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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
76 to 100 of 327 Research Studies DisplayedAustin JM, Kirley EM, Rosen MA
A comparison of two structured taxonomic strategies in capturing adverse events in U.S. hospitals.
The purpose of this study was to compare the ability of AHRQ’s Quality and Safety Review System (QSRS) and the proposed triadic structure for the 11th version of the International Classification of Disease (ICD-11) to capture adverse events in U.S. hospitals. One thousand admissions were chosen for this study in a random sample from 3 general, acute care hospitals in Maryland and Washington D.C. and abstracted by two different sets of coding specialists for QSRS and the ICD-11. The results showed less than 20 percent agreement between QSRS and ICD-11 in their ability to identify the same adverse events. The sensitivity of ICD-11 improved when coders were given a list of potential adverse events. The authors conclude that in its draft form, ICD-11 has a limited ability to capture the same types of events as QSRS and that coders may need more training to improve its ability to identify adverse events.
AHRQ-funded; 233201500020I.
Citation: Austin JM, Kirley EM, Rosen MA .
A comparison of two structured taxonomic strategies in capturing adverse events in U.S. hospitals.
Health Serv Res 2019 Jun;54(3):613-22. doi: 10.1111/1475-6773.13090..
Keywords: Adverse Events, Health Services Research (HSR), Hospitals, Patient Safety
Aouad M, Brown TT, Whaley CM
Reference pricing: the case of screening colonoscopies.
In this study, the investigators studied the introduction of reference pricing to the California Public Employees' Retirement System. The investigators found a 10 percentage point increase in the share of patients using an ambulatory surgery center (ASC), leading to a $2300 to $1700 reduction in prices paid for patients who switched to ASCs. They indicated that their results suggested the use of ASCs had a causal effect on prices paid and had no negative effect on patient health outcomes.
AHRQ-funded; HS022098.
Citation: Aouad M, Brown TT, Whaley CM .
Reference pricing: the case of screening colonoscopies.
J Health Econ 2019 May;65:246-59. doi: 10.1016/j.jhealeco.2019.03.002..
Keywords: Colonoscopy, Shared Decision Making, Health Services Research (HSR), Healthcare Costs, Healthcare Delivery, Screening
Wisk LE, Nelson EB, Magane KM
Clinical trial recruitment and retention of college students with type 1 diabetes via social media: an implementation case study.
The purpose of this study was to quantify the efficiency and acceptability of Internet-based recruitment for engaging college-students with type 1 diabetes (T1D) and to describe the approach used for implementing a health-related trial entirely online using off-the-shelf Internet tools. Young people aged 17-25 years with T1D were recruited through social media platforms and other outreach channels; Facebook was the highest yield recruitment source. Demographics differed by platform. Response rate and participant characteristics were quantified and engagement metrics tracked via Google Analytics and participant survey data. The researchers conclude that recruitment of college students with T1D for a trial via social media is feasible, efficient, acceptable, and yields a sample that represents the user-base from which they were drawn.
AHRQ-funded; HS022986.
Citation: Wisk LE, Nelson EB, Magane KM .
Clinical trial recruitment and retention of college students with type 1 diabetes via social media: an implementation case study.
J Diabetes Sci Technol 2019 May;13(3):445-56. doi: 10.1177/1932296819839503..
Keywords: Diabetes, Health Services Research (HSR), Research Methodologies, Social Media, Young Adults
Althoff KN, Wong C, Hogan B
Mind the gap: observation windows to define periods of event ascertainment as a quality control method for longitudinal electronic health record data.
Under the hypothesis that use of electronic health records in health research may lead to false assumptions of complete event ascertainment, the authors of this article estimated "observation windows" (OWs) as a quality-control approach to reduce the likelihood of false assumption. The impact of OWs on estimating rates of type II diabetes mellitus from HIV clinical cohorts are demonstrated. Data from 16 HIV clinical cohorts to the NA-ACCORD were used to identify and evaluate OWs for an operationalized definition of diabetes occurrence. The authors conclude that OWs have utility as a quality-control approach to complete event ascertainment and help to improve the accuracy of estimates.
