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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results51 to 75 of 11623 Research Studies Displayed
Smith DC, Phillippi JC, Tilden EL
Comparing cesarean birth utilization between US hospitals: a demonstration of the robson ten-group classification system for use in quality improvement and benchmarking.
The objective of this study was to describe the application and utility of the World Health Organization-endorsed Robson Ten-Group Classification System (TGCS) to compare hospital-level cesarean births rates for use in quality improvement and benchmarking. The authors conducted a descriptive, secondary data analysis of the Consortium on Safe Labor dataset using data from births from 2002-08 at 12 sites across the US. Results showed a variation in use of cesarean birth, labor induction, and trial of labor after cesarean (TOLAC) across the 12 sites. The authors concluded that TGCS provides a method for between-hospital comparisons and adoption of TGCS in the US would provide an effective benchmarking tool to assist in reducing the use of cesarean birth and increasing the support of TOLAC.
Citation: Smith DC, Phillippi JC, Tilden EL . Comparing cesarean birth utilization between US hospitals: a demonstration of the robson ten-group classification system for use in quality improvement and benchmarking. J Perinat Neonatal Nurs 2023 Jul-Sep; 37(3):214-22. doi: 10.1097/jpn.0000000000000670..
Keywords: Hospitals, Healthcare Utilization, Maternal Care, Women, Quality Improvement, Quality Measures, Quality of Care
Anderson NW, Russ SA, Eisenberg D
Dashboards as mechanisms for community empowerment: developing a prototype for child and adolescent well-being in California.
This study’s objective was to develop a measurement framework of young peoples' well-being that would be engaging and actionable to a broad and diverse set of stakeholders in California. The authors began with a scan of relevant literature documenting previous efforts to measure young peoples' well-being, both within the United States and internationally. They then individually interviewed a set of key informants and convened a multidisciplinary panel of experts to solicit feedback on their approach. Findings suggested that data dashboards were the most promising approach of presenting a parsimonious yet holistic picture of young peoples' well-being. Their framework organized indicators over 5 types: child-centric, subjective well-being, contextual determinants, developmental, and equity-focused. Dashboards have flexibility that can also highlight important gaps in data collection that are of interest to end users such as indicators not yet collected among the broader population. They can also include interactive features, such as selecting key data elements, and helping communities articulate priority areas for policy action, thereby generating momentum and enthusiasm for future iterations and improvements.
Citation: Anderson NW, Russ SA, Eisenberg D . Dashboards as mechanisms for community empowerment: developing a prototype for child and adolescent well-being in California. J Public Health Manag Pract 2023 Jul-Aug; 29(4):529-38. doi: 10.1097/phh.0000000000001746..
Kaufmann MB, Tan JC, Chertow GM
Deceased donor kidney transplantation for older transplant candidates: a new microsimulation model for determining risks and benefits.
This study examined what potential health gains could be made by increasing kidney transplant access to older candidates from the use of a deceased donor kidney through developing and calibrating a microsimulation model of the transplantation process and long-term outcomes. The authors estimated risk equations for transplant outcomes using the Scientific Registry of Transplant Recipients (SRTR), which contains data on all US transplants (2010-2019). They calibrated the model to key transplant outcomes and used acceptance sampling, retaining the best-fitting 100 parameter sets. They then examined life expectancy gains from allocating kidneys even of lower quality across patient subgroups defined by age and designated race/ethnicity. The best-fitting 100 parameter sets (among 4,000,000 sampled) enabled their model to closely match key transplant outcomes. They found clear survival benefits for older transplant candidates who receive deceased kidney donors, even lower quality ones, compared with remaining on the waitlist.
Citation: Kaufmann MB, Tan JC, Chertow GM . Deceased donor kidney transplantation for older transplant candidates: a new microsimulation model for determining risks and benefits. Med Decis Making 2023 Jul; 43(5):576-86. doi: 10.1177/0272989x231172169..
Keywords: Kidney Disease and Health, Transplantation
Garber A, Garabedian P, Wu L
Developing, pilot testing, and refining requirements for 3 EHR-integrated interventions to improve diagnostic safety in acute care: a user-centered approach.
