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 195 Research Studies DisplayedClancy CM
AHRQ Author: Clancy CM
Creating a healing environment.
Healthcare-associated infections, or HAIs, are as familiar as they are distressing but they are also largely preventable. The author, a former director of AHRQ, argues that the design of the healthcare facility environment (including layout, placement of equipment, and ease of access to materials) has the ability to improve patient safety, and more specifically, prevent the spread of HAIs.
Citation: Clancy CM .
Creating a healing environment.
HERD 2013 Oct;7(1 suppl):5-7..
Keywords: Healthcare-Associated Infections (HAIs), Patient Safety, Quality of Care
Everett CM, Thorpe CT, Palta M
Division of primary care services between physicians, physician assistants, and nurse practitioners for older patients with diabetes.
The investigators described the division of patients and services between primary care providers for older diabetes patients on panels with varying levels of PA/NP involvement. They concluded that understanding how patients and services are divided between PA/NPs and physicians will assist in defining provider roles on primary care teams.
AHRQ-funded; HS017646; HS018368; HS000083.
Citation: Everett CM, Thorpe CT, Palta M .
Division of primary care services between physicians, physician assistants, and nurse practitioners for older patients with diabetes.
Med Care Res Rev 2013 Oct;70(5):531-41. doi: 10.1177/1077558713495453.
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Keywords: Diabetes, Provider: Health Personnel, Patient-Centered Healthcare, Primary Care, Teams
Levit KR, Friedman B, Wong HS
AHRQ Author: Friedman B, Wong HS
Estimating inpatient hospital prices from state administrative data and hospital financial reports.
The researchers developed a tool for estimating hospital-specific inpatient prices for major payers. They found that hospital prices can be reasonably estimated for 10 geographically diverse states. They further found that estimated prices compare well with Medicare, MarketScan private insurance, and the Medical Expenditure Panel Survey prices for major payers, given limitations of each dataset.
AHRQ-authored; AHRQ-funded.
Citation: Levit KR, Friedman B, Wong HS .
Estimating inpatient hospital prices from state administrative data and hospital financial reports.
Health Serv Res 2013 Oct;48(5):1779-97. doi: 10.1111/1475-6773.12065.
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Keywords: Healthcare Costs, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Medical Expenditure Panel Survey (MEPS)
Lewandowski RE, Acri MC, Hoagwood KE
Evidence for the management of adolescent depression.
This article reports on the development of a care pathway and quality indicators (QIs) for the primary and specialty care management of adolescent depression. It also reviews clinical practice guidelines and identifies barriers to the development of QIs, such as gaps in the empirical evidence. Finally, a research agenda is suggested.
AHRQ-funded; HS020503
Citation: Lewandowski RE, Acri MC, Hoagwood KE .
Evidence for the management of adolescent depression.
Pediatrics. 2013 Oct;132(4):e996-e1009. doi: 10.1542/peds.2013-0600..
Keywords: Children/Adolescents, Depression, Quality Indicators (QIs), Guidelines, Quality of Care
Lenfestey NF, Denham ME, Hall KK
http://journals.sagepub.com/doi/full/10.1177/193758671300701S05
Expert opinions on the role of facility design in the acquisition and prevention of healthcare-associated infections.
The purpose of this study was to assess expert knowledge, perceptions, and experience on the role of the built environment in the acquisition and transmission of healthcare-associated infections (HAIs), facility design decision-making considerations, and strategies for intervention through facility design and technologies. It concluded that no single intervention is entirely effective in mitigating HAI risk; multiple interventions are needed.
AHRQ-funded; 290201000024I.
Citation: Lenfestey NF, Denham ME, Hall KK .
Expert opinions on the role of facility design in the acquisition and prevention of healthcare-associated infections.
HERD 2013 Oct;7(1 suppl):31-45..
Keywords: Healthcare-Associated Infections (HAIs), Patient Safety, Quality of Care
Fakih MG, George C, Edson BS
Implementing a national program to reduce catheter-associated urinary tract infection: a quality improvement collaboration of state hospital associations, academic medical centers, professional societies, and governmental agencies.
