Quality of Care

Research Findings

Research Activities, August 2008:
Depression and burnout are problems among pediatric residents
Part-time doctors report less burnout, greater satisfaction, and more work control than full-time physicians
Cardiac surgeons are not reluctant to treat high-risk cardiac patients who may tarnish their quality scorecards
More vigilance in disinfecting hospital surfaces is critical for reducing vancomycin-resistant infections
Studies examine effectiveness and cost-effectiveness of depression quality improvement programs in primary care

Research Activities, July 2008:
Studies examine racial/ethnic disparities and use patterns for nonsteroidal anti-inflammatory drugs
Hospital governing boards are actively engaged in quality oversight, especially those with a board quality committee
Minority status and vulnerable early life experiences prompt physicians' engagement in reducing care disparities
Elderly Asian Americans in traditional fee-for-service Medicare receive fewer needed services than their white counterparts
Quality of care for patients with coronary heart disease is not strongly influenced by medical practice characteristics
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
Asian-Pacific Islanders are more likely to die from serious, but treatable, hospital complications

Research Activities, June 2008:
AHRQ's patient safety indicators may be useful for comparing quality of care across delivery systems
Primary care practices can perform very well in several quality areas
Sending high-risk heart attack patients to certain hospitals reduces deaths, minimizes hospital volume shifts
Use of quality improvement strategies by home care agencies may reduce hospitalizations of home patients

Research Activities, May 2008:
AHRQ's 2007 State Snapshots provide broader portraits of State-by-State health care performance
Staff education and performance feedback only slightly improve fracture prevention among nursing home residents
Surgery patients have better outcomes when their surgical team communicates and collaborates
Delaying repair of an asymptomatic hernia does not adversely affect the patient
Hospitalists shorten stays but don't save much money or more lives
Nurses can facilitate quality improvement in primary care practices with electronic medical records
Physicians generally followed drug treatment guidelines for atrial fibrillation, but only one-third used warfarin

Research Activities, April 2008:
Modest health care quality gains outpaced by spending
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
Conference on assisted living reveals its evolution, dearth of research, and quality of life for residents
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 unstable angina do not have better 1-year health status or rehospitalization outcomes than heart attack patients, despite better 2-year survival
Patients with depression who receive mental health treatment and are involved in therapeutic decisions are more satisfied with their care
Patients with heart problems fare better at cardiac hospitals than general hospitals

Research Activities, March 2008:
New patient safety proposed regulation aims to improve health care quality and patient safety
Most employers review but do not use quality data when selecting health care plans
Care quality is not necessarily better with electronic health records
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
Pediatricians often do not pursue answers to questions that arise during medical visits
Simulation improves caregivers' performance but whether it improves patient outcomes is still uncertain
Studies examine emergency communication, use of defibrillators, and benefit of ED pharmacists
Limiting out-of-hospital endotracheal intubation to experienced rescuers would limit the practice

Research Activities, February 2008:
Pediatric outpatient medication errors are common and are often due to mistakes made at home
Children with special health care needs seem to benefit from Medicaid managed care programs with case managers
Studies examine the impact of nurse staffing on complications, mortality, and length of hospital stay
Staffing levels and turnover are influenced by nursing home expenditure patterns
A combination of maternal, baby, and episiotomy factors contribute to high rates of maternal birth trauma in Iowa
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

Research Activities, January 2008:
Some women with breast cancer do not receive adjuvant treatments recommended by guidelines
A computer-based intravenous protocol can improve glycemic control in surgical ICU patients
Following recommended guidelines to manage cardiovascular disease improves patient outcomes
Internal medicine physicians find it more difficult to apply clinical guidelines to patients with multiple medical conditions
Possible problematic drug interactions are not always reported in medical records
Illinois hospitals are not ready to implement intrapartum strategies to eradicate pediatric HIV infection

