Research Activities, December 2012, No. 388
Boulet, J.R., Murray, D. (2012). "Review article: Assessment in anesthesiology education." (AHRQ grant HS18734). Canadian Journal of Anesthesiology 52, pp. 182-192.
Assessment plays a fundamental role in the education of anesthesiologists. Many different types of assessments are needed to measure the competencies of anesthesia providers. The development of sound assessment practices can help ensure the safe and effective provision of care.
Burke, J.F., Kerber, K.A., Iwashyna, T.J., and Morgenstern, L.B. (2012). "Wide variation and rising utilization of stroke magnetic resonance imaging: Data from 11 States." (AHRQ grant HS17690). Annals of Neurology 71, pp. 179-185.
For the diagnosis of stroke, magnetic resonance imaging (MRI) is more accurate than computed tomography (CT), but it is also more costly and time-consuming. A study of MRI use during stroke hospitalization from 1999 to 2008 found that it increased substantially, with wide geographic variation. Since neuroimaging practices are not standardized, there may be an opportunity to improve the efficiency of stroke care.
Castle, M.G., Wagner, L.M., Ferguson, J.C., and others (2012). "Alcohol misuse and abuse in assisted living." (AHRQ grant HS165347). Journal of the American Medical Directors Association 13, p. e7.
Data on alcohol misuse and abuse in assisted living were collected from 832 nurse aides working in Pennsylvania assisted living (AL) facilities. Nurse aides believe that 8 percent of residents have untreated alcohol-related problems. These findings present preliminary evidence that alcohol misuse and abuse may be a problem in AL facilities.
Dahabreh, I.J., Chung, M., Balk, E.M., and others (2012). "Active surveillance in men with localized prostate cancer." (AHRQ Contract No. 290-07-10055). Annals of Internal Medicine 156, pp. 582-590.
The authors systematically reviewed strategies for observational management of prostate cancer (active surveillance [AS] or watchful waiting [WW]); the factors affecting their use; and comparative effectiveness of observational management versus immediate treatment with curative intent. Evidence is insufficient to assess whether AS is an appropriate option for men with localized prostate cancer.
Doshi, P., Jones, M., and Jefferson, T. (2012). "Rethinking credible evidence synthesis." (AHRQ grant T32 HS19488). British Medical Journal 344, p. d7898.
After publication of a Cochrane review on the effectiveness of oseltamivir in 2009, the authors obtained access to 3,195 pages of study reports for 10 treatment trials of oseltamivir. Their thoughts on this experience provide the basis for their argument that open access to all relevant trial data is a necessity to make ethical decisions in health care.
Elder, N.C., and Barney, K. (2012, April). "But what does it mean for me?' Primary care patients' communication preferences for test result notification." Joint Commission Journal on Quality and Patient Safety 38(4), pp. 168-176.
The researchers conducted a study to determine the factors that patients believe are important in communicating test results. They found three themes to be important in the satisfaction and understanding of test results: the information shared, the significance of the results, and personal preferences for communication. The researchers proposed an algorithm that may enhance patient satisfaction and use of test results by patients.
Fink, H.A., Ishani, A., Taylor, B.C., and others (2012). "Screening for, monitoring, and treatment of chronic kidney disease stages 1 to 3: A systematic review for the U.S. Preventive Services Task Force and for an American College of Physicians Clinical Practice Guideline." (AHRQ Contract No. 290-07-10064). Annals of Internal Medicine 156, pp. 570-581.
This review summarizes evidence about the benefits and harms of screening for and monitoring and treatment of chronic kidney disease (CKD) stages 1 to 3. It found no trials evaluating screening or monitoring, and 110 trials that evaluated treatments. Since evidence about outcomes was sometimes scant and derived from post-hoc analyses of subgroups of patients enrolled in trials, the authors concluded that the role of CKD screening or monitoring in improving clinical outcomes is uncertain.
Gurses, A.P., Ozok, A. A., and Pronovost, P.J. (2012). "Time to accelerate integration of human factors and ergonomics in patient safety." (AHRQ grant HS18762). BMJ Quality and Safety 21, pp. 347-351.
This paper gives an overview of the discipline of human factors and ergonomics and describes its role in improving patient safety. The authors provide examples of how these disciplines have improved both care processes and patient outcomes. They also provide five major recommendations to better integrate human factors and ergonomics in patient safety improvement efforts.
