Research Activities, February 2014
Abrahamson, K., Davila, H., Mueller, C., and others (2013). "Examining the lived experience of nursing home quality improvement. The case of a multifacility falls reduction project." (AHRQ grant HS18464). Journal of Gerontological Nursing 39(9), pp. 24-30.
The researchers conducted a case study of a falls reduction project to better understand the lived experience of nursing home quality improvement. Through interviews with 37 nursing home employees of 13 different facilities participating in the project, they found that the project resulted in organizational changes that were non-linear and emergent.
Almasalha, F., Xu, D., Keenan, G.M., and others (2013, February). "Data mining nursing care plans of end-of-life patients: A study to improve healthcare decisionmaking." (AHRQ grant HS05403). International Journal of Nursing Knowledge 24(1), pp. 15-24.
The purpose of this study is to reveal hidden patterns and knowledge present in nursing care information documented with standardized nursing terminologies on end-of-life (EOL) hospitalized patients. The study involved the use of data mining techniques applied to nursing care plan data collected on 569 EOL patients.
Baur, C., and Brach, C. (2013). "Pharmacy research on health literacy can contribute to national goals and health care system improvements." Research in Social and Administrative Pharmacy 9, pp. 498-502. Reprints (AHRQ Publication No. 14-R005) are available from AHRQ.
This editorial introduces a special issue focused on the dissemination, translation, and evaluation of health literacy tools in pharmacy practice. The articles in the special issue pay special attention to providing accessible, accurate, and actionable health information and health literate health care services.
Bilimoria, K.Y., Chung, J., Haur, E.R., and others (2013, October). "Evaluation of surveillance bias and the validity of the venous thromboembolism quality measure." (AHRQ grants HS21857, HS17952). Journal of the American Medical Association 310(14), pp. 1482-1489.
The researchers performed three analyses to examine the effect of surveillance bias on the validity of venous thromboembolism (VTE) as a quality measure. Their findings suggest that such a bias does influence the validity of VTE measurement. The publicly reported PSI-12 VTE outcome measure reflects the intensity of VTE imaging rather than the actual quality of care.
Branas, C.C., Wolff, C.S., Williams, J., and others (2013). "Simulating changes to emergency care resources to compare system effectiveness." (AHRQ grant HS10914). Journal of Clinical Epidemiology 66, pp. S57-S64.
This study was an optimization analysis of the location of trauma centers (TCs), helicopter depots (HDs) and severely injured patients in need of time-critical care in select U.S. States. It found that optimal changes to TCs produced greater increases in access to care than optimal changes to HDs, although these results varied across States.
Buys, D.R., Flood, K.L., Real, K. (2013). "Mealtime assistance for hospitalized older adults." (AHRQ grant T32 HS13852). Journal of Gerontological Nursing 39(9), pp. 18-22.
This article reports the implementation of the Support for and Promotion Of Optimal Nutritional Status (SPOONS) volunteer assistance program. It found an estimated cost savings of $11.94 per encounter had the service been provided by a patient care technician and $26 per encounter had it been provided by a registered nurse.
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.
Comparative effectiveness research (CER) at the population level is missing standardized approaches to quantify and weigh interventions in terms of their clinical risks, benefits, and uncertainty. The authors present a framework for population-based decisionmakers to quantitatively weigh and better grasp the collective intervention-specific clinical risks and benefits and their uncertainty.
Cohen, S.B., Rohde, F., and Yu, W. (2013). "Building wave response rates in a longitudinal survey: Essential for nonsampling error reduction or last in—first out." Field Methods 25(4), pp. 361-387. Reprints (AHRQ Publication No. 14-R006) are available from AHRQ.
This study examined the implications of alternative field procedures for dealing with reluctant respondents in the Medical Expenditures Panel Survey, defined as those who responded at the end of the first-round field period. These reluctant respondents were more likely to be non-Hispanics, elderly, and those residing in metropolitan areas as well as the northeast. Study findings reveal non-uniform results when evaluating the capacity of alternative design strategies to achieve precision targets.
Darney, B.G., Weaver, M.R., VanDerhei, D., and others (2013). "'One of those areas that people avoid' a qualitative study of implementation in miscarriage management." (AHRQ grant T32 HS13853). BMC Health Services Research 13, p. 123.
This process evaluation sought to identify barriers and facilitators to implementation of office-based manual vacuum aspiration (MVA) in family residency sites in Washington State. The researchers found that the common major barriers to implementation were low volume and a perception of miscarriage as emotional and/or like abortion, while the inclusion of support staff in training and effective champions facilitated successful implementation of MVA services.
