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
876 to 900 of 12139 Research Studies DisplayedAli MM, McClellan C, Mutter R
AHRQ Author: McClellan C
Recreational marijuana laws and the misuse of prescription opioids: evidence from National Survey on Drug Use and Health microdata.
Using micro data from the National Survey on Drug Use and Health, researchers examined the relationship between recreational marijuana laws (RMLs) and the misuse of prescription opioids. They found that RML adoption reduced the likelihood of misusing prescription opioids; however, this initial effect appeared to dissipate 2 or 3 years after RML adoption, when the relationship to the likelihood of misusing prescription opioids became positive.
AHRQ-authored.
Citation: Ali MM, McClellan C, Mutter R .
Recreational marijuana laws and the misuse of prescription opioids: evidence from National Survey on Drug Use and Health microdata.
Health Econ 2023 Feb; 32(2):277-301. doi: 10.1002/hec.4620..
Keywords: Opioids, Medication, Substance Abuse, Behavioral Health, Policy
Robertson SE, Steingrimsson JA, Dahabreh IJ
Regression-based estimation of heterogeneous treatment effects when extending inferences from a randomized trial to a target population.`
This study looked at recent work on estimating target population conditional average treatment effects (CATEs) using baseline covariate, treatment, and outcome data from the trial and covariate data from the target population that only allows for the examination of heterogeneity over distinct subgroups. The authors described flexible pseudo-outcome regression modeling methods for estimating target population CATEs conditional on discrete or continuous baseline covariates when the trial is embedded in a sample from the target population (i.e., in nested trial designs). They constructed pointwise confidence intervals for the CATE at a specific value of the effect modifiers and uniform confidence bands for the CATE function. Last, they illustrated the methods using data from the Coronary Artery Surgery Study (CASS) to estimate CATEs given history of myocardial infarction and baseline ejection fraction value in the target population of all trial-eligible patients with stable ischemic heart disease.
AHRQ-funded; HS028373.
Citation: Robertson SE, Steingrimsson JA, Dahabreh IJ .
Regression-based estimation of heterogeneous treatment effects when extending inferences from a randomized trial to a target population.`
Eur J Epidemiol 2023 Feb; 38(2):123-33. doi: 10.1007/s10654-022-00901-5..
Keywords: Research Methodologies
Ehmann MR, Mitchell J, Levin S
Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis.
The purpose of this retrospective study was to investigate the relationship between intravenous contrast media (CM) administration and persistent acute kidney injury (AKI) in patients with pre-existing AKI. The researchers used propensity-weighted and entropy-balanced observational cohort analysis of consecutive hospitalized patients aged 18 years or older who met the Kidney Disease Improving Global Outcomes (KDIGO) creatinine-based criteria for AKI upon arrival at one of three emergency departments between 7/ 2017 and 6/2021. Patients either received or did not receive intravenous CM. The analysis included 14,449 patient encounters, with 12.8% admitted to the intensive care unit (ICU). The study found that CM was administered in 18.4% of all encounters. AKI resolved before hospital discharge in 69.1% of cases. No association between intravenous CM administration and persistent AKI was found after unadjusted multivariable logistic regression modeling, propensity weighting, and entropy balancing. Similar results were obtained from sub-group analysis of patients admitted to the ICU. Initiation of dialysis within 180 days occurred in 5.4% of the cohort, with no observed association between CM administration and increased risk of dialysis within this timeframe.
AHRQ-funded; HS027793; HS02664002.
Citation: Ehmann MR, Mitchell J, Levin S .
Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis.
Intensive Care Med 2023 Feb; 49(2):205-15. doi: 10.1007/s00134-022-06966-w..
Keywords: Kidney Disease and Health, Adverse Drug Events (ADE), Adverse Events, Outcomes
Crits-Christoph P, Gallop R, Duong L
Repeated assessments of depressive symptoms in randomized psychosocial intervention trials: best practice for analyzing symptom change over time.
