research title about health care services

Handbook of Epidemiology pp 1–67 Cite as

Health Services Research

• Thomas Schäfer 3 ,
• Christian A. Gericke 4 &
• Reinhard Busse 5  
• Living reference work entry
• Later version available View entry history
• First Online: 02 September 2023

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After a brief introduction into the general field of health services research, a large section deals with the specific issues arising when epidemiological or statistical methods are used to study health services. This is followed by sections describing the main fields of investigation which are usually thought of as pertaining to the wider realm of health services research. These are studies of demand, need, utilization, and access to health services which have the interface between the patient and health services in common. The next section describes the importance of financial resources, structure, and organization for the delivery of effective and efficient health care. This is followed by a description of the processes and outcomes of health care, including concepts such as effectiveness and appropriateness of care and their use, e.g., in physician profiling or in hospital rankings. In the section on outcomes, special emphasis is put on health status measurement and the evaluation of health systems in international comparisons. Important health economic concepts, such as cost-effectiveness and efficiency, are covered in various sections. The chapter concludes with describing common pitfalls and caveats in interpreting health services research.

• Allocation of resources
• Quality of care
• Hospital ranking
• Physician profiling
• Administrative databases
• Complex models for data analysis
• Risk adjustment
• Confounding

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This survey had three predecessors in the years 1984–1986, 1987–1989, and 1990–1991 and was supplemented by the German National Health Interview and Examination Survey for Children and Adolescents (KiGGS), carried out from May 2003 to May 2006. The target population were children and adolescents aged between 0 and 17 and living in Germany (Kurth 2007 ). The Robert Koch Institute continued the KiGGS Study by carrying out telephone-based health interviews (Robert Koch Institute 2021 ).

But the increased use of cellular phones poses a problem and there is need for research to broaden the approach beyond the restrictions of the conventional telephone network.

About 10% of Medicare enrollees are younger, disabled persons, who are tracked from their time of certification.

The hospitals and the pharmacies had started to transfer their beneficiary-related data to the sickness funds long before.

Random digit dialing in order to sample for computer-assisted telephone interviews is considered as a way to handle this problem if the existing lists are not complete and the target population can be accessed by conventional telephone network.

Of course, the choice of the sampling scheme has to be relevant to the population being sampled. A population that is not completely covered by social security would be unsuitable for sampling by means of social security number.

CMS: Centers for Medicare and Medicaid Services; HCC: Hierarchical Condition Categories

The high-cost pool consists of insured with high cost in the past year (above a fixed threshold) which are shared by all statutory sickness funds.

This trade name has its roots in the Research Triangle Institute (RTI), which was established by the universities located in the Triangle’s three cities Raleigh, Durham, and Chapel Hill in North Carolina.

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Schäfer, T., Gericke, C.A., Busse, R. (2023). Health Services Research. In: Ahrens, W., Pigeot, I. (eds) Handbook of Epidemiology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6625-3_38-1

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Research Training in the Biomedical, Behavioral, and Clinical Research Sciences (2011)

Chapter: 8 health services research, 8 health services research.

Health services research (HSR) provides the information needed to understand the effectiveness and efficiency of our health care delivery system and its impact on the health and well-being of individuals and populations. 1 Health services research documents deficiencies in patient and population health and in the provision of health services and seeks to identify contributing factors. There are many examples: being uninsured in America reduces access to health care and contributes to poorer health outcomes (Institute of Medicine [IOM] reports on uninsured); medical errors too frequently occur in hospitals and many patients suffer injury or death (IOM, 1999); and in the community, only half of the time are individuals receiving preventive and chronic disease care consistent with scientific evidence (McGlynn, 2003).

Health services researchers seek solutions to these and other problems that adversely affect access to care, quality, safety, and cost of care. Health services research evaluates the impact of government and private-sector health policies, designs and evaluates innovations in health care organization and financing, and examines the effects of new technologies or new uses of existing technologies. Assessing the impact of health services on population health requires health services researchers to go beyond disease outcomes to examine health status and health-related quality of life outcomes, assess delivery system quality and efficiency, as well as focus attention on prevention and health promotion services.

The contributions of health services research to policy, management, and clinical care have been diverse. Planners and policy makers, for example, are frustrated by the inability to generalize and use findings from efficacy studies: persons recruited to randomized control trials testing new treatments typically are not representative of the larger population expected to benefit from the treatment. Thus, it is up health services research to fill this information gap by assessing the impact of diagnostic and treatment technologies on patient outcomes and costs across real-world practice settings and diverse populations.

Translational research has emerged as an important dimension of health services research design and analysis; translational research provides the knowledge base to move scientific discoveries from laboratory, clinical, or population studies into clinical applications at the National Cancer Institute. Yet translation alone is generally not sufficient to ensure these services are available across America. Implementation research is needed to effectively adapt new clinical applications to diverse real-world practice settings in which programs, tools, and guidelines will be utilized and need to be integrated into the existing hospitals and community practice settings (Rubenstein and Pugh, 2006). Together translation and implementation research are gaining greater visibility as we have come to recognize that many Americans are failing to receive consistent high-quality health care based on the latest scientific knowledge. Meeting the challenges of translation and implementation research requires additional disciplinary breadth, drawing on areas of organizational and operations research, psychology, marketing, education, and adult learning. Also expanded applications of health information technology are needed in support of consumer-patient decision making and real-time decision support for health care providers. The rapid growth and continuing change in scientific health information will result in the translation and implementation processes being continual and not one-time or infrequent events. The capacity to achieve this goal may require fundamental re-thinking of information flow and how it supports all aspects of health services.

Central to advances in all scientific fields are measurement tools, and for health services research measurement tools span payment and financing, appropriateness of utilization (overuse, underuse, and misuse; IOM, 2001), quality of care, and patient outcomes of care. Health services research

has provided the measurement tools being used in payment for inpatient hospital services, outpatient services, and nursing home care, as well as capitation payment methods for persons enrolled in health plans. Improved payment methods are making it possible to adjust payment for quality of care and to better reward efficiency. These measurement tools, and others to be developed, will be needed to monitor and evaluate the impact of the 2010 Health Reform legislation and how well it achieves its goals. Examples of quality-of-care measures that will require further development include: assessing the timeliness of health care, measuring coordination of patient care when multiple providers are involved in diagnosis and treatment, providing patient-centeredness of care, and equity of health care. Although these are not new, there are few if any accepted measurement tools to assess deficiencies and progress toward the goals of health reform. The training and support of researchers who focus on measurement is a continuing and growing need in health services research.

Since 2003 Congress has provided support to the Agency for Healthcare Research and Quality (AHRQ) to develop and fund comparative effectiveness research (CER). In 2009, the American Recovery and Reinvestment Act (ARRA) augmented CER support with $1.1 billion for research and training through AHRQ, the National Institutes of Health, and the Office of the Secretary of Health and Human Services (HHS). CER as defined by HHS combines key elements of health services and clinical research:

Comparative effectiveness research is the conduct and synthesis of research comparing the benefits and harms of different interventions and strategies to prevent, diagnose, treat and monitor health conditions in “real world” settings. The purpose of this research is to improve health outcomes by developing and disseminating evidence-based information to patients, clinicians, and other decision-makers, responding to their expressed needs, about which interventions are most effective for which patients under specific circumstances.

To provide this information, comparative effectiveness research must assess a comprehensive array of health-related outcomes for diverse patient populations and sub-groups.

Defined interventions compared may include medications, procedures, medical and assistive devices and technologies, diagnostic testing, behavioral change, and delivery system strategies.

This research necessitates the development, expansion, and use of a variety of data sources and methods to assess comparative effectiveness and actively disseminate the results.

The expectation is that CER will provide new information that is not currently available about what treatments and services work best for individuals across America’s diverse populations, taking into consideration the person’s circumstances and the timing of services. The new CER mandate complements the initiatives discussed above in translation and implementation research, intensifying the focus on research driving health system transformation to achieve better health outcomes for all Americans and greater efficiency.

FEDERAL SUPPORT OF HEALTH SERVICES RESEARCH

In 1968, Congress recognized the emerging role of health services research for improving health care delivery in the United States and created the National Center for Health Services Research and Development (NCHSRD) in the Department of Health, Education, and Welfare (DHEW). During the years 1968-1989, NCHSRD sought to develop research on issues of access, cost, and quality, and to develop data systems to support research on utilization and cost of care. 2 However, over time the budget for NCHSRD declined and the future of the NCHSRD became uncertain. Private foundations played a critical role in sustaining the health services research field during these years. 3

In 1989, health services research once again found strong support in Congress and a new vision for health services research was created in the authorization of the Agency for Health Care Policy and Research (AHCPR). Congress directed the Agency—subsequently renamed the Agency for Healthcare Quality and Research—to undertake research on patient outcomes, develop practice guidelines, and disseminate the research to change the practice of medicine. 4 The agency placed greater emphasis than previously on the examination of clinical practice, decision making, and comparative effectiveness of alternative approaches to diagnosis and treatment. The funding for AHRQ has grown over the years from $128 million in fiscal year 1993 to $397 million in fiscal year 2010, plus $300 million in CER funding from the ARRA appropriation.

While the National Research Service Awards (NRSA) program included support for health services research from its inception (see, for example, NRC, 1977), Congress specified in 1989 that one-half of 1 percent of the NRSA budget for training be allocated for training health services researchers through AHRQ, subsequently expanding that

allocation to 1 percent of NRSA funding in 1999, which has remained unchanged.

It should be noted that in the early 1990s Congress authorized a 15 percent set-aside for both research and NRSA training in service-related research supported by the National Institute of Mental Health (NIMH), the National Institute of Drug Abuse (NIDA), and the National Institute of Alcohol Abuse and Alcoholism (NIAAA) as part of the reorganization of the former Alcohol, Drug Abuse and Mental Health Administration into the National Institutes of Health. Even with this congressionally mandated set-aside for these NIH institutes, AHRQ remained the lead agency for health services research. NIH funding has been directed at HSR focused on questions related to the delivery of health care for specific diseases/disorders. AHRQ and NIH fund complementary research and in many instances have co-funded major health services research studies.

HEALTH SERVICES RESEARCH WORKFORCE

No national statistical system reports on the size and composition of the health services research workforce (Moore and McGinnis, 2009; Pittman and Holve, 2009). Obtaining information on the workforce in this field is a challenge. Identifying scientists who primarily do health services research is complicated by the interdisciplinary nature of the field. Health services research is an applied field, and so most health services researchers have another unique discipline or profession that they bring to health services research. Workforce data usually classify health services researchers by their primary discipline or profession and often are unable to identify the field of scientific inquiry as health services research. As NIH moves more toward trans-disciplinary research, the problem of not having multiple classifications incorporating both discipline and field of application may be an issue faced by many basic sciences and clinical researchers, as well as health services research.

In addition, anecdotal evidence suggests that some investigators involved in health services research studies do not identify themselves as health services researchers, nor do they necessarily belong to the only national professional association in this area, namely AcademyHealth. This partial or part-time involvement of many scientists in health services research only further complicates efforts to estimate the size and composition of the health services research workforce.

McGinnis and Moore addressed this issue in their study on the current status of the health services research workforce. In a conservative estimate of the field, counting HSRProj investigators (since 2004), speakers from AcademyHealth’s Annual Research Meeting in 2007, and AcademyHealth members whose membership has lapsed or joined in 2000 or later, Moore and McGinnis found that the field has more than doubled in size since the IOM’s estimate in 1995, growing from approximately 5,000 health services researchers to more than 13,000 researchers in 2007. Using a more expansive definition of the field by including researchers in disciplinary associations with subgroups that sometimes do health services research, such as the American Public Health Association, the American Society of Health Economists, the American Statistical Association, and the American Sociological Association, there could be an additional 6,000 intermitted members of the field (Moore and McGinnis, 2009).

The best data available on the composition of health services research workforce 5 likely comes from the most recent AcademyHealth membership survey in 2008 (AcademyHealth, 2008). AcademyHealth draws its members from both health services research and health policy, and includes student memberships. Although this database more than likely underestimates the total size of the workforce, it does provide some insights into its composition.

As of 2008, 51 percent of AcademyHealth’s 3,500 individual members report having a Ph.D., Sc.D., or other doctoral-level training in science. There are another 12 percent reporting an M.D. Table 8-1 shows the distribution of health services researchers by employment sector.

AcademyHealth membership has greater female representation (60.7 percent) than male (39.3 percent). This representation has changed slightly from AcademyHealth’s survey of members in 2002, when 55 percent of the respondents were women and 45 percent were men. Of note is that the youngest members were twice as likely to be female as to be male, while the oldest respondents were twice as likely to be male as to be female. The ethnic mix of members is 21 percent from minority ethnic backgrounds, including Asian/Pacific Islanders (10.6 percent), African Americans (5.2 percent), and Hispanics/Latinos (2.6 percent), plus 79 percent Caucasian and 2.5 percent other. Representation of all minorities has increased since 2002—to 21 percent from 12.8 percent.

Table 8-2 shows the primary field of interest by the members of AcademyHealth, and the largest share of the members classify their primary discipline as public health (21.5 percent). Only 13.3 percent of members identify their primary discipline as health services research.

In a study on the demand for health services researchers, Thornton and Brown (2009) found that the demand from both universities and non-academic employers is expected to increase. Based on their work one can anticipate there will be a growing demand for “people who can analyze the effectiveness of health service systems from disease management firms; investment firms with a large stake in the health care sector; state and local government; hospitals and providers that will be implementing quality reporting systems and pay-for-performance systems;” and the health

TABLE 8-1 Setting of Primary Employment, 2008

TABLE 8-2 Primary Field of AcademyHealth Members, 2008

industry including equipment manufacturers, pharmaceutical firms, and insurers.

Graduate Programs in Health Services Research

Graduate programs in health services research are not separately accredited, and because many graduates could come from doctoral programs with a different specialty than health services research, there is no accurate tally of doctoral students earning degrees in health services research (Ricketts, 2009). However, in its 2009 online directory of master’s and doctoral programs in HSR, AcademyHealth reports that there are now 41 schools providing HSR doctoral programs and 22 schools with postdoctoral training programs. Doctoral programs are mainly Ph.D. programs, including both disciplinary (e.g., health economics, medical sociology) and general training in health services research. An example of additional training opportunities is illustrated by Veterans Administration’s description of a new fellowship program:

VA Advanced Fellowship Program in Health Services Research and Development (HSR&D): This includes 16 training sites for Ph.D. associated health professionals, 8 training sites for post-residency physician associated health professionals, and 3 sites for post-doctoral physician associated health professionals. HSR&D also participates in the VA Advanced Fellowship Program in Medical Informatics which includes 7 training sites for post-doctoral and physician health professionals in medical informatics.

The NRSA program provides support for training in health services research. As discussed above, the AHRQ has received funding equal to one percent of all NRSA funds for NIH. AHRQ supplements NRSA funding with $500,000 annually. As shown in Table 8-3 , both NIH and AHRQ are funding HSR training at predoctoral and postdoctoral levels. Taken together, there were 107 predoctoral training positions in 2008, 68 percent of them funded by AHRQ. There were also a total of 85 postdoctoral positions, of which 49 percent were funded by AHRQ. The agency accepts new and renewal training grant applications every 5 years. In general, the agency has been able to fund only two-thirds of the requested training positions, and this is very similar to the rate for all NIH training awards. In addition, several NIH institutes provide NRSA awards in health services research, including NIMH, NIAAA, and NIDA. Overall, the total number of trainees is likely less than 2 percent of all NRSA training positions. No data are available on graduates of doctoral programs who are not funded by the NRSA program but who plan to pursue health services research careers. It would be expected that these numbers far exceed NRSA recipients, as they do in other health research fields.

Although there is incomplete information on the characteristics and careers of all individuals with training in health services research, there is some information of NRSA trainees supported by AHRQ. In particular, AHRQ commissioned an outcome study in 1999 of NRSA trainees between 1986 and 1997, which used information from the curricula vitae (CV) of the traimees. The results of this study were reported in the last assessment of the NRSA program. These data were updated in 2005 when data on trainees from 1998 to 2003 were added and data on the earlier trainees were made current to 2003. From 1986 to August 2003, AHRQ supported more than 1,000 individuals through different funding mechanisms. The NRSA program T32 institutional awards supported 346 predoctoral and 435 postdoctoral trainees through 27 university-based or university-affiliated training sites. Another 81 AHRQ F32 individual NRSA postdoctoral fellowships and 5 predoctoral fellowships were awarded. Some individuals had multiple awards under different mechanisms. A total of 854 individuals had support.

TABLE 8-3 Health Services Research Training Positions Funded by AHRQ and the NIH

In 2000, AHRQ launched its career development (K) award program and by August 2003 had made 48 awards. The majority of AHRQ-supported NRSA trainees and fellows between 1986 and 2003 were female (502 of 854, or 59 percent), a difference especially evident among T32 predoctoral trainees (229 of 346, or 66 percent) and F32 fellows (45 of 76, or 58 percent). There were almost even numbers of males (203) and females (225) with T32 postdoctoral trainees during this period.

The CVs of 709 trainees provided information on career progression and research productivity. CVs were received from 850: 346 had T32 predoctoral support, 428 had T32 postdoctoral support, and 76 had F32 fellowships. Of those who earned a doctorate by 2003, about 75 percent or 244 of the doctorates with a known degree field earned their doctorate in a health science field, including: health services research (81); related multidisciplinary health fields such as health policy, health administration, or public health (118); or one of the other health sciences (45). Over 90 percent of the T32 predoctoral trainees earned their baccalaureate degrees in one of the sciences, with 42 percent in the social sciences, 15 percent in the health sciences, and 19 percent in other scientific fields, including the physical and mathematical sciences. The degrees of those with baccalaureate degrees in non-sciences were either in education, humanities, or professional fields. Length of time in training for T32 and F31 predoctoral students averaged about 20 months, but 36 percent were only in training for 12 months. There was some difference in length of training by gender, with 81 percent of females in training for 24 months or less and 75 percent of males for this period. At the postdoctoral level, 84 percent of F32 fellows were in training for 24 months or less, and 86 percent of the T32 awardees were in training for this period. For both the T32 and F32 trainees, about half were in training for 24 months.

Half of the AHRQ NRSA T32 postdoctoral trainees with research doctorates earned them in the social sciences (sociology, economics, or the other social sciences); the remainder earned them in a variety of health or other fields. The other half of the AHRQ NRSA T32 postdoctoral trainees had clinical doctorates, and about half of these were earned in internal medicine; another 20 percent were earned in pediatrics and another 6 percent were earned in family practice, with the remainder earned in a wide variety of other clinical specialties. About 20 percent, or 59, of the 241 clinical doctorates with CV information earned a joint M.D./Ph.D. Just over half of the AHRQ NRSA F32 fellows held clinical doctorates, and more were in internal medicine.

The study also showed that the AHRQ NRSA trainees and fellows actively pursue research careers through a variety of employment paths. Most AHRQ NRSA T32 predoctoral trainees who completed their doctorates by 2003 did not pursue formal postdoctoral research training. First employment data were available for 555 of the predoctoral and postdoctoral trainees, and a large majority of both groups where employed in academic institutions. For the postdoctorates, 71 percent of 382 trainees were in academe, 23 percent were in for-profit or non-profit organizations, and 5 percent were in government. Of those in academic positions, 76 percent were Ph.D.s and 72 percent had clinical degrees. Most of the clinical doctorates that complete training began their academic career as an instructor. The percentage for the 165 predoctoral trainees formed a similar pattern, but only 57 percent had an academic position and 29 percent were in for-profit or non-profit organizations. The current employment of postdoctoral trainees at the end of 2003 closely resembles their first employment with 79 percent in academic positions and 13 percent in health-related employment. The remaining 8 percent were in for-profit or other organizations. For T32 predoctoral trainees, academic employment was almost as high at 67 percent, with 21 percent in health-related employment and the remaining 11 percent in for-profit or other organizations.

Of the employed NRSA T32 predoctoral trainees, about half (48 percent) reported having received post-training research support, and about 77 percent reported at least one post-training scientific journal publication. For NRSA T32

postdoctoral trainees with research doctorates, 72 percent reported having received post-training research support, and 85 percent listed at least one scientific journal publication following training. About 60 percent of the employed NRSA T32 postdoctoral trainees with clinical doctorates reported having received post-training research support, and about 78 percent had at least one scientific journal publication following training. Two-thirds of the employed former AHRQ NRSA F fellows reported having received grant support. In general, 90 percent of all trainees had at least one post-training scientific journal publication.

FEDERAL HEALTH SERVICES RESEARCH FUNDING

The broad relevance of health services research has contributed to federal funding through multiple agencies, unlike the funding of most other areas of health research. AHRQ’s research is expected to address cross-cutting issues such as access, quality and cost issues that are faced by the entire American health care system. Other funding sources seek to fund health services research in support of their organizational missions. The VA and DoD focus on their delivery systems, CMS on financing Medicare and Medicaid, CDC on prevention, and the NIH on delivery of services for specific diseases. These funding sources are complemented by private sources, including major foundations (e.g., Robert Wood Johnson Foundation, Commonwealth Fund, MacArthur Foundation, Kellogg Foundation, Kaiser Family Foundation, and a number of state-based foundations) and private corporations. The following discussion will be limited to federal funding of health services research.

In 2001 the Coalition for Health Services Research (CHSR), the advocacy affiliate of AcademyHealth, began an initiative to document health services research funding levels across the federal government. The first report was completed in 2003 and now there are annual updates. As of FY 2009, the Coalition estimates that a total of $1.48 billion was expended for health services research and related activities by the federal government in as shown below:

Agency for Healthcare Research and Quality (AHRQ)—$372 million;

Centers for Disease Control and Prevention (CDC):

National Center for Health Statistics (NCHS)—$125 million;

Extramural Prevention Research Program—$31 million;

Prevention Research Centers—$31 million;

Centers for Medicare and Medicaid Services (CMS)—$39 million; 6

Health Resources and Services Administration (HRSA)—$9 million;

National Institutes of Health (NIH) (All Institutes)—$779 million;

Veterans Health Administration (VHA)—$75 million; and

The Department of Defense (DoD)—$17 million.

Despite repeated calls from the Coalition for Health Services Research that federal agencies use a standard definition or uniform categories to report their expenditures, the data presented above are measured by these agencies using their own unique definition for what constitutes health services research. Only with a uniform definition and standard categories, would it be possible to assess how the current funding meets emerging needs.

Comparing the health services research funding of $1.5 billion to total federal health research funding of $35 billion in 2005 (Global Forum for Health Research, 2005) shows that approximately 4 percent of total funding is being devoted to health services research, based on classifications used within each agency and institute.

NIH institutes report funding health services research as shown in Table 8-4 . NIMH, NIDA, and NCI have the largest programmatic commitment, ranging from 17 to 23 percent of budget. Other institutes report smaller commitments of budget to health services research.

In summary, AHRQ provides 25 percent of all health services research funding as reported by federal agencies. Other federal agencies support more focused program-specific and disease-specific health services research. Private funding of health services research is substantial but no comprehensive source of information is available on non-federal sources.

CAREERS IN HEALTH SERVICES RESEARCH

The employment opportunities and careers in health services research are widely varied. Academic careers may be in schools of medicine, nursing, public health, and other health professional schools, as well as engineering and traditional arts and sciences departments, along with business and public policy schools. To effectively manage interdisciplinary research, academic institutions usually have organizational structures such as centers or institutes for health services research that cross school and departmental boundaries. At some institutions there are multiple centers reflecting different areas of specialization and the availability of funding for specialized centers from federal and private sources.

Private-sector health services research careers are available in many areas. Federal contract work evaluating major public policy initiatives are primarily done by private research firms. These organizations include RAND, Mathematica, Abt Associates, Westat, and others. These organizations are organized to do short-term large-scale studies that are not as easily organized and managed in most academic settings.

TABLE 8-4 NIH Institute Health Services Research Budgets Health Services Research FY 2008 Estimate (Dollars in Thousands)

Other private-sector health services research careers are in research organizations sponsored by HMOs and health plans, hospital systems, pharmaceutical firms, insurers, and other major stakeholders in health care. Health services research positions may involve directing research, translating research into practice and products, and managing and evaluating health care operations.

Associations for professional groups, manufacturers, and advocacy groups recruit people trained in health services research to strengthen their capacity to use information com-ing from health services research to advance their advocacy objectives and meet the needs of their members. As efforts to translate science into practice accelerate, the demand for individuals skilled in health services research and communication to users is likely to grow.

Government agencies recruit substantial numbers of health services research professionals to lead and manage research programs, to support policy analysis and development, and to work with managers and providers in the VA and DoD health care delivery systems.

New career paths for health services research professionals may emerge as research into effective translation of knowledge into practice grows. The 2003 Medicare prescription drug legislation mandated in Section 1013 that comparative effectiveness studies of health care services including prescription drugs increased the need for health services researchers trained in pharmaco-economics. The ARRA provided a substantial increase in CER funding for both research and investment in research infrastructure including methods and data. The development of tools and techniques to support translation is likely to become an industry that will require research skills in the design, evaluation, and testing of new technologies. Translation of knowledge for clinicians may be the initial priority, but priorities will likely expand to include managers, patients, and the public. The passage of the 2010 Affordable Health Care Act for America brings new and increased demands to monitor the success of health reform and identify unintended consequences. To achieve goals of greater efficiency in American health care and better quality, additional investments in health services research and translation and implementation in practice will be needed. The future demand for well-trained health services researchers is currently strong and growing.

RECOMMENDATIONS

Recommendation 8–1: Health services research training should be expanded and strengthened within each NIH institute and center.

Biomedical research has created a growing gap between research advances in biomedical science and the ability to apply them effectively to improve the health of the public. Thus there is a need for more effective health care delivery practices to ensure effective and evidence-based care, and to reduce waste and unnecessary risk to patients.

Recommendation 8–2: AHRQ training programs should be expanded, at a minimum commensurate with the growth in total federal spending on health services research, including comparative effectiveness research.

Recognition of the rising costs of care, with concerns about quality and consistency, have driven increases in services research. Health services research has established an important evidence base to enable patients and health care organizations to evaluate benefits and risks of diagnostic and therapeutic intervention and to compare relative values of older and newer approaches as choices proliferate. This field can also evaluate different approaches to health care delivery and financing, which will allow the nation to get more benefit from the dramatic advances in biomedical science. Ideally, the total numbers of persons being trained in HSR should grow at the same rate as national health

care expenditures. The NRSA program provides funding for a fraction of all trainees, which is divided among NIH institutes and AHRQ. Since NRSA funding is expected to ensure an adequate supply of research personnel for health research, it is reasonable to expect the proportion of NRSA funding for HSR trainees to approximate the proportion of the federal health research that is HSR. This guideline suggests the need to roughly double NRSA funding of HSR training, from the current level of approximately 2 percent of NRSA funds to 4 percent.

AcademyHealth. AcademyHealth Membership Survey 2008. Internal document.

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Kaplan, R.M., and J.P. Anderson . 1988. The quality of well-being scale: rationale for a single quality of life index. In: S.R. Walker and R. M. Rosser, eds. Quality of Life Assessment and Application. Lancaster, England, 51-78. MTP Press,

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Moore, J., and S. McGinnis. 2009. The health services research workforce: current stock. Health Services Research 2009; 44(6).

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National Research Council. 1983. Personnel Needs and Training for Biomedical and Behavioral Research. Washington, DC: National Academy Press.

National Research Council. 1989. Biomedical and Behavioral Research Scientists: Their Training and Supply. Volume I: Findings. Washington, DC: National Academy Press.

National Research Council. 1995. Meeting the Nation’s Needs for Biomedical and Behavioral Scientists. Washington, DC: National Academy Press.

Pittman, P., and E. Holve. 2009. The health services researcher of 2020: a summit to assess the field’s workforce needs. Health Services Research 44(6): 2198-2213.

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Comprehensive research and a highly-trained workforce are essential for the improvement of health and health care both nationally and internationally. During the past 40 years the National Research Services Award (NRSA) Program has played a large role in training the workforce responsible for dramatic advances in the understanding of various diseases and new insights that have led to more effective and targeted therapies. In spite of this program, the difficulty obtaining jobs after the postdoc period has discouraged many domestic students from pursuing graduate postdoc training. In the United States, more than 50 percent of the postdoc workforce is made up of individuals who obtained their Ph.D.s from other countries. Indeed, one can make a strong argument that the influx of highly trained and creative foreigners has contributed greatly to U.S. science over the past 70 years.

