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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 19 of 19 Research Studies DisplayedNapolitano N, Polikoff L, Edwards L
Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children.
This study’s goal was to determine if apneic oxygenation (AO) delivered via nasal cannula during the apneic phase of tracheal intubation (TI) reduces adverse TI-associated events (TIAEs) in children. AO was implemented at 14 pediatric intensive care units as a quality improvement intervention from 2016 through 2020. Implementation consisted of an intubation safety checklist, leadership endorsement, use of a local champion, and data feedback to frontline clinicians. Of 6549 TIs during the study period, 2554 occurred during the pre-implementation phase and 3995 during post-implementation phase. AO utilization increased from 23 to 68%. It was utilized less often when intubating infants, those with a primary cardiac diagnosis or difficult airway features, and patients intubated due to respiratory or neurological failure or shock. Conversely, it was used more often in TIs done for procedures or those associated by video laryngoscopy. AO utilization was associated with a lower incidence of adverse TIAEs (AO 10.5% vs. without AO 13.5%). However, after further adjusting for patient and provider characteristics (secondary analysis), AO utilization was not independently associated with the occurrence of adverse TIAEs, and the occurrence of hypoxemia was not different (AO 14.2% versus without AO 15.2%).
AHRQ-funded; HS024511.
Citation: Napolitano N, Polikoff L, Edwards L .
Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children.
Crit Care 2023 Jan 17; 27(1):26. doi: 10.1186/s13054-023-04304-0..
Keywords: Children/Adolescents, Critical Care, Adverse Events, Respiratory Conditions
Lindell RB, Fitzgerald JC, Rowan CM
The use and duration of preintubation respiratory support is associated with increased mortality in immunocompromised children with acute respiratory failure.
The purpose of this retrospective cohort study was to examine the relationship between preintubation respiratory support and outcomes in pediatric patients with acute respiratory failure and to evaluate the impact of immunocompromised (IC) diagnoses on outcomes. The study utilized data from the Virtual Pediatric Systems database which included 82 centers, and focused on patients intubated in the Pediatric Intensive Care Unit (PICU) ranging in age from 1 month old to 17 years of age who received invasive mechanical ventilation (IMV) for more than or equal to 24 hours. Of the 5,348 PICU intubations across 82 centers, high-flow nasal cannula (HFNC) or noninvasive positive-pressure ventilation (NIPPV) or both were used before intubation in 34% (1,825) of patients. Fifty percent of the patients had no IC diagnosis. The researchers found that exposure to HFNC was associated with greater odds of PICU mortality when compared with patients intubated without prior support. When analyzing subgroups of IC status, preintubation support was related to higher odds of PICU mortality in IC patients and HCT patients when compared with IC/ HCT patients intubated without prior respiratory support. A duration of HFNC/NIPPV of more than 6 hours was associated with increased mortality in IC HCT patients. Rates of preintubation HFNC/NIPPV use and PICU mortality varied between the 82 centers. The researchers concluded that greater duration of exposure to HFNC/NIPPV prior to IMV is associated with increased mortality in HCT patients, and preintubation exposure to HFNC and/or NIPPV in IC pediatric patients is associated with increased odds of PICU mortality, independent of the severity of the illness.
AHRQ-funded; HS024511.
Citation: Lindell RB, Fitzgerald JC, Rowan CM .
The use and duration of preintubation respiratory support is associated with increased mortality in immunocompromised children with acute respiratory failure.
Crit Care Med 2022 Jul;50(7):1127-37. doi: 10.1097/ccm.0000000000005535..
Keywords: Children/Adolescents, Respiratory Conditions, Mortality, Critical Care
Wayne MT, Seelye S, Molling D
Variation in U.S. hospital practices for bronchoscopy in the intensive care unit.
The authors sought to measure bronchoscopy rates among mechanically ventilated ICU patients and to assess for variation across hospitals. In this cohort of over 150 diverse hospitals across the United States, they found that nearly 4% of mechanically ventilated ICU patients underwent bronchoscopy, representing a more than 20-fold variation in its use, which was only minimally attenuated after adjusting for patient and hospital characteristics. They recommended future studies to understand the drivers and impact of this variation on patient outcomes.
AHRQ-funded; HS028038.
Citation: Wayne MT, Seelye S, Molling D .
Variation in U.S. hospital practices for bronchoscopy in the intensive care unit.