Keywords: Depression, Behavioral Health, Research Methodologies
Optional keywords: mental psychotherapy
Summary
The purpose of this study was to investigate the optimal statistical model for analyzing time effects in psychotherapy randomized trials, specifically when the primary outcome involves repeated assessments of depression symptoms. The researchers utilized data from three studies comparing psychotherapy treatments for major depressive disorder. Self-report ratings were used in Study 1 (N=237) and Study 2 (N=100), while clinician ratings were utilized in Study 3 (N=120). Depression symptoms were assessed at every session in Studies 1 and 2 and monthly in Study 3. Time patterns examined included linear, quadratic, cubic, logarithmic transformation of time, piecewise linear, and unstructured models. The researchers found that in Study 1, a logarithmic-linear model demonstrated the best fit. Study 2 found that all models had negligible support compared to the unstructured model, which was the best fitting. In Study 3, although the cubic model displayed the best fit, it was not significantly superior to the log-linear or unstructured model. The study concluded that when evaluating repeated measures of depression symptoms as the primary outcome, trials should consistently compare various time models, including an unstructured model.
Optional keywords: mental psychotherapy
Summary
The purpose of this study was to investigate the optimal statistical model for analyzing time effects in psychotherapy randomized trials, specifically when the primary outcome involves repeated assessments of depression symptoms. The researchers utilized data from three studies comparing psychotherapy treatments for major depressive disorder. Self-report ratings were used in Study 1 (N=237) and Study 2 (N=100), while clinician ratings were utilized in Study 3 (N=120). Depression symptoms were assessed at every session in Studies 1 and 2 and monthly in Study 3. Time patterns examined included linear, quadratic, cubic, logarithmic transformation of time, piecewise linear, and unstructured models. The researchers found that in Study 1, a logarithmic-linear model demonstrated the best fit. Study 2 found that all models had negligible support compared to the unstructured model, which was the best fitting. In Study 3, although the cubic model displayed the best fit, it was not significantly superior to the log-linear or unstructured model. The study concluded that when evaluating repeated measures of depression symptoms as the primary outcome, trials should consistently compare various time models, including an unstructured model.
AHRQ-funded; HS018440
Citation: Crits-Christoph P, Gallop R, Duong L .
Repeated assessments of depressive symptoms in randomized psychosocial intervention trials: best practice for analyzing symptom change over time.
Psychother Res 2023 Feb;33(2):158-72. doi: 10.1080/10503307.2022.2073289.
Keywords: Depression, Behavioral Health, Research Methodologies
Ervin JN, Vitous CA, Wells EE
Rescue Improvement Conference: a novel tool for addressing failure to rescue.
The objective of this study was to understand the effectiveness of the Rescue Improvement Conference, a forum that addresses failure to rescue (FTR). FTR is the phenomenon where delayed recognition or response to surgical complications leads to a progressive cascade of adverse events culminating in patient death. The authors used 5 indicators of effectiveness: educational value, conference takeaways, discussion time, changes to surgical practice, and opportunities for improvement and conducted semi-structured interviews. The results showed that conference felt that the Rescue Improvement Conference was effective in all five indicators. The authors concluded that the conference has the potential to support other surgical departments in developing system-level strategies to recognize and manage postoperative complications that contribute to FTR.
AHRQ-funded; HS024403; HS023621.
Citation: Ervin JN, Vitous CA, Wells EE .
Rescue Improvement Conference: a novel tool for addressing failure to rescue.
Ann Surg 2023 Feb; 277(2):233-37. doi: 10.1097/sla.0000000000004832..
Keywords: Surgery, Adverse Events, Patient Safety, Quality of Care, Quality Improvement
Carey K, Lin MY
Safety-net hospital performance under comprehensive care for joint replacement.
The objective of this study was to investigate the relative progress of safety-net hospitals (SNHs) under Medicare's Comprehensive Care for Joint Replacement (CJR) mandatory bundled payment model and to identify contributors to SNHs' realization of success under the CJR program. Secondary data on all CJR hospitals from 2016-2020 were taken from CMS public use files and from the American Hospital Association. The findings indicated that SNHs were less successful in meeting spending targets when compared to CJR hospitals overall. The authors concluded that the formula used by CMS to determine spending targets may not be sufficient to address disparities in SNH financial performances under mandatory bundled payment.
