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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.

de la Guardia FH, Hwang J, Adams JL
The authors specified loss functions and evaluated the potential cost of misclassification for physician report card designs. They found that misclassification cost depends on how performance information will be used and by whom; selecting the lowest-cost design for a given stakeholder could maximize the usefulness of physician performance data. They conlcuded that misclassification cost could guide report card design, improving the usefulness of a report card for one stakeholder without disadvantaging others.
Health Services and Outcomes Research Methodology 2018 Jun;18(2):96-108. doi: 10.1007/s10742-018-0179-2.
AHRQ-funded; HS021860.
View abstract on the National Library of Medicine site.
Keywords: Health Care Quality, Provider Performance, Quality Measurement, Value
Krishnan S, Pappadis MR, Weller SC
Patient-centered mobility outcome preferences according to individuals with stroke and caregivers: a qualitative analysis.
This study explored the mobility-related preferences among stroke survivors and caregivers following post-acute rehabilitation at inpatient or skilled nursing facilities. Frequently mentioned outcome preferences by survivors were ability to walk (88 percent), move, and balance. They also wanted to acquire assistive devices to move independently. Caregivers were concerned with the survivor's safety and wanted them to drive (53 percent), prevent falls, have home accommodations, and transfer independently.
Disabil Rehabil 2018 Jun;40(12):1401-09. doi: 10.1080/09638288.2017.1297855.
AHRQ-funded; HS022134; HS024711.
View abstract on the National Library of Medicine site.
Keywords: Caregiving, Patient-Centered Outcomes Research, Patient Safety, Rehabilitation, Stroke
Jones AL, Cochran SD, Leibowitz A
Racial, ethnic, and nativity differences in mental health visits to primary care and specialty mental health providers: analysis of the Medical Expenditures Panel Survey, 2010-2015.
The researchers sought to guide post-ACA efforts to address mental health service disparities, by using a nationally representative sample to characterize baseline race-, ethnicity-, and nativity-associated differences in mental health services in the context of primary care. They found that all racial/ethnic groups were less likely than non-Latino Whites to have any primary care (PC) visit. Their conclusion was that racial-, ethnic-, and nativity-associated disparities persist in PC provided mental health services.
Healthcare 2018 Mar 22;6(2). doi: 10.3390/healthcare6020029.
AHRQ-funded; HS021721.
View abstract on the National Library of Medicine site.
Keywords: Disparities, Medical Expenditure Panel Survey (MEPS), Mental Health Services, Primary Care, Racial and Ethnic Minority Groups
Agimi Y, Albert SM, Youk AO
Mandatory physician reporting of at-risk drivers: the older driver example.
The hypothesis that mandatory physician reporting laws reduce the rate of crash-related hospitalizations among older adult drivers was tested. Mandatory physician reporting failed to explain any significant variation in crash hospitalization rates, when adjusting for other state-specific laws and characteristics. Vision testing at in-person license renewal was a significant predictor of lower crash hospitalization rate.
Gerontologist 2018 May 8;58(3):578-87. doi: 10.1093/geront/gnw209.
AHRQ-authored.
View abstract on the National Library of Medicine site.
Keywords: Elderly, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Injuries/Wounds, Reporting
AHRQ Author: Steiner CA
Allegranzi B, Aiken AM, Zeynep Kubilay N
A multimodal infection control and patient safety intervention to reduce surgical site infections in Africa: a multicentre, before-after, cohort study.
The researchers aimed to establish the effect of a multimodal intervention on surgical site infections (SSIs) in Africa. SSI cumulative incidence significantly decreased post intervention, from 8.0 percent to 3.8 percent and this decrease persisted in the sustainability period. A substantial improvement in compliance with prevention measures was consistently observed in the follow-up and sustainability periods.
Lancet Infect Dis 2018 May;18(5):507-15. doi: 10.1016/s1473-3099(18)30107-5.
AHRQ-funded; 290201000027.
View abstract on the National Library of Medicine site.
