- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
- Access to Care (383)
- Adverse Drug Events (ADE) (307)
- Adverse Events (709)
- Alcohol Use (60)
- Ambulatory Care and Surgery (194)
- Antibiotics (223)
- Antimicrobial Stewardship (145)
- Anxiety (45)
- Arthritis (129)
- Asthma (115)
- Autism (31)
- Back Health and Pain (56)
- Behavioral Health (643)
- Blood Clots (60)
- Blood Pressure (96)
- Blood Thinners (71)
- Brain Injury (61)
- Breast Feeding (18)
- Burnout (55)
- Cancer (729)
- Cancer: Breast Cancer (189)
- Cancer: Cervical Cancer (18)
- Cancer: Colorectal Cancer (113)
- Cancer: Lung Cancer (73)
- Cancer: Ovarian Cancer (9)
- Cancer: Prostate Cancer (99)
- Cancer: Skin Cancer (12)
- Cardiovascular Conditions (657)
- Care Coordination (100)
- Caregiving (213)
- Care Management (224)
- Case Study (102)
- Catheter-Associated Urinary Tract Infection (CAUTI) (54)
- Centers for Education and Research on Therapeutics (CERTs) (12)
- Central Line-Associated Bloodstream Infections (CLABSI) (59)
- Children's Health Insurance Program (CHIP) (40)
- Children/Adolescents (1419)
- Chronic Conditions (669)
- Clinical Decision Support (CDS) (180)
- Clinician-Patient Communication (271)
- Clostridium difficile Infections (54)
- Colonoscopy (36)
- Communication (366)
- Community-Acquired Infections (55)
- Community-Based Practice (141)
- Community Partnerships (17)
- Comparative Effectiveness (463)
- Complementary and Alternative Medicine (22)
- Comprehensive Unit-based Safety Program (CUSP) (9)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (82)
- COVID-19 (255)
- Critical Care (206)
- Cultural Competence (57)
- Data (177)
- Decision Making (572)
- Dementia (96)
- Dental and Oral Health (58)
- Depression (231)
- Diabetes (356)
- Diagnostic Safety and Quality (505)
- Dialysis (24)
- Digestive Disease and Health (108)
- Disabilities (66)
- Disparities (406)
- Domestic Violence (28)
- Ear Infections (4)
- Education (30)
- Education: Academic (24)
- Education: Continuing Medical Education (154)
- Education: Curriculum (22)
- Education: Patient and Caregiver (226)
- Elderly (903)
- Electronic Health Records (EHRs) (695)
- Electronic Prescribing (E-Prescribing) (23)
- Emergency Department (520)
- Emergency Medical Services (EMS) (159)
- Emergency Preparedness (26)
- Evidence-Based Practice (876)
- Eye Disease and Health (29)
- Falls (82)
- Family Health and History (68)
- Genetics (92)
- Guidelines (345)
- Healthcare-Associated Infections (HAIs) (405)
- Healthcare Cost and Utilization Project (HCUP) (350)
- Healthcare Costs (755)
- Healthcare Delivery (528)
- Healthcare Utilization (376)
- Health Information Exchange (HIE) (50)
- Health Information Technology (HIT) (1310)
- Health Insurance (407)
- Health Literacy (119)
- Health Promotion (75)
- Health Services Research (HSR) (319)
- Health Status (129)
- Health Systems (92)
- Heart Disease and Health (435)
- Hepatitis (41)
- Home Healthcare (131)
- Hospital Discharge (206)
- Hospitalization (506)
- Hospital Readmissions (309)
- Hospitals (706)
- Human Immunodeficiency Virus (HIV) (247)
- Hypertension (25)
- Imaging (229)
- Implementation (181)
- Infectious Diseases (249)
- Influenza (39)
- Injuries and Wounds (194)
- Inpatient Care (199)
- Intensive Care Unit (ICU) (248)
- Kidney Disease and Health (182)
- Labor and Delivery (106)
- Learning Health Systems (39)
- Lifestyle Changes (133)
- Long-Term Care (213)
- Low-Income (162)
- Maternal Care (139)
- Medicaid (335)
- Medical Devices (64)
- Medical Errors (189)
- Medical Expenditure Panel Survey (MEPS) (182)
- Medical Liability (26)
- Medicare (538)
- Medication (1585)
- Medication: Safety (213)
- Men's Health (49)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (72)
- Mortality (381)
- Neonatal Intensive Care Unit (NICU) (43)
- Neurological Disorders (186)
- Newborns/Infants (237)
- Nursing (104)
- Nursing Homes (311)
- Nutrition (129)
- Obesity (238)
- Obesity: Weight Management (100)
- Opioids (280)
- Organizational Change (71)
- Orthopedics (99)
- Osteoporosis (30)
- Outcomes (760)
- Pain (202)
- Palliative Care (136)
- Patient-Centered Healthcare (442)
- Patient-Centered Outcomes Research (1025)
- Patient Adherence/Compliance (225)
- Patient and Family Engagement (266)
- Patient Experience (248)
- Patient Safety (1249)
- Patient Self-Management (135)
- Payment (191)
- Pneumonia (76)
- Policy (415)
- Practice-Based Research Network (PBRN) (16)
- Practice Improvement (32)
- Practice Patterns (298)
- Pregnancy (295)
- Pressure Ulcers (27)
- Prevention (757)
