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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.

Powers EM, Shiffman RN, Melnick ER
Efficacy and unintended consequences of hard-stop alerts in electronic health record systems: a systematic review.
Clinical decision support (CDS) hard-stop alerts-those in which the user is either prevented from taking an action altogether or allowed to proceed only with the external override of a third party-are increasingly common but can be problematic. To understand their appropriate application, the investigators explored 3 key questions: (1) To what extent are hard-stop alerts effective in improving patient health and healthcare delivery outcomes? (2) What are the adverse events and unintended consequences of hard-stop alerts? (3) How do hard-stop alerts compare to soft-stop alerts?
J Am Med Inform Assoc 2018 Nov;25(11):1556-66. doi: 10.1093/jamia/ocy112.
AHRQ-funded; HS024332.
View abstract on the National Library of Medicine site.
Keywords: Clinical Decision Support (CDS), Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare: Delivery, Patient Safety
Ricciardi R, Shofer M
Nurses and patients: Natural partners to advance patient safety.
In this Agency for Healthcare Research and Quality commentary, the authors discuss the nurse-patient partnership and its potential for enhancing communication and improving patient safety practices.
J Nurs Care Qual 2019 Jan/Mar;34(1):1-3. doi: 10.1097/ncq.0000000000000377.
AHRQ-authored.
View abstract on the National Library of Medicine site.
Keywords: Nursing, Provider: Nurse, Patient Safety
AHRQ Author: Ricciardi R, Shofer M
Cooper Z, Lilley EJ, Bollens-Lund E
High burden of palliative care needs of older adults during emergency major abdominal surgery.
The purpose of this retrospective study was to quantify preoperative illness burden in older adults undergoing emergency major abdominal surgery (EMAS), to examine the association between illness burden and postoperative outcomes, and to describe end-of-life care in the year after discharge. The investigators found that most older adults undergoing EMAS have preexisting high illness burden and experience high mortality and healthcare use in the year after surgery, particularly near the end of life.
J Am Geriatr Soc 2018 Nov;66(11):2072-78. doi: 10.1111/jgs.15516.
AHRQ-funded; HS022763.
View abstract on the National Library of Medicine site.
Keywords: Acute Care, Elderly, Palliative Care, Surgery
Bateni SB, Gingrich AA, Stewart SL
Hospital utilization and disposition among patients with malignant bowel obstruction: a population-based comparison of surgical to medical management.
In this study, the investigators sought to compare clinically meaningful outcomes in malignant bowel obstruction (MBO) patients treated with surgical versus medical management using population-based data. In this population-based analysis, medical management was associated with less hospital utilization at 30- and 90-days, fewer in-hospital deaths, and more frequent discharges to home. The authors suggest that these data underscore the potential benefits of medical management for MBO patients at the end-of-life.
BMC Cancer 2018 Nov 26;18(1):1166. doi: 10.1186/s12885-018-5108-9.
AHRQ-funded; HS022236.
View abstract on the National Library of Medicine site.
Keywords: Cancer, Comparative Effectiveness, Hospitalization, Palliative Care, Patient-Centered Outcomes Research, Surgery
Adisa O, Jaar BG, Masud T
Association of social worker-assessed psychosocial factors with 30-day hospital readmissions among hemodialysis patients.
In this study, the investigators examined whether social worker-assessed factors were associated with 30-day readmission among prevalent hemodialysis patients. Data on 14 factors were extracted from the first available psychosocial assessment performed by social workers at three metropolitan Atlanta dialysis centers. The authors indicated that results suggested psychosocial issues may be associated with risk of 30-day readmission among dialysis patients.
BMC Nephrol 2018 Dec 17;19(1):360. doi: 10.1186/s12882-018-1162-4.
AHRQ-funded; HS025018.
View abstract on the National Library of Medicine site.
Keywords: Dialysis, Hospital Readmissions
Lin L
Quantifying and presenting overall evidence in network meta-analysis.
This article classified treatment networks into three types under different assumptions; they included networks with each treatment comparison's edge width proportional to the corresponding number of studies, sample size, and precision. In addition, three new measures (ie, the effective number of studies, the effective sample size, and the effective precision) were proposed to preliminarily quantify overall evidence gained in Network meta-analysis.
Stat Med 2018 Dec 10;37(28):4114-25. doi: 10.1002/sim.7905.
AHRQ-funded; HS024743.
View abstract on the National Library of Medicine site.
Keywords: Evidence-based Medicine, Research, Research Methodologies
Agarwal D, Werner RM
Effect of hospital and post-acute care provider participation in accountable care organizations on patient outcomes and Medicare spending.
The purpose of this study was to test for differences in patient outcomes when hospital and post-acute care (PAC) providers participated in accountable care organizations (ACOs). The investigators concluded that hospital and skilled nursing facilities (SNF) participation in an ACO was associated with lower readmission rates, Medicare spending on SNF, and SNF length of stay.
Health Serv Res 2018 Dec;53(6):5035-56. doi: 10.1111/1475-6773.13023.
AHRQ-funded; HS024266.
