Search All Research Studies
AHRQ Research Studies Date
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 10430 Research Studies Displayed
Yakovchenko V, Morgan TR, Chinman MJ
Mapping the road to elimination: a 5-year evaluation of implementation strategies associated with hepatitis C treatment in the Veterans Health Administration.
While few countries and healthcare systems are on track to meet the World Health Organization's hepatitis C virus (HCV) elimination goals, the US Veterans Health Administration (VHA) has been a leader in these efforts. In this study the investigators aimed to determine which implementation strategies were associated with successful national viral elimination implementation within the VHA. They conducted a five-year, longitudinal cohort study of the VHA Hepatic Innovation Team (HIT) Collaborative between October 2015 and September 2019.
Citation: Yakovchenko V, Morgan TR, Chinman MJ . Mapping the road to elimination: a 5-year evaluation of implementation strategies associated with hepatitis C treatment in the Veterans Health Administration. BMC Health Serv Res 2021 Dec 18;21(1):1348. doi: 10.1186/s12913-021-07312-4..
Keywords: Hepatitis, Chronic Conditions, Veterans
Wurcel AG, Essien UR, Ortiz C
Variation by race in antibiotics prescribed for hospitalized patients with skin and soft tissue infections.
This cohort study examined antibiotics prescribed and variations by race among hospitalized patients with skin and soft tissue infections (SSTIs). A subanalysis of multisite, cross-sectional data collected through a national survey of acute care hospital groups within Vizient, Inc. considering adult inpatients treated for SSTIs was used. Of the 1242 adult inpatients included from 91 US hospitals, 45% were female, 18% were Black, and 69% were White with a mean age of 58 years. Penicillin allergy with hives was found in 23%, 19% with rash, and 18% with unknown effects, with allergy found more frequent in Black patients (23%) versus White (18%). Adjusting for multiple factors, White inpatients were at an increased risk of cefazolin use and decreased risk of clindamycin use compared with Black inpatients. Cefazolin use with less likely to be prescribed to Black inpatients than White inpatients and they were likely to be prescribed clindamycin. Cefazolin is considered a first-line SSTI treatment with clindamycin not recommended given frequent dosing and high potential for adverse effects including Clostridioides difficile infection (CDI). Although penicillin allergy is described as more prevalent among White patients, the authors observed an increased prevalence among Black inpatients compared with White inpatients treated for SSTI.
Citation: Wurcel AG, Essien UR, Ortiz C . Variation by race in antibiotics prescribed for hospitalized patients with skin and soft tissue infections. JAMA Netw Open 2021 Dec;4(12):e2140798. doi: 10.1001/jamanetworkopen.2021.40798..
Keywords: Antibiotics, Skin Conditions, Racial / Ethnic Minorities, Practice Patterns, Medication
Topham EW, Bristol A, Luther B
Caregiver inclusion in IDEAL discharge teaching: implications for transitions from hospital to home.
The purpose of this study was to explore perceptions of caregivers regarding their discharge preparation, focusing particular attention on whether and how they believed discharge preparation impacted post-discharge patient outcomes. Through interviews with four English-speaking caregivers, findings showed that, once home, the caregivers reported gaps in their knowledge of how to care for the patient, suggesting key gaps related to knowledge of warning signs and problems. Two of the four caregiver participants attributed a hospital readmission to post-discharge knowledge gaps. This study of caregiver experiences suggests that AHRQ’s IDEAL discharge planning strategy remains a useful and important framework for case managers to follow when providing discharge services.
Citation: Topham EW, Bristol A, Luther B . Caregiver inclusion in IDEAL discharge teaching: implications for transitions from hospital to home. Prof Case Manag 2022 Jul-Aug;27(4):181-93. doi: 10.1097/ncm.0000000000000563..
Keywords: Hospital Discharge, Transitions of Care, Caregiving
Merkow RP, Chung JW, Slota JM
Correlation of the US News and World Report-calculated nurse staffing index with actual hospital-reported nurse staffing.
