National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Events (1)
- Ambulatory Care and Surgery (1)
- Back Health and Pain (1)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (4)
- Critical Care (1)
- Disparities (1)
- Education: Continuing Medical Education (2)
- Electronic Health Records (EHRs) (2)
- Healthcare Costs (1)
- Health Information Technology (HIT) (3)
- Health Systems (1)
- Hospital Readmissions (1)
- Hospitals (4)
- Intensive Care Unit (ICU) (1)
- Long-Term Care (1)
- Medicare (5)
- Nursing Homes (2)
- Obesity (1)
- Outcomes (4)
- Patient-Centered Outcomes Research (1)
- Patient Experience (5)
- Patient Safety (1)
- Payment (2)
- Practice Improvement (1)
- Primary Care (1)
- Provider (1)
- Provider: Health Personnel (1)
- Provider: Physician (3)
- (-) Provider Performance (22)
- Quality Improvement (5)
- Quality Indicators (QIs) (2)
- Quality Measures (5)
- Quality of Care (17)
- Racial and Ethnic Minorities (1)
- Shared Decision Making (1)
- Simulation (3)
- Surgery (6)
- Training (2)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 22 of 22 Research Studies DisplayedWilcock AD, Joshi S, Escarce J
Luck of the draw: role of chance in the assignment of Medicare readmissions penalties.
Pay-for-performance programs are one strategy used by health plans to improve the efficiency and quality of care delivered to beneficiaries. Under such programs, providers are often compared against their peers in order to win bonuses or face penalties in payment. The purpose of this study was to investigate the impact luck can have on the assessment of performance, the researchers investigated its role in assigning penalties under Medicare's Hospital Readmissions Reduction Policy (HRRP), a program that penalizes hospitals with excess readmissions.
AHRQ-funded; HS024284.
Citation: Wilcock AD, Joshi S, Escarce J .
Luck of the draw: role of chance in the assignment of Medicare readmissions penalties.
PLoS One 2021 Dec 21;16(12):e0261363. doi: 10.1371/journal.pone.0261363..
Keywords: Medicare, Payment, Hospital Readmissions, Provider Performance, Quality of Care
Greenberg JK, Olsen MA, Dibble CF
Comparison of cost and complication rates for profiling hospital performance in lumbar fusion for spondylolisthesis.
Investigators sought to evaluate the reliability of 90-day inpatient hospital costs, overall complications, and rates of serious complications for profiling hospital performance in lumbar fusion surgery for spondylolisthesis. Using HCUP data, they found that 90-day inpatient costs were highly reliable for assessing variation across hospitals, whereas overall and serious complications were only moderately reliable for profiling performance. They concluded that their results support the viability of emerging bundled payment programs that assume true differences in costs of care exist across hospitals.
AHRQ-funded; HS027075; HS019455.
Citation: Greenberg JK, Olsen MA, Dibble CF .
Comparison of cost and complication rates for profiling hospital performance in lumbar fusion for spondylolisthesis.
Spine J 2021 Dec;21(12):2026-34. doi: 10.1016/j.spinee.2021.06.014..
Keywords: Healthcare Costs, Hospitals, Provider Performance, Surgery, Quality Measures, Quality of Care
Davila H, Shippee TP, Park YS
Inside the black box of improving on nursing home quality measures.
This qualitative study investigated how nursing homes (NHs) interact with quality measures (QMs) used by Nursing Home Compare (NHC) as part of its 5-star rating system. Semistructured interviews were conducted with 110 NH personnel and 23 NH provider association representatives. Observations of organizational processes in 12 NHs in three states were also done. The authors found that most NHs are working to improve the quality of care they provide, not merely to improve their QM scores. They also found limitations with the QMs, suggesting that the QMs on their own may not accurately reflect the quality of care that NHs provide. The findings suggest several changes to improve NHC.
AHRQ-funded; HS024967.
Citation: Davila H, Shippee TP, Park YS .
Inside the black box of improving on nursing home quality measures.
Med Care Res Rev 2021 Dec;78(6):758-70. doi: 10.1177/1077558720960326..
