Research Activities March 2013, No. 391
Andrews, A.M., Zhang, N., Magee, J.C., and others. (2012, June). "Increasing donor designation through black churches: Results of a randomized trial." (AHRQ grant HS08574). Progress in Transplantation 22(20), pp. 161-167.
A program using church members trained as lay health advisors was able to increase minority enrollment in an organ donor registry, even absent a change in attitudes. The advisors conducted organ donation discussions with church groups and showed a DVD created for this program.
Campbell, N.L., Boustain, M.A., Skopelja, E.N., and others. (2012, June). "Medication adherence in older adults with cognitive impairment: A systematic evidence-based review." (AHRQ grant HS19818). The American Journal of Geriatric Pharmacotherapy 10(3), pp. 165-177.
This review identified barriers to medication adherence in cognitively impaired older adults as well as interventions to improve adherence. Barriers included: understanding new directions, living alone, and scheduling medication administration into the daily routine. Successful interventions to improve medication adherence focused on frequent human communication as reminder systems.
Chang H.-Y., Weiner J.P., Richards T.M., and others. (2012, April). "Predicting costs with Diabetes Complications Severity Index in claims data." (AHRQ Contract No. 290-05-0034). American Journal of Managed Care 18(4), pp. 213-219.
The Diabetes Complications Severity Index (DCSI) without laboratory test results is a better predictor of total costs for a patient with diabetes than counts of complications, found this study. The DCSI scores each of seven diabetes complication categories (retinopathy, nephropathy, cerebrovascular disease, cardiovascular disease, peripheral vascular disease, and metabolic syndrome) 0, 1, or 2—to produce an index value (range, 0–13).
Chien, A.T. (2012, October). "Can pay for performance improve the quality of adolescent substance abuse treatment?" (AHRQ grant HS17146). Archives of Pediatric Adolescent Medicine 166(10), pp. 962-963.
This article comments on a new study of the effects of a pay-for-performance (P4P) plan on adolescent substance abuse treatment and outcomes. The author cites it as the first such study on a subpopulation of children with special health care needs and places it in the context of other P4P studies on adults. In addition, she points to large gaps in the understanding of the effectiveness of P4P strategies and discusses questions relating to P4P program design that have emerged in the broader P4P literature.
Clancy, C. (2013). "New hospital readmission policy links financial and quality incentives." Journal of Nursing Care Quality 28(1), pp. 1-4. Reprints (AHRQ Publication No. 13-R020) are available from the Agency for Healthcare Research and Quality Publications Clearinghouse.
Under provisions included in the Affordable Care Act, hospitals with high readmission rates for certain procedures could see their annual hospital Medicare payments reduced by up to 1 percent. In response, hospitals must learn to maintain effective and consistent levels of nurse staffing, which has been shown to decrease preventable readmissions, and invest in nurses’ capability to educate patients.
D’Allesandro, A.M., Peltier, J.W., and Dahl, A.J. (2012, June). "A large-scale qualitative study of the potential use of social media by university students to increase awareness and support for organ donation." (AHRQ grant HS13416). Progress in Transplantation 22(20), pp. 183-191.
This project identified a conceptual model of how college students, especially those in student organizations, can be the social media catalyst for viral communications designed to motivate others to learn about the need for organ donation and become organ donors. The findings of the study suggest that the donation community can motivate college students to register as donors and become advocates through outreach efforts that use social media.
DeVoe, J.E., Westfall, N., Crocker, S., and others. (2012, January). "Why do some eligible families forego public insurance for their children? A qualitative analysis." (AHRQ grants HS14645, HS16181, and HS18569). Family Medicine 44(1), pp. 39-46.
The researchers interviewed 24 parents of children eligible for public insurance and identified four barriers to children’s enrollment. These included: (1) parental confusion about enrollment and eligibility requirements, (2) difficulties navigating the complexities of obtaining public coverage, (3) frustrations with the limited availability of providers, and (4) often finding that many services are not covered or that there are coverage gaps.
Grossman, J.M., Cross, D.A., Boukus, E.R., and others. (2012, May/June). "Transmitting and processing electronic prescriptions: Experiences of physician practices and pharmacies." (AHRQ Contract No. 290-05-0007). Journal of the American Medical Informatics Association 19(3), pp. 353-359.
