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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 10488 Research Studies Displayed
Yakovchenko V, Morgan TR, Chinman MJ
Mapping the road to elimination: a 5-year evaluation of implementation strategies associated with hepatitis C treatment in the Veterans Health Administration.
While few countries and healthcare systems are on track to meet the World Health Organization's hepatitis C virus (HCV) elimination goals, the US Veterans Health Administration (VHA) has been a leader in these efforts. In this study the investigators aimed to determine which implementation strategies were associated with successful national viral elimination implementation within the VHA. They conducted a five-year, longitudinal cohort study of the VHA Hepatic Innovation Team (HIT) Collaborative between October 2015 and September 2019.
Citation: Yakovchenko V, Morgan TR, Chinman MJ . Mapping the road to elimination: a 5-year evaluation of implementation strategies associated with hepatitis C treatment in the Veterans Health Administration. BMC Health Serv Res 2021 Dec 18;21(1):1348. doi: 10.1186/s12913-021-07312-4..
Keywords: Hepatitis, Chronic Conditions, Veterans
Wurcel AG, Essien UR, Ortiz C
Variation by race in antibiotics prescribed for hospitalized patients with skin and soft tissue infections.
This cohort study examined antibiotics prescribed and variations by race among hospitalized patients with skin and soft tissue infections (SSTIs). A subanalysis of multisite, cross-sectional data collected through a national survey of acute care hospital groups within Vizient, Inc. considering adult inpatients treated for SSTIs was used. Of the 1242 adult inpatients included from 91 US hospitals, 45% were female, 18% were Black, and 69% were White with a mean age of 58 years. Penicillin allergy with hives was found in 23%, 19% with rash, and 18% with unknown effects, with allergy found more frequent in Black patients (23%) versus White (18%). Adjusting for multiple factors, White inpatients were at an increased risk of cefazolin use and decreased risk of clindamycin use compared with Black inpatients. Cefazolin use with less likely to be prescribed to Black inpatients than White inpatients and they were likely to be prescribed clindamycin. Cefazolin is considered a first-line SSTI treatment with clindamycin not recommended given frequent dosing and high potential for adverse effects including Clostridioides difficile infection (CDI). Although penicillin allergy is described as more prevalent among White patients, the authors observed an increased prevalence among Black inpatients compared with White inpatients treated for SSTI.
Citation: Wurcel AG, Essien UR, Ortiz C . Variation by race in antibiotics prescribed for hospitalized patients with skin and soft tissue infections. JAMA Netw Open 2021 Dec;4(12):e2140798. doi: 10.1001/jamanetworkopen.2021.40798..
Keywords: Antibiotics, Skin Conditions, Racial / Ethnic Minorities, Practice Patterns, Medication
Hails KA, Petts RA, Hostutler CA
COVID-19 distress, negative parenting, and child behavioral problems: the moderating role of parent adverse childhood experiences.
This study’s objective was to test a moderated mediation model to determine whether families’ COVID-19-related distress is associated with young children's emotional/behavioral functioning via negative parenting, and whether these relationships vary based on parents' adverse childhood experiences (ACEs). Participants were 267 parents recruited from five primary care sites across the United States with children ages 1.5-5 years. Internet questionnaires were completed on measures including demographics, parent ACEs, negative parenting, parent mental health, and COVID-19 distress. Negative parenting significantly mediated the relationship between COVID-19 distress and child emotional/behavioral problems. The model accounted for 42% variance in child emotional/behavioral problems.
Citation: Hails KA, Petts RA, Hostutler CA . COVID-19 distress, negative parenting, and child behavioral problems: the moderating role of parent adverse childhood experiences. Child Abuse Negl 2022 Aug;130(Pt 1):105450. doi: 10.1016/j.chiabu.2021.105450..
Keywords: Children/Adolescents, COVID-19, Behavioral Health, Stress
Adams C, Wortley P, Chamberlain A
Declining COVID-19 case-fatality in Georgia, USA, March 2020 to March 2021: a sign of real improvement or a broadening epidemic?
This article examined whether declines in the crude US COVID-19 case fatality ratio is due to improved clinical care and/or other factors. The authors used multivariable logistic regression to examine associations between report month and mortality among confirmed and probable COVID-19 cases and hospitalized cases in Georgia from March 2020 through March 2021. Mortality risk was lowest in November 2020 compared to August 2020 and remained lower until March 2021. Among hospitalized cases, mortality risk increased in December 2020 and January 2021 before declining in March 2021. The authors concluded that improved clinical management may have contributed to lower mortality risk.
