National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (5)
- Adverse Drug Events (ADE) (10)
- Adverse Events (13)
- Ambulatory Care and Surgery (1)
- Antibiotics (18)
- Antimicrobial Stewardship (14)
- Behavioral Health (6)
- Blood Thinners (1)
- Brain Injury (2)
- Burnout (2)
- Cancer (4)
- Cancer: Lung Cancer (2)
- Cardiovascular Conditions (11)
- Care Coordination (8)
- Caregiving (2)
- Care Management (4)
- Case Study (1)
- Catheter-Associated Urinary Tract Infection (CAUTI) (7)
- Central Line-Associated Bloodstream Infections (CLABSI) (1)
- Chronic Conditions (5)
- Clinical Decision Support (CDS) (2)
- Clinician-Patient Communication (1)
- Clostridium difficile Infections (2)
- Communication (9)
- Comparative Effectiveness (4)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (3)
- COVID-19 (13)
- Data (2)
- Decision Making (11)
- Dementia (21)
- Dental and Oral Health (4)
- Depression (3)
- Diabetes (3)
- Diagnostic Safety and Quality (7)
- Digestive Disease and Health (2)
- Disparities (5)
- Education: Continuing Medical Education (2)
- Education: Patient and Caregiver (4)
- Elderly (173)
- Electronic Health Records (EHRs) (3)
- Emergency Department (3)
- Emergency Medical Services (EMS) (1)
- Emergency Preparedness (2)
- Evidence-Based Practice (12)
- Falls (11)
- Guidelines (5)
- Healthcare-Associated Infections (HAIs) (22)
- Healthcare Costs (13)
- Healthcare Delivery (6)
- Healthcare Utilization (4)
- Health Information Technology (HIT) (26)
- Health Insurance (1)
- Health Literacy (1)
- Health Services Research (HSR) (2)
- Health Status (2)
- Heart Disease and Health (11)
- Home Healthcare (7)
- Hospital Discharge (20)
- Hospitalization (22)
- Hospital Readmissions (15)
- Hospitals (16)
- Human Immunodeficiency Virus (HIV) (4)
- Implementation (2)
- Infectious Diseases (9)
- Influenza (3)
- Injuries and Wounds (17)
- Inpatient Care (1)
- Long-Term Care (158)
- Medicaid (8)
- Medical Errors (3)
- Medicare (39)
- Medication (58)
- Medication: Safety (5)
- Men's Health (1)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (7)
- Mortality (9)
- Neurological Disorders (10)
- Nursing (1)
- (-) Nursing Homes (326)
- Nutrition (1)
- Obesity (2)
- Opioids (3)
- Organizational Change (2)
- Outcomes (16)
- Pain (4)
- Palliative Care (2)
- Patient-Centered Healthcare (7)
- Patient-Centered Outcomes Research (16)
- Patient and Family Engagement (5)
- Patient Experience (6)
- Patient Safety (46)
- Payment (8)
- Pneumonia (6)
- Policy (6)
- Practice Patterns (10)
- Pressure Ulcers (6)
- Prevention (26)
- Primary Care (3)
- Provider (7)
- Provider: Clinician (2)
- Provider: Health Personnel (7)
- Provider: Nurse (6)
- Provider: Pharmacist (1)
- Provider: Physician (2)
- Provider Performance (21)
- Public Health (9)
- Public Reporting (6)
- Quality Improvement (25)
- Quality Indicators (QIs) (13)
- Quality Measures (22)
- Quality of Care (54)
- Quality of Life (3)
- Racial and Ethnic Minorities (13)
- Rehabilitation (8)
- Research Methodologies (5)
- Respiratory Conditions (1)
- Risk (14)
- Rural Health (1)
- Sepsis (2)
- Skin Conditions (1)
- Sleep Problems (1)
- Social Determinants of Health (2)
- Social Media (1)
- Stroke (4)
- Surgery (8)
- Surveys on Patient Safety Culture (2)
- Telehealth (6)
- Tools & Toolkits (1)
- Training (1)
- Transitions of Care (26)
- Trauma (1)
- Treatments (1)
- Urban Health (1)
- Urinary Tract Infection (UTI) (12)
- Vaccination (3)
- Vulnerable Populations (3)
- Web-Based (2)
- Women (1)
- Workflow (1)
- Workforce (4)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
51 to 75 of 326 Research Studies DisplayedPanagiotou OA, Keeney T, Ogarek JA
Prevalence of functional limitations and their associations with systemic cancer therapy among older adults in nursing homes with advanced non-small cell lung cancer.
