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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 9495 Research Studies Displayed
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
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
Fong A, Adams K, Samarth A
AHRQ Author: Chappel T, Grace E, Terrillion S
Assessment of automating safety surveillance from electronic health records: Analysis for the quality and safety review system.
Researchers provided a heuristic assessment of the feasibility of automatically populating the Quality and Safety Review System (QSRS) questions from electronic health record (EHR) data. They developed the Relative Abstraction Complexity Framework to assess relative complexity of data abstraction questions. Their results suggested that Blood and Hospital Acquired Infections-Clostridium Difficile Infection (HAI-CDI) modules would be relatively easier to automate, whereas Surgery and HAI-Surgical Site Infection would be more difficult to automate.
AHRQ-authored; AHRQ-funded; 290201400008I.
Citation: Fong A, Adams K, Samarth A . Assessment of automating safety surveillance from electronic health records: Analysis for the quality and safety review system. J Patient Saf 2021 Sep 1;17(6):e524-e28. doi: 10.1097/pts.0000000000000402..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Chua KP, Linder JA
Prevalence of inappropriate antibiotic prescribing by antibiotic among privately and publicly insured non-elderly US patients, 2018.
The authors used 2018 commercial and Medicaid claims to assess inappropriate prescribing of antibiotics. In their analysis, 22% of antibiotic claims were inappropriate. Azithromycin had an outsized role in inappropriate prescribing. They concluded that broad-based stewardship initiatives remain important given widespread inappropriate prescribing of all antibiotics.
AHRQ-funded; HS024930; HS026506; 2332015000201.
Citation: Chua KP, Linder JA . Prevalence of inappropriate antibiotic prescribing by antibiotic among privately and publicly insured non-elderly US patients, 2018. J Gen Intern Med 2021 Sep;36(9):2861-64. doi: 10.1007/s11606-020-06189-z..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Medicaid, Health Insurance
AHRQ Author: Abdus S
Financial burdens of out-of-pocket prescription drug expenditures under high-deductible health plans.
This study examines financial burdens of out-of-pocket prescription drug expenditures across different levels of deductibles, focusing on low-income adults with multiple, prevalent chronic conditions. The results of this study suggest that for low-income adults with multiple chronic conditions who are enrolled in employer-sponsored high-deductible plans, out-of-pocket prescription drug costs may still result in significant financial hardships. The key takeaway point of this paper for general internists is that for patients with chronic conditions, out-of-pocket costs of prescription drugs could be excessively burdensome if they are enrolled in high-deductible plans.
Citation: Abdus S . Financial burdens of out-of-pocket prescription drug expenditures under high-deductible health plans. J Gen Intern Med 2021 Sep;36(9):2903-05. doi: 10.1007/s11606-020-06226-x..
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Healthcare Costs, Medication
Ye J, Zhang R, Bannon JE
Identifying practice facilitation delays and barriers in primary care quality improvement.
Practice facilitation is an effective approach to implementing quality improvement (QI) interventions in practice-based research networks (PBRNs). Regular facilitator-practice interactions are necessary for successful facilitation and missed engagements may hinder the process of practice improvement. This study employed a mixed-methods approach to characterize the dynamics of practice facilitation and examine facilitation delays and barriers, as well as their association with the achievement of QI program goals in a PBRN initiative.
Citation: Ye J, Zhang R, Bannon JE . Identifying practice facilitation delays and barriers in primary care quality improvement. J Am Board Fam Med 2020 Sep-Oct;33(5):655-64. doi: 10.3122/jabfm.2020.05.200058..
Keywords: Practice Improvement, Primary Care, Quality Improvement, Quality of Care
Angier H, Giebultowicz S, Kaufmann J
Creation of a linked cohort of children and their parents in a large, national electronic health record dataset.
Researchers sought to identify a national cohort of children that link to at least one parent in the same electronic health record dataset and describe their demographics. They were able to link 33% of children to a parent in electronic health record data from a large network of community health centers across the United States. They stated that further analyses utilizing these linkages will allow examination of the multi-level factors that impact a child's receipt of recommended health care.