Research Activities, December 2007:
Many underinsured U.S. children are not getting needed vaccines due to the current vaccine financing system
Family-centered, high quality primary care is linked to fewer nonurgent emergency department visits by children
Full disclosure of medical errors to patients is becoming more and more transparent
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
Studies suggest ways to improve the hospital discharge process to reduce postdischarge adverse events and rehospitalizations
Use of simple clinical information systems can improve outcomes of patients with diabetes
Primary care practices face competing demands, not clinical inertia, in providing quality care to patients with diabetes
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
Death and complications after breast cancer surgery are rare, with wound infection the most common problem
Caregivers of children with special health care needs rate Medicaid managed care as having better care access than fee-for-service
Nursing home report cards have prompted many nursing homes to improve care, especially those with poor scores
Studies explore the use and functions of electronic health records
Implementing a basic electronic prescribing system may reduce nonclinical prescribing errors
Studies examine patients' ratings of physicians
Diagnostic codes poorly identify deep vein thrombosis or pulmonary embolism after surgery from hospital claims
Several factors prompt patients with HIV to voluntarily switch physicians
Complications following heart valve replacements are prevalent and worsen patient outcomes
Surgery is more likely than angioplasty to relieve pain for patients with coronary artery disease

Research Activities, October 2007:
Studies examine dispensing of sample medications and preventing medication errors in primary care practices
Accurate laboratory detection of bladder cancer requires close follow-up with repeated testing
Elderly blacks' higher hospitalization rates for certain conditions suggest worse quality of outpatient care

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
Women in Medicare and private managed care plans receive worse care than men for cardiovascular disease and diabetes
A multipronged quality improvement strategy can markedly improve the quality of diabetes care and patient outcomes
Physicians have positive attitudes about pay-for-quality programs, but are ambivalent about certain program features

Research Activities, August 2007:
Hope, experience, and education help nurses feel more comfortable and competent in providing palliative care to children
The gender of both the child and parent affect a child's participation during visits to the doctor
Many children treated at pediatric hospitals receive at least one "off-label" medication
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
Financial pressures on hospitals in the 1990s led to less investment in care resources and poorer quality of care

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
Smaller physician office practices are slower to adopt use of electronic health records
Studies examine the surge capacity of U.S. hospitals to respond to bioterrorism or other public health disasters
Family physicians manage skin conditions well
Mandatory limits on medical resident work hours may constrain hospital house staff and affect patient outcomes and resource use
AHRQ's annual State Snapshots highlight States' gains and lags in health care quality
New Web tool provides samples of report cards on health care quality

Research Activities, June 2007:
The State Children's Health Insurance Program can improve care access, use, and quality for children with special health care needs and adolescents
Prophylactic antibiotics given to prevent surgical site infections are more timely if given in the operating room
AHRQ's annual State Snapshots highlight States' gains and lags in health care quality
New Web tool provides samples of report cards on health care quality

Research Activities, May 2007:
Both poor and black patients are more likely to believe that a positive self-presentation can affect the quality of their medical care
Americans can obtain quality heart care at hospitals that are not ranked in the top 50 by U.S. News & World Report

Research Activities, April 2007:
Community health centers provide poorer quality of care to the uninsured with chronic disease
Medicare/Medicaid patients with unstable angina receive poorer quality of care than other Medicare patients

Research Activities, March 2007:
Efforts to improve chronic disease management quality yield better care delivery but not better intermediate outcomes
Reliability model improves hospital safety and eliminates bloodstream infections in the ICU
Studies highlight the interaction between managed care and market forces and their impact on quality of care
Emergency departments with physician residents are less effective in determining which children require hospital admission
Study provides national time averages for transporting trauma patients by ambulance and helicopter
Higher-than-recommended doses of antipsychotic medications may not benefit people with schizophrenia and may increase side effects
HIV-infected women receive worse quality of care than HIV-infected men
Regionalization of high-risk surgeries may not result in loss of patients or revenue from small rural hospitals

Research Activities, February 2007:
Shifting from a culture of blame to a culture of safety in nursing homes could help identify and prevent medical errors
Racial disparities in care vary widely among Medicare health plans and are only weakly correlated with overall quality of care
Standardizing data input for electronic health records may improve their potential to measure care quality
Followup care after total hip replacement could be improved

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
Health systems dedicated to improving patient safety are beginning their journey and need a roadmap to prioritize initiatives
Studies reveal that error disclosure is similar among American and Canadian doctors, despite different malpractice environments
Adding lab data and refining secondary diagnosis information improves the ability to measure hospital quality of care
Most quality improvement strategies produce only small to modest improvements in glycemic control among patients with diabetes
Identifying patients' medical conditions at hospital admission provides a more accurate picture of hospital performance

Research Activities, December 2006:
Both hospitals and Medicare would gain financially by improving patient safety
Functional outcomes may be good markers of quality of care for hip fracture surgery patients

