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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.
Keywords: Healthcare Utilization, Health Insurance, Surgery
Wang S, Lai S, von Itzstein MS
Type and case volume of health care facility influences survival and surgery selection in cases with early-stage non-small cell lung cancer.
With the expansion of non-small cell lung cancer (NSCLC) screening methods, the percentage of cases with early-stage NSCLC is anticipated to increase. Yet it remains unclear how the type and case volume of the health care facility at which treatment occurs may affect surgery selection and overall survival for cases with early-stage NSCLC. In this study, the investigators examine how type and case volume of health care facility influenced survival and surgery selection in cases with early-stage non-small cell lung cancer.
Cancer 2019 Dec 1;125(23):4252-59. doi: 10.1002/cncr.32377. AHRQ-funded; HS022418.
Keywords: Cancer: Lung Cancer, Surgery, Cancer, Patient-Centered Outcomes Research, Outcomes, Mortality
Vu JV, Gunaseelan V, Dimick JB
Mechanisms of age and race differences in receiving minimally invasive inguinal hernia repair.
Black patients and older adults are less likely to receive minimally invasive hernia repair. In this study, the investigators explored the association between race, age, and surgeon utilization of minimally invasive surgery (MIS) with the likelihood of receiving MIS inguinal hernia repair. The investigators concluded that race differences were explained by surgeon MIS utilization, implicating access to MIS-performing surgeon as a mediator. Conversely, age disparity was independent of MIS utilization, even after adjusting for comorbidities, indicating some degree of provider bias against performing MIS repair in older patients.
Surg Endosc 2019 Dec;33(12):4032-37. doi: 10.1007/s00464-019-06695-0. AHRQ-funded; HS025778.
Keywords: Racial / Ethnic Minorities, Surgery, Elderly, Access to Care, Healthcare Utilization
Tilden EL, Phillippi JC, Ahlberg M
Describing latent phase duration and associated characteristics among 1281 low-risk women in spontaneous labor.
Recent research suggests that latent phase of labor may terminate at 6 rather than 4 centimeters of cervical dilation. The objectives of this study were to: (a) characterize duration of the latent phase of labor among term, low-risk, United States women in spontaneous labor using the women's self-identified onset; and (b) quantify associations between demographic and maternal/newborn health characteristics and the duration of the latent phase.
Birth 2019 Dec;46(4):592-601. doi: 10.1111/birt.12428. AHRQ-funded; HS024733.
Keywords: Labor and Delivery, Pregnancy, Women
Sklar M, Seijo C, Goldman RE
Beyond checkboxes: a qualitative assessment of physicians' experiences providing care in a patient-centred medical home.
The patient-centered medical home (PCMH) is an innovative approach to health care reform. Despite a well-established process for recognizing PCMH practices, fidelity to, and/or adaptation of, the PCMH model can limit health care and population health improvements. This study explored the connection between fidelity/adaptation to the PCMH model with implementation successes and challenges through the experiences of family and internal medicine PCMH physicians.
J Eval Clin Pract 2019 Dec;25(6):1142-51. doi: 10.1111/jep.13136. AHRQ-funded; HS024192.
Keywords: Patient-Centered Healthcare, Provider: Physician, Provider, Primary Care
Rosenthal M, Shortell S, Shah ND
Physician practices in Accountable Care Organizations are more likely to collect and use physician performance information, yet base only a small proportion of compensation on performance data.
The purpose of this study was to characterize the strategies that physician practices use to improve clinician performance and determine their association with accountable care organizations (ACOs) and other payment reforms. The investigators concluded that ACO-affiliated practices are using more performance improvement strategies than other practices, but base only a small fraction of compensation on quality or cost.
Health Serv Res 2019 Dec;54(6):1214-22. doi: 10.1111/1475-6773.13238. AHRQ-funded; HS024075.
Keywords: Provider Performance, Pay for Performance, Quality Improvement, Quality of Care, Payment
Krist AH, Davidson KW, Ngo-Metzger Q
Social determinants as a preventive service: U.S. Preventive Services Task Force methods considerations for research.
The authors offer a brief review of the social determinants of health that may be germane to the USPSTF, the methods the USPSTF uses to evaluate relevant evidence, and current evidence gaps for social risks. Their road map for research is intended to spark ingenuity and purpose in the next generation of research studies, thereby ensuring that future recommendations to address and prevent social risks in primary care are informed by high-quality evidence.
Am J Prev Med 2019 Dec;57(6s1):S6-s12. doi: 10.1016/j.amepre.2019.07.013. AHRQ-authored; AHRQ-funded; HS026664.
Keywords: U.S. Preventive Services Task Force (USPSTF), Social Determinants of Health, Research Methodologies, Evidence-based Practice, Prevention
Ngo-Metzger Q, Mills J
Huffstetler AN, Phillips RL
Payment structures that support social care integration with clinical care: social deprivation indices and novel payment models.
