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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.

Vila PM, Olsen MA, Piccirillo JF
Rates of sialoendoscopy and sialoadenectomy in 5,111 adults with private insurance.
The purpose of this study was to determine frequencies and trends in sialoendoscopy and sialoadenectomy for the treatment of obstructive, non-neoplastic submandibular salivary gland disease. Researchers conducted an epidemiologic study of insurance claims from 2006 to 2013 in a large, private insurance claims database; 5,111 adults with sialadenitis who had a sialoendoscopy or submandibular gland excision were included. The results of this study indicate that the use of sialoendoscopy procedures has increased over time, while the overall rate of sialoadenectomy has decreased, but the authors conclude that both procedures are safe for the treatment of patients with sialadenitis and sialolithiasis.
Laryngoscope 2019 Dec 16;129(3):602-06. doi: 10.1002/lary.27243.
AHRQ-funded; HS019455.
View abstract on the National Library of Medicine site.
Keywords: Healthcare Utilization, Health Insurance, Surgery
Ankerst DP, Goros M, Tomlins SA
Incorporation of urinary prostate cancer antigen 3 and TMPRSS2:ERG into Prostate Cancer Prevention Trial Risk Calculator.
The objective of this study was to determine whether the incorporation of two urinary markers, prostate cancer antigen 3 (PCA3) and TMPRSS2:ERG (T2:ERG), into the Prostate Cancer Prevention Trial Risk Calculator (PCPTRC) tool improves its discrimination, accuracy, and clinical net benefit. A Bayesian modeling approach was used to combine data where the markers were measured in a Michigan cohort with the PCPTRC as prior probabilities to create an updated PCPTRC; this update was compared to the existing PCPTRC in terms of discrimination, calibration, and decision curve analysis. Net benefit was improved for the updated PCPTRC, but calibration was not. The authors note that, the updated PCPTRC is limited since it was based on two separate cohorts, and further validation is required. The updated tool is available online.
Eur Urol Focus 2019 Jan;5(1):54-61. doi: 10.1016/j.euf.2018.01.010.
AHRQ-funded; HS024810.
View abstract on the National Library of Medicine site.
Keywords: Cancer, Cancer: Prostate Cancer, Men's Health, Risk
Glick AF, Brach C, Yin HS
Health literacy in the inpatient setting: implications for patient care and patient safety.
This article considers how health literacy plays a part in events that lead up to children's hospitalizations both during hospital admission and after discharge. The authors discussed interventions that incorporate health-literacy-informed strategies and that target patients, families, and health care systems that should be implemented to improve patient outcomes and patient-centered and family-centered care.
Pediatr Clin North Am 2019 Aug;66(4):805-26. doi: 10.1016/j.pcl.2019.03.007.
AHRQ-authored.
View abstract on the National Library of Medicine site.
Keywords: Children/Adolescents, Health Literacy, Hospital Discharge, Hospitalization, Hospitals, Inpatient Care, Patient Safety
AHRQ Author: Brach C
Newman TB, Wu YW, Kuzniewicz MW
Childhood seizures after phototherapy.
A recent Danish study found an increased risk of childhood epilepsy only in boys after phototherapy; researchers investigated this association in a Kaiser Permanente Northern California cohort of infants born after at least 35 weeks' gestation in 1995-2011. The mean follow-up period was 8.1 years. Primary outcome was at least 1 encounter with a seizure diagnosis plus at least 1 prescription for an antiepileptic drug. Results indicated that boys were at higher risk of seizures overall, and had a higher adjusted hazard ratio for phototherapy than girls, although effect modification by sex was not statistically significant. The researchers conclude that infant phototherapy is associated with a small increased risk of childhood seizures, and the risk is more significant in boys.
Pediatrics 2018 Oct;142(4):pii: e20180648. doi: 10.1542/peds.2018-0648.
AHRQ-funded; HS020618.
View abstract on the National Library of Medicine site.
Keywords: Adverse Events, Children/Adolescents, Neurological Disorders, Risk
Tandan M, Sloane PD, Ward K
Antimicrobial resistance patterns of urine culture specimens from 27 nursing homes: impact of a two-year antimicrobial stewardship intervention.
This study evaluated the impact of a two-year antimicrobial stewardship intervention program at 27 nursing homes. The objective was to identify changes in the prevalence and antimicrobial resistance patterns of potentially pathogenic bacteria in urine cultures. All urine cultures were audited during the time period, and out of 6,718 total urine cultures collected, 68% were positive for potentially antimicrobial resistant bacteria. Most of the bacteria identified were E. coli, Proteus spp, and Klebsiella pneumonia. During the 2-year program there was a significant decrease in nitrofurantoin resistance among E. coli and ciprofloxacin resistant among Proteus spp, but carbanepem resistance increased for Proteus spp. Overall, while there was some reduction in antibiotic resistance, the reductions were too small and scattered to conclude the intervention made a big impact.
