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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
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
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
Ye L, Owens RL, Dykes P
Individualized sleep promotion in acute care hospitals: Identifying factors that affect patient sleep.
The aim of this study was develop a tool that can be used to measure factors that affect patient sleep in acute care hospitals. A tool called Factors Affected Inpatient Sleep (FAIS) was developed using literature review and was validated by content validity testing. The scale was tested on 105 hospitalized patients and the most significant sleep disruptors were identified. The final FAIS scale included 14 items in three subscales. The biggest factors for sleep disruption included 1) emotional or physical impairment due to illness or hospitalization; 2) sleep disturbance due to discomfort of their care plan schedule; and 3) sleep interruption due to the hospital environment or medical care. The reliability of the scale was measured at 0.87 with Cronbach’s alpha coefficient and reliability of the subscales ranged from 0.72 to 0.81.
Appl Nurs Res 2019 Aug;48:63-67. doi: 10.1016/j.apnr.2019.05.006. AHRQ-funded; HS024330.
Keywords: Health Promotion, Hospitalization, Hospitals, Inpatient Care, Sleep
Wright NC, Melton ME, Sohail M
Race plays a role in the knowledge, attitudes, and beliefs of women with osteoporosis.
This study examined racial disparities in knowledge of osteoporosis among women aged 65 and over with osteoporosis. Focus groups were created with a total of 48 women (36 white, 12 African American) enrolled. A knowledge scale called “Osteoporosis & You” was used to compare scores. White women had a mean score of 7.8 versus African American women who scored a mean of 6.6 out of 10 on the scale. The “powerful others” domain was significantly higher among African Americans versus white women as well. These racial differences can impact bone health and indicated a need to improve education and awareness about osteoporosis among African American women.
J Racial Ethn Health Disparities 2019 Aug;6(4):707-18. doi: 10.1007/s40615-019-00569-w. AHRQ-funded; HS023009.
Keywords: Disparities, Racial / Ethnic Minorities, Osteoporosis, Women
Wallace DD, Pack A, Uhrig Castonguay B
Validity of social support scales utilized among HIV-infected and HIV-affected populations: a systematic review.
This systematic review aimed to identify validated social support scales utilized among HIV-infected and HIV-affected populations. After a systematic literature search was conducted, a total of 17 studies remained with two of them assessing multiple social support scales, which brought the total number of scales up to 19. Most scales assessed positive social support behaviors with perceived social support (n=14) being the most common behavior compared to perceived social support. There was a reliability range of 0.67 to 0.97. Validity was mostly based on content and construct and rarely for criterion-related measures.
AIDS Behav 2019 Aug;23(8):2155-75. doi: 10.1007/s10461-018-2294-z. AHRQ-funded; HS000032.
Keywords: Human Immunodeficiency Virus (HIV)
Song LD, Newhouse JP, Garcia-De-Albeniz X
Changes in screening colonoscopy following Medicare reimbursement and cost-sharing changes.
This study examined changes in screening colonoscopy rates after Medicare reimbursement and cost-sharing changed when the Affordable Care Act (ACA) was implemented. A 20% random sample of fee-for-service (FFS) Medicare claims from 2002-2012 was used in this study. Screening colonoscopy rates did increase after 2001 when cost-sharing was eliminated but the amount varied depending on the algorithm used to classify the indication.
Health Serv Res 2019 Aug;54(4):839-50. doi: 10.1111/1475-6773.13150. AHRQ-funded; HS023128.
Keywords: Colonoscopy, Healthcare Costs, Healthcare Utilization, Medicare, Payment, Prevention, Screening
Sklar M, Hatch MR, Aarons GA
A climate for evidence-based practice implementation in the patient-centred medical home.
This paper discusses variations in climate for evidence-based practice (EBP) implementation in patient-centered medical homes (PCMHs) in the United States. The study compared two Rhode Island PCMHs, one a Family Care Center (FCC), and the other an Internal Medicine Clinic (IMC). The FCC staff had more positive attitudes towards EBP than IMC staff. They also reported greater educational support for EBPs than IMC staff and physicians. The importance of removing barriers to EBP implementation was emphasized.
J Eval Clin Pract 2019 Aug;25(4):637-47. doi: 10.1111/jep.13050. AHRQ-funded; HS024192.
