National Healthcare Quality and Disparities Report
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Topics
- Arthritis (1)
- Back Health and Pain (6)
- Behavioral Health (3)
- Cancer (2)
- Cancer: Breast Cancer (1)
- Cancer: Lung Cancer (1)
- Cardiovascular Conditions (1)
- Care Management (3)
- Children/Adolescents (1)
- Chronic Conditions (16)
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- Comparative Effectiveness (2)
- Diabetes (1)
- Disparities (1)
- Elderly (3)
- Electronic Health Records (EHRs) (1)
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- Guidelines (2)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (2)
- Healthcare Delivery (1)
- Healthcare Utilization (3)
- Health Information Technology (HIT) (1)
- Health Services Research (HSR) (1)
- Health Status (1)
- Heart Disease and Health (1)
- Hospital Readmissions (1)
- Hospitals (1)
- Human Immunodeficiency Virus (HIV) (1)
- Imaging (1)
- Implementation (1)
- Injuries and Wounds (1)
- Medicare (1)
- Medication (19)
- Medication: Safety (3)
- Neurological Disorders (1)
- Opioids (18)
- Orthopedics (5)
- Outcomes (2)
- (-) Pain (35)
- Patient-Centered Healthcare (2)
- Patient-Centered Outcomes Research (5)
- Patient Experience (1)
- Patient Safety (2)
- Patient Self-Management (1)
- Practice Patterns (6)
- Prevention (2)
- Primary Care (4)
- Primary Care: Models of Care (1)
- Provider (1)
- Provider: Clinician (1)
- Provider: Physician (1)
- Quality of Life (6)
- Racial and Ethnic Minorities (2)
- Rehabilitation (1)
- Research Methodologies (2)
- Respiratory Conditions (1)
- Rural Health (1)
- Shared Decision Making (4)
- Sickle Cell Disease (1)
- Substance Abuse (4)
- Surgery (8)
- Trauma (1)
- Women (2)
- Young Adults (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 35 Research Studies DisplayedShapiro HFJ, Loder E, Shapiro DJ
Association between clinician specialty and prescription of preventive medication for young adults with migraine: a retrospective cohort study.
The purpose of this multicenter retrospective cohort study was to compare prescribing patterns of preventive medications between pediatric and adult neurologists for young adults with migraine. The primary study outcome was whether the patient received a prescription for any preventive medication during the study period. Among the 767 included patients, 37.8% were seen by a pediatric neurologist. Preventive medications were prescribed for 45.2% of patients seen by a pediatric neurologist and 43.2% of patients seen by an adult neurologist. In the mixed effects logistic regression model, clinician specialty was not related with preventive medication use Female sex and number of visits during the study period were related with receiving preventive medication. The study concluded that proportion of young adults being prescribed migraine medications did not differ according to clinician specialty.
AHRQ-funded; HS000063.
Citation: Shapiro HFJ, Loder E, Shapiro DJ .
Association between clinician specialty and prescription of preventive medication for young adults with migraine: a retrospective cohort study.
Headache 2023 Oct; 63(9):1232-39. doi: 10.1111/head.14628..
Keywords: Young Adults, Medication, Pain, Neurological Disorders
Somohano VC, Smith CL, Saha S
Patient-provider shared decision-making, trust, and opioid misuse among US veterans prescribed long-term opioid therapy for chronic pain.
This article examined the role that trust in a prescribing provider has on shared decision-making and opioid misuse in opioid-specific pain management. A secondary analysis of data from a prospective cohort study was conducted of US Veterans (N = 1273) prescribed long-term opioid therapy (LTOT) for chronic non-cancer pain. Patient-provider shared decision-making had a total significant effect on opioid misuse, in the absence of the mediator, such that higher levels of shared decision-making were associated with lower levels of reported opioid misuse. When trust in provider was added to the mediation model, the indirect effect of shared decision-making on opioid misuse through trust in provider remained significant.
AHRQ-funded; HS026370.
