National Healthcare Quality and Disparities Report
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Search All Research Studies
Topics
- Adverse Drug Events (ADE) (7)
- Adverse Events (6)
- Antibiotics (7)
- Antimicrobial Stewardship (3)
- Blood Thinners (1)
- Cancer: Prostate Cancer (1)
- Cardiovascular Conditions (1)
- Children/Adolescents (5)
- Chronic Conditions (1)
- Critical Care (1)
- Data (1)
- Depression (1)
- Diabetes (1)
- (-) Diagnostic Safety and Quality (19)
- Electronic Health Records (EHRs) (2)
- Genetics (2)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Costs (2)
- Health Information Technology (HIT) (2)
- Infectious Diseases (2)
- Intensive Care Unit (ICU) (2)
- Kidney Disease and Health (1)
- Long-Term Care (1)
- Medical Errors (2)
- Medical Expenditure Panel Survey (MEPS) (1)
- (-) Medication (19)
- Medication: Safety (4)
- Nursing Homes (1)
- Organizational Change (1)
- Osteoporosis (1)
- Patient-Centered Outcomes Research (1)
- Patient Safety (3)
- Pneumonia (1)
- Practice Patterns (1)
- Prevention (1)
- Quality Improvement (1)
- Quality of Care (1)
- Respiratory Conditions (1)
- Risk (1)
- Screening (2)
- Sepsis (1)
- Shared Decision Making (2)
- Skin Conditions (1)
- Urinary Tract Infection (UTI) (1)
- Workflow (1)
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 19 of 19 Research Studies DisplayedChiotos K, Marshall D, Kellom K
Mixed-methods process evaluation of a respiratory-culture diagnostic stewardship intervention.
The purpose of this study was to perform an evaluation of a diagnostic stewardship initiative for respiratory culture in the healthcare setting within a pediatric intensive care unit (PICU) in a tertiary-care center. The study found that the frequency of culture collection per day of service differed among attending physicians, ranging from 2.2 to 27 cultures per 100 days. A total of 14 interviews were conducted, and 87 clinicians (response rate: 47%) along with 77 nurses or respiratory therapists (response rate: 17%) participated in the survey. There was a variation in clinicians' stated practices concerning culture ordering, which was influenced by both their specialty and their perception of the respiratory culture's usefulness. Additionally, group "default" practices, fear, and hierarchy affected the decision to order cultures. Obstacles to standardization encompassed concerns about missing a diagnosis and the conflict between standardized practices and individual judgment.
AHRQ-funded; HS026393.
Citation: Chiotos K, Marshall D, Kellom K .
Mixed-methods process evaluation of a respiratory-culture diagnostic stewardship intervention.
Infect Control Hosp Epidemiol 2023 Feb; 44(2):191-99. doi: 10.1017/ice.2022.299..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Antibiotics, Medication, Antimicrobial Stewardship, Intensive Care Unit (ICU)
Woods-Hill CZ, Colantuoni EA, Koontz DW
Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.
The purpose of this AHRQ-funded prospective study was to assess the relationship between a 14-site PICU blood culture collaborative, the Bright STAR (Testing Stewardship for Antibiotic Reduction) collaborative, and culture rates, antibiotic use, and patient outcomes. The researchers collected data from each participating PICU across the United States and from the Children’s Hospital Association Pediatric Health Information System. The main outcome was blood culture rates, with secondary outcomes including: broad-spectrum antibiotic use and PICU rates of central line-associated bloodstream infection (CLABSI), Clostridioides difficile infection, readmission, length of stay, sepsis, severe sepsis/septic shock, and mortality. The study found that the blood culture rate preimplementation across the 14 PICUs was 149.4 per 1000 patient days per month, and the rate postimplementation was 100.5 for a 33% relative reduction postimplementation. For those same periods, the rate of antibiotic use decreased from 506 days per 1000 patient-days per month preimplementation to 440 days per 1000 patient-days per month postimplementation, which reflects a 13% relative reduction. Rates of CLABSI decreased from 1.8 to 1.1 per 1000 central venous line days per month, a 36% relative reduction. The variables of length of stay, readmission, sepsis, severe sepsis/septic shock, and mortality were similar before and after implementation. The researchers concluded that collaborative interventions can reduce blood culture and antibiotic use in the PICU.
