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- Adverse Drug Events (ADE) (1)
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- Digestive Disease and Health (1)
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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 15 of 15 Research Studies DisplayedByrnes ME, Varlamos CJ, Rivard SJ
"You're used to being the one that can fix things…": a qualitative snapshot of colorectal surgeons during COVID-19.
This viewpoint article reflects the narratives of 58 colorectal surgeons who engaged in an in-depth qualitative interview during the COVID-19 shutdown of elective surgeries. The goal for reporting these findings is to offer a snapshot of surgeon perspectives on the delays of elective surgeries and to give voice to surgeons who were unable to perform most or all their duties as a surgeon.
AHRQ-funded; HS025365; HS000053.
Citation: Byrnes ME, Varlamos CJ, Rivard SJ .
"You're used to being the one that can fix things…": a qualitative snapshot of colorectal surgeons during COVID-19.
Dis Colon Rectum 2020 Dec;63(12):1575-78. doi: 10.1097/dcr.0000000000001818..
Keywords: Surgery, Provider: Physician, Provider, COVID-19, Public Health, Infectious Diseases
Dossett LA, Waljee JF, Dimick JB
Ensuring equal access to mentorship and sponsorship for surgeons through structured team-based mentoring.
This perspective paper describes how Michigan Medicine has developed early- and mid-career mentoring programs for surgeons in the hopes of reducing inequities in access to mentorship and foster a culture of mentorship for women and underrepresented minorities. The university hospital developed a mentoring program with Launch Teams for early career surgeons and Boost Teams for mid-career surgeons. The Launch Teams consist of 5-7 members meeting as a group 4 to 6 times yearly for 3 years. Members are selected jointly by the mentee and a member of the departmental leadership and include a clinical mentor, research mentors (if applicable), one or more external mentors and other members with specific research, administrative, educational, or leadership positions. Mid-career surgeons can elect to join a Boost Team after promotion or making a mid-career institutional transition. The team consists of a larger number of members outside the department or institution than Launch Teams. This team also meets every other month and the goal is to establish a leadership phenotype and long-term goals.
AHRQ-funded; HS026030.
Citation: Dossett LA, Waljee JF, Dimick JB .
Ensuring equal access to mentorship and sponsorship for surgeons through structured team-based mentoring.
Ann Surg 2020 Dec;272(6):939-40. doi: 10.1097/sla.0000000000004500..
Keywords: Provider: Physician, Provider, Surgery
Ehlers AP, Vitous CA, Sales A
Exploration of factors associated with surgeon deviation from practice guidelines for management of inguinal hernias.
Investigators explored factors associated with surgeon choice of approach (minimally invasive vs open) in inguinal hernia repair as a tool to gain an understanding of guideline-discordant care. They found that decision-making for the approach to inguinal hernia repair was largely influenced by surgeon preference and access to resources rather than patient factors. Although a one-size-fits-all approach is not recommended, the operative approach should ideally be informed by patient factors, including hernia characteristics. They recommended addressing surgeon preference and available resources with a clinician-facing decision aid to provide an opportunity to optimize care for patients undergoing inguinal hernia repair.
AHRQ-funded; HS025778.
Citation: Ehlers AP, Vitous CA, Sales A .
Exploration of factors associated with surgeon deviation from practice guidelines for management of inguinal hernias.
JAMA Netw Open 2020 Nov 2;3(11):e2023684. doi: 10.1001/jamanetworkopen.2020.23684..
Keywords: Surgery, Guidelines, Provider: Physician, Provider, Shared Decision Making, Evidence-Based Practice
Shubeck SP, Newman EA, Vitous CA
Hiring practices of US academic surgery departments-challenges and opportunities for more inclusive hiring.
To increase workforce diversity among academic medical centers, the Association of American Medical Colleges recommends multiple inclusive strategies for evaluating and hiring candidates. The objective of this study was to determine (1) usual and inclusive hiring practices used among academic surgery departments and (2) the barriers to utilization of inclusive hiring practices. The investigators concluded that many chairs rely heavily on internal hires or trusted networks, which may limit both demographic and cognitive diversity.