Citation: Adams C, Wortley P, Chamberlain A . Declining COVID-19 case-fatality in Georgia, USA, March 2020 to March 2021: a sign of real improvement or a broadening epidemic? Ann Epidemiol 2022 Aug;72:57-64. doi: 10.1016/j.annepidem.2022.05.008..
Keywords: COVID-19, Public Health, Mortality
Beeber AS, Hoben M, Leeman J
Developing a toolkit to improve resident and family engagement in the safety of assisted living: Engage-A stakeholder-engaged research protocol.
This paper describes an AHRQ-funded study protocol (Engage) to develop a toolkit for increasing resident and family engagement in assisted living (AL) safety. The study goals are to engage AL residents and family caregivers, AL staff, and other AL stakeholders to (1) identify common AL safety problems; (2) prioritize safety problems and identify and evaluate existing PFE interventions with the potential to address safety problems in the AL setting; and (3) develop a testable toolkit to improve PFE in AL safety. Methods, including qualitative interviews, a scoping review of persona and family engagement (PFE) interventions, and stakeholder panel meetings are discussed. The authors also detail how the protocol was modified to address the unique challenges of the COVID-19 pandemic.
Citation: Beeber AS, Hoben M, Leeman J . Developing a toolkit to improve resident and family engagement in the safety of assisted living: Engage-A stakeholder-engaged research protocol. Res Nurs Health 2022 Aug;45(4):413-23. doi: 10.1002/nur.22232..
Keywords: Patient and Family Engagement, Patient Safety, Caregiving, Public Health, Long-Term Care
Koball H, Kirby J, Hartig S
AHRQ Author: Kirby J
The relationship between states' immigrant-related policies and access to health care among children of immigrants.
The purpose of this AHRQ-authored paper was to explore immigrants’ children’s access to preventive healthcare, and the impact of sanctuary policies (state policies that limit federal immigration enforcement involvement) and the provision of driver’s licenses for undocumented immigrants on that access. Primary outcomes included whether the child had a well child check-up, unmet medical needs, or a regular source for care. The 2008-2016 Medical Panel Expenditure Survey (MPES) merged with policy data at the state level were analyzed, with the researchers reporting that sanctuary policies and having a state driver’s license were both associated with having a regular source for care and less unmet medical needs among the children of immigrants. The researchers emphasized the importance of access to preventive care and concluded that sanctuary policies are related to increased access to preventive health care among the children of immigrants.
Citation: Koball H, Kirby J, Hartig S . The relationship between states' immigrant-related policies and access to health care among children of immigrants. J Immigr Minor Health 2022 Aug;24(4):834-41. doi: 10.1007/s10903-021-01282-9..
Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Policy, Access to Care
Eldridge N, Wang Y, Metersky M
AHRQ Author: Eldridge N, Perdue-Puli J, Brady PJ, Grace E, Rodrick D
Trends in adverse event rates in hospitalized patients, 2010-2019.
This AHRQ-authored serial cross-sectional study’s objective was to determine the change in the rate of adverse events in hospitalized patients from 2010 to 2019. The study used data from the Medicare Patient Safety Monitoring System and included 244,542 adult patients hospitalized in 3156 acute care hospitals across 4 condition groups: acute myocardial infarction (17%), heart failure (17%) pneumonia (21%), major surgical procedures (22%), and all other conditions (22%). Information on adverse events collected included 21 measures across 4 adverse event domains: adverse drug events, hospital-acquired infections, adverse events after a procedure, and general adverse events such as pressure ulcers and falls. The study sample included 190,286 hospital discharges in the combined 4 condition-based groups and 54,256 hospital discharges for all other conditions. From 2010 to 2019, the total change for adverse events per 1000 discharges for acute myocardial infarction decreased from 218 to 139, from 168 to 116 for heart failure, from 195 to 119 for pneumonia, and from 204 to 130 for major surgical procedures. The rate for all other conditions remained unchanged at 70 adverse events per 1000 discharges.
AHRQ-authored; AHRQ-funded; 290201800005C.
Citation: Eldridge N, Wang Y, Metersky M . Trends in adverse event rates in hospitalized patients, 2010-2019. JAMA 2022 Jul 12;328(2):173-83. doi: 10.1001/jama.2022.9600..
