National Healthcare Quality and Disparities Report
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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
101 to 125 of 12139 Research Studies DisplayedKakara M, Venkataramani AS
Earnings of US physicians with and without disabilities.
The researchers report that across industries, workers with disabilities earn less than workers without disabilities. As greater numbers of people with disabilities enter medicine, they face substantial challenges in medical education and higher risks of mistreatment at work. As physicians in older age groups grows, the incidence of disability increases. The purpose of this study was to explore possible disability earnings gaps in medicine. The study cohort included 92,469 physicians, 2.0% of whom reported having a disability. The study found that in the adjusted analyses of employed physicians, annual earned income was 20.8% lower and hourly earned income was 13.3% lower among physicians with disabilities. Physicians reporting disabilities worked an average of 110 hours fewer per year compared with those without disabilities. Estimated differences in annual income by disability status were similar after adjusting for hours worked and surgical specialty status and across age groups; estimates were much greater for disabilities affecting cognitive function, ambulation, independent living, and self-care than vision or hearing.
AHRQ-funded; HS026116.
Citation: Kakara M, Venkataramani AS .
Earnings of US physicians with and without disabilities.
JAMA Health Forum 2023 Dec; 4(12):e233954. doi: 10.1001/jamahealthforum.2023.3954..
Keywords: Provider: Physician, Disabilities
Fingar KR, Weiss AJ, Roemer M
AHRQ Author: Roemer M, Reid LD
Effects of the COVID-19 early pandemic on delivery outcomes among women with and without COVID-19 at birth.
This AHRQ-authored paper examined the early pandemic-related changes in birth outcomes for pregnant women with and without a COVID-19 diagnosis at delivery. They compared four delivery outcomes-preterm delivery (PTD), severe maternal morbidity (SMM), stillbirth, and cesarean birth-between 2017 and 2019 (prepandemic) and between April and December 2020 (early pandemic) using interrupted time series models on 11.8 million deliveries, stratified by COVID-19 infection status at birth with entropy weighting for historical controls, from the HCUP across 43 states and the District of Columbia. Relative to 2017-2019, women without COVID-19 at delivery in 2020 had lower odds of PTD (OR = 0.93) and SMM (OR = 0.88) but increased odds of stillbirth (OR = 1.04). COVID-19 deliveries had an excess of each outcome, by factors of 1.07-1.46 for outcomes except SMM at 4.21. The effect for SMM was more pronounced for Asian/Pacific Islander non-Hispanic (API; OR = 10.51) and Hispanic (OR = 5.09) pregnant women than for White non-Hispanic (OR = 3.28) women.
AHRQ-authored; AHRQ-funded; 290201800001C.
Citation: Fingar KR, Weiss AJ, Roemer M .
Effects of the COVID-19 early pandemic on delivery outcomes among women with and without COVID-19 at birth.
Birth 2023 Dec; 50(4):996-1008. doi: 10.1111/birt.12753..
Keywords: Healthcare Cost and Utilization Project (HCUP), COVID-19, Maternal Care, Women, Outcomes
Jindal M, Chaiyachati KH, Fung V
Eliminating health care inequities through strengthening access to care.
The objective of this study was to provide a research agenda and recommendations to address inequities in access to health care based on findings from AHRQ's 2022 Health Equity Summit and subsequent meetings of access and equity experts from academia, industry, and the government. The authors noted that addressing access inequities cannot be done without considering the roles of racism and intersectionality. Their recommendations included funding research that measures racism within health care as well as tests burgeoning anti-racist practices, synthesizing best practices to mitigate racism, and forging a path forward for research on equity and access. They concluded that AHRQ is well-positioned to develop and fund an action plan and convene stakeholders across the health care spectrum to employ these recommendations.
AHRQ-funded.
Citation: Jindal M, Chaiyachati KH, Fung V .
Eliminating health care inequities through strengthening access to care.