AHRQ-funded; HS026030.
Citation: Shubeck SP, Newman EA, Vitous CA .
Hiring practices of US academic surgery departments-challenges and opportunities for more inclusive hiring.
J Surg Res 2020 Oct;254:23-30. doi: 10.1016/j.jss.2020.03.054..
Keywords: Surgery, Provider: Physician, Provider, Workforce, Hospitals
Varban OA, Thumma JR, Carlin AM
Peer assessment of operative videos with sleeve gastrectomy to determine optimal operative technique.
Global assessments of technical skill have been associated with surgical outcomes. More detailed understanding of which specific aspects of technique combine to make the "optimal" sleeve gastrectomy are necessary to help surgeons improve their practice. In this article, the investigators described their study in which the review of de-identified videos of practicing bariatric surgeons was conducted by a minimum of 10 peer surgeons. The videos were assessed on the technical quality of 9 operative maneuvers (ie mobilization of the fundus, stapler location, and sleeve width).
AHRQ-funded; HS017765.
Citation: Varban OA, Thumma JR, Carlin AM .
Peer assessment of operative videos with sleeve gastrectomy to determine optimal operative technique.
J Am Coll Surg 2020 Oct;231(4):470-77. doi: 10.1016/j.jamcollsurg.2020.06.016..
Keywords: Surgery, Obesity: Weight Management, Obesity, Adverse Events, Provider: Physician, Provider
Vitous CA, Jafri SM, Seven C
Exploration of surgeon motivations in management of abdominal wall hernias: a qualitative study.
Although evidence-based guidelines designed to minimize health care variation and promote effective care are widely accepted, creating guidelines alone does not often lead to the desired practice change. Such knowledge-to-practice gaps are well-recognized in the management of patients with abdominal wall hernia. The purpose of this study was to evaluate the systematic application of the Theoretical Domains Framework (TDF) to explore motivations and behaviors associated with surgical decision-making in abdominal wall hernia practice to help inform the future design of theory-based interventions for desired practice and behavior change.
AHRQ-funded; HS025778.
Citation: Vitous CA, Jafri SM, Seven C .
Exploration of surgeon motivations in management of abdominal wall hernias: a qualitative study.
JAMA Netw Open 2020 Sep;3(9):e2015916. doi: 10.1001/jamanetworkopen.2020.15916..
Keywords: Surgery, Digestive Disease and Health, Provider: Physician, Provider
Thomas GW, Long S, Tatum M
A vision for using simulation & virtual coaching to improve the community practice of orthopedic trauma surgery.
In this paper, a vision is presented to elevate community orthopedic practice and improve patient safety by advancing the use of simulators for training and assessing surgical skills. Key elements of this vision included 1) methods for the objective and rigorous assessment of the performance of practicing surgeons now exist, 2) simulators are sufficiently mature and sophisticated that practicing surgeons will use them, and 3) practicing surgeons can improve their performance with appropriate feedback and coaching.
AHRQ-funded; HS022077; HS025353.
Citation: Thomas GW, Long S, Tatum M .
A vision for using simulation & virtual coaching to improve the community practice of orthopedic trauma surgery.
Iowa Orthop J 2020;40(1):25-34..
Keywords: Orthopedics, Surgery, Simulation, Training, Provider: Physician, Provider
Pruitt LCC, Skarda DE, Barnhart DC
Impact of consolidation of cases on post-operative outcomes for index pediatric surgery cases.
The effect of the consolidation of neonatal pediatric surgical cases to limited surgeons within a hospital is unknown. In this retrospective cohort study, the authors elected to model the distribution of complex neonatal procedures using an economic measure of market concentration, the Herfindahl-Hirschmann Index (HHI), and study its effect on outcomes of index pediatric surgical operations.
AHRQ-funded; HS025776.
Citation: Pruitt LCC, Skarda DE, Barnhart DC .