AHRQ-funded; 90047713.
Citation: Althoff KN, Wong C, Hogan B .
Mind the gap: observation windows to define periods of event ascertainment as a quality control method for longitudinal electronic health record data.
Ann Epidemiol 2019 May;33:54-63. doi: 10.1016/j.annepidem.2019.01.015..
Keywords: Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR), Quality of Care
Marshall IJ, Marshall R, Wallace BC
Rapid reviews may produce different results to systematic reviews: a meta-epidemiological study.
Researchers analyzed the difference in results between systematic reviews and rapid reviews. They stimulated searching only PubMed, excluding older articles, smaller trials, and using the largest trial only. They examined percentage changes in pooled odds ratios (ORs), statistical significance, and biases between systematic reviews and rapid reviews. A total of 2,512 systematic reviews were included. Using only PubMed had the smallest risk of changed ORs. There were also changes in statistical significance but no evidence of bias. They concluded that rapid reviews can be considered where approximately 10% risk of the primary outcome or by changing greater than 20% could be tolerated.
AHRQ-funded; HS025024.
Citation: Marshall IJ, Marshall R, Wallace BC .
Rapid reviews may produce different results to systematic reviews: a meta-epidemiological study.
J Clin Epidemiol 2019 May;109:30-41. doi: 10.1016/j.jclinepi.2018.12.015..
Keywords: Evidence-Based Practice, Health Services Research (HSR), Research Methodologies
Chopra V, Burden M, Jones CD
State of research in adult hospital medicine: results of a national survey.
This study examined the state of research in academic hospital medicine by conducting a survey of members of the Society of Hospital Medicine (SHM). A total of 100 programs were considered eligible and surveys sent to corresponding individuals. Among those programs, 28 completed the survey. There was a total 1,586 faculty members represented with 12% identified as engaging or having obtained extramural funding with 41% as engaging in quality improvement efforts. Most of the programs (61%) received $500,000 or less and 29% received >$1 million in funding. The major federal funders were AHRQ, NIH, and the Veterans Health Administration. Only five programs currently have a research fellow program in hospital medicine, with many programs citing a lack of funding as the major barrier to establishing a program. Almost half of the respondents indicated their faculty were publishing between 11-50 peer-reviewed manuscripts each year.
AHRQ-funded; HS024569.
Citation: Chopra V, Burden M, Jones CD .
State of research in adult hospital medicine: results of a national survey.
J Hosp Med 2019 Apr;14(4):207-11. doi: 10.12788/jhm.3136.
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Keywords: Hospitals, Health Services Research (HSR)
Ita AJ, Olden HA, Kippen KE
A flexible model for patient engagement: achieving quality outcomes and building a research agenda for head and neck cancer.
This article describes the work of a head and neck cancer survivors who became advisors on a multidisciplinary team of providers. The survivors provided feedback to providers on areas of improvement for clinical flow and they also have provided advice on efforts to increase public awareness. They have also been very active at cancer symposiums and other local presentations.
AHRQ-funded; HS022417.
Citation: Ita AJ, Olden HA, Kippen KE .
A flexible model for patient engagement: achieving quality outcomes and building a research agenda for head and neck cancer.
Head Neck 2019 Apr;41(4):1087-93. doi: 10.1002/hed.25584..
Keywords: Cancer, Health Services Research (HSR), Patient-Centered Outcomes Research, Patient and Family Engagement
Schroeder J, Karkar R, Fogarty J
A patient-centered proposal for bayesian analysis of self-experiments for health.
This article describes the types of questions people want to answer via self-experimentation in order to develop a complementary patient-centered perspective on the potential benefits of Bayesian analysis. Information was gathered via the authors’ experiences in engaging with irritable bowel syndrome patients and their healthcare providers and a survey that investigated what questions individuals want to answer about their health and wellness. The authors find that the majority of the questions people want to answer with self-tracking data are better answered with Bayesian methods than with frequentist methods. Examples of how those questions might be answered using frequentist null hypothesis significance testing, frequentist estimation, and Bayesian estimation and prediction, as well as design recommendations for analyses and visualizations to help people answer and interpret such questions are also provided.