AHRQ-funded; HS025642.
Citation: Woods-Hill CZ, Colantuoni EA, Koontz DW .
Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.
JAMA Pediatr 2022 Jul;176(7):690-98. doi: 10.1001/jamapediatrics.2022.1024..
Keywords: Children/Adolescents, Sepsis, Critical Care, Antibiotics, Medication, Diagnostic Safety and Quality, Antimicrobial Stewardship
Beeber AS, Kistler CE, Zimmerman S
Nurse decision-making for suspected urinary tract infections in nursing homes: potential targets to reduce antibiotic overuse.
This study’s goal was to determine what information is most important to registered nurses (RNs) decisions to call clinicians about suspected urinary tract infections (UTIs) in nursing home residents. An online survey was conducted with a convenience sample of 881 RNs recruited from a health care research panel. Clinical scenarios from 10 categories of resident characteristics were used: UTI risk, resident type, functional status, mental status, lower urinary tract status, body temperature, physical exam, urinalysis, antibiotic request, and goals of care. Participants were randomized into 2 deliberation conditions: self-paced (n=437) and forced deliberation (n=444). Painful or difficult urinary, obvious blood in urine and temperature at 101.5° had the highest odds of a RN calling a clinician by the forced-deliberation group. For the self-paced group, painful or difficult urination had the highest odds.
AHRQ-funded; HS024519.
Citation: Beeber AS, Kistler CE, Zimmerman S .
Nurse decision-making for suspected urinary tract infections in nursing homes: potential targets to reduce antibiotic overuse.
J Am Med Dir Assoc 2021 Jan;22(1):156-63. doi: 10.1016/j.jamda.2020.06.053..
Keywords: Urinary Tract Infection (UTI), Antibiotics, Antimicrobial Stewardship, Medication, Nursing Homes, Long-Term Care, Shared Decision Making, Diagnostic Safety and Quality
Stone CA, Trubiano JA, Phillips EJ
Testing strategies and predictors for evaluating immediate and delayed reactions to cephalosporins.
Although 1% to 2% of the general population carries a cephalosporin allergy label (CAL), there is a lack of validated testing strategies and predictors of true allergy. The objective of this study was to identify cross-reactivity patterns and predictors of skin test positive (STP) in geographically disparate patients with a CAL. The investigators found that cephalosporin cross-reactivity was based on shared R1 groupings. Increasing time since the original reaction and the presence of a PAL with unknown cephalosporin tolerance predicted a lower likelihood of cephalosporin STP.
AHRQ-funded; HS026395.
Citation: Stone CA, Trubiano JA, Phillips EJ .
Testing strategies and predictors for evaluating immediate and delayed reactions to cephalosporins.
J Allergy Clin Immunol Pract 2021 Jan;9(1):435-44e13. doi: 10.1016/j.jaip.2020.07.056..
Keywords: Antibiotics, Medication, Adverse Drug Events (ADE), Adverse Events, Skin Conditions, Diagnostic Safety and Quality
Salmasian H, Blanchfield BB, Joyce K
Association of display of patient photographs in the electronic health record with wrong-patient order entry errors.
Wrong-patient order entry (WPOE) errors have a high potential for harm; these errors are particularly frequent wherever workflows are complex and multitasking and interruptions are common, such as in the emergency department (ED). The purpose of this study was to evaluate whether the use of noninterruptive display of patient photographs in the banner of the electronic health record (EHR) is associated with a decreased rate of WPOE errors.
AHRQ-funded; HS024713.
Citation: Salmasian H, Blanchfield BB, Joyce K .
Association of display of patient photographs in the electronic health record with wrong-patient order entry errors.
AMA Netw Open 2020 Nov 2;3(11):e2019652. doi: 10.1001/jamanetworkopen.2020.19652..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Adverse Drug Events (ADE), Adverse Events, Medication, Medication: Safety, Patient Safety, Diagnostic Safety and Quality
Stone CA, Stollings JL, Lindsell CJ
Risk-stratified management to remove low-risk penicillin allergy labels in the ICU.