This study’s objective was to understand how the Nurse Staffing Index (NSI) used in the US News and World Report “Best Hospitals” rankings correlates to actual nurse staffing levels. Nurse staffing data was obtained from publicly available data in the states of Illinois, California, and New Jersey. No other states had publicly accessible data. Hospital characteristics were obtained from the 2016 American Hospital Association (AHA) survey. The NSI was calculated using AHA data and is defined as the number of FTE RNs per adjusted patient day. Hospital characteristics were assessed using Hospital Compare data. Higher actual hospital-reported nurse staffing in Illinois and New Jersey was paradoxically associated with lower nurse staffing when measured by the NSI. California hospital-reported staffing intensity was weakly correctly with the NSI and RN nursing hours per patient day was not correlated with any of the 9 structural measures of hospital quality, while NSI was positively correlated with 3 of the 9 measures, particularly hospital volume status. None of the 11 outcome measures the authors assessed were associated with RN nursing hours per patient day or the NSI in either Illinois or California. All 12 patient experience measures were significantly and positively correlated with RN nursing hours in Illinois. However, none of the patient experience measures were significantly associated with the NSI in Illinois. The authors concluded that the NSI may not measure actual nurse staffing as intended.
AHRQ-funded; HS024516; HS026385.
Citation: Merkow RP, Chung JW, Slota JM . Correlation of the US News and World Report-calculated nurse staffing index with actual hospital-reported nurse staffing. J Nurs Care Qual 2022 Jul-Sep;37(3):195-98. doi: 10.1097/ncq.0000000000000619..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Provider: Nurse, Workforce
Sorra J, Zebrak K, Yount N
Development and pilot testing of survey items to assess the culture of value and efficiency in hospitals and medical offices.
Given rising costs and changing payment models, healthcare organisations are increasingly focused on value and efficiency. The goal of this study was to develop survey items to assess clinician and staff perspectives about the extent to which the organizational culture in hospitals and medical offices supports value and efficiency. The investigators concluded when added to the Agency for Healthcare Research and Quality Surveys on Patient Safety Culture, the item sets they developed extended those surveys by assessing additional dimensions of organizational culture that affect care delivery.
Citation: Sorra J, Zebrak K, Yount N . Development and pilot testing of survey items to assess the culture of value and efficiency in hospitals and medical offices. BMJ Qual Saf 2022 Jul;31(7):493-502. doi: 10.1136/bmjqs-2020-012407..
Keywords: Surveys on Patient Safety Culture, Organizational Change, Value
Kowitt SD, Goldstein AO, Cykert S
A heart healthy intervention improved tobacco screening rates and cessation support in primary care practices.
This study investigated the outcomes of an evidence-based cardiovascular disease risk reduction tool called Heart Health Now to improve rates for tobacco cessation screening and counseling in small primary care practices in North Carolina. This tool was developed as part of AHRQ’s EvidenceNow initiative. This stepped wedge, stratified, cluster randomized trial looked at 28 practices that were staffed by 10 or fewer clinicians and had an electronic health record. Heart Health Now consisted of education tools, onsite practice facilitation for a year, and a practice-specific cardiovascular population management dashboard that included monthly, measure-specific run charts to help guide quality improvement. The practices included in their analyses consisted of 78,120 patients, and 17,687 smokers. From pre- to post-intervention, screening rates significantly increased from 82.7 to 96.2%. Cessation support rates also significantly increased from 44.3% to 50.1%. Some of the practices associated with improvement included being in an academic health center or faculty, having more clinicians, and having a lower percentage of White patients.
Citation: Kowitt SD, Goldstein AO, Cykert S . A heart healthy intervention improved tobacco screening rates and cessation support in primary care practices. J Prev 2022 Jun;43(3):375-86. doi: 10.1007/s10935-022-00672-5..
Keywords: Tobacco Use, Tobacco Use: Smoking Cessation, Screening, Primary Care, Evidence-Based Practice, Heart Disease and Health, Cardiovascular Conditions
Sanchez JI, Shankaran V, Unger JM
Disparities in post-operative surveillance testing for metastatic recurrence among colorectal cancer survivors.