Health Serv Res 2023 Dec; 58(suppl 3):300-10. doi: 10.1111/1475-6773.14202..
Keywords: Disparities, Access to Care, Healthcare Delivery
James TG, Sullivan MK, McKee MM
Emergency department patient-centred care perspectives from deaf and hard-of-hearing patients.
The objectives of this qualitative study were to describe emergency department (ED) care-seeking and patient-centered care perspectives among deaf and hard-of-hearing (DHH) patients and to explain quantitative findings related to ED outcomes among DHH and non-DHH patients. Researchers conducted semi-structured interviews with four DHH American Sign Language (ASL)-users and six DHH English speakers from north central Florida. Two themes emerged: DHH patients engage in complex decisionmaking processes to determine ED utilization and patient-centered ED care differs between DHH ASL-users and English speakers. The researchers concluded that their study underscores the importance of better understanding and intervention in DHH patient ED care seeking and delivery to improve patient outcomes.
AHRQ-funded; HS027537.
Citation: James TG, Sullivan MK, McKee MM .
Emergency department patient-centred care perspectives from deaf and hard-of-hearing patients.
Health Expect 2023 Dec; 26(6):2374-86. doi: 10.1111/hex.13842..
Keywords: Emergency Department, Patient-Centered Healthcare, Disabilities, Vulnerable Populations
Michelson KA, Bachur RG, Rangel SJ
Emergency department volume and delayed diagnosis of pediatric appendicitis: a retrospective cohort study.
The objective of this study was to assess the association of emergency department (ED) volume of children and delayed appendicitis diagnoses and to compare complication rates by delayed diagnosis occurrence. HCUP data from eight states were studied on children under the age of 18 with appendicitis in all EDs. The results indicated that higher ED volumes were associated with lower risk of delayed diagnosis of pediatric appendicitis; delay was associated with complications.
AHRQ-funded; HS026503.
Citation: Michelson KA, Bachur RG, Rangel SJ .
Emergency department volume and delayed diagnosis of pediatric appendicitis: a retrospective cohort study.
Ann Surg 2023 Dec 1; 278(6):833-38. doi: 10.1097/sla.0000000000005972..
Keywords: Children/Adolescents, Emergency Department, Diagnostic Safety and Quality
Roemer M, Schaefer MB, Pickens GT
AHRQ Author: Roemer M
Estimating state-specific population-based hospitalization rates from in-state hospital discharge data.
The purpose of this study was to develop weights to estimate state population-based hospitalization rates for all residents of a state using only data from in-state hospitals. The researchers utilized Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases (SID), for data from 2018-2019, including 47 states plus Washington D.C. and excluding residents treated in other states. SID were based on administrative billing records collected by hospitals, shared with statewide data organizations, and provided to HCUP. The study found that of 34,186,766 discharged patients in 2018, 4.2% were movers. A greater share of movers (vs. stayers) lived in state border and rural counties; a lower share had discharges billed to Medicaid or were hospitalized for maternal/neonatal services. The difference between 2019 observed and estimated total discharges for all included states and D.C. was 9,402. The researchers reported an overestimation of discharges with an expected payer of Medicaid, from the lowest income communities, and for maternal/neonatal care. The researchers reported an underestimation of discharges with an expected payer of private insurance, from the highest income communities, and with injury diagnoses and surgical services. Estimates for the majority of subsets were reported to be not within a 95% confidence interval, attributed to factors such as hospital closures/openings, shifting consumer preferences, and other issues impossible to account for.
AHRQ-authored; AHRQ-funded; 290201800001C.
Citation: Roemer M, Schaefer MB, Pickens GT .
Estimating state-specific population-based hospitalization rates from in-state hospital discharge data.
Health Serv Res 2023 Dec; 58(6):1314-27. doi: 10.1111/1475-6773.14216..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitalization, Hospital Discharge
Hughes PM, Ostrach B, Tak CR
Examining differences in opioid deaths by race in North Carolina following the STOP Act, 2010-2019.
