National Healthcare Quality and Disparities Report
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Topics
- Access to Care (4)
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- Antimicrobial Stewardship (12)
- Behavioral Health (5)
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- Chronic Conditions (3)
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- Communication (2)
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- Medication (30)
- Medication: Safety (3)
- Men's Health (1)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (5)
- Mortality (3)
- Neurological Disorders (9)
- Nursing (1)
- (-) Nursing Homes (158)
- Nutrition (1)
- Obesity (2)
- Opioids (3)
- Organizational Change (1)
- Outcomes (5)
- Pain (3)
- Palliative Care (1)
- Patient-Centered Healthcare (1)
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- Patient and Family Engagement (2)
- Patient Experience (2)
- Patient Safety (25)
- Payment (2)
- Pneumonia (3)
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- Practice Patterns (5)
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- Sleep Problems (1)
- Social Determinants of Health (1)
- Stroke (1)
- Surgery (1)
- Surveys on Patient Safety Culture (1)
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- Transitions of Care (9)
- Urinary Tract Infection (UTI) (9)
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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
101 to 125 of 158 Research Studies DisplayedMcCreedy E, Loomer L, Palmer JA
Representation in the care planning process for nursing home residents with dementia.
This study examined the participation of residents, family members, or representatives in nursing home (NH) long-term care planning for residents with cognitive impairment. A large for-profit NH system was used to recruit study participants. A sample of 18,552 long-stay NH residents in 2016 were surveyed. Of residents with no cognitive impairment, 8% had family or representative participation in care planning, compared with 26% of residents with severe impairments. Family participation was greater in NHs with more social workers.
AHRQ-funded; HS000011.
Citation: McCreedy E, Loomer L, Palmer JA .
Representation in the care planning process for nursing home residents with dementia.
J Am Med Dir Assoc 2018 May;19(5):415-21. doi: 10.1016/j.jamda.2018.01.004..
Keywords: Dementia, Nursing Homes, Long-Term Care, Patient and Family Engagement, Neurological Disorders
Dore DD, Zullo AR, Mor V
Age, sex, and dose effects of nonbenzodiazepine hypnotics on hip fracture in nursing home residents.
This study examined the rate of hip fracture in nursing home residents prescribed nonbenzodiazepine hypnotics. A sample of nursing home residents was used and linked to Medicare and Minimum Data Set (2007-2008) data. The rate of hip fracture was higher in residents aged 90 and above, and lower in residents 70 or below. There was no different by sex.
AHRQ-funded; HS022998.
Citation: Dore DD, Zullo AR, Mor V .
Age, sex, and dose effects of nonbenzodiazepine hypnotics on hip fracture in nursing home residents.
J Am Med Dir Assoc 2018 Apr;19(4):328-32.e2. doi: 10.1016/j.jamda.2017.09.015..
Keywords: Injuries and Wounds, Medication, Nursing Homes, Long-Term Care, Adverse Drug Events (ADE), Adverse Events, Falls, Risk, Patient Safety
Li S, Middleton A, Ottenbacher KJ
Trajectories over the first year of long-term care nursing home residence.
This retrospective cohort study examined changes in situation for Medicare fee-for-service beneficiaries newly admitted to long-term nursing homes from July 2012 to December 2013 for the first year after admission. Data was used from the Minimum Data Set and Medicare Provider and Analysis Reviews claims data. Median length of stay in long-term care was 127 days, and for any institution 158 days. At 12 months post admission, 35% had died, 36.9% remained in long-term care, 23.4% were in the community, and 4.7% were in acute care hospitals or other institutions.
AHRQ-funded; HS022134.
Citation: Li S, Middleton A, Ottenbacher KJ .
Trajectories over the first year of long-term care nursing home residence.
J Am Med Dir Assoc 2018 Apr;19(4):333-41. doi: 10.1016/j.jamda.2017.09.021.
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Keywords: Long-Term Care, Nursing Homes, Elderly, Medicare, Patient-Centered Outcomes Research, Outcomes
Jump RLP, Crnich CJ, Mody L
Infectious diseases in older adults of long-term care facilities: update on approach to diagnosis and management.
The diagnosis, treatment, and prevention of infectious diseases in older adults in long-term care facilities (LTCFs), particularly nursing facilities, remains a challenge for all health providers who care for this population. This review provides updated information on the currently most important challenges of infectious diseases in LTCFs. With the increasing prescribing of antibiotics in older adults, particularly in LTCFs, the topic of antibiotic stewardship is presented in this review.