This population-based study assesses individual- and neighborhood-level factors associated with receipt of carcinoembryonic antigen (CEA) and computer tomography (CT) surveillance testing. Using SEER-Medicare data to identify beneficiaries diagnosed with colorectal cancer (CRC) stages II-III, they found that, overall, 78% and 58% of CRC survivors received CEA and CT testing, respectively. Further, Medicare-Medicaid dual coverage was associated with 39% lower odds of receipt of CEA tests among non-Hispanic Whites, while Blacks with dual coverage had almost two times the odds of receiving CEA tests compared to Blacks without dual coverage. Although this study did not find significant differences in receipt of initial CEA and CT surveillance testing across racial/ethnic groups, the assessment of the factors that measure access to care suggests differences in access to these procedures within racial/ethnic groups.
Citation: Sanchez JI, Shankaran V, Unger JM . Disparities in post-operative surveillance testing for metastatic recurrence among colorectal cancer survivors. J Cancer Surviv 2022 Jun;16(3):638-49. doi: 10.1007/s11764-021-01057-z..
Keywords: Disparities, Cancer: Colorectal Cancer, Cancer
Huang J, Park GW, Jones RM
Efficacy of EPA-registered disinfectants against two human norovirus surrogates and Clostridioides difficile endospores.
This study’s goal was to determine the efficacy of a panel of nine EPA-registered disinfectants against two human norovirus (HuNoV) surrogates (feline calicivirus [FCV] and Tulane virus [TuV]) and Clostridioides difficile endospores. These products, five of which contained H2O2 (hydrogen peroxide) as the active ingredient, were tested against infectious FCV, TuV, and C. difficile endospores using two ASTM methods, a suspension and carrier test. Products containing hydrogen peroxide were the most efficacious. Of the five products containing hydrogen peroxide, no strong correlation was observed between disinfection efficacy and hydrogen peroxide concentration. Addition of 0.025% ferrous sulphate to 1% hydrogen peroxide solution improved efficacy against FCV, TuV and C. difficile.
Citation: Huang J, Park GW, Jones RM . Efficacy of EPA-registered disinfectants against two human norovirus surrogates and Clostridioides difficile endospores. J Appl Microbiol 2022 Jun;132(6):4289-99. doi: 10.1111/jam.15524..
Keywords: Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Prevention, Patient Safety
Luo Q, Moghtaderi A, Markus A
Financial impacts of the Medicaid expansion on community health centers.
This study’s objective was to determine the impact of Medicaid expansion on community health centers. The authors combined data from the Uniform Data System, IRS nonprofit tax returns, and county-level characteristics from the Census Bureau. Their final dataset included 5841 center-year observations. They found a $2.08 million relative increase in Medicaid revenues, offset by a $0.44 million decrease in total grants among community health centers in expansion states compared with centers in non-expansion states. They found a large but not statistically significant $0.98 million relative increase in total expenditures among expansion state centers. Uncompensated care for health centers in expansion states decreased by $1.19 million relative to their counterparts in non-expansion states.
Citation: Luo Q, Moghtaderi A, Markus A . Financial impacts of the Medicaid expansion on community health centers. Health Serv Res 2022 Jun;57(3):634-43. doi: 10.1111/1475-6773.13897..
Keywords: Medicaid, Community-Based Practice, Healthcare Costs
Djulbegovic B, Ahmed MM, Hozo I
High quality (certainty) evidence changes less often than low-quality evidence, but the magnitude of effect size does not systematically differ between studies with low versus high-quality evidence.
The study researchers state that assumptions and general beliefs exist about certainty of evidence (CoE) and its impact on estimates of treatment effects, however empirical assessment of those assumptions and beliefs is lacking. The purpose of this study was to evaluate the differences between low CoE (low-quality evidence) and high CoE (high-quality evidence) in precision of estimating treatment effects. The researchers reviewed the Cochrane Database of Systematic Reviews from January 2016 through May 2021 for pairs of original and updated reviews for change in CoE assessments based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. Differences in effect sizes between the original reviews and the updated reviews were assessed as a function of change in CoE. The researchers concluded that low CoE changes more frequently than high CoE, but the effect size in low CoE studies did not differ from the effect size in high CoE studies. The researchers state that the effect size finding is an indicator of the need to further assess and improve the critical appraisal methods currently utilized in evidence-based medicine.