This study’s objective was to describe a user-centered approach to develop, pilot test, and refine requirements for 3 electronic health record (EHR)-integrated interventions that target key diagnostic process failures in hospitalized patients. The interventions to be developed were a Diagnostic Safety Column (DSC) within an EHR-integrated dashboard to identify at-risk patients; a Diagnostic Time-Out (DTO) for clinicians to reassess the working diagnosis; and a Patient Diagnosis Questionnaire (PDQ) to gather patient concerns about the diagnostic process. After initial refinement from an analysis, final requirements were created for 10 test cases predicted by the DSC, 18 clinician DTO participants, and 39 PDQ responses including the following: DSC configurable parameters (variables, weights) to adjust baseline risk estimates in real-time based on new clinical data collected during hospitalization; more concise DTO wording and flexibility for clinicians to conduct the DTO with or without the patient present; and integration of PDQ responses into the DSC to ensure closed-looped communication with clinicians. An analysis of focus groups confirmed that tight integration of the interventions with the EHR would be necessary to prompt clinicians to reconsider the working diagnosis in cases with elevated diagnostic error (DE) risk or uncertainty. Potential implementation barriers identified included alert fatigue and distrust of the risk algorithm (DSC); time constraints, redundancies, and concerns about disclosing uncertainty to patients (DTO); and patient disagreement with the care team's diagnosis (PDQ).
Citation: Garber A, Garabedian P, Wu L . Developing, pilot testing, and refining requirements for 3 EHR-integrated interventions to improve diagnostic safety in acute care: a user-centered approach. JAMIA Open 2023 Jul; 6(2):ooad031. doi: 10.1093/jamiaopen/ooad031..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Diagnostic Safety and Quality, Patient Safety
Darling KE, Hayes JF, Evans EW
Engaging stakeholders to adapt an evidence-based family healthy weight program.
The purpose of this study was to describe the procedure of utilizing qualitative data from community and intervention stakeholders, children with overweight or obesity from low-income backgrounds, and caregivers to inform adaptations to the JOIN for ME pediatric weight management intervention. The researchers conducted qualitative interviews with 21 key community and intervention stakeholders, and conducted focus groups in both Spanish and English with 35 children with overweight or obesity from low-income backgrounds and 71 caregivers of children with overweight or obesity from low-income backgrounds. The results of the qualitative data analysis guided intervention modifications including content revisions to simplify and tailor materials, contextual revisions to improve intervention engagement and framing, resource awareness, and modality of delivery, training adaptations, and implementation/scale-up activities to improve community partner connections.
Citation: Darling KE, Hayes JF, Evans EW . Engaging stakeholders to adapt an evidence-based family healthy weight program. Transl Behav Med 2023 Jul; 13(7):423-31. doi: 10.1093/tbm/ibac113..
Keywords: Obesity, Family Health and History, Evidence-Based Practice, Children/Adolescents
Ong T, Albon D, Amin RS
Establishing a Cystic Fibrosis Learning Network: interventions to promote collaboration and data-driven improvement at scale.
This paper describes the Cystic Fibrosis Learning Network (CFLN), which was designed to improve medical outcomes and quality of life through an intentional focus on achieving reliable evidence-based chronic care delivery and creating a system for data-driven collaborative learning. The authors described the development and growth of the CFLN considering six domains of a Network Maturity Grid: system leadership; governance and policy management; quality improvement (QI); engagement and community building; data and analytics; and research. The CFLN represents 36 accredited care centers in the CF Foundation Care Center Network caring for over 6300 patients, with 77% of 6779 patient clinical care visits/quarter entering into the Registry within 30 days. Almost all CFLN teams (94%) have a patient/family partner (PFP), and 74% of PFPs indicate they are actively participating, taking ownership of, or leading QI initiatives with the interdisciplinary care team. In 2022, most (97%) centers reported completing 1-13 improvement cycles per month, and 82% contributed to monthly QI progress reports to share learning.