Citation: Somohano VC, Smith CL, Saha S .
Patient-provider shared decision-making, trust, and opioid misuse among US veterans prescribed long-term opioid therapy for chronic pain.
J Gen Intern Med 2023 Sep; 38(12):2755-60. doi: 10.1007/s11606-023-08212-5..
Keywords: Shared Decision Making, Opioids, Medication, Substance Abuse, Behavioral Health, Pain, Chronic Conditions
Bongiovanni T, Pletcher MJ, Lau C
A behavioral intervention to promote use of multimodal pain medication for hospitalized patients: a randomized controlled trial.
Administration of nonsteroidal anti-inflammatory drugs (NSAIDs) has become a foundational strategy to decrease the use of opioids, but data is lacking to describe recommending utilization when admitting patients using electronic health record systems. The purpose of this study was to assess an electronic health record system to increase ordering of NSAIDs for hospitalized adults. The researchers conducted a cluster randomized controlled trial of clinicians admitting adult patients to a health system over a period of 9-months. Clinicians in the intervention arm were required to actively order or decline NSAIDs; the control arm was provided the same order but without a required response. A total of 20,085 hospitalizations were included. The study found that among the hospitalizations, 52% were admitted by a clinician randomized to the intervention arm. NSAIDs were ordered in 22% of the interventions and 22% of the control admissions. There were no statistically significant differences in NSAID administration, pain scores, or opioid prescribing. There were no differences in clinical harms, with average pain scores of 3.36 in the control group and 3.39 in the intervention group, on a scale of 0-5.
AHRQ-funded; HS026383.
Citation: Bongiovanni T, Pletcher MJ, Lau C .
A behavioral intervention to promote use of multimodal pain medication for hospitalized patients: a randomized controlled trial.
J Hosp Med 2023 Aug; 18(8):685-92. doi: 10.1002/jhm.13153..
Keywords: Pain, Opioids, Medication, Behavioral Health, Practice Patterns
Kim HS, Strickland KJ, Seitz AL
Patient perspectives on seeking emergency care for acute low back pain and access to physical therapy in the emergency department.
This study’s purpose was to explore patient perspectives on visiting the emergency department (ED) for low back pain to inform a more patient-centered approach to emergency care. The authors conducted focus group discussions and individual interviews among patients visiting an urban academic ED for acute low back pain. They recruited participants from an ongoing prospective study of 101 patients receiving either ED-initiated physical therapy or usual care. They conducted 4 focus group discussions among 18 participants (median age 46.5 years, 66.7% women, 61.1% Black) and individual interviews with 27 participants (median age 45 years, 55.6% women, 44.4% White). They identified 5 summary themes: (1) the decision to seek emergency care for low back pain is motivated by severe pain, resulting disability, and fears about a catastrophic diagnosis, (2) participants sought various goals from their ED visit but emphasized the primacy of pain control, (3) participants were reluctant to use pain medications but also acknowledged their benefit, (4) participants perceived a number of benefits from direct access to an ED physical therapist in the ED, and (5) participation in physical therapy ultimately facilitated recovery, but the pain was a barrier to performing exercises.
AHRQ-funded; HS023011; HS027426.
Citation: Kim HS, Strickland KJ, Seitz AL .
Patient perspectives on seeking emergency care for acute low back pain and access to physical therapy in the emergency department.
Ann Emerg Med 2023 Aug; 82(2):154-63. doi: 10.1016/j.annemergmed.2022.12.028..
Keywords: Emergency Department, Back Health and Pain, Pain
Ayers DC, Yousef M, Yang W
Age-related differences in pain, function, and quality of life following primary total knee arthroplasty: results from a FORCE-TJR (Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement) cohort.