Keywords: Adverse Events, Patient Safety, Hospitals, Inpatient Care
Doty AM, Rising KL, Hsiao T
"Unfortunately, I don't have an answer for you": how resident physicians communicate diagnostic uncertainty to patients during emergency department discharge.
This study’s objective was to describe how emergency medicine resident physicians discuss diagnostic uncertainty during a simulated emergency department (ED) discharge discussion. Most residents in the simulation explained the evaluation revealed no cause for symptoms, noted concerning diagnoses that were excluded, and acknowledged both symptoms and patients’ feelings. However, 28% of residents did not discuss diagnostic uncertainty in any form. All residents were reassuring. Those who did discuss diagnostic uncertainty used explicit and implicit language with similar frequency.
Citation: Doty AM, Rising KL, Hsiao T . "Unfortunately, I don't have an answer for you": how resident physicians communicate diagnostic uncertainty to patients during emergency department discharge. Patient Educ Couns 2022 Jul;105(7):2053-57. doi: 10.1016/j.pec.2021.12.002..
Keywords: Clinician-Patient Communication, Emergency Department, Communication, Diagnostic Safety and Quality
Keller SC, Caballero TM, Tamma PD
AHRQ Author: Miller MA
Assessment of changes in visits and antibiotic prescribing during the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use and the COVID-19 pandemic.
This cohort study evaluated the effectiveness of the AHRQ Safety Program for Improving Antibiotic Use aimed to improve antibiotic prescribing in ambulatory practices by engaging clinicians and staff to incorporate antibiotic stewardship into practice culture, communication, and decision-making. The study ran from December 2019 through November 2020. A total of 389 ambulatory care practices with over 6.5 million visits to 5483 clinicians were compared from the baseline to completion of the program. Participants included 82 primary care practices, 103 urgent care practices, 34 federally supported practices, 21 pediatric-only practices, 39 pediatric urgent care practices, 21 pediatric-only practices, and 14 other practice types. Of the 389 practices who completed the program, 75% submitted completed data. Visits per practice per month decreased from a mean of 1624 at baseline to a nadir of 906 early in the COVID-19 pandemic (April 2020) and were 1797 at the end of the program. Total antibiotic prescribing decreased from 18.2% of visits at baseline to 9.5% at completion of the program. Acute respiratory infection (ARI) visits per practice per month decreased from a baseline of 321 to a nadir of 76 early in the pandemic (May 2020) and gradually increased through completion of the program (n = 239). Antibiotic prescribing for ARIs decreased from 39.2% at baseline to 24.7% at completion of the program.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Keller SC, Caballero TM, Tamma PD . Assessment of changes in visits and antibiotic prescribing during the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use and the COVID-19 pandemic. JAMA Netw Open 2022 Jul;5(7):e2220512. doi: 10.1001/jamanetworkopen.2022.20512..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, COVID-19, Public Health, Respiratory Conditions
Topham EW, Bristol A, Luther B
Caregiver inclusion in IDEAL discharge teaching: implications for transitions from hospital to home.
The purpose of this study was to explore perceptions of caregivers regarding their discharge preparation, focusing particular attention on whether and how they believed discharge preparation impacted post-discharge patient outcomes. Through interviews with four English-speaking caregivers, findings showed that, once home, the caregivers reported gaps in their knowledge of how to care for the patient, suggesting key gaps related to knowledge of warning signs and problems. Two of the four caregiver participants attributed a hospital readmission to post-discharge knowledge gaps. This study of caregiver experiences suggests that AHRQ’s IDEAL discharge planning strategy remains a useful and important framework for case managers to follow when providing discharge services.
Citation: Topham EW, Bristol A, Luther B . Caregiver inclusion in IDEAL discharge teaching: implications for transitions from hospital to home. Prof Case Manag 2022 Jul-Aug;27(4):181-93. doi: 10.1097/ncm.0000000000000563..
Keywords: Hospital Discharge, Transitions of Care, Caregiving
Merkow RP, Chung JW, Slota JM
Correlation of the US News and World Report-calculated nurse staffing index with actual hospital-reported nurse staffing.
