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
1 to 25 of 86 Research Studies DisplayedBateni SB, Gingrich AA, Stewart SL
Hospital utilization and disposition among patients with malignant bowel obstruction: a population-based comparison of surgical to medical management.
In this study, the investigators sought to compare clinically meaningful outcomes in malignant bowel obstruction (MBO) patients treated with surgical versus medical management using population-based data. In this population-based analysis, medical management was associated with less hospital utilization at 30- and 90-days, fewer in-hospital deaths, and more frequent discharges to home. The authors suggest that these data underscore the potential benefits of medical management for MBO patients at the end-of-life.
AHRQ-funded; HS022236.
Citation: Bateni SB, Gingrich AA, Stewart SL .
Hospital utilization and disposition among patients with malignant bowel obstruction: a population-based comparison of surgical to medical management.
BMC Cancer 2018 Nov 26;18(1):1166. doi: 10.1186/s12885-018-5108-9..
Keywords: Cancer, Comparative Effectiveness, Hospitalization, Palliative Care, Patient-Centered Outcomes Research, Surgery
Lowenstern A, Al-Khatib SM, Sharan L
Interventions for preventing thromboembolic events in patients with atrial fibrillation: a systematic review.
The purpose of this review was to compare the effectiveness of therapies to prevent thromboembolic events and bleeding complications in adults with nonvalvular atrial fibrillation (AF). Two independent reviewers screened citations in order to identify comparative studies of treatments to prevent stroke in adults with nonvalvular AF who reported thromboembolic or bleeding complications, then abstracted data from 220 selected articles, assessed study quality and applicability, and rated the strength of evidence. The article concludes that available direct-acting oral anticoagulants (DOACs) are at least as effective and safe as warfarin for patients with nonvalvular AF and had similar benefits across several patient subgroups.
AHRQ-funded; 290201500004I.
Citation: Lowenstern A, Al-Khatib SM, Sharan L .
Interventions for preventing thromboembolic events in patients with atrial fibrillation: a systematic review.
Ann Intern Med 2018 Dec 4;169(11):774-87. doi: 10.7326/m18-1523..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Blood Thinners, Adverse Drug Events (ADE), Adverse Events, Medication, Comparative Effectiveness, Patient-Centered Outcomes Research, Evidence-Based Practice
Wilkinson ST, Kiselycznyk C, Banasr M
Serum and plasma brain-derived neurotrophic factor and response in a randomized controlled trial of riluzole for treatment resistant depression.
In this paper, the authors report serum brain-derived neurotrophic factor (BDNF) and plasma BDNF levels from a randomized controlled, adjunctive, sequential parallel comparison design trial of riluzole in major depressive disorder. The investigators noted that preliminary evidence suggested that lower baseline BDNF may be associated with better clinical response to riluzole.
AHRQ-funded; HS023000.
Citation: Wilkinson ST, Kiselycznyk C, Banasr M .
Serum and plasma brain-derived neurotrophic factor and response in a randomized controlled trial of riluzole for treatment resistant depression.
J Affect Disord 2018 Dec 1;241:514-18. doi: 10.1016/j.jad.2018.08.075..
Keywords: Comparative Effectiveness, Depression, Medication, Patient-Centered Outcomes Research
Ma X, Lin L, Qu Z
Performance of between-study heterogeneity measures in the Cochrane Library.
The growth in comparative effectiveness research and evidence-based medicine has increased attention to systematic reviews and meta-analyses. Assessing heterogeneity is critical for performing a meta-analysis and interpreting results. This article evaluates two heterogeneity measures. To evaluate these measures' performance empirically, the investigators applied them to 20,599 meta-analyses in the Cochrane Library.
AHRQ-funded; HS024743.
Citation: Ma X, Lin L, Qu Z .
Performance of between-study heterogeneity measures in the Cochrane Library.
Epidemiology 2018 Nov;29(6):821-24. doi: 10.1097/ede.0000000000000857..
Keywords: Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research, Research Methodologies
Drucker AM, Adam GP, Rofeberg V
Treatments of primary basal cell carcinoma of the skin: a systematic review and network meta-analysis.