Research Training in the Biomedical, Behavioral, and Clinical Research Sciences discusses a number of important issues, including: the job prospects for postdocs completing their training; questions about the continued supply of international postdocs in an increasingly competitive world; the need for equal, excellent training for all graduate students who receive NIH funding; and the need to increase the diversity of trainees. The book recommends improvements in minority recruiting, more rigorous and extensive training in the responsible conduct of research and ethics, increased emphasis on career development, more attention to outcomes, and the requirement for incorporating more quantitative thinking in the biomedical curriculum.

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Open Access

Peer-reviewed

Research Article

Level of satisfaction and associated factors among patients attending outpatient departments of south Wollo health facilities, Ethiopia

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Resources, Software, Supervision, Validation, Writing – original draft

Affiliation Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Validation, Writing – original draft

Affiliation Department of Internal Medicine, Dessie Referral Hospital, Dessie City, South Wollo, Ethiopia

Roles Data curation, Formal analysis, Investigation, Methodology, Resources, Software, Supervision, Validation, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Department of Health Systems and Policy, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia

• Wolde Melese Ayele, 
• Abdurahman Ewunetu, 
• Muluken Genetu Chanie

• Published: July 21, 2022
• https://doi.org/10.1371/journal.pgph.0000761
• Reader Comments

Patient satisfaction is a key metric for determining how efficient healthcare is delivered. When patients visit health care facilities, they express a clear desire for high-quality services. Inadequately meeting their anticipated needs and expectations may lead to disappointment. This study sought to investigate the level of satisfaction expressed by participants regarding services provided by outpatient departments of selected health facilities in the south Wollo zone of Ethiopia and associated predictors.

A facility-based cross-sectional study with a total sample of 540 patients was conducted from May 13 to 25, 2019. A multistage sampling technique was used to select participants. Data were collected an interviewer-administered structured validated questionnaire. Data analysis was conducted with SPSS version 20 to identify predictor variables, applying bivariate and multivariate logistic regression analysis to determine variables that most significantly predicted the outcome variable of the level of patient-satisfaction at 5% level of significance and 95% confidence interval.

There were 537 participants in the study consisting of males (50.6%) and females (49.4%). An estimated 35.6% of respondents were between the ages of 28 and 37 years. The proportion of respondents high educational attainment was 179 (33.3%), and 155 (28.9%) of respondents reported having receive free health service of charge.

The study’s results revealed that overall client satisfaction was low. Furthermore, the politeness of health service providers, the convenience of the environment for asking questions, and the availability of all prescription drugs were found to have a significant relationship with level of satisfaction with the health center. Health managers and service providers should come up with creative ways to improve health workers’ caring behavior, protect patients’ privacy, and increase patient satisfaction by making all necessary drugs available.

Citation: Ayele WM, Ewunetu A, Chanie MG (2022) Level of satisfaction and associated factors among patients attending outpatient departments of south Wollo health facilities, Ethiopia. PLOS Glob Public Health 2(7): e0000761. https://doi.org/10.1371/journal.pgph.0000761

Editor: Nnodimele Onuigbo Atulomah, Babcock University, NIGERIA

Received: May 28, 2021; Accepted: June 23, 2022; Published: July 21, 2022

Copyright: © 2022 Ayele et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are included in the paper.

Funding: This research was funded by Wollo University as a postgraduate student thesis development (AE). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Patient satisfaction refers to how satisfied patients are with the service offered in terms of meeting their needs and desires. According to health services researchers report, patients who satisfied were more likely to comply with treatment, keep follow-up appointments, and use health services. While patients who dissatisfied were less likely to comply with treatment, keep follow-up appointments, and use health services [ 1 ].

Patient satisfaction is one of the most important aspects of healthcare service-quality, which includes treating patients with respect, respecting their needs, and offering services that meet their needs [ 2 ]. Patient satisfaction is considered to be one of the most important factors in a healthcare facility’s success. It is much easier to assess the patient’s satisfaction with the services provided than it is to assess the patient’s satisfaction with the services offered. It is also much easier to assess a patient’s satisfaction with the services offered than it is to assess the quality of medical care they receive [ 3 ].

Long wait time during registration, doctor visits after registration, examination room privacy, laboratory procedures and doctor revisiting for evaluation with laboratory results, failure to obtain prescribed drugs and supplies from hospital pharmacies, and insufficient information were all observed problems in studies carried in Out Patient Departments (OPD) of various hospitals in Ethiopia [ 4 , 5 ].

As the quality of healthcare rises, so does the demand for health services. To achieve high quality, the World Health Organization (WHO) now proposes a "people-centered" approach to health care, in which the patient is treated as a whole person with multiple needs, rather than just a disease condition to be managed. Patients’ satisfaction with the services they receive is one way to quantify health-care quality [ 6 ]. The modern patient is more informed and educated, has greater access to information, and has higher expectations of the health-care system. As a result, it is now more important than ever to address service delivery problems in this context [ 7 ]. A patient with positive attitudes has a better chance of achieving positive results. Negative patient attitudes and disappointment with health-care services lead to low compliance and, in extreme cases, patients resort to negative word-of-mouth, discouraging others from seeking health-care services from the system [ 8 ].

Individuals in Africa did not visit their local primary health care centers even for serious illnesses, according to studies, due to a perception of poor quality of care at these centers [ 9 ]. Patient satisfaction is important because it is linked to better compliance with doctors’ instructions, timely care seeking by the patient, and greater understanding and retention of information [ 10 ]. One of the indicators of the quality of care is patient satisfaction. Its evaluation will aid in the improvement of health care services and delivery based on patient feedback [ 9 ].

Some studies on patient satisfaction have been conducted in Ethiopia, but they have primarily focused on hospital settings. There has been little research on level of patient-satisfaction in primary health care settings, particularly among outpatient attendants at health centers. Thus, this study therefore investigated the level of patient-satisfaction among outpatient attendants in South Wollo, Ethiopia. The finding will have a vital impact on the policymakers, health care providers, especially for providers in primary healthcare settings, and clients to give a personal decision on the approach of service seeking to meet their needs and desire.

Materials and methods

Study design and setting.

A cross-sectional study was conducted among outpatient department customers at health facilities from May 13 to 25, 2019. The study was carried out in south Wollo, one of Amara National Regional State’s fourteen administrative zones. Dessie city is 400 kilometers from Addis Ababa, the capital of the country and 480 kilometers from Bahirdar, the main city of Amara National Regional State. According to the information obtained from Amhara Regional State, Bureau of Finance and Economic Development (BOFED) the current estimated population is 3,095,457. The zone has a total of 11 primary hospitals, 131 health centers, 523 health posts, 134 private primary clinics ( BOFED report , 2020 ).

Source and study population

All patients who visited the outpatient departments of the chosen health centers were considered the source population, and all patients who visited the outpatient departments of those ten health centers (from the five districts) during the study period were the study population.

Study variables

The study’s dependent variable was level of patient-satisfaction. The independent variables were socio-demographic characteristics (age, religion, marital status, level of education, occupation), and outpatient service-related characteristics.

Inclusion and exclusion criteria

During the study period, patients over the age of 18 who visited health centers were included. Patients who were seriously ill at the time of data collection were excluded because they were not respond properly.

Sample size determination and sampling procedures

The following assumptions were used to calculate the required sample size using a single population proportion formula. Overall patient satisfaction in health care services is 80.1 percent [ 5 ], with an accuracy of 3% at a 95% confidence level and a 10% non-response rate.

With a 10% non-response rate and a design effect of 2, the final sample size was n = 540. The sample size for the second objective was also computed using Epi-Info version 7 by applying double population proportion formula. The following assumptions: 95% confidence level, 80% power, 3.89 odds ratio, and 10% non-response were used to calculate the sample size for the second objective. However, the sample size was smaller than the sample size obtained for the first objective. Hence, the final sample size of the current study was 540 clients.

As a sampling technique, first multistage sampling technique was used. Five districts in the south Wollo zone were selected by lottery from a total of 24. (Wuchalie, Harbu, Bati, Mekaneselam and Albuko). Two health centers (HC) from each of these districts were selected again by lottery from the available HCs. Finally, the samples were drawn using a simple random sampling method, which involved taking the average daily patient flow from the adult outpatient department of the chosen HCs over the previous year’s same month. Prior to data collection, the total samples were proportionally assigned to the HCs.

Operational definitions

Patient waiting time..

The time between receiving service at the next outpatient station and departing from the previous outpatient station.

Patient satisfaction.

Patients’ perceived needs and expectations in relation to factors such as the health care provider and amenities are met. Very satisfied, satisfied, neutral, unhappy, and very dissatisfied were the five likert scale questions in the tool. It was divided into two categories: satisfied and very satisfied clients were considered satisfied, while neutral, dissatisfied, and very dissatisfied clients were considered unsatisfied.

Data collection tools and procedures

Data collection tools were developed from reviewing different literatures and organized to fit this study. Data collection was conducted by using a structured interviewer administered questionnaire. Data collectors were three diploma nurses and one BSc nursing professionals. Patients’ socio-demographic data and their level of satisfaction with health services were collected from each study participants. Participants were interviewed at the exit of the health centers.

Data quality management and analysis

The questionnaires were first prepared in English and then translated to local language /Amharic/. Data collectors were trained for one day on data collection procedures before the beginning of data collection. The questionnaires were pretested on 5% (27) of the samples in Tita and Kombolcha 03 health centres. Completeness and consistency were checked during data collection and at the end of data collection by the supervisor and investigators.

After checking for completeness and consistency, the data were entered using Epi data version 3.1 and exported to SPSS version 20 software for advanced analysis. Both descriptive and analytical statistical procedures were employed. To identify factors associated with patient satisfaction, logistic regression was conducted. First the association between each independent variable with the outcome variable was assessed separately using bivariable logistic regression. Then those variables with p-value less than or equal to 0.25 were fitted to multivariable logistic regression model to control the possible confounding variables. In multivariable logistic regression, those variables with P–value less than 0.05 were considered as significantly associated with the level of patient-satisfaction. Adjusted Odds Ratio (AOR) at 95% Confidence Interval (CI) was used to indicate the strength of statistical associations of variables.

Ethical consideration

Ethical clearance was obtained from the ethical review committee of the College of Medicine and Health Sciences, Wollo University. A formal letter of cooperation was given to each Health Centers. After explaining the objective of the study, informed written consent was obtained from the study participants to confirm their willingness for participation. The respondents were notified that they have the right to withdraw at any moment of the interview. Their confidentiality and safety were secured and all the procedures were conducted according to the Helsinki Declaration.

Socio-demographic characteristics of the study participants

A total of 537 study participants were included in the study, making 99.4% response rate. Two hundred seventy-one (50.4%) of the participants were males. An estimated 191(35.6%) of the respondents were between the age group of 28 and 37 years. With regards to educational status of respondents, 179(33.3%) of them had college and/or more education level. More than half, 299 (55.6%) of the respondents were married, whereas nearly one-fourth (24.1%) of the respondents were merchants by occupation. About 296 (55.2%) of respondents were visited the health centers more than one times and 382 (71.1%) were paid for their service. Majority of the respondents 243 (45.2%) had a monthly income of more than two thousand Ethiopian Birr (ETB) ( Table 1 ).

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https://doi.org/10.1371/journal.pgph.0000761.t001

Estimated time taken to arrive at the health centers and resources expended (time and money) in the health centers by respondents

Among the total respondents, 324 (60.4%) of them had a length of 1–2 hours stay in the health centers. Based on the respondents’ rating of the length of stay they had to stay to receive care, the length of stay was reported to be fair for those 234 (43.7%) participants.

Payments at the health centers may be for registration, laboratory investigation, medication, treatment procedures, or any of the combinations. As to the patients’ perception towards the amount of payment requested by the health center for the aforementioned activities/services, 215 (40%) of the respondents rated the payment was fair. Three hundred ten (57.8%) of the respondents reported that the time taken to arrive at the health center was 15-30minutes ( Table 2 ).

https://doi.org/10.1371/journal.pgph.0000761.t002

Friendliness of outpatient services and availability of advised medical services or drugs in the health centers

Nearly 467(87%) of respondents reported the outpatient department they visited was convenient to ask questions. Out of all respondents, 527 (98.1%) of them reported that their privacy at the out-patient department was maintained. Five hundred three (93.7%) of respondents declared to have had a good dialogue with outpatient service providers. The scale (politely, neutral, impolitely) was used to assess the degree of politeness of outpatient service providers who served the respondents. Thus, 350 (65.2%) of respondents described outpatient service providers were polite during service provision. Among the total patients interviewed, 296(55.2%) and 294 (54.8%) reported to have got all ordered laboratory tests and drugs from the health centers, respectively. Exactly 483 (90%) and 471 (87.8%) of the respondents wish the health center for their future visit and would like to recommend to visit the health center to their friends or relatives, respectively. The overall patient satisfaction rate of the study was 64.4% with a 95% CI (59.3–67.6%) ( Table 3 ).

https://doi.org/10.1371/journal.pgph.0000761.t003

Factors associated with patient satisfaction

Binary and multiple logistic regression models were performed to identify factors associated with patients’ satisfaction. Respondents who got all the prescribed drugs from the health centers and have convenient environment to ask questions were more satisfied than their counterparts (AOR = 6.3, 95% CI: 3.2–12.5) & (AOR = 6.97, 95% CI: 3.46–8.55) respectively ( Table 4 ).

https://doi.org/10.1371/journal.pgph.0000761.t004

The aim of this study was to assess the level of patient satisfaction and its associated factors among OPD attending patients at health centers in south Wollo Zone. The overall level of patient satisfaction in this study was 64.4% (95% CI: 59.3–67.6%). This finding is in agreement with the findings of a study carried out at Calabar Teaching Hospital in Nigeria (57.1%), Jimma (57.7%,), Debrebirhan hospital (61.9%), Amhara Region Referral Hospitals (65.9%) [ 11 – 14 ].

Allover patient satisfaction level was lower compared to the reports of the studies conducted in Jimma University Specialized Hospital (77%) and Hawassa University Teaching Hospital (80.1%), India (78%), Egypt (86.2%), Kenya (84%) [ 5 , 6 , 15 – 17 ]. The difference might be due to the fact that those studies were conducted in specialized teaching and referral hospitals which are equipped very well and have enough diversity of health professionals, better diagnostic facilities, health service infrastructures, and awareness of service providers of different levels that are expected to demonstrate the standard way of patient examination resulting in higher level satisfaction.

On the other hand, this finding was higher than the findings of a study conducted in Eastern Ethiopia (54.1%), Tigray Zonal hospital (43.6%) and Gondar referral hospital (22%) [ 18 – 20 ]. The reason might be one would ordinarily expect a higher level of satisfaction with care received at a tertiary hospitals and hospitals because of the available expertise, technology and sophisticated procedures that can be obtained rather than health centers.

In this study more than half (54.8%) of the respondents have got all prescribed drugs from the health centers pharmacy. Similar study conducted in Jimma University Specialized Hospital (70%), Amhara regional hospitals (66.7%), Tigray Zonal hospital (61%), Jimma hospital (1/3rd of total clients) of the patients didn’t get all or some of prescribed drugs from hospitals pharmacy and lack of drugs and supplies were their major problems, which were in contrast to the findings of this study [ 5 , 12 , 14 , 20 ]. On the other hand, patient satisfaction for the availability of prescribed drugs from the health institutions pharmacy was high in studies conducted in India (75%), Adama (65%) and Wolayita sodo hospital (64.3%) as compared to this result [ 17 ]. This may be due to the reason that hospitals are well organized in all health facility services than health centers.

Patients’ satisfaction with politeness of health service provider’s was higher at the health centers. This may have resulted from the lower demand for general practice care at the health center when compared with the daily influx of patients that seek such services at the teaching hospitals. High patient turnover, occupational stress and stringent work targets could affect the communication and interpersonal relationship between patients and providers. There is a link between communication capabilities of clinicians and patient satisfaction. Ineffective communication like unfriendliness and discourtesy by doctors, insufficient explanations on diagnosis and management protocol have been implicated in the dissatisfaction of patients with health care [ 21 , 22 ].

Patients who did not claim the existence of a convenient environment to ask questions and patients who did not have a good dialogue with outpatient health service providers were less satisfied. A study carried out in health centers in central Ethiopia also revealed that good dialogue and non-verbal communications to be predictors of high degree of patients’ satisfaction [ 23 ]. This is also supported by a study conducted in United Arab Emirates at public hospitals which identified perceived welcoming approach of service providers as a significant determinant of patient satisfaction [ 24 ]. A study conducted in South Africa revealed lack of communication and relevant messages to patients were identified as an important issue impacting on quality thus affecting client satisfaction [ 25 ].

Limitations

There are no accessible similar studies done at the health centers level. This leads not to compare the findings with the similar institution services. The finding of this study might be subjected to social desirability bias because the respondents were interviewed in the health centers compound.

Conclusions

Patients attending health centers are messenger of spreading good images of the health centers and therefore patients’ satisfaction is equally important for health centers management to improve the health care quality. The overall patient satisfaction of this study was low. Environmental convenience to ask questions, politeness of service providers and availability of ordered drugs were statistically significant factors for patient satisfaction. Management bodies need to give attention to the physical cleanness of the health centers, patient safety and privacy, and fulfilment of essential drugs to improve their patients and/or customers’ satisfaction from their service provision.

Acknowledgments

First we would like to thank all study participants for their cooperation in providing the necessary information. We would also thank data collectors and supervisors for the devotion and quality work during data collection.

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• 15. Patient Satisfation. Available from: http://www.ijcmph.com

Research Topics & Ideas: Healthcare

100+ Healthcare Research Topic Ideas To Fast-Track Your Project

Finding and choosing a strong research topic is the critical first step when it comes to crafting a high-quality dissertation, thesis or research project. If you’ve landed on this post, chances are you’re looking for a healthcare-related research topic , but aren’t sure where to start. Here, we’ll explore a variety of healthcare-related research ideas and topic thought-starters across a range of healthcare fields, including allopathic and alternative medicine, dentistry, physical therapy, optometry, pharmacology and public health.

NB – This is just the start…

The topic ideation and evaluation process has multiple steps . In this post, we’ll kickstart the process by sharing some research topic ideas within the healthcare domain. This is the starting point, but to develop a well-defined research topic, you’ll need to identify a clear and convincing research gap , along with a well-justified plan of action to fill that gap.

If you’re new to the oftentimes perplexing world of research, or if this is your first time undertaking a formal academic research project, be sure to check out our free dissertation mini-course. In it, we cover the process of writing a dissertation or thesis from start to end. Be sure to also sign up for our free webinar that explores how to find a high-quality research topic.

Overview: Healthcare Research Topics

• Allopathic medicine
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Allopathic (Conventional) Medicine

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• The impact of poor sleep on the treatment of chronic illnesses
• The role of inflammation in the development of chronic diseases such as lupus
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Topics & Ideas: Alternative Medicine

• The benefits of herbal medicine in treating young asthma patients
• The use of acupuncture in treating infertility in women over 40 years of age
• The effectiveness of homoeopathy in treating mental health disorders: A systematic review
• The role of aromatherapy in reducing stress and anxiety post-surgery
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• The use of chiropractic therapy in treating back pain of pregnant women
• The efficacy of traditional Chinese medicine such as Shun-Qi-Tong-Xie (SQTX) in treating digestive disorders in China
• The impact of yoga on physical and mental health in adolescents
• The benefits of hydrotherapy in treating musculoskeletal disorders such as tendinitis
• The role of Reiki in promoting healing and relaxation post birth
• The effectiveness of naturopathy in treating skin conditions such as eczema
• The use of deep tissue massage therapy in reducing chronic pain in amputees
• The impact of tai chi on the treatment of anxiety and depression
• The benefits of reflexology in treating stress, anxiety and chronic fatigue
• The role of acupuncture in the prophylactic management of headaches and migraines

Topics & Ideas: Dentistry

• The impact of sugar consumption on the oral health of infants
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• The benefits of dental implants in restoring missing teeth in adolescents
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• The role of fluoride in promoting remineralization and slowing down demineralization
• The impact of stress-induced reflux on oral health
• The benefits of dental crowns in restoring damaged teeth in elderly patients
• The use of sedation dentistry in managing dental anxiety in children
• The efficacy of teeth whitening treatments in improving dental aesthetics in patients with braces
• The role of orthodontic appliances in improving well-being
• The impact of periodontal disease on overall health and chronic illnesses

Tops & Ideas: Veterinary Medicine

• The impact of nutrition on broiler chicken production
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• The importance of parasite control in animal health in piggeries
• The impact of animal behaviour on welfare in the dairy industry
• The effects of environmental pollution on the health of cattle
• The role of veterinary technology such as MRI in animal care
• The importance of pain management in post-surgery health outcomes
• The impact of genetics on animal health and disease in layer chickens
• The effectiveness of alternative therapies in veterinary medicine: A systematic review
• The role of veterinary medicine in public health: A case study of the COVID-19 pandemic
• The impact of climate change on animal health and infectious diseases in animals
• The importance of animal welfare in veterinary medicine and sustainable agriculture
• The effects of the human-animal bond on canine health
• The role of veterinary medicine in conservation efforts: A case study of Rhinoceros poaching in Africa
• The impact of veterinary research of new vaccines on animal health

Topics & Ideas: Physical Therapy/Rehab

• The efficacy of aquatic therapy in improving joint mobility and strength in polio patients
• The impact of telerehabilitation on patient outcomes in Germany
• The effect of kinesiotaping on reducing knee pain and improving function in individuals with chronic pain
• A comparison of manual therapy and yoga exercise therapy in the management of low back pain
• The use of wearable technology in physical rehabilitation and the impact on patient adherence to a rehabilitation plan
• The impact of mindfulness-based interventions in physical therapy in adolescents
• The effects of resistance training on individuals with Parkinson’s disease
• The role of hydrotherapy in the management of fibromyalgia
• The impact of cognitive-behavioural therapy in physical rehabilitation for individuals with chronic pain
• The use of virtual reality in physical rehabilitation of sports injuries
• The effects of electrical stimulation on muscle function and strength in athletes
• The role of physical therapy in the management of stroke recovery: A systematic review
• The impact of pilates on mental health in individuals with depression
• The use of thermal modalities in physical therapy and its effectiveness in reducing pain and inflammation
• The effect of strength training on balance and gait in elderly patients

Topics & Ideas: Optometry & Opthalmology

• The impact of screen time on the vision and ocular health of children under the age of 5
• The effects of blue light exposure from digital devices on ocular health
• The role of dietary interventions, such as the intake of whole grains, in the management of age-related macular degeneration
• The use of telemedicine in optometry and ophthalmology in the UK
• The impact of myopia control interventions on African American children’s vision
• The use of contact lenses in the management of dry eye syndrome: different treatment options
• The effects of visual rehabilitation in individuals with traumatic brain injury
• The role of low vision rehabilitation in individuals with age-related vision loss: challenges and solutions
• The impact of environmental air pollution on ocular health
• The effectiveness of orthokeratology in myopia control compared to contact lenses
• The role of dietary supplements, such as omega-3 fatty acids, in ocular health
• The effects of ultraviolet radiation exposure from tanning beds on ocular health
• The impact of computer vision syndrome on long-term visual function
• The use of novel diagnostic tools in optometry and ophthalmology in developing countries
• The effects of virtual reality on visual perception and ocular health: an examination of dry eye syndrome and neurologic symptoms

Topics & Ideas: Pharmacy & Pharmacology

• The impact of medication adherence on patient outcomes in cystic fibrosis
• The use of personalized medicine in the management of chronic diseases such as Alzheimer’s disease
• The effects of pharmacogenomics on drug response and toxicity in cancer patients
• The role of pharmacists in the management of chronic pain in primary care
• The impact of drug-drug interactions on patient mental health outcomes
• The use of telepharmacy in healthcare: Present status and future potential
• The effects of herbal and dietary supplements on drug efficacy and toxicity
• The role of pharmacists in the management of type 1 diabetes
• The impact of medication errors on patient outcomes and satisfaction
• The use of technology in medication management in the USA
• The effects of smoking on drug metabolism and pharmacokinetics: A case study of clozapine
• Leveraging the role of pharmacists in preventing and managing opioid use disorder
• The impact of the opioid epidemic on public health in a developing country
• The use of biosimilars in the management of the skin condition psoriasis
• The effects of the Affordable Care Act on medication utilization and patient outcomes in African Americans

Topics & Ideas: Public Health

• The impact of the built environment and urbanisation on physical activity and obesity
• The effects of food insecurity on health outcomes in Zimbabwe
• The role of community-based participatory research in addressing health disparities
• The impact of social determinants of health, such as racism, on population health
• The effects of heat waves on public health
• The role of telehealth in addressing healthcare access and equity in South America
• The impact of gun violence on public health in South Africa
• The effects of chlorofluorocarbons air pollution on respiratory health
• The role of public health interventions in reducing health disparities in the USA
• The impact of the United States Affordable Care Act on access to healthcare and health outcomes
• The effects of water insecurity on health outcomes in the Middle East
• The role of community health workers in addressing healthcare access and equity in low-income countries
• The impact of mass incarceration on public health and behavioural health of a community
• The effects of floods on public health and healthcare systems
• The role of social media in public health communication and behaviour change in adolescents

Examples: Healthcare Dissertation & Theses

While the ideas we’ve presented above are a decent starting point for finding a healthcare-related research topic, they are fairly generic and non-specific. So, it helps to look at actual dissertations and theses to see how this all comes together.

Below, we’ve included a selection of research projects from various healthcare-related degree programs to help refine your thinking. These are actual dissertations and theses, written as part of Master’s and PhD-level programs, so they can provide some useful insight as to what a research topic looks like in practice.

• Improving Follow-Up Care for Homeless Populations in North County San Diego (Sanchez, 2021)
• On the Incentives of Medicare’s Hospital Reimbursement and an Examination of Exchangeability (Elzinga, 2016)
• Managing the healthcare crisis: the career narratives of nurses (Krueger, 2021)
• Methods for preventing central line-associated bloodstream infection in pediatric haematology-oncology patients: A systematic literature review (Balkan, 2020)
• Farms in Healthcare: Enhancing Knowledge, Sharing, and Collaboration (Garramone, 2019)
• When machine learning meets healthcare: towards knowledge incorporation in multimodal healthcare analytics (Yuan, 2020)
• Integrated behavioural healthcare: The future of rural mental health (Fox, 2019)
• Healthcare service use patterns among autistic adults: A systematic review with narrative synthesis (Gilmore, 2021)
• Mindfulness-Based Interventions: Combatting Burnout and Compassionate Fatigue among Mental Health Caregivers (Lundquist, 2022)
• Transgender and gender-diverse people’s perceptions of gender-inclusive healthcare access and associated hope for the future (Wille, 2021)
• Efficient Neural Network Synthesis and Its Application in Smart Healthcare (Hassantabar, 2022)
• The Experience of Female Veterans and Health-Seeking Behaviors (Switzer, 2022)
• Machine learning applications towards risk prediction and cost forecasting in healthcare (Singh, 2022)
• Does Variation in the Nursing Home Inspection Process Explain Disparity in Regulatory Outcomes? (Fox, 2020)

Looking at these titles, you can probably pick up that the research topics here are quite specific and narrowly-focused , compared to the generic ones presented earlier. This is an important thing to keep in mind as you develop your own research topic. That is to say, to create a top-notch research topic, you must be precise and target a specific context with specific variables of interest . In other words, you need to identify a clear, well-justified research gap.

Need more help?

If you’re still feeling a bit unsure about how to find a research topic for your healthcare dissertation or thesis, check out Topic Kickstarter service below.

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15 Comments

I need topics that will match the Msc program am running in healthcare research please

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Thank you to create new knowledge on research problem verse research topic

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This post might be useful: https://gradcoach.com/research-problem-statement/

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Please can someone help me with research topics in public health ?

Hello I have requirement of Health related latest research issue/topics for my social media speeches. If possible pls share health issues , diagnosis, treatment.