The purpose of this prospective, multicenter cohort study was to evaluate the differences in pain, function, and quality of life (QoL) reported 1 year after total knee arthroplasty (TKA) across varying age groups. The researchers preoperatively assessed 11,602 unilateral primary TKA patients, and collected demographic data, comorbid conditions, and patient-reported outcome measures including the knee injury and osteoarthritis outcome score (KOOS), KOOS-12, KOOS Joint Replacement, and Short-Form health survey (12-item) and then collected again at 1-year postoperatively. The study found that prior to surgery, patients less than 55 years reported worse KOOS pain (39), function (50), and QoL (18) scores with poor mental health score (47) than other older patient groups. At 1 year after TKA, patients less than 55 years reported lower KOOS pain, function, and QoL scores when compared to patients 75 years or older. The differences in score changes among the age groups were statistically significant but clinically irrelevant. Further statistical analyses revealed that age was a significant predictor for pain, but not for function at 1 year where KOOS pain score was predicted to be higher in patients 75 years or older when compared to patients less than 55 years of age.
AHRQ-funded; HS018910.
Citation: Ayers DC, Yousef M, Yang W .
Age-related differences in pain, function, and quality of life following primary total knee arthroplasty: results from a FORCE-TJR (Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement) cohort.
J Arthroplasty 2023 Jul; 38(7 Suppl 2):S169-S76. doi: 10.1016/j.arth.2023.04.005..
Keywords: Orthopedics, Surgery, Quality of Life, Outcomes, Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research, Pain
Ayers DC, Zheng H, Yang W
How back pain affects patient satisfaction after primary total knee arthroplasty.
This study looked at patient-reported outcomes (PROs) for patients with back pain (BP) who underwent total knee arthroscopy (TKA) surgery for pre- and postoperatively. This multicenter cohort study included 9,057 patients undergoing primary unilateral TKA who were enrolled in FORCE-TJ. Back pain (BP) intensity was assessed using the Oswestry back disability index (ODI) pain intensity questionnaire, with BP severity then classified into 4 categories. PROs were collected preoperatively and postoperatively after 1 year including the Knee injury and Osteoarthritis Outcome Score (KOOS) (total score, pain, Activities of Daily Living (ADL), and Quality of Life (QOL), Short-Form health survey 36-item (SF-36) Physical Component Score (PCS), and Mental Component Score (MCS)). At 1 year a total of 18.3% TKA patients were dissatisfied. At the time of surgery, a total of 4,765 patients (52.6%) reported back pain, divided into mild BP (24.9%), moderate (20.3%), and severe (7.2%). Severe back pain was significantly associated with patient dissatisfaction at 1 year after TKA. The predictive variables for dissatisfaction include age [odds ratio (OR) for younger patients <65 years versus older patients ≥65 years], educational level [OR for post high school versus less], smoking [OR for nonsmoker versus current smoker)], and Charlson comorbidity index [OR for CCI ≥2 versus 0]. The authors recommend surgeons consider a spine evaluation in patients who have severe BP prior to TKA.
AHRQ-funded; HS018910.
Citation: Ayers DC, Zheng H, Yang W .
How back pain affects patient satisfaction after primary total knee arthroplasty.
J Arthroplasty 2023 Jun; 38(6s):S103-s08. doi: 10.1016/j.arth.2023.03.072..
Keywords: Back Health and Pain, Pain, Pain, Patient Experience, Orthopedics, Surgery
Ganguli I, Ying W, Shakley T
Cascade services and spending following low-value imaging for uncomplicated low back pain among commercially insured adults.
The purpose of this study was to examine the impact of low-value imaging on cascade services and spending in commercially-insured adults with uncomplicated acute low back pain. The researchers analyzed medical claims from Blue Cross Blue Shield of Massachusetts members aged 18-50 years who received a 2018 diagnosis of uncomplicated low back pain, for which imaging was considered inappropriate according to the National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set (HEDIS) criteria. In 2018, 30,892 members were eligible for low-value imaging. Of these, 6009 (19.5%) received low-value imaging: 5091 (16.5%) X-ray and 787 (2.5%) MRI. The study found that when compared to patients without low-value imaging, those with low-value X-ray or MRI had higher adjusted probabilities of receiving cascade services and greater adjusted total spending at 3, 6, and 12 months. These results were robust to falsification testing. Members with high deductible health plans (HDHP) had higher narrowly defined cascade-associated out-of-pocket spending than those in other plans. The most common sources of narrowly defined cascade-associated spending were physical therapy, office visits, radiology studies, laboratory studies, and surgery.
