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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.
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1 to 25 of 8025 Research Studies DisplayedNarla S, Silverberg JI
Multimorbidity and mortality risk in hospitalized adults with chronic inflammatory skin disease in the United States.
Chronic inflammatory skin diseases (CISD) represent a significant burden of skin disease in the United States, and a growing number of studies demonstrate that CISD are associated with multiple comorbidities. However, few studies examined multimorbidity in adults with CISD. In this study, the investigators sought to determine whether hospitalized US adults with chronic inflammatory skin disorders had increased multi-morbidity and mortality risk.
AHRQ-funded; HS023011.
Citation: Narla S, Silverberg JI .
Multimorbidity and mortality risk in hospitalized adults with chronic inflammatory skin disease in the United States.
Arch Dermatol Res 2020 Sep;312(7):507-12. doi: 10.1007/s00403-020-02043-8..
Keywords: Skin Conditions, Chronic Conditions, Mortality, Hospitalization
McClellan C, Maclean JC, Saloner B
Integrated care models and behavioral health care utilization: quasi-experimental evidence from Medicaid health homes.
This study provided the first population-level evidence on the effects of Medicaid health homes (HH) on behavioral health care service use. As of 2016, 16 states had adopted an HH for enrollees with serious mental illness and/or substance use disorder. Using data from the National Survey on Drug Use and Health, the authors found that HH adoption increased service use among enrollees and enrollee self-reported health improved post-HH.
AHRQ-authored.
Citation: McClellan C, Maclean JC, Saloner B .
Integrated care models and behavioral health care utilization: quasi-experimental evidence from Medicaid health homes.
Health Econ 2020 Sep;29(9):1086-97. doi: 10.1002/hec.4027..
Keywords: Mental Health, Medicaid, Substance Abuse, Primary Care: Models of Care, Primary Care, Outpatient Care, Patient-Centered Outcomes Research
Auerbach A, O'Leary KJ, Greysen SR
Hospital ward adaptation during the COVID-19 pandemic: a national survey of academic medical centers.
The authors sought to characterize inpatient adaptations to care for non-ICU COVID-19 patients. They found that the COVID-19 pandemic has required medical wards to rapidly adapt with expanding use of respiratory isolation units and use of technology emerging as critical approaches. Reports of unrecognized or delayed diagnoses highlight how such adaptations may produce potential adverse effects on care.
AHRQ-funded; HS026383; HS026215; HS027369.
Citation: Auerbach A, O'Leary KJ, Greysen SR .
Hospital ward adaptation during the COVID-19 pandemic: a national survey of academic medical centers.
J Hosp Med 2020 Aug;15(8):483-88. doi: 10.12788/jhm.3476..
Keywords: Hospitals, Emergency Preparedness, Infectious Diseases, Organization and Administration, Inpatient Care
Schafer R, Phillippi JC
Group B streptococcal bacteriuria in pregnancy: an evidence-based, patient-centered approach to care.
Screening and management of group B streptococcus (GBS) bacteriuria in pregnancy aims to reduce the incidence of pyelonephritis and GBS-related neonatal morbidity and mortality. This article used a case study approach to discuss evidence-based, patient-centered care for group B streptococcal bacteriuria in pregnancy as well as ethical incorporation of individual patient preferences and values.
AHRQ-funded; HS024733.
Citation: Schafer R, Phillippi JC .
Group B streptococcal bacteriuria in pregnancy: an evidence-based, patient-centered approach to care.
J Midwifery Womens Health 2020 May;65(3):376-81. doi: 10.1111/jmwh.13085..
Keywords: Infectious Diseases, Pregnancy, Women, Patient-Centered Healthcare, Evidence-based Practice, Newborns, Sepsis, Case Study
Sankaran R, Gulseren B, Nuliyalu U R, Gulseren B, Nuliyalu U
A comparison of estimated cost savings from potential reductions in hospital-acquired conditions to levied penalties under the CMS Hospital-Acquired Condition Reduction Program.
