National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Events (1)
- Ambulatory Care and Surgery (1)
- Antibiotics (3)
- Antimicrobial Stewardship (1)
- Asthma (1)
- Blood Clots (1)
- Blood Pressure (1)
- Blood Thinners (1)
- Cardiovascular Conditions (3)
- Caregiving (1)
- Case Study (1)
- Children/Adolescents (2)
- Chronic Conditions (3)
- Clinical Decision Support (CDS) (1)
- Dental and Oral Health (1)
- Digestive Disease and Health (1)
- Education: Patient and Caregiver (1)
- Elderly (2)
- Electronic Health Records (EHRs) (1)
- Healthcare Costs (2)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (2)
- Health Insurance (1)
- Heart Disease and Health (3)
- Inpatient Care (1)
- (-) Medication (16)
- Medication: Safety (2)
- Opioids (1)
- Patient-Centered Healthcare (2)
- Patient-Centered Outcomes Research (1)
- Patient Safety (4)
- Practice Patterns (3)
- Prevention (2)
- Provider (1)
- Provider: Pharmacist (1)
- Quality Improvement (1)
- Quality of Care (1)
- Respiratory Conditions (1)
- (-) Shared Decision Making (16)
- Sickle Cell Disease (1)
- Surgery (1)
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 16 of 16 Research Studies DisplayedJones YO, Hubbell BB, Thomson J
Things we do for no reason: systemic corticosteroids for wheezing in preschool-aged children.
This installment of the “Things We Do For No Reason” series presents and discusses a case study concerning the administration of systemic corticosteroids in a 4-year-old child presenting with wheezing, tachypnea, and respiratory distress. The authors conclude that current evidence does not support the routine use of systemic corticosteroids for preschool-aged children admitted for mild to moderate wheezing episodes, and that the patient in the introductory case would likely receive no clinical benefit from dexamethasone treatment.
AHRQ-funded; HS025138.
Citation: Jones YO, Hubbell BB, Thomson J .
Things we do for no reason: systemic corticosteroids for wheezing in preschool-aged children.
J Hosp Med 2019 Dec;14(12):774-76. doi: 10.12788/jhm.3255..
Keywords: Children/Adolescents, Respiratory Conditions, Asthma, Case Study, Shared Decision Making, Medication
Leeds IL, DiBrito SR, Canner JK
Cost-benefit limitations of extended, outpatient venous thromboembolism prophylaxis following surgery for Crohn's disease.
This goal of this study was to assess the cost-effectiveness of extended prophylaxis in patients with Crohn's disease after abdominal surgery. A decision tree model was used to assess cost-effectiveness and cost-per-case averted with extended-duration venous thromboembolism prophylaxis following abdominal surgery. Results showed that extended prophylaxis in patients with Crohn's disease postoperatively is not cost-effective when the cumulative incidence of posthospital thrombosis remains less than 4.9%. These findings are driven by the low absolute risk of thrombosis in this population and the considerable cost of universal treatment.
AHRQ-funded; HS024547.
Citation: Leeds IL, DiBrito SR, Canner JK .
Cost-benefit limitations of extended, outpatient venous thromboembolism prophylaxis following surgery for Crohn's disease.
Dis Colon Rectum 2019 Nov;62(11):1371-80. doi: 10.1097/dcr.0000000000001461..
Keywords: Prevention, Digestive Disease and Health, Surgery, Healthcare Costs, Adverse Events, Patient Safety, Blood Clots, Shared Decision Making, Medication
Blecker S, Austrian JS, Horwitz LI
Interrupting providers with clinical decision support to improve care for heart failure.
The goal of this study was to develop a clinical decision support (CDS) system to recommend an angiotenson converting enzyme (ACE) inhibitor during hospitalization so it could be promoted for continuation at discharge. Patients who were hospitalized with reduced ejection fraction were pseudo-randomized to deliver interruptive or non-interruptive CDS alerts to providers based on the patients’ even or odd medical record number. The utilization rate was higher for interruptive alert versus non-interruptive alert hospitalizations for a sample of 958. This resulted in improved quality of care for heart failure patients.
AHRQ-funded; HS023683.
Citation: Blecker S, Austrian JS, Horwitz LI .
Interrupting providers with clinical decision support to improve care for heart failure.
Int J Med Inform 2019 Nov;131:103956. doi: 10.1016/j.ijmedinf.2019.103956..
Keywords: Clinical Decision Support (CDS), Shared Decision Making, Heart Disease and Health, Cardiovascular Conditions, Medication, Medication: Safety, Patient Safety, Quality Improvement, Quality of Care
Moore AB, Navarrett S, Herzig SJ
Potentially inappropriate use of intravenous opioids in hospitalized patients.