AHRQ-funded; HS023654.
Citation: Schroeder J, Karkar R, Fogarty J .
A patient-centered proposal for bayesian analysis of self-experiments for health.
J Healthc Inform Res 2019 Mar;3(1):124-55. doi: 10.1007/s41666-018-0033-x..
Keywords: Health Information Technology (HIT), Health Services Research (HSR)
Adrian M, Moreno M, Nicodimos S
Research strategy for health sciences: Facebook friend request is non-differentially accepted in a diverse, young adult population.
The aim of this study was to report on overall success of recruiting young adults in diverse settings, with respect to education and employment, into a study using Facebook (FB). The investigators assert that friending through FB is a feasible way to reach young adults involved in health and behavioral research, and could be a way to expand the populations that are studied in health science research to maximize generalizability of the conclusions drawn.
AHRQ-funded; HS022982.
Citation: Adrian M, Moreno M, Nicodimos S .
Research strategy for health sciences: Facebook friend request is non-differentially accepted in a diverse, young adult population.
Nurs Health Sci 2019 Mar;21(1):71-77. doi: 10.1111/nhs.12557..
Keywords: Health Services Research (HSR), Research Methodologies, Social Media, Young Adults
Turan JM, Elafros MA, Logie CH
Challenges and opportunities in examining and addressing intersectional stigma and health.
The purpose of this article was to review and highlight existing intersectional stigma literature, as well as to identify gaps in methods for studying and addressing intersectional stigma. 'Intersectional stigma' is defined as a concept that characterizes the convergence of multiple stigmatized identities within a person or group and addresses effects on health and well-being. Examples illustrating promising analytical approaches are provided, and priorities for future health research elucidated. Evidence from existing literature, as well as the examples presented, suggest that people in diverse settings experience intersecting forms of stigma that influence their mental and physical health and their corresponding health behaviors. The authors conclude that intersectional stigma are a common reality, but remain poorly understood; it is vital that instruments and methods be developed to characterize the mechanisms and effects of intersectional stigma in relation to various health conditions.
AHRQ-funded; HS013852.
Citation: Turan JM, Elafros MA, Logie CH .
Challenges and opportunities in examining and addressing intersectional stigma and health.
BMC Med 2019 Feb 15;17(1):7. doi: 10.1186/s12916-018-1246-9..
Keywords: Health Services Research (HSR), Social Stigma
Gartlehner G, Nussbaumer-Streit B, Wagner G
Increased risks for random errors are common in outcomes graded as high certainty of evidence.
The goal of this article was to assess the risk for random errors in outcomes graded as high certainty of evidence (CoE). Results showed that, overall, 38% of high CoE outcomes had increased risks for random errors. Outcomes assessing harms were more frequently affected than outcomes assessing benefits. Regrading of outcomes with increased random errors showed that 74% should have been downgraded based on current guidance. Recommendations included being aware that outcomes rated as high CoE often have increased risks for false-positive or false-negative findings.
AHRQ-funded; HS024749.
Citation: Gartlehner G, Nussbaumer-Streit B, Wagner G .
Increased risks for random errors are common in outcomes graded as high certainty of evidence.
J Clin Epidemiol 2019 Feb;106:50-59. doi: 10.1016/j.jclinepi.2018.10.009..
Keywords: Evidence-Based Practice, Health Services Research (HSR), Patient-Centered Outcomes Research, Research Methodologies
Jones CD, Jones J, Bowles KH
Patient, caregiver, and clinician perspectives on expectations for home healthcare after discharge: a qualitative case study.
The objective of this study was to evaluate and compare expectations for skilled home health care (HHC) from the patient, caregiver, and HHC perspectives after hospital discharge. Results showed that unclear expectations occurred when the patient and/or caregiver expectations were uncertain or misaligned with the services received; in most such cases, the patient and caregiver did not have prior experience with HHC. Recommendations to improve HHC transitions included actively engaging both patients and caregivers in the hospital and HHC settings to provide education about HHC services and assess and address additional care needs.