View abstract on the National Library of Medicine site.
Keywords: Hospital Readmissions, Hospitals, Medicare, Nursing Homes, Outcomes
Abdus S, Keenan PS
Financial burden of employer-sponsored high-deductible health plans for low-income adults with chronic health conditions.
In this research letter, the authors used 2011-2015 Medical Expenditure Panel Survey Household Component data on adults 19 to 64 years of age enrolled in employer-sponsored insurance plans throughout the year to examine the burden of high deductible health plans on low income adults with chronic health conditions.
JAMA Intern Med 2018 Dec;178(12):1706-08. doi: 10.1001/jamainternmed.2018.4706.
AHRQ-authored.
View abstract on the National Library of Medicine site.
Keywords: Chronic Conditions, Health Care Costs, Health Insurance, Low-Income Population, Medical Expenditure Panel Survey (MEPS)
AHRQ Author: Abdus S, Keenan PS
Wang SY, Hsu SH, Huang S
Regional practice patterns and racial/ethnic differences in intensity of end-of-life care.
The purpose of this study was to examine whether regional practice patterns impact racial/ethnic differences in intensity of end-of-life care for cancer decedents. The investigators found that there was greater variation in intensity of end-of-life care among Hispanics, Asians, and whites in high-expenditure hospital referral regions (HRRs) than in low-expenditure HRRs.
Health Serv Res 2018 Dec;53(6):4291-309. doi: 10.1111/1475-6773.12998.
AHRQ-funded; HS023900.
View abstract on the National Library of Medicine site.
Keywords: Cancer, End-of-Life Care, Provider Practice Patterns, Racial / Ethnic Minorities
Vakharia PP, Chopra R, Silverberg NB
Efficacy and safety of topical cantharidin treatment for molluscum contagiosum and warts: a systematic review.
The objective of this systematic review was to assess the efficacy and safety of topical cantharidin treatment for molluscum contagiosum and warts. The investigators found that topical cantharidin demonstrated clearance of warts, particularly in combination with podophyllotixin and salicylic acid, and modest benefit for pediatric molluscum contagiosum with good tolerability and safety.
Am J Clin Dermatol 2018 Dec;19(6):791-803. doi: 10.1007/s40257-018-0375-4.
AHRQ-funded; HS023011.
View abstract on the National Library of Medicine site.
Keywords: Skin Conditions, Treatment Effectiveness
Swietek KE, Domino ME, Beadles C
Do medical homes improve quality of care for persons with multiple chronic conditions?
The purpose of this study was to examine the association between medical home enrollment and receipt of recommended care for Medicaid beneficiaries with multiple chronic conditions (MCC). The investigators found that patient-centered medical home enrollment was associated with an increased likelihood of receiving eight recommended mental and physical health services, including A1C testing for persons with diabetes, lipid profiles for persons with diabetes and/or hyperlipidemia, and psychotherapy for persons with major depression and persons with schizophrenia.
Health Serv Res 2018 Dec;53(6):4667-81. doi: 10.1111/1475-6773.13024.
AHRQ-funded; HS019659.
View abstract on the National Library of Medicine site.
Keywords: Chronic Care, Chronic Conditions, Health Care Quality, Patient-Centered Healthcare, Quality Improvement
Shuman CJ, Xie XJ, Herr KA
Sustainability of evidence-based acute pain management practices for hospitalized older adults.
This article reported on the sustainability of evidence-based acute pain management practices in hospitalized older adults following testing of a multifaceted Translating Research Into Practice (TRIP) implementation intervention. Results revealed most evidence-based acute pain management practices were sustained for 18 months following implementation.
West J Nurs Res 2018 Dec;40(12):1749-64. doi: 10.1177/0193945917738781.
AHRQ-funded; HS010482.
View abstract on the National Library of Medicine site.
Keywords: Elderly, Evidence-based Practice, Inpatient Care, Pain, Prevention and Care Management
Selden TM, Karaca Z, Decker S
Has inpatient hospital treatment before and after age 65 changed as the difference between private and Medicare payment rates has widened?
This study examined whether inpatient hospital treatment before and after age 65 changed as the difference between private and Medicare payment rates widened. Using a large discharge dataset covering the period 2001-2011, the investigators tracked changes at age 65 in multiple dimensions of hospital care.
Int J Health Econ Manag 2018 Dec;18(4):409-23. doi: 10.1007/s10754-018-9240-5.
AHRQ-authored.
View abstract on the National Library of Medicine site.
Keywords: Health Care Payment, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Inpatient Care, Medicare
AHRQ Author: Selden TM, Karaca Z, Decker S
Neal JL, Lowe NK, Caughey AB
Applying a physiologic partograph to Consortium on Safe Labor data to identify opportunities for safely decreasing cesarean births among nulliparous women.
The aims of this study were to assess associations of labor status at admission (i.e., preactive or active) and active labor progress (i.e., dystocic or physiologic) with oxytocin augmentation, cesarean birth, and adverse neonatal outcome rates. The authors suggest that adoption of evidence-based, standardized approaches for diagnosing active labor onset, assessing labor progress, and diagnosing dystocia may safely decrease oxytocin augmentation and cesarean birth rates in the United States.
