Research Activities, August 2013
Berg, L.J., Delgado, M.K., Ginde, A.A., and others (2012). "Characteristics of U.S. emergency departments that offer routine human immunodeficiency virus screening." (AHRQ grant T32 HS00028). Academic Emergency Medicine 19(8), pp. 894–900.
This study examined 2008–2009 survey data on preventive health services performed in U.S. hospital emergency departments. It found that factors that significantly increased the likelihood of HIV screening included being at a county-owned hospital, having 24-hour social worker availability, and having at least 35 percent of patients without insurance.
Campbell, J.D., Zerzan, J., Garrison, L.P., and Libby, A.M. (2013). "Comparative-effectiveness research to aid population decision making by relating clinical outcomes and quality-adjusted life years." (AHRQ grant HS19464). Clinical Therapeutics 35(4), pp. 364-370.
A gap exists in an approach for bridging various forms of evidence for population-level decisions about the superiority of alternative interventions. This article presents a framework for population-based decisionmakers to quantitatively weigh and better grasp the collective intervention-specific clinical risks and benefits and their uncertainty. The authors propose a comparative effectiveness research framework that extends decision-analytical modeling, without requiring the inclusion of cost, to incorporate comparative risks and benefits.
Chakraborty, D.P., Joons, H.-J., and Mello-Thoms, C. (2012, December). "Application of threshold-bias independent analysis to eye-tracking and FROC data." (AHRQ grant HS18365). Academic Radiology 19(12), pp. 1474-1483.
This methodological study compares different schemes for evaluating radiologists’ readings of radiographic images. These include the receiver operating characteristic (ROC) paradigm, which uses information about decisions made on images, and the free-response ROC paradigm, which uses information about decisions made on perceived suspicious regions. The researchers also add information gathered from eye tracking that is processed by algorithms.
Chambers, D.A., Haim, A., Mullican, C.A., and others (2013, July-August). "[Editorial] Health information technology and mental health services research: A path forward." General Hospital Psychiatry 35(4), pp. 329-331. Reprints (AHRQ Publication No. 13-R058) are available from AHRQ.
The authors introduce a series of papers developed in response to a joint AHRQ-National Institute of Mental Health workshop in November 2010 on health information technology (IT)—enhanced interventions for the treatment of mental disorders. The authors summarize the meeting discussions and the four papers that accompany the editorial. Finally, they describe what actions the two Agencies have taken to advance the agenda for mental health-related IT research, including four currently open AHRQ program announcements.
Kim, H., El-Kareh, R., Goel, A., and others (2012). "An approach to improve LOINC mapping through augmentation of local test names." (AHRQ grant HS19913). Journal of Biomedical Informatics 45(4), pp. 651-657.
To share test-related data between health care institutions, medical test names need to be mapped into a standardized vocabulary. The researchers describe a process to enhance local names by incorporating the required information for Logical Observation Identifiers, Names, and Codes (LOINC®) into the test names themselves, significantly increasing the number of test names successfully mapped into LOINC.
Kim, J.M., Labrique, A., West, K.P., and others (2012, December). "Maternal morbidity in early pregnancy in rural northern Bangladesh." (AHRQ Grant T32 HS19488). International Journal of Gynecology and Obstetrics 119(3), pp. 227-233.
The researchers used cross-sectional data from 42,896 pregnant women (5–12 weeks of gestation) enrolled in a vitamin A supplementation trial in Bangladesh to determine baseline maternal morbidity in the rural northern region of this poor country. The researchers found significantly increased risk of malnutrition for women with symptoms of anemia (30 percent), vaginal discharge (37 percent), or high-grade fever (23 percent) compared with women without these symptoms.
McNellis, R.J., Genevro, J.L., and Meyers, D.S. (2013). "Lessons learned from the study of primary care transformation." Annals of Family Medicine 11 (Supplement 1), pp. S2-S5. Reprints (AHRQ Publication No. 13-R057) are available from AHRQ.
In 2010, AHRQ awarded 14 grants to better understand the processes and determinants of primary care transformation. The authors of this commentary summarize the characteristics of the practices and interventions studied by the 14 grantees and highlight their impressions, as the funding agency, of the lessons learned on the process of transforming a primary care practice into a patient-centered medical home.
Miller, G.E. and Selden, T.M. (2012). "Tax subsidies for employer-sponsored health insurance: Updated microsimulation estimates and sensitivity to alternative incidence assumptions." Health Services Research 48(2, Part II), pp. 866-883. Reprints (AHRQ Publication No. 13-R051) are available from AHRQ.
The authors of this paper simulated tax expenditures for employer-sponsored health insurance (ESI)to examine the sensitivity of ESI tax subsidy estimates to the effect of employer size and employee pay levels. The authors estimate that the total ESI tax subsidy for 2012 was $257.4 billion. Most of this subsidy goes to large establishments or those with workforces that are principally highly paid or full-time.