Keywords: Evidence-based Practice, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care, Provider
Selden TM, Abdus S, Miller GE
Decomposing changes in the growth of U.S. prescription drug use and expenditures, 1999-2016.
Data from the Medical Expenditure Panel Survey (MEPS) was examined to analyze factors associated with changes in prescription drug use and expenditures in the US from 1999 to 2016. There were large increases in prescription drug use during that period, with per capita utilization increasing by nearly half and per capita expenditures more than doubled. Treatment of long-term conditions was a large driver in the increases in medication use.
Health Serv Res 2019 Aug;54(4):752-63. doi: 10.1111/1475-6773.13164. AHRQ-authored.
Keywords: Healthcare Costs, Healthcare Utilization, Medical Expenditure Panel Survey (MEPS), Medication
Selden TM, Abdus S, Miller GE
Pickens G, Karaca Z, Gibson TB
Changes in hospital service demand, cost, and patient illness severity following health reform.
This study examined the effects of expanded Medicaid coverage and the health insurance exchange on the number of hospital inpatient and emergency department (ED) utilization rates, cost, and patient illness severity. There was a significant drop in uninsured inpatient discharges and ED visits in states where Medicaid was expanded. For all by young females, uninsured inpatient discharge rates fell by 39% or greater. In nonexpansion states, the rates remained unchanged or increased slightly. Changes in all-payer and private insurance rates were not as dramatic, as was inpatient costs per discharge and all-payer inpatient costs.
Health Serv Res 2019 Aug;54(4):739-51. doi: 10.1111/1475-6773.13165. AHRQ-authored; AHRQ-funded; 290201300002C.
Keywords: Access to Care, Health Insurance, Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Healthcare Utilization, Hospitals, Medicaid, Policy, Uninsured
Karaca Z, Wong HS
Perraillon MC, Brauner DJ, Konetzka RT
Nursing home response to Nursing Home Compare: the provider perspective.
This paper examined the validity of quality ratings of nursing homes with Nursing Home Compare (NHC) and assessed the views of nursing home administrators and staff. There was a conflict found between improving ratings and competing goals of maximizing profits and avoidance of litigation. Since the NHC is self-reported there is controversy on its validity due to self-reporting bias.
Med Care Res Rev 2019 Aug;76(4):425-43. doi: 10.1177/1077558717725165. AHRQ-funded; HS018718.
Keywords: Long-Term Care, Nursing Homes, Provider Performance, Quality of Care, Quality Improvement, Value
Musuuza JS, Hundt AS, Carayon P
Implementation of a Clostridioides difficile prevention bundle: understanding common, unique, and conflicting work system barriers and facilitators for subprocess design.
This study assessed the factors that should be considered when designing subprocesses of a Clostridioides difficile (C. difficile) prevention bundle. Three focus groups were conducted with environmental services staff, physicians and nurses to assess their perspectives on the prevention bundle and barriers to implementation. Common barriers included inconsistencies in knowledge and practice of CD management procedures; increased workload; poor setup of aspects of the physical environment; and inconsistencies in CD documentation. There were also unique barriers in different hospital environments. The authors recommend a systems engineering approach to help holistically identify factors that influence successful implementation of subprocesses of the CD infection prevention bundle.
Infect Control Hosp Epidemiol 2019 Aug;40(8):880-88. doi: 10.1017/ice.2019.150. AHRQ-funded; HS023791.
Keywords: Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Patient Safety, Prevention
Lipira L, Williams EC, Huh D
HIV-related stigma and viral suppression among African-American women: exploring the mediating roles of depression and ART nonadherence.
Investigators recruited a sample of African-American women living with HIV to participate in a stigma-reduction intervention. The women lived in Chicago and Birmingham from 2013 to 2015. The relationship between HIV-related stigma and viral suppression was evaluated and the role of depression and nonadherence to antiretroviral therapy (ART) was assessed. Among 100 women who participated 95% reported some level of HIV-related stigma. Those who reported higher levels of stigma did have lower odds of being virally suppressed. The indirect effects of depression and ART nonadherence were not statistically significant.
AIDS Behav 2019 Aug;23(8):2025-36. doi: 10.1007/s10461-018-2301-4. AHRQ-funded; HS013853.
