National Healthcare Quality and Disparities Report
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- Access to Care (1)
- Adverse Events (3)
- Antibiotics (1)
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- Blood Clots (1)
- Children/Adolescents (1)
- Comparative Effectiveness (2)
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- Healthcare-Associated Infections (HAIs) (2)
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- (-) Injuries and Wounds (23)
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- (-) Outcomes (23)
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- Patient-Centered Outcomes Research (11)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 23 of 23 Research Studies DisplayedNguyen JK, P P
Comparison of survival outcomes among older adults with major trauma after trauma center versus non-trauma center care in the United States.
This study’s objective was to compare level 1 and 2 trauma centers with similarly sized non-trauma centers on survival after major trauma among older adults. The authors used claims of 100% of 2012-2017 Medicare fee-for-service beneficiaries who received hospital care after major trauma. They assessed the roles of prehospital care, hospital quality, and volume. Thirty-day mortality was higher overall at level 1 versus non-trauma centers by 2.2 percentage points (pp). Thirty-day mortality was higher at level 1 versus non-trauma centers by 2.3 pp for falls and 2.3 pp for motor vehicle crashes. Outcomes were similar at level 1 and 2 trauma centers. The difference was not explained by hospital quality and volume. There were also no statistical differences in the ambulance-transported group, after adjusting for prehospital variables.
AHRQ-funded; HS025720.
Citation: Nguyen JK, P P .
Comparison of survival outcomes among older adults with major trauma after trauma center versus non-trauma center care in the United States.
Health Serv Res 2023 Aug; 58(4):817-27. doi: 10.1111/1475-6773.14148..
Keywords: Elderly, Trauma, Outcomes, Injuries and Wounds, Emergency Department, Hospitals
Bowman JA, Nuño M, Jurkovich GJ
Association of hospital-level intensive care unit use and outcomes in older patients with isolated rib fractures.
Researchers characterized interhospital variability in intensive care unit (ICU) vs non-ICU admission of older patients with isolated rib fractures and evaluated whether greater hospital-level use of ICU admission is associated with improved outcomes. This study included trauma patients who were admitted to trauma centers participating in the National Trauma Data Bank. The researchers found that admission location of older patients with isolated rib fractures was variable across hospitals, but hospitalization at a center with greater ICU use was associated with improved outcomes. They recommended that hospitals with low ICU use admit more such patients to an ICU.
AHRQ-funded; HS022236.
Citation: Bowman JA, Nuño M, Jurkovich GJ .
Association of hospital-level intensive care unit use and outcomes in older patients with isolated rib fractures.
JAMA Netw Open 2020 Nov 2;3(11):e2026500. doi: 10.1001/jamanetworkopen.2020.26500..
Keywords: Elderly, Injuries and Wounds, Intensive Care Unit (ICU), Hospitals, Patient-Centered Outcomes Research, Outcomes, Mortality
Bowman JA, Jurkovich GJ, Nishijima DK
Older adults with isolated rib fractures do not require routine intensive care unit admission.
This study examined whether older adults with isolated rib fractures should be admitted to an intensive care unit (ICU) due to higher presumed morbidity and mortality. Patients 50 years and older who were admitted between 2013 and 2017 were analyzed. The outcomes being looked at were any critical care intervention or adverse event based on accepted critical care guidelines. Out of 401 patients, 251 (63%) were admitted to the ICU. In the ICU, 33% experienced an adverse event while only 7% admitted to the ward experienced an adverse event. The most common events were hypotension, frequent respiratory therapy and oxygen desaturation. Predictors of these events included incentive spirometry, use of a walker, increased chest Abbreviated Injury Scale score, age 72 or greater, and active smoking. The investigators concluded routine ICU admission is not necessary for most older adults with isolated rib fractures.
AHRQ-funded; HS022236.
Citation: Bowman JA, Jurkovich GJ, Nishijima DK .
Older adults with isolated rib fractures do not require routine intensive care unit admission.
J Surg Res 2020 Jan;245:492-99. doi: 10.1016/j.jss.2019.07.098..
Keywords: Elderly, Injuries and Wounds, Intensive Care Unit (ICU), Patient-Centered Outcomes Research, Outcomes
Fink HA, MacDonald R, Forte ML
Long-term drug therapy and drug discontinuations and holidays for osteoporosis fracture prevention: a systematic review.
Optimal long-term osteoporosis drug treatment (ODT) is uncertain. The purpose of this study was to summarize the effects of long-term ODT and ODT discontinuation and holidays. The investigators concluded that: long-term alendronate and zoledronic acid therapies reduce fracture risk in women with osteoporosis; long-term bisphosphonate treatment may increase risk for rare adverse events, and continuing treatment beyond 3 to 5 years may reduce risk for vertebral fractures; and long-term hormone therapy reduces hip fracture risks but has serious harms.