The Hospital-Acquired Condition Reduction Program (HACRP) from the Centers for Medicare & Medicaid Services (CMS) reduces Medicare payments to hospitals with high rates of hospital-acquired conditions (HACs) by 1% each year. It is not known how the savings accruing to CMS from such penalties compare to savings resulting from a reduction in HACs driven by this program. This study compared the reported savings to CMS from financial penalties levied under the HACRP with savings resulting from potential reductions in HACs.
AHRQ-funded; HS000053; HS026244.
Citation: Sankaran R, Gulseren B, Nuliyalu U R, Gulseren B, Nuliyalu U .
A comparison of estimated cost savings from potential reductions in hospital-acquired conditions to levied penalties under the CMS Hospital-Acquired Condition Reduction Program.
Jt Comm J Qual Patient Saf 2020 Aug;46(8):438-47. doi: 10.1016/j.jcjq.2020.05.002.
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Keywords: Healthcare Costs, Healthcare-Associated Infections (HAIs), Hospitals, Patient Safety, Medicare
Otto L, Wang A, Wheeler K
Comparison of manual and computer assigned injury severity scores.
The study objective was to compare the ISS manually assigned by hospital personnel and those generated by the ICDPIC software for value agreement and predictive power of length of stay (LOS) and mortality. The investigators found that the LOS and mortality predictive power were significantly higher for manually assigned ISS when compared with computer assigned ISS in both PTC and NTDB data sets. They indicated that hospitals should be cautious about transitioning to computer assigned ISS, specifically for patients who are critically injured.
AHRQ-funded; HS024263.
Citation: Otto L, Wang A, Wheeler K .
Comparison of manual and computer assigned injury severity scores.
Inj Prev 2020 Aug;26(4):330-33. doi: 10.1136/injuryprev-2019-043224..
Keywords: Health Information Technology (HIT), Injuries and Wounds, Trauma, Hospitals
Machta RM, Reschovsky J, Jones DJ
Can vertically integrated health systems provide greater value: the case of hospitals under the comprehensive care for joint replacement model?
The authors sought to assess whether system providers perform better than non-system providers under an alternative payment model that incentivizes high-quality, cost-efficient care. Using CMS data linked to AHRQ’s Compendium of US Health Systems, along with secondary sources, they found that when operating under alternative payment model incentives, vertical integration may enable hospitals to lower costs with similar quality scores.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Machta RM, Reschovsky J, Jones DJ .
Can vertically integrated health systems provide greater value: the case of hospitals under the comprehensive care for joint replacement model?
Health Serv Res 2020 Aug;55(4):541-47. doi: 10.1111/1475-6773.13313..
Keywords: Healthcare Systems, Hospitals, Orthopedics, Value, Healthcare Costs, Payment, Quality of Care
Heintzman J, Marino M, Clark K
Using electronic health record data to study Latino immigrant populations in health services research.
The purpose of this study was to validate an electronic health record (EHR)-based algorithm that could serve as a safe proxy for self-reported immigration status for health services researchers. Researchers developed an EHR algorithm to classify a population of patients as likely undocumented or recent Latino immigrants and validated this algorithm by conducting semi-structured interviews of staff. They concluded that the EHR has potential for studying immigration status in health services research, although more study is needed to determine the accuracy and utility of EHRs for this purpose.
AHRQ-funded; HS021522.
Citation: Heintzman J, Marino M, Clark K .
Using electronic health record data to study Latino immigrant populations in health services research.
J Immigr Minor Health 2020 Aug;22(4):754-61. doi: 10.1007/s10903-019-00925-2..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Racial / Ethnic Minorities, Health Services Research (HSR)
Furukawa MF, Machta RM, Barrett KA
Landscape of health systems in the United States.
