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 84 Research Studies DisplayedSolberg LI, Ziegenfuss JY, Rivard RL
Is there room for individual patient-specified preferences in the patient-reported outcome measurement revolution?
The goal of this study was to test the feasibility of collecting qualitative patient-preferred goals and its feasibility as an addition to a standardized process for collecting quantitative composite patient-reported outcome measures (PROMs) from patients undergoing knee joint replacement. The study found that joint replacement patients who responded to quantitative PROMS were willing to report on their other preferred outcomes.
AHRQ-funded; HS025618.
Citation: Solberg LI, Ziegenfuss JY, Rivard RL .
Is there room for individual patient-specified preferences in the patient-reported outcome measurement revolution?
J Patient Cent Res Rev 2023 Fall; 10(4):210-18. doi: 10.17294/2330-0698.2017..
Keywords: Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Neerland C, Slaughter-Acey J, Behrens K
An evidence map for social and structural determinants for maternal morbidity and mortality: a systematic review.
The study aimed to identify social and structural determinants of maternal morbidity and mortality during prenatal and postpartum periods in the U.S. Out of 8,378 references screened, 118 studies were included, covering domains like identity, socioeconomic factors, violence, and trauma. Findings revealed mixed patterns between risk factors and outcomes, with notable attention to depression and mental health. Advancing the field long-term should involve developing comprehensive datasets to thoroughly investigate intersections with biological and medical risk factors.
AHRQ-funded; 75Q80120D00008.
Citation: Neerland C, Slaughter-Acey J, Behrens K .
An evidence map for social and structural determinants for maternal morbidity and mortality: a systematic review.
Obstet Gynecol 2024 Mar; 143(3):383-92. doi: 10.1097/aog.0000000000005489.
Keywords: Social Determinants of Health, Maternal Care, Mortality, Evidence-Based Practice, Risk, Women, Outcomes
Wu J, Yuan CT, Moyal-Smith R
Electronic health record-supported implementation of an evidence-based pathway for perioperative surgical care.
This study examines the role of electronic health records (EHRs) in implementing enhanced recovery pathways (ERPs) for perioperative surgical care. Interviews with informaticians and clinicians from eight US hospitals revealed three thematic clusters: "EHR difficulties," "EHR enablers," and "EHR barriers." Researchers concluded that high performers and improvers successfully integrated ERPs into EHRs with dedicated multidisciplinary teams, while others faced challenges. Early involvement of informatics expertise benefited ERP implementation and sustainability.
AHRQ-funded; 2332015000201.
Citation: Wu J, Yuan CT, Moyal-Smith R .
Electronic health record-supported implementation of an evidence-based pathway for perioperative surgical care.
J Am Med Inform Assoc 2024 Feb 16; 31(3):591-99. doi: 10.1093/jamia/ocad237.
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Surgery, Evidence-Based Practice, Hospitals
Hernandez SE, Solomon D, Moon J
Understanding clinical implementation coordinators' experiences in deploying evidence-based interventions.
Researchers described their fluoroquinolone restriction for the prevention of Clostridioides difficile infection (FIRST) trial, a multisite clinical study which used an electronic health record-based best-practice alert to optimize the use of fluoroquinolone antibiotics in acute care settings. Their goals were to describe the roles and responsibilities of clinical implementation coordinators within antibiotic stewardship teams and to identify facilitators and barriers coordinators experienced within the implementation process. The researchers conducted directed content analysis of semistructured interviews, implementation diaries, and check-in meetings. Their results indicated that clinical implementation coordinators facilitated the implementation process via their roles and responsibilities and acted as strategic partners in the improvement of adoption and sustainability of a fluoroquinolone preauthorization protocol.
AHRQ-funded; HS026226.
Citation: Hernandez SE, Solomon D, Moon J .
Understanding clinical implementation coordinators' experiences in deploying evidence-based interventions.
Am J Health Syst Pharm 2024 Feb 8; 81(4):120-28. doi: 10.1093/ajhp/zxad272.