The purpose of this study was to determine the relationship of self-care task disabilities with the use of systemic cancer therapies for advanced non-small cell lung cancer (NSCLC) in nursing home patients. The investigators concluded that systemic cancer therapy was not commonly used in this population and was strongly predicted by disability in self-care tasks.
AHRQ-funded; HS000011.
Citation: Panagiotou OA, Keeney T, Ogarek JA .
Prevalence of functional limitations and their associations with systemic cancer therapy among older adults in nursing homes with advanced non-small cell lung cancer.
J Geriatr Oncol 2021 Jun;12(5):765-70. doi: 10.1016/j.jgo.2021.02.007..
Keywords: Elderly, Cancer: Lung Cancer, Cancer, Nursing Homes
Anderson MC, Evans E, Zonfrillo MR
Rural/urban differences in discharge from rehabilitation in older adults with traumatic brain injury.
This study compared differences in outcomes for older adults with traumatic brain injury (TBI) in rural and urban settings by 1) comparing the rates of successful community discharge; and 2) reasons for not achieving successful discharge. This retrospective national cohort study looked at skilled nursing facility (SNF) patients aged 66 and older using Medicare inpatient claims with Minimum Data Set assessments. A total of 11,771 SNFs were identified with a total population of 61,021 Medicare beneficiaries discharged to a SNF following hospitalization for TBI between 2011 and 2015. Patients in rural settings had lower rates of successful discharge compared with patients in urban settings (52.1% vs 58.5%). Reasons for unsuccessful discharge differed between rural and urban settings with rural patients less likely to discharged from SNF within 100 days although they were less likely to be rehospitalized within 30 days of SNF discharge.
AHRQ-funded; HS000011.
Citation: Anderson MC, Evans E, Zonfrillo MR .
Rural/urban differences in discharge from rehabilitation in older adults with traumatic brain injury.
J Am Geriatr Soc 2021 Jun;69(6):1601-08. doi: 10.1111/jgs.17065..
Keywords: Elderly, Brain Injury, Trauma, Rural Health, Urban Health, Rehabilitation, Nursing Homes
Savitz ST, Falk K, Stearns SC
Coronary revascularization outcomes in relation to skilled nursing facility use following hospital discharge.
Observational analyses comparing coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI) among elderly or frail patients are likely biased by treatment selection. PCI is typically chosen for frail patients, while CABG is more common for patients with good recovery potential. In this study. The investigators hypothesized that skilled nursing facility (SNF) use after revascularization was a measure of relative frailty associated with outcomes following coronary revascularization.
AHRQ-funded; HS000032.
Citation: Savitz ST, Falk K, Stearns SC .
Coronary revascularization outcomes in relation to skilled nursing facility use following hospital discharge.
Clin Cardiol 2021 May;44(5):627-35. doi: 10.1002/clc.23583..
Keywords: Elderly, Heart Disease and Health, Cardiovascular Conditions, Surgery, Outcomes, Nursing Homes
Olivieri-Mui B, McGuire J, Griffith J
Exploring the association between the quality of HIV care in nursing homes and hospitalization.
Persons living with HIV/AIDS (PLWH) are living long enough to need age-related and HIV-related nursing home (NH) care. Nursing home quality of care has been associated with risk for hospitalization, but it is unknown if quality of HIV care in NHs affects hospitalization in this population. In this study, the investigators assessed HIV care quality with four national measures adapted for the NH setting.
AHRQ-funded; R36 HS025662.
Citation: Olivieri-Mui B, McGuire J, Griffith J .
Exploring the association between the quality of HIV care in nursing homes and hospitalization.
J Healthc Qual 2021 May-Jun;43(3):174-82. doi: 10.1097/jhq.0000000000000277..