This paper describes AHRQ’s development of the Compendium of U.S. Health Systems to help identify and describe health systems. This data resource supports research on comparative health system performance. The authors describe the methods used to create the compendium and create a picture of vertical integration. They identified 626 health systems in 2016, which accounted for 70% of nonfederal general acute care hospitals. The systems varied by key structural attributes, including size, ownership, and geographic prevalence.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Furukawa MF, Machta RM, Barrett KA .
Landscape of health systems in the United States.
Med Care Res Rev 2020 Aug;77(4):357-66. doi: 10.1177/1077558718823130..
Keywords: Healthcare Systems, Healthcare Delivery, Hospitals
Beltran Ale G, Benscoter D, Hossain MM
Impact of respiratory viral polymerase chain reaction testing on de-escalation of antibiotic therapy in children who require chronic positive pressure ventilation.
This study examined whether positive viral infection results stops antibiotic use in children who require chronic positive pressure ventilation (CPPV) who are frequently hospitalized with acute respiratory infections. A retrospective cohort study was conducted with 118 children on CPPV who had respiratory viral polymerase chain reaction (RVP) testing on admission. A viral pathogen was identified in 46.5% of the cases, with rhinovirus the most frequently identified. Antibiotic de-escalation occurred in only 33% of admissions and did not seem to impact antibiotic prescribing for hospitalized children on CPPV.
AHRQ-funded; HS012538.
Citation: Beltran Ale G, Benscoter D, Hossain MM .
Impact of respiratory viral polymerase chain reaction testing on de-escalation of antibiotic therapy in children who require chronic positive pressure ventilation.
Pediatr Pulmonol 2020 Aug;55(8):2150-55. doi: 10.1002/ppul.24884..
Keywords: Children/Adolescents, Respiratory Conditions, Antibiotics, Medication, Chronic Conditions
Bath J, Smith JB, Kruse RL
Neutrophil-lymphocyte ratio predicts disease severity and outcome after lower extremity procedures.
This study examined the association of neutrophil-lymphocyte ratio (NLR) and complications for patients undergoing interventions for peripheral artery disease (PAD) and other lower extremity conditions. NLR has been associated with higher mortality and other adverse outcomes for those with PAD. The study used inpatients undergoing lower extremity procedures (2008-2016) that were selected from the Cerner Health Facts database (Cerner Corporation, North Kansas City, Mo) using ICD-9 procedure codes. A total of 3687 patients were evaluated, with 2183 undergoing endovascular procedures and 1504 undergoing open procedures. White patients were likely to experience claudication but have less tissue loss. Open procedures had higher NLR rates than endovascular procedures. Preoperative high NLR was strongly associated with in-hospital deaths, cardiac complications, amputation, renal failure, respiratory complications, and prolonged length of stay. Postoperative high NLR values were also associated with more severe PAD.
AHRQ-funded; HS022140.
Citation: Bath J, Smith JB, Kruse RL .
Neutrophil-lymphocyte ratio predicts disease severity and outcome after lower extremity procedures.
J Vasc Surg 2020 Aug;72(2):622-31. doi: 10.1016/j.jvs.2019.10.094..
Keywords: Surgery, Cardiovascular Conditions, Outcomes, Chronic Conditions
Akincigil A, Mackie TI, Cook S
Effectiveness of mandatory peer review to reduce antipsychotic prescriptions for Medicaid-insured children.
This retrospective observation study examined the effectiveness of mandatory peer review to reduce antipsychotic prescriptions for Medicaid-insured children. Data was analyzed from Medicaid Analytical eXtracts (MAX) with administrative claims from 2006-2011 in Washington State. Within two years of policy implementation, prescription prevalence decreased from 6.17 to 4.04 while the synthetic control group remained stable at 6.47. The results show the effectiveness of the peer review program.
AHRQ-funded; HS026001.
Citation: Akincigil A, Mackie TI, Cook S .
Effectiveness of mandatory peer review to reduce antipsychotic prescriptions for Medicaid-insured children.
Health Serv Res 2020 Aug;55(4):596-603. doi: 10.1111/1475-6773.13297..