AHRQ-funded; 290201500008I.
Citation: Fink HA, MacDonald R, Forte ML .
Long-term drug therapy and drug discontinuations and holidays for osteoporosis fracture prevention: a systematic review.
Ann Intern Med 2019 Jul 2;171(1):37-50. doi: 10.7326/m19-0533.
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Keywords: Evidence-Based Practice, Injuries and Wounds, Medication, Osteoporosis, Outcomes, Patient-Centered Outcomes Research, Prevention
Newgard CD, Lin A, Yanez ND
Long-term outcomes among injured older adults transported by emergency medical services.
This study examined the outcomes of injured older adults who were transported by emergency medical services (EMS) to the hospital. Older adults 65 years and older who were transported by 44 EMS agencies to 51 hospitals in 2011 were included and then had a 12-month follow-up through December 31, 2012. The majority of older adults were transported after a fall (84.5%). Serious injuries occurred in 3.5% with a serious extremity injury being the most common (17.8%). Mortality rates for older adults with severe injuries ranged from 1.6% in the hospital to 20.3% at 1 year. The most common causes of death was cardiovascular diseases and dementia.
AHRQ-funded; HS023796.
Citation: Newgard CD, Lin A, Yanez ND .
Long-term outcomes among injured older adults transported by emergency medical services.
Injury 2019 Jun;50(6):1175-85. doi: 10.1016/j.injury.2019.04.028..
Keywords: Elderly, Emergency Medical Services (EMS), Falls, Injuries and Wounds, Outcomes, Trauma
Gandek B, Roos EM, Franklin PD
A 12-item short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-12): tests of reliability, validity and responsiveness.
The purpose of this study was to evaluate reliability, validity and responsiveness of KOOS-12, a 12-item short form of the 42-item Knee injury and Osteoarthritis Outcome Score (KOOS) that provides Pain, Function and Quality of Life (QOL) scale scores and a summary knee impact score. Results showed that KOOS-12 was a reliable and valid alternative to KOOS in total knee replacement patients with moderate to severe knee osteoarthritis and provided three domain-specific and summary knee impact scores with substantially reduced respondent burden.
AHRQ-funded; HS024632; HS018910.
Citation: Gandek B, Roos EM, Franklin PD .
A 12-item short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-12): tests of reliability, validity and responsiveness.
Osteoarthritis Cartilage 2019 May;27(5):762-70. doi: 10.1016/j.joca.2019.01.011..
Keywords: Arthritis, Evidence-Based Practice, Injuries and Wounds, Outcomes, Pain, Patient-Centered Outcomes Research, Quality of Life
Zullo AR, Zhang T, Lee Y
Effect of bisphosphonates on fracture outcomes among frail older adults.
The purpose of this study was to estimate the effects of bisphosphonates on hip fractures, nonvertebral fractures, and severe esophagitis among frail, older adults. Participants were residents of long-stay U.S. nursing homes who were 65 years and older and had no recent use of osteoporosis medication. The matched cohort included new bisphosphonate users and an equal number of calcitonin users. Outcomes for hip fracture, nonvertebral fracture, and esophagitis were measured using Part A claims. Bisphosphonate users were less likely than calcitonin users to experience hip fracture, but had similar rates of nonvertebral fracture and esophagitis events. The researchers conclude that bisphosphonate use is associated with a meaningful reduction in hip fracture among frail, older adults.
AHRQ-funded; HS022998.
Citation: Zullo AR, Zhang T, Lee Y .
Effect of bisphosphonates on fracture outcomes among frail older adults.
J Am Geriatr Soc 2019 Apr;67(4):768-76. doi: 10.1111/jgs.15725..
Keywords: Elderly, Injuries and Wounds, Medication, Outcomes, Patient-Centered Outcomes Research
Marcolini EG, Albrecht JS, Sethuraman KN
Gender disparities in trauma care: how sex determines treatment, behavior, and outcome.
This study used US and European trauma database statistics, including the National Trauma Databank, to examine sex disparities in trauma care. Their findings indicate that sex differences in risk-taking behaviors that lead to traumatic injury have been associated with males, with female menstrual cycle timing, and with cortisol levels. Differences in access to services at trauma centers, including triage or transfer and level of medical attention are associated with sex as well race, rural or urban location, and insurance status. Outcomes, such as in-hospital mortality, multiple organ failure, pneumonia, and sepsis are associated with sex disparities in the general trauma patient; outcomes after general trauma and specifically traumatic brain injury show mixed results.
