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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.
Results1 to 25 of 9119 Research Studies Displayed
Lee K, Gani F, Canner JK
Racial disparities in utilization of palliative care among patients admitted with advanced solid organ malignancies.
The primary objective of this study was to describe racial differences in the use of inpatient palliative care consultations (IPCC) for patients with advanced cancer who are admitted to a hospital in the United States. Hospital admissions of patients with advanced cancers were identified through the National Inpatient Dataset. Findings showed that death during hospitalization was a significant modifier of the relationship between race and receipt of palliative care consultation. There were significant racial disparities in the utilization of IPCC for patients with advanced cancer.
Citation: Lee K, Gani F, Canner JK . Racial disparities in utilization of palliative care among patients admitted with advanced solid organ malignancies. Am J Hosp Palliat Care 2021 Jun;38(6):539-46. doi: 10.1177/1049909120922779..
Keywords: Healthcare Cost and Utilization Project (HCUP), Palliative Care, Cancer, Disparities, Racial / Ethnic Minorities, Healthcare Utilization, Inpatient Care, Chronic Conditions
Levis B, Benedetti A, Ioannidis JPA
Patient Health Questionnaire-9 scores do not accurately estimate depression prevalence: individual participant data meta-analysis.
The authors compared PHQ-9 ≥10 prevalence to Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID) major depression prevalence and assessed whether an alternative PHQ-9 cutoff could more accurately estimate prevalence. They found that PHQ-9 ≥10 substantially overestimated depression prevalence, as there was too much heterogeneity to correct statistically in individual studies.
Citation: Levis B, Benedetti A, Ioannidis JPA . Patient Health Questionnaire-9 scores do not accurately estimate depression prevalence: individual participant data meta-analysis. J Clin Epidemiol 2020 Jun;122:115-28.e1. doi: 10.1016/j.jclinepi.2020.02.002..
Keywords: Depression, Mental Health, Diagnostic Safety and Quality, Diagnosis
Zubiago J, Murphy M, Guardado R
Increased HIV testing in people who use drugs hospitalized in the first wave of the COVID-19 pandemic.
During the COVID-19 pandemic, due to lapses in harm reduction services, several public health experts forecasted subsequent increases in diagnosis of HIV in PWUD. As many inpatient hospitals reworked patient flow during the COVID-19 surge, the investigators hypothesized that HIV testing in PWUD would decrease. To answer this question, they compiled a deidentified list of hospitalized patients with electronic medical record indicators of substance use-a positive urine toxicology screen, prescribed medications to treat opioid use disorder, a positive CIWA score, or a positive CAGE score-admitted between January, 2020 and August, 2020.
Citation: Zubiago J, Murphy M, Guardado R . Increased HIV testing in people who use drugs hospitalized in the first wave of the COVID-19 pandemic. J Subst Abuse Treat 2021 May;124:108266. doi: 10.1016/j.jsat.2020.108266..
Keywords: Human Immunodeficiency Virus (HIV), Opioids, Substance Abuse, Alcohol Consumption, Hospitalization, Public Health, Screening
Shaheen MS, Silverberg JI
Association of inflammatory skin diseases with venous thromboembolism in US adults.
Patients with certain inflammatory skin diseases have multiple risk factors for venous thromboembolism (VTE). The objective of the study was to determine whether atopic dermatitis (AD), psoriasis, pemphigus, pemphigoid and/or hidradenitis was associated with VTE in US adults. Data were analyzed from the 2002-2012 Nationwide Inpatient Sample, a representative cohort of US hospitalizations.
Citation: Shaheen MS, Silverberg JI . Association of inflammatory skin diseases with venous thromboembolism in US adults. Arch Dermatol Res 2021 May;313(4):281-89. doi: 10.1007/s00403-020-02099-6..
Keywords: Healthcare Cost and Utilization Project (HCUP), Skin Conditions, Blood Clots, Risk
Okado I, Pagano I, Cassel K
Perceptions of care coordination in cancer patient-family caregiver dyads.