Physician practices and pharmacies are generally satisfied with electronic transmission of new prescriptions, but use of this process for renewals is inconsistent, requiring workarounds for both parties that reduced efficiency, according to a new study. Despite e-prescribing, the pharmacies may have to enter the drug name semi-manually because the National Drug Code in the physician practice’s system or the pharmacy’s database may not be up-to-date.
Jarvik, J.G., Comstock, B.A., Bresnahan, B.W., and others. (2012, May). "Study protocol: The back pain outcomes using longitudinal data (BOLD) registry." (AHRQ grant HS19222). BMC Musculoskeletal Disorders 13, p. 64.
The overall goal of this project is to establish a rich, sustainable registry to describe the natural history and evaluate prospectively the effectiveness, safety, and cost-effectiveness of interventions for patients 65 and older with back pain. By establishing this registry, the researchers are creating a resource that contains patient-reported outcome measures as well as electronic medical record data for elderly patients with back pain.
Jones, M., Samore, M.H., Carter, M., and others. (2012, June). "Long-term care facilities in Utah: A description of human and information technology resources applied to infection control practice." (AHRQ Grant No. HS14017). American Journal of Infection Control 40(5), pp. 446-450.
The researchers surveyed all 80 long-term care facilities in Utah to get information on the staffing and operation of their infection control (IC) programs. The surveys showed that most infection preventionists (71 percent) were registered nurses and 82 percent had on-the-job training. For 94 percent of the staff, IC was a secondary assignment. Information infrastructure was not up-to-date, except for the provision of desktop computers.
Kesselheim, A.S. and Avorn, J. (2012). "The Food and Drug Administration has the legal basis to restrict promotion of flawed comparative effectiveness research." (AHRQ grant HS18465). Health Affairs 31(10), pp. 2200-2205.
The authors review the legal and methodological issues surrounding the authorization of promotional claims for drugs based on observational studies and support the FDA’s wariness in authorizing such claims. They point out that, as comparative effectiveness research matures, the FDA may choose to modify that perspective, along with its definition of acceptable, adequate, and well-controlled investigations, in limited circumstances.
Kesselheim, A.S., Lee, J.L., Avorn, J., and others. (2012, January). "Conflict of interest in oncology publications: A survey of disclosure policies and statements." (AHRQ grant HS18465). Cancer 118(1), pp. 188–195.
The authors find that there is still much variation among cancer-related journals in their policies for reporting authors’ conflicts of interest. Among 131 cancer research journals identified by the researchers, only 112 provided disclosure policies. Of these 112 journals, 99 requested that authors disclose conflicts of interest, but 13 did not require it.
Leeman, J. and Sandelowski, M. (2012). "Practice-based evidence and qualitative inquiry." (AHRQ grant HS19468). Journal of Nursing Scholarship 44(2), pp. 171-179.
The authors present a framework for the use of qualitative methods to contribute to the following categories of practice-based evidence: (a) practice-based interventions and implementation strategies, (b) causal mechanisms, (c) approaches to adaptation, (d) how-to guidance, unanticipated effects, and (f) relevant contextual factors. They argue that qualitative inquiry has an essential role to play in incorporating more practice-based evidence into the evidence base for nursing practice.
Norris, S.L., Holmer, H.K., Burda, B.U., and others. (2012, May). "Conflict of interest policies for organizations producing a large number of clinical practice guidelines." (AHRQ grant HS18500). PLoS ONE 7(5), e37413 (12 pp.).
Conflict of interest (COI) policies related to the writing of clinical practice guidelines (CPGs), among organizations that develop multiple CPGs, fail to meet all seven of the principles set out in the Institute of Medicine’s 2011 standards for CPG developers, according to the researchers. They identified 17 COI policies directly relevant to CPGs from 37 organizations with five or more guidelines in the AHRQ National Guideline Clearinghouse between January 2009 and November 2010.
Saldanha, I.J., Wilson, L.M., Bennett, W. L., and others. (2012, September). "Development and pilot test of a process to identify research needs from a systematic review." (AHRQ Contract No. 290-07-10061). Journal of Clinical Epidemiology [Epub ahead of print].
There is a need for a methodologically rigorous process of identifying and prioritizing research needs from systematic reviews in order to effectively distribute resources to areas of highest priority. The authors pilot-tested an eight-step process to identify clinically important research needs in the area of gestational diabetes mellitus. They suggest this process should be tested using systematic reviews of other diseases.
