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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 9737 Research Studies Displayed
Gupta AR, Brajcich BC, Yang AD
Necessity of posttreatment surveillance for low-grade appendiceal mucinous neoplasms.
This study’s objectives were to characterize posttreatment surveillance and determine the risk of recurrence following surgical resection of low-grade appendiceal mucinous neoplasms (LAMNs). Patients who underwent surgical rection of localized LAMNs in an 11-hospital regional healthcare system from 2000 to 2019 were included. A total of 114 patients with LAMNs were identified with various tumor grades, most of them pTis (80.7%). Patients were followed up with posttreatment surveillance (n = 39). No patients experienced tumor recurrence after a mean follow-up duration of 4.7 years, suggesting that routine surveillance may be unnecessary.
Citation: Gupta AR, Brajcich BC, Yang AD . Necessity of posttreatment surveillance for low-grade appendiceal mucinous neoplasms. J Surg Oncol 2021 Dec;124(7):1115-20. doi: 10.1002/jso.26621..
Keywords: Cancer, Surgery, Care Management
Greenzang KA, Kelly CA, Al-Sayegh H
Thinking ahead: parents' worries about late effects of childhood cancer treatment.
This study examined parental perceived likelihood, impact, and worry about late effects of treatment for childhood cancer. The authors surveyed 96 parents of pediatric cancer patients at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center within a year of diagnosis. Most parents (96%) valued information about late effects, and 93% considered late effects in their treatment decision-making. However, 24% could not recall receiving information about late effects, and only 51% felt well-prepared for potential late effects. Only one-fifth of parents consider late effects to be likely for their child, while 61% were extremely/very worried about late effects.
Citation: Greenzang KA, Kelly CA, Al-Sayegh H . Thinking ahead: parents' worries about late effects of childhood cancer treatment. Pediatr Blood Cancer 2021 Dec;68(12):e29335. doi: 10.1002/pbc.29335..
Keywords: Children/Adolescents, Cancer, Education: Patient and Caregiver, Health Literacy, Caregiving
Tandan M, Zimmerman S, Sloane PD
Which nursing home residents with pneumonia are managed on-site and which are hospitalized? Results from 2 years' surveillance in 14 US homes.
Pneumonia is a frequent cause of hospitalization among nursing home (NH) residents, but little information is available as to how clinical presentation and other characteristics relate to hospitalization, and the differential use of antimicrobials based on hospitalization status. This study examined how hospitalized and nonhospitalized NH residents with pneumonia differ. The investigators concluded that respiratory rate was associated with hospitalization but was not documented for more than a quarter of residents.
Citation: Tandan M, Zimmerman S, Sloane PD . Which nursing home residents with pneumonia are managed on-site and which are hospitalized? Results from 2 years' surveillance in 14 US homes. J Am Med Dir Assoc 2020 Dec;21(12):1862-68.e3. doi: 10.1016/j.jamda.2020.07.028..
Keywords: Elderly, Nursing Homes, Pneumonia, Respiratory Conditions, Hospitalization
McInerney M, Mellor JM, Sabik LM. M, Mellor JM, Sabik LM
Welcome mats and on-ramps for older adults: the impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid.
The authors examined whether Medicaid participation by low-income adults age 65 and up increased as a result of Medicaid expansions to working-age adults under the Affordable Care Act (ACA). Using American Community Survey data and state variation in ACA Medicaid expansions, they found that Medicaid expansions to working-age adults increased Medicaid participation among low-income older adults by 4.4 percent. They also found evidence of an “on-ramp” effect, which is an important mechanism behind welcome mat effects among some older adults.
Citation: McInerney M, Mellor JM, Sabik LM. M, Mellor JM, Sabik LM . Welcome mats and on-ramps for older adults: the impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid. J Policy Anal Manage 2021 Win;40(1):12-41. doi: 10.1002/pam.22259..
Keywords: Elderly, Medicaid, Medicare, Low-Income, Health Insurance, Policy
Feldman AG, Squires JE, Hsu EX
The current state of pediatric transplant hepatology fellowships: a survey of recent graduates.
This study’s goal was to describe the clinical, didactic, procedural, and research experiences of recent pediatric transplant hepatology (PTH) fellowship graduates. Findings showed that there is variability in the didactic, clinical, and procedural training among PTH fellowship programs. Although uniformly viewed as a beneficial fellowship year, there is an opportunity to collaborate to create a more standardized training experience.
