Research Activities, June 2012, No. 382
Akincigil, A., Wilson, I.B., Walkup, J.T., and others (2011). "Antidepressant treatment and adherence to antiretroviral medications among privately insured persons with HIV/AIDS." (AHRQ grant HS16097). AIDS Behavior 15, pp. 1819-1828.
For individuals living with HIV/AIDS, being depressed may have dire consequences if it results in nonadherence to HIV medications and subsequent disease progression. In fact, this study reveals that individuals receiving treatment for depression are more likely to be compliant with their HIV medication regimens than those whose depression is untreated.
Alexander, E.L., Morgan, D.J., Kesh, S., and others (2011). "Prevalence, persistence, and microbiology of Staphylococcus aureus nasal carriage among hemodialysis outpatients at a major New York hospital." (AHRQ grant HS18111). Diagnostic Microbiology and Infectious Disease 70, pp. 37-44.
Having Staphylococcus aureus present in the nose is a major risk factor for more invasive infection, as well as the spread of the bacteria from one person to another. The purpose of this study was to determine the factors related to S. aureus nasal colonization in hemodialysis patients. The researchers found that nasal carriage in dialysis patients was both limited and transient. However, having HIV infection was associated with persistent nasal colonization.
Anderson, K.M., Owens, D.K., and Paltiel, A.D. (2011). "Scaling up circumcision programs in southern Africa: The potential impact of gender disparities and changes in condom use behaviors on heterosexual HIV transmission." (AHRQ grant HS17589). AIDS Behavior 15, pp. 938-948.
This study found that even a modest increase in the rates of circumcision in southern Africa can have considerable impact on reducing heterosexual transmission of HIV to the man when the female partner is HIV-positive. For their study, researchers developed a dynamic model for HIV transmission and disease progression. Their model incorporated various characteristics of the HIV epidemic in Africa to include heterosexual transmission, limited knowledge of one's HIV status, and gender differences regarding sexual risk.
Bahensky, J.A., Wood, M.M., Nyarko, K., and Li, P. (2011). "HIT implementation in critical access hospitals: Extent of implementation and business strategies supporting IT use." (AHRQ grant HS15009). Journal of Medical Systems 35, pp. 599-607.
Small rural hospitals classified as critical access hospitals (CAHs) have basic business and communication systems operations. However, most CAHs are just beginning to plan for and begin implementation of complex clinical information systems, concludes this study. The survey of 70 rural CAHs in Iowa on their use of health information technology (IT) found that 34 percent of the hospitals did not employ any IT staff and half only employed one or two IT staff.
Bayliss, E.A., Blatchford, P.J., Newcomer, S.R., and others (2011, June). "The effect of incident cancer, depression and pulmonary disease exacerbations on type 2 diabetes control." (AHRQ grants HS17627, HS15476). Journal of General Internal Medicine 26(6), pp. 575-581.
Little is known about how the development of a new health condition affects management of existing conditions over time. This study finds that diabetes control in patients with type 2 diabetes does not appear to be affected by newly developed coexisting conditions such as cancer, depression, or worsened pulmonary disease. One possible explanation is that the stability of the diabetes control outcomes in these patients represents well-established patient self-care behaviors.
Borden, W.B., Redberg, R.F., Mushlin, A.I., and others (2011). "Patterns and intensity of medical therapy in patients undergoing percutaneous coronary intervention." (AHRQ grant HS16075). Journal of the American Medical Association 305(18), pp. 1882-1889.
Less than half of patients with stable coronary artery disease, who undergo coronary angiography, receive optimal medical therapy (OMT) before the procedure, despite guideline recommendations to maximize OMT before the procedure. Even after publication of the widely publicized 2007 Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial, which showed that a trial of OMT is warranted before percutaneous coronary intervention, practice changed little, according to this study.
Boult, C., Reider, L., Leff, B., and others (2011). "The effect of guided care teams on the use of health services." (AHRQ grant HS14580). Archives of Internal Medicine 171(5), pp. 460-466.
A new model of interdisciplinary primary care called "guided care" has been developed to address the problem of older Americans with multiple chronic conditions, who frequently fail to receive high-quality, cost-effective, well-coordinated health care. The guided care team that includes a specially trained registered nurse, two to five physicians, and members of a primary care office staff provides a comprehensive geriatric assessment, evidence-based planning, case management, transitional care, patient self-management advice, and caregiver support. The only significant impact of this guided care model was a 29.7 percent reduction in the use of home health care services, concludes this study.
