Quality of Care

Research Findings

Research Activities, September 2012:
AHRQ-funded medical liability and patient safety initiative shows promise for reducing patient harm, lawsuits, and costs
A five-point checklist can help public report sponsors avoid misclassifying the performance of health care providers
Hospital volume does not predict mortality for patients undergoing lung cancer surgery
Distance-based training in spirometry use increases the quality of asthma diagnosis
Opioid prescriptions for treating chronic abdominal pain doubled between 1997 and 2008
Study fails to find link between guideline-based emergency treatment for pediatric asthma and patient outcomes
Telemedicine dermatology consultations change diagnoses and improve outcomes
Minority-serving hospitals have problems with quality of care and patient satisfaction

Research Activities, August 2012:
Outcomes of trauma patients depend heavily on whether recommended practices are followed
Patients hospitalized for burn injuries in New York have comparable outcomes at major burn centers
Medicare managed care reduced preventable hospitalizations in 2004 more than fee-for-service Medicare
Ways to reduce contrast-induced acute kidney injury from imaging procedures in patients with cardiovascular disease
New tool developed to reduce risks to patients during clinical handoffs
Complications increase mortality of trauma patients
Liver transplant patients who taper off or do not take corticosteroids after transplantation have better quality of life
Benefits and risks of helicopter transport for trauma patients investigated
Introduction of hospice services by nursing homes does not significantly affect nursing assistant staffing
Patients often say good things about their physicians on rate-your-doc Web sites, but are less positive about system issues

Research Activities, July 2012:
High-volume hospitals have low rates of adverse events for high-risk surgeries
Complications and in-hospital deaths more frequent among patients who undergo anterior rather than posterior spine fusion
Adjusting hospital admissions by day can help with overcrowding in children's hospitals
Perceived reputation and other factors influence consumers' hospital choices
Market competition has only marginal effect on hospital performance for heart failure
Study identifies signals that may predict infant neurological impairment
Having a usual source of care promotes preventive health counseling for children
Electronic health records can help detect diagnostic errors in primary care
Primary care practices can boost clinical preventive services with electronic health records and quality improvement support
AHRQ report finds teamwork and followup as strengths of medical offices but work pressure and pace are problematic

Research Activities, June 2012:
Disparities Report highlights health care challenges for minorities, underscores importance of Affordable Care Act
Dual Veterans Administration/Medicare users are not hospitalized more for ambulatory care sensitive conditions
A hospital's ability to rescue patients from complications after high-risk surgery determines mortality rates
Infrequent physician use of implantable cardioverter-defibrillators presents potential risks to patient safety
Patients recovering in the hospital from total knee or hip replacement have increased risk of falls
Contact isolation of new patients reduces adherence to process-of-care quality measures for pneumonia
1 in 10 computer-generated prescriptions include at least one error
Magnet® hospitals offer better work environment for nurses than non-Magnet hospitals

Research Activities, May 2012:
Trauma centers vary in screening for deep vein thrombosis
Leapfrog survey may not accurately report use of safe practices in trauma centers
Lower complications are seen after laparoscopic kidney removal
Dissemination and implementation of clinical trial results are needed to encourage recommended practices
Electronic health records improve nursing care, coordination, and patient safety
Consumers choose "high-value" health care providers when given combined cost and quality information

Research Activities, April 2012:
A "diabetes dashboard" screen helps clinicians quickly and accurately access patient data needed for quality diabetes care
Patient surveys are an additional useful tool for identifying adverse events occurring during hospital stays
Public reporting of performance data seems to motivate and energize improvements to hospital performance
Physician personality factors do not seem to influence whether patients with symptoms undergo extended diagnostic evaluations
Performance measures for gastroenterology can lead to improved accountability
Improving quality of care for falls and urinary incontinence also improves quality of life in elderly patients
Lower flu vaccination rates for black nursing home residents a cause for concern