Keywords: Evidence-Based Practice, Implementation, COVID-19
Al Hussein Al Awamlh B, Wallis CJD, Penson DF
Functional outcomes after localized prostate cancer treatment.
The objective of this observational cohort study was to compare rates of adverse functional outcomes between specific treatments for localized prostate cancer. Researchers used data from five U.S. Surveillance, Epidemiology, and End Results Program registries. Participants were patients treated for localized prostate cancer in 2011-2012. The results indicated that radical prostatectomy was associated with worse urinary incontinence, but not with worse sexual function, at 10-year followup when compared with radiotherapy or surveillance. Among patients with unfavorable-prognosis disease, external beam radiotherapy with androgen deprivation therapy was associated with worse bowel and hormone function at 10-year followup compared with radical prostatectomy.
AHRQ-funded; HS019356; HS022640.
Citation: Al Hussein Al Awamlh B, Wallis CJD, Penson DF .
Functional outcomes after localized prostate cancer treatment.
JAMA 2024 Jan 23; 331(4):302-17. doi: 10.1001/jama.2023.26491.
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Keywords: Cancer: Prostate Cancer, Cancer, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Feltner C, Wallace IF, Nowell SW
Screening for speech and language delay and disorders in children 5 years or younger: evidence report and systematic review for the US Preventive Services Task Force.
This evidence report and systematic review reviewed the evidence on screening for speech and language delay or disorders in children 5 years or younger to inform the US Preventive Services Task Force. This literature review looked at English-language studies of screening test accuracy, trials or cohort studies comparing screening vs no screening; randomized clinical trials (RCTs) of interventions. Main outcomes and measures were screening test accuracy, speech and language outcomes, school performance, function, quality of life, and harms. A total of 38 studies in 41 articles were included (N = 9006). There were 21 studies (n = 7489) that assessed the accuracy of 23 different screening tools that varied with regard to whether they were designed to be completed by parents vs trained examiners, and to screen for global (any) language problems vs specific skills (e.g., expressive language). Three studies assessing parent-reported tools for expressive language skills had consistently high sensitivity (range, 88%-93%) and specificity (range, 88%-85%). Other screening tools had widely varying accuracy. Seventeen RCTs (n = 1517) evaluated interventions for speech and language delay or disorders. There were no RCTs included on the harms of interventions.
AHRQ-funded; 75Q80120D00006.
Citation: Feltner C, Wallace IF, Nowell SW .
Screening for speech and language delay and disorders in children 5 years or younger: evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2024 Jan 23; 331(4):335-51. doi: 10.1001/jama.2023.24647..
Keywords: U.S. Preventive Services Task Force (USPSTF), Children/Adolescents, Screening, Prevention, Evidence-Based Practice
Cantor AG, Jungbauer RM, Skelly AC
Respectful maternity care : a systematic review.
The purpose of this systematic review was to collect information on definitions and valid measurements of respectful maternity care (RMC), its effectiveness for improving pregnant and postpartum maternal and infant health outcomes, and strategies for implementation. Frameworks for RMC were found to be well described but varied in definition. Evidence was lacking on the effectiveness of implementing RMC to improve any maternal or infant health outcome. Tools to measure RMC demonstrated consistency but lacked a gold standard; the authors conclude that further evaluation was needed before implementation in U.S. settings.
AHRQ-funded; 75Q80120D00006
Citation: Cantor AG, Jungbauer RM, Skelly AC .
Respectful maternity care : a systematic review.
Ann Intern Med 2024 Jan; 177(1):50-64. doi: 10.7326/m23-2676..
Keywords: Maternal Care, Women, Patient-Centered Outcomes Research, Evidence-Based Practice
Peaker B, Dooley C B, Peaker B, Dooley C C
AHRQ Author: Peaker B
Screening for syphilis in nonpregnant adolescents and adults.