This study’s objective was to understand how the Nurse Staffing Index (NSI) used in the US News and World Report “Best Hospitals” rankings correlates to actual nurse staffing levels. Nurse staffing data was obtained from publicly available data in the states of Illinois, California, and New Jersey. No other states had publicly accessible data. Hospital characteristics were obtained from the 2016 American Hospital Association (AHA) survey. The NSI was calculated using AHA data and is defined as the number of FTE RNs per adjusted patient day. Hospital characteristics were assessed using Hospital Compare data. Higher actual hospital-reported nurse staffing in Illinois and New Jersey was paradoxically associated with lower nurse staffing when measured by the NSI. California hospital-reported staffing intensity was weakly correctly with the NSI and RN nursing hours per patient day was not correlated with any of the 9 structural measures of hospital quality, while NSI was positively correlated with 3 of the 9 measures, particularly hospital volume status. None of the 11 outcome measures the authors assessed were associated with RN nursing hours per patient day or the NSI in either Illinois or California. All 12 patient experience measures were significantly and positively correlated with RN nursing hours in Illinois. However, none of the patient experience measures were significantly associated with the NSI in Illinois. The authors concluded that the NSI may not measure actual nurse staffing as intended.
AHRQ-funded; HS024516; HS026385.
Citation: Merkow RP, Chung JW, Slota JM . Correlation of the US News and World Report-calculated nurse staffing index with actual hospital-reported nurse staffing. J Nurs Care Qual 2022 Jul-Sep;37(3):195-98. doi: 10.1097/ncq.0000000000000619..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Provider: Nurse, Workforce
Sorra J, Zebrak K, Yount N
Development and pilot testing of survey items to assess the culture of value and efficiency in hospitals and medical offices.
Given rising costs and changing payment models, healthcare organisations are increasingly focused on value and efficiency. The goal of this study was to develop survey items to assess clinician and staff perspectives about the extent to which the organizational culture in hospitals and medical offices supports value and efficiency. The investigators concluded when added to the Agency for Healthcare Research and Quality Surveys on Patient Safety Culture, the item sets they developed extended those surveys by assessing additional dimensions of organizational culture that affect care delivery.
Citation: Sorra J, Zebrak K, Yount N . Development and pilot testing of survey items to assess the culture of value and efficiency in hospitals and medical offices. BMJ Qual Saf 2022 Jul;31(7):493-502. doi: 10.1136/bmjqs-2020-012407..
Keywords: Surveys on Patient Safety Culture, Organizational Change, Value
Hoffmann JA, Johnson JK, Pergjika A
Development of quality measures for pediatric agitation management in the emergency department.
This study’s objective was to develop quality measures for pediatric emergency department (ED) agitation management informed by multidisciplinary perspectives. A multidisciplinary panel was created to develop quality measures for pediatric ED agitation management through the modified Delphi method. The panelists included 36 physicians, nurses, social workers, security, child life specialists, hospital data analysts, and parents. Measures were ranked by panelists in importance and feasibility on a 9-point scale during 2 survey rounds, with a teleconference discussion between surveys. Consensus was defined at >75% of panelists ranking a quality measure greater or equal to 7 in importance and median feasibility of greater or equal to 4. Consensus was reached on 20 quality measures that incorporated multidisciplinary perspectives.
Citation: Hoffmann JA, Johnson JK, Pergjika A . Development of quality measures for pediatric agitation management in the emergency department. J Healthc Qual 2022 Jul-Aug;44(4):218-29. doi: 10.1097/jhq.0000000000000339..
Keywords: Children/Adolescents, Quality Measures, Quality Indicators (QIs), Quality of Care, Emergency Department
Haessler S, Guo N, Deshpande A
Etiology, treatments, and outcomes of patients with severe community-acquired pneumonia in a large U.S. sample.
This study compared the clinical practice and outcomes in severe community-acquired pneumonia (sCAP) patients to those in non-sCAP patients using guideline-defined criteria for sCAP. The definition for sCAP includes a principal diagnosis of pneumonia or a secondary pneumonia diagnosis paired with a principal diagnosis of sepsis or respiratory failure. One-hundred seventy-seven US hospitals within the Premier Healthcare Database were used to identify 154,799 patients with pneumonia, with 14.1% meeting criteria for sCAP. The sCAP patients had higher organ failure scores and inpatient mortality, longer lengths of stay, and higher costs than those with nonsevere disease. Patients with sCAP had twice the rate of positive blood cultures and respiratory cultures and more often had isolates resistant to first-line community-acquired pneumonia antibiotics. The most common pathogen acquired from blood cultures was Streptococcus pneumoniae and from the respiratory tract Staphylococcus aureus and Pseudomonas species. The most common antibiotics prescribed were vancomycin (65%) and piperacillin-tazobactam (42.8%), regardless of cultures positive for a resistant organism.