The authors describe a large-scale national effort funded by AHRQ to reduce catheter-associated urinary tract infections (CAUTI). They elucidate the importance of the collaboration between the different national and local associations, societies, and agencies that is required for a successful program. They also illustrate the complexities of implementing both the technical and socioadaptive improvement efforts focused on reducing CAUTI.
AHRQ-funded; 290201000025I; 29032001T
Citation: Fakih MG, George C, Edson BS .
Implementing a national program to reduce catheter-associated urinary tract infection: a quality improvement collaboration of state hospital associations, academic medical centers, professional societies, and governmental agencies.
Infect Control Hosp Epidemiol. 2013 Oct;34(10):1048-54. doi: 10.1086/673149..
Keywords: Urinary Tract Infection (UTI), Healthcare-Associated Infections (HAIs), Quality of Care, Patient Safety, Catheter-Associated Urinary Tract Infection (CAUTI)
Raebel MA, Xu S, Goodrich GK
Initial antihyperglycemic drug therapy among 241 327 adults with newly identified diabetes from 2005 through 2010: a surveillance, prevention, and management of diabetes mellitus (SUPREME-DM) study.
This study sought to identify predictors of initiating any antihyperglycemic medication, and specifically sulfonylurea versus metformin in patients with newly diagnosed with diabetes. Most (59.7 percent) patients with newly diagnosed diabetes did not start any antihyperglycemic medication. Among those who did, metformin was generally the first antihyperglycemic initiated.
AHRQ-funded; HS019859
Citation: Raebel MA, Xu S, Goodrich GK .
Initial antihyperglycemic drug therapy among 241 327 adults with newly identified diabetes from 2005 through 2010: a surveillance, prevention, and management of diabetes mellitus (SUPREME-DM) study.
Ann Pharmacother. 2013 Oct;47(10):1280-91. doi: 10.1177/1060028013503624..
Keywords: Diabetes, Medication, Comparative Effectiveness
Huckfeldt PJ, Sood NB, Romley JA
Medicare payment reform and provider entry and exit in the post-acute care market.
The researchers examined the impact of Medicare payment reform on the entry and exit of post-acute providers (home health agencies and skilled nursing facilities). They found that payment reforms reducing average and marginal payments reduced entries and increased exits from the market, with entries more likely to be affected.
AHRQ-funded; HS018541
Citation: Huckfeldt PJ, Sood NB, Romley JA .
Medicare payment reform and provider entry and exit in the post-acute care market.
Health Serv Res. 2013 Oct;48(5):1557-80. doi: 10.1111/1475-6773.12059..
Keywords: Medicare, Critical Care, Healthcare Costs, Home Healthcare, Long-Term Care
Gabler NB, Ratcliffe SJ, Wagner J
Mortality among patients admitted to strained intensive care units.
A study of 264,401 patients admitted to 155 U.S. intensive care units (ICUs) found several factors associated with small increases in mortality: ICU census on the day of a patient’s admission, the presence of higher acuity patients, and the proportion of new admissions. These sources of ICU strain were associated with mortality increases particularly in ICUs employing closed staffing models.
AHRQ-funded; HS018406
Citation: Gabler NB, Ratcliffe SJ, Wagner J .
Mortality among patients admitted to strained intensive care units.
Am J Respir Crit Care. 2013 Oct 1;188(7):800-6. doi: 10.1164/rccm.201304-0622OC..
Keywords: Mortality, Intensive Care Unit (ICU), Critical Care, Patient Safety, Workforce
Randhawa G
AHRQ Author: Randhawa G
Moving to a user-driven research paradigm.
The combination of changes in research practice and in health care delivery, growing complexity in decision-making, increasing use of electronic health records, and growing resource constraints necessitate a shift to a user-driven research paradigm to generate new knowledge. This article's conceptual framework was created to clarify the perspective of the decision makers as well as the range of factors and the variability in thresholds used to make decisions. It may help researchers in creating actionable information to meet the needs of decision makers, which is needed for the transition to a user-driven research paradigm.
AHRQ-authored.
Citation: Randhawa G .
Moving to a user-driven research paradigm.
EGEMS 2013 Oct;1(2):1017. doi: 10.13063/2327-9214.1017.
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Keywords: Shared Decision Making, Electronic Health Records (EHRs), Evidence-Based Practice, Healthcare Delivery, Implementation
Liss DT, Fishman PA, Rutter CM
Outcomes among chronically ill adults in a medical home prototype.