J Gen Intern Med 2023 Mar;38(4):1102-05. doi: 10.1007/s11606-022-07829-2
Citation: Ganguli I, Ying W, Shakley T .
Cascade services and spending following low-value imaging for uncomplicated low back pain among commercially insured adults.
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Keywords: Imaging, Back Health and Pain, Pain, Healthcare Costs
Navis A, George MC, Nmashie A
Validation of the Safer Opioid Prescribing Evaluation Tool (SOPET) for assessing adherence to the Centers for Disease Control opioid prescribing guidelines.
This study assessed the use of the Safer Opioid Prescribing Evaluation Tool (SOPET) which was designed to improve the implementation of the 2016 Centers for Disease Control Guidelines on the prescription of opioids for chronic pain. Four raters with varying levels of clinical experience were trained to use the SOPET and then used it to evaluate 21 baseline patient scenarios. Inter-rater reliability was measured using intraclass correlation coefficient (ICC) estimates and their 95% confidence intervals for the total SOPET score based on a mean-rating absolute-agreement, two-way random-effects model. Inter-rater reliability was found to be good for the three physician raters (0.92, 0.97, and 0.99). However, inter-rater reliability for the non-physician rater was lower (0.67).
AHRQ-funded; HS025641.
Citation: Navis A, George MC, Nmashie A .
Validation of the Safer Opioid Prescribing Evaluation Tool (SOPET) for assessing adherence to the Centers for Disease Control opioid prescribing guidelines.
Pain Med 2020 Dec 25;21(12):3655-59. doi: 10.1093/pm/pnaa138..
Keywords: Opioids, Medication, Medication: Safety, Patient Safety, Guidelines, Practice Patterns, Pain, Chronic Conditions, Evidence-Based Practice
Militello LG, Hurley RW, Cook RL
Primary care clinicians' beliefs and strategies for managing chronic pain in an era of a national opioid epidemic.
Investigators sought a better understanding of primary care clinicians’ approaches to managing patients with chronic pain and explored implications for technological and administrative interventions. They found that primary care clinicians’ beliefs about opioid therapy generally align with the clinical evidence but may have some important gaps, suggesting the potential value of interventions that include improved access to research findings, organizational changes to support spending time with patients to develop rapport, and the need for innovative clinical cognitive support.
AHRQ-funded; HS023306.
Citation: Militello LG, Hurley RW, Cook RL .
Primary care clinicians' beliefs and strategies for managing chronic pain in an era of a national opioid epidemic.
J Gen Intern Med 2020 Dec;35(12):3542-48. doi: 10.1007/s11606-020-06178-2..
Keywords: Primary Care, Opioids, Medication, Pain, Chronic Conditions, Provider: Physician, Provider: Clinician, Provider, Care Management
Romman AN, Hsu CM, Chou LN
Opioid prescribing to Medicare Part D enrollees, 2013-2017: shifting responsibility to pain management providers.
This study looked at trends in opioid prescribing frequency to Medicare Part D enrollees from 2013 to 2017 by medical specialty and provider type. The authors analyzed opioid claims and prescribing trends for specialties accounting for ≥1% of all opioid claims. Pain management specialists increased Medicare Part D opioid claims by 27.3% to 1,140 mean claims per provider in 2017. Physical medicine and rehabilitation providers increased claims by 16.9% to 511 mean claims per provider in 2017. All other medical specialties decreased opioid claims during this period, with emergency medicine decreasing the most (-19.9%) and orthopedic surgery (-16%) dropping opioid claims the most of all the other specialties. Overall physician decrease was -5.2%. However opioid claims among dentists (+5.6%) and nonphysician providers (+10.2%) increased during this period.
