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Skip Navigation U.S. Department of Health and Human Services
Agency for Healthcare Research Quality

Hospital Care, Cost, and Use

Tools & Resources

AHRQ Hospital Surge ModelNew!
   AHRQ Hospital Surge Model: DescriptionNew!
   AHRQ Hospital Surge Model: User ManualNew!
Becoming a High Reliability Organization: Operational Advice for Hospital Leaders
Emergency Severity Index, Version 4: Implementation Handbook
Evaluating Domestic Violence Programs
Health Care-Associated InfectionsNew
The Hospital Built Environment: What Role Might Funders of Health Services Research Play?
Hospital Survey on Patient Safety Culture
   Hospital Comparative Database Submission Information
   2008 Comparative Database Report
   2007 Comparative Database Report
   Nursing Home Survey on Patient Safety: User's GuideNew!
Managing and Evaluating Rapid-Cycle Process Improvements as Vehicles for Hospital System Redesign
Tool for Evaluating Core Elements of Hospital Disaster DrillsNew!
Tools for Hospitals and Health Care Systems
Transforming Hospitals: Designing for Safety and Quality

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Evidence Reports

Evidence Report/Technology Assessment, No. 95:
Training of Hospital Staff To Respond to a Mass Casualty Incident
Technical Review, No. 4:
Refinement of the HCUP Quality Indicators
Technical Review, No. 5:
Measures of Patient Safety Based on Hospital Administrative Data—The Patient Safety Indicators

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Healthcare Cost and Utilization Project (HCUP)

HCUPnet: Interactive Tool for National Hospital Statistics
HCUP Findings and Publications
Serving the Uninsured: Safety-Net Hospitals, 2003—HCUP Fact Book No. 8

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Development and Testing of the CAHPS Hospital Survey

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Inpatient Quality Indicators

Inpatient Quality Indicators: Fact Sheet
Inpatient Quality Indicators: Software Download

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Workshops & Conferences

America's Hospitals: In Danger or Bouncing Back?
Web Conference, November 19-21, 2002
Can You Minimize Health Care Costs by Improving Patient Safety?
Web Conference, September 20, 30, and October 1, 2002
Health Care Costs: Why Do They Increase? What Can We Do?
Workshop Brief, May 21-23, 2001

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Research Findings

Agency Press Releases
Date   Title
10/1/08 AHRQ Awards $3 Million To Help Reduce Central Line-Associated Bloodstream Infections in Hospital ICUs
9/15/08 AHRQ Releases Two New Resources to Help Consumers and Clinicians Prevent Dangerous Blood Clots
8/20/08 New AHRQ Tool Helps Hospitals Evaluate Disaster Drills

News and Numbers

Date   Title
8/27/08 Hospital Cost Increases Appear To Be Slowing
8/14/08 Children Hospitalized Less Often for Asthma but More Have the Disease
7/30/2008 Rare Forms of Meningitis More Deadly Than Viral Meningitis
7/16/08 Hospitalizations Soar for Kids with Skin Infections

Research Activities, August 2008:
Part-time doctors report less burnout, greater satisfaction, and more work control than full-time physicians
More vigilance in disinfecting hospital surfaces is critical for reducing vancomycin-resistant infections
An antimicrobial stewardship program improves appropriate antimicrobial use among hospitalized children
Education campaign reduces antibiotic prescribing by emergency department physicians for upper respiratory tract infections
Asthma rates soaring among adult hospital patients

Research Activities, July 2008:
Patient complaints about poor coordination of care or other services may help identify patient safety hazards
Hospital governing boards are actively engaged in quality oversight, especially those with a board quality committee
Children with asthma and flu are more likely to end up in the hospital
Emergency departments vary in their approach to psychiatric emergencies, underscoring the need for standards
Hospital and demographic factors influence emergency department triage of patients with mini-strokes
Physician experience may influence outcomes of hospitalized patients with HIV disease more than hospital HIV experience
Emergency department bills exceed payments over 9-year period
Patient safety problems are relatively infrequent among hospitalized children
State policies can influence the safety of hospitalized children via Medicaid payments
Asian-Pacific Islanders are more likely to die from serious, but treatable, hospital complications
Hospital emergency departments treat mostly poor children
Hospitalizations for ischemic stroke drop by one-third

