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AHRQ Research Studies

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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.

Vila PM, Olsen MA, Piccirillo JF
Rates of sialoendoscopy and sialoadenectomy in 5,111 adults with private insurance.
The purpose of this study was to determine frequencies and trends in sialoendoscopy and sialoadenectomy for the treatment of obstructive, non-neoplastic submandibular salivary gland disease. Researchers conducted an epidemiologic study of insurance claims from 2006 to 2013 in a large, private insurance claims database; 5,111 adults with sialadenitis who had a sialoendoscopy or submandibular gland excision were included. The results of this study indicate that the use of sialoendoscopy procedures has increased over time, while the overall rate of sialoadenectomy has decreased, but the authors conclude that both procedures are safe for the treatment of patients with sialadenitis and sialolithiasis.
Laryngoscope 2019 Dec 16;129(3):602-06. doi: 10.1002/lary.27243.
AHRQ-funded; HS019455.
View abstract on the National Library of Medicine site.
Keywords: Healthcare Utilization, Health Insurance, Surgery
Newman TB, Wu YW, Kuzniewicz MW
Childhood seizures after phototherapy.
A recent Danish study found an increased risk of childhood epilepsy only in boys after phototherapy; researchers investigated this association in a Kaiser Permanente Northern California cohort of infants born after at least 35 weeks' gestation in 1995-2011. The mean follow-up period was 8.1 years. Primary outcome was at least 1 encounter with a seizure diagnosis plus at least 1 prescription for an antiepileptic drug. Results indicated that boys were at higher risk of seizures overall, and had a higher adjusted hazard ratio for phototherapy than girls, although effect modification by sex was not statistically significant. The researchers conclude that infant phototherapy is associated with a small increased risk of childhood seizures, and the risk is more significant in boys.
Pediatrics 2018 Oct;142(4):pii: e20180648. doi: 10.1542/peds.2018-0648.
AHRQ-funded; HS020618.
View abstract on the National Library of Medicine site.
Keywords: Adverse Events, Children/Adolescents, Neurological Disorders, Risk
Wyatt DL
Employing technology to make care transitions safer.
This commentary discusses the potential for errors in patient handoffs; important information about medications and instructions regarding patient care may be overlooked when the patient is referred to special care, moved to a new hospital setting, or discharged. The problem is especially acute for patients with multiple chronic conditions who often undergo frequent transitions to new care settings and healthcare providers. The author describes AHRQ’s funding opportunities for health information technology interventions that aim to improve communication and coordination during care transitions, such as location-based smartphone alerts, a patient-centered discharge toolkit, and a ‘smart pillbox’ electronic medication adherence reporting project.
J Nurs Care Qual 2019 Jul/Sep;34(3):185-88. doi: 10.1097/ncq.0000000000000417.
AHRQ-authored.
View abstract on the National Library of Medicine site.
Keywords: Adverse Events, Care Coordination, Chronic Conditions, Communications, Health Information Technology (HIT), Healthcare Delivery, Hospital Discharge, Medical Errors, Medication, Patient Safety, Transition of Care
AHRQ Author: Wyatt DL
Triebwasser JE, Kamdar NS, Langen ES
Hospital contribution to variation in rates of vaginal birth after cesarean.
The purpose of this retrospective cohort study was to determine the influence of delivery hospital on the rate of vaginal birth after cesarean (VBAC). Claims data were obtained from Blue Cross and Blue Shield of Michigan and included women with a prior cesarean and a singleton live birth. Hospital-specific risk-standardized VBAC rates and the median odds ratio as a measure of variation were calculated. From their results, the authors conclude that the individual delivery hospital contributes to the significant variation in rates of VBAC, after adjustment for patient and hospital characteristics.
J Perinatol 2019 Jul;39(7):904-10. doi: 10.1038/s41372-019-0373-2.
AHRQ-funded; HS025465.
View abstract on the National Library of Medicine site.
Keywords: Hospitals, Labor and Delivery, Maternal Care, Pregnancy, Women
Miglioretti DL, Abraham L, Lee CI
Digital breast tomosynthesis: radiologist learning curve.
This study examined if detect rates and lower recall rates occurred with the adoption of digital breast tomosynthesis (DBT) than for traditional breast mammography. Performance was compared before and after DBT adoption using data from the Breast Cancer Surveillance Consortium cohort. There was a small improvement in recall rates, with more improvement in women with nondense breasts. Cancer detection rates were similar.
Radiology 2019 Apr;291(1):34-42. doi: 10.1148/radiol.2019182305.
AHRQ-funded; HS018366.
View abstract on the National Library of Medicine site.
