National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
76 to 100 of 12195 Research Studies DisplayedSick-Samuels AC, Koontz DW, Xie A
A survey of PICU clinician practices and perceptions regarding respiratory cultures in the evaluation of ventilator-associated infections in the BrighT STAR Collaborative.
A survey of medical professionals from 16 different academic pediatric hospitals was conducted from May 2021-January 2022. The goal of the survey was to examine respiratory culture practices, drivers, and barriers in mechanically ventilated patients. The study concluded that respiratory culture practices were inconsistent.
AHRQ-funded; HS028634.
Citation: Sick-Samuels AC, Koontz DW, Xie A .
A survey of PICU clinician practices and perceptions regarding respiratory cultures in the evaluation of ventilator-associated infections in the BrighT STAR Collaborative.
Pediatr Crit Care Med 2024 Jan; 25(1):e20-e30. doi: 10.1097/pcc.0000000000003379..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Healthcare-Associated Infections (HAIs)
Powell KR, Farmer M, Liu J
A survey of technology abandonment in US nursing homes.
This study examined abandonment of health information technology (HIT) by US nursing homes (NHs) and its association with organizational characteristics among a national sample of US NHs. This longitudinal, retrospective analysis used data from 2 sources: the HIT Maturity Survey and Staging model and public data from the Care Compare database. The authors used a random sample of 299 NHs representing each US state that completed the HIT maturity survey in 2 consecutive years: year 1 (Y1) was June 2019-August 2020 and year 2 (Y2) was June 2020-August 2021. The primary dependent variable was technology abandonment, operationalized by using total HIT maturity score, HIT maturity stage, and subscale scores within each dimension/domain; and independent variables were NH organizational characteristics including bed size, type of ownership, urbanicity, Centers for Medicare & Medicaid Services Five-Star Overall Rating and Staffing Rating. Results were that over the 2-year period HIT abandonment occurred in 28% of NHs compared with 44% that experienced growth in HIT systems. Capabilities in resident care was abandoned most frequently. They found that large NHs (bed size greater than 120) were more likely to experience technology abandonment in administrative activities. They concluded that technology abandonment can increase strain on scarce resources and may impact administrators' ability to oversee clinical operations, especially in large NHs.
AHRQ-funded; HS022497.
Citation: Powell KR, Farmer M, Liu J .
A survey of technology abandonment in US nursing homes.
J Am Med Dir Assoc 2024 Jan; 25(1):6-11. doi: 10.1016/j.jamda.2023.09.002..
Keywords: Nursing Homes, Health Information Technology (HIT), Long-Term Care
Sprackling CM, Kieren MQ, Nacht CL
Adolescent access to clinicians' notes: adolescent, parent, and clinician perspectives.
This study’s goal was to identify adolescent, parent, and clinician perspectives on the anticipated benefits and concerns of giving adolescents access to clinicians’ notes and strategies in response to a 2021 federal mandate. The authors conducted six focus groups with adolescents, parents, and clinicians at a children's hospital from May to October 2021. A semistructured facilitator guide captured patient perspectives of the benefits, concerns, and strategies. A total of 38 stakeholders (17 adolescents, 10 parents, and 11 clinicians) described four benefits, three concerns, and four implementation strategies regarding adolescent note-sharing. Potential benefits captured in the focus groups included adolescents using notes to remember and reinforce the visit, gaining knowledge about their health, strengthening the adolescent-clinician relationship, and increasing agency in health care decisions. Concerns the guide captured included notes leading to a breach in confidentiality, causing negative emotions, and becoming less useful for clinicians. Strategies to address these concerns included making note-sharing more secure, optimizing note layout and content, setting clear expectations, and having a portion of the note for clinician use only.
AHRQ-funded; HS027214; HS027894.
Citation: Sprackling CM, Kieren MQ, Nacht CL .
Adolescent access to clinicians' notes: adolescent, parent, and clinician perspectives.
J Adolesc Health 2024 Jan; 74(1):155-60. doi: 10.1016/j.jadohealth.2023.08.008..
