Research Activities April 2013, No. 392
Alexander, G.C., Kruszewski, S.P., and Webster, D.W. (2012, November). "Rethinking opioid prescribing to protect patient safety and public health." (AHRQ grant HS18960). Journal of the American Medical Association 308(18), pp. 1865-1866.
The authors believe that the substantial increase in the nonmedical use of opioids, along with the accompanying rise in the numbers of fatal drug overdoses, is a predictable effect of substantial increases in the prescribing of these medications. They call for changes in prescribing practices to reverse what has become a pervasive epidemic leading to widespread morbidity, mortality, and community strife.
Bowblis, J.R., Crystal, S., Intrator, O., and Lucas, J.A. (2012). "Response to regulatory stringency: The case of antipsychotic medication use in nursing homes." (AHRQ grant HS16097). Health Economics 21, pp. 977-993.
This study found that nursing homes increased their use of antipsychotics, but that the rate of increase varied significantly by State, consistent with the general trend in antipsychotic use from 2000 to 2005. Although case mix partly explains the rise in the use of antipsychotics, an important factor is the variation in the deficiency citation rates across States.
Carlos, R.C., Buist, D.S.M., Wernii, K.J., and Swan, J.S. (2012). "Patient-centered outcomes in imaging: Quantifying value." (AHRQ grant HS19482). Journal of the American College of Radiology 9, pp. 725-728.
This article describes the role of the newly created Patient-Centered Outcomes Research Institute with particular emphasis on the need for such research in radiology. The authors argue that patient-centered outcomes research in radiology should focus on patients’ experiences of care beyond traditional measures of patient satisfaction. They encourage radiologists across the practice spectrum to participate in studies demonstrating imaging as a high-value service in the patient-centered care arena.
Carpenter, W.R., Meyer, A.M., Abernethy, A.P, and others. (2012). "A framework for understanding cancer comparative effectiveness research data needs." (AHRQ Contract No. 290-05-0040). Journal of Clinical Epidemiology 65, pp. 1150-1158.
The authors reviewed prevalent data models and incorporated feedback from cancer comparative effectiveness research (CER) and outcomes researchers to develop a conceptual model for examining secondary data in cancer CER. Their model provides a template for informing future data collection and method development efforts relevant to not only secondary data but also prospective research.
Cleary, P.D., Crofton, C., Hays, R.D., and Horner, R. (2012). "Introduction." (AHRQ grants HS16978, HS16980). Medical Care 50(11) suppl 3, p. S1. Reprints (AHRQ Publication No.13-R030) are available from the AHRQ Publications Clearinghouse.
This article introduces a special issue focusing on recent work by Consumer Assessment of Healthcare Providers and Services (CAHPS) researchers. Specific subjects include how experiences with Medicare Part D insurance varies by race and ethnicity and whether cultural competence among hospital staff is associated with better patient experiences. Also included is a section on reporting the results from CAHPS surveys and using CAHPS data for quality improvement.
Courtwright, S.H., Stewart, G.L., and Ward, M.M. (2012). "Applying research to save lives: Learning from team training approaches in aviation and health care." (AHRQ grant HS18396). Organizational Dynamics 41, pp. 291-301.
As with aviation, many health care professionals and government officials agree that teamwork is one of the most important ways to curb errors. TeamSTEPPS®, like Crew Resource Management (used in aviation), is an evidence-based framework and training approach to improving care safety through teamwork. The authors discuss barriers to implementing this type of approach in health care as well as implementation solutions to overcome these barriers.
Dimick, J.B., Staiger, D.O., Osborne, N.H., and others. (2012, November). "Composite measures for rating hospital quality with major surgery." (AHRQ grant HS17765). HSR: Health Services Research 45(7), pp. 1862-1879.
The researchers investigated the value of empirically weighted composite measures for assessing surgical performance. They found that several input measures explained much of the hospital-level variation in risk-adjusted mortality, but the relative importance of each measure varied across each of five major surgical procedures. Composite measures combining hospital volume, risk-adjusted mortality, and structural measures such as nurse-to-patient ratios were better at forecasting future performance than existing quality indicators.
Dyer, N., Sorra, J.S., Smith, S.A., and others. (2012, November). "Psychometric properties of the Consumer Assessment of Healthcare Providers and Systems Clinician and Group Adult Visit Survey." (AHRQ Contract No. 290-07-10024, grants HS16978, HS16980). Medical Care 50, pp. S28-S34.
The Consumer Assessment of Healthcare Providers and Systems Clinician and Group Survey (CG-CAHPS) was developed to assess patient experiences with ambulatory care. The researchers evaluated the reliability and hypothesized factor structure of the CG-CAHPS Adult Visit Survey using data submitted to the CG-CAHPS database. They found that the survey has acceptable psychometric properties at the individual level and practice-site level.
Fawale, O.A., Dy, S.M., Wilson, R.F., and others. (2012). "A systematic review of communication quality improvement interventions for patients with advanced and serious illness." (AHRQ Contract No. 290-07-10061). Journal of General Internal Medicine [Epub ahead of print].
In their review, the authors found that communications in the care of patients with advanced and serious illness can be improved using quality improvement interventions, particularly for health care use as an outcome. Interventions using a consultative as opposed to an integrative approach may be more effective.