Research Activities, November 2006:
Coverage that allows interns to nap during extended shifts can increase their sleep time and decrease fatigue
Patient safety indicators are useful tools for tracking and monitoring patient safety events
Use of physical therapist assistants in place of physical therapists may result in lower quality of rehabilitation care
Long-term outpatient central venous catheters for bone infections cause complications in about 40 percent of children
Many outpatients taking drugs with a narrow therapeutic range do not receive drug concentration monitoring to prevent toxicity

Research Activities, October 2006:
Organizational silence threatens patient safety
Learning collaboratives are a potentially effective way to improve the quality of care delivered by pediatric practices
Use of pediatric hospitalists decreases hospital costs and stays without adversely affecting clinicians or parents

Research Activities, September 2006:
Financial incentives to physicians and hospitals to improve quality of care seem ineffective
Survey suggests that hospitals in Iowa have made the most progress in following long-standing safe practices
Children receiving surgery for hypoplastic left heart syndrome have better outcomes at hospitals that perform more such surgeries
Using handheld computers with specific prescribing software at the point of care can reduce unsafe NSAID prescribing
Nurse-led care improves functioning for patients with heart failure in minority communities
Previous hospital performance, internal operations, and market competition are key in improving hospital performance

Research Activities, August 2006:
Studies examine the safety climate and teamwork in hospital operating rooms
Long work hours and family care-giving affect nurses' hospital performance
Pharmacists help identify patient safety and quality issues by clarifying prescriptions

Research Activities, July 2006:
Work hour limits improve residents' quality of life, but not their satisfaction with their medical education
High-quality/low-cost hospital performance is linked to organizational characteristics and market forces
Physicians appear to be driven more by professional standards of quality than financial incentives
Blacks and Hispanics receive worse care than whites, yet rate their interactions with health care providers more positively
Treatment of black adults with diabetes and depression insured through Medicaid raises quality concerns
Enrollment in New York's State Children's Health Insurance Program improves asthma care quality and access
Greater use of agency nurses in nursing homes may lead to poorer quality of care
Paramedic errors in lifesaving endotracheal intubation may be a symptom of larger emergency medical system problems

Research Activities, June 2006:
Hospital patient safety systems show moderate progress in meeting Institute of Medicine recommendations
Interventions for primary care providers improve management of diabetes
Communication between primary care patients and their doctors does not necessarily result in shared decisionmaking

Research Activities, May 2006
Many primary care doctors still do not use electronic antibiotic prescribing for acute infections
Medicaid managed care plans with case management programs may benefit children with disabilities more than fee-for-service plans
AHRQ's health care quality and disparities reports can help nurse leaders make key decisions about quality and patient safety
Researchers examine gender disparities in the quality of preventive care and management of heart disease and diabetes
Nursing homes that emphasize team effort and staff flexibility are more likely to sustain improvements in quality of care
Nursing home working conditions are linked to care performance
Studies connect patient satisfaction with back pain outcomes
Primary care doctors often fail to prescribe "controller medications" for asthma patients after an emergency room visit
Multidisciplinary physician/nurse practitioner teams can reduce the costs of hospital care while maintaining care quality

Research Activities, April 2006
Studies examine ways to improve the quality of diabetes care
Patient responses to medical errors depend on the timeliness and quality of the physician's communication about the event
Over one-third of outpatients prescribed drugs for the first time do not receive recommended laboratory monitoring
Researchers describe the development and testing of the CAHPS® Hospital Survey
New information will help health care providers adopt health information technologies
Doctor-patient communication is critical to how parents view the quality of end-of-life care for children with cancer
More intense guideline implementation results in more patients treated appropriately for pneumonia

Research Activities, March 2006
AHRQ's Quality Indicators can be used as a screening tool to identify potential quality of care problems
Some for-profit Medicare health plans provide lower quality of care than not-for-profit plans

Research Activities, February 2006:
Noninvasive tests may miss breast cancer
Excessive nurse workload is a key factor affecting the safety of patients in intensive care units
Up to 12 percent of tissues examined by pathologists for cancer result in diagnosis errors
Experienced nurse practitioners and physician assistants provide high-quality care for people with HIV
Study examines the relevance and applications of the Institute of Medicine's quality aims on pediatric critical care

Research Activities, January 2006:
Having a usual source of care increases wellness visits among children with asthma
Women with mild-to-moderate pelvic inflammatory disease have similar reproductive outcomes from inpatient and outpatient care
Prohibiting physicians from dispensing drugs reduces overall drug use and inappropriate prescribing

