AHRQ Research Studies

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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.

Reid MC, Eccleston C, Pillemer K
Management of chronic pain in older adults.
This review summarized recent evidence on the assessment and management of pain in older patients. Evidence is taken from systematic reviews, meta-analyses, individual trials, and clinical guidelines. Based on their review, the authors argue that all older adults with chronic pain should undergo a comprehensive geriatric pain assessment and that a comprehensive assessment can guide selection of treatments most likely to benefit the patient and identify targets for intervention besides pain relief.
BMJ 2015;350:h532. doi: 10.1136/bmj.h532.
AHRQ-funded; HS020648.
View abstract on the National Library of Medicine site.
Keywords: Chronic Pain, Elderly, Comparative Effectiveness, Prevention and Care Management
Ahmed S, Siegel CA, Melmed GY
Implementing quality measures for inflammatory bowel disease.
The author argues that implementation of quality measures may depend on the care setting and whether quality measurement and improvement can be incorporated into workflows and electronic medical records. He also asserts that collaborative networks, utilization of care pathways, and standardized treatment algorithms may represent avenues for wide-scale implementation of quality improvement.
Curr Gastroenterol Rep 2015 Apr;17(4):14. doi: 10.1007/s11894-015-0437-1.
AHRQ-funded; HS021747.
View abstract on the National Library of Medicine site.
Keywords: Quality Measures, Health Care Quality, Quality Improvement, Electronic Medical Records (EMRs), Health Information Technology (HIT)
Wu AC, Butler MG, Li L
Primary adherence to controller medications for asthma is poor.
The objective of this study was to compare real-world adherence, including both primary and secondary adherence, to the major controller regimens (inhaled corticosteroids (ICSs), leukotriene antagonists (LTRAs), or ICS/long-acting b-agonists (ICS/LABAs) in diverse, insured populations. It found that adherence to controller medications is poor and many patients do not ever fill prescriptions for controller medications. However, primary adherence to ICSs was better than to LTRAs and ICS/LABAs.
Ann Am Thorac Soc 2015 Feb;12(2):161-6. doi: 10.1513/AnnalsATS.201410-459OC.
AHRQ-funded; HS019669.
View abstract on the National Library of Medicine site.
Keywords: Asthma, Patient Adherence, Medications, Comparative Effectiveness
Wong SL, Revels SL, Yin H
Variation in hospital mortality rates with inpatient cancer surgery.
The purpose of this national study was to elucidate clinical mechanisms underlying variation in hospital mortality with major cancer surgery. It found that case-fatality rates among patients with complications at high-mortality hospitals were approximately twice as high as at low-mortality hospitals. This study implicates failure to rescue as the major reason for differences in hospital mortality rates with major cancer surgery.
Ann Surg 2015 Apr;261(4):632-6. doi: 10.1097/sla.0000000000000690.
AHRQ-funded; HS020937.
View abstract on the National Library of Medicine site.
Keywords: Mortality, Surgery, Cancer, Patient Safety, Health Care Quality
Wang Y, Eldridge N, Metersky ML
National trends in patient safety for four common conditions, 2005-2011.
The researchers estimated trends in the rate of occurrence of adverse events for which patients were at risk, the proportion of patients with one or more adverse events, and the number of adverse events per 1000 hospitalizations. From 2005 through 2011, adverse-event rates declined substantially among patients hospitalized for acute myocardial infarction or congestive heart failure but not among those hospitalized for pneumonia or conditions requiring surgery. AHRQ-authored; AHRQ-funded; 290201200003C.
N Engl J Med 2014 Jan 23;370(4):341-51. doi: 10.1056/NEJMsa1300991.
AHRQ-authored; AHRQ-funded; 290201200003C.
View abstract on the National Library of Medicine site.
Keywords: Patient Safety, Adverse Medical Events, Hospitalization, Myocardial Infarction, Heart Failure
AHRQ Author: Eldridge N, Battles J
Simianu VV, Flum DR
Rethinking elective colectomy for diverticulitis: a strategic approach to population health.
The authors argue that a rethinking of elective colectomy should come from a patient-centered approach that considers the risks of recurrence, quality of life, patient wishes and experiences about surgical and medical treatment options as well as operative morbidity and risks.
World J Gastroenterol 2014 Nov 28;20(44):16609-14. doi: 10.3748/wjg.v20.i44.16609.
AHRQ-funded; HS020025.
View abstract on the National Library of Medicine site.
Keywords: Patient-Centered Outcomes Research, Comparative Effectiveness, Surgery, Adverse Medical Events, Risk Factors
Lacson R, O'Connor SD, Sahni VA
Impact of an electronic alert notification system embedded in radiologists' workflow on closed-loop communication of critical results: a time series analysis.
The researchers evaluated the impact of a patient safety initiative with an alert notification system on reducing critical results lacking documented communication, and assessed potential overuse of the alerting system for communicating results. They found that a patient safety initiative with an alert notification system reduced the proportion of critical results among reports lacking documented communication between care providers.