Boyarsky, B.J., Hall, E.C., Singer, A.L., and others (2011). "Estimating the potential pool of HIV-infected deceased organ donors in the United States." (AHRQ Contract No. 290-01-0012). American Journal of Transplantation 11(6), pp. 1209-1217.
The National Organ Transplant Act of 1984 prohibits the use of organs from deceased donors with HIV/AIDS. Recent studies have shown excellent outcomes in carefully selected HIV-infected recipients of donor kidneys and livers, suggesting that HIV infection is no longer considered an absolute contraindication to solid organ transplantation. Reversal of the legal prohibition could provide roughly 500 patients living with HIV/AIDS with kidney or liver transplants each year, concludes a new study.
Brouwer, E.S., Napravnik, S., Smiley, S.G., and others (2011). "Self-report of current and prior antiretroviral drug use in comparison to the medical record among HIV-infected patients receiving primary HIV care." (AHRQ grant HS18731). Pharmocoepidemiology and Drug Safety 20, pp. 432-439.
Critical to effectively managing HIV infection is knowing what antiretroviral drugs (ARVs) a person has taken since the beginning of their infection. Asking patients to reconstruct this drug history, however, may not be the best approach, concludes a new study. It found that most patients find it difficult to recount all of their previous ARVs and some can't even recall ARVs they are currently taking.
Cameron, K.A., Persell, S.D., Brown, T., and others (2011). "Patient outreach to promote colorectal cancer screening among patients with an expired order for colonoscopy." (AHRQ grant HS17163). Archives of Internal Medicine 171(7), pp. 642-646.
Colorectal cancer is the second leading cause of cancer death in the United States. Yet 40 to 50 percent of the 90 million Americans who could benefit from colorectal cancer screening have not been screened. Reminders and followup to patients referred for colonoscopies, but who had not had the procedure 3 months later, can improve screening rates, suggests this study.
Carr, B.G., Reilly, P.M., Schwab, C.W., and others (2011). "Weekend and night outcomes in a statewide trauma system. (AHRQ grant HS17960). Archives of Surgery 146(7), pp. 810-817.
Contrary to findings for patients admitted to emergency departments (EDs), injured patients admitted to trauma centers on the weekend are less likely to die than those admitted during weekdays, according to a new study. Previous studies of patients treated in EDs found that there was a "weekend effect," in which being seen for emergency care on a weekend or at night was associated with a higher risk of poor outcomes.
Cevasco, M., Borzecki, A.M., Chen, Q., and others (2011). "Positive predictive value of the AHRQ Patient Safety Indicator �Postoperative Sepsis': Implications for practice and policy." (AHRQ Contract No. 290-04-0020). Journal of the American College of Surgery, 212(6), pp. 962-967.
Researchers performed medical record reviews for events that Patient Safety Indicator 13 (PSI 13), postoperative sepsis, flagged at Veterans Administration and nonfederal hospitals. They found that PSI 13 was not effective in identifying postoperative sepsis cases. As a result, the authors assert PSI 13 is not ready to be used in safety profiling, public reporting, and pay-for-performance measures.
Chang, J.C., Cluss, P.A., Burke, J.G., and others (2011). "Partner violence screening in mental health." (AHRQ grant HS13913). General Hospital Psychiatry 33, pp. 58-65.
Intimate partner violence is prevalent among women and men receiving mental health services, but less than half of them are asked about intimate partner violence by their clinician, found this study. A total of 270 women and 158 men participated in the study. Among the participants, 38 percent disclosed having experienced physical abuse from a romantic partner.
Cook, N.L., Orav, E.J., Liang, C.L., and others (2011). "Racial and gender disparities in implantable cardioverter-defibrillator placement: Are they due to overuse or underuse?" (AHRQ grant T32 HS00020). Medical Care Research and Review 68, pp. 226-246.
Implantable cardioverter-defibrillators (ICDs) are a relatively new technology with evolving placement criteria. A new study suggests overuse of ICDs in men and whites who are not clinically appropriate for the device and underuse among clinically appropriate blacks and women. This has led to disparities in ICD placement for cardiac arrhythmias.
Debbink, M.P., and Bader, M.D.M. (2011, September). "Racial residential segregation and low birth weight in Michigan's metropolitan areas." (AHRQ grant T32 HS00053). American Journal of Public Health 101(9), pp. 1714-1720.