Impact of consolidation of cases on post-operative outcomes for index pediatric surgery cases.
J Pediatr Surg 2020 Jun;55(6):1048-52. doi: 10.1016/j.jpedsurg.2020.02.044..
Keywords: Newborns/Infants, Surgery, Hospitals, Provider: Physician, Provider
Jafri SM, Vitous CA, Dossett LA
Surgeon attitudes and beliefs toward abdominal wall hernia repair in female patients of childbearing age.
This qualitative study examined surgeons’ thoughts on decision-making in repairing an abdominal wall hernia in a woman or girl of childbearing age.
AHRQ-funded; HS026030.
Citation: Jafri SM, Vitous CA, Dossett LA .
Surgeon attitudes and beliefs toward abdominal wall hernia repair in female patients of childbearing age.
JAMA Surg 2020 Jun;155(6):528-30. doi: 10.1001/jamasurg.2020.0099..
Keywords: Provider: Physician, Provider, Surgery, Women, Pregnancy, Shared Decision Making
Khorfan R, Yuce TK, Love R
Cumulative effect of flexible duty-hour policies on resident outcomes: long-term follow-up results from the FIRST trial.
The authors investigated the long-term effect of flexible duty-hour policies on resident outcomes. They found that cumulative time under flexible duty-hour policies had no detrimental effects on duty-hour violations or resident well-being. After multiple years of flexibility, residents continue to report a high rate of satisfaction and positive effects on continuity of care.
Citation: Khorfan R, Yuce TK, Love R .
Cumulative effect of flexible duty-hour policies on resident outcomes: long-term follow-up results from the FIRST trial.
Ann Surg 2020 May;271(5):791-98. doi: 10.1097/sla.0000000000003802..
Keywords: Education: Continuing Medical Education, Patient Safety, Provider: Physician, Provider, Surgery
Sheetz KH, Nuliyalu U, Nathan H
Association of surgeon case numbers of pancreaticoduodenectomies vs related procedures with patient outcomes to inform volume-based credentialing.
The purpose of this study was to evaluate whether surgeon experience with related procedures was associated with better outcomes for pancreaticoduodenectomy compared with procedure-specific experience alone. In this proof-of-concept cohort study, few surgeons met even modest annual volume thresholds for pancreaticoduodenectomy. The investigators indicated that inclusion of related procedure volumes may safely expand the cohort of surgeons credentialed to perform certain procedures under volume-based standards.
AHRQ-funded; HS000053; HS024763.
Citation: Sheetz KH, Nuliyalu U, Nathan H .
Association of surgeon case numbers of pancreaticoduodenectomies vs related procedures with patient outcomes to inform volume-based credentialing.
JAMA Netw Open 2020 Apr;3(4):e203850. doi: 10.1001/jamanetworkopen.2020.3850..
Keywords: Surgery, Provider: Physician, Provider, Outcomes, Patient Safety
Wilson N, Jehn M, Kisana H
Nurses' perceptions of implant barcode scanning in surgical services.
Health policy changes have prompted hospital systems to assess implementation of implant barcode scanning systems to capture unique device identifiers. The aims of this project were to assess predictors of operating room nurses' acceptance of a new implant barcode scanning system, describe operating room nurses' perceptions of the system value, and identify operating room nurses' perceived gaps in system implementation.
AHRQ-funded; HS022340.
Citation: Wilson N, Jehn M, Kisana H .
Nurses' perceptions of implant barcode scanning in surgical services.
Comput Inform Nurs 2020 Mar;38(3):131-38. doi: 10.1097/cin.0000000000000579..
Keywords: Provider: Nurse, Provider, Surgery, Health Information Technology (HIT)
Tang AB, Childers CP, Dworsky JQ
Surgeon work captured by the National Surgical Quality Improvement Program across specialties.