Keywords: Children/Adolescents, Clinician-Patient Communication, Patient and Family Engagement
King CA, Beetham T, Smith N
Adolescent residential addiction treatment in the US: uneven access, waitlists, and high costs.
This study examined adolescent residential addiction treatment facilities in the United States, and their accessibility and cost. The authors used the Substance Abuse and Mental Health Services Administration's treatment locator and search engine advertising data to identify 160 residential addiction treatment facilities that treated adolescents with opioid use disorder as of December 2022. They called facilities while role-playing as the aunt or uncle of a sixteen-year-old child with a recent nonfatal overdose to inquire about policies and costs. A little over half (54.5%) had a bed immediately available. The mean wait time for a bed was 28.4 days among sites with a waitlist. Of the facilities that provided cost information, the mean cost of treatment per day was $878, with daily costs among for-profit facilities triple of nonprofit facilities. Half of facilities required up-front payments by noninsured patients, with a mean up-front cost of $28,731. They were unable to identify any facilities for adolescents in ten states or Washington, D.C.
AHRQ-funded; HS017589.
Citation: King CA, Beetham T, Smith N .
Adolescent residential addiction treatment in the US: uneven access, waitlists, and high costs.
Health Aff 2024 Jan; 43(1):64-71. doi: 10.1377/hlthaff.2023.00777..
Keywords: Children/Adolescents, Substance Abuse, Healthcare Costs, Access to Care
Jolliff A, Coller RJ, Kearney H
An mHealth design to promote medication safety in children with medical complexity.
This study describes an effort to design a health information technology tool to improve medication safety for children with medical complexity (CMC). The study engaged family caregivers, secondary caregivers, and clinicians who work with CMC in a co-design process to identify: 1) medication safety challenges experienced by CMC caregivers and, 2) design requirements for a mobile health application to improve medication safety for CMC in the home. Family caregivers, secondary caregivers, and clinicians from a children's hospital-based pediatric complex care program participated in virtual co-design sessions. During these sessions, the facilitator guided 16 co-designers in generating and converging upon medication safety challenges and design requirements. These sessions were recorded and reviewed after conclusion to confirm that all designer comments had been captured. An analysis yielded 11 challenges to medication safety and 11 corresponding design requirements that fit into three broader challenges: giving the right medication at the right time; communicating with others about medications; and accommodating complex medical routines.
AHRQ-funded; HS028409.
Citation: Jolliff A, Coller RJ, Kearney H .
An mHealth design to promote medication safety in children with medical complexity.
Appl Clin Inform 2024 Jan; 15(1):45-54. doi: 10.1055/a-2214-8000..
Keywords: Children/Adolescents, Medication: Safety, Medication, Health Information Technology (HIT), Chronic Conditions, Telehealth, Caregiving
MohammadiGorji S, Joseph A, Mihandoust S
Anesthesia workspaces for safe medication practices: design guidelines.
The purpose of this study was to create a set of evidence-based design guidelines for the design of anesthesia workspaces to support safer anesthesia medication tasks in operating rooms (ORs). The researchers collected data through literature review, observation, and coding of prerecorded videos of outpatient surgical procedures to identify challenges encountered by anesthesia providers while performing medication tasks. The study findings were summarized into 7 design guidelines, including: 1) locate critical tasks within a primary field of vision, 2) eliminate other staff travel into and through the anesthesia zone, 3) identify and delineate a clear anesthesia zone with adequate space for the anesthesia provider, 4) maximize the ability to reconfigure the anesthesia workspace, 5) minimize workspace clutter from equipment, 6) provide adequate and appropriately positioned surfaces for medication preparation and administration, and 7) optimize lighting of tasks and surfaces.
AHRQ-funded.
Citation: MohammadiGorji S, Joseph A, Mihandoust S .
Anesthesia workspaces for safe medication practices: design guidelines.
HERD 2024 Jan; 17(1):64-83. doi: 10.1177/19375867231190646..