The authors examined cancer patients and their family caregivers' perspectives of care coordination (CC) using a dyadic research design. They found that a subgroup of family caregivers reported poorer perception of CC than patients, suggesting that those family caregivers and providers may benefit from intervention. They concluded that further understanding of patient-family caregiver dyads' perspectives of CC can inform development of strategies to integrate family caregivers into the cancer care team, develop effective CC interventions for family caregivers, and contribute to improved quality and value of cancer care.
Citation: Okado I, Pagano I, Cassel K . Perceptions of care coordination in cancer patient-family caregiver dyads. Support Care Cancer 2021 May;29(5):2645-52. doi: 10.1007/s00520-020-05764-8..
Keywords: Cancer, Caregiver, Care Coordination, Quality of Care
Narla S, Silverberg JI
The inpatient burden and comorbidities of pyoderma gangrenosum in adults in the United States.
The objective of this study was to determine the prevalence, predictors, outcomes, and costs of hospitalization for pyoderma gangrenosum (PG) in United States adults. Data from the 2002-2012 National Inpatient Sample were analyzed. Findings showed that PG admissions were more likely at teaching and medium or large hospitals. The majority of inpatients with PG were classified with minor or moderate likelihood of dying, but moderate and major loss of function. PG was associated with numerous other health disorders. This study demonstrated a substantial and increasing inpatient burden of PG in the United States, with considerable disability and mortality risk, multiple comorbid health disorders, and costs.
Citation: Narla S, Silverberg JI . The inpatient burden and comorbidities of pyoderma gangrenosum in adults in the United States. Arch Dermatol Res 2021 May;313(4):245-53. doi: 10.1007/s00403-020-02098-7..
Keywords: Healthcare Cost and Utilization Project (HCUP), Skin Conditions, Injuries and Wounds, Hospitalization, Healthcare Costs
Bunting AM, Frank D, Arshonsky J
Socially-supportive norms and mutual aid of people who use opioids: an analysis of Reddit during the initial COVID-19 pandemic.
This study looked at the effect big events like the COVID-19 pandemic can have on transforming social structures, social interactions, and social norms. The social media site Reddit.com was used to collect data on the impact of COVID-19 and opioid use. Posts from March to May 2020 were collected from the two most popular opioid subreddits. Out of 2000 posts, 300 were found to be relevant to the study. The pandemic led to robust social support and mutual aid on Reddit including advice on coping with social isolation, withdrawal, managing cravings, and accessing recovery resources.
Citation: Bunting AM, Frank D, Arshonsky J . Socially-supportive norms and mutual aid of people who use opioids: an analysis of Reddit during the initial COVID-19 pandemic. Drug Alcohol Depend 2021 May 1;222:108672. doi: 10.1016/j.drugalcdep.2021.108672..
Keywords: Opioids, Medication, Substance Abuse, Infectious Diseases, Social Media
Brajcic BC, Ko CY, Liu JB
A NSQIP-based randomized clinical trial evaluating choice of prophylactic antibiotics for pancreaticoduodenectomy.
This paper describes the protocol for an upcoming multicenter randomized surgical trial to evaluate choice of prophylactic antibiotics for pancreaticoduodenectomy. The rationale and methodology of the trial evaluating piperacillin-tazobactam compared to cefoxitin for surgical site infection prevention is described. The study will utilize a clinical registry for data collection.
Citation: Brajcic BC, Ko CY, Liu JB . A NSQIP-based randomized clinical trial evaluating choice of prophylactic antibiotics for pancreaticoduodenectomy. J Surg Oncol 2021 May;123(6):1387-94. doi: 10.1002/jso.26402..
Keywords: Cancer, Antibiotics, Medication, Prevention, Surgery, Healthcare-Associated Infections (HAIs), Comparative Effectiveness, Evidence-based Practice
Bartsch SM, O'Shea KJ, Wedlock PT
The benefits of vaccinating with the first available COVID-19 coronavirus vaccine.
