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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: Health Care Utilization, Health Insurance, Surgery
Martin B, Mirza SK, Spina N
Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004-2015.
Spinal fusion remains a controversial procedure for the treatment of axial pain secondary to degenerative disc disease. This study’s goal was to describe recent trends in U.S. rates of lumbar fusion procedures and its associated costs, using data from the National Inpatient Sample from 2004 to 2015. Trends in elective lumber fusion were grouped by surgical indication as degenerative scoliosis, degenerative spondylolisthesis, spinal stenosis, disc herniation, or disc degeneration; generalize linear regression was used to estimate trends in hospital costs, adjusted for age, sex, indication, comorbidity, and inflation. The article concludes that the rate of elective lumbar fusion surgery has increased most for spondylolisthesis and scoliosis, with indications of relatively good evidence of effectiveness. The proportion of fusions coded for indications with less evidence of effectiveness decreased slightly in the most recent years.
Spine 2019 Mar 1;44(5):369-76. doi: 10.1097/brs.0000000000002822.
AHRQ-funded; HS024714.
View abstract on the National Library of Medicine site.
Keywords: Health Care Costs, Healthcare Cost and Utilization Project (HCUP), Surgery
Dir AL, Saldana L, Chapman JE
Burnout and mental health stigma among juvenile probation officers: the moderating effect of participatory atmosphere.
This study examined the effects of job burnout on mental health stigma among juvenile probation offices (JPOs). Due to the high rate of mental health issues among juveniles in the justice system, there is a high burnout rate among JPOs.
Adm Policy Ment Health 2019 Mar;46(2):167-74. doi: 10.1007/s10488-018-0902-x.
AHRQ-funded; HS024296.
View abstract on the National Library of Medicine site.
Keywords: Burnout, Mental Health, Social Stigma
Gore MO, Krantz MJ, Albright K
A controlled trial of mobile short message service among participants in a rural cardiovascular disease prevention program.
Researchers with the Colorado Healthy Heart Solutions (CHHS) program conducted a pilot trial to see determine if the use of mobile phone SMS (text messages) improves cardiovascular disease (CVD) risk profiles for the medically underserved population it serves. Results showed that for most outcomes there was no statistical significance between the intervention and control groups for all but self-reported fat intake.
Prev Med Rep 2019 Mar;13:126-31. doi: 10.1016/j.pmedr.2018.11.021.
View abstract on the National Library of Medicine site.
Keywords: Cardiovascular Conditions, Health Information Technology (HIT), Prevention, Rural & Inner-City Areas
Turan JM, Elafros MA, Logie CH
Challenges and opportunities in examining and addressing intersectional stigma and health.
The purpose of this article was to review and highlight existing intersectional stigma literature, as well as to identify gaps in methods for studying and addressing intersectional stigma. 'Intersectional stigma' is defined as a concept that characterizes the convergence of multiple stigmatized identities within a person or group and addresses effects on health and well-being. Examples illustrating promising analytical approaches are provided, and priorities for future health research elucidated. Evidence from existing literature, as well as the examples presented, suggest that people in diverse settings experience intersecting forms of stigma that influence their mental and physical health and their corresponding health behaviors. The authors conclude that intersectional stigma are a common reality, but remain poorly understood; it is vital that instruments and methods be developed to characterize the mechanisms and effects of intersectional stigma in relation to various health conditions.
BMC Med 2019 Feb 15;17(1):7. doi: 10.1186/s12916-018-1246-9.
AHRQ-funded; HS013852.
View abstract on the National Library of Medicine site.
Keywords: Health Services Research (HSR), Social Stigma
Ngo-Metzger Q, Adsul P
Screening for cervical cancer.
This case study describes a 48-year-old woman, non-smoker, who has no history of sexually transmitted diseases or other remarkable conditions in her medical history. She had a human papillomavirus (HPV) test and a Pap smear three years ago, the results of both negative. The woman’s 19-year-old daughter has recently become sexually active and the woman wonders if she should schedule a Pap smear for her daughter. The case study questions are based on USPSTF recommendations for cervical cancer screening and the updated evidence report and systematic review on screening for cervical cancer with high-risk human papillomavirus testing.
Am Fam Physician 2019 Feb 15;99(4):253-54.
View abstract on the National Library of Medicine site.
