Research Activities, July 2013
Ahern, D.K., Stinson, L.J., Uebelacker, L.A., and others. (2012, September/October). "E-Health blood pressure control program." (AHRQ grant HS18238). Medical Practice Management, pp. 91-100.
The researchers describe both technological and human factors design elements necessary to integrate home blood pressure monitoring and patient navigator support into a primary care setting. They found that their e-health blood pressure control system with personal navigator support was well-received by patients and providers.
Clancy, C., and Moy, E. (2013). "Commentary: Measuring what matters most." Milbank Quarterly 91(1), pp. 201-204. Reprints (AHRQ Publication No. 13-R055) are available from AHRQ.
Guidance to aid the selection of measures for tracking inequalities in health care has generally been absent. This article is a commentary on a 2011 Milbank Quarterly article by J. Frank and S. Haw that discusses guidelines to assess the appropriateness of measures for tracking socioeconomic inequalities in health outcomes. The authors think that with some small modifications, the approach taken by Frank and Haw can be applied to other types of measures and to uses other than assessing interventions.
Cooke, C.R. (2013, February). "Improving the efficiency of ICU admission decisions." (AHRQ grant HS20672). Critical Care Medicine 41(2), pp. 662-663.
This commentary discusses and critiques another article in the same issue (Yang et al) that develops and compares three queuing and simulation-based models to determine the best way to allocate intensive care unit (ICU) beds to incoming postoperative patients in a cardiothoracic ICU. The author’s main criticism is that these models rely on a flawed assumption: that all patients who are admitted to the ICU will benefit from critical care services.
Cooke, C.R. and Iwashnya, T.J. (2013, March). "Using existing data to address important clinical questions in critical care." (AHRQ grant HS20672). Critical Care Medicine 41(3), pp. 886-893.
The authors examine several existing critical care data sources commonly used for secondary data analysis in critical care and present a practical approach to the selection of a database based on the strength of the source. Their article is aimed both at investigators seeking to answer research questions in critical care and at readers of the medical literature interested in ways to appraise the data sources selected in published studies.
Del Fiol, G., Huser, V., Strasberg, H.R., and others. (2012). "Implementation of the HL7 context-aware knowledge retrieval (Infobutton) standard: Challenges, strengths, limitations, and uptake." (AHRQ grant HS18352). Journal of Biomedical Informatics 45, pp. 726-735.
The authors examined the experience of 17 organizations in the course of implementing the HL7 Infobutton Standard. "Infobuttons" are computerized information retrieval tools that deliver contextually relevant knowledge resources into clinical information systems. Overall, implementers reported a very positive experience with the HL7 Infobutton Standard.
Doshi, P., and Jefferson, T. (2013, March). "The first two years of the European Medicines Agency’s policy on access to documents: Secret no longer." (AHRQ grant T32 HS19488). JAMA Internal Medicine 173(50), pp. 380-382.
The authors seek to inform discussion of access to clinical trial data by describing how the European Medicines Agency policy is being used. They found that 457 requests for information had been made, mostly by the pharmaceutical industry, media, and law firms. The types of material requested varied widely, with the most frequently requested types being assessment reports, dossiers, and clinical study reports.
Gibbons, R.D., Brown, C.H., Hur, K., and others. (2013, January). "Inappropriate data and measures lead to questionable conclusions—reply." (AHRQ grant HS16973). JAMA Psychiatry 70(1), pp. 122-123.
The authors respond to criticisms of their work on antidepressant treatment and suicidal thoughts and behavior in a letter by Spielmans et al. that claims they excluded data from relevant trials, included data from inappropriate trials, and used a poor measure to detect suicidality. Each of these claims is given a detailed response.
Gibbons, R.D., Brown, C.H., Hur, K., and others. (2013, January). "Suicide risk and efficacy of antidepressant drugs—reply." (AHRQ grant HS16973). JAMA Psychiatry 70(1), pp. 124-125.
The authors respond in detail to criticisms of their work in a letter by Carroll et al. claiming that their conclusion that there are no significant effects of antidepressant treatment on suicidal thoughts and behavior was unsound. Carroll’s criticism centered on two studies by Gibbons and colleagues that contained risk/efficacy reanalyses of selected data sets on the use of atomoxetine hydrochloride and fluoxetine.
Guise, J-M., O’Haire, C., McPheeters, M., and others. (2013). "A practice-based tool for engaging stakeholders in future research: A synthesis of current practices." (AHRQ Contract No. 290-07-10057). Journal of Clinical Epidemiology 66, pp. 666-674.
In order to learn more about the best methods to engage a wide range of stakeholders in prioritizing patient-centered outcomes and comparative effectiveness research, the authors reviewed 56 relevant articles and conducted interviews with leading research organizations and eight Evidence-based Practice Centers. From the accumulation of findings, they developed recommendations for stakeholder engagement and a reporting checklist.
Hagan, M., and Dowd, B. (2013, April). "Introduction and commentary for special issue simulation techniques in health services research." HSR: Health Services Research 48(2), Part II, pp. 683-685.
This editorial states that the special issue on simulation techniques in health services research includes articles which address methodological challenges and solutions to problems when using such techniques. The issue also has articles featuring simulations used to address important content areas in health services research such as supply-side simulation, health care costs, health care policy, and others.
Ibrahim, S.A., and Franklin, P.D. (2013, April). "Race and elective joint replacement: Where a disparity meets patient preference." (AHRQ grant HS18910). American Journal of Public Health 103(4), pp. 583-584.