Keywords: Elderly, Human Immunodeficiency Virus (HIV), Nursing Homes, Long-Term Care, Quality of Care, Quality Measures
Mack DS, Baek J, Tjia J
Geographic variation of statin use among US nursing home residents with life-limiting illness.
The authors described regional variation in statin use among residents with life-limiting illness. Statin usage was determined by examination of Medicare Part D claims. Findings suggested extensive geographic variation in US statin prescribing across hospital referral regions, especially for those aged 76 years or older. This variation may reflect clinical uncertainty given the largely absent guidelines for statin use in nursing home residents.
AHRQ-funded; HS026840.
Citation: Mack DS, Baek J, Tjia J .
Geographic variation of statin use among US nursing home residents with life-limiting illness.
Med Care 2021 May;59(5):425-36. doi: 10.1097/mlr.0000000000001505..
Keywords: Elderly, Nursing Homes, Long-Term Care, Medicare, Practice Patterns
Powell KR, Deroche CB, Alexander GL
Health data sharing in US nursing homes: a mixed methods study.
The purposes of this study were to understand the extent to which nursing homes have the capability for data sharing and to explore nursing home leaders' perceptions of data sharing with other health care facilities and with residents and family members. Findings showed that perceived challenges to health data sharing included variance in systems and software, privacy and security concerns, and organizational factors slowing uptake of technology. Perceived benefits included improved communication, improved care planning, and anticipating future demand. Recommendations included working to mitigate barriers and to capitalize on potential benefits of implementing this technology in nursing homes.
AHRQ-funded; HS022497.
Citation: Powell KR, Deroche CB, Alexander GL .
Health data sharing in US nursing homes: a mixed methods study.
J Am Med Dir Assoc 2021 May;22(5):1052-59. doi: 10.1016/j.jamda.2020.02.009..
Keywords: Nursing Homes, Electronic Health Records (EHRs), Health Information Technology (HIT)
Mack DS, Hume AL, Tjia J
National trends in statin use among the United States nursing home population (2011-2016).
AHRQ-funded; HS026840.
Citation: Mack DS, Hume AL, Tjia J .
National trends in statin use among the United States nursing home population (2011-2016).
Drugs Aging 2021 May;38(5):427-39. doi: 10.1007/s40266-021-00844-8..
Keywords: Elderly, Nursing Homes, Long-Term Care, Blood Thinners, Medication
Evans E, Gutman R, Resnik L
Successful community discharge among older adults with traumatic brain injury in skilled nursing facilities.
The purpose of this retrospective cohort study was to identify patient, injury, and functional status characteristics associated with successful discharge to the community following a skilled nursing facility (SNF) stay among older adults hospitalized following traumatic brain injury (TBI). Participants were Medicare fee-for-service beneficiaries admitted to an SNF after hospitalization for TBI. Findings showed that among older adults with TBI who discharge to an SNF, sociodemographic and functional status characteristics are associated with successful discharge and may be useful to clinicians for discharge planning.
AHRQ-funded; HS000011.
Citation: Evans E, Gutman R, Resnik L .
Successful community discharge among older adults with traumatic brain injury in skilled nursing facilities.
J Head Trauma Rehabil 2021 May-Jun;36(3):E186-e98. doi: 10.1097/htr.0000000000000638..
Keywords: Elderly, Brain Injury, Transitions of Care, Nursing Homes
Hua CL, Cornell PY, Zimmerman S
Trends in serious mental illness in US assisted living compared to nursing homes and the community: 2007-2017.
This study examined trends in the prevalence of serious mental illness (SMI) in assisted living (AL) communities in the United States over time and in relationship to characteristics such as dual eligibility and health conditions. Using Medicare data, findings showed that the prevalence of SMI in AL increased by 54% from 2007 to 2017. Residents with SMI were more likely to be dually eligible for Medicare and Medicaid than residents without SMI. Approximately 10% of AL communities had over half of the sample's AL residents with SMI.
AHRQ-funded; HS000011.
Citation: Hua CL, Cornell PY, Zimmerman S .