Keywords: Nursing Homes, Quality Indicators (QIs), Quality Measures, Quality Improvement, Quality of Care, Provider Performance, Long-Term Care
Thelen AE, Kendrick DE, Chen X
Novel method to link surgical trainee performance data to patient outcomes.
A significant roadblock in surgical education research has been the inability to compare trainee performance to the outcomes of those surgeons after they enter independent practice. In this study, the investigators described the feasibility of an innovative method to link trainee performance data with patient outcomes. They indicated that this innovation could enable future research investigating the relationship between surgical trainee performance and patient outcomes in independent practice.
AHRQ-funded; HS027653.
Citation: Thelen AE, Kendrick DE, Chen X .
Novel method to link surgical trainee performance data to patient outcomes.
Am J Surg 2021 Dec;222(6):1072-78. doi: 10.1016/j.amjsurg.2021.10.018..
Keywords: Surgery, Education: Continuing Medical Education, Provider Performance, Provider: Physician, Outcomes
de Cordova PB, Johansen ML, Zha P
Does public reporting of staffing ratios and Nursing Home Compare ratings matter?
This study’s objective was to examine the association between publicly available staffing ratios and the Five-Star Quality Ratings from Nursing Home Compare over time. Findings showed that decreasing the number of residents assigned to a registered nurse in nursing homes resulted in an increase in staffing ratings. Mandatory public reporting held nursing homes accountable for quality outcomes but did not improve staffing ratios. Recommendations included continuing to focus on improving quality in nursing homes, which may improve staffing ratios across shifts.
AHRQ-funded; HS024339.
Citation: de Cordova PB, Johansen ML, Zha P .
Does public reporting of staffing ratios and Nursing Home Compare ratings matter?
J Am Med Dir Assoc 2021 Nov;22(11):2373-77. doi: 10.1016/j.jamda.2021.03.011..
Keywords: Nursing Homes, Quality of Care, Provider Performance
Quigley DD, Elliott MN, Slaughter ME
Shadow coaching improves patient experience with care, but gains erode later.
Health care organizations strive to improve patient care experiences. Some use one-on-one provider counseling (shadow coaching) to identify and target modifiable provider behaviors. In this study, the investigators examined whether shadow coaching improved patient experience across 44 primary care practices in a large urban Federally Qualified Health Center. The investigators concluded that shadow coaching improved providers' overall performance and communication immediately after being coached.
AHRQ-funded; HS025920.
Citation: Quigley DD, Elliott MN, Slaughter ME .
Shadow coaching improves patient experience with care, but gains erode later.
Med Care 2021 Nov;59(11):950-60. doi: 10.1097/mlr.0000000000001629..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Provider Performance, Quality Improvement, Quality of Care, Primary Care
Roberts ET, Song Z, Ding L
Changes in patient experiences and assessment of gaming among large clinician practices in precursors of the merit-based incentive payment system.
Medicare's Merit-Based Incentive Payment System (MIPS), a public reporting and pay-for-performance program, adjusts clinician payments based on publicly reported measures that are chosen primarily by clinicians or their practices. Within precursor programs of the MIPS, this study examined 1) practices' selection of Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experience measures for quality scoring under pay-for-performance and 2) the association between mandated public reporting on CAHPS measures and performance on those measures.
AHRQ-funded; HS026727.
Citation: Roberts ET, Song Z, Ding L .
Changes in patient experiences and assessment of gaming among large clinician practices in precursors of the merit-based incentive payment system.
JAMA Health Forum 2021 Oct;2(10). doi: 10.1001/jamahealthforum.2021.3105..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Medicare, Provider Performance, Payment, Quality Improvement, Quality of Care
Fowler FJ, Brenner PS, Hargraves JL
Comparing web and mail protocols for administering Hospital Consumer Assessment of Healthcare Providers and Systems surveys.
