Research Activities, March 2014
Akbaraly, T.N., Hamer, M., Ferrie, J.E., and others (2013, November). "Chronic inflammation as a determinant of future aging phenotypes." (AHRQ grant HS06516). Canadian Medical Association Journal 185(16), pp. E763-E770.
This study found that chronic inflammation, as ascertained by repeat measurements of interleukin-6, was related to a range of unhealthy aging phenotypes and a decreased likelihood of successful aging. It analyzed aging phenotypes based on validated clinic-based measures and medical records in a large sample with a long followup.
Baer, H.J., Cho, I., Walmer, R.A., and others (2013 July/August). "Using electronic health records to address overweight and obesity: A systematic review." (AHRQ Grant HS19789). American Journal of Preventive Medicine 45 (4), pp. 494-500.
This systematic review found only a small number of papers (11 out of 1,188 unique citations) that discussed adding a new featureor modifying an existing oneto electronic health records (EHRs), to enhance their ability to help clinicians identify, evaluate, or manage patients with clinical overweight or obesity. Of the 11 relevant papers, 7 focused on overweight/obesity in children and adolescents, while 4 were related to this problem in adults.
Beaubrun, A.C., Kanda, E., Bond, C., and McClellan, W.M. (2013). "Form CMS-2728 data versus erythropoietin data: Implications for quality of care studies." (AHRQ grant T32 HS00032). Renal Failure 35(3), pp. 320-326.
This study used logistic and multivariate regressions to compare the use of either Form CMS-2728 or the corresponding claims data to predict mortality and the probability of meeting target hemoglobin levels. Patients with a predialysis erythropoietin claim were less likely to die compared with patients without a claim, but there was no relationship observed between predialysis care and death using only Form CMS-2728 predictors.
Bell, H., Preisser, J.S., and Rozier, G. (2013). "Accuracy of record linkage software in merging dental administrative data sets." (AHRQ grant HS18076). Journal of Public Health Dentistry 73, pp. 89-93.
The objective of this study was to determine the accuracy of record matching using "Link King" software that uses an ordinal score for the certainty that linked records are valid matches. It found that this publicly available program accurately merged Medicaid and surveillance data.
Brotman, D.J., Shihab, H.M., Prakasa, K.R., and others (2013, July). "Pharmacologic and mechanical strategies for preventing venous thromboembolism after bariatric surgery. A systematic review and meta-analysis." (AHRQ Contract No. 290-07-100611). JAMA Surgery 148(7), pp. 675-686.
After reviewing the literature through August 2012 on prevention of venous thromboembolism following bariatric (weight-reduction) surgery, the authors found only 13 primary studies that included 2 interventions (8 studies of pharmacologic strategies and 5 studies of intravenous filter placement). None of the studies randomly assigned its subjects to an intervention.
Campbell, N.L., Dexter, P., Perkins, A.J., and others (2013, May). "Medication adherence and tolerability of Alzheimer's disease medications: Study protocol for a randomized controlled trial." (AHRQ grant HS19818). [BMC] Trials 14(125), 9 pp.
Researchers in central Indiana have designed and begun enrolling subjects in a randomized controlled trial to evaluate the rates of discontinuation of and adherence over 18 weeks to donepezil, galantamine, and rivastigmine—three acetylcholinesterase inhibitors, which are approved by the U.S. Food and Drug Administration to treat patients with mild to moderate Alzheimer's disease. In the article, the researchers explain the purpose of the study, the methods and design, the primary and secondary outcomes, and the status of the trial at the time of publication.
De Koning, H.J., Meza, R., Plevritis, S.K., and others (2013, December). "Benefits and harms of computed tomography lung cancer screening strategies: A comparative modeling study for the U.S. Preventive Services Task Force." (Interagency agreement between AHRQ and the National Cancer Institute). Annals of Internal Medicine.
The researchers sought to identify efficient computed tomography (CT) screening scenarios in which relatively more lung cancer deaths are averted for fewer CT screening exams. The most advantageous strategy was annual screening from ages 55 through 80 years for ever-smokers with a smoking history of at least 30 pack-years and ex-smokers with less than 15 years since quitting.