AHRQ-funded; HS020642.
Citation: Romman AN, Hsu CM, Chou LN .
Opioid prescribing to Medicare Part D enrollees, 2013-2017: shifting responsibility to pain management providers.
Pain Med 2020 Nov 7;21(7):1400-07. doi: 10.1093/pm/pnz344..
Keywords: Elderly, Opioids, Medication, Medicare, Pain, Chronic Conditions, Practice Patterns
Scherer M, Weiss L, Kamler A M, Weiss L, Kamler A
Patient recommendations for opioid prescribing in the context of HIV care: findings from a set of public deliberations.
It is widely acknowledged that the growing opioid epidemic and associated increase in overdose deaths necessitates a reexamination of processes and procedures related to an opioid prescription for the treatment of chronic pain. However, the perspectives of patients, including those at the highest risk for opioid-related harms, are largely missing from this reexamination. To partially address the gap, the investigators conducted a pair of one-day public deliberations on opioid prescribing in the context of HIV care.
AHRQ-funded; HS025641.
Citation: Scherer M, Weiss L, Kamler A M, Weiss L, Kamler A .
Patient recommendations for opioid prescribing in the context of HIV care: findings from a set of public deliberations.
AIDS Care 2020 Nov;32(11):1471-78. doi: 10.1080/09540121.2019.1705962..
Keywords: Human Immunodeficiency Virus (HIV), Opioids, Medication, Chronic Conditions, Pain
Brown TJ Keshvani, N Gupta, et al.
Rates of appropriate laxative prophylaxis for opioid-induced constipation in veterans with lung cancer: a retrospective cohort study.
This study examined trends in the use of laxatives for opioid-induced constipation (OIC) in patients prescribed opioids for cancer pain treatment. A retrospective study was conducted of lung cancer patients seen in the Veteran’s Affair system from 2003 to 2016. There were 130,990 individuals included in the analysis. The majority (87%) received no prophylaxis (75%) or received docusate alone while 5% received OIC prophylaxis with the unnecessary addition of docusate. Throughout the study period, laxative prescription significantly decreased while categories of OIC prophylaxis were unchanged. The study concluded that almost 90% received inadequate or inappropriate OIC prophylaxis.
AHRQ-funded; HS022418.
Citation: Brown TJ Keshvani, N Gupta, et al..
Rates of appropriate laxative prophylaxis for opioid-induced constipation in veterans with lung cancer: a retrospective cohort study.
Support Care Cancer 2020 Nov;28(11):5315-21. doi: 10.1007/s00520-020-05364-6..
Keywords: Cancer: Lung Cancer, Cancer, Opioids, Medication, Prevention, Pain
Singh SA, Bakshi N, Mahajan P
What is the future of patient-reported outcomes in sickle-cell disease?
Sickle cell disease (SCD) is a complex, chronic disease caused by abnormal polymerization of hemoglobin, which leads to severe pain episodes, fatigue, and end-organ damage. Patient reported outcomes (PROs) have emerged as a critical tool for measuring SCD disease severity and response to treatment. In this study, the authors reviewed the key issues involved when deciding to use a PRO in a clinical trial. They described the most highly recommended generic and disease-specific PRO tools in SCD and discussed the challenges of incorporating them in clinical practice.
AHRQ-funded; HS024953; HS026622.
Citation: Singh SA, Bakshi N, Mahajan P .
What is the future of patient-reported outcomes in sickle-cell disease?
Expert Rev Hematol 2020 Nov;13(11):1165-73. doi: 10.1080/17474086.2020.1830370..
Keywords: Sickle Cell Disease, Pain, Quality of Life, Chronic Conditions, Patient-Centered Healthcare, Patient-Centered Outcomes Research
Azad AD, Bozkurt S, Wheeler AJ
Acute pain after breast surgery and reconstruction: a two-institution study of surgical factors influencing short-term pain outcomes.