Research Activities, March 2012:
Learning networks can help implement strategies to improve emergency department patient flow
Trauma patients with hospital-acquired infections have poor outcomes, including increased mortality risk
Hawaii's experience shows that a national collaborative effort can reduce central line-associated bloodstream infections
Crisis checklists for the operating room can improve safety and management
Evaluation of TeamSTEPPS® implementation finds improved teamwork and clinical outcomes
Guideline management of inpatient cellulitis and cutaneous abscess reduces antibiotic use
Electronic health records in community health centers provide a better picture of care than insurance claims data
Study identifies attributes of surgeons more willing to provide charity care
Growth in the physician assistant workforce will be insufficient to meet future needs of primary care
Despite recommendations against it, early discharge of late-preterm newborns remains common
Medicaid nursing home reimbursement affects nursing homes' approach to end-of-life care

Research Activities, February 2012:
Superficial surgical site infections are a reliable measure of hospital quality
Adults with individual and employment-related health insurance report similar, often good, access to care
Study finds potentially suboptimal use of antidepressants for residents in Veterans Affairs nursing homes

Research Activities, January 2012:
Primary care coordination is more difficult for patients who see many specialists
Medicaid pay-for-performance program in Massachusetts fails to improve quality during first-year
State regulation of care quality is costly to nursing homes
Clinical informatics monitoring tool helps reduce adverse drug events in nursing home settings
Interdisciplinary team training with in-situ simulation helps reduce adverse events in obstetric patients
No greater risk or mortality observed for endoscopic vein harvesting for coronary bypass surgery
Duplicate medication order errors increase after computerized provider order entry is implemented
Medical residents can use quality improvement methods to promote obesity screening
Measuring quality of care for middle ear infection has many pitfalls
California nurse staffing mandate did not reduce nursing workforce skill levels
Leg compression devices are not a significant factor in in-hospital falls
A large proportion of hospitalized children receive numerous medications during their hospitalization
Clostridium difficile infection rate has risen among hospitalized children since late 1990s
Communications between patients with HIV and their providers differ along racial and substance use lines
New study finds e-prescribing is safe and efficient, but barriers remain

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Research Activities, December 2011:
Volume of paid outpatient malpractice claims underscores need for greater patient safety efforts in this area
Evidence-based strategies substantially reduce the incidence of ventilator-associated pneumonia in ICUs
Trauma patients are more likely to die after a major complication in high-mortality hospitals
Hospital boards adopt practices to enhance oversight on quality of care
Pharmacy, medical, and nurse practitioner students need more education on drug-drug interactions
For-profit dialysis chains have higher mortality rates than non-profit dialysis chain
Enrollment in Medicare Advantage managed care plans reduces racial/ethnic disparities in primary care quality in some States
Financial performance has modest effect on nursing home quality improvement

Research Activities, November 2011:
Nearly 1 in 10 outpatient computerized prescriptions contains errors
Nurses in hospital units with a higher proportion of short-term patients take longer to respond to patient call lights
Fecal occult blood tests and followup need to be better targeted to healthy older adults
Physicians who use electronic health records more intensively are more likely to use patient registries to improve care
Updated report highlights hospitals’ progress in reducing bloodstream infections
AHRQ initiative encourages better two-way communication between clinicians and patients

Research Activities, October 2011:
MONAHRQ gains momentum
Less than half of pharmacy computer systems studied correctly identified drug-drug interactions
Simpler drug warning labels are easier to understand
Medical students, interns, and residents need training to disclose medical errors
Certain factors increase risk of medication errors in the neonatal intensive care unit (NICU)
Going "smooth" can help relieve weekday crowding at children's hospitals
Transparency enhances physician communication with patients
Physician recommendations for defibrillator therapy not influenced by race or gender
Hospital deaths from heart failure cut by half over 7 years

Research Activities, September 2011:
Surgical risk score does not work well for knee and hip replacement operations
Pay-for-performance project showed early gains but tapered in the fourth and fifth years
Low- and middle-income children with public and private insurance have similar rates of unmet health care needs
The quality of children's asthma care is affected by emergency department crowding