The purpose of the study was to evaluate the comparative effectiveness and safety of treatments of primary basal cell carcinoma (BCC) in adults. The investigators concluded that surgical treatments and external-beam radiation have low recurrence rates for the treatment of low-risk BCC, but substantial uncertainty exists about their comparative effectiveness versus other treatments. Gaps remain regarding high-risk BCC subtypes and important outcomes, including costs.
AHRQ-funded; 290201500002I.
Citation: Drucker AM, Adam GP, Rofeberg V .
Treatments of primary basal cell carcinoma of the skin: a systematic review and network meta-analysis.
Ann Intern Med 2018 Oct 2;169(7):456-66. doi: 10.7326/m18-0678.
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Keywords: Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research, Cancer: Skin Cancer, Treatments
Pulia MS, Schwei RJ, Patterson BW
Effectiveness of outpatient antibiotics after surgical drainage of abscesses in reducing treatment failure.
The objective of this retrospective observational study was to evaluate the real-world effectiveness of outpatient antibiotic prescribing after surgical drainage of cutaneous abscesses on reducing treatment failure. The investigators found that this real-world, comparative effectiveness analysis did not demonstrate any significant reduction in treatment failure with the use of antibiotics after drainage of abscesses in the emergency department.
AHRQ-funded; HS024558; HS024342.
Citation: Pulia MS, Schwei RJ, Patterson BW .
Effectiveness of outpatient antibiotics after surgical drainage of abscesses in reducing treatment failure.
J Emerg Med 2018 Oct;55(4):512-21. doi: 10.1016/j.jemermed.2018.06.036..
Keywords: Antibiotics, Comparative Effectiveness, Patient-Centered Outcomes Research, Surgery
Mentias A, Shantha G, Chaudhury P
Assessment of outcomes of treatment with oral anticoagulants in patients with atrial fibrillation and multiple chronic conditions: a comparative effectiveness analysis.
The purpose of this retrospective comparative effectiveness analysis was to determine whether there are differences in efficacy and safety of dabigatran, rivaroxaban, and warfarin regarding stroke prevention and bleeding rates, respectively, in elderly patients with atrial fibrillation (AF) with multiple chronic conditions (MCC). The investigators concluded that oral anticoagulants were similarly effective in stroke prevention among patients with AF with MCC. However, the indicate that dabigatran and rivaroxaban use may be associated with lower rates of mortality in patients with MCC.
AHRQ-funded; HS023104.
Citation: Mentias A, Shantha G, Chaudhury P .
Assessment of outcomes of treatment with oral anticoagulants in patients with atrial fibrillation and multiple chronic conditions: a comparative effectiveness analysis.
JAMA Netw Open 2018 Sep 7;1(5):e182870. doi: 10.1001/jamanetworkopen.2018.2870..
Keywords: Blood Thinners, Heart Disease and Health, Cardiovascular Conditions, Outcomes, Patient-Centered Outcomes Research, Medication, Evidence-Based Practice, Comparative Effectiveness, Chronic Conditions
Lee DJ, Barocas DA, Zhao Z
Contemporary prostate cancer radiation therapy in the United States: patterns of care and compliance with quality measures.
This study measured compliance with quality measures for radiation therapy treatment of prostate cancer. The Comparative Effectiveness Analysis of Surgery and Radiation Study enrolled men who were treated for localized prostate cancer from 2011 and 2012. Medical records were reviewed, and patients completed surveys. Researchers concluded that men who received external beam radiation therapy (EBRT) were treated more appropriately than those treated with brachytherapy (BT). White men were also more likely to receive appropriate treatment than African-American and other minorities.
AHRQ-funded; HS019356; HS022640.
Citation: Lee DJ, Barocas DA, Zhao Z .
Contemporary prostate cancer radiation therapy in the United States: patterns of care and compliance with quality measures.
Pract Radiat Oncol 2018 Sep-Oct;8(5):307-16. doi: 10.1016/j.prro.2018.04.009..
Keywords: Cancer, Cancer: Prostate Cancer, Comparative Effectiveness, Evidence-Based Practice, Guidelines, Patient-Centered Outcomes Research, Practice Patterns, Quality Measures
Bailey SR, Stevens VJ, Fortmann SP
Long-term outcomes from repeated smoking cessation assistance in routine primary care.