Trends in serious mental illness in US assisted living compared to nursing homes and the community: 2007-2017.
Am J Geriatr Psychiatry 2021 May;29(5):434-44. doi: 10.1016/j.jagp.2020.09.011..
Keywords: Elderly, Behavioral Health, Nursing Homes, Long-Term Care, Medicare
Reistetter TA, Eschbach K K, Prochaska J
Understanding variation in postacute care: developing rehabilitation service areas through geographic mapping.
This study’s goal was to demonstrate a method for developing rehabilitation service areas for post-acute care. A secondary analysis of 2013-2014 Medicare records for older patients in Texas (n = 469,172) was conducted. The analysis included admission records for inpatient rehabilitation facilities, skilled nursing facilities, and long-term care hospitals. The authors used Ward’s algorithm to cluster patient ZIP code tabulation areas based on which facilities patients were admitted to for rehabilitation. They set the number of rehabilitation clusters to 22 to allow for comparison to the 22 hospital referral regions. Interclass Correlation Coefficient (ICC) and variance in the number of rehabilitation beds across areas were the methods used to evaluate rehabilitation service areas. The service areas had a higher ICC and variance in beds than the hospital referral regions.
AHRQ-funded; HS024711.
Citation: Reistetter TA, Eschbach K K, Prochaska J .
Understanding variation in postacute care: developing rehabilitation service areas through geographic mapping.
Am J Phys Med Rehabil 2021 May;100(5):465-72. doi: 10.1097/phm.0000000000001577..
Keywords: Elderly, Rehabilitation, Medicare, Nursing Homes, Long-Term Care, Home Healthcare, Access to Care
Downer B, Pritchard K, Thomas KS
Improvement in activities of daily living during a nursing home stay and one-year mortality among older adults with sepsis.
This study looked at the association between recovery of activities of daily living (ADLs) during a skilled nursing facility (SNF) stay and 1-year mortality after SNF discharge among Medicare beneficiaries treated in intensive care for sepsis. This retrospective cohort study identified 59,383 Medicare beneficiaries who were admitted to an SNF within 3 days of discharge from hospitalization that included time in an ICU for sepsis from all of 2013 to October 2015. About 58% of SNF residents showed improvement in ADL function. The higher the improvement in ADL score the less the mortality risk compared to residents who did not improve.
AHRQ-funded; HS026133.
Citation: Downer B, Pritchard K, Thomas KS .
Improvement in activities of daily living during a nursing home stay and one-year mortality among older adults with sepsis.
J Am Geriatr Soc 2021 Apr;69(4):938-45. doi: 10.1111/jgs.16915..
Keywords: Elderly, Nursing Homes, Medicare, Sepsis, Mortality, Outcomes
Lydecker AD, Osei PA, Pineles L
Targeted gown and glove use to prevent Staphylococcus aureus acquisition in community-based nursing homes: a pilot study.
This study tested the feasibility of targeted gown and glove use by healthcare personnel caring for high-risk nursing home residents to present Staphylococcus aureus transmission in short-stay residents. The study included 322 residents in 2 community-based Maryland nursing homes on mixed short- and long-stay units. During a 2-month baseline period, all residents had nose and inguinal fold swabs taken to estimate S. aureus presence. MRSA acquisition rate decreased from 11.9% during the baseline period to 3.6% during the intervention period among short-stay residents. MRSA acquisition rate also decreased from 9.1% during the baseline period to 3.6% during the intervention period for longer-term care residents. Resident-to-resident transmission rate also decreased from 5.9% during the baseline period to 0.8% during the intervention period.
AHRQ-funded; HS025451.
Citation: Lydecker AD, Osei PA, Pineles L .
Targeted gown and glove use to prevent Staphylococcus aureus acquisition in community-based nursing homes: a pilot study.
Infect Control Hosp Epidemiol 2021 Apr;42(4):448-54. doi: 10.1017/ice.2020.1219..
Keywords: Nursing Homes, Healthcare-Associated Infections (HAIs), Methicillin-Resistant Staphylococcus aureus (MRSA), Patient Safety
Evans E, Kosar CM, Thomas KS
Positive beliefs and the likelihood of successful community discharge from skilled nursing facilities.