Citation: Haessler S, Guo N, Deshpande A . Etiology, treatments, and outcomes of patients with severe community-acquired pneumonia in a large U.S. sample. Crit Care Med 2022 Jul;50(7):1063-71. doi: 10.1097/ccm.0000000000005498..
Keywords: Community-Acquired Infections, Pneumonia, Respiratory Conditions, Outcomes
Korthuis PT, Cook RR, Lum PJ
HIV clinic-based extended-release naltrexone versus treatment as usual for people with HIV and opioid use disorder: a non-blinded, randomized non-inferiority trial.
Opioid Use Disorder (OUD) treatment medications can improve outcomes for human immunodeficiency virus (HIV) and also reduce opioid use. The purpose of the study was to determine if outpatient naltrexone treatment could also reduce opioid use and improve outcomes for HIV. The researchers reported that enrollment was stopped early because of slower than expected recruitment, resulting in 114 final participants with untreated OUD and HIV, with 62% positive for fentanyl, 60% positive for cocaine, and 47% positive for other opioids at the baseline. The intervention compared treatment as usual (TAU) of methadone or buprenorphine with extended-release naltrexone (XR-NTX) on group differences in viral suppression at 24 weeks and past 30-day use of opioids at 24 weeks. The study reported that at 24 weeks the outcome of viral suppression was similar for TAU and XR-NTX, and that fewer XR-NTX participants initiated medication than TAU participants. The outcome of previous 30-day use of opioids was similar for TAU as compared to XR-NTX. Of those participants who did initiate medication, those administered XR-NTX experienced less days of opioid use when compared with TAU in the prior 30 days. The researchers reported that the study evidence was not conclusive but did support that XR-NTX is not inferior to TAU for HIV viral suppression, and that study participants who started XR-NTX used less opioids at 24 weeks than participants who were administered TAU.
Citation: Korthuis PT, Cook RR, Lum PJ . HIV clinic-based extended-release naltrexone versus treatment as usual for people with HIV and opioid use disorder: a non-blinded, randomized non-inferiority trial. Addiction 2022 Jul;117(7):1961-71. doi: 10.1111/add.15836..
Keywords: Human Immunodeficiency Virus (HIV), Opioids, Substance Abuse, Behavioral Health, Medication, Treatments, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Ivlev I, Beil TL, Haynes JS
Rapid evidence review of digital cognitive-behavioral therapy for adolescents with depression.
This rapid evidence review was conducted to explore the benefits and harms of digital cognitive-behavioral therapy (dCBT) and the barriers to and facilitators of implementing dCBT for adolescents. An extensive literature review was done through December 6, 2021 for controlled trials conducted in settings highly applicable to the US. Additionally, the authors searched relevant systematic reviews for eligible studies. They identified 12 trials that examined the effects of nine dCBT programs. Overall, dCBT was slightly superior to other therapies in improving depression symptoms immediately, but not at a longer follow-up. There did not appear to be an increased risk for suicidal attempts or ideation with dCBT, however the number of events was very small. Potential barriers to implementing and maintaining dCBT included challenges engaging/retaining patients, developing infrastructure, and training therapists to facilitate dCBT. No data on harms or unintended negative consequences were reported in the included studies.
Citation: Ivlev I, Beil TL, Haynes JS . Rapid evidence review of digital cognitive-behavioral therapy for adolescents with depression. J Adolesc Health 2022 Jul;71(1):14-19. doi: 10.1016/j.jadohealth.2022.01.220..
Keywords: Children/Adolescents, Depression, Behavioral Health, Evidence-Based Practice, Patient-Centered Outcomes Research
Giesler DL, Krein S, Brancaccio A
Reducing overuse of antibiotics at discharge home: a single-center mixed methods pilot study.
This article described a single-center, controlled pilot study of a pharmacist-facilitated antibiotic timeout prior to hospital discharge. The timeout addressed key elements of duration and was designed and implemented using iterative cycles with rapid feedback. The authors evaluated implementation outcomes related to feasibility, including usability, adherence, and acceptability. The pharmacists conducted 288 antibiotic timeouts with a mean duration of 2.5 minutes. Pharmacists recommended an antibiotic change in 25% of timeouts with 70% of recommended changes accepted by hospitalists. Barriers included unanticipated and weekend discharges. There were no differences in antibiotic use after discharge during the intervention compared to control services.