This study used State-level secondary data to examine the impact of North Carolina's 2017 STOP Act on opioid overdose deaths by race. The results showed that the opioid overdose death rate among the White population decreased following the STOP Act, but found no significant change among the Black/African American population. The authors concluded that these findings have implications for health equity and may inform the development of future substance use policies.
AHRQ-funded; HS000032.
Citation: Hughes PM, Ostrach B, Tak CR .
Examining differences in opioid deaths by race in North Carolina following the STOP Act, 2010-2019.
J Subst Use Addict Treat 2023 Dec; 155:209171. doi: 10.1016/j.josat.2023.209171..
Keywords: Opioids, Mortality, Substance Abuse, Policy
Danilack VA, Siegel-Reamer L, Lum L
From "disappointing" to "fantastic": women's experiences with labor induction in a U.S. tertiary hospital.
This study examined women’s expectations and experiences regarding labor induction. Labor induction patients were recruited in a US tertiary care hospital's postpartum mother-baby unit and invited to participate in semi-structured qualitative interviews. From April to September 2018, 26 women were interviewed about expectations and experiences of the labor induction process, side effects and health outcomes of concern, reflections on personal tolerance of different interventions, and thoughts about an ideal process. A wide range of experiences were described- with characterizations from horrible, frustrating, and terrifying to simple, fast and smooth. The Foley balloon catheter was the most polarizing induction method. Other concerns centered on the health of their baby, and an ideal induction involved fewer interventions.
AHRQ-funded; HS025013.
Citation: Danilack VA, Siegel-Reamer L, Lum L .
From "disappointing" to "fantastic": women's experiences with labor induction in a U.S. tertiary hospital.
Birth 2023 Dec; 50(4):959-67. doi: 10.1111/birt.12750..
Keywords: Women, Maternal Care, Hospitals, Patient Experience
Goyal N, Gannon M, Sood E
Group well child care for mothers with opioid use disorder: framework for implementation.
The purpose of this study was to utilize an implementation science framework to examine barriers and facilitators to group well child care (WCC) interventions for parents with opioid use disorder and their children. The researchers conducted a qualitative study using structured phone interviews as a component of the planning phase of a trial of group WCC. Eligible parents were English speaking and had a child less than two years old. Thirty-one parents and 13 pediatric clinicians participated in the interviews. 68% of parents reported that they would be likely or very likely to bring their child to the OUD treatment center for WCC. The researchers found 6 themes emerged describing perceived implementation barriers, including intervention difficulty, complexity, and potential negative outcomes including loss of privacy. Six themes emerged as implementation facilitators: 1. focus on parental OUD and recovery, 2. peer support, 3. accessibility and coordination of care, 4. clinician skill and expertise in parental OUD, 5. increased time for patient care, and 6. continuity of care.
AHRQ-funded; HS027399.
Citation: Goyal N, Gannon M, Sood E .
Group well child care for mothers with opioid use disorder: framework for implementation.
Matern Child Health J 2023 Dec; 27(suppl 1):75-86. doi: 10.1007/s10995-023-03762-w..
Keywords: Children/Adolescents, Women, Substance Abuse, Opioids, Behavioral Health
Chin MH, Afsar-Manesh N, Bierman AS
AHRQ Author: Bierman AS, Chang C, Jain A, Umscheid C
Guiding principles to address the impact of algorithm bias on racial and ethnic disparities in health and health care.
A panel of experts was convened by AHRQ and the National Institute for Minority Health and Health Disparities to provide a conceptual framework and guiding principles for preventing bias in health care algorithms to promote health care equity. Multiple stakeholders can mitigate bias at each phase of the algorithm life cycle. Five principles should guide these efforts: promoting health and health care equity during all phases of the algorithm life cycle; ensuring algorithm use is transparent and explainable; engaging patients and communities during all phases of the algorithm life cycle to earn trustworthiness; identifying algorithmic fairness issues and establishing accountability for equity and fairness in outcomes from health care algorithms.