Research Activities, August 2011:
AHRQ's clinical care tools help clinicians ensure better and safer care
Hospital-acquired infections dramatically increase trauma patients' risk of in-hospital death and hospital stay
Trigger tools have potential to detect adverse events following outpatient surgery
Electronic order sets can help treatment conform to guidelines for antibiotic use after surgery
Mental demands of pediatric hospital pharmacy staff have varying effects on likelihood of medication errors and adverse events
High performance on quality measures linked to financial benefits for nursing homes
Having a usual source of care as well as insurance reduces unmet health needs

Primary anterior cervical fusion has lower in-hospital complication rates and deaths than posterior cervical fusion
Up to $500 million in Affordable Care Act funding will help health providers improve care

Research Activities, July 2011:
Health care quality gaps and disparities persist in every State
Delays in reporting medical errors at Japanese hospital nearly triple that of United States hospital
Hospitals with a teamwork culture have better patient safety climates
Quality measures are not used with all patients who suffer heart attacks
Studies examine safety of pain killers among older adults
Immersive simulation training for CPR shows no benefit over standard training
Patients who suffer strokes and are seen at designated stroke centers fare better in the short and long run
Trauma center patients treated after hours or on weekends have no difference in mortality rates
Guideline familiarity does not equal guideline adherence
Chronic Care Model linked to exercise discussions during primary care office visits for diabetes
Preventive care for patients with lupus could be improved
Health insurance is necessary but not sufficient for children's access to care
ICUs in Michigan sustain zero bloodstream infections for up to 2 years
Readmissions in 30 days or less account for 1 in 9 hospital admissions

Research Activities, June 2011:
Nursing homes more often voluntarily terminate from Medicare and Medicaid programs in States with strong quality regulations
Length of stays in emergency departments varies considerably
An automated phone response system can help track adverse drug events in primary care patients
No consistent association found between volume or quality and outcomes of complex surgeries for cancer

Research Activities, May 2011:
Systems to detect adverse drug events need buy-in from leaders and staff to become part of hospital routine
Laboratory monitoring of high-risk medications varies greatly
Performing cardiac catheterization and heart surgery on different hospital admissions may reduce risk of kidney damage
Specific primary care strategies may improve medication safety
Surgery and imaging rates for children's kidney stones are stable, but vary greatly from hospital to hospital

Research Activities, April 2011:
Health care quality still improving slowly, but disparities and gaps in access to care persist
Medication safety indicators can guide improvement in primary care drug selection, dosing, and monitoring
Hospital Compare data may not help surgical patients find hospitals with better outcomes
Electronic health record decision support improves the care of children with ADHD
Adverse drug event surveillance tailored to hospitalized children
Rates of pneumonia dramatically reduced in patients on ventilators in Michigan intensive care units

Research Activities, March 2011:
Re-engineered discharge project dramatically reduces return trips to the hospital
Hospitals with a high volume of sepsis admissions have lowest mortality rates
Hospitals face dilemmas about disclosure of large-scale adverse events
Most process-of-care events do not harm transplant patients, but they boost costs and lengthen hospital stays
Person-to-person transmission of E. coli resistant to fluoroquinolone drugs is rare among hospital patients
Automated screening of patient electronic medical records is only the first step to identifying a medication problem
When health plans share physicians, they may have less incentive to improve care quality
Colony-stimulating factor is effective in reducing infection for elderly patients with non-Hodgkin's lymphoma on chemotherapy
Children with a medical home more likely to receive health screenings and advice
Asthma project helps resident physicians improve care for minority patients
Expert workshop discusses disparities in health care quality and role of health IT in underresourced settings
Anemia is common among nursing home residents and affects their physical functioning
Better hospital quality of care for the elderly is associated with lower mortality after discharge
Landmark initiative to reduce healthcare-associated infections cuts deaths among Medicare patients in Michigan ICUs

Research Activities, February 2011:
Hospitals vary greatly in the quality of their trauma care
Flawed State apology and disclosure laws dilute their intended impact on malpractice suits
Simulation training improves insertion of central venous catheters
Nurses with higher education levels rate themselves as having more clinical expertise and are sought out for their guidance
Trauma care costs less at hospitals with lower mortality rates
Nearly one-third of emergency department visits involve nonideal care events
Pilot study finds a low level of medication errors for look-alike, sound-alike drugs prescribed for children
Ketorolac, a pain medication, is underused in children operated on for bladder reflux
Prenatal screening for Group B streptococci often fails to live up to current screening and treatment guidelines
Nurse-facilitated guided care for elders and their caregivers leads to improved perceptions of quality of care
Poorer patients less likely to receive specific treatment for head and neck cancer
Primary care physicians' performance ratings depend on the makeup of their patient population