This study’s objective was to compare results of using web-based and mail HCAHPS data collection protocols. The cohort included patients who were hospitalized in a New England Hospital. Patients who provided email addresses were randomized to 1 of 3 data collection protocols: web-only, web with postal mail follow-up, and postal mail only. Those who did not provide email addresses were surveyed by postal mail only. The study lasted 8 weeks. Measures looked at included response rates, characteristics of respondents, 6 composite measures of their patient experiences, and two ratings of the hospital. Web-only response rates were significantly lower than for mail or combined protocols, and those who had not provided email addresses also had lower response rates. Older adults over age 65 were more likely to respond to all protocols, especially for mail-only respondents. Respondents without email addresses were older, less educated, and reported worse health than those who had email addresses.
AHRQ-funded; HS016978.
Citation: Fowler FJ, Brenner PS, Hargraves JL .
Comparing web and mail protocols for administering Hospital Consumer Assessment of Healthcare Providers and Systems surveys.
Med Care 2021 Oct;59(10):907-12. doi: 10.1097/mlr.0000000000001627..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Hospitals, Health Information Technology (HIT), Quality Measures, Provider Performance, Quality of Care
Shintani Smith S, Cheng BT, Kern RC
Publicly reported patient satisfaction scores in academic otolaryngology departments.
Despite controversy regarding their impact and validity, there is a rising national focus on patient satisfaction scores (PSS). In this retrospective cross-sectional study the investigators described the landscape of online PSS as posted by academic otolaryngology practices. The investigators concluded that patient satisfaction with otolaryngology providers at academic institutions was consistently high, as demonstrated by high online PSS with little variability.
AHRQ-funded; HS023011.
Citation: Shintani Smith S, Cheng BT, Kern RC .
Publicly reported patient satisfaction scores in academic otolaryngology departments.
Laryngoscope 2021 Oct;131(10):2204-10. doi: 10.1002/lary.29557..
Keywords: Patient Experience, Quality of Care, Provider Performance
Cardell CF, Knapp L, Cohen ME
Successful implementation of enhanced recovery in elective colorectal surgery is variable and dependent on the local environment.
This study looked at the results of a national colorectal enhanced recovery program (ERP) to improve patient outcomes. A total of 207 hospitals participated between 2017 and 2020. Quantitative (patient-level process and outcome) and qualitative (survey and structured interviews with hospital teams) data were collected and analyzed. Results shows that 62 hospitals were characterized as High Performance, and 52 as High Improvement. High Performance hospitals were larger with more annual colorectal surgeries. Fewer barriers to staff-buy-in and competing priorities, and more experience with standardized perioperative care were also characteristics of High Performance hospitals. High Improvement hospitals had lower baseline process measure (PM) adherence and less experience with perioperative care but had positive trends in annual patient outcomes such as annual morbidity, readmission, and prolonged length of stay compared to Low Improvement Hospitals.
AHRQ-funded; 233201500020I.
Citation: Cardell CF, Knapp L, Cohen ME .
Successful implementation of enhanced recovery in elective colorectal surgery is variable and dependent on the local environment.
Ann Surg 2021 Oct 1;274(4):605-12. doi: 10.1097/sla.0000000000005069..
Keywords: Surgery, Quality Improvement, Quality of Care, Outcomes, Patient-Centered Outcomes Research, Provider Performance
Holmgren AJ, Kuznetsova M, Classen D
Assessing hospital electronic health record vendor performance across publicly reported quality measures.
The authors measured hospital performance, stratified by electronic health record (EHR) vendor, across 4 quality metrics. They found that no EHR vendor was associated with higher quality across all measures, and the 2 largest vendors were not associated with the highest scores. Only a small fraction of quality variation was explained by EHR vendor choice. They concluded that top performance on quality measures can be achieved with any EHR vendor, as much of quality performance is driven by the hospital and how it uses the EHR.
AHRQ-funded; HS023696.
Citation: Holmgren AJ, Kuznetsova M, Classen D .
Assessing hospital electronic health record vendor performance across publicly reported quality measures.
J Am Med Inform Assoc 2021 Sep 18;28(10):2101-07. doi: 10.1093/jamia/ocab120..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Indicators (QIs), Quality Measures, Hospitals, Quality of Care, Provider Performance
Greenberg JK, Olsen MA, Poe J
Administrative data are unreliable for ranking hospital performance based on serious complications after spine fusion.
