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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.

Churchill SS, Kieckhefer GM
One year follow-up of outcomes from the randomized clinical trial of the building on family strengths program.
This study tested the 12-month efficacy of an inclusive non-diagnosis-specific, parent education program with seven in-person sessions. The outcome measures were self-efficacy, parent and child shared management of chronic condition, coping skills, parental depressive symptoms and quality of life. All of the outcomes improved within the intervention group over 12 months.
Matern Child Health J 2018 Jun;22(6):913-21. doi: 10.1007/s10995-018-2467-4.
AHRQ-funded; HS013384.
View abstract on the National Library of Medicine site.
Keywords: Children, Chronic Conditions, Consumer Information and Education, Family Health and History, Patient & Family Engagement
Chou R, Baker WL, Banez LL
Agency for Healthcare Research and Quality Evidence-based Practice Center methods provide guidance on prioritization and selection of harms in systematic reviews.
A workgroup of methodologists from Evidence-based Practice Centers (EPCs) developed consensus-based guidance on selection and prioritization of harms in systematic reviews. Ten recommendations were developed on selection and prioritization of harms, including routinely focusing on serious as well as less serious but frequent or bothersome harms; and routinely engaging stakeholders and using literature searches and other data sources to identify important harms.
J Clin Epidemiol 2018 Jun;98:98-104. doi: 10.1016/j.jclinepi.2018.01.007.
AHRQ-authored; AHRQ-funded; HS022998.
View abstract on the National Library of Medicine site.
Keywords: Adverse Medical Events, Evidence-based Medicine, Patient-Centered Outcomes Research, Research Methodologies
Cheng TL, Mistry KB, Wang G
Folate nutrition status in mothers of the Boston birth cohort, sample of a US urban low-income population.
Researchers examined maternal folic acid supplementation and plasma folate concentrations in the Boston Birth Cohort, a predominantly urban, low-income, minority population. Their findings indicated that fewer than 5 percent of mothers in the Boston Birth Cohort started folic acid supplements before pregnancy, and approximately one third of mothers had either too low or too high plasma folate levels.
Am J Public Health 2018 Jun;108(6):799-807. doi: 10.2105/ajph.2018.304355.
View abstract on the National Library of Medicine site.
Keywords: Nutrition, Pregnancy, Low-Income Population, Urban Health, Vitamins and Supplements
AHRQ Author: Mistry KB
Boyle WA, Murray DJ, Beyatte MB
Simulation-based assessment of critical care "front-line" providers.
The researchers developed a standardized simulation method to assess clinical skills of ICU providers. Their simulation assessments yielded reasonably reliable measures of Critical Care Medicine decision-making skills. Despite a wide range of performance, those with more ICU training and experience performed better, providing evidence to support the validity of the scores.
Crit Care Med 2018 Jun;46(6):e516-e22. doi: 10.1097/ccm.0000000000003073.
AHRQ-funded; HS018734; HS022265.
View abstract on the National Library of Medicine site.
Keywords: Critical Care, Decisionmaking, Intensive Care Unit (ICU), Provider Performance, Training
de la Guardia FH, Hwang J, Adams JL
The authors specified loss functions and evaluated the potential cost of misclassification for physician report card designs. They found that misclassification cost depends on how performance information will be used and by whom; selecting the lowest-cost design for a given stakeholder could maximize the usefulness of physician performance data. They conlcuded that misclassification cost could guide report card design, improving the usefulness of a report card for one stakeholder without disadvantaging others.
Health Services and Outcomes Research Methodology 2018 Jun;18(2):96-108. doi: 10.1007/s10742-018-0179-2.
AHRQ-funded; HS021860.
View abstract on the National Library of Medicine site.
Keywords: Health Care Quality, Provider Performance, Quality Measurement, Value
Krishnan S, Pappadis MR, Weller SC
Patient-centered mobility outcome preferences according to individuals with stroke and caregivers: a qualitative analysis.