Patients admitted to a medical ICU (MICU) often have chronic illnesses or altered immunity, increasing their need for immediate antibiotic use. In this study, the investigators sought to determine whether MICU patients with low-risk penicillin allergy history could be challenged directly with amoxicillin to have their allergy label safely removed during an acute inpatient stay.
Citation: Stone CA, Stollings JL, Lindsell CJ .
Risk-stratified management to remove low-risk penicillin allergy labels in the ICU.
Am J Respir Crit Care Med 2020 Jun 15;201(12):1572-75. doi: 10.1164/rccm.202001-0089LE..
Keywords: Intensive Care Unit (ICU), Antibiotics, Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events, Risk, Diagnostic Safety and Quality
Saff RR, Li Y, Santhanakrishnan N
Identification of inpatient allergic drug reactions using ICD-9-CM codes.
The study of allergic drug reactions has been limited because of challenges in identifying and confirming cases. The objective of this study was to determine the utility of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for identifying inpatient allergic drug reactions and to compare findings with previous data in the emergency department.
AHRQ-funded; HS022728; HS025375.
Citation: Saff RR, Li Y, Santhanakrishnan N .
Identification of inpatient allergic drug reactions using ICD-9-CM codes.
J Allergy Clin Immunol Pract 2019 Jan;7(1):259-64.e1. doi: 10.1016/j.jaip.2018.07.022..
Keywords: Adverse Drug Events (ADE), Adverse Events, Medication: Safety, Medication, Diagnostic Safety and Quality, Patient Safety
Schneider JG, Wood JB, Schmitt BH
Susceptibility Provision Enhances Effective De-escalation (SPEED): utilizing rapid phenotypic susceptibility testing in Gram-negative bloodstream infections and its potential clinical impact.
In this study, the investigators evaluated the performance and time to result for pathogen identification (ID) and antimicrobial susceptibility testing (AST) of the Accelerate Pheno system (AXDX) compared with standard of care (SOC) methods. They also assessed the hypothetical improvement in antibiotic utilization if AXDX had been implemented. The authors indicated that by providing fast and reliable ID and AST results, AXDX has the potential to improve antimicrobial utilization and enhance antimicrobial stewardship.
AHRQ-funded; HS026390.
Citation: Schneider JG, Wood JB, Schmitt BH .
Susceptibility Provision Enhances Effective De-escalation (SPEED): utilizing rapid phenotypic susceptibility testing in Gram-negative bloodstream infections and its potential clinical impact.
J Antimicrob Chemother 2019 Jan;74(Suppl 1):i16-i23. doi: 10.1093/jac/dky531..
Keywords: Healthcare-Associated Infections (HAIs), Infectious Diseases, Antibiotics, Medication, Diagnostic Safety and Quality
Shaker M, Verma K, Greenhawt M
The health and economic outcomes of early egg introduction strategies.
This study compared the costs and benefits of early egg introduction (EEI) using simulation and Markov modeling over a 20-year horizon with data from the United States, Europe, and Canada. Per child it was more expensive to provide early screening for all children with early-onset eczema than to have a “wait and see” approach. While there would be more egg allergy diagnosis with early screening, the increased costs were too great compared to the no-screening approach.
Citation: Shaker M, Verma K, Greenhawt M .
The health and economic outcomes of early egg introduction strategies.
Allergy 2018 Nov;73(11):2214-23. doi: 10.1111/all.13565..
Keywords: Children/Adolescents, Screening, Healthcare Costs, Diagnostic Safety and Quality, Medication
Bates DW, Singh H
Two decades since To Err Is Human: an assessment of progress and emerging priorities in patient safety.
This paper comments on the progress made in improving patient safety since the 1999 report from The Institute of Medicine titled “To Err is Human” was published. This landmark report highlighted problem areas, and since then there has been a number of effective interventions to prevent hospital-acquired infections and improve medication safety. Additional areas for improvement have also been identified in the past two decades, including outpatient care, diagnostic, errors and the use of health information technology. The authors believe that electronic data developments can help increase patient safety even further.
AHRQ-funded; HS022087; HS017820.
Citation: Bates DW, Singh H .
Two decades since To Err Is Human: an assessment of progress and emerging priorities in patient safety.
Health Aff 2018 Nov;37(11):1736-43. doi: 10.1377/hlthaff.2018.0738..