Fakih, M.G., George, C., Edson, B.S., and others (2013, October). "Implementing a national program to reduce catheter-associated urinary tract infection: A quality improvement collaboration of State hospital associations, academic medical centers, professional societies, and government agencies." (AHRQ Contract No. 290-10-00025). Infection Control and Hospital Epidemiology 34(10), pp. 1048-1054.
The authors outline the logic behind and history of the national implementation of the successful pilot program to reduce catheter-associated urinary tract infection (CAUTI). This effort involves changing clinicians' use of catheters by restricting the indications for catheter use in hospitalized patients and limiting their length of use. Preventing the infection is important to hospitals because the Center for Medicare & Medicaid Services stopped reimbursing hospitals for hospital-acquired CAUTI in 2008.
Fraser, I., and Sandmeyer, B. (2013, Fall). "Improving quality through enhanced public reporting." Premier Quality Outlook QTR 3.13, pp. 26-29. Reprints (AHRQ Publication No. 14-R001) are available from AHRQ.
The AHRQ researchers give a brief history of public reporting of health care quality and the reports that increased policymakers' and public interest in comparative reports for the public on quality and cost of care. They include a map showing State-level and regional variations in the overall quality of care. The researchers also discuss several challenges for public reporting.
Gilmer, T. P., Katz, M.L., Stefanic, A., and Palinkas, L.A. (2013, December). "Variation in the implementation of California's full service partnerships for persons with serious mental illness." (AHRQ grant HS19986). HSR: Health Services Research 48(6), Part II, pp. 2245-2263.
This study examined variation in the implementation of California's Full Service Partnerships (FSPs), which are supported housing programs that do "whatever it takes" to improve outcomes among persons with serious mental illness who are homeless or at risk of homelessness. It found substantial variation in implementation among FSPs, indicating that many FSPs implemented a variety of services, but applied housing readiness requirements and did not adhere to consumer choice in housing.
Joshi, A., Wilhelm, S., Aguirre, T., and others (2013, July–December). "An interactive, bilingual touch screen program to promote breastfeeding among Hispanic rural women: Usability study." (AHRQ grant HS21321). JMIR [Journal of Medical Internet Research] Research Protocols 2(2)c47, 11 pp.
The researchers tested the usability of a proposed computerized educational intervention on breastfeeding for rural Hispanic women using a 10-person convenience sample recruited at a rural medical center in Nebraska. The women were asked to perform six tasks with the Patient Education and Motivation Tool program and evaluate its usability using a 5-point Likert scale to respond to 10 questions. The average system usability score was 90, representing a product with exceptional usability.
Kesselheim, A.S., Wang, B., and Avorn, J. (2013, September). "Defining "innovativeness" in drug development: A systematic review." (AHRQ grant HS18465). Nature 94(3), pp. 336-347.
The objective of this review was to develop a taxonomy of various methodologies used to measure pharmaceutical innovation and determine whether alternative definitions of "innovation" provided different perspectives on the actual rate of innovation. It found that studies using counts of new product approval were significantly more likely than studies using any other measure of pharmaceutical innovation to find a favorable or positive trend in pharmaceutical innovation.
Lawrence, W. (2013). "Comparative effectiveness research in practice and policy for radiation oncology." Seminars in Radiation Oncology 24, pp. 54-60.
In radiation oncology, where many of the traditional clinical trials are comparative in nature, the line between comparative effectiveness research (CER) and "traditional" research may be blurry. The author argues that an increased emphasis on CER can help to build a bridge between the research enterprise and clinical practice, helping to inform decisionmaking at the patient, clinician, and policy levels.
Mogos, M.F., Salihu, H.M., Aliyu, M.H., and others (2013, February). "Association between reproductive cancer and fetal outcomes: A population-based study." (AHRQ grant HS19997). International Journal of Gynecological Cancer 23(2), pp. 218-226.
The researchers sought to determine how fetal birth outcomes are affected by the mother having reproductive system cancer. Using a retrospective population-based cohort of 1.57 million women giving birth to a single child in Florida, the researchers compared women diagnosed with reproductive system cancer (cases) with cancer-free controls. They found that the affected women (0.21 percent of the study population) had a significantly higher risk of having a low birth–weight infant or a preterm infant.
