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.

Yu H, Greenberg M, Haviland A
The impact of state medical malpractice reform on individual-level health care expenditures.
This study aims to fill the evidence gap concerning the effect of different types of malpractice reform by examining the general population, not a subgroup or a specific health condition, and controlling for individual-level sociodemographic and health status. It found that only two of the 10 major state-level malpractice reforms had significant impacts on the growth of individual-level health expenditures.
Health Serv Res 2017 Dec;52(6):2018-37. doi: 10.1111/1475-6773.12789.
AHRQ-funded; HS023336.
View abstract on the National Library of Medicine site.
Keywords: Health Care Costs, Legislation/Regulations, Medical Liability, Policy, Value
Taira DA, Seto BK, Davis JW
Examining factors associated with nonadherence and identifying providers caring for nonadherent subgroups.
This study examined racial/ethnic and regional differences in medication adherence in patients with diabetes taking oral anti-diabetic, anti-hypertensive, and cholesterol lowering medications and to identify the pharmacies and prescribers who serve these communities. After adjustment for other factors, Filipinos, Native Hawaiians, and people of other race were significantly less adherent to anti-diabetic and anti-hypertensive medications than Japanese.
J Pharm Health Serv Res 2017 Dec;8(4):247-53. doi: 10.1111/jphs.12193.
AHRQ-funded; HS023185.
View abstract on the National Library of Medicine site.
Keywords: Diabetes, Medications, Patient Adherence, Patient-Centered Healthcare, Racial and Ethnic Minority Groups
Raven MC, Guzman D, Chen AH
Out-of-network emergency department use among managed Medicaid beneficiaries.
The researchers examined factors associated with out-of-network ED use among Medicaid beneficiaries. They concluded that there are a number of factors related to out-of-network ED use, including the proximity and density of out-of-network EDs, race and ethnicity, a prior history of out-of-network ED use, and individuals' connection to primary care.
Health Serv Res 2017 Dec;52(6):2156-74. doi: 10.1111/1475-6773.12604.
AHRQ-funded; HS021700.
View abstract on the National Library of Medicine site.
Keywords: Emergency Department, Emergency Medical Services, Medicaid, Primary Care, Socioeconomic Factors
Krein SL, Harrod M, Collier S
A national collaborative approach to reduce catheter-associated urinary tract infections in nursing homes: a qualitative assessment.
AHRQ’s Safety Program for Long-term Care: Health Care-Associated Infections/Catheter-Associated Urinary Tract Infection, a national performance improvement program, was designed to promote implementation of a catheter-associated urinary tract infections (CAUTI) prevention program through state-based or regional collaboratives in more than 500 nursing homes across the United States. The observed program success and positive views of those participating suggest that collaboratives are an important strategy for providing nursing homes with enhanced expertise and support.
Am J Infect Control 2017 Dec;45(12):1342-48. doi: 10.1016/j.ajic.2017.07.006.
AHRQ-funded; 290201000025I; 29032008T.
View abstract on the National Library of Medicine site.
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Long-Term Care, Nursing Homes, Quality Improvement, Patient Safety
Kirby JB, Sharma R
The availability of community health center services and access to medical care.
This study examined the associations between the availability of Community Health Centers (CHCs) services in communities and two key measures of ambulatory care access - having a usual source of care and having any office-based medical visits over a one year period. It found that the availability of CHC services was positively associated with both measures of access among those with no insurance coverage.
Healthc 2017 Dec;5(4):174-82. doi: 10.1016/j.hjdsi.2016.12.006.
View abstract on the National Library of Medicine site.
Keywords: Access to Care, Community-Based Medicine, Medicaid, Medical Expenditure Panel Survey (MEPS), Uninsured
AHRQ Author: Kirby JB
Kemper AR, Fan T, Grossman DC
Gaps in evidence regarding iron deficiency anemia in pregnant women and young children: summary of US Preventive Services Task Force recommendations.