Keywords: Adverse Drug Events (ADE), Adverse Events, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Medication, Medication: Safety, Patient Safety, Prevention
Shaker M, Stukus D, Chan ES
"To screen or not to screen": comparing the health and economic benefits of early peanut introduction strategies in five countries.
This study compared the costs and benefits of early peanut introduction (EPI) using data from five countries: US, Canada, Australia, New Zealand and United Kingdom. Per child it was more expensive to provide early screening for all children with early-onset eczema and/or egg allergy than to have a “wait and see” approach. While there would be more peanut allergy diagnosis with early screening, the increased costs were too great compared to the no-screening approach.
AHRQ-funded; HS024599.
Citation: Shaker M, Stukus D, Chan ES .
"To screen or not to screen": comparing the health and economic benefits of early peanut introduction strategies in five countries.
Allergy 2018 Aug;73(8):1707-14. doi: 10.1111/all.13446..
Keywords: Children/Adolescents, Screening, Diagnostic Safety and Quality, Healthcare Costs, Medication, Medication
Shetterly Shetterly, S Flory, J
Diagnosis-based cohort augmentation using laboratory results data: the case of chronic kidney disease.
This study used data from FDA’s Sentinel System to determine if augmenting a diagnosis-based chronic kidney disease cohort with patients identified through laboratory results impacted cohort characteristics and outcomes. They divided the cohort into three different groups to compare demographic, clinical, and health care utilization characteristics. They observed mortality rates between the different groups.
AHRQ-funded; HS023898.
Citation: Shetterly Shetterly, S Flory, J .
Diagnosis-based cohort augmentation using laboratory results data: the case of chronic kidney disease.
Pharmacoepidemiol Drug Saf 2018 Aug;27(8):872-77. doi: 10.1002/pds.4583..
Keywords: Diagnostic Safety and Quality, Kidney Disease and Health, Chronic Conditions, Adverse Drug Events (ADE), Medication, Adverse Events
Olfson M, Blanco C, Marcus SC
Treatment of adult depression in the United States.
The researchers characterized the treatment of adult depression in the United States. They concluded that most US adults who screen positive for depression did not receive treatment for depression, whereas most who were treated did not screen positive. In light of these findings, it is important to strengthen efforts to align depression care with each patient's clinical needs.
AHRQ-funded; HS02112.
Citation: Olfson M, Blanco C, Marcus SC .
Treatment of adult depression in the United States.
JAMA Intern Med 2016 Oct;176(10):1482-91. doi: 10.1001/jamainternmed.2016.5057.
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Keywords: Medication, Depression, Diagnostic Safety and Quality, Medical Expenditure Panel Survey (MEPS)
Raebel MA, Shetterly S, Lu CY
Methods for using clinical laboratory test results as baseline confounders in multi-site observational database studies when missing data are expected.
The purpose of this paper was to quantify missing baseline laboratory results, assess predictors of missingness, and examine performance of missing data methods. The researchers used the Mini-Sentinel Distributed Database to select three exposure-outcome scenarios with laboratory results as baseline confounders. They found that missing data methods performed similarly.
AHRQ-funded; HS023898.
Citation: Raebel MA, Shetterly S, Lu CY .
Methods for using clinical laboratory test results as baseline confounders in multi-site observational database studies when missing data are expected.
Pharmacoepidemiol Drug Saf 2016 Jul;25(7):798-814. doi: 10.1002/pds.4015.
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Keywords: Adverse Drug Events (ADE), Blood Thinners, Data, Diagnostic Safety and Quality, Medication
Fenton JJ, Robbins JA, Amarnath AL
Osteoporosis overtreatment in a regional health care system.
The researchers estimated the frequency of osteoporosis overtreatment in a regional health care system where DXA reports routinely include T scores for anatomic sites (e.g., lateral lumbar spine) that the International Society for Clinical Densitometry does not recommend for osteoporosis diagnosis. They found that two-thirds of new osteoporosis drug prescriptions were potentially inappropriate.
AHRQ-funded; HS022236.
Citation: Fenton JJ, Robbins JA, Amarnath AL .
Osteoporosis overtreatment in a regional health care system.
JAMA Intern Med 2016 Mar;176(3):391-3. doi: 10.1001/jamainternmed.2015.6020.