Citation: Angier H, Giebultowicz S, Kaufmann J . Creation of a linked cohort of children and their parents in a large, national electronic health record dataset. Medicine 2021 Aug 13;100(32):e26950. doi: 10.1097/md.0000000000026950..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare Delivery
Fishbein AB, Cheng BT, Tilley CC
Sleep disturbance in school-aged children with atopic dermatitis: prevalence and severity in a cross-sectional sample.
The authors sought to estimate the US prevalence of sleep disturbance and its impact on psychological and neurocognitive function in patients with atopic dermatitis (AD). Using PROMIS (Patient Reported Outcome Measurement Information System), they found that sleep disturbance was a common symptom of AD affecting approximately 3 million US children and was associated with neuropsychiatric impairment, including depression, anxiety, and inattention. They recommended that clinicians screen for these symptoms in school-aged children, particularly with moderate-to-severe AD.
Citation: Fishbein AB, Cheng BT, Tilley CC . Sleep disturbance in school-aged children with atopic dermatitis: prevalence and severity in a cross-sectional sample. J Allergy Clin Immunol Pract 2021 Aug;8(8):3120-29.e3. doi: 10.1016/j.jaip.2021.04.064..
Keywords: Children/Adolescents, Sleep, Skin Conditions
Dorr DA, D'Autremont C, Pizzimenti C
Assessing data adequacy for high blood pressure clinical decision support: a quantitative analysis.
This study examined guideline-based high blood pressure (HBP) and hypertension recommendations and evaluated the suitability and adequacy of the data and logic required for a Fast Healthcare Interoperable Resources-based, patient-facing clinical decision support HBP application. Findings showed that data quality from the electronic health record required to implement recommendations for HBP was highly inconsistent, reflecting a fragmented health care system and incomplete implementation of standard terminologies and workflows. Although imperfect, data were deemed adequate for two test use cases.
Citation: Dorr DA, D'Autremont C, Pizzimenti C . Assessing data adequacy for high blood pressure clinical decision support: a quantitative analysis. Appl Clin Inform 2021 Aug;12(4):710-20. doi: 10.1055/s-0041-1732401..
Keywords: Hypertension, Blood Pressure, Clinical Decision Support (CDS), Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT), Guidelines
Dahabreh IJ, Haneuse SJA, Robins JM
Study designs for extending causal inferences from a randomized trial to a target population.
In this article, the authors examined study designs for extending causal inferences from a randomized trial to a target population. They showed that the counterfactual quantities that can be identified in each study design depend on what is known about the probability of sampling nonrandomized individuals. They explored the implications of the sampling properties underlying the designs for the identification and estimation of the probability of trial participation.
Citation: Dahabreh IJ, Haneuse SJA, Robins JM . Study designs for extending causal inferences from a randomized trial to a target population. Am J Epidemiol 2021 Aug;190(8):1632-42. doi: 10.1093/aje/kwaa270..
Keywords: Research Methodologies
Chilakamarri P, Finn EB, Sather J
Failure mode and effect analysis: engineering safer neurocritical care transitions.
Investigators presented failure mode and effect analysis (FMEA) as a systems-engineering methodology to be applied to neurocritical care transitions to reduce failures in communication and improve patient safety. They described their local implementation of FMEA to improve the safety of inter-hospital transfer for patients with intracerebral and subarachnoid hemorrhage as evidence of success. They found that application of the FMEA approach yielded meaningful and sustained process change for patients with neurocritical care needs.
Citation: Chilakamarri P, Finn EB, Sather J . Failure mode and effect analysis: engineering safer neurocritical care transitions. Neurocrit Care 2021 Aug;35(1):232-40. doi: 10.1007/s12028-020-01160-6..
Keywords: Patient Safety, Transitions of Care, Critical Care, Communications, Quality Improvement, Quality of Care
Abdul-Chani MM, Moreno CP, Reeder JA
Perceived community disability stigma in multicultural, low-income populations: measure development and validation.