AHRQ-funded; HS027786.
Citation: Carey K, Lin MY .
Safety-net hospital performance under comprehensive care for joint replacement.
Health Serv Res 2023 Feb; 58(1):101-06. doi: 10.1111/1475-6773.14042..
Keywords: Hospitals, Surgery, Orthopedics, Provider Performance
Giordano NA, Swan BA, Johnson TM
Scalable and sustainable approaches to address the well-being of healthcare personnel.
This article discusses current research that stemmed from a HRSA grant to implement interventions to reduce burnout and optimize behavioral health in the healthcare workforce as part of their Health and Public Safety Workforce Resilient Training Program. A total of 34 awards were made, with the common focus on implementing individual-level mindfulness and compassion-based interventions. The authors are one of the awardees and discuss their efforts to implement a program called Atlanta’s Resiliency Resource fOr frontline Workers (ARROW). This program offers comprehensive resources for resiliency enrichment, mindfulness training and professional development for clinicians and staff working within metropolitan Atlanta healthcare systems. The authors hope to address concerns regarding the paucity of long-term data following participation in mindfulness training, the use of heterogenous and unscalable interventions and restricted enrollment that hinders generalizability.
AHRQ-funded; HS026232.
Citation: Giordano NA, Swan BA, Johnson TM .
Scalable and sustainable approaches to address the well-being of healthcare personnel.
J Adv Nurs 2023 Feb; 79(2):e12-e15. doi: 10.1111/jan.15505..
Keywords: Burnout, Provider: Health Personnel, Stress
Sonik RA, Coleman-Jensen A, Creedon TB
SNAP participation and emergency department use.
The objectives of this study were to examine whether Supplemental Nutrition Assistance Program (SNAP) participation is associated with emergency department use among low-income children, and whether any such association is mediated by household food hardship and child health status and/or moderated by special health care needs (SHCN) status. Researched pooled cross-sectional samples of children in low-income households from 2016-19 National Survey of Children's Health. SNAP participation was found to be associated with lower likelihoods of emergency department use. The researchers concluded that food hardship relief may improve outcomes for vulnerable children as well as the health systems that serve them.
poverty food
Citation: Sonik RA, Coleman-Jensen A, Creedon TB .
SNAP participation and emergency department use.
Pediatrics 2023 Feb;151(2):e2022058247. doi: 10.1542/peds.2022-058247.
Keywords: Children/Adolescents, Nutrition, Vulnerable Populations, Low-Income, Emergency Department
Aswani MS, Roberts ET
Social risk adjustment in the hospital readmission reduction program: pitfalls of peer grouping, measurement challenges, and potential solutions.
The objective of this study was to investigate the limitations of peer grouping and associated challenges in the measurement of social risk in Medicare's Hospital Readmission Reduction Program (HRRP). Public data on hospitals in the HRRP were used to examine the relationship between hospital dual share and readmission rates within peer groups as well as changes in hospital peer group assignments, readmission rates, and penalties, and the relationship between state Medicaid eligibility rules and peer groups. The findings indicated that peer grouping is limited in the extent to which it accounts for differences in hospitals' patient populations. The authors concluded that problems arise from the construction of peer groups and the measure of social risk used to define them.
AHRQ-funded; HS026727.
Citation: Aswani MS, Roberts ET .
Social risk adjustment in the hospital readmission reduction program: pitfalls of peer grouping, measurement challenges, and potential solutions.
Health Serv Res 2023 Feb; 58(1):51-59. doi: 10.1111/1475-6773.13969..
Keywords: Hospital Readmissions, Hospitals, Risk
Kanbar LJ, Dexheimer Jw, Zahner J
Standardizing electronic health record ventilation data in the pediatric long-term mechanical ventilator-dependent population.