Ann Am Thorac Soc 2022 Jun;19(6):1061-65. doi: 10.1513/AnnalsATS.202110-1141RL..
Keywords: Hospitals, Intensive Care Unit (ICU), Critical Care, Respiratory Conditions
Ginestra JC, Mitchell OJL, Anesi GL
COVID-19 critical illness: a data-driven review.
This paper is a data-driven review of COVID-19 critical illness, including the extreme demand for intensive care unit (ICU) resources and the rapidly evolving understanding of the disease. Almost one-third of hospitalized patients with COVID-19 experience critical illness. The most common type of organ failure experienced is acute hypoxic respiratory failure, which presents clinically as acute respiratory distress syndrome (ARDS) in three-quarters of ICU patients. Management of ARDS in COVID-19 patients is similar to that of non-COVID-19 ARDS patients. Mortality rates have decreased over the course of the pandemic likely due to increasing disease familiarity, data-driven pharmacologics, and improved adherence to evidence-based critical care.
AHRQ-funded; HS026372.
Citation: Ginestra JC, Mitchell OJL, Anesi GL .
COVID-19 critical illness: a data-driven review.
Annu Rev Med 2022 Jan 27;73:95-111. doi: 10.1146/annurev-med-042420-110629..
Keywords: COVID-19, Critical Care, Respiratory Conditions, Intensive Care Unit (ICU)
Geneslaw AS, Lu Y, Miles CH
Long-term increases in mental disorder diagnoses after invasive mechanical ventilation for severe childhood respiratory disease: a propensity matched observational cohort study.
They found that children without major comorbidity requiring invasive mechanical ventilation for severe respiratory illness had a 43% higher incidence of subsequent mental disorder diagnoses and a 67% higher incidence of psychotropic medication use. Both increases were substantially higher than in PICU patients with respiratory illness not necessitating invasive mechanical ventilation. They recommended further research to determine which factors related to invasive mechanical ventilation and severe respiratory illness are associated with abnormal neurodevelopment.
AHRQ-funded; HS022941.
Citation: Geneslaw AS, Lu Y, Miles CH .
Long-term increases in mental disorder diagnoses after invasive mechanical ventilation for severe childhood respiratory disease: a propensity matched observational cohort study.
Pediatr Crit Care Med 2021 Dec;22(12):1013-25. doi: 10.1097/pcc.0000000000002790..
Keywords: Children/Adolescents, Respiratory Conditions, Behavioral Health, Critical Care
Gershengorn HB, Hu Y, Chen JT
The impact of high-flow nasal cannula use on patient mortality and the availability of mechanical ventilators in COVID-19.
This study looked at the effects of the use of high-flow nasal cannula for COVID-19 patients on mortality and the availability of mechanical ventilators. The authors constructed dynamical simulation models of high-flow nasal cannula and mechanical ventilation use in the United States. There were two outcomes looked for: 1) cumulative number of deaths; and 2) days without available ventilators. The strategy resulted in an estimated number of 10,000-40,000 fewer deaths than if high-flow nasal cannula were not available. This strategy also led up to 25 fewer days without available ventilators.
AHRQ-funded; HS026188.
Citation: Gershengorn HB, Hu Y, Chen JT .
The impact of high-flow nasal cannula use on patient mortality and the availability of mechanical ventilators in COVID-19.
Ann Am Thorac Soc 2021 Apr;18(4):623-31. doi: 10.1513/AnnalsATS.202007-803OC..
Keywords: COVID-19, Respiratory Conditions, Mortality, Critical Care
Anesi GL, Chelluri J, Qasim ZA
Association of an emergency department-embedded critical care unit with hospital outcomes and intensive care unit use.
The purpose of this study was to evaluate the potential impact of an emergency department-embedded critical care unit (CCU) at the Hospital of the University of Pennsylvania among patients with sepsis and acute respiratory failure (ARF) admitted from the emergency department to a medical ward or ICU from January 2016 to December 2017. Findings showed that the emergency department-embedded CCU was not associated with clinical outcomes among patients admitted with sepsis or ARF. Among less sick patients with sepsis, the emergency department-embedded CCU was initially associated with reduced rates of direct ICU admission from the emergency department. Further research was recommended to further evaluate the impact and utility of the emergency department-embedded CCU model.
AHRQ-funded; HS026372.
Citation: Anesi GL, Chelluri J, Qasim ZA .
Association of an emergency department-embedded critical care unit with hospital outcomes and intensive care unit use.
