Research Activities, October 2013
Centurion, V.P., Huang, F., Naureckas, E.T., and others (2012). "Confirmatory spirometry for adults hospitalized with a diagnosis of asthma or chronic obstructive pulmonary disease exacerbation." (AHRQ grant HS17894). BMC Pulmonary Medicine 12(73).
This study was designed to determine the feasibility of spirometry and to determine its usefulness in confirming the diagnosis in patients hospitalized with a physician diagnosis of asthma or chronic obstructive pulmonary disease exacerbation. It found that confirmatory spirometry was a useful tool to help reduce overdiagnosis of obstructive lung disease, especially among obese patients.
Cohen, M.D., Hilligoss, B., and Amaral, A.C. (2012). "A handoff is not a telegram: An understanding of the patient is co-constructed." (AHRQ grant HS18758). Critical Care 16(303).
The authors are concerned that an undue emphasis on one-way information transfer during handoffs of hospitalized patients can lead to research designs and policy recommendations that fail to recognize the active participation of both parties in co-constructing the oncoming caregiver's understanding of the patient. They present some of the findings from research outside medicine that support and refine this idea.
Daly, J.M., Xu, Y., and Levy, B.T. (2012). "Patient and physician management of self-monitoring of blood glucose: An Iowa research network study." (AHRQ grant HS14859). Journal of Diabetes Science and Technology 6(3), pp. 718-720.
The purpose of this study was to compare those who and those who do not conduct self-monitoring of blood glucose (SMBG) as recommended with respect to patient demographics, self-care behaviors, barriers to SMBG, and purchase of blood-glucose testing supplies. Twenty of the 42 participants reported testing their blood glucose one or more times a day while 7 had their blood glucose tested only when they were at their physician's office.
Dusetzina, S.B., Mack, C.D., and Sturmer, T. (2013, May). "Propensity score estimation to address calendar time-specific channeling in comparative effectiveness research of second generation antipsychotics." (AHRQ grant HS18996). PLOS ONE 8(5), p. e3973.
The researchers sought to demonstrate channeling among new users of second-generation antipsychotics following an FDA safety advisory and to evaluate the impact of channeling on cardiovascular risk estimates over time. They found that changes in channeling had limited impact on cardiovascular risk estimates, possibly due to unmeasured confounding factors.
Dusetzina, S.B., Farley, J.F., Weinberger, M., and others (2012). "Treatment use and costs among privately insured youths with diagnoses of bipolar disorder." (AHRQ grant T32 HS00032). Psychiatric Services 63(10), pp. 1019-1025.
The objectives of this study were to identify utilization patterns and estimate health plan payments for inpatient, outpatient, and pharmacy services among privately insured children with bipolar disorder diagnoses. The researchers found that the costs of care among this population are similar to those for adults. However, spending on children is concentrated on mental health-related services.
Elliott, S.J., Ivanescu, A., Leland, N.E., and others (2012). "Feasibility of interdisciplinary community-based fall risk screening." (AHRQ grant T32 HS00011). American Journal of Occupational Therapy 66, pp. 161-168.
The researchers undertook a pilot study to examine the feasibility of (1) conducting interdisciplinary fall risk screens at a communitywide adult fall prevention event and (2) collecting preliminary follow-up data about the balance confidence of adults screened at the event, as well as home or activity modifications they made after receiving educational information at the event. They found that screening conducted in this context is feasible and can facilitate environmental and behavior changes to reduce fall risk.
Garman, A., McAlearney, A., Robbins, J., and Harrison, M. (2012). "Getting to zero on CLABSIs—and staying there." H & HN Daily December 5. Reprints (AHRQ Publication No. 13-R063) are available from AHRQ.
This article describes recent research to determine why some organizations are more successful than others in reducing central line-associated bloodstream infections (CLABSIs). In case studies at nine hospitals involving interviews with 226 clinicians and administrators, researchers identified some keys to successful efforts. These included strong, visible clinical leadership; systematic approaches to training; a belief that zero CLABSIs is achievable; more pervasive information sharing; a greater sense of personal accountability; and an eye toward sustainability.