This research aimed to create a framework for standardizing mechanical ventilation terminology using ventilator data for a cohort of children who were weaned from mechanical ventilation (MV) to long-term mechanical ventilation (LTMV). Currently there is a lack of data standardization which is a major barrier to data sharing. The authors proposed a framework for standardizing the data using a common data model (CDM) across multiple populations and sites. They extracted and described relevant electronic health record (EHR) ventilation data. They developed a framework for Clinical Ideas into the PEDSnet CDM based on the Observational Medical Outcomes Partnership (OMOP). They identified 78 children with LMTV dependence who were weaned from ventilator support. They found 25 unique device names and 28 unique ventilation mode names used in the cohort. They decided on the following data concepts: device, interface, ventilation mode, settings, measurements, and duration of ventilation usage per day. They used Concepts from the SNOMED-CT vocabulary and integrated an existing ventilator mode taxonomy to create a framework for CDM and OMOP integration.
AHRQ-funded; HS026393.
Citation: Kanbar LJ, Dexheimer Jw, Zahner J .
Standardizing electronic health record ventilation data in the pediatric long-term mechanical ventilator-dependent population.
Pediatr Pulmonol 2023 Feb; 58(2):433-40. doi: 10.1002/ppul.26204..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT)
Tracer H, Barnhart H
AHRQ Author: Tracer H
Statin use for the primary prevention of cardiovascular disease in adults.
In this Putting Prevention into Practice case study to increase understanding of the USPSTF final recommendation on statin use for the primary prevention of cardiovascular disease (CVD) in adults, a 66-year-old woman presents for a wellness visit. The patient’s smoking history, blood pressure, VMI, and cholesterol levels are described. Three multiple-choice questions are presented regarding when to initiate statin use, and other information provided in the final recommendation.
AHRQ-authored.
Citation: Tracer H, Barnhart H .
Statin use for the primary prevention of cardiovascular disease in adults.
Am Fam Physician 2023 Feb; 107(2):185-86..
Keywords: U.S. Preventive Services Task Force (USPSTF), Medication, Prevention
Song J, Chae S, Bowles KH
The identification of clusters of risk factors and their association with hospitalizations or emergency department visits in home health care.
The purpose of this retrospective cohort study was to identify risk factor clusters in home health care and assess whether the clusters are related with hospitalizations or emergency department visits. The researchers included 61,454 patients associated with 79,079 episodes receiving home health care from one of the largest home health care organizations in the U.S. The study found that a total of 11.6% of home health episodes resulted in hospitalizations or emergency department visits. Three clusters were formed by the risk factors: 1) Cluster 1- a combination of risk factors related to situations where patients may experience increased pain ("impaired physical comfort with pain"). 2) Cluster 2 - characterized by multiple comorbidities or other risks for hospitalization (e.g., prior falls, called "high comorbidity burden"). 3) Cluster 3 - "impaired cognitive/psychological and skin integrity" which includes dementia or skin ulcer. The risk of hospitalizations or emergency department visits increased by 1.95 times for Cluster 2 and by 2.12 times for Cluster 3 when compared to cluster 1. The study concluded that Varying combinations of risk factors affected the likelihood of negative outcomes.
AHRQ-funded; HS027742.
Citation: Song J, Chae S, Bowles KH .
The identification of clusters of risk factors and their association with hospitalizations or emergency department visits in home health care.
J Adv Nurs 2023 Feb; 79(2):593-604. doi: 10.1111/jan.15498..
Keywords: Emergency Department, Hospitalization, Home Healthcare, Risk
Ding Y, Miller GE
AHRQ Author: Ding Y, Miller GE
The impact of sharing drug rebates at the point of sale on out-of-pocket payments for enrollees in employer-sponsored insurance.
The purpose of this study was to estimate the effect of sharing drug rebates at the point of sale on out-of-pocket spending by connecting estimated rebates to administrative claims data for employer-sponsored insurance enrollees in 2018. The researchers utilized the drug rebate rate with the retail price of each brand name drug fill, and the reductions were allocated to out-of-pocket spending based on cost-sharing provisions. Individual out-of-pocket spending was aggregated across drug fills. It was assumed that generic drugs have no rebates for employer-sponsored insurance. The impact of sharing rebates at the point of sale on out-of-pocket spending overall, for therapeutic classes and specific drugs with the highest average out-of-pocket spending per user, and by health plan type was assessed. The study found that across four simulations with different assumptions about cross-fill effects, 10.4% to 12.2% of enrollees in the sample would have realized savings on out-of-pocket spending if rebates were shared at the point of sale. Among those with savings, approximately half would save $50 or less, and 10% would save more than $500 annually. A premium increase of $1.06 to $1.41 per member per month among the continuously enrolled, insured population would be sufficient to finance the out-of-pocket savings in the sample.