Investigators sought to develop and validate a brief bilingual (English/Spanish) perceived disability stigma measure, to compare perceived disability and autism stigma, and to examine perceived disability stigma by parent sociodemographic characteristics and disability familiarity. They found that perceived autism stigma was greater than perceived disability stigma, with Latino parents reporting less perceived disability stigma than white parents. They concluded that their perceived disability stigma scale demonstrated sound psychometric properties, with results suggesting differences in how stigma is perceived across sociodemographic characteristics and disability familiarity.
Citation: Abdul-Chani MM, Moreno CP, Reeder JA . Perceived community disability stigma in multicultural, low-income populations: measure development and validation. Res Dev Disabil 2021 Aug;115:103997. doi: 10.1016/j.ridd.2021.103997..
Keywords: Disabilities, Low-Income, Vulnerable Populations, Social Stigma
Zuvekas SH, Grosse SD, Lavelle TA
AHRQ Author: Zuvekas SH
Healthcare costs of pediatric autism spectrum disorder in the United States, 2003-2015.
Published healthcare cost estimates for children with autism spectrum disorder (ASD) vary widely. One possible contributor is different methods of case ascertainment. In this study, autism spectrum disorder (ASD) case status was determined using two sources of parent reports among 45,944 children ages 3-17 years in the Medical Expenditure Panel Survey (MEPS) linked to the National Health Interview Survey (NHIS) Sample Child Core questionnaire. In this paper, the investigators describe their process and conclusions.
Citation: Zuvekas SH, Grosse SD, Lavelle TA . Healthcare costs of pediatric autism spectrum disorder in the United States, 2003-2015. J Autism Dev Disord 2021 Aug;51(8):2950-58. doi: 10.1007/s10803-020-04704-z..
Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Autism, Healthcare Costs, Behavioral Health
Vemulakonda VM, Sevick C, Juarez-Colunga E
Treatment of infants with ureteropelvic junction obstruction: findings from the PURSUIT network.
Studies based on administrative databases show that infant pyeloplasty is associated with minority race/ethnicity but lack clinical data that may influence treatment. The objective of this study was to identify clinical and demographic factors associated with pyeloplasty in infants from three large tertiary centers. The investigators found that infant pyeloplasty rates varied between sites. In addition, they found that prolonged T½ was associated with surgery despite prior studies suggesting this was a poor predictor of worsening dilation or function.
Citation: Vemulakonda VM, Sevick C, Juarez-Colunga E . Treatment of infants with ureteropelvic junction obstruction: findings from the PURSUIT network. Int Urol Nephrol 2021 Aug;53(8):1485-95. doi: 10.1007/s11255-021-02866-y..
Keywords: Newborns/Infants, Treatments, Practice Patterns
Suls J, Bayliss EA, Berry J
AHRQ Author: Bierman AS
Measuring multimorbidity: selecting the right instrument for the purpose and the data source.
Adults have a higher prevalence of multimorbidity-or having multiple chronic health conditions-than having a single condition in isolation. Researchers, health care providers, and health policymakers find it challenging to decide upon the most appropriate assessment tool from the many available multimorbidity measures. The objective of this study was to describe a broad range of instruments and data sources available to assess multimorbidity and offer guidance about selecting appropriate measures.
Citation: Suls J, Bayliss EA, Berry J . Measuring multimorbidity: selecting the right instrument for the purpose and the data source. Med Care 2021 Aug;59(8):743-56. doi: 10.1097/mlr.0000000000001566..
Keywords: Chronic Conditions
Snyder ME, Adeoye-Olatunde OA, Gernant SA
A user-centered evaluation of medication therapy management alerts for community pharmacists: recommendations to improve usability and usefulness.
Community pharmacists provide comprehensive medication reviews (CMRs) through pharmacy contracts with medication therapy management (MTM) vendors. These CMRs are documented in the vendors' web-based MTM software platforms, which often integrate alerts to assist pharmacists in the detection of medication therapy problems. The objectives of this study were to 1) assess the usability and usefulness of MTM alerts for MTM vendor-contracted community pharmacists and 2) generate recommendations for improving MTM alerts for use by community pharmacists.
Citation: Snyder ME, Adeoye-Olatunde OA, Gernant SA . A user-centered evaluation of medication therapy management alerts for community pharmacists: recommendations to improve usability and usefulness. Res Social Adm Pharm 2021 Aug;17(8):1433-43. doi: 10.1016/j.sapharm.2020.10.015..