Women living in black segregated urban neighborhoods in Michigan are more than twice as likely as women living in white nonsegregated neighborhoods to give birth to a low birth weight baby, according to a new study. These differences persisted after controlling for measures of economic well-being, such as concentrated poverty, percent of vacant buildings, and percent of college-educated women. Complications related to premature birth and low birth weight are the leading causes of death in non-Hispanic black infants.
Diggs, N.G., Holub, J.L., Lieberman, D.A., and others (2011). "Factors that contribute to blood loss in patients with colonic angiodysplasia from a population-based study." (AHRQ grant HS14062). Clinical Gastroenterology and Hepatology 9, pp. 415-420.
Angiodysplasia is a condition where small, vascular malformations develop on the wall of the large intestine. Patients suffering from angiodysplasia experience gastrointestinal bleeding and anemia. The study found a variety of predictors for blood loss including being black or Hispanic, hospitalization, being older than 80 years, having a severe coexisting illness, and the discovery of 2 to 10 or more lesions.
Dintzis, S.M., Stetsenko, G.Y., Sitlani, C.M., and others (2011). "Communicating pathology and laboratory errors. Anatomic pathologists' and laboratory medical directors' attitudes and experiences." (AHRQ grant HS16506). American Journal of Clinical Pathology 135, pp. 760-765.
Pathologists and laboratory medical directors face unique challenges related to error reporting and disclosure, because they traditionally have no prior relationship with the affected patient. This survey found that the vast majority of those surveyed reported having been involved with a medical error and almost all believed that serious errors should be disclosed to patients. However, many expressed discomfort with their communication skills in regard to error disclosure.
Finks, J.F., Kole, K.L., Yenumula, P.R., and others (2011, October). "Predicting risk for serious complications with bariatric surgery: Results from the Michigan Bariatric Surgery Collaborative," (AHRQ grant HS18050). Annals of Surgery 254(4), pp. 633-640.
Predicting which patients may experience complications after bariatric surgery would have tremendous benefit to the surgeon and the patient. Recently, researchers analyzed bariatric surgery data to determine which risk factors are associated with serious complications after bariatric surgery. The study resulted in the development of a risk calculator that can be used before surgery to identify patients at risk for complications.
Holman, R.C., Folkema, A.M., Singleton, R.J., and others (2011, July/August). "Disparities in infectious disease hospitalizations for American Indian/Alaska Native people." (AHRQ grant HS17258). Public Health Reports 126, pp. 508-521.
Hospitalizations for infectious diseases (ID) among American Indian/Alaska Native (AI/AN) people still loom larger for them than for the general population of the United States. From 2004–2006, hospitalizations for ID accounted for 22 percent of all hospitalizations among AI/AN people, compared with 14 percent of hospitalizations for the general U.S. population. Infections of the lower respiratory tract; skin and soft tissue infections; and kidney, urinary tract, and bladder infections contributed the most to these health disparities.
Hu, C-Y., Delclos, G.L., Chan, W., and others (2011). "Post-treatment surveillance in a large cohort of patients with colon cancer." (AHRQ grant HS16743). The American Journal of Managed Care 17(5), pp. 329-336.
Most patients who have been treated for local or regional colon cancer (stages I-III) generally follow their clinician's recommendations on scheduling followup office visits (83.9 percent) and colonoscopies (74.3 percent). However, only a minority (29.4 percent) of the 7,348 patients in the study follow the recommended schedule for carcinoembryonic antigen (CEA) tests, a potential cancer marker in the blood.
Hysong, S.J., Sawhney, M.K., Wilson, L., and others (2011). "Understanding the management of electronic test result notifications in the outpatient setting." (AHRQ grant T32 HS17586). BMC Medical Informatics and Decision Making 11, p. 22.
Previous studies have found a significant number of instances where abnormal test results reported through the electronic health record lacked timely followup. Participants were asked to discuss barriers and facilitators to successful management and followup of abnormal test result alerts and provide suggestions for improvement. The most frequently raised barrier was the number of alerts received by providers.
Jena, A.B., and Goldman, D.P. (2010). "Growing Internet use may help explain the rise in prescription drug abuse in the United States." (AHRQ grant T32 HS00046). Health Affairs 30(6), pp. 1192-1199.