I would like a topic thought around first-line support for Gender-Based Violence for survivors or one related to prevention of Gender-Based Violence

Please can I be helped with a master’s research topic in either chemical pathology or hematology or immunology? thanks

Can u please provide me with a research topic on occupational health and safety at the health sector

Good day kindly help provide me with Ph.D. Public health topics on Reproductive and Maternal Health, interventional studies on Health Education

may you assist me with a good easy healthcare administration study topic

May you assist me in finding a research topic on nutrition,physical activity and obesity. On the impact on children

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• Open access
• Published: 02 April 2024

The effectiveness of knowledge-sharing techniques and approaches in research funded by the National Institute for Health and Care Research (NIHR): a systematic review

• Helen Baxter   ORCID: orcid.org/0000-0002-3320-2915 1 , 3 ,
• Lindsay Bearne 1 , 2 ,
• Tracey Stone 3 , 6 ,
• Clare Thomas 3 , 4 , 6 ,
• Rachel Denholm 5 , 6 ,
• Sabi Redwood 3 , 6 ,
• Sarah Purdy 6 &
• Alyson Louise Huntley 6 , 7  

Health Research Policy and Systems volume  22 , Article number:  41 ( 2024 ) Cite this article

Metrics details

The National Institute of Health and Care Research (NIHR), funds, enables and delivers world-leading health and social care research to improve people’s health and wellbeing. To achieve this aim, effective knowledge sharing (two-way knowledge sharing between researchers and stakeholders to create new knowledge and enable change in policy and practice) is needed. To date, it is not known which knowledge sharing techniques and approaches are used or how effective these are in creating new knowledge that can lead to changes in policy and practice in NIHR funded studies.

In this restricted systematic review, electronic databases [MEDLINE, The Health Management Information Consortium (including the Department of Health’s Library and Information Services and King’s Fund Information and Library Services)] were searched for published NIHR funded studies that described knowledge sharing between researchers and other stakeholders. One researcher performed title and abstract, full paper screening and quality assessment (Critical Appraisal Skills Programme qualitative checklist) with a 20% sample independently screened by a second reviewer. A narrative synthesis was adopted.

In total 9897 records were identified. After screening, 17 studies were included. Five explicit forms of knowledge sharing studies were identified: embedded models, knowledge brokering, stakeholder engagement and involvement of non-researchers in the research or service design process and organisational collaborative partnerships between universities and healthcare organisations. Collectively, the techniques and approaches included five types of stakeholders and worked with them at all stages of the research cycle, except the stage of formation of the research design and preparation of funding application. Seven studies (using four of the approaches) gave examples of new knowledge creation, but only one study (using an embedded model approach) gave an example of a resulting change in practice. The use of a theory, model or framework to explain the knowledge sharing process was identified in six studies.

Conclusions

Five knowledge sharing techniques and approaches were reported in the included NIHR funded studies, and seven studies identified the creation of new knowledge. However, there was little investigation of the effectiveness of these approaches in influencing change in practice or policy.

Peer Review reports

Academic research has little influence on the commissioning, design and delivery of health care services [ 1 , 2 , 3 ]. Stakeholders, including patients, are currently not consulted sufficiently for research to be genuinely informed by their experiences [ 4 , 5 ]. This is of concern to research funders globally, who have a remit to fund health and social care research that improves people’s health and wellbeing [ 6 ]. Knowledge mobilisation is a generic term that refers to making knowledge ready for action and includes activities ranging from dissemination to co-production [ 7 ]. Other similar terms are often used such as knowledge translation, knowledge exchange and integrated knowledge translation (IKT). For the purposes of this review, the key element of knowledge sharing was focused on within the field of knowledge mobilisation to explore knowledge mobilisation as an intervention and an active process, within research studies. Exploration of the lack of integration between researchers and stakeholders within the fields of knowledge mobilisation and implementation has highlighted that knowledge sharing needs to be a two-way process and not, as previously accepted, a linear one [ 8 , 9 , 10 , 11 ]. This shift in understanding has been driven through a recognition of the complexity and messiness inherent in bringing together different communities to develop a common or shared understanding [ 3 , 12 ]. Consequently, activities to improve knowledge sharing and implementation have shifted away from targeting research findings towards patients, practitioners and policy makers and been replaced with techniques to encourage two-way knowledge sharing and co-production [ 9 , 13 , 14 , 15 ]. A variety of theories, models and frameworks have been used to support this two-way process, with varying degrees of success [ 16 , 17 ].

Knowledge mobilisation is defined by the NIHR as ‘sharing knowledge between different communities to create new knowledge to catalyse change’ [ 18 ]. There is consensus that if knowledge is shared between two or more communities, it can result in the creation of new knowledge, which has a greater likelihood of leading to change within practice or research [ 7 , 19 , 20 , 21 ]. Change that can be linked back to original research findings or outcomes is often referred to as research impact [ 22 , 23 , 24 ]. Techniques and approaches that have been developed to follow this mechanism of knowledge sharing include, models of embedded researchers or practitioners, use of knowledge brokers, stakeholder engagement, organisational collaborative partnerships and the involvement of stakeholders in the research or service design process itself. For example, embedded models can facilitate the knowledge sharing process by a researcher or health care practitioner leaving their home organisation to work in a host organisation, thereby increasing the opportunities for sharing knowledge between the two organisations. The underlying premise is that it is through people and their interactions that knowledge is shared and by increasing the proximity of individuals this can facilitate interactional opportunity [ 10 , 25 , 26 ]. They may be hosted by one organisation, but their function is to work between the organisations to facilitate knowledge sharing [ 27 , 28 , 29 ]. Stakeholder engagement, when conducted for two-way knowledge sharing, involves inviting stakeholders to share knowledge at specific meetings, workshops and events [ 30 ]. Involving stakeholders in the research or service design process as equal decision makers, advisers and informed representatives of their community, can also follow two-way knowledge sharing [ 21 , 31 , 32 ]. An additional mechanism is knowledge sharing at an organisational level, where collaborative partnerships are formed [ 33 ].

In the United Kingdom, the National Institute of Health and Care Research (NIHR) awards around £1 billion in research funding per year and, along with other funders, has a strong remit to reduce the research to practice and policy gap [ 34 ]. Yet, to date, there has been limited research that systematically explores and identifies the knowledge sharing techniques and approaches in the NIHR portfolio of research studies. One review examined the mechanisms and pathways to impact of NIHR funded public health research (Boulding, Kamenetzky et al. 2020). It explored the mechanisms and pathways reported on Research fish (a database for researchers to document impact related activities) and triangulated this with qualitative data exploring the researchers’ perspectives of the impact of their research. The authors concluded that the standardised measures were not capturing impact in localised settings or longer-term impact [ 23 ]. A second study explored the public health researchers’ perspectives on impact reporting and highlighted a need for funders to identify their expectations of the impact resulting from the research they fund and to increase their support for knowledge mobilisation activities [ 24 ]. These studies highlighted the need for researchers to have a clearer understanding of the knowledge mobilisation techniques and approaches to inform pathways to impact and focused on NIHR health funding streams [ 23 , 24 ]. To our knowledge, there has been no systematic review that describes the knowledge sharing techniques and approaches that have been applied in NIHR funded research nor synthesises their effectiveness.

This review aimed to answer the following questions: (1) Which knowledge sharing techniques and approaches have been included in NIHR funded health research? (2) How effective are these knowledge sharing techniques and approaches in creating new knowledge that can lead to changes in practice and research?

The protocol for this systematic review was registered on the International Prospective Register of Systematic Reviews (PROSPERO, CRD42020171293; reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses [ 35 ]). A restricted systematic methodology was chosen to balance methodological rigour with the resources available [ 36 ].

Search strategy

Electronic databases MEDLINE via OVID and The Health Management Information Consortium, which is a compilation of data from two sources, the Department of Health’s Library and Information Services and King’s Fund Information and Library Services, were searched from inception to 24.4.20 for published studies, which was then updated and rerun on the 1.7.22. The search strategy was based on the terms for the intervention (knowledge sharing techniques and mechanisms, including terms for knowledge transfer, exchange and translation) and population (researchers with patients, clinicians or health services managers) (Additional file 1 : Search Strategy). Additional references were identified from reference lists of included full papers.

Eligibility criteria

This systematic review included studies that described knowledge sharing between researchers with patients, members of the public, clinicians, health service managers (i.e. commissioners, policy makers and hospital managers) or voluntary agencies, that were funded by the NIHR (Table  1 ). Knowledge sharing was defined as ‘any interactional activity through any medium (including in person, email, telephone, etc.) that involves knowledge sharing about healthcare’. For the purposes of this review, knowledge sharing techniques and mechanisms were considered as an intervention, i.e. ‘the act or an instance of intervening’ [ 37 ], where an explicit knowledge-sharing approach had been adopted in contrast to the established process of knowledge remaining within one community. The setting was defined as any healthcare setting, e.g. primary, secondary, tertiary health care services and public health. The outcome was defined as the use of evidence in policy and practice or the involvement of stakeholders in the research process. Where relevant, studies were included irrespective of comparator group. All study designs were included, except protocols and reviews of literature. Only studies published in the English language were included. Studies were excluded if they did not describe knowledge sharing between researchers and a stakeholder group, e.g. describing knowledge sharing between two other stakeholder groups (e.g. clinicians with health service managers, clinicians with patients and patients with health service managers).

Study selection

Records were exported and deduplicated in Endnote and then imported to Covidence for screening [ 38 , 39 ]. The title and abstract screening was conducted by one reviewer (H.B.), with a 20% sample independently screened by one of two reviewers (C.T. and R.D.). Any discrepancies were resolved by discussion. A third reviewer (A.H.) arbitrated if needed. Full text screening was conducted by one reviewer (H.B.) with a 20% sample independently screened by one of two reviewers (T.S. and L.B.); any discrepancies were resolved by discussion. A third reviewer (S.R.) arbitrated if needed.

Data extraction

Data from included studies were abstracted by one reviewer (T.S.) into a data extraction form, which was piloted a priori on 10% of the included studies (S.P.) and checked for accuracy by a second reviewer (H.B.). Extraction included: study design, author name, author, year, aims, population, intervention/approach and a detailed intervention description. In some instances, studies contained a knowledge sharing element, which was not the primary focus or outcome of the study. In these cases, the detailed description of this element of the study was extracted as the technique or approach. A modified template of the TiDieR checklist was used [ 40 ]. The data were extracted on the design, presence of an evaluation, use of theory or goal, procedures, materials used, context influencing factors, tailoring modifications and assessment of outcome and applicability.

Quality appraisal

Quality appraisal was conducted independently by T.S. with a 20% sample of included studies, which were reviewed by H.B., followed by discussion for any discrepancies. The Critical Appraisal Skills Programme (CASP) qualitative checklist, Critical Appraisal Skills Programme (2018) [ 41 ] was used where appropriate. The CASP qualitative checklist includes two screening question (yes/no) and an additional eight questions (yes/ no/can not tell) if the response to both screening questions were ‘yes’. As outlined by Long and French, the quality of studies was assessed with a focus on the rigour of the data analysis, with consideration of the trustworthiness of the results given [ 41 ]. Using this focus with the overall score from the checklist, the studies were categorised to be of high, moderate or of lower quality.

Data synthesis

A narrative synthesis method was adopted, as it includes a formal analytical process of synthesis to generate new insights [ 42 ]. This narrative synthesis focussed on four key elements: (1) identification of a theory of change. In this review, knowledge sharing as a mechanism to facilitate change was used to explain the anticipated process. (2) Development of a preliminary synthesis of the findings of included studies. A preliminary synthesis was conducted to organise the results of the included studies and identify any factors that influenced the results reported. This was conducted by developing initial descriptions of the results of the included studies, which were then organised to describe patterns, so that the factors impacting on the mechanisms of the intervention could be identified. (3) Exploring relationships in the data. The studies were explored for relationships within and between studies, which involved a process of concept mapping supported by qualitative case descriptions. In particular, the studies were examined for instances where similar mechanisms may be at work even though the overall approach may be described differently. This process was initiated by H.B. in categorising the data under overarching themes based on the mechanism of knowledge sharing, which were refined further through discussion and reflection with L.B. and T.S. into subheadings. (4) Assessing the robustness of the synthesis. An assessment of the robustness of the synthesis was made and only studies that reached a minimum standard of methodological quality assessed by T.S. were included in the final synthesis [ 43 ].

In total, 9897 records were identified after deduplication. A total of 697 full-text studies were screened and 17 studies were included [ 20 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 ] (Fig.  1 ).

PRISMA diagram

Study characteristics

The characteristics of the included studies are shown in Table  2 . These were the author, year, aims, population, knowledge sharing technique or approach, mechanism of knowledge sharing and outcome (new knowledge or change in practice or research).

Five of the included studies were descriptive studies and could not be included in the quality appraisal process [ 20 , 49 , 51 , 53 , 57 ]. Of the remaining 10 studies, two were rated of moderate quality [ 47 , 48 ] and eight were rated as high [ 44 , 45 , 46 , 50 , 52 , 54 , 55 , 56 ]. Two studies could not be rated as they provided insufficient detail on the knowledge mobilisation intervention, so these were excluded from the final synthesis (Table  3 ).

Types of knowledge sharing techniques and approaches

Five explicit forms of knowledge sharing studies were described in the included studies (Table  2 ). Three studies applied embedded models of researchers or practitioners [ 20 , 44 , 54 ], and two studies used knowledge brokering. [ 46 , 47 ]. Stakeholder engagement approaches that applied two-way knowledge sharing were used in five studies. These were either priority setting consensus building workshops [ 51 , 55 , 57 ] or facilitated knowledge-sharing events [ 49 , 52 ]. Three studies described approaches where non-researchers were involved in the research or service design process itself. One study did this with patients and members of the public in research projects and another with professionals [ 53 , 56 ]. The approach of involving patient and public members was also used in another study to assist with service design [ 45 ]. Two studies examined organisational collaborative partnerships between universities and healthcare organisations [ 48 , 50 ].

Types of stakeholders

Of the stakeholder groups participating via these approaches, clinicians were involved in nine studies [ 44 , 46 , 49 , 50 , 51 , 53 , 54 , 55 , 57 ], and patients and the public were involved in six studies [ 45 , 49 , 51 , 53 , 56 , 57 ]. Commissioners and policy makers were involved in six studies [ 20 , 48 , 49 , 50 , 51 , 56 ]. Four studies involved health care or service managers [ 51 , 53 , 54 , 56 ]. Four studies also involved members of the voluntary sector [ 47 , 49 , 52 , 56 ], and two studies included local authority staff [ 52 , 56 ].

Timing within research cycle

Six studies applied a knowledge-sharing approach to topic identification [ 44 , 46 , 47 , 49 , 50 , 55 ], and one study extended topic identification to also defining the research question [ 57 ]. Five studies used a knowledge-sharing approach for the conduct of the research [ 20 , 48 , 53 , 54 , 56 ]. One study used knowledge sharing to facilitate the adoption of findings [ 52 ], and two studies used knowledge sharing for the production of service design [ 45 , 51 ]. There were no studies that used a knowledge-sharing approach or technique for designing the research or preparing the funding application.

Sources of NIHR funding

Eight of the studies were funded or supported by a Collaboration for Leadership in Applied Health Research (CLAHRC) [ 44 , 46 , 48 , 50 , 51 , 54 , 55 , 56 ]. One study was funded by a Knowledge Mobilisation Research Fellowship [ 45 ], and one study reported support from both a Knowledge Mobilisation Research Fellowship and a CLAHRC [ 20 ]. Two studies were from the Health Services and Delivery Research funding stream [ 49 , 53 ], one study was from multiple sources, including NIHR funding [ 47 ], one was funded by the Public Health Research Programme [ 52 ] and one was funded by Programme Grants for Applied Research Funding [ 57 ].

Use of theory

Of the 15 studies, 6 studies drew upon or referred to a theory, theoretical basis or used a framework [ 20 , 46 , 47 , 48 , 50 , 56 ], (Table  4 ). The theory most frequently drawn upon was that of Communities of Practice [ 60 , 61 ], which was referred to by three of the studies to explain the process of knowledge sharing [ 20 , 50 , 56 ]. Two studies drew upon other theories to explain knowledge sharing as part of a co-production process. One referred to Ritual Theory [ 62 ] and the concept of Interaction Ritual Chain [ 56 , 63 ], and the other used three theoretical lenses, the co-productionist idiom [ 64 ], interactionist currents within organisation studies [ 65 , 66 ] and communication, argumentation and critique from a pragmatic perspective [ 67 , 68 ], In Ref. [ 48 ]. Another study drew on the sociological theory of dramaturgical perspective [ 47 , 69 ], and one study used the frameworks of why, whose, what and how [ 70 ] and PAHRIS [ 71 ] to explain their approach [ 46 ]. Only one study explicitly referred to a theory of change and outlined a potential process [ 50 ]. Nine studies did not use any theory or frameworks to explain or predict the knowledge sharing process leading to change [ 44 , 45 , 49 , 51 , 52 , 53 , 54 , 55 , 57 ].

Knowledge sharing as a mechanism to facilitate change

The theory of change identified from a preliminary synthesis of the included studies followed the process outlined within the literature, which is shown in Fig.  2 .

Theory of change model developed to inform initial synthesis

All studies confirmed the causal direction of the knowledge sharing mechanism as shown by the arrows in Fig.  2 and were found to be following the process of knowledge sharing across communities with an intention of creating new knowledge (Table  2 ). Seven studies reported that new knowledge had been created through knowledge sharing [ 45 , 50 , 51 , 53 , 54 , 55 , 57 ]. However, only three studies attempted to outline the anticipated change from the knowledge-sharing approach [ 45 , 50 , 53 ], and only one study provided any evidence of change [ 54 ] (Table  2 ).

Evaluation of knowledge sharing technique or approach

Ten studies conducted an evaluation of the knowledge sharing technique or approach to understand its process or effectiveness (perceived or intended) [ 44 , 45 , 46 , 47 , 48 , 50 , 52 , 54 , 55 , 56 ], (Table  4 ). The other five studies gave detailed descriptive accounts of the knowledge sharing process [ 20 , 49 , 51 , 53 , 57 ]. There was no relationship between the knowledge-sharing approaches used and whether an evaluation was conducted. Three studies using stakeholder engagement approaches gave a process description [ 49 , 51 , 57 ], one involvement study [ 53 ] and one study using an embedded model [ 20 ]. Of those studies that conducted an evaluation a range of methodologies were used, which were predominantly qualitative. Six studies used semi-structured interviews [ 44 , 50 , 52 , 54 , 55 , 56 ], three studies used mainly observational methods [ 48 , 52 , 56 ], two studies used document analysis [ 55 ], two studies used reflective diaries [ 44 , 46 ] and two studies analysed field notes and emails or meeting recordings [ 45 , 47 ]. Other methods used were focus groups, surveys and postal questionnaires [ 45 , 48 ]. Five of the studies that conducted an evaluation of the knowledge sharing technique or approach drew upon a theory or framework to understand or explain the process [ 46 , 47 , 48 , 50 , 56 ] (Table  4 ).

Evidence of effectiveness

Of the seven studies that reported the creation of new knowledge [ 45 , 50 , 51 , 53 , 54 , 55 , 57 ], four also evaluated the process and also attempted to outline the anticipated change from the knowledge-sharing approach [ 45 , 50 , 54 , 55 ]. One of these studies used the knowledge-sharing approach of involvement of stakeholders in service design, one explored an organisational collaborative partnership, another used an embedded model and the other a stakeholder engagement approach [ 45 , 50 , 54 , 55 ]. The only study that reported a change in practice or research did not outline the process of change and did not explain the process using a theory or framework [ 54 ]. However, this study of an embedded model was the only report of a change in practice as a result of a knowledge sharing technique or approach (Table  4 ).

This review summarises the knowledge sharing techniques and approaches used in NIHR studies between 2006 and 2022. Five knowledge sharing techniques and approaches have been included in NIHR funded health research: embedded models, knowledge brokers, stakeholder engagement, involved research or service design and organisational collaborative partnerships. In applying a mechanism of knowledge sharing, three studies outlined anticipated change from the process of knowledge sharing using the approach of stakeholder involvement [ 45 , 53 ] and organisational collaborative partnerships [ 50 ], and only one study provided evidence of change, which used an embedded model [ 54 ].

We found that in some studies knowledge sharing techniques and approaches were used but not identified using established terminology and in other studies terminology was used interchangeably, with a lack of consensus on the definition of terms. This may well reflect the developments overtime in how knowledge is mobilised in a non-linear fashion, as this review included papers from 2008 and tracks the gradual establishment of agreed terminology. However, a current lack of clarity of terms has been identified in the literature around co-design, co-production and co-creation, where terms are used interchangeably and clarity around the aims of the approaches are unclear [ 72 ]. This seems also to be the case in what we have referred to as the embedded models, which included researchers in residence and secondment opportunities. It was unclear in synthesising the studies what the different roles were that these terms applied to, as terminology was used differently across the models for example using the term knowledge broker to refer to an embedded researcher working within clinical practice [ 44 ].

Knowledge sharing techniques and approaches were often used without reference to underlying theory or an explanation of the anticipated change process. Although an acknowledgment of the clarity provided by a clear theoretical basis to understand the process of knowledge mobilisation has been accepted, this has been relatively recent [ 73 , 74 ]. Recent studies have highlighted and categorised a large number of theories, models and frameworks available but acknowledged a limited evidence base on their use [ 75 , 76 ]. In this review, only six studies drew on a theoretical base to explain or predict causality, and only four studies used this for evaluating the knowledge sharing technique or approach. A recent systematic scoping review of knowledge transfer and exchange models also noted a lack of evaluation of the processes and outcomes by those engaged in knowledge mobilisation activities [ 77 ]. Evaluation models do exist in the field that construct a framework for assessing impact or change at multiple levels, which also take account of the inherent complexity and uncertainties in assessing change [ 7 ]. To encourage greater use of knowledge mobilisation techniques and approaches amongst non-specialists, more explanation of these is needed to facilitate replication with confidence. Studies describing a knowledge sharing technique or approach without reference to an output, outcome or change mechanism, risk losing the interest of the wider research community, as the benefits of this approach are unclear.

This review included studies where knowledge sharing techniques or approaches could be identified but may not necessarily been acknowledged by the authors. Where knowledge-sharing approaches were not acknowledged, the knowledge sharing component was often not reported in detail. For example, in Batchelor 2013, the knowledge-sharing element of the James Lind Alliance Priority Setting Partnership was given little attention in the reporting and was difficult to untangle from the information gathering element of the study [ 57 ]. As an older study this may reflect less interest at the time in the process of knowledge sharing with stakeholders, although there were clear attempts to extend the remit of the James Lind Alliance to include researchers in the workshops and to involve stakeholders in designing the research questions. Unfortunately, the lack of detail on the procedure reduces the opportunity for replication or wider evaluation when a project is deemed to be successful, reducing the opportunity for future learning. In work involving public contributors, researchers often gave a more detailed account of process and procedures, which may indicate greater maturity in the field for working with this stakeholder group. This may also give an indication as to why so few studies reported on their knowledge sharing activities and intended impact. As the request from funders for the demonstration of research impact is a relatively new requirement, previous work in this area may not have been seen as important or as a core component of a research study. Likewise, prior to the agreement from funders to fund and support impact related activities such as knowledge mobilisation, achieving impact in services or society may have not been seen as within the remit of the research community to deliver.

Promising techniques and approaches that were evaluated, often focused more on acceptability of the approach rather than whether new knowledge was created. This may have been due to an interest in how to maintain ongoing work with stakeholders, or possibly a lack of confidence in the technique or mechanism leading to new knowledge or in the sensitivity of the evaluation to identify it. Although knowledge sharing can be seen as a simple concept, achieving an authentic approach is known to be a complex process [ 7 , 78 ]. It is not to suggest that complexity does not exist, only that current reporting may render the purpose of knowledge sharing techniques and approaches invisible to those outside the specialist field. While the importance of identifying and reporting on impact remains a central issue to funders, identifying techniques and approaches that can lead to changes in practice and research will be of value. Currently the NIHR as a funder, requests engagement and impact plans in applications for funding and advocates the use of knowledge mobilisation strategies from the outset of the study to achieve this [ 18 , 79 ]. Monitoring of the impact from NIHR funded research is then conducted for 5 years after study completion via an online system (Researchfish) [ 80 ].

Strengths and limitations of the review

This systematic review restricted the number of database searches to two and did not explore grey literature, which may have resulted in not identifying all relevant studies. The included studies were also restricted to the English language. However, given that this review is focused on the literature produced by the major UK funder with a requirement for publication in mainstream open access journals, this is less of a concern. A restricted systematic review methodology was used to balance rigour with the resource available [ 36 ]. This requires only a proportion of the screening, full-text review and data extraction to be conducted by two reviewers. Given the difficulties with the terminology, unclear methodologies and complex study designs, studies may not have been identified through the initial searches. As outlined earlier, studies often did not report knowledge mobilisation or knowledge sharing activities in a thorough way and this led to difficulties with data extraction and may have led to an underestimation of use of knowledge-sharing approaches. This review specifically focused on the relationship between knowledge sharing as a key element of knowledge mobilisation activity, leading to the creation of new knowledge with the potential to lead to changes in practice or research (impact). Studies that mobilised knowledge for other outcomes were excluded, which may be a weakness in understanding knowledge mobilisation processes more generally. A key strength of this review was the attempt to apply a robust review framework to an often-confusing field of terms and mixed approaches. An established framework was applied to synthesise the current knowledge in this field with the intention to collate the learning to date and to guide those who are not specialists in knowledge mobilisation towards the techniques and approaches which might be useful for future research.

Key learning

There is a need for clear reporting in the field of knowledge mobilisation that recognises the goals of these techniques and approaches. Theories and models exist that support exploratory work and complex systems, which could be used more widely to explain the knowledge sharing mechanism of knowledge mobilisation approaches. Evaluations of these techniques and approaches could be better linked to the underlying goals or outcomes of change and impact via established theories and explanatory models. This would enable researchers not specialist in the field of knowledge mobilisation to better understand the field and have confidence in introducing these techniques and approaches into their work. Clearer reporting on knowledge sharing processes and outcomes can support the research community and funders alike in identifying where knowledge mobilisation can assist in closing the research to practice gap.

There is little evidence of the effectiveness of knowledge sharing techniques and approaches used in NIHR research studies in influencing change in practice or ongoing research. This does not mean these techniques and approaches are not effective in instigating change or impacting on practice, rather that clear evidence for this has not yet been produced. Although a complex and often messy field, there are theories, models and frameworks that can be used to shed more light on techniques and approaches that currently show promise but lack evidence for their effectiveness.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

National Institute for Health and Care Research

Critical Appraisal Skills Programme

Collaboration for Leadership in Applied Health Research

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This study was funded by the National Institute for Health and Care Research (NIHR) [2021/02]. This study presents independent research funded by the National Institute for Health and Care Research (NIHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Tracey Stone’s time is supported by the National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West). Clare Thomas is partly funded by National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) and the National Institute for Health and Care Research, Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation.

