National Healthcare Quality and Disparities Report
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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
276 to 300 of 326 Research Studies DisplayedChopra V, Montoya A, Joshi D
Peripherally inserted central catheter use in skilled nursing facilities: a pilot study.
The purpose of this study was to describe patterns of use, care practices, and outcomes related to peripherally inserted central catheter (PICC) use in skilled nursing facilities (SNFs). The most common indication for PICC use was intravenous antibiotic delivery. The average PICC dwell time was 43 days, and most devices were single-lumen PICCs. Major and minor complications were common and occurred in 11 (20 percent) and 18 (32 percent) participants, respectively.
AHRQ-funded; HS022835; HS019979.
Citation: Chopra V, Montoya A, Joshi D .
Peripherally inserted central catheter use in skilled nursing facilities: a pilot study.
J Am Geriatr Soc 2015 Sep;63(9):1894-9. doi: 10.1111/jgs.13600..
Keywords: Adverse Events, Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Nursing Homes, Patient Safety
Roghmann MC, Johnson JK, Sorkin JD
Transmission of methicillin-resistant Staphylococcus aureus (MRSA) to healthcare worker gowns and gloves during care of nursing home residents.
This study estimated the frequency of methicillin-resistant Staphylococcus aureus (MRSA) transmission to gowns and gloves worn by healthcare workers (HCWs) interacting with nursing home residents to better inform infection prevention policies in this setting. It found that MRSA transmission from MRSA-positive residents to health care worker gown and gloves is substantial; high-contact activities of daily living confer the highest risk.
AHRQ-funded; HS019979.
Citation: Roghmann MC, Johnson JK, Sorkin JD .
Transmission of methicillin-resistant Staphylococcus aureus (MRSA) to healthcare worker gowns and gloves during care of nursing home residents.
Infect Control Hosp Epidemiol 2015 Sep;36(9):1050-7. doi: 10.1017/ice.2015.119..
Keywords: Methicillin-Resistant Staphylococcus aureus (MRSA), Patient Safety, Nursing Homes, Prevention
Leland NE, Gozalo P, Bynum J
What happens to patients when they fracture their hip during a skilled nursing facility stay?
This study characterized outcomes of patients experiencing a fall and subsequent hip fracture while in a nursing home receiving skilled nursing facility (SNF) services. In the first 90 days following hospitalization for surgical repair of the hip fracture, 24.1 percent of patients died, 7.3 percent were discharged to the community but remained fewer than 30 days, and 14.0 percent achieved successful community discharge.
AHRQ-funded; HS000011.
Citation: Leland NE, Gozalo P, Bynum J .
What happens to patients when they fracture their hip during a skilled nursing facility stay?
J Am Med Dir Assoc 2015 Sep;16(9):767-74. doi: 10.1016/j.jamda.2015.03.026..
Keywords: Nursing Homes, Falls, Injuries and Wounds, Outcomes
Mukamel DB, Ye Z, Glance LG
Does mandating nursing home participation in quality reporting make a difference? Evidence from Massachusetts.
This study investigated one of the mechanisms that may detract from the effectiveness of quality report cards: voluntary versus mandatory participation of nursing homes in public quality reporting. It found that once reporting became mandatory, nonvolunteers improved more than volunteers in all but 2 staffing measures.
AHRQ-funded; HS021844.
Citation: Mukamel DB, Ye Z, Glance LG .
Does mandating nursing home participation in quality reporting make a difference? Evidence from Massachusetts.
Med Care 2015 Aug;53(8):713-9. doi: 10.1097/mlr.0000000000000390..
Keywords: Nursing Homes, Long-Term Care, Public Reporting, Provider Performance, Quality Improvement, Quality of Care, Quality Indicators (QIs), Quality Measures, Elderly
Mody L, Crnich C
Effects of excessive antibiotic use in nursing homes.
This research commentary discussed effects of excessive antibiotic use in nursing homes (NH), including Clostridium difficile infection, adverse drug reactions, and an increased risk of colonization and infection with multidrug-resistant organisms. The authors recommended that antibiotic improvement teams tailor their improvement efforts based on a locally generated needs assessment.
AHRQ-funded; HS022465.
Citation: Mody L, Crnich C .
Effects of excessive antibiotic use in nursing homes.
JAMA Intern Med 2015 Aug;175(8):1339-41. doi: 10.1001/jamainternmed.2015.2774.