AHRQ-funded; HS022465.
Citation: Jump RLP, Crnich CJ, Mody L .
Infectious diseases in older adults of long-term care facilities: update on approach to diagnosis and management.
J Am Geriatr Soc 2018 Apr;66(4):789-803. doi: 10.1111/jgs.15248.
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Keywords: Elderly, Healthcare-Associated Infections (HAIs), Infectious Diseases, Nursing Homes, Long-Term Care, Antimicrobial Stewardship, Antibiotics, Medication, Evidence-Based Practice, Guidelines
Berridge C, Tyler DA, Miller SC
Staff empowerment practices and CNA retention: findings from a nationally representative nursing home culture change survey.
This article examines whether staff empowerment practices common to nursing home culture change are associated with certified nursing assistant (CNA) retention. It concluded that after adjustment for covariates, a greater staff empowerment practice score was positively associated with greater retention. Compared with the low empowerment category, nursing homes with scores in the medium category had a 44 percent greater likelihood of having higher CNA retention.
AHRQ-funded; HS000011.
Citation: Berridge C, Tyler DA, Miller SC .
Staff empowerment practices and CNA retention: findings from a nationally representative nursing home culture change survey.
J Appl Gerontol 2018 Apr;37(4):419-34. doi: 10.1177/0733464816665204.
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Keywords: Long-Term Care, Nursing Homes, Provider, Provider: Health Personnel, Workforce
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
Makam AN, Nguyen OK, Xuan L
Factors associated with variation in long-term acute care hospital vs skilled nursing facility use among hospitalized older adults.
This study examined factors associated with variation in long-term acute care hospitals (LTACs) vs less costly skilled nursing facilities (SNFs) transfer among hospitalized older adults. It concluded that half of the variation in LTAC vs SNF transfer is independent of patients' illness severity or clinical complexity, and is explained by where the patient was hospitalized and in what region, with far greater use in the South.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Xuan L .
Factors associated with variation in long-term acute care hospital vs skilled nursing facility use among hospitalized older adults.
JAMA Intern Med 2018 Mar;178(3):399-405. doi: 10.1001/jamainternmed.2017.8467.
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Keywords: Elderly, Long-Term Care, Hospitals, Nursing Homes, Transitions of Care
Sorkin DH, Amin A, Weimer DL
Hospital discharge and selecting a skilled nursing facility: a comparison of experiences and perspectives of patients and their families.
This article seeks to examine and compare the experiences and perspectives of patients and others involved in the selection of the nursing home (predominately adult children and spouses). It found that patients were the primary decision makers about 23 percent of the time but were often involved in the decision even when family members/involved others were primarily making decisions in the discharge process.
AHRQ-funded; HS021844.
Citation: Sorkin DH, Amin A, Weimer DL .
Hospital discharge and selecting a skilled nursing facility: a comparison of experiences and perspectives of patients and their families.
Prof Case Manag 2018 Mar/Apr;23(2):50-59. doi: 10.1097/ncm.0000000000000252.
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Keywords: Decision Making, Hospital Discharge, Long-Term Care, Nursing Homes, Patient Experience
Ye L, Richards KC
Sleep and long-term care.
This review describes the nature and consequences of sleep disturbances in long-term care (LTC), clinical assessment and management of sleep disturbances in LTC, and implications for future research and clinical practice.
AHRQ-funded; HS024330.
Citation: Ye L, Richards KC .
Sleep and long-term care.
Sleep Med Clin 2018 Mar;13(1):117-25. doi: 10.1016/j.jsmc.2017.09.011..
Keywords: Quality of Care, Long-Term Care, Nursing Homes, Sleep Problems
Zullo AR, Zhang T, Beudoin FL
Pain treatments after hip fracture among older nursing home residents.
In this retrospective cohort study the investigators examined the association between use of opioids versus other analgesics with death and functioning after hip fracture in older nursing home (NH) residents. The investigators concluded that a rigorous study addressing the limitations of their study is critical to validate their preliminary findings and provide evidence about the effect of using opioid versus nonopioid analgesics to optimize acute pain in NH residents with a hip fracture.
AHRQ-funded; HS022998.
Citation: Zullo AR, Zhang T, Beudoin FL .
Pain treatments after hip fracture among older nursing home residents.
J Am Med Dir Assoc 2018 Feb;19(2):174-76. doi: 10.1016/j.jamda.2017.11.008..