Garroutte, E.M., Sarkisian, N., and Karamnov, S. (2012). "Affective interactions in medical visits: Ethnic differences among American Indian older adults." (AHRQ grant HS10854). Journal of Aging and Health 24(7), pp. 1233-1251.
These authors investigated the influence of ethnicity on older American Indian patients' interpretations of providers' affective behaviors. Using data from 115 older American Indian patients, the researchers found that in models accounting for patients' ethnicity only, high scores for American Indian ethnicity were linked to reduced evaluations for providers' respect. High scores on white ethnicity were associated with elevated ratings for empathy and rapport.
Holve, E., Lopez, M.H., Scott, L., and Segal, C. (2012). "A tall order on a tight timeframe: Stakeholder perspectives on comparative effectiveness research using electronic clinical data." (AHRQ grant HS19564). Journal of Comparative Effectiveness Research 1(5), pp. 441-451).
The AcademyHealth Electronic Data Methods Forum aims to advance the national dialogue on the use of electronic clinical data (ECD) for comparative effectiveness research (CER) by facilitating exchange and collaboration among 11 research projects and external stakeholders. To this end, AcademyHealth conducted a mixed-method needs assessment with the forum's key stakeholders to assess stakeholder views on developing new infrastructure for CER using ECD.
Husky, M.M., Olfson, M., He, J-P., and others (2012). "Twelve-month suicidal symptoms and use of services among adolescents: Results from the National Comorbidity Survey." (AHRQ grant HS02112). Psychiatric Services 63(10), pp. 989-996.
This study examined national rates of suicidal ideation, plans, and attempts in the past year among a large, nationally representative sample of adolescents. During 12 months, 3.6 percent of adolescents reported suicidal ideation without a plan or attempt, and 1.9 percent made a suicide attempt. Most of those in either category did not have any contact with a mental health specialist in the past year.
Irwin, B., Hirsch, B.R., Samsa, G.P., and Abernethy, A.P. (2012). "Conflict of interest disclosure in off-label oncology clinical trials." (AHRQ Contract No. 290-02-0025). Journal of Oncology Practice 8(5), pp. 298-302.
The researchers examined the prevalence, reliability, and predictors of conflict of interest (COI) and funding disclosure statements for studies of anticancer targeted therapies conducted in the off-label prescribing setting. They found that disclosure of potential sources of bias in COI and funding statements was low and did not increase substantially over time.
Leland, N.E., Elliott, S.J., O'Malley, L., and Murphy, S.L. (2012). "Occupational therapy in fall prevention: Current evidence and future directions." (AHRQ grant T32 HS00011). American Journal of Occupational Therapy 66(2), pp. 149-160.
The purpose of this literature review is to summarize the existing occupational therapy-related fall prevention literature in order to develop information on occupational therapy's current involvement in these efforts and offer suggestions for future opportunities for occupational therapy in fall preventions for community-dwelling older adults.
Maher, A.R., and Theodore, G. (2012). Summary of the comparative effectiveness review of off-label use of atypical antipsychotics." (AHRQ Contract No. 290-10-00006). Journal of Managed Care Pharmacy 18(5-b), pp. S3-S18.
This article summarizes the key findings of the AHRQ 2011 Comparative Effectiveness Review (CER), which describes the efficacy and harms of off-label uses of atypical antipsychotics, updated from the 2006 AHRQ CER report. Scientific literature on the utilization, efficacy, adverse effects, dosing, and treatment duration on patient outcomes is reviewed in order to inform prescribing decisions. Applications of the AHRQ findings to practice are discussed to provide clinicians information to support evidence-based care for their patients.
Olomu, A.B., Corser, W.D., Stommel, M., and others (2012). "Do self-report and medical record comorbidity data predict longitudinal functional capacity and quality of life health outcomes similarly?" (AHRQ grant HS10531). BMC Health Services Research 12, p. 398.
The study evaluated the performance of the Self-Administered Comorbidity Questionnaire (SCQ) to predict functional capacity and quality of life health outcomes compared to Charlson Comorbidity Index (CCI) medical records data in the same patients. The patients were admitted to the hospital with a diagnosis of acute coronary syndrome. The results showed that the self-report SCQ index is a good alternative method to predict quality of life health outcomes when compared to a CCI medical record score.