Keywords: Children/Adolescents, Medication, Medicaid, Policy
Smith ME, Vitous CA, Hughes TM
Barriers and facilitators to de-implementation of the Choosing Wisely((R)) guidelines for low-value breast cancer surgery.
The objective of this study was to understand why surgeons stop performing certain unnecessary cancer operations but not others and how best to de-implement entrenched and emerging unnecessary procedures. The investigators concluded that with a growing focus on the elimination of ineffective, unproven or low value practices, it is imperative that the behavioral determinants are understood and targeted with specific interventions to decrease utilization rapidly.
AHRQ-funded; HS026030.
Citation: Smith ME, Vitous CA, Hughes TM .
Barriers and facilitators to de-implementation of the Choosing Wisely((R)) guidelines for low-value breast cancer surgery.
Ann Surg Oncol 2020 Aug;27(8):2653-63. doi: 10.1245/s10434-020-08285-0..
Keywords: Cancer: Breast Cancer, Cancer, Surgery, Decision Making, Guidelines, Women
Halladay JR, Weiner BJ, In Kim J
Practice level factors associated with enhanced engagement with practice facilitators; findings from the Heart Health Now study.
In this analysis, the authors explored the practice and facilitator factors associated with greater team engagement at the mid-point of a 12-month practice facilitation intervention focused on implementing cardiovascular prevention activities in practice. Using data from the EvidenceNow initiative's NC Cooperative, named Heart Health Now, they found that their analysis provided information for practice facilitation stakeholders to consider when determining which practices may be more amendable to embracing facilitation services.
AHRQ-funded; HS023912.
Citation: Halladay JR, Weiner BJ, In Kim J .
Practice level factors associated with enhanced engagement with practice facilitators; findings from the Heart Health Now study.
BMC Health Serv Res 2020 Jul 28;20(1):695. doi: 10.1186/s12913-020-05552-4.
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Keywords: Heart Disease and Health, Cardiovascular Conditions, Primary Care, Primary Care: Models of Care, Patient-Centered Healthcare, Evidence-based Practice, Teams
Kittelson AJ, Elings J, Colborn K
Reference chart for knee flexion following total knee arthroplasty: a novel tool for monitoring postoperative recovery.
This study’s goal was to develop and validate a reference chart for monitoring recovery of knee flexion following total knee arthroplasty surgery. The researchers conducted a retrospective analysis of data collected for routine rehabilitation practice of post-TKA surgical patients. They concluded that a reference chart developed with clinically collected data offers a new approach to monitoring knee flexion following total knee arthroplasty.
AHRQ-funded; HS024316; HS025692.
Citation: Kittelson AJ, Elings J, Colborn K .
Reference chart for knee flexion following total knee arthroplasty: a novel tool for monitoring postoperative recovery.
BMC Musculoskelet Disord 2020 Jul 22;21(1):482. doi: 10.1186/s12891-020-03493-x..
Keywords: Orthopedics, Surgery
Sprague BL, Miglioretti DL, Lee CI
New mammography screening performance metrics based on the entire screening episode.
Established mammography screening performance metrics use the initial screening mammography assessment because they were developed for radiologist performance auditing, yet these metrics are frequently used to inform health policy and screening decision making. The authors developed new performance metrics based on the final assessment that consider the entire screening episode, including diagnostic workup. They concluded that established screening performance metrics underestimated the interval cancer rate of a mammography screening episode, particularly for women with dense breasts or an elevated breast cancer risk.
AHRQ-funded; HS018366.
Citation: Sprague BL, Miglioretti DL, Lee CI .
New mammography screening performance metrics based on the entire screening episode.
Cancer 2020 Jul 15;126(14):3289-96. doi: 10.1002/cncr.32939..
Keywords: Mammogram, Screening, Cancer: Breast Cancer, Cancer, Prevention, Women, Provider Performance
Greenzang KA, Fasciano KM, Block SD
Early information needs of adolescents and young adults about late effects of cancer treatment.