Citation: Ong T, Albon D, Amin RS . Establishing a Cystic Fibrosis Learning Network: interventions to promote collaboration and data-driven improvement at scale. Learn Health Syst 2023 Jul; 7(3):e10354. doi: 10.1002/lrh2.10354..
Keywords: Learning Health Systems, Health Systems
Watach AJ, McPhillips MV, Saconi B
Exploring nurse practitioner students' perceptions of a sleep e-learning program.
The objective of this qualitative descriptive study was to explore nurse practitioner students' perceptions of a sleep e-learning program. Twenty-four students participated in two focus groups. The students embraced sleep education; they spoke of content relevance to themselves and patients and of their intentions to adopt sleep assessment practices. Two overarching themes emerged: perceptions of course design, and content. The authors concluded that their study highlighted the feasibility of increasing curricular exposure to sleep education and ensuring nurse practitioners have the skills to recognize implications of poor and disordered sleep for patients.
Citation: Watach AJ, McPhillips MV, Saconi B . Exploring nurse practitioner students' perceptions of a sleep e-learning program. Nurs Educ Perspect 2023 Jul-Aug; 44(4):229-36. doi: 10.1097/01.Nep.0000000000001132..
Keywords: Education: Curriculum, Education: Academic, Sleep Problems, Provider: Nurse
Quinn M, Fowler KE, Harrod M
Exploring sacred moments in hospitalized patients: an exploratory qualitative study.
This explorative qualitative study discusses the phenomena known as “sacred moments”, defined as brief periods of time in which people experience a deep interconnectedness that may possess spiritual qualities and emotions in acute care hospital settings. This study included in-depth interviews with patients and healthcare workers at two academic medical centers in the Midwestern United States. Semi-structured telephone interviews were conducted between August 2020 and April 2021 with 30 hospital healthcare workers and discharged patients with a recent hospital stay. Interviews were recorded and transcribed. Findings were organized into three main domains including (1) several common elements described by participants as marking these moments; (2) benefits experienced by both patients and healthcare workers; and (3) suggestions for fostering sacred moments within the hospital setting.
Citation: Quinn M, Fowler KE, Harrod M . Exploring sacred moments in hospitalized patients: an exploratory qualitative study. J Gen Intern Med 2023 Jul; 38(9):2038-44. doi: 10.1007/s11606-022-07999-z..
Keywords: Patient and Family Engagement, Provider: Physician, Provider: Health Personnel
Leininger LJ, Tomaino M, Meara E
Health-related quality of life in high-cost, high-need populations.
This retrospective longitudinal study examined health care utilization, expenditures, and patient-reported health for high-cost, high-need (HCHN) populations comparing a baseline (year 1) and follow-up year (year 2). The sample included adults (n = 46,934) participating in the Medical Expenditure Panel Survey between 2011 and 2016. The authors estimated health-related quality of life (HRQOL) for each sample member using the physical and mental health scales from the Medical Outcomes Study Short Form 12. They compared HRQOL stratified by HCHN, defined as patients whose baseline (year 1) demographics, utilization, and clinical characteristics predicted top decile health spending in year 2. The physical health scale exhibited robust measure validity, reliability, and responsiveness, but the mental health scale did not. Mean physical health was 1.25 SDs lower in HCHN vs other patients (37.9 vs 51.0 on a 0-100 scale increasing in self-perceived health). Patient-reported health outcomes continued to remain poor in HCHN populations, even after health care utilization recedes.
Citation: Leininger LJ, Tomaino M, Meara E . Health-related quality of life in high-cost, high-need populations. Am J Manag Care 2023 Jul; 29(7):362-68. doi: 10.37765/ajmc.2023.89396..
Keywords: Medical Expenditure Panel Survey (MEPS), Quality of Life, Healthcare Costs
Zamudio J, Kanji FF, Lusk C
Identifying workflow disruptions in robotic-assisted bariatric surgery: elucidating challenges experienced by surgical teams.