Research Activities, January 2011:
Health information technology improves care and saves lives
Most acute-care hospitals follow national guidelines for the prevention and treatment of MRSA infections
Hospitalists modestly improve quality of care
Greater use of preventive measures needed for hospitalized patients with suspected venous thromboembolism
Serious complications from bariatric surgery are fewer when done by high-volume hospitals and surgeons
Treatment for blocked carotid arteries varies depending on where you live
Public reporting on quality of care has definite, if modest, effects on nursing home care improvement
Public report cards prompt nursing homes to spend more on clinical services
Nursing home hospice patients are not receiving adequate treatment for nonpain symptoms
Review looks at approaches to improve drug prescribing in nursing homes

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Research Activities, December 2010:
AHRQ awards $34 million to expand fight against healthcare-associated infections
Surgical infection prevention measures reduce postoperative infections when used together, but not singly
Physicians can use 10 strategies to manage abnormal test result alerts in electronic health records
Rescuer experience with out-of-hospital emergency intubation is often associated with improved patient survival
Fragmentation of care for complex diabetes patients may be associated with greater use of the emergency department

Research Activities, November 2010:
Oral chemotherapy drugs not immune to medication errors
Whistleblowers in pharmaceutical fraud cases pursue Federal lawsuits for moral reasons, not money
MRSA can spread slowly but surely in households
Electronic medical record boosts documentation of test results, but still falls short for patient notification and test followup
Various factors affect providers' ability to identify spoken drug names
AHRQ patient safety indicator can be used to identify cases of hospital-acquired collapsed lung
Cesarean delivery rates may not be a useful measure of obstetric quality
Hospital report cards on coronary bypass surgery are more accurate when based on 2-year data

Research Activities, October 2010:
Quality improvement initiative successful in sustaining reduction in bloodstream infections caused by catheters
Timely followup remains an issue with abnormal lab results in electronic health records
Parents continue to weigh vaccine benefits with adverse effects when deciding to vaccinate their children
Pay-for-performance does not improve care quality in the short term in safety-net settings
Use of certain electronic health record features is associated with improved primary care quality measures
Southeastern and mid-Atlantic States have highest rate of sepsis-related deaths
Study recommends disclosure of medical mistakes that affect multiple patients

Research Activities, September 2010:
Assessment of hospital computerized physician order entry systems finds many medication errors are missed
Detailed, up-to-date medication lists help prevent errors
Physician champions key to successful quality improvement projects
Physicians' use of "we" during patient visits does not necessarily foster patient-physician partnership
Blacks with lung cancer have higher mortality rates than whites
Hydroxychloroquine still underused by patients with lupus, but use more likely if treated by rheumatologists
Relative inefficiency of rural critical access hospitals must be balanced against their contributions to care access and quality

Research Activities, August 2010:
Emergency physicians suggest ways to reduce errors in patient handoffs during shift changes
Hospital risk managers more likely than physicians to recommend error disclosure, but less likely to apologize
Patient preferences are important when making clinical decisions for those who can't, but other factors also play a role
Consider local health care systems when designing services for the uninsured
Minority patients are less likely to have surgery performed by high-volume surgeons and hospitals
Care setting affects likelihood that children with persistent asthma will receive inhaled steroids
Lower mortality rates after surgery at high-volume hospitals due to fewer complications and other factors
Challenges abundant for practices that use fax referrals to smoking cessation quitlines