AHRQ-funded; HS024560.
Citation: Marcolini EG, Albrecht JS, Sethuraman KN .
Gender disparities in trauma care: how sex determines treatment, behavior, and outcome.
Anesthesiol Clin 2019 Mar;37(1):107-17. doi: 10.1016/j.anclin.2018.09.007..
Keywords: Access to Care, Disparities, Injuries and Wounds, Outcomes, Patient-Centered Outcomes Research, Risk, Sex Factors, Trauma
Myers SR, Branas CC, French B
A national analysis of pediatric trauma care utilization and outcomes in the United States.
The goal of this study was to provide the first national description of the proportion of injured children treated at pediatric trauma centers, and to clarify the presumed benefit of pediatric trauma center verification by comparing injury mortality across hospital types. The study used data from the 2006 Healthcare Cost and Utilization Project Kids Inpatient Database combined with national trauma center inventories. The results of the study may provide evidence that treatment of injured children at verified pediatric trauma centers may improve outcomes.
AHRQ-funded; HS017960; HS018604.
Citation: Myers SR, Branas CC, French B .
A national analysis of pediatric trauma care utilization and outcomes in the United States.
Pediatr Emerg Care 2019 Jan;35(1):1-7. doi: 10.1097/pec.0000000000000902..
Keywords: Children/Adolescents, Healthcare Utilization, Healthcare Cost and Utilization Project (HCUP), Injuries and Wounds, Outcomes, Patient-Centered Outcomes Research, Trauma
Wahl TS, Graham LA, Morris MS
Association between preoperative proteinuria and postoperative acute kidney injury and readmission.
This retrospective cohort study investigated whether preoperative proteinuria is associated with surgical outcomes including postoperative acute kidney injury (AKI) and readmission. The cohort used were undergoing elective inpatient surgery at 119 Veterans Affairs facilities from October 2007 to September 2014. The data collected was for a 7-month period in 2016. A higher probability of 30-day unplanned readmission was associated with preoperative proteinuria and postoperative AKI.
AHRQ-funded; HS013852.
Citation: Wahl TS, Graham LA, Morris MS .
Association between preoperative proteinuria and postoperative acute kidney injury and readmission.
JAMA Surg 2018 Sep;153(9):e182009. doi: 10.1001/jamasurg.2018.2009..
Keywords: Kidney Disease and Health, Injuries and Wounds, Adverse Events, Surgery, Risk, Hospital Readmissions, Outcomes
Sakran JV, Mehta A, Fransman R
Nationwide trends in mortality following penetrating trauma: are we up for the challenge?
This study analyzed contemporary trends in pre-hospital mortality from penetrating trauma in the past decade using The National Trauma Data Bank. The authors concluded the odds of pre-hospital mortality has increased over 4-fold for gunshot wounds and almost 9-fold for stab wounds. Examining violence intensity, along with improvements in hospital care and data collection, may explain these findings.
AHRQ-funded; HS024547.
Citation: Sakran JV, Mehta A, Fransman R .
Nationwide trends in mortality following penetrating trauma: are we up for the challenge?
J Trauma Acute Care Surg 2018 Jul;85(1):160-66. doi: 10.1097/ta.0000000000001907..
Keywords: Injuries and Wounds, Mortality, Outcomes, Trauma
Yarbrough CK, Bommarito KM, Gamble PG
Population-based approaches to treatment and readmission after spinal cord injury.
Recent studies in surgical and non-surgical specialties have suggested that patients admitted on the weekend may have worse outcomes. It is unclear whether this extends to patients with spinal cord injury (SCI). This study was designed to evaluate factors for readmission after index hospitalization for spinal cord injury. The study’s results suggested that the weekend effect, described previously in other patient populations, may not play as important a role in patients with SCI.
AHRQ-funded; HS019455.
Citation: Yarbrough CK, Bommarito KM, Gamble PG .
Population-based approaches to treatment and readmission after spinal cord injury.
J Neurosurg Sci 2018 Apr;62(2):107-15. doi: 10.23736/s0390-5616.16.03617-1..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Outcomes, Injuries and Wounds
Gandek B, Ware JE, Jr.
Validity and responsiveness of the knee injury and osteoarthritis outcome score: a comparative study among total knee replacement patients.
The researchers evaluated validity and responsiveness of the Knee Injury and Osteoarthritis Outcome Score (KOOS) in relation to other patient-reported outcome measures before and after total knee replacement (TKR). They concluded that KOOS scales were valid and responsive in a cohort of 1,143 US TKR patients. KOOS QOL performed particularly well in capturing aggregate knee-specific outcomes.
