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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.

Lee JS, Parashar V, Miller JB
Opioid prescribing after curative-intent surgery: a qualitative study using the theoretical domains framework.
To identify targets for intervention, researchers performed a qualitative study of opioid prescribing after curative-intent surgery using the Theoretical Domains Framework, a well-established implementation science method for identifying factors influencing healthcare provider behavior. They concluded that key determinants of opioid prescribing behavior after curative-intent surgery include environmental and social factors. Interventions targeting these factors are likely to improve opioid prescribing in surgical oncology.
Ann Surg Oncol 2018 Jul;25(7):1843-51. doi: 10.1245/s10434-018-6466-x.
AHRQ-funded; HS023313.
View abstract on the National Library of Medicine site.
Keywords: Medications, Opioids, Provider Practice Patterns, Surgery
Vogel TR, Smith JB, Kruse RL
Hospital readmissions after elective lower extremity vascular procedures.
This study evaluated risk factors associated with 30-day readmission after open and endovascular lower extremity revascularization. Factors associated with readmission following lower extremity bypass included heart failure, transfusions, hyponatremia, black race, and bronchodilator use. Risk factors for endovascular readmissions were often chronic conditions including coronary artery disease, kidney disease, hypertension, and hypertensive medications.
Vascular 2018 Jun;26(3):250-61. doi: 10.1177/1708538117728637.
AHRQ-funded; HS022140.
View abstract on the National Library of Medicine site.
Keywords: Hospitalization, Patient-Centered Outcomes Research, Readmissions, Risk Factors, Surgery
Sorkin DH, Rook KS, Campos B
Rationale and study protocol for Unidas por la Vida (United for Life): a dyadic weight-loss intervention for high-risk Latina mothers and their adult daughters.
The intervention aims to improve health behaviors and promote weight loss in two at-risk members of the same family: mothers with type 2 diabetes and their overweight/obese adult daughters who are at risk for developing diabetes. Both the dyadic and individual lifestyle interventions are expected to produce greater weight loss at 6, 12, and 18 months than those in minimal intervention control group.
Contemp Clin Trials 2018 Jun;69:10-20. doi: 10.1016/j.cct.2018.03.013.
View abstract on the National Library of Medicine site.
Keywords: Diabetes, Lifestyle Changes, Obesity, Racial and Ethnic Minority Groups, Obesity: Weight Management
AHRQ Author: Ngo-Metzger Q
Roumie CL, Patel NJ, Munoz D
Design and outcomes of the Patient Centered Outcomes Research Institute coronary heart disease cohort study.
The objective was to electronically identify, recruit, and survey coronary heart disease (CHD) patients and describe their characteristics and willingness to participate in future research. The majority reported that their health was good or very good, while 40 percent reported that their general and physical health were fair or poor. A patient sample was provided with a trial summary which would randomize their aspirin dose; and 63 percent reported that they would consider participating.
Contemp Clin Trials Commun 2018 Jun;10:42-49. doi: 10.1016/j.conctc.2018.03.001.
AHRQ-funded; HS022990.
View abstract on the National Library of Medicine site.
Keywords: Cardiovascular Conditions, Heart Disease, Patient-Centered Outcomes Research, Research Methodologies
Owen JL, Vakharia PP, Silverberg JI
The role and diagnosis of allergic contact dermatitis in patients with atopic dermatitis.
Recent systematic reviews have suggested that allergic contact dermatitis (ACD) is a significant clinical problem in both children and adults with atopic dermatitis (AD). The authors review the clinical scenarios where patch testing is indicated in AD. In addition, they review the contraindications, preferred patch-testing series, pitfalls, and challenges determining the relevance of positive patch-test reactions in AD patients.
Am J Clin Dermatol 2018 Jun;19(3):293-302. doi: 10.1007/s40257-017-0340-7.
AHRQ-funded; HS023011.
View abstract on the National Library of Medicine site.
Keywords: Diagnosis, Diagnostics, Skin Conditions
Luckenbaugh AN, Holllenbeck BK, Kaufman SR
Impact of accountable care organizations on diagnostic testing for prostate cancer.
The researchers sought to determine if Accountable Care Organizations (ACOs) have the potential to accelerate the impact of prostate cancer screening recommendations. They concluded that the rate of PSA testing was not differentially affected by ACO participation. Conversely, there was an increase in the rate of prostate biopsy among patients of ACO-aligned physicians.
Urology 2018 Jun;116:68-75. doi: 10.1016/j.urology.2018.01.056.
AHRQ-funded; HS024728; HS025707; HS024525.
View abstract on the National Library of Medicine site.
Keywords: Diagnostics, Health Services Research (HSR), Prostate Cancer, Screening
Khandelwal N, Hough CL, Downey L
Prevalence, risk factors, and outcomes of financial stress in survivors of critical illness.