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Baxter, H., Bearne, L., Stone, T. et al. The effectiveness of knowledge-sharing techniques and approaches in research funded by the National Institute for Health and Care Research (NIHR): a systematic review. Health Res Policy Sys 22 , 41 (2024). https://doi.org/10.1186/s12961-024-01127-5

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• Health-Illness Continuum and Its Role This paper aims to discuss the relation of this model to health care practices and define the ways to move towards wellness.
• Nursing Informatics: Electronic Health Records Nursing informatics entail the use of health care technology such as the EHR. Electronic health records provide integrated data that nurses can use to support safe and patient-centered care.
• Calgary Family Assessment Model in Healthcare Calgary Family Assessment Model is a tool utilized by health care specialists to evaluate the overall wellbeing of a family.
• Science of Human Flourishing and Health The state of human flourishing determines the happiness, longevity, and prosperity of both the individual and the entire nation.
• Capstone Project Change Proposal in Healthcare Sector Nursing understaffing is caused primarily by the emotional exhaustion of medical workers due to the stressful workload in the sector.
• Ethical Issues in Healthcare Essay: Ethical Dilemma This paper describes an ethical dilemma in healthcare, its specific characteristics, violated ethical principles, and existent barriers to ethical practice.
• Effects of Poor Communication in Healthcare Reviewing various categories of interactions within the healthcare system will enable an in-depth understanding of the effects of poor communication.
• Chickenpox Epidemiology and Community Health Nurse Chickenpox, which is also referred to as Varicella, is a viral disease with considerably high rates of transmissibility and is caused by varicella zoster virus.
• The Novant Health Organization’s Structure & Management This paper analyzes Novant Health’s organizational structure, service line, the interaction between leadership and service quality, and management strategy.
• Pros and Cons of the Gatekeeper Healthcare System The article describes the levels of the healthcare system, its advantages and disadvantages, while the author believes that the advantages outweigh.
• Microplastics and Environmental Health The environment suffers from microplastics (further referred to as MPs) released by the degraded synthetic clothing, cosmetics, plastic bags, bottles, and containers.
• The Food Quality Impact on Economy and Health The problem of food quality and its impact on the economy and health of not only one country but the whole world cannot be overemphasized.
• Discussion: Smoking and Health Risks The WHO and numerous other influential organizations are persistent in their attempts to draw attention to the problem and encourage efficient ways to prevent people from smoking.
• The U.S Healthcare System and the Roemer Model Roemer’s model of a healthcare system demonstrates how a socialist healthcare system operates. This paper explores the entire U.S healthcare system in relation to Roemer’s model.
• Family Health Assessment: Weaknesses and Strengths The paper will examine the benefits of interviews to assess the structure, weaknesses, and strengths of family health.
• Physical Activity’s Lack Effects on Health Problems A sedentary lifestyle is a common phenomenon in today’s world and is characterized by minimal and irregular physical activity.
• The Purpose of Health Promotion This paper discusses the purpose of health promotion and how the nursing role and responsibilities are evolving health promotion.
• Statistics Application in Healthcare and Nursing Statistical analyses are efficient mechanisms for obtaining accurate data based on calculations and affecting not only the quality of care.
• Benefits of the Beach: Effects on the Mental and Physical Aspects of Health in People This paper aims at discussing the benefits of the beach: advantages of seawater, sunshine, walking on the sand, its positive impact on health and bodyweight.
• Health and Social Care Services: Barriers to Working Partnerships This paper gives a comprehensive discussion on the major barriers that affect the sustainability of working partnerships between two healthcare services and social providers.
• History of Public Health The targeted course will explore the major issues associated with public health towards professional nursing practice.
• Steps in the Process of Risk Management in Healthcare Risk management is essential for any enterprise, but for healthcare organizations, it has even greater significance because, frequently, people’s lives are at stake.
• Healthcare Organizations’ Mission, Vision and Values This project identifies four health organizations coupled with reviewing their vision, mission, and values and proposes changes to the organizations’ missions, visions, and values.
• Goals and Objectives of the Community Health Needs It is important to learn how to inform the community about the ideas and ways of public health improvement. This week will be dedicated to the planning of health interventions.
• Mental Health Advocacy for Children Mental disorders are increasingly becoming rampant due to an array of issues affecting all individuals across the lifespan.
• Stress Effect on Physical and Mental Health The paper analyzes the primary effects of stress on human health. The study outlines the concept of stress as well as estimates its ultimate causes.
• Expectancy Theory in the Healthcare Sector This paper explores the fundamentals of Expectancy Theory and applies it to the healthcare sector. Expectancy theory has found use in healthcare education contexts.
• Public Health. Precaution Adoption Process Model The paper argues the Precaution Adoption Process model strives to explain what happens before people take action and explains how people translate these decisions into action.
• Primary Health Care: Issues and Challenges Primary health care as a concept gained popularity following the 1978 International Conference on Primary Health Care jointly held by WHO and UNICEF at Alma-Ata.
• The Impact of Ageism on Mental Health and Addiction Ageism refers to prejudice towards persons because of their age. This form of discrimination is exhibited in the unfair treatment of older people.
• Helvie Energy Theory of Nursing and Health The objective of this paper is to pay specific attention to the concept of the environment, as viewed in the energy theory of health and nursing developed by Carl Helvie.
• Occupational Health and Safety: Workers Neglect of Precautionary Measures Occupational health and safety within the organizations are extremely significant as the opportunity to work in safe conditions is one of the most important rights of any employee.
• Patient Education: Improving Health Status Patient education refers to a process by which health professionals impart some knowledge to the patients to improve their health status.
• Importance of Theory in Health Promotion Effectual health promotion initiatives assist persons to uphold and advancing health, lessening disease risks, and controlling persistent illness.
• Social Work in Mental Health Settings Social workers are regarded as highly trained individuals working closely to foster the standard of life and the well-being of other people through crisis intervention.
• Healthcare Services: Right or Privilege? It is believed that all people should have free access to healthcare. But today it is a privilege that only particular people can access even though it should be a human right.
• Stages of Life and Influence of Age in Healthcare Age is a factor in the way patients interact with the healthcare system. This paper discusses the stages of life and the influence of age in healthcare from the patient’s perspective.
• Levels of Health Prevention The types of care that are maintained in healthcare institutions largely determine the nature of a particular treatment plan, the features of recovery, and patient outcomes.
• Electronic Health Record System’s Life Cycle The essay focuses on the electronic health record system and its lifecycle: needs assessment and analysis, system selection and design, implementation, evaluation and maintenance.
• Occupational Health and Safety: Precautionary Principle Occupational health and safety officers in many industries are usually very concerned with the exposure of the workforce to potentially harmful situations, including radiation.
• Sexual and Reproductive Health Education The participation of women in sexual and reproductive health education can increase their level of adaptation in society and improve health and behavioral outcomes.
• The Negative Influence of Social Media on Teenagers’ Mental Health This essay is purposed to explain the aspects in which excessive use of social media affects teenagers’ mental health.
• The Role of Cultural Relativism in Healthcare The Nacirema is a group of North Americans living in the territory between the “Canadian Cree, the Yaqui and Tarahumara of Mexico, and the Carib and Arawak of the Antilles”
• Regression Analysis for Healthcare Organization The paper studies the regression analysis that enables managers to evaluate the patterns within the health care organization and make predictions for decision-making.
• Sexual Health Nurses: Functions and Responsibilities Sexual health nurses focus on family planning, but their functions do not end there. Their responsibilities also include advising patients about sexually transmitted infections.
• Preventive Health Care Issues Preventive healthcare does not primarily refer to medicine; it may refer to measures taken to prevent occurrences of given diseases.
• Application of Pender’s Health Promotion Model Pender’s model can influence the physiological condition of the aging population due to the implementation of new behavioral patterns.
• Electronic Health Records Implementation Examples Electronic Health Records (EHRs) are becoming increasingly popular with the growing demand for convenient and high-quality healthcare services.
• Promoting Health and Wellbeing of Older People and Raising Community Awareness The care of older people has become an important issue due to increased life expectancy and improved healthcare and health education.
• Russian and American Healthcare Systems Comparison The comparison of the health care system of Russia and the health care system in America shows that neither system meets the health care needs of its populations.
• Evolution of Healthcare Information Systems Healthcare and hospital information systems have greatly changed in the past twenty years and this has been as a result of the improvement of information technology.
• Health and Safety Assessment Health and safety laws are designed to ensure that working environments are safe for all workers. The law requires that both employers and employees take caution.
• Sentinel Town Community Health Assessment This paper is an assessment of health-related environmental factors that affect the population’s health in Sentinel Town.
• Change Management in Healthcare Changes in the healthcare field are always associated with difficulties since they affect the ways care is delivered, as well as medical professionals’ and clients’ experiences.
• Continuous Probability Distributions in Biostatistics and Public Health This paper aims to increase the understanding of continuous probability distributions as used in biostatistics and public health.
• The Influence of Social Media on Mental Health The paper discusses the consequences of social media on people’s mental health, behavior, lifestyle and possible benefits.
• Healthcare Regulatory Agencies in the US The purpose of this paper is to identify 5 major healthcare regulatory agencies in the US, describe the agency, level of regulatory authority, and role within the US healthcare system.
• Community Health Assessment This paper aims to conduct a community health assessment to identify the community’s resources, strengths, challenges, and health issues.
• Why Health Insurance Should Cover Art and Music Therapy? In the article, the author talks about the benefits of art therapy and music therapy for the mental health of patients.
• Importance of Health Equity It is efficient if everyone who needs assistance receives adequate care, which is possible because of Health Equity.
• US and Singapore Healthcare Systems Comparison The Healthcare system is a major concern for many countries. Comparing and contrasting the quality of healthcare in the U.S. and Singapore might provide valuable insights.
• South Africa Health Care System This paper determines the role the health care systems of South Africa play in delivering the population access to appropriate health care services.
• Fulmer SPICES Tool in Patient Health Assessment The purpose of this paper is to review the Fulmer SPICES tool and analyze its usability. The Fulmer SPICES includes six major areas to be considered.
• Health Care: Fundamentals and Importance Care is a crucial part of healthcare services provided as a method promoting patients’ physical and mental wellbeing and as an essential factor in a competitive aspect.
• Healthcare Manager’s Conceptual, Technical, and Interpersonal Skills A healthcare manager is a person who facilitates, administrates, and influences the healthcare system as a manager is an indispensable part of the medical system.
• Mission and Vision Statements in a Health Organization This paper discusses the mission and vision statements of a particular hospital by showing the rationale of the words.
• Quality Management in Healthcare Quality management in healthcare is essential to ensure patient safety. It is helpful by providing the opportunity to evaluate quality in healthcare organizations.
• Concepts of Women’s Health Education Women’s health education is crucial for safe childbirth, healthy living, and successful parenthood. The proposal will investigate the feasibility of using women’s health campaign.
• Environmental Changes: Negative and Positive Impact on Human Health Environmental changes have both negative and positive impacts on human health. While some effects are direct, others are hard to decipher.
• Health Promotion Proposal Obesity Prevention The purpose of this proposal is to inform and educate parents, children and adolescents of the importance of having a well balance diet and exercise in their daily lives to avoid obesity.
• Analysis of Limited Access to Healthcare The analysis will primarily focus on geographic and related factors in regards to the issue of healthcare access.
• Social Determinants of Health This paper presents an analysis of social determinants of health based on the article by Koh, Piotrowski, Kumanyika and Fielding.
• Barriers to Collecting a Health History A medical specialist has not only to be competent in his or her field but to employ specific tools and communication techniques to ensure trustworthy relationships with patients.
• Impact of Outdoor Activities on Mental Health This paper explores the therapeutic value of outdoor activities for human mental health and well-being and discusses the positive effects of spending time in nature.
• Effects of Poor Workplace Culture on Healthcare Organizations The current paper provides a unique outlook on the fundamental value held by workplace culture in healthcare organizations.
• Spirituality and Mental Health Nowadays, spirituality plays a huge role for many people around the world, and the connection between the inner feelings of every person with the outside world is a crucial part.
• Personal Health Initiative Report: Achieving a Normal Body Mass Index This paper reports on the initiatives taken to achieve change in eating behavior and achieve a normal body mass index.
• Risk Management in Health Care This essay seeks to define risk management in health care delivery, discuss the basics of sentinel reporting, the legal implications of sentinel events.
• CDC’s Top Ten Public Health Achievements of Workplace Safety The mining industry is associated with a risk to life, as a historical retrospective demonstrates the mortal danger to workers.
• Religion and Its Health Benefits Religion and spirituality offer potential health benefits in reducing mortality risks and improving coping techniques, which leads to enhanced recovery among patients.
• Patient Assessment, Health Patterns and Family Characteristics Family characteristics may significantly promote either potential or actual dysfunctional health patterns. One of the characteristics refers to family relationships.
• Single-Parent Family Health Assessment The current family development stage is ‘a family with school-aged children’, and the family managed to accomplish the tasks of previous stages rather well.
• Behavioral and Cognitive Mental Health Theories Mental health approaches attempt to explain the development of human beings socially, psychologically, and behaviorally.
• The Family Health Assessment This essay seeks to provide a family health assessment of an Amish family using the Friedman Family Assessment Model, analyze family data and develop a plan of care for the family.
• Cash Flow Statement as a Reflection of Financial Health Lack of working capital, a constant search for money to repay debts to suppliers, employees, budget all lead to the fact that a company cannot manage its obligations.
• Health-Illness Continuum Review The health-illness continuum can be used to elaborate on how an individual, regardless of the absence of physical illness, may suffer anxiety, depression, and other conditions.
• Healthcare in the United Kingdom The purpose of this paper is to examine the healthcare in the United Kingdom, providing recent data and covering the main issues in this area.
• Social Change: The Nurse’s Role in Global Healthcare To advocate for the global perspective on the issue of the opioid crisis and the need to change the current standards for opioid prescription.
• Examples of Environment in Nursing Metaparadigm The metaparadigms that form personal nursing philosophy include such wide conceptions as patient, nurse, health, and environment.
• Traditional Public-Health Prevention Model Nowadays, the treatment of many common diseases is believed to be influenced by prevention. Therefore, new approaches have been developed to enhance prevention strategies.
• Biomedical View of Health The biomedical view categorized diseases and illnesses in an objective manner and in the process ends up objectifying the health of an individual.
• Sanitation, Inspection and Public Health Administration Public healthcare administration is the science of preventing, improving, and promoting the health of the community at large.
• Mental Health in the Community Health institutions set goals to improve the mental health of the population. Two of those goals are to reduce the instance of suicide and disordered eating among adolescents.
• Role of Family in Healthcare and How Culture Affects Health Beliefs The paper will discuss how family shapes the role of care and attitudes towards health and how culture affects health beliefs and community health.
• Basketball: History and Health Benefits Basketball is the best sport because it is the most skill-intensive, has a lot of health advantages, and is both entertaining to play and watch.
• Overcrowding in Prisons and Its Impact on Health Overcrowding in prison is a significant issue that affects a lot of countries and it is challenging to detect as there is no uniform internationally accepted standard.
• Social Media Impact on Mental Health Social media became popular only several decades ago, but at present, they constitute an important part of everyone’s daily routine.
• Advantages of Computer Technology in Healthcare The emergence of computer technology within healthcare is the catalyst of changes that began to display the improvement of medical procedures and care quality.
• Mental Health Issues in College Students Although some types of mental health issues a college student usually faces might come from childhood traumas, some of them are appropriate in the grown-up period.
• Qualitative and Quantitative Methods in Public Health Qualitative and quantitative methods alike can be helpful in public health and work in accord to offer a clearer picture and a more thorough understanding of a given matter.
• Health Information Systems Project An operational health information management system focuses on the internal processes of the healthcare facility, including matters such as staffing and scheduling.
• Health Promotion in School Health Center The purpose of education activities is to inform the audience about healthy lifestyles and address the social issues affecting their well-being and health.
• Healthcare Problems of Modern Society The public health system, as an organizational construct of a social institution, affects the formation and effective use of human capital.
• Quality Improvement Team in Healthcare Institution The essay considers creation of an interdisciplinary quality improvement team, risks associated with working with such teams and the ways to address these issues.
• Cause and Effect: Living with Pets Improves Their Owners’ Health Experiencing positive emotions is, perhaps, the key cause that deserves to be mentioned as the factor contributing to the improvement in pets’ owners’ health.
• CVS Health Corporation’s SWOT Analysis CVS Health Corporation is a leading American healthcare company. It provides a vast range of services and is not a classic medical group that owns a chain of pharmacies.
• The Health Benefits of the Green Tea
• US and French Health Care Systems Comparison
• The Health Promotion Model by Nola Pender
• Quality Improvement in Healthcare
• Littering on Campus: The Issue of Maintaining Cleanliness and Averting Health Hazards
• Using the PRECEDE-PROCEED Model in Designing a Community-Based Health Program
• Healthcare Employee Recruitment and Selection
• Nola J. Pender’s Health Promotion Model in Nursing
• Importance of Education for Healthcare Professionals
• Teacup Dogs: Appearance, History, Health Complications, Art
• The Challenges Faced by Healthcare Workers
• The Effect of Mental Health Programs on Students Academic Performance
• The Impact of Technology on the Social Institution of Health
• Health Promotion for Obesity in Adults
• Partnering to Heal: Healthcare-Associated Infections Prevention
• The Role of Religious Beliefs and Spirituality in Health Care
• Cultural Barriers in Healthcare Management
• Healthcare in Canada: Problems and Solutions
• Community Health: Disaster Recovery Plan
• The Importance of Good Health
• Pareto Efficiency. Health Care System
• What Is E-Health: Discussion
• Food Additives: Dangers and Health Impact
• Family Health History Genogram Assessment
• Influenza and Community Health Nurse’s Role
• Occupational Health and Safety Communication
• The Importance of Mental Health Care
• Creating App in Healthcare: Business Plan
• Patient-Centered Healthcare Coordination Plan
• Perfect Competition and the Cost of Healthcare
• Quality and Risk Management in Healthcare
• Health and Safety Effects of Computer Use
• A Mental Health Nursing Social Interventions for Patients With Schizophrenia
• Family Health Assessment Using Gordon’s Patterns
• Health: The Benefits of Running
• Information Technology Applications in Healthcare
• Interpersonal Communication Skills in Healthcare
• Water Quality Improvement for Global Health
• Ways to Improve the US Healthcare System
• Person, Health, Environment in Nursing Philosophy
• Health and Lifestyle in Russian Culture
• The Gibbs Reflection Cycle Method in Healthcare
• Cuban Cultural Communication in Relation to Healthcare
• Categorical Variables in a Healthcare Research
• A Community Health Action Plan
• Public Dental Health Policies: Allocative and Regulatory
• The Definition of Public Health Leadership
• Public Health in the UK
• Leadership in Motivating Healthcare Staff to Increase Performance
• Legal Aspect of Health Care Administrator
• Conflict Stages and Its Resolution in Healthcare
• Gordon’s Functional Health Patterns in a Community
• Health Promotion and Ethical Considerations
• Health Effects of Environmental Change
• Nursing Informatics Policy and Its Influence on Healthcare Delivery
• NYU Langone Health Center’s Strategic (SWOT) Analysis
• The Flo Health App and Technological Utopia
• Pollution and Children’s Health
• Intercultural Communication in Business, Education, and Healthcare
• Overcoming Personal Biases, Prejudice, and Stereotyping in Healthcare
• Health Information Technology Service Management
• Quality Documentation and Reporting in Primary Health Care
• Prominent Health Concerns in Developed Countries
• Financial Management Role in Healthcare
• Healthcare Environment: Challenges to Teamwork and Collaboration
• Ethics in the Healthcare Industry: Armando Dimas’ Case
• Online Learning and Students’ Mental Health
• Public Health in 21st Century
• Major Third-party Payers to Healthcare Providers
• Maternal Health Nursing Theories and Practice
• Universal Health Care: Arguments For and Against
• The Role of a Nurse in Mental Health
• Refugee Mental Health Issue
• Bullying Effects on Health and Life Quality
• Demand and Supply of Healthcare Workforce in Oman
• Risk Management in Healthcare Construction Projects
• Principles of Primary Health Care
• Organizational Behavior Management in Health Care
• Health Information in Print and Digital Media
• Conflict Resolution in a Healthcare Setting
• Customer Focus in Healthcare Project Management
• High Taxes’ Benefits for Education and Healthcare
• Advocacy in Mental Health Counseling
• Health Information Exchange (HIE) Models
• The Connection Between Education and Better Health
• Contrast of Health Care Systems: Italy v. the United States
• Impact of Social Media on Mental Health
• GE Energy and GE Healthcare: Strategic Customer Relationships
• Globalization and Health
• Comparison of Healthcare Systems: The United States and Switzerland
• Healthcare for Hindus: Purnell Model for Cultural Competence
• Community Nursing Roles in Occupational Health Settings
• Margaret Newman’s Theory of Health as Expanding Consciousness
• Environmental Health and Health Effects of Environment
• Technology in Health Care: Current Trends
• Nuclear Family Health Assessment in Nursing
• Why Is Public Health Important
• Equality, Diversity, and Rights in Health and Social Care
• Project Management in Healthcare
• Ethical Theory in a Healthcare Scenario
• Ethics of Researching Mental Health Issues
• Health Belief Model of Chronic Obstructive Pulmonary Disease
• Health Promotion Theory for Chronic Kidney Disease
• Nursing Informatics in Healthcare
• The Banner Health Care System Strategic Plan
• COVID-19: The Impact on Mental Health
• Malawi Health and Education System Analysis
• Improving Mental Health by Preventing Mental Illness
• The Role of Health Care Administrator
• Artificial Intelligence in Healthcare: Pros & Cons
• Family in Health Crisis
• Employee Mental Health and Workplace Wellbeing
• ABC Healthcare Cyber and Computer Network Security
• Health and Physical Education Instructor
• Evaluation in Nursing Education and Healthcare Organization
• Motivational Axiom, Health Behavior and Promotion
• The Family Health Assessment in the Nursing Practice
• Communicating in Health and Social Care Organisation
• Health Education Plan
• Common Mental Health Problems
• Evidence-Based Population Health Improvement Plan
• Factors Influencing Food Choices and Their Impact on Health
• Social Media Impact on Mental Health
• Evaluation of Mental Health Project Presentation
• Environmental and Public Health Risks Caused by Plastic Pollution
• The Use of Psychiatric Mental Health Nurse Practitioners
• Reproductive Health and Abortion Practices in Fiji
• Diversity Project Kickoff: Diversity in Health Care
• Healthcare Professions: EMT and Occupational Therapist
• Nurse’s Role in Health Promotion
• Health Issues: A National and Global Perspective
• Sociological Analysis of Health and Illness
• Occupational Health Safety Management in the USA
• Theory, Risk, and Quality Management in Healthcare Facilities
• Social Media and Its Effect on Mental Health
• Elder Abuse and Neglect as a Health Problem
• Nursing: Community Health Project by Nola Pender
• Training and Education in Health Care Organization
• Research Approaches in Health and Social Care
• Evidence-Based Conflict Resolution Strategies in Healthcare
• Unionization and Magnet Accreditation in Healthcare
• Critique of Population Health Intervention
• The Roles of a Community Health Nurse
• Community Health Nursing and Occupational Safety
• Determinants of Health: Factors Influencing Health Status
• Physical Assessment in Health Care
• Health and Safety Training for Early Childhood Educators
• Climate Change Affecting Global Public Health
• Fashion Affecting People’s Health
• Effective Health Care’ Components
• The Role of Nursing on the Patient Health Improvement
• Digital Health Information Technologies
• Ethics, Morals, and Values in Healthcare
• Social Problems and Policy: Youth Unemployment and Mental Health
• Modern Healthcare Management: The Role of Information Technologies
• Competing Needs and Quadruple Aim in Healthcare
• US and Canada Healthcare Systems Comparison
• Leadership in Healthcare Management & Administration
• Environment and Health Relationship
• Cell Phone and Health. Nomophobia
• Impact of Leisure and Recreation on Mental Health
• The Effectiveness of the Internet in Healthcare
• Alberta Health Services: Organizational Structure
• Dental Public Health Project
• The Health Status of a Population
• Behavioral Cues in Healthcare Behaviors
• Ethical and Legal Issues in Healthcare Services
• The Importance of Moral Courage in the Healthcare
• Southern Regional Health System: Case Study
• Cultural Beliefs in Health Education
• Impact of Technology on the Healthcare System
• Managerial Accounting Concepts in Health Care Industry
• Absenteeism and Lateness in the Healthcare Field
• Healthcare Professional Training and Development
• Climate Change and Impact on Human Health
• Healthcare Robotics Impact
• Professional Nurses’ Involvement in Health Policy
• Occupational Health Nurses’ Role and Settings
• Peplau’s Interpersonal Relations Theory in a Mental Health Setting
• Leadership Theories in the Healthcare Industry
• Occupational Safety and Health Threat Scenarios
• United Healthcare Group and Its Strategic Plan
• Social Psychology and Health Issues
• Health Promotion Strategies for Obesity
• Non-Verbal Communication in Mental Health Nursing
• Ethics and Social Justice in Mental Health System
• Food Donation and Food Safety: Environmental Health
• The Pender Health Promotion Model for Behavioral Change
• Private Hospitals’ Health Facility Capacity
• Global Women’s Health and Rights
• Importance of Mental Health Policy
• Interprofessional Collaboration in Health Care
• Mental Health Challenges and Their Stigmatization
• Health Profile Assessment: Coronary Heart Disease
• Program Evaluation in Public Health
• Sudden Infant Death Syndrome: Health Promotion Plan
• Intentional Exaggeration: Healthcare Plans and Products
• Cost Allocation in Healthcare Analysis
• Community Health Nursing: Home Care
• Community Health: Assessment of New York’s Chinatown
• The Role of Chief Information Officers in Healthcare
• Building Trust Within the Healthcare Setting
• Nursing Profession: Health and Economic Issues
• Nurse Activist: Healthcare Policy and Advocacy
• Implementing Electronic Health Records in Hospitals
• Pregnant Women’s Mental Health Difficulties
• Access to Healthcare Services
• Diabetes Type 2 Treatment and Health Promotion
• Childhood Obesity Study and Health Belief Model
• Family Health Assessment
• Healthcare Quality Improvement Team Meeting Plan
• Virtual Reality in Healthcare and Education
• How Do Various Factors Influence Health in Your Community?
• Leading Interprofessional Collaboration in Healthcare
• Police Officers’ Wellness and Mental Health
• Jehovah’s Witnesses’ Views on Healthcare
• Powerade Food Myth Buster: Investigating Health Claims
• Spirituality and Mental Health
• Mental Health Crisis and Stigma
• Health Aspects of Young Adulthood
• Women’s Mental Health Program Proposal
• Qualitative Research in Healthcare
• Health of North West of Edinburgh Community
• Healthcare Informatics: Introduction to Theory
• Interprofessional Teamwork in Healthcare
• Poor Housing Conditions and Health of Maori Children
• Shared Decision Making in Health Care
• Mental Health and COVID-19 Pandemic
• Anglo-Americans’ Health Beliefs and Practices
• Spain’s Current Healthcare System
• Stage Theory of Organizational Change in Public Health
• Infectious Disease and Public Health Focus
• Examples of Literacy and Health Literacy
• Health and Medicine in Thailand
• Poor Solid Waste Management: The Health Effects
• Effects of Nightmares in Health
• The Public Health Issue Analysis
• Leadership in Healthcare Overview
• Typhoid Fever: Health Promotion Pamphlet
• Primary Prevention: Public Health Concept
• Adaptive Leadership in Health Care
• Health Promotion Model: The Lifestyle Change Project
• Promoting Better Health for the American Population
• Lillian Wald and Community Health Nursing
• Replication and Its Importance in Healthcare Research
• Health Psychology and Stress: Correlations
• Pathogenic and Salutogenic Concepts of Health
• Program Planning: Health and Wellness for Senior Citizens
• Administrative and Financial System in Healthcare
• Cash Versus Accrual Accounting Methods in Healthcare Organizations
• Strategic Management Aspects in Health Care
• How to Reduce Obesity and Maintain Health?
• Outbreak at Watersedge: A Public Health Discovery Game
• Adolescent Mental Health: Depression
• Personality Type and Leadership in Healthcare
• Affordable Health Care Act in Sociological Aspect
• Community and Public Health Nursing
• Healthcare Policy, Leadership and Performance
• Global Health Nursing Position Statement
• Family Relationships and Response to Health Issues
• Community Health Nursing: Chikungunya Threat
• Non-traditional Healthcare Practices: Can It Replace the Actual Medicine?
• Using of the Electronic Health Record
• Healthcare Problems in South Africa
• Health Promotion and Disease Prevention
• Strengthening Community Health Through Technology: Key Barriers
• Public Health Career Opportunities
• Organizational Change in Healthcare
• Hospital Ownership Types and Impacts on Healthcare Finance
• Disaster Recovery Plan for the Vila Health Community
• Barriers to LGBT Health Care Access and Effective Nursing Interventions
• Cybersecurity and Protection in Healthcare
• Public Health Promotion: World Health Organization
• Using of Virtual Reality in Healthcare
• Clinical Career Ladders in Healthcare
• Health Level Seven: Value Sets, Code Systems, and Data Types
• The Action Research in Healthcare
• Trauma-Addictions and Mental Health
• The Mental Health of Medical Staff
• Health Disparities in Rural Versus Urban Areas
• Oral Health Program: Funding Examples Discussion
• Health Campaign Audience and Implementation
• Change Leadership in the Baptist Health South Florida Hospital
• Diffusion of Innovations Theory in Public Health
• Managed Care in Behavioral Health
• Fast Food and Health Relations
• Design and Health Promotion Program for Someone to Quit Smoking
• Financial Analysis in Healthcare Organizations
• Leadership and Change in Healthcare Management
• Peru’s Healthcare System Assessment
• Health Promotion Project for Chronic Diabetic Kidney Disease
• Practice in the Field of Healthcare: Literature Review
• Teamwork and Collaboration in Healthcare
• Health Maintenance Plan for Diverse Developmental Stages
• Major Health Concerns in Sentinel City
• French Huna for Health
• The Interdisciplinary Health Care Delivery Model
• Practical Application of Robotics in Health Care
• Disaster Recovery Plan At Vila Health
• Health Safety in the Police Department
• Incomplete or Missing Documentation: Patient Safety in Healthcare
• Theory of Control in the Healthcare
• Health Insurance for Employees
• Planned Parenthood as a Healthcare Research Topic
• Ethical and Religious Directives for Catholic Healthcare Services
• Psychiatric Interview for Mental Health Treatment
• Overview of Health Promotion
• Global Health Crisis and Initiatives to Tackle It
• Health-Based and Non-Nursing Theories in Examples
• Healthcare Delivery Models and Nursing Trends
• K-12 Health & Physical Education Curriculum
• Healthcare Human Resources Management and Changes
• Trends in the Healthcare Sector
• The Patient Health Questionnaire
• Fad Diets and Their Impact on Human Health
• South African and Namibian Healthcare
• Malnutrition and Patient Safety Healthcare Policy
• Healthcare Disparities in the LGBT Community
• Pender’s Health Promotion Model and Parse’s Theory
• Evidence-Based Practice Role in Healthcare
• Pets Effects on Their Owners’ Health
• Social Determinants of Health in Wolverhampton Town
• Corruption in South Africa’s Healthcare Sector
• How Social Media Contribute to Mental Health
• Patient Identity Management Policy in Healthcare
• Mental Health Problems in the UK and the US
• Personal Health Promotion Plan: Better Eating Habits
• Sexual Health Through Natural and Social Sciences Lens
• Health-Related Sustainable Development Goals
• Voluntary Accreditation in Healthcare: Requirements, Compliance, and Standards
• Aspects of Maternal Child Health
• Performance Appraisal Process in a Healthcare Organization
• Role of Mandatory Health Insurance
• Professional Relationships in Healthcare
• Occupational Stress Management in Healthcare
• Healthcare Social Issue for Indigenous People in Canada
• Management and Leadership in Healthcare
• Summary of the Health History Interview
• Communication as a Barrier to Providing Healthcare
• Mental Health Issues in Uganda
• How Digital Literacy Skills Will Help Me in the Healthcare Setting
• Aspects of Healthcare Costs
• Applying Ethical Principles in Healthcare
• Roles of a Financial Manager in Healthcare
• Current Problems in Pediatric and Adolescent Health Care
• Strategic Planning: Electronic Health Record System Launch
• System Implementation: The Health Information Management Systems
• The Impact of Socioeconomic Status on Health
• The Legal System & Framing Issues in Law and Public Health
• Public Health and Health Policy: Newham’s Cases of Homelessness
• The Heart Failure Patients: Health Belief Model
• Price Setting and Price Regulation in Health Care
• Canada’s Public Health System
• Partners and Stakeholders for Health Advocacy in Kenya
• Analysis of Health Care Around the World
• Public Health: The Issue of HIV/AIDS Pandemic
• Globalization and Health Systems in India
• Aspects of Global Health Issues
• Elements of Strategic Planning in Health Organizations
• Communication Technology Tools in Public Health Campaigns
• Patient Rights When Interacting With Healthcare Providers
• The Role of Epidemiology in Public Health
• Healthcare Accreditation and Licensing
• Traumatic Fractures: A Healthcare Research
• Health and Medicine: Vicodin
• The U.S. Healthcare System Crisis
• Role of Hospitals in the American Healthcare System
• Leadership and Communication in Healthcare Setting
• Health Care Delivery Models and Nursing Practice
• Cash vs. Accrual Accounting for Healthcare Organization
• How Ageism Affects Mental Health and Addiction?
• Mental Health in “The Tell-Tale Heart” by Edgar Allan Poe and “The Yellow Wallpaper” by Charlotte Perkins Gilman
• Playing Music and Its Benefits for Health
• Navajo People Health Review, Analysis, and Suggestions
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• Rising Health Care Costs: Analyzing Issues
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• First Steps on Becoming a Grassroots Lobbyist or Advocate for Health Care Policy
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• Shift Work: Negative Effects on the Health and Performance of Nurses
• Authoritarian Parenting Impact on Children’s Health
• The Island Nation of Tekram: Health Strategy Analysis
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• Adolescent Health Care: Factors and Impact
• Quality Initiatives in Healthcare
• Levine’s Conservation Theory in Healthcare Research
• Family Structure, History, Health Assessment
• Obesity as American Social Health Issue
• American and Icelandic Healthcare Systems
• The Health History and Physical Assessment
• Gender Stereotypes’ Effects Career and Mental Health
• Role of Ethics in Healthcare Leadership
• Healthcare Conflict Resolution Case
• Pediatric Nurses Creating Health Care Environment
• Childhood Obesity and Health Promotion
• Leadership Style and Motivation in Health Care
• Family with a Chronically Ill Member: Health Assessment
• Electronic Health Record’ Benefits
• Implementation and Adoption of Health Information Technology
• Nursing Quality Models in Healthcare Institutions
• Community Health Nursing: Family Health Assessment
• Mental Health: General Hospital Psychiatry
• Environmental Pollution Effects on Health
• Women’s Health Teaching Proposal: on Healthy Lifestyle Choices, Diet and Activity
• Billing and Coding Regulations in Healthcare
• The Right to Healthcare as a Basic Human Right
• Interprofessional Collaboration in Healthcare
• Cryotherapy for a Complex Adult Health Client
• Holistic Health Principles in Nursing

