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.

Heintzman J, Marino M, Hoopes M
Supporting health insurance expansion: do electronic health records have valid insurance verification and enrollment data?
The researchers sought to validate electronic health record (EHR) insurance information for low-income pediatric patients at Oregon community health centers (CHCs), compared to reimbursement data and Medicaid coverage data. They concluded that EHR coverage data for children had a high overall correspondence with Medicaid data and reimbursement data, suggesting that in some systems EHR data could be utilized to promote insurance stability in their patients.
J Am Med Inform Assoc 2015 Jul;22(4):909-13. doi: 10.1093/jamia/ocv033.
AHRQ-funded; HS021522.
View abstract on the National Library of Medicine site.
Keywords: Electronic Health Records (EHRs), Health Insurance, Medicaid, Low-Income Population, Children
Smith JJ, Johnston JM, Hiratsuka VY
Medical home implementation and trends in diabetes quality measures for AN/AI primary care patients.
The researchers investigated changes in trend for type 2 diabetes mellitus (DM-II) quality indicators after patient-centered medical home (PCMH) implementation at Southcentral Foundation, a tribal health organization in Alaska. They found that rates of new DM-II diagnoses were stable prior to but increased after implementation. DM-II rates of HbA1c screening increased, though not significantly before and remained stable after implementation.
Prim Care Diabetes 2015 Apr;9(2):120-6. doi: 10.1016/j.pcd.2014.06.005.
AHRQ-funded; HS019154.
View abstract on the National Library of Medicine site.
Keywords: Quality Indicators, Diabetes, Patient-Centered Medical Home, Primary Care, Prevention and Care Management
Reid MC, Eccleston C, Pillemer K
Management of chronic pain in older adults.
This review summarized recent evidence on the assessment and management of pain in older patients. Evidence is taken from systematic reviews, meta-analyses, individual trials, and clinical guidelines. Based on their review, the authors argue that all older adults with chronic pain should undergo a comprehensive geriatric pain assessment and that a comprehensive assessment can guide selection of treatments most likely to benefit the patient and identify targets for intervention besides pain relief.
BMJ 2015;350:h532. doi: 10.1136/bmj.h532.
AHRQ-funded; HS020648.
View abstract on the National Library of Medicine site.
Keywords: Chronic Pain, Elderly, Comparative Effectiveness, Prevention and Care Management
Ahmed S, Siegel CA, Melmed GY
Implementing quality measures for inflammatory bowel disease.
The author argues that implementation of quality measures may depend on the care setting and whether quality measurement and improvement can be incorporated into workflows and electronic medical records. He also asserts that collaborative networks, utilization of care pathways, and standardized treatment algorithms may represent avenues for wide-scale implementation of quality improvement.
Curr Gastroenterol Rep 2015 Apr;17(4):14. doi: 10.1007/s11894-015-0437-1.
AHRQ-funded; HS021747.
View abstract on the National Library of Medicine site.
Keywords: Quality Measures, Health Care Quality, Quality Improvement, Electronic Medical Records (EMRs), Health Information Technology (HIT)
Brady J
Why we study disparities: the human stories behind the data.
AHRQ’s Quality and Disparities Report demonstrates that great progress has been made in improving quality in the last decade—but the persistence of disparities means that this progress is uneven. The next step in improving quality should be to focus on disparities in quality as a way to drive improvement more efficiently.
J Nurs Care Qual. 2016 Jul-Sep;31(3):197-200
AHRQ-authored
View abstract on the National Library of Medicine site.
Keywords: Disparities, Health Care Quality, Quality Improvement
AHRQ Author: Brady, J.
Wu AC, Butler MG, Li L
Primary adherence to controller medications for asthma is poor.
The objective of this study was to compare real-world adherence, including both primary and secondary adherence, to the major controller regimens (inhaled corticosteroids (ICSs), leukotriene antagonists (LTRAs), or ICS/long-acting b-agonists (ICS/LABAs) in diverse, insured populations. It found that adherence to controller medications is poor and many patients do not ever fill prescriptions for controller medications. However, primary adherence to ICSs was better than to LTRAs and ICS/LABAs.
Ann Am Thorac Soc 2015 Feb;12(2):161-6. doi: 10.1513/AnnalsATS.201410-459OC.
AHRQ-funded; HS019669.
View abstract on the National Library of Medicine site.
Keywords: Asthma, Patient Adherence, Medications, Comparative Effectiveness
Wong SL, Revels SL, Yin H
Variation in hospital mortality rates with inpatient cancer surgery.
The purpose of this national study was to elucidate clinical mechanisms underlying variation in hospital mortality with major cancer surgery. It found that case-fatality rates among patients with complications at high-mortality hospitals were approximately twice as high as at low-mortality hospitals. This study implicates failure to rescue as the major reason for differences in hospital mortality rates with major cancer surgery.