Research Activities, December 2005:
Work hour limitations may improve resident quality of life, but other effects are unknown
Studies examine barriers to self-management for patients with chronic illness and interventions that improve care

Research Activities, November 2005:
Real-time safety audits can detect a broad range of errors in neonatal intensive care units
Physician knowledge and skills and team communication improve safety in intensive care units
Web-based patient safety education curriculum incorporates suggestions from physicians, nurses, and patients
Written reminders can reduce the length of time patients have urinary catheters
Patient safety problems increase when hospital profit margins decline over time
Generalist physicians with appropriate experience and expertise can provide high-quality care to patients with HIV

Research Activities, October 2005:
AHRQ awards over $22.3 million in health information technology implementation grants

Research Activities, September 2005:
Improving physician knowledge of psychiatric problems and relevant medications could improve quality of care
Patients in intensive care units are at significant risk for adverse events and serious errors
Collaboration between gastroenterologists and pharmacists improves the management of patients with chronic acid-related symptoms

Research Activities, August 2005:
Efforts beyond expanding health coverage may be needed to improve access and quality for low-income and minority children
Resident work hour limits in New York teaching hospitals were not associated with improved safety for surgery patients
One hospital's experience suggests that communication problems may underlie a substantial number of hospital adverse events
Study explores physician job satisfaction and quality of care and outcomes for managed care patients with pain and depression
Physicians welcome patients' participation in medical decisionmaking

Research Activities, July 2005:
Publicly reporting quality information may inadvertently reduce, rather than improve, care quality
Physicians should disclose financial incentives, address patients' reactions, and negotiate a fair plan to win trust
New Web-based ICU safety reporting system may have the potential to reduce medical errors at ICUs across the country
Stem cell transplant centers that have greater physician involvement in patient care have better patient outcomes
Study questions whether competition among HMOs will inherently improve care quality

Research Activities, June 2005:
Absence of chest pain in patients with suspected heart attack or angina does not signal a less severe condition
More frequent sit-down rounds in dialysis units are associated with better patient outcomes
Researchers find racial and socioeconomic disparities in compensation for work-related back injuries
Hospitals with internal support for quality improvement are most likely to prescribe beta-blockers for heart attack patients
Limiting residents' work hours may have unintended consequences on continuity of care
Publishing report cards about a surgeon's quality influences consumer selection of surgeons
Doctors who have been in practice longer may be more likely to provide lower quality of care
Nursing home complaints, taken together with other measures, can be used to assess nursing home quality of care
Veterans Health Administration clinics provide better overall quality of care than many other sites
Better monitoring of outpatients taking thyroid replacement therapy may reduce drug-related problems
Partnering with hospitalized patients to monitor medication use is a feasible strategy for reducing drug errors

Research Activities, May 2005:
Missing clinical information during primary care visits is commonplace and can adversely affect patient care
Use of a clinical decision rule can improve the accuracy and efficiency of orthopedists in diagnosing deep vein thrombosis
Study cites several barriers to adoption of guideline-recommended osteoporosis care for frail nursing home residents
High-risk patients often undergo bypass surgery at low-volume hospitals where their risk of dying is higher
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
AHRQ-sponsored "Summit" brings together health care leaders to consider next steps in improving health care quality
Despite promising efforts over the past 5 years to improve patient safety, the American public does not feel safer

Research Activities, April 2005:
Postoperative functioning, age, obesity, and social support influence where patients go after total hip replacement
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
Nursing home quality of care may suffer if budget shortfalls force States to freeze or reduce Medicaid rates
Researchers describe ways to improve health care experiences for people who are blind or have low vision
Improvement in HIV care within the VA health system has been substantial, but some disparities persist

Research Activities, March 2005:
Health plans take action to improve services for members with limited English proficiency
Increased use of early revascularization in heart attack patients with cardiogenic shock will save lives
Enhanced CT performs better than unenhanced CT in predicting extent of damaged brain tissue in acute stroke patients

Research Activities, February 2005:
Following up on abnormal test results is challenging for busy doctors who view hundreds of results a week