Research Activities, June 2008:
When financially vulnerable rural hospitals become critical access hospitals, patient safety improves in several areas
Medical and surgical intensive care unit patients suffer from similar types of safety problems and related harm
Smoking in the home leads to more emergency visits and hospitalizations for lung problems among young children
Sending high-risk heart attack patients to certain hospitals reduces deaths, minimizes hospital volume shifts
More than 200 abused children under age 5 died in U.S. hospitals in 2005
Potentially deadly infection doubled among hospital patients over last 5 years

Research Activities, May 2008:
Leaving hospitals against medical advice puts heart attack patients at substantial risk for rehospitalization or death within 2 years
Hospitalists shorten stays but don't save much money or more lives

Research Activities, April 2008:
Certain interventions have the potential to reduce costly and risky hospitalizations of the frail elderly
Quality of care for geriatric-prevalent conditions is worse than general care among the hospitalized frail elderly
More work is needed to determine the impact of hospital information technology applications on patient outcomes
Consultations on major surgeries bring higher costs and longer stays but not care improvements
Patients with heart problems fare better at cardiac hospitals than general hospitals
Chest pain is a leading reason for hospital emergency department visits

Research Activities, March 2008:
Hospital incident reporting systems often miss physician high-risk procedure and prescribing errors
Collaboration between hospital and community palliative care services can improve care for dying children
Parents of hospitalized children with chronic illnesses report fewer care-related problems than other parents
Studies examine emergency communication, use of defibrillators, and benefit of ED pharmacists
Rural emergency departments have a high rate of medication errors with the potential to harm children
More than half a million patients visit the emergency department for severe sepsis each year
Hospitalists can reduce hospital stays and costs for children with common pediatric conditions like asthma
Crash site data along with pelvic x-rays may aid triage of motor vehicle crash victims with pelvic fractures

Research Activities, February 2008:
Age, gender, and location are keys to predicting patient fall injuries in hospitals
Blacks, Hispanics, and other minority groups are less likely to get strong pain medications in hospital emergency departments
Competing priorities, burnout, and collegial support all play a role in nursing career decisions
Studies examine the impact of nurse staffing on complications, mortality, and length of hospital stay
Nurse midwives deliver more babies in hospitals than homes in Washington State
Observational videos can identify ways to improve emergency endotracheal intubation
Hospitals serving the uninsured and underserved need help with public reporting and pay-for-performance measures
Managed care helps the elderly avoid preventable hospitalizations more than traditional Medicare

Research Activities, January 2008:
AHRQ releases toolkits to help providers and patients implement safer health care practices
A computer-based intravenous protocol can improve glycemic control in surgical ICU patients
Studies examine pharmacy workload and medication errors and cost savings of hospital barcode medication systems
New studies reveal the impact of drug copayment and coinsurance policies on statin and beta-blocker therapy after heart attack

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Research Activities, December 2007:
Many errors by medical residents are caused by teamwork breakdowns and lack of supervision
Hospital CEOs need more research relevant to the challenges they face in the health care system
Women leaving the hospital against medical advice after delivering a baby should be targeted for more services
Studies suggest ways to improve the hospital discharge process to reduce postdischarge adverse events and rehospitalizations
Interns taught teamwork during neonatal resuscitation training may be better able to resuscitate newborns
Both invasive and noninvasive strategies can reduce the cardiac risks of noncardiac surgery
AHRQ releases a new DVD about designing hospitals for safety and quality

Research Activities, November 2007:
AHRQ expands therapeutics education and research centers and adds new topics: Health IT, economics, and formularies
Women suffer fewer postoperative problems after vascular surgery at Veterans Administration than at private hospitals
Premature infants with chronic lung disease can be safely cared for by community-based providers coordinating with a nurse specialist
Postdischarge care management that integrates medical and social care can improve outcomes of the low-income elderly
Diagnostic codes poorly identify deep vein thrombosis or pulmonary embolism after surgery from hospital claims
Complications following heart valve replacements are prevalent and worsen patient outcomes
Studies examine prescribing of antibiotics for respiratory infections in hospital emergency departments
Adults who arrive at the emergency department with acute cough and vital sign abnormalities may have pneumonia
Patients who were uninsured use more medical services once they enroll in Medicare