AHRQ-authored; AHRQ-funded.
Citation: Chin MH, Afsar-Manesh N, Bierman AS .
Guiding principles to address the impact of algorithm bias on racial and ethnic disparities in health and health care.
JAMA Netw Open 2023 Dec; 6(12):e2345050. doi: 10.1001/jamanetworkopen.2023.45050..
Keywords: Racial and Ethnic Minorities, Disparities
O'Halloran A, Lockwood J, Sosa T
How do we detect and respond to clinical deterioration in hospitalized children? Results of the Pediatric Care BefOre Deterioration Events (CODE) survey.
This study’s objective was to describe systems to detect/respond to deteriorating hospitalized children at Pediatric Resuscitation Quality Collaborative (pediRES-Q) institutions. The authors performed a cross-sectional survey of pediRES-Q leaders utilizing expert validation and cognitive interviews, with 30 centers (88%) responding. Most institutions (93%) used ≥1 system to detect deterioration: most commonly, early warning scores (83%), watcher lists (55%), and proactive surveillance teams (31%). Most (90%) collect relevant data, including number of rapid responses (88%), arrests outside intensive care units (100%), and serious safety events (88%).
AHRQ-funded; HS026975.
Citation: O'Halloran A, Lockwood J, Sosa T .
How do we detect and respond to clinical deterioration in hospitalized children? Results of the Pediatric Care BefOre Deterioration Events (CODE) survey.
J Hosp Med 2023 Dec; 18(12):1102-08. doi: 10.1002/jhm.13224..
Keywords: Children/Adolescents, Inpatient Care
Dullabh P, Heaney-Huls KK, Chiao AB
Implementation and evaluation of an electronic health record-integrated app for postpartum monitoring of hypertensive disorders of pregnancy using patient-contributed data collection.
This paper describes a pilot intervention of a smartphone app for postpartum monitoring of hypertensive disorders of pregnancy (HDP) that integrates patient-contributed data into electronic health records (EHRs) to support monitoring and clinical decision-making. Results from the pilot evaluation highlighted the resources needed when implementing the app, challenges for integrating an app into the EHR, and the usability and utility of the HDP monitoring app for patient and clinician users. Key observations of the implementation team included the importance of a local clinical champion, more robust patient involvement and support for the remote patient monitoring program, an impetus for EHR developers to adopt data integration standards, and a need to expand the capabilities of the standards to support interventions using patient-contributed data.
AHRQ-funded; 233201500023I.
Citation: Dullabh P, Heaney-Huls KK, Chiao AB .
Implementation and evaluation of an electronic health record-integrated app for postpartum monitoring of hypertensive disorders of pregnancy using patient-contributed data collection.
JAMIA Open 2023 Dec; 6(4):ooad098. doi: 10.1093/jamiaopen/ooad098..
Keywords: Electronic Health Records (EHRs), Maternal Care, Blood Pressure, Telehealth, Health Information Technology (HIT), Women
Frehn JL, Li JN, Liu KR
Implementation of a universal screening and follow-up care system for pediatric developmental and behavioral health in federally qualified health center sites.
This study assessed the results of implementing an intervention to increase screening of developmental delays in children at six federally qualified health center (FQHC) sites in Northern California from April 2014 to April 2017. The goals of the intervention were to increase (a) standardized developmental screening at recommended intervals and (b) follow-up care and support for early intervention services. The aim was to optimize each site's screening processes, supported by an automated electronic tablet-based system. Social workers were hired to conduct follow-up clinical assessments, provide psychosocial education and treatment, provide referrals, provide case management support, and collaborate with service partners. During the last year of the intervention, when tablet-based screening was adopted, the sites screened an estimated 6,550 children ages 0-18 at 23 intervals in three domains (developmental, autism, and psychosocial/behavioral), compared to a baseline where they screened children ages 0-3 at four intervals in one domain. Screening rates increased from 65.3% to 75.5% after automation was extended from the first to the second site and continued its’ increase to 91.8% after automation was expanded to the remaining sites. Ranges for follow-up visits were between 74% and 88%.