Citation: Feldman AG, Squires JE, Hsu EX . The current state of pediatric transplant hepatology fellowships: a survey of recent graduates. Pediatr Transplant 2021 Nov;25(7):e14065. doi: 10.1111/petr.14065..
Keywords: Children/Adolescents, Provider: Physician, Education: Continuing Medical Education, Training
Bender M, Williams M, Cruz MF
A study protocol to evaluate the implementation and effectiveness of the Clinical Nurse Leader care model in improving quality and safety outcomes.
The authors discuss the Clinical Nurse Leader care model, a Hybrid Type II Implementation-Effectiveness study to evaluate the effect of the care model on standardized quality and safety outcomes and to identify implementation characteristics that are sufficient and necessary to achieve outcomes. Findings are expected to elucidate Registered Nurse's mechanisms of action as organized into frontline models of care and link actions to improved care quality and safety.
Citation: Bender M, Williams M, Cruz MF . A study protocol to evaluate the implementation and effectiveness of the Clinical Nurse Leader care model in improving quality and safety outcomes. Nurs Open 2021 Nov;8(6):3688-96. doi: 10.1002/nop2.910..
Keywords: Implementation, Quality Improvement, Quality of Care, Patient Safety, Nursing, Evidence-Based Practice
Santana S, Brach C, Harris L
AHRQ Author: Brach C
Updating Health Literacy for Healthy People 2030: Defining Its Importance for a New Decade in Public Health.
The US Department of Health & Human Services (HHS) updates the Healthy People objectives each decade based on the most current science. For the development of HP2030, the HHS drew on recommendations from the Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 (Secretary's Advisory Committee), an independent advisory committee of national health experts, to update the 20-year old individual-focused Healthy People definition of health literacy. This paper discusses that process.
Citation: Santana S, Brach C, Harris L . Updating Health Literacy for Healthy People 2030: Defining Its Importance for a New Decade in Public Health. J Public Health Manag Pract 2021 Nov-Dec;27(Suppl 6):S258-S64. doi: 10.1097/phh.0000000000001324..
Keywords: Health Literacy, Public Health, Health Promotion
Bajaj JS, Shamsaddini A, Fagan A
Distinct gut microbial compositional and functional changes associated with impaired inhibitory control in patients with cirrhosis.
The authors sought to assess the impact of inhibitory control versus traditional cirrhosis-related cognitive performance on gut microbial composition and function. They found that the gut microbial signature of impaired inhibitory control, which is associated with addictive disorders that can lead to cirrhosis, is distinct from cirrhosis-related cognitive impairment.
Citation: Bajaj JS, Shamsaddini A, Fagan A . Distinct gut microbial compositional and functional changes associated with impaired inhibitory control in patients with cirrhosis. Gut Microbes 2021 Jan-Dec;13(1):1953247. doi: 10.1080/19490976.2021.1953247..
Keywords: Digestive Disease and Health
Aouad M, Brown TT, Whaley CM
Understanding the distributional impacts of health insurance reform: evidence from a consumer cost-sharing program.
Investigators examined the heterogeneous effects of reference pricing, a health insurance reform introduced by the California Public Employees' Retirement System (CalPERS), on the distribution of spending by patients and insurers. Using the changes-in-changes approach to estimate the quantile treatment effects (QTE) of the program across different medical procedures, they found that the QTE vary across the patient spending distributions, with a range of positive and negative estimates of the QTE, depending on the medical procedure considered.
Citation: Aouad M, Brown TT, Whaley CM . Understanding the distributional impacts of health insurance reform: evidence from a consumer cost-sharing program. Health Econ 2021 Nov;30(11):2780-93. doi: 10.1002/hec.4410..
Keywords: Health Insurance, Healthcare Costs
Davidson KW, Krist AH, Tseng CW
AHRQ Author: Mills J, Borsky A
Incorporation of social risk in US Preventive Services Task Force Recommendations and identification of key challenges for primary care.
The authors assessed how social risks have been considered in USPSTF recommendation statements and identified current gaps in evidence needed to expand the systematic inclusion of social risks in future recommendations. They concluded that their report serves as a benchmark and foundation for ongoing work to advance the goal of ensuring that health equity and social risks are incorporated into USPSTF methods and recommendations.