Research Activities, July 2010:
One in four patients experiences revolving-door hospitalizations
Simplified drug warnings improve patients' understanding of what to do or avoid when given a particular prescription
Health plans vary widely in the prescribing of antibiotics
Physicians' reasons for deviating from quality guidelines are usually justified
Adequate financial bonuses and peer support motivate providers to adhere to evidence-based treatment guidelines
Community health center collaboratives improve care quality but have little impact on disparities
Patients at small urban hospitals are more likely to suffer from pressure sores than those at small rural hospitals
Study suggests caution in interpreting impact of nurse staffing levels on postsurgical complication rates
Patient outcomes are better than hospital volume for identifying high-quality bariatric surgery centers
Elderly lung cancer patients experience more adverse events during chemotherapy than younger patients
Computerized provider order entry significantly reduces medication errors in an ambulatory setting
Using bar-code technology with eMAR reduces medication administration and transcription errors

Research Activities, June 2010:
Annual quality and disparities reports include data on health care-associated infections, obesity, and health insurance
Nursing homes using more agency staff have lower quality of care
Nursing home physicians and nurses struggle with communication barriers
Patients who undergo knee ligament reconstruction do better when the doctor or hospital perform it frequently
Higher nurse-patient ratios result in societal cost benefits for some hospital areas
Medicare Advantage enrollees are admitted to hospitals with higher mortality rates than Medicare fee-for-service enrollees
For 1 in 10 Medicaid patients, it's back to the hospital in a month

Research Activities, May 2010:
Adverse events occurring during pediatric sedation are recorded in charts but not always reported
Restricting residents' working hours decreases teaching time but improves well-being
Study provides insights into problems confronting quality improvement educational programs in rural hospitals
Participation in reporting quality data can be costly for physicians and practices
Improvements are needed to better measure mental health care quality
Published sources on warfarin interactions with other drugs, food, and supplements tend not to agree
Drug monitoring may be improved by the use of health information technology and clinical pharmacists
Opioid-naïve nursing home residents are commonly prescribed long-acting opioids, a potentially dangerous practice

Research Activities, April 2010:
Physicians need to be better educated about FDA-approved indications for drugs and evidence for off-label drug use
To reduce hospital deaths, managing surgical complications may be as important as preventing them
FACE cards have a small positive effect on hospital patients' ability to identify their physicians
Types and rates of fungal infections vary among groups and treatment is often suboptimal
Rural and urban residents have similar perceptions of health care quality, despite differences in care delivery
Making nursing home quality reports public leads to improved posthospitalization care
Outpatient advice on pediatric medication safety is inadequate
The stability of a usual source of care is important to the care of low-income children
Certain factors can help prepare families to bring infants home from neonatal intensive care units
Medication review technique may help identify drug-related problems in the elderly

Research Activities, March 2010:
Simulation training in the operating room improves competency for the entire operating room team
One patient safety indicator may offer a glimpse at a hospital's overall safety record
Pain management in emergency departments has improved but can still be better
Nursing home studies focus on the costs of staff turnover rates and selective admission of patients

Research Activities, February 2010:
Vaccines with names that look and sound alike can lead to vaccination errors
Nonphysicians can be trained to assess residents' competence in catheter insertion
Medicaid drug restrictions may lead to adverse events for psychiatric patients

Research Activities, January 2010:
Administration of antimicrobials just prior to surgery reduces the risk of surgical site infections
Simulating equipment failures can be useful to hone anesthesia providers' skills
Failure to order and follow up medical tests are leading causes of diagnostic errors
Medication changes are not always documented properly in physician notes or the electronic medical record
Criteria used to identify "drugs to avoid" in the elderly are not very accurate
Physicians in practices focused on quality improvement are less likely to be dissatisfied and stressed
Physicians aren't confident they can recognize infections from anthrax and other bioterrorism disease threats
Computerized decisionmaking systems improve physician prescribing for long-term-care residents
Longer use of electronic health records is not linked to improved quality of care
Studies examine impact of drug caps and pay for performance on care costs and outcomes

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Research Activities, December 2009:
Specimens from multiple body sites are needed to accurately test for MRSA
Using trigger tools to review medical charts helps identify adverse drug events among older adults
Public reporting of hospital antibiotic timing for patients with pneumonia is not linked to antibiotic overuse or overdiagnosis
Women in Michigan who suffer miscarriages may not be receiving patient-centered care
New guidelines issued for nephrotic syndrome in children
Electronic patient-provider messaging is linked to good diabetes control
More than half of primary care physicians report stressful working conditions