Ann Surg 2015 Apr;261(4):632-6. doi: 10.1097/sla.0000000000000690.
AHRQ-funded; HS020937.
View abstract on the National Library of Medicine site.
Keywords: Mortality, Surgery, Cancer, Patient Safety, Health Care Quality
Wang Y, Eldridge N, Metersky ML
National trends in patient safety for four common conditions, 2005-2011.
The researchers estimated trends in the rate of occurrence of adverse events for which patients were at risk, the proportion of patients with one or more adverse events, and the number of adverse events per 1000 hospitalizations. From 2005 through 2011, adverse-event rates declined substantially among patients hospitalized for acute myocardial infarction or congestive heart failure but not among those hospitalized for pneumonia or conditions requiring surgery. AHRQ-authored; AHRQ-funded; 290201200003C.
N Engl J Med 2014 Jan 23;370(4):341-51. doi: 10.1056/NEJMsa1300991.
AHRQ-authored; AHRQ-funded; 290201200003C.
View abstract on the National Library of Medicine site.
Keywords: Patient Safety, Adverse Medical Events, Hospitalization, Myocardial Infarction, Heart Failure
AHRQ Author: Eldridge N, Battles J
Simianu VV, Flum DR
Rethinking elective colectomy for diverticulitis: a strategic approach to population health.
The authors argue that a rethinking of elective colectomy should come from a patient-centered approach that considers the risks of recurrence, quality of life, patient wishes and experiences about surgical and medical treatment options as well as operative morbidity and risks.
World J Gastroenterol 2014 Nov 28;20(44):16609-14. doi: 10.3748/wjg.v20.i44.16609.
AHRQ-funded; HS020025.
View abstract on the National Library of Medicine site.
Keywords: Patient-Centered Outcomes Research, Comparative Effectiveness, Surgery, Adverse Medical Events, Risk Factors
Lacson R, O'Connor SD, Sahni VA
Impact of an electronic alert notification system embedded in radiologists' workflow on closed-loop communication of critical results: a time series analysis.
The researchers evaluated the impact of a patient safety initiative with an alert notification system on reducing critical results lacking documented communication, and assessed potential overuse of the alerting system for communicating results. They found that a patient safety initiative with an alert notification system reduced the proportion of critical results among reports lacking documented communication between care providers.
BMJ Qual Saf 2016 Jul;25(7):518-24. doi: 10.1136/bmjqs-2015-004276.
AHRQ-funded; HS022586.
View abstract on the National Library of Medicine site.
Keywords: Patient Safety, Health Information Technology (HIT), Communications
Linder SK, Kamath GR, Pratt GF
Citation searches are more sensitive than keyword searches to identify studies using specific measurement instruments.
This study compared the effectiveness of two search methods in identifying studies that used the Control Preferences Scale (CPS), a health care decision-making instrument commonly used in clinical settings. It found that keyword searches in bibliographic databases yielded high average precision (90%) but low average sensitivity (16%). PubMed was the most precise, followed closely by Scopus and WOS.
J Clin Epidemiol 2015 Apr;68(4):412-7. doi: 10.1016/j.jclinepi.2014.10.008.
AHRQ-funded; HS022134.
View abstract on the National Library of Medicine site.
Keywords: Research Methodologies, Decisionmaking, Evidence-based Research
Coulam R, Kralewski J, Dowd B
The role of medical group practice administrators in the adoption and implementation of Medicare's physician quality reporting system.
The purpose of this study was to gain insights into the role these administrators play in quality assurance programs. It found that administrators conducted due diligence on Medicare's physician quality reporting system, influenced how the issue was presented to physicians for adoption, and managed implementation thereafter. Administrators' recommendations were heavily influenced by practice characteristics, financial incentives, and practice commitments to early adoption of quality improvement innovations.
Health Care Manage Rev. 2016 Apr-Jun;41(2):145-54
AHRQ-funded; HS019964
View abstract on the National Library of Medicine site.
Keywords: Medicare, Provider Performance, Quality Improvement, Reporting
Augustine J, Warholak TL, Hines LE
Ability and use of comparative effectiveness research by P&T committee members and support staff: a 1-year follow-up.
The study’s objective was to provide a follow-up assessment of the use of comparative effectiveness research (CER) in the pharmacy and therapeutics (P&T) committee decision-making process, using information collected from participants 1 year after attending a live continuing education program. It concluded that health professionals attending a continuing education CER program reported higher use of CER materials compared with nonattendees.
J Manag Care Spec Pharm. 2016 Jun;22(6):618-25
AHRQ-funded; HS019220
View abstract on the National Library of Medicine site.
Keywords: Comparative Effectiveness, Continuing Education, Health Personnel, Pharmacists
Chen J, Hsieh AF, Dharmarajan K
National trends in heart failure hospitalization after acute myocardial infarction for Medicare beneficiaries: 1998-2010.