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Keywords: Adverse Drug Events (ADE), Antibiotics, Practice Patterns, Nursing Homes, Healthcare-Associated Infections (HAIs)
Grebla RC, Keohane L, Lee Y
Waiving the three-day rule: admissions and length-of-stay at hospitals and skilled nursing facilities did not increase.
The authors compared hospital and postacute skilled nursing facility utilization among Medicare Advantage enrollees in matched plans that did or did not eliminate that requirement in 2006-10. Among hospitalized enrollees with a skilled nursing facility admission, the mean hospital length-of-stay declined for those no longer subject to the qualifying stay but increased among those still subject to it. The elimination of the three-day-stay requirement was not associated with more hospital or skilled nursing facility admissions or with longer lengths-of-stay in a skilled nursing facility.
AHRQ-funded; HS000011.
Citation: Grebla RC, Keohane L, Lee Y .
Waiving the three-day rule: admissions and length-of-stay at hospitals and skilled nursing facilities did not increase.
Health Aff 2015 Aug;34(8):1324-30. doi: 10.1377/hlthaff.2015.0054.
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Keywords: Elderly, Hospitalization, Long-Term Care, Nursing Homes, Patient-Centered Outcomes Research
Tjia J, Field T, Mazor K
Dissemination of evidence-based antipsychotic prescribing guidelines to nursing homes: a cluster randomized trial.
This study evaluated the effectiveness of efforts to translate and disseminate evidence-based guidelines about atypical antipsychotic use to nursing homes (NHs). It found that RE-AIM indicators suggest some success in disseminating the toolkit and differences in reach, adoption, and implementation according to dissemination strategy but no measurable effect on antipsychotic prescribing trends.
AHRQ-funded; HS019351.
Citation: Tjia J, Field T, Mazor K .
Dissemination of evidence-based antipsychotic prescribing guidelines to nursing homes: a cluster randomized trial.
J Am Geriatr Soc 2015 Jul;63(7):1289-98. doi: 10.1111/jgs.13488..
Keywords: Communication, Evidence-Based Practice, Guidelines, Long-Term Care, Medication, Nursing Homes, Practice Patterns, Tools & Toolkits, Implementation
Mody L, Meddings J, Edson BS
Enhancing resident safety by preventing healthcare-associated infection: a national initiative to reduce catheter-associated urinary tract infections in nursing homes.
The authors describe a new initiative based on lessons learned from a recent multimodal Targeted Infection Prevention program in a group of nursing homes as well as a national initiative to prevent catheter-associated urinary tract infections in over 950 acute care hospitals. This initiative will now be implemented in nearly 500 nursing homes through a project funded by AHRQ. It will emphasize professional development in catheter utilization, catheter care and maintenance, and antimicrobial stewardship.
AHRQ-funded; 2902010000251; HS019979; HS019767.
Citation: Mody L, Meddings J, Edson BS .
Enhancing resident safety by preventing healthcare-associated infection: a national initiative to reduce catheter-associated urinary tract infections in nursing homes.
Clin Infect Dis 2015 Jul 1;61(1):86-94. doi: 10.1093/cid/civ236..
Keywords: Nursing Homes, Healthcare-Associated Infections (HAIs), Urinary Tract Infection (UTI), Patient Safety, Inpatient Care
Abrahamson K, DeCrane S, Mueller C
Implementation of a nursing home quality improvement project to reduce resident pain: a qualitative case study.
This article describes the experiences of staff members working within nursing homes that successfully implemented a quality improvement project aimed at reducing resident pain. Findings from the interviews were organized using the Consolidated Framework for Implementation Research. Interdisciplinary communication, supportive leadership, training, and nursing assistant participation facilitated implementation. Increased documentation, resistance to change, and difficulty measuring outcomes were perceived challenges.
AHRQ-funded; HS018464.
Citation: Abrahamson K, DeCrane S, Mueller C .
Implementation of a nursing home quality improvement project to reduce resident pain: a qualitative case study.
J Nurs Care Qual 2015 Jul-Sep;30(3):261-8. doi: 10.1097/ncq.0000000000000099..
Keywords: Nursing Homes, Quality Improvement, Pain, Chronic Conditions
Alexander GL
Nurse assistant communication strategies about pressure ulcers in nursing homes.
The author explored strategies nursing assistants use to communicate pressure ulcer prevention practices in nursing homes with variable information technology sophistication measures. Three major themes emerged: Passing on Information, Keeping Track of Needs, and Information Access.