Ann Am Thorac Soc 2020 Dec;17(12):1599-609. doi: 10.1513/AnnalsATS.201912-912OC..
Keywords: Emergency Department, Critical Care, Intensive Care Unit (ICU), Hospitals, Sepsis, Respiratory Conditions, Outcomes, Patient-Centered Outcomes Research, Healthcare Delivery
Brady AK, Brown W, Denson JL
Variation in intensive care unit intubation practices in pulmonary critical care medicine fellowship.
This study looked at outcomes of participation of fellows for Pulmonary and Critical Medicine (PCCM) training in endotracheal intubation in the medical intensive care unit (ICU). The authors administered a survey to a convenience sample of US PCCM fellows. A total of 89 discrete US PCCM and Internal Medicine CCM training programs were represented. Almost half (43%) of PCCM fellows were “always or almost always” designed the primary operator for intubation, whereas 21% of programs had the PCCM fellow “rarely or never” the primary operator responsible for intubating in the ICU. Various influencing factors included time of day, hospital policies, attending skill or preference, ICU census and acuity, and patient factors. There was an association between location of the training program but not program size whether the PCCM fellow was the primary operator.
AHRQ-funded; HS026122.
Citation: Brady AK, Brown W, Denson JL .
Variation in intensive care unit intubation practices in pulmonary critical care medicine fellowship.
ATS Sch 2020 Dec;1(4):395-405. doi: 10.34197/ats-scholar.2020-0004OC..
Keywords: Intensive Care Unit (ICU), Respiratory Conditions, Training, Education: Academic, Critical Care
Miller Miller AG, Napolitano N, Turner DA, Miller AG, Napolitano N, Turner DA Miller AG, Napolitano N, Turner DA, Miller AG, Napolitano N, Turner DA
Respiratory therapist intubation practice in pediatric ICUs: a multicenter registry study.
Tracheal intubation by respiratory therapists (RTs) is a well-established practice that has been described primarily in adult and neonatal patients. However, minimal data exist regarding RTs' intubation performance in pediatric ICUs. The purpose of this study was to describe the current landscape of intubations performed by RTs in pediatric ICUs. The investigators found that RTs infrequently intubated in pediatric ICUs, with success rates similar to other providers but higher adverse event rates. RTs were more likely to use video laryngoscopy than other providers.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Miller Miller AG, Napolitano N, Turner DA, Miller AG, Napolitano N, Turner DA Miller AG, Napolitano N, Turner DA, Miller AG, Napolitano N, Turner DA .
Respiratory therapist intubation practice in pediatric ICUs: a multicenter registry study.
Respir Care 2020 Oct;65(10):1534-40. doi: 10.4187/respcare.07667..
Keywords: Children/Adolescents, Respiratory Conditions, Intensive Care Unit (ICU), Registries, Critical Care
Kitsios GD, Yang L, Manatakis DV
Host-response subphenotypes offer prognostic enrichment in patients with or at risk for acute respiratory distress syndrome.
This study examined whether certain plasma biomarkers can be used to help classify mechanically ventilated ICU patients with acute respiratory distress syndrome into hyper- and hypoinflammatory subphenotypes to facilitate more effective targeted therapy. The researchers performed longitudinal measures of 10 plasma biomarkers of host injury and inflammation. They were able to demonstrate that two-class models (hyper- vs hypoinflammatory subphenotypes) fit better than one-class models in patients with acute respiratory distress syndrome or patients at risk for acute respiratory distress (ARFA). Hyperinflammatory classification was associated higher severity of illness, worse clinical outcomes, and persistently elevated biomarkers of host injury and inflammation compared with hypoinflammatory patients.
AHRQ-funded; HS025455.
Citation: Kitsios GD, Yang L, Manatakis DV .
Host-response subphenotypes offer prognostic enrichment in patients with or at risk for acute respiratory distress syndrome.
Crit Care Med 2019 Dec;47(12):1724-34. doi: 10.1097/ccm.0000000000004018..
Keywords: Respiratory Conditions, Critical Care, Intensive Care Unit (ICU), Risk
Sanders R, Edwards L, Nishisaki A
Tracheal intubations for critically Ill children outside specialized centers in the United Kingdom-patient, provider, practice factors, and adverse events.