The USPSTF found insufficient evidence to recommend routine iron supplementation for pregnant women or routine screening for iron deficiency anemia in pregnant women or young children. The USPSTF identified a critical evidence gap that is related to whether changing hematologic indexes in otherwise asymptomatic pregnant women or in infants within populations who are reflective of the United States leads to an improvement in maternal or child health outcomes.
Am J Clin Nutr 2017 Dec;106(Suppl 6):1555s-58s. doi: 10.3945/ajcn.117.155788.
View abstract on the National Library of Medicine site.
Keywords: Children, Evidence-based Medicine, Pregnancy, U.S. Preventive Services Task Force (USPSTF), Vitamins and Supplements
AHRQ Author: Fan T
Ganapathy D, Acharya C, Lachar J
The patient buddy app can potentially prevent hepatic encephalopathy-related readmissions.
The researchers aimed to define the feasibility of using the Patient Buddy App and its impact on 30-day readmissions by engaging and educating cirrhotic inpatients and caregivers in a pilot study. In their proof-of-concept trial, the use of Patient Buddy is feasible in recently discharged patients with cirrhosis and their caregivers. Eight hepatic encephalopathy-related readmissions were potentially avoided after the use of the App.
Liver Int 2017 Dec;37(12):1843-51. doi: 10.1111/liv.13494.
AHRQ-funded; HS024004.
View abstract on the National Library of Medicine site.
Keywords: Caregiving, Chronic Conditions, Health Information Technology (HIT), Patient & Family Engagement, Readmissions
Galbraith AA, Meyers DJ, Ross-Degnan D
Long-term impact of a postdischarge community health worker intervention on health care costs in a safety-net system.
This study evaluated the impact of a patient navigator (PN) intervention on health system costs in the 180 days after discharge for high-risk patients in a safety-net system. Total costs per patient over the 180 days postindex discharge for those aged >/=60 years were significantly lower for PN patients compared to controls ($5,676 vs. $7,640); differences for patients aged <60 ($9,942 vs. $9,046) or for the entire cohort ($7,092 vs. $7,953) were not significant.
Health Serv Res 2017 Dec;52(6):2061-78. doi: 10.1111/1475-6773.12790.
AHRQ-funded; HS020628.
View abstract on the National Library of Medicine site.
Keywords: Health Care Costs, Patient Satisfaction, Readmissions, Safety Net, Value
Donovan LM, Rise PJ, Carson SS
Sleep disturbance in smokers with preserved pulmonary function and chronic obstructive pulmonary disease.
This study compared the magnitude and correlates of sleep disturbance between smokers with preserved pulmonary function and those with airflow obstruction. It found that among smokers with clinically identified chronic obstructive pulmonary disease (COPD), the severity of sleep disturbance is greater among those with preserved pulmonary function compared to those with airflow obstruction. Non-respiratory symptoms, such as depression, were associated with sleep disturbance in both groups.
Ann Am Thorac Soc 2017 Dec;14(12):1836-43. doi: 10.1513/AnnalsATS.201706-453OC.
AHRQ-funded; HS017894.
View abstract on the National Library of Medicine site.
Keywords: Chronic Obstructive Pulmonary Disease (COPD), Respiratory Conditions, Sleep, Sleep Apnea, Tobacco Use
Childers CP, Childers KK, Maggard-Gibbons M
National estimates of genetic testing in women with a history of breast or ovarian cancer.
In the United States, 3.8 million women have a history of breast (BC) or ovarian cancer (OC). Up to 15 percent of cases are attributable to heritable mutations, which, if identified, provide critical knowledge for treatment and preventive care. This study found that fewer than one in five individuals with a history of BC or OC meeting select National Cancer Comprehensive Network criteria have undergone genetic testing.
J Clin Oncol 2017 Dec 1;35(34):3800-06. doi: 10.1200/jco.2017.73.6314.
AHRQ-funded; HS025079.
View abstract on the National Library of Medicine site.