- Primary Care (680)
- Primary Care: Models of Care (87)
- Provider (299)
- Provider: Clinician (63)
- Provider: Health Personnel (84)
- Provider: Nurse (102)
- Provider: Pharmacist (86)
- Provider: Physician (215)
- Provider: Physician Assistant (1)
- Provider Performance (187)
- Public Health (169)
- Public Reporting (41)
- Quality Improvement (532)
- Quality Indicators (QIs) (136)
- Quality Measures (221)
- Quality of Care (946)
- Quality of Life (191)
- Racial and Ethnic Minorities (693)
- Registries (146)
- Rehabilitation (87)
- Research Methodologies (405)
- Respiratory Conditions (341)
- Risk (732)
- Rural/Inner-City Residents (4)
- Rural Health (116)
- Screening (426)
- Sepsis (130)
- Sex Factors (63)
- Sexual Health (113)
- Sickle Cell Disease (48)
- Simulation (46)
- Skin Conditions (114)
- Sleep Problems (66)
- Social Determinants of Health (330)
- Social Media (45)
- Social Stigma (52)
- Spinal Cord Injury (9)
- Stress (71)
- Stroke (152)
- Substance Abuse (273)
- Surgery (1048)
- Surveys on Patient Safety Culture (13)
- System Design (15)
- Teams (131)
- TeamSTEPPS (16)
- Telehealth (228)
- Tobacco Use (78)
- Tobacco Use: Smoking Cessation (20)
- Tools & Toolkits (48)
- Training (137)
- Transitions of Care (181)
- Transplantation (130)
- Trauma (97)
- Treatments (183)
- U.S. Preventive Services Task Force (USPSTF) (201)
- Uninsured (75)
- Urban Health (86)
- Urinary Tract Infection (UTI) (65)
- Vaccination (150)
- Value (197)
- Veterans (119)
- Vitamins and Supplements (28)
- Vulnerable Populations (201)
- Web-Based (84)
- Women (498)
- Workflow (58)
- Workforce (85)
- Young Adults (81)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 11363 Research Studies Displayed
Huff NR, Liu G, Chimowitz H
COVID-19 related negative emotions and emotional suppression are associated with greater risk perceptions among emergency nurses: a cross-sectional study.
The objectives of this study were to investigate the relationship between emergency nurses' emotional experiences in response to the COVID-19 pandemic and their perceptions of risk to both patients and themselves, and also to investigate the extent to which the use of suppression and reappraisal processes for emotion management were associated with these perceptions. Nurses' negative emotions in response to the pandemic were associated with greater perceptions of both personal and patient safety risks. Chronic tendencies to suppress emotions uniquely predicted higher perceptions of risk. The authors concluded that understanding the factors that influence perceptions of risk are important, since these perceptions can motivate behaviors that may impact patient safety adversely.
Citation: Huff NR, Liu G, Chimowitz H . COVID-19 related negative emotions and emotional suppression are associated with greater risk perceptions among emergency nurses: a cross-sectional study. Int J Nurs Stud Adv 2023 Dec; 5:100111. doi: 10.1016/j.ijnsa.2022.100111.
Keywords: COVID-19, Emergency Department, Provider: Nurse
Chatrath S, Silverberg JI
Phenotypic differences of atopic dermatitis stratified by age.
Atopic dermatitis (AD) is a prevalent condition affecting individuals of all age groups. A deeper understanding of the diverse age-related phenotypes can enhance AD treatment strategies. The purpose of this study was to identify clinical phenotypes of AD associated with different age groups. A prospective study involving 380 participants was conducted in a dermatology practice setting. AD severity was assessed through questionnaires and comprehensive physical examinations. The study included 23 (6.1%) pediatric patients (<18 years), 176 (46.3%) young adults (18-39 years), and 181 (47.6%) older adults (≥ 40 years). The study found that both young and older adults displayed a lower likelihood of AD on the ankles, moderate to severe AD on flexures, pityriasis alba, weeping lesions, moderate to severe excoriations, and intense itching in comparison to pediatric patients. Young adults had more AD around the eyes. Older adults exhibited increased AD on elbows, nipples, knees, keratosis pilaris, and lichenification. Four distinct classes were identified regarding AD distribution and related signs.
Citation: Chatrath S, Silverberg JI . Phenotypic differences of atopic dermatitis stratified by age. JAAD Int 2023 Jun;11:1-7. doi: 10.1016/j.jdin.2022.08.026.
Keywords: Skin Conditions
Lowry KP, Ichikawa L, Hubbard RA
Variation in second breast cancer risk after primary invasive cancer by time since primary cancer diagnosis and estrogen receptor status.