Keywords: Medication: Safety, Medication, Patient Safety
Atkinson MK, Biddinger PD, Chughtai MA
Assessing health care leadership and management for resilience and performance during crisis: the HERO-36.
The authors developed a Healthcare Emergency Response Optimization survey to examine health care organizations’ resilience and performance during crisis. The survey was administered to health care administrators and frontline staff involved in hospitals’ emergency response during the COVID-19 pandemic. Eight measures emerged to assess crisis leadership and management; informal practices mattered most for resilience, while formal practices mattered for performance. The authors identified specific practices for resilience and performance. They concluded that organizations using these measures may modify their preparedness and planning approaches to improve management in future crises.
AHRQ-funded; HS028240.
Citation: Atkinson MK, Biddinger PD, Chughtai MA .
Assessing health care leadership and management for resilience and performance during crisis: the HERO-36.
Health Care Manage Rev 2024 Jan-Mar; 49(1):14-22. doi: 10.1097/hmr.0000000000000387..
Keywords: COVID-19, Public Health
Franklin PD, Drane D
Assessment of learning health system science competency in the equity and justice domain.
This paper assessed learning health system (LHS) competency in the newly added knowledge domain of Equity and Justice. This eighth domain was adopted by AHRQ in mid-2022. The authors developed a proficiency assessment for the new equity and justice domain. The assessment criteria were iteratively defined, reviewed, and edited by content experts and trainees. The new items were developed by trainees and experts at one LHS training center with experience conducting research focused on healthcare inequities among marginalized populations. The same proficiency assessment criteria as for the other domains was applied with four levels of mastery: "no exposure," "foundational awareness," "emerging," and "proficient".
AHRQ-funded; HS026385.
Citation: Franklin PD, Drane D .
Assessment of learning health system science competency in the equity and justice domain.
Learn Health Syst 2024 Jan; 8(1):e10381. doi: 10.1002/lrh2.10381..
Keywords: Learning Health Systems, Health Systems
Moniz MH, Stout MJ, Kolenic GE
Association of childbirth with medical debt.
The purpose of this study was to assess the relationship between childbirth and having medical debt in collections and explored variations by neighborhood socioeconomic status. The study found that among a statewide cohort (n=26,717) of commercially insured pregnant and postpartum adults, having medical debt in collections was more likely among postpartum individuals compared with pregnant individuals and those in lowest-income neighborhoods compared with all others. Postpartum adults in the lowest-income neighborhoods also had the greatest predicted probabilities of having medical debt in collections, followed by pregnant adults in the lowest-income neighborhoods, followed by all other postpartum and pregnant adults.
AHRQ-funded; HS025465; HS028672; HS027788.
Citation: Moniz MH, Stout MJ, Kolenic GE .
Association of childbirth with medical debt.
Obstet Gynecol 2024 Jan; 143(1):11-13. doi: 10.1097/aog.0000000000005381..
Keywords: Maternal Care, Women, Healthcare Costs
Engelberg RS, Scheidell JD, Islam N
Associations between incarceration history and risk of hypertension and hyperglycemia: consideration of differences among Black, Hispanic, Asian and White Subgroups.
This study’s objective was to assess racial/ethnic group differences in the association between incarceration and hypertension and hyperglycemia. The authors performed a secondary data analysis using the National Longitudinal Survey of Adolescent to Adult Health (Add Health). They used Poisson regression to estimate the associations between lifetime history of incarceration reported during early adulthood with hypertension and hyperglycemia outcomes measured in mid-adulthood, including incident diagnosis. They evaluated whether associations varied by self-reported race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, and Asian) with an analytic sample of 4,015 Add Health respondents. Outcome measures included hypertension, systolic blood pressure >130 mmHG, and hyperglycemia. There was no evidence of an association between incarceration and measured health outcomes among non-Hispanic Black and non-Hispanic White participants. Among Hispanic participants, incarceration was associated with hyperglycemia (Adjusted Risk Ratio (ARR): 2.1), but not with hypertension risk. Incarceration was associated with elevated systolic blood pressure (ARR: 3.1) and hypertension (ARR: 1.7) among Asian participants, but not with hyperglycemia risk. Incarceration was associated with incident hypertension (ARR 2.5) among Asian subgroups.