Research Activities, October 2007:
Studies show lower colorectal cancer screening rates and access to surgery among the poor, minority, and uninsured
Elderly blacks' higher hospitalization rates for certain conditions suggest worse quality of outpatient care
One-third of patients with acute coronary syndrome and diabetes do not have their blood sugar assessed before hospital discharge
Studies show shorter hospital stays for coronary bypass surgery reduce costs without harm to patients

Research Activities, September 2007:
Medication errors are made during care for half of the children seen at rural California emergency departments
Hospitals that operate at or over capacity are more likely to have patient safety problems
Intensive care nurses face noise, distractions, small workspace, and other obstacles to providing care to critically ill patients
Drug therapy has reduced hospitalization for HIV patients, but those hospitalized are getting older and sicker
Available and timely access to AZT for HIV-infected mothers giving birth needs to be improved in Illinois birthing hospitals

Research Activities, August 2007:
Hospice care dramatically reduces end-of-life hospitalizations of nursing home residents
Many children treated at pediatric hospitals receive at least one "off-label" medication
More than one-third of hospitalized patients are concerned about medical errors, which they define more broadly than clinicians
Over half of missed diagnoses in the emergency department alleged in malpractice claims resulted in harm to patients
Price competition induced by HMOs and other managed care plans in California has not diminished hospital quality of care
Acute respiratory distress syndrome leads to poor outcomes and high care costs, even after treatment with inhaled nitric oxide
Attaining clinical targets among hemodialysis patients is linked to better outcomes
Substance abuse and psychiatric illness account for the majority of hospital admissions among homeless veterans
Providing combination medication for elderly patients following a heart attack can save both lives and money
Education, income, and wealth all affect medical care expenditures among Medicare managed care members

Research Activities, July 2007:
Greater access to physician services may narrow mortality differences among the black and white elderly
One-third of Medicare patients say that the decision about where to undergo surgery was made mainly by their doctor
The Medicare short stay transfer policy reduced hospital incentives to discharge orthopedic surgery patients early
Studies examine the surge capacity of U.S. hospitals to respond to bioterrorism or other public health disasters
Total, partial, and revision hip replacement are associated with different rates of postoperative complications and readmissions
Supportive housing may be a feasible and appropriate model of care for chronically homeless persons
Mandatory limits on medical resident work hours may constrain hospital house staff and affect patient outcomes and resource use

Research Activities, June 2007:
Reduced payments to hospitals may jeopardize patient safety
Risk factors can help predict which patients with hospital-acquired urinary tract infections will develop blood infections
Rate of childbirth-related hospital stays decreases for girls under age 18

Research Activities, May 2007:
Fullness of the neonatal intensive care unit influences early discharge of moderately preterm infants
Examining use of "rescue drugs" in a hospital can reveal previously unreported adverse drug events
Americans can obtain quality heart care at hospitals that are not ranked in the top 50 by U.S. News & World Report
Hand washing, barrier protection, and other procedures can reduce catheter-related bloodstream infections in the ICU
Hip fracture patients with osteoarthritis have longer hospital stays, but similar functional gain as those without the condition
Study profiles the number, distribution, and basic use patterns of U.S. emergency departments
Emergency physicians ask over half of female patients if they smoke, but don't counsel or advise them to quit
One in six emergency transports of children to South Carolina emergency rooms is medically unnecessary
Studies examine effect of physician practice size and opening of specialty cardiac hospitals on treatment of heart attack patients
Assessing all health conditions and heart attack severity at admission helps assess patients' risk of dying
Regionalizing stroke care to high-volume hospitals may not improve stroke outcomes or lower costs for some regions

Research Activities, April 2007:
One in four hospital patients is admitted with a mental health or substance abuse disorder
Racial/ethnic disparities in knee replacement rates may be partly due to due to differences in preferences for surgery

Working conditions influence intensive care unit nurses' decision to leave their current position
Moderate to severe depressive symptoms are poorly recognized in hospitalized patients with acute coronary syndrome
Many transplant surgeons are inadequately vaccinated against the hepatitis B virus, exposing themselves and patients to infection
Patients who undergo lumbar spine surgery are likely to have another operation later