Citation: Djulbegovic B, Ahmed MM, Hozo I . High quality (certainty) evidence changes less often than low-quality evidence, but the magnitude of effect size does not systematically differ between studies with low versus high-quality evidence. J Eval Clin Pract 2022 Jun;28(3):353-62. doi: 10.1111/jep.13657..
Keywords: Research Methodologies, Evidence-Based Practice
Mobley EM, Moke DJ, Milam J
Interventions to address disparities and barriers to pediatric cancer survivorship care: a scoping review.
This scoping review’s aim was to demonstrate evidence-based approaches to alleviate barriers and decrease disparities among childhood cancer survivors. A literature review identified 16 proposed strategies to address disparities and barriers endorsed by professional organizations including 9 clinical practice guidelines, 4 policy statements, and 3 recommendations. Twenty-seven published studies evaluated an intervention; however these evaluated interventions were not well aligned with the proposed strategies endorsed by professional organizations. Interventions most commonly evaluated survivorship care plans (n = 11), or models of care (n = 11) followed by individual survivorship care services (n= 9). Interventions predominantly targeted patients rather than providers or systems.
Citation: Mobley EM, Moke DJ, Milam J . Interventions to address disparities and barriers to pediatric cancer survivorship care: a scoping review. J Cancer Surviv 2022 Jun;16(3):667-76. doi: 10.1007/s11764-021-01060-4..
Keywords: Children/Adolescents, Disparities, Cancer
Greenberg JK, Olsen MA, Johnson GW
Measures of intracranial injury size do not improve clinical decision making for children with mild traumatic brain injuries and intracranial injuries.
This study evaluated whether measuring traumatic brain injury size (eg, hematoma size) in children with mild traumatic brain injuries (mTBIs) and intracranial injuries (ICIs) improves risk prediction compared with the KIIDS intracranial injury decision support tool for traumatic brain injury (KIIDS-TBI) model. The cohort included children ≤18 years who presented to 1 of the 5 centers within 24 hours of TBI, had Glasgow Coma Scale scores of 13 to 15, and had ICI on neuroimaging. The data set was split into training and testing cohorts. The generalized linear model (GLM) and recursive partitioning (RP) models showed similar specificity across all risk cutoffs, but the GLM model had higher sensitivity. By comparison, the KIIDS-TBI model had slightly higher sensitivity but lower specificity.
Citation: Greenberg JK, Olsen MA, Johnson GW . Measures of intracranial injury size do not improve clinical decision making for children with mild traumatic brain injuries and intracranial injuries. Neurosurgery 2022 Jun;90(6):691-99. doi: 10.1227/neu.0000000000001895..
Keywords: Children/Adolescents, Brain Injury, Decision Making
Anderson KE, Polsky D, Dy S
Prescribing of low- versus high-cost Part B drugs in Medicare Advantage and traditional Medicare.
The purpose of this study was to compare Medicare Advantage (MA) coverage with traditional Medicare (TM) coverage as it relates to whether MA is associated with greater efficiency of prescribing Part B drugs. The authors sampled 20% of all 2016 outpatient and carrier TM claims and MA encounter records and Master Beneficiary Summary File data and analyzed whether MA enrollees more often received the low-cost Part B drug compared to TM enrollees. Four clinical scenarios were evaluated where multiple, similarly effective drugs exist: (1) anti-VEGF agents to treat macular degeneration, (2) bone resorption inhibitors for osteoporosis, (3) bone resorption inhibitors for malignant neoplasms, and (4) intravenous iron for iron deficiency anemia. The researchers estimated spending differences if TM prescribing aligned with MA prescribing and evaluated whether differences between MA and TM prescribing patterns were due to differences in the hospitals and provider practices who treat MA and TM enrollees or differences in how those hospitals and provider practices engage with their MA vs TM patients. The researchers found that more MA enrollees received the low-cost drug vs. TM enrollees in all 4 clinical scenarios, and that if TM prescribing matched that of ME prescribing, there would be a spending savings of 6% to 20% for each of the 4 scenarios. The study concluded that in 4 clinical scenarios in which similarly or equally effective treatment options exist, MA enrollees were more likely than TM enrollees to receive low-cost Part B drugs.