Quigley, D.D., Martino, S.C., Brown, J.A., and Hays, R.D. (2013). "Evaluating the content of the communications items in the CAHPS Clinician and Group Survey and supplemental items with what high-performing physicians say they do." (AHRQ grant HS16980). Patient 6, pp. 169-177.
An evaluation of how well the CAHPS Clinician and Group 2.0 core and supplemental survey items captures doctor-patient communication found that it fully captures six of the nine behaviors most commonly mentioned by high-performing physicians. Some of these are: employing office staff with good people skills; spending enough time with patients; listening carefully; providing clear, simple explanations, and devising an action plan with each patient.
Ringold, S., Weiss, P.F., Beukelman, T., and others (2013). "2013 update of the American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: Recommendations for the medical therapy of children with systemic juvenile idiopathic arthritis and tuberculosis screening among children receiving biologic medications." (AHRQ grant HS19482). Arthritis Care & Research 65(10), pp. 1551-1563).
The overarching objective of this project was to update the 2011 recommendations for the use of nonbiologic and biologic disease-modifying anti-rheumatic drugs in the treatment of systemic juvenile idiopathic arthritis (JIA). There is a need for an update due to newly published data from randomized trials of new IL-1 inhibitors and IL-6 inhibitors in children with systemic JIA.
Spector, W.D. (2013, January). "Optimal staffing to prevent nursing home hospitalizations." Medical Care 52(1), pp. 93-94.
The author replies to a letter by Dr. G. Allen Power concerning the author's study on potentially avoidable hospitalizations for elderly long-stay residents in nursing homes. In contrast to Dr. Powers' strategy of adding one aspect of care organization at a time, the author advocates identifying a small set of easily collected measures that generally modify the effects of care organization innovations and putting these in place.
Wade-Vuturo, A.E., Mayberry, L.S., and Osborn, C.Y. (2013, May/June). "Secure messaging and diabetes management: Experiences and perspectives of patient portal users." (AHRQ grant T32 HS13833). Journal of the American Medical Informatics Association 20(3), pp. 519-525.
This study of adults with type 2 diabetes mellitus sought to find out the benefits of secure messaging (SM) within a medical center's patient portal, as well as the barriers to such use. The researchers gathered information from the 54 subjects, through a focus group combined with a survey, or through a survey alone. They found that greater self-reported use of SM to manage medical appointments was significantly associated with a patient's glycemic control.
Wang, S., Jiang, X., Wu, Y., and others (2013). EXpectation Propagation Logistic REgRession (EXPLORER): Distributed privacy-preserving online model learning." (AHRQ grant HS19913). Journal of Biomedical Informatics 46, pp. 480-496.
The researchers developed the EXPLORER model for distributed privacy-preserving online learning. The proposed framework provides a high-level guarantee for protecting sensitive information. When new observations are recorded, EXPLORER can be updated one point at a time rather than having to retrain the entire data set when new observations are recorded.
Wren, T.A.L., Lening, C., Rehtlefsen, S.A., and Kay, R.M. (2013). "Impact of gait analysis on correction of excessive hip internal rotation in ambulatory children with cerebral palsy: A randomized controlled trial." (AHRQ grant HS14169). Developmental Medicine & Child Neurology 55, pp. 919-925.
The purpose of this study was to examine the impact of gait analysis on the correction of excessive internal hip rotation using data from a randomized controlled trial. It found that gait analysis can improve outcomes when its recommendations for external femoral derotation osteotomy were incorporated into the treatment plan.
Zwaan, L., Schiff, G.D., and Singh, H. (2013). "Advancing the research agenda for diagnostic error reduction." (AHRQ grant HS17820). BMJ Quality and Safety 22, pp. ii52-ii57.
The authors classify current research in diagnostic error reduction into three main topic areas: (1) epidemiology of diagnostic error (frequency, types, detection methods), (2) cause of diagnostic error (cognitive and system issues), and (3) error prevention strategies (development, implementation, and evaluation of interventions). They summarize the methods used to conduct research in these areas and outline future research needs to better understand and reduce diagnostic error in medicine.