This editorial discusses a research study on outcomes of performing pediatric trachael intubations (TIs) and how the results can be applied to performing intubations on critically ill children in the United Kingdom outside of specialized centers. One of the authors is from a U.S. site that submits its airway management data to the National Emergency Airway Registry for Children (NEAR4KIDS). The results from the registry were compared to the results from the study. A total of 1,051 patients out of 1,237 eligible patients were analyzed. The results came from 47 nonspecialized local hospitals in the North Thames and East Anglia region of the UK. Adverse TI-associated events (TIAEs) occurred in 22.7% of the patients, which is higher than those in PICUs and cardiac ICUs. The majority of intubations were performed by the anesthesiologist in the team. The results were similar to those in the NEAR4KIDS registry. There were more complications with children with a higher grade of airway difficulties and comorbidities. The authors believe that pediatric airway management for acutely ill children would benefit from new strategies. They recommend a system change using Plan, Do, Study, Act (PDSA) cycles.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Sanders R, Edwards L, Nishisaki A .
Tracheal intubations for critically Ill children outside specialized centers in the United Kingdom-patient, provider, practice factors, and adverse events.
Pediatr Crit Care Med 2019 Jun;20(6):572-73. doi: 10.1097/pcc.0000000000001946..
Keywords: Adverse Events, Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Outcomes, Patient Safety, Registries, Respiratory Conditions
Iyer AS, Benzo RP, Bakitas MA
Easing the tension between palliative care and intensive care in chronic obstructive pulmonary disease.
This editorial discusses palliative care and intensive care in chronic obstructive pulmonary disease and comments on an article by Shen, et al., published, in 2018, in the Journal of Palliative Care, entitled “Life-sustaining procedures, palliative care consultation, and do-not resuscitate status in dying patients with COPD in US hospitals: 2010-2014.”
AHRQ-funded; HS023009.
Citation: Iyer AS, Benzo RP, Bakitas MA .
Easing the tension between palliative care and intensive care in chronic obstructive pulmonary disease.
J Palliat Care 2018 Jul;33(3):123-24. doi: 10.1177/0825859718782505..
Keywords: Chronic Conditions, Respiratory Conditions, Critical Care, Elderly, Palliative Care, Quality of Care
Kojima T, Harwayne-Gidansky I, Shenoi AN
Cricoid pressure during induction for tracheal intubation in critically ill children: a report from National Emergency Airway Registry for Children.
The objective of this retrospective cohort study was to evaluate the association between cricoid pressure use and the occurrence of regurgitation during tracheal intubation for critically ill children in pediatric intensive care unit (PICU). The investigators found that cricoid pressure during induction and mask ventilation before tracheal intubation in the current ICU practice was not associated with a lower regurgitation rate after adjusting for previously reported confounders.
AHRQ-funded; HS024511.
Citation: Kojima T, Harwayne-Gidansky I, Shenoi AN .
Cricoid pressure during induction for tracheal intubation in critically ill children: a report from National Emergency Airway Registry for Children.
Pediatr Crit Care Med 2018 Jun;19(6):528-37. doi: 10.1097/pcc.0000000000001531.
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Keywords: Children/Adolescents, Critical Care, Children/Adolescents, Registries, Respiratory Conditions
Khan S, Biju A, Wang S
Mobile critical care recovery program (m-CCRP) for acute respiratory failure survivors: study protocol for a randomized controlled trial.
The Mobile Critical Care Recovery Program (m-CCRP) study is a two arm, randomized clinical trial. The researchers will randomize 620 patients admitted to the ICU with acute respiratory failure requiring mechanical ventilation to one of two arms - m-CCRP intervention versus attention control. Their primary aim is to assess the efficacy of m-CCRP in improving the quality of life of acute respiratory failure survivors at 12 months
AHRQ-funded; HS024384.
Citation: Khan S, Biju A, Wang S .
Mobile critical care recovery program (m-CCRP) for acute respiratory failure survivors: study protocol for a randomized controlled trial.
Trials 2018 Feb 7;19(1):94. doi: 10.1186/s13063-018-2449-2.
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Keywords: Critical Care, Intensive Care Unit (ICU), Quality of Life, Respiratory Conditions, Respiratory Conditions
Kojima T, Laverriere EK, Owen EB
Clinical impact of external laryngeal manipulation during laryngoscopy on tracheal intubation success in critically ill children.
In this retrospective observational study, the objective was to evaluate the association between external laryngeal manipulation use and initial tracheal intubation attempt success in pediatric ICUs. The investigators found that external laryngeal manipulation during direct laryngoscopy was associated with lower initial tracheal intubation attempt success in critically ill children, even after adjusting for underlying differences in patient factors and provider levels. They asserted that the indiscriminate use of external laryngeal manipulation cannot be recommended.