Citation: Anderson KE, Polsky D, Dy S . Prescribing of low- versus high-cost Part B drugs in Medicare Advantage and traditional Medicare. Health Serv Res 2022 Jun;57(3):537-47. doi: 10.1111/1475-6773.13912..
Keywords: Medication, Medicare, Healthcare Costs
Milliren CE, Bailey G, Graham DA
Relationships between pediatric safety indicators across a national sample of pediatric hospitals: dispelling the myth of the "safest" hospital.
This observational study aimed to explore the covariance of pediatric hospital quality indicators and evaluate the use of a single composite score. Pediatric hospital performance across 13 safety indicators were extracted from the Pediatric Health Information System, a comparative database of children’s hospitals in the U.S. Patients discharged from 36 hospitals from 2016 to 2019 were included. The authors investigated relationships among patient safety measures from AHRQ pediatric quality indicators and Center for Medicare and Medicaid Services hospital-acquired conditions. They identified 5 orthogonal variance components accounting for 68% of variation in pediatric hospital quality indicators. The ranking comparison and summary found greater within-hospital variation compared with between-hospital variation. They observed discordant rankings among commonly used summary measures and concluded that these measures demonstrate at least 2 underlying variance components.
Citation: Milliren CE, Bailey G, Graham DA . Relationships between pediatric safety indicators across a national sample of pediatric hospitals: dispelling the myth of the "safest" hospital. J Patient Saf 2022 Jun 1;18(4):e741-e46. doi: 10.1097/pts.0000000000000938..
Keywords: Children/Adolescents, Quality Indicators (QIs), Quality Measures, Patient Safety, Hospitals, Quality of Care
Ellsworth BL, Metz AK, Mott MM
Review of cancer-specific quality measures promoting the avoidance of low-value care.
The purpose of this study was to explore cancer quality measures to identify and describe those that encourage the avoidance of caner overtreatment and low-value care. The study also aimed to identify gaps that could direct the future development of cancer-specific quality measures. The researchers collected, reviewed, and identified 313 quality measures encouraging the avoidance of low-value cancer care, from six leading quality measures organizations. Of the 313 quality measures identified, 55 (18%) focused on avoidance of low-value care. Quality measure most likely to focus on low-value care included: 13 end-of-life care measures (50%); 12 breast cancer care measures (18%); 9 lung cancer care measures (31%); 8 colon cancer care measures (20%); 5 prostate cancer care measures (38%); and 4 general cancer care measures (3%). The study concluded that the majority of cancer quality measures are not aimed at avoiding cancer over-treatment and low value care, and existing recommendations have not been incorporated in the field.
Citation: Ellsworth BL, Metz AK, Mott MM . Review of cancer-specific quality measures promoting the avoidance of low-value care. Ann Surg Oncol 2022 Jun;39(6):3750-62. doi: 10.1245/s10434-021-11303-4..
Keywords: Cancer, Quality Measures, Quality Indicators (QIs), Quality of Care, Value
McDowell A, Myong C, Tevis D
Sexual orientation and gender identity data reporting among U.S. health centers.
This study examined sexual orientation and gender identity data reporting among community health centers. The study used the 2016-2019 Uniform Data System for 1,381 community health centers to look at trends in reporting. From 2016 to 2016, the percentage of community health centers with sexual orientation and gender identity data for ≥75% of patients increased from 14.9% to 53.0%. In 2019, community health centers were more likely to have this data for ≥75% of patients if they were in nonmetro counties versus metro, were in the South or West (versus Northeast), and had more patients aged between 18 and 39 years, between 40 and 64 years (versus <18 years), or veterans. This was less likely among smaller community health centers serving 10-20,000 patients or >20,000 patients, and centers with more patients of American Indian/Alaskan Native or unknown race (versus White).
Citation: McDowell A, Myong C, Tevis D . Sexual orientation and gender identity data reporting among U.S. health centers. Am J Prev Med 2022 Jun;62(6):e325-e32. doi: 10.1016/j.amepre.2021.12.017..