The goal of this observational study was to investigate the impact of robotic bariatric surgery (RBS) on the surgical work system via the study of flow disruptions (FDs), or deviations from the natural workflow progression. Twenty-nine RBS procedures were observed at three sites; FDs were recorded in real time and subsequently classified into one of nine work system categories. FDs occurred approximately every 2.4 minutes and happened most frequently during the final patient transfer and robot docking phases of RBS. The coordination challenges that contributed most to these disruptions were associated with waiting for staff/instruments and readjusting equipment.
Citation: Zamudio J, Kanji FF, Lusk C . Identifying workflow disruptions in robotic-assisted bariatric surgery: elucidating challenges experienced by surgical teams. Obes Surg 2023 Jul; 33(7):2083-89. doi: 10.1007/s11695-023-06620-4..
Keywords: Obesity: Weight Management, Surgery, Workflow, Obesity
Giuliano J, Krishna A, Napolitano N
Implementation of video laryngoscope-assisted coaching reduces adverse tracheal intubation-associated events in the PICU.
The purpose of this study was to assess the implementation of a video laryngoscope (VL) as a coaching device to decrease adverse tracheal intubation associated events (TIAEs). Between 2016 and 2020 the researchers implemented VLs as coaching devices with standardized coaching language. Laryngoscopists were encouraged to perform direct laryngoscopy with video images only available in real-time for experienced supervising clinician-coaches. The study found that a VL was used in 71% of 5,060 tracheal intubations. VL utilization increased from a baseline of 29.7% to an implementation phase level of 89.4%. VL utilization was related with lower TIAEs compared with standard laryngoscope (SL). VL utilization was related with lower severe TIAE rate, but not related with a reduction in severe hypoxemia. VL utilization was related with greater first attempt success. In the primary analysis after adjusting for site clustering, VL utilization was related with lower adverse TIAEs. In secondary analyses, VL utilization was not significantly related with severe TIAEs, severe hypoxemia, or first attempt success. After additional controlling for patient and provider characteristics, VL utilization was independently related with a lower TIAE rate.
Citation: Giuliano J, Krishna A, Napolitano N . Implementation of video laryngoscope-assisted coaching reduces adverse tracheal intubation-associated events in the PICU. Crit Care Med 2023 Jul; 51(7):936-47. doi: 10.1097/ccm.0000000000005847..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Adverse Events, Patient Safety
Michelson KA, Bachur RG, Grubenhoff JA
Outcomes of missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis, and sepsis in five pediatric hospitals.
This study’s objective was to determine 90-day complication rates and hospital utilization after a missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis (DKA), or sepsis. The authors evaluated patients under 21 years of age visiting five pediatric emergency departments (EDs) with a study condition. Case patients included had a preceding ED visit within 7 days of diagnosis and underwent case review to confirm a missed diagnosis. The authors compared complication rates and utilization between case and control patients after adjusting for age, sex, and insurance. They analyzed 29,398 children with appendicitis, 5366 with DKA, and 3622 with sepsis, of whom 429, 33, and 46, respectively, had a missed diagnosis. Patients with a missed appendicitis or DKA diagnosis had more hospital days and readmissions, but there were no significant differences for those with sepsis. Those with missed appendicitis were more likely to have abdominal abscess drainage or perforated appendicitis. Those with missed DKA were more likely to have cerebral edema, mechanical ventilation, or death. Those with missed sepsis were less likely to have mechanical ventilation.
Citation: Michelson KA, Bachur RG, Grubenhoff JA . Outcomes of missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis, and sepsis in five pediatric hospitals. J Emerg Med 2023 Jul; 65(1):e9-e18. doi: 10.1016/j.jemermed.2023.04.006..
Keywords: Children/Adolescents, Sepsis, Diabetes, Diagnostic Safety and Quality
Titus AR, Mezuk B, Hirschtick JL
Patterns and predictors of depressive and anxiety symptoms within a population-based sample of adults diagnosed with COVID-19 in Michigan.