AHRQ-funded; HS026120.
Citation: Engelberg RS, Scheidell JD, Islam N .
Associations between incarceration history and risk of hypertension and hyperglycemia: consideration of differences among Black, Hispanic, Asian and White Subgroups.
J Gen Intern Med 2024 Jan; 39(1):5-12. doi: 10.1007/s11606-023-08327-9..
Keywords: Vulnerable Populations, Racial and Ethnic Minorities, Blood Pressure, Cardiovascular Conditions, Risk
Foot C, Korthuis PT, Tsui JI
Associations between stimulant use and return to illicit opioid use following initiation onto medication for opioid use disorder.
The objective of this secondary analysis of data from two clinical trials comparing buprenorphine and extended-release naltrexone was to estimate the effect of ongoing stimulant use on return to illicit opioid use after initiation of medication for opioid use disorder (MOUD). The findings indicated that people on medication for opioid use disorder who subsequently used stimulants appeared more likely to return to non-prescribed opioids use compared with those without stimulant use; this association appeared stronger among patients who initiated buprenorphine compared with those who initiated extended-release naltrexone.
AHRQ-funded; HS026370.
Citation: Foot C, Korthuis PT, Tsui JI .
Associations between stimulant use and return to illicit opioid use following initiation onto medication for opioid use disorder.
Addiction 2024 Jan; 119(1):149-57. doi: 10.1111/add.16334..
Keywords: Opioids, Substance Abuse, Medication, Behavioral Health
Haimovich AD, Shah MN, Southerland LT
Automating risk stratification for geriatric syndromes in the emergency department.
This study discussed using automated risk stratification to implement screening programs for geriatric syndromes in the emergency department (ED). This method would reduce significant workloads at a time of record-breaking ED patient volumes, staff shortages, and hospital boarding crises. The authors defined the concept of automated risk stratification and screening using existing electronic health record (EHR) data. They discussed progress made in three potential use cases in the ED: falls, cognitive impairment, and end-of-life and palliative care; emphasizing the importance of linking automated screening with systems of healthcare delivery. They found that research progress and operational deployment vary by use case, ranging from deployed solutions in falls screening to algorithmic validation in cognitive impairment and end-of-life care, but should still be considered a potential solution.
AHRQ-funded; HS027735.
Citation: Haimovich AD, Shah MN, Southerland LT .
Automating risk stratification for geriatric syndromes in the emergency department.
J Am Geriatr Soc 2024 Jan; 72(1):258-67. doi: 10.1111/jgs.18594..
Keywords: Elderly, Emergency Department, Risk, Health Information Technology (HIT)
Adams DR
Availability and accessibility of mental health services for youth: a descriptive survey of safety-net health centers during the COVID-19 pandemic.
The goal of this study was to assess the availability of outpatient mental health services for children and adolescents at safety-net health centers in a large metropolitan county. A comprehensive sample of Community Mental Health Centers (CMHCs) and Federally Qualified Health Centers (FQHCs) received a 5-minute survey approximately one year after the beginning of the COVID-19 pandemic. The response indicated that 10% of health centers had closed and 20% reported that they were not offering outpatient mental health services. Reported wait times were longer at CMHCs than FQHCs. The author concluded that these findings suggested that online directories such as the SAMHSA Treatment Locator are often inaccurate or out-of-date.
AHRQ-funded; HS000084.
Citation: Adams DR .
Availability and accessibility of mental health services for youth: a descriptive survey of safety-net health centers during the COVID-19 pandemic.
Community Ment Health J 2024 Jan; 60(1):88-97. doi: 10.1007/s10597-023-01127-9..