This case study described a 42-year-old male presenting at the clinic with low back pain that had been radiating down his right leg for one week. Case study questions related to the USPSTF recommendation on Screening for Syphilis in Nonpregnant Adolescents and Adults addressed why this patient was at increased risk, whether screening should take place, and why the USPSTF does not recommend screening for all people.
AHRQ-authored.
Citation: Peaker B, Dooley C B, Peaker B, Dooley C C .
Screening for syphilis in nonpregnant adolescents and adults.
Am Fam Physician 2024 Jan; 109(1):79-80..
Keywords: U.S. Preventive Services Task Force (USPSTF), Screening, Evidence-Based Practice, Sexual Health, Children/Adolescents
Kim HS, Hernaez R, Sansgiry S
Comparative effectiveness of surveillance colonoscopy intervals on colorectal cancer outcomes in a national cohort of patients with inflammatory bowel disease.
The purpose of this study was to determine the comparative effectiveness of varying colonoscopy intervals on colorectal cancer (CRC) outcomes among patients with inflammatory bowel disease (IBD). Data was from the National Veterans Health Administration. Findings showed that, in a national cohort of patients with CRC-IBD, colonoscopy within 3 years prior to CRC diagnosis was associated with early tumor stage at diagnosis, and colonoscopy within 1 year was associated with a reduced all-cause mortality compared with no colonoscopy, supporting colonoscopy intervals of 1 to 3 years in patients with IBD in order to reduce late-stage CRC and all-cause mortality.
AHRQ-funded; HS024122.
Citation: Kim HS, Hernaez R, Sansgiry S .
Comparative effectiveness of surveillance colonoscopy intervals on colorectal cancer outcomes in a national cohort of patients with inflammatory bowel disease.
Clin Gastroenterol Hepatol 2022 Dec;20(12):2848-57.e2. doi: 10.1016/j.cgh.2022.02.048..
Keywords: Cancer: Colorectal Cancer, Cancer, Digestive Disease and Health, Imaging, Screening, Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research
Marcaccio CL, Anjorin A, Patel PB
In-hospital outcomes after upper extremity versus transfemoral and transcarotid access for carotid stenting in the Vascular Quality Initiative.
This comparative study examined outcomes for treatment of patients at high risk of carotid endarterectomy using different approaches of carotid artery stenting (CAS). The study compared the effects of transradial or transbrachial (tr/tbCAS) versus more established transfemoral (tfCAS) or transcarotid (TCAR) CAS procedures. Patients were identified from the Quality Initiative registry from January 2016 to December 2021. Among 40,835 CAS identified patients, 962 underwent tr/tbCAS, 28,850 underwent tfCAS, and 21,033 underwent TCAR. Among matched patients who underwent tr/tbCAS versus tfCAS, there was no significant difference in the risk of stroke/death (4.1% vs 2.9), but tr/tbCAS was associated with a higher risk of death (2.4% vs 1.3). In the symptomatic subgroup, tr/tbCAS was associated with a higher risk of stroke/death (6.1% vs 3.9%) and death (3.6% vs 1.7%), but there were no differences in asymptomatic patients. After adjustment for Modified Rankin Scale in patients with preoperative stroke, there were no significant differences in stroke/death or death between groups.
AHRQ-funded; HS027285.
Citation: Marcaccio CL, Anjorin A, Patel PB .
In-hospital outcomes after upper extremity versus transfemoral and transcarotid access for carotid stenting in the Vascular Quality Initiative.
J Vasc Surg 2022 Dec;76(6):1603-14.e7. doi: 10.1016/j.jvs.2022.05.030..
Keywords: Stroke, Cardiovascular Conditions, Outcomes, Evidence-Based Practice, Comparative Effectiveness, Patient-Centered Outcomes Research
Saldanha IJ, Adam GP, Bañez LL
AHRQ Author: Bañez LL
Inclusion of nonrandomized studies of interventions in systematic reviews of interventions: updated guidance from the Agency for Health Care Research and Quality Effective Health Care program.