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StudyCorgi. (2022, June 5). 580 Health Essay Topics. https://studycorgi.com/ideas/health-essay-topics/

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StudyCorgi . "580 Health Essay Topics." June 5, 2022. https://studycorgi.com/ideas/health-essay-topics/.

StudyCorgi . 2022. "580 Health Essay Topics." June 5, 2022. https://studycorgi.com/ideas/health-essay-topics/.

These essay examples and topics on Health were carefully selected by the StudyCorgi editorial team. They meet our highest standards in terms of grammar, punctuation, style, and fact accuracy. Please ensure you properly reference the materials if you’re using them to write your assignment.

This essay topic collection was updated on January 8, 2024 .

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Health Spending Growth Has Slowed: Will the Curve Continue?

Department & Center Events

2024 Sam Shapiro Lecture featuring Joesph P. Newhouse, PhD, John D. MacArthur Research Professor of Health Policy and Management, Harvard University

Join the Center for Health Services and Outcomes Research for the 2024 Sam Shapiro Lecture "Health Care Spending Growth has Slowed: Will the Curve Continue?" The event will feature Joseph P. Newhouse, PhD, John D. MacArthur Research Professor of Health Policy and Management at Harvard University delivering the keynote address. 

Other panelists include Aditi Sen, PhD, MA, Chief of Health Policy Studies Unit, Congressional Budget Office; Matthew Eisenberg, PhD, Associate Professor of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health; and Eva Dugoff, PhD, MPP, Senior Health Advisor, US Senate Committee on Finance. 

Albert Wu, MD, MPh, Fred and Juliet Soper Professor and Director, Center for Health Services and Outcomes Research, Johns Hopkins Bloomberg School of Public Health, will moderate the event. 

Lunch will be provided and begins at 11:30 a.m., with the lecture and panel to follow at noon. 

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[ORGANIZATION OF MEDICAL CARE FOR CHILDREN WITH A NEW CORONAVIRUS INFECTION IN PATIENT CONDITIONS ON THE EXAMPLE OF THE CHILDREN'S CITY CLINICAL HOSPITAL NAMED AFTER Z. A. BASHLYAEVA]

Affiliations.

• 1 Children's City Clinical Hospital named after Z. A. Bashlyaeva of the Moscow City Health Department, 125373, Moscow, Russian Federation.
• 2 Pirogov Russian National Research Medical University, 117997, Moscow, Russian Federation.
• 3 Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation, 125993, Moscow, Russian Federation.
• 4 Pirogov Russian National Research Medical University, 117997, Moscow, Russian Federation, [email protected].
• 5 Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department, 115088, Moscow, Russian Federation.
• PMID: 34792888
• DOI: 10.32687/0869-866X-2021-29-s2-1343-1349

The article presents an analysis of the work of the largest children's COVID-19 center in Moscow, organized on the basis of the Children's City Clinical Hospital named after Z. A. Bashlyaeva of the Moscow City Health Department. From March to November 2020 at the COVID-19 Center were hospitalized 2,837 patients with suspected/confirmed diagnosis of COVID-19, in total in 2020 1,876 children with a confirmed diagnosis of COVID-19 were treated, 58 (3%) children were in serious condition in the intensive care unit, of which children 11-18 years old were 25%. At the 2020 neonatal COVID-19 center, 215 newborns were observed with suspected COVID-19 diagnosis. The diagnosis of COVID-19 was confirmed in 18 children, while 8 newborns came from the home of COVID-19. In the Center for rehabilitation, where children aged 0 to 3 years old who were born with very low and extremely low body weight are observed, dispensary observation for children who have undergone COVID-19 is organized. 45 children who were observed fell ill with the new coronavirus infection. There were no deaths among children with COVID-19.

Keywords: COVID-19; COVID-center; children; new coronavirus infection; newborns; treatment.

• COVID-19 Testing*
• Child, Preschool
• Hospitals, Pediatric
• Infant, Newborn
• Retrospective Studies

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New Medical Breakthroughs Older Adults Need to Know About

three health advances unveiled in 2024 offer hope for parkinson’s, colorectal cancer, kidney failure  .

Rachel Nania,

Richard “Rick” Slayman made history on March 16 by becoming the first living person to receive a genetically modified kidney — from a pig. 

The 62-year-old Weymouth, Massachusetts, resident had end-stage kidney disease and was running out of options. In 2023, the kidney he received about five years before from a human donor started to fail; he was placed on dialysis but experienced complications that required frequent hospitalization.

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That’s when his doctors at Massachusetts General Hospital in Boston suggested an experimental pig kidney transplant. “I saw it not only as a way to help me, but a way to provide hope for the thousands of people who need a transplant to survive,” Slayman said in a statement released by Massachusetts General, where the transplant was performed.

This is just one example of a groundbreaking medical advance that could one day help countless older adults. Here’s a closer look at it, plus two other recent breakthroughs announced in early 2024.

1. Transplanting a kidney from pig to patient

Taking an organ from one species and transplanting it in another — called xenotransplantation — is what Steven Potter, M.D., describes as “one of the holy grails in transplantation” science. A big reason: There is not enough supply from human organ donors to meet demand. About 17 people die each day waiting for an organ transplant, according to the Health Resources & Services Administration.

A kidney is the most common organ needed for transplant, and demand is only expected to increase alongside accelerating rates of end-stage kidney disease in the U.S. Currently, nearly 808,000 people in the U.S. are living with end-stage kidney disease. Most kidney transplant recipients are between the ages of 45 and 65, according to Cleveland Clinic. For these people, a transplant is the ideal treatment, as it can drastically improve an individual’s quality of life, says Potter, director of pancreas transplantation at Medstar Georgetown Transplant Institute. Dialysis — an expensive therapy where a machine takes on the work for the kidneys — is the other option.

The pig kidney that Slayman received was genetically edited “to remove harmful pig genes and add certain human genes to improve its compatibility with humans,” Massachusetts General said in a news release. And a new class of immunosuppressant medications that help prevent organ rejection was used for the pioneering procedure, so it was “advancing on multiple fronts,” Potter says.

Even though it may be a while before xenotransplantation becomes more common in operating rooms around the country (doctors have also transplanted a pig heart into living humans), Potter says Slayman’s March 16 surgery is “a big step forward.”

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2. A blood test for colorectal cancer 

Colorectal cancer trends in the U.S. are worrying — and so are screening rates.

According to a 2024 report from the American Cancer Society, incidence for the cancer, which is most commonly diagnosed in older adults, is increasing . (More than 80 percent of colorectal cancer cases are among people age 50 and older.) Death rates are also rising for people under age 55. All the while, just over half of adults who should get screened for colorectal cancer do. Some scientists are hoping that a new screening option — one with fewer barriers and less of an ick factor — could bump that share up among people either reluctant or unable to undergo a colonoscopy or participate in one of the other recommended screenings.

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A new study published in The New England Journal of Medicine found that while colonoscopy remains the gold standard, a blood test developed by Guardant Health detected colorectal cancer in 83 percent of people who had the disease. That’s similar to what we see for routine stool-based colorectal cancer screening tests, says study coauthor William M. Grady, M.D., a gastroenterologist at the Fred Hutchinson Cancer Center.

The blood test detects certain cancer signals in DNA that’s been shed from a tumor, Grady says. And if that tumor material is found in the blood, the next step is to do a colonoscopy to confirm if cancer is present. Earlier detection can potentially expand treatment options and improve odds of recovery.

The blood test is currently available for physicians to order for their patients, but Grady says many insurance companies don’t cover it. That could change with formal approval from the Food and Drug Administration (FDA), which could come this year. An official FDA approval makes it more likely the test, which retails for $895, would be covered by insurers, Grady says.

If the test is approved and becomes a more widespread screening tool, Grady says it will be important for patients to talk to their doctors about the pros and cons of each available screening test before deciding on one.

“We know when people are given options that it increases the likelihood that they’re going to do one of them,” Grady says. “And so in this case, what we’re hoping is that by having this blood-based test, it will increase compliance.”

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3. A skin biopsy for Parkinson’s disease

Diagnosing Parkinson’s disease isn’t as cut-and-dried as diagnosing some other health conditions. Often doctors rely on a patient’s symptoms, medical history and lab tests or brain scans to rule out other disorders.

“In some cases, it can be very clear when we first see a patient that, yes, they have Parkinson's disease,” says Christopher Gibbons, M.D., a neurologist at Beth Israel Deaconess Medical Center in Boston and associate professor of neurology at Harvard Medical School — for example, if they have a tremor. Other cases are less obvious , and the patient may have to wait some time for a definitive diagnosis.

That can be a frustrating process, Gibbons says. It can also delay treatment. (No drug available yet can reverse or slow the progression of the disease, which occurs when nerve cells in the brain die or become damaged. But some medications can help with Parkinson’s symptoms.)

A new study published in JAMA , however, suggests a skin biopsy could help some doctors in the diagnostic process. The test was roughly 93 percent accurate at detecting Parkinson’s disease in people who had a confirmed case.

The test, which is already commercially available for doctors to order but isn’t widely used, can identify a misfolded protein, called alpha-synuclein, that is a hallmark of Parkinson’s. It can also detect this protein in people with related neurodegenerative conditions, including dementia with Lewy bodies.   

This misfolded protein spreads throughout the nervous system, including to the nerves in the skin, says Gibbons, a coauthor on the JAMA study. The researchers took three punch biopsies from study participants — each equivalent to one-eighth the size of a pencil eraser, Gibbons says. The biopsy detected misfolded alpha-synuclein in 92.7 percent of patients with confirmed Parkinson’s disease in the study.

Researchers recently developed a spinal fluid test that can also detect misfolded alpha-synuclein. Gibbons says the utility for these tests is going to be increasingly important, especially when it comes to drug development and enrolling patients in clinical trials. Many potential treatments are in the research pipeline, he says, “and if one of those treatments becomes available, it’ll be incredibly important to know who has the protein and who would respond to a therapy.” 

Rachel Nania is an award-winning health editor and writer at AARP.org, who covers a range of topics including diseases and treatments. 

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Prevention of Child Maltreatment: Primary Care Interventions

About this resource:.

Source: U.S. Preventive Services Task Force

The last reviewed date indicates when the evidence for this resource last underwent a comprehensive review.

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The U.S. Preventive Services Task Force (USPSTF) found that the current evidence is insufficient to assess the balance of benefits and harms of primary care interventions to prevent child maltreatment in children and adolescents younger than 18 years who don’t have signs or symptoms of, or known exposure to, maltreatment.  

More research is needed to help primary care clinicians accurately identify families who might benefit from supportive interventions to prevent child maltreatment. Studies are also needed to:

• Determine whether intervention effectiveness or child maltreatment reporting differs by social factors and race and ethnicity
• Evaluate the effectiveness of interventions, using more accurate outcome measures that limit bias
• Establish consistency in outcome measure definitions, outcome types, and outcome timing
• Identify the most effective ways to prevent child maltreatment, including interventions that address the social determinants of health that can negatively affect families

USPSTF recommends clinicians should use their judgment to decide if and when to provide interventions to help prevent child maltreatment in children without signs or symptoms. 

Objectives related to this resource (2)

Suggested citation.

U.S. Preventive Services Task Force. (2024). Final Recommendation Statement: Prevention of Child Maltreatment: Primary Care Interventions. Retrieved from https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/child-maltreatment-primary-care-interventions .

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NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

2021 National Healthcare Quality and Disparities Report [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2021 Dec.

2021 National Healthcare Quality and Disparities Report [Internet].

Quality in healthcare.

The foundation of quality healthcare is doing the right thing at the right time in the right way for the right person and having the best results possible. Quality healthcare often means striking the right balance when providing healthcare services by avoiding overuse (e.g., unnecessary tests), underuse (e.g., missed blood pressure screening), or misuse (e.g., prescribing of drugs with harmful interactions). 1

The COVID-19 pandemic has affected almost all aspects of the way people live and work, especially with regard to healthcare and quality of healthcare people have received during the pandemic. More data are needed to fully understand how healthcare quality has been affected but one area with evidence of a decrease in quality of care is preventive healthcare. For instance, cancer screening is integral to cancer control and prevention. Due to the COVID-19 outbreak, many screenings have either been canceled or postponed, leaving a vast number of patients without access to recommended healthcare services. This disruption to cancer screening services may have a significant impact on patients, healthcare practitioners, and health systems. 2

The quality of healthcare can be measured, monitored, and improved over time. By specifying clearly, based on current science, which services should be provided to patients who have or are at risk for certain conditions and finding out whether those services are being correctly provided at the right time, we can track the performance of our medical care system. Experts in a field can propose a measure of performance, then test, adopt, and implement it.

Measures of healthcare quality tracked in the National Healthcare Quality and Disparities Report (NHQDR) encompass a broad array of services (prevention, acute treatment, and chronic disease management) and settings (doctors’ offices, emergency departments [EDs], dialysis centers, hospitals, nursing homes, hospices, and home health). Most NHQDR quality measures quantify processes that make up high-quality healthcare or outcomes related to receipt of high-quality healthcare. A few structural measures are included, such as the availability of health information technologies and workforce diversity.

• Surveys of patients, patients’ families, caregivers, and providers;
• Administrative data from healthcare facilities;
• Abstracts of clinical charts;
• Registry data; and
• Vital statistics.

Most data are reported annually and are generally available through 2016, 2017, or 2018.

As defined by the landmark Institute of Medicine report Crossing the Quality Chasm: A New Health System for the 21st Century , “equity” in health caregiving is based on the idea that “all individuals rightly expect to be treated fairly by social institutions, including health care organizations.” In addition, applying an “equity” approach ensures that quality care is available to all and that the quality of care provided does not differ by race, ethnicity, or other personal characteristics unrelated to a patient’s reason for seeking care. 3

Due in part to unfair policies, practices, and conditions, the quality of healthcare has varied based on race, ethnicity, socioeconomic status, age, sex, disability status, sexual orientation, and residence location. As specified in the Healthcare Research and Quality Act, this report focuses on disparities related to race, ethnicity, socioeconomic status, and geographic location. Through the examination of disparities in care, policymakers, researchers, providers, and public health practitioners can better understand the relationship between quality and equity in care.

• TRENDS IN QUALITY

Major updates made to three data sources since 2018—specifically the Medical Expenditure Panel Survey (MEPS), Healthcare Cost and Utilization Project (HCUP), and National Health Interview Survey (NHIS)—have had an outsized impact on the information available for presentation as part of the 2021 NHQDR. Trend data are currently not available for almost half of the core measures. Therefore, the 2021 NHQDR does not include a summary figure showing all trend measures or all changes in disparities. The report does include summary trend and change in disparities figures for some populations and results for individual measures.

• Trends in Person-Centered Care

[H]ealth care that establishes a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients’ wants, needs, and preferences and that patients have the education and support they need to make decisions and participate in their own care. 4

Patient centeredness “encompasses qualities of compassion, empathy, and responsiveness to the needs, values, and expressed preferences of the individual patient.” Error! Bookmark not defined. In addition, translation and interpretation services, as well as auxiliary aids and services, facilitate communication between individuals and providers and are often a legal requirement. xii The patient- or person-centered approach includes viewing the individual as a unique person, rather than focusing strictly on the diagnosis or chronic condition, and building a therapeutic alliance based on the person’s and provider’s perspectives.

Person-centered care is supported by good communication between individuals and providers so that individuals’ needs and wants are understood and addressed and individuals understand and participate in their own care. This approach to care has been shown to improve health and healthcare. 5 , 6 , 7 , 8 Examples of person-centered care are ensuring that individuals’ feedback on their preferences, desired outcomes, and experiences of care is integrated into care delivery and enabling people to effectively manage their own care and services.

• Language barriers.
• Racial and ethnic concordance between individuals and providers.
• Effects of disabilities on individuals’ healthcare experiences.
• Providers’ cultural competency.
• Accommodations for low health literacy.

Importance of Person-Centered Care

Morbidity and mortality.

• Person-centered decision making (when physicians consider the needs and circumstances of an individual) for planning an individual’s care has been shown to improve healthcare outcomes. 10
• Person-centered approaches to care have been shown to improve individuals’ health status. These approaches rely on building a relationship between the individual and the provider, improving communication, fostering a positive atmosphere, and encouraging individuals to actively participate in interactions with their provider. 11
• Person-centered care can reduce the chance of misdiagnosis due to poor communication. 12
• A small but significant absolute risk reduction of mortality from coronary artery disease,
• Improved control of diabetes and hyperlipidemia,
• Better adherence to antihypertensive medication,
• Bereavement adjustment in caregivers of cancer patients, and
• Higher self-efficacy of adherence to HIV medications. 13
• Poor communication, lack of collaboration, and lack of support for self-care are associated with suffering and waste in healthcare. 14
• Person-centeredness has been shown to reduce overuse of medical care. 15
• Improved communication methods can lower barriers to discussion about medication costs with individuals. 16
• Improved communication between individuals and providers during medical decision making can reduce costs. 17

Findings on Person-Centered Care

• Patient Experience of Care.
• Hospital Communication.
• Home Health Care Communication.
• Hospice Care.

Data for these measures can be found at https://datatools.ahrq.gov/nhqdr .

• Adults who reported that home health care providers talked about pain in the last 2 months of care.
• Family caregivers who received the right amount of emotional and spiritual support from the hospice care team.
• Adult hospital patients who sometimes or never had good communication about medications they received in the hospital.

More than half of the Person-Centered Care measures showed significant improvement, with measures of communication between individuals and providers showing the greatest improvement.

Improving Trend: Discussions About Pain for Individuals in Home Health Care

More than 50 million adults in the United States have chronic daily pain. Best practices for pain management emphasize person-centered care in the diagnosis and treatment of pain. 18 However, individuals can be reluctant to discuss pain with their providers. 19 It is imperative for providers to openly discuss, actively monitor, and accurately assess pain with those in their care, as collaborative and effective interventions can improve individuals’ pain. 20 Pain assessment and pain management are also requirements for accrediting home health organizations. 21

Adults who reported that home health care providers talk ed about pain in the last 2 months of care, 2012–2019. Note: The benchmark calculation takes the average of the top 10% of states with statistically reliable data. U.S. territories are not (more...)

• From 2012 to 2019, overall, the percentage of adults who reported that home health care providers talked about pain in the last 2 months of care increased from 87.5% to 90.0% ( Figure 1 ).
• The 2015 achievable benchmark was 91.3%. At the current rate of increase, overall, the benchmark could be achieved in 3 years.
• The top 10% of states that contributed to the achievable benchmark were Alabama, Missouri, New Mexico, North Dakota, Oklahoma, West Virginia, and Wisconsin. One territory, Guam, was not included in the benchmark but was in the benchmark range.

Improving Trend: Emotional and Spiritual Support for Family Caregivers

Hospice care increasingly relies on unpaid caregivers in home and other community settings, a difficult role for people who may not be formally trained, as “responsibilities must be managed while simultaneously witnessing and coping with the impending death of a loved one.” 22 However, quality of care can decline as caregivers’ anxiety and depression increase. 23 Addressing the emotional and spiritual well-being of family caregivers is therefore an essential part of effective hospice care for both the caregiver and the patient.

Family caregivers who received the right amount of emotional and spiritual support from the hospice care team, 2015–2019. Note: The benchmark calculation takes the average of the top 10% of states with statistically reliable data. U.S. territories (more...)

• From 2015 to 2019, overall, the percentage of family caregivers who received the right amount of emotional and spiritual support from the hospice care team increased from 88.8% to 90.0% ( Figure 2 ).
• The 2015 achievable benchmark was 90.9%. At the current rate of increase, overall, the benchmark could be achieved in 3 years.
• The top 10% of states that contributed to the achievable benchmark were Arkansas, Idaho, Kentucky, North Carolina, and West Virginia.

Improving Trend: Communication About Medication for Inpatients

Inpatients often receive medications during their hospital stay. For example, 80% of ED visits involve drug therapy. 24 Good communication between the individual and the healthcare provider decreases the risk of medication-related adverse events 25 and has also been shown to increase adherence to prescription medications. 26 , 27 Therefore, effectively discussing medications is a key component of communication between individuals and providers.

Adult hospital patients who sometimes or never had good communication about medications they received in the hospital, 2009–2019 (lower rates are better). Note: The benchmark calculation takes the average of the top 10% of states with statistically (more...)

• From 2009 to 2019, overall, the percentage of adult hospital patients who sometimes or never had good communication about medications they received in the hospital decreased from 12.7% to 10.8% ( Figure 3 ).
• The 2015 achievable benchmark was 7.8%. At the current rate of increase, overall, the benchmark could not be achieved for 15 years.
• The top 10% of states that contributed to the achievable benchmark were Alabama, Alaska, Colorado, Kansas, Mississippi, South Dakota, Utah, and Wyoming. One territory, the Virgin Islands, was not included in the benchmark but its percentage was in the benchmark range.
• Through its Consumer Assessment of Healthcare Providers and Systems (CAHPS ® ) program, the Agency for Healthcare Research and Quality (AHRQ) has been dedicated to advancing scientific knowledge, measurement, and improvement of person-centered care since 1995. The CAHPS surveys assess healthcare quality by asking patients to report on
• their experiences with care. Survey findings are used to monitor and drive improvements in experience with care and better inform consumers about healthcare providers in their area. Users of CAHPS surveys include the Centers for Medicare & Medicaid Services (CMS), National Committee for Quality Assurance, Department of Veterans Affairs, and Department of Defense.
• The HHS Office of Minority Health has developed Think Cultural Health , a website featuring information, resources, and continuing education opportunities related to culturally and linguistically appropriate services (CLAS) and the National CLAS Standards for healthcare professionals.
• The HHS Office for Civil Rights (OCR) Medical School Curriculum Initiative educates future healthcare practitioners about OCR’s civil rights authorities to prevent and address racial and ethnic health disparities. Since 2009, OCR has presented the medical school curriculum to approximately 8,500 medical school, nursing, and allied health students, including professional school and undergraduate students. As part of this initiative, OCR takes part in the Association of American Medical Colleges’ Summer Health Professionals Education Program (SHPEP). Through the SHPEP, OCR has provided training to nearly 1,000 premedical and predental college students at a dozen universities every summer since 2014. Currently, SHPEP trainings consist of two modules. The first module, launched in 2014, addresses compliance with Title VI of the Civil Rights Act of 1964, which prohibits recipients from discriminating on the basis of race, color, or national origin. It also covers Title IX of the Education Amendments of 1972 and Section 1557 of the Affordable Care Act (Section 1557), which prohibit harassment and discrimination on the basis of sex (including pregnancy, sexual orientation, and gender identity) in education and health programs or activities funded by HHS. In 2020, OCR added a second module on effective communication requirements for individuals who are deaf or hard of hearing, pursuant to Section 1557, Section 504 of the Rehabilitation Act of 1973, and the Americans With Disabilities Act.
• The Administration for Community Living (ACL) and CMS administer the National Center on Advancing Person-Centered Practices and Systems (NCAPPS) to help states, tribes, and territories apply person-centered thinking, planning, and practice. NCAPPS provides technical assistance, learning collaboratives, public monthly webinars, and a resource clearinghouse dedicated to improving education about and implementation of person-centered principles.
• The Veterans Health Administration (VHA) Office of Patient Centered Care & Cultural Transformation is transforming from the traditional model of healthcare to a personalized, proactive, patient-driven model through the Whole Health program .

