Research Activities, August 2012, No. 384
Krawlewski, J.E., Zink, T., and Boyle, R. (2011). "Factors influencing electronic information exchange in small medical group practices." (AHRQ Contract No. 290-07-10010). Journal of Rural Health 28, pp. 28-33.
The researchers conducted interviews at eight small rural group practices to identify factors influencing their participation in health information exchange (HIE) and to suggest initiatives that would enhance HIE implementation. They found that HIE was largely limited to exchanging immunization data through the State health department and exchanging clinical information within owned provider systems. Limiting factors included data protection concerns, competition among providers, costs, and lack of compatible electronic health record systems.
Sarkar, U., Schillinger, D., Bibbins-Domingo, K., and others (2011). "Patient-physicians' information exchange in outpatient cardiac care." (AHRQ grant HS01758). Patient Education and Counseling 85, pp. 173-179.
Researchers surveyed English, Spanish, or Cantonese-speaking patients and their doctors at a public hospital cardiology clinic to learn if patients and their physicians agreed on the following areas: cardiac functional status, barriers to self-management, cardiac diagnoses, and treatment. They found that physicians and patients often fail to communicate effectively and suggest further studies of determinants of concordance in cardiovascular care.
Singh, H., Graber, M.L., Kissam, S.M., and others (2012). "System-related interventions to reduce diagnostic errors: A narrative review." BMJ Quality and Satisfaction 21, pp. 160-170. Reprints (AHRQ Publication No. 12-R052) are available from the AHRQ Publications Clearinghouse.
The authors conducted a literature review of articles published over the last decade to identify key interventions to reduce or prevent diagnostic errors. They aimed at identifying interventions that have been, or could be, implemented to address system-related factors that contribute directly to diagnostic errors. Few empirical studies have tested interventions to reduce diagnostic errors.
Spector, W.D., Limcangco, M.R., Ladd, H., and Mukamel, D.A. (2011, February). "Incremental cost of postacute care in nursing homes." HSR: Health Services Research 46(10, Part I), pp. 105-119. Reprints (AHRQ Publication No. 12-R057) are available from the AHRQ Publications Clearinghouse.
The authors analyze whether the Resource Utilization Groups Case Mix Index sufficiently captures the cost burden of postacute patients. They estimate cost functions that include inpatient days, ownership, wage index, and the percent of days due to Medicare skilled care days. In addition to the impact on total costs, they also estimate the impact on two cost categories that are expected to be affected�rehabilitation and non-therapy ancillary services.
Tapp, H., Herbert, L., and Dulin, M. (2011). "Comparative effectiveness of asthma interventions within a practice based research network." (AHRQ grant HS19946). BMC Health Services Research 11, p. 188.
A study protocol is presented for a study investigating the impact of three interventions on clinical outcomes for patients with asthma. Interventions are: an integrated approach to care that incorporates asthma management based on the chronic care model, a shared decisionmaking intervention for asthma patients in underserved or disadvantaged populations, and a school-based approach.
Thygeson, N.M., Solberg, L.I., Asche, S.E., and others (2012, February). "Using fuzzy set qualitative comparative analysis (fs/QCA) to explore the relationship between medical 'homeness' and quality." (AHRQ Contract No. 290-07-10010). HSR: Health Services Research 47(1), Part I, pp. 22-44.
The purpose of this study is to use fuzzy set qualitative comparative analysis (fs/QCA) to evaluate the connection between medical home system capabilities and quality outcomes. In the 21 Level III Patient Centered Medical Home (PCMH) clinics, fs/QCA identified relationships between PCMH-related systems capabilities and quality outcomes that were not statistically significant using conventional analysis.
Tija, J., Mazor, K.M., Field, T., and others (2011). "Predicting nursing home adherence to a clinical trial intervention: Lessons for the conduct of cluster randomized trials." (AHRQ grant HS16463). Journal of the American Geriatric Society 59, pp. 2332-2336.
This study describes nursing home (NH) adherence to a clinical trial intervention and examines its relationship with factors hypothesized to be associated with intervention adherence. These factors include structural NH characteristics, NH quality of care, and participation in a study survey. Three factors differentiated adherent from nonadherent NHs: director of nursing turnover, Centers for Medicare and Medicaid Services nurse staffing ratio, and questionnaire response rate.
Williams, S.K., and Ogedegbe, G. (2012). "Unraveling the mechanism of renin-angiotensin-aldoesterone system activation and target organ damage in hypertensive blacks." (AHRQ grant TS32 HS00066). Hypertension 59, pp. 10-11.
Blacks experience disproportionately higher rates of hypertension-related target organ damage (TOD) compared with whites. The mediators of the higher rates of TOD noted in blacks are most likely attributed to high levels of downstream mediators of renin-angiotensin-aldosterone system (RAAS), such as aldosterone and angiotensin II. This commentary discusses an article in the same issue that addresses the mechanism by which RAAS activation affects blood pressure regulation.
Winthrop, K.L., Varley, C.D., Ory, J., and others (2011, September). "Pulmonary disease associated with nontuberculous mycobacteria, Oregon, USA." (AHRQ grant HS17552). Emerging Infectious Diseases 17(9), pp. 1759-1761.
The researchers report on a statewide nontuberculous mycobacteria (NTM) surveillance project in Oregon. Their findings suggest that pulmonary NTM disease is closely associated with urban living. They suspect that the difference in disease rates between urban and rural areas might reflect differences in host exposure to these pathogens.
Young, M.J., Brown, S.E.S., Truog, R.D., and Halpern, S.D. (2012). "Rationing in the intensive care unit: To disclose or disguise?" (AHRQ grant HS18406). Critical Care Medicine 40(1), pp. 261-266.
The authors consider the conceptual and practical complexities surrounding the disclosure of rationing decisions to patients and surrogates and the ethical justifications for and against disclosure. They conclude that disclosure will often be consistent with clinicians' professional obligations. Systematic disclosure of prevailing intensive care norms for making allocation decisions can promote transparent, professional, and effective health care delivery.