Keywords: Breast Cancer, Genetic Testing, Health Care Quality, Ovarian Cancer, Women's Health
Brach C
The journey to become a health literate organization: a snapshot of health system improvement.
This chapter explores the journey that a growing number of organizations are taking to become health literate. A part of the chapter highlights the experiences of three organizations that have explicitly set a goal to become health literate: Carolinas Healthcare System (CHS), Intermountain Healthcare, and Northwell Health. The chapter ends with lessons learned from the experiences of health literacy pioneers that may be useful to organizations embarking on the journey.
Stud Health Technol Inform 2017;240:203-37.
View abstract on the National Library of Medicine site.
Keywords: Health Literacy, Health Care Systems, Quality Improvement
AHRQ Author: Brach C
Lou Y, Cao J, Zhang S
Sample size calculations for time-averaged difference of longitudinal binary outcomes.
In this study, the researchers investigated sample size calculation for the comparison of time-averaged responses between treatment groups in clinical trials with longitudinally observed binary outcomes. Their simulation showed that the nominal power and type I error are well preserved over a wide range of design parameters. The researchers believe that theirs is the first study to consider the mixture of missing patterns in sample size calculation.
Commun Stat Theory Methods 2017;46(1):344-53. doi: 10.1080/03610926.2014.991040.
AHRQ-funded; HS022418.
View abstract on the National Library of Medicine site.
Keywords: Research Methodologies, Comparative Effectiveness, Outcomes
Cosgrove L, Krimsky S, Wheeler EE
Conflict of interest policies and industry relationships of guideline development group members: A cross-sectional study of clinical practice guidelines for depression.
The purpose of the present study was to assess a) the disclosure requirements of guideline development groups in a cross-section of guidelines for major depression; and, b) the extent and type of conflicts of panel members. It found that most of the guidelines were developed by panels that had members with industry financial ties to drug companies that manufacture antidepressant medication.
Account Res 2017;24(2):99-115. doi: 10.1080/08989621.2016.1251319.
AHRQ-funded; HS022940.
View abstract on the National Library of Medicine site.
Keywords: Guidelines, Disclosure, Antidepressants, Depression, Pharmaceuticals
Ratanawongsa N, Chan LL, Fouts MM
The challenges of electronic health records and diabetes electronic prescribing: implications for safety net care for diverse populations.
This review highlights how the EHR electronic prescribing transformation has affected diabetes care for vulnerable patients and offers recommendations for improving patient safety through EHR electronic prescribing design, implementation, policy, and research. Specifically, it presents evidence for the adoption of RxNorm and standardized naming and picklist options for high alert medications such as insulin.
J Diabetes Res 2017;2017:8983237. doi: 10.1155/2017/8983237.
AHRQ-funded; HS022561; HS023558.
View abstract on the National Library of Medicine site.
Keywords: Electronic Health Records (EHRs), Computer-Based Provider Order Entry (CPOE), Safety Net, Diabetes, Patient Safety
Goldstone AB, Chiu P, Baiocchi M
Mechanical or biologic prostheses for aortic-valve and mitral-valve replacement.
This study compared long-term mortality and rates of reoperation, stroke, and bleeding between cohorts of patients who underwent primary aortic-valve replacement or mitral-valve replacement with a mechanical or biologic prosthesis. The long-term mortality benefit associated with a mechanical prosthesis, as compared with a biologic prosthesis, persisted until 70 years of age among patients undergoing mitral-valve replacement and until 55 years of age among those undergoing aortic-valve replacement.
N Engl J Med 2017 Nov 9;377(19):1847-57. doi: 10.1056/NEJMoa1613792.
AHRQ-funded; HS022192.
View abstract on the National Library of Medicine site.
Keywords: Adverse Medical Events, Cardiovascular Conditions, Medical Devices, Patient-Centered Outcomes Research, Surgery
Zullo AR, Sharmin S, Lee Y
Secondary prevention medication use after myocardial infarction in U.S. nursing home residents.
