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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
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.
Maclean JC, Pesko MF, Hill SC
Public insurance expansions and smoking cessation medications.
The authors examined public insurance expansion on use of smoking cessation medications. The Affordable Care Act expanded coverage of these medications with financing with Medicaid. Data was analyzed from retail and online pharmacies from 2011 to 2017, and the expansion increased smoking cessation prescriptions by 24% in new medication use.
Econ Inq 2019 Oct;57(4):1798-820. doi: 10.1111/ecin.12794. AHRQ-authored.
Keywords: Tobacco Use: Smoking Cessation
Fung VC, Overhage LN, Sylvia LG
Complex polypharmacy in bipolar disorder: side effect burden, adherence, and response predictors.
Investigators assessed the associations between complex polypharmacy (CP), adherence, and side effect burden, and patient traits associated with clinical improvement in relationship to CP in patients with bipolar disorder. They found that bipolar disorder patients with CP were less likely to adhere to therapy, and those with worse adherence to CP were less likely to clinically respond. They recommended that clinicians assess medication adherence prior to adding another agent to medication regimens.
J Affect Disord 2019 Oct 1;257:17-22. doi: 10.1016/j.jad.2019.06.050. AHRQ-funded; HS019371.
Keywords: Patient-Centered Outcomes Research
Addington EL, Cheung EO, Bassett SM
The MARIGOLD study: feasibility and enhancement of an online intervention to improve emotion regulation in people with elevated depressive symptoms.
This paper described the first two phases of pilot testing of MARIGOLD; MARIGOLD is an online self-guided positive emotion skills intervention for adults with elevated depressive symptoms, along with enhancements to overcome retention and adherence problems reported in previous research. Results suggested that positive emotion skills, plus enhancements for web-based, self-guided delivery, warrant additional study in people with elevated depressive symptoms.
J Affect Disord 2019 Oct 1;257:352-64. doi: 10.1016/j.jad.2019.07.049. AHRQ-funded; HS000084.
Stepkowski SM, Mierzejewska B, Fumo D
The 6-year clinical outcomes for patients registered in a multiregional United States Kidney Paired Donation program - a retrospective study.
This retrospective study examined 6-year clinical outcomes for patients registered in a multiregional US Kidney Paired Donation (KPF) program. A total of 1121 end-stage renal disease patients who registered with their willing/incompatible living donors for kidney exchange were followed. Out of the 1121, 65% were transplanted with 37% of them in kidney paired donations, 10% with compatible live donors, and 18% with deceased donors. The remaining patients withdrew due to illness or death, or were still waiting (20%). There were similar survival rates with the different donor methods.
Transpl Int 2019 Aug;32(8):839-53. doi: 10.1111/tri.13423. AHRQ-funded; HS020610.
Keywords: Kidney Disease and Health, Mortality, Outcomes, Transplantation
Manojlovich M, Ameling JM, Forman J
Contextual barriers to communication between physicians and nurses about appropriate catheter use.
This study identified contextual barriers to communication between physicians and nurses that contribute to inappropriate use of catheters and increased risk of health care-associated infections. The researchers conducted individual and small-group semistructured interviewed with physicians and nurses in a progressive care unit of an academic hospital. Common barriers included workflow misalignment between clinicians, issues with electronic medical records and pagers, and strained relationships between clinicians.
Am J Crit Care 2019 Jul;28(4):290-98. doi: 10.4037/ajcc2019372. AHRQ-funded; HS024385.
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Communications, Healthcare-Associated Infections (HAIs), Organization and Administration, Patient Safety, Provider, Provider: Nurse, Provider: Physician, Urinary Tract Infection (UTI), Workflow
Kundi H, Popma JJ, Valsdottir LR
The value of claims-based nontraditional risk factors in predicting long-term mortality after MitraClip procedure.
The goals of this study were to identify nontraditional risk factors coded in administrative claims data and to evaluate their ability to improve prediction of long-term mortality in patients undergoing percutaneous mitral valve repair. Patients undergoing transcatheter mitral valve repair using MitraClip implantation were identified among Medicare fee-for-service beneficiaries; researchers used nested Cox regression models to identify claims codes predictive of long-term mortality. Four groups of variables were introduced: cardiac, noncardiac, and nontraditional risk factors, and presentation characteristics. The authors conclude that risk-prediction models, which include nontraditional risk factors as identified in claims data, can be used to predict long-term mortality risk more accurately in patients who have undergone MitraClip procedures.