This study examined the frequency of potentially inappropriate intravenous (IV) opioid use in hospitalized patients. The researchers looked at patients hospitalized at a tertiary medical center. Patients with cancer, receiving comfort care, or gastrointestinal dysfunction were excluded. Using guidelines from the Society of Hospital Medicine IV doses were defined as potentially inappropriate if administered more than an initial IV does in patients who did not have nil per os status. Of the 200 patients in the study, 31% were administered potentially inappropriate IV opioids at least once during hospitalization, and 33% of all IV doses were potentially administered inappropriately.
AHRQ-funded; HS026215.
Citation: Moore AB, Navarrett S, Herzig SJ .
Potentially inappropriate use of intravenous opioids in hospitalized patients.
J Hosp Med 2019 Nov 1;14(10):678-80. doi: 10.12788/jhm.3225..
Keywords: Opioids, Medication, Inpatient Care, Shared Decision Making
Linsky A, Gellad WF, Linder JA
Advancing the science of deprescribing: a novel comprehensive conceptual framework.
Polypharmacy is common in older adults and associated with inappropriate medication use, adverse drug events, medication nonadherence, higher costs, and increased mortality compared with those without polypharmacy. Deprescribing, the clinically supervised process of stopping or reducing the dose of medications when they cause harm or no longer provide benefit, may improve outcomes. This article discusses a novel comprehensive conceptual framework for deprescribing.
AHRQ-funded; 2332015000201; HS026506; HS024930.
Citation: Linsky A, Gellad WF, Linder JA .
Advancing the science of deprescribing: a novel comprehensive conceptual framework.
J Am Geriatr Soc 2019 Oct;67(10):2018-22. doi: 10.1111/jgs.16136..
Keywords: Medication, Elderly, Shared Decision Making
Wang SV, Rogers JR, Jin Y
Stepped-wedge randomised trial to evaluate population health intervention designed to increase appropriate anticoagulation in patients with atrial fibrillation.
Clinical guidelines recommend anticoagulation for patients with atrial fibrillation (AF) at high risk of stroke; however, studies report 40% of this population is not anticoagulated. The purpose of this study was to evaluate a population health intervention to increase anticoagulation use in high-risk patients with AF. The investigators concluded that algorithms to identify underuse of anticoagulation among patients with AF in healthcare databases may not capture clinical subtleties or patient preferences and may overestimate the extent of undertreatment.
AHRQ-funded; HS022193.
Citation: Wang SV, Rogers JR, Jin Y .
Stepped-wedge randomised trial to evaluate population health intervention designed to increase appropriate anticoagulation in patients with atrial fibrillation.
BMJ Qual Saf 2019 Oct;28(10):835-42. doi: 10.1136/bmjqs-2019-009367..
Keywords: Blood Thinners, Heart Disease and Health, Cardiovascular Conditions, Medication, Health Information Technology (HIT), Shared Decision Making, Electronic Health Records (EHRs), Practice Patterns, Healthcare Utilization
Snyder ME, Jaynes H, Gernant SA
Alerts for community pharmacist-provided medication therapy management: recommendations from a heuristic evaluation.
This study evaluated the effectiveness of alerts for community pharmacist-provided medication therapy management (MTM). The alerts come in five categories: indication, effectiveness, safety, adherence, and cost-containment. The heuristic evaluation used the Instrument for Evaluating Human-Factors Principles in Medication-Related Decision Support Alerts (I-MeDeSA). Four analysts’ individual ratings were summed for each alert, and a mean score on the modified I-MeDeSA was computed. The analysts’ scores were similar. The scores indicated opportunities for improvement across all MTM alert categories including principles of alert prioritization; text-based information; alarm philosophy; and corrective actions.
AHRQ-funded; HS025005.
Citation: Snyder ME, Jaynes H, Gernant SA .
Alerts for community pharmacist-provided medication therapy management: recommendations from a heuristic evaluation.
BMC Med Inform Decis Mak 2019 Jul 16;19(1):135. doi: 10.1186/s12911-019-0866-0..
Keywords: Shared Decision Making, Health Information Technology (HIT), Medication, Provider, Provider: Pharmacist
Suda KJ, Calip GS, Zhou J
Assessment of the appropriateness of antibiotic prescriptions for infection prophylaxis before dental procedures, 2011 to 2015.