Keywords: Healthcare-Associated Infections, Patient Safety, Surgery, Surgical Safety
Springer R, Marino M, O'Malley JP
Oregon Medicaid Expenditures after the 2014 Affordable Care Act Medicaid expansion: over-time differences among new, returning, and continuously insured enrollees.
This study assessed health care expenditures among Medicaid enrollees in the 24 months after Oregon's 2014 Medicaid expansions and examine whether expenditure patterns were different among the newly, returning, and continuously insured (CI). After initial increases, newly and returning insured (RI) outpatient expenditures dropped below CI. Expenditures for emergency department and dental services among the RI remained higher than among the newly insured.
Med Care 2018 May;56(5):394-402. doi: 10.1097/mlr.0000000000000907.
AHRQ-funded; HS024270.
View abstract on the National Library of Medicine site.
Keywords: Health Care Costs, Health Reform, Health Services Research (HSR), Medicaid
Nanji KC, Roberto SA, Morley MG
Preventing adverse events in cataract surgery: recommendations from a Massachusetts expert panel.
The purpose of this article is to identify contributing factors to the adverse events (AEs) reported in Massachusetts and present the panel's recommended strategies to prevent them. The panel identified 2 principal categories of contributing factors to the state's cataract surgery-related AEs: systems failures and choice of anesthesia technique. The panel recommended several strategies to prevent AEs during cataract surgery, including performing a distinct time-out with at least 2 care-team members before block administration.
Anesth Analg 2018 May;126(5):1537-47. doi: 10.1213/ane.0000000000002529.
AHRQ-funded; HS024764.
View abstract on the National Library of Medicine site.
Keywords: Adverse Medical Events, Evidence-based Practice, Eye Health, Patient Safety, Surgery
Mistry B, Stewart De Ramirez S, Kelen G
Accuracy and reliability of emergency department triage using the emergency severity index: an international multicenter assessment.
This study assessed the accuracy and variability of triage score assignment by emergency department (ED) nurses using the Emergency Severity Index (ESI) in 3 countries. It found that the concordance of nurse-assigned ESI score with reference standard was universally poor and variability was high. Although the ESI is the most popular ED triage tool in the United States and is increasingly used worldwide, its findings point to a need for more reliable ED triage tools.
Ann Emerg Med 2018 May;71(5):581-87.e3. doi: 10.1016/j.annemergmed.2017.09.036.
AHRQ-funded; HS023641.
View abstract on the National Library of Medicine site.
Keywords: Decisionmaking, Emergency Department, Emergency Medical Services, Health Information Technology (HIT), Nursing
Lindly OJ, Thorburn S, Heisler K
Parents' use of complementary health approaches for young children with autism spectrum disorder.
Researchers conducted a study to better understand factors influencing parents' decision to use complementary health approaches (CHA) for children with autism spectrum disorder (ASD). CHA use was negatively associated with older child age and positively associated with parents' belief ASD has major consequences and medication use. Nine themes help explain these results.
J Autism Dev Disord 2018 May;48(5):1803-18. doi: 10.1007/s10803-017-3432-6.
AHRQ-funded; HS000063.
View abstract on the National Library of Medicine site.
Keywords: Autism, Children, Complementary and Alternative Medicine, Decisionmaking, Disabilities
Levin S, Toerper M, Hamrock E
Machine-learning-based electronic triage more accurately differentiates patients with respect to clinical outcomes compared with the emergency severity index.
This study seeks to evaluate an electronic triage system (e-triage) based on machine learning that predicts likelihood of acute outcomes enabling improved patient differentiation. It concluded that E-triage more accurately classifies emergency severity index (ESI) level 3 patients and highlights opportunities to use predictive analytics to support triage decisionmaking.
Ann Emerg Med 2018 May;71(5):565-74.e2. doi: 10.1016/j.annemergmed.2017.08.005.
AHRQ-funded; HS023641.
View abstract on the National Library of Medicine site.