Citation: Giesler DL, Krein S, Brancaccio A . Reducing overuse of antibiotics at discharge home: a single-center mixed methods pilot study. Am J Infect Control 2022 Jul;50(7):777-86. doi: 10.1016/j.ajic.2021.11.016..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Hospital Discharge, Transitions of Care
Lindell RB, Fitzgerald JC, Rowan CM
The use and duration of preintubation respiratory support is associated with increased mortality in immunocompromised children with acute respiratory failure.
The purpose of this retrospective cohort study was to examine the relationship between preintubation respiratory support and outcomes in pediatric patients with acute respiratory failure and to evaluate the impact of immunocompromised (IC) diagnoses on outcomes. The study utilized data from the Virtual Pediatric Systems database which included 82 centers, and focused on patients intubated in the Pediatric Intensive Care Unit (PICU) ranging in age from 1 month old to 17 years of age who received invasive mechanical ventilation (IMV) for more than or equal to 24 hours. Of the 5,348 PICU intubations across 82 centers, high-flow nasal cannula (HFNC) or noninvasive positive-pressure ventilation (NIPPV) or both were used before intubation in 34% (1,825) of patients. Fifty percent of the patients had no IC diagnosis. The researchers found that exposure to HFNC was associated with greater odds of PICU mortality when compared with patients intubated without prior support. When analyzing subgroups of IC status, preintubation support was related to higher odds of PICU mortality in IC patients and HCT patients when compared with IC/ HCT patients intubated without prior respiratory support. A duration of HFNC/NIPPV of more than 6 hours was associated with increased mortality in IC HCT patients. Rates of preintubation HFNC/NIPPV use and PICU mortality varied between the 82 centers. The researchers concluded that greater duration of exposure to HFNC/NIPPV prior to IMV is associated with increased mortality in HCT patients, and preintubation exposure to HFNC and/or NIPPV in IC pediatric patients is associated with increased odds of PICU mortality, independent of the severity of the illness.
Citation: Lindell RB, Fitzgerald JC, Rowan CM . The use and duration of preintubation respiratory support is associated with increased mortality in immunocompromised children with acute respiratory failure. Crit Care Med 2022 Jul;50(7):1127-37. doi: 10.1097/ccm.0000000000005535..
Keywords: Children/Adolescents, Respiratory Conditions, Mortality, Critical Care
Balamuth F, Scott HF, Weiss SL
Validation of the pediatric Sequential Organ Failure Assessment score and evaluation of Third International Consensus Definitions for Sepsis and Septic Shock Definitions in the pediatric emergency department.
This study analyzed whether a measure used to quantity organ dysfunction, the Sequential Organ Failure Assessment (SOFA) in adults can also be used for critically ill children in an emergency department (ED) population. This retrospective cohort study took place in 9 US children’s hospitals included in the Pediatric Emergency Care Applied Research Network (PECARN registry from January 2012 to January 31, 2020. A score of 2 or more can indicate an infection. Almost 4 million ED visits were included, with 3.2% having a pSOFA score of 2 or more. The pSOFA score showed poor sensitivity as a screening tool for hospital mortality but children with a pSOfA score of 2 or less were at very low risk of death, with high specificity and negative predictive value.
Citation: Balamuth F, Scott HF, Weiss SL . Validation of the pediatric Sequential Organ Failure Assessment score and evaluation of Third International Consensus Definitions for Sepsis and Septic Shock Definitions in the pediatric emergency department. JAMA Pediatr 2022 Jul;176(7):672-78. doi: 10.1001/jamapediatrics.2022.1301..
Keywords: Children/Adolescents, Sepsis, Emergency Department
Eiraldi R, McCurdy BL, Khanna MS
Development and evaluation of a remote training strategy for the implementation of mental health evidence-based practices in rural schools: pilot study protocol.
This paper describes a pilot study protocol to develop and evaluate a remote training strategy for the implementation of mental health evidence-based practices (EBPs) in rural schools. Rural schools are increasingly implementing multi-tier positive behavioral interventions and supports (PBIS) to address school-climate problems. The study will use a mixed-methods approach for the development of the training platform, and a hybrid type 2, pilot randomized controlled trial to examine the implementation and student outcomes of two training strategies: Remote Video vs. Remote Video plus Coaching. The EPBs will be evaluated on appropriateness, feasibility, acceptability, usability, and preliminary student outcomes of the two online training strategies for the implementation of EPBs at PBIS Tier 2.