A guidance workgroup comprised systematic review experts utilized an informal consensus generation method to develop guidelines to inform decisions regarding the inclusion of nonrandomized studies of interventions (NRSIs) in systematic reviews (SRs) of the effects of interventions. The study found that varying topics may require varying decisions regarding NRSI inclusion. The researchers identified key considerations to inform the decisions; from refinement of topics through to development of protocols. During the scoping and refinement of topics, considerations were associated with the clinical decisional dilemma, adequacy of randomized controlled trials (RCTs) to address the crucial questions, risk of bias in NRSIs, and the degree to which NRSIs are likely to complement RCTs. When NRSIs are included, during SR team formation, familiarity with topic-specific data sources and advanced analytic methods for NRSIs should be considered. During protocol development, the decision regarding NRSI inclusion or exclusion should be justified, and potential implications explained. When NRSIs are included, the protocol should describe the processes for synthesizing evidence from RCTs and NRSIs and determining the overall strength of evidence. CONCLUSION: We identified specific considerations for decisions regarding NRSI inclusion in SRs and highlight the importance of flexibility and transparency.
AHRQ-authored; AHRQ-funded; 290-2017-00003 -C; 75Q80120D00001- 75Q8120D00003; 75Q80120D00005 - 75Q8120D00009.
Citation: Saldanha IJ, Adam GP, Bañez LL .
Inclusion of nonrandomized studies of interventions in systematic reviews of interventions: updated guidance from the Agency for Health Care Research and Quality Effective Health Care program.
J Clin Epidemiol 2022 Dec; 152:300-06. doi: 10.1016/j.jclinepi.2022.08.015..
Keywords: Evidence-Based Practice, Research Methodologies, Health Services Research (HSR)
De B, Pasalic D, Barocas DA
Patient-reported outcomes after external beam radiotherapy with low dose rate brachytherapy boost vs radical prostatectomy for localized prostate cancer: five-year results from a prospective comparative effectiveness study.
The purpose of this study was to compare patient reported outcomes through 5 years following radical prostatectomy or external beam radiation therapy with low dose rate brachytherapy boost for localized prostate cancer. The researchers enrolled men 80 years of age or under who had localized prostate adenocarcinoma and followed them longitudinally from 2011 to 2012. The study found that when compared with radical prostatectomy, external beam radiation therapy with low dose rate brachytherapy boost was related with clinically meaningful worse urinary irritative/obstructive and better urinary incontinence function through 5 years. Urinary function bother was similar between groups. Treatment with external beam radiation therapy with low dose rate brachytherapy boost was associated with worse bowel function through 5 years compared to radical prostatectomy. Treatment with external beam radiation therapy with low dose rate brachytherapy boost was associated with better sexual function at 1 year compared to radical prostatectomy, but there was insufficient evidence to reject the supposition that no difference was seen at 3 or 5 years. The researcher concluded that external beam radiation therapy with low dose rate brachytherapy boost was related with clinically meaningful worse urinary irritative/obstructive and bowel functions but better urinary incontinence function through 5 years after treatment compared to radical prostatectomy.
AHRQ-funded; HS019356; HS022640.
Citation: De B, Pasalic D, Barocas DA .
Patient-reported outcomes after external beam radiotherapy with low dose rate brachytherapy boost vs radical prostatectomy for localized prostate cancer: five-year results from a prospective comparative effectiveness study.
J Urol 2022 Dec;208(6):1226-39. doi: 10.1097/ju.0000000000002902..