This study examined the timing of second breast cancers by primary cancer estrogen receptor (ER) status in the Breast Cancer Surveillance Consortium. The cohort studied included women who were diagnosed with American Joint Commission on Cancer stage I-III breast cancer identified within six Breast Cancer Surveillance Consortium registries from 2000 to 2017. Characteristics collected during primary breast cancer diagnosis included demographics, ER status, and treatment. Second breast cancer events included subsequent ipsilateral or contralateral breast cancers diagnosed >6 months after primary diagnosis. Cumulative incidence and second breast cancer rates by primary cancer ER status during 1-5 versus 6-10 years after diagnosis was examined. At 10 years, the cumulative second breast cancer incidence was 11.8% for women with ER-negative disease and 7.5% for those with ER-positive disease. Women with ER-negative cancer had higher second breast cancer rates than those with ER-positive cancer during the first 5 years of follow-up. After 5 years, second breast cancer rates were similar for women with ER-negative versus ER-positive breast cancer.
Citation: Lowry KP, Ichikawa L, Hubbard RA . Variation in second breast cancer risk after primary invasive cancer by time since primary cancer diagnosis and estrogen receptor status. Cancer 2023 Apr 15;129(8):1173-82. doi: 10.1002/cncr.34679.
Keywords: Cancer: Breast Cancer, Cancer, Women, Risk
Steeves-Reece AL, Davis MM, Hiebert Larson J
Patients' willingness to accept social needs navigation after in-person versus remote screening.
The authors conducted a cross-sectional study in order to assess possible adverse effects of screening patients remotely on patient engagement and interest in accepting social needs navigation. Participants were Medicare and Medicaid beneficiaries in the Oregon Accountable Health Communities (AHC) model. The results indicated that over 70% of participants were willing to accept help with social needs; neither the mode of screening nor interaction term were significantly associated with willingness to accept navigation assistance. The authors concluded remote screening may not adversely affect patient willingness to accept health care-based navigation for social needs.
Citation: Steeves-Reece AL, Davis MM, Hiebert Larson J . Patients' willingness to accept social needs navigation after in-person versus remote screening. J Am Board Fam Med 2023 Apr 3;36(2):229-39. doi: 10.3122/jabfm.2022.220259R1.
Keywords: Telehealth, Screening, Health Information Technology (HIT), Social Determinants of Health
Steiger KG, Boehmer KR, Klanderman MC
Who is most burdened in health care? An analysis of responses to the ICAN Discussion Aid.
The objective of this study was to create a model based on patients' characteristics that predicted the number of burdens reported using the ICAN Discussion Aid, in order to target use of this tool to the patients most likely to benefit. Participants were 635 adult patients who completed the ICAN Aid at a Scottsdale, Arizona, family medicine clinic; patient characteristics were gathered from their health records. The results showed that the number of burdens a patient will report on the ICAN Aid can be approximated based on certain patient characteristics. Adults with major depression, a BMI of 26 or greater, and those of a younger age may have greater reported burdens on ICAN. The authors noted that these finding will need to be validated in independent samples.
AHRQ-funded; HS026379; HS026379.
Citation: Steiger KG, Boehmer KR, Klanderman MC . Who is most burdened in health care? An analysis of responses to the ICAN Discussion Aid. J Am Board Fam Med 2023 Apr 3;36(2):277-88. doi: 10.3122/jabfm.2022.220251R1.
Keywords: Depression, Behavioral Health
Wendel CL, LaPierre TA, Sullivan DL
"Anything that benefits the workers should benefit the client": opportunities and constraints in self-directed care during the COVID-19 pandemic.
The purpose of this study was to assess how self-directed care (SDC) models reacted to the COVID-19 pandemic and to examine the impact of COVID-19 on Home and Community Based Services (HCBS) services in Kansas. The study found that self-directed consumers carried levels of employer responsibility with limited resources and systemic barriers contributing to unmet care needs, stress, and burden. Flexibilities in policies related to the hiring of family members were helpful, but inadequate to address working conditions lacking in resources and labor shortages that were amplified by the pandemic.
Citation: Wendel CL, LaPierre TA, Sullivan DL . "Anything that benefits the workers should benefit the client": opportunities and constraints in self-directed care during the COVID-19 pandemic. J Appl Gerontol 2023 Apr; 42(4):7334648221143604. doi: 10.1177/07334648221143604.
Keywords: COVID-19, Patient Self-Management
Sibley AL, Baker R, Levander XA
"I am not a junkie": social categorization and differentiation among people who use drugs.
The purpose of this qualitative study, framed by Social Identity Theory/Self-Categorization Theory, was to investigate strategies of within-group categorization and differentiation among people who use drugs (PWUD) and the roles these social categories play in shaping intragroup attitudes, perceptions, and behaviors. Data were taken from the Rural Opioid Initiative. Through interviews with participating PWUDs, researchers identified several facets of identity, behavioral and demographic, along which PWUDs perceived salient social boundaries. Patterns of categorization and differentiation revealed negative intragroup attitudes, including stigma, that may hinder collective action in this marginalized group.
Citation: Sibley AL, Baker R, Levander XA . "I am not a junkie": social categorization and differentiation among people who use drugs. Int J Drug Policy 2023 Apr;114:103999. doi: 10.1016/j.drugpo.2023.103999.
