012 and 2016. Variables in the prediction model included sex, race, resident dependency on care, the presence of any medical device, diabetes mellitus, and chronic skin breakdown. The prediction model showed good performance although it showed less utility in the validation cohort.
AHRQ-funded; HS019979.
Citation: Jackson SS, Lydecker AD, Magder LS .
Development and validation of a clinical prediction rule to predict transmission of methicillin-resistant Staphylococcus aureus in nursing homes.
Am J Epidemiol 2019 Jan;188(1):214-21. doi: 10.1093/aje/kwy220..
Keywords: Elderly, Healthcare-Associated Infections (HAIs), Infectious Diseases, Long-Term Care, Methicillin-Resistant Staphylococcus aureus (MRSA), Nursing Homes, Patient Safety
Zullo AR, Zhang T, Banerjee G
Facility and state variation in hip fracture in U.S. nursing home residents.
The purpose of this study was to quantify the variation in hip fracture incidence across U.S. nursing home (NH) facilities and states and examine how hip fracture incidence varies according to facility- and state-level characteristics. The investigators concluded that much of the variation in hip fracture incidence remained unexplained. They suggested that their findings indicated that potentially modifiable state and facility characteristics such as psychoactive drug prescribing and minimum staffing requirements could be addressed to help reduce the rate of hip fracture in U.S. NHs.
AHRQ-funded; HS022998.
Citation: Zullo AR, Zhang T, Banerjee G .
Facility and state variation in hip fracture in U.S. nursing home residents.
J Am Geriatr Soc 2018 Mar;66(3):539-45. doi: 10.1111/jgs.15264..
Keywords: Elderly, Injuries and Wounds, Long-Term Care, Nursing Homes, Patient Safety
Meddings J, Saint S, Krein SL
Systematic review of interventions to reduce urinary tract infection in nursing home residents.
This paper is a systematic literature review of strategies to reduce urinary tract infections (UTIs) in nursing home residents. It concludes that several practices, often implemented in bundles, such as improving hand hygiene, reducing and improving catheter use, managing incontinence without catheters, and enhanced barrier precautions, appear to reduce UTI or catheter-associated UTI in nursing home residents.
AHRQ-funded; HS019767; HS018334; 290201000025I.
Citation: Meddings J, Saint S, Krein SL .
Systematic review of interventions to reduce urinary tract infection in nursing home residents.
J Hosp Med 2017 May;12(5):356-68. doi: 10.12788/jhm.2724.
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Keywords: Antibiotics, Catheter-Associated Urinary Tract Infection (CAUTI), Elderly, Evidence-Based Practice, Long-Term Care, Nursing Homes, Patient Safety, Prevention, Urinary Tract Infection (UTI)
Ismail MD, Luo T, McNamara S
Long-term carriage of ciprofloxacin-resistant Escherichia coli Isolates in high-risk nursing home residents.
This paper's objective was to characterize the incidence and duration of carriage of ciprofloxacin-resistant Escherichia coli (CipREc) in nursing homes and to identify those in the O25b-ST131 lineage. The authors found that CipREc occurred frequently in nursing home residents and is carried for long durations, and that reacquisition following clearance is common.
AHRQ-funded; HS019979.
Citation: Ismail MD, Luo T, McNamara S .
Long-term carriage of ciprofloxacin-resistant Escherichia coli Isolates in high-risk nursing home residents.
Infect Control Hosp Epidemiol 2016 Apr;37(4):440-7. doi: 10.1017/ice.2015.326.
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Keywords: Nursing Homes, Long-Term Care, Elderly, Antibiotics, Patient Safety
Moga DC, Carnahan RM, Lund BC
Risks and benefits of bladder antimuscarinics among elderly residents of Veterans Affairs Community Living Centers.
This study evaluated the risks and benefits of drugs to reduce urinary incontinence that were used by elderly VA nursing home residents. It found that the use of these drugs, known as bladder antimuscarinics, resulted in improved continence rates and better social engagement but also led to a higher risk of fractures in new users.
AHRQ-funded; HS016094
Citation: Moga DC, Carnahan RM, Lund BC .
Risks and benefits of bladder antimuscarinics among elderly residents of Veterans Affairs Community Living Centers.
J Am Med Dir Assoc. 2013 Oct;14(10):749-60. doi: 10.1016/j.jamda.2013.03.008..
Keywords: Elderly, Medication, Medication: Safety, Nursing Homes, Long-Term Care, Injuries and Wounds, Patient Safety