Daugherty, A., and Raz, N. (2013). "Age-related differences in iron content of subcortical nuclei observed in vivo." (AHRQ grant T32 HS13819). Neuroimage 70, pp. 113-121.
The reported in vivo estimates of adult age differences in iron content within subcortical nuclei are highly variable. The authors present a meta-analysis of 20 in vivo magnetic resonance imaging studies that estimated iron content in the caudate nucleus, globus pallidus, putamen, red nucleus, and substantia nigra.
Devine, E.B., Alfonso-Cristancho, R., Devlin, A., and others (2013). "A model for incorporating patient and stakeholder voices in a learning health care network: Washington State's Comparative Effectiveness Research Translation Network." (AHRQ grant HS20025). Journal of Clinical Epidemiology 66, pp. S122-S129.
The authors describe a multisite, longitudinal, prospective, observational cohort study grounded in patient-centered outcome research. They outline the ways in which patients and stakeholders are being incorporated into all aspects of research in the context of a prospective cohort study to compare invasive and noninvasive treatments for peripheral arterial disease, and describe how results are being returned to practice.
Elliott, T.E., Holmes, J.H., Davidson, A. J., and others (2013). "Data warehouse governance programs in healthcare settings: A literature review and a call to action." (AHRQ grant HS19912). eGEMs (Generating Evidence & Methods to improve patient outcomes) 1(1), Article 15.
Because there is extensive data stored in health care data warehouses, data warehouse governance policies are needed to ensure data integrity and privacy. The authors review the current state of the data warehouse governance literature as it applies to health care data warehouses, identify knowledge gaps, provide recommendations, and suggest approaches to further research.
Fitzgibbons, R.J., Ramanan, B., Arya, S., and others (2013, September). "Long-term results of a randomized controlled trial of a nonoperative strategy (watchful waiting) for men with minimally symptomatic inguinal hernias." (AHRQ grant HS09860). Annals of Surgery 258(3), pp. 508-515.
This study assessed the long-term crossover rate in men undergoing watchful waiting (WW) as a primary treatment strategy for their asymptomatic or minimally symptomatic inguinal hernia. The results of the study show that WW remains a safe strategy even on long-term followup. However patients with this condition, especially if elderly, will almost certainly need surgery eventually.
Flannery, K., Resnick, B., Galik, E., and others (2013). "Reliability and validity assessment of the job attitude scale." (AHRQ grant HS13372). Geriatric Nursing 33(6), pp. 465-472.
The purpose of this study was to provide psychometric support for a measure of job satisfaction, the Job Attitude Scale (JAS), used with nursing assistants who work in long-term care facilities. The study established important evidence of reliability, validity, and generalizability for the JAS when the measure was used in nursing homes and assisted living communities.
Harting, B., Johnson, T., Abrams, R., and others (2013, October). "An exploratory analysis of the correlation of pain scores, patient satisfaction with relief from pain, and a new measure of pain control on the total dose of opioids in pain care." (AHRQ grant HS21093). Quality Management in Health Care 22(40), pp. 322-326.
The researchers evaluated the use of pain scores as an appropriate quality of care measurement by studying the association between pain scores and other pain assessment measures with the total dose of opioid used to treat pain. They found that the individual measures of pain control poorly explained variation in the dose of opioid used to control pain.
Hearld, L.R., Weech-Maldonado, R., and Asagbra, O.E. (2013). "Variations in patient-centered medical home capacity: A linear growth curve analysis." (AHRQ grant HS46501). Medical Care Research and Review 70 (6), pp. 597-620.
The purpose of this study was to document the patient-centered medical home (PCMH) capacity of physician practices, defined as the ability to offer a service identified as a component part of the PCMH across 12 different domains over a 26-month period. The research suggests that more attention should be paid to the differential challenges associated with these component parts, instead of treating these programs in aggregate.
Hendrix, K.S., Meslin, E.M., Carroll, A.E., and Downs, S.M. (2013). "Attitudes about the use of newborn dried blood spots for research: A survey of underrepresented parents." (AHRQ grant T32 HS17588). Academic Pediatrics 13, pp. 451-457.
The researchers sought to identify the relative importance of factors (parental consent, affiliation of the researcher, whether the child's name is linked to the sample) that impact parents' attitudes toward use of their child's dried newborn blood spots for research purposes. They found that parents strongly prefer that consent be sought for each use of their children's blood spots.
Hernandez, S.E., Conrad, D.A., Marcus-Smith, M.S., and others (2013). "Patient-centered innovation in health care organizations: A conceptual framework and case study application." (AHRQ grant T32 HS13853). Health Care Management Review 38(2), pp. 166-175.