Keywords: Substance Abuse, Behavioral Health, Social Stigma
Straccia A, Chassagne F, Bass DI
A novel patient-specific computational fluid dynamics study of the activation of primary collateral pathways in the Circle of Willis during vasospasm.
This study presented a novel technique to create patient-specific computational fluid dynamics simulations of the Circle of Willis (a redundant network of blood vessels that perfuses the brain) before and during vasospasm. Computed tomographic angiography scans are segmented to model the vasculature, and transcranial Doppler ultrasound measurements of blood flow velocity are applied as boundary conditions. The authors stated that this analysis can be applied in future to a cohort of patients to investigate the relationship between the locations and severities of vasospasm, anatomical variability in individuals’ Circle of Willis, and the activation of collateral pathways.
Citation: Straccia A, Chassagne F, Bass DI . A novel patient-specific computational fluid dynamics study of the activation of primary collateral pathways in the Circle of Willis during vasospasm. J Biomech Eng 2023 Apr;145(4):041008. doi: 10.1115/1.4055813.
Keywords: Cardiovascular Conditions, Simulation
Nembhard IM, David G, Ezzeddine I
A systematic review of research on empathy in health care.
This systematic review’s aim was to summarize the predictors and outcomes of empathy by health care personnel, methods used to study their empathy, and the effectiveness of interventions targeting their empathy, in order to advance understanding of the role of empathy in health care and facilitate additional research aimed at increasing positive patient care experiences and outcomes. English-language publications were searched for empirical studies of research from 1971 to April 2021. Out of 2270 articles, 455 reporting on 270 analyses satisfied the inclusion criteria. The authors found that most studies have been survey-based, cross-sectional examinations. Greater empathy is associated with better clinical outcomes and patient care experiences; and empathy predictors are many and fall into five categories (provider demographics, provider characteristics, provider behavior during interactions, target characteristics, and organizational context). One-hundred twenty-eight intervention studies were found of which 80% found a positive and significant effect. Except for 4 studies, interventions were educational programs focused on individual clinicians or trainees.
Citation: Nembhard IM, David G, Ezzeddine I . A systematic review of research on empathy in health care. Health Serv Res 2023 Apr;58(2):250-63. doi: 10.1111/1475-6773.14016.
Keywords: Provider: Health Personnel, Patient Experience
Goodsmith N, Dossett EC, Gitlin R
Acceptability of reproductive goals assessment in public mental health care.
The purpose of this study was to evaluate the perspectives of patients and clinicians on the feasibility of assessing reproductive objectives in public mental health facilities and provide insights for potential customization in these environments. The researchers analyzed primary qualitative data from clients and healthcare providers at four urban public mental health centers catering to individuals with persistent mental disorders (gathered between November 2020 and October 2021). This exploratory qualitative investigation involved female patients of reproductive age who spoke English and were predominantly Black or Latina, as well as mental health professionals (psychiatrists, therapists, case managers, nurses). The study focused on the acceptability of evaluating reproductive aspirations in mental health treatment and gathered input on two discussion guides for reproductive goals assessment: PATH (Pregnancy Attitudes, Timing, and Importance of Pregnancy Prevention) and OKQ (One Key Question). Semi-structured phone interviews were conducted with 22 patients and 36 healthcare providers. Rapid qualitative analysis was employed to summarize interview transcripts, and matrix analysis was used to identify themes. The study found that attitudes towards reproductive goals assessment were generally favorable. Clinicians believed that the discussion guides would "initiate" essential conversations, enhance comprehension of patients' objectives, and aid in medication guidance and planning. A small number of patients expressed unease or uncertainty; some recommended that providers seek permission or enable patients to introduce the subject. Additional themes encompassed the necessity for contextual framing to address personal inquiries, the importance of establishing rapport before posing questions, and the difficulty of managing multiple priorities. Several participants found both PATH and OKQ prompts acceptable; some favored the "dialogue-based" and "open-ended" phrasing of PATH.
Citation: Goodsmith N, Dossett EC, Gitlin R . Acceptability of reproductive goals assessment in public mental health care. Health Serv Res 2023 Apr;58(2):510-20. doi: 10.1111/1475-6773.14111.
Keywords: Behavioral Health, Women, Sexual Health
McClintock HF, Edmonds SE, Bogner HR
Adherence patterns to oral hypoglycemic agents among primary care patients with type 2 diabetes.
This study’s objective was to examine patterns of adherence to oral hypoglycemic agents among primary care patients with type 2 diabetes mellitus and to assess whether these patterns were associated with baseline intervention allocation, sociodemographic characteristics, and clinical indicators. Adherence patterns for 72 participants were examined by Medication Event Monitoring System (MEMS) caps at baseline and 12 weeks. Participants were randomly allocated to a Patient Prioritized Planning (PPP) intervention or a control group. A card-sort task was used in the PPP intervention to identify health-related priorities that included social determinants of health to address medication nonadherence. Afterward, a problem-solving process was used to address unmet needs involving referral to resources. Patients were found to be either adherent, increasingly adherent, or non-adherent. Participants assigned to the PPP intervention were significantly more likely to have a pattern of improving adherence and adherence than participants assigned to the control group.