AHRQ-funded; HS018910; HS024632.
Citation: Gandek B, Ware JE, Jr. .
Validity and responsiveness of the knee injury and osteoarthritis outcome score: a comparative study among total knee replacement patients.
Arthritis Care Res 2017 Jun;69(6):817-25. doi: 10.1002/acr.23193.
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Keywords: Arthritis, Surgery, Patient-Centered Outcomes Research, Outcomes, Injuries and Wounds
O'Toole RV, Gary JL, Reider L
A prospective randomized trial to assess fixation strategies for severe open tibia fractures: modern ring external fixators versus internal fixation (FIXIT study).
The FIXIT study is a prospective, multicenter randomized trial comparing 1-year outcomes after treatment of severe open tibial shaft fractures with modern external ring fixation versus internal fixation among men and women of ages 18-64. The primary outcome is rehospitalization for major limb complications. One-year treatment costs and patient satisfaction will be compared between the 2 groups.
AHRQ-funded; HS000029.
Citation: O'Toole RV, Gary JL, Reider L .
A prospective randomized trial to assess fixation strategies for severe open tibia fractures: modern ring external fixators versus internal fixation (FIXIT study).
J Orthop Trauma 2017 Apr;31 Suppl 1:S10-s17. doi: 10.1097/bot.0000000000000804.
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Keywords: Injuries and Wounds, Surgery, Patient-Centered Outcomes Research, Comparative Effectiveness, Outcomes, Evidence-Based Practice
Obremskey WT, Schmidt AH, O'Toole RV
A prospective randomized trial to assess oral versus intravenous antibiotics for the treatment of postoperative wound infection after extremity fractures (POvIV study).
The POvIV study is a prospective, multicenter, randomized trial to compare oral (PO) with intravenous (IV) antibiotic therapy in patients with postoperative wound infections after extremity fractures. This study will be the largest prospective randomized trial to evaluate the safety and effectiveness of PO antibiotic use for treatment of postoperative wound infections. Results will inform clinician decisions on antibiotic delivery in patients with postoperative wound infections.
AHRQ-funded; HS000029.
Citation: Obremskey WT, Schmidt AH, O'Toole RV .
A prospective randomized trial to assess oral versus intravenous antibiotics for the treatment of postoperative wound infection after extremity fractures (POvIV study).
J Orthop Trauma 2017 Apr;31 Suppl 1:S32-s38. doi: 10.1097/bot.0000000000000802.
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Keywords: Antibiotics, Surgery, Injuries and Wounds, Healthcare-Associated Infections (HAIs), Comparative Effectiveness, Medication, Patient Safety, Adverse Events, Prevention, Patient-Centered Outcomes Research, Outcomes
Wegener ST, Pollak AN, Frey KP
The Trauma Collaborative Care Study (TCCS).
This article describes the Trauma Collaborative Care (TCC) program and the design of a multicenter study to evaluate its effectiveness for improving patient outcomes after major, high-energy orthopaedic trauma at level 1 trauma centers. Compared with standard treatment alone, it is hypothesized that access to the TCC program plus standard treatment will result in lower rates of poor patient-reported function, depression, and posttraumatic stress disorder.
AHRQ-funded; HS000029.
Citation: Wegener ST, Pollak AN, Frey KP .
The Trauma Collaborative Care Study (TCCS).
J Orthop Trauma 2017 Apr;31 Suppl 1:S78-s87. doi: 10.1097/bot.0000000000000792.
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Keywords: Injuries and Wounds, Outcomes, Patient-Centered Outcomes Research, Behavioral Health, Screening, Trauma
Lipman GS, Krabak BJ, Rundell SD
Incidence and prevalence of acute kidney injury during multistage ultramarathons.
The objective of this study was to determine the prevalence, incidence, and risk factors of acute kidney injury (AKI) during multistage ultramarathons. The authors found that prevalence of AKI was 63%-78% during multistage ultramarathons, and that female sex, lower pack weight, and greater weight loss were associated with renal impairment.
AHRQ-funded; HS022982.
Citation: Lipman GS, Krabak BJ, Rundell SD .
Incidence and prevalence of acute kidney injury during multistage ultramarathons.
Clin J Sport Med 2016 Jul;26(4):314-9. doi: 10.1097/jsm.0000000000000253.
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Keywords: Injuries and Wounds, Risk, Sex Factors, Outcomes
Jung HY, Trivedi AN, Grabowski DC
Does more therapy in skilled nursing facilities lead to better outcomes in patients with hip fracture?