Research Activities, March 2007:
Emergency departments with physician residents are less effective in determining which children require hospital admission
Urban influence codes reveal more about children's patterns of health care use and coverage
Some patients on mechanical ventilation fare worse at low-volume hospitals
Regionalization of high-risk surgeries may not result in loss of patients or revenue from small rural hospitals

Research Activities, February 2007:
Demand for primary care internists has decreased, while demand for hospital-based internists has increased
Modest levels of cost-sharing for emergency department care decrease emergency department visits without worsening health
Inpatient lumbar surgery rates remained stable from 1994 to 2000, but outpatient surgery increased
Los Angeles County hospitals are limited in disaster preparedness and severely limited in surge capacity

Research Activities, January 2007:
Missed opportunities: Too few Americans are being screened or counseled to prevent colorectal cancer, obesity, and other conditions
Physicians' extended work shifts are associated with increased risks of medical errors that harm patients
Extended resident work hours jeopardize both resident health and patient safety
Adding lab data and refining secondary diagnosis information improves the ability to measure hospital quality of care
Pediatric hospitalists are more likely than community pediatricians to use evidence-based care for hospitalized children
Management of emergency department information on children's medication allergies needs improvement
Identifying patients' medical conditions at hospital admission provides a more accurate picture of hospital performance
Increased use of prescription medicines is changing health care spending patterns

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Research Activities, December 2006:
Both hospitals and Medicare would gain financially by improving patient safety
Racial differences in religiosity and religious coping styles are linked to use of health care services by low-income older women
The decision to hospitalize nursing home residents is driven primarily by residents' preference and quality of life
Medical injuries among children result in longer hospital stays and higher charges

Research Activities, November 2006:
Fungal infections in immunocompromised children dramatically increase mortality rate, length of hospital stay, and costs
Patient and hospital factors may contribute to worse outcomes for patients who suffer heart attacks

Research Activities, October 2006:
Perceptions of teamwork in hospital labor and delivery units depend on caregiver role and the unit environment
Use of pediatric hospitalists decreases hospital costs and stays without adversely affecting clinicians or parents
Severity of illness and rural location affect the willingness of elderly people to travel longer distances to the hospital
Prescription drug benefits limits for Medicare beneficiaries are associated with less use of prescription drugs, worse clinical outcomes, and higher hospitalization costs
Patients with more chronic conditions increase hospital costs
Study details the prevalence of and deaths from the most common pulmonary fungal infections in immunocompetent people

Research Activities, September 2006:
Children's hospitals are much more likely than general hospitals to diagnose child abuse in severely injured infants
Children receiving surgery for hypoplastic left heart syndrome have better outcomes at hospitals that perform more such surgeries
Previous hospital performance, internal operations, and market competition are key in improving hospital performance
Study identifies factors contributing to growth in hospital inpatient costs since 1998
Hospitals could be better linked with other community response teams to manage public health emergencies

Research Activities, August 2006:
Obesity surgery complication rates are higher over time
Complications from chemotherapy in women with breast cancer are greater than previously estimated
Studies examine the safety climate and teamwork in hospital operating rooms
Older veterans need to become more actively involved in hospital discharge planning for their post-hospital needs
U.S. hospitals treat many uninsured victims of car crashes, violence, and other injuries

Research Activities, July 2006:
High-quality/low-cost hospital performance is linked to organizational characteristics and market forces
Some adults with diabetes face high health care expenditures

Research Activities, July 2006:
High-quality/low-cost hospital performance is linked to organizational characteristics and market forces
Collaboration of hospitalists/attending physicians and nurse practitioners can reduce hospital stays and increase profit

Research Activities, June 2006:
Blacks are more likely than whites and Hispanics to die following cardiovascular procedures, despite hospital experience
Hospital patient safety systems show moderate progress in meeting Institute of Medicine recommendations

Research Activities, May 2006
Medicaid may reduce racial/ethnic differences in preventable hospitalizations, but Medicaid managed care adds no extra benefit
Greater Medicare HMO penetration is associated with a shift in elderly stroke deaths from hospital to non-hospital settings
Multidisciplinary physician/nurse practitioner teams can reduce the costs of hospital care while maintaining care quality
Accidental lung puncture is a substantial threat to hospitalized patients undergoing a wide range of procedures
Preoperative risk factors and surgical complexity are more predictive of hospital costs than postoperative complications