Keywords: Cancer: Prostate Cancer, Cancer, Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research, Treatments
Feltnerl. C, Wallace IF, Aymes S
Screening for obstructive sleep apnea in adults: updated evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this study was to examine the evidence on screening for obstructive sleep apnea (OSA) in asymptomatic adults or those with unrecognized OSA symptoms to inform the U.S. Preventive Services Task Force. The researchers utilized data from PubMed/MEDLINE, Cochrane Library, Embase, and trial registries through August 23, 2021 and surveillance data through September 23, 2022. The main outcomes were accuracy, excessive daytime sleepiness, sleep-related and general health-related quality of life (QOL), and harms. Eighty-six studies were included (N = 11,051), researchers finding that no study directly compared screening with no screening. Five studies evaluating the accuracy of other screening tools provided inconsistent results. When compared with inactive control, positive airway pressure was associated with a significant improvement in ESS score from baseline, sleep-related QOL, and general health-related QOL measured by the 36-Item Short Form Health Survey (SF-36) mental health component summary score change, and SF-36 physical health component summary score change. When compared with controls, utilization of mandibular advancement devices was also related with a significantly larger ESS score change. Reporting of other health outcomes was scarce; no trial included in the study found significant benefit related with treatment on mortality, cardiovascular events, or motor vehicle crashes. In 3 systematic reviews, positive airway pressure was significantly associated with reduced blood pressure; but the difference was relatively small. The researchers concluded that the accuracy and clinical usefulness of OSA screening tools was unclear.
Citation: Feltnerl. C, Wallace IF, Aymes S .
Screening for obstructive sleep apnea in adults: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2022 Nov 15;328(19):1951-71. doi: 10.1001/jama.2022.18357..
Keywords: U.S. Preventive Services Task Force (USPSTF), Sleep Problems, Screening, Evidence-Based Practice, Prevention
Schroeder MC, Chapman CG, Chrischilles EA
Generating practice-based evidence in the use of guideline-recommended combination therapy for secondary prevention of acute myocardial infarction.
This study’s goal was to determine if variation in real-world practice of guideline-recommended combination therapy for secondary prevention of acute myocardial infarction (AMI) reflects poor quality-of-care or a balance of outcome tradeoffs among patients. Medicare fee-for-service beneficiaries hospitalized 2007-2008 for AMI were included. Treatment within 30-days post-discharge was grouped into one of eight possible combinations for the three drug classes: beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers, and statins. Outcomes looked at included one-year overall survival, one-year cardiovascular-event-free survival, and 90-day adverse events. Results were found that each drug combination was observed in the final sample (N = 124,695), with 35.7% having all three, and 13.5% having none. There were both treatment benefits and harms in patients with AMIs with higher rates of guideline-recommended treatment.
AHRQ-funded; HS018381.
Citation: Schroeder MC, Chapman CG, Chrischilles EA .
Generating practice-based evidence in the use of guideline-recommended combination therapy for secondary prevention of acute myocardial infarction.
Pharmacy 2022 Nov 3;10(6). doi: 10.3390/pharmacy10060147..
Keywords: Evidence-Based Practice, Guidelines, Heart Disease and Health, Cardiovascular Conditions, Comparative Effectiveness, Patient-Centered Outcomes Research, Prevention
Shah SC, Tarassishin L, Eisele C
Breastfeeding is associated with lower likelihood of Helicobacter pylori colonization in babies, based on a prospective USA maternal-infant cohort.
The authors evaluated maternal and baby factors associated with likelihood of H. pylori colonization in the babies. They found that H. pylori prevalence was 31.8% in mothers and 19.7% in their babies. Dominant breastfeeding and maternal IBD were associated with significantly lower likelihood of H. pylori colonization among babies; no other clinical factors were associated with H. pylori colonization in the babies. They concluded that dominant breastfeeding may protect against early H. pylori colonization.
AHRQ-funded; HS026395.
Citation: Shah SC, Tarassishin L, Eisele C .
Breastfeeding is associated with lower likelihood of Helicobacter pylori colonization in babies, based on a prospective USA maternal-infant cohort.
Dig Dis Sci 2022 Nov;67(11):5149-57. doi: 10.1007/s10620-021-07371-x..
Keywords: Newborns/Infants, Breast Feeding, Evidence-Based Practice
Gartlehner G, Patel SV, Reddy S
Hormone therapy for the primary prevention of chronic conditions in postmenopausal persons: updated evidence report and systematic review for the US Preventive Services Task Force.