This study explored the mobility-related preferences among stroke survivors and caregivers following post-acute rehabilitation at inpatient or skilled nursing facilities. Frequently mentioned outcome preferences by survivors were ability to walk (88 percent), move, and balance. They also wanted to acquire assistive devices to move independently. Caregivers were concerned with the survivor's safety and wanted them to drive (53 percent), prevent falls, have home accommodations, and transfer independently.
Disabil Rehabil 2018 Jun;40(12):1401-09. doi: 10.1080/09638288.2017.1297855.
AHRQ-funded; HS022134; HS024711.
View abstract on the National Library of Medicine site.
Keywords: Caregiving, Patient-Centered Outcomes Research, Patient Safety, Rehabilitation, Stroke
Jones AL, Cochran SD, Leibowitz A
Racial, ethnic, and nativity differences in mental health visits to primary care and specialty mental health providers: analysis of the Medical Expenditures Panel Survey, 2010-2015.
The researchers sought to guide post-ACA efforts to address mental health service disparities, by using a nationally representative sample to characterize baseline race-, ethnicity-, and nativity-associated differences in mental health services in the context of primary care. They found that all racial/ethnic groups were less likely than non-Latino Whites to have any primary care (PC) visit. Their conclusion was that racial-, ethnic-, and nativity-associated disparities persist in PC provided mental health services.
Healthcare 2018 Mar 22;6(2). doi: 10.3390/healthcare6020029.
AHRQ-funded; HS021721.
View abstract on the National Library of Medicine site.
Keywords: Disparities, Medical Expenditure Panel Survey (MEPS), Mental Health Services, Primary Care, Racial and Ethnic Minority Groups
Agimi Y, Albert SM, Youk AO
Mandatory physician reporting of at-risk drivers: the older driver example.
The hypothesis that mandatory physician reporting laws reduce the rate of crash-related hospitalizations among older adult drivers was tested. Mandatory physician reporting failed to explain any significant variation in crash hospitalization rates, when adjusting for other state-specific laws and characteristics. Vision testing at in-person license renewal was a significant predictor of lower crash hospitalization rate.
Gerontologist 2018 May 8;58(3):578-87. doi: 10.1093/geront/gnw209.
View abstract on the National Library of Medicine site.
Keywords: Elderly, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Injuries/Wounds, Reporting
AHRQ Author: Steiner CA
Funk RJ, Owen-Smith J, Kaufman SA
Association of informal clinical integration of physicians with cardiac surgery payments.
This study examined how physician interaction patterns vary between health systems and to assess whether variation in informal integration is associated with care delivery payments. It found that when beneficiaries were treated in health systems with higher informal integration, the greatest savings of lower estimated payments were from hospital readmissions (13.0 percent) and postacute care services (5.8 percent).
JAMA Surg 2018 May;153(5):446-53. doi: 10.1001/jamasurg.2017.5150.
AHRQ-funded; HS024728.
View abstract on the National Library of Medicine site.
Keywords: Health Care Costs, Health Care Payment, Health Care Systems, Surgery, Value
Fingar KR, Coffey RM, Mulcahy AW
Shifts in Medicaid and uninsured payer mix at safety-net and non-safety-net hospitals during the Great Recession.
The authors examined payer mix at safety-net hospitals (SNHs) and non-SNHs during a period covering the Great Recession using data from 38 states. The number of privately insured stays decreased at both SNHs and non-SNHs. Non-SNHs increasingly served Medicaid-enrolled and uninsured patients; in SNHs, the number of Medicaid stays decreased and uninsured stays remained stable.
J Healthc Manag 2018 May-Jun;63(3):156-72. doi: 10.1097/jhm-d-16-00024.
AHRQ-authored; AHRQ-funded; 290201300002C.
View abstract on the National Library of Medicine site.