Keywords: Children/Adolescents, Behavioral Health, Access to Care, COVID-19, Public Health
Jurlina A, Maul T, Hunsaker P
Changes in bronchiolitis characteristics during the COVID-19 pandemic: a description of pediatric emergency department visits in a community hospital, 2019-2021.
The purpose of this retrospective, cross-sectional study was to describe changes in bronchiolitis characteristics in pediatric emergency department patients in a community hospital during the COVID-19 pandemic. The researchers conducted the study with children with bronchiolitis aged 1 to 24 months during an ED visit between 2019 and 2021. The study found that bronchiolitis cases decreased by 75% from 2019 to 2020 and rose back to prepandemic levels by 2021. Radiographs, steroids, and bronchodilators decreased during the study period. Laboratory studies, viral testing, antibiotic use, and respiratory support were unchanged. The decrease in steroids and bronchodilators was related to a clinical pathway that discouraged their use. Respiratory support remained unchanged.
AHRQ-funded; HS026393.
Citation: Jurlina A, Maul T, Hunsaker P .
Changes in bronchiolitis characteristics during the COVID-19 pandemic: a description of pediatric emergency department visits in a community hospital, 2019-2021.
Clin Pediatr 2024 Jan; 63(1):73-79. doi: 10.1177/00099228231208941..
Keywords: COVID-19, Respiratory Conditions, Children/Adolescents, Emergency Department
Qureshi N, Kroger J, Zangwill KM
Changes in perceptions of antibiotic stewardship among neonatal intensive care unit providers over the course of a learning collaborative: a prospective, multisite, mixed-methods evaluation.
The purpose of this study was to assess clinician perceptions towards the value and implementation of antibiotic stewardship (AS) in neonatal intensive care units (NICU). The researchers conducted a mixed-methods study of AS perceptions utilizing surveys and interviews in 30 California NICUs before and after a multicenter collaborative (Optimizing Antibiotic Use in California NICUs [OASCN]). The study found that pre-OASCN, 24% of respondents believed there was "a lot of" or "some" inappropriate prescribing, often driven by fear of a bad outcome or hesitation to change existing practices. Clinicians reported statistically significant increases in AS importance, perceived AS activity, and more openness to change after OASCN.
AHRQ-funded; HS026168.
Citation: Qureshi N, Kroger J, Zangwill KM .
Changes in perceptions of antibiotic stewardship among neonatal intensive care unit providers over the course of a learning collaborative: a prospective, multisite, mixed-methods evaluation.
J Perinatol 2024 Jan; 44(1):62-70. doi: 10.1038/s41372-023-01823-0..
Keywords: Antibiotics, Antimicrobial Stewardship, Newborns/Infants, Intensive Care Unit (ICU), Critical Care
Chase BA, Semenov I, Rubin S
Characteristics associated with response to subcutaneously administered anti-CGRP monoclonal antibody medications in a real-world community cohort of persons living with migraine: a retrospective clinical and genetic study.
This study’s objective was to evaluate response to anti-calcitonin gene-related peptide (CGRP) migraine preventives in a real-world community cohort of persons living with migraine and to identify clinical and genetic characteristics associated with efficacious response. The authors looked at users of erenumab-aooeb, fremanezumab-vrfm, and galcanezumab-gnl and their reasons for stopping or starting these medications. No difference was seen at either first or second follow-ups between galcanezumab and fremanezumab or fremanezumab and erenumab. There was a decrease in MDM at follow-up that was generally proportional to baseline MDM, larger in females, and increased with months on medication, with the reasons for switching or stopping a preventive varying between medications and was often related to cost or insurance coverage. At both follow-ups, patient tolerance and continued use were high and similar across preventives.
AHRQ-funded; HS024057.
Citation: Chase BA, Semenov I, Rubin S .
Characteristics associated with response to subcutaneously administered anti-CGRP monoclonal antibody medications in a real-world community cohort of persons living with migraine: a retrospective clinical and genetic study.
Headache 2024 Jan; 64(1):68-92. doi: 10.1111/head.14655.AHRQ-funded; HS024057..