Halpern, S.D., and Emanuel, E.J. (2012, February). "Advance directives and cost savings." (AHRQ grant HS18046). Archives of Internal Medicine 172(30), pp. 266-268.
Despite the legal use of advance directives for 35 years, there is a lack of convincing evidence that increased use of advance directives actually lowers health care costs. The authors discuss a study in the same issue by Nichols et al. suggesting that advance directives may enable patients to defend against unwanted aggressive care. They conclude that the findings of this study provide strong impetus for interventional advance directive studies, but little impetus for immediate policy changes.
Haukoos, J.S., Lyons, M.S., Lindsell, C.J., and others (2012). "Derivation and validation of the Denver human immunodeficiency virus (HIV) risk score for targeted HIV screening." (AHRQ grant HS17526). American Journal of Epidemiology 175(8), pp. 838-846.
The authors derived and validated an instrument to accurately identify patients at risk for HIV infection, using patient data from a metropolitan sexually transmitted disease clinic in Denver. The derivation sample included 92,635 patients, of whom 504 were diagnosed with HIV infection. The authors believe that theirs is the first study to empirically derive and externally validate an HIV risk prediction tool.
Hempel, S., Newberry, S.J., Maher, A.R., and others (2012). "Probiotics for the prevention and treatment of antibiotic-associated diarrhea." (AHRQ Contract No. 290-07-10062). Journal of the American Medical Association 307(18), pp. 1959-1969.
The authors performed a systematic review to evaluate the evidence for probiotic use in the prevention and treatment of antibiotic-associated diarrhea (AAD). The review found that pooled evidence suggests an association of probiotics with a reduction in AAD.
Linder, S.K., Swank, P.R., Vernon, S.W., and others (2011). "Validity of a low literacy version of the Decisional Conflict Scale." (AHRQ grant HS10612). Patient Education and Counseling 85, pp. 521-524.
This study evaluated the psychometric properties of the 4-factor low literacy Decisional Conflict Scale (DCS-LL) with men eligible for prostate cancer screening (PCS). The study provides support for use of the DCS-LL in PCS decision aid studies, but suggests caution about using the individual subscales as evaluative criteria.
Luo, Z., Yetisgen-Yildiz, M., and Weng, C. (2011). "Dynamic categorization of clinical research eligibility criteria by hierarchical clustering." (AHRQ grant HS19853). Journal of Biomedical Informatics 44, pp. 927-935.
Currently there is no standard categorization of clinical research eligibility criteria. The authors sought to semi-automatically induce semantic categories of eligibility criteria from text and to automatically classify eligibility criteria based on their semantic similarity. They found that the UMLS semantic feature representation outperforms the "bag of words" feature representation in 89 percent of the criteria categories.
Mane, K.K., Bizon, C., Schmitt, C., and others (2012). "VisualDecisionLinc: A visual analytics approach for comparative effectiveness-based clinical decision support in psychiatry." (AHRQ grant HS19023). Journal of Biomedical Informatics 45, pp. 101-106.
The authors highlight the role that visual analytics can play in comparative effectiveness research (CER)-based clinical decision support. They developed a VisualDecisionLinc (VDL) tool prototype that uses visual analytics to provide CER-derived data views to facilitate rapid interpretation of large amounts of data. A next step is to perform a formal evaluation of the clinical utility of the developed VDL clinical decision support tool.
Nembhard, I.M. (2012, June). "All teach, all learn, all improve?: The role of interorganizational learning in quality improvement collaborative." (AHRQ grant HS98701). Health Care Management Review 37(2), pp. 154-164.
This study examined the use of interorganizational learning activities (inter-OLAs) as an explanation for mixed performance improvement among collaborative participants. After surveying 52 teams participating in 4 Institute for Healthcare Improvement collaboratives, the authors found that the more collaborative teams used inter-OLAs, the more their organizations' performance improved. The results also suggest that complementing high use of inter-OLAs with intra-OLA use and quality-focused human resource practices enhanced performance improvement.
O'Reilly, D., Tarride, J.E., Goeree, R., and others (2012). "The economics of health information technology in medication management: A systematic review of economic evaluations." (AHRQ Contract No. 290-07-10060). Journal of the American Medical Informatics Association 19, pp. 423-438.