Keywords: Cancer, Cancer: Breast Cancer, Diagnosis, Imaging, Mammogram, Screening
Joseph A, Khoshkenar A, Taaffe KM
Minor flow disruptions, traffic-related factors and their effect on major flow disruptions in the operating room.
This study researched the impact of minor flow disruptions (FDs) on operating room (OR) flow and how it contributes to an increase in serious adverse events. The rate of minor FDs increases the rate of major FDs. More major and minor FDs occur in the anesthesia area than in all other OR areas. They concluded that room design and layout issues contribute to those FDs and that is an important consideration in OR design.
BMJ Qual Saf 2019 Apr;28(4):276-83. doi: 10.1136/bmjqs-2018-007957.
AHRQ-funded; HS024380.
View abstract on the National Library of Medicine site.
Keywords: Adverse Events, Healthcare Delivery, Patient Safety, Surgery, Workflow
Coe NB, Guo J, Konetzka RT
What is the marginal benefit of payment-induced family care? Impact on Medicaid spending and health of care recipients.
Research on home-based long-term care has centered almost solely on the costs; there has been very little, if any, attention paid to the relative benefits. This study exploited the randomization built into the Cash and Counseling Demonstration and Evaluation program that directly impacted the likelihood of having family involved in home care delivery. The investigators found that some family involvement in home-based care significantly decreased health-care utilization: lower likelihood of emergency room use, Medicaid-financed inpatient days, any Medicaid hospital expenditures, and fewer months with Medicaid-paid inpatient use.
Health Econ 2019 May;28(5):678-92. doi: 10.1002/hec.3873.
AHRQ-authored.
View abstract on the National Library of Medicine site.
Keywords: Home Healthcare, Long-Term Care, Medicaid
AHRQ Author: Guo J
Sorkin DH, Rizzo S, Biegler K
Novel health information technology to aid provider recognition and treatment of major depressive disorder and posttraumatic stress disorder in primary care.
This article describes a multicomponent health information technology screening tool designed to aid provider recognition and treatment of major depressive disorder and posttraumatic stress disorder (PTSD) in the primary care setting, with an eye toward meeting the mental health needs of traumatized refugees in the US Cambodian community. In a randomized controlled trial, 18 primary care providers were randomized to receive access to the mental health screening intervention, or to a minimal intervention control group. Cambodian American patients empaneled to participating providers were assigned to the providers' randomized group. From the results, the authors conclude that this approach offers the potential for training providers to diagnose and treat traumatized patients seeking mental health care in primary care.
Med Care 2019 Jun;57 Suppl 6 Suppl 2:S190-s96. doi: 10.1097/mlr.0000000000001036.
AHRQ-authored.
View abstract on the National Library of Medicine site.
Keywords: Depression, Diagnosis, Health Information Technology (HIT), Mental Health, Primary Care, Primary Care: Models of Care, Racial / Ethnic Minorities, Screening
AHRQ Author: Ngo-Metzger Q
Keller SC, Alexander M, Williams D
Perspectives on central-line-associated bloodstream infection surveillance in home infusion therapy.
This study examined in the differences between 3 professional society members who provide home infusion services in diagnosing and defining central-line-associated bloodstream infections (CLABSIs). The three societies surveyed were members of the Infusion Nurses Society (INS), the National Home Infusion Association (NHIA), and the Society for Healthcare Epidemiology of America Research Network (SRN). The INS is a 6000-member global organization of main nurses who work in all practice settings including home infusion. The NHIA is a 400-member trade organization focused on providing infusion products and services in the home, and SRN is a network of 111 healthcare institutions that collaborate on research to prevent healthcare-associated infections and antibiotic resistance. There was a difference in the criteria used for defining a CLABSI with home testing, and their use of the Association for Professionals in Infection Control/Healthcare Infection Control Practices Advisory Committee (APIC-HICPAC) criteria. Although some perspective was gained from a wide variety of professionals, there was a low response rate, which suggests the possibility of response bias.
Infect Control Hosp Epidemiol 2019 Jun;40(6):729-31. doi: 10.1017/ice.2019.90.
AHRQ-funded; HS025782.
View abstract on the National Library of Medicine site.
Keywords: Home Healthcare, Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Patient Safety
Hass Z, Woodhouse M, Grabowski DC
Assessing the impact of Minnesota's return to community initiative for newly admitted nursing home residents.
This study evaluated the Minnesota Return to Community Initiative (RTCI) program which facilitates community discharge of non-Medicaid nursing home residents. It was implemented statewide without a control group. The program assists with discharge planning, transitioning to the community, and postdischarge follow-up. Results showed the program increased discharge rates by an estimated 11 percent. Success increased with time as nursing home facilities increased their participation.
Health Serv Res 2019 Jun;54(3):555-63. doi: 10.1111/1475-6773.13118.