AHRQ-funded; HS024569.
Citation: Jones CD, Jones J, Bowles KH .
Patient, caregiver, and clinician perspectives on expectations for home healthcare after discharge: a qualitative case study.
J Hosp Med 2019 Feb;14(2):90-95. doi: 10.12788/jhm.3140..
Keywords: Caregiving, Health Services Research (HSR), Home Healthcare, Patient Experience, Provider, Provider: Clinician, Transitions of Care
Hunter SR, Applegate EA, Arora V
An introduction to multiobjective simulation optimization.
The authors provide an introduction to multiobjective simulation optimization at the advanced tutorial level, aimed at researchers and practitioners who wish to begin working in this area. Their introduction includes an overview of existing theory, methods, and provably convergent algorithms. Key open questions that remain in this emerging field are also discussed.
AHRQ-funded; HS024384.
Citation: Hunter SR, Applegate EA, Arora V .
An introduction to multiobjective simulation optimization.
ACM Trans. Model. Comput. Simul. 2019 Feb;29(1):1-36. doi: 10.1145/3299872..
Keywords: Health Services Research (HSR), Research Methodologies
Lin L, Xing A, Kofler MJ
Borrowing of strength from indirect evidence in 40 network meta-analyses.
This study investigated the use of network meta-analysis (NMA) in providing clinicians with direct and indirect evidence when comparing multiple treatment options. Researchers analyzed 915 possible treatment combinations although 53% had no direct evidence. They concluded that the potential to provide more precise results only reliably occurs when at least two head-to-head studies are available and the treatments are well connected.
AHRQ-funded; HS024743.
Citation: Lin L, Xing A, Kofler MJ .
Borrowing of strength from indirect evidence in 40 network meta-analyses.
J Clin Epidemiol 2019 Feb;106:41-49. doi: 10.1016/j.jclinepi.2018.10.007..
Keywords: Evidence-Based Practice, Health Services Research (HSR), Research Methodologies
Miller MR, Mistry KB
AHRQ Author: Mistry KB
Developing pediatric patient safety research priorities.
This article is a commentary on a newly published article by Hoffman et al entitled “Priorities for Pediatric Safety Research”. The authors agree with the discussion in the article and further elaborate on several ideas in the article. The four points discussed are: 1) broadening the stakeholders; 2) recognize the role of distinct data sources; 3) understand real-world barriers to uptake of evidence-based strategies; and 4) incorporate maternal health factors into the research.
AHRQ-authored.
Citation: Miller MR, Mistry KB .
Developing pediatric patient safety research priorities.
Pediatrics 2019 Feb;143(2):pii: e20182970. doi: 10.1542/peds.2018-2970..
Keywords: Children/Adolescents, Health Services Research (HSR), Patient Safety
Riley AR, Freeman KA
Impacting pediatric primary care: opportunities and challenges for behavioral research in a shifting healthcare landscape.
This commentary discusses the role that behavioral analysts can have in partnership with pediatric medicine. There have been advances, but there has been limited impact for the daily practice of pediatrics. The authors discuss why behavioral pediatrics has failed to gain traction in primary care, describe possible opportunities for an expanded portfolio of research, and identify several examplars from the behavior analytic literature that has influenced pediatric primary care, and make further recommendations for producing influential data.
AHRQ-funded; HS022981.
Citation: Riley AR, Freeman KA .
Impacting pediatric primary care: opportunities and challenges for behavioral research in a shifting healthcare landscape.
Behav Anal 2019 Feb;19(1):23-38. doi: 10.1037/bar0000114..
Keywords: Behavioral Health, Children/Adolescents, Health Services Research (HSR), Healthcare Delivery, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care, Primary Care: Models of Care, Research Methodologies
Foglia EE, Ades A, Sawyer T
Neonatal intubation practice and outcomes: an international registry study.