Research Activities, April 2006
Researchers describe the development and testing of the CAHPS® Hospital Survey

Research Activities, March 2006
AHRQ's Quality Indicators can be used as a screening tool to identify potential quality of care problems
Ventilator-associated pneumonia is a serious and costly side effect of mechanical ventilation
Fear of malpractice prompts emergency physicians to practice defensive medicine with potential heart attack patients
Medi-Cal changes in the 1990s shifted newborn deliveries from large public hospitals to smaller community hospitals

Research Activities, February 2006:
Excessive nurse workload is a key factor affecting the safety of patients in intensive care units
Hospital type and location influence discharge disposition of adolescents hospitalized for suicide attempts
Minority adults with asthma in the inner city spend more time in the emergency department and hospital

Research Activities, January 2006:
National anatomic pathology errors database can reduce hospital pathology errors
Despite increase in cat ownership, the hospitalization rate for children with cat-scratch disease remains stable
Salmonella aortitis should be considered in adults with evidence of salmonella bloodstream infection but no associated GI symptoms

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Research Activities, December 2005:
Hospitalized patients can help improve patient safety by identifying medical errors not captured by hospital systems
Patient Safety Indicators may be useful screening tools in Veterans Health Administration hospitals
Children hospitalized in the ICU or who have arterial catheters are at higher risk of dying from Candida blood infections
Anemia increases a patient's risk of dying after hospitalization for unstable angina or heart attack
Four clinical factors can help diagnose pneumonia in children seen in hospital emergency departments
Psychiatric emergency services vary widely in hospital emergency departments
Hospital admissions of patients with HIV have fallen by more than half since 1995

Research Activities, November 2005:
Web-based patient safety education curriculum incorporates suggestions from physicians, nurses, and patients
Patient safety problems increase when hospital profit margins decline over time
Black and Hispanic patients are more likely to be readmitted to hospitals for complications associated with diabetes

Research Activities, October 2005:
Arthritis accounts for a substantial number of hospital admissions each year
Study identifies factors contributing to more surgical complications among black patients
Older and minority elderly are less willing to travel to distant hospitals for care
Level of HMO penetration in a hospital's market affects the relationships between nurse staffing, length of stay, and mortality

Research Activities, September 2005:
Guidance is available to help communities reopen former hospitals to care for survivors of Hurricane Katrina
Patients in intensive care units are at significant risk for adverse events and serious errors
Hospitalization rates vary for nursing home residents with suspected pneumonia
Ethics consultations can reduce nonbeneficial treatments and costs among dying patients

Research Activities, August 2005:
Resident work hour limits in New York teaching hospitals were not associated with improved safety for surgery patients

Research Activities, July 2005:
Some care disparities among blacks may be due to low technology use in hospitals that treat mostly black patients
AHRQ study finds weight-loss surgeries quadrupled in 5 years
Certain clinical factors can accurately identify patients at low risk of active TB who don't need respiratory isolation
Trauma center patients are much more likely to have experienced previous traumas than the general population
Nursing homes vary widely in their hospitalization of residents, particularly those with Alzheimer's disease

Research Activities, June 2005:
Rural hospitals appear to deliver care similar to nonrural hospitals for many common pediatric conditions

Research Activities, May 2005:
Use of maximal sterile barriers when placing central venous catheters may reduce the risk of catheter-related infections
Informal care of elderly parents by adult children limits use of nursing home and other formal care and shortens hospital stays
Recently hospitalized individuals are more likely to have bloodstream infections that are drug-resistant
HMO penetration in a hospital's market affects the relationship between RN staffing and quality of care
Survey reveals that hospital leaders are concerned about the impact of mandatory error-reporting systems

Research Activities, April 2005:
SPECT imaging with Tc-99m sestamibi can improve ED triage of diabetes patients with suspected cardiac ischemia
Informal caregiver characteristics influence the hospitalization and discharge of elderly women
More frequent placements of foster children increase their reliance on emergency departments for outpatient care
Hospital readmission for venous thromboembolism among postoperative patients may signal quality of care problems
Pain management is often inadequate for elderly patients hospitalized for surgery