This retrospective cohort study examined the association of patient and direct-care staff beliefs about patients’ probabilities of a successful discharge to the community after a skilled nursing facility (SNF) stay. 100% Medicare inpatient claims and Minimum Data Set resident assessment data was used to identify a cohort of 526,432 Medicare beneficiaries aged 66 or older who were discharged to an SNF after hospitalization for stroke, hip fracture, or traumatic brain injury. A successful discharge was considered to be patients who were discharged alive 90 or more days after hospitalization and remained in the community for at least 30 days without dying or health care facility readmission. A positive patient attitude was found to increase probability of successful discharge without or without positive staff beliefs. However, the difference in successful discharge probability between patients with positive and negative beliefs was larger when staff had positive beliefs.
AHRQ-funded; HS000011.
Citation: Evans E, Kosar CM, Thomas KS .
Positive beliefs and the likelihood of successful community discharge from skilled nursing facilities.
Arch Phys Med Rehabil 2021 Mar;102(3):480-87. doi: 10.1016/j.apmr.2020.09.375..
Keywords: Elderly, Nursing Homes, Patient-Centered Healthcare
Hass Z, Woodhouse M, Arling G
Using a semi-Markov Model to estimate Medicaid cost savings due to Minnesota's Return to Community Initiative.
This simulation estimated the level of uncertainty for Medicaid cost savings due to Minnesota’s Return to Community Initiative (RTCI). This statewide program assists private paying nursing home residents with discharge to the community. Prior analysis estimated that approximately 1 in 9 residents targeted for transition by the program would not have returned to the community without the RTCI. Data from 30,234 private pay nursing home residents admitted during 2011 to 378 facilities and followed for 4 years postadmission for outcomes and time to event was used. The simulation was run 1000 times with and without the RTCI impact to estimate change in Medicaid nursing home days. Program savings was estimated at $4.1 million per year over a 4-year accumulation period. This is a modest Medicaid cost savings more than the annual program budget of $3.5 million.
AHRQ-funded; HS020224.
Citation: Hass Z, Woodhouse M, Arling G .
Using a semi-Markov Model to estimate Medicaid cost savings due to Minnesota's Return to Community Initiative.
J Am Med Dir Assoc 2021 Mar;22(3):642-47.e1. doi: 10.1016/j.jamda.2020.07.016..
Keywords: Medicaid, Nursing Homes, Healthcare Costs, Transitions of Care
Dean JM, Hreha K, Hong I
Post-acute care use patterns among hospital service areas by older adults in the United States: a cross-sectional study.
This study examined post-stroke acute care patterns across Hospital Service Areas among a national stroke cohort of Medicare beneficiaries to determine drivers of variation in post-acute care service utilization. Data was extracted from 2013 to 2014 (174,498 total records across 3232 Hospital Service Areas). Patients’ residence ZIP codes were linked to the facility ZIP code where care was received. Patients were considered a “traveler” if they did not live in the Hospital Service Area where they received care. Only 23.5% of all patients received care in skilled nursing-only Hospital Service Areas although 73.4% of all Hospital Service Areas were skilled nursing-only. Thirty-five percent of all patients traveled to a different Hospital Service Area from their residence. Patients living in skilled nursing-only Hospital Service Areas had more than 5 times the odds of traveling compared to those living in Hospital Service Areas with skilled nursing, inpatient rehabilitation, and long-term care hospital services.
AHRQ-funded; HS026133; HS024711.
Citation: Dean JM, Hreha K, Hong I .
Post-acute care use patterns among hospital service areas by older adults in the United States: a cross-sectional study.
BMC Health Serv Res 2021 Feb 25;21(1):176. doi: 10.1186/s12913-021-06159-z..
Keywords: Elderly, Hospitals, Access to Care, Stroke, Cardiovascular Conditions, Healthcare Utilization, Rehabilitation, Nursing Homes
Enyioha C, Khairat S, Kistler CE
Adoption of electronic health records by practices of nursing home providers and Wi-Fi availability in nursing homes.