This study’s objective was to determine quantitatively the benefits of early vaccination for COVID-19 even if later on in the pandemic a latter vaccine has substantially higher efficacy. The team developed this model in 2020 before vaccinations became available. For example if a vaccine with 50% efficacy becomes available when 10% of the population has already been infected, waiting until 40% of the population are infected for a vaccine with 80% efficacy results in 15.6 million additional cases and 1.5 million additional hospitalizations, costing $20.6 billion more in direct medical costs and $12.4 billion more in productivity losses.
Citation: Bartsch SM, O'Shea KJ, Wedlock PT . The benefits of vaccinating with the first available COVID-19 coronavirus vaccine. Am J Prev Med 2021 May;60(5):605-13. doi: 10.1016/j.amepre.2021.01.001..
Keywords: Vaccination, Infectious Diseases, Healthcare Costs, Prevention
Barry CL, Anderson KE, Han H
Change over time in public support for social distancing, mask wearing, and contact tracing to combat the COVID-19 pandemic among US adults, April to November 2020.
This study examined changes over time in attitudes towards social distancing, mask wearing, and contact tracing to combat the COVID-19 pandemic among US adults, April to November 2020. Surveys of a nationally representative cohort of US adults were conducted in April, July, and November 2020. Support for social distancing dropped from 89% in April to 79% in July but remained stable in November at 78%. In July and November, more than 75% of respondents supported mask wearing and nearly as many supported contact tracing. Support differences were most pronounced by age, partisanship, and trust in science. Higher support for contact tracing was independently predicted by having a more fluid worldview.
Citation: Barry CL, Anderson KE, Han H . Change over time in public support for social distancing, mask wearing, and contact tracing to combat the COVID-19 pandemic among US adults, April to November 2020. Am J Public Health 2021 May;111(5):937-48. doi: 10.2105/ajph.2020.306148..
Keywords: Infectious Diseases, Public Health, Emergency Preparedness
Anderson KE, Saloner B, Eckstein J
Quality of buprenorphine care for insured adults with opioid use disorder.
This retrospective cohort study evaluated the quality of treatment for insured adults with opioid use disorder (OUD) in the United States. A total of 45,210 commercially insured and Medicare Advantage (MA) enrollees 18 years or older from the OptumLabs Data Warehouse database with an OUD diagnosis in 2018 were analyzed. The treatment analyzed was use of buprenorphine. Only 1 in 10 eligible individuals with OUD initiated buprenorphine within 365 days of diagnosis with 2850 individuals (6.3%) initiating buprenorphine within 14 days of diagnosis. Of the 4600 individuals who received buprenorphine, half were maintained in care with 180 days or more of covered treatment. Treatment quality was generally lower for individuals with MA compared with commercial coverage as well as Hispanic and Black adults compared with White adults.
Citation: Anderson KE, Saloner B, Eckstein J . Quality of buprenorphine care for insured adults with opioid use disorder. Med Care 2021 May;59(5):393-401. doi: 10.1097/mlr.0000000000001530..
Keywords: Opioids, Medication, Substance Abuse, Quality of Care
Dymek C, Kim B, Melton GB
AHRQ Author: Dymek C, Hsiao CJ
Building the evidence-base to reduce electronic health record-related clinician burden.
This paper looks at the evidence-base to reduce electronic health record-related (EHR-related) clinician burden. Evidence-based informatics approaches, pragmatic next steps, and future research directions are presented to improve three of the highest contributors to EHR burden: documentation, chart review, and inbox tasks. Perspectives are also offered on how EHR vendors, healthcare system leaders, and policymakers can play an integral role to make EHR easier to use.
AHRQ-authored; AHRQ-funded; HS027363.
Citation: Dymek C, Kim B, Melton GB . Building the evidence-base to reduce electronic health record-related clinician burden. J Am Med Inform Assoc 2021 Apr 23;28(5):1057-61. doi: 10.1093/jamia/ocaa238..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Burnout, Evidence-based Practice, Provider: Clinician, Provider: Physician, Provider
Kaltenborn Z, Paul K, Kirsch JD
Super fragmented: a nationally representative cross-sectional study exploring the fragmentation of inpatient care among super-utilizers.