The authors evaluated the extent to which a metric of serious complications determined from administrative data can reliably profile hospital performance in spine fusion surgery. They found that a metric of serious complications was unreliable for benchmarking cervical fusion outcomes and only modestly reliable for thoracolumbar fusion. They concluded that, when assessed using administrative datasets, these measures appeared to be inappropriate for high-stakes applications, such as public reporting or pay-for-performance.
AHRQ-funded; HS027075; HS019455.
Citation: Greenberg JK, Olsen MA, Poe J .
Administrative data are unreliable for ranking hospital performance based on serious complications after spine fusion.
Spine 2021 Sep 1;46(17):1181-90. doi: 10.1097/brs.0000000000004017..
Keywords: Surgery, Provider Performance, Hospitals, Adverse Events, Back Health and Pain
Khodyakov D, Buttorff C, Xenakis L
Alignment between objective and subjective assessments of health system performance: findings from a mixed-methods study.
This study was a survey of health system executives to examine whether their performance assessments match objective performance assessments and qualitatively explore ways to achieve high performance. Interviews were conducted with 138 C-suite executives of 24 health systems in California, Minnesota, Washington, and Wisconsin between 2017 and 2019. The interviews were focused on executives’ perceptions of their own health system’s performance and factors they perceived generally contributed to high performance. The authors grouped health systems based on objective performance levels used in sampling and compared the ratings to executives’ subjective performance assessments. There was poor agreement between objective and subjective performance assessments. Executives whose views were inconsistent with objective assessments did not cite clinical care quality as their basis for their assessment but focused instead on market competition, financial performance, and high customer satisfaction and loyalty. Executives who cited clinical quality metrics had subjective ratings consistent with objective ratings.
AHRQ-funded; HS024067.
Citation: Khodyakov D, Buttorff C, Xenakis L .
Alignment between objective and subjective assessments of health system performance: findings from a mixed-methods study.
J Healthc Manag 2021 Sep-Oct;66(5):380-94. doi: 10.1097/jhm-d-20-00249..
Keywords: Health Systems, Quality of Care, Practice Improvement, Provider Performance
Murray DJ, Boulet JR, Boyle WA
Competence in decision making: setting performance standards for critical care.
Health care professionals must be able to make frequent and timely decisions that can alter the illness trajectory of intensive care patients. A competence standard for this ability is difficult to establish yet assuring practitioners can make appropriate judgments is an important step in advancing patient safety. In this study, the investigators hypothesized that simulation could be used effectively to assess decision-making competence.
AHRQ-funded; HS022265.
Citation: Murray DJ, Boulet JR, Boyle WA .
Competence in decision making: setting performance standards for critical care.
Anesth Analg 2021 Jul 1;133(1):142-50. doi: 10.1213/ane.0000000000005053..
Keywords: Critical Care, Shared Decision Making, Intensive Care Unit (ICU), Simulation, Provider Performance, Patient Safety, Quality of Care
Greenberg CC, Byrnes ME, Engler TA
Association of a statewide surgical coaching program with clinical outcomes and surgeon perceptions.
Investigators assessed risk-adjusted outcomes and participant perceptions following a statewide coaching program for bariatric surgeons. They found that this surgical coaching program was perceived as valuable and surgeons reported numerous practice changes. Additionally, operative times improved, but there was no significant improvement in risk-adjusted outcomes.
AHRQ-funded; HS023597.
Citation: Greenberg CC, Byrnes ME, Engler TA .
Association of a statewide surgical coaching program with clinical outcomes and surgeon perceptions.
Ann Surg 2021 Jun;273(6):1034-39. doi: 10.1097/sla.0000000000004800..
Keywords: Surgery, Provider: Physician, Provider Performance, Outcomes
Meyers DJ, Rahman M, Mor V
Association of Medicare Advantage Star Ratings with racial, ethnic, and socioeconomic disparities in quality of care.