Keywords: Opioids, Pain, Nursing Homes, Long-Term Care, Elderly, Medication, Injuries and Wounds, Patient-Centered Outcomes Research, Healthcare Utilization
Kerstenetzky L, Birschbach MJ, Beach KF
Improving medication information transfer between hospitals, skilled-nursing facilities, and long-term-care pharmacies for hospital discharge transitions of care: a targeted needs assessment using the Intervention Mapping framework.
The authors of this study report on the development of a logic model that will be used to explore methods for minimizing patient care medication delays and errors while further improving handoff communication to skilled nurse facilities and long term care pharmacy staff.
AHRQ-funded; HS021984.
Citation: Kerstenetzky L, Birschbach MJ, Beach KF .
Improving medication information transfer between hospitals, skilled-nursing facilities, and long-term-care pharmacies for hospital discharge transitions of care: a targeted needs assessment using the Intervention Mapping framework.
Res Social Adm Pharm 2018 Feb;14(2):138-45. doi: 10.1016/j.sapharm.2016.12.013..
Keywords: Adverse Drug Events (ADE), Hospital Discharge, Hospitals, Long-Term Care, Medical Errors, Medication, Medication: Safety, Nursing Homes, Patient Safety, Transitions of Care
Blackburn J, Albright KC, Haley WE
Men lacking a caregiver have greater risk of long-term nursing home placement after stroke.
The purpose of this study was to understand how the availability of a caregiver can affect nursing home placement after ischemic stroke and how this affects different subgroups differently. The investigators found that in men aged 65 and older who have survived an ischemic stroke, the lack of an available caregiver is associated with triple the risk of NHP within 5 years.
AHRQ-funded; HS023009.
Citation: Blackburn J, Albright KC, Haley WE .
Men lacking a caregiver have greater risk of long-term nursing home placement after stroke.
J Am Geriatr Soc 2018 Jan;66(1):133-39. doi: 10.1111/jgs.15166..
Keywords: Cardiovascular Conditions, Caregiving, Elderly, Long-Term Care, Men's Health, Nursing Homes, Stroke
Middleton A, Li S, Kuo YF
New institutionalization in long-term care after hospital discharge to skilled nursing facility.
Approximately half of individuals newly admitted to long-term care (LTC) nursing homes (NHs) experienced a prior hospitalization followed by discharge to a skilled nursing facility (SNF). The objective of this study was to examine characteristics associated with new institutionalizations of older adults on this care trajectory. Associations between risk factors and new LTC institutionalizations varied according to race and ethnicity, age, and level of cognitive function.
AHRQ-funded; HS022134.
Citation: Middleton A, Li S, Kuo YF .
New institutionalization in long-term care after hospital discharge to skilled nursing facility.
J Am Geriatr Soc 2018 Jan;66(1):56-63. doi: 10.1111/jgs.15131..
Keywords: Long-Term Care, Nursing Homes, Hospital Discharge, Elderly, Hospitalization, Medicare
Blackburn J, Zheng Q, Grabowski DC
Nursing home chain affiliation and its impact on specialty service designation for Alzheimer disease.
Specialty care units (SCUs) in nursing homes (NHs) grew in popularity during the 1990s to attract residents while national policies and treatment paradigms changed. Alzheimer disease has consistently been the dominant form of SCU. This study explored the extent to which chain affiliation, which is common among NHs, affected SCU bed designation.
AHRQ-funded; HS023009.
Citation: Blackburn J, Zheng Q, Grabowski DC .
Nursing home chain affiliation and its impact on specialty service designation for Alzheimer disease.
Inquiry 2018 Jan-Dec;55:46958018787992. doi: 10.1177/0046958018787992..
Keywords: Elderly, Nursing Homes, Long-Term Care, Dementia, Neurological Disorders
Krein SL, Harrod M, Collier S
A national collaborative approach to reduce catheter-associated urinary tract infections in nursing homes: a qualitative assessment.
AHRQ’s Safety Program for Long-term Care: Health Care-Associated Infections/Catheter-Associated Urinary Tract Infection, a national performance improvement program, was designed to promote implementation of a catheter-associated urinary tract infections (CAUTI) prevention program through state-based or regional collaboratives in more than 500 nursing homes across the United States. The observed program success and positive views of those participating suggest that collaboratives are an important strategy for providing nursing homes with enhanced expertise and support.
AHRQ-funded; 290201000025I; 29032008T.
Citation: Krein SL, Harrod M, Collier S .
