National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (1)
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- Behavioral Health (2)
- Blood Clots (1)
- Blood Pressure (1)
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- (-) Chronic Conditions (18)
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- (-) Medication (18)
- Medication: Safety (2)
- Mortality (1)
- Opioids (11)
- Pain (9)
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- Policy (1)
- Practice Patterns (3)
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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 18 of 18 Research Studies DisplayedAgbalajobi OM, Gmelin T, Moon AM
Characteristics of opioid prescribing to outpatients with chronic liver diseases: a call for action.
This retrospective cohort study investigated opioid prescribing patterns among patients with chronic liver disease (CLD) at a single medical center. These patients (12,425) were followed for one year from October 2015 to September 2016. Nearly half (47%) were prescribed opioids over a one-year period, with 17% receiving high-risk prescriptions. Characteristics associated with high-risk opioid prescriptions included female gender, Medicaid insurance, cirrhosis and baseline chronic pain, depression, anxiety, substance use disorder, and Charlson comorbidity score. Non-alcoholic fatty liver disease was associated with decreased high-risk opioid prescriptions.
AHRQ-funded; HS019461.
Citation: Agbalajobi OM, Gmelin T, Moon AM .
Characteristics of opioid prescribing to outpatients with chronic liver diseases: a call for action.
PLoS One 2021 Dec 17;16(12):e0261377. doi: 10.1371/journal.pone.0261377..
Keywords: Opioids, Medication, Practice Patterns, Pain, Chronic Conditions
Cerda M, Wheeler-Martin K, Bruzelius E
Spatiotemporal analysis of the association between pain management clinic laws and opioid prescribing and overdose deaths.
The authors investigated the impact of pain management clinic laws. They analyzed data on county-level, opioid overdose deaths via the National Vital Statistics System and patients filling long-duration or high-dose opioid prescriptions in the US 2010-2018. Their findings suggested that laws with criminal penalties were associated with intended reductions in high-risk opioid prescribing and some opioid overdoses but raised concerns regarding unintended consequences on heroin/synthetic overdoses.
AHRQ-funded; HS023258.
Citation: Cerda M, Wheeler-Martin K, Bruzelius E .
Spatiotemporal analysis of the association between pain management clinic laws and opioid prescribing and overdose deaths.
Am J Epidemiol 2021 Dec;190(12):2592-603. doi: 10.1093/aje/kwab192..
Keywords: Opioids, Pain, Chronic Conditions, Medication, Practice Patterns, Policy
Schirle L, Jeffery A, Yaqoob A
Two data-driven approaches to identifying the spectrum of problematic opioid use: a pilot study within a chronic pain cohort.
Although electronic health records (EHR) have significant potential for the study of opioid use disorders (OUD), detecting OUD in clinical data is challenging. Models using EHR data to predict OUD often rely on case/control classifications focused on extreme opioid use. IN this study, the investigators discussed two data-driven approaches to identifying the spectrum of problematic opioid use. The investigators concluded that risk scores comprising comorbidities and text offer differing but synergistic insights into characterizing problematic opioid use.
AHRQ-funded; HS026395.
Citation: Schirle L, Jeffery A, Yaqoob A .
Two data-driven approaches to identifying the spectrum of problematic opioid use: a pilot study within a chronic pain cohort.
Int J Med Inform 2021 Dec;156:104621. doi: 10.1016/j.ijmedinf.2021.104621..
Keywords: Opioids, Pain, Chronic Conditions, Medication, Health Information Technology (HIT)
Cook RR, Torralva R, King C
Associations between fentanyl use and initiation, persistence, and retention on medications for opioid use disorder among people living with uncontrolled HIV disease.
This study examined the associations between fentanyl use and initiation, persistence, and retention on medications for opioid use disorder (OUD) among people living with uncontrolled HIV disease. Data from a multisite clinical trial was used to compare extended-release naltrexone (XR-NTX) with treatment as usual (TAU: buprenorphine or methadone) to achieve HIV viral suppression among people with OUD and uncontrolled HIV disease. Exposure to fentanyl use was measured by urine drug screening. The cohort was 11 participants had an average age of 47 years, were 62% male, 57% Black and 13% Hispanic. Baseline fentanyl use was 64% for participants. Participants with baseline fentanyl use were 11 times less likely to initiative XR-NTX than those negative for fentanyl, but there was no evidence that fentanyl use impacted the likelihood of TAU initiation.