Birth 2018 Dec;45(4):358-67. doi: 10.1111/birt.12358.
AHRQ-funded; HS024733.
View abstract on the National Library of Medicine site.
Keywords: Labor and Delivery, Pregnancy, Women's Health
Musci RJ, Kharrazi H, Wilson RF
The study of effect moderation in youth suicide-prevention studies.
A systematic review was conducted focusing on identifying youth suicide-prevention studies within the United States. This paper reports on the methods utilized for understanding possible moderators of suicide-prevention program outcomes. The investigators found that only a small percentage of the reviewed articles assessed moderation effects. They assert that this is a substantial research gap driven by sample size or other limitations which have impeded the identification of intervention effect heterogeneity.
Soc Psychiatry Psychiatr Epidemiol 2018 Dec;53(12):1303-10. doi: 10.1007/s00127-018-1574-2.
AHRQ-funded; 29020150000XI.
View abstract on the National Library of Medicine site.
Keywords: Children/Adolescents, Mental Health, Prevention and Care Management
Kempker JA, Martin GS
Severity and timing of onset drive economic costs and clinical outcomes with sepsis.
Sepsis disproportionately affects older adults (mean age, 65 yr); is predominantly community acquired (87%); is expensive (mean hospital costs $21,500); and is associated with high hospital mortality (one in eight patients) and high rates of 30-day readmission for survivors (one in eight patients). In this editorial, the authors discuss an article- by Paoli et al, published in 2018 in Volume 46 of Critical Care Medicine- on sepsis epidemiology.
Crit Care Med 2018 Dec;46(12):2043-44. doi: 10.1097/ccm.0000000000003376.
AHRQ-funded; HS025240.
View abstract on the National Library of Medicine site.
Keywords: Health Care Costs, Mortality, Outcomes, Sepsis
Kalogera E, Nelson G
Surgical technical evidence review for gynecologic surgery conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
The objective of this study was to review the enhanced recovery pathways (ERPs) literature in gynecologic surgery (GS) and provide the framework for Improving Surgical Care and Recovery (ISCR) pathway for GS. The investigators concluded that evidence and existing guidelines supported 29 protocol elements for the AHRQ Safety Program for ISCR in GS.
Am J Obstet Gynecol 2018 Dec;219(6):563.e1-63.e19. doi: 10.1016/j.ajog.2018.07.014.
AHRQ-funded; 23337004T.
View abstract on the National Library of Medicine site.
Keywords: Evidence-based Medicine, Evidence-based Practice, Health Care Quality, Patient Safety, Quality Improvement, Surgery, Women's Health
Jacobs PD, Kronick R
Getting what we pay for: how do risk-based payments to Medicare Advantage plans compare with alternative measures of beneficiary health risk?
The purpose of this study was to estimate the relative health risk of Medicare Advantage (MA) beneficiaries compared to those in Traditional Medicare (TM). The investigators indicate that their findings add to a growing body of evidence suggesting MA receives favorable, or, at worst, neutral selection. They assert that if MA beneficiaries are no healthier and no sicker than similar beneficiaries in TM, then payments to MA plans exceed what is warranted based on their health status.
Health Serv Res 2018 Dec;53(6):4997-5015. doi: 10.1111/1475-6773.12977.
AHRQ-authored.
View abstract on the National Library of Medicine site.
Keywords: Health Care Payment, Medicare
AHRQ Author: Jacobs PD
Guise JM, Savitz LA, Friedman CP
Mind the gap: putting evidence into practice in the era of learning health systems.
This paper discusses two main mechanisms to close the evidence-to-practice gap: (1) integrating Learning Health System (LHS) results with existing systematic review evidence and (2) providing this combined evidence in a standardized, computable data format.
J Gen Intern Med 2018 Dec;33(12):2237-39. doi: 10.1007/s11606-018-4633-1.
AHRQ-funded; 29020120004C.
View abstract on the National Library of Medicine site.
Keywords: Evidence-based Medicine, Evidence-based Practice, Healthcare: Delivery, Learning Health Systems, Translating Research Into Practice (TRIP)
Federman A, Sarzynski E, Brach C
Challenges optimizing the after visit summary.
The purpose of this study was to describe experiences of health systems implementing a redesigned outpatient after visit summary (AVS) in commercially available electronic health record (EHR) systems to inform future optimization. The authors noted limitations to AVS modifications in EHR systems present challenges to optimizing the tool. They recommended that EHR vendors should incorporate learning from healthcare systems innovation efforts and consider building more flexibility into their product development.
Int J Med Inform 2018 Dec;120:14-19. doi: 10.1016/j.ijmedinf.2018.09.009.
AHRQ-authored; AHRQ-funded; HS023844.
View abstract on the National Library of Medicine site.
Keywords: Ambulatory Care and Surgery, Electronic Health Records (EHRs), Health Information Technology (HIT), System Design
AHRQ Author: Brach C

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