Keywords: Cancer: Cervical Cancer, Case Study, Prevention, Screening, U.S. Preventive Services Task Force (USPSTF)
AHRQ Author: Ngo-Metzger Q
Marcum ZA, Walker RL, Jones BL
Patterns of antihypertensive and statin adherence prior to dementia: findings from the adult changes in thought study.
Using the hypothesis that changes in medication adherence might represent an early sign of cognitive impairment, this study examined antihypertensive and statin adherence trajectories in community-dwelling older adults to compare which went on to develop dementia and which did not. Data from Adult Changes in Thought (ACT), a population-based cohort study, was analyzed; 4368 participants aged 65 years or older who had at least one follow-up visit were selected, included on the basis of whether they were prevalent users of either a statin or antihypertensive medication on the first day of follow up. Research-quality dementia diagnoses were used to identify cases. Non-dementia control visits were matched by age, sex, and study cohort that occurred at similar follow-up time as the selected case dementia onset. The authors conclude that the patterns of medication adherence that emerged may be useful to identify people with higher likelihood of developing dementia.
BMC Geriatr 2019 Feb 14;19(1):41. doi: 10.1186/s12877-019-1058-6.
AHRQ-funded; HS022982.
View abstract on the National Library of Medicine site.
Keywords: Cognitive Disorders, Dementia, Elderly, Medication, Patient Adherence/Compliance
Huang SS, Singh R, McKinnell JA
Decolonization to reduce postdischarge infection risk among MRSA carriers.
This study compared postdischarge methicillin-resistant Staphylococcus aureus (MRSA) rates in study participant who received education alone versus decolonization and education. Decolonization was done with chlorhexidine mouthwash and showers, and nasal sprays. Decolonization with education resulted in a 30% reduction in MRSA infection versus education alone.
N Engl J Med 2019 Feb 14;380(7):638-50. doi: 10.1056/NEJMoa1716771.
AHRQ-funded; HS019388.
View abstract on the National Library of Medicine site.
Keywords: Education: Patient and Caregiver, Healthcare-Associated Infections (HAIs), Hospital Discharge, Methicillin-Resistant Staphylococcus aureus (MRSA), Prevention, Risk
Cross WF, West JC, Pisani AR
A randomized controlled trial of suicide prevention training for primary care providers: a study protocol.
This paper summarizes the protocol for an ongoing study used to determine the most effective way to train primary care providers in suicide prevention. The effectiveness of training using simulation is being studies using two conditions: 1) a control group that receives online training via brief videos and; 2) the same online training plus two standardized patient (SP) interactions that can be either face-to-face, or telehealth.
BMC Med Educ 2019 Feb 14;19(1):58. doi: 10.1186/s12909-019-1482-5.
AHRQ-funded; HS024224.
View abstract on the National Library of Medicine site.
Keywords: Education: Continuing Medical Education, Mental Health, Prevention, Primary Care, Training
Anesi JA, Lautenbach E, Nachamkin I
The role of extended-spectrum cephalosporin-resistance in recurrent community-onset
This study found an association between the use of extended-spectrum cephalosporin-resistance (ESC-R) and recurring Enterobacteriacaea urinary tract infections (EB UTIs). There was a significant increase in emergency room visits within 12 months after the first UTI visit.
BMC Infect Dis 2019 Feb 14;19(1):163. doi: 10.1186/s12879-019-3804-y.
AHRQ-funded; HS020002.
View abstract on the National Library of Medicine site.
Keywords: Antibiotics, Community-Acquired Infections, Medication, Urinary Tract Infection (UTI)
Liyanage-Don N, Fung D, Phillips E
Implementing home blood pressure monitoring into clinical practice.
The purpose of this study was to review data that supports the use of home blood pressure monitoring (HBPM) and to provide practical guidance to clinicians who wish to incorporate HBPM into their practice. Home blood pressure monitoring more accurately reflects the risk of cardiovascular events than office blood pressure measurements, and evidence supports the hypothesis that HBPM combined with clinical support improves blood pressure control. In spite of this, HBPM use remains low due to barriers between patients, clinicians, and healthcare system levels; understanding these barriers is crucial for the development of strategies to implement HBPM. This article considers how recommended best practices can facilitate the successful and effective implementation of HBPM.