AHRQ-funded; HS020224.
View abstract on the National Library of Medicine site.
Keywords: Care Coordination, Long-Term Care, Nursing Homes, Transition of Care
Caroff DA, Menchaca JT, Zhang Z
Oral vancomycin prophylaxis during systemic antibiotic exposure to prevent Clostridiodes difficile infection relapses.
This study’s goal was to determine if giving hospitalized patients oral vancomycin along with systematic antibiotics prevents relapse of Cloistridioides difficile infection (CDI). The results show that the outcome was not statistically significant, although it may help patients who have only had 1 prior CDI episode.
Infect Control Hosp Epidemiol 2019 Jun;40(6):662-67. doi: 10.1017/ice.2019.88.
AHRQ-funded; HS025008.
View abstract on the National Library of Medicine site.
Keywords: Antibiotics, Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Medication, Prevention
Alexander GL, Powell K, Deroche CB
Building consensus toward a national nursing home information technology maturity model.
This study describes the development of a nursing home information technology (IT) maturity model in 2 phases. The first phase was to develop a preliminary maturity model. Phase II involved 3 rounds of questionnaires using a Delphi panel of expert nursing home administrators. Three Delphi rounds were done, and this evolved the model from 5-stages (stages 1-5) to a 7-stage model (stages 0-6).
J Am Med Inform Assoc 2019 Jun;26(6):495-505. doi: 10.1093/jamia/ocz006.
AHRQ-funded; HS022497.
View abstract on the National Library of Medicine site.
Keywords: Health Information Technology (HIT), Long-Term Care, Nursing Homes
Heintzman J, Kaufmann J, Ezekiel-Herrera D
Asthma/COPD disparities in diagnosis and basic care utilization among low-income primary care patients.
Obstructive pulmonary disease outcomes in the United States differ between Latinos and non-Hispanic whites. There is little objective data about diagnosis prevalence and primary care visit frequency in these disease processes. In this study, the investigators used electronic health record data to perform a retrospective cohort analysis of 34,849 low-income patients seen at Oregon community health centers between 2009 and 2013 to assess joint racial/ethnic and insurance disparities in diagnosis and visit rates between Latino and non-Hispanic white patients.
J Immigr Minor Health 2019 Jun;21(3):659-63. doi: 10.1007/s10903-018-0798-2.
AHRQ-funded; HS021522.
View abstract on the National Library of Medicine site.
Keywords: Asthma, Chronic Obstructive Pulmonary Disease (COPD), Chronic Conditions, Disparities, Healthcare Utilization, Low-Income, Primary Care, Respiratory Conditions
Chan B, Goldman LE, Sarkar U
High perceived social support and hospital readmissions in an older multi-ethnic, limited English proficiency, safety-net population.
This study examined the association between perceived social support and 30-day hospital readmission or death in older adults. The study used the cohort from the Support From Hospital to Home for Elders (SHHE) trial. Participants were English, Chinese and Spanish-speaking adults living in the community who were admitted to wards at an urban safety-net hospital in San Francisco. Overall readmission or death rate was 15%. Participants had a mean age of 66.2 with the majority being Asian (31.9%), then Black (24.8%), Latino (19.3%) and White (18.8%). Researchers found that those with high social support had half the odds of admission or death than those with low social support. The protection however seemed true only among minorities, and seemed to have the opposite effect among whites.
BMC Health Serv Res 2019 May 24;19(1):334. doi: 10.1186/s12913-019-4162-6.
AHRQ-funded; HS022981.
View abstract on the National Library of Medicine site.
Keywords: Communications, Cultural Competence, Elderly, Hospital Readmissions, Racial / Ethnic Minorities
Schnall R, Carcamo J, Porras T
Use of the phase-based model of smoking treatment to guide intervention development for persons living with HIV who self-identify as African American tobacco smokers.
To address the issue of developing effective tobacco cessation interventions for persons with HIV, this study conducted six focus group sessions with 45 African American smokers who are living with HIV in order to understand barriers to smoking cessation and strategies to help overcome these barriers. The participants articulated key components for incorporation into tobacco cessation intervention: personalized plans for quitting, reminders about the plan, and a support system. Participants also described barriers to use of pharmacotherapy, such as adverse side effects of nicotine gum and patch, and expressed concerns about negative health effects of some oral medications. The authors conclude that their findings provide information on the components of a tobacco cessation intervention for persons living with HIV.
Int J Environ Res Public Health 2019 May 15;16(10). doi: 10.3390/ijerph16101703.
AHRQ-funded; HS025071.
View abstract on the National Library of Medicine site.
Keywords: Human Immunodeficiency Virus (HIV), Primary Care: Models of Care, Racial / Ethnic Minorities, Tobacco Use, Tobacco Use: Smoking Cessation
Krist AH, Davidson KW, Ngo-Metzger Q
What evidence do we need before recommending routine screening for social determinants of health?