The researchers compared quality, utilization, and cost outcomes for patients with selected chronic illnesses at a patient-centered medical home (PCMH) prototype site with outcomes for patients with the same chronic illnesses at 19 nonintervention control sites. They concluded that a clinic-level population-based PCMH redesign can decrease downstream utilization and reduce total healthcare costs in a subpopulation of patients with common chronic illnesses.
AHRQ-funded; HS019129.
Citation: Liss DT, Fishman PA, Rutter CM .
Outcomes among chronically ill adults in a medical home prototype.
Am J Manag Care 2013 Oct;19(10):e348-58.
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Keywords: Chronic Conditions, Healthcare Costs, Quality of Care, Patient-Centered Healthcare, Patient-Centered Outcomes Research
Wagner J, Gabler NB, Ratcliffe SJ
Outcomes among patients discharged from busy intensive care units.
This study of 155 U.S. intensive care units (ICUs) found that when their capacities are strained, triage decisions seem to be affected such that patients are discharged from the ICU more quickly, and have slightly greater odds of being readmitted to the ICU. However, short-term patient outcomes are unaffected.
AHRQ-funded; HS018406
Citation: Wagner J, Gabler NB, Ratcliffe SJ .
Outcomes among patients discharged from busy intensive care units.
Ann Intern Med. 2013 Oct 1;159(7):447-55. doi: 10.7326/0003-4819-159-7-201310010-00004..
Keywords: Intensive Care Unit (ICU), Patient Safety, Outcomes, Hospital Discharge, Mortality
Katz DF, Sun J, Khatri V
QTc interval screening in an opioid treatment program.
This pilot study supports the feasibility of implementing a population-based electrocardiographic monitoring program in order to decrease the QTc interval in high-risk patients undergoing methadone maintenance in an opioid treatment program. Clinical characteristics alone were inadequate to identify patients in need of electrocardiographic screening.
AHRQ-funded; HS021138
Citation: Katz DF, Sun J, Khatri V .
QTc interval screening in an opioid treatment program.
Am J Cardiol. 2013 Oct 1;112(7):1013-8. doi: 10.1016/j.amjcard.2013.05.037..
Keywords: Opioids, Medication, Substance Abuse, Screening, Adverse Drug Events (ADE), Adverse Events, Medication: Safety, Risk, Implementation
Moga DC, Carnahan RM, Lund BC
Risks and benefits of bladder antimuscarinics among elderly residents of Veterans Affairs Community Living Centers.
This study evaluated the risks and benefits of drugs to reduce urinary incontinence that were used by elderly VA nursing home residents. It found that the use of these drugs, known as bladder antimuscarinics, resulted in improved continence rates and better social engagement but also led to a higher risk of fractures in new users.
AHRQ-funded; HS016094
Citation: Moga DC, Carnahan RM, Lund BC .
Risks and benefits of bladder antimuscarinics among elderly residents of Veterans Affairs Community Living Centers.
J Am Med Dir Assoc. 2013 Oct;14(10):749-60. doi: 10.1016/j.jamda.2013.03.008..
Keywords: Elderly, Medication, Medication: Safety, Nursing Homes, Long-Term Care, Injuries and Wounds, Patient Safety
Sheppard KD, Brown CJ, Hearld KR
Symptom burden predicts nursing home admissions among older adults.
Using a sample of community-dwelling Medicare beneficiaries in Alabama who were contacted by telephone every 6 months during an eight and a half-year study, researchers found that symptom burden is an independent risk factor for NH admission. The study suggests that symptom assessment and management may reduce NH utilization.
AHRQ-funded; HS013852
Citation: Sheppard KD, Brown CJ, Hearld KR .
Symptom burden predicts nursing home admissions among older adults.
J Pain Symptom Manage. 2013 Oct;46(4):591-7. doi: 10.1016/j.jpainsymman.2012.10...
Keywords: Medicare, Long-Term Care, Elderly, Nursing Homes, Healthcare Costs
Henriksen K, Brady J
AHRQ Author: Henriksen K, Brady J
The pursuit of better diagnostic performance: a human factors perspective.