Neonatal tracheal intubation is a critical but potentially dangerous procedure. In this study, the investigators sought to characterize intubation practice and outcomes in the NICU and delivery room (DR) settings and to identify potentially modifiable factors to improve neonatal intubation safety. They developed the National Emergency Airway Registry for Neonates and collected standardized data for patients, providers, practices, and outcomes of neonatal intubation. They suggest that their results will inform future interventional studies to improve neonatal intubation safety.
AHRQ-funded; HS024511.
Citation: Foglia EE, Ades A, Sawyer T .
Neonatal intubation practice and outcomes: an international registry study.
Pediatrics 2019 Jan;143(1). doi: 10.1542/peds.2018-0902..
Keywords: Emergency Department, Health Services Research (HSR), Intensive Care Unit (ICU), Newborns/Infants, Outcomes, Patient Safety, Registries
Li F, Thomas LE, Li F
Addressing extreme propensity scores via the overlap weights.
This article examines the overlap weighting method, which mitigates the issues of biased estimates and excessive variance from extreme propensity scores in the probability weighting method. Overlap weighting emphasizes the target population with the most overlap in observed characteristics between treatments, continuously down-weighting the units in the tails of the propensity score distribution. The authors of this study use simulations to compare overlap weighting to standard inverse probability weighting in terms of bias, variance, and 95% confidence interval coverage. A consistent estimator for standard error of treatment effect, estimated using overlap weighting, is also provided to facilitate practical implementation.
AHRQ-funded; HS024310.
Citation: Li F, Thomas LE, Li F .
Addressing extreme propensity scores via the overlap weights.
Am J Epidemiol 2019 Jan;188(1):250-57. doi: 10.1093/aje/kwy201..
Keywords: Health Services Research (HSR), Research Methodologies
Werner RM, Kanter GP, Polsky D
Association of physician group participation in Accountable Care Organizations with patient social and clinical characteristics.
The goal of this retrospective cohort study was to estimate the association between the patient characteristics of a physician group and the group's participation in a newly formed accountable care organization (ACOs). A random sample of Medicare fee-for-service beneficiaries attributed to physician groups were identified by Medicare claims made before ACO participation. Physician groups that participated and did not participate in the Medicare Shared Savings Program (MSSP) were then identified. ACO-participating physician groups were compared with non-participating groups for reference, and estimates were made at both the physician and patient level. The study found that physician groups that participated in the MSSP ACO program cared for more vulnerable patients than non-participating groups did; ACO-participating physician groups cared for an equally large number of vulnerable patients compared with non-participating groups. The authors conclude that ACOs may be an effective approach to target care among high-risk patients.
AHRQ-funded; HS025184.
Citation: Werner RM, Kanter GP, Polsky D .
Association of physician group participation in Accountable Care Organizations with patient social and clinical characteristics.
JAMA Netw Open 2019 Jan 4;2(1):e187220. doi: 10.1001/jamanetworkopen.2018.7220..
Keywords: Health Services Research (HSR), Medicare, Vulnerable Populations
Klig JE, Fang A, Fox SM
2018 Academic Emergency Medicine Consensus Conference: Advancing Pediatric Emergency Medicine Education Through Research and Scholarship.
To achieve high-quality emergency care for pediatric patients nationwide, it is necessary to define the key elements for pediatric emergency medicine (PEM) education and scholarship. A working group of medical educators was formed to review the literature, develop a framework for consensus discussion at the breakout session, and then translate their findings into recommendations for future research and scholarship.
AHRQ-funded; HS026101.
Citation: Klig JE, Fang A, Fox SM .
2018 Academic Emergency Medicine Consensus Conference: Advancing Pediatric Emergency Medicine Education Through Research and Scholarship.
Acad Emerg Med 2018 Dec;25(12):1327-35. doi: 10.1111/acem.13632..
Keywords: Emergency Department, Children/Adolescents, Health Services Research (HSR)
I Auerbach, M Badaki-Makun, O
AHRQ Author: Barata
A research agenda to advance pediatric emergency care through enhanced collaboration across emergency departments.
In 2018, the Society for Academic Emergency Medicine and the journal Academic Emergency Medicine (AEM) convened a consensus conference entitled, "Academic Emergency Medicine Consensus Conference: Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps." This article is the product of the breakout session, "Emergency Department Collaboration-Pediatric Emergency Medicine in Non-Children's Hospital."