A systematic review of the evidence surrounding the cost-effectiveness of health information technology (IT) in the medication process finds that the quality of the economic literature in this area is poor. Given the uncertainty that surrounds the cost and outcomes data and limited study designs, it is difficult to reach any definitive conclusion as to whether the additional costs and benefits of health IT represent value for money.
Rahbar, M.H., Chen, Z., Jeon, S., and others (2012). "A nonparametric test for equality of survival medians." (AHRQ grant HS14206). Statistics in Medicine 31, pp. 844-854.
The authors propose a new nonparametric method for testing the equality of several survival medians based on the Kaplan-Meier estimation from randomly right-censored data. They derive asymptotic properties of this test statistic. Through simulations, they compute and compare the empirical probabilities of type I errors and the power of this new procedure with those of Brookmeyer-Crowley, log-rank, and Wilcoxon methods.
Ratanawongnsa, N., Handley, M.A., Quan, J., and others (2012). "Quasi-experimental trial of diabetes Self-Management Automated and Real-Time Telephonic Support (SMARTSteps) in a Medicaid managed care plan: Study protocol." (AHRQ grant HS17261). BMC Health Services Research 12, p. 22.
This paper presents a description of the study design and recruitment results for the Self-Management Automated and Real-Time Telephonic Support (SMARTSteps), a controlled quasi-experimental evaluation study to improve diabetes quality of life, self-management, and clinical outcomes. The study uses two variants of a language-concordant automated telephonic self-management intervention for a Medicaid managed care plan serving a low-income, ethnically diverse urban population.
Reidenberg, M.M. (2012). "Early research on renal function and drug action." (AHRQ grant HS16075). Journal of Clinical Pharmacology 52, pp. 7S-9S.
Since the 1960s, systematic studies of drug action in renal failure have found many differences between patients with renal failure and those without. The pharmacokinetics of antimicrobials and dosage recommendations for azotemic patients (with elevated urea and other nitrogenous wastes in the blood due to poor kidney function) were first delineated in 1867. Other effects of renal failure on drug action were found to include increases in some pathways of drug metabolism with decreases in others and no change in the rest. These and other findings have made drug therapy for azotemic patients safer and more effective over time.
Saldana, S.N., Hooper, D.K., Froehlich, T.E., and others (2011, December). "Characteristics of successful recruitment in prospective pediatric pharmacogenetic studies." (AHRQ grant HS16957). Clinical Therapeutics 33(12), pp. 272-281.
The aim of this study was to identify factors affecting recruitment of eligible subjects in pharmacogenetics studies. The objectives were to evaluate recruitment success of ongoing trials and ascertain contributors to differential recruitment rates. Some characteristics of studies with successful recruitment were: standardized clinical care, an ongoing team-patient relationship, severe and/or life-threatening outcomes measures, and a study coordinator with experience in clinical research.
Shamliyan, T., Wyman, J.F., Ramakrishnan, R., and others (2012, June). "Systematic review: Benefits and harms of pharmacologic treatment for urinary incontinence in women." (AHRQ Contract No. 290-07-10064). Annals of Internal Medicine 156(12), pp. 861-874.
The authors conducted a systematic review of drugs for urgency urinary incontinence in women. Their pooled analyses of 94 randomized controlled trials found small benefits for the tested drugs. Continence rates for 1,000 women treated by four different drugs were between 8.5 percent and 13 percent. The authors conclude that therapeutic choices should consider the harms profile of each drug. Evidence for long-term adherence and safety of treatments is lacking.
Shen, C., Li, X., Li, L., and Were, M.C. (2012). "Sensitivity analysis for causal inference using inverse probability weighting." (AHRQ Contract No. 290-04-0015, Grant HS15409). Biometrical Journal 53(5), pp. 822-837.
Evaluation of the impact of potential uncontrolled confounding is an important component for causal inference based on observational studies. The authors introduce a general framework of sensitivity analysis that is based on inverse probability weighting. They propose a general methodology that allows both non-parametric and parametric analyses. Their method is illustrated with two medical data sets.
Song, P.H., Robbins, J., Garman, A.N., and McAlearney, A.S. (2012, June). "High-performance work systems in health care, Part 3: The role of the business case." (AHRQ Contract No. 290-06-0022). Health Care Management Review 37(2), pp. 110-121.
The aim of this study is to enhance understanding about organizations' perspectives of the business case of high-performance work practices (HPWPs) in U.S. health care organizations. The authors' analysis of the 67 interviews with key informants found that the organizations they studied did not appear to have explicit financial return expectations for investments in HPWPs. In addition, evaluation efforts were rare.