An individual’s experience is also affected by health literacy levels. AHRQ has produced a toolkit called the SHARE approach , which involves a five-step process for shared decision making and tools to help individuals and providers ensure clear understanding and communication with one another.

Examining Person-Centered Care Quality Measures by Setting of Care

Number and percentage of all person-centered care measures improving, not changing, or worsening from 2002 to 2019, by setting of care. Key: n = number of measures. Note: For each measure with at least four data points over time, the estimates are realigned (more...)

Core measures listed below are noted as improving (green) or not changing (yellow). More information on how this analysis is conducted is available in the NHQDR Introduction and Methods . More details about the measures shown here are available at the NHQDR website ( https://datatools.ahrq.gov/nhqdr ).

Hospital Measures. Among the core Person-Centered Care measures, only one speaks to inpatient quality of care. The inpatient quality of care measure improved.

Ambulatory Measures. Among eight measures related to ambulatory care, six were improving over time and two were not changing. These measures include experience of care measures that examine communication between individuals and providers over the course (more...)

Home Health Care Measures. Among nine home health care measures, four improved over time. Five measures showed no statistically significant change.

Hospice Care Measures. Among eight hospice care outcome measures, three improved over time. Five measures showed no statistically significant change.

• Trends in Patient Safety

The Institute of Medicine (IOM) xiv defines patient safety as “freedom from accidental injury due to medical care or medical errors.” 28 In 1999, the IOM published their landmark report, To Err Is Human: Building a Safer Health System , 28 which called for a national effort to reduce medical errors and improve patient safety. Since then, AHRQ has been the federal lead for patient safety research. xv

The IOM report was the impetus for the Patient Safety and Quality Improvement Act of 2005. The Act outlined a patient safety reporting system to provide anonymous and aggregated data about patient safety events, including the creation of AHRQ’s Network of Patient Safety Databases (NPSD) and certification of listed Patient Safety Organizations (PSOs).

In 2015, the National Academy of Medicine built on its initial report on patient safety by publishing Improving Diagnosis in Health Care , which identifies eight major goals for effecting progress on diagnostic error and improving patient safety outcomes. 12 Although improving diagnostic safety and quality was not fully addressed in To Err is Human , the patient safety field has now established consensus that more attention needs to be placed on reducing diagnostic error.

In 2020, AHRQ published an updated synthesis of the scientific evidence for various patient safety practices, Making Healthcare Safer III ( https://www.ahrq.gov/research/findings/making-healthcare-safer/mhs3/index.html ). This compendium summarizes the evidence for 47 different patient safety practices that address 17 different harm areas, such as healthcare-associated infections, medication management, and diagnostic safety.

More recently, AHRQ released Strategies to Improve Patient Safety: Draft Report to Congress for Public Comment and Review by the National Academy of Medicine ( https://pso.ahrq.gov/sites/default/files/wysiwyg/strategies-to-improve-patient-safety_draft-report.pdf ) for public comments in December 2020. This draft report provides an overview of the Patient Safety and Quality Improvement Act of 2005, strategies for reducing medical errors and increasing patient safety, and recommendations for encouraging the use of patient safety strategies.

• Reducing preventable hospital admissions and readmissions,
• Reducing the incidence of adverse healthcare-associated conditions (HACs), and
• Reducing harm from inappropriate or unnecessary care.

To meet these goals, AHRQ supports research and quality improvement programs to reduce healthcare-associated infections (HAIs) and HACs, adverse drug events, and other preventable adverse events. In particular, a common cause of adverse events is gaps in communication either between providers or with patients, their family members, or caregivers.

Communication gaps may occur unintentionally and may result from implicit biases among healthcare providers. 29 Thus, researchers, providers, and policymakers are considering patient safety and person-centered care together to better understand breakdowns in care so that patients experience safer care and better health outcomes.

Importance of Patient Safety

Findings on patient safety.

• Healthcare-Associated Infections.
• Surgical Care.
• Other Complications of Hospital Care.
• Complications of Medication.
• Birth-Related Complications.
• Maternal Morbidity and Mortality.
• Inappropriate Treatment.
• Supportive and Palliative Care.

Data for these measures can be found at https://datatools.ahrq.gov/nhqdr . More information on maternal morbidity and mortality measures, including measures related to postpartum hemorrhage, eclampsia/preeclampsia, and cesarean delivery, can be found in the NHQDR Chartbook on Patient Safety .

Measures related to urinary tract infections and pressure ulcers in nursing home residents were better than the benchmark.

• Long-stay nursing home residents with a urinary tract infection.
• Short-stay nursing home patients with pressure ulcers that are new or worsened.
• Adverse drug event with IV heparin in adult hospital patients who received an anticoagulant.
• Adults who reported a home health care provider asking to see all the prescription and over-the-counter medicines they were taking, when they first started getting home health care.

Improving Trend: Urinary Tract Infections Among Nursing Home Residents

Urinary tract infections are one of the most frequent types of infections among nursing home residents. These residents typically have other comorbidities and may not receive timely diagnoses, “leading to increased rates of adverse drug effects and more recurrent infections with drug-resistant bacteria.” 33

Long-stay nursing home residents with a urinary tract infection, 2013–2018 (lower rates are better). Note: The benchmark calculation takes the average of the top 10% of states with statistically reliable data. U.S. territories are not included (more...)

• From 2013 to 2018, overall, the percentage of long-stay nursing home residents with a urinary tract infection decreased from 4.9% to 2.0% ( Figure 5 ).
• The 2015 achievable benchmark was 2.8%. The national rate in 2018 was better than the benchmark percentage.
• The top 10% of states that contributed to the achievable benchmark were California, Connecticut, Hawaii, New Jersey, and New Mexico.

Improving Trend: New or Worsening Pressure Ulcers Among Nursing Home Patients

Pressure ulcers, also known as bedsores, are injuries to the skin typically caused by pressure against the skin in people with limited mobility. The earlier pressure ulcers are identified, the easier they are to treat. Chronic pressure ulcers are often more difficult to treat and recur after healing. Severe pressure ulcers may require surgery. Although they are typically preventable, pressure ulcers affect more than 3 million people each year. 34 , 35

Short-stay nursing home patients with pressure ulcers that are new or worsened, 2013–2018 (lower rates are better). Note: The benchmark calculation takes the average of the top 10% of states with statistically reliable data. U.S. territories are (more...)

• From 2013 to 2018, overall, the percentage of short-stay nursing home patients with pressure ulcers that are new or worsened decreased from 0.68% to 0.23% ( Figure 6 ).
• The 2015 achievable benchmark was 0.31%. The national rate in 2018 was better than the benchmark percentage.
• The top 10% of states that contributed to the achievable benchmark were Arizona, Hawaii, Nevada, Utah, and Vermont.

Improving Trend: Adverse Drug Events With Heparin and Factor Xa

Adverse drug events (ADEs) include medication errors and adverse drug reactions, representing a major source of harm among hospitalized patients. Anticoagulant drugs are some of the most implicated medications causing ADEs in hospitalized patients and many of their associated ADEs may be preventable. 36

Anticoagulant drugs include warfarin, unfractionated heparin (UFH), and low-molecular-weight heparin (LMWH). UFH and LMWH are used to prevent venous thromboembolic disease on acute or elective admission to the hospital and to treat deep vein thrombosis and pulmonary embolism. Factor Xa is used to reverse the effects of certain anticoagulant drugs when bleeding becomes uncontrolled.

Adverse drug event with IV heparin in adult hospital patients who received an anticoagulant, 2014–2019 (lower rates are better). Note: Data were pooled for 2018 and 2019.

• From 2014 to 2019, overall, the percentage of inpatient adults who received an anticoagulant and experienced an ADE associated with IV heparin decreased from 11.1% to 5.8% ( Figure 7 ).

Worsening Trend: Home Health Care Provider Checking Medication

Home health care providers’ asking to see all prescribed and over-the-counter medications is a preliminary step in ensuring that patients take only medications appropriate to their condition and understand why, when, and how much of each medication to take. This step may be especially important in protecting against medication errors and adverse events after transitions from facility-based institutional care to care in the community. 37

This measure focuses on patients’ recollection of their experience with the home health care agency. It is important to note that the skill sets and required background training of home health care workers vary substantially across states. While home health care workers in some states may be trained to assist providers in medication reconciliation, workers in other states may not. Medication reconciliation is a key part of ambulatory care.

Adults who reported a home health care provider asking to see all the prescription and over-the-counter medicines they were taking when they first started getting home health care, 2012–2019. Note: The benchmark calculation takes the average of (more...)

• From 2012 to 2019, overall, the percentage of adults who reported a home health care provider asking to see all the prescription and over-the-counter medicines they were taking when they first started getting home health care decreased from 78.8% to 76.3% ( Figure 8 ).
• The 2015 achievable benchmark was 85.5%. There is no evidence of progress toward the benchmark.
• The top 10% of states that contributed to the achievable benchmark were Alabama, Arkansas, Louisiana, Mississippi, Texas, and West Virginia. Four territories, Guam, Northern Mariana Islands, Puerto Rico, and Virgin Islands, while not included in the benchmark, had percentages within the benchmark range.

One home health care measure showed widening disparities over time between Asian people and White people: Oral medication management among home health care patients (see Disparities section, Racial and Ethnic Disparities ).

Efforts to promote patient safety are underway within HHS. The following are examples of resources available related to patient safety background, education and training, toolkits, data, and surveys. Additional resources can be found on AHRQ’s Patient Safety site .

• The National Steering Committee for Patient Safety is cochaired by AHRQ and the Institute for Healthcare Improvement with members from the healthcare, policy, regulatory, and advocacy communities. The committee is charged with creating a national action plan to guide patient safety efforts across the country in a cohesive and coordinated fashion.
• Recognizing the role ADE prevention plays in improving patient safety, the Office of Disease Prevention and Health Promotion developed the National Action Plan for Adverse Drug Event Prevention . The initial targets of the Action Plan are bleeding related to use of anticoagulants; hypoglycemia related to use of diabetes medications; and accidental overdose, oversedation, and respiratory depression related to use of opioids. The plan suggests a four-pronged approach of surveillance, prevention, incentives and oversight, and research.
• AHRQ implements the Patient Safety and Quality Improvement Act of 2005 except for the confidentiality and related enforcement provisions delegated to the Office for Civil Rights. The goal of the Act is to improve patient safety, in part by creating federally listed PSOs to collect and analyze aggregated, privileged, and confidential data on patient safety events.
• AHRQ maintains PSNet , a web-based tool with more than 15,000 resources, providing the latest literature, news, and commentary on patient safety. PSNet includes weekly literature updates, news, tools, and meetings; patient safety primers; and annotated links to important research and other information on patient safety.
• Morbidity and Mortality Rounds on the Web ( Web M&M ) is a peer-reviewed online journal and forum on patient safety and healthcare quality. It provides case reports, safety perspectives, and expert analysis.

Education and Training

• AHRQ sponsors the Comprehensive Unit-based Safety Program (CUSP). This patient safety method combines improvement in safety culture, teamwork, and communication with a set or checklist of evidence-based practices known to be effective in preventing HAI or other harms. It builds the capacity to address safety issues by combining clinical best practices and the science of safety. The core CUSP principles can be applied to reduce and eliminate HAIs and perinatal safety events. AHRQ has sponsored 10 related programs to date. CUSP also provides a 23-minute video, Understand the Science of Safety .
• AHRQ, with the Department of Defense, sponsored the development of Team Strategies and Tools to Enhance Performance and Patient Safety ( TeamSTEPPS ® ). TeamSTEPPS is an evidence-based set of teamwork tools aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals. The TeamSTEPPS curriculum is available online and can be used to train inpatient, nursing home, and medical office providers.
• AHRQ developed the SHARE Approach and workshop curriculum to provide a comprehensive resource to healthcare staff, with materials supporting shared decision making between providers, patients, and patients’ caregivers.
• AHRQ’s Health Literacy microsite includes improvement tools, such as the AHRQ Health Literacy Universal Precautions Toolkit , to promote better understanding by all patients. It also provides education and trainings to increase health literacy and publications related to health literacy. The microsite includes the AHRQ Pharmacy Health Literacy Center .
• Communication and Optimal Resolution (CANDOR) is a process healthcare institutions and practitioners can use to respond in a timely, thorough, and just way when unexpected events cause patient harm. AHRQ has pilot tested and produced the CANDOR Toolkit for hospitals and healthcare systems to implement as a process for responding to harm events and initiating improvements in safety outcomes.
• AHRQ created the On-Time Pressure Ulcer Prevention Toolkit to help nursing homes with electronic medical records reduce the occurrence of in-house pressure ulcers.
• AHRQ developed the Safety Program for Perinatal Care (SPPC) to improve the patient safety culture of labor and delivery units and decrease maternal and neonatal adverse events resulting from poor communication and system failures. The SPPC developed the Toolkit for Improving Perinatal Safety around three program pillars: teamwork and communication skills, perinatal safety strategies, and in situ simulation training.
• To improve consistency between a patient’s current medication regimen and physicians’ orders, AHRQ funded the development of the Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for medication reconciliation.
• AHRQ provides toolkits to reduce specific HAIs, including Toolkit for Reduction of Clostridium difficile Infections Through Antimicrobial Stewardship , Toolkit for Reducing Catheter-Associated Urinary Tract Infections (CAUTIs) in Hospitals , and Toolkit for Reducing Central Line-Associated Blood Stream Infections (CLABSIs) .
• Recognizing that medical errors can occur during transitions in care due, in part, to a lack of effective communication, AHRQ funded the Toolkit to Engage High-Risk Patients in Safe Transitions Across Ambulatory Settings . The goal is to help providers actively engage patients and their care partners to prevent errors during transitions of care from one ambulatory setting to another.
• AHRQ provides the Toolkit to Promote Safe Surgery to reduce patient safety events in hospitals and the Toolkit to Improve Safety in Ambulatory Surgery Centers to improve patient safety in ambulatory settings.
• AHRQ’s Network of Patient Safety Databases consists of patient safety data submitted by providers through PSOs that can be used for national learning to improve patient safety. The NPSD represents the first attempt to collect this type of comprehensive data on a national scale, and its data reporting tools include annually updated dashboards and chartbooks. Findings based on the 2020 NPSD Dashboards are presented below.
• The AHRQ National Scorecard on Hospital-Acquired Conditions provides longitudinal data and reports related to trends across hospital-acquired conditions overall and for specific conditions, such as ADEs, HAIs, and falls. The scorecard also provides data visualization tools.
• The Centers for Disease Control and Prevention (CDC) HAI and Antibiotic Use Prevalence Survey assesses the prevalence and types of HAIs, types of antimicrobial medications (e.g., antibiotics), and ways antimicrobial medications are used in hospitals and nursing homes. Especially with the rise in antibiotic-resistant strains of germs such as bacteria and fungi, the survey is critical in tracking HAIs and the medications used to treat them.
• AHRQ funded the development of the Surveys on Patient Safety Culture (SOPS ® ) to give healthcare staff resources to assess the patient safety and healthcare quality in their facility. The surveys are tailored to the healthcare setting and are available for hospitals, medical offices, nursing homes, community pharmacies, and ambulatory surgery centers.
• AHRQ oversees and funds the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. The surveys assess patient experiences with their providers, healthcare facilities, and health plans. CAHPS databases provide aggregated data from select CAHPS surveys.
• CDC’s National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) may be used to assess various procedures and screenings (or lack thereof) when certain diagnoses are present, in relation to some guideline or best practice. In addition, NHAMCS collects data from ED visits related to injuries and falls.

Additional Resources

• AHRQ funds the Nursing Home COVID-19 Action Network to support the implementation of patient safety and quality best practices in nursing homes to reduce the spread of COVID-19.
• Information about outpatient antibiotic prescribing rates and implementation of hospital antibiotic stewardship programs by state;
• National Healthcare Safety Network Antimicrobial Use Option updates and success stories;
• Recent literature highlighting progress made and opportunities for improvement;
• New and updated resources for health departments, facilities, and healthcare professionals to implement antibiotic stewardship; and
• Examples of key contributions to improve antibiotic prescribing practices.
• Presents information on select HAIs across four healthcare settings: acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, and long-term acute care hospitals.
• Provides national- and state-level data about HAI incidence during 2020, primarily focusing on the following HAIs: CLABSIs, CAUTIs, ventilator-associated events (VAEs), surgical site infections (SSIs), methicillin-resistant Staphylococcus aureus (MRSA) bloodstream events, and Clostridioides difficile ( C. difficile ) events.
• Assesses the impact of the COVID-19 pandemic on HAI incidence.

Examining Patient Safety Quality Measures by Setting of Care

Number and percentage of all patient safety measures improving, not changing, or worsening from 2002 to 2019, by setting of care. Key: n = number of measures. Note: Patient safety measures include measures related to nursing home resident safety. For (more...)

Core measures listed below are noted as improving (green), not changing (yellow), or worsening (red) over time. More information on how this analysis is conducted is available in the NHQDR Introduction and Methods . More details about the measures shown here are available at the NHQDR website ( https://datatools.ahrq.gov/nhqdr ).

Hospital Measures. Among 11 Patient Safety measures for inpatients, 2 measures were improving and 9 were not changing. The improving measures were related to medication safety and HAIs.

Ambulatory Measures. Both of the two ambulatory care Patient Safety measures were improving over time. Both were process measures pertaining to prescription medications.

Home Health Care Measures. Among eight home health care measures, three measures were improving over time, one of which examines a healthcare outcome by looking at oral medication management. One measure was worsening over time, home health care provider (more...)

Nursing Home Care Measures. Among five nursing home care measures, four were improving over time. The one measure that was not changing over time examines long-stay (e.g., 100+ days) nursing home patients who experience injuries after falls.

Examining Patient Safety Data Reported to the Network of Patient Safety Databases by AHRQ-Listed Patient Safety Organizations

The NPSD provides an interactive, evidence-based resource for providers, PSOs, and others with the capacity to accept, aggregate, and analyze nonidentifiable patient safety work product submitted by PSOs from across the country. The NPSD is a unique source of data that supports national learning into how and why patient safety events occur by providing insight into areas such as contributing factors.

The NPSD strives to make data publicly available at a level of detail that is useful for learning about patient safety, but it must do so without compromising the confidentiality of patients, providers, and reporters. The NPSD does not contain a representative sample of patient safety concerns and cannot be used to calculate the actual incidence or prevalence of patient safety concerns.

The data presented in this section are based on the NPSD Dashboards , visualization products based on more than 1.7 million records reported by healthcare providers to approximately 15% of AHRQ-listed PSOs . Providers and PSOs that contribute data play an essential role in growing the NPSD into a more robust national resource for patient safety and quality improvement. The voluntarily submitted patient safety data include information about patient safety concern (event types), report type, extent of harm, and event type-specific details.

The data below are a subset of figures available on the NPSD Dashboards. Figures 10 – 12 present data across multiple patient safety concerns (event types) from the NPSD Generic Dashboard. Figures 13 – 16 provide information on four of the patient safety concern-specific dashboards (Blood and Blood Product Dashboard; Device or Medical/Surgical Supply, Including HIT, Dashboard; Falls Dashboard; and Medication or Other Substance Dashboard).

Distribution of Patient Safety Concerns (Event Types) Reported to the Network of Patient Safety Databases by AHRQ-Listed Patient Safety Organizations, 2009–2019. Note: Patient safety concerns (event types) also include healthcare-associated infection (more...)

• In 2009–2019, most reported patient safety concerns were categorized as an “other” event type (50.6%) ( Figure 10 ). Medication or other substance (22.6%) and fall (10.7%) were the next most common types of reported patient safety concerns.

Distribution of Report Type by Patient Safety Concerns (Event Types) Reported to the Network of Patient Safety Databases by AHRQ-Listed Patient Safety Organization, 2009–2019. Note: Patient safety concerns (event types) also include healthcare-associated (more...)

• In 2009–2019, 100% of reported fall, perinatal, and pressure ulcer patient safety concerns were incidents ( Figure 11 ). The percentage of near-miss reports was highest for device or medical/surgical supply (28.4%) and medication or other substance (27.3%). The percentage of reported unsafe conditions was highest for other event types (9.6%) and device or medical/surgical supply (9.0%).

Distribution of Extent of Harm by Patient Safety Concerns (Event Types) Reported to the Network of Patient Safety Databases by AHRQ-Listed Patient Safety Organizations, 2009–2019. Note: Patient safety concerns (event types) also include healthcare-associated (more...)

• In 2009–2019, blood or blood product patient safety concerns had the highest percentage of no harm reported (64.6%), and pressure ulcer had the highest percentage of mild harm reported (70.1%) ( Figure 12 ). Surgery or anesthesia had the highest percentage of moderate harm (6.3%), severe harm (1.0%), and death reported (1.0%).

Distribution of Process Stage When Blood or Blood Product Event Originated Reported to the Network of Patient Safety Databases by AHRQ-Listed Patient Safety Organizations, 2009–2019. Note: The percentages for sample receipt and unknown categories (more...)

• In 2009–2019, posttransfusion or administration (15.8%), other process (12.8%), and sample collection (12.0%) were the three most commonly reported process stages for blood or blood product patient safety concerns ( Figure 13 ).

Distribution of Device Type for Device or Medical/Surgical Supply Patient Safety Concern Reported to the Network of Patient Safety Databases by AHRQ-Listed Patient Safety Organizations, 2009–2019. Note: Patient safety concerns related to device (more...)

• In 2009–2019, medical equipment (77.8%) was the most commonly reported device type for patient safety concerns related to device or medical/surgical supply. Implantable device (4.9%) was the least commonly reported device type ( Figure 14 ).

Distribution of Injury Type Experienced by Patient With Fall Resulting in Injury Reported to the Network of Patient Safety Databases by AHRQ-Listed Patient Safety Organizations, 2009–2019. Note: The patient outcomes for fall include no injury, (more...)

• In 2009–2019, the most commonly reported fall-related injuries were a skin tear, avulsion, hematoma, or significant bruising (39.8%) and “other injury” not specified on the form (39.7%) ( Figure 15 ).

Distribution of Incorrect Actions for Medication or Other Substance Patient Safety Concern Reported to the Network of Patient Safety Databases by AHRQ-Listed Patient Safety Organizations, 2009–2019. Note: Incorrect dosage form refers to incorrect (more...)

• In 2009–2019, other incorrect action (32.8%), incorrect dose (25.5%), and incorrect medication or substance (11.5%) were the three most commonly reported types of incorrect action for medication or other substance patient safety concerns ( Figure 16 ).
• Trends in Care Coordination

Healthcare delivery in the United States can be fragmented. Clinical services are frequently organized around small groups of providers who function autonomously and specialize in specific symptoms or organ systems. Therefore, many patients receive attention only for individual health conditions rather than receiving coordinated care. For example, the typical Medicare beneficiary sees a median of two primary care providers and five specialists working in four different practices each year. 38 Communication of important information among providers and between providers and patients and caregivers may entail delays or inaccuracies or may fail to occur.

Care coordination is a conscious effort to ensure that all key information needed to make care decisions is available to patients and providers. It is defined as the deliberate organization of patient care activities between two or more participants involved in a patient’s care to facilitate appropriate delivery of healthcare services. 39 Care coordination is multidimensional and essential to preventing adverse events, ensuring efficiency, and making care person centered. 40

• Multiple chronic medical conditions,
• Concurrent care from several health professionals across care settings,
• Many medications,
• Extensive diagnostic workups, and
• Transitions from one care setting to another.

Effective care coordination requires well-defined multidisciplinary teamwork based on the principle that all who interact with a person must work together to ensure the delivery of safe, high-quality care in every setting.

The goal of care coordination is to enable healthcare providers, patients, and caregivers to all work together to understand and make sure that “patient’s needs and preferences are known and communicated at the right time to the right people and that this information is used to guide the delivery of safe, appropriate, and effective care.” 41 While measurement of care coordination is at an early stage of development, key goals include coordinating transitions of care, reducing hospital readmissions, communicating medication information, and reducing preventable ED visits.

Importance of Care Coordination

• Reduce mortality among patients with heart failure;
• Reduce mortality and dependency among patients with stroke;
• Reduce symptoms among patients with depression and at the end of life; and
• Improve glycemic control among patients with diabetes. 39
• Reduce hospitalizations among patients with heart failure;
• Reduce readmissions among patients with mental health conditions; and
• Be cost-effective when applied to treatment of depression. 39

Findings on Care Coordination

• Medication Information.
• Preventable Emergency Department Visits.
• Preventable Hospitalizations Among Home Health Patients.
• Transitions of Care.
• Preventable Hospitalizations.
• Potentially Harmful Services Without Benefit.
• Potentially Avoidable Admissions.

Progress in Care Coordination in certain settings has been slow, with little improvement and three measures getting worse.

• Home health care patients who had timely initiation of care.
• Home health care patients who had to be admitted to the hospital.
• Adult hospital patients who did not receive good communication about discharge information.
• Emergency department visits for asthma per 10,000 population, ages 2–19.
• Home health care patients who had an emergency department visit without a hospitalization.
• Adult hospital patients who strongly disagree or disagree that staff took their preferences and those of their family and caregiver into account when deciding what the patient’s discharge healthcare would be.

Improving Trend: Initiation of Home Health Care

The demand for home health care services is increasing due to the growing older population, rising rates of chronic conditions, personal preferences, and advances in the provision of health-related services in patients’ homes. In 2017, 11,844 home health agencies served 3.4 million Medicare beneficiaries at a cost of $17.7 billion. 42

Home health care patients who had timely initiation of care, 2013–2018. Note: The benchmark calculation takes the average of the top 10% of states with statistically reliable data. U.S. territories are not included in the calculations. Some benchmarks (more...)

• From 2013 to 2018, overall, the percentage of home health care patients who had timely initiation of care increased from 90.4% to 94.0% ( Figure 17 ).
• The 2015 achievable benchmark was 94.9%. At the current rate of increase, overall, the benchmark could be achieved in 1 year.
• The top 10% of states that contributed to the achievable benchmark were Louisiana, Nebraska, North Dakota, South Dakota, and West Virginia.

Improving Trend: Hospitalization of Home Health Care Patients

Nearly 20% of all Medicare beneficiaries discharged from hospitals are rehospitalized within 30 days and 34% are rehospitalized within 90 days. 43 Reducing the rate of acute care hospitalization for Medicare beneficiaries receiving home health benefits can improve quality and reduce healthcare costs.

Home health care patients who had to be admitted to the hospital, 2013–2018 (lower rates are better). Note: The benchmark calculation takes the average of the top 10% of states with statistically reliable data. U.S. territories are not included (more...)

• From 2013 to 2018, overall, the percentage of home health care patients who had to be admitted to the hospital decreased from 15.0% to 11.5% ( Figure 18 ).
• The 2015 achievable benchmark was 10.5%. There is no evidence of progress toward the benchmark.
• The top 10% of states that contributed to the achievable benchmark were Colorado, Delaware, Montana, South Dakota, and Utah.

Improving Trend: Communication About Discharge Information

Effective care coordination begins with ensuring that accurate clinical information is available to support medical decisions by patients and providers. A common transition of care is discharge from the hospital. Giving patients and caregivers self-management support after discharge has been shown to reduce readmissions to the hospital and lower costs. 44

Adult hospital patients who did not receive good communication about discharge information, 2009–2019 (lower rates are better). Note: The benchmark calculation takes the average of the top 10% of states with statistically reliable data. U.S. territories (more...)