Paugh, T.A., Dickinson, T.A., Theurer, P.F., and others (2012). "Validation of a perfusion registry: Methodological approach and initial findings." (AHRQ grant HS15663). Journal of ExtraCorporeal Technology 44, p. 104-115.
The researchers developed and implemented a cardiovascular perfusion registry to improve understanding of the practice of cardiopulmonary bypass within the setting of a regional cardiovascular surgical collaborative (Michigan Society of Thoracic and Cardiovascular Surgeons [MSTCVS]). They were able to successfully and accurately collect data on cardiovascular perfusion among 14 institutions in conjunction with the MSTCVS.
Prince, J.D., Walkup, J., Akincigil, A., and others (2012). "Serious mental illness and risk of new HIV/AIDS diagnoses: An analysis of Medicaid beneficiaries in eight States." (AHRQ grant HS16097). Psychiatric Services 63(10), pp. 1032-1038.
The researchers explored the relationship between diagnosis of serious mental illness and subsequent new diagnoses of HIV in a Medicaid population in 8 States. After substance abuse or dependence was controlled for longitudinally, little independent association between serious mental illness and the risk of new HIV diagnoses was found.
Raman, G., Moorthy, D., Hadar, N., and others (2013, May). "Management strategies for asymptomatic carotid stenosis." (AHRQ Contract No. 290-07-10055). Annals of Internal Medicine 158, pp. 676-685.
The primary objective of this systematic review was to compare management strategies for adults with asymptomatic carotid artery disease. The secondary objective was to evaluate contemporary stroke rates in studies evaluating medical therapy alone. The review of 47 studies found that evidence was neither sufficiently robust for carotid artery stenting nor applicable to current clinical practice for carotid endarterectomy to determine the comparative effectiveness of management approaches for adults with asymptomatic carotid stenosis.
Shoemaker, J.S., Davidoff, A.J., Stuart, B., and others (2012). "Eligibility and take-up of the Medicare Part D low-income subsidy." (AHRQ grant HS20866). Inquiry 49, pp. 214-230.
The researchers evaluated eligibility and participation in the Medicare Part D Low-Income Subsidy (LIS) by enhancing the reliability of the Medicare Current Beneficiary Survey financial information. They used unpublished survey data on income and assets together with an income imputation procedure. They found an LIS take-up rate of 30 percent among those who were not auto-enrolled. Also, the majority of LIS-eligible nonenrollees obtained unsubsidized drug coverage.
Viswanathan, M., Nerz, P., Dalberth, B., and others (2012). "Assessing the impact of systematic reviews on future research: Two case studies." (AHRQ Contract No. 290-07-10056). Journal of Comparative Effectiveness Research 1(4), pp. 329-346.
The researchers evaluated the impact of systematic reviews on research funded by AHRQ through Evidence-based Practice Centers (EPCs) to identify barriers to and facilitators of the effects of these documents on future research. They concluded that AHRQ and the EPCs may be able to improve the likelihood of impact by creating more targeted products, planning for and expanding dissemination activities, improving the readability and other attributes of the reports themselves, and actively involving funders early on and throughout the process of creating and publishing the reviews.
Wagner, L.M., McDonald, S.M., and Castle, N.G. (2012). "Joint Commission accreditation and quality measures in U.S. nursing homes." (AHRQ grant HS13983). Policy, Politics, and Nursing Practice 13(1), pp. 8-16.
The researchers examined the association between accreditation and select measures of quality in U.S. nursing homes. Comparing quality in the year before accreditation by the Joint Commission with the first year after accreditation, all five quality measures and both five-star categories demonstrated improvement. After 8 years of accreditation, three of the quality measures continued to improve. There were no cases where accreditation was associated with decreased quality.
Zuvekas, S.H. (2012). "Health economics and investments in suicide prevention." In: Suicide from a Global Perspective: Public Health Approaches. Eds. Shrivastava, A., Kimbrell, M., and Lester, D. Chapter 4. New Jersey: Nova Science Publishers, 2012.
The few existing economic studies cannot serve as a strong evidence base for guiding effective formulation of national suicide prevention strategies. The author makes a series of recommendations for improving the scientific evidence base to support more effective formulation and implementation of suicide prevention strategies, using economic analyses to maximize scarce resources.