AHRQ-authored.
Citation: Ding Y, Miller GE .
The impact of sharing drug rebates at the point of sale on out-of-pocket payments for enrollees in employer-sponsored insurance.
Value Health 2023 Feb; 26(2):226-33. doi: 10.1016/j.jval.2022.08.001..
Keywords: Health Insurance, Medication
Herman WH, Bullock A, Boltri JM
AHRQ Author: Tracer H
The National Clinical Care Commission report to Congress: background, methods, and foundational recommendations.
This AHRQ-authored paper describes the background, methods, and recommendations of the National Clinical Care Commission (NCCC) focused on factors likely to improve the delivery of high-quality care to all people with diabetes. It is the first in a series of five articles describing the recommendations. The Commission made recommendations at all levels: patient, practice, health system, and health policy. This is the first paper in a series of five articles about the NCCC recommendations. The five articles include recommendations to 1) reduce diabetes-related risks, prevent type 2 diabetes, and avert diabetes complications through changes in federal policies and programs affecting the general population; 2) prevent type 2 diabetes in at-risk individuals through targeted lifestyle and medication interventions; and 3) improve the treatment of diabetes and its complications to improve the health outcomes of people with diabetes. This first article reviews the successes and limitations of previous federal efforts to combat diabetes, describes the establishment of and charge to the NCCC, and discusses the development of a hybrid conceptual model that guided the NCCC’s novel all-of-government approach to address diabetes as a societal and medical problem. The authors then review the procedures used by the NCCC to gather information from federal agencies, stakeholders, key informants, and the public and to conduct literature reviews. Finally, they review the NCCC's three foundational recommendations: 1) improve the coordination of non-health-related and health-related federal agencies to address the social and environmental conditions that are accelerating the diabetes epidemic; 2) ensure that all Americans at risk for and with diabetes have health insurance and access to health care; and 3) ensure that all federal policies and programs promote health equity in diabetes.
AHRQ-authored; AHRQ-funded.
Citation: Herman WH, Bullock A, Boltri JM .
The National Clinical Care Commission report to Congress: background, methods, and foundational recommendations.
Diabetes Care 2023 Feb; 46(2):e14-e23. doi: 10.2337/dc22-0611..
Keywords: Diabetes, Chronic Conditions, Prevention, Research Methodologies
Schillinger D, Bullock A, Powell C
The National Clinical Care Commission report to Congress: leveraging federal policies and programs for population-level diabetes prevention and control: recommendations from the National Clinical Care Commission.
The purpose of this article was to explore and consider the National Clinical Care Commission’s (NCCC) population-wide recommendations focusing on food systems; consumption of water over beverages sweetened with sugar; labeling of food and beverages; marketing and advertising; workplace, ambient, and built environments; and research to address the myriad of complex factors contributing to Type 1 and 2 diabetes. The authors’ recommendations are directed toward federal policies, agencies, departments and programs, including the Environmental Protection Agency, the Food and Drug Administration, the Department of Housing and Urban Development, and others.
AHRQ-funded.
Citation: Schillinger D, Bullock A, Powell C .
The National Clinical Care Commission report to Congress: leveraging federal policies and programs for population-level diabetes prevention and control: recommendations from the National Clinical Care Commission.
Diabetes Care 2023 Feb; 46(2):e24-e38. doi: 10.2337/dc22-0619..
Keywords: Diabetes, Chronic Conditions, Policy, Prevention
Greenlee MC, Bolen S, Chong W
The National Clinical Care Commission report to Congress: leveraging federal policies and programs to improve diabetes treatment and reduce complications.