Keywords: Medication, Provider: Pharmacist, Community-Based Practice
McCoy RG, Van Houten HK, Dunlay SM
Race and sex differences in the initiation of diabetes drugs by privately insured US adults.
The authors examined the differences in the use of three glucose-lowering medications as a function of both sex and race. They found that, compared to white men, GLP-1RA were 43% more likely to be started by White women, 12% more likely to be started by non-White men, and 21% less likely to be started by non-White women. SGLT2i were at least 10% less likely to be started by all groups compared to White men, and DPP4i were used more often by non-White than White patients of both sexes.
Citation: McCoy RG, Van Houten HK, Dunlay SM . Race and sex differences in the initiation of diabetes drugs by privately insured US adults. Race and sex differences in the initiation of diabetes drugs by privately insured US adults..
Keywords: Diabetes, Chronic Conditions, Medication, Sex Factors, Racial / Ethnic Minorities
Kandel ZK, Rittenhouse DR, Bibi S
The CMS State Innovation Models Initiative and improved health information technology and care management capabilities of physician practices.
The Centers for Medicare and Medicaid Services' (CMS) State Innovation Models (SIMs) initiative funded 17 states to implement health care payment and delivery system reforms to improve health system performance. The authors investigated whether SIM improved health information technology (HIT) and care management capabilities of physician practices. They found that the CMS SIM Initiative did not accelerate the adoption of ten foundational physician practice capabilities beyond national trends.
Citation: Kandel ZK, Rittenhouse DR, Bibi S . The CMS State Innovation Models Initiative and improved health information technology and care management capabilities of physician practices. Med Care Res Rev 2021 Aug;78(4):350-60. doi: 10.1177/1077558719901217..
Keywords: Health Information Technology (HIT), Healthcare Delivery, Payment, Healthcare Systems, Innovations and Emerging Issues
Borsky AE, Zuvekas SH, Kent EE
AHRQ Author: Borsky AE, Zuvekas SH
Understanding the characteristics of US cancer survivors with informal caregivers.
This AHRQ-authored paper’s purpose is to provide a national representative description of the sociodemographic characteristics of cancer survivors who have or had an informal caregiver. Cross-sectional data from the MEPS Experiences With Cancer Survivorship Supplement survey in 2011, 2016, and 2017 was used. The study population consisted of 720 US adult survivors of cancer other than nonmelanoma skin cancer who were treated for cancer less than 3 years before the survey and were living in the community. A total of 55.2% of cancer survivors reported having an informal caregiving during or after their cancer treatment. Males were more likely to have a spouse as their caregiver and females were more likely to have a child. Cancer survivors who were female, were married, were of a non-White race/ethnicity, or were in poor health were more likely to have an informal caregiver.
Citation: Borsky AE, Zuvekas SH, Kent EE . Understanding the characteristics of US cancer survivors with informal caregivers. Cancer 2021 Aug 1;127(15):2752-61. doi: 10.1002/cncr.33535..
Keywords: Medical Expenditure Panel Survey (MEPS), Cancer, Caregiving
Allen L, Cummings JR, Hockenberry JM
The impact of urgent care centers on nonemergent emergency department visits.
This study looked at the impact of urgent care centers on nonemergency emergency department (ED) use. Secondary data from a novel urgent care center database, linked to the HCUP State Emergency Department Databases (SEDD) from six states was used. Data from ZIP codes with no urgent care centers served as a control group compared to areas with local urgent care centers. Having an open urgent care center in a ZIP code reduced the total number of ED visits by residents by 17.2% largely due to visits for less urgent conditions. The effect was concentrated in areas with hospitals with the longest ED wait times. The total number of uninsured visits to the ED were reduced by 21% and for Medicaid visits by 29.1%.
Citation: Allen L, Cummings JR, Hockenberry JM . The impact of urgent care centers on nonemergent emergency department visits. Health Serv Res 2021 Aug;56(4):721-30. doi: 10.1111/1475-6773.13631..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Healthcare Utilization, Access to Care
Adams LB, Richmond J, Watson SN
Community health worker training curricula and intervention outcomes in African American and Latinx communities: a systematic review.