Keywords: Decisionmaking, Health Information Technology (HIT), Medical Informatics, Outcomes
Chen Y, Lairson DR, Chan W
Risk of adverse events associated with front-line anti-myeloma treatment in Medicare patients with multiple myeloma.
This study aims to examine the risks of adverse events associated with anti-multiple myeloma (MM) therapies in a large population-based cohort of elderly patients with MM. It found that novel agents significantly increased the risk of anemia, peripheral neuropathy, and thromboembolic events. Combination therapies consisting of proteasome inhibitor plus immunomodulatory drugs were associated with significantly higher risk for anemia, neutropenia and thromboembolic events.
Ann Hematol 2018 May;97(5):851-63. doi: 10.1007/s00277-018-3238-4.
AHRQ-funded; HS018956.
View abstract on the National Library of Medicine site.
Keywords: Adverse Drug Events, Cancer, Chemotherapy, Medications, Risk
Abdus S, Decker SL
The long-term uninsured were less likely than the short-term uninsured to gain insurance in 2014.
This study assessed the probability of having insurance in at least 1 month of 2014 for a sample of US citizens aged 19–63 who were uninsured in December 2013. It found that among those uninsured at the end of 2013, 2014 insurance take-up was lower the longer a person had been uninsured.
J Gen Intern Med 2018 May;33(5):593-95. doi: 10.1007/s11606-018-4365-2.
AHRQ-authored.
View abstract on the National Library of Medicine site.
Keywords: Health Care Costs, Health Insurance, Medical Expenditure Panel Survey (MEPS), Uninsured
AHRQ Author: Abdus S, Decker SL
Goldstone AB, Chiu P, Baiocchi M
Second arterial versus venous conduits for multi-vessel coronary artery bypass surgery in California.
This study sought to determine whether a second arterial conduit improves outcomes after multi-vessel coronary artery bypass grafting. It concluded that second arterial conduit use in California is low and declining, but arterial grafts were associated with significantly lower mortality and fewer cardiovascular events. A right internal thoracic artery graft offered no benefit over that of a radial artery, but did increase risk of sternal wound infection.
Circulation 2018 Apr 17;137(16):1698-707. doi: 10.1161/circulationaha.117.030959.
AHRQ-funded; HS022192.
View abstract on the National Library of Medicine site.
Keywords: Cardiovascular Conditions, Comparative Effectiveness, Mortality, Patient-Centered Outcomes Research, Surgery
Armstrong MJ, Mullins CD, Gronseth GS
Impact of patient involvement on clinical practice guideline development: a parallel group study.
The aim of this study was to investigate the effect of patient and public involvement (PPI) on guideline question formation and validate a conceptual model of patient and public contributions to guidelines. The qualitative analysis of the discussions occurring during guideline question development demonstrated key differences in group conduct and validated the proposed conceptual model of patient and public contributions to guidelines.
Implement Sci 2018 Apr 16;13(1):55. doi: 10.1186/s13012-018-0745-6.
AHRQ-funded; HS024159; HS022135.
View abstract on the National Library of Medicine site.
Keywords: Evidence-based Practice, Guidelines, Patient & Family Engagement, Patient-Centered Outcomes Research, Research Methodologies
Adam GP, Springs S, Trikalinos T
Does information from ClinicalTrials.gov increase transparency and reduce bias? Results from a five-report case series.
The researchers investigated whether information in ClinicalTrials.gov would impact the conclusions of five ongoing systematic reviews. Of the 173 total ClinicalTrials.gov records identified across the five projects, between 11 and 43 percent did not have an associated publication. In the 14 percent of records that contained results, the new data provided in the ClinicalTrials.gov records did not change the results or conclusions of the reviews.
Syst Rev 2018 Apr 16;7(1):59. doi: 10.1186/s13643-018-0726-5.
AHRQ-authored; AHRQ-funded; HS022998.
View abstract on the National Library of Medicine site.