This study evaluated the importance, quality, and implications of information about late effects in adolescents and young adults (AYA) recently diagnosed with cancer. Surveying AYAs with cancer who were 15 to 29 years old and were treated at the Dana-Farber Cancer Institute, researchers found that most AYAs with cancer value early information about the risks of late effects and infertility, yet many patients felt that they had not received high-quality information about these topics. They recommended the development of age-appropriate late-effect communication strategies that recognize high AYA distress to address the gap between desired information and perceived information quality.
AHRQ-funded; HS022986.
Citation: Greenzang KA, Fasciano KM, Block SD .
Early information needs of adolescents and young adults about late effects of cancer treatment.
Cancer 2020 Jul 15;126(14):3281-88. doi: 10.1002/cncr.32932..
Keywords: Children/Adolescents, Young Adults, Cancer, Education: Patient and Caregiver, Clinician-Patient Communication, Communications, Risk
Hreha KP, Fisher SR, Reistetter TA
Use of the ICD-10 vision codes to study ocular conditions in Medicare beneficiaries with stroke.
The purpose of this study was to describe the use of ICD-10 vision codes in a large cohort of stroke survivors. Findings showed that ocular comorbidity was present in a portion of the studied stroke survivors, but the vision codes used to describe impairments in this population were few and lacked specificity. Recommendations included future studies to compare ophthalmic examination results with billing codes in order to characterize the type and frequency of ocular comorbidity.
AHRQ-funded; HS024711.
Citation: Hreha KP, Fisher SR, Reistetter TA .
Use of the ICD-10 vision codes to study ocular conditions in Medicare beneficiaries with stroke.
BMC Health Serv Res 2020 Jul 8;20(1):628. doi: 10.1186/s12913-020-05484-z..
Keywords: Medicare, Stroke, Cardiovascular Conditions
Amar-Dolan LG, Horn MH, O'Connell B B
"This is how hard it is". family experience of hospital-to-home transition with a tracheostomy.
This study explores the experience of family caregivers of children and young adults with a tracheostomy during the transition from hospital to home care. Researchers sought to identify the specific unmet needs of families to direct future interventions. Using semi-structured interviews, they found a need for family-centered discharge processes including coordination of care and teaching focused on emergency preparedness.
AHRQ-funded; HS000063.
Citation: Amar-Dolan LG, Horn MH, O'Connell B B .
"This is how hard it is". family experience of hospital-to-home transition with a tracheostomy.
Ann Am Thorac Soc 2020 Jul;17(7):860-68. doi: 10.1513/AnnalsATS.201910-780OC..
Keywords: Transitions of Care, Home Healthcare, Caregiver, Patient Experience, Care Coordination, Hospital Discharge, Hospitals, Children/Adolescents, Patient-Centered Healthcare
Abrams EM, Brough HA, Keet C
Pros and cons of pre-emptive screening programmes before peanut introduction in infancy.
In this review, researchers evaluated the advantages and disadvantages of a pre-emptive screening approach before the early introduction of peanuts in infants at high risk of peanut allergy. The Learning Early About Peanut study and the National Institute of Allergy and Infectious Diseases (NIAID) expert panel recommendations are compared.
AHRQ-funded; HS024599.
Citation: Abrams EM, Brough HA, Keet C .
Pros and cons of pre-emptive screening programmes before peanut introduction in infancy.
Lancet Child Adolesc Health 2020 Jul;4(7):526-35. doi: 10.1016/s2352-4642(20)30029-8..
Keywords: Newborns, Screening, Guidelines, Evidence-based Practice
Zhu W, Patterson BW, Smith M
A Markov chain model for transient analysis of handoff process in emergency departments.
Transfer of care between multiple units or facilities is of significant importance for patient safety, care quality, and operation efficiency. Such transfers are often referred to as handoffs in hospitals, which need to be carried out timely, safely, and smoothly with accurate information. This paper introduced a Markov chain model to study the transients of handoff process in hospital emergency departments.