This retrospective cohort study examined the use of antibiotic prophylaxis prescribed before dental procedures with patients who have commercial dental insurance. Data from the Truven insurance network was used for claims from 2009 to 2015. Patients in the study were given an antibiotic prescription 7 days before a dental visit. These patients have an appropriate cardiac diagnosis and the median age was 63 and majority female. The majority of dental visits were classified as diagnostic (70.2%) or and/or preventive (58.8%). There were prevalent comorbidities in some patients including prosthetic joint devices (42.5%) and cardiac conditions at higher risk of adverse outcome from infections (20.9%). It was found that 80.9% of antibiotic prescriptions were deemed to be unnecessary based on guidelines.
AHRQ-funded; HS025177.
Citation: Suda KJ, Calip GS, Zhou J .
Assessment of the appropriateness of antibiotic prescriptions for infection prophylaxis before dental procedures, 2011 to 2015.
JAMA Netw Open 2019 May 3;2(5):e193909. doi: 10.1001/jamanetworkopen.2019.3909..
Keywords: Shared Decision Making, Dental and Oral Health, Medication, Practice Patterns, Prevention
Schiff GD, Tripathi JB, Galanter W
Drug formulary decision-making: ethnographic study of 3 pharmacy and therapeutics committees.
This study analyzed the processes of how 3 pharmacy and therapeutic (P&T) committees weighed options and their topics of discussion during meetings. There was a wide range of topics discussed with roughly half the time spent on drug safety than discussions of efficacy. Logistics of using the drugs in their institutions was also a popular topic. The issues varied from drug to drug, and there were quite a few tangential issues raised by committee members.
AHRQ-funded; HS016973.
Citation: Schiff GD, Tripathi JB, Galanter W .
Drug formulary decision-making: ethnographic study of 3 pharmacy and therapeutics committees.
Am J Health Syst Pharm 2019 Apr 8;76(8):537-42. doi: 10.1093/ajhp/zxz022..
Keywords: Shared Decision Making, Medication
Pulia M, Fox B
Antibiotics should not be routinely prescribed after incision and drainage of uncomplicated abscesses.
This article considers recent challenges to the 2013 antimicrobial stewardship recommendation from the American College of Emergency Physicians on avoidance of systemic antibiotic therapy after adequate incision and drainage of uncomplicated abscesses. Although the latest results from randomized controlled trials indicate that there are benefits in favoring antibiotics in the management of uncomplicated abscesses, the authors note that these results have also ‘paradoxically given rise to a unique clinical dilemma that carries significant public health implications’ and may lead to tens of thousands of patients receiving unnecessary antibiotics treatment each year. To limit development of unnecessary antibiotic resistance and reduce possible adverse reactions to antibiotics, the authors propose that antibiotic usage for uncomplicated abscesses be considered only for high-risk patients, such as those with immunocompromised status, a history of MRSA infections, or limited access to follow-up care.
AHRQ-funded; HS024342.
Citation: Pulia M, Fox B .
Antibiotics should not be routinely prescribed after incision and drainage of uncomplicated abscesses.
Ann Emerg Med 2019 Apr;73(4):377-78. doi: 10.1016/j.annemergmed.2018.04.026..
Keywords: Antibiotics, Antimicrobial Stewardship, Shared Decision Making, Medication
Shaffer VA, Wegier P, Valentine KD
Patient judgments about hypertension control: the role of variability, trends, and outliers in visualized blood pressure data.
Uncontrolled hypertension is a significant health problem in the United States, even though multiple drugs exist to effectively treat this chronic disease. As part of a larger project developing data visualizations to support shared decision making about hypertension treatment, the investigators conducted a series of studies to understand how perceptions of hypertension control were impacted by data variations inherent in the visualization of blood pressure (BP) data.
AHRQ-funded; HS023328.
Citation: Shaffer VA, Wegier P, Valentine KD .
Patient judgments about hypertension control: the role of variability, trends, and outliers in visualized blood pressure data.
J Med Internet Res 2019 Mar 26;21(3):e11366. doi: 10.2196/11366..
Keywords: Blood Pressure, Shared Decision Making, Patient-Centered Healthcare, Medication, Chronic Conditions
Chua KP, Fischer MA, Linder JA
Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study.
This study used ICD-10 codes to determine the appropriateness of outpatient antibiotic prescriptions filled in privately insured patients in the US. Determinations were made based on diagnosis whether the prescriptions were “appropriate”, “potentially appropriate”, “inappropriate”, or no diagnosis code found. Among a cohort of over 19 million, only 12.8% were deemed appropriate, 23.2% were inappropriate, 35.5% potentially inappropriate, and 28.% not associated with a diagnosis code.