Research Activities, November 2009:
Children are commonly harmed by adverse events in intensive care units
Infants are at the highest risk for errors involving cardiovascular drugs
Intervention leads to reduction in central venous catheter-associated blood stream infections for pediatric patients
Quality of care may be more important than volume when it comes to heart bypass surgery
Safety awareness and technological adoption are keys to managing test results in family medicine offices
Input from clinical staff helps when evaluating the purchase of equipment
Evaluating team member perceptions can help guide future failure mode and effects analysis activities
Instituting patient safety rounds can boost adverse event reporting in outpatient cancer clinics
Inappropriate medications raise the risk of adverse drug events among older adults

Research Activities, October 2009:
New video helps patients use blood thinner pills safely and effectively
Electronic prescriptions help community pharmacists recognize prescribing errors
Physician-owned single specialty hospitals may prod nearby hospitals to increase nurse staffing levels
Blacks are less likely than whites to receive lung cancer treatments

Research Activities, September 2009:
Shift workers suffer fatigue and poor performance
Spine and pain clinics in North Carolina vary by types of practitioners and services offered

Research Activities, August 2009:
New snapshots show States vary widely in providing quality health care
Clinical practice guidelines for cardiology are steeped more in expert opinion than scientific evidence
Specialists are less likely than generalists to spot clinically important drug-drug interactions
Hospitals with better safety climates have fewer events that can potentially harm patients
Medicare claims data identify hospital-acquired catheter-associated urinary tract infections with limited accuracy
Accurate secondary diagnosis codes improve risk adjustment of inpatient mortality rates
Quality adjusted life years: Looking for consensus
Performance obstacles negatively affect how ICU nurses perceive the quality and safety of care they deliver
Diagnostic codes alone may misclassify bacterial infections among hospitalized patients with rheumatoid arthritis

Research Activities, July 2009:
Underresourced clinics with more challenging patients may underlie poor chronic disease outcomes of minorities
Inner-city Hispanic adults with limited English proficiency have poorer asthma control and quality of life
Fewer than half of patients with diabetes are referred for lifestyle counseling, nutrition, and exercise
Quality and accessible primary care is linked to fewer emergency department visits by Medicaid-insured children
Data derived from electronic health records is not superior to administrative data for measuring performance
Surgeons are skeptical about how surgeon-specific quality outcomes should be measured and reported
Several practices of hospital governing boards are linked to improved quality of care

Research Activities, June 2009:
Quality of asthma care varies significantly in emergency departments
Faculty and leadership are unhappy with medical school culture
Study calls for better data for physician profiling
Competition among HMOs may have a negative impact on quality
Recent past performance ratings of HMOs predict good performance in the future
Study outlines the challenges of conducting quality improvement studies at rural and small community hospitals

Research Activities, May 2009:
Lack of resources and time, along with staff burnout, are barriers to sustaining quality improvement in community health centers
Telephone nurse support can be cost-effective to help improve functioning and quality of life for patients with diabetes

Research Activities, April 2009:
Quality improvement collaborative fails to improve infection prevention in surgical patients
Care quality disparities exist for children seen in urban versus rural hospitals
Antibiotic use and diarrhea are factors in hospital room contamination with vancomycin-resistant organisms
Hospitalists and general internists provide similar quality of care for patients with congestive heart failure

Research Activities, March 2009:
Mandatory public reporting of care performance did not affect quality of care for Medicare managed care patients
Staffing level mix affects quality of care in nursing homes

Research Activities, February 2009:
Care quality and treatment differences may underlie greater functional disability among older blacks and Latinos
Quality of care and working conditions influence job satisfaction of surgical residents
Leadership support and fair work distribution keep morale high during quality improvement initiatives
Adding more staff may be a necessary, but insufficient, way to improve nursing home quality/
The Web-based Nursing Home Compare report card improves nursing home quality, but not across the board

Research Activities, January 2009:
New inventory of HHS quality measures to improve public- and private-sector performance measurement efforts have been released

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