This study assessed the importance of primary care support for smokers trying to quit. This retrospective, observational cohort study followed over 33,000 patients at six diverse health systems over 4 years. Long-term quit (LTQ) status (longer than 365 days) was measured, and it was determined that frequent visits (more than 75% of visits) had almost 3 times the success than patients who visited less than 25%.
AHRQ-funded; HS019828.
Citation: Bailey SR, Stevens VJ, Fortmann SP .
Long-term outcomes from repeated smoking cessation assistance in routine primary care.
Am J Health Promot 2018 Sep;32(7):1582-90. doi: 10.1177/0890117118761886..
Keywords: Comparative Effectiveness, Lifestyle Changes, Outcomes, Patient-Centered Outcomes Research, Primary Care, Tobacco Use
Boffa DJ, Kosinski AS, Furnary AP
Minimally invasive lung cancer surgery performed by thoracic surgeons as effective as thoracotomy.
The study authors hypothesized that the minimally invasive video-assisted thoracic surgery (VATS) approach to lobectomy for stage I lung cancer resulted in a longitudinal outcome that was not inferior to thoracotomy. After conducting their study, they concluded that the long-term efficacy of lobectomy for stage I lung cancer performed using the VATS approach by board-certified thoracic surgeons does not seem to be inferior to that of thoracotomy.
AHRQ-funded; HS022279.
Citation: Boffa DJ, Kosinski AS, Furnary AP .
Minimally invasive lung cancer surgery performed by thoracic surgeons as effective as thoracotomy.
J Clin Oncol 2018 Aug 10;36(23):2378-85. doi: 10.1200/jco.2018.77.8977..
Keywords: Cancer: Lung Cancer, Comparative Effectiveness, Patient-Centered Outcomes Research, Surgery
Ciolino JD, Jackson KL, Liss DT
Design of Healthy Hearts in the Heartland (H3): a practice-randomized, comparative effectiveness study.
The Healthy Hearts in the Heartland (H3) study is part of a nationwide effort, EvidenceNOW, seeking to better understand the ability of small primary care practices to improve "ABCS" clinical quality measures: appropriate Aspirin therapy, Blood pressure control, Cholesterol management, and Smoking cessation. In this paper, the authors describe the design and randomization of the H3 study.
AHRQ-funded; HS023921.
Citation: Ciolino JD, Jackson KL, Liss DT .
Design of Healthy Hearts in the Heartland (H3): a practice-randomized, comparative effectiveness study.
Contemp Clin Trials 2018 Aug;71:47-54. doi: 10.1016/j.cct.2018.06.004..
Keywords: Cardiovascular Conditions, Comparative Effectiveness, Evidence-Based Practice, Heart Disease and Health, Prevention, Primary Care, Quality of Care, Quality Improvement, Outcomes, Patient-Centered Outcomes Research
Simon KC, Tideman S, Hillman L
Design and implementation of pragmatic clinical trials using the electronic medical record and an adaptive design.
The purpose of this study was to demonstrate the feasibility of pragmatic clinical trials comparing the effectiveness of treatments using the electronic medical record (EMR) and an adaptive assignment design. The authors suggest that the demonstration of successful pragmatic clinical trials based on a customized EMR and adaptive design is an important next step in achieving personalized medicine and provides a framework for future studies of comparative effectiveness.
AHRQ-funded; HS024057.
Citation: Simon KC, Tideman S, Hillman L .
Design and implementation of pragmatic clinical trials using the electronic medical record and an adaptive design.
JAMIA Open 2018 Jul;1(1):99-106. doi: 10.1093/jamiaopen/ooy017..
Keywords: Comparative Effectiveness, Electronic Health Records (EHRs), Health Information Technology (HIT), Research Methodologies, System Design
Tyson MD, Koyama T, Lee D
Effect of prostate cancer severity on functional outcomes after localized treatment: comparative effectiveness analysis of surgery and radiation study results.