AHRQ-funded; HS026370.
Citation: Cook RR, Torralva R, King C .
Associations between fentanyl use and initiation, persistence, and retention on medications for opioid use disorder among people living with uncontrolled HIV disease.
Drug Alcohol Depend 2021 Nov 1;228:109077. doi: 10.1016/j.drugalcdep.2021.109077..
Keywords: Opioids, Medication, Substance Abuse, Behavioral Health, Human Immunodeficiency Virus (HIV), Chronic Conditions
Everhart A, Desai NR, Dowd B
Physician variation in the de-adoption of ineffective statin and fibrate therapy.
The objective of this study was to describe physicians' variation in de-adopting concurrent statin and fibrate therapy for type 2 diabetic patients following a reversal in clinical evidence. Researchers modeled fibrate use among Medicare Advantage and commercially insured type 2 diabetic statin users before and after the publication of the ACCORD lipid trial. Findings showed that, on average, physicians decreased fibrate prescribing following the trial; however, many physicians increased prescribing following the trial. Observable physician characteristics did not explain variations in prescribing.
AHRQ-funded; HS025164; HS000036.
Citation: Everhart A, Desai NR, Dowd B .
Physician variation in the de-adoption of ineffective statin and fibrate therapy.
Health Serv Res 2021 Oct;56(5):919-31. doi: 10.1111/1475-6773.13630..
Keywords: Diabetes, Medication, Practice Patterns, Chronic Conditions
Johnson LF, Kariminia A, Trickey A
Achieving consistency in measures of HIV-1 viral suppression across countries: derivation of an adjustment based on international antiretroviral treatment cohort data.
This aim of this research is to propose that countries with different viral suppression thresholds make adjustments to standardize estimates to the <1000 HIV-1 RNA copies/ml threshold in patients on antiretroviral treatment (ART) by 2020. The authors considered three possible distributions for viral loads in ART patients: Weibull, Pareto and reverse Weibull. The models were fitted to data on viral load distribution in ART patients in the International epidemiology Databases to Evaluate AIDS (IeDEA) collaboration and the ART Cohort Collaboration, using separate random effects models for adults and children. The models were validated using data from the World Health Organization (WHO) HIV drug resistance report and the Brazilian national ART program. Models were calibrated using 921,157 adult and 37,431 pediatric viral load measurements from 2010 to 2019. The Parento and reverse Weibull models provided the best fits to the data.
J Int AIDS Soc 2021 Sep;24(Suppl 5):e25776. doi: 10.1002/jia2.25776.
Citation: Johnson LF, Kariminia A, Trickey A .
Achieving consistency in measures of HIV-1 viral suppression across countries: derivation of an adjustment based on international antiretroviral treatment cohort data.
AHRQ-funded; 90051652..
Keywords: Human Immunodeficiency Virus (HIV), Chronic Conditions, Medication
Auty SG, Shafer PR, Dusetzina SB
Association of Medicaid managed care drug carve outs with hepatitis C virus prescription use.
The purpose of this cross-sectional study was to explore the relationship between Medicaid-covered Hepatitis C Virus (HCV) medication fills and Medicaid managed care organization (MCO) carve outs of direct-acting antiviral HCV medications. The researchers assessed changes in fills of Medicaid-covered direct-acting antiviral HCV medications in 4 states (Indiana, Michigan, New Hampshire, and West Virginia) that carved out these drugs from Medicaid MCOs between 2015 and 2017. The study found that carve outs were associated with a mean quarterly increase of 22.1 HCV prescriptions per 100 000 Medicaid enrollees. This was a relative increase of 86.3% compared with synthetic control states. Compared with each state's respective synthetic control, HCV prescription fills were associated with an increase of 11.5 HCV prescription fills per 100 000 Medicaid enrollees per quarter in Indiana, 36.6 in Michigan, 20.7 in West Virginia, and 43.6 in New Hampshire. The researchers concluded that carve outs of direct-acting antiviral HCV medications from Medicaid MCO prescription drug coverage were associated with significant increases in HCV medication use.