Curr Hypertens Rep 2019 Feb 12;21(2):14. doi: 10.1007/s11906-019-0916-0.
AHRQ-funded; HS024262.
View abstract on the National Library of Medicine site.
Keywords: Blood Pressure, Diagnosis, Primary Care, Screening
Hartung DM, Johnston K, Geddes J
Buprenorphine coverage in the Medicare Part D program for 2007 to 2018.
This letter discusses a study which looked into coverage of buprenorphine for opioid use disorder (OUP) with Medicare. The majority of plans do cover the generic version. However, the number of plans which require previous authorization has increased over from 2007 to 2018. This may hamper treatment by primary care physicians.
JAMA 2019 Feb 12;321(6):607-09. doi: 10.1001/jama.2018.20391.
AHRQ-funded; HS024227.
View abstract on the National Library of Medicine site.
Keywords: Health Insurance, Medicare, Medication, Opioids, Substance Abuse
Mehta B, Szymonifka J, Dey S
Living in immigrant communities does not impact total knee arthroplasty outcomes: experience from a high-volume center in the United States.
The objective of this study was to assess the relationship of neighborhood immigrant proportion (IP) to preoperative and 2-year postoperative pain and function after elective total knee arthroplasty (TKA) using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Patients in a high-volume institutional TKA registry were analyzed retrospectively, and demographics, pre-op and 2-year post-op WOMAC pain and function scores, and addresses obtained. Patient-level variables were linked to Census Bureau tract data. Researchers conclude that patients living in high IP neighborhoods do not have worse pre-op or 2-year post-op pain and function outcomes after TKA compared to those living in lower IP neighborhoods.
BMC Musculoskelet Disord 2019 Feb 9;20(1):67. doi: 10.1186/s12891-019-2446-y.
AHRQ-funded; HS016075.
View abstract on the National Library of Medicine site.
Keywords: Arthritis and Osteoarthritis, Outcomes, Patient-Centered Outcomes Research, Racial / Ethnic Minorities, Socioeconomic Factors, Surgery
Parthipan A, Banerjee I, Humphreys K
Predicting inadequate postoperative pain management in depressed patients: a machine learning approach.
Researchers employed a machine-learning approach to identify patients who were prescribed a combination of selective serotonin reuptake inhibitors (SSRIs) and prodrug opioids in order to examine the effect of this combination on postoperative pain control. They identified patients who received surgery over a 9-year period by using EHR data from an academic medical center, then developed and validated natural language processing (NLP) algorithms to extract depression-related information from both structured and unstructured data elements. The machine-learning algorithm accurately predicted the increase or decrease of the discharge, 3-week, and 8-week follow-up pain scores when compared to the pre-operative pain score; pre-operative pain, surgery type, and opioid tolerance were the strongest predictors of postoperative pain control. The researchers conclude that their study results provide the first direct clinical evidence that the known ability of SSRIs to inhibit prodrug opioid effectiveness is associated with worse pain control among depressed patients. They suggest that prescribers might choose direct acting opioids such as oxycodone or morphine for depressed patients on SSRIs instead of prodrug opioids.
PLoS One 2019 Feb 6;14(2):e0210575. doi: 10.1371/journal.pone.0210575.
AHRQ-funded; HS024096.
View abstract on the National Library of Medicine site.
Keywords: Care Management, Depression, Medication, Opioids, Pain, Surgery
Hsu HE, Wang R, Jentzsch MS
Association between value-based incentive programs and catheter-associated urinary tract infection rates in the critical care setting.
This letter discussed a study which was done on value-based incentive programs to reduce the number of catheter-associated urinary tract infections (CAUTI) in intensive care units (ICUs). The study used data from 592 hospitals in the District of Columbia and 49 states. Researchers found these incentive programs did not significantly reduce CAUTI.
JAMA 2019 Feb 5;321(5):509-11. doi: 10.1001/jama.2018.18997.
AHRQ-funded; HS000063; HS025008; HS018414.
View abstract on the National Library of Medicine site.
Keywords: Adverse Events, Catheter-Associated Urinary Tract Infection (CAUTI), Catheters, Critical Care, Healthcare-Associated Infections (HAIs), Inpatient Care, Patient Safety, Urinary Tract Infection (UTI), Value
Alapati V, Tang F, Charlap E
Discharge heart rate after hospitalization for myocardial infarction and long-term mortality in 2 US registries.