AHRQ-funded; HS000046.
Citation: Frehn JL, Li JN, Liu KR .
Implementation of a universal screening and follow-up care system for pediatric developmental and behavioral health in federally qualified health center sites.
Fam Syst Health 2023 Dec; 41(4):454-66. doi: 10.1037/fsh0000803..
Keywords: Children/Adolescents, Disabilities, Screening, Implementation
Chisolm DJ, Dugan JA, Figueroa JF
Improving health equity through health care systems research.
This study’s objective was to describe health equity research priorities for health care delivery systems and delineate a research and action agenda that generates evidence-based solutions to persistent racial and ethnic inequities in health outcomes. This project was conducted as a component of the AHRQ stakeholder engaged process to develop an Equity Agenda and Action Plan to guide priority setting to advance health equity. The stakeholders included experts from academia, health care organizations, industry, and government. Five priority themes were derived iteratively through experts from academia, health care organizations, industry, and government. They identified six priority themes for research; (1) institutional leadership, culture, and workforce; (2) data-driven, culturally tailored care; (3) health equity targeted performance incentives; (4) health equity-informed approaches to health system consolidation and access; (5) whole person care; (6) and whole community investment. They also suggested cross-cutting themes regarding research workforce and research timelines.
AHRQ-funded.
Citation: Chisolm DJ, Dugan JA, Figueroa JF .
Improving health equity through health care systems research.
Health Serv Res 2023 Dec; 58(suppl 3):289-99. doi: 10.1111/1475-6773.14192..
Keywords: Health Systems, Disparities, Social Determinants of Health, Healthcare Delivery
Kaufman BG, Holland DE, Vanderboom CE
Multicomponent pharmacist intervention did not reduce clinically important medication errors for ambulatory patients initiating direct oral anticoagulants.
The aim of this randomized controlled trial study was to evaluate the effectiveness of a multicomponent intervention for decreasing clinically important medication errors (CIMEs). The researchers included ambulatory patients beginning a DOAC or resuming one after a complication. The intervention included pharmacist evaluation and monitoring based on the implementation of a recently published checklist. The primary measure was anticoagulant-related CIMEs and non-anticoagulant-related CIMEs over 90 days from DOAC initiation. Primary variables included evaluation of the appropriateness of DOAC, need for DOAC affordability assistance, three pharmacist-initiated telephone consultations, access to a DOAC hotline, documented hand-off to the patient's continuity provider, and monitoring of follow-up laboratory tests. A total of 561 patients contributed 479 anticoagulant-CIMEs including 31 preventable and ameliorable ADEs and 448 significant anticoagulant medication errors without subsequent documented ADEs. The most common anticoagulant-related CIMEs were failure to perform required blood tests and concurrent, inappropriate usage of a DOAC with aspirin or NSAIDs despite pharmacist documentation systematically identifying these issues when present. There was no reduction in anticoagulant-related CIMEs among intervention patients or non-anticoagulant-related CIMEs.
AHRQ-funded; HS02592401.
Citation: Kaufman BG, Holland DE, Vanderboom CE .
Multicomponent pharmacist intervention did not reduce clinically important medication errors for ambulatory patients initiating direct oral anticoagulants.
J Gen Intern Med 2023 Dec; 38(16):3526-34. doi: 10.1007/s11606-023-08315-z..
Keywords: Provider: Pharmacist, Medication, Adverse Drug Events (ADE), Adverse Events, Medical Errors, Blood Thinners, Medication: Safety, Patient Safety
Eaton TL, Lincoln TE, Lewis A
Palliative care in survivors of critical illness: a qualitative study of post-intensive care unit program clinicians.