Keywords: Neurological Disorders, Medication
Jones KM, Krein SL, Mantey J
Characterizing infection prevention programs and urinary tract infection prevention practices in nursing homes: a mixed-methods study.
This study assessed nursing home (NH) infection prevention and control (IPC) resources and practices related to catheter and non-catheter-associated urinary tract infection (CAUTI and UTI). This mixed-methods study was conducted from April 2018 through November 2019 using quantitative surveys and semistructured qualitative interviews. Surveys were completed by 51 NH infection preventionists (IPs), and interviews were conducted with 13 participants from 7 NHs. The participating IPs had limited experience and/or additional roles, and in 36.7% of NHs, IPs had no specific IPC training, with a high turnover rate often mentioned during interviews. Most NHs were aware of their CAUTI and UTI rates and reported using prevention practices, such as hydration (85.7%) or nurse-initiated catheter discontinuation (65.3%). Interviewees expressed concerns about overuse of urine testing and antibiotics. Transfer sheets were used by 84% to communicate about infection, but the information received was described as suboptimal.
AHRQ-funded; HS25451.
Citation: Jones KM, Krein SL, Mantey J .
Characterizing infection prevention programs and urinary tract infection prevention practices in nursing homes: a mixed-methods study.
Infect Control Hosp Epidemiol 2024 Jan; 45(1):40-47. doi: 10.1017/ice.2023.127..
Keywords: Urinary Tract Infection (UTI), Nursing Homes, Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Prevention
Jardon C, Choi KR
COVID-19 experiences and mental health among graduate and undergraduate nursing students in Los Angeles.
This observational study’s purpose was to 1) describe the mental health of nursing students during the COVID-19 pandemic, (2) investigate relationships between stressful COVID-19 experiences and mental health, and (3) examine correlates of mental health service use. The authors created a web-based survey to assess COVID-19 experiences, self-reported mental health, and mental health service utilization among nursing students in Los Angeles in spring 2021 (N = 174, 30.1% response rate). The survey measured stressful COVID-19 experiences (personal COVID-19 illness, hospitalization of close friends or family, and death of close friends or family), loneliness, resilience, depression, anxiety, COVID-19-related traumatic stress, and utilization of campus and noncampus mental health services. Students were found to have high levels of depression (30%), anxiety (38%), and traumatic stress (30%). No relationship was found between stressful COVID-19 experiences and mental health, but loneliness was associated with higher odds of mental health problems and resilience with lower odds. Students with primary caregiving responsibilities (OR = 0.22) and students who identified as Asian/Pacific Islander (OR = 0.24) had lower odds of mental health service utilization.
AHRQ-funded; HS026407.
Citation: Jardon C, Choi KR .
COVID-19 experiences and mental health among graduate and undergraduate nursing students in Los Angeles.
J Am Psychiatr Nurses Assoc 2024 Jan-Feb; 30(1):86-94. doi: 10.1177/10783903211072222..
Keywords: COVID-19, Provider: Nurse, Education: Academic, Burnout
Yilmaz S, LeClaire M, Begnaud A
Developing LHS scholars' competency around reducing burnout and moral injury.
The study addresses the lack of a wellness competency focusing on burnout and moral injury prevention within Learning Health Systems (LHS). Experts collaborated to develop pathways for implementing such programs, emphasizing distinctions between moral injury and burnout, proposing interventions, and integrating expert input. The study found that a competency aimed at equipping scholars with skills for measuring, intervening, and embedding burnout and moral injury prevention into LHS structures, would potentially improve work lives and patient outcomes within LHS.
AHRQ-funded; HS026379.
Citation: Yilmaz S, LeClaire M, Begnaud A .
Developing LHS scholars' competency around reducing burnout and moral injury.
Learn Health Syst 2024 Jan; 8(1):e10378. doi: 10.1002/lrh2.10378..
Keywords: Learning Health Systems, Health Systems, Burnout, Provider: Health Personnel
Wolf RM, Hall M, Williams DJ
Disparities in pharmacologic restraint for children hospitalized in mental health crisis.