This systematic review examined research on the relationship between community health worker (CHW) training curricula and intervention outcomes conducted among African American and Latinx populations. Studies included were quantitative, qualitative, and mixed methods studies employed to conduct outcome and process evaluations of CHW-led interventions. Out of 3,295 articles from the extensive literature search, only 36 met the review’s inclusion criteria. Overall, the strength of evidence linking specific CHW training curricula components to primary health interventions in conditions such as hypertension and diabetes was weak, and no studies directly linked outcomes to specific characteristics of CHW training. Studies that discussed training related to didactic sessions or classified as high intensity reported higher percentages of positive outcomes compared to other CHW training methods.
AHRQ-funded; HS000032; HS026122.
Citation: Adams LB, Richmond J, Watson SN . Community health worker training curricula and intervention outcomes in African American and Latinx communities: a systematic review. Health Educ Behav 2021 Aug;48(4):516-31. doi: 10.1177/1090198120959326..
Keywords: Community-Based Practice, Racial / Ethnic Minorities, Training, Outcomes, Provider: Health Personnel
Magee LA, Ranney ML, Fortenberry JD
Identifying nonfatal firearm assault incidents through linking police data and clinical records: cohort study in Indianapolis, Indiana, 2007-2016.
Nonfatal firearm assault incidents are more prevalent than gun homicides, however, little is understood about nonfatal firearm assault incidents due to a lack of accurate data in the United States. This is a descriptive study of all nonfatal firearm assault incidents identified through police and clinical records from 2007 to 2016 in Indianapolis, Indiana.
Citation: Magee LA, Ranney ML, Fortenberry JD . Identifying nonfatal firearm assault incidents through linking police data and clinical records: cohort study in Indianapolis, Indiana, 2007-2016. Prev Med 2021 Aug;149:106605. doi: 10.1016/j.ypmed.2021.106605..
Keywords: Injuries and Wounds
Johnson CL, Schwartz H, Greenberg A
Patient perceptions on barriers and facilitators to accessing low-acuity surgery during COVID-19 pandemic.
The onset of the COVID-19 pandemic led to the postponement of low-acuity surgical procedures in an effort to conserve resources and ensure patient safety. This study aimed to characterize patient-reported concerns about undergoing surgical procedures during the pandemic. The investigators concluded that eliciting patients' perspectives, adapting processes to address potential barriers, and effectively educating patients about institutional measures to minimize in-hospital transmission of COVID-19 should be integrated into surgical care.
Citation: Johnson CL, Schwartz H, Greenberg A . Patient perceptions on barriers and facilitators to accessing low-acuity surgery during COVID-19 pandemic. J Surg Res 2021 Aug;264:30-36. doi: 10.1016/j.jss.2021.01.028..
Keywords: COVID-19, Surgery, Access to Care, Patient Experience, Public Health
Delaney LD, Kattapuram M, Haidar JA
The impact of surgeon adherence to preoperative optimization of hernia repairs.
This study looked at the ways that surgeon-level adherence to preoperative optimization impacts postoperative outcomes. A cohort of patients receiving hernia repair surgery were studied using data from the Michigan Surgical Quality Collaborative from 2014 to 2018. Adherence to preoperative optimization was defined as operating on patients who were nontobacco users with a body mass index of >18.5 kg/m2 and <40 kg/m2. Risk- and reliability-adjusted adherence rates were used to divide surgeons into tertiles. Across 70 Michigan hospitals, 15,016 patients underwent ventral and incisional hernia repair, cared for by 454 surgeons. Preoperative optimization rates ranged from 51% to 76%. Surgeons in the lowest tertile had higher rates of emergency department visits and serious complications versus any complication than middle and high optimization tertiles.
Citation: Delaney LD, Kattapuram M, Haidar JA . The impact of surgeon adherence to preoperative optimization of hernia repairs. J Surg Res 2021 Aug;264:8-15. doi: 10.1016/j.jss.2021.01.044..
Keywords: Surgery, Provider: Physician, Provider, Outcomes