This editorial, co-written by two members of the U.S. Preventive Services Task Force (USPSTF), and a member of the Agency for Healthcare Research and Quality (AHRQ) discusses the need to determine if social determinants of health (SDOH) should be discussed during a primary care visit. At the present time only 2 USPSTF recommendations are social determinants (intimate partner violence, elder abuse, and abuse of vulnerable adults; and child maltreatment). However, there are recommendations for nine health behaviors and three mental health behaviors that are included in SDOH. There is an absence of evidence of benefit for routine screening for many of the social determinants, and the USPSTF is currently conducting an evaluation to understand the state of screening for SDOH.
Am Fam Physician 2019 May 15;99(10):602-05.
AHRQ-authored.
View abstract on the National Library of Medicine site.
Keywords: Evidence-based Practice, Guidelines, Primary Care, Screening, Social Determinants of Health, U.S. Preventive Services Task Force (USPSTF)
AHRQ Author: Ngo-Metzger Q
Gordon BE, Basak R, Carpenter WR
Factors influencing prostate cancer treatment decisions for African American and white men.
This prospective, population-based cohort study examined some possible reasons for mortality outcome differences for prostate cancer between African American (AA) and white patients. A cohort of 1170 men with nonmetastatic prostate cancer were enrolled from 2011 to 2013 before treatment in North Carolina. Participants were asked to rate their aggressiveness of their cancer, and also the importance of 10 factors their treatment decision-making process. Among low-risk patients, there was no difference in perception of their cancer as “not very aggressive”. Among high-risk patients, 54% of AA patients considered their cancer to be “not very aggressive” while only 24% of white patients did. For AA patients, cost, treatment time, and recovery time were considered very important more than white patients.
Cancer 2019 May 15;125(10):1693-700. doi: 10.1002/cncr.31932.
AHRQ-funded.
View abstract on the National Library of Medicine site.
Keywords: Decisionmaking, Cancer, Cancer: Prostate Cancer, Disparities, Men's Health, Outcomes, Patient-Centered Outcomes Research, Racial / Ethnic Minorities
Delling FN, Vittinghoff E, Dewland TA
Does cannabis legalisation change healthcare utilisation? A population-based study using the healthcare cost and utilisation project in Colorado, USA.
Researchers studied whether the legalization of cannabis in Colorado has affected healthcare utilization compared to two states where it is still illegal (New York and Oklahoma). ICD-9 was used to determine changes in healthcare utilization relative to various medical diagnoses. According to the National Academy of Science (NAS), legal cannabis use creates an increase in cannabis abuse hospitalizations and also linked to motor vehicle accidents, alcohol abuse, and overdose injury and that was true in CO. There was not a change in hospital stays and costs in CO compared to NY and OK.
BMJ Open 2019 May 15;9(5):e027432. doi: 10.1136/bmjopen-2018-027432.
AHRQ-funded.
View abstract on the National Library of Medicine site.
Keywords: Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Healthcare Utilization, Policy, Substance Abuse
Borsky AE, Zhang E
Screening for intimate partner violence, elder abuse, and abuse of vulnerable adults.
This Putting Prevention into Practice case study demonstrates how a U.S. Preventive Services Task Force (USPSTF) recommendation can used by clinicians. This case study uses the Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults recommendation as an example. Three quiz questions are given which directly link to the recommendations. The questions involve screening guidelines, screening instruments, and follow-up if there is a positive screening and detailed answers are provided.
Am Fam Physician 2019 May 15;99(10):649-50.
AHRQ-authored.
View abstract on the National Library of Medicine site.
Keywords: Case Study, Domestic Violence, Elderly, Evidence-based Practice, Screening, U.S. Preventive Services Task Force (USPSTF), Vulnerable Populations
AHRQ Author: Borsky AE
Wachter RM, Murray SG, Adler-Milstein J
Restricting the number of open patient records in the electronic health record: is the record half open or half closed?
This editorial discusses the increasing use of electronic health records (EHRs), and how the standardization of workflow decisions by EHRs creates issues in balancing efficiency and patient safety. These issues are discussed with reference to the article by Adelman et al in this same issue of JAMA, which addresses the question: What are the patient safety implications of allowing physicians to have multiple patient records open at the same time? The Adelman study involved the implementation of a new EHR into a large integrated health system; this editorial considers their findings.
JAMA 2019 May 14;321(18):1771-73. doi: 10.1001/jama.2019.3835.
Editorial accompanying AHRQ-funded study.
View abstract on the National Library of Medicine site.
Keywords: Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare Delivery, Medical Errors, Patient Safety

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