AHRQ-funded; HS026395.
Citation: Auty SG, Shafer PR, Dusetzina SB .
Association of Medicaid managed care drug carve outs with hepatitis C virus prescription use.
JAMA Health Forum 2021 Aug;2(8):e212285. 2021/08/27. doi: 10.1001/jamahealthforum.2021.2285..
Keywords: Medicaid, Hepatitis, Chronic Conditions, Medication
McCoy RG, Van Houten HK, Dunlay SM
Race and sex differences in the initiation of diabetes drugs by privately insured US adults.
The authors examined the differences in the use of three glucose-lowering medications as a function of both sex and race. They found that, compared to white men, GLP-1RA were 43% more likely to be started by White women, 12% more likely to be started by non-White men, and 21% less likely to be started by non-White women. SGLT2i were at least 10% less likely to be started by all groups compared to White men, and DPP4i were used more often by non-White than White patients of both sexes.
AHRQ-funded; HS024075.
Citation: McCoy RG, Van Houten HK, Dunlay SM .
Race and sex differences in the initiation of diabetes drugs by privately insured US adults.
Race and sex differences in the initiation of diabetes drugs by privately insured US adults..
Keywords: Diabetes, Chronic Conditions, Medication, Sex Factors, Racial and Ethnic Minorities
Bedford T, Adediran T, Haycock NR
Patient and provider acceptability of a patient preauthorized concealed opioid reduction.
Researchers investigated patient and provider acceptance of a concealed opioid reduction for chronic pain. They conducted a cross-sectional survey with patients who are taking or have taken high dose opioids via REDcap, and with providers via a validated questionnaire. They found that patients and providers have positive attitudes toward a concealed reduction of opioid dosages. They concluded that their findings support future randomized controlled trials that compare concealed and overt opioid tapering in patients with chronic pain.
AHRQ-funded; HS022135.
Citation: Bedford T, Adediran T, Haycock NR .
Patient and provider acceptability of a patient preauthorized concealed opioid reduction.
Pain Med 2021 Jul 25;22(7):1651-59. doi: 10.1093/pm/pnaa454..
Keywords: Opioids, Medication, Pain, Chronic Conditions
Bernard DM, Encinosa W, Cohen J
AHRQ Author: Bernard DM Encinosa W Cohen J Fang Z
Patient factors that affect opioid use among adults with and without chronic pain.
Investigators sought to determine patient characteristics associated with opioid use among adults with and without chronic pain treatment. Using MEPS data, they found that health-related attitudes affect both adults with and without chronic pain treatment similarly. Adults with self-reliant health attitudes were less likely to start and more likely to discontinue opioid use. Exercise was associated with higher probability of choosing no analgesic treatments over using opioids and also with higher probability of discontinuing opioid use in the year following opioid initiation for those electing to use them.
AHRQ-authored.
Citation: Bernard DM, Encinosa W, Cohen J .
Patient factors that affect opioid use among adults with and without chronic pain.
Res Social Adm Pharm 2021 Jun;17(6):1059-65. doi: 10.1016/j.sapharm.2020.07.036..
Keywords: Medical Expenditure Panel Survey (MEPS), Opioids, Medication, Pain, Chronic Conditions
Anderson KE, Alexander GC, Niles L
Quality of preventive and chronic illness care for insured adults with opioid use disorder.
Investigators sought to measure quality of non-opioid use disorder (OUD) preventive and chronic illness care and care coordination for individuals with OUD compared with individuals without OUD. They used deidentified data on outpatients throughout the United States from claims for commercially insured and Medicare Advantage enrollees aged 18 years or older with diagnosis codes for OUD. They found that individuals with OUD have moderately lower quality of care across preventive and chronic illness care and care coordination for non-OUD care compared with individuals without OUD. They recommended more attention to measurement and improvement of non-OUD care for these individuals.