The purpose of this study was to determine whether differences in predicted function over time between radical prostatectomy (RP) or external beam radiotherapy (EBRT) for localized cancer varied by risk group. Patient-reported, disease-specific function was measured using the Expanded Prostate Index Composite and predicted function was estimated using regression models, compared by disease risk. The study found that sexual function was similar between surgery and radiation for patients with high-risk disease, and the authors conclude that high-risk patients undergoing radiation therapy should be counseled that their sexual function may not be as good as low-risk patients also undergoing radiation.
AHRQ-funded; HS019356; HS022640.
Citation: Tyson MD, Koyama T, Lee D .
Effect of prostate cancer severity on functional outcomes after localized treatment: comparative effectiveness analysis of surgery and radiation study results.
Eur Urol 2018 Jul;74(1):26-33. doi: 10.1016/j.eururo.2018.02.012..
Keywords: Cancer: Prostate Cancer, Cancer, Comparative Effectiveness, Treatments, Surgery, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Wu P, Escobar GJ, Gebretsadik T
Effectiveness of respiratory syncytial virus immunoprophylaxis in reducing bronchiolitis hospitalizations among high-risk infants.
This retrospective cohort study examined the effectiveness of respiratory syncytial virus (RSV) prophylaxis for infants born between 1996 and 2008. The infants were enrolled in the Kaiser Permanente Northern California integrated health system. Infants who ever received RSV immunoprophylaxis had a 32% decreased risk of bronchiolitis hospitalization and finants with chronic lung disease (CLD) had a 52% decreased risk. The 2014 American Academy of Pediatrics (AAP) guidelines changed recommendations for RSV immunoprophylaxis which made 48% of infants no longer eligible but nearly all infants with CLD would remain eligible.
AHRQ-funded; HS018454.
Citation: Wu P, Escobar GJ, Gebretsadik T .
Effectiveness of respiratory syncytial virus immunoprophylaxis in reducing bronchiolitis hospitalizations among high-risk infants.
Am J Epidemiol 2018 Jul;187(7):1490-500. doi: 10.1093/aje/kwy008..
Keywords: Comparative Effectiveness, Evidence-Based Practice, Hospitalization, Newborns/Infants, Outcomes, Patient-Centered Outcomes Research, Prevention, Respiratory Conditions, Risk
Tian L, Fu H, Ruberg SJ
Efficiency of two sample tests via the restricted mean survival time for analyzing event time observations.
This article assesses the relative efficiency of the hazard ratio (HR) and restricted means survival time or t-year mean survival time (t-MST) tests with respect to the statistical power under various proportional hazards (PH) and non-PH models, both theoretically and empirically. The results indicate that when the PH assumption is valid, the t-MST test performs almost as well as the HR test, but for non-PH models, the t-MST test can substantially outperform its HR counterpart. The authors discuss issues and implications regarding their sample tests.
AHRQ-funded; HS022193.
Citation: Tian L, Fu H, Ruberg SJ .
Efficiency of two sample tests via the restricted mean survival time for analyzing event time observations.
Biometrics 2018 Jun;74(2):694-702. doi: 10.1111/biom.12770..
Keywords: Comparative Effectiveness, Research Methodologies
Sharma A, Al-Khatib SM, Ezekowitz JA
Implantable cardioverter-defibrillators in heart failure patients with reduced ejection fraction and diabetes.
This study evaluates the effectiveness of a strategy that uses an implantable cardioverter-defibrillator (ICD) plus medical therapy versus medical therapy alone among patients with heart failure (HF) and diabetes. Researchers conducted a patient-level combined-analysis using a combined dataset that included four primary prevention ICD trials of patients with HF or severely reduced ejection fractions. The results indicate that primary prevention ICD in combination with medical therapy versus medical therapy alone was not significantly associated with a reduced risk of all-cause death. The authors conclude that further studies are needed to evaluate the effectiveness of ICDs among patients with diabetes.
AHRQ-funded; HS018505.
Citation: Sharma A, Al-Khatib SM, Ezekowitz JA .
Implantable cardioverter-defibrillators in heart failure patients with reduced ejection fraction and diabetes.
Eur J Heart Fail 2018 Jun;20(6):1031-38. doi: 10.1002/ejhf.1192..