Souter, K.J., and Gallagher, T.H. (2012). "The disclosure of unanticipated outcomes of care and medical errors: What does this mean for anesthesiologists?" (AHRQ grant HS16506). Anesthesia & Analgesia 114, pp. 615-621.
This article reviews the currently available literature related to disclosure of unanticipated outcomes to patients. Disclosures, especially those related to medical errors are discussed in reference to the practice of anesthesiology. The specific challenges of disclosures for anesthesiologists are highlighted, particularly in the ways they differ from other specialties.
Tang, X., Luo, Z., and Gardiner, J.C. (2012, June). "Modeling hospital length of stay by Coxian phase-type regression with heterogeneity." (AHRQ grant HS14206). Statistics in Medicine 31(14), pp. 1502-1516.
This study demonstrates the application of Coxian phase-type stochastic regression models to hospital length of stay (LOS) to account for the heavy skewness and heterogeneity in the data. The authors demonstrate that selecting an appropriate number of phases and a regression model for hazard rates can account for some heterogeneity in LOS. They used a classification method to assign patients to different LOS groups and illustrated this approach by applying it to hospital admissions for heart attack in the 2003 Nationwide Inpatient Sample from the Healthcare Utilization Project.
Thornton, R.L.J., Powe, N.R., Roter, D., and Cooper, L.A. (2012). "Patient-physician social concordance, medical visit communication and patients' perceptions of health care quality." (AHRQ grant HS32650). Patient Education and Counseling 85, pp. e201-e208.
This study examined whether social concordance is associated with differences in the quality of medical visit communication and patients' perceptions of care. It found that lower patient-physician social concordance was associated with less positive patients' perceptions of care and lower positive patient affect. Social concordance between physician and patient refers to similarity with respect to social identity characteristics (race, gender, age, education).
Toledo, P. (2012). "What's new in obstetric anesthesia: The 2011 Gerard W. Ostheimer lecture." (AHRQ grant HS20122). International Journal of Obstetric Anesthesiology 21, pp. 68-74.
Each year, a member of the Society for Obstetric Anesthesia and Perinatology is asked to review the previous year's literature and identify articles that are most relevant to the practice of obstetric anesthesia. The articles reviewed in this lecture focus on maternal co-existing disease, complications of anesthesia, the administration and safety of oxytocin, and patient safety.
Van Cleave, J., Dougherty, D., and Perrin, J.M. (2011). "Strategies for addressing barriers to publishing pediatric quality improvement research." (AHRQ Contract No. 290-07-000192). Pediatrics 128, p. e678.
The authors sought to identify barriers to publishing results of quality improvement (QI) research and provide practical strategies that QI researchers can use to enhance publishability of their work. They summarized a workshop on publishing QI research, interviewed experts, and reviewed pediatric QI studies. They identified strategies to overcome barriers that included collaborating with research methodologists and creating incentives to publish.
Wilkins, T.L., Rust, G.S., and Sambamoorthi, U. (2012, June). "Changing BMI categories and healthcare expenditures among elderly Medicare beneficiaries." (AHRQ grant HS15390). Obesity Journal 20(6), pp. 1240-1248.
The primary objective of this paper is to analyze the effects of changing body mass index on a variety of health expenditures, including total, in-patient, outpatient, medical, prescription, and dental expenditures among the elderly, using a nationally representative sample of Medicare beneficiaries. Based on their analysis of health-care expenditures subsequent to short-term weight gains, the researchers found that individuals who stayed obese had higher total, outpatient, prescription, and medical provider expenditures compared to those who remained at normal weight.
Zodet, M.W., Hill, S.C., and Zuvekas, S.H. (2012). "Evaluating an alternative data source for editing MEPS drug prices." Reprints (AHRQ Publication No. 12-R088) are available from the
AHRQ Publications Online Store
or can be downloaded at http://www.fcsm.gov/12papers/Zodet_2012FCSM_IV-C.pdf (PDF).
These authors assessed the feasibility of replacing average wholesale unit prices with median retail prices estimated from the MarketScan Outpatient Pharmaceutical Claims database for editing drug prices in the Medical Expenditures Panel Survey. In the second part of their evaluation, the authors determine whether thresholds that suggest outlier unit prices derived from retail prices outperform thresholds derived from the average wholesale price.