The study objectives were: (1) to examine temporal trends in therapy hour volumes and (2) to evaluate whether more therapy hours are associated with improved patient outcomes. It concluded that increases in the quantity of therapy during the study period cannot be explained by changes in case mix at skilled nursing facility (SNF) admission.
AHRQ-funded; HS020756.
Citation: Jung HY, Trivedi AN, Grabowski DC .
Does more therapy in skilled nursing facilities lead to better outcomes in patients with hip fracture?
Phys Ther 2016 Jan;96(1):81-9. doi: 10.2522/ptj.20150090.
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Keywords: Outcomes, Injuries and Wounds, Medicare, Nursing Homes
Leland NE, Gozalo P, Christian TJ
An examination of the first 30 days after patients are discharged to the community from hip fracture postacute care.
This study examined the percentage of PAC patients who remain in the community at least 30 days after discharge (i.e., successful community discharge) after hip fracture rehabilitation and described differences among PAC facilities based on this outcome. It found that between 1999 and 2007, 57 percent of patients achieved successful community discharge. Black were less likely than similar whites to achieve successful community discharge.
AHRQ-funded; HS000011.
Citation: Leland NE, Gozalo P, Christian TJ .
An examination of the first 30 days after patients are discharged to the community from hip fracture postacute care.
Med Care 2015 Oct;53(10):879-87. doi: 10.1097/mlr.0000000000000419..
Keywords: Rehabilitation, Injuries and Wounds, Hospital Discharge, Hospital Readmissions, Outcomes
Hemmila MR, Osborne NH, Henke PK
Prophylactic inferior vena cava filter placement does not result in a survival benefit for trauma patients.
The researchers examined the relationship between prophylactic inferior vena cava (IVC) filter use, mortality, and venous thromboembolic events (VTE). They found that high rates of prophylactic IVC filter placement have no effect on reducing trauma patient mortality and are associated with an increase in deep venous thromboembolism (DVT) events.
AHRQ-funded; HS018728.
Citation: Hemmila MR, Osborne NH, Henke PK .
Prophylactic inferior vena cava filter placement does not result in a survival benefit for trauma patients.
Ann Surg 2015 Oct;262(4):577-85. doi: 10.1097/sla.0000000000001434..
Keywords: Blood Clots, Outcomes, Mortality, Injuries and Wounds, Prevention
Gozalo P, Leland NE, Christian TJ
Volume matters: returning home after hip fracture.
This study examined the effect of the relationship between volume (number of hip fracture admissions during the 12 months before participant’s fracture) and other facility characteristics on outcomes. It concluded that in community-dwelling persons with their first hip fracture, successful return to the community varies substantially, according to skilled nursing facility provider volume and staffing characteristics.
AHRQ-funded; HS000011.
Citation: Gozalo P, Leland NE, Christian TJ .
Volume matters: returning home after hip fracture.
J Am Geriatr Soc 2015 Oct;63(10):2043-51. doi: 10.1111/jgs.13677..
Keywords: Injuries and Wounds, Elderly, Outcomes, Hospital Discharge
Leland NE, Gozalo P, Bynum J
What happens to patients when they fracture their hip during a skilled nursing facility stay?
This study characterized outcomes of patients experiencing a fall and subsequent hip fracture while in a nursing home receiving skilled nursing facility (SNF) services. In the first 90 days following hospitalization for surgical repair of the hip fracture, 24.1 percent of patients died, 7.3 percent were discharged to the community but remained fewer than 30 days, and 14.0 percent achieved successful community discharge.
AHRQ-funded; HS000011.
Citation: Leland NE, Gozalo P, Bynum J .
What happens to patients when they fracture their hip during a skilled nursing facility stay?
J Am Med Dir Assoc 2015 Sep;16(9):767-74. doi: 10.1016/j.jamda.2015.03.026..
Keywords: Nursing Homes, Falls, Injuries and Wounds, Outcomes
Durkin MJ, Dicks KV, Baker AW
Postoperative infection in spine surgery: does the month matter?
The authors evaluated for seasonal variation of surgical site infection (SSI) following spine surgery in a network of nonteaching community hospitals. They found that the rate of SSI following fusion or spinal laminectomy/laminoplasty was higher during the summer in this network of community hospitals, most likely due to S. aureus rather than the July effect.
AHRQ-funded; HS023866.
Citation: Durkin MJ, Dicks KV, Baker AW .
Postoperative infection in spine surgery: does the month matter?
J Neurosurg Spine 2015 Jul;23(1):128-34. doi: 10.3171/2014.10.spine14559.
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Keywords: Surgery, Healthcare-Associated Infections (HAIs), Injuries and Wounds, Adverse Events, Patient Safety, Hospitals, Outcomes, Quality of Care