Can J Cardiol 2018 Dec;34(12):1648-54. doi: 10.1016/j.cjca.2018.10.002. AHRQ-funded; HS024520.
Keywords: Cardiovascular Conditions, Elderly, Mortality, Percutaneous Coronary Interventions, Medicare, Risk, Surgery
Health insurance and food insecurity: sparking a potential virtuous cycle.
Food insecurity is a significant public health problem in the United States. This editorial discusses an article by Himmelstein, published in the September 2019 American Journal of Public Health related to the associations between food insecurity and health care.
Am J Public Health 2019 Sep;109(9):1163-65. doi: 10.2105/ajph.2019.305252. AHRQ-funded; HS026317.
Keywords: Socioeconomic Factors
Mogul DB, Lee J, Purnell TS
Barriers to access in pediatric living-donor liver transplantation.
This study examined knowledge and attitudes about living donor liver transplantation (LDLT) among patients/caregivers for children awaiting or having received a liver transplant. LDLT is only used for 10% of transplant recipients, but has a much better outcome. A survey was conducted among 217 respondents. While 97% of respondents knew an individual could donate a portion of their kidney, only 72% knew evaluation steps, and 69% knew the donor surgery was covered by the recipient’s insurance. Individuals receiving public insurance and without a college degree were less likely to know someone who had been a living donor. This gap in knowledge can create barriers to increasing LDLT for children.
Pediatr Transplant 2019 Sep;23(6):e13513. doi: 10.1111/petr.13513. AHRQ-funded; HS023876; HS024600.
Meyerhoefer CD, Zuvekas SH, Farkhad BF
The demand for preventive and restorative dental services among older adults.
This study examined the use of preventive and restorative dental services among older adults. Traditional Medicare does not have dental benefits, and older adults must either be employed, have post-retirement dental benefits or spousal coverage, or enroll in a Medicare Advantage program that includes dental coverage. The authors used 2007-2015 Medical Expenditure Panel Survey and supplemental data on dental care prices to estimate the demand for dental care. Dental service was not sensitive to out-of-pocket prices. Older adults with private dental insurance increased preventive service by 25%, and dental coverage through Medicaid increased basic and major service use by 23% and 36%. Women used dental insurance more than men.
Health Econ 2019 Sep;28(9):1151-58. doi: 10.1002/hec.3921. AHRQ-authored.
Liu TL, Taylor YJ, Mahabaleshwarkar R
Shared decision making and time to exacerbation in children with asthma.
This study examined the use of shared decision making (SDM) to delay exacerbation in children with asthma. A prospective cohort of children at five primary care practices in Charlotte, North Carolina that serve vulnerable population was studied between 2011 and 2013. The cohort included 746 children, with 60.5% male and 54.2% African American with a mean age of 8.6 years. The final analysis included 100 matched pairs of children for use of SDM and normal care. There was a marginally significant difference in the time of exacerbation between the two groups.
J Asthma 2018 Sep;55(9):949-55. doi: 10.1080/02770903.2017.1378357. AHRQ-funded; HS019946.
Keywords: Vulnerable Populations
Carr BG, Kilaru AS, Karp DN
Quality through coopetition: an empiric approach to measure population outcomes for emergency care-sensitive conditions.
Researchers developed a novel approach for measuring regional outcomes for emergency care-sensitive conditions. They identified regional use patterns for emergency conditions requiring a community-wide system response. They concluded that this method of attribution allows regional performance to be benchmarked and could be used to develop population-based outcome measures after life-threatening illness and injury.
Ann Emerg Med 2018 Sep;72(3):237-45. doi: 10.1016/j.annemergmed.2018.03.004. AHRQ-funded; HS023614.
Carlson NS, Neal JL, Tilden EL
Influence of midwifery presence in United States centers on labor care and outcomes of low-risk parous women: a Consortium on Safe Labor study.
The authors analyzed the association between midwifery presence in maternity care teams and the birth processes and outcomes of low-risk parous women. They found that parous women have significantly higher rates of vaginal birth, including vaginal birth after cesarean, and a lower likelihood of labor induction when cared for in centers with midwives. They concluded that their findings support integrated, team-based models of perinatal care to improve maternal outcomes.
Birth 2019 Sep;46(3):487-99. doi: 10.1111/birt.12405. AHRQ-funded; HS024733.