Researchers sought to determine the prevalence of super-utilizers who receive fragmented care across different hospitals and to describe associated risks, costs, and health outcomes. Using HCUP data, they found that inpatient care fragmentation was common among super-utilizers and disproportionately affected vulnerable populations. It was associated with high yearly costs and a decreased probability of correctly identifying super-utilizers.
Citation: Kaltenborn Z, Paul K, Kirsch JD . Super fragmented: a nationally representative cross-sectional study exploring the fragmentation of inpatient care among super-utilizers. BMC Health Serv Res 2021 Apr 14;21(1):338. doi: 10.1186/s12913-021-06323-5..
Keywords: Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Hospitalization
Sinz E, Banerjee A, Steadman R
Reliability of simulation-based assessment for practicing physicians: performance is context-specific.
Even physicians who routinely work in complex, dynamic practices may be unprepared to optimally manage challenging critical events. High-fidelity simulation can realistically mimic critical clinically relevant events, however the reliability and validity of simulation-based assessment scores for practicing physicians has not been established. In this study, standardised complex simulation scenarios were developed and administered to board-certified, practicing anesthesiologists who volunteered to participate in an assessment study during formative maintenance of certification activities.
Citation: Sinz E, Banerjee A, Steadman R . Reliability of simulation-based assessment for practicing physicians: performance is context-specific. BMC Med Educ 2021 Apr 12;21(1):207. doi: 10.1186/s12909-021-02617-8..
Keywords: Simulation, Education: Continuing Medical Education, Training, Provider Performance
Moniz MH, Bonawitz K, Wetmore MK
Implementing immediate postpartum contraception: a comparative case study at 11 hospitals.
Researchers examined how organizational context and implementation strategies drive successful implementation of immediate postpartum long-acting reversible contraception services, with a goal of informing the design of future implementation interventions. Semi-structured interviews were conducted with clinicians, nurses, residents, pharmacy and revenue cycle staff, and hospital administrators. They found that implementation efforts in maternity settings may be more successful if they select strategies to optimize local conditions for success. They recommended future research to evaluate whether these strategies effectively optimize local conditions for successful implementation in a variety of settings.
AHRQ-funded; HS025465; HS023784.
Citation: Moniz MH, Bonawitz K, Wetmore MK . Implementing immediate postpartum contraception: a comparative case study at 11 hospitals. Implement Sci Commun 2021 Apr 12;2(1):42. doi: 10.1186/s43058-021-00136-7..
Keywords: Contraception, Maternal Care, Women, Hospitals, Implementation
Carey RM, Wright JT, Taler SJ
Guideline-driven management of hypertension: an evidence-based update.
This paper is an evidence-based update to the 2017 American College of Cardiology/American Heart Association Blood Pressure Guideline. The authors conducted a literature review of relevant observational studies, randomized clinical trials, and meta-analyses published between January 2018 and March 2021. Topics included blood pressure (BP) measurement, patient evaluation, patient evaluation for secondary hypertension, cardiovascular disease risk assessment and BP threshold for drug therapy, lifestyle and pharmacological management, treatment target BP goal, management of hypertension in older adults, diabetes, chronic kidney disease, resistant hypertension, and optimization of care using patient, provider, and health system approaches.
Citation: Carey RM, Wright JT, Taler SJ . Guideline-driven management of hypertension: an evidence-based update. Circ Res 2021 Apr 2;128(7):827-46. doi: 10.1161/circresaha.121.318083..
Keywords: Hypertension, Cardiovascular Conditions, Evidence-based Practice, Guidelines, Chronic Conditions, Blood Pressure
Wilt TJ, Ullman KE, Linskens EJ
Therapies for clinically localized prostate cancer: a comparative effectiveness review.
In this study, the investigators sought to identify new information evaluating clinically localized prostate cancer therapies. The investigators concluded that radical prostatectomy reduced mortality vs watchful waiting in clinically detected localized prostate cancer but caused more harms. Effectiveness may be limited to younger men and those with intermediate risk disease. Active monitoring resulted in little to no mortality difference vs radical prostatectomy or external beam radiation plus androgen deprivation.