Citation: McClintock HF, Edmonds SE, Bogner HR . Adherence patterns to oral hypoglycemic agents among primary care patients with type 2 diabetes. Prim Care Diabetes 2023 Apr;17(2):180-84. doi: 10.1016/j.pcd.2023.01.014.
Keywords: Diabetes, Patient Adherence/Compliance, Primary Care, Medication, Chronic Conditions
McHugh M, Philbin S, Carroll AJ
An approach to evaluating multisector partnerships to support evidence-based quality improvement in primary care.
This study’s goal was to describe an approach for evaluating the development and effectiveness of a multisector partnership using data from the first year of the Healthy Hearts for Michigan (HH4M) Cooperative, a multisector partnership of nine organizations tasked with designing and implementing evidence-based QI strategies for hypertension management and tobacco cessation in 50 rural primary care practices. A 49-item survey focused on factors that facilitate or hinder multisector partnerships, drawing on implementation science and partnership, engagement, and collaboration research was developed. All 44 members of the HH4M Cooperative (79.5% response rate) were surveyed, interviews conducted with 14 members. Having a clear purpose and trust and respect among members were the strengths reported. A need for common terminology, clarification of roles and functions, and improvement in communication across workgroups were areas for improvement. The Cooperative’s biggest challenge was the lack of engagement from physician practices due to capacity constraints, exacerbated by the COVID-19 pandemic.
Citation: McHugh M, Philbin S, Carroll AJ . An approach to evaluating multisector partnerships to support evidence-based quality improvement in primary care. Jt Comm J Qual Patient Saf 2023 Apr;49(4):199-206. doi: 10.1016/j.jcjq.2023.01.002.
Keywords: Quality Improvement, Evidence-Based Practice, Primary Care, Quality of Care, Patient-Centered Outcomes Research
Levin JS, Komanduri S, Whaley C
Association between hospital-physician vertical integration and medication adherence rates.
This study’s goal was to test the association between vertical integration of primary care providers (PCPs) and adherence rates for anti-diabetics, renin angiotensin system antagonists (RASA), and statins. Data was extracted from Medicare Part B outpatient fee-for-service claims and Medicare Part D event data from 2014 to 2017. There was a 23% increase in the proportion of patients who had a vertically integrated PCP during the study period. Changes in adherence did not differ significantly between patients based on whether their PCP became integrated. However, among patients with PCPs who become integrated, there were significant decreases in patients who were above 80 years old, were Black, Asian, Hispanic, or Native America, and had greater comorbidities for all three classes.
Citation: Levin JS, Komanduri S, Whaley C . Association between hospital-physician vertical integration and medication adherence rates. Health Serv Res 2023 Apr; 58(2):356-64. doi: 10.1111/1475-6773.14090.
Keywords: Medication, Patient Adherence/Compliance, Medicare, Primary Care
Sun EC, Rishel CA, Waljee JF
Association between state limits on opioid prescribing and the incidence of persistent postoperative opioid use among surgical patients.
The objective of this study was to examine whether laws limiting opioid prescribing were associated with reductions in the incidence of persistent postoperative opioid use. Over identified 950,000 privately insured patients who had undergone one of 10 procedures were identified; researchers then estimated the association between persistent postoperative opioid use and whether state opioid prescribing limits were in effect on the day of surgery. The findings suggested that laws limiting opioid prescriptions were not associated with subsequent reductions in persistent postoperative opioid use.
Citation: Sun EC, Rishel CA, Waljee JF . Association between state limits on opioid prescribing and the incidence of persistent postoperative opioid use among surgical patients. Ann Surg 2023 Apr;277(4):e759-e65. doi: 10.1097/sla.0000000000005283.
Keywords: Opioids, Medication, Surgery, Substance Abuse, Practice Patterns
Katz AJ, Chen RC, Usinger DS
Cardiovascular disease prevention and management of pre-existent cardiovascular disease in a cohort of prostate cancer survivors.
This study examined receipt of preventive care and management of pre-existing cardiovascular disease (CVD) in a prospective cohort of men newly diagnosed with prostate cancer between 2011 and 2013 throughout North Carolina linked to Medicare and private insurance claims and clinical data from the Veterans Affairs (VA). Primary outcome for patients with pre-existent CVD was a composite measure of annual preventive care (blood glucose screening, cholesterol level testing, and ≥ 1 primary care provider visit). The sample comprised 492 patients successfully linked to insurance claims and/or VA data, among whom 103 (20.9%) had pre-existent CVD. Receipt of preventive care declined from 52.7% during the first year after prostate cancer diagnosis to 40.8% during the third year. Among patients with pre-existent CVD, only 23.4% saw a cardiologist in all 3 years. Black men were more likely than White men to visit a cardiologist during the first year after diagnosis.
Citation: Katz AJ, Chen RC, Usinger DS . Cardiovascular disease prevention and management of pre-existent cardiovascular disease in a cohort of prostate cancer survivors. J Cancer Surviv 2023 Apr;17(2):351-59. doi: 10.1007/s11764-022-01229-5.
Keywords: Cardiovascular Conditions, Cancer: Prostate Cancer, Cancer, Prevention
Arcia A, Pho AT, Lor M
Comparison of newest vital sign and brief health literacy screen scores in a large, urban Hispanic cohort.