Frentzel, E.M., Sangl, J.A., Evensen, C.T., and others. (2012). "Giving voice to the vulnerable. The development of a CAHPS Nursing Home Survey measuring family members’experiences." (AHRQ grant HS13193). Medical Care 50, pp. S20-S27. Reprints (AHRQ Publication No. 13-R026) are available from the AHRQ Publications Clearinghouse.
The researchers describe the development of a survey to measure family members’ experiences with nursing homes. This survey complements a related nursing home resident survey. The paper discusses the procedures that were used, the issues that were identified, and the bases on which candidate questions were developed, eliminated, retained, or revised to finalize the Consumer Assessment of Healthcare Providers and Systems Nursing Home Surveys: Family Member Instrument.
Gagne, J.J., Walker, A.M., Glynn, R.J., and others. (2012). "An event-based approach for comparing the performance of methods for prospective medical product monitoring." (AHRQ grant HS18088). Pharmacoepidemiology and Drug Safety 21, pp. 631-639.
Many stakeholders are currently developing and testing methods for medical product safety monitoring systems, but little attention has been paid to how such methods should be evaluated. The authors propose an event-based classification approach that explicitly accounts for the accuracy in alerting, the timeliness in alerting, and the trade-offs between the false-negative and false-positive alerting.
Martino, S.C., Kanouse, D.E., Elliott, M.N., and others. (2012, November). "A field experiment on the impact of physician-level performance data on consumers’ choice of physician." (AHRQ grant HS16980). Medical Care 50(11) suppl 3, pp. S65-S73.
A Michigan-based health plan introduced an online primary care provider (PCP) report that displays clinical quality data and patients’ ratings of their experience with PCPs on a public Web site. A study comparing the responses of plan members who received added encouragement (a letter and follow-up phone call) to use the report with those who did not found that although those receiving additional encouragement selected PCPs with higher patient experience ratings, this difference was not explained by their greater likelihood of accessing the online report.
McInnes, D.K., Brown, J.A., Hays, R.D., and others. (2012, November). "Development and evaluation of CAHPS questions to assess the impact of health information technology on patient experiences with ambulatory care." (AHRQ grants HS16978, HS16980). Medical Care 50(11) suppl 3, S11-S19.
The Consumer Assessment of Healthcare Providers and Systems Clinician and Group 1.0 Survey is used to measure patient experiences with ambulatory care, but it does not include health information technology (IT) questions. The authors developed health IT items and assessed their psychometric properties. The resulting items, and the 3 composites they formed, assess patients’ experiences when the doctor uses health IT and patients’ direct interactions with health IT.
Memtsoudis, S.G., Mantilla, C.B., Parvizi, J., and others. (2013). "Have bilateral total knee arthroplasties become safer?" (AHRQ grant HS01675). Clinical Orthopedics and Related Research 471, pp. 17-25.
Younger and healthier individuals are increasingly likely to undergo bilateral total knee arthroplasty (TKA) in an effort to reduce complications, but it remains unclear whether this development has reduced overall perioperative morbidity and mortality. Using data between 1999 and 2008, the researchers determined whether demographics and comorbidity patterns of patients undergoing TKAs changed with time, and if there were detectable changes in the length and cost of hospitalization or the in-hospital mortality rate and incidence of major complications.
Morrato, E.H., and Ling, S.H. (2012, November). "The drug safety and risk management advisory committee. A case study of meeting frequency, content, and outcomes before and after FDAAA." (AHRQ grant HS19464). Medical Care 50(11), pp. 970-986.
The Food and Drug Administration Amendments Act (FDAAA) of 2007 granted FDA expanded drug safety authority. After enactment, the annual number of meetings of the Drug Safety and Risk Management Committee doubled due to the increased focus on safety. FDA questions to the committee were more likely to request an explicit drug safety assessment after FDAAA (from 31 percent to 76 percent of meetings).
Nembhard, I.M., Northrup, V., Shaller, D., and Cleary, P.D. (2012, November). "Improving organizational climate for quality of care." (AHRQ grants HS16978, HS18987). Medical Care 50(11), suppl 3, S74-S82.
This study of 21 clinics, 4 of which participated in a collaborative to improve quality of care, found that collaborative membership did not offer an advantage compared with other activities that nonparticipating clinics used to improve their quality-oriented climate. All study clinics seem to have pursued equally effective, organizational climate improvement efforts once they had received their baseline Leading a Culture of Quality Survey results.
O’Connor, S.S., Zatzick, D.F., Wang, J., and others. (2012, June). "Association between posttraumatic stress, depression, and functional impairments in adolescents 24 months after traumatic brain injury." (AHRQ grant T32 HS13835). Journal of Traumatic Stress 25, pp. 264-271.
Little research has examined the association between posttraumatic stress, depression, and functional impairments in adolescents 24 months after traumatic brain injury (TBI). A new study of adolescents 14–17 years of age with mild TBI without intracranial hemorrhage finds that they reported significantly worse post traumatic stress disorder (PTSD) compared with those who experienced an arm injury only. Greater levels of PTSD syndrome were associated with poorer school functioning.
Patterson, B.J., Doucette, W.R., Lindgren, S.D., and Chrischilles, E.A. (2012). "Living with disability: Patterns of health problems and symptom mediation of health consequences." (AHRQ grant HS16094). Disability and Health Journal 5, pp. 151-158.
This study found that adults with disability reported significantly greater prevalence and frequencies for 21 commonly reported symptoms, with pain and fatigue being the most common. The indirect effect through cumulative symptom frequency explained roughly half of the total effect of disability on general health status, and about one-third of the total effect on physical functioning.
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