Research Activities, January 2005:
Multifaceted QI program greatly improves use of prophylactic surfactant for high-risk preterm infants
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
Use of comprehensive QI program in primary care can improve delivery of preventive services for heart disease and stroke
Study finds declining quality of primary care for elderly Medicare patients
Researchers find potentially inappropriate drug use in nursing homes associated with deaths of elderly residents
Voluntary primary care safety reporting system includes errors due to communication, diagnostic tests, and medication
Clinicians value medication safety alerts and welcome small-group training to make better use of them
Community pharmacists receive many computer-generated alerts about drug-drug interactions, most of which they override
Involving all staff members in guideline-recommended care can improve oversight and coordination of patient care
Internal medicine residents and interns prefer inpatient rotations that are supervised by hospitalists
Marketing and prescribing of hormone replacement therapy declined substantially following reports of harm
Substantial barriers prevent cancer patients from obtaining optimal care at the end of life
Appropriately targeting thrombolytic therapy for heart attack patients has the potential to save both lives and money
Early referral of patients with chronic kidney disease reduces complications and mortality
First-week followup of newborns after hospital discharge is critical to prevent severe jaundice and other problems
Patients are more trusting of doctors who spend more time with them and discuss the impact of their illness
Centers specializing in primary care for women consistently deliver preventive services and have high patient satisfaction
Nursing homes that employ physician extenders and provide training for nurses' aides have fewer hospitalizations

Research Activities, December 2004:
Results of a consumer survey on patient safety present both an opportunity and a challenge to make health care safer
Anonymity, feedback, and a blame-free environment promote reporting of medical errors
Many primary care errors stem from problems with access to clinicians and doctor/patient interaction

Research Activities, November 2004:
Limiting medical interns' work to 16 consecutive hours can substantially reduce serious medical errors in ICUs
Differences in white and minority patients' satisfaction with care may hinge on satisfaction with physician interaction

Research Activities, October 2004:
Parents are willing to travel to distant hospitals to achieve a better outcome following pediatric cardiac surgery
Computerized information systems prompt monitoring tests and medication adjustment that can improve diabetes care and outcomes
Very little of the variation in quality of diabetes care is explained by practice factors
Daily visit volume is similar for dying patients receiving hospice care in nursing homes and in the community

Research Activities, September 2004:
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
Root cause analysis should be conducted after a wrong site surgery to reduce future errors
Children with special health care needs in Medicaid managed care plans receive more needed care than those in Medicaid FFS plans
Researchers examine the effects of financial and nonfinancial incentives on health care use, costs, and quality

Research Activities, August 2004:
Initial surfactant treatment to prevent respiratory distress in very premature infants is often delayed in routine practice
Residents are more likely to transfer out of nursing homes with low quality of care
Researchers examine factors affecting the quality of end-of-life care
Quality assurance programs are more likely to be adopted if they are compatible with the culture of the medical group practice
Outcomes usually are poor among patients receiving home enteral nutrition from informal caregivers

Research Activities, July 2004:
Women who undergo hysterectomy for abnormal uterine bleeding report improved health-related quality of life
Medical errors appear to be common among ICU patients, and a simple blame-free reporting system can help identify them
Improved access to medication and therapy for depressed primary care patients improves 5-year outcomes

Research Activities, June 2004:
Children in hospitals frequently experience medical injuries
Both the nature of physician contact and visit frequency are important factors in hemodialysis patient outcomes
Nursing home staffing and quality improved after passage of the Nursing Home Reform Act
Hospital workers worry about patient safety at their hospitals and look to hospital leaders for a commitment to safety
Conference participants focus on the role of nursing in health care quality improvement

Research Activities, May 2004:
QI approaches improved diabetes care in Midwest community health centers in 1 year
Deaf and hearing-impaired patients suggest ways doctors can improve communication to improve care quality and safety
Significant pain is common among hospitalized patients, even those at low risk for pain
Researchers find New York SCHIP improves health care access, continuity, and quality

Research Activities, April 2004:
Researchers examine ways to measure the quality of health services for children and adolescents

Research Activities, March 2004:
Both low- and high-risk patients benefit from undergoing coronary bypass surgery at high-volume hospitals
Updated ICU information systems substantially free nurses from documentation, giving them more time for direct patient care
Nurses' contributions to patient-centered care and care equity are important components of health care quality
Physicians are much less likely to examine patients in contact isolation, compared with nonisolated patients

Research Activities, January 2004:
Racial differences exist in parents' opinions about the quality of primary care provided to their children
Interdisciplinary teamwork is a key to patient safety in the operating room, ICU, and ER
Using chlorhexidine gluconate solution for vascular catheter site care greatly reduces the risk of catheter-related infection
Changing health insurance plans might adversely affect a persons' care as well as increase care costs during the first year
Following an urban hospital closure, remaining hospitals operate more efficiently due to high admissions