Keywords: Vulnerable Populations, Community-Based Practice
Bowring MG, Massie AB, Schwarz KB
Survival benefit of split-liver transplantation for pediatric and adult candidates.
The patient and graft survival rates for split -liver transplantations (SLTs) among pediatric and adult recipients are similar to those of whole-liver transplantations (WLTs), yet SLTs are rarely used. The purpose of the study was to compare the survival benefit of accepting an offer of a splittable graft vs waiting for a subsequent offer. The researchers utilized data from the 2010 to 2018 Scientific Registry of Transplant Recipients (SRTR) on 1814 adult and 928 pediatric liver transplantation candidates ever offered a splittable graft, and compared the eventual mortality between patients who accepted vs declined an offer for an SLT. The study discovered that among adult candidates, acceptance of an SLT offer was associated with a 43% reduction in mortality, and within 1 year of declining an offer 39.3% received a WLT, and 7.9% died. In pediatric cases with a weight of less than or equal to 7 kilograms, acceptance of a split liver offer versus declining the offer was associated with a 63% reduction in mortality, and within 1 year of declining 45.8% received a WLT and 6.4% died. In the group of pediatric cases with weight greater than 7 kilograms there was no significant difference between acceptance of an SLT offer and decline. The study concluded that accepting an offer for SLT could significantly improve survival for adults and small children on the liver transplant waiting list.
Citation: Bowring MG, Massie AB, Schwarz KB . Survival benefit of split-liver transplantation for pediatric and adult candidates. Liver Transpl 2022 Jun;28(6):969-82. doi: 10.1002/lt.26393..
Keywords: Children/Adolescents, Transplantation
Roberson ML, Nichols HB, Olshan AF
Trends in surgical treatment of early-stage breast cancer reveal decreasing mastectomy use between 2003 and 2016 by age, race, and rurality.
The authors sought to examine trends in the surgical treatment of breast cancer by age, rurality, and among Black women in a populous, racially diverse, state in the Southeastern United States of America. Using data from the North Carolina Central Cancer Registry, they found declining mastectomy rates in the early 2000s in a Southern US state with a racially and geographically diverse population. These decreasing trends were consistent among key subgroups affected by cancer inequities, including Black and White rural women.
Citation: Roberson ML, Nichols HB, Olshan AF . Trends in surgical treatment of early-stage breast cancer reveal decreasing mastectomy use between 2003 and 2016 by age, race, and rurality. Breast Cancer Res Treat 2022 Jun;193(2):445-54. doi: 10.1007/s10549-022-06564-w..
Keywords: Cancer: Breast Cancer, Cancer, Women, Surgery, Racial / Ethnic Minorities, Rural Health
Choi KR, Lotfizadah AD, Bhakta B
Concordance between patient-centered and adaptive behavior outcome measures after applied behavior analysis for autism.
In clinical trials, applied behavioral analysis (ABA) is an evidence-based approach to autism spectrum disorder that has been shown to improve child functional status. Setting and tracking individualized, patient-centered goals is a focus in ABA, yet there is little research on measuring progress on such goals. The purpose of this study was to observe and evaluate a clinical sample of children 3 to 16 years of age (N=154) receiving 24 months of ABA for autism spectrum disorder, and assess the concordance between patient-centered and standard outcome measures of treatment progress. The study found that there was limited concordance among measures at 12 and 24 months of ABA. The study also found that between 12 and 24 months of ABA, the percentage of children who achieved clinically meaningful gain on patient-centered goal measures increased, while the percentage of children who achieved clinically meaningful gains in adaptive behavior decreased. The study concluded that providers should have continuous dialogue with patients and caregivers to ensure that ASD programs and interventions progress toward meaningful goals and outcomes for patients and their caregivers.
Citation: Choi KR, Lotfizadah AD, Bhakta B . Concordance between patient-centered and adaptive behavior outcome measures after applied behavior analysis for autism. BMC Pediatr 2022 May 27;22(1):314. doi: 10.1186/s12887-022-03383-2..