Citation: Wilt TJ, Ullman KE, Linskens EJ . Therapies for clinically localized prostate cancer: a comparative effectiveness review. J Urol 2021 Apr;205(4):967-76. doi: 10.1097/ju.0000000000001578..
Keywords: Cancer: Prostate Cancer, Cancer, Comparative Effectiveness, Evidence-based Practice, Patient-Centered Outcomes Research, Men's Health
Wang T, Bredbeck BC, Sinco B
Variations in persistent use of low-value breast cancer surgery.
Through the Choosing Wisely campaign, surgical specialties identified 4 low-value breast cancer operations. Preliminary data suggest varying rates of deimplementation and have identified patient-level and clinician-level determinants of continued overuse. However, little information exists about facility-level variation or determinants of differential deimplementation. In this retrospective cohort study the investigators sought to identify variation and determinants of persistent use of low-value breast cancer surgical care.
Citation: Wang T, Bredbeck BC, Sinco B . Variations in persistent use of low-value breast cancer surgery. JAMA Surg 2021 Apr;156(4):353-62. doi: 10.1001/jamasurg.2020.6942..
Keywords: Cancer: Breast Cancer, Cancer, Surgery, Value, Women
Tanabe P, Blewer AL, Bonnabeau E
Dissemination of evidence-based recommendations for sickle cell disease to primary care and emergency department providers in North Carolina: a cost benefit analysis.
Sickle cell disease (SCD) is a genetic condition affecting primarily individuals of African descent, who happen to be disproportionately impacted by poverty and who lack access to health care. Many providers do not feel prepared to care for individuals with SCD, despite the existence of evidence-based guidelines. The authors report the development of a SCD toolbox and the dissemination process to primary care and emergency department (ED) providers in North Carolina (NC). They report the effect of this dissemination on health-care utilization, cost of care, and overall cost-benefit.
Citation: Tanabe P, Blewer AL, Bonnabeau E . Dissemination of evidence-based recommendations for sickle cell disease to primary care and emergency department providers in North Carolina: a cost benefit analysis. J Health Econ Outcomes Res 2021 Apr 1;8(1):18-28. doi: 10.36469/jheor.2021.21535..
Keywords: Sickle Cell Disease, Evidence-based Practice, Guidelines, Primary Care, Emergency Department, Tools & Toolkits
Sanghavi P, Jena AB, Newhouse JP
Identifying outlier patterns of inconsistent ambulance billing in Medicare.
The objective of this study was to illustrate a method that accounts for sampling variation in identifying suppliers and counties with outlying rates of a particular pattern of inconsistent billing for ambulance services to Medicare. The investigators concluded that health care fraud and abuse were frequently asserted but could be difficult to detect. They suggested that their data-driven approach may be a useful starting point for further investigation.
AHRQ-funded; 6HS022798; HS025720.
Citation: Sanghavi P, Jena AB, Newhouse JP . Identifying outlier patterns of inconsistent ambulance billing in Medicare. Health Serv Res 2021 Apr;56(2):188-92. doi: 10.1111/1475-6773.13622..
Keywords: Medicare, Payment, Health Services Research (HSR)
Roberts ET, Glynn A, Cornelio N
Medicaid coverage 'cliff' increases expenses and decreases care for near-poor Medicare beneficiaries.
Cost sharing in traditional Medicare can consume a substantial portion of the income of beneficiaries who do not have supplemental insurance, resulting in a supplemental coverage cliff. The authors estimated that Medicaid beneficiaries affected by this cliff incurred an additional $2,288 in out-of-pocket spending over the course of two years, used 55 percent fewer outpatient evaluation and management services per year, and filled fewer prescriptions. They recommended expanding eligibility for Medicaid supplemental coverage and increasing take-up of Part D subsidies to lessen cost-related barriers to health care among near-poor Medicare beneficiaries.