This cross-sectional study looked at racial/ethnic minority and socioeconomic disparities in ratings for Medicare Advantage (MA) plans, which disproportionately enroll these populations. A total of 1,578,564 enrollees were included in this analysis that used 22 measures of quality and satisfaction at the individual enrollee level, aggregated into simulated star ratings from 2-5 stratified by socioeconomic status (SES) and race/ethnicity. Low SES enrollees had simulated stratified star ratings 0.5 stars lower than individuals with high SES in the same contract. Black enrollees had simulated star ratings that were 0.3 stars lower and Hispanic enrollees had 0.1 lower simulated star ratings than White enrollees in the same contract. There was a larger difference in ratings with 4.5 to 5-star contracts with Black and Hispanic enrollees with Whites, and no statistical difference in 2.0 to 2.5 star-rated contracts. There was only low correlation between simulated ratings for enrollees of low SES and high SES.
AHRQ-funded; HS02705101.
Citation: Meyers DJ, Rahman M, Mor V .
Association of Medicare Advantage Star Ratings with racial, ethnic, and socioeconomic disparities in quality of care.
JAMA Health Forum 2021 Jun;2(6):e210793..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Medicare, Patient Experience, Disparities, Quality Measures, Provider Performance, Quality of Care, Racial and Ethnic Minorities
Sen AP, Meiselbach MK, Anderson KE
Physician network breadth and plan quality ratings in Medicare Advantage.
This research letter describes a cross-sectional study that was conducted to examine the extent of narrow networks across Medicare Advantage (MA), types of counties where they are common, enrollment in narrow network plans, and how networks are associated with star ratings. The authors used Vericred physician networks data, publicly available CMS MA plan data, and Census and Area Health Resources File data on county characteristics. Network breadth was defined as the percentage of eligible county-level physicians in network, with narrow defined as fewer than 25% of eligible physicians. The authors examined the 2019 physician breadth among the most prevalent MA plan designs (HMOs and PPOs), described the percentage of enrollees in narrow network plans by state, and assessed whether network breadth was associated with star ratings, adjusting for plan and county characteristics. The sample included 44,715 plan-counties and 18,448,434 MA enrollees. The mean MA network included 41.2% of local physicians. From the 44,715 plan-counties, 28% had narrow networks and 72% were non-narrow. The majority of narrow networks were HMOs (79.8%) compared with 50.7% among non-narrow plans. More narrow networks were in large metropolitan counties (40%) than in non-narrow networks (26.7%). Counties with higher narrow networks had more mean MA penetration and a larger mean percentage of population older than 65 years who self-identified as Hispanic. Six states had more than 50% of beneficiaries in a narrow network plan, including California, Florida, Minnesota, Maryland, Wyoming, and Kansas.
AHRQ-funded; HS000029.
Citation: Sen AP, Meiselbach MK, Anderson KE .
Physician network breadth and plan quality ratings in Medicare Advantage.
JAMA Health Forum 2021 Jul 30; 2(7):e211816. doi: 10.1001/jamahealthforum.2021.1816..
Keywords: Medicare, Quality of Care, Provider Performance
Sinz E, Banerjee A, Steadman R
Reliability of simulation-based assessment for practicing physicians: performance is context-specific.
Even physicians who routinely work in complex, dynamic practices may be unprepared to optimally manage challenging critical events. High-fidelity simulation can realistically mimic critical clinically relevant events, however the reliability and validity of simulation-based assessment scores for practicing physicians has not been established. In this study, standardised complex simulation scenarios were developed and administered to board-certified, practicing anesthesiologists who volunteered to participate in an assessment study during formative maintenance of certification activities.
AHRQ-funded; HS020415.
Citation: Sinz E, Banerjee A, Steadman R .
Reliability of simulation-based assessment for practicing physicians: performance is context-specific.
BMC Med Educ 2021 Apr 12;21(1):207. doi: 10.1186/s12909-021-02617-8..
Keywords: Simulation, Education: Continuing Medical Education, Training, Provider Performance
Shekelle PG, Pane JD, Agniel D
Assessment of variation in electronic health record capabilities and reported clinical quality performance in ambulatory care clinics, 2014-2017.