Researchers examined the intersection of demographic, economic, and illness-related predictors of depressive and anxiety symptoms within a population-based sample of adults diagnosed with COVID-19 in Michigan. Data were taken from a population-based survey of Michigan adults who experienced a COVID-19 diagnosis prior to August 2020. Results indicated that relative risks for experiencing poor mental health outcomes varied by race/ethnicity, sex, age, and income. Symptom severity was associated with a higher burden of comorbid depressive/anxiety symptoms. "Long COVID" was associated with all outcomes. The researchers concluded that because of overlapping risk factors, integrated approaches to treating depressive/anxiety symptoms among COVID-19 survivors is warranted.
Citation: Titus AR, Mezuk B, Hirschtick JL . Patterns and predictors of depressive and anxiety symptoms within a population-based sample of adults diagnosed with COVID-19 in Michigan. Soc Psychiatry Psychiatr Epidemiol 2023 Jul; 58(7):1099-108. doi: 10.1007/s00127-023-02453-9..
Keywords: COVID-19, Depression, Anxiety, Behavioral Health
Lenz KB, Nishisaki A, Lindell RB
Peri-intubation adverse events in the critically ill child after hematopoietic cell transplant.
The goal of this study was to investigate whether adverse peri-intubation associated events occur at increased frequency in pediatric patients with hematopoietic cell transplant (HCT) compared with non-HCT oncologic or other pediatric ICU (PICU) patients and therefore might contribute to increased mortality. This retrospective cohort study of critically ill children who underwent tracheal intubation (TI) was conducted between 2014 and 2019. Data was merged from local airway management quality databases and Virtual Pediatric Systems. Data was supplemented with a retrospective chart review for HCT-related data, including HCT indication, transplant-related comorbidity status, and patient condition at the time of TI procedure. There was a total of 1,931 children identified who underwent TI, of which 92 (4.8%) were post-HCT, while 319 (16.5%) had history of malignancy without HCT, and 1,520 (78.7%) had neither HCT nor malignancy. Children post-HCT were older, more often had respiratory failure, use of catecholamine infusions peri-intubation, and use of noninvasive ventilation prior to intubation. There was no difference in hemodynamic tracheal intubation-associated adverse events (TIAEs) or peri-intubation hypoxemia across three groups (HCT 16%, non-HCT with malignancy 10%, other 15%). The authors did not find an association between HCT status and the adverse TI outcome after adjusting for age, difficulty airway feature, provider type, device, apneic oxygenation use, and indication for intubation.
Citation: Lenz KB, Nishisaki A, Lindell RB . Peri-intubation adverse events in the critically ill child after hematopoietic cell transplant. Pediatr Crit Care Med 2023 Jul; 24(7):584-93. doi: 10.1097/pcc.0000000000003243..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Adverse Events
Narindrarangkura P, Alafaireet PE, Khan U
Predicting suicide attempts among people with diabetes using a large multicenter electronic health records dataset.
This study’s goal was to determine the risk factors for suicidal behaviors of people with diabetes as they have a higher risk than the general population. The authors investigated risk factors and predicted suicide attempts in people with diabetes using the Least Absolute Shrinkage and Selection Operator (LASSO) regression. They used data from Cerner Real-World Data™ and included over 3 million diabetes patients in the study. They analyzed gender-, diabetes-type, and depression-specific LASSO regression models. The study included 7764 subjects diagnosed with suicide attempts with an average age of 45. They found risk factors for suicide attempts in diabetes patients, such as being an American Indian or Alaska Native, atypical agents, benzodiazepines, and antihistamines. Amyotrophy had a negative coefficient for suicide attempts with males with diabetes but had a positive coefficient for females. Using MAOI had a negative coefficient for suicide attempts in T1DM patients. Patients less than 20 years of age had a positive coefficient for suicide in depressed and non-depressed patients with diabetes.
Citation: Narindrarangkura P, Alafaireet PE, Khan U . Predicting suicide attempts among people with diabetes using a large multicenter electronic health records dataset. Int J Psychiatry Med 2023 Jul; 58(4):302-24. doi: 10.1177/00912174231162477..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Behavioral Health, Diabetes, Chronic Conditions
Zhu JM, Meiselbach MK, Drake C C
Psychiatrist networks In Medicare Advantage plans are substantially narrower than in Medicaid and ACA Markets.