Infect Control Hosp Epidemiol 2019 Jul;40(7):780-86. doi: 10.1017/ice.2019.108.
AHRQ-funded; HS022846.
View abstract on the National Library of Medicine site.
Keywords: Antibiotics, Antimicrobial Stewardship, Elderly, Long-Term Care, Medication, Nursing Homes
Krishnan S, Hay CC, Pappadis MR
Stroke survivors' perspectives on post-acute rehabilitation options, goals, satisfaction, and transition to home.
This study analyzed stroke survivors’ perspectives on post-acute rehabilitation involvement with their care during discharge planning. Researchers interviewed eighteen stroke survivors who were sent to inpatient rehabilitation facilities after a stroke. They were surveyed about their involvement in decisions made in the selection of their rehabilitation facilities, and more than half were not. About two-thirds of patients were not involved in rehabilitation goal setting. However, most patients were satisfied with their rehabilitation stay.
J Neurol Phys Ther 2019 Jul;43(3):160-67. doi: 10.1097/npt.0000000000000281.
AHRQ-funded; HS022134; HS024711.
View abstract on the National Library of Medicine site.
Keywords: Hospital Discharge, Rehabilitation, Stroke, Transition of Care
Johnston FM, Beckman M
Navigating difficult conversations.
In this paper, the authors discussed breaking bad news and navigating difficult conversations in surgical oncology practice. They note that mounting evidence supports a patient-centered communication approach and models of shared decisionmaking. Physician training in patient-centered cancer communication also continues to evolve.
J Surg Oncol 2019 Jul;120(1):23-29. doi: 10.1002/jso.25472.
AHRQ-funded; HS024736.
View abstract on the National Library of Medicine site.
Keywords: Cancer, Clinician-Patient Communication, Communications, Decisionmaking, Patient-Centered Healthcare, Patient and Family Engagement, Provider: Physician, Surgery
Gupta K, Lisker S, Rivadeneira NA
Decisions and repercussions of second victim experiences for mothers in medicine (SAVE DR MoM).
Researchers characterized events contributing to the second-victim effect among a diverse sample of physician mothers, described the impact on both provider and patient, and sought to determine the association between experiencing a mistake and burnout. They found that physician mothers involved in errors experience negative outcomes and may be at increased risk for burnout. They recommended additional research focusing on strategies to mitigate burnout associated with the second victim effect, particularly among women physicians and those with family responsibilities.
BMJ Qual Saf 2019 Jul;28(7):564-73. doi: 10.1136/bmjqs-2018-008372.
AHRQ-funded; HS023558.
View abstract on the National Library of Medicine site.
Keywords: Adverse Events, Burnout, Medical Errors, Patient Safety, Provider: Physician
Cios K, Cohen B, Quittell LM
Impact of colonizing organism in the respiratory tract on the incidence, duration, and time between subsequent hospitalizations among patients with cystic fibrosis.
The purpose of this study was to examine the association between colonizing respiratory tract organism and frequency, duration, and time between subsequent hospitalizations among hospitalized patients with cystic fibrosis (CF). A retrospective cohort study of 312 CF patients from two New York City hospitals found that CF patients with P aeruginosa alone experienced more hospitalizations, longer length of stay, and shorter time to readmission versus patients with S aureus or both organisms.
Am J Infect Control 2019 Jul;47(7):750-54. doi: 10.1016/j.ajic.2018.12.021.
AHRQ-funded; HS024915.
View abstract on the National Library of Medicine site.
Keywords: Hospitalization, Respiratory Conditions
Bateni SB, Davidson AJ, Arora M
Is breast-conserving therapy appropriate for male breast cancer patients? A national cancer database analysis.
The purpose of this study was to compare overall survival rates among male breast cancer patients who underwent breast-conserving therapy (BCT) versus mastectomy. A retrospective analysis identified 8445 stage I-II male breast cancer patients from the National Cancer Database and grouped them according to surgical and radiation therapy (RT). Most of the patients underwent total mastectomy, while 18.2% underwent BCT, 12.4% underwent total mastectomy with RT, and 8.2% underwent partial mastectomy alone. Partial mastectomy alone, total mastectomy alone, and total mastectomy with RT were associated with worse overall survival rates compared with BCT. The authors conclude that BCT is associated with greater survival, but the underlying mechanisms of this association warrant further study.
Ann Surg Oncol 2019 Jul;26(7):2144-53. doi: 10.1245/s10434-019-07159-4.
AHRQ-funded; HS022236.
View abstract on the National Library of Medicine site.