Keywords: Cardiovascular Conditions, Comparative Effectiveness, Diabetes, Heart Disease and Health, Medical Devices, Prevention
Goode AP, Coeytaux RR, Maslow GR
Nonpharmacologic treatments for attention-deficit/hyperactivity disorder: a systematic review.
The authors assessed the comparative effectiveness of non-pharmacologic treatments for attention-deficit/hyperactivity disorder (ADHD) among individuals 17 years of age and younger. Non-pharmacologic treatments they identified included neurofeedback, cognitive training, cognitive behavioral therapy, child or parent training, dietary omega fatty acid supplementation, and herbal and/or dietary approaches. They identified no new guidance regarding the comparative effectiveness of non-pharmacologic treatments, concluding that, despite wide use, there are significant gaps in knowledge regarding the effectiveness of ADHD non-pharmacologic treatments.
AHRQ-funded; 290201500004I.
Citation: Goode AP, Coeytaux RR, Maslow GR .
Nonpharmacologic treatments for attention-deficit/hyperactivity disorder: a systematic review.
Pediatrics 2018 Jun;141(6). doi: 10.1542/peds.2018-0094.
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Keywords: Children/Adolescents, Behavioral Health, Comparative Effectiveness, Treatments, Evidence-Based Practice
Hoffman SR, Vines AI, Halladay JR
Optimizing research in symptomatic uterine fibroids with development of a computable phenotype for use with electronic health records.
The objective of the study was to develop an electronic health record-based algorithm to identify women with symptomatic uterine fibroids for a comparative effectiveness study of medical or surgical treatments on quality-of-life measures. The study concluded that an electronic health record-based algorithm is capable of identifying cases of symptomatic uterine fibroids with moderate positive predictive value and may be an efficient approach for large-scale study recruitment.
AHRQ-funded; HS023418.
Citation: Hoffman SR, Vines AI, Halladay JR .
Optimizing research in symptomatic uterine fibroids with development of a computable phenotype for use with electronic health records.
Am J Obstet Gynecol 2018 Jun;218(6):610.e1-10.e7. doi: 10.1016/j.ajog.2018.02.002..
Keywords: Comparative Effectiveness, Electronic Health Records (EHRs), Research Methodologies, Women
Horiguchi M, Tian L, Uno H
Quantification of long-term survival benefit in a comparative oncology clinical study.
The authors discuss the quantification of long-term survival benefit in a comparative oncology clinical study. They assert that from the perspective of cost-risk-benefit, using a long-term survival benefit criterion for selecting anticancer therapies may be more appropriate.
AHRQ-funded; HS022193.
Citation: Horiguchi M, Tian L, Uno H .
Quantification of long-term survival benefit in a comparative oncology clinical study.
JAMA Oncol 2018 Jun;4(6):881-82. doi: 10.1001/jamaoncol.2018.0518..
Keywords: Cancer, Comparative Effectiveness, Outcomes, Research Methodologies
Skrivankova V, Heagerty PJ
Single index methods for evaluation of marker-guided treatment rules based on multivariate marker panels.
Answering the scientific challenge to identify and validate the factors that can reliably be used to target treatment and to quantify the expected treatment benefit as a function of candidate markers, the authors of this article propose to focus on a smooth, non-parametric evaluation of a canonical single-index score that estimates the expected treatment benefit associated with patient characteristics. Their methods decouple the model used to generate the treatment benefit score from the methods adopted in order to evaluate the performance of the resulting single-index score. They also demonstrate that the canonical single-index treatment benefit score can be used for selecting subsets of patients with enriched expected treatment response.
AHRQ-funded; HS019222.
Citation: Skrivankova V, Heagerty PJ .
Single index methods for evaluation of marker-guided treatment rules based on multivariate marker panels.
Biometrics 2018 Jun;74(2):663-72. doi: 10.1111/biom.12752..
Keywords: Comparative Effectiveness, Shared Decision Making, Outcomes, Treatments
Rizvi RF, Adam TJ, Lindemann EA
Comparing existing resources to represent dietary supplements.