This paper’s goal was to understand beliefs, attitudes, and experiences of post-intensive care unit (ICU) program clinicians regarding palliative care and to explore barriers and facilitators to incorporating palliative care into critical illness survivorship care. The authors conducted semistructured interviews with 29 international members (United States, United Kingdom, Canada) of the Critical and Acute Illness Recovery Organization post-ICU clinic collaborative. All clinicians described components of palliative care as essential to post-ICU clinic practice, including symptom management, patient/family support, facilitation of goal-concordant care, expectation management and anticipatory guidance, spiritual support, and discussion of future health care wishes and advance care planning. These clinician-level facilitators promoted palliative care strategies including first-hand experience, perceived value, and a positive attitude regarding palliative care. Clinician-level barriers discussed included insufficient palliative care knowledge, lack of self-efficacy, and a perceived need to protect ICU survivors from interventions the clinician felt may adversely affect recovery or change the care trajectory. System-level barriers mentioned were time constraints, cost, and lack of specialty palliative care services.
AHRQ-funded; HS027210.
Citation: Eaton TL, Lincoln TE, Lewis A .
Palliative care in survivors of critical illness: a qualitative study of post-intensive care unit program clinicians.
J Palliat Med 2023 Dec; 26(12):1644-53. doi: 10.1089/jpm.2023.0034..
Keywords: Palliative Care, Critical Care
Buchanan CL, Morris MA, Matlock D
Parental experience and understanding of parent-provider discussions of treatment for infants with ureteropelvic junction obstruction.
The objective of this study was to understand what families perceive as necessary information to guide decisionmaking in the treatment of children with ureteropelvic junction obstruction (UPJO). The authors conducted semi-structured interviews with parents of children with UPJO. Their findings were organized into three major themes: barriers to meaningful participation in decisionmaking, logistical aspects, and psychosocial aspects. They concluded that these results highlighted the importance of caregivers needing clear and accurate information to engage in meaningful discussions related to surgical decisionmaking regarding UPJO treatment. They recommended patient education and enhanced psychosocial support for more meaningful parental engagement in the surgical decisionmaking process.
AHRQ-funded; HS024597.
Citation: Buchanan CL, Morris MA, Matlock D .
Parental experience and understanding of parent-provider discussions of treatment for infants with ureteropelvic junction obstruction.
PEC Innov 2023 Dec; 2:100142. doi: 10.1016/j.pecinn.2023.100142..
Keywords: Newborns/Infants, Patient Experience, Decision Making, Patient and Family Engagement, Clinician-Patient Communication
Hoffmann JA, Carter CP, Olsen CS
Pediatric firearm injury emergency department visits from 2017 to 2022: a multicenter study.
This retrospective study aimed to assess how pediatric firearm injury emergency department (ED) visits during the pandemic differed from expected prepandemic trends. The authors looked at firearm injury ED visits by children <18 years old at 9 US hospitals participating in the Pediatric Emergency Care Applied Research Network Registry before (January 2017 to February 2020) and during (March 2020 to November 2022) the pandemic. They calculated rate ratios (RRs) of observed to expected visits per 30 days, overall, and by sociodemographic characteristics. They identified 1904 firearm injury ED visits (52.3% 15-17 years old, 80.0% male, 63.5% non-Hispanic Black), with 694 prepandemic visits and 1210 visits during the pandemic. Death in the ED/hospital increased from 3.1% prepandemic to 6.1% during the pandemic. Firearm injury visits per 30 days increased from 18.0 prepandemic to 36.1 during the pandemic (RR 2.09). Increases beyond expected rates were seen for 10- to 14-year-olds (RR 2.61), females (RR 2.46), males (RR 2.00), Hispanic children (RR 2.30), and Black non-Hispanic children (RR 1.88).
AHRQ-funded; R01HS020270.
Citation: Hoffmann JA, Carter CP, Olsen CS .
Pediatric firearm injury emergency department visits from 2017 to 2022: a multicenter study.
Pediatrics 2023 Dec; 152(6). doi: 10.1542/peds.2023-063129..