This US Preventive Services Task Force (USPSTF) recommendation is an updated evidence report and systematic review on the use of hormone therapy in postmenopausal persons for the primary prevention of chronic conditions. The reviewers included 20 trials (N = 39,145) and 3 cohort studies (N = 1,155,410) from a dual review of abstracts, full-text articles, and study quality. Harms and benefits were compared for participants using estrogen only compared with estrogen plus progestin. Participants using estrogen only compared with placebo had significantly lower risks for diabetes and fractures, but increased for gallbladder disease over 7.1 years, stroke over 7.2 years, venous thromboembolism over 7.2 years and urinary incontinence over 1 year. For participants using estrogen plus progestin some benefits were found, but there was also an increased risk of harms significantly for invasive breast cancer, gallbladder disease, venous thromboembolism, probable dementia, and urinary incontinence.
AHRQ-funded; 75Q80120D00007.
Citation: Gartlehner G, Patel SV, Reddy S .
Hormone therapy for the primary prevention of chronic conditions in postmenopausal persons: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2022 Nov 1;328(17):1747-65. doi: 10.1001/jama.2022.18324..
Keywords: U.S. Preventive Services Task Force (USPSTF), Prevention, Evidence-Based Practice, Guidelines, Chronic Conditions, Women
Tracer H, Justus M
AHRQ Author: Tracer H
Vitamin, mineral, and multivitamin supplementation to prevent cardiovascular disease and cancer.
This Putting Prevention into Practice case study is used to increase understanding of the USPSTF final recommendation on vitamin, mineral, and multivitamin supplementation to prevent cardiovascular disease and cancer. A case study was presented using a 53-year-old-patient with no significant history presenting for a wellness visit. The patient’s 10-year cardiovascular risk and BMI are described. Three multiple-choice questions are presented regarding harms and benefits, and recommendations not to use supplementation to prevent cardiovascular disease and cancer.
AHRQ-authored.
Citation: Tracer H, Justus M .
Vitamin, mineral, and multivitamin supplementation to prevent cardiovascular disease and cancer.
Am Fam Physician 2022 Nov;106(5):565-66..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cardiovascular Conditions, Cancer, Prevention, Evidence-Based Practice, Guidelines
Ko H, Pelt CE, Martin BI
Patient-reported outcomes following cemented versus cementless primary total knee arthroplasty: a comparative analysis based on propensity score matching.
The purpose of this study was to compare baseline and early post-operative global and condition-specific patient reported outcomes (PROs) between patients undergoing cemented versus cementless total knee arthroplasty (TKA). The researchers prospectively collected PROs through the Comparative Effectiveness Pulmonary Embolism Prevention After Hip and Knee Replacement (PEPPER) trial using the short-form of the Knee Injury and Osteoarthritis Outcome Score (KOOS-Jr.), the Patient-Reported Outcomes Measurement Information System Physical Health (PROMIS-PH), and the Numeric Pain Rating Scale (NPRS). Pre- and post-operative outcomes in 5,961 patients undergoing primary TKA between December 2016 and August 2021 were examined. The study found that significant pre to- post-operative were observed in both groups. The researchers concluded that patients with cemented TKA reported early benefit in KOOS-Jr. over those with cementless TKA.
AHRQ-funded; HS024714.
Citation: Ko H, Pelt CE, Martin BI .
Patient-reported outcomes following cemented versus cementless primary total knee arthroplasty: a comparative analysis based on propensity score matching.
BMC Musculoskelet Disord 2022 Oct 27;23(1):934. doi: 10.1186/s12891-022-05899-1..
Keywords: Orthopedics, Surgery, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Viswanathan M, Wallace IF, Cook Middleton J
Screening for depression and suicide risk in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
The authors sought to review the evidence on screening for depression or suicide risk in children and adolescents to inform the US Preventive Services Task Force. They found indirect evidence that suggested some screening instruments were reasonably accurate for detecting depression. Further, psychotherapy and pharmacotherapy were associated with some benefits and no statistically significant harms for depression, but the evidence was limited for suicide risk screening instruments and interventions.