Keywords: Cancer, Cancer: Breast Cancer, Decisionmaking, Mortality, Outcomes, Patient-Centered Outcomes Research
Wyatt DL
Employing technology to make care transitions safer.
This commentary discusses the potential for errors in patient handoffs; important information about medications and instructions regarding patient care may be overlooked when the patient is referred to special care, moved to a new hospital setting, or discharged. The problem is especially acute for patients with multiple chronic conditions who often undergo frequent transitions to new care settings and healthcare providers. The author describes AHRQ’s funding opportunities for health information technology interventions that aim to improve communication and coordination during care transitions, such as location-based smartphone alerts, a patient-centered discharge toolkit, and a ‘smart pillbox’ electronic medication adherence reporting project.
J Nurs Care Qual 2019 Jul/Sep;34(3):185-88. doi: 10.1097/ncq.0000000000000417.
AHRQ-authored.
View abstract on the National Library of Medicine site.
Keywords: Adverse Events, Care Coordination, Chronic Conditions, Communications, Health Information Technology (HIT), Healthcare Delivery, Hospital Discharge, Medical Errors, Medication, Patient Safety, Transition of Care
AHRQ Author: Wyatt DL
Triebwasser JE, Kamdar NS, Langen ES
Hospital contribution to variation in rates of vaginal birth after cesarean.
The purpose of this retrospective cohort study was to determine the influence of delivery hospital on the rate of vaginal birth after cesarean (VBAC). Claims data were obtained from Blue Cross and Blue Shield of Michigan and included women with a prior cesarean and a singleton live birth. Hospital-specific risk-standardized VBAC rates and the median odds ratio as a measure of variation were calculated. From their results, the authors conclude that the individual delivery hospital contributes to the significant variation in rates of VBAC, after adjustment for patient and hospital characteristics.
J Perinatol 2019 Jul;39(7):904-10. doi: 10.1038/s41372-019-0373-2.
AHRQ-funded; HS025465.
View abstract on the National Library of Medicine site.
Keywords: Hospitals, Labor and Delivery, Maternal Care, Pregnancy, Women
Miglioretti DL, Abraham L, Lee CI
Digital breast tomosynthesis: radiologist learning curve.
This study examined if detect rates and lower recall rates occurred with the adoption of digital breast tomosynthesis (DBT) than for traditional breast mammography. Performance was compared before and after DBT adoption using data from the Breast Cancer Surveillance Consortium cohort. There was a small improvement in recall rates, with more improvement in women with nondense breasts. Cancer detection rates were similar.
Radiology 2019 Apr;291(1):34-42. doi: 10.1148/radiol.2019182305.
AHRQ-funded; HS018366.
View abstract on the National Library of Medicine site.
Keywords: Cancer, Cancer: Breast Cancer, Diagnosis, Imaging, Mammogram, Screening
Joseph A, Khoshkenar A, Taaffe KM
Minor flow disruptions, traffic-related factors and their effect on major flow disruptions in the operating room.
This study researched the impact of minor flow disruptions (FDs) on operating room (OR) flow and how it contributes to an increase in serious adverse events. The rate of minor FDs increases the rate of major FDs. More major and minor FDs occur in the anesthesia area than in all other OR areas. They concluded that room design and layout issues contribute to those FDs and that is an important consideration in OR design.
BMJ Qual Saf 2019 Apr;28(4):276-83. doi: 10.1136/bmjqs-2018-007957.
AHRQ-funded; HS024380.
View abstract on the National Library of Medicine site.
Keywords: Adverse Events, Healthcare Delivery, Patient Safety, Surgery, Workflow
Coe NB, Guo J, Konetzka RT
What is the marginal benefit of payment-induced family care? Impact on Medicaid spending and health of care recipients.
Research on home-based long-term care has centered almost solely on the costs; there has been very little, if any, attention paid to the relative benefits. This study exploited the randomization built into the Cash and Counseling Demonstration and Evaluation program that directly impacted the likelihood of having family involved in home care delivery. The investigators found that some family involvement in home-based care significantly decreased health-care utilization: lower likelihood of emergency room use, Medicaid-financed inpatient days, any Medicaid hospital expenditures, and fewer months with Medicaid-paid inpatient use.
Health Econ 2019 May;28(5):678-92. doi: 10.1002/hec.3873.
AHRQ-authored.
View abstract on the National Library of Medicine site.
Keywords: Home Healthcare, Long-Term Care, Medicaid
AHRQ Author: Guo J
Cottrell E, Darney BG, Marino M
Study protocol: a mixed-methods study of women's healthcare in the safety net after Affordable Care Act implementation - EVERYWOMAN.