AHRQ-funded; HS000029.
Citation: Anderson KE, Alexander GC, Niles L .
Quality of preventive and chronic illness care for insured adults with opioid use disorder.
JAMA Netw Open 2021 Apr;4(4):e214925. doi: 10.1001/jamanetworkopen.2021.4925..
Keywords: Opioids, Medication, Substance Abuse, Quality Indicators (QIs), Quality of Care, Behavioral Health, Chronic Conditions, Prevention
Wyse JJ, Lovejoy J, Holloway J
Patients' perceptions of the pathways linking chronic pain with problematic substance use.
This study examined how patients with chronic pain perceive their relationship between their substance use disorder (SUD) and chronic pain. About one-half of patients with SUDs experience chronic pain. The authors conducted qualitative interviews with 34 patients involved in SUD treatment who were also diagnosed with chronic pain. The interviews revealed 3 primary pathways. One group described SUD as development independently from their experiences of chronic pain. A second group described turning to substances to self-manage or cope with the chronic pain. A third group described encounters with opioid medications as the causal agent.
AHRQ-funded; HS026370.
Citation: Wyse JJ, Lovejoy J, Holloway J .
Patients' perceptions of the pathways linking chronic pain with problematic substance use.
Pain 2021 Mar;162(3):787-93. doi: 10.1097/j.pain.0000000000002077..
Keywords: Opioids, Substance Abuse, Medication, Pain, Chronic Conditions
McCoy RG, Van Houten HK, Deng Y
Comparison of diabetes medications used by adults with commercial insurance vs Medicare Advantage, 2016 to 2019.
Investigators sought to compare trends in initiation of treatment with GLP-1RA, SGLT2i, and DPP-4i by older adults with type 2 diabetes insured by Medicare Advantage vs commercial health plans. They found that Medicare Advantage beneficiaries may be less likely than commercially insured beneficiaries to be treated with newer medications to lower glucose levels, with greater disparities among lower-income patients. They recommended further investigation of nonclinical factors contributing to treatment decisions and efforts to promote greater equity in diabetes management.
AHRQ-funded; HS025164.
Citation: McCoy RG, Van Houten HK, Deng Y .
Comparison of diabetes medications used by adults with commercial insurance vs Medicare Advantage, 2016 to 2019.
JAMA Netw Open 2021 Feb;4(2):e2035792. doi: 10.1001/jamanetworkopen.2020.35792..
Keywords: Elderly, Diabetes, Chronic Conditions, Medication, Medicare, Health Insurance, Disparities, Low-Income
Horton DB, Xie F, Chen L
Oral glucocorticoids and incident treatment of diabetes mellitus, hypertension, and venous thromboembolism in children.
The purpose of this study was to quantify rates of incident treatment for diabetes mellitus, hypertension, and venous thromboembolism (VTE) associated with oral glucocorticoid exposure in children aged 1-18 years. Participants were identified using US Medicaid claims data and included more than 930,000 children diagnosed with autoimmune diseases or a nonimmune comparator condition. Findings showed strong dose-dependent relationships between current glucocorticoid exposure and all outcomes, suggesting strong relative risks, but low absolute risks, of newly-treated VTE, diabetes, and especially hypertension in children taking high-dose oral glucocorticoids.
AHRQ-funded; HS021110.
Citation: Horton DB, Xie F, Chen L .
Oral glucocorticoids and incident treatment of diabetes mellitus, hypertension, and venous thromboembolism in children.
Am J Epidemiol 2021 Feb 1;190(3):403-12. doi: 10.1093/aje/kwaa197..
Keywords: Children/Adolescents, Diabetes, Chronic Conditions, Blood Clots, Medication: Safety, Medication, Adverse Drug Events (ADE), Adverse Events, Risk, Patient Safety, Blood Pressure
Hood-Medland EA, White AEC, Kravitz RL
Agenda setting and visit openings in primary care visits involving patients taking opioids for chronic pain.