AHRQ-funded; 290201500011I.
Citation: Viswanathan M, Wallace IF, Cook Middleton J .
Screening for depression and suicide risk in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2022 Oct 18;328(15):1543-56. doi: 10.1001/jama.2022.16310..
Keywords: U.S. Preventive Services Task Force (USPSTF), Children/Adolescents, Depression, Behavioral Health, Screening, Primary Care, Guidelines, Evidence-Based Practice, Prevention
Kuzel AJ, Cuellar A, Nichols L
The EvidenceNOW practice support initiative: the Heart of Virginia Healthcare.
The purpose of this study was for The Heart of Virginia Health care (HVH) collaborative (one of the Agency for Healthcare Research and Quality's (AHRQ) Evidence Now project’s 7 collaboratives) to test different ways to improve performance and outcomes on ABCS clinical quality measures (appropriate Aspirin use, Blood pressure control, Cholesterol control, and Smoking cessation counseling) within small primary care practices. The researchers recruited 264 eligible practices and randomized them to 3 cohorts in a stepped wedge design, with 173, utilizing 16 different EHRs, participated through the entire initiative. Trained coaches delivered the practice support curriculum to improve performance on the ABCS measures. The program included an initial kickoff meeting, 3 months of focused support, 9 months of continued support, and access to online materials and faculty. The intervention phase was shortened due to difficulty in recruiting a sufficient number of practices. The study found that the short HVH intervention had a small but statistically significant positive average effects on appropriate use of aspirin and other anti-thrombotics, small negative effects on blood pressure control, except for those practices which did not attend the kickoff, and small negative effects on smoking cessation counseling. The researchers concluded that the truncation of the intervention contributed to the lack of substantial improvements in the ABCS.
AHRQ-funded; HS023913.
Citation: Kuzel AJ, Cuellar A, Nichols L .
The EvidenceNOW practice support initiative: the Heart of Virginia Healthcare.
J Am Board Fam Med 2022 Oct 18;35(5):979-89. doi: 10.3122/jabfm.2022.05.210021..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Evidence-Based Practice, Primary Care, Patient-Centered Outcomes Research, Quality Improvement, Quality of Care, Healthcare Delivery
Viswanathan M, Wallace IF, Cook Middleton J
Screening for anxiety in children and adolescents: evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this paper was to review the evidence on screening for anxiety in children and adolescents to inform the US Preventive Services Task Force. Indirect evidence of findings suggested that some screening instruments were reasonably accurate. Cognitive behavioral therapy and pharmacotherapy were associated with benefits; no statistically significant association with harms was reported.
AHRQ-funded; 290201500011I, 75Q80120D00007.
Citation: Viswanathan M, Wallace IF, Cook Middleton J .
Screening for anxiety in children and adolescents: evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2022 Oct 11;328(14):1445-55. doi: 10.1001/jama.2022.16303..
Keywords: U.S. Preventive Services Task Force (USPSTF), Children/Adolescents, Anxiety, Behavioral Health, Primary Care, Screening, Guidelines, Evidence-Based Practice, Prevention
Scott Scott, Kempe A, Bajaj L
"These are our kids": qualitative interviews with clinical leaders in general emergency departments on motivations, processes, and guidelines in pediatric sepsis care.
Researchers sought to identify barriers and facilitators to pediatric sepsis care in general emergency departments (EDs), including care processes, the role of guidelines, and incentivized metrics. They interviewed medical directors, nurse managers, and quality coordinators. They found that leaders in general EDs were motivated to provide high-quality pediatric sepsis care but disagreed on whether reportable metrics would drive improvements. Leaders universally sought direct support from their nearest children's hospitals and actionable guidelines.
AHRQ-funded; HS025696.
Citation: Scott Scott, Kempe A, Bajaj L .
"These are our kids": qualitative interviews with clinical leaders in general emergency departments on motivations, processes, and guidelines in pediatric sepsis care.