This study evaluated new use of secondary prevention medications after acute myocardial infarction (AMI) in NH residents who were previously nonusers and to evaluate what factors were associated with use. More than one-third of older NH residents in the United States do not have any secondary prevention medications initiated after AMI, with fewer medications initiated in older residents; women; and those with, DNR orders, poor physical function, and cognitive impairment.
J Am Geriatr Soc 2017 Nov;65(11):2397-404. doi: 10.1111/jgs.15144.
AHRQ-funded; HS022998.
View abstract on the National Library of Medicine site.
Keywords: Elderly, Medications, Myocardial Infarction, Nursing Homes, Prevention and Care Management
Wang Z, Whiteside SPH, Sim L
Comparative effectiveness and safety of cognitive behavioral therapy and pharmacotherapy for childhood anxiety disorders: a systematic review and meta-analysis.
This review evaluated the comparative effectiveness and adverse events of cognitive behavioral therapy (CBT) and pharmacotherapy for childhood anxiety disorders. Evidence supports the effectiveness of CBT and selective serotonin reuptake inhibitors (SSRIs) for reducing childhood anxiety symptoms. Serotonin-norepinephrine reuptake inhibitors also appear to be effective based on less consistent evidence.
JAMA Pediatr 2017 Nov;171(11):1049-56. doi: 10.1001/jamapediatrics.2017.3036.
AHRQ-funded; 290201500013I.
View abstract on the National Library of Medicine site.
Keywords: Anxiety, Behavioral Health, Children, Comparative Effectiveness, Medications
Magnusson DM, Minkovitz CS, Kuhlthau KA
Beliefs regarding development and early intervention among low-income African American and Hispanic mothers.
This study sought to understand the role of health beliefs in shaping maternal decisions regarding help-seeking for children with developmental delay (DD) and explore differences between African American and Hispanic mothers. Five major themes emerged describing the role of maternal health beliefs in shaping key stages of the help-seeking pathway for children with DD. Differences between African American and Hispanic mothers are also described.
Pediatrics 2017 Nov;140(5):pii: e20172059. doi: 10.1542/peds.2017-2059.
View abstract on the National Library of Medicine site.
Keywords: Children, Decisionmaking, Disabilities, Low-Income Population, Racial and Ethnic Minority Groups
AHRQ Author: Mistry KB
Katz MJ, Gurses AP, Tamma PD
Implementing antimicrobial stewardship in long-term care settings: an integrative review using a human factors approach.
In this integrative review, the authors analyzed published evidence in the context of a human factors engineering approach as well as educational interventions to understand aspects of multimodal interventions associated with the implementation of successful stewardship programs in long term care facilities. The outcomes indicate that effective antimicrobial stewardship in long-term care is supported by incorporating multidisciplinary education, tools integrated into the workflow of nurses and prescribers that facilitate review of antibiotic use, and involvement of infectious disease consultants.
Clin Infect Dis 2017 Nov;65(11):1943-51. doi: 10.1093/cid/cix566.
AHRQ-authored; AHRQ-funded; 2332015000201.
View abstract on the National Library of Medicine site.
Keywords: Antimicrobials, Healthcare-Associated Infections, Elderly, Long-Term Care, Nursing Homes
AHRQ Author: Miller MA
Heslin KC, Owens PL, Karaca Z
Trends in opioid-related inpatient stays shifted after the US transitioned to ICD-10-CM diagnosis coding in 2015.
This study examines how trend analyses of inpatient stays involving opioid diagnoses were affected by the transition to ICD-10-CM. It found a sharp increase in opioid-related stays overall during the transition to ICD-10-CM. This may indicate that the new classification system is capturing stays that were missed by ICD-9-CM data.
Med Care 2017 Nov;55(11):918-23. doi: 10.1097/mlr.0000000000000805.
View abstract on the National Library of Medicine site.
Keywords: Critical Care, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Opioids, Substance Abuse
AHRQ Author: Heslin KC; Owens PL; Karaca Z; Elixhauser A