Citation: Davidson KW, Krist AH, Tseng CW . Incorporation of social risk in US Preventive Services Task Force Recommendations and identification of key challenges for primary care. JAMA 2021 Oct 12;326(14):1410-15. doi: 10.1001/jama.2021.12833..
Keywords: U.S. Preventive Services Task Force (USPSTF), Primary Care, Social Determinants of Health, Risk, Evidence-Based Practice, Research Methodologies, Guidelines
Henke RM, Fingar KR, Jiang HJ
AHRQ Author: Jiang HJ, Liang L
Access to obstetric, behavioral health, and surgical inpatient services after hospital mergers in rural areas.
This study examined the influence of rural hospital mergers on changes to inpatient service lines at hospitals and within their catchment areas. The authors used hospital discharge data from 32 HCUP Inpatient Databases from 2007 to 2018. They found that merged hospitals were more likely than independent hospitals to eliminate maternal/neonatal and surgical care. They also found that while the number of mental/substance use disorder-related stays decreased or remained stable at merged hospitals and their catchment areas, it increased for unaffiliated hospitals and their catchment areas. This indicates a potential unmet need in the communities of rural hospitals postmerger.
AHRQ-authored; AHRQ-funded; 290201800001C.
Citation: Henke RM, Fingar KR, Jiang HJ . Access to obstetric, behavioral health, and surgical inpatient services after hospital mergers in rural areas. Health Aff 2021 Oct;40(10):1627-36. doi: 10.1377/hlthaff.2021.00160..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitals, Access to Care, Rural Health
Grafova IB, Jarrín OF
Beyond Black and White: mapping misclassification of Medicare beneficiaries race and ethnicity.
This study examined state-level variation in racial/ethnic misclassification of race and ethnicity in the Centers for Medicare and Medicaid Services administrative database using the enrollment database (EDB) beneficiary race code and the Research Triangle Institute (RTI) race code. The cohort included 4,231,370 Medicare beneficiaries who utilized home health care services in 2015. The authors found substantial variation between states in misclassification of self-identified Hispanic, Asian American/Pacific Islander, and American Indian/Alaska Native beneficiaries.
Citation: Grafova IB, Jarrín OF . Beyond Black and White: mapping misclassification of Medicare beneficiaries race and ethnicity. Med Care Res Rev 2021 Oct;78(5):616-26. doi: 10.1177/1077558720935733..
Keywords: Medicare, Racial / Ethnic Minorities, Disparities
Everhart A, Desai NR, Dowd B
Physician variation in the de-adoption of ineffective statin and fibrate therapy.
The objective of this study was to describe physicians' variation in de-adopting concurrent statin and fibrate therapy for type 2 diabetic patients following a reversal in clinical evidence. Researchers modeled fibrate use among Medicare Advantage and commercially insured type 2 diabetic statin users before and after the publication of the ACCORD lipid trial. Findings showed that, on average, physicians decreased fibrate prescribing following the trial; however, many physicians increased prescribing following the trial. Observable physician characteristics did not explain variations in prescribing.
AHRQ-funded; HS025164; HS000036.
Citation: Everhart A, Desai NR, Dowd B . Physician variation in the de-adoption of ineffective statin and fibrate therapy. Health Serv Res 2021 Oct;56(5):919-31. doi: 10.1111/1475-6773.13630..
Keywords: Diabetes, Medication, Practice Patterns
Erim DO, Bennett AV, Gaynes BN
Mapping the Memorial Anxiety Scale for Prostate Cancer to the SF-6D.
The purpose of this study was to create a crosswalk that predicts Short Form 6D (SF-6D) utilities from Memorial Anxiety Scale for Prostate Cancer (MAX-PC) scores. Findings showed that this study provided a crosswalk that converts MAX-PC scores to SF-6D utilities for economic evaluation of clinically significant prostate cancer-related anxiety treatment options for prostate cancer survivors.
Citation: Erim DO, Bennett AV, Gaynes BN . Mapping the Memorial Anxiety Scale for Prostate Cancer to the SF-6D. Qual Life Res 2021 Oct;30(10):2919-28. doi: 10.1007/s11136-021-02871-9..
Keywords: Cancer: Prostate Cancer, Cancer, Research Methodologies
Dominici L, Hu J, Zheng Y
Association of local therapy with quality-of-life outcomes in young women with breast cancer.