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Keywords: Shared Decision Making, Diagnostic Safety and Quality, Medication, Osteoporosis
Bhatia N, Santos M, Jones LW
Cardiovascular effects of androgen deprivation therapy for the treatment of prostate cancer: ABCDE steps to reduce cardiovascular disease in patients with prostate cancer.
Since cardiovascular disease risk may be increased by the use of androgen deprivation therapy (ADT), the researchers have adapted the five-step "ABCDE" algorithm for prostate cancer survivors. Its treatment recommendations come under the following headings: awareness and aspirin, blood pressure, cholesterol and cigarettes, diet and diabetes, and exercise. The algorithm is illustrated by a hypothetical case study.
AHRQ-funded; HS022990.
Citation: Bhatia N, Santos M, Jones LW .
Cardiovascular effects of androgen deprivation therapy for the treatment of prostate cancer: ABCDE steps to reduce cardiovascular disease in patients with prostate cancer.
Circulation 2016 Feb 2;133(5):537-41. doi: 10.1161/circulationaha.115.012519.
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Keywords: Cardiovascular Conditions, Cancer: Prostate Cancer, Diagnostic Safety and Quality, Medication, Patient-Centered Outcomes Research
Cutting EM, Overby CL, Banchero M
Using workflow modeling to identify areas to improve genetic test processes in the University of Maryland Translational Pharmacogenomics Project.
The researchers used information gained from focus groups in order to illustrate the current process of delivering genetic test results to clinicians. They proposed a business process model and notation (BPMN) representation of this process for a Translational Pharmacogenomics Project being implemented at the University of Maryland Medical Center. They found that the current process could be improved to reduce input errors, better inform and notify clinicians about the implications of certain genetic tests, and make results more easily understood. They demonstrated theiruse of BPMN to improve this important clinical process for CYP2C19 genetic testing.
AHRQ-funded; HS023390.
Citation: Cutting EM, Overby CL, Banchero M .
Using workflow modeling to identify areas to improve genetic test processes in the University of Maryland Translational Pharmacogenomics Project.
AMIA Annu Symp Proc 2015 Nov 5;2015:466-74.
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Keywords: Genetics, Diagnostic Safety and Quality, Medication, Workflow, Quality Improvement, Quality of Care, Organizational Change
Carmody D, Lindauer KL, Naylor RN
Adolescent non-adherence reveals a genetic cause for diabetes.
Glucokinase related maturity-onset diabetes of the young (GCK-MODY) is frequently unrecognized or misdiagnosed as Type 1 or Type 2 diabetes, resulting in unnecessary pharmacologic therapy. The authors recommend considering a genetic cause when evaluating every person with new-onset hyperglycaemia or those with atypical diabetes. Testing costs for the most common MODY causing genes may be offset by savings made in therapeutic costs. They suggest that it is important that all clinicians supervising diabetes care recognize the cardinal features that distinguish GCK-MODY from other forms of diabetes.
AHRQ-funded; HS023007.
Citation: Carmody D, Lindauer KL, Naylor RN .
Adolescent non-adherence reveals a genetic cause for diabetes.
Diabet Med 2015 Jun;32(6):e20-3. doi: 10.1111/dme.12669.
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Keywords: Children/Adolescents, Diabetes, Diagnostic Safety and Quality, Genetics, Medication
Linder JA
Sore throat: avoid overcomplicating the uncomplicated.
In this editorial, the author described issues involving sore throat diagnosis and delineated various points concerning an article within the same journal issue, concluding that physicians should remember that the prevalence of group A streptococcus in adults with a sore throat is approximately 10%; and that they should use the Centor scoring criteria; selectively use rapid antigen-detection testing; limit antibiotic treatment to patients most likely to have group A streptococcus; and most of the time when prescribing antibiotics, use penicillin.
AHRQ-funded; HS018419.
Citation: Linder JA .
Sore throat: avoid overcomplicating the uncomplicated.
Ann Intern Med 2015 Feb 17;162(4):311-2. doi: 10.7326/m14-2899.
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Keywords: Antibiotics, Diagnostic Safety and Quality, Infectious Diseases, Medication, Pneumonia, Respiratory Conditions, Practice Patterns