This study used a complete national sample of 2 789 943 AMI hospitalizations of Medicare fee-for-service beneficiaries from 1998 through 2010, we evaluated annual changes in the incidence of subsequent heart failure (HF) hospitalization and mortality using Poisson and survival analysis models. It found that HF hospitalization after AMI decreased from 1998 to 2010, which may indicate improvements in the management of AMI.
Circulation 2013 Dec 17;128(24):2577-84. doi: 10.1161/circulationaha.113.003668.
AHRQ-funded; HS018781.
View abstract on the National Library of Medicine site.
Keywords: Hospitalization, Medicare, Myocardial Infarction, Heart Failure, Mortality
Kaplan HC, Sherman SN, Cleveland C
Reliable implementation of evidence: a qualitative study of antenatal corticosteroid administration in Ohio hospitals.
The objective of this study was to understand conditions that enable delivery of antenatal corticosteroid administration (ANCS) with high reliability among hospitals participating in an Ohio Perinatal Quality Collaborative (OPQC) ANCS project. Among the major themes supporting reliable implementation of ANCS at these hospitals that emerged were: (1) presence of a high reliability culture, (2) processes that emphasize high reliability, and (3) timely and efficient administration process.
BMJ Qual Saf 2016 Jun 8;25(3):173-81. doi: 10.1136/bmjqs-2015-003984.
AHRQ-funded; HS021114.
View abstract on the National Library of Medicine site.
Keywords: Evidence-based Medicine, Patient-Centered Outcomes Research, Maternal Care, health care delivery
Basu J, Avila R, Ricciardi R
Hospital readmission rates in U.S. states: are readmissions higher where more patients with multiple chronic conditions cluster?
This study examines small area variations in readmission rates to assess whether higher readmission rate in an area is associated with higher clusters of patients with multiple chronic conditions. It found that areas with higher concentration of patients with increased comorbid conditions are more likely to have higher readmission rates.
Health Serv Res 2016 Jun;51(3):1135-51. doi: 10.1111/1475-6773.12401.
AHRQ-authored.
View abstract on the National Library of Medicine site.
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Chronic Conditions
AHRQ Author: Basu J, Ricciardi R
Longo DR, Crabtree BF, Pellerano MB
A qualitative study of vulnerable patient views of type 2 diabetes consumer reports.
This study aims to identify whether vulnerable populations with type 2 diabetes perceive consumer reports as helpful in making decisions about diabetes care. It found that participants in 18 focus groups expressed minimal interest in currently available consumer reports. They instead listed personal referrals and interpersonal interactions among the most important factors when choosing a physician.
Patient 2016 Jun;9(3):231-40. doi: 10.1007/s40271-015-0146-8.
AHRQ-funded; HS021902.
View abstract on the National Library of Medicine site.
Keywords: Diabetes, Consumer Information and Education, Consumer Health, Decisionmaking, Chronic Care: Management
Chung S, Zhao B, Lauderdale D
Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.
The researchers examined patterns and predictors of initiation of treatment for incident diabetes in an ambulatory care setting in the US. They found that only half of patients were treated during the first year following diabetes incidence, and only 20% of patients received both medication prescription and lifestyle modification interventions.
Prim Care Diabetes 2015 Feb;9(1):23-30. doi: 10.1016/j.pcd.2014.04.005.
AHRQ-funded; HS019815.
View abstract on the National Library of Medicine site.
Keywords: Diabetes, Prevention and Care Management, Health Care Utilization, Primary Care
Bennette CS, Richards C, Sullivan SD
Steady increase in prices for oral anticancer drugs after market launch suggests a lack of competitive pressure.
The researchers used pharmacy claims for commercially insured individuals to examine trends in postlaunch prices over time for orally administered anticancer drugs recently approved by the Food and Drug Administration. They found that in the period 2007-13, inflation-adjusted per patient monthly drug prices increased 5 percent each year.
Health Aff (Millwood). 2016 May 1;35(5):805-12
AHRQ-funded; HS022982
View abstract on the National Library of Medicine site.
Keywords: Cancer, Health Care Costs, Medications, Pharmaceuticals
Shirley DK, Kaner RJ, Glesby MJ
Screening for chronic obstructive pulmonary disease (COPD) in an urban HIV clinic: a pilot study.
This study aimed to determine the predictive value of a COPD screening strategy validated in the general population and to identify HIV-related factors associated with decreased lung function. It found that questionnaire and peak flow together had low sensitivity, but abnormal peak flow shows potential as a screening tool for COPD in HIV/AIDS. These data suggest that lung function may be influenced by HIV-related factors.
AIDS Patient Care STDS 2015 May;29(5):232-9. doi: 10.1089/apc.2014.0265.
AHRQ-funded; HS000066.
View abstract on the National Library of Medicine site.
Keywords: Human Immunodeficiency Virus (HIV), Screening

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