The purpose of this study was to examine the relationship between Newest Vital Sign (NVS) and Brief Health Literacy Screen (BHLS) scores in a large cohort of English- and Spanish-speaking urban Hispanic adults. Scores on both measures showed good internal consistency but NVS items had high difficulty; greater than 50% of respondents scored 0. The correlation between measures was weak. The study concluded that health literacy scores were poor predictors of objective scores.
AHRQ-funded; HS019853; HS022961.
Citation: Arcia A, Pho AT, Lor M . Comparison of newest vital sign and brief health literacy screen scores in a large, urban Hispanic cohort. Patient Educ Couns 2023 Apr; 109:107628. doi: 10.1016/j.pec.2023.107628
Keywords: Health Literacy, Racial and Ethnic Minorities, Urban Health
Barnett S, Matthews K, DeWindt L
Deaf Weight Wise: a novel randomized clinical trial with Deaf sign language users.
The purpose of this research was to address the lack of scientifically supported weight management programs specifically designed for the Deaf population. The researchers developed the Deaf Weight Wise (DWW) trial and intervention which was informed by community-based participatory research. The primary focus of DWW is promoting a healthy lifestyle and weight management through dietary adjustments and physical activity. A total of 104 Deaf adults aged 40 to 70 years, with a BMI ranging from 25 to 45, were recruited from community settings in Rochester, New York. Participants were randomized into either immediate intervention (n = 48) or a 1-year delayed intervention group (n = 56). The latter group served as a no-intervention control until the trial's midpoint. Data were collected at five time points (every six months) from baseline to 24 months. All DWW intervention leaders and participants were Deaf individuals using American Sign Language (ASL). The study found that at the 6-month mark, the average weight change difference between the immediate-intervention group and the delayed-intervention group (no intervention yet) was -3.4 kg. A majority (61.6%) of those in the immediate intervention group lost ≥5% of their baseline weight, compared to 18.1% in the no-intervention-yet group. Indicators of participant engagement included an average attendance of 11/16 sessions (69%), and 92% completed the 24-month data collection. The researchers concluded that the DWW program, which is community-engaged, culturally tailored, and provides language accessibility, successfully supported weight loss among Deaf ASL users.
Citation: Barnett S, Matthews K, DeWindt L . Deaf Weight Wise: a novel randomized clinical trial with Deaf sign language users. Obesity 2023 Apr;31(4):965-76. doi: 10.1002/oby.23702.
Keywords: Obesity: Weight Management, Disabilities, Obesity
Djulbegovic B, Hozo I, Lizarraga D
Decomposing clinical practice guidelines panels' deliberation into decision theoretical constructs.
The creation of clinical practice guidelines (CPG) is hindered by the absence of a clear and transparent structure for integrating key components needed to develop practice recommendations. The purpose of the study was to compare the American Society of Hematology (ASH) CPG panel's deliberations for managing pulmonary embolism (PE) to relevant decision-theoretic constructs to evaluate the concordance between panel recommendations and explicit decision modeling. Five constructs were identified, with three employed to rephrase the panel's recommendations: 1) a standard, expected utility threshold (EUT) decision model; 2) an acceptable regret threshold model (ARg) for determining the acceptable frequency of false negative (FN) or false positive (FP) recommendations, and 3) fast-and-frugal tree (FFT) decision trees for devising a comprehensive strategy for PE management. The researchers compared four management approaches: withholding testing versus D-dimer → computerized pulmonary angiography (CTPA) ('ASH-Low') versus CTPA → D-dimer ('ASH-High') versus treatment without testing. The study found that various models yielded diverse recommendations. For instance, EUT suggested that testing should be withheld for prior PE probability <0.13%, a clinically implausible threshold up to 15 times (2/0.13) lower than the ASH guidelines threshold for excluding PE (at post probability of PE ≤2%). Only three models concurred that the 'ASH low' strategy should be applied to pretest PE probabilities between 0.13% and 13.27% and that the 'ASH high' approach should be utilized in a narrow range of prior PE probabilities between 90.85% and 93.07%. For all other prior PE probabilities, selecting one model did not guarantee consistency with other models
Citation: Djulbegovic B, Hozo I, Lizarraga D . Decomposing clinical practice guidelines panels' deliberation into decision theoretical constructs. J Eval Clin Pract 2023 Apr;29(3):459-71. doi: 10.1111/jep.13809.
Keywords: Guidelines, Evidence-Based Practice, Decision Making
Burden M, Keniston A, Gundareddy VP
Discharge in the A.M.: a randomized controlled trial of physician rounding styles to improve hospital throughput and length of stay.