Citation: Eiraldi R, McCurdy BL, Khanna MS . Development and evaluation of a remote training strategy for the implementation of mental health evidence-based practices in rural schools: pilot study protocol. Pilot Feasibility Stud 2022 Jun 17;8(1):128. doi: 10.1186/s40814-022-01082-4..
Keywords: Children/Adolescents, Behavioral Health, Evidence-Based Practice, Rural Health, Training
Blanco C, Kato EU, Aklin WM
AHRQ Author: Kato EU, Tong ST, Bierman A, Meyers D
Research to move policy - using evidence to advance health equity for substance use disorders.
This paper discusses ways that evidence-based research can advance health equity for substance use disorder (SUD) treatment. Racial and ethnic disparities in treatment access and outcomes have widened, despite substantial efforts to address the epidemic of overdose-related deaths in the US. Overdose rates are rising faster in Black, Latinx, and American Indian and Alaska Native populations than in White populations. Possible opportunities to address these disparities include addressing social determinants of health, implementing prevention measures, and supporting data science. The steps to ensure that research reduces disparities are to: 1) include members of underrepresented groups in the development of preventive interventions and treatments, 2) adequately recruit members of historically represented groups and ensure that studies are large enough to measure differences in outcomes according to race and ethnic group, 3) establish equitable partnerships with people who currently have or have had SUDS and their families and engage these groups in evidence production, 4) diversify the scientific workforce, and 4) have investigators measure the effects of policies and interventions on equity.
Citation: Blanco C, Kato EU, Aklin WM . Research to move policy - using evidence to advance health equity for substance use disorders. N Engl J Med 2022 Jun 16;386(24):2253-55. doi: 10.1056/NEJMp2202740..
Keywords: Substance Abuse, Behavioral Health, Policy, Racial / Ethnic Minorities, Disparities, Social Determinants of Health
Kerlikowske K, Su YR, Sprague BL
Association of screening with digital breast tomosynthesis vs digital mammography with risk of interval invasive and advanced breast cancer.
The purpose of this study was to compare digital breast tomosynthesis (DBT) with digital mammography to determine whether DBT was correlated with lower rates of internal invasive cancer and advanced breast cancer, taking into consideration breast density and breast cancer risk. From 2011 through 2018, the researchers studied a cohort of 504,427 women between the ages of 40 and 79 who underwent 375,189 screening DBT exams and 1,003,900 screening digital mammography exams, and who were then followed up for cancer diagnoses between 2011 and 2019 after being identified via linkage to state or regional cancer registries. The median age at the time of screening was 58 years (IQR 50-65 years) and the diagnostic screenings took place at 44 Breast Cancer Surveillance Consortium (BCSC) facilities in the United States. The study found that among women at low to average risk, or at high risk with almost entirely fatty, scattered fibroglandular densities, or heterogeneously dense breasts, advanced cancer rates were not significantly different for DBT vs digital mammography. There was no significant difference between DBT and digital mammography for interval cancer rates per 1000 exams. Interval invasive cancer rates were also not significantly different among the 413,061 examinations with BCSC 5-year risk of 1.67% or higher (high risk) across breast density categories, or among all the 836,250 examinations with BCSC 5-year risk less than 1.67% (low to average-risk). For the 3.6% of women with extremely dense breasts and at high risk of breast cancer (13,291 examinations in the DBT group and 31,300 in the digital mammography group) advanced cancer rates per 1000 examinations were significantly lower for DBT vs digital mammography, but not for women at low to average risk (10,611 examinations in the DBT group and 37,796 in the digital mammography group). The researchers reported that there was no significant difference in the 96.4% of women with extremely dense breasts not at high risk, heterogeneously dense breasts, or nondense breasts, and concluded that screening with DBT vs digital mammography was associated with a significantly lower risk of advanced breast cancer among the 3.6% of women with extremely dense breasts and at high risk of breast cancer, and was not associated with a significant difference in risk of interval invasive cancer.