This study’s objective was to assess the association between electronic health records (EHRs) with different degrees of capabilities and publicly reported ambulatory quality measures in at least 3 clinical domains of care. This cross-sectional and longitudinal study was conducted using survey responses from 1141 ambulatory clinics in Minnesota, Washington, and Wisconsin affiliated with a health system and reported performance measures in 2014 to 2017. A composite measure of EHR capability that considered 50 EHR capabilities was created using 7 functional domains: no functional EHR, EHR underuser, EHR, neither underuser nor superuser, and EHR superuser; as well as a standardized composite of ambulatory clinical measures that included a median of 13 individual measures (3 to 25). The proportion of clinics that were EHR superusers increased from 51% in 2014 to 61% in 2017. In all survey years EHR superusers had better clinical quality performance than other clinics. This difference in scores translated into an approximately 9% difference in a clinic’s rank order in clinical quality.
AHRQ-funded; HS024067.
Citation: Shekelle PG, Pane JD, Agniel D .
Assessment of variation in electronic health record capabilities and reported clinical quality performance in ambulatory care clinics, 2014-2017.
JAMA Netw Open 2021 Apr;4(4):e217476. doi: 10.1001/jamanetworkopen.2021.7476..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Ambulatory Care and Surgery, Provider Performance, Quality of Care
Mazur LM, Adams R, Mosaly PR
Effect of simulation-based training and neurofeedback interventions on radiation technologists' workload, situation awareness, and performance.
The purpose of this study was to assess the effect of a combined intervention - simulation-based training supported by neurofeedback sessions - on radiation technologists' (RTs') workload, situation awareness, and performance during routine quality assurance and treatment delivery tasks. The investigators found that RTs randomized to simulation-based training followed by neurofeedback sessions demonstrated no significant changes in perceived workload or situation awareness scores but did have better performance compared with other study groups (P < .01).
AHRQ-funded; HS025597.
Citation: Mazur LM, Adams R, Mosaly PR .
Effect of simulation-based training and neurofeedback interventions on radiation technologists' workload, situation awareness, and performance.
Pract Radiat Oncol 2021 Mar-Apr;11(2):e124-e33. doi: 10.1016/j.prro.2020.08.005..
Keywords: Simulation, Training, Provider Performance, Provider: Health Personnel
Chhabra KR, Thumma JR, Varban OA
Associations between video evaluations of surgical technique and outcomes of laparoscopic sleeve gastrectomy.
The authors examined associations between technique and outcomes in laparoscopic sleeve gastrectomy. Technical approaches to five controversial aspects of laparoscopic sleeve gastrectomy were studied: dissection of the proximal stomach, sleeve caliber, sleeve anatomy, staple line reinforcement, and leak testing. The authors found that variations in surgical technique can be measured by video review and are associated with differences in patient outcomes.
AHRQ-funded; HS023597; HS025365.
Citation: Chhabra KR, Thumma JR, Varban OA .
Associations between video evaluations of surgical technique and outcomes of laparoscopic sleeve gastrectomy.
JAMA Surg 2021 Feb;156(2):e205532. doi: 10.1001/jamasurg.2020.5532..
Keywords: Surgery, Obesity, Provider Performance, Provider: Physician, Provider, Quality of Care
Meyers DJ, Trivedi AN, Wilson IB, DJ, Trivedi AN, Wilson IB
Higher Medicare Advantage Star Ratings are associated with improvements In patient outcomes.
Researchers examined CMS' five-star rating system for the overall quality of Medicare Advantage (MA) contracts. They found that enrollees experiencing a one-star MA rating increase were 20.8 percent less likely to leave their plan voluntarily to enroll in another plan or traditional Medicare. When hospitalized, enrollees were 3.4 percent more likely to use a higher-quality hospital and 2.6 percent less likely to be readmitted within ninety days. These findings suggest that MA star ratings may capture key domains of an MA plan's quality.
AHRQ-funded; HS027051.
Citation: Meyers DJ, Trivedi AN, Wilson IB, DJ, Trivedi AN, Wilson IB .
Higher Medicare Advantage Star Ratings are associated with improvements In patient outcomes.
Health Aff 2021 Feb;40(2):243-50. doi: 10.1377/hlthaff.2020.00845..
Keywords: Patient Experience, Provider Performance, Medicare, Quality Improvement, Quality of Care, Outcomes