Improving diagnostic performance is increasingly recognised as a multifaceted challenge. This paper addresses a few of these challenges, including questions that focus on who owns the problem, treating cognitive and system shortcomings as separate issues, why knowledge in the head is not enough, and what we are learning from health information technology and the use of checklists. The authors propose a systems engineering approach making use of rapid-cycle prototyping and simulation, and they call for the formation of substantive partnerships with those in disciplines beyond the clinical domain.
AHRQ-authored.
Citation: Henriksen K, Brady J .
The pursuit of better diagnostic performance: a human factors perspective.
BMJ Qual Saf 2013 Oct;22 Suppl 2:ii1-ii5. doi: 10.1136/bmjqs-2013-001827.
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Keywords: Diagnostic Safety and Quality, Health Information Technology (HIT), Medical Errors, Health Information Technology (HIT), Quality Improvement
Zimring C, Denham ME, Jacob JT
http://journals.sagepub.com/doi/10.1177/193758671300701S09
The role of facility design in preventing healthcare-associated infection: interventions, conclusions, and research needs.
The objective of this report was to summarize the findings and provide recommendations based on the multidisciplinary literature review and industry scan, focusing on the links between the built environment and healthcare-associated infections. It concluded that there are currently few data that demonstrate a reduction in infection rates. There is a need for multidisciplinary collaboration and increased efforts to standardize the evaluation of environmental studies.
AHRQ-funded; 290201000024I.
Citation: Zimring C, Denham ME, Jacob JT .
The role of facility design in preventing healthcare-associated infection: interventions, conclusions, and research needs.
HERD 2013 Oct;7(1 suppl):127-39..
Keywords: Evidence-Based Practice, Quality of Care, Healthcare-Associated Infections (HAIs), Hospitals
Zimring C, Jacob JT, Denham ME
http://journals.sagepub.com/doi/pdf/10.1177/193758671300701S04
The role of facility design in preventing the transmission of healthcare-associated infections: Background and conceptual framework.
This paper describes the conceptual framework and methodology used to conduct a comprehensive literature review of current evidence evaluating the role of the built environment in the transmission of healthcare-associated infections. The methodology involves a chain of transmission interventions model that is a multidisciplinary conceptualization of the interaction between pathogens and the built environment. This model facilitated a systematic literature review of a very large amount of data.
AHRQ-funded; 290201000024I.
Citation: Zimring C, Jacob JT, Denham ME .
The role of facility design in preventing the transmission of healthcare-associated infections: Background and conceptual framework.
HERD 2013 Oct;7(1 suppl):18-30.
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Keywords: Evidence-Based Practice, Quality of Care, Healthcare-Associated Infections (HAIs), Research Methodologies
Jacob JT, Kasali A, Steinberg JP
http://journals.sagepub.com/doi/abs/10.1177/193758671300701S07
The role of the hospital environment in preventing healthcare-associated infections caused by pathogens transmitted through the air.
This review assesses and synthesizes available evidence in the infection control and healthcare design literature on strategies using the built environment to reduce the transmission of pathogens in the air that cause healthcare-associated infections (HAIs). It found that current evidence is limited by the complexity of the interactions between pathogens and potential hosts, and in the methods used to assess impact of these strategies.
AHRQ-funded; 290201000024I.
Citation: Jacob JT, Kasali A, Steinberg JP .
The role of the hospital environment in preventing healthcare-associated infections caused by pathogens transmitted through the air.
HERD 2013 Oct;7(1 suppl):74-98..
Keywords: Healthcare-Associated Infections (HAIs), Patient Safety, Quality of Care
Steinberg JP, Denham ME, Zimring C
https://www.researchgate.net/publication/276382905/download
The role of the hospital environment in the prevention of healthcare-associated infections by contact transmission.
The authors describe the role of the hospital environment in the spread of pathogens by direct and indirect contact. In addition, the prevention of transmission through interventions involving the built environment is discussed. They conclude that enhanced environmental cleaning including touchless technologies and self-cleaning surfaces can reduce environmental contamination and may prevent infections.
AHRQ-funded; 290201000024I.
Citation: Steinberg JP, Denham ME, Zimring C .
The role of the hospital environment in the prevention of healthcare-associated infections by contact transmission.
HERD 2013 Oct;7(1 suppl):46-73..