The National Surgical Quality Improvement Program (NSQIP) database is increasingly used for surgical research. However, it is unclear how well this database represents the breadth of work performed by different specialties. Using the 2017 NSQIP participant use file and the 2017 Medicare Physician/Supplier Procedure Summary file, the investigators evaluated (1) what proportion of surgical work was captured by NSQIP, (2) what procedures and disciplines were undersampled, and (3) the overall concordance between the NSQIP sample and a national sample.
AHRQ-funded; HS000046.
Citation: Tang AB, Childers CP, Dworsky JQ .
Surgeon work captured by the National Surgical Quality Improvement Program across specialties.
Surgery 2020 Mar;167(3):550-55. doi: 10.1016/j.surg.2019.11.013..
Keywords: Surgery, Quality Improvement, Quality of Care, Provider: Physician, Provider, Medicare, Patient-Centered Outcomes Research
de Meireles A, Carlin AM, Cain-Nielsen A
Association between surgeon practice knowledge and venous thromboembolism.
Venous thromboembolism (VTE) is the most common cause of mortality following bariatric surgery. This study aimed to determine practice patterns of VTE chemoprophylaxis among bariatric surgeons participating in a large statewide quality collaborative and compare the results of surgeon self-reported chemoprophylaxis prescription practices versus actual data from abstracted charts. They administered a 13-question survey to 66 surgeons to reveal VTE practice patterns such as medication type, dosage, timing, duration, and level of trainee involvement. They also examined the charts of all patients who had developed VTE during the study period and 15 other randomly selected patient charts per site. There was found to be a greater discordance between surgeon self-reported and actual perioperative VTE prophylaxis, but there was no significant discordance postoperatively. Greater perioperative discordance is associated with significantly increased risk of VTE.
AHRQ-funded; HS02362; HS024403.
Citation: de Meireles A, Carlin AM, Cain-Nielsen A .
Association between surgeon practice knowledge and venous thromboembolism.
Obes Surg 2020 Feb 16;30(6):2274-79. doi: 10.1007/s11695-020-04468-6..
Keywords: Surgery, Obesity: Weight Management, Obesity, Blood Clots, Practice Patterns, Provider: Physician, Provider
Banerjee A, Burden A, Slagle JM
Key performance gaps of practicing anesthesiologists: how they contribute to hazards in anesthesiology and proposals for addressing them.
This study analyzed performance gaps of practicing anesthesiologists, and used 4 different scenarios that illustrate those gaps and how they contribute to hazards in anesthesiology and proposals for addressing them. The authors used 4 standardized simulated scenarios of common events that anesthesiologists would expect to see in their practice. The 4 perioperative crisis events are: (1) local anesthetic systemic toxicity (LAST) leading to hemodynamic collapse; (2) retroperitoneal bleeding from insertion of a laparoscopic surgery trocar leading to hemorrhagic shock; (3) malignant hyperthermia (MH) presenting in the postanesthesia care unit; and (4) acute atrial fibrillation with hemodynamic instability, followed by signs of a ST-elevation myocardial infarction (AFib-MI). These scenarios came from a 2017 paper by Weinger, et al. A group of subject matter experts defined a set of clinical performance elements (CPEs) that they would expect to be performed in the scenarios. Only 4% of encounters in these scenarios had perfect performance by anesthesiologists where all prescribed CPEs were performed. Recommendations for improvement included providing high-fidelity simulation training, incorporating clinical lessons about gaps, fostering regular use by anesthesiologists and OR teams of clinical guidance, modifying organizational arrangements at clinical sites to ensure backup help is readily available, and implementing periodic formative performance assessments.
AHRQ-funded; HS020415.
Citation: Banerjee A, Burden A, Slagle JM .
Key performance gaps of practicing anesthesiologists: how they contribute to hazards in anesthesiology and proposals for addressing them.
Int Anesthesiol Clin 2020 Winter;58(1):13-20. doi: 10.1097/aia.0000000000000262..
Keywords: Medical Errors, Adverse Events, Adverse Drug Events (ADE), Patient Safety, Provider Performance, Provider: Physician, Provider, Surgery