Dietary supplements (DS) are widely consumed despite limited knowledge around their safety/efficacy and any well-established regulatory policies. In this pilot study, five DS resources were evaluated and compared both quantitatively and qualitatively. The authors found fragmented and inconsistent distribution of DS representation in terms of essential data elements across five resources.
AHRQ-funded; HS022085.
Citation: Rizvi RF, Adam TJ, Lindemann EA .
Comparing existing resources to represent dietary supplements.
AMIA Jt Summits Transl Sci Proc 2018 May 18;2017:207-16..
Keywords: Comparative Effectiveness, Nutrition, Patient Safety
Stewart EA, Lytle BL, Thomas L
The comparing options for management: patient-centered results for uterine fibroids (COMPARE-UF) registry: Rationale and design.
The purpose of the study was to design and establish a uterine fibroid (UF) registry based in the United States to provide comparative effectiveness data regarding UF treatment. This registry, called Comparing Options for Management: Patient-centered Results for Uterine Fibroids (COMPARE-UF), will generate evidence on the comparative effectiveness of different procedural options for UF, in order to help patients and their caregivers make informed decisions that best meet an individual patient's short- and long-term preferences.
AHRQ-funded; HS023418.
Citation: Stewart EA, Lytle BL, Thomas L .
The comparing options for management: patient-centered results for uterine fibroids (COMPARE-UF) registry: Rationale and design.
Am J Obstet Gynecol 2018 May 8. doi: 10.1016/j.ajog.2018.05.004..
Keywords: Comparative Effectiveness, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Registries, Women
Semenkovich TR, Panni RZ, Hudson JL
Comparative effectiveness of upfront esophagectomy versus induction chemoradiation in clinical stage T2N0 esophageal cancer: a decision analysis.
This study examined comparative effectiveness and survival rates for upfront esophagectomy versus induction chemoradiation in patients with clinical stage T2N20 esophageal cancer. A decision analysis model was created for the two treatment strategies. Results showed comparable median survival rates for both strategies. The optimal treatment strategy depended on the accuracy of endoscopic ultrasound staging.
AHRQ-funded; HS022330.
Citation: Semenkovich TR, Panni RZ, Hudson JL .
Comparative effectiveness of upfront esophagectomy versus induction chemoradiation in clinical stage T2N0 esophageal cancer: a decision analysis.
J Thorac Cardiovasc Surg 2018 May;155(5):2221-30.e1. doi: 10.1016/j.jtcvs.2018.01.006..
Keywords: Treatments, Cancer, Surgery, Comparative Effectiveness, Shared Decision Making, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes, Medication
Dabbous F, Dolecek TA, Friedewald SM
Performance characteristics of digital vs film screen mammography in community practice.
In this study, the investigators examined performance characteristics of digital vs film screen mammography in community practice by comparing the performance characteristics of 297 629 full field digital (FFDM) and 416 791 screen film mammograms (SFM). In their study, modest gains in performance were achieved with the introduction of FFDM as a replacement for SFM, in a large health care organization.
AHRQ-funded; HS018366.
Citation: Dabbous F, Dolecek TA, Friedewald SM .
Performance characteristics of digital vs film screen mammography in community practice.
Breast J 2018 May;24(3):369-72. doi: 10.1111/tbj.12942..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Imaging, Women, Prevention, Comparative Effectiveness, Diagnostic Safety and Quality
Wald-Dickler N, Holtom P, Spellberg B
Busting the myth of "static vs cidal": a systemic literature review.
This study compared the effectiveness of bactericidal antibiotics versus bacteriostatic agents. A systematic literature review was conducted of published, randomized, controlled trials that were comparison studies. Of the 56 identified trials published since 1985, 49 found no significant difference in effectiveness between the two types of antibiotics. Only 1 trial found the bactericidal agent was superior.
AHRQ-funded; HS025690.
Citation: Wald-Dickler N, Holtom P, Spellberg B .
Busting the myth of "static vs cidal": a systemic literature review.
Clin Infect Dis 2018 Apr 17;66(9):1470-74. doi: 10.1093/cid/cix1127..
Keywords: Antibiotics, Medication, Comparative Effectiveness, Evidence-Based Practice