This study looked at primary care visit opening styles to assess use of agenda and non-agenda setting visit openings and their effects on participant experience with patients taking opioids for chronic pain. The study analyzed 83 video-recorded US primary care visits at a single academic medical center in California. A total of 49 family medicine and internal resident physicians and 83 patients were filmed. The authors developed a coding scheme that assessed the presence of agenda setting, distinct visit opening styles, and the number of total topics, major topics, surprise patient topics, and returns to prior topics discusses. They identified 2 visit opening styles with agenda setting (agenda eliciting, agenda reframing) and 3 non-agenda opening styles (open-ended question, patient launch, physician launch). Only 11% of visits included agenda setting and was associated with fewer surprise patient topics than visits without agenda setting.
AHRQ-funded; HS022236.
Citation: Hood-Medland EA, White AEC, Kravitz RL .
Agenda setting and visit openings in primary care visits involving patients taking opioids for chronic pain.
BMC Fam Pract 2021 Jan 4;22(1):4. doi: 10.1186/s12875-020-01317-4..
Keywords: Primary Care, Opioids, Medication, Pain, Chronic Conditions, Clinician-Patient Communication, Communication, Ambulatory Care and Surgery
Wyse J, Simmons A, Ramachandran B
"I don't mind doing what it takes to be safe." Patient perspectives of urine drug testing for pain.
This study sought to uncover patients’ beliefs regarding UDT and its implications for the patient–clinician relationship. Urine drug testing (UDT) is a standard recommendation for those prescribed long-term opioid therapy (LTOT) for pain but remains underutilized. Clinician fears regarding negative patient perceptions have been identified as a barrier to conducting UDT; however, little is known about patient perspectives of UDT.
AHRQ-funded; HS026370.
Citation: Wyse J, Simmons A, Ramachandran B .
"I don't mind doing what it takes to be safe." Patient perspectives of urine drug testing for pain.
J Gen Intern Med 2021 Jan;36(1):243-44. doi: 10.1007/s11606-020-05688-3..
Keywords: Pain, Chronic Conditions, Opioids, Medication, Medication: Safety, Patient Safety, Substance Abuse
Stephens KA, Ike B, Baldwin LM
Challenges and approaches to population management of long-term opioid therapy patients.
Primary care is challenged with safely prescribing opioids for patients with chronic noncancer pain (CNCP), specifically to address risks for overdose, opioid use disorder, and death. In this study, the investigators identified sociotechnical challenges, approaches, and recommendations in primary care to effectively track and monitor patients on long-term opioid therapy, a key component for supporting adoption of opioid prescribing guidelines.
AHRQ-funded; HS023750.
Citation: Stephens KA, Ike B, Baldwin LM .
Challenges and approaches to population management of long-term opioid therapy patients.
J Am Board Fam Med 2021 Jan-Feb;34(1):89-98. doi: 10.3122/jabfm.2021.01.190100..
Keywords: Opioids, Pain, Chronic Conditions, Care Management, Medication, Primary Care, Ambulatory Care and Surgery
Bramante CT, Ingraham NE, Murray TA
Metformin and risk of mortality in patients hospitalised with COVID-19: a retrospective cohort analysis.
This study examined whether metformin use by patients with diagnosed with type 2 diabetes had reduced mortality when hospitalized for COVID-19. Pharmacy claims data from UnitedHealth Group’s Clinical Discovery Claims Database was used. Patient data were included if they were aged 18 years or older; had type 2 diabetes or obesity (defined based on claims); at least 6 months of continuous enrolment in 2019; and admission to hospital for COVID-19 confirmed by PCR; manual chart review by UHG; or reported from the hospital to UHG. Metformin was not associated with significant reduction in mortality among men, but there was an association with decreased mortality in women.
AHRQ-funded; HS026379.
Citation: Bramante CT, Ingraham NE, Murray TA .
Metformin and risk of mortality in patients hospitalised with COVID-19: a retrospective cohort analysis.
Lancet Healthy Longev 2021 Jan;2(1):e34-e41. doi: 10.1016/s2666-7568(20)30033-7..
Keywords: COVID-19, Hospitalization, Medication, Mortality, Risk, Diabetes, Chronic Conditions, Public Health, Infectious Diseases