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitals, Medicaid, Safety Net, Uninsured
AHRQ Author: Andrews RM, Stocks C
Favier LA, Taylor J, Loiselle Rich K
Barriers to adherence in juvenile idiopathic arthritis: a multicenter collaborative experience and preliminary results.
The purpose of our study was to design and implement a standardized approach to identifying adherence barriers for youth with juvenile idiopathic arthritis (JIA) and to assess the frequency of adherence barriers in patients and their caregivers across treatment modalities. It concluded that implementing a standardized tool assessing adherence barriers in the JIA population across multiple clinical settings is feasible.
J Rheumatol 2018 May;45(5):690-96. doi: 10.3899/jrheum.171087.
AHRQ-funded; HS021114.
View abstract on the National Library of Medicine site.
Keywords: Arthritis, Caregiving, Children, Patient Adherence, Quality Improvement
Eze-Ajoku E, Lavoie M, DeCamp M
Exploring the evidence base behind quality measures.
This study examined the strength of evidence behind quality measures used in Medicare’s 2016 Shared Savings Program. These measures apply to more than 430 accountable care organizations (ACOs). Differences existed in the grading systems used and the evidentiary strength. Based on average ACO performance, performance appeared to be lower in the moderate evidence category (overall average, 61 percent) compared to the high evidence category (overall average, 77 percent).
Am J Med Qual 2018 May/Jun;33(3):321-22. doi: 10.1177/1062860617721645.
AHRQ-funded; HS023684.
View abstract on the National Library of Medicine site.
Keywords: Evidence-based Medicine, Medicare, Pay for Performance, Provider Performance, Quality Measures
Allegranzi B, Aiken AM, Zeynep Kubilay N
A multimodal infection control and patient safety intervention to reduce surgical site infections in Africa: a multicentre, before-after, cohort study.
The researchers aimed to establish the effect of a multimodal intervention on surgical site infections (SSIs) in Africa. SSI cumulative incidence significantly decreased post intervention, from 8.0 percent to 3.8 percent and this decrease persisted in the sustainability period. A substantial improvement in compliance with prevention measures was consistently observed in the follow-up and sustainability periods.
Lancet Infect Dis 2018 May;18(5):507-15. doi: 10.1016/s1473-3099(18)30107-5.
AHRQ-funded; 290201000027.
View abstract on the National Library of Medicine site.
Keywords: Healthcare-Associated Infections, Patient Safety, Surgery, Surgical Safety
Springer R, Marino M, O'Malley JP
Oregon Medicaid Expenditures after the 2014 Affordable Care Act Medicaid expansion: over-time differences among new, returning, and continuously insured enrollees.
This study assessed health care expenditures among Medicaid enrollees in the 24 months after Oregon's 2014 Medicaid expansions and examine whether expenditure patterns were different among the newly, returning, and continuously insured (CI). After initial increases, newly and returning insured (RI) outpatient expenditures dropped below CI. Expenditures for emergency department and dental services among the RI remained higher than among the newly insured.
Med Care 2018 May;56(5):394-402. doi: 10.1097/mlr.0000000000000907.
AHRQ-funded; HS024270.
View abstract on the National Library of Medicine site.
Keywords: Health Care Costs, Health Reform, Health Services Research (HSR), Medicaid
Nanji KC, Roberto SA, Morley MG
Preventing adverse events in cataract surgery: recommendations from a Massachusetts expert panel.
The purpose of this article is to identify contributing factors to the adverse events (AEs) reported in Massachusetts and present the panel's recommended strategies to prevent them. The panel identified 2 principal categories of contributing factors to the state's cataract surgery-related AEs: systems failures and choice of anesthesia technique. The panel recommended several strategies to prevent AEs during cataract surgery, including performing a distinct time-out with at least 2 care-team members before block administration.
Anesth Analg 2018 May;126(5):1537-47. doi: 10.1213/ane.0000000000002529.
AHRQ-funded; HS024764.
View abstract on the National Library of Medicine site.