In an effort to alleviate hospital capacity constraints, medical facilities frequently promote the prioritization of early morning discharges, which could potentially lead to unintended repercussions. The purpose of this study was to investigate the impact of hospitalist physicians focusing on discharging patients before attending to other tasks in comparison to their customary rounding practices. This prospective, multi-center randomized controlled trial involved three major academic hospitals. Participants included Hospital Medicine attending-level physicians and the patients under their care during the study, who were at least 18 years old, admitted to a Medicine service, and assigned to a hospitalist team through routine procedures. Physicians were randomized into two groups: 1) giving precedence to discharging patients as care permitted or 2) maintaining their usual practice. The primary outcome measure was the time of discharge order. Secondary outcomes encompassed actual discharge time, length of stay (LOS), and order timings for procedures, consultations, and imaging. The study found that between February 9, 2021, and July 31, 2021, 59 physicians were randomized to prioritize patient discharges or maintain their usual rounding practice, resulting in the discharge of 4,437 patients. In the primary adjusted analysis (intention-to-treat), there was no significant difference in discharge order time or actual discharge time between physicians who prioritized discharging patients first and those who followed their usual rounding style. Additionally, LOS and order times for other physician orders remained unchanged.
Citation: Burden M, Keniston A, Gundareddy VP . Discharge in the A.M.: a randomized controlled trial of physician rounding styles to improve hospital throughput and length of stay. J Hosp Med 2023 Apr;18(4):302-15. doi: 10.1002/jhm.13060.
Keywords: Hospital Discharge, Hospitals
Kuzma N, Khan A, Rickey L
Effect of Patient and Family Centered I-PASS on adverse event rates in hospitalized children with complex chronic conditions.
This study’s objective was to compare the effect of the intervention Patient and Family Centered (PFC)I-PASS on adverse events (AE) rates in children with and without complex chronic conditions (CCCs). A cohort of 3106 hospitalized children from seven North American pediatric hospitals between December 2014 and January 2017 were included. An effect modification analysis did not show difference in the intervention on children with and without CCCs. There was no statistically significant change in AEs for children with or without CCCs.
Citation: Kuzma N, Khan A, Rickey L . Effect of Patient and Family Centered I-PASS on adverse event rates in hospitalized children with complex chronic conditions. J Hosp Med 2023 Apr;18(4):316-20. doi: 10.1002/jhm.13065.
Keywords: Children/Adolescents, Patient-Centered Healthcare, Chronic Conditions, Adverse Events, Inpatient Care, Transitions of Care
Glenn BA, Crespi CM, Herrmann AK
Effectiveness and feasibility of three types of parent reminders to increase adolescent human papillomavirus (HPV) vaccination.
Efforts to boost human papillomavirus (HPV) vaccination rates among adolescents have seen moderate success with the use of parent notifications. Nonetheless, there is limited research on the comparative efficacy and practicality of various HPV reminder methods in settings with restricted resources. The purpose of this quasi-experimental study (2016-2017) assessed the impact of three types of parent reminders (written correspondence, automated phone calls, and SMS messages) on HPV vaccine uptake for the subsequent dose among 12-year-olds at a prominent Federally Qualified Health Center in Los Angeles County. The researchers matched six clinics into three groups, randomly allocating one clinic from each group to either intervention or control. The intervention clinics were randomly assigned one of the three reminder methods. The researchers determined the rates of vaccine uptake for the next dose and analyzed intervention outcomes using logistic regression models. The proportion of successfully delivered reminders for each method was used as a measure of feasibility. The study included 877 12-year-olds due for an HPV vaccine dose (47% female, more than 85% Latino). The study found that after a 4-month follow-up, 23% of those in the intervention group received an HPV vaccine dose, compared to just 12% in the control group. Overall, receiving any reminder led to higher rates of the next-required HPV vaccine compared to standard care (p = 0.046). Notable improvements were seen with SMS reminders (p = 0.036) and among boys (p = 0.006). Automated phone calls proved to be the least feasible method. Text message reminders are both effective and practical in encouraging HPV vaccination.
Citation: Glenn BA, Crespi CM, Herrmann AK . Effectiveness and feasibility of three types of parent reminders to increase adolescent human papillomavirus (HPV) vaccination. Prev Med 2023 Apr;169:107448. doi: 10.1016/j.ypmed.2023.107448.
Keywords: Children/Adolescents, Vaccination, Sexual Health
Martino SC, Reynolds KA, Grob R
Evaluation of a protocol for eliciting narrative accounts of pediatric inpatient experiences of care.
This study’s objective was to evaluate the measurement properties of a set of six items designed to elicit narrative accounts of pediatric inpatient experience. This cross-sectional survey with follow-up phone interviews used data from 163 participants recruited from a probability-based online panel of US adults. Eligible participants were family members of a child who had an overnight hospital stay in the past 12 months. Participants completed an online (n = 129) or phone (n = 34) survey about their child's hospitalization experience that contained closed-ended items from the Child HCAHPS Survey followed by the six narrative items. About two weeks after completing the survey, 47 participants additionally completed a one-hour, semi-structured phone interview, the results of which served as a "gold standard" for evaluating the fidelity of narrative responses. The average narrative was 248 words, with 79% of narratives mentioning a topic included on the Child HCAHPS survey; 89% mentioning a topic not covered by that survey; 75% including at least one detailed description of an actionable event. Overall, there was a 66% correspondence between narrative and interview responses, with higher correspondence in the phone than in the online condition (75% vs. 59%).
AHRQ-funded; HS025920; HS016978.