This paper is the fourth in a series of five articles describing the recommendations of the National Clinician Care Commission (NCCC) on diabetes care. This paper focused on the recommendations of the Treatment and Complications subcommittee of the National Clinical Care Commission. The Commission made recommendations at all levels: patient, practice, health system, and health policy. They also identified several areas that need additional research, such as studying the barriers to uptake of diabetes self-management education and support, exploring methods to implement team-based care, and evaluating the importance of digital connectivity as a social determinant of health.
AHRQ-funded.
Citation: Greenlee MC, Bolen S, Chong W .
The National Clinical Care Commission report to Congress: leveraging federal policies and programs to improve diabetes treatment and reduce complications.
Diabetes Care 2023 Feb; 46(2):e51-e59. doi: 10.2337/dc22-0621..
Keywords: Diabetes, Chronic Conditions, Policy, Prevention, Quality of Life
Boltri JM, Tracer H, Strogatz D
AHRQ Author: Tracer H
The National Clinical Care Commission report to Congress: leveraging federal policies and programs to prevent diabetes in people with prediabetes.
This article described the recommendations of a National Clinical Care Commission subcommittee focused primarily on the prevention of type 2 diabetes in people with prediabetes. The goal of these recommendations is to improve current Federal diabetes prevention activities by increasing awareness of and diagnosis of prediabetes on a population basis, facilitating FDA review and approval of metformin for diabetes prevention, and supporting research to enhance the effectiveness of diabetes prevention. The recommendations also highlight the importance of research to advance understanding of the etiology of and opportunities for prevention of type 1 diabetes.
AHRQ-authored; AHRQ-funded.
Citation: Boltri JM, Tracer H, Strogatz D .
The National Clinical Care Commission report to Congress: leveraging federal policies and programs to prevent diabetes in people with prediabetes.
Diabetes Care 2023 Feb; 46(2):e39-e50. doi: 10.2337/dc22-0620..
Keywords: Diabetes, Prevention, Chronic Conditions
Herman WH, Schillinger D, Bolen S
AHRQ Author: Tracer H
The National Clinical Care Commission report to Congress: recommendations to better leverage federal policies and programs to prevent and control diabetes.
This AHRQ-authored article is an overview paper of the recommendations of the National Clinical Care Commission (NCCC) Report to Congress to better leverage federal policies and programs to prevent and control diabetes. The NCCC surveyed federal agencies and conducted follow-up meetings with representatives from 10 health-related and 11 non-health-related federal agencies. They held 12 public meetings, solicited comments, met with numerous interested parties and key informants, and performed comprehensive literature reviews. The final report was transmitted to Congress in January 2022 and contained 39 specific recommendations, including 3 foundational recommendations that addressed the necessity of an all-of-government approach to diabetes, health equity, and access to health care. Recommendations were made at the general population level and the individual level to strengthen federal policies and programs to increase awareness of prediabetes and remove barriers to proven effective treatments for diabetes and its complications.
AHRQ-authored; AHRQ-funded.
Citation: Herman WH, Schillinger D, Bolen S .
The National Clinical Care Commission report to Congress: recommendations to better leverage federal policies and programs to prevent and control diabetes.
Diabetes Care 2023 Feb; 46(2):255-61. doi: 10.2337/dc22-1587..
Keywords: Diabetes, Chronic Conditions, Policy, Prevention
Conlin PR, Boltri JM, Bullock A
The National Clinical Care Commission report to Congress: summary and next steps.
This article summarized recommendations of the National Clinical Care Commission (NCCC) to prevent and control diabetes and its complications more effectively. The NCCC has determined that diabetes should not be considered solely as a medical problem but must also as a societal problem. Its recommendations cover policies and programs of both non-health-related and health-related federal agencies, including three recommendations that: non-health-related and health-related federal agencies coordinate their activities to better address diabetes; all federal agencies and departments ensure health equity as a guiding principle for their policies and programs that impact diabetes; all Americans have access to comprehensive and affordable health care. The NCCC also recommends that a coordinating Office of National Diabetes Policy be established.
AHRQ-authored; AHRQ-funded.