Keywords: Adverse Medical Events, Evidence-based Practice, Eye Health, Patient Safety, Surgery
Mistry B, Stewart De Ramirez S, Kelen G
Accuracy and reliability of emergency department triage using the emergency severity index: an international multicenter assessment.
This study assessed the accuracy and variability of triage score assignment by emergency department (ED) nurses using the Emergency Severity Index (ESI) in 3 countries. It found that the concordance of nurse-assigned ESI score with reference standard was universally poor and variability was high. Although the ESI is the most popular ED triage tool in the United States and is increasingly used worldwide, its findings point to a need for more reliable ED triage tools.
Ann Emerg Med 2018 May;71(5):581-87.e3. doi: 10.1016/j.annemergmed.2017.09.036.
AHRQ-funded; HS023641.
View abstract on the National Library of Medicine site.
Keywords: Decisionmaking, Emergency Department, Emergency Medical Services, Health Information Technology (HIT), Nursing
Lindly OJ, Thorburn S, Heisler K
Parents' use of complementary health approaches for young children with autism spectrum disorder.
Researchers conducted a study to better understand factors influencing parents' decision to use complementary health approaches (CHA) for children with autism spectrum disorder (ASD). CHA use was negatively associated with older child age and positively associated with parents' belief ASD has major consequences and medication use. Nine themes help explain these results.
J Autism Dev Disord 2018 May;48(5):1803-18. doi: 10.1007/s10803-017-3432-6.
AHRQ-funded; HS000063.
View abstract on the National Library of Medicine site.
Keywords: Autism, Children, Complementary and Alternative Medicine, Decisionmaking, Disabilities
Levin S, Toerper M, Hamrock E
Machine-learning-based electronic triage more accurately differentiates patients with respect to clinical outcomes compared with the emergency severity index.
This study seeks to evaluate an electronic triage system (e-triage) based on machine learning that predicts likelihood of acute outcomes enabling improved patient differentiation. It concluded that E-triage more accurately classifies emergency severity index (ESI) level 3 patients and highlights opportunities to use predictive analytics to support triage decisionmaking.
Ann Emerg Med 2018 May;71(5):565-74.e2. doi: 10.1016/j.annemergmed.2017.08.005.
AHRQ-funded; HS023641.
View abstract on the National Library of Medicine site.
Keywords: Decisionmaking, Health Information Technology (HIT), Medical Informatics, Outcomes
Chen Y, Lairson DR, Chan W
Risk of adverse events associated with front-line anti-myeloma treatment in Medicare patients with multiple myeloma.
This study aims to examine the risks of adverse events associated with anti-multiple myeloma (MM) therapies in a large population-based cohort of elderly patients with MM. It found that novel agents significantly increased the risk of anemia, peripheral neuropathy, and thromboembolic events. Combination therapies consisting of proteasome inhibitor plus immunomodulatory drugs were associated with significantly higher risk for anemia, neutropenia and thromboembolic events.
Ann Hematol 2018 May;97(5):851-63. doi: 10.1007/s00277-018-3238-4.
AHRQ-funded; HS018956.
View abstract on the National Library of Medicine site.
Keywords: Adverse Drug Events, Cancer, Chemotherapy, Medications, Risk
Abdus S, Decker SL
The long-term uninsured were less likely than the short-term uninsured to gain insurance in 2014.
This study assessed the probability of having insurance in at least 1 month of 2014 for a sample of US citizens aged 19–63 who were uninsured in December 2013. It found that among those uninsured at the end of 2013, 2014 insurance take-up was lower the longer a person had been uninsured.
J Gen Intern Med 2018 May;33(5):593-95. doi: 10.1007/s11606-018-4365-2.
View abstract on the National Library of Medicine site.
Keywords: Health Care Costs, Health Insurance, Medical Expenditure Panel Survey (MEPS), Uninsured
AHRQ Author: Abdus S, Decker SL