This study analyzed the relationship between differing breast cancer excisional procedures, reconstruction, and short-term pain outcomes. Women who underwent breast cancer surgery with and without reconstruction were included from two institutions: an academic hospital (AH) and a Veterans Health Administration (VHS) facility. Average pain scores at time of discharge and at 30-day follow-up were analyzed. The study included 1402 patients at AH and 1435 at VHA. Of those, 425 AH and 165 VHA patients underwent breast reconstruction. Pain scores were highest at discharge and improved over time. Younger age, preoperative opioid use, and longer length of stay were all associated with worse pain scores.
AHRQ-funded; HS024096.
Citation: Azad AD, Bozkurt S, Wheeler AJ .
Acute pain after breast surgery and reconstruction: a two-institution study of surgical factors influencing short-term pain outcomes.
J Surg Oncol 2020 Sep 15;122(4):623-31. doi: 10.1002/jso.26070..
Keywords: Pain, Cancer: Breast Cancer, Cancer, Surgery, Outcomes, Women
Nayfe R, Chansard M, Hynan LS
Comparison of patient-reported outcomes measurement information system and legacy instruments in multiple domains among older veterans with chronic back pain.
This study evaluated construct (convergent and discriminant) validity and time to complete NIH's Patient Reported Outcomes Measurement Information System (PROMIS) as compared to legacy instruments. Results showed that, given time efficiency of using PROMIS, along with strong construct validity, PROMIS instruments are a practical choice for measuring multidimensional patient-reported outcomes in older Veterans with chronic low back pain for both research and clinical purposes.
AHRQ-funded; HS022418.
Citation: Nayfe R, Chansard M, Hynan LS .
Comparison of patient-reported outcomes measurement information system and legacy instruments in multiple domains among older veterans with chronic back pain.
BMC Musculoskelet Disord 2020 Sep 8;21(1):598. doi: 10.1186/s12891-020-03587-6..
Keywords: Elderly, Back Health and Pain, Pain, Chronic Conditions, Patient-Centered Outcomes Research, Research Methodologies
Rundell SD, Resnik L, Heagerty PJ
Performance of the Functional Comorbidity Index (FCI) in prognostic models for risk adjustment in patients with back pain.
The Functional Comorbidity Index (FCI) is a comorbidity measure associated with physical function and may contribute to risk adjustment models in rehabilitation settings, but an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) of the FCI has not been tested in outpatient settings. The purpose of this cohort study was to examine the ability of an ICD-9-CM- based FCI to predict function, health-related quality of life, and overall health care use.
AHRQ-funded; HS01922201; HS022972.
Citation: Rundell SD, Resnik L, Heagerty PJ .
Performance of the Functional Comorbidity Index (FCI) in prognostic models for risk adjustment in patients with back pain.
Pm r 2020 Sep;12(9):891-98. doi: 10.1002/pmrj.12315..
Keywords: Back Health and Pain, Pain, Chronic Conditions, Quality of Life, Rehabilitation
Johnson BN, Lumley MA, Cheavens JS
Exploring the links among borderline personality disorder symptoms, trauma, and pain in patients with chronic pain disorders.
The authors compared study participants high or low on borderline personality disorder (BPD) symptoms on patterns of pain experience and types of child and adult traumas. They found that BPD symptoms were associated with increased clinical severity among patients with chronic pain as well as a unique manifestation of pain experiencing. Childhood trauma of all types is associated with chronic pain and BPD co-occurrence. They recommended that researchers and clinicians assess for BPD in people with chronic pain to enhance conceptual models of the transaction between these disorders and to improve clinical care.
AHRQ-funded; HS022990.
Citation: Johnson BN, Lumley MA, Cheavens JS .
Exploring the links among borderline personality disorder symptoms, trauma, and pain in patients with chronic pain disorders.
J Psychosom Res 2020 Aug;135:110164. doi: 10.1016/j.jpsychores.2020.110164..