In this study, researchers evaluated the association of discharge and admission heart rates with 3-year mortality. They concluded that a higher discharge heart rate after AMI was more strongly associated with 3-year mortality than a high heart rate at admissions.
J Am Heart Assoc 2019 Feb 5;8(3):e010855. doi: 10.1161/jaha.118.010855.
AHRQ-funded; HS011282.
View abstract on the National Library of Medicine site.
Keywords: Cardiovascular Conditions, Hospital Discharge, Mortality, Myocardial Infarction, Registries
Herrick CJ, Keller MR, Trolard AM
Postpartum diabetes screening among low income women with gestational diabetes in Missouri 2010-2015.
This study looked at postpartum screening for type 2 diabetes among low-income women who were previously diagnosed with gestational diabetes. Gestational diabetes increases risk for developing type 2 diabetes 7-fold so it is recommended that screening is done within months after delivery. Results in a Missouri population found that almost 20% were screened within the first year of delivery.
BMC Public Health 2019 Feb 4;19(1):148. doi: 10.1186/s12889-019-6475-0.
AHRQ-funded; HS019455.
View abstract on the National Library of Medicine site.
Keywords: Gestational Diabetes, Low-Income, Pregnancy, Screening, Women
Shubeck SP, Kanters AE, Dimick JB
Surgeon leadership style and risk-adjusted patient outcomes.
The goal of this study was to determine if individual surgeons' personality traits and related leadership behaviors – such as participation in continuing education, effective self-reflection, and openness to feedback – correlated with patient-level outcomes after bariatric surgery. Surgeons from the Michigan Bariatric Surgery Collaborative (MBSC) were administered the Life Styles Inventory (LSI) assessment, the results of which were then collapsed into three styles corresponding with particular patterns of individual thinking and behavior: constructive, passive/defensive, and aggressive/defensive. Patient-level risk-adjusted rates of complications after bariatric surgery were then used to quantify the impact surgeon style had on post-operative outcomes. The results of the study demonstrate that surgeons' leadership styles are correlated with surgical outcomes for their individual patients.
Surg Endosc 2019 Feb;33(2):471-74. doi: 10.1007/s00464-018-6320-z.
AHRQ-funded; HS023597.
View abstract on the National Library of Medicine site.
Keywords: Education: Continuing Medical Education, Patient Safety, Outcomes, Provider: Physician, Surgery
Rhee C, Wang Jentzsch, MS
Comparison of hospital surgical site infection rates and rankings using claims versus National Healthcare Safety Network surveillance data.
This article examines national policies that target healthcare-associated infections by use of medical claims and National Healthcare Safety Network surveillance data. The authors looked at rates and rankings for surgical site infection following colon surgery in 155 hospitals, and found low concordance between these two data sources; they conclude that this underscores the limitations of evaluating hospital quality by using claims data.
Infect Control Hosp Epidemiol 2019 Feb;40(2):208-10. doi: 10.1017/ice.2018.310.
AHRQ-funded; HS025008; HS000063; HS018414.
View abstract on the National Library of Medicine site.
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Patient Safety, Surgical Safety, Surgery
Pinto D, Bockenholt U, Lee J
Preferences for physical activity: a conjoint analysis involving people with chronic knee pain.
The goals of this study were to investigate individual preferences for physical activity attributes in adults with chronic knee pain, to identify clusters of individuals with similar preferences, and to identify whether these individuals differ by demographic or health characteristics. Researchers conducted an adaptive conjoint analysis (ACA) using the Potentially All Pairwise RanKings of all possible Alternatives (PAPRIKA) method to determine preference weights representing the relative importance of six physical activity attributes: health benefit, enjoyment, convenience, financial cost, effort, and time cost. The study sample included 146 participants. The authors conclude that patients with chronic knee pain have preferences for physical activities which are effectively distinguished by using ACA methods, and that adults with chronic knee pain, as clustered by their preferences, share distinguishing characteristics.
Osteoarthritis Cartilage 2019 Feb;27(2):240-47. doi: 10.1016/j.joca.2018.10.002.
AHRQ-funded; HS023011.
View abstract on the National Library of Medicine site.
Keywords: Arthritis and Osteoarthritis, Chronic Conditions, Pain


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