Citation: Martino SC, Reynolds KA, Grob R . Evaluation of a protocol for eliciting narrative accounts of pediatric inpatient experiences of care. Health Serv Res 2023 Apr;58(2):271-81. doi: 10.1111/1475-6773.14134.
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Inpatient Care
Fernandes-Taylor S, Yang Q, Yang DY
Greater patient sharing between hospitals is associated with better outcomes for transferred emergency general surgery patients.
The availability of emergency surgical services has diminished as the rural workforce has decreased. The growing need for interhospital patient transfers makes care coordination across different settings essential for maintaining high-quality care. The purpose of this study was to investigate the impact of recurrent patient-sharing between hospitals on the outcomes of emergency general surgery (EGS) patient transfers. A multicenter analysis was conducted involving inpatient acute care hospital stays in Wisconsin that required the transfer of EGS patients. Data was sourced from the Wisconsin Hospital Association (WHA), a comprehensive statewide hospital discharge database for the years 2016-2018. We postulated that a higher percentage of patients transferred between hospitals would lead to improved outcomes. The relationship between the proportion of EGS patient transfers and patient outcomes, such as in-hospital morbidity, mortality, and duration of stay, was examined. Additional factors considered were hospital organizational features and patient sociodemographic and clinical attributes. The researchers found that during the two-year study period, 118 hospitals transferred 3,197 EGS patients; 1,131 of these patients experienced in-hospital complications, death, or an extended stay (beyond the 75th percentile). The average patient age was 62 years, with 50% being female and 5% non-white. In the mixed-effects model, the proportion of shared patients between hospitals was linked to a reduced likelihood of in-hospital complications. Specifically, when the proportion of shared patients doubled between two hospitals, the relative odds of any adverse outcome shifted by 0.85.
Citation: Fernandes-Taylor S, Yang Q, Yang DY . Greater patient sharing between hospitals is associated with better outcomes for transferred emergency general surgery patients. J Trauma Acute Care Surg 2023 Apr;94(5):592-98. doi: 10.1097/ta.0000000000003789.
Keywords: Emergency Department, Hospitals, Surgery, Transitions of Care
Lee AH, McEvoy DS, Stump T
Implementation of an electronic alert to improve timeliness of second dose antibiotics for patients with suspected serious infections in the emergency department: a quasi-randomized controlled trial.
This study analyzed the influence of clinical decision support (CDS) to prevent delays in second doses of broad-spectrum antibiotics in the emergency department (ED). The authors allocated adult patients who received cefepime or piperacillin/tazobactam in 9 EDs within an integrated health care system to an electronic alert that reminded ED clinicians to reorder antibiotics at the appropriate interval vs usual care. Primary outcome was a median delay in antibiotic administration, and secondary outcomes were rates of intensive care unit (ICU) admission, hospital mortality, and hospital length of stay. A total of 1,113 ED patients treated with cefepime or piperacillin/tazobactam were enrolled in the study, of whom 420 remained under ED care when their second dose was due. The electronic alert system was associated with reduced antibiotic delays, but there were no differences in ICU transfers, inpatient mortality, or hospital length of stay.
Citation: Lee AH, McEvoy DS, Stump T . Implementation of an electronic alert to improve timeliness of second dose antibiotics for patients with suspected serious infections in the emergency department: a quasi-randomized controlled trial. Ann Emerg Med 2023 Apr;81(4):485-91. doi: 10.1016/j.annemergmed.2022.10.022.
Keywords: Antibiotics, Medication, Emergency Department, Clinical Decision Support (CDS), Health Information Technology (HIT)
Lee AK, Bobb JF, Richards JE
Integrating alcohol-related prevention and treatment into primary care: a cluster randomized implementation trial.
This study’s goal was to evaluate an implementation intervention to increase (1) population-based alcohol-related prevention with brief interventions and (2) treatment of alcohol use disorder (AUD) in primary care implemented with a broader program of behavioral health integration. This stepped-wedge cluster randomized trial called the Sustained Patient-Centered Alcohol-Related Care (SPARC) trial included 22 primary care practices in an integrated health system in Washington state. Participants consisted of all adult patients 18 years or older with primary care visits from January 2015 to July 2018. The study included 7 waves, with practices randomly assigned launch dates. A total of 333,596 patients visited primary care (mean age, 48 years; 193,583 [58%] female; 234,764 [70%] White individuals). The proportion of patients with brief intervention was higher during SPARC intervention than usual care periods (57 vs 11 per 10,000 patients per month). The proportion with AUD treatment engagement did not differ during intervention and usual care. However, it did increase intermediate outcomes: screening (83.2% vs 20.8%), new AUD diagnosis (33.8 vs 28.8 per 10,000), and treatment initiation (7.8 vs 6.2 per 10,000).
Citation: Lee AK, Bobb JF, Richards JE . Integrating alcohol-related prevention and treatment into primary care: a cluster randomized implementation trial. JAMA Intern Med 2023 Apr;183(4):319-28. doi: 10.1001/jamainternmed.2022.7083.
Keywords: Alcohol Use, Substance Abuse, Behavioral Health, Primary Care, Patient-Centered Healthcare