A national collaborative approach to reduce catheter-associated urinary tract infections in nursing homes: a qualitative assessment.
Am J Infect Control 2017 Dec;45(12):1342-48. doi: 10.1016/j.ajic.2017.07.006.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Long-Term Care, Nursing Homes, Quality Improvement, Patient Safety
Britton MC, Ouellet GM, Minges KE
Care transitions between hospitals and skilled nursing facilities: perspectives of sending and receiving providers.
This study was conducted to identify the perspectives of sending and receiving providers regarding care transitions between the hospital and skilled nursing facilities. Four main themes emerged: increasing patient complexity, identifying an optimal care setting, rising financial pressure, and barriers to effective communication. The investigators indicated that the data highlighted hospital and SNF providers' shared concerns about patient-level risk factors and escalating costs of care.
AHRQ-funded; HS023554.
Citation: Britton MC, Ouellet GM, Minges KE .
Care transitions between hospitals and skilled nursing facilities: perspectives of sending and receiving providers.
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Keywords: Communication, Long-Term Care, Nursing Homes, Risk, Transitions of Care
Katz MJ, Gurses AP, Tamma PD
AHRQ Author: Miller MA
Implementing antimicrobial stewardship in long-term care settings: an integrative review using a human factors approach.
In this integrative review, the authors analyzed published evidence in the context of a human factors engineering approach as well as educational interventions to understand aspects of multimodal interventions associated with the implementation of successful stewardship programs in long term care facilities. The outcomes indicate that effective antimicrobial stewardship in long-term care is supported by incorporating multidisciplinary education, tools integrated into the workflow of nurses and prescribers that facilitate review of antibiotic use, and involvement of infectious disease consultants.
AHRQ-authored; AHRQ-funded; 2332015000201.
Citation: Katz MJ, Gurses AP, Tamma PD .
Implementing antimicrobial stewardship in long-term care settings: an integrative review using a human factors approach.
Clin Infect Dis 2017 Nov;65(11):1943-51. doi: 10.1093/cid/cix566.
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Keywords: Antimicrobial Stewardship, Healthcare-Associated Infections (HAIs), Elderly, Long-Term Care, Nursing Homes
Banaszak-Holl J, Reichert H, Todd Greene M
Do safety culture scores in nursing homes depend on job role and ownership? Results from a national survey.
Researchers sought to identify facility- and individual-level predictors of nursing home safety culture. Their survey of nursing home staff (N = 14,177) from 170 of 210 participating facilities found that perceptions of safety culture vary widely among nursing home staff, with administrators consistently perceiving better safety culture than clinical staff who spend more time with residents.
AHRQ-funded; 2902010000251.
Citation: Banaszak-Holl J, Reichert H, Todd Greene M .
Do safety culture scores in nursing homes depend on job role and ownership? Results from a national survey.
J Am Geriatr Soc 2017 Oct;65(10):2244-50. doi: 10.1111/jgs.15030.
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Keywords: Patient Safety, Nursing Homes, Long-Term Care
Mody L, Greene MT, Meddings J
AHRQ Author: Burwen DR, Battles J
A national implementation project to prevent catheter-associated urinary tract infection in nursing home residents.
The researchers developed, implemented, and evaluated an intervention to reduce catheter-associated urinary tract infection (UTI). They found that in a large-scale, national implementation project involving community-based nursing homes, combined technical and socioadaptive catheter-associated UTI prevention interventions successfully reduced the incidence of catheter-associated UTIs.
AHRQ-authored; AHRQ-funded; 290201000025I; HS019767; HS024385; HS018334.
Citation: Mody L, Greene MT, Meddings J .
A national implementation project to prevent catheter-associated urinary tract infection in nursing home residents.
JAMA Intern Med 2017 Aug;177(8):1154-62. doi: 10.1001/jamainternmed.2017.1689.
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Keywords: Antibiotics, Catheter-Associated Urinary Tract Infection (CAUTI), Elderly, Long-Term Care, Nursing Homes, Prevention, Urinary Tract Infection (UTI)
Jutkowitz E, Kuntz KM, Dowd B
Effects of cognition, function, and behavioral and psychological symptoms on out-of-pocket medical and nursing home expenditures and time spent caregiving for persons with dementia.
This study used cross-sectional data (Aging, Demographics, and Memory Study) to estimate probabilities of experiencing outcomes by clinical features. It found that no clinical feature predicted the probability of having out-of-pocket medical expenditures. For those with medical expenditures, higher cognition and poorer function were associated with more spending.