AHRQ-funded; HS024930; 233201500020I.
Citation: Chua KP, Fischer MA, Linder JA .
Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study.
BMJ 2019 Jan 16;364:k5092. doi: 10.1136/bmj.k5092..
Keywords: Ambulatory Care and Surgery, Antibiotics, Shared Decision Making, Health Insurance, Medication
Smith GH, Shore S, Allen LA
Discussing out-of-pocket costs with patients: shared decision making for sacubitril-valsartan in heart failure.
This study examined how prescription costs can greatly impact decision-making in patients with serious medical conditions. Forty-nine patients with heart failure with reduced ejection fracture were recruited and interviewed about a drug sacrubitril-valsartan. The drug is considered effective but can be costly. Most patients (45/49) said they would take the medicine if the out-of-pocket cost was only $5 per month more than their current medication. But if the costs increased to $100 more per month then only 43% would switch to sacrubritil-valsartan. Only 20% of participants said their physician had discussed medication costs in the past year.
AHRQ-funded; HS026081.
Citation: Smith GH, Shore S, Allen LA .
Discussing out-of-pocket costs with patients: shared decision making for sacubitril-valsartan in heart failure.
J Am Heart Assoc 2019 Jan 8;8(1):e010635. doi: 10.1161/jaha.118.010635..
Keywords: Healthcare Costs, Shared Decision Making, Heart Disease and Health, Cardiovascular Conditions, Medication, Chronic Conditions
Crosby LE, Walton A, Shook LM
Development of a hydroxyurea decision aid for parents of children with sickle cell anemia.
This study developed a decision aid for use of hydroxyurea for parents of children with sickle cell anemia. There are national evidence-based guidelines, but they do not offer strategies for implementation. A multicomponent decision aid was developed via a needs assessment, clinic observations and iterative feedback. The decision aid was considered useful by the 75 parents and 28 clinicians who participated in all phases of the study.
AHRQ-funded; HS021114.
Citation: Crosby LE, Walton A, Shook LM .
Development of a hydroxyurea decision aid for parents of children with sickle cell anemia.
J Pediatr Hematol Oncol 2019 Jan;41(1):56-63. doi: 10.1097/mph.0000000000001257..
Keywords: Caregiving, Children/Adolescents, Chronic Conditions, Shared Decision Making, Education: Patient and Caregiver, Medication, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Sickle Cell Disease
Tamma PD, Miller MA, Cosgrove SE
AHRQ Author: Miller MA
Rethinking how antibiotics are prescribed: incorporating the 4 moments of antibiotic decision making into clinical practice.
This editorial viewpoint discusses structured approaches that emphasize the four critical time points (‘Moments’) in the process of antibiotic prescribing, and which may improve antibiotic decisionmaking by clinicians and communication about antibiotic decisions among health care practitioners. AHRQ’s Safety Program for Improving Antibiotic Use is highlighted, since it features the training of clinicians to incorporate the ‘4 moments’ of antibiotic decisionmaking into their thought processes when prescribing antibiotics. The 4 moments are described and an example provided for each. The authors conclude that an organized approach such as the 4 moments of antibiotic decisionmaking could be helpful if it is used every time antibiotic therapy is considered.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Tamma PD, Miller MA, Cosgrove SE .
Rethinking how antibiotics are prescribed: incorporating the 4 moments of antibiotic decision making into clinical practice.
JAMA 2019 Jan;321(2):139-40. doi: 10.1001/jama.2018.19509..
Keywords: Antibiotics, Shared Decision Making, Medication, Patient Safety, Practice Patterns
Srinivas P, Campbell NL, Clark DO
Understanding older adults' medication decision making and behavior: a study on over-the-counter (OTC) anticholinergic medications.
The purpose of this study was to inform the design of future over the counter (OTC) medication safety interventions for older adults, this study investigated consumers' decision making and behavior related to OTC medication purchasing and use, with a focus on OTC anticholinergic medications. Drawing on study findings and behavioral theories, the model depicted dual processes for OTC medication decision making - habit-based and deliberation-based - as well as the antecedents and consequences of decision making.
AHRQ-funded; HS024384.
Citation: Srinivas P, Campbell NL, Clark DO .
Understanding older adults' medication decision making and behavior: a study on over-the-counter (OTC) anticholinergic medications.
Res Social Adm Pharm 2019 Jan;15(1):53-60. doi: 10.1016/j.sapharm.2018.03.002..
Keywords: Shared Decision Making, Elderly, Medication, Medication: Safety, Patient Safety