Citation: Conlin PR, Boltri JM, Bullock A .
The National Clinical Care Commission report to Congress: summary and next steps.
Diabetes Care 2023 Feb; 46(2):e60-e63. doi: 10.2337/dc22-0622..
Keywords: Diabetes, Chronic Conditions, Policy, Prevention
Tierney WM, Henning JM, Altillo BS
User-centered design of a clinical tool for shared decision-making about diet in primary care.
This study described how the authors engaged primary care clinicians and their patients in an iterative design process for a software application to enhance clinician-patient diet discussions. The goal is to help prevent clinician burnout and career dissatisfaction brought on by poorly designed health information technology. Individual clinician and patient interviews were conducted to detail the desired informational content of the screens displayed followed by iterative reviews of intermediate and final versions of the program and its outputs. Participants were primary care clinicians practicing in an urban federally qualified health center and two academic primary care clinics, and their patients who were overweight or obese with diet-sensitive conditions. Three iterations of design and review were conducted with substantial evolution of the program’s content, format, and flow of information. The amount of information was fine-tuned so it would be just the right amount displayed to facilitate shared dietary goal setting.
AHRQ-funded; HS027660.
Citation: Tierney WM, Henning JM, Altillo BS .
User-centered design of a clinical tool for shared decision-making about diet in primary care.
J Gen Intern Med 2023 Feb; 38(3):715-26. doi: 10.1007/s11606-022-07804-x..
Keywords: Patient-Centered Healthcare, Decision Making, Primary Care
Westley L, Manworren RCB, Griffith DM
Using hospital incident command systems to respond to the pediatric mental and behavioral health crisis of the COVID-19 pandemic.
The purpose of this study was to quantify issues related to hospital incident command systems (HICS) implemented to expand mental and behavioral healthcare (MBHC) services during the COVID-19 pandemic, and track progress toward HICS goals. The researchers analyzed data on patient census, nurse vacancies, staff injuries, and staff perceptions and resources were developed. The study found that after HICS implementation, 84% of nurses reported confidence in providing care to youth with acute MBHC needs.
AHRQ-funded; HS026385.
Citation: Westley L, Manworren RCB, Griffith DM .
Using hospital incident command systems to respond to the pediatric mental and behavioral health crisis of the COVID-19 pandemic.
J Nurs Adm 2023 Feb; 53(2):96-103. doi: 10.1097/nna.0000000000001254..
Keywords: COVID-19, Children/Adolescents, Behavioral Health, Hospitals
Conley CC, Wernli KJ, Knerr S
Using protection motivation theory to predict intentions for breast cancer risk management: intervention mechanisms from a randomized controlled trial.
The objective of this study was to evaluate direct and indirect effects of a web-based, Protection Motivation Theory (PMT)-informed education and decision support tool for risk-reducing medication and breast MRI among women with high risk of breast cancer. Findings indicated that PMT-informed intervention effected behavioral intentions. No direct intervention effect on intentions for risk-reducing medication or MRI were found, but there were significant indirect effects on risk-reducing medication intentions via perceived risk, self-efficacy, and response efficacy, and on MRI intentions via perceived risk and response efficacy, The authors suggested that future research should extend these findings from intentions to behavior.
AHRQ-funded; HS022982.
Citation: Conley CC, Wernli KJ, Knerr S .
Using protection motivation theory to predict intentions for breast cancer risk management: intervention mechanisms from a randomized controlled trial.
J Cancer Educ 2023 Feb; 38(1):292-300. doi: 10.1007/s13187-021-02114-y..
Keywords: Cancer: Breast Cancer, Cancer, Risk, Education: Patient and Caregiver, Health Information Technology (HIT)
Jaramillo ET, Willging CE, Saldana L
Barriers and facilitators to implementing evidence-based interventions in the context of a randomized clinical trial in the United States: a qualitative study.