Keywords: Antiretroviral Therapy, Depression, Human Immunodeficiency Virus (HIV), Medication, Mental Health, Patient Adherence/Compliance, Racial / Ethnic Minorities, Social Stigma, Women
Ibrahim N, Alameddine M, Brennan J
New onset alcohol use disorder following bariatric surgery.
Researchers sought to characterize the patients and incidence of alcohol use disorder (AUD) following sleeve gastrectomy (SG) compared to Roux-en-Y gastric bypass (RYGB). They found that the prevalence of alcohol use disorder in patients undergoing SG and RYGB was similar pre- and postoperatively, with the majority of patients developing AUD following their second postoperative year. The authors recommended understanding the timing and incidence of AUD in order to provide appropriate counseling and treatment.
Surg Endosc 2019 Aug;33(8):2521-30. doi: 10.1007/s00464-018-6545-x. AHRQ-funded; HS023621; HS024403.
Keywords: Alcohol Consumption, Behavioral Health, Obesity, Obesity: Weight Management, Substance Abuse, Surgery
Hung A, Slejko JF, Lugo A
Validating a budget impact model using payer insight and claims data: a framework and case study.
The goal of this study was to assess the face validity, internal verification, and predictive validity of a previously published model that assessed the budgetary impact of antidiabetic formulary changes. The authors found that the budget impact model overpredicted utilization in the year after the formulary changes, and that discoveries through the validation process improved the accuracy and transparency of the model.
J Manag Care Spec Pharm 2019 Aug;25(8):913-21. doi: 10.18553/jmcp.2019.25.8.913. AHRQ-funded; HS024857.
Keywords: Healthcare Costs, Medication, Pharmaceuticals
Hung A, Lugo A, Mullins CD
Modeling the budgetary impact of payer utilization management strategies: an adapted framework based on lessons learned.
In this paper, the authors proposed the adaptation of a budget impact model framework to answer the payer question: "What is the budget impact of our approaches to managing the utilization of drugs and technologies?" They also described lessons learned while collaborating with a U.S. payer to evaluate the budgetary impact of specific antidiabetic drug utilization management approaches.
J Manag Care Spec Pharm 2019 Aug;25(8):922-26. doi: 10.18553/jmcp.2019.25.8.922. Commentary accompanying AHRQ-funded study.
Keywords: Healthcare Costs, Medication, Pharmaceuticals
Hsuan C, Hsia RY, Horwitz JR
Ambulance diversions following public hospital emergency department closures.
The purpose of this study was to examine whether hospitals are more likely to temporarily close their emergency departments to ambulances, through ambulance diversions, if neighboring diverting hospitals are public vs private. Results showed that sample hospitals respond differently to diversions by neighboring public (vs private) hospitals. The authors conclude that these findings suggest that these hospitals might be strategically declaring ambulance diversions to avoid treating low-paying patients served by public hospitals.
Health Serv Res 2019 Aug;54(4):870-79. doi: 10.1111/1475-6773.13147. AHRQ-funded; HS024247.
Keywords: Access to Care, Emergency Department, Emergency Medical Services (EMS), Health Services Research (HSR), Hospitals
Hoonakker PLT, Wooldridge AR, Hose BZ
Information flow during pediatric trauma care transitions: things falling through the cracks.
In order to investigate information flow during pediatric trauma care transitions, researchers interviewed 18 clinicians about communication and coordination between the emergency department, operating room, and pediatric intensive care unit, then surveyed the clinicians about patient safety during these transitions. They found that, despite the fact that the many services and units involved in pediatric trauma cooperate well together during trauma cases, important patient care information is often lost when transitioning patients between units. To manage the transition of this fragile and complex population better, they recommend finding ways to manage the information flow during these transitions better by, for instance, providing technological support to ensure shared mental models.
Intern Emerg Med 2019 Aug;14(5):797-805. doi: 10.1007/s11739-019-02110-7. AHRQ-funded; HS023837.
Keywords: Children/Adolescents, Communications, Emergency Department, Healthcare Delivery, Intensive Care Unit (ICU), Organization and Administration, Patient Safety, Provider, Provider: Clinician, Surgery, Transition of Care, Trauma