Biener AI, Decker SL, Rohde F
Prevalence and treatment of chronic obstructive pulmonary disease (COPD) in the United States.
This infographic depicts MEPS data concerning the prevalence and treatment of chronic obstructive pulmonary disease, including information on costs, medications and other chronic conditions.
JAMA 2019 Aug 20;322(7):602. doi: 10.1001/jama.2019.10241. AHRQ-authored.
Keywords: Medical Expenditure Panel Survey (MEPS)
Decker SL, Rohde F
Goldstein E, Olesen SW, Karaca Z
Levels of outpatient prescribing for four major antibiotic classes and rates of septicemia hospitalization in adults in different US states - a statistical analysis.
The authors related state-specific rates of outpatient prescribing overall for oral fluoroquinolones, penicillins, macrolides, and cephalosporins between 2011 and 2012 to state-specific rates of septicemia hospitalization in several age groups of adults. They found positive associations between the rates of prescribing for penicillins and the rates of hospitalization with septicemia in US adults aged 50-84 years and recommended further studies.
BMC Public Health 2019 Aug 19;19(1):1138. doi: 10.1186/s12889-019-7431-8. AHRQ-authored.
Ankerst DP, Goros M, Tomlins SA
Incorporation of urinary prostate cancer antigen 3 and TMPRSS2:ERG into Prostate Cancer Prevention Trial Risk Calculator.
The objective of this study was to determine whether the incorporation of two urinary markers, prostate cancer antigen 3 (PCA3) and TMPRSS2:ERG (T2:ERG), into the Prostate Cancer Prevention Trial Risk Calculator (PCPTRC) tool improves its discrimination, accuracy, and clinical net benefit. A Bayesian modeling approach was used to combine data where the markers were measured in a Michigan cohort with the PCPTRC as prior probabilities to create an updated PCPTRC; this update was compared to the existing PCPTRC in terms of discrimination, calibration, and decision curve analysis. Net benefit was improved for the updated PCPTRC, but calibration was not. The authors note that, the updated PCPTRC is limited since it was based on two separate cohorts, and further validation is required. The updated tool is available online.
Eur Urol Focus 2019 Jan;5(1):54-61. doi: 10.1016/j.euf.2018.01.010. AHRQ-funded; HS024810.
Keywords: Cancer, Cancer: Prostate Cancer, Men's Health, Risk
Durstenfeld MS, Katz SD, Park H
Mineralocorticoid receptor antagonist use after hospitalization of patients with heart failure and post-discharge outcomes: a single-center retrospective cohort study.
The purpose of this paper was to describe contemporary mineralocorticoid receptor antagonists (MRA) prescription for heart failure patients before and after the full scope of hospitalizations and the association between MRA discharge prescription and post-hospitalization outcomes. Results showed that, among hospitalized patients with heart failure with a reduced ejection fraction, 75% did not receive MRA before or after hospitalization, and nearly 90% of eligible patients did not have MRA initiated. These results suggest that hospitalization may represent an opportunity to initiate guideline-directed heart failure therapy.
BMC Cardiovasc Disord 2019 Aug 9;19(1):194. doi: 10.1186/s12872-019-1175-3. AHRQ-funded; HS023683.
Bartsch SM, Asti L, Cox S
What is the value of different Zika vaccination strategies to prevent and mitigate Zika outbreaks.
The authors developed models of Honduras, Brazil, and Puerto Rico, simulated targeting different populations for Zika vaccination, and then introduced various Zika outbreaks. Their models showed that, when considering transmission, while vaccinating everyone naturally averted the most cases, specifically targeting women of childbearing age or young adults was the most cost-effective.
J Infect Dis 2019 Aug 9;220(6):920-31. doi: 10.1093/infdis/jiy688. AHRQ-funded; HS023317.
Hale K, Ostbye T, Perera B
A novel adaptation of the HOME Inventory for Elders: the importance of the home environment across the life course.
This study adapted the Home Observation for Measurement of the Environment (HOME) Inventory to assess the quality of stimulation and support available to elders in their habitual households in Sri Lanka. Results indicated that elders are active household contributors who strive to achieve harmonious relations with co-resident kin. These findings reveal notable synergies between early- and late-life efforts to improve cognitive and psychological health, and highlight household considerations for future healthy aging research.
Int J Environ Res Public Health 2019 Aug 8;16(16). doi: 10.3390/ijerph16162826. AHRQ-funded; HS000032.
Keywords: Home Healthcare