This study examined factors that facilitate or impede success in the implementation of evidence-based interventions in a clinical trial. This study utilized the clinical trial SafeCare®, a child maltreatment intervention. Qualitative data were obtained between May and October 2017 as part of a larger mixed-methods study involving a cluster randomized trial comparing SafeCare to usual services for caregivers within nine child welfare agencies across four states. Individual interviews were conducted with a purposive sample of 21 child welfare administrators and 24 supervisors, and 19 focus groups were conducted with 84 providers. Facilitators and barriers were determined with facilitators including: 1) Benefits afforded through RCT participation; (2) Shared vision and sustained buy-in across system and organizational levels; and (3) Ongoing leadership support for SafeCare and the RCT. The three barriers identified that hindered SafeCare were: (1) Insufficient preparation to incorporate SafeCare into services; (2) Perceived lack of fit, leading to mixed support for SafeCare and the RCT; and (3) Requirements of RCT participation at the provider level.
AHRQ-funded; HS023370.
Citation: Jaramillo ET, Willging CE, Saldana L .
Barriers and facilitators to implementing evidence-based interventions in the context of a randomized clinical trial in the United States: a qualitative study.
BMC Health Serv Res 2023 Jan 26; 23(1):88. doi: 10.1186/s12913-023-09079-2..
Keywords: Evidence-Based Practice, Health Services Research (HSR)
Becker MW, Kashy DA, Harben A
A novel strategy to optimize critical information on over the counter labels for older adults.
In this article, the authors described two experiments in which they evaluated the impact of over-the-counter (OTC) medication label designs that employ highlighting and warning labels placed on package fronts on the attention and use of critical information by older consumers. In both experiments. participants aged 65 or over were required to access and use critical label information to respond correctly to questions. Highlighting or placing critical information on the front of packaging significantly improved response accuracy. The authors concluded that these results are relevant for regulations which dictate label design to further ease and safety of use of medications for older adults.
AHRQ-funded; HS025386.
Citation: Becker MW, Kashy DA, Harben A .
A novel strategy to optimize critical information on over the counter labels for older adults.
Health Sci Rep 2023 Jan 25; 6(1):e1062. doi: 10.1002/hsr2.1062..
Keywords: Elderly, Medication: Safety, Medication, Patient Safety, Communication
Moise N, Paniagua-Avila A, Barbecho JM
A theory-informed, rapid cycle approach to identifying and adapting strategies to promote sustainability: optimizing depression treatment in primary care clinics seeking to sustain collaborative care (the transform depcare study).
This study used a collaborative care (CC) use case to describe a novel, theory-informed, stakeholder engaged process for operationalizing strategies for sustainability using a behavioral lens. The goal is to optimize depression treatment in primary care clinics using the Transform DepCare shared decision-making and psychoeducation patient tool. The authors applied the Behaviour Change Wheel to their prior mixed methods to identify key sustainability behaviors and determinants of sustainability. The authors enlisted 22 national and local stakeholders to operationalize and adapt a multi-level, multi-component implementation strategy to maximally target behavioral and contextual determinants of sustainability. They identified ongoing care manager CC delivery, provider treatment optimization, and patient enrollment as key sustainability behaviors. They determined that a waiting room that delivered DepCare, the results of which are delivered to providers, as well as ongoing problem-solving meetings/local technical assistance with care managers would be the most acceptable and equitable multi-level strategy in diverse settings seeking to sustain CC programs. Key improvements would include expanding the DepCare tool to incorporate anxiety/suicide screening, triage support, multi-modal delivery, and patient activation (vs. shared decision making) (patient); pairing summary reports with decisional support and yearly onboarding/motivational educational videos (provider); incorporating behavioral health providers into problem-solving meetings and shifting from billing support to quality improvement and triage (system).
AHRQ-funded; HS025198.
Citation: Moise N, Paniagua-Avila A, Barbecho JM .
A theory-informed, rapid cycle approach to identifying and adapting strategies to promote sustainability: optimizing depression treatment in primary care clinics seeking to sustain collaborative care (the transform depcare study).
Implement Sci Commun 2023 Jan 25; 4(1):10. doi: 10.1186/s43058-022-00383-2..
Keywords: Depression, Primary Care, Behavioral Health, Patient-Centered Healthcare, Patient-Centered Outcomes Research