Citation: Kerlikowske K, Su YR, Sprague BL . Association of screening with digital breast tomosynthesis vs digital mammography with risk of interval invasive and advanced breast cancer. JAMA 2022 Jun 14;327(22):2220-30. doi: 10.1001/jama.2022.7672..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Women, Mammogram, Imaging, Risk
Dullabh P, Sandberg SF, Heaney-Huls K
AHRQ Author: Berliner E, Dymek C, Harrison MI, Swiger J
Challenges and opportunities for advancing patient-centered clinical decision support: findings from a horizon scan.
This AHRQ-authored horizon scan identified challenges and opportunities for advancing patient-centered clinical decision support (PC CDS) and future directions for PC CDS. The authors engaged a technical expert panel, conducted a scoping literature review, and interviewed key informants. They quantitatively analyzed literature and interview transcripts and mapped the findings to the 4 phases translating evidence into PC CDS interventions (Prioritizing, Authoring, Implementing, and Measuring) and to external factors. Twelve challenges were identified for PC CDS development with lack of patient input identified as a critical challenge. Lack of patient-centered terminology standards was viewed as a challenge in authoring PC CDS. They also found a dearth of CDS studies that measured clinical outcomes, creating significant gaps in the understanding of PC CDS’ impact.
AHRQ-authored; AHRQ-funded; 233201500023I.
Citation: Dullabh P, Sandberg SF, Heaney-Huls K . Challenges and opportunities for advancing patient-centered clinical decision support: findings from a horizon scan. J Am Med Inform Assoc 2022 Jun 14;29(7):1233-43. doi: 10.1093/jamia/ocac059.
Keywords: Clinical Decision Support (CDS), Patient-Centered Healthcare, Health Information Technology (HIT), Decision Making, Patient-Centered Outcomes Research, Evidence-Based Practice
Fang Y, Idnay B, Sun Y
Combining human and machine intelligence for clinical trial eligibility querying.
This study’s objective was to combine machine efficiency and human intelligence for converting complex clinical trial eligibility criteria text into cohort queries. The machine interactive tool Criteria2Query (C2Q) 2.0 was developed to enable real-time user intervention for criteria selection and simplification, parsing error correction, and concept mapping. This tool had been previously evaluated using a curated gold standard – the annotated eligibility criteria of 1010 COVID-19 clinical trials. The usability and usefulness were evaluated by 10 research coordinators using 5 Alzheimer’s disease trials with data collected by user interaction logging, a demographic questionnaire, the Health Information Technology Usability Evaluation Scale (Health-ITUES), and a feature-specific questionnaire. C2Q 2.0 achieved a moderate usability score (3.84/5) and a high learnability score (4.54/5). Experienced researchers made more modifications to the tool than novice researchers. The most frequent modification was deletion.
Citation: Fang Y, Idnay B, Sun Y . Combining human and machine intelligence for clinical trial eligibility querying. J Am Med Inform Assoc 2022 Jun 14;29(7):1161-71. doi: 10.1093/jamia/ocac051..
Keywords: Health Information Technology (HIT)
Haque W, Ahmadzada M, Janumpally S
Adherence to a federal hospital price transparency rule and associated financial and marketplace factors.
This research letter describes a study that evaluated adherence to the federal Hospital Price Transparency Rule 6 to 9 months after the final rule effective date (January 1, 2021). The rule’s aim is to increase health price transparency and facilitation patient price shopping online. Hospitals were required to post 5 price types: gross charges, discounted prices, payer-specific negotiated prices, minimum and maximum prices in a machine-readable file, and a separate accessible display or price estimator for at least 300 shoppable items. The authors used the Herfindahl-Hirschman Index (HHI) to measure inpatient hospital market concentration. The data was collected for 185 of 929 core-based statistical areas from 2019. HHI is divided into the following categories: unconcentrated, moderately concentrated, or highly or very concentrated. Results showed that out of 5239 total hospitals, 729 (13.9%) had an adherent machine-readable file but no shoppable display, 1542 (29.4%) had an adherent shoppable display but no machine-readable file, and 300 (5.7%) had both. The most adherent hospitals tended to be acute care hospitals with lesser revenue per patient-day, within unconcentrated health care markets, and in urban areas.
Citation: Haque W, Ahmadzada M, Janumpally S . Adherence to a federal hospital price transparency rule and associated financial and marketplace factors. JAMA 2022 Jun 7;327(21):2143-45. doi: 10.1001/jama.2022.5363..
Keywords: Policy, Hospitals, Healthcare Costs