Norton, W.E., McCannon, C.J., Schall, M.W., and others (2012 December). "A stakeholder-driven agenda for advancing the science and practice of scale-up and spread in health." (AHRQ grant HS19422). Implementation Science 7:118.
A Conference To Advance the Science and Practice of Scale-Up and Spread of Effective Health Programs in Healthcare and Public Health, held in July 2010, made five major recommendations. The first two recommendations were to develop, evaluate, and refine innovative scale-up and spread methods, including novel incentives and pull strategies, and to develop and apply new approaches for evaluation of scale-up and spread.
Ritchie, C., Richman, J., Sobko, H., and others (2012, November). "The E-Coach transition support computer telephony implementation study: Protocol for a randomized trial." (AHRQ grant HS17786). Contemporary Clinical Trials 33(6), pp. 1172–1179.
The researchers are investigating the use of E-Coach, an interactive voice response-enhanced care transition intervention, to monitor patients with complex problems at home, using their personal telephone. The E-Coach intervention will be tested in a randomized controlled trial in patients with congestive heart failure and chronic obstructive pulmonary disease, who were admitted to a large tertiary care hospital. The primary outcome measure will be the rehospitalization rate at 30 days after discharge.
Ryan, A.M., and Bao, Y. (2013, April). "Profiling provider outcome quality for pay-for-performance in the presence of missing data: A simulation approach." (AHRQ grant HS18546). Health Services Research 48(2, Part II), pp. 810-825.
For a panel of patients with major depression, the researchers used Monte Carlo simulation to evaluate error rates for a relative threshold (being above the 80th percentile for remission for providers) and an absolute threshold (having at least 30 percent of patients in remission) for 6-month recovery. Using a variety of scenarios, they found relative profiling had 20 percent lower total error rates and 50 percent lower error rates due to missing data than absolute profiling.
Sokas, R., Braun, B., Chenven, L., and others (2013, April). "Frontline hospital workers and the worker safety/patient safety nexus." The Joint Commission Journal on Quality and Patient Safety 39(4), pp. 185-192. Reprints (AHRQ Publication No. 13-R059) are available from AHRQ.
The authors summarize the content of a 1-day workshop on the relationship between worker safety for frontline—but nonclinician—health care workers (HCWs) and patient safety. Among the recommendations were to develop champions and leaders at hospitals to push for the implementation of "person safety" for anyone entering the facility as a patient, visitor, or health care worker and to add nonclinician HCWs, as well as patients, to the hospital’s quality and safety committee.
Stafford-Smith, M. (2013, March). "Can ‘earlier biomarkers’ help early biomarkers predict acute kidney injury?" (AHRQ grant HS15704). Critical Care Medicine 41(3), pp. 914-915.
Since there is currently limited understanding of why some patients sustain acute kidney injury related to heart surgery, the recent emergence of preoperative biomarkers with substantial explanatory value is very interesting. These early biomarkers include ouabain, brain natriuretic peptide, and hemoglobin A1c in non-diabetic patients. The author discusses recent literature in this area.
Zhang, Y., Wu, S.-H., Fendrick, A.M., and Baicker, K. (2013, March). "Variation in medication adherence in heart failure." JAMA Internal Medicine 172(6), pp. 468-470.
To study regional variation in heart failure (HF) medication adherence, the authors used Medicare Part D data for a 5 percent random sample of Medicare beneficiaries. They found that, on average, 52 percent of patients had good adherence for HF medications. The proportion having good adherence varied considerably by area, from the lowest 36 percent to the highest 71 percent.
Zhou, L., Plasek, J.M., Mahoney, L.M., and others (2012). "Mapping Partners Master Drug Dictionary in RxNorm using an NLP-based approach." (AHRQ grant HS18288). Journal of Biomedical Informatics 45, pp. 626-633.
The authors seek to develop an automated method based on natural language processing (NLP) to facilitate the creation and maintenance of a mapping between RxNorm and a local medication terminology for interoperability and meaningful use purposes. They found that an automated approach based on NLP followed by human expert review is an efficient and feasible way for conducting dynamic mapping.
Zima, B.T., Murphy, J.M., Scholle, S.H., and others (2013, March). "National quality measures for child mental health care: Background, progress, and next steps." (AHRQ grants HS20506, HS20503, HS20498). Pediatrics 131 (Supplement 1), S38-S49.
Recent recommendations for measures of the quality of care received by U.S. children have included few measures related to child mental health care. The authors review recent relevant health policy initiatives, the selection of national child health quality measures, and existing national standards for child mental health care. They include the strength of the evidence supporting them, an update on development of new quality measures related to child mental health care, and early lessons learned from these national efforts.