Shaikh, U., Nettiksimmons, J., Bell, R.A., and others. (2012, March). "Accuracy of parental report and electronic health record documentation as measures of diet and physical activity counseling." (AHRQ grant HS18567). Academic Pediatrics 12(2), pp. 81-87.
The study objective was to determine whether parental reports and electronic records of physician counseling reflect actual counseling provided. The researchers concluded that parental report via a questionnaire administered directly after the medical visit was a better alternative to electronic health record documentation in quality improvement or research studies when resources do not allow for direct observation.
Stefanone, M., Anker, M., Thomas, M.E., and Feeley, H. (2012, June). "Click to ‘like’ organ donation: The use of online media to promote organ donor registration." (AHRQ grant HS0961). Progress in Transplantation 22(20), pp. 168-174.
These authors describe results of an intervention to promote organ donor registration that relies solely on online media to communicate to target audiences. The study used 3 formats: traditional online advertising, student seeders’ social networking sites campaigns, and challenge campaigns. Online advertising was less effective than the other two formats.
Taylor, J.L., McPheeters, M.L., Sathe, N.A., and others. (2012, September). "A systematic review of vocational interventions for young adults with autism spectrum disorders." (AHRQ Contract No. 290-07-10065). Pediatrics 130(3), pp. 531-538.
The researchers undertook a systematic review to assess the impact of vocational interventions on teenagers and young adults with autism spectrum disorders (ASDs). Assessment of 1,035 full-text articles led the researchers to only 6 papers (representing 5 studies) that addressed vocational interventions for teens and young adults with ASD, ages 13 to 30 years. Because of the poor quality of the studies identified, no conclusions could be drawn.
Utter, G.H., Cuny, J., Strater, A., and others. (2012, September). "Variation in academic medical centers’ coding practices for postoperative respiratory complications." (AHRQ Contract No. 290-04-0020). Medical Care 50(8), pp. 792-800.
AHRQ’s Patient Safety Indicator 11 uses ICD-9 Clinical Modification diagnosis code 518.81 ("acute respiratory failure")—but not the closely related alternative, code 518.5 ("pulmonary insufficiency after trauma and surgery")—to detect cases of postoperative respiratory failure. The researchers investigated whether hospitals vary in the use of 518.81 vs. 518.5 and whether such variation correlates with coder beliefs.
Weech-Maldonado, R., Carle, A., Weidmer, B., and others. (2012, September). "The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Cultural Competence (CC) Item Set." (AHRQ grant HS16980). Medical Care 50(9) Suppl. 2, pp. S22-S31. (Reprint?)
There is a need for reliable and valid measures of cultural competence from the patient’s perspective. The authors evaluated the reliability and validity of the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) 26-item cultural competence set and found that it demonstrated adequate measurement properties and can be used as a supplemental item set to the CAHPS Clinician and Group Surveys in assessing culturally competent care from the patient’s perspective.
Weidmer, B.A., Brach, C., and Hays, R.D. (2012, September). "Development and evaluation of CAHPS® survey items assessing how well healthcare providers address health literacy." Medical Care 50(9) Suppl 2, pp. S3-S11). Reprints (AHRQ Publication No. 13-R015) are available from the Agency for Healthcare Research and Quality Publications Clearinghouse.
The researchers developed and tested CAHPS® 22 survey items for addressing health literacy and assessing how well providers communicate health information. After reviewing 601 completed surveys and developing two composite measures derived from the 22 items, they concluded that the CAHPS® Item Set for Addressing Health Literacy was both reliable and valid.
Weidmer, B.A., Brach, C., Slaughter, M.E., and Hays, R.D. (2012, September). "Development of items to assess patients’ health literacy experiences at hospitals for the Consumer Assessment for Healthcare Providers and Systems (CAHPS®) Hospital Survey." Medical Care 50(9) Suppl 2, pp. S12-S21. Reprints (AHRQ Publication No. 13-R014) are available from the Agency for Healthcare Research and Quality Publications Clearinghouse.
The researchers developed and tested an Item Set for Addressing Health Literacy to supplement the CAHPS® Hospital Survey to assess how well hospitals communicate health information to inpatients. After analyzing 1,013 surveys and identifying three composites (communication about tests, communication about how to care for self and medicines, communication about forms) drawn from the 62 items, they found that their study supported the measurement properties of the Item Set.