BMJ Qual Saf 2016 Jul;25(7):518-24. doi: 10.1136/bmjqs-2015-004276.
AHRQ-funded; HS022586.
View abstract on the National Library of Medicine site.
Keywords: Patient Safety, Health Information Technology (HIT), Communications
Linder SK, Kamath GR, Pratt GF
Citation searches are more sensitive than keyword searches to identify studies using specific measurement instruments.
This study compared the effectiveness of two search methods in identifying studies that used the Control Preferences Scale (CPS), a health care decision-making instrument commonly used in clinical settings. It found that keyword searches in bibliographic databases yielded high average precision (90%) but low average sensitivity (16%). PubMed was the most precise, followed closely by Scopus and WOS.
J Clin Epidemiol 2015 Apr;68(4):412-7. doi: 10.1016/j.jclinepi.2014.10.008.
AHRQ-funded; HS022134.
View abstract on the National Library of Medicine site.
Keywords: Research Methodologies, Decisionmaking, Evidence-based Research
Chen J, Hsieh AF, Dharmarajan K
National trends in heart failure hospitalization after acute myocardial infarction for Medicare beneficiaries: 1998-2010.
This study used a complete national sample of 2 789 943 AMI hospitalizations of Medicare fee-for-service beneficiaries from 1998 through 2010, we evaluated annual changes in the incidence of subsequent heart failure (HF) hospitalization and mortality using Poisson and survival analysis models. It found that HF hospitalization after AMI decreased from 1998 to 2010, which may indicate improvements in the management of AMI.
Circulation 2013 Dec 17;128(24):2577-84. doi: 10.1161/circulationaha.113.003668.
AHRQ-funded; HS018781.
View abstract on the National Library of Medicine site.
Keywords: Hospitalization, Medicare, Myocardial Infarction, Heart Failure, Mortality
Longo DR, Crabtree BF, Pellerano MB
A qualitative study of vulnerable patient views of type 2 diabetes consumer reports.
This study aims to identify whether vulnerable populations with type 2 diabetes perceive consumer reports as helpful in making decisions about diabetes care. It found that participants in 18 focus groups expressed minimal interest in currently available consumer reports. They instead listed personal referrals and interpersonal interactions among the most important factors when choosing a physician.
Patient 2016 Jun;9(3):231-40. doi: 10.1007/s40271-015-0146-8.
AHRQ-funded; HS021902.
View abstract on the National Library of Medicine site.
Keywords: Diabetes, Consumer Information and Education, Consumer Health, Decisionmaking, Chronic Care: Management
Chung S, Zhao B, Lauderdale D
Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.
The researchers examined patterns and predictors of initiation of treatment for incident diabetes in an ambulatory care setting in the US. They found that only half of patients were treated during the first year following diabetes incidence, and only 20% of patients received both medication prescription and lifestyle modification interventions.
Prim Care Diabetes 2015 Feb;9(1):23-30. doi: 10.1016/j.pcd.2014.04.005.
AHRQ-funded; HS019815.
View abstract on the National Library of Medicine site.
Keywords: Diabetes, Prevention and Care Management, Health Care Utilization, Primary Care
Shirley DK, Kaner RJ, Glesby MJ
Screening for chronic obstructive pulmonary disease (COPD) in an urban HIV clinic: a pilot study.
This study aimed to determine the predictive value of a COPD screening strategy validated in the general population and to identify HIV-related factors associated with decreased lung function. It found that questionnaire and peak flow together had low sensitivity, but abnormal peak flow shows potential as a screening tool for COPD in HIV/AIDS. These data suggest that lung function may be influenced by HIV-related factors.
AIDS Patient Care STDS 2015 May;29(5):232-9. doi: 10.1089/apc.2014.0265.
AHRQ-funded; HS000066.
View abstract on the National Library of Medicine site.
Keywords: Human Immunodeficiency Virus (HIV), Screening, Chronic Obstructive Pulmonary Disease (COPD)
Mitchell SE, Martin J, Holmes S
How hospitals reengineer their discharge processes to reduce readmissions.
The Re-Engineered Discharge (RED) program is a hospital-based initiative shown to decrease hospital reutilization. Researchers implemented the RED in 10 hospitals to study the implementation process. They found wide variability in the fidelity of the RED intervention. Engaged leadership and multidisciplinary implementation teams were keys to success of the program. Eight out of 10 hospitals reported improvement in 30-day readmission rates after RED implementation.
J Healthc Qual 2016 Mar-Apr;38(2):116-26. doi: 10.1097/jhq.0000000000000005.
AHRQ-authored; AHRQ-funded; 290200600012I.
View abstract on the National Library of Medicine site.
Keywords: ReEngineered Discharge, Readmissions, Hospital Discharge
AHRQ Author: Brach C
Knackstedt ED, Stockmann C, Davis CR
Outpatient parenteral antimicrobial therapy in pediatrics: an opportunity to expand antimicrobial stewardship.