The authors used a novel data set that linked insurance network service areas, plans, and providers across Medicare Advantage, Medicaid managed care, and Affordable Care Act plan markets to compare psychiatrist network breadth; their purpose was to assess the percentage of providers in a given area considered in network for a plan. They found that nearly two-thirds of psychiatrist networks in Medicare Advantage contained fewer than 25 percent of providers in a network's service area. They concluded that these findings suggest a certain “narrowness” in psychiatrist networks in Medicare Advantage, which may disadvantage enrollees attempted to obtain mental health services.
Citation: Zhu JM, Meiselbach MK, Drake C C . Psychiatrist networks In Medicare Advantage plans are substantially narrower than in Medicaid and ACA Markets. Health Aff 2023 Jul; 42(7):909-18. doi: 10.1377/hlthaff.2022.01547..
Keywords: Elderly, Medicare, Behavioral Health, Access to Care
Olfson M, Zuvekas SH, McClellan C
AHRQ Author: Zuvekas SH, McClellan C
Racial-ethnic disparities in outpatient mental health care in the United States.
Using data from the 2018-19 Medical Expenditure Panel Survey, researchers compared national rates and patterns of use for outpatient mental health care among Hispanic, non-Hispanic Black, and non-Hispanic White individuals. Analyses focused on individuals using psychotropic medications, psychotherapy, or both, and receipt of minimally adequate mental health care. The results showed that the rate of outpatient mental health service use was more than twice as high for White individuals, and that Black and Hispanic patients were significantly less likely to receive psychotropic medications; Black and Hispanic patients were more likely to receive psychotherapy. No significant differences were found in patients who received minimally adequate treatment for depression, anxiety, attention-deficit hyperactivity disorder, or disruptive behavior disorders. The authors concluded that achieving racial-ethnic equity will require dedicated efforts to promote greater mental health service access for Black and Hispanic persons in need.
Citation: Olfson M, Zuvekas SH, McClellan C . Racial-ethnic disparities in outpatient mental health care in the United States. Psychiatr Serv 2023 Jul; 74(7):674-83. doi: 10.1176/appi.ps.20220365..
Keywords: Medical Expenditure Panel Survey (MEPS), Racial and Ethnic Minorities, Disparities, Behavioral Health, Ambulatory Care and Surgery
Wang Y, Eldridge N, Metersky ML
AHRQ Author: Eldridge N and Rodrick D
Relationship between in-hospital adverse events and hospital performance on 30-day all-cause mortality and readmission for patients with heart failure.
Researchers sought to evaluate the association between hospital performance on mortality and readmission with hospital performance on safety adverse event rates. Their cross-sectional study linked patient-level adverse events data from the Medicare Patient Safety Monitoring System to hospital-level, heart failure (HF)-specific, 30-day, all-cause mortality and readmissions data from CMS. The study included data on over 39,000 patients with HF from over 3000 hospitals. Patients admitted with HF to hospitals with high 30-day, all-cause mortality and readmission rates had a higher risk of in-hospital adverse events. The researchers concluded that there might be common quality issues among the measure concepts in these hospitals that produce poor performance for patients with HF.
AHRQ-funded; AHRQ-authored; 290201800005C.
Citation: Wang Y, Eldridge N, Metersky ML . Relationship between in-hospital adverse events and hospital performance on 30-day all-cause mortality and readmission for patients with heart failure. Circ Cardiovasc Qual Outcomes 2023 Jul; 16(7):e009573. doi: 10.1161/circoutcomes.122.009573..
Keywords: Hospitals, Hospital Readmissions, Heart Disease and Health, Cardiovascular Conditions, Adverse Events, Provider Performance
Hoonakker PLT, Carayon P, Brown RL
Satisfaction of older patients with emergency department care: psychometric properties and construct validity of the Consumer Emergency Care Satisfaction Scale.