AHRQ-funded; HS016862.
Citation: Alexander GL .
Nurse assistant communication strategies about pressure ulcers in nursing homes.
West J Nurs Res 2015 Jul;37(7):984-1004. doi: 10.1177/0193945914555201.
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Keywords: Communication, Health Information Technology (HIT), Nursing Homes, Pressure Ulcers, Prevention
Wysocki A, Thomas KS, Mor V
Functional improvement among short-stay nursing home residents in the MDS 3.0.
This study examined the completeness of the activities of daily living (ADL) items on admission and discharge assessments and the improvement in ADL performance among short-stay residents in the newly adopted Minimum Data Set (MDS) 3.0. It found that the ADL self-performance items are complete at both admission and discharge, with less than 1 percent missing for any item.
AHRQ-funded; HS000011.
Citation: Wysocki A, Thomas KS, Mor V .
Functional improvement among short-stay nursing home residents in the MDS 3.0.
J Am Med Dir Assoc 2015 Jun;16(6):470-4. doi: 10.1016/j.jamda.2014.11.018..
Keywords: Nursing Homes, Elderly, Data
Keohane LM, Grebla RC, Mor V
Medicare Advantage members' expected out-of-pocket spending for inpatient and skilled nursing facility services.
In 2011, new federal regulations restricted inpatient and skilled nursing facility cost sharing and mandated limits on out-of-pocket spending in Medicare Advantage (MA) plans. The authors found that some MA beneficiaries may still have difficulty affording acute and postacute care despite greater regulation of cost sharing.
AHRQ-funded; HS000011.
Citation: Keohane LM, Grebla RC, Mor V .
Medicare Advantage members' expected out-of-pocket spending for inpatient and skilled nursing facility services.
Health Aff 2015 Jun;34(6):1019-27. doi: 10.1377/hlthaff.2014.1146.
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Keywords: Healthcare Costs, Hospitalization, Policy, Medicare, Nursing Homes
Marcum ZA, Hardy SE
Medication management skills in older skilled nursing facility residents transitioning home.
The objective of this pilot study was to describe potential medication management deficiencies of older SNF residents transitioning home. It found that medication management deficiencies were found to be common in a high-risk group of elderly adults making this important transition.
AHRQ-funded; HS020831.
Citation: Marcum ZA, Hardy SE .
Medication management skills in older skilled nursing facility residents transitioning home.
J Am Geriatr Soc 2015 Jun;63(6):1266-8. doi: 10.1111/jgs.13469..
Keywords: Patient Safety, Nursing Homes, Elderly, Medication, Transitions of Care
Daly JM, Bay CP, Levy BT
Caring for people with dementia and challenging behaviors in nursing homes: a needs assessment geriatric nursing.
The authors conducted a needs assessment of directors of nursing (DON) in Iowa nursing homes in relation to caring for patients with Behavioral and Psychological Symptoms of Dementia. They found that facilities with a larger proportion of patients with challenging behaviors being treated with non-drug approaches instead of antipsychotics had DONs who were more likely to be confident in non-drug management strategies and have knowledge about the FDA antipsychotic medications risks.
AHRQ-funded; HS019355.
Citation: Daly JM, Bay CP, Levy BT .
Caring for people with dementia and challenging behaviors in nursing homes: a needs assessment geriatric nursing.
Geriatr Nurs 2015 May-Jun;36(3):182-91. doi: 10.1016/j.gerinurse.2015.01.001.
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Keywords: Elderly, Dementia, Nursing Homes, Long-Term Care, Nursing
Konetzka RT, Grabowski DC, Perraillon MC
Nursing home 5-star rating system exacerbates disparities in quality, by payer source.
The researchers examined how the Centers for Medicare and Medicare Services’ five-star rating system for nursing homes has affected residents who are dually enrolled in Medicare and Medicaid (“dual eligibles”). They found that by 2010 the increased likelihood of choosing the highest-rated homes was substantially smaller for dual eligibles than for non–dual eligibles.
AHRQ-funded; HS021877.
Citation: Konetzka RT, Grabowski DC, Perraillon MC .
Nursing home 5-star rating system exacerbates disparities in quality, by payer source.
Health Aff 2015 May;34(5):819-27. doi: 10.1377/hlthaff.2014.1084..
Keywords: Nursing Homes, Medicare, Medicaid, Quality of Care
Abrahamson K, Miech E, Davila HW
Pay-for-performance policy and data-driven decision making within nursing homes: a qualitative study.