Drawing on peer-reviewed evidence and theory regarding determinants of organizational change, the authors propose a framework for understanding the process of initiating patient-centered innovation. Using an extended case study of an organization in Washington State as an example, they illustrate the framework's applicability and usefulness for understanding the process of innovation.
Khare, R.K., Nannicelli, A.P., Powell, E.S., and others (2013, October). "Use of risk assessment analysis by failure mode, effects, and criticality to reduce door-to-balloon time." (AHRQ grant HS19005). Annals of Emergency Medicine 62(4), pp. 388-398.
Prompt treatment increases the likelihood of survival for patients who have ST-segment elevation myocardial infarction. The researchers use a proactive risk assessment method of failure mode, effects, and criticality analysis to evaluate door-to-balloon time process, to investigate how each component failure may affect the performance of a system, and to evaluate the frequency and the potential severity of harm of each failure.
Kulldorff, M., Dashevsky, I., Avery, T.R., and others (2013). "Drug safety data mining with a tree-based scan statistic." (AHRQ grant HS10391). Pharmacoepidemiology and Drug Safety 22, pp. 517-523.
In this methodological paper, the authors evaluated the tree-based scan statistic data mining method for drug safety surveillance. With the tree-based scan statistic, they assessed the safety of selected antifungal and diabetes drugs and found that it can be successfully applied as a data mining tool in drug safety surveillance using observational data.
Lannon, C.M., and Peterson, L.E. (2013). "Pediatric collaborative networks for quality improvement and research." (AHRQ grant HS21114). Academic Pediatrics 13, pp. S69-S74.
The authors describe the collaborative improvement network model, provided examples of these networks in pediatrics, and discuss how pediatric collaborative networks can serve to close the quality gap and accelerate the translation of evidence into practice, resulting in improved care and outcomes for children.
McCormick, M.C., Co, J.P.T., and Dougherty, D. (2013). "Quality improvement in pediatric health care: Introduction to the supplement." Academic Pediatrics 13, S1-S4.
This article introduces a supplemental issue focused on making readers aware of key developments in quality improvement (QI) policy, practice, education, and evaluation research. The authors discuss papers treating QI evaluation research methods as well as QI in clinical settings and networks.
Newman-Toker, D.E., McDonald, K.M., and Meltzer, D.O. (2013). "How much diagnostic safety can we afford, and how should we decide? A health economics perspective." (AHRQ grant HS19252). BMJ Quality and Safety 22, ii11-ii20.
The authors use a case study example to explore complex inter-relationships between diagnostic test characteristics, appropriate use, actual use, diagnostic safety and cost effectiveness. They assess the role of economic analysis and suggest areas for future research related to the public health imperative of better value and safety in diagnosis.
Nkoy, F.L., Stone, B.L., Fassl, B.A., and others (2013). "Longitudinal validation of a tool for asthma self-monitoring." (AHRQ grants HS18166, HS18678). Pediatrics 132, pp. e1554-e1561.
The researchers developed a new tool, the Asthma Symptom Tracker (AST), a paper-based, patient-centered tool designed to facilitate ongoing monitoring of asthma control through weekly assessment of asthma symptoms. Their study of 210 asthma assessments completed during hospitalization and 6 months after discharge found the AST to be reliable, valid, and responsive to change over time.
Nicholas, L.H., and Dimick, J.B. (2013). "Bariatric surgery in minority patients before and after implementation of a Centers of Excellence Program." (AHRQ grant HS17765). Journal of the American Medical Association 310 (13), pp. 1399-1400.
In 2006, the Centers for Medicare & Medicaid Services implemented a National Coverage Decision (NCD) restricting Medicare patients to centers of excellence for bariatric surgery. Concerned that the new rule could reduce access for vulnerable populations, the researchers compared rates of bariatric surgery for minority Medicare vs. non-Medicare patients before and after implementation of the NCD.
Nix, M. (2013, September). "Guest Editorial: Guideline clearinghouse updates inclusion criteria." Ostomy Wound Management 59(9). Reprints (AHRQ Publication No. 14-R010) are available from AHRQ.
Evidence-based clinical practice guidelines (CPGs) are fundamental to high-quality health care. In March 2011, the Institute of Medicine updated its definitions of CPGs. In response, the National Guidelines Clearinghouse, created by AHRQ together with major health care industry organizations, updated its inclusion criteria. The two main changes require that the full text guidelines in English must be available to the public on request and the CPG must have been developed, reviewed, or revised within the last 5 years.