This retrospective cohort study examined associations between pharmacologic restraint use and race and ethnicity among children (aged 5-≤18 years) admitted for mental health conditions to acute care nonpsychiatric children's hospitals. Study period was 2018 to 2022 and was conducted at 41 US children’s hospitals and included a cohort of 61,503 hospitalizations. Compared with non-Hispanic Black children, children of non-Hispanic White (adjusted odds ratio [aOR], 0.81), Asian (aOR, 0.82), or other race and ethnicity (aOR, 0.68) were less likely to receive pharmacologic restraint, with no significant difference with Hispanic children. When stratified by sex, racial/ethnic differences were magnified in males, except for Hispanic males, and not found in females. Sensitivity analysis revealed amplified disparities for all racial/ethnic groups, including Hispanic youth.
AHRQ-funded; HS026122.
Citation: Wolf RM, Hall M, Williams DJ .
Disparities in pharmacologic restraint for children hospitalized in mental health crisis.
Pediatrics 2024 Jan; 153(1). doi: 10.1542/peds.2023-061353..
Keywords: Disparities, Children/Adolescents, Behavioral Health, Inpatient Care, Hospitals, Medication
Li J
Home health agencies with high quality of patient care star ratings reduced short-term hospitalization rates and increased days independently at home.
Accurate Medicare Quality of Patient Care home health star ratings are crucial to helping patients find high-quality care, yet critics of these ratings indicate that they are not valid. The purpose of this retrospective study was to assess whether using the highest-rated home health agency available in a ZIP code improves outcomes. The researchers included 1,870,080 Medicare fee-for-service beneficiaries using home health care from July 2015 through July 2016 in the United States. The study found that treatment by the highest-rated agencies available decreased risks of hospitalization, emergency department use, and institutionalization during the initial episode, and increased days independently at home by 2.6% or 3.75 days in the 180 days after the end of the initial episode. Treatment effects were stronger for agencies that were above-average, had 1 or more stars than the next-best agency, and nonrural residents. Effects were positive for both postacute and community-entry patients.
AHRQ-funded; HS026836.
Citation: Li J .
Home health agencies with high quality of patient care star ratings reduced short-term hospitalization rates and increased days independently at home.
Med Care 2024 Jan; 62(1):11-20. doi: 10.1097/mlr.0000000000001930..
Keywords: Home Healthcare, Quality of Care, Hospitalization, Provider Performance
Donnelly JP, Seelye SM, Kipnis P
Impact of reducing time-to-antibiotics on sepsis mortality, antibiotic use, and adverse events.
Researchers estimated benefits and harms of shortened time-to-antibiotics for sepsis. Their simulation study used a cohort of over 1.5 million hospitalizations via emergency department with more than two systemic inflammatory response syndrome criteria. The results showed that impacts of faster time-to-antibiotics for sepsis varied markedly across simulated hospital types; however, even in worst-case scenarios, new antibiotic-associated adverse events were rare.
AHRQ-funded; HS026725.
Citation: Donnelly JP, Seelye SM, Kipnis P .
Impact of reducing time-to-antibiotics on sepsis mortality, antibiotic use, and adverse events.
Ann Am Thorac Soc 2024 Jan; 21(1):94-101. doi: 10.1513/AnnalsATS.202306-505OC..
Keywords: Antibiotics, Medication, Sepsis, Mortality
Kaufman BG, Holland DE, Vanderboom CE
Implementation costs of technology-enhanced transitional palliative care for rural caregivers.