Ann Emerg Med 2022 Oct;80(4):347-57. doi: 10.1016/j.annemergmed.2022.05.030..
Keywords: Children/Adolescents, Emergency Department, Sepsis, Guidelines, Evidence-Based Practice
Adam GP, Pappas D, Papageorgiou H
A novel tool that allows interactive screening of PubMed citations showed promise for the semi-automation of identification of biomedical literature.
This study looked at a novel tool named Pythia that allows interactive screening of PubMed citations to provide semi-automation of identification of biomedical literature for use with systematic reviews. Pythia incorporates a set of natural-language questions with machine-learning algorithms to rank all PubMed citations based on relevance, returning the 100 top-ranked citations. Of the seven systematic reviews conducted, the number of abstracts reviewed per relevant abstract number needed to read was lower than in the manually screened project in four reviews, higher in two, and had mixed results in one. The reviews that had greater overall sensitivity retrieved more relevant citations in early batches, but retrieval was generally unaffected by other aspects, such as study design, study size, and specific key question.
AHRQ-funded; HS027247.
Citation: Adam GP, Pappas D, Papageorgiou H .
A novel tool that allows interactive screening of PubMed citations showed promise for the semi-automation of identification of biomedical literature.
J Clin Epidemiol 2022 Oct;150:63-71. doi: 10.1016/j.jclinepi.2022.06.007..
Keywords: Research Methodologies, Evidence-Based Practice
Adhia AH, Feinglass JM, Schlick CJR
Hospital volume predicts guideline-concordant care in stage III esophageal cancer.
This study developed quality measures for management of stage III esophageal cancer including: utilization of neoadjuvant therapy, surgical sampling of at least 15 lymph nodes, resection within 60 days of chemotherapy or radiation, and completeness of resection to determine whether hospital volume varies measure adherence of published guidelines. A total of 1345 hospitals participating in the National Cancer Database from 2004 to 2016 were included. The authors examined association of volume, program accreditation, safety net status, geographic region, and patient travel distance on adequate adherence (≥85% of patients are adherent) using logistic regression modeling. The rate of adequate adherence was worst in nodal staging at 12.6% and highest for utilization of neoadjuvant therapy at 84.8%. Academic programs had the highest rate of adequate adherence for induction therapy (77.2%), timing of surgery (56.6%), and completeness of resection (78.5%) but lowest for nodal staging at only 4.4%. Every additional esophagectomy performed per year increased the odds of adequate adherence for induction therapy and completeness of resection but decreased for nodal staging.
AHRQ-funded; HS026385.
Citation: Adhia AH, Feinglass JM, Schlick CJR .
Hospital volume predicts guideline-concordant care in stage III esophageal cancer.
Ann Thorac Surg 2022 Oct;114(4):1176-82. doi: 10.1016/j.athoracsur.2021.07.092..
Keywords: Hospitals, Cancer, Guidelines, Evidence-Based Practice
Leland NE, Lekovitch C, Martínez J
Optimizing post-acute care patient safety: a scoping review of multifactorial fall prevention interventions for older adults.
The purpose of this scoping review was to describe the evidence for multifactorial post-acute care (PAC) fall prevention interventions for older patients. The researchers included 33 studies and characterized common intervention domains including: evaluating patient-specific fall risk factors, developing an individualized risk profile and treatment plan that targets each patient's fall risk factors, and implementing facility-based strategies such as staff education. There was not consensus across studies in how the domains were addressed and to what extent. The researchers concluded that health system efforts to prevent accidental falls in PAC should consider a patient-centered multifactorial approach.
AHRQ-funded; HS022907.
Citation: Leland NE, Lekovitch C, Martínez J .
Optimizing post-acute care patient safety: a scoping review of multifactorial fall prevention interventions for older adults.
J Appl Gerontol 2022 Oct;41(10):2187-96. doi: 10.1177/07334648221104375..
Keywords: Elderly, Falls, Prevention, Patient Safety, Evidence-Based Practice