Keywords: Behavioral Health, Trauma, Pain, Chronic Conditions
Martsolf GR, Nuckols TK, Fingar KR
AHRQ Author: Stocks C, Owens PL
Nonspecific chest pain and hospital revisits within 7 days of care: variation across emergency department, observation and inpatient visits.
The purpose of this study was to compare the rate at which patients with nonspecific chest pain return to the hospital within 7 days after index observation visits versus after index emergency department and inpatient visits. Findings showed that up to 1 in 10 patients discharged with nonspecific chest pain returned to the hospital within 1week. Compared with emergency department and inpatient care, observation visits were associated with lower revisit rates. Recommendations include further research to refine clinical standards of care for nonspecific chest pain as well as to investigate the healthcare delivery and patient factors that influence 7-day revisit rates.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Martsolf GR, Nuckols TK, Fingar KR .
Nonspecific chest pain and hospital revisits within 7 days of care: variation across emergency department, observation and inpatient visits.
BMC Health Serv Res 2020 Jun 8;20(1):516. doi: 10.1186/s12913-020-05200-x..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Pain, Healthcare Utilization, Hospitals, Heart Disease and Health, Cardiovascular Conditions
Hernandez-Boussard T, Graham LA, Carroll I
Perioperative opioid use and pain-related outcomes in the Veterans Health Administration.
This study characterized perioperative exposure to morphine and its association with postoperative pain and 30-day readmissions. Utilizing nationwide Veterans Healthcare Administration (VHA) data on four high-volume surgical procedures, the researchers found that patients receiving high perioperative oral morphine equivalents were more likely to return to care for pain-related problems.
AHRQ-funded; HS024096.
Citation: Hernandez-Boussard T, Graham LA, Carroll I .
Perioperative opioid use and pain-related outcomes in the Veterans Health Administration.
Am J Surg 2020 Jun;219(6):969-75. doi: 10.1016/j.amjsurg.2019.06.022..
Keywords: Opioids, Medication, Pain, Substance Abuse, Surgery, Hospital Readmissions
Wolff C, Dowd WN, Ali MM
AHRQ Author: McClellan C
The impact of the abuse-deterrent reformulation of extended-release OxyContin on prescription pain reliever misuse and heroin initiation.
The introduction of abuse-deterrent OxyContin in 2010 was intended to reduce its misuse by making it more tamper resistant. However, some studies have suggested that this reformulation might have had unintended consequences, such as increases in heroin-related deaths. In this study, the investigators used the 2005-2014 cross-sectional U.S. National Survey on Drug Use and Health to explore the impact of this reformulation on intermediate outcomes that precede heroin-related deaths for individuals with a history of OxyContin misuse.
AHRQ-authored.
Citation: Wolff C, Dowd WN, Ali MM .
The impact of the abuse-deterrent reformulation of extended-release OxyContin on prescription pain reliever misuse and heroin initiation.
Addict Behav 2020 Jun;105:106268. doi: 10.1016/j.addbeh.2019.106268..
Keywords: Opioids, Medication, Medication: Safety, Patient Safety, Prevention, Pain, Substance Abuse
Weng Y, Tian L, Tedesco D
Trajectory analysis for postoperative pain using electronic health records: a nonparametric method with robust linear regression and K-medians cluster analysis.
Postoperative pain scores are widely monitored and collected in the electronic health record, yet current methods fail to fully leverage the data with fast implementation. This article describes a trajectory analysis for postoperative pain using electronic health records. A robust linear regression was fitted to describe the association between the log-scaled pain score and time from discharge after total knee replacement.
AHRQ-funded; HS024096.
Citation: Weng Y, Tian L, Tedesco D .
Trajectory analysis for postoperative pain using electronic health records: a nonparametric method with robust linear regression and K-medians cluster analysis.
Health Informatics J 2020 Jun;26(2):1404-18. doi: 10.1177/1460458219881339..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Pain, Surgery, Orthopedics, Research Methodologies, Health Services Research (HSR)
Bowen E, Nayfe R, Milburn N
Do decision aids benefit patients with chronic musculoskeletal pain? A systematic review.