Keywords: Children/Adolescents, Emergency Department, Healthcare Utilization, Injuries and Wounds
Grove LR, Berkowitz SA, Cuddeback G
Permanent supportive housing receipt and health care use among adults with disabilities.
This study’s objective was to assess whether permanent supportive housing (PSH) participation is associated with health service use among a population of adults with disabilities, including people transitioning into PSH from community and institutional settings. Primary data sources used were 2014 to 2018 secondary data from a PSH program in North Carolina linked to Medicaid claims. The authors used propensity score weighting to estimate the average treatment effect on the treated of PSH participation. Using weighted analysis, they found that among individuals who were institutionalized prior to PSH, PSH participation was associated with greater hospitalizations and emergency department (ED) visits and fewer primary care visits during the follow-up period, compared with similar individuals who largely remained institutionalized. There was no significantly different health service use from similar comparison group members for individuals who entered PSH from community settings during the 12-month follow-up period.
AHRQ-funded; HS000032.
Citation: Grove LR, Berkowitz SA, Cuddeback G .
Permanent supportive housing receipt and health care use among adults with disabilities.
Med Care Res Rev 2023 Dec; 80(6):596-607. doi: 10.1177/10775587231183192..
Keywords: Disabilities, Vulnerable Populations, Access to Care
Tracer H, Lorei NC
AHRQ Author: Tracer H
Preexposure prophylaxis to prevent acquisition of HIV.
This case study described a 28-year-old woman presented to a community health clinic for sexually transmitted infection (STI) testing. Case study questions related to the USPSTF recommendation on Preexposure Prophylaxis (PrEP) to prevent acquisition of HIV, guidelines for candidacy for PrEP, guidelines for the use of PrEP for the primary prevention of HIV in adults.
AHRQ-authored.
Citation: Tracer H, Lorei NC .
Preexposure prophylaxis to prevent acquisition of HIV.
Am Fam Physician 2023 Dec; 108(6):617-18..
Keywords: U.S. Preventive Services Task Force (USPSTF), Human Immunodeficiency Virus (HIV), Prevention, Evidence-Based Practice
Tallman JE, Wallis CJD, Zhao Z
Prostate volume, baseline urinary function, and their association with treatment choice and post-treatment urinary function in men treated for localized prostate cancer.
The purpose of this study was to assess the relationship between prostate volume (PV) and baseline urinary function with treatment choice and post-treatment urinary function among men with localized prostate cancer. The researchers identified 1,647 patients from CEASAR, a multicenter population-based, prospective cohort study of men with localized prostate cancer. The primary study outcomes were treatment choice and health-related quality of life (HRQOL) assessed at pre-specified intervals up to 5 years. The study found that median baseline PV was 36 mL (IQR 27-48), and baseline urinary irritative/obstructive domain score was 87 (IQR 75-100). The study did not find any observed clinically meaningful relationship between PV and treatment choice or post-treatment urinary function. In participants with poor baseline urinary function, treatment with radiation or surgery was related with statistically and clinically significant improvement in urinary function at 6 months which endured through 5 years.
AHRQ-funded; HS019356; HS022640.
Citation: Tallman JE, Wallis CJD, Zhao Z .
Prostate volume, baseline urinary function, and their association with treatment choice and post-treatment urinary function in men treated for localized prostate cancer.
Prostate Cancer Prostatic Dis 2023 Dec; 26(4):787-94. doi: 10.1038/s41391-022-00627-1..
Keywords: Cancer: Prostate Cancer, Cancer, Men's Health
Taylor LN, Wilson BM, Singh M
Syndromic antibiograms and nursing home clinicians' antibiotic choices for urinary tract infections.
The goal of this survey study was to determine if providing nursing home (NH) clinicians with syndromic antibiograms improves antibiotic treatment urinary tract infections (UTIs). The researchers concluded providing the NH clinicians with urinary antibiograms is associated with selection of active and optimal antibiotics when empirically treating UTIs under simulated conditions.