Citation: Roberts ET, Glynn A, Cornelio N . Medicaid coverage 'cliff' increases expenses and decreases care for near-poor Medicare beneficiaries. Health Aff 2021 Apr;40(4):552-61. doi: 10.1377/hlthaff.2020.02272..
Keywords: Medicaid, Medicare, Healthcare Costs, Low-Income, Health Insurance
Richardson JS, Kemper AR, Grosse SD
Health and economic outcomes of newborn screening for infantile-onset Pompe disease.
The authors sought to estimate health and economic outcomes associated with newborn screening for infantile-onset Pompe disease in the United States. They found that newborn screening for Pompe disease resulted in substantial health gains for individuals with infantile-onset Pompe disease, but with additional costs.
Citation: Richardson JS, Kemper AR, Grosse SD . Health and economic outcomes of newborn screening for infantile-onset Pompe disease. Genet Med 2021 Apr;23(4):758-66. doi: 10.1038/s41436-020-01038-0..
Keywords: Newborns, Screening, Genetics
Rauscher GH, Murphy AM, Qiu Q
The "sweet spot" revisited: optimal recall rates for cancer detection with 2D and 3D digital screening mammography in the Metro Chicago Breast Cancer Registry.
The authors examined the trade-offs for higher recall rates in terms of biopsy recommendations and cancer detection in mammography in a single large health care organization. 2D analog, 2D digital, and 3D digital mammography screenings among women 40-79 years old with cancer follow-up were examined. They found that the results of their investigation were in contrast to those of a recent study suggesting appropriateness of higher recall rates. They concluded that optimal cancer detection appeared to be in the recall rate range of 7-9% for both 2D digital mammography and 3D tomosynthesis.
Citation: Rauscher GH, Murphy AM, Qiu Q . The "sweet spot" revisited: optimal recall rates for cancer detection with 2D and 3D digital screening mammography in the Metro Chicago Breast Cancer Registry. AJR Am J Roentgenol 2021 Apr;216(4):894-902. doi: 10.2214/ajr.19.22429.
Keywords: Cancer: Breast Cancer, Cancer, Mammogram, Screening, Diagnostic Safety and Quality, Diagnosis, Women, Prevention
Peltz A, Kan K, Garg A
Racial and ethnic differences in managed care enrollment among US children.
The authors used national survey data to compare rates of HMO enrollment, by race and ethnicity, for children with commercial and public coverage. They found that, when adjusted for sociodemographic characteristics, Hispanic children with public coverage, non-Hispanic Black children with commercial coverage, and Hispanic children with commercial coverage were more likely to be enrolled in HMOs than non-Hispanic White children. They recommended future study to examine the degree to which the observed national imbalance in HMO enrollment results from state-specific policies, family preferences, or coverage affordability.
Citation: Peltz A, Kan K, Garg A . Racial and ethnic differences in managed care enrollment among US children. JAMA Netw Open 2021 Apr;4(4):e214162. doi: 10.1001/jamanetworkopen.2021.4162..
Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Managed Care, Health Insurance, Racial / Ethnic Minorities
Peahl AF, Powell A, Berlin H
Patient and provider perspectives of a new prenatal care model introduced in response to the coronavirus disease 2019 pandemic.
The authors evaluated institutional-level adoption and patient and provider experiences with a coronavirus disease 2019 prenatal care model. They found that reduced visit schedules and virtual visits were rapidly integrated into real-world care, with positive experiences for many patients and providers. They recommended future research to understand the health outcomes and care experience associated with alternative approaches to prenatal care delivery across more diverse patient populations outside of the coronavirus disease 2019 pandemic to inform broader health policy decisions.
Citation: Peahl AF, Powell A, Berlin H . Patient and provider perspectives of a new prenatal care model introduced in response to the coronavirus disease 2019 pandemic. Am J Obstet Gynecol 2021 Apr;224(4):384.e1-84.e11. doi: 10.1016/j.ajog.2020.10.008..
Keywords: Maternal Care, Pregnancy, Patient-Centered Healthcare, Telehealth, Health Information Technology (HIT), Healthcare Delivery