To review the effect of patient decision aids for adults making treatment decisions regarding the management of chronic musculoskeletal pain. The investigators performed a systematic review of randomized controlled trials of adults using patient decision aids to make treatment decisions for chronic musculoskeletal pain in the outpatient setting. The investigators concluded that decision aids may improve patients' knowledge about treatment options for chronic musculoskeletal pain but largely did not impact other outcomes.
AHRQ-funded; HS022418.
Citation: Bowen E, Nayfe R, Milburn N .
Do decision aids benefit patients with chronic musculoskeletal pain? A systematic review.
Pain Med 2020 May;21(5):951-69. doi: 10.1093/pm/pnz280..
Keywords: Shared Decision Making, Pain, Chronic Conditions
Gaskin DJ, Karmarkar TD, Maurer A
Potential role of cost and quality of life in treatment decisions for arthritis-related knee pain in African American and Latina women.
This study examined whether using a decision-making tool would aid Latina and African-American women over age 45 years with arthritic knee pain in making more informed treatment decisions. The researchers conducted 4 focus groups of Latina and African-American women and 2 focus groups with primary care providers who treated them for knee pain. They found that minority women and primary care providers all endorsed the use of a decision-making tool that provided information on the impact of treatment on quality of life, medical care costs, and work productivity.
AHRQ-funded; HS000029.
Citation: Gaskin DJ, Karmarkar TD, Maurer A .
Potential role of cost and quality of life in treatment decisions for arthritis-related knee pain in African American and Latina women.
Arthritis Care Res 2020 May;72(5):692-98. doi: 10.1002/acr.23903..
Keywords: Arthritis, Orthopedics, Pain, Quality of Life, Healthcare Costs, Shared Decision Making, Racial and Ethnic Minorities, Women
Goyal MK, Johnson TJ, Chamberlain JM
Racial and ethnic differences in emergency department pain management of children with fractures.
Researchers tested the hypotheses that minority children with long-bone fractures are less likely to receive analgesics, to receive opioid analgesics, and to achieve pain reduction. Using data from the Pediatric Emergency Care Applied Research Network Registry, they found that there are differences in process and outcome measures by race and ethnicity in the emergency department management of pain among children with long-bone fractures. Although minority children are more likely to receive analgesics and achieve reduction in pain, they are less likely to receive opioids and achieve optimal pain reduction.
AHRQ-funded; HS020270.
Citation: Goyal MK, Johnson TJ, Chamberlain JM .
Racial and ethnic differences in emergency department pain management of children with fractures.
Pediatrics 2020 May;145(5):e20193370. doi: 10.1542/peds.2019-3370..
Keywords: Children/Adolescents, Racial and Ethnic Minorities, Emergency Department, Pain, Injuries and Wounds, Medication, Opioids, Disparities
Marcial LH, Blumenfeld B, Harle C
Barriers, facilitators, and potential solutions to advancing interoperable clinical decision support: multi-stakeholder consensus recommendations for the opioid use case.
These proceedings report on the AHRQ-sponsored Patient-Centered CDS Learning Network (PCCDS LN) Technical Framework Working Group (TechFWG), which was convened to identify barriers, facilitators, and potential solutions for interoperable clinical decision support, with a specific focus on addressing the opioid epidemic. The key insights were extrapolated to CDS-facilitated care improvement outside of the specific opioid use case. If applied broadly, the recommendations should help advance the availability and impact of interoperable CDS delivered at scale.
AHRQ-funded; HS024849.
Citation: Marcial LH, Blumenfeld B, Harle C .
Barriers, facilitators, and potential solutions to advancing interoperable clinical decision support: multi-stakeholder consensus recommendations for the opioid use case.
AMIA Annu Symp Proc 2020 Mar 4;2019:637-46..
Keywords: Clinical Decision Support (CDS), Shared Decision Making, Opioids, Medication, Pain, Patient-Centered Healthcare, Patient-Centered Outcomes Research