AHRQ-funded; HS026101.
Citation: I Auerbach, M Badaki-Makun, O .
A research agenda to advance pediatric emergency care through enhanced collaboration across emergency departments.
Acad Emerg Med 2018 Dec;25(12):1415-26. doi: 10.1111/acem.13642..
Keywords: Care Coordination, Children/Adolescents, Emergency Department, Evidence-Based Practice, Health Services Research (HSR), Outcomes, Quality of Care, Quality Improvement
Burgette JM, Preisser JS, Rozier RG
Access to preventive services after the integration of oral health care into early childhood education and medical care.
The authors compared children enrolled in North Carolina Early Head Start (EHS) programs with similar children enrolled in Medicaid but not EHS on the use of POHS. They analyzed 4 dependent variables (oral assessment by medical health care provider, oral assessment by oral health care provider, fluoride application by medical health care provider, fluoride application by oral health care provider) by using multivariate logistic regression that controlled for covariates.
AHRQ-funded; HS000032.
Citation: Burgette JM, Preisser JS, Rozier RG .
Access to preventive services after the integration of oral health care into early childhood education and medical care.
J Am Dent Assoc 2018 Dec;149(12):1024-31.e2. doi: 10.1016/j.adaj.2018.07.019..
Keywords: Access to Care, Children/Adolescents, Dental and Oral Health, Health Services Research (HSR), Medicaid, Patient-Centered Healthcare, Prevention
Adelgais KM, Hansen M, Lerner EB
Establishing the key outcomes for pediatric emergency medical services research.
The evidence supporting best practices when treating children in the prehospital setting or even the effect emergency medical services (EMS) has on patient outcomes is limited. This article describes a consensus process among stakeholders in the pediatric emergency medicine and EMS community that identified the critical outcomes for EMS care in five clinical areas (traumatic brain injury, general injury, respiratory disease/failure, sepsis, and seizures).
AHRQ-funded; HS026101.
Citation: Adelgais KM, Hansen M, Lerner EB .
Establishing the key outcomes for pediatric emergency medical services research.
Acad Emerg Med 2018 Dec;25(12):1345-54. doi: 10.1111/acem.13637..
Keywords: Children/Adolescents, Emergency Medical Services (EMS), Evidence-Based Practice, Health Services Research (HSR), Outcomes, Patient-Centered Outcomes Research
Marshall IJ, Noel-Storr A, Kuiper J
Machine learning for identifying randomized controlled trials: an evaluation and practitioner's guide.
The purpose of this study was to evaluate machine learning models for RCT classification. Models were evaluated on an external dataset. The authors demonstrate that machine learning approaches are better able to discriminate between RCTs and non-RCTs than traditional database search filters, and also provide practical guidance on the role of machine learning in systematic reviews, and rapid reviews and clinical question answering as well as an open-source software.
AHRQ-funded; HS025024.
Citation: Marshall IJ, Noel-Storr A, Kuiper J .
Machine learning for identifying randomized controlled trials: an evaluation and practitioner's guide.
Res Synth Methods 2018 Dec;9(4):602-14. doi: 10.1002/jrsm.1287..
Keywords: Evidence-Based Practice, Health Services Research (HSR), Research Methodologies
Van Domelen DR, Mitchell EM, Perkins NJ
AHRQ Author: Mitchell EM
Logistic regression with a continuous exposure measured in pools and subject to errors.
A logistic regression model for poolwise data is available, but validity requires that the assay yields the precise mean exposure for members of each pool. To account for errors, the authors assume the assay returns the true mean exposure plus a measurement error (ME) and/or a processing error (PE). They describe their process in this paper.
AHRQ-authored.
Citation: Van Domelen DR, Mitchell EM, Perkins NJ .
Logistic regression with a continuous exposure measured in pools and subject to errors.
Stat Med 2018 Nov 30;37(27):4007-21. doi: 10.1002/sim.7891.
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Keywords: Health Services Research (HSR)