Radecki, R.P. (2013). [Letter]. "Safety of thrombolysis in stroke mimics: Results from a multicenter cohort study." (AHRQ grant HS17586). Stroke 44, p. e105.
In this comment on Zinkstok, et al.'s article and the accompanying editorial by Guerrero, the author suggests that it perhaps would be prudent for the National Quality Foundation to endorse a performance measure for thrombolytic therapy requiring patients receiving thrombolysis for acute ischemic stroke to undergo confirmatory testing.
Randhawa, G. (2013). "Moving to a user-driven research paradigm." eGEMS (Generating Evidence & Methods to improve patient outcomes) 1(2), Article 2.
The focus of decisionmakers of health care delivery organizations has been on issues related to care delivery and not on shaping the research agenda by moving to a user-driven research paradigm. The author presents a conceptual framework to clarify the perspective of decisionmakers, as well as the range of factors and the variability in thresholds used to make decisions.
Ritchie, C.S., Hearld, K.R., Gross, A., and others (2013). "Measuring symptoms in community-dwelling older adults." (AHRQ grants HS17786, HS16956). Medical Care 51, pp. 949-955.
The researchers sought to understand symptom experience in a population-based sample of older adults. They accomplished this by identifying symptoms common in this population, performing confirmatory factor analyses on the symptom indicators, testing biases in symptom endorsement, and exploring the associations between an inventory of symptoms and other indicators of function and self-rated health.
Russ, A.L., Fairbanks, R.J., Karsh, B-T., and others (2013). "The science of human factors: Separating fact from fiction." (AHRQ grant HS17902). BMJ Quality and Safety 22, pp. 802-808.
There is growing evidence of confusion about human factors science, both anecdotally and in scientific literature. The objective of this article is to describe the scientific discipline of human factors and provide common ground for partnerships between health care and human factors communities.
Salanitro, A.H., Kripalani, S., Resnic, J., and others (2013). "Rationale and design of the Multicenter Medication Reconciliation Quality Improvement Study (MARQUIS)." (AHRQ grant HS19598). BMC Health Services Research 13, p. 230.
Unresolved medication discrepancies during hospitalization can contribute to adverse drug events, resulting in patient harm. The goals of the MARQUIS study are to operationalize best practices for inpatient medication reconciliation, test their effect on potentially harmful unintentional medication discrepancies, and understand barriers and facilitators of successful implementation.
Singh, H. (2013). "Diagnostic errors: Moving beyond 'no respect' and getting ready for prime time." (AHRQ grants HS18252, HS17820). BMJ Quality and Safety 22, pp. 789-792.
This editorial introduces a supplemental issue reflecting the novel scholarship and synthesis of knowledge that have been shaped through the Diagnostic Error in Medicine forum presentations and discussions over the last 3 years. The author briefly discusses some of the articles in the supplement. He believes that several areas of opportunity have emerged for study and reduction of diagnostic error.
Srichai, M.B., Barreto, M., Lilm, R.P., and others (2013). "Prospective-triggered sequential dual-source end-systolic coronary CT angiography for patients with atrial fibrillation: A feasibility study." (AHRQ grant HS19473). Journal of Cardiovascular Computer Tomography 7, pp. 102-109.
The purpose of this study was to evaluate image quality, inter-reader diagnostic variability, and radiation dose with the use of prospective ECG-triggered sequential dual-source data acquisition at end systole for evaluation of coronary artery disease in patients with atrial fibrillation. The researchers found that prospectively ECG-triggered end-systolic dual-source data acquisition with arrhythmia rejection and high temporal resolution provides high diagnostic image quality with potentially low radiation doses for patients with this condition.
Toledo, P., Sun, J., Peralta, F., and others (2013). "A qualitative analysis of parturients' perspectives on neuraxial labor analgesia." (AHRQ grant HS20122). International Journal of Obstetric Anesthesia 22, pp. 119-123.
The decision to use, or not to use, neuraxial analgesia is unique for each patient. As part of a quantitative survey published elsewhere, the authors included several open-ended questions in order to investigate patients' perspectives on this subject. This report summarizes the analysis of the answers to these questions.
Watkins, S., Jonsson-Funk, M., Brookhart, M.A., and others (2013, October). "An empirical comparison of tree-based methods for propensity score estimation." (AHRQ grant HS17950). HSR: Health Services Research 48(5), pp. 1798-1817.
The authors illustrate the use of three tree-based methods; bagging, random forest classification, and a single classification tree. They evaluate these methods in the context of an analysis to understand the effect of physical and occupational therapy services on the motor skills of preschoolers who were born with very low birth weight.