Keywords: Patient-Centered Healthcare, Autism, Behavioral Health
Kim HS, Muschong KM, Fishman IL KM, Fishman IL
Embedded emergency department physical therapy versus usual care for acute low back pain: a protocol for the NEED-PT randomised trial.
This protocol paper discusses a study that will evaluate outcomes of having an embedded physical therapist in the emergency department (ED) for patients experiencing acute low back pain. The desired outcome is lower patient-reported opioid use post-discharge. The study will enroll patients with acute low back pain at an urban academic ED in Chicago, Illinois. This case-control study will randomize patients to either the embedded physical therapy or the usual care. The authors will follow the patients to a primary endpoint of 3 months and compare a primary outcome of change in PROMIS-Pain Interference score and secondary outcomes of change in modified Oswestry Disability Index score and patient-reported opioid use.
Citation: Kim HS, Muschong KM, Fishman IL KM, Fishman IL . Embedded emergency department physical therapy versus usual care for acute low back pain: a protocol for the NEED-PT randomised trial. BMJ Open 2022 May 24;12(5):e061283. doi: 10.1136/bmjopen-2022-061283..
Keywords: Emergency Department, Back Health and Pain, Pain
Jin MC, Hsin G, Ratliff J
Modifiers of and disparities in palliative and supportive care timing and utilization among neurosurgical patients with malignant central nervous system tumors.
This study analyzed a cohort of privately insured patients with malignant brain or spinal tumors derived from the Optum Clinformatics Datamart Database to investigate health disparities and access and utilization of palliative care and supportive services. The authors introduced a novel construct, “provider patient racial diversity index” (provider pRDI) which is a measure of the proportion of non-white minority patients a provider encounters to approximate a provider's patient demographics and suggest a provider's cultural sensitivity and exposure to diversity. Their analysis demonstrated low rates of palliative care, home health, and social work services among racial minority patients, with Hispanics having the lowest likelihood of engagement with all three categories of supportive services. Patients who saw providers categorized into high provider pRDI (categories II and III) were increasingly more likely to interface with supportive care services and at an earlier point in their disease courses.
Citation: Jin MC, Hsin G, Ratliff J . Modifiers of and disparities in palliative and supportive care timing and utilization among neurosurgical patients with malignant central nervous system tumors. Cancers 2022 May 23;14(10). doi: 10.3390/cancers14102567..
Keywords: Palliative Care, Disparities, Cancer
Loo S, Mullikin K, Robbins C
Patient navigator team perceptions on the implementation of a citywide breast cancer patient navigation protocol: a qualitative study.
This study’s goal was to assess the implementation of the 2018 Translating Research Into Practice (TRIP), an evidence-based patient navigation intervention aimed at addressing breast cancer care disparities, across six Boston hospitals. Patient navigator team member perspectives regarding implementation barriers and facilitators one-year post-study implementation were assessed. Seventeen interviews were conducted with patient navigators, patient navigator supervisors, and designated clinical champions. The following benefits were identified by participants: 1) increased networking and connections for navigators across clinical sites (Cosmopolitanism), 2) formalization of the patient navigation process (Goals and Purpose, Access to Knowledge and Information, and Relative Advantage), and 3) flexibility within the TRIP intervention that allowed for diversity in implementation and use of TRIP components across sites (Adaptability). Barriers included documentation requirements and the structured patient follow up guidelines that did not always align with the timeline of existing site navigation processes.
Citation: Loo S, Mullikin K, Robbins C . Patient navigator team perceptions on the implementation of a citywide breast cancer patient navigation protocol: a qualitative study. BMC Health Serv Res 2022 May 21;22(1):683. doi: 10.1186/s12913-022-08090-3..
Keywords: Patient-Centered Healthcare, Cancer: Breast Cancer, Cancer, Patient-Centered Outcomes Research, Evidence-Based Practice
Evans LV, Ray JM, Bonz JW
Improving patient and clinician safety during COVID-19 through rapidly adaptive simulation and a randomised controlled trial: a study protocol.
The purpose of this study will be to simultaneously assess the challenges and facilitators of COVID-19 preparedness in the emergency department (ED) and the mitigation of emergency physician stress, test the effectiveness of a simulation preparedness intervention on physician physiological stress, and improve physician preparedness while decreasing physician stress and anxiety.