There is a marked racial disparity between black patients compared to white patients in the use of total joint replacement (TJR) surgery. The authors discuss some of the reasons for this disparity and urge that better ways be found to solicit informed preferences from patients considering preference-sensitive treatments such as TJR, especially minority patients who have found the traditional doctor-patient communication a less-than-ideal venue for expressing their choices and beliefs.
Jones, M., Hama, R., Jefferson, T., and Doshi, P. (2012). "Neuropsychiatric adverse events and oseltamivir for prophylaxis." (AHRQ grant T32 HS19488). Drug Safety 35(12), pp. 1187-1188.
An earlier study by Toovey et al had stated that in randomized controlled studies, significantly fewer oseltamivir patients reported neuropsychiatric adverse events (NPAEs) than placebo patients. The authors of this letter request that Toovey prove further details on what events were included in their comparison of NPAE, including the list of 98 preferred terms they mention in their article.
Kesselheim, A.S. (2013, February). "Drug company gifts to medical students: The hidden curriculum." (AHRQ grant HS18465). British Medical Journal [Epub ahead of print].
This editorial comments on an article examining the effect of restricting industry gifts to students on their prescribing of three recently approved brand-name psychotropic drugs. Prescription trends were measured at least 4 years after the policy was implemented, when all students had completed their residencies. The author believes that this study adds an important new dimension to the debate over policies on industry interactions on medical school campuses.
Krishnan, J.A., Lindenauer, P.K., Au, D.H., and others. (2013, February). "Stakeholder priorities for comparative effectiveness research in chronic obstructive pulmonary disease. A workshop report." (AHRQ grant HS17894). American Journal of Respiratory Critical Care Medicine 187(3), pp. 320-326.
This article discusses the methodology and development of a national comparative effectiveness research (CER) agenda for chronic obstructive pulmonary disease (COPD), which may help to inform groups intending to respond to funding opportunities for CER in COPD. Fifty-four stakeholder groups participated in the workshops. Research priorities varied, but generally focused on studies to evaluate different approaches to health care delivery (e.g., spirometry for diagnosis and treatment).
Li, A.C., Kannry, J.L., Kushniruk, A., and others. (2012). "Integrating usability testing and think-aloud protocol analysis with "near-live" clinical simulations in evaluating clinical decision support." (AHRQ grant HS18491). International Journal of Medical Informatics 81, pp. 761-772.
This paper describes two phases of evaluation conducted prior to widespread deployment of the integrated clinical prediction rule clinical decision support (iCPR CDS) tool. Phase I involved usability testing in conjunction with "think-aloud" protocol analysis to assess human-computer interaction as the health care providers performed specific tasks following a script for invoking the iCPR CDS. Phase II involved a "near-live" clinical simulation to assess how providers interact with the iCPD CDS while interviewing a simulated patient.
Likosky, D.S., Goldberg, J.B., DiScipio, A.W., and others. (2012). "Variability in surgeons’ perioperative practices may influence the incidence of low-output failure after coronary artery bypass grafting surgery." (AHRQ grant HS15663). Circulation Cardiovascular Quality Outcomes 5, pp. 638-644.
Low-output failure (LOF) is one of the most significant adverse sequelae of isolated coronary artery bypass surgery (CABG). A study investigating factors associated with the development of LOF after isolated on-pump CABG surgery has found that perioperative surgical practices rather than patient case mix or other preoperative factors are responsible for most of the surgeon-to-surgeon variation in rates of LOF.
Liu, V., Turk, B.J., Ragins, A.I., and others. (2013, January). "An electronic simplified acute physiology score-based risk adjustment score for critical illness in an integrated healthcare system." (AHRQ Grant HS19181). Clinical Care Medicine 41(1), pp. 41–48.
The researchers used structured data from the Kaiser Permanente of Northern California HealthConnect electronic medical record system and adapted it for use in an automated system to calculate risk-adjustment scores for patients in an intensive care unit (ICU). They then developed an automated scoring model using 40 percent of 67,889 first-time ICU patients admitted between 2007 and 2011 to 21 hospitals associated with Kaiser Permanente. They tested the model by calculating hospital mortality rates for the remaining 60 percent.
Parente, S.T. and Feldman, R. (2013, April). "Microsimulation of private health insurance and Medicaid take-up following the U.S. Supreme Court decision upholding the Affordable Care Act." (AHRQ Contract No. 262-05-63293). HSR: Health Services Research 48(2), Part II, pp. 826-849.
The researchers seek to predict both how many people will take up private health insurance under the Affordable Care Act (ACA) and how many will take up Medicaid under several possible patterns for States opting out of the ACA’s Medicaid expansion. Using data from several large employers, the Medical Expenditure Panel Survey Household Component, and other sources, they find that the ACA will increase coverage substantially in the private insurance market as well as Medicaid. The total number of uninsured, at best, will drop by more than 20 million.
Rangachari, P. (2013). "Effective communication network structures for hospital infection prevention: A study protocol." (AHRQ grant HS19785). Quality Managed Health Care 22(1), pp. 16-24.
The author has developed a protocol for a study with 2 aims: (1) to examine associations between quality improvement interventions and communication structure and content, and (2) to examine associations between communication structure and content and outcomes at the unit level. The study, to be undertaken in two hospital intensive care units, aims to assist hospitals in implementing the central line bundle. This bundle consists of five evidence-based practices known to significantly reduce, if not eliminate, the incidence of catheter-related bloodstream infections.