Researchers examined the association of surgery with longer-term satisfaction and quality of life (QOL) in young breast cancer survivors. Participants were women 40 years or older who enrolled in the Young Women's Breast Cancer Study. The results suggested that local therapy in young breast cancer survivors is persistently associated with poorer scores in multiple QOL domains, particularly among those treated with mastectomy and radiotherapy, irrespective of breast reconstruction. Socioeconomic stressors also appear to play a role.
Citation: Dominici L, Hu J, Zheng Y . Association of local therapy with quality-of-life outcomes in young women with breast cancer. JAMA Surg 2021 Oct;156(10):e213758. 2021. doi: 10.1001/jamasurg.2021.3758..
Keywords: Cancer: Breast Cancer, Cancer, Quality of Life, Women, Surgery
Coley RY, Walker RL, Cruz M
Clinical risk prediction models and informative cluster size: assessing the performance of a suicide risk prediction algorithm.
Investigators used data from seven health systems to predict suicide attempt within 90 days. They recommended dividing clustered data on the person level, rather than visit level, to ensure strong performance in prospective use and accurate estimation of future performance at the time of model development.
Citation: Coley RY, Walker RL, Cruz M . Clinical risk prediction models and informative cluster size: assessing the performance of a suicide risk prediction algorithm. Biom J 2021 Oct;63(7):1375-88. doi: 10.1002/bimj.202000199..
Keywords: Behavioral Health, Risk
Bierman AS, Wang J, O'Malley PG
AHRQ Author: Bierman AS, Wang J, O'Malley PG, Moss DK
Transforming care for people with multiple chronic conditions: Agency for Healthcare Research and Quality's research agenda.
This article describes issues addressing the needs of those with multiple chronic conditions and discusses the AHRQ research agenda.
Citation: Bierman AS, Wang J, O'Malley PG . Transforming care for people with multiple chronic conditions: Agency for Healthcare Research and Quality's research agenda. Health Serv Res 2021 Oct;56(Suppl 1):973-79. doi: 10.1111/1475-6773.13863..
Keywords: Chronic Conditions, Health Services Research (HSR), Healthcare Delivery, Quality of Care, Primary Care, Guidelines, Evidence-Based Practice
Baughman AW, Renton M, Wehbi NK
Building community and resilience in Massachusetts nursing homes during the COVID-19 pandemic.
Researchers discuss the partnership of the Massachusetts Senior Care Association and Hebrew SeniorLife with AHRQ ECHO National Nursing Home COVID-19 Action Network (the Network). This educational program provided 16 weeks of free weekly virtual sessions to 295 eligible nursing homes. The Network weekly meetings were a source of connection, emotional support, and validation and may be a valuable mechanism to support resilience and wellbeing for nursing home staff.
Citation: Baughman AW, Renton M, Wehbi NK . Building community and resilience in Massachusetts nursing homes during the COVID-19 pandemic. J Am Geriatr Soc 2021 Oct;69(10):2716-21. doi: 10.1111/jgs.17389..
Keywords: COVID-19, Elderly, Nursing Homes, Evidence-Based Practice, Provider: Health Personnel, Education: Continuing Medical Education, Training
Austin EJ, LeRouge C, Lee JR
A learning health systems approach to integrating electronic patient-reported outcomes across the health care organization.
The authors reported on their effort to develop generalizable learnings that can support the integration of electronic patient-reported outcome measures into clinical practice within a learning health system (LHS) framework. They concluded that the guidelines produced from this work highlighted the complex, multidisciplinary nature of implementing change within LHS contexts, as well as the value of action research approaches to enable rapid, iterative learning that leverages the knowledge and experience of communities of practice.
Citation: Austin EJ, LeRouge C, Lee JR . A learning health systems approach to integrating electronic patient-reported outcomes across the health care organization. Learn Health Syst 2021 Oct;5(4):e10263. doi: 10.1002/lrh2.10263..
Keywords: Learning Health Systems, Health Information Technology (HIT), Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Anesi GL, Kerlin MP
The impact of resource limitations on care delivery and outcomes: routine variation, the coronavirus disease 2019 pandemic, and persistent shortage.
Researchers discuss the impact of resource limitations on care delivery and outcomes. They conclude that the interaction between resource limitation and care delivery and outcomes is complex and incompletely understood. Further, the COVID-19 pandemic provides a learning opportunity for strain response during both pandemic and non-pandemic times.