This study evaluated the rate of electronic health record (EHR) adoption by nursing homes (NHs) and nursing home providers and Wi-Fi availability in nursing homes by geographical region. The authors conducted a cross-sectional survey on a convenience sample of NH primary care providers (PCPs) serving 867 NHs recruited from the Medefield Primary Care research panel. They also sought to evaluate the proportion of NHs with Wi-Fi access. The states were categorized into four geographical locations: Midwest, Northeast, South, and West. Participants included a total of 515 physicians, 209 nurse practitioners, and 143 physician assistants. Mean age of participants was 49 years, 56% were male, and 76% white. The mean number of days per week participants worked in a NH was 1.8 and number of hours per week 32.3. Overall, 89.4% reported EHR adoption in their practice, and 73.2% reported Wi-Fi presence in their primary NH. The three most EHRs were EpicCare Ambulatory (24.0%), Vitera (20.4%), and eClinicalWorks (14.4%) Wi-Fi access was highest in the Northeast (78.1%) and lowest in the West (63.9%). Rates of EHR adoption was also highest in the Northeast (94.5%). These differences may help explain continued deficiencies in care coordination between NH and other sites of clinical care.
AHRQ-funded; HS024519.
Citation: Enyioha C, Khairat S, Kistler CE .
Adoption of electronic health records by practices of nursing home providers and Wi-Fi availability in nursing homes.
J Am Med Dir Assoc 2021 Feb;22(2):475-76. doi: 10.1016/j.jamda.2020.09.028..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Nursing Homes, Long-Term Care
Alexander GL, Powell KR, Deroche CB
An evaluation of telehealth expansion in U.S. nursing homes.
This study contains the results of a national survey about telehealth use reported in a random sample of US nursing homes. The sample includes 664 nursing homes that completed surveys about information technology maturity from January 2019 to August 4, 2020. Differences in nursing home telehealth use was examined prior to and after telehealth expansion. A cumulative telehealth score was calculated using survey data from 6 questions about the expansion of telehealth use (score range 0-42). Larger metropolitan nursing homes had greater telehealth use. Ownership type had little effect. Nursing home telehealth use postexpansion used telehealth applications for resident evaluation 11.24 times more than pre-expansion. A wide range of telehealth use was reported, with approximately 16% having no telehealth use and 5% having the maximum amount of telehealth use. Mean telehealth use scores reported by the majority of these nursing homes were on the lower end of the range. However, increasing use will most likely continue due to the current pandemic.
AHRQ-funded; HS022497.
Citation: Alexander GL, Powell KR, Deroche CB .
An evaluation of telehealth expansion in U.S. nursing homes.
J Am Med Inform Assoc 2021 Feb 15;28(2):342-48. doi: 10.1093/jamia/ocaa253..
Keywords: Nursing Homes, Long-Term Care, Telehealth, Health Information Technology (HIT)
Orth J, Li Y, Simning A
End-of-life care among nursing home residents with dementia varies by nursing home and market characteristics.
This study’s objectives were to examine variations in end-of-life (EOL) care/outcomes among decedents with Alzheimer's disease/related dementias (ADRD) and to identify associations with nursing home (NH)/market characteristics. Findings showed that decedents with ADRD in NHs that were nonprofit, had Alzheimer's units, higher licensed nurse staffing, and in more competitive markets, had better EOL care/outcomes. Recommendations included modifications to state Medicaid NH payments to promote better EOL care/outcomes and future research to understand NH care practices associated with presence of Alzheimer's units in order to identify mechanisms possibly promoting higher-quality EOL care.
AHRQ-funded; HS024923.
Citation: Orth J, Li Y, Simning A .
End-of-life care among nursing home residents with dementia varies by nursing home and market characteristics.
J Am Med Dir Assoc 2021 Feb;22(2):320-28.e4. doi: 10.1016/j.jamda.2020.06.021..
Keywords: Elderly, Palliative Care, Dementia, Nursing Homes, Long-Term Care
Hanlon JT, Perera S, Schweon S
Improvements in antibiotic appropriateness for cystitis in older nursing home residents: a quality improvement study with randomized assignment.