AHRQ-funded; HS026624.
Citation: Zhu W, Patterson BW, Smith M .
A Markov chain model for transient analysis of handoff process in emergency departments.
IEEE Robot Autom Lett 2020 Jul;5(3):4360-67. doi: 10.1109/lra.2020.2996066..
Keywords: Emergency Department, Hospitals, Transitions of Care, Healthcare Delivery, Patient Safety
Villa Zapata L, Hansten PD, Panic J
Risk of bleeding with exposure to warfarin and nonsteroidal anti-inflammatory drugs: a systematic review and meta-analysis.
Warfarin use can trigger the occurrence of bleeding independently or as a result of a drug-drug interaction when used in combination with nonsteroidal anti-inflammatory drugs (NSAIDs). This article examines the risk of bleeding in individuals exposed to concomitant warfarin and NSAID compared with those taking warfarin alone. The investigators concluded that risk of bleeding was significantly increased among persons taking warfarin and a NSAID or COX-2 inhibitor together as compared with taking warfarin alone.
AHRQ-funded; HS025984.
Citation: Villa Zapata L, Hansten PD, Panic J .
Risk of bleeding with exposure to warfarin and nonsteroidal anti-inflammatory drugs: a systematic review and meta-analysis.
Thromb Haemost 2020 Jul;120(7):1066-74. doi: 10.1055/s-0040-1710592..
Keywords: Blood Thinners, Medication, Medication: Safety, Risk, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Evidence-based Practice, Patient-Centered Outcomes Research, Outcomes
Thomas LE, Yang S, Wojdyla D
Matching with time-dependent treatments: a review and look forward.
Observational studies of treatment effects attempt to mimic a randomized experiment by balancing the covariate distribution in treated and control groups, thus removing biases related to measured confounders. In this paper, the authors define a class of longitudinal matching methods and provide a review of existing variations, with guidance regarding study design, execution, and analysis. They identify avenues for future research and highlight the relevance of this methodology to high-quality comparative effectiveness studies in the era of big data.
AHRQ-funded; HS24310.
Citation: Thomas LE, Yang S, Wojdyla D .
Matching with time-dependent treatments: a review and look forward.
Stat Med 2020 Jul;39(17):2350-70. doi: 10.1002/sim.8533..
Keywords: Research Methodologies, Evidence-based Practice, Comparative Effectiveness
Schoenfeld EM, Houghton C, Patel PM
Shared decision making in patients with suspected uncomplicated ureterolithiasis: a decision aid development study.
The objective of this study was to develop a decision aid (DA) to facilitate shared decision making (SDM) around whether to obtain computed tomography (CT) imaging in patients presenting to the emergency department (ED) with suspected uncomplicated ureterolithiasis. Using stakeholder engagement and qualitative inquiry, the investigators developed their evidence-based DA. They indicated that future research will test the efficacy of the DA in facilitating SDM.
AHRQ-funded; HS025701.
Citation: Schoenfeld EM, Houghton C, Patel PM .
Shared decision making in patients with suspected uncomplicated ureterolithiasis: a decision aid development study.
Acad Emerg Med 2020 Jul;27(7):554-65. doi: 10.1111/acem.13917..
Keywords: Decision Making, Emergency Department, Imaging, Diagnosis, Diagnostic Safety and Quality
Rising KL, Powell RE, Cameron KA
Development of the uncertainty communication checklist: a patient-centered approach to patient discharge from the emergency department.
Acad Med 2020 Jul;95(7):1026-34. doi: 10.1097/acm.0000000000003231.
AHRQ-funded; HS025651.
Citation: Rising KL, Powell RE, Cameron KA .
Development of the uncertainty communication checklist: a patient-centered approach to patient discharge from the emergency department.
Acad Med 2020 Jul;95(7):1026-34. doi: 10.1097/acm.0000000000003231..
Keywords: Patient-Centered Healthcare, Hospital Discharge, Emergency Department, Clinician-Patient Communication, Communications