This study’s purpose to was examine the construct validity of the Consumer Emergency Care Satisfaction Scale (CECSS), designed to measure patient satisfaction in the emergency department (ED). The authors administered 2 surveys to older adults who presented with a fall to the ED and used electronic health record data to examine construct validity of the CECSS and ceiling effects. Using several criteria, they improved construct validity of the CECSS, reduced ceiling effects, and standardized scoring.
Citation: Hoonakker PLT, Carayon P, Brown RL . Satisfaction of older patients with emergency department care: psychometric properties and construct validity of the Consumer Emergency Care Satisfaction Scale. J Nurs Care Qual 2023 Jul-Sep; 38(3):256-63. doi: 10.1097/ncq.0000000000000694..
Keywords: Elderly, Emergency Department, Patient Experience
Arbaje AI, Woodman S, Keita Fakeye MB
Senior services in US hospitals and readmission risk or mortality among Medicare beneficiaries since the Affordable Care Act.
This study examined whether there was an association between readmission risk or mortality among Medicare beneficiaries and passage of the Affordable Care Act. The study updated the Senior Care Services Scale (SCSS) which describes hospital provision of older adult services before the passage of the Affordable Care Act. The authors conducted a retrospective cohort analysis of older adults ≥65 years (n = 1,416,669), admitted to 2570 US acute-care hospitals from 2014 to 2015. Outcomes were hospital readmission, or death, within 30 and 90 days of discharge. The updated SCSS included three service groups: Inpatient Specialty Care, Post-Acute Community Care, and Home Care and Hospice. Older adults admitted to high Inpatient-Specialty-Care-scoring hospitals had lower risk of death within 30 days, and 90 days. There was no significant association between the other two groups and study outcomes.
Citation: Arbaje AI, Woodman S, Keita Fakeye MB . Senior services in US hospitals and readmission risk or mortality among Medicare beneficiaries since the Affordable Care Act. J Appl Gerontol 2023 Jul; 42(7):1424-32. doi: 10.1177/07334648231161925..
Keywords: Elderly, Hospitals, Hospital Readmissions, Medicare
Stierman EK, O'Brien BT, Stagg J
AHRQ Author: Fabiyi CA, Chew E, Harding B, Mistry KB
Statewide perinatal quality improvement, teamwork, and communication activities in Oklahoma and Texas.
The objective of this study was to describe perinatal quality improvement activities, specifically the implementation of Alliance for Innovation on Maternal Health (AIM) patient safety bundles and use of teamwork and communication tools in obstetric units. Researchers conducted a survey of AIM-enrolled hospitals in Oklahoma and Texas and gathered data on obstetric unit organization and QI processes. Their findings showed that adoption of QI processes varied and also highlighted the need to reinforce support for rural obstetric units, which often face greater barriers to implementing patient safety and QI processes than urban units. The researchers concluded that this has implications for implementing future perinatal QI initiatives.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Stierman EK, O'Brien BT, Stagg J . Statewide perinatal quality improvement, teamwork, and communication activities in Oklahoma and Texas. Qual Manag Health Care 2023 Jul-Sep; 32(3):177-88. doi: 10.1097/qmh.0000000000000407..
Keywords: Quality Improvement, Teams, Communication, Maternal Care, Quality of Care
Huff NR, Chimowitz H, DelPico MA
The consequences of emotionally evocative patient behaviors on emergency nurses' patient assessments and handoffs: an experimental study using simulated patient cases.
The purpose of this experimental vignette research study was to explore the impact of emotionally evocative patient behavior and mental illness on 130 emergency nurses' emotions, patient assessments, testing advocacy, and written handoffs. The researchers asked the nurses to complete four multimedia computer-simulated patient encounters in which patient behavior (irritable vs. calm) and mental illness (present vs. absent) were purposely varied. The nurses recorded their emotions and clinical evaluations, recommended diagnostic tests, and provided written handoffs. The study found that the nurses experienced greater negative emotions (anger, unease) and reported decreased engagement when evaluating patients demonstrating irritable (vs. calm) behavior. Nurses also considered patients with irritable (vs. calm) behavior as more likely to exaggerate their pain and as poorer historians, and as less likely to cooperate, return to work, and recover. Nurses' handoffs were more likely to include negative descriptions of patients with irritable (vs. calm) behavior and exclude specific clinical information. The existence of mental illness increased unease and sadness and lead to nurses being less likely to recommend a needed test for a correct diagnosis.