Citation: Anesi GL, Kerlin MP . The impact of resource limitations on care delivery and outcomes: routine variation, the coronavirus disease 2019 pandemic, and persistent shortage. Curr Opin Crit Care 2021 Oct 1;27(5):513-19. doi: 10.1097/mcc.0000000000000859..
Keywords: COVID-19, Public Health, Healthcare Delivery, Intensive Care Unit (ICU), Outcomes
Tong ST, Webel BK, Donahue EE
AHRQ Author: Tong ST
Understanding the value of the wellness visit: a descriptive study.
Clinical preventive services can reduce mortality and morbidity, but Americans receive only half of the recommended care. Although wellness visits protect time for clinicians to review needs and discuss care with patients, studies have not shown that having a wellness visit improves health outcomes. This study sought to understand the types of discussions and volume of care delivered during wellness visits.
Citation: Tong ST, Webel BK, Donahue EE . Understanding the value of the wellness visit: a descriptive study. Am J Prev Med 2021 Oct;61(4):591-95. doi: 10.1016/j.amepre.2021.02.023..
Keywords: U.S. Preventive Services Task Force (USPSTF), Prevention
Tignanelli CJ, Bramante CT, Dutta NT
Metabolic surgery may protect against admission for COVID-19 in persons with nonalcoholic fatty liver disease.
SARS-CoV-2 (COVID-19) disease causes significant morbidity and mortality through increased inflammation and thrombosis. Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are states of chronic inflammation and indicate advanced metabolic disease. The purpose of this observational study was to characterize the risk of hospitalization for COVID-19 in patients with NAFLD/NASH and evaluate the mitigating effect of various metabolic treatments.
Citation: Tignanelli CJ, Bramante CT, Dutta NT . Metabolic surgery may protect against admission for COVID-19 in persons with nonalcoholic fatty liver disease. Surg Obes Relat Dis 2021 Oct;17(10):1780-86. doi: 10.1016/j.soard.2021.05.029..
Keywords: COVID-19, Surgery, Obesity: Weight Management, Obesity
Smulowitz PB, O'Malley AJ, McWilliams JM
Variation in rates of hospital admission from the emergency department among Medicare patients at the regional, hospital, and physician levels.
Rates of admission from the emergency department (ED) vary widely across regions of the country, hospitals within regions, and physicians within hospitals. The study objective was to determine the extent to which variation in admission decisions was described by differences in admission rates at these 3 levels. The investigators concluded that within-area variation, both across hospitals within a region and across physicians within a hospital, was a more substantial component of observed variation in admission rates from the ED than regional level variation.
Citation: Smulowitz PB, O'Malley AJ, McWilliams JM . Variation in rates of hospital admission from the emergency department among Medicare patients at the regional, hospital, and physician levels. Ann Emerg Med 2021 Oct;78(4):474-83. doi: 10.1016/j.annemergmed.2021.03.020..
Keywords: Medicare, Hospitalization, Emergency Department, Practice Patterns
Shintani Smith S, Cheng BT, Kern RC
Publicly reported patient satisfaction scores in academic otolaryngology departments.
Despite controversy regarding their impact and validity, there is a rising national focus on patient satisfaction scores (PSS). In this retrospective cross-sectional study the investigators described the landscape of online PSS as posted by academic otolaryngology practices. The investigators concluded that patient satisfaction with otolaryngology providers at academic institutions was consistently high, as demonstrated by high online PSS with little variability.
Citation: Shintani Smith S, Cheng BT, Kern RC . Publicly reported patient satisfaction scores in academic otolaryngology departments. Laryngoscope 2021 Oct;131(10):2204-10. doi: 10.1002/lary.29557..
Keywords: Patient Experience, Quality of Care, Provider Performance
Portney DS, Zhu Z, Chen EM
COVID-19 and use of teleophthalmology (CUT Group): trends and diagnoses.
The coronavirus disease 2019 (COVID-19) pandemic altered how clinicians care for patients. Ophthalmologists saw an estimated 81% drop in volume, the most of any specialty during the initial pandemic and public health restrictions. This study demonstrates the characteristics of telehealth use in ophthalmology on a large scale with primary data before and during the COVID-19 pandemic.
Citation: Portney DS, Zhu Z, Chen EM . COVID-19 and use of teleophthalmology (CUT Group): trends and diagnoses. Ophthalmology 2021 Oct;128(10):1483-85. doi: 10.1016/j.ophtha.2021.02.010..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Healthcare Delivery