This perspective article focuses on four models employed both internationally and domestically to outline the implementation, successes, limitations, and research needed to support national application of social determinants of health (SDH) models. The association between high social risk and poor medical outcomes has been established globally; however, healthcare payment policies designed to respond to this relationship generally lack evidence of affecting outcomes. In countries with a legacy of adjusting healthcare payments for social risk, more robust evaluation of associated effects could be helpful. Payers, states, or health systems making similar resource commitments should build in robust longitudinal evaluations of outcomes to inform the evolution of their payment policies.
Am J Prev Med 2019 Dec;57(6s1):S82-s88. doi: 10.1016/j.amepre.2019.07.011. AHRQ-funded; HS026664.
Keywords: Payment, Social Determinants of Health, Managed Care, Policy
Gaufberg E, Olmsted MW, Bell SK
Third things as inspiration and artifact: a multi-stakeholder qualitative approach to understand patient and family emotions after harmful events.
The authors discuss an AHRQ conference held to establish a research agenda on patient and family emotional harm after medical errors. Topics include implications for quality and safety, educational innovation, and qualitative research.
J Med Humanit 2019 Dec;40(4):489-504. doi: 10.1007/s10912-019-09563-z. AHRQ-funded; HS024463.
Keywords: Medical Errors, Adverse Events, Clinician-Patient Communication, Communications, Patient and Family Engagement, Patient Safety
Fitzsimmons-Craft EE, Eichen DM, Kass AE
Reciprocal longitudinal relations between weight/shape concern and comorbid pathology among women at very high risk for eating disorder onset.
This study examined short-term reciprocal longitudinal relations between weight/shape concern and comorbid symptoms and behaviors over the course of 24 months using cross-lagged panel models. Subjects were women 18-25 years old at high risk for onset of an eating disorder (ED), randomized to an online ED preventive intervention or waitlist control. Results supported focusing intervention on reducing weight/shape concern over reducing comorbid constructs for efficient short-term change.
Eat Weight Disord 2019 Dec;24(6):1189-98. doi: 10.1007/s40519-017-0469-7. AHRQ-funded; HS00078.
Keywords: Obesity, Obesity: Weight Management, Women, Risk, Mental Health, Young Adults
Fichtenberg CM, Alley DE, Mistry KB
Improving social needs intervention research: key questions for advancing the field.
This paper summarizes emerging evidence and identifies key areas where more research is needed to advance implementation and policy development. Gaps exist in terms of comparative effectiveness and cost effectiveness of social needs intervention approaches. Increased understanding of mechanisms of action to maximize practitioners' ability to tailor interventions would be a benefit. More research is recommended to guard against unintended consequences and ensure these interventions reduce health inequities. Implementation science research should identify supports and incentives for adoption of effective interventions. Focusing both public and private research efforts on these evidence gaps can help advance identification of interventions that maximize both health equity and healthcare value.
Am J Prev Med 2019 Dec;57(6s1):S47-s54. doi: 10.1016/j.amepre.2019.07.018. AHRQ-authored; AHRQ-funded; HS026664.
Keywords: Evidence-based Practice, Patient-Centered Outcomes Research, Social Determinants of Health, Value
Chan B, Lyles C, Kaplan C
A comparison of electronic patient-portal use among patients with resident and attending primary care providers.
In this study, the authors investigated differences in overall and patterns of portal use for patients with resident and attending primary care providers (PCPs). They concluded that given the lower patient-portal use among residents' patients, residency programs should develop curricula to bolster trainee competence in using the patient-portal for communication and to enhance the patient-physician relationship.
J Gen Intern Med 2018 Dec;33(12):2085-91. doi: 10.1007/s11606-018-4637-x. AHRQ-funded; HS022981; HS022408.
Keywords: Clinician-Patient Communication, Education: Continuing Medical Education, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Provider, Provider: Physician
Ancker JS, Sharko M, Hong M
Should parents see their teen's medical record? Asking about the effect on adolescent-doctor communication changes attitudes.
Parents routinely access young children's medical records, but medical societies strongly recommend confidential care during adolescence, and most medical centers restrict parental records access during the teen years. In this study, the investigators sought to assess public opinion about adolescent medical privacy. The investigators concluded that although medical societies recommend confidential care for adolescents, public opinion was largely in favor of parental access.
J Am Med Inform Assoc 2018 Dec;25(12):1593-99. doi: 10.1093/jamia/ocy120. AHRQ-funded; HS021531.