Keywords: Healthcare-Associated Infections (HAIs), Infectious Diseases, Hospitals, Prevention, Patient Safety
Denham ME, Kasali A, Steinberg JP
http://journals.sagepub.com/doi/abs/10.1177/193758671300701S08
The role of water in the transmission of healthcare-associated infections: opportunities for intervention through the environment.
The purpose of this review was to assess and synthesize available evidence in the infection control and healthcare design literature on strategies using the built environment to reduce the transmission of pathogens in water that cause healthcare-associated infections (HAIs). It determined that current evidence clearly identifying the environment’s role in the chain of infection is limited.
AHRQ-funded; 290201000024I.
Citation: Denham ME, Kasali A, Steinberg JP .
The role of water in the transmission of healthcare-associated infections: opportunities for intervention through the environment.
HERD 2013 Oct;7(1 suppl):99-126..
Keywords: Healthcare-Associated Infections (HAIs), Patient Safety, Quality of Care
Hall KK, Kamerow DB
http://journals.sagepub.com/doi/abs/10.1177/193758671300701S03
Understanding the role of facility design in the acquisition and prevention of healthcare-associated infections.
The authors characterize the HAI-Design project and discuss briefly each paper in this issue. These papers highlight how the built environment can impact patient safety through the use of a specific and high-impact example: healthcare-associated infections. The overall goal is to identify design strategies that appear to be effective in interrupting pathogen transmission and reducing HAIs.
AHRQ-funded; 290201000024I.
Citation: Hall KK, Kamerow DB .
Understanding the role of facility design in the acquisition and prevention of healthcare-associated infections.
HERD 2013 Oct;7(1 suppl):13-17..
Keywords: Healthcare-Associated Infections (HAIs), Patient Safety, Quality of Care
Nurgalieva ZZ, Franzini L, Morgan RO
Utilization of lymph node dissection, race/ethnicity, and breast cancer outcomes.
This study reports on the impact of nodal surgery utilization on survival among white, African American, Hispanic, and Asian women in a large population of women with breast cancer. It found that the disparities in survival among African American and Hispanic women with breast cancer are not explained by nodal surgery utilization among women with micrometastasis and macrometastasis in sentinel lymph nodes.
AHRQ-funded; HS018956.
Citation: Nurgalieva ZZ, Franzini L, Morgan RO .
Utilization of lymph node dissection, race/ethnicity, and breast cancer outcomes.
Am J Manag Care 2013 Oct;19(10):805-10..
Keywords: Cancer: Breast Cancer, Comparative Effectiveness, Disparities, Patient-Centered Outcomes Research, Racial and Ethnic Minorities
O'Donnell BE, Schneider KM, Brooks JM
Standardizing Medicare payment information to support examining geographic variation in costs.
This paper describes a method for standardizing claim payments, and demonstrates the difference in actual versus standardized payments by geographic region. It found that without standardization of payments, certain areas of the country are mischaracterized as either high or low healthcare resource-consuming areas.
AHRQ-funded; HS019574; HS019440.
Citation: O'Donnell BE, Schneider KM, Brooks JM .
Standardizing Medicare payment information to support examining geographic variation in costs.
Medicare Medicaid Res Rev 2013 Sep 10;3(3). doi: 10.5600/mmrr.003.03.a06..
Keywords: Medicare, Healthcare Costs, Hospitalization, Hospitals
Glanz JM, Wagner NM, Narwaney KJ
A mixed methods study of parental vaccine decision making and parent-provider trust.
Given the growing public health problem of parental vaccine hesitancy, researchers investigated parental vaccine decisionmaking through the use of focus groups and a mailed survey. They found that parents had overall trust in their pediatricians but not in the information they provided about vaccines. Parents refusing or delaying vaccines were twice as likely to begin thinking about vaccines before their child was born.
AHRQ-funded; HS019760
Citation: Glanz JM, Wagner NM, Narwaney KJ .
A mixed methods study of parental vaccine decision making and parent-provider trust.
Acad Pediatr. 2013 Sep-Oct;13(5):481-8. doi: 10.1016/j.acap.2013.05.030..
Keywords: Children/Adolescents, Vaccination, Education: Patient and Caregiver, Healthcare Utilization, Shared Decision Making