In this paper, the authors describe a 5-year, mixed-methods study comparing women's contraceptive, preventive, prenatal and postpartum care before and after ACA implementation and between Medicaid expansion and non-expansion states. They conclude that the findings will be relevant to policy and practice, informing efforts that enhance the provision of timely, evidence-based reproductive care, to improve health outcomes, and to reduce disparities among women. Patient, provider and practice-level interviews will serve to contextualize their findings and to develop subsequent studies and interventions to support women's healthcare provision in community health center settings.
Health Res Policy Syst 2019 Jun 11;17(1):58. doi: 10.1186/s12961-019-0445-y.
AHRQ-funded; HS025155.
View abstract on the National Library of Medicine site.
Keywords: Access to Care, Contraception, Health Services Research (HSR), Pregnancy, Prevention, Maternal Care, Medicaid, Policy, Safety Net, Women
Chou R, Evans C, Hoverman A
Preexposure prophylaxis for the prevention of HIV infection: evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this study was to synthesize evidence on the benefits and harms of PrEP (preexposure prophylaxis), instruments for predicting incident HIV infection, and PrEP adherence, to inform the US Preventive Services Task Force. The study found that in adults at increased risk of HIV infection, PrEP with oral tenofovir disoproxil fumarate monotherapy or tenofovir disoproxil fumarate/emtricitabine was associated with decreased risk of acquiring HIV infection compared with placebo or no PrEP, with effectiveness decreasing with suboptimal adherence. Most adverse events were mild and reversible.
JAMA 2019 Jun 11;321(22):2214-30. doi: 10.1001/jama.2019.2591.
AHRQ-funded; 290201500009I.
View abstract on the National Library of Medicine site.
Keywords: Antiretroviral Therapy, Evidence-based Practice, Human Immunodeficiency Virus (HIV), Medication, Prevention, U.S. Preventive Services Task Force (USPSTF)
Burnham JP, Fritz SA, Yaeger LH
Telemedicine infectious diseases consultations and clinical outcomes: a systematic review and meta-analysis protocol.
This article describes a proposed systematic review that will evaluate the current evidence on the effect of telemedicine infectious diseases consultation within a range of clinical outcomes, including mortality, hospital readmission, antimicrobial use, and cost. Standard systematic review methodology will be used. Data will be grouped by outcome. Primary outcome will be 30-day all-cause mortality. Secondary outcomes will include: readmission within 30 days after discharge from an initial hospitalization with an infection; patient compliance/adherence; patient satisfaction; cost effectiveness; hospital length of stay, use of antimicrobials and antimicrobial stewardship. The findings of this review will add to the established literature regarding feasibility of telemedicine consultation.
Syst Rev 2019 Jun 7;8(1):135. doi: 10.1186/s13643-019-1056-y.
AHRQ-funded; HS024269.
View abstract on the National Library of Medicine site.
Keywords: Evidence-based Practice, Health Information Technology (HIT), Infectious Diseases, Outcomes, Patient Safety
Gupta NM, Lindenauer PK, Yu PC
Association between alcohol use disorders and outcomes of patients hospitalized with community-acquired pneumonia.
The purpose of this study was to compare the causes, treatment, and outcomes of pneumonia in patients with and without alcohol use disorder (AUD). Results suggest that, compared with hospitalized patients with community-acquired pneumonia but without AUD, those with AUD less often harbor resistant organisms. The authors conclude that higher age-adjusted risk of death among patients with AUD appears to be largely attributable to differences in comorbidities, whereas greater use of health care resources may be attributable to alcohol withdrawal.
JAMA Netw Open 2019 Jun 5;2(6):e195172. doi: 10.1001/jamanetworkopen.2019.5172.
AHRQ-funded; HS024277; HS025026.
View abstract on the National Library of Medicine site.
Keywords: Alcohol Consumption, Community-Acquired Infections, Hospitalization, Outcomes, Pneumonia, Substance Abuse
Yoo BK, Schaffer SJ, Humiston SG
Cost effectiveness of school-located influenza vaccination programs for elementary and secondary school children.
This paper describes a clinical trial which created a school-located influenza vaccination (SLIV) program in upstate New York. Researchers wanted to determine if this was a cost-effective alternative to vaccination in primary care practices. Two groups of students were vaccinated – one in an elementary school and the other in a secondary school. Secondary school vaccinations were more cost-effective than elementary schools with a lower median cost per vaccination. The authors concluded that it does raise vaccination rates, but it is not cost-effective due to the higher costs for consent systems and project coordination.
BMC Health Serv Res 2019 Jun 24;19(1):407. doi: 10.1186/s12913-019-4228-5.
AHRQ-funded; HS021163.
View abstract on the National Library of Medicine site.
Keywords: Children/Adolescents, Education, Healthcare Costs, Influenza, Public Health, Vaccination, Value

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