Citation: Huff NR, Chimowitz H, DelPico MA . The consequences of emotionally evocative patient behaviors on emergency nurses' patient assessments and handoffs: an experimental study using simulated patient cases. Int J Nurs Stud 2023 Jul; 143:104507. doi: 10.1016/j.ijnurstu.2023.104507..
Keywords: Emergency Department, Behavioral Health, Nursing, Workflow
Solano QP, Howard R, Mullens CL
The impact of frailty on ventral hernia repair outcomes in a statewide database.
Researchers examined the association of frailty with short-term postoperative outcomes after ventral hernia repair (VHR). They retrospectively reviewed the Michigan Surgery Quality Collaborative Hernia Registry (MSQC-HR) for adult patients who underwent VHR. : After controlling for patient, operative, and hernia characteristics, frailty was found to be independently associated with increased odds of postoperative complications. The researchers concluded that their findings highlight the importance of preoperative frailty assessment for risk stratification and to inform patient counseling.
Citation: Solano QP, Howard R, Mullens CL . The impact of frailty on ventral hernia repair outcomes in a statewide database. Surg Endosc 2023 Jul; 37(7):5603-11. doi: 10.1007/s00464-022-09626-8..
Keywords: Surgery, Outcomes
Saucke MC, Alagoz E, Arroyo N
The invisible work of transfer centre nurses: a qualitative study of strategies to overcome communication challenges.
The objective of this study was to explore the role of transfer center nurses and their strategies to facilitate communication between providers during calls related to interhospital transfers. Researchers conducted semi-structured interviews with 17 transfer center nurses at one tertiary medical center and asked them to describe their work. The results indicated that transfer center nurses employed multiple strategies to overcome communication challenges; providers' lack of knowledge of the nurses' role can impede respectful and efficient transfer conversations. The researchers concluded that interventions to support and optimize the transfer center nurses' critical work are needed.
Citation: Saucke MC, Alagoz E, Arroyo N . The invisible work of transfer centre nurses: a qualitative study of strategies to overcome communication challenges. J Adv Nurs 2023 Jul; 79(7):2539-52. doi: 10.1111/jan.15603..
Keywords: Communication, Provider: Nurse, Nursing
Pagani K, Lukac D, Olbricht SM
Urgent referrals from primary care to dermatology for lesions suspicious for skin cancer: patterns, outcomes, and need for systems improvement.
The purpose of this study was to explore primary care and dermatology triaging and processing of urgent dermatology referrals. The researchers conducted chart reviews of all dermatology referrals designated by primary care as urgent for evaluation of a lesion concerning for skin cancer. Dermatology encounters for patients occurred on or before 30 days for 50.6% of referrals and on or after 31 days for 38.4% of referrals, with 10.9% never completed. The rate of non-English languages in the delayed group was 7.1% greater than in the timely group. The rate of all races excluding whites, non-Hispanic in the delayed appointment group (31 days or more) was 15.1% greater than in the timely appointment group (30 days or less). Overall, 15.8% of referrals yielded malignancy diagnoses, while 76.8% and 7.4% resulted in benign and pre-malignant diagnoses, respectively. The primary care team documented completed, incomplete, or pending referral status during their subsequent visits with the patients in only 37.5% of the referrals.
Citation: Pagani K, Lukac D, Olbricht SM . Urgent referrals from primary care to dermatology for lesions suspicious for skin cancer: patterns, outcomes, and need for systems improvement. Arch Dermatol Res 2023 Jul; 315(5):1397-400. doi: 10.1007/s00403-022-02456-7..
Keywords: Cancer: Skin Cancer, Cancer, Primary Care, Skin Conditions, Access to Care