Citation: Evans LV, Ray JM, Bonz JW . Improving patient and clinician safety during COVID-19 through rapidly adaptive simulation and a randomised controlled trial: a study protocol. BMJ Open 2022 May 19;12(5):e058980. doi: 10.1136/bmjopen-2021-058980..
Keywords: COVID-19, Patient Safety, Simulation, Burnout, Provider: Clinician
Cedillo G, George MC, Deshpande R
Toward safer opioid prescribing in HIV care (TOWER): a mixed-methods, cluster-randomized trial.
Healthcare and behavioral health providers are lacking a methodology to implement the 2016 U.S. Centers for Disease Control and Prevention Opioid Prescribing Guideline (CDC Guideline), measure prescriber adherence to it, and systematically test its effect on patient and public health outcomes. The Guideline is currently being reviewed and revised due to concern that it may be harmful to people with chronic pain on long-term opioid therapy (CP-LTOT). The purpose of the study was to develop and test a CDC Guideline implementation strategy termed “TOWER,” focused on an outpatient HIV primary care setting with patients with CP-LTOT. The TOWER strategy included: 1) a patient-facing app for opioid management (OM-App); 2) a template for progress notes (OM-Note) intended to guide the patient’s office visit; and 3) a primary care provider (PCP) training. TOWER was developed in a multi-step, stakeholder-engaged process within a behavioral change framework. The researchers evaluated the TOWER strategy in a randomized-controlled trial of HIV-PCPs (N=11) and their patients with HIV and CP-LTOT (N=40). The main outcome was CDC Guideline adherence based on electronic health record (EHR) documentation and measured by the Safer Opioid Prescribing Tool (SOPTET). Qualitative data was also collected, including one-on-one PCP interviews. The study found that the PCPs randomized to utilize the TOWER strategy were 48% more CDC Guideline adherent. Qualitative data reflected high levels of intervention provider confidence in administering the TOWER processes, and that the OM-Note supported provider efforts, but experience with the patient-facing OM-App was mixed. The study concluded that adherence to the 2016 CDC Guidelines is not associated with worsening of outcomes for people with HIV with CP-LTOT, and adherence to the CDC Guidelines can be promoted and measured. The researchers recommend additional research into the scalability of these results and the impact of CDC Guideline adherence on public health.
Citation: Cedillo G, George MC, Deshpande R . Toward safer opioid prescribing in HIV care (TOWER): a mixed-methods, cluster-randomized trial. Addict Sci Clin Pract 2022 May 16;17(1):28. doi: 10.1186/s13722-022-00311-8..
Keywords: Opioids, Medication, Human Immunodeficiency Virus (HIV), Guidelines, Evidence-Based Practice
Giardina TD, Choi DT, Upadhyay DK
Inviting patients to identify diagnostic concerns through structured evaluation of their online visit notes.
This study’s objective was to test if patients can identify concerns about their diagnosis through structured evaluation of their online visit notes in an electronic health record (EHR) system. Patients aged 18-85 years in a large integrated health system who actively used the patient portal were invited to respond to an online questionnaire if an EHR algorithm detected any recent visit following an initial primary care consultation. The authors developed and tested an instrument (Safer Dx Patient Instrument) to help patients identify concerns related to the diagnostic process based on notes review and recall of recent “at-risk” visits. The algorithm identified 1282 eligible patients, of whom 486 responded. Of the 418 patients included in the analysis, 51 patients (12.2%) identified a diagnostic concern. Patients were more likely to report a concern if they disagreed with statements "The care plan the provider developed for me addressed all my medical concerns", "I trust the provider that I saw during my visit" and agreed with the statement "I did not have a good feeling about my visit".
AHRQ-funded; HS027363; HS025474.
Citation: Giardina TD, Choi DT, Upadhyay DK . Inviting patients to identify diagnostic concerns through structured evaluation of their online visit notes. J Am Med Inform Assoc 2022 May 11;29(6):1091-100. doi: 10.1093/jamia/ocac036..
Keywords: Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Experience, Patient Safety