Research Activities, March 2005:
New study on computerized order entry finds flaws that could lead to errors, but there are opportunities for improvement
Computerized standing orders can increase rates of flu and pneumonia vaccination of hospital patients
Increased use of early revascularization in heart attack patients with cardiogenic shock will save lives
Significant exposure to tobacco smoke and underuse of controller medications exacerbate asthma symptoms among Head Start children

Research Activities, February 2005:
Out-of-hospital endotracheal intubation found to be associated with adverse outcomes for traumatic brain injury patients
New study sheds light on substantial injuries and deaths due to motorcycle accidents
Adoption of medical innovation, which is driving much of health care costs, is largely outside the control of health plans

Research Activities, January 2005:
Improving access to coronary angioplasty in hospitals without CABG surgery programs is risky
Use of multidisciplinary team can reduce hospital stays and costs without adverse effects on readmissions or outcomes
Internal medicine residents and interns prefer inpatient rotations that are supervised by hospitalists
During the mid-1990s, Medicare HMOs in California reduced inpatient use beyond that attributable to favorable selection

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Research Activities, December 2004:
Underreporting of medical errors affecting children is a significant problem, particularly among physicians
Some low-income parents do not recognize mental health problems and service needs of children with special health care needs
Obesity contributes to early-onset heart problems and longer hospital stays
Nursing home treatment for lower respiratory infection is safe and less costly than hospitalization for some residents

Research Activities, November 2004:
Prehypertension is a considerable health risk, particularly in people aged 45 and older
Hospitals profit less from privately insured patients than from Medicare patients and profit least from Medicaid and self-pay patients

Research Activities, October 2004:
Higher volume in trauma centers does not necessarily correlate with improved survival of trauma victims

Research Activities, September 2004:
Communication problems often contribute to untimely care of acute infections in nursing homes
Despite overall national improvement in beta-blocker use after heart attack, the rate of improvement varies across hospitals
In-hospital mortality is similar for cardiac surgery patients treated at either medium- or high-volume hospitals
Based on postoperative complication rates, teaching and nonteaching hospitals may provide similar quality of care
Potentially preventable hospital readmissions may be determined by the severity and complexity of underlying chronic problems
Premature infants with bronchopulmonary dysplasia are rehospitalized at twice the rate of other premature infants

Research Activities, August 2004:
Hospital costs and length of stay for HIV patients depend in part on geographic area
Gastrointestinal disorders are a leading cause of hospitalization in children
Patients of general internists and hospitalists tend to have shorter hospital stays

Research Activities, July 2004:
Studies reveal patient cost-sharing influences patients' use of cancer screening and emergency department care

Research Activities, June 2004:
Variation in outcomes is small for CABG surgery patients treated at high-volume vs. lower volume hospitals
Fewer Medicare patients die in the hospital than in the past, but those who do receive more intensive and expensive treatment
Most appeals to two of the Nation's largest HMOs to cover emergency care are resolved in favor of patients

Research Activities, May 2004:
Researchers find no adverse perinatal outcomes associated with respiratory hospitalizations of pregnant women during flu season
Doctors should target chronic disease and functioning among frail older patients to lower the risk of hospitalization
Greater HMO penetration in an area reduces the number of preventable hospitalizations

Research Activities, April 2004:
Researchers examine racial and ethnic disparities in emergency care

Research Activities, March 2004:
Hospital costs are higher for elderly Medicare patients with low functional status
Hospitalizations for work-related injuries and illnesses declined from 1997-1999, but charges increased
Many major teaching hospitals might not be able to offer adequate access to specialty care for uninsured patients

Research Activities, February 2004:
New study estimates potential savings gained by expanding use of beta-blockers in heart failure patients
Better education for children and parents could eliminate the need for many pediatric hospitalizations
Researchers identify measures of workflow that may help to explain and manage emergency department overcrowding
Hospital mergers, not consolidation of local hospitals into systems, result in cost savings
AHRQ researchers examine use of hospital, emergency, and outpatient care among patients with HIV disease

Research Activities, January 2004:
Premature birth increases infants' risk of hospitalization and complications from respiratory syncytial virus
Transfusion after hip fracture surgery reduces the risk of rehospitalization for older patients with significant anemia
Following an urban hospital closure, remaining hospitals operate more efficiently due to high admissions

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