AHRQ-funded; HS027820.
Citation: Taylor LN, Wilson BM, Singh M .
Syndromic antibiograms and nursing home clinicians' antibiotic choices for urinary tract infections.
JAMA Netw Open 2023 Dec; 6(12):e2349544. doi: 10.1001/jamanetworkopen.2023.49544..
Keywords: Nursing Homes, Antibiotics, Medication, Urinary Tract Infection (UTI)
Watnick S, Blake PG, Mehrotra R
System-level strategies to improve home dialysis: policy levers and quality initiatives.
This article discusses trends in home dialysis use, reviews the evolving understanding of what constitutes high quality care for the home dialysis population (as well as how this can be measured), and discusses policy and advocacy efforts that continue to shape the care of US patients, and compares with experiences in other countries. The authors conclude by discussing future directions for quality and advocacy efforts.
AHRQ-funded; HS028684.
Citation: Watnick S, Blake PG, Mehrotra R .
System-level strategies to improve home dialysis: policy levers and quality initiatives.
Clin J Am Soc Nephrol 2023 Dec; 18(12):1616-25. doi: 10.2215/cjn.0000000000000299..
Keywords: Home Healthcare, Kidney Disease and Health, Policy, Quality Improvement, Quality of Care
Fabius CD, Okoye SM, Wu MMJ
The role of place in person- and family-oriented long-term services and supports.
The authors developed a conceptual framework to identify environmental domains contributing to the use, care quality, and care experiences of long-term services and supports (LTSS). They found that LTSS-relevant environmental characteristics are differentially relevant to the care experiences of older adults with disabilities. Measures of neighborhood social and economic deprivation were highly associated with adverse consequences due to unmet care needs. Measures of health care and social services delivery environment were inversely associated with participation restrictions in valued activities. The authors concluded that greater attention should be given to strengthening state- and community-based policies and practices that support aging in place.
AHRQ-funded; HS000029.
Citation: Fabius CD, Okoye SM, Wu MMJ .
The role of place in person- and family-oriented long-term services and supports.
Milbank Q 2023 Dec; 101(4):1076-138. doi: 10.1111/1468-0009.12664..
Keywords: Long-Term Care, Elderly, Disabilities
Hasegawa S, Livorsi DJ, Perencevich EN S, Livorsi DJ, Perencevich EN
Diagnostic accuracy of hospital antibiograms in predicting the risk of antimicrobial resistance in enterobacteriaceae isolates: a nationwide multicenter evaluation at the Veterans Health Administration.
This study examined the effectiveness of an antibiogram to predict antimicrobial resistance (AMR) at the patient-level for Escherichia coli and Klebsiella spp. The authors retrospectively generated hospital antibiograms for the nationwide Veterans Health Administration (VHA) facilities from 2000 to 2019 using all clinical culture specimens positive for E. coli and Klebsiella spp., then assessed the diagnostic accuracy of an antibiogram to predict resistance for isolates in the following calendar year using logistic regression models and predefined 5-step interpretation thresholds. At 127 VHA facilities, the discrimination abilities of hospital-level antibiograms in predicting individual patient AMR were mostly poor, with the areas under the receiver operating curve at 0.686 and 0.715 for ceftriaxone, 0.637 and 0.675 for fluoroquinolones, and 0.576 and 0.624 for trimethoprim-sulfamethoxazole, respectively.
AHRQ-funded; HS027472.
Citation: Hasegawa S, Livorsi DJ, Perencevich EN S, Livorsi DJ, Perencevich EN .
Diagnostic accuracy of hospital antibiograms in predicting the risk of antimicrobial resistance in enterobacteriaceae isolates: a nationwide multicenter evaluation at the Veterans Health Administration.
Clin Infect Dis 2023 Nov 30; 77(11):1492-500. doi: 10.1093/cid/ciad467..
Keywords: Diagnostic Safety and Quality, Hospitals