• From 2009 to 2019, overall, the percentage of adult hospital patients who did not receive good communication about discharge information decreased from 15.8% to 10.7% ( Figure 19 ).
• The 2015 achievable benchmark was 7.7%. At the current rate of decrease, overall, the benchmark could be achieved in 6 years.
• The top 10% of states that contributed to the achievable benchmark were Colorado, Nebraska, New Hampshire, South Dakota, and Utah.

Worsening Trend: Emergency Department Visits for Asthma Among Children

In 2019, 20 million adults and 5.1 million children in the United States had asthma. 45 Access to care is hampered by socioeconomic disparities, shortages of primary care physicians in minority communities, and language and literacy barriers. 46

Emergency department visits for asthma per 10,000 population, ages 2–19, 2006–2017 (lower rates are better).

• From 2006 to 2017, overall, the rate of ED visits for asthma among people ages 2–19 years increased from 82.5 to 91.2 per 10,000 population ( Figure 20 ).

Worsening Trend: Emergency Department Visits of Home Health Care Patients

Home health care patients can often manage their care with a home health care provider’s support and coordination. When a patient’s need exceeds the resources available to a home health care provider, the provider may refer the patient to an ED.

An ED visit for an urgent need or assessment without a hospitalization is a positive outcome; however, without care coordination, patients may experience similar or related emergencies and return to the ED. Such recurrences can lead to increased costs to the patient and poor health outcomes.

Home health care patients who had an emergency department visit without a hospitalization, 2013–2018 (lower rates are better). Note: The benchmark calculation takes the average of the top 10% of states with statistically reliable data. U.S. territories (more...)

• From 2013 to 2018, overall, the percentage of home health care patients who had an ED visit without a hospitalization increased from 3.5% to 3.9% ( Figure 21 ).
• The 2015 achievable benchmark was 2.8%. There is no evidence of progress toward the benchmark.
• The top 10% of states that contributed to the achievable benchmark were Alabama, District of Columbia, Florida, New Jersey, and Texas. Puerto Rico was not included in the benchmark calculation but its percentage was in the benchmark range.

Worsening Trend: Staff Consideration of Patient Preferences on Discharge

Effective care coordination begins with ensuring that accurate clinical information is available to support medical decisions by patients and providers. A common transition of care is discharge from the hospital. Giving patients and caregivers self-management support after discharge has been shown to reduce readmissions to the hospital and lower costs. 40

Adult hospital patients who strongly disagree or disagree that staff took their preferences and those of their family and caregiver into account when deciding what the patient’s discharge healthcare would be, 2014–2019 (lower rates are (more...)

• From 2014 to 2019, overall, the percentage of adult hospital patients who strongly disagree or disagree that staff took their preferences and those of their family and caregiver into account when deciding what the patient’s discharge healthcare would be increased from 5.4% to 5.9% ( Figure 22 ).
• The 2015 achievable benchmark was 3.2%. There is no evidence of progress toward the benchmark.
• The top 10% of states that contributed to the achievable benchmark were Iowa, Minnesota, Nebraska, South Dakota, and Utah.
• The Care Coordination Measures Atlas Update (published in 2014) expands on the atlas first published by AHRQ in 2011. The updated compendium of care coordination measures offers new measures with a focus on those that reflect coordination efforts within the primary care setting. It also includes a section on emerging trends in care coordination measurement.
• The CAHPS Home Health Care Survey asks patients who receive home health care services about their experiences with home health care agencies, providers, and staff. This instrument focuses on patients who receive skilled home health care services from Medicare-certified home health agencies. Skilled services refer to healthcare services provided by nurses and therapists, including physical, occupational, and speech-language therapists.
• The Clinical-Community Relationships Measures Atlas was published in 2013 to identify ways to further define, measure, and evaluate programs based on clinical-community relationships for the delivery of clinical preventive services. This atlas provides a measurement framework and lists existing measures of clinical-community relationships and is intended to support research and evaluation in the field.

Examining Care Coordination Quality Measures by Topic Areas

Number and percentage of all care coordination measures improving, not changing, or worsening from 2002 to 2019, by sub-area. Key: n = number of measures. Note: For each measure with at least four data points over time, the estimates are realigned to (more...)

Core measures listed below are noted as improving (green), not changing (yellow), or worsening (red) over time. More information on how this analysis was conducted is available in the NHQDR Introduction and Methods . More details about the measures shown here are available at the NHQDR website ( https://datatools.ahrq.gov/nhqdr ).

Medication Information Measures. One medication information measure improved over time.

Preventable Emergency Department Visit Measures. One measure pertaining to ED visits for asthma worsened over time.

Preventable Hospitalizations Among Home Health and Nursing Home Patient Measures. One measure pertaining to preventable ED visits did not change over time.

Supportive and Palliative Care Measures. Four measures under supportive and palliative care examine the experiences of home health care patients. Patient reporting of home health care provider awareness of the past treatment plan showed improvement whereas (more...)

Transitions of Care Measures. One measure pertaining to communication about discharge information improved over time and another examining patient experience of providers who considered their preferences worsened over time.

• Trends in Affordable Care

The goal of the Affordable Care Act was to establish quality, affordable healthcare for Americans. The law also created a platform to test new healthcare payment and delivery models through the Centers for Medicare & Medicaid Services. Tracking this quality domain helps healthcare professionals, researchers, and policymakers better understand the status of affordable care.

Reducing the cost of healthcare will support two related goals under this quality domain. The first includes ensuring affordable and accessible high-quality healthcare for people, families, caregivers, employers, and governments. The second is supporting and enabling communities to ensure accessible, high-quality care while reducing waste and fraud.

Importance of Affordable Care

Affordability of care remains a central barrier to access to care for many individuals and families and caregivers. Several financial and nonfinancial barriers contribute to the inaccessibility of care. Financial barriers include high premiums and copays, lack of insurance, and underinsurance. Nonfinancial barriers include transportation challenges, negative interactions with care teams, delayed access to a healthcare provider, and inability to access care due to competing demands (e.g., childcare, work schedules). 47 Past research continues to show that lack of insurance and inaccessible care are linked to patient mortality. 48 , 49

Cost of affordable care includes insurance, usual source of care, and personal medical expenditures.

Findings on Affordable Care

• Financial Burden of Healthcare.
• Usual Source of Care.
• People under age 65 whose family’s health insurance premium and out-of-pocket medical expenditures were more than 10% of total family income.
• People without a usual source of care who indicated a financial or insurance reason for not having a source of care.

Improving Trend: High Family Medical Expenditures

The most prominent barriers to healthcare coverage include affordability, eligibility for public coverage in a person’s state, immigration status, and lack of familiarity with signup procedures. 50 Poor health may require a family to spend more on healthcare, resulting in less income. Costs will vary based on each person or family’s needs and may inhibit a family’s ability to reach other goals. 51

People under age 65 whose family’s health insurance premium and out-of-pocket medical expenditures were more than 10% of total family income by insurance status, 2002–2018 (lower rates are better).

• From 2002 to 2018, for public health insurance, the percentage of people under age 65 whose family’s health insurance premium and out-of-pocket medical expenditures were more than 10% of total family income decreased from 17.7% to 12.7% ( Figure 24 ).

Improving Trend: Difficulty Accessing a Usual Source of Care

People with lower incomes may experience difficulty accessing affordable care and are less likely to have a usual source of care that is readily accessible. 51 People who are unwell and have low incomes are also more likely to experience poverty. 48

People without a usual source of care who indicated a financial or insurance reason for not having a source of care, by insurance status, 2002–2018 (lower rates are better).

• From 2002 to 2018, for public health insurance, the percentage of people without a usual source of care who indicated a financial or insurance reason for not having a source of care decreased from 18.5% to 17.9% ( Figure 25 ).
• The Department is working to transform the U.S. system from one that pays for procedures and sickness (volume-based care) to one that pays for outcomes and health (value-based care, or VBC). CMS operates multiple VBC programs , which span different settings of care (e.g., inpatient, home health) and conditions (e.g., end stage renal disease and hospital-acquired conditions). In January 2017, CMS implemented the Quality Payment Program for clinicians, which consists of two tracks: the Merit-based Incentive Payment Systems (MIPS); and participation in Advanced Alternative Payment Models. Both tracks commit clinicians to practicing VBC.
• The Health Resources and Services Administration (HRSA)-sponsored Federally Qualified Health Centers function as part of the nation’s safety net. These providers receive funds from the HRSA Health Center Program to provide primary care services in underserved areas.
• The Consumer Assistance Program originated as a state-based federal grant program. State programs offer direct assistance by phone, direct mail, email, or walk-in locations to help consumers learn how to obtain or use their insurance effectively.
• CMS produces Coverage to Care (C2C) , which offers healthcare coverage information in multiple languages for providers and consumers.

Examining Affordable Care Quality Measures by Sub-Areas

Number and percentage of all affordable care measures improving, not changing, or worsening from 2002 to 2018, by sub-area. Key: n = number of measures. Note: For each measure with at least four data points over time, the estimates are realigned to the (more...)

Financial Burden of Healthcare Measures. The core set of measures includes only one measure that specifically examines the financial burden of healthcare. This measure did not show statistically significant change over time.

Usual Source of Care Measures. Among all Affordable Care core measures, one usual source of care measure did not show statistically significant change over time.

• Trends in Effective Treatment

As better understanding of health has led to superior ways of preventing, diagnosing, and treating diseases, the health of most Americans has improved dramatically; however, more than half of all Americans are managing one chronic disease and do not receive the full benefits of high-quality care. 52 , 53

The Effective Treatment quality domain focuses on effective ways to prevent and treat the leading causes of mortality. The NHQDR focuses on leading causes of mortality because these conditions are important and have more robust data available. For organizational purposes, musculoskeletal disease, which is not a leading cause of death, is included in this section because it is a leading cause of functional limitation in the United States. Measures of tobacco cessation counseling and obesity care, which are also effective ways to reduce morbidity and mortality, are reported in the Healthy Living section.

Importance of Effective Treatment

• Heart disease: 659,041.
• Cancer: 599,601.
• Chronic lower respiratory diseases: 156,979.
• Stroke (cerebrovascular diseases): 150,005.
• Alzheimer’s disease: 121,499.
• Diabetes: 87,647.
• Nephritis, nephrotic syndrome, and nephrosis (kidney disorders): 51,565.
• Intentional self-harm (suicide): 47,511.

Effective primary and preventive care can help reduce the prevalence and mortality of these conditions.

Findings on Effective Treatment

• Management of Breast Cancer
• Deaths From Breast Cancer
• Management of Colorectal Cancer
• Deaths From Colorectal Cancer
• Deaths From Lung Cancer
• Control of High Blood Pressure
• Management of Dialysis for End Stage Renal Disease
• Kidney Transplantation for End Stage Renal Disease
• Management of Diabetes
• Prevention of Diabetes-Related Complications
• Prevention of HIV Infection
• Management of HIV Infection
• Deaths From HIV Infection
• Management of Depression
• Deaths From Suicide
• Management of Substance Use
• Healthcare Utilization for Opioid-Related Illness
• Management of Joint Pain
• Management of Viral Upper Respiratory Infections
• Management of Tuberculosis Infections

Measures cover preventive care, treatment of illness, chronic disease management, and outcomes of care. Data for these measures can be found at https://datatools.ahrq.gov/nhqdr .

The three Effective Treatment measures that worsened most overall are related to substance use or mental illness. Recent data point to important developments in the years since 2018 for both conditions.

• Doctor’s office and ED visits where antibiotics were prescribed for a diagnosis of common cold per 10,000 population.
• Patients with colon cancer who received surgical resection of colon cancer that included at least 12 lymph nodes pathologically examined.
• HIV infection deaths per 100,000 population.
• Emergency department visits involving opioid-related diagnoses per 100,000 population.
• Hospital inpatient stays involving opioid-related diagnoses per 100,000 population.
• Suicide deaths among people age 12 and over per 100,000 population.

Improving Trend: Antibiotics for Common Cold

Most people around the world will have one or more common cold episodes each year. However, common colds are caused by viruses, which do not respond to antibiotics, and antibiotics can cause side effects, such as adverse drug reactions and diarrhea. Overuse of antibiotics also leads to bacteria becoming resistant to antibiotics. 55

Doctor’s office, emergency department, and outpatient department visits where antibiotics were prescribed for a diagnosis of common cold per 10,000 population, 2010–2011 to 2016–2017 (lower rates are better).

• From 2010–2011 to 2016–2017, overall, the rate of doctor’s office and ED visits where antibiotics were prescribed for a diagnosis of common cold per 10,000 population decreased from 108.8 to 42.0 per 10,000 population ( Figure 27 ).

Improving Trend: Colon Cancer Treatment

Surgical removal is a potentially curative treatment for localized, early stage colon cancers. 56 Clinical practice guidelines recommend removal and examination of lymph nodes during surgical resection. Lymph node examination can identify otherwise undetected spread of cancer, inform prognosis, and guide postoperative management decisions, such as whether to also administer chemotherapy. Oncology research has shown that examination and removal of lymph nodes during surgical treatment of colon cancer are linked with better patient outcomes and survival. 57 , 58

Patients with colon cancer who received surgical resection of colon cancer that included at least 12 lymph nodes pathologically examined, 2005–2017. Note: The benchmark calculation takes the average of the top 10% of states with statistically (more...)

• From 2005 to 2017, overall, the percentage of patients with colon cancer who received surgical resection of colon cancer that included at least 12 lymph nodes pathologically examined increased from 59.9% to 92.9% ( Figure 28 ).
• The 2015 achievable benchmark was 95.4%. At the current rate of increase, overall, the benchmark could be achieved in 1 year.
• The top 10% of states that contributed to the achievable benchmark were District of Columbia, Maine, Massachusetts, Rhode Island, and Vermont.

Improving Trend: Deaths From HIV infection

HIV mortality rates are a function of the nation’s effectiveness in preventing new HIV infection and extending the lives of those already infected. In 2018, 37,881 new cases of HIV infection were diagnosed in the United States and its territories. 59 This 7% decrease in overall incidence between 2014 and 2018 can be attributed to public health prevention efforts, such as routine screening for HIV, use of pre- and postexposure prophylaxis, and educational campaigns.

Mortality for people with HIV infection has also decreased due to early linkage to specialty care, improved quality of care, and widespread use of anti-retroviral therapy (ART). It is now estimated that life expectancy of a patient with HIV infection who receives ART can approach that of a person without HIV infection. 60

Barriers to effective HIV treatment include lack of awareness of HIV status, difficulty accessing care for HIV, and difficulty remaining in care and treatment. In 2018, an estimated 1 in 7 people with HIV infection in the United States were unaware of their infection. 61

HIV infection deaths per 100,000 population, 2005–2018 (lower rates are better). Note: The benchmark calculation takes the average of the top 10% of states with statistically reliable data. U.S. territories are not included in the calculations. (more...)

• From 2005 to 2018, the overall rate of HIV infection deaths per 100,000 population improved from 4.2 to 1.5 ( Figure 29 ).
• The 2015 achievable benchmark was 0.75 per 100,000 population. At the current rate of increase, overall, the benchmark could be achieved in 3 years.
• The top 10% of states that contributed to the achievable benchmark were Kansas, Kentucky, Minnesota, Missouri, Ohio, and Washington.

Worsening Trend: Emergency Department Visits Involving Opioids

Opioid-related illness and deaths constitute a continuing public health emergency. 62 Drug overdose deaths quadrupled between 1999 and 2019, and opioid-related deaths accounted for the largest share of deaths during this period, with more than 70% of overdose deaths in 2019 involving an opioid. 63

In addition to the human toll, economic analyses published in 2017 estimate the opioid epidemic’s total cost to the nation to be $1.02 trillion, factoring in loss of life, reduced quality of life, healthcare utilization, criminal justice, and lost productivity. 64 Other analyses describe the unequal distribution of this burden, with per capita costs to states ranging between $1,204 (Hawaii) and $7,247 (West Virginia). 65

Emergency department visits involving opioid-related diagnoses per 100,000 population, 2005–2018 (lower rates are better). Note: The benchmark calculation takes the average of the top 10% of states with statistically reliable data. U.S. territories (more...)

• From 2005 to 2018, overall, the rate of ED visits related to opioid use increased from 89.1 to 238.0 per 100,000 population. The rate peaked at 249.1 emergency visits per 100,000 population in 2017 ( Figure 30 ).
• The 2015 achievable benchmark was 65.3 emergency visits per 100,000 population. There has been no progress toward the benchmark.
• The top 10% of states that contributed to the achievable benchmark were Iowa, Kansas, Nebraska, and South Dakota.

Worsening Trend: Hospital Stays Involving Opioids

Hospital inpatient stays involving opioid-related diagnoses per 100,000 population, 2005–2018 (lower rates are better). Note: The benchmark calculation takes the average of the top 10% of states with statistically reliable data. U.S. territories (more...)

• From 2005 to 2018, overall, the rate of hospital inpatient stays related to opioid use increased from 136.8 to 286.1 per 100,000 population. The rate peaked at 299.7 hospitalizations per 100,000 population in 2017 ( Figure 31 ).
• The 2015 achievable benchmark was 102.9 hospitalizations per 100,000 population. There has been no progress toward the benchmark.
• The top 10% of states that contributed to the achievable benchmark were Georgia, Iowa, Nebraska, Texas, and Wyoming.

The flattening curve shown in Figures 30 and 31 should be interpreted with care. The opioid epidemic has evolved through multiple waves since the 1990s, with the first, second, and third waves characterized by overdose deaths due to prescription opioids, heroin, and synthetic opioids such as illicitly manufactured fentanyl, respectively. 66 These data may represent a snapshot that captures a brief reprieve between one wave’s retreat and another’s arrival.

Prescription opioids and heroin accounted for most opioid-related ED visits, hospitalizations, and overdose deaths between 1999 and 2016. Thus, a decline in overdoses due to these substance between 2017 and 2018 may account for the plateauing ED visit and hospitalization rates shown here. 67 However, during the same period, rates of overdose due to synthetic opioids were rising rapidly, even as a “fourth wave” of overdose deaths related to polysubstance use, specifically the co-use of opioids and psychostimulants such as methamphetamine and cocaine, emerged. 68

Leading indicators point to synthetic opioids and co-occurring use of opioids and psychostimulants replacing earlier substances as primary drivers, and even accelerators, of the opioid epidemic. Provisional drug overdose counts from CDC show the overdose death rate falling by 4% from 2017 to 2018, but rapidly increasing by 4.8% from 2018 to 2019 and by 30% from 2019 to 2020. 69 The continuing rapid rise in opioid-related deaths and their association with different, more potent substances suggest important changes in the opioid crisis, which these figures may obscure.

Worsening Trend: Suicide Mortality

Suicide rates, which increased 33% between 1999 and 2018, represent a crisis occurring in parallel with the opioid epidemic. Suicide currently is the 10 th leading cause of death in the United States, accounting for more than 47,500 deaths annually. 70 Studies estimate that for every suicide death, as many as 30 additional suicide attempts, or 1.4 million individuals, are made each year. Based on 2010 data, the estimated cost of suicides and suicide attempts was more than $55 billion per year in lifetime medical and work-loss costs (or nearly $70 billion after adjusting for inflation). 71

Suicide deaths among people age 12 and over, per 100,000 population, 2008–2018. Note: The benchmark calculation takes the average of the top 10% of states with statistically reliable data. U.S. territories are not included in the calculations. (more...)

• From 2008 to 2018, overall, the rate of suicide deaths among people age 12 and over increased from 14.0 to 17.2 per 100,000 population ( Figure 32 ), which is nearly double the achievable benchmark rate.
• The 2015 achievable benchmark was 9.4 suicide deaths per 100,000 population.
• The top 10% of states that contributed to the achievable benchmark were District of Columbia, Maryland, Massachusetts, New Jersey, and New York.

As with the trends in opioid-related conditions, the data shown in Figure 32 may have captured a moment just before an inflection point occurred in the suicide epidemic.

Earlier this year, CDC reported that the national suicide rate among people age 10 years and over decreased by 2.1% from a rate of 14.2 deaths per 100,000 population to 16.9 deaths per 100,000 population between 2018 and 2019, interrupting the multiyear trend shown above. 72 This overall improvement was attributable to fewer suicides in White (−2.2% relative change) and Hispanic (−1.4% relative change) populations, while suicide rates either remained stable or continued to rise in Asian (no change), American Indian/Alaska Native (+0.9% relative change), Black (+2.7% relative change), and Native Hawaiian/Pacific Islander (+21.0% relative change) populations.

While promising, the recent CDC report should be interpreted cautiously. A single-year change might occur due to statistical variability or to the way data are collected and reported in a given year and thus should not be interpreted as a trend. Nonetheless, the CDC’s findings offer evidence that national suicide prevention efforts, including those outlined in the National Suicide Prevention Strategy, 73 , 74 are working They also signal an urgent need to both build on current suicide prevention efforts and develop targeted strategies for populations in which suicide rates continue to rise.

Efforts to promote effective screening for and treatment of substance use and depression are underway within HHS. These efforts include medications for opioid use disorder (MOUD) (previously called medication-assisted treatment), xvi which improve the likelihood of successfully stopping opioid use and reduce the risk of overdose among people with opioid use disorder. Thus, it is a cornerstone of many treatment programs.

HHS efforts in this area include the following.

Resources for Addressing Substance Use

• HHS has established the Behavioral Health Coordinating Council to coordinate the Department’s behavioral health efforts. The Council is cochaired by the Assistant Secretary for Substance Abuse and Mental Health, Dr. Miriam Delphin-Rittmon, and the Assistant Secretary for Health, Dr. Rachel L Levine.
• HHS has also released a national Overdose Prevention Strategy , which includes resources to address four priority areas : primary prevention, harm reduction, evidence-based treatment, and recovery support.
• AHRQ has published an evidence review, a rapid review, and several statistical briefs on opioid use. In 2020, the U.S. Preventive Services Task Force published recommendation statements on Screening for Unhealthy Drug Use in adolescents, adults, and seniors; and on interventions to prevent illicit drug use in adolescents and children .
• Six Building Blocks: A Team-Based Approach to Improving Opioid Management in Primary Care . An AHRQ grantee developed a structured systems-based approach for primary care providers and their staff members to improve management of patients on chronic opioid therapy.
• The Academy: Integrating Behavioral Health and Primary Care . AHRQ has previously sponsored the Academy, which works to expand the integration of behavioral healthcare and primary care. It also supports those who are implementing MOUD/MAT in primary care settings.
• CDC, in addition to providing a collection of information and data on the opioid epidemic, offers several practical resources for frontline clinicians and health systems. These include a Guideline for Prescribing Opioids for Chronic Pain and a Handbook for Healthcare Executives who want to implement best practices for opioid prescribing.
• The Substance Abuse and Mental Health Services Administration (SAMHSA) has developed a Treatment Improvement Protocol on Medications for Opioid Use Disorder , Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants , and tip sheets to inform people with substance use disorders and family members about using naloxone to rescue people from overdose and to help them find high-quality treatment .
• The Food and Drug Administration offers a Remove the Risk outreach toolkit , which provides fact sheets and multiple-format public service announcements and tools to raise awareness about risks related to storing opioid pain medications in the home, as well as providing guidance for safely disposing of them.
• The Health Resources and Services Administration funds several efforts intended to expand capacity for providing substance use and mental health services in rural, frontier, and other underserved communities. These include programs that provide training, technical assistance, and access to substance use and mental health expertise to disseminate resources and share best practices for treating substance use disorders and mental health concerns. Other HRSA efforts focus on expanding capacity in underserved communities, such as programs that build telehealth infrastructure to deliver substance use and mental health services to rural communities, and programs that encourage National Health Services Corp clinicians to offer MOUD/MAT.
• The Centers for Medicare & Medicaid Services (CMS) provides an online data visualization tool that maps state-level opioid prescribing rates.
• The National Institutes of Health has established the Helping to End Addiction Long-term ® (HEAL) initiative. HEAL is an aggressive, transagency effort to accelerate research to improve treatment of opioid misuse and addiction and to advance the science of managing chronic pain.
• The National Institute on Drug Abuse (NIDA) is a scientific institute under the National Institutes of Health, which supports scientific research on drug use and its consequences and applies that knowledge to improve individual and public health. Through NIDAMED , it compiles several resources for healthcare professionals, including educational opportunities, resources for screening for and treating substance use disorders, and tools to help clinicians discuss drug use and addiction prevention with patients.
• The U.S. Department of Agriculture (USDA) offers a Rural Community Toolbox , which provides communities with tools and access to funding opportunities to address opioid misuse in rural communities. USDA also funded the development of an interactive map that visually displays county-level drug overdose deaths in the United States and can be stratified by social and economic factors, such as age, race/ethnicity, unemployment rate, and availability of substance use and mental health services.

Resources for Addressing Risk for Suicide

• The Surgeon General has issued a Call to Action To Implement the National Strategy for Suicide Prevention , which follows up on the Surgeon General’s National Action Strategy and 2012 report.
• HHS and the SAMHSA Center for Mental Health Services jointly fund the Suicide Prevention Resource Center , which builds capacity to implement the National Strategy for Suicide Prevention by linking states, tribal communities, colleges and universities, EDs, primary care, and other settings to resources, training, and consultation services.
• SAMHSA also implemented the National Suicide Prevention Lifeline , a national network of more than 180 local crisis centers, combining custom local care and resources with national standards and best practices. Accessed through a single toll-free phone number, the Lifeline provides free and confidential emotional support 24 hours a day, 7 days a week to people in suicidal crisis or emotional distress. Other suicide prevention resources include tools focused on American Indian and Alaska Native communities and high school-age students , as well as videos.
• CDC has published Preventing Suicide: A Technical Package of Policy, Programs, and Practices , a select group of strategies based on the best available evidence to help communities and states sharpen their focus on activities with the greatest potential to prevent suicide. These strategies include strengthening economic supports; strengthening access and delivery of suicide care; creating protective environments; promoting connectedness; teaching coping and problem-solving skills; identifying and supporting people at risk; and lessening harms and preventing future risk. A CDC Suicide Prevention website offers links to other reports and resources, including links for the Suicide Prevention Lifeline and the Veterans Crisis Line.
• The Department of Veterans Affairs and the Department of Defense have published clinical practice guidelines 75 that provide evidence-based guidelines to support identification of individuals at risk for suicide, provider evaluation, and management of acute risk for suicide.

Examining Effective Treatment Measures by Sub-Areas

The core measures within the Effective Treatment priority area are summarized below. They are grouped by clinical condition sub-areas and displayed as improving (green), not changing (yellow), or worsening (red) over time. More information on how this analysis is conducted is available in the NHQDR Introduction and Methods .

Number and percentage of all effective treatment measures improving, not changing, or worsening from 2000 to 2018 by disease category. Key: n = number of measures.

The tables that follow provide details about the Effective Treatment core measures in each clinical condition sub-area.

Cancer Measures. Among the six core measures of cancer care, five have improved over time. These include measures related to management of patients with the most common forms of cancer: breast, colorectal, and lung cancer. The sixth measure, women with (more...)

Cardiovascular Disease Measures. The core set of cardiovascular disease care measures includes one measure assessing blood pressure control. High blood pressure, also known as hypertension, is a chronic condition in which blood vessel walls are damaged (more...)

• The Surgeon General has issued a Call to Action To Control Hypertension, 77 which describes a multisector approach to increase blood pressure control and reduce cardiovascular risk.
• In collaboration with a wide range of partners, the Centers for Disease Control and Prevention have organized Million Hearts 2022 with the aim of preventing 1 million heart attacks and strokes within 5 years.
• The Million Hearts initiative includes information and tools for health systems, providers, and patients that support effective hypertension management, as well as cholesterol management, smoking cessation, and strategies to prevent heart attacks after one has occurred.

End Stage Renal Disease Measures. In 2018, an estimated 785,883 people in the United States had end stage renal disease (ESRD). Approximately 70% of people with ESRD are treated with hemodialysis or peritoneal dialysis, while just under 30% receive kidney (more...)