This study evaluated the impact of an educational quality improvement initiative on the appropriateness of antibiotic prescribing restricted to uncomplicated cystitis in older noncatheterized nursing home residents. This 1-year case-control study used 25 participating nursing homes that were randomized to the intervention or usual care group by strata that included state, urban/rural status, bed size, and geographic separation. A total of 75 cases of cystitis were found in the intervention groups and 92 in the control groups. The intervention group had a nonsignificant 21% reduction in the risk of antibiotic prescribing. There was a favorable comparison in appropriateness of duration. However, the intervention group had more problems with drug-drug interactions than the control group (8% vs 1%). There were also more problems with dosage in the intervention group. Both groups had similar rates of problems with choice or effectiveness (44% vs 45%). The most common antibiotic class that was prescribed inappropriately was quinolones.
AHRQ-funded; R18 HS023779.
Citation: Hanlon JT, Perera S, Schweon S .
Improvements in antibiotic appropriateness for cystitis in older nursing home residents: a quality improvement study with randomized assignment.
J Am Med Dir Assoc 2021 Jan;22(1):173-77. doi: 10.1016/j.jamda.2020.07.040..
Keywords: Elderly, Nursing Homes, Long-Term Care, Antibiotics, Medication, Quality Improvement, Quality of Care, Urinary Tract Infection (UTI), Decision Making
Beeber AS, Kistler CE, Zimmerman S
Nurse decision-making for suspected urinary tract infections in nursing homes: potential targets to reduce antibiotic overuse.
This study’s goal was to determine what information is most important to registered nurses (RNs) decisions to call clinicians about suspected urinary tract infections (UTIs) in nursing home residents. An online survey was conducted with a convenience sample of 881 RNs recruited from a health care research panel. Clinical scenarios from 10 categories of resident characteristics were used: UTI risk, resident type, functional status, mental status, lower urinary tract status, body temperature, physical exam, urinalysis, antibiotic request, and goals of care. Participants were randomized into 2 deliberation conditions: self-paced (n=437) and forced deliberation (n=444). Painful or difficult urinary, obvious blood in urine and temperature at 101.5° had the highest odds of a RN calling a clinician by the forced-deliberation group. For the self-paced group, painful or difficult urination had the highest odds.
AHRQ-funded; HS024519.
Citation: Beeber AS, Kistler CE, Zimmerman S .
Nurse decision-making for suspected urinary tract infections in nursing homes: potential targets to reduce antibiotic overuse.
J Am Med Dir Assoc 2021 Jan;22(1):156-63. doi: 10.1016/j.jamda.2020.06.053..
Keywords: Urinary Tract Infection (UTI), Antibiotics, Antimicrobial Stewardship, Medication, Nursing Homes, Long-Term Care, Decision Making, Diagnostic Safety and Quality
Montoya A, Jenq G, Mills JP
Partnering with local hospitals and public health to manage COVID-19 outbreaks in nursing homes.
In this study, the authors described, among short-term and long-term residents at three nursing homes (NHs) in Michigan, the outbreak identification process, universal testing, point prevalence of COVID-19, and subsequent containment efforts, outcomes, and challenges. They found that proactive and coordinated steps between NH medical directors and administrators, referral hospitals including their laboratories, and local public health officials were necessary to respond rapidly to an outbreak and to limit the transmission of COVID-19. They suggested that this coordinated public health approach may save lives, minimize the burden to the healthcare system, and reduce healthcare costs.
AHRQ-funded; HS025451.
Citation: Montoya A, Jenq G, Mills JP .
Partnering with local hospitals and public health to manage COVID-19 outbreaks in nursing homes.
J Am Geriatr Soc 2021 Jan;69(1):30-36. doi: 10.1111/jgs.16869..
Keywords: Hospitals, Nursing Homes, Long-Term Care, Public Health, COVID-19, Elderly, Infectious Diseases
Kim JJ, Johnson JK, Stucke EM
Burden of perianal Staphylococcus aureus colonization in nursing home residents increases transmission to healthcare worker gowns and gloves.