The researchers reviewed patient discharges with outpatient parenteral antimicrobial therapy (OPAT) to determine whether OPAT was modifiable or unnecessary at a large tertiary care children’s hospital. At least one modification definitely or possibly would have been recommended for 78 percent of episodes. For more than 40 percent of episodes, OPAT was potentially not indicated.
Infect Control Hosp Epidemiol 2015 Feb;36(2):222-4. doi: 10.1017/ice.2014.27.
AHRQ-funded; HS023320.
View abstract on the National Library of Medicine site.
Keywords: Bacterial Infections, Antimicrobials, Children, Hospital Outpatient Care
Wittie M, Ngo-Metzger Q, Lebrun-Harris L
Enabling quality: electronic health record adoption and meaningful use readiness in federally funded health centers.
This study, the first to examine the adoption and use of electronic health records (EHRs) among all 1,128 federally funded health centers, found that, as of 2011, 80 percent of health centers reported using an EHR, and high proportions reported using many advanced EHR functionalities. There were no indications of disparities in EHR adoption by census region, urban/rural location, patient sociodemographic compositions, physician staffing or health center funding.
J Healthc Qual. 2016 Jan-Feb;38(1):42-51. doi: 10.1111/jhq.12067.
View abstract on the National Library of Medicine site.
Keywords: Health IT, Electronic Health Records (EHRs), Disparities, Socioeconomic Factors
AHRQ Author: Ngo-Metzger Q
Elliott MN, Cohea CW, Lehrman WG
Accelerating improvement and narrowing gaps: trends in patients' experiences with hospital care reflected in HCAHPS public reporting.
The researchers describe the experiences of over 4 million patients discharged from hospitals that participated in the second and fifth years of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) public reporting and assess the changes in HCAHPS scores across different types of hospital and patient groups. They found that HCAHPS scores increased by 2.8 percentage points from 2008 to 2011 in the most positive response category.
Health Serv Res 2015 Dec;50(6):1850-67. doi: 10.1111/1475-6773.12305.
AHRQ-funded; HS016978.
View abstract on the National Library of Medicine site.
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Hospitals, Health Care Quality, Public Reporting
Grainger R, Dalbeth N, Keen H
Imaging as an outcome measure in gout studies: Report from the OMERACT Gout Working Group.
Discussion in the Outcome Measures in Rheumatology (OMERACT) working group was focused to consider (1) features of gout that should be recorded using imaging, (2) best methods of measuring these features, and (3) joints that should be imaged. The working group identified 3 relevant domains for imaging in gout studies: urate deposition (tophus burden), joint inflammation, and structural joint damage.
J Rheumatol 2015 Dec;42(12):2460-4. doi: 10.3899/jrheum.141164.
AHRQ-funded; HS021110.
View abstract on the National Library of Medicine site.
Keywords: Imaging, Patient-Centered Outcomes Research, Outcomes, Chronic Conditions
Risko R, Merdan S, Womble PR
Clinical predictors and recommendations for staging computed tomography scan among men with prostate cancer.
This study identified clinical variables associated with a positive computed tomography (CT) scan and estimated the performance of imaging recommendations in patients with newly diagnosed prostate cancer. It found that implementation of criterion for CT imaging that includes PSA levels greater than 20, a Gleason score of 8 or higher, or locally advanced disease (interpreted as cT3/4) would ensure that CT scans are performed for almost all men who would test positive for metastases.
Urology. 2014 Dec;84(6):1329-34. doi: 10.1016/j.urology.2014.07.051.
AHRQ-funded; HS018346
View abstract on the National Library of Medicine site.
Keywords: Computed Tomography (CT) Scan, Cancer: Prostate Cancer, Screening, Diagnosis, Diagnostics
Stuart BC, Davidoff AJ, Erten MZ
Changes in medication management after a diagnosis of cancer among Medicare beneficiaries with diabetes.
The researchers sought to determine whether a new cancer diagnosis is associated with changes in medication adherence among Medicare beneficiaries with diabetes. They concluded that cancer diagnosis among patients with diabetes reduced adherence with evidence-based medications, particularly if patients’ life expectancy was short.
J Oncol Pract 2015 Nov;11(6):429-34. doi: 10.1200/jop.2014.003046.
View abstract on the National Library of Medicine site.
Keywords: Medication, Medicare, Cancer, Diabetes, Patient Adherence
AHRQ Author: Davidoff AJ
Ndumele CD, Sommers BD, Trivedi AN
The ACA's 65th birthday challenge: moving from Medicaid to Medicare.
Following the Affordable Care Act’s coverage expansion, many newly-insured older enrollees will lose Medicaid coverage on their 65th birthday and transition from Medicaid to Medicare as their primary insurer. This article discusses the transition in primary health insurance coverage that includes changes to benefits, patient cost-sharing, and provider reimbursement, which could have profound consequences on the use of health services and associated health outcomes for low-income seniors.
J Gen Intern Med 2015 Nov;30(11):1704-6. doi: 10.1007/s11606-015-3328-0.
AHRQ-funded; HS021291.
View abstract on the National Library of Medicine site.
Keywords: Health Insurance, Affordable Care Act, Medicare, Elderly, Low-Income Population