AHRQ-funded; HS024165.
Citation: Jutkowitz E, Kuntz KM, Dowd B .
Effects of cognition, function, and behavioral and psychological symptoms on out-of-pocket medical and nursing home expenditures and time spent caregiving for persons with dementia.
Alzheimers Dement 2017 Jul;13(7):801-09. doi: 10.1016/j.jalz.2016.12.011.
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Keywords: Caregiving, Dementia, Elderly, Healthcare Costs, Long-Term Care, Neurological Disorders, Nursing Homes
Goodwin JS, Li S, Zhou J
Comparison of methods to identify long term care nursing home residence with administrative data.
Researchers compared different methods for identifying a long term care (LTC) nursing home stay, distinct from stays in skilled nursing facilities (SNFs), to the method currently used by the Center for Medicare and Medicaid Services (CMS). They concluded that using both Medicare and Minimum Data Set (MDS), data to identify LTC stays will lead to more accurate attribution of CMS nursing home quality indicators.
AHRQ-funded; HS022134.
Citation: Goodwin JS, Li S, Zhou J .
Comparison of methods to identify long term care nursing home residence with administrative data.
BMC Health Serv Res 2017 May 30;17(1):376. doi: 10.1186/s12913-017-2318-9.
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Keywords: Data, Long-Term Care, Nursing Homes, Quality Indicators (QIs)
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)
Mody L, Greene MT, Saint S
Comparing catheter-associated urinary tract infection prevention programs between Veterans Affairs nursing homes and non-Veterans Affairs nursing homes.
Nursing homes provided baseline information about their infection prevention programs to assess strengths and gaps related to catheter-associated urinary tract infection (CAUTI) prevention via a needs assessment questionnaire. Among nursing homes participating in an AHRQ-funded collaborative, VA and non-VA nursing homes differed in their approach to CAUTI prevention. Best practices from both settings should be applied universally to create an optimal infection prevention program within emerging integrated healthcare systems.
AHRQ-funded; 290201000025I; HS019767; HS024385; HS018334.
Citation: Mody L, Greene MT, Saint S .
Comparing catheter-associated urinary tract infection prevention programs between Veterans Affairs nursing homes and non-Veterans Affairs nursing homes.
Infect Control Hosp Epidemiol 2017 Mar;38(3):287-93. doi: 10.1017/ice.2016.279.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Long-Term Care, Nursing Homes, Prevention
Fain KM, Alexander GC, Dore DD
Frequency and predictors of analgesic prescribing in U.S. nursing home residents with persistent pain.
The purpose of this study was to quantify prescription analgesic use of elderly nursing home (NH) residents with persistent noncancer pain and to identify individual and facility traits associated with no treatment. The investigators concluded that through 2008, pain remained undertreated in NHs, especially in certain subpopulations, including cognitively impaired and older residents. The authors suggest that changes in pain management practice and policies may be necessary to target these vulnerable residents.
AHRQ-funded; HS022998.
Citation: Fain KM, Alexander GC, Dore DD .
Frequency and predictors of analgesic prescribing in U.S. nursing home residents with persistent pain.
J Am Geriatr Soc 2017 Feb;65(2):286-93. doi: 10.1111/jgs.14512..
Keywords: Care Management, Chronic Conditions, Elderly, Long-Term Care, Medication, Nursing Homes, Opioids, Pain, Practice Patterns
Fain KM, Castillo-Salgado C, Dore DD
Inappropriate fentanyl prescribing among nursing home residents in the United States.
In this cross-sectional study, the investigators quantified transdermal fentanyl prescribing in elderly nursing home residents without prior opioid use or persistent pain, and the association of individual and facility traits with opioid-naive prescribing. The investigators concluded that most nursing home residents initiating transdermal fentanyl did not have persistent pain and many were opioid-naive. They suggest that changes in prescribing practices may be necessary to ensure Food and Drug Administration warnings are followed, particularly for vulnerable subgroups, such as the cognitively impaired.
AHRQ-funded; HS018960.
Citation: Fain KM, Castillo-Salgado C, Dore DD .
Inappropriate fentanyl prescribing among nursing home residents in the United States.
J Am Med Dir Assoc 2017 Feb;18(2):138-44. doi: 10.1016/j.jamda.2016.08.015..
Keywords: Care Management, Chronic Conditions, Elderly, Long-Term Care, Medication, Nursing Homes, Opioids, Pain, Practice Patterns