The researchers explored ways in which data were collected, thought about and used by nursing home employees as a result of participation in a pay-for-performance (P4P) program. Their findings indicated that participants in the Minnesota Performance-based Incentive Payment Program’s quality improvement (QI) projects perceived a change in the rate and manner in which they gathered, used, and considered data in their QI decisions.
AHRQ-funded; HS018464
Citation: Abrahamson K, Miech E, Davila HW .
Pay-for-performance policy and data-driven decision making within nursing homes: a qualitative study.
BMJ Qual Saf. 2015 May;24(5):311-7. doi: 10.1136/bmjqs-2014-003362..
Keywords: Nursing Homes, Long-Term Care, Payment, Provider Performance, Decision Making, Policy, Quality Improvement, Quality of Care
Min L, Galecki A, Mody L
Functional disability and nursing resource use are predictive of antimicrobial resistance in nursing homes.
This study used a simple measure of activities of daily living, wounds, and indwelling devices (urinary catheter, feeding tube) to predict prevalent, new, and intermittent multidrug-resistant organism (MDRO) acquisition in nursing home (NH) residents. It found that MDRO acquisition is common in community NHs. The need for nursing care predicts new MDRO acquisition in NHs, suggesting potential mechanisms for MDRO acquisition and strategies for future interventions for high-risk individuals.
AHRQ-funded; HS019979.
Citation: Min L, Galecki A, Mody L .
Functional disability and nursing resource use are predictive of antimicrobial resistance in nursing homes.
J Am Geriatr Soc 2015 Apr;63(4):659-66. doi: 10.1111/jgs.13353..
Keywords: Nursing Homes, Antimicrobial Stewardship, Elderly, Long-Term Care, Risk
Mody L
Preventing aspiration pneumonia in high-risk nursing home residents: role of chlorhexidine-based oral care questioned again.
This commentary discusses a study by Juthani-Mehta et al in this issue of Clinical Infectious Diseases that adds more steam to the ongoing controversy of the value of chlorhexidine-based oral care by challenging an earlier study. That study found that the odds of dying from pneumonia in those who did not receive oral care was >3 times that of the group receiving oral care. By contrast, the Juthani-Mehta et al study finds no benefit to chlorhexidine use.
AHRQ-funded; HS019979.
Citation: Mody L .
Preventing aspiration pneumonia in high-risk nursing home residents: role of chlorhexidine-based oral care questioned again.
Clin Infect Dis 2015 Mar 15;60(6):858-9. doi: 10.1093/cid/ciu941..
Keywords: Nursing Homes, Dental and Oral Health, Elderly, Patient Safety
Park Y, Franklin JM, Schneeweiss S
Antipsychotics and mortality: adjusting for mortality risk scores to address confounding by terminal illness.
The researchers sought to determine whether adjustment for prognostic indices specifically developed for nursing home populations affect the magnitude of previously observed associations between mortality and conventional and atypical antipsychotics. They concluded that although causality cannot be proven based on nonrandomized studies, this study adds to the body of evidence rejecting explanations other than causality for the greater mortality risk associated with conventional antipsychotics than with atypical antipsychotics.
AHRQ-funded; HS017918; HS02112.
Citation: Park Y, Franklin JM, Schneeweiss S .
Antipsychotics and mortality: adjusting for mortality risk scores to address confounding by terminal illness.
J Am Geriatr Soc 2015 Mar;63(3):516-23. doi: 10.1111/jgs.13326..
Keywords: Nursing Homes, Mortality, Medication, Elderly, Dementia
Liu W, Unick J, Galik E
Barthel Index of activities of daily living: item response theory analysis of ratings for long-term care residents.
This study compared the fit and appropriateness of the one-parameter logistic model (1PL), the partial credit model (PCM), and the extension of the generalized partial credit model implemented in ConQuest (GPCM-CQ) for the 15-item Barthel Index (BI). GPCM-CQ results suggested that further revision of the BI may be warranted.
AHRQ-funded; HS013372.
Citation: Liu W, Unick J, Galik E .
Barthel Index of activities of daily living: item response theory analysis of ratings for long-term care residents.
Nurs Res 2015 Mar-Apr;64(2):88-99. doi: 10.1097/nnr.0000000000000072..