The objective was to describe the prevalence of financial stress among critically ill patients and their families and explore associations between financial stress and psychologic distress. It found that factors associated with financial stress included female sex, young children at home, and baseline financial discomfort. Also, financial stress after critical illness was common and associated with symptoms of anxiety and depression.
Crit Care Med 2018 Jun;46(6):e530-e39. doi: 10.1097/ccm.0000000000003076.
AHRQ-funded; HS022982.
View abstract on the National Library of Medicine site.
Keywords: Critical Care, Health Care Costs, Risk Factors, Patient-Centered Outcomes Research, Stress
Hsu HE, Kawai AT, Wang R
The impact of the Medicaid healthcare-associated condition program on mediastinitis following coronary artery bypass graft.
This study aimed to evaluate the impact of a program that eliminated additional Medicare payment for mediastinitis following coronary artery bypass graft (CABG) to include Medicaid on mediastinitis rates reported by the National Healthcare Safety Network (NHSN). It found that the 2012 Medicaid program to eliminate additional payments for mediastinitis following CABG had no impact on reported mediastinitis rates.
Infect Control Hosp Epidemiol 2018 Jun;39(6):694-700. doi: 10.1017/ice.2018.69.
AHRQ-funded; HS025008; HS018414; HS000063.
View abstract on the National Library of Medicine site.
Keywords: Cardiovascular Conditions, Health Care Payment, Healthcare-Associated Infections, Patient Safety, Surgery
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, Education: Patient and Caregiver, 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
Villani J, Ngo-Metzger Q, Vincent IS
Sources of funding for research in evidence reviews that inform recommendations of the US Preventive Services Task Force.
This study characterizes the sources of funding for the scientific evidence base used by the USPSTF. One or more funding sources were identified for 79 percent of the 1,650 research articles. Government agencies provided support for 931 articles (56 percent). The remaining support came from nonprofits or universities (530 articles, 32 percent) and industry (282 articles, 17 percent).The sources of funding varied by recommendation topic.
JAMA 2018 May 22;319(20):2132-33. doi: 10.1001/jama.2018.5404.
View abstract on the National Library of Medicine site.
Keywords: Evidence-based Medicine, Guidelines, Prevention and Care Management, Research Methodologies, U.S. Preventive Services Task Force (USPSTF)
AHRQ Author: Ngo-Metzger Q
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
Roberts MC, Dotson WD, DeVore CS
Delivery of cascade screening for hereditary conditions: a scoping review of the literature.
The authors conducted a scoping review to obtain a broad overview of cascade screening interventions, facilitators and barriers to their use, relevant policy considerations, and future research needs. They sought standardized best practices for optimizing cascade screening across various geographic and policy contexts, but found none. Studies in which trained providers contacted relatives directly, rather than through probands (index patients), showed greater cascade screening uptake; however, policies in some states might limit this approach.
Health Aff 2018 May;37(5):801-08. doi: 10.1377/hlthaff.2017.1630.
View abstract on the National Library of Medicine site.
Keywords: Family Health and History, Genetic Testing, Genetics, Screening
AHRQ Author: Ganiats TG
Ray KN, Drnach M, Mehrotra A
Impact of implementation of electronically-transmitted referrals on pediatric subspecialty visit attendance.
The researchers evaluated the impact of implementing electronically-transmitted referrals on subspecialty visit attendance. While electronically-transmitted referrals improved visit attendance after pediatric subspecialty referral, the sizeable percentage of children without attended visits, the muted effect at control practices, and pediatrician survey responses indicate that additional work is needed to address barriers to pediatric subspecialty care.
Acad Pediatr 2018 May-Jun;18(4):409-17. doi: 10.1016/j.acap.2017.12.008.
AHRQ-funded; HS022989.
View abstract on the National Library of Medicine site.
Keywords: Children, Health Information Technology (HIT), Patient-Centered Healthcare, Pediatrics
Raji MA, Kuo YF, Adhikari D
Decline in opioid prescribing after federal rescheduling of hydrocodone products.
This study examined differences in opioid prescribing by patient characteristics and variation in hydrocodone combination product (HCP) prescribing attributed to states, before and after the 2014 Drug Enforcement Administration's reclassification of HCP from schedule III to the more restrictive schedule II. It found that HCP prescribing decreased by 26 percent from June 2013 to June 2015; the rate of prescriptions for any opioid decreased by 11 percent.
Pharmacoepidemiol Drug Saf 2018 May;27(5):513-19. doi: 10.1002/pds.4376.
AHRQ-funded; HS022134.
View abstract on the National Library of Medicine site.
Keywords: Legislation/Regulations, Opioids, Provider Practice Patterns, Policy