Keywords: Evidence-based Medicine, Patient-Centered Outcomes Research, Research Methodologies
AHRQ Author: Berliner E
Sobieraj DM, Baker WL, Nguyen E
Association of inhaled corticosteroids and long-acting muscarinic antagonists with asthma control in patients with uncontrolled, persistent asthma: a systematic review and meta-analysis.
The authors conducted a systematic review and meta-analysis of the effects associated with long-acting muscarinic antagonists (LAMAs) vs placebo or vs other controllers as an add-on therapy to inhaled corticosteroids. They concluded that use of LAMA compared with placebo as add-on therapy to inhaled corticosteroids was associated with a lower risk of asthma exacerbations.
JAMA 2018 Apr 10;319(14):1473-84. doi: 10.1001/jama.2018.2757.
AHRQ-funded; 290201500012I.
View abstract on the National Library of Medicine site.
Keywords: Asthma, Medications, Patient-Centered Outcomes Research, Prevention and Care Management, Respiratory Care
Rahman F, Guan J, Glazier RH
Association between quality domains and health care spending across physician networks.
One of the more fundamental health policy questions is the relationship between health care quality and spending. Researchers measured 65 validated quality indicators (QI) across Ontario physician networks. Higher physician spending, especially outpatient primary care spending, was associated with lower rates of avoidable hospitalizations and higher rates of timely hospital-community transitions and moderately associated with lower readmission rates.
PLoS One 2018 Apr 3;13(4):e0195222. doi: 10.1371/journal.pone.0195222.
AHRQ-authored.
View abstract on the National Library of Medicine site.
Keywords: Health Care Costs, Health Care Quality, Patient-Centered Outcomes Research, Quality Indicators
AHRQ Author: Bierman AS
Barbieri AL, Fadare O, Fan L
Challenges in communication from referring clinicians to pathologists in the electronic health record era.
This study reports on the role played by electronic health record inbox messages (EHRmsg) in a safety event involving pathology. Clinicians assumed that pathologists used EHRmsg as clinical care team members, however, pathologists rarely did. Communication gaps exist between primary clinicians and pathologists in the EHR era and they have potential to result in patient harm.
J Pathol Inform. 2018 Apr 2;9:8. doi: 10.4103/jpi.jpi_70_17.
AHRQ-funded; HS022087.
View abstract on the National Library of Medicine site.
Keywords: Adverse Medical Events, Communication, Electronic Health Records, Health Information Technology (HIT), Patient Safety
Balasubramanian BA, Marino M, Cohen DJ
Use of quality improvement strategies among small to medium-size us primary care practices.
This study examined variations in use of QI strategies among 1,181 small to medium-size primary care practices engaged in a national initiative spanning 12 US States to improve quality of care for heart health and assessed factors associated with those variations. It concluded that there is substantial variation in the use of QI strategies among small to medium-size primary care practices across 12 US States.
Ann Fam Med 2018 Apr;16(Suppl 1):S35-s43. doi: 10.1370/afm.2172.
AHRQ-funded; HS023940.
View abstract on the National Library of Medicine site.
Keywords: Evidence-based Practice, health care delivery, Patient-Centered Outcomes Research, Primary Care, Quality Improvement
Wey A, Salkowski N, Kremers WK
A kidney offer acceptance decision tool to inform the decision to accept an offer or wait for a better kidney.
The researchers developed a kidney offer acceptance decision tool to predict the probability of graft survival and patient survival for first-time kidney-alone candidates after an offer is accepted or declined, and they characterized the effect of restricting the donor pool with a maximum acceptable kidney donor profile index (KDPI). Donor pool restrictions were associated with worse 3-year outcomes, especially for candidates with high allocation priority.
Am J Transplant 2018 Apr;18(4):897-906. doi: 10.1111/ajt.14506.
AHRQ-funded; HS024527.
View abstract on the National Library of Medicine site.
Keywords: Clinical Decision Support (CDS), Decisionmaking, Kidney Disease, Medical Expenditure Panel Survey (MEPS), Transplantation

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