AHRQ-funded; HS024511.
Citation: Kojima T, Laverriere EK, Owen EB .
Clinical impact of external laryngeal manipulation during laryngoscopy on tracheal intubation success in critically ill children.
Pediatr Crit Care Med 2018 Feb;19(2):106-14. doi: 10.1097/pcc.0000000000001373..
Keywords: Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Children/Adolescents, Respiratory Conditions
Finn Davis K, Napolitano N, Li S
Promoters and barriers to implementation of tracheal intubation airway safety bundle: a mixed-method analysis.
This study describes promoters and barriers to implementation of an airway safety quality improvement bundle from the perspective of interdisciplinary frontline clinicians and ICU quality improvement leaders. Both early and late adopters identified similar promoter and barrier themes. Early adopter sites customized the quality improvement bundle and had an interdisciplinary quality improvement team approach.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Finn Davis K, Napolitano N, Li S .
Promoters and barriers to implementation of tracheal intubation airway safety bundle: a mixed-method analysis.
Pediatr Crit Care Med 2017 Oct;18(10):965-72. doi: 10.1097/pcc.0000000000001251.
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Keywords: Critical Care, Intensive Care Unit (ICU), Patient Safety, Quality Improvement, Respiratory Conditions
Ishizuka M, Rangarajan V, Sawyer TL
The development of tracheal intubation proficiency outside the operating suite during pediatric critical care medicine fellowship training: a retrospective cohort study using cumulative sum analysis.
The researchers hypothesized that both overall and first-attempt tracheal intubation success rates by pediatric critical care medicine fellows would improve over the course of training. They found that all fellows who completed 3 years of training during the study period achieved an acceptable 90% overall tracheal intubation success rate. They concluded that further investigations on a larger scale across different training programs are necessary to clarify intensity and duration of the training to achieve tracheal intubation procedural competency.
AHRQ-funded; HS021583; HS022464.
Citation: Ishizuka M, Rangarajan V, Sawyer TL .
The development of tracheal intubation proficiency outside the operating suite during pediatric critical care medicine fellowship training: a retrospective cohort study using cumulative sum analysis.
Pediatr Crit Care Med 2016 Jul;17(7):e309-16. doi: 10.1097/pcc.0000000000000774.
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Keywords: Children/Adolescents, Critical Care, Education: Continuing Medical Education, Children/Adolescents, Respiratory Conditions
Hasvold J, Sjoding M, Pohl K
The role of human metapneumovirus in the critically ill adult patient.
The purpose of the study is to describe the role of human metapneumovirus (hMPV) infection in critical illness and acute respiratory distress syndrome (ARDS). It concluded that although most patients hospitalized with hMPV had chronic cardiac or pulmonary disease, hMPV can also be associated with serious respiratory illness and ARDS in adult patients without significant comorbidities or immunosuppression.
AHRQ-funded; HS020672.
Citation: Hasvold J, Sjoding M, Pohl K .
The role of human metapneumovirus in the critically ill adult patient.
J Crit Care 2016 Feb;31(1):233-7. doi: 10.1016/j.jcrc.2015.09.035.
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Keywords: Critical Care, Respiratory Conditions, Intensive Care Unit (ICU), Hospitalization
Kelesidis T, Braykov N, Uslan DZ
Indications and types of antibiotic agents used in 6 acute care hospitals, 2009-2010: a pragmatic retrospective observational study.
This study characterized the indications for antibiotic therapy, agents used, duration, combinations, and microbiological justification in 6 acute-care US facilities with varied location, size, and type of antimicrobial stewardship programs. It concluded that the use of broad-spectrum empirical therapy was prevalent in 6 US acute care facilities. Fluoroquinolones, vancomycin, and antipseudomonal penicillins were the most frequently used antibiotics, particularly for respiratory indications
AHRQ-funded; HS021188.
Citation: Kelesidis T, Braykov N, Uslan DZ .
Indications and types of antibiotic agents used in 6 acute care hospitals, 2009-2010: a pragmatic retrospective observational study.
Infect Control Hosp Epidemiol 2016 Jan;37(1):70-9. doi: 10.1017/ice.2015.226.
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Keywords: Antimicrobial Stewardship, Critical Care, Hospitals, Medication, Respiratory Conditions