Transmission of Staphylococcus aureus (S. aureus) to health care workers (HCWs) on gowns and gloves has been an issue in nursing homes. This study evaluated the effect of the burden in 13 community-based nursing homes in Maryland and Michigan. Residents were cultured for S. aureus at the perianal skin and the anterior nares areas. A total of 403 residents were enrolled, with 169 colonized with methicillin-resistant S. aureus (MRSA) or methicillin-sensitive S. aureus (MSSA). Transmission to HCW gowns and gloves was greater from those colonized with greater quantities of S. aureus on the perianal skin. These findings inform future infection control practices for both MRSA and MSSA in nursing homes.
AHRQ-funded; HS019979; HS025451.
Citation: Kim JJ, Johnson JK, Stucke EM .
Burden of perianal Staphylococcus aureus colonization in nursing home residents increases transmission to healthcare worker gowns and gloves.
Infect Control Hosp Epidemiol 2020 Dec;41(12):1396-401. doi: 10.1017/ice.2020.336..
Keywords: Elderly, Nursing Homes, Long-Term Care, Healthcare-Associated Infections (HAIs), Infectious Diseases, Methicillin-Resistant Staphylococcus aureus (MRSA), Prevention
Temkin-Greener H, Guo W, Mao Y
COVID-19 pandemic in assisted living communities: results from seven states.
The purpose of this observational study was to describe variations in COVID-19 confirmed cases and deaths among assisted living (AL) residents and examine their associations with key AL characteristics. The investigators concluded that ALs with a higher proportion of minorities had more COVID-19 cases. Many of the previously identified individual risk factors were also present in this vulnerable population.
AHRQ-funded; HS024923; HS026893; HS026893.
Citation: Temkin-Greener H, Guo W, Mao Y .
COVID-19 pandemic in assisted living communities: results from seven states.
J Am Geriatr Soc 2020 Dec;68(12):2727-34. doi: 10.1111/jgs.16850..
Keywords: Elderly, Public Health, COVID-19, Nursing Homes, Vulnerable Populations, Risk
McKinnell JA, Miller LG, Singh RD
High prevalence of multidrug-resistant organism colonization in 28 nursing homes: an "iceberg effect."
The objective of this study was to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended-spectrum beta-lactamase producing organisms (ESBLs), and carbapenem-resistant Enterobacteriaceae (CRE) among residents and in the environment of nursing homes (NHs). The investigators concluded that in more than half of the NHs, more than 50% of residents were colonized with MDROs of clinical and public health significance, most commonly MRSA and ESBL. Additionally, the vast majority of resident rooms and common areas were MDRO contaminated.
AHRQ-funded; HS024286.
Citation: McKinnell JA, Miller LG, Singh RD .
High prevalence of multidrug-resistant organism colonization in 28 nursing homes: an "iceberg effect."
J Am Med Dir Assoc 2020 Dec;21(12):1937-43.e2. doi: 10.1016/j.jamda.2020.04.007..
Keywords: Nursing Homes, Long-Term Care, Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs)
Konetzka RT, Jung DH, Gorges RJ
Outcomes of Medicaid home- and community-based long-term services relative to nursing home care among dual eligibles.
This study measured the outcomes of dual-eligible recipients of Medicaid home- and community-based long-term services (HCBS) compared to nursing home residents. The authors used the 2005 and 2012 Medicaid Analytic eXtract (MAX) database, a national compilation of Medicaid claims which merges Medicare claims to identify hospital admissions. A cohort of 1,312,498 older adults dually enrolled in Medicaid and Medicare and using long-term care was tracked. HCBS users were found to have 10 percent points higher annual rates of hospitalization than their nursing home counterparts when selection bias is addressed. The differences persisted across races, dementia status, and intensity of HCBS spending.
AHRQ-funded; HS000084.
Citation: Konetzka RT, Jung DH, Gorges RJ .
Outcomes of Medicaid home- and community-based long-term services relative to nursing home care among dual eligibles.
Health Serv Res 2020 Dec;55(6):973-82. doi: 10.1111/1475-6773.13573..
Keywords: Elderly, Long-Term Care, Nursing Homes, Medicaid, Medicare, Outcomes