While some Internet-based pharmacies are legitimate or extensions of brick-and-mortar stores, other sites may promote the purchase of prescription medications without physician approval. A new study finds a direct correlation between the increased use of these Internet sites and rising levels of admission to treatment facilities for prescription drug abuse. Specifically, for every 10 percent increase in Internet use, admissions rise by 1 percent.
Kociol, R.D., Greiner, M.A., Fonarow, G.C., and others (2011, October). "Association of patient demographic characteristics and regional physician density with early physician follow-up among Medicare beneficiaries hospitalized with heart failure." (HS16964). American Journal of Cardiology 108(7), pp. 985-991.
Medicare beneficiaries hospitalized for heart failure are more likely to have early followup by a physician if they live in a region with a higher concentration of physicians, according to this study. In contrast, patients who are female, black, live in rural areas, or of low socioeconomic status are less likely to have early followup after discharge.
Kozhimannil, K.B., Trinacty, C.M., Busch, A.B., and others (2011). "Racial and ethnic disparities in postpartum depression care among low-income women." (AHRQ grant HS18072). Psychiatric Services 62(6), pp. 619-625.
Black and Hispanic women who gave birth while insured by Medicaid are about half as likely to begin mental health treatment for postpartum depression as are Medicaid-insured white women, a new study finds. Of the 29,601 low-income, Medicaid-insured mothers studied, a higher percentage of white women (9 percent) began antidepressant drug therapy or use of outpatient mental health services within 6 months after delivery than did black women (4 percent) or Hispanic women (5 percent).
LeMasters, T., and Sambamoorthi, U. (2011). "A national study of out-of-pocket expenditures for mammography screening." (AHRQ grant HS15390). Journal of Women's Health 20(12), pp. 1775-1783.
Burdensome out-of-pocket expenditures may lead some women to forego receiving a mammogram, suggests a new study. These are women who are low-income, uninsured, or insured through health plans with increased cost-sharing. The researchers looked at women receiving mammograms in 2007 or 2008, and found that the average out-of-pocket mammography expenditure for all groups in 2007 was $32.90.
Mainous, A.G., Diaz, V.A., Matheson, E.M., and others (2011). "Trends in hospitalizations with antibiotic-resistant infections: U.S., 1997–2006." (AHRQ Contract No. 290-07-10015). Trends in Public Health Reports 126, pp. 354-360.
Hospitalizations associated with antibiotic-resistant infections have become more common over a recent 2-decade period, especially among young patients, reveals a new study. Since the 1990s, increased resistance to antibiotics has been found for a variety of pathogens. The emergence of vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus, initially in hospitalized patients and later in the community, has made it difficult to treat infections with these resistant organisms.
Matthews, J.L., Parkhill, A.L., Schlehofer, D.A., and others (2011). Role-reversal exercise with Deaf Strong Hospital to teach communication competency and cultural awareness." AHRQ grant HS15700). American Journal of Pharmaceutical Education 75(3), Article 53.
A role-reversal exercise can help pharmacy students understand the communications needs of persons with hearing impairment, found this study. In the role-reversal exercise, hearing students act out illness scenarios in a simulated hospital staffed by deaf volunteers. The exercise has been incorporated into the curriculum of first-year pharmacy students at the Wegmans School of Pharmacy.
Martinez, E.A., Shore, A., Colantuoni, E., and others (2011). "Cardiac surgery errors: Results from the UK National Reporting and Learning System." (AHRQ grants HS13904, HS18762). International Journal for Quality in Health Care, 23(2), pp. 151-158.
To better understand where cardiac surgery errors occur and to target interventions, researchers used the United Kingdom's National Reporting and Learning System, a voluntary incident reporting system. They found that of 4,828 reported cardiac surgery incidents, 1,004 (21 percent) happened in the operating room (OR). The authors note that given the relatively short period the patient is actually in the OR, the percentage of incidents occurring there is high.
Rochon, D., Ross, M.W., Looney, C., and others (2011). "Communication strategies to improve HIV treatment adherence." (AHRQ grant HS16093). Health Communication 26(5), pp. 461-467.
One of the major challenges in HIV/AIDS care is to get patients to take their multiple medications regularly and according to the way they are prescribed. Recently, researchers developed and tested an adherence intervention that used health communication and marketing approaches. In the process, they identified factors that can be modified through effective communication strategies and result in improved adherence.