Keywords: Caregiver, Children/Adolescents, Clinician-Patient Communication, Communications, Electronic Health Records (EHRs), Health Information Technology (HIT), Policy
Rhodes RL, Ukoha NCE, Williams KA
Understanding underuse of advance care planning among a cohort of African American patients with advanced cancer: formative research that examines gaps in intent to discuss options for care.
Advance care planning (ACP), palliative care (PC), and hospice are often underutilized by African Americans. This study assessed the impact of stage of intent to discuss ACP options as key potential barriers. The investigators concluded that despite being hospitalized with advanced cancer and having poor prognosis, intent to discuss ACP options, PC, and hospice in this population was variable, and completion of these activities was low.
Am J Hosp Palliat Care 2019 Dec;36(12):1057-62. doi: 10.1177/1049909119843276. AHRQ-funded; HS022418.
Keywords: Cancer, Palliative Care, Patient-Centered Healthcare, Racial / Ethnic Minorities
Perkins NJ, Weck J, Mumford SL
Combining biomarker calibration data to reduce measurement error.
This paper discusses biomarker assay measurement, stating that collapsing calibration information across batches before statistical analysis has been shown to reduce measurement error and improve estimation. Further, these simple and practical procedures are minor adjustments implemented by study personnel without altering laboratory protocols which could have positive estimation and cost-saving implications especially for population-based studies.
Epidemiology 2019 Nov;30 Suppl 2:S3-s9. doi: 10.1097/ede.0000000000001094. AHRQ-authored.
Keywords: Diagnostic Safety and Quality
Feldman AG, Sundaram SS, Beaty BL
Immunization status at the time of liver transplant in children and adolescents.
In this research letter, the authors quantified the percentage of patients at Society of Pediatric Liver Transplantation centers who were up to date for their age on immunizations at the time of transplant, and determined whether demographic and clinical factors were associated with immunization status at the time of transplant. They concluded that further research is needed to understand barriers to immunization in the pediatric transplant population and called for novel tools that provide pretransplant vaccine education and enhance communication between primary care and subspecialty clinicians.
JAMA 2019 Nov 12;322(18):1822-24. doi: 10.1001/jama.2019.14386. AHRQ-funded; HS026510.
Keywords: Transplantation, Children/Adolescents, Vaccination, Surgery
Neal JL, Carlson NS, Phillippi JC
Midwifery presence in United States medical centers and labor care and birth outcomes among low-risk nulliparous women: a Consortium on Safe Labor study.
This study compared labor care and birth outcomes between medical centers with interprofessional care (midwives and physicians) versus noninterprofessional care (physicians only). A retrospective cohort study was conducted using Consortium on Safe labor data from low-risk nulliparous women who birthed in interprofessional (7393) or noninterprofessional (6982). Women at interprofessional medical centers were 74% less likely to undergo labor induction and 75% less likely to have oxytocin augmentation. In addition, the cesarean rate was 12% lower.
Birth 2019 Nov 11;46(3):475-86. doi: 10.1111/birt.12407. AHRQ-funded; HS024733.
Cai Y, Huang J, Ning J
Two-sample test for correlated data under outcome-dependent sampling with an application to self-reported weight loss data.
This research conducted simulation studies to evaluate a proposed score test to eliminate type I errors when applied to longitudinal or clustered data. The proposed score test’s purpose is to capture differences in the mean and variance between two groups simultaneously. The simulation used was to compare self-reported weight loss data in a friends’ referral group.
Stat Med 2019 Nov 10;38(25):4999-5009. doi: 10.1002/sim.8346. AHRQ-funded; HS022900.
Keywords: Research Methodologies
Dickerson LK, Rouhizadeh M, Korotkaya Y
Language impairment in adults with end-stage liver disease: application of natural language processing towards patient-generated health records.
This study examined the association between language and cognitive impairment in adults with end-stage liver disease (ESLD) and patients post-transplant where the impairments have resolved themselves. Patients showed great improvement after transplant, and the natural language processing (NLP) impairment can be used to detect cognitive impairment in ESLD.
NPJ Digit Med 2019 Nov 4;2:106. doi: 10.1038/s41746-019-0179-9. AHRQ-funded; HS023876.
Keywords: Chronic Conditions, Neurological Disorders, Health Information Technology (HIT)
Knoll BC, Lindemann EA, Albert AL
Recurrent deep network models for clinical NLP tasks: use case with sentence boundary disambiguation.
The complexities of clinical documentation of natural language processing tasks often lead to a poor performance by existing solutions. The authors of this article present an alternative solution that relies on a convolutional neural network layer followed by a bidirectional long short-term memory layer for the task of sentence boundary disambiguation and described an ensemble approach for domain adaptation using two training corpora.
Stud Health Technol Inform 2019 Aug 21;264:198-202. doi: 10.3233/shti190211. AHRQ-funded; HS022085.
Keywords: Health Information Technology (HIT)