Anemia (i.e., low hemoglobin) is common among people with chronic kidney disease, including those with end-stage renal disease. Screening for and treating anemia is recommended for routine hemodialysis care, as it is associated with increased risk for hospitalization and higher morbidity and mortality if left untreated. 81

Hemodialysis patients whose hemoglobin level is less than 10 g/dL, 2015–2019 (lower rates are better). Key: AI/AN = American Indian/Alaska Native.

• Overall, the percentage of hemodialysis patients with a hemoglobin level less than 10 g/dL increased from 2015 to 2019 ( Figure 34 ).
• From 2015 to 2019, the percentage of hemodialysis patients with a hemoglobin level less than 10 g/dL increased for American Indian and Alaska Native, Black, and White populations. Further examination of these data may point to targeted ways to reverse this worsening trend and the persistent health disparity between Black people and White people (the Disparities section of this report provides more information on measures with disparities).

Diabetes Measures. An estimated 34.1 million adults age 18 years and over, or 13% of all U.S. adults, had diabetes in 2018. Type 2 diabetesis a chronic illness that often can be prevented through physical activity, healthy diet, and weight loss. Left (more...)

The Centers for Disease Control and Prevention has organized the National Diabetes Prevention Program (National DPP), which Congress authorized in 2010 to prevent or delay type 2 diabetes mellitus through partnerships with public and private organizations. The National DPP builds on findings from clinical research funded by the National Institutes of Health, 84 which showed that a lifestyle change program focused on reducing calories and increasing physical activity to at least 2.5 hours per week or treatment with metformin reduced the risk of type 2 diabetes by 58% among adults at high risk. In addition, patients continued to benefit 10 and 15 years later. 85 , 86

Working with a range of organizations, such as state and local health departments, businesses with a focus on wellness, employers, healthcare providers, and others, CDC provides training and support to help people with diabetes. The goals are to ensure Americans have access to high-quality lifestyle change programs, ensure that programs adhere to scientifically proven standards, facilitate referrals to the programs, and help increase insurance coverage for program services. Information about the National DPP is available through the National DPP website .

HIV Infection Measures. An estimated 1,061,482 adults and adolescents were living with HIV infection in 2019, compared with 1,038,812 people with HIV in 2018. The core set of measures includes five measures that examine HIV management. One assesses prevention (more...)

Mental Health and Substance Use Measures. The core set of measures includes measures that assess the care delivered to people with depression and people with substance use disorders. One measure, examining prevention of depression symptoms among nursing (more...)

Musculoskeletal Disease Measures. From 2013 to 2015, an estimated 54.4 million people had doctor-diagnosed arthritis. Among these individuals, approximately 44% had symptoms severe enough to limit activities. Chronic joint pain is a leading cause of work (more...)

Respiratory Disease Measures. Two core measures pertaining to respiratory treatment were improving over time. One examines appropriate use of antibiotics among patients with viral respiratory illness. The other assesses quality of care delivered to people (more...)

• Trends in Healthy Living

The percentage of home health care patients who had influenza vaccination during flu season has increased consistently since 2015 and has surpassed the achievable benchmark.

Many illnesses associated with chronic conditions are related to unhealthy behaviors, environmental hazards, and poor social supports. These illnesses can be prevented by increasing access to effective clinical preventive services and promoting community interventions that advance public and population health. Working with communities is critical to ensure that immunizations and early detection and prevention services reach everyone who needs them and to build healthy neighborhoods and support networks.

Promoting healthy lifestyles that prevent disease and disability is better for people and more efficient than treating conditions after organ damage has occurred.

Importance of Healthy Living

Healthy living is supported through preventive care strategies that cross all age groups and the care continuum. Among the most impactful preventive strategies are vaccinations for children and prenatal care.

Advances in medical science protect children against more diseases than ever before. Some diseases that once injured or killed thousands of children have been eradicated completely and others are close to eradication, primarily due to safe and effective vaccines. Polio is one example of the great impact vaccines have had in the United States. Polio was once America’s most feared disease, causing death and paralysis across the country, but today, thanks to vaccination, there are no reports of polio in the United States.

Effective and continuous prenatal care can also improve birth and health outcomes for mothers and children. Currently, the NHQDR tracks one preventive health measure related to maternal health (i.e., women who completed a pregnancy in the last 12 months who received early and adequate prenatal care).

Research has shown that most cases of maternal mortality and severe maternal morbidity are preventable, and prevention strategies can directly reduce morbidity and mortality. 89 , 90 , 91 Recognition is growing of the need to develop, monitor, and improve performance on quality measures in obstetrics care, particularly around disparities. 92 Addressing disparities in maternal health and birth outcomes is a national priority, covered in The Surgeon General’s Call to Action To Improve Maternal Health . 93

A strong body of research shows the cost-effectiveness of immunization; however, opportunities still exist for providers, patients, and systems to optimize immunization participation. It is less expensive to prevent a disease using immunization than to treat it. In a 2005 study on the economic impact of routine childhood immunization in the United States, researchers estimated that for every dollar spent, the vaccination program saved more than $5 in direct costs and approximately $11 in additional costs to society. 94

Findings on Healthy Living

• Maternal and Child Health.
• Lifestyle Modification.
• Functional Status Preservation and Rehabilitation.
• Clinical Preventive Services.
• Home health care patients who had influenza vaccination during flu season.
• Long-stay nursing home residents with physical restraints.
• Adolescents ages 16–17 who received 1 or more doses of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) since the age of 10 years.
• Long-stay nursing home residents who were assessed for pneumococcal vaccination.
• Children ages 2–19 with obesity.

These measures are also discussed in the Disparities section to show narrowing and widening disparities (see Disparities section, Race, Income).

Improving Trend: Influenza Vaccinations in Home Health Patients

Influenza vaccination is a proven preventive strategy for reducing the incidence of influenza. All people age 6 months and over are recommended to receive the vaccination, and vulnerable populations, including home health care patients, are especially encouraged to do so. 95

Home health care patients who had influenza vaccination during flu season, 2015–2018. Note: The benchmark calculation takes the average of the top 10% of states with statistically reliable data. U.S. territories are not included in the calculations. (more...)

• From 2015 to 2018, overall, the percentage of home health care patients who had influenza vaccinations during flu season increased from 87.3% to 95.2% ( Figure 35 ).
• The 2015 achievable benchmark was 94.1%. The benchmark was achieved in 2017 and again in 2018.
• The top 10% of states that contributed to the achievable benchmark were Montana, Nebraska, North Dakota, South Dakota, Vermont, and Wisconsin.

Improving Trend: Physical Restraint Use in Nursing Home Residents

Long-stay residents typically enter a nursing facility because they can no longer care for themselves at home. They tend to remain in the facility for several months or years. Most residents want to care for themselves, and the ability to perform daily activities is important to their quality of life. While some functional decline among residents cannot be avoided, high-quality nursing home care should minimize the rate of decline and the number of patients experiencing decline.

Adverse outcomes associated with physical restraint of nursing home residents include decreases in cognitive function and performance of activities of daily living, falls, pressure ulcers, and incontinence. 96

Long-stay nursing home residents with physical restraints, 2013–2018 (lower rates are better). Note: The benchmark calculation takes the average of the top10% of states with statistically reliable data. U.S. territories are not included in the (more...)

• From 2013 to 2018, overall, the percentage of long-stay nursing home patients with physical restraints decreased from 1.3% to 0.25% ( Figure 36 ).
• The 2015 achievable benchmark was 0.27%. In 2018, the benchmark was achieved.
• The top 10% of states that contributed to the achievable benchmark were Arizona, Kansas, Minnesota, Nebraska, and New Hampshire.

Improving Trend: Adolescent Tdap Vaccination

CDC’s Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination for tetanus, diphtheria, and pertussis. Infants and young children are recommended to receive a 5-dose series of diphtheria and tetanus toxoids and acellular pertussis vaccines, with one adolescent booster dose of Tdap vaccine. One study noted that the cost per quality-adjusted life-year saved from immunization would be approximately $163,361 (booster at 16 years) and $204,556 (booster at 21 years). 97

Adolescents ages 16–17 who received 1 or more doses of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) since the age of 10 years, 2008–2018. Note: The benchmark calculation takes the average of the top 10% of (more...)

• From 2008 to 2018, overall, the percentage of adolescents ages 16–17 years who received 1 or more doses of Tdap vaccine increased from 31.9% to 90% ( Figure 37 ).
• The 2015 achievable benchmark was 95.9%. At the current rate of increase, overall, the benchmark could be achieved in 1 year.
• The top 10% of states that contributed to the achievable benchmark were Alabama, Georgia, Missouri, Rhode Island, and Vermont.

Worsening Trend: Pneumococcal Vaccinations in Nursing Home Residents

ACIP recommends that all adults over 65 years of age and those with risk factors such as chronic disease receive pneumococcal vaccinations. 98

Long-stay nursing home residents who were assessed for pneumococcal vaccination, 2013–2018. Note: The benchmark calculation takes the average of the top 10% of states with statistically reliable data. U.S. territories are not included in the calculations. (more...)

• From 2013 to 2018, overall, the percentage of long-stay nursing home residents who were assessed for pneumococcal vaccination decreased from 93.8% to 92.1% ( Figure 38 ).
• The 2015 achievable benchmark was 97.0%. There is no evidence of progress toward the benchmark.
• The top 10% of states that contributed to the achievable benchmark were Delaware, Mississippi, New Hampshire, North Dakota, Utah, and Wisconsin.

Worsening Trend: Childhood Obesity

In children, sex-specific body mass index (BMI)-for-age percentile cutoffs from the CDC growth charts are used to define a level above which a child is more likely to have or be at risk of developing obesity-associated adverse health outcomes or diseases. BMI between the 85th and 94th percentiles is in the overweight range, whereas BMI ≥95th percentile for age and gender is in the obese range. 99

Children with obesity are four times as likely to develop type 2 diabetes compared with children with a normal BMI. 100 As many as 60% of children and adolescents with obesity have obstructive sleep apnea or some sort of disrupted breathing during sleep. 101 The greatest risk factor for pediatric hypertension is elevated BMI. 102

• High blood pressure and high cholesterol, which are risk factors for cardiovascular disease;
• Increased risk of impaired glucose tolerance, insulin resistance, and type 2 diabetes;
• Breathing problems, such as asthma and sleep apnea;
• Joint problems and musculoskeletal discomfort; and
• Fatty liver disease, gallstones, and gastroesophageal reflux. 103

Children ages 2–19 with obesity, 1999–2018.

• From 1999–2002 to 2015–2018, overall, the percentage of children with obesity increased from 14.8% to 18.9% ( Figure 39 ).
• CDC’s School Health Guidelines to Promote Healthy Eating and Physical Activity ( https://www.cdc.gov/healthyschools/npao/pdf/MMWR-School-Health-Guidelines.pdf ). CDC synthesized research and best practices related to promoting healthy eating and physical activity in schools, culminating in nine guidelines. The guidelines serve as the foundation for developing, implementing, and evaluating school-based healthy eating and physical activity policies and practices for students. Each guideline is accompanied by a set of implementation strategies to help schools work toward achieving healthy eating and physical activity goals.
• CDC’s Guidance for Influenza Outbreak Management in Long-Term Care and Post-Acute Care Facilities ( https://www.cdc.gov/flu/professionals/infectioncontrol/ltc-facility-guidance.htm ) outlines how to prevent the introduction and spread of influenza viruses using a multifaceted approach of influenza vaccination, testing, prevention and control measures, and treatment. The guideline notes that, if possible, all residents should receive inactivated influenza vaccine annually before influenza season.
• Childhood Obesity Research Demonstration (CORD) 3.0 ( https://www.cdc.gov/obesity/strategies/healthcare/cord3.html ) focuses on adapting, testing, and packaging effective programs to reduce obesity among children from lower income families. In addition, CORD 3.0 projects work toward programs that are sustainable and cost-effective in multiple settings.

Summary of Healthy Living Measures by Topic Areas

The core Healthy Living measures in the 2021 NHQDR are summarized in Figure 40 by topic area. The topic areas are clinical preventive services, functional status preservation and rehabilitation, supportive and palliative care, lifestyle modification, and maternal and child health.

Number and percentage of all healthy living measures improving, not changing, or worsening from 2000 to 2019, by topic area. Key: n = number of measures. Note: National Health Interview Survey measures that have been included in previous years were unavailable (more...)

• From 2000 to 2019, 90% of supportive and palliative care, 83% of functional status and rehabilitation, 58% of clinical preventive services, 50% of lifestyle modification, and 33% of maternal and child health measures showed improvement.

The Clinical Preventive Services measures (n=38) in the Healthy Living section are further broken out by sub-areas to show the variation of measures ( Figure 41 ). These sub-areas include adult preventive care, childhood immunization, other childhood preventive care, and overall preventive care.

Number and percentage of all clinical preventive services measures improving, not changing, or worsening from 2000 to 2019, by sub-area. Key: n = number of measures. Note: National Health Interview Survey measures that have been included in previous years (more...)

More information about the average annual percent change and the statistical significance for these measures is also available at https://datatools.ahrq.gov/nhqdr .

Clinical Preventive Measures: Adult Preventive Care. The core set of measures includes six measures that were improving. Improving measures included four measures examining vaccinations and two measures of diagnosis of cancer at an advanced stage. Four (more...)

Colorectal cancer diagnosed at advanced stage per 100,000 population age 50 and over, 2000–2017 (lower rates are better). Note: Rates are age-adjusted to the 2000 U.S. standard population (19 age groups - Census P25-1130). Includes NPCR and SEER (more...)

• From 2000 to 2017, overall, the rate of colorectal cancer diagnosed at advanced stage decreased from 101.5 per 100,000 population to 63.8 per 100,000 population ( Figure 42 ).

Cervical cancer diagnosed at advanced stage per 100,000 women age 20 and over, 2000–2017 (lower rates are better). Note: Includes NPCR and SEER registries meeting United States Cancer Statistics publication criteria by year. The period 2003–2017 (more...)

• From 2000 to 2017, overall, the rate of cervical cancer diagnosed at advanced stage decreased from 13.4 per 100,000 women to 10.5 per 100,000 women ( Figure 43 ).

Breast cancer diagnosed at advanced stage, 2000–2017 (lower rates are better). Note : Includes NPCR and SEER registries meeting United States Cancer Statistics publication criteria by year. The period 2003–2017 covers 100% of the U.S. population; (more...)

• From 2000 to 2017, overall, the rate of breast cancer diagnosed at advanced stage did not have any statistically significant changes, decreasing from 95.6 per 100,000 women to 84.5 per 100,000 women ( Figure 44 ).

Adults age 18 and over who had a dental visit in the calendar year, 2002–2018.

• From 2002 to 2018, overall, the percentage of adults age 18 and over who had a dental visit in the calendar year did not have any statistically significant changes, increasing slightly from 43.2% to 44.0% ( Figure 45 ).

Adults age 18 and over who received any preventive dental service in the calendar year, 2002–2018.

• From 2002 to 2018, overall, the percentage of adults age 18 and over who received any preventive dental service in the calendar year did not have any statistically significant changes, increasing slightly from 33.6% to 35.4% ( Figure 46 ).

Clinical Preventive Measures: Childhood Immunization. The core set of childhood immunization measures includes 11 measures that were improving, 3 measures that showed no statistically significant changes over time, and none that were worsening. The three (more...)

Adolescents ages 16–17 who received 1 or more doses of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) since the age of 10 years, 2008–2018.

• From 2008 to 2018, overall, the percentage of adolescents ages 16–17 years who received 1 or more doses of tetanus-diphtheria-acellular pertussis (Tdap) vaccine increased from 31.9% to 90.0% ( Figure 47 ).

Adolescents ages 16–17 years who received 1 or more doses of meningococcal conjugate vaccine, 2008–2018.

• From 2008 to 2018, overall, the percentage of adolescents ages 16–17 years who received 1 or more doses of meningococcal conjugate vaccine increased from 38.6%to 87.2% ( Figure 48 ).

Adolescents ages 13–15 who received 1 or more doses of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) since the age of 10 years, 2008–2018.

• From 2008 to 2018, overall, the percentage of adolescents ages 13–15 years who received 1 or more doses of tetanus-diphtheria-acellular pertussis (Tdap) vaccine increased from 46.7% to 88.2% ( Figure 49 ).

Children ages 19–35 months who received 3 or more doses of hepatitis B vaccine, 2001–2018.

• From 2001 to 2018, overall, the percentage of children ages 19–35 months who received 3 or more doses of hepatitis B vaccine showed no statistically significant change (88.9% to 92.1%) ( Figure 50 ).

Children ages 19–35 months who received 4 or more doses of diphtheria-tetanus-pertussis vaccine, 2001–2018.

• From 2001 to 2018, overall, the percentage of children ages 19–35 months who received 4 or more doses of diphtheria-tetanus-pertussis vaccine showed no statistically significant change (82.1% to 83.8%) ( Figure 51 ).

Children ages 19–35 months who received 1 or more doses of measles-mumps-rubella vaccine, 2001–2018.

• From 2001 to 2018, overall, the percentage of children ages 19–35 months who received 1 or more doses of measles-mumps-rubella vaccine showed no statistically significant change (91.4% to 92.1%) ( Figure 52 ).

Clinical Preventive Measures: Other Childhood Preventive Care. Three improving measures pertain to multiple sub-areas, including height/weight measurement, vision screening, and counseling about car seat safety. Five measures were not changing over time, (more...)

Children who had their height and weight measured by a health provider within the past 2 years, 2002–2018.

• From 2002 to 2018, overall, the percentage of children who had their height and weight measured by a health provider within the past 2 years increased from 86.7% to 89.9% ( Figure 53 ).

Children ages 3–5 who ever had their vision checked by a health provider, 2002–2018.

• From 2002 to 2018, overall, the percentage of children who had their vision checked by a health provider within the past 2 years increased from 54.5% to 70.7% ( Figure 54 ).

Children 41–80 lb for whom a health provider gave advice within the past 2 years about using a booster seat when riding in the car, 2002–2018.

• From 2002 to 2018, overall, the percentage of children 41–80 lb for whom a health provider gave advice within the past 2 years about using a booster seat when riding in the car increased from 26.8% to 38.0% ( Figure 55 ).

Children ages 2–17 who received a preventive dental service in the calendar year, 2002–2018.

• From 2002 to 2018, overall, the percentage of children ages 2–17 who received any preventive dental service in the calendar year showed no statistically significant change (40.0% to 48.5%) ( Figure 56 ).

Children for whom a health provider gave advice within the past 2 years about how smoking in the house can be bad for a child, 2002–2018.

• From 2002 to 2018, overall, the percentage of children for whom a health provider gave advice within the past 2 years about how smoking in the house can be bad for a child showed no statistically significant change (38.8% to 40.9%) ( Figure 57 ).

Children ages 2–17 for whom a health provider gave advice within the past 2 years about using a helmet when riding a bicycle or motorcycle, 2002–2018.

• From 2002 to 2018, overall, the percentage of children ages 2–17 for whom a health provider gave ad vice within the past 2 years about using a helmet when riding a bicycle or motorcycle showed no statistically significant change (31.2% to 34.4%) ( Figure 58 ).

Clinical Preventive Measures: Overall Preventive Care. The core set of measures includes two measures improving over time that look at influenza vaccination in home health care and nursing home care. Two nursing home and one home health care measure did (more...)

Home health care patients who had influenza vaccination during flu season, 2015–2018.

• From 2015 to 2018, overall, the percentage of home health patients who had influenza vaccination during flu season increased from 87.3% to 95.2% ( Figure 59 ).

Long-stay nursing home patients who were assessed and appropriately given the seasonal influenza vaccine, 2013–2018.

• From 2013 to 2018, overall, the percentage of long-stay nursing home patients who were assessed and appropriately given the seasonal influenza vaccine increased from 90.0% to 91.7% ( Figure 60 ).

Short-stay nursing home residents who had flu vaccination appropriately given, 2013–2018.

• From 2013 to 2018, overall, the percentage of short-stay nursing home patients who had flu vaccination appropriately given showed no statistically significant change (86.8% to 86.8%) ( Figure 61 ).

Short-stay nursing home residents who were assessed and appropriately given the pneumococcal vaccination, 2013–2018.

• From 2013 to 2018, overall, the percentage of short-stay nursing home residents who were assessed for pneumococcal vaccination showed no statistically significant change (85.6% to 85.6%) ( Figure 62 ).

Home health care patients who had pneumococcal polysaccharide vaccination, 2015–2018.

• From 2015 to 2018, overall, the percentage of home health care patients who had pneumococcal polysaccharide vaccination showed no statistically significant change (84.0% to 82.2%) ( Figure 63 ).

Long-stay nursing home residents who were assessed for pneumococcal vaccination, 2013–2018.

• From 2013 to 2018, overall, the percentage of long-stay nursing home residents who were assessed for pneumococcal vaccination decreased from 93.8% to 92.1% ( Figure 64 ).

Functional Status Preservation and Rehabilitation Measures. The core set of measures includes four home health care measures and one nursing home measure that were improving over time. One measure was not changing over time. Home health care measures (more...)

Home health care patients whose ability to get in and out of bed improved, 2013–2018.

• From 2013 to 2018, overall, the percentage of home health care patients whose ability to get in and out of bed improved increased from 57.9% to 78.6% ( Figure 65 ).

Home health care patients whose ability to walk or move around improved, 2013–2018.

• From 2013 to 2018, overall, the percentage of home health care patients whose ability to walk or move around improved increased from 62.2% to 78.4% ( Figure 66 ).

Home health care patients whose bathing improved, 2013–2018.

• From 2013 to 2018, overall, the percentage of home health care patients whose bathing improved increased from 68.3% to 80.3% ( Figure 67 ).

Long-stay nursing home residents with worsening ability to move independently, 2013–2018 (lower rates are better).

• From 2013 to 2018, overall, the percentage of long-stay nursing home residents with worsening ability to move independently showed no statistically significant changes (24.5% to 23.9%) ( Figure 68 ).

Supportive and Palliative Care Measures. Nine measures pertaining to nursing home care and home health care improved over time. The three fastest improving measures were measures of the use of physical restraints, shortness of breath, and pain. One nursing (more...)

Long-stay nursing home residents with physical restraints, 2013–2018 (lower rates are better). Note: Data reflect care for the latest episode in the calendar year.

• From 2013 to 2018, overall, the percentage of long-stay nursing home residents with physical restraints decreased from 1.3% to 0.25% ( Figure 69 ).

Home health care patients with decreased shortness of breath, 2013–2018.

• From 2013 to 2018, overall, the percentage of home health care patients with decreased shortness of breath (improved breathing) increased from 65.2% to 80.3% ( Figure 70 ).

Short-stay nursing home residents with moderate to severe pain, 2013–2017 (lower rates are better).

• From 2013 to 2017, overall, the percentage of short-stay nursing home residents with moderate to severe pain decreased from 17.7% to 11.3% ( Figure 71 ).

Long-stay nursing home residents with loss of control of bowels or bladder, 2013–2017 (lower rates are better).

• From 2013 to 2017, overall, the percentage of long-stay nursing home residents with loss of control of bowels or bladder increased from 64.2% to 74.3% ( Figure72 ).

Lifestyle Modification Measures. Three core measures improved over time. These measures examine related topics, including smoking in adults, children’s diet, and exercise and fitness in children. Two measures were not changing over time and include (more...)

Adult current smokers with a doctor’s office or clinic visit in the last 12 months who received advice to quit smoking, 2002–2017. Note: Estimates are age-adjusted to the 2000 U.S. standard population using three age groups: 18–44, (more...)

• From 2002 to 2017, overall, the percentage of adults who currently smoke and had a doctor’s office or clinic visit in the last 12 months who received advice to quit smoking increased from 65.2% to 76.5% ( Figure 73 ).

Children ages 2–17 for whom a health provider gave advice within the past 2 years about healthy eating, 2002–2018.

• From 2002 to 2018, overall, the percentage of children ages 2–17 for whom a health provider gave advice within the past 2 years about healthy eating increased from 46.9% to 52.0% ( Figure 74 ).

Children ages 2–17 for whom a health provider gave advice within the past 2 years about the amount and kind of exercise, sports, or physically active hobbies they should have, 2002–2018.

• From 2002 to 2018, overall, the percentage of children ages 2–17 for whom a health provider gave advice within the past 2 years about the amount and kind of exercise, sports, or physically active hobbies they should have increased from 30.0% to 38.4% ( Figure 75 ).

The only lifestyle modification measure that showed no statistically significant change over time and had updated data was a measure related to provider communication about childhood obesity.

Children ages 2–19 with obesity who had been told by a doctor or health professional that they were overweight, 1999–2018.

• From 1999–2002 to 2015–2018, overall, the percentage of children ages 2–19 with obesity who had been told by a doctor or health professional that they were overweight showed no statistically significant changes (37.0% to 43.8%) ( Figure 76 ).

Children ages 2–19 with obesity, 1999–2018 (lower rates are better).

• From 1999–2002 to 2015–2018, overall, the percentage of children ages 2–19 with obesity increased from 14.8% to 18.9% ( Figure 77 ).

Maternal and Child Health Measures. The core set of measures includes only one measure that examines breastfeeding and this measure improved over time. Two measures examined infant mortality and low birth weight. These measures were not changing over (more...)

Infants born in the calendar year who received breastfeeding exclusively through 3 months, 2009–2018.

• From 2009 to 2018, overall, the percentage of infants born in the calendar year who received breastfeeding exclusively through 3 months increased from 35.9% to 46.3% ( Figure 78 ).

Infant mortality per 1,000 live births, birth weight 2,500 grams or more, 2001–2017 (lower rates are better). Note: 2006 data not available.

• From 2001 to 2017, overall, the rate of infant mortality per 1,000 live births, birth weight 2,500 grams or more, showed no statistically significant changes (2.4% to 2.0%) ( Figure 79 ).

Live-born infants with low birth weight (less than 2,500 grams), 2007–2019 (lower rates are better).

• From 2007 to 2019, overall, the percentage of live-born infants with low birth weight (less than 2,500 grams) showed no statistically significant changes (8.2% to 8.3%) ( Figure 80 ).

For example, Section 1557 of the Affordable Care Act (ACA), 42 U.S.C. 18116, and Title VI of the Civil Rights Act of 1964, 42 U.S.C. 2000d, require the practitioner or hospital to take reasonable steps to ensure meaningful access to individuals with limited English proficiency, such as providing language interpreters and translating vital documents. Section 1557 of the ACA and Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. 794, require the practitioner or hospital to take appropriate steps to ensure effective communication with individuals with disabilities, such as by providing sign language interpreters, materials in Braille, and/or accessible electronic formats.

Eight measures of patient experience of care in ambulatory settings included in this report were not updated this year because new data were not available. They will be updated in the 2022 report when new data become available.

The Institute of Medicine formally changed its name to the National Academy of Medicine in 2015.

This report focuses on patient safety activities led by AHRQ. Other federal agencies, including the Centers for Disease Control and Prevention and CMS, also have large portfolios of patient safety work that are not fully captured in this report.

HHS, in accordance with expert recommendation, has replaced the term “medication-assisted therapy” (MAT) with “medications for opioid use disorder” (MOUD) when referring to an evidence-based treatment approach that uses medications, such as methadone, buprenorphine, or naltrexone, to reduce cravings and withdrawal symptoms associated with stopping opioid use. More information is available in National Academies of Sciences, Engineering, and Medicine. 2019. Medications for Opioid Use Disorder Save Lives. Washington, DC: The National Academies Press. https://doi ​.org/10.17226/25310 . As both terms remain in use, this report, when appropriate, describes tools as MOUD/MAT in recognition that some resources may still use the older term for this approach.

The most recent hypertension guidelines published by the American College of Cardiology and American Heart Association recommend blood pressure control targets of less than 140/90 mm Hg for most people and less than 130/80 mm Hg for people with elevated cardiovascular risk. The NHQDR defines blood pressure control in this report as blood pressure less than 140/90 mmHg, which aligns with the blood pressure control threshold used by Healthy People 2030.

SAMHSA defines substance use disorder as characterized by impairment caused by the recurrent use of alcohol, other drugs (including illicit drugs), or both, leading to health problems, disability, and failure to meet major responsibilities at work, school, or home.

This document is in the public domain and may be used and reprinted without permission. Citation of the source is appreciated.

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