Keywords: Long-Term Care, Nursing Homes
Hakkarainen TW, Ayoung-Chee P, Alfonso R
Structure, process, and outcomes in skilled nursing facilities: understanding what happens to surgical patients when they cannot go home. A systematic review.
This systematic review of current literature surrounding the structural, process of care, and outcomes measurement for patients in skilled nursing facilities (SNFs) found that the role of the care setting and care delivery in contributing to outcomes has not been well-studied. In particular, there was very little published information addressing surgical or trauma patients discharged to SNFs.
AHRQ-funded; HS020025
Citation: Hakkarainen TW, Ayoung-Chee P, Alfonso R .
Structure, process, and outcomes in skilled nursing facilities: understanding what happens to surgical patients when they cannot go home. A systematic review.
J Surg Res. 2015 Feb;193(2):772-80. doi: 10.1016/j.jss.2014.06.002..
Keywords: Nursing Homes, Outcomes, Surgery, Quality of Care
van Hasselt M, McCall N, Keyes V
Total cost of care lower among Medicare fee-for-service beneficiaries receiving care from patient-centered medical homes.
The authors compared health care utilization and payments between NCQA-recognized patient-centered medical home (PCMH) practices and practices without such recognition. They found that, relative to the comparison group, total Medicare payments, acute care payments, and the number of emergency room visits declined after practices received NCQA PCMH recognition. The decline was larger for practices with sicker than average patients, primary care practices, and solo practices.
AHRQ-funded; HS000029.
Citation: van Hasselt M, McCall N, Keyes V .
Total cost of care lower among Medicare fee-for-service beneficiaries receiving care from patient-centered medical homes.
Health Serv Res 2015 Feb;50(1):253-72. doi: 10.1111/1475-6773.12217.
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Keywords: Healthcare Costs, Medicare, Nursing Homes, Patient-Centered Healthcare
Pimentel CB, Donovan JL, Field TS
Use of atypical antipsychotics in nursing homes and pharmaceutical marketing.
The objectives of this study were to describe the extent and type of pharmaceutical marketing in a convenience sample of nursing homes (NHs) in one state and to provide preliminary evidence for the potential influence of pharmaceutical marketing on the use of atypical antipsychotics in NHs. No association was detected between the level of atypical antipsychotic prescribing and reports of any pharmaceutical marketing by at least one NH leader.
AHRQ-funded; HS019351.
Citation: Pimentel CB, Donovan JL, Field TS .
Use of atypical antipsychotics in nursing homes and pharmaceutical marketing.
J Am Geriatr Soc 2015 Feb;63(2):297-301. doi: 10.1111/jgs.13180..
Keywords: Nursing Homes, Medication, Elderly
Aspinall SL, Zhao X, Semia TP
Epidemiology of drug-disease interactions in older veteran nursing home residents.
The objective of this study was to assess the prevalence of and factors associated with potentially inappropriate drug– disease combinations according to the AGS 2012 Beers criteria that are clinically important in elderly adults residing in Veterans Affairs Community Living Centers. It found that drug-disease interactions were common in older residents with dementia or cognitive impairment or a history of falls or hip fracture.
AHRQ-funded; HS018721.
Citation: Aspinall SL, Zhao X, Semia TP .
Epidemiology of drug-disease interactions in older veteran nursing home residents.
J Am Geriatr Soc 2015 Jan;63(1):77-84. doi: 10.1111/jgs.13197..
Keywords: Adverse Drug Events (ADE), Adverse Events, Dementia, Elderly, Falls, Injuries and Wounds, Medication, Medication: Safety, Neurological Disorders, Nursing Homes, Patient Safety
Lepore MJ, Shield RR, Looze J
Medicare and Medicaid reimbursement rates for nursing homes motivate select culture change practices but not comprehensive culture change.
The researchers use mixed methods to examine the presence of culture change practices in the context of a nursing home’s (NH’s) payer sources. They concluded that qualitative data show how higher pay from Medicare versus Medicaid influences implementation of select culture change practices, and quantitative data show NHs with higher proportions of Medicare residents have significantly higher (measured) environmental culture change implementation.
AHRQ-funded; HS000011.
Citation: Lepore MJ, Shield RR, Looze J .
Medicare and Medicaid reimbursement rates for nursing homes motivate select culture change practices but not comprehensive culture change.
J Aging Soc Policy 2015;27(3):215-31. doi: 10.1080/08959420.2015.1022102..
Keywords: Nursing Homes, Medicare, Medicaid, Payment, Health Insurance