Rural FCG experience higher levels of burden accessing coordinated care for their loved ones during and after hospitalization than urban family caregivers (FCG). The role of technology-enhanced transitional palliative care (TPC) on caregiver outcomes is currently being assessed in a randomized control trial. The purpose of this study was to assess resource use and health system costs of this FCG-focused TPC intervention and potential Medicare reimbursement mechanisms. The researchers randomized rural caregivers of hospitalized patients into an 8-week intervention which included video visits conducted by a registered nurse certified in palliative care, and supplemented with phone calls and texts (n = 215), or attentional control. The researchers estimated labor costs for a registered nurse and compared to scenario analyses utilizing a nurse practitioner or social worker wages. Medicare reimbursement scenarios included Transitional Care Management (TCM) and Chronic Care Management (CCM) CPT codes. The researchers found the base case, TPC cost was $395 per FCG conducted by a registered nurse, compared to $337 and $585 if conducted by a social worker or nurse practitioner, respectively. Reimbursement in the CCM-only scenario was $348 and $274 for complex and non-complex patients, respectively. Average Medicare reimbursement in the TCM-only scenario was $322 and $260 for high or moderate complexity patients, respectively. Reimbursement in the TCM+CCM scenario was $496 and $397, for high/complex and moderate/non-complex patients, respectively.
AHRQ-funded; HS026379.
Citation: Kaufman BG, Holland DE, Vanderboom CE .
Implementation costs of technology-enhanced transitional palliative care for rural caregivers.
Am J Hosp Palliat Care 2024 Jan; 41(1):38-44. doi: 10.1177/10499091231156145..
Keywords: Rural Health, Caregiving, Palliative Care, Health Information Technology (HIT)
Eliason EL, Agostino J, Vivier P
Infant health care disruptions by race and ethnicity, income, and insurance during the COVID-19 pandemic.
This cross-sectional study examined the impact that the COVID-19 pandemic had on infant health care, and broke it down by race and ethnicity, income, and insurance type. This study used the Pregnancy Risk Assessment Monitoring System COVID-19 supplement with data from 29 jurisdictions to examine infant health care disruptions due to the pandemic: 1) well visits/checkups canceled or delayed, 2) well visits/checkups changed to virtual appointments, and 3) postponed immunizations. The authors found that among 12,053 parental respondents with infants born from April to December 2020, 7.25% reported cancelations or delays in infant well visits/checkups, 5.49% reported changes to virtual infant care appointments, and 5.33% reported postponing immunizations, with significant differences by race and ethnicity, income, and insurance type. They found higher odds of canceling/delaying visits and postponing immunizations among non-Hispanic Black infants and infants whose parents were uninsured or had Medicaid-paid deliveries. The odds of switching to virtual appointments was also significantly higher among Hispanic infants and infants whose parents had Medicaid-paid deliveries.
AHRQ-funded; HS000011.
Citation: Eliason EL, Agostino J, Vivier P .
Infant health care disruptions by race and ethnicity, income, and insurance during the COVID-19 pandemic.
Acad Pediatr 2024 Jan-Feb; 24(1):105-10. doi: 10.1016/j.acap.2023.07.005..
Keywords: Newborns/Infants, Racial and Ethnic Minorities, COVID-19, Access to Care, Uninsured, Health Insurance, Healthcare Delivery
Cohen TN, Berdahl CT, Coleman BL
Medication safety event reporting: Factors that contribute to safety events during times of organizational stress.
This study’s objective was to understand the insights conveyed in hospital incident reports about how work system factors affected medication safety during a coronavirus disease-2019 (COVID-19) surge. The authors randomly selected 100 medication safety incident reports from an academic medical center (December 2020 to January 2021), identified near misses and errors, and classified contributing work system factors using the Human Factors Analysis and Classification System-Healthcare. Results showed that among 35 near misses/errors, incident reports described contributing factors (mean 1.3/report) involving skill-based errors (n = 20), communication (n = 8), and tools/technology (n = 4). Seven of these events were linked to COVID-19.
AHRQ-funded; HS027455.
Citation: Cohen TN, Berdahl CT, Coleman BL .
Medication safety event reporting: Factors that contribute to safety events during times of organizational stress.
J Nurs Care Qual 2024 Jan-Mar; 39(1):51-57. doi: 10.1097/ncq.0000000000000720..
Keywords: Medication: Safety, Medication, Patient Safety, COVID-19, Adverse Drug Events (ADE), Adverse Events, Medical Errors