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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.
View abstract on the National Library of Medicine site.
Keywords: Healthcare Utilization, Health Insurance, Surgery
Szilagyi PG, Schaffer S, Rand CM
Text message reminders for child influenza vaccination in the setting of school-located influenza vaccination: a randomized clinical trial.
This study assessed whether text message reminders to parents could raise rates for children receiving school-located influenza vaccination (SLIV). Researchers randomized families with children in urban elementary schools to receive either text message plus SLIV (intervention) or SLIV alone (comparison). All parents were also sent two ‘backpack’ notifications and two autodialer phone reminders about SLIV at a single SLIV clinic. The text message reminders did not raise influenza vaccination rates above those observed with SLIV alone, and the authors conclude that more intensive interventions are needed to raise influenza vaccination rates.
Clin Pediatr 2019 Apr;58(4):428-36. doi: 10.1177/0009922818821878.
AHRQ-funded; HS021163.
View abstract on the National Library of Medicine site.
Keywords: Children/Adolescents, Influenza, Health Information Technology (HIT), Vaccination
Swor DE, Thomas LF, Maas MB
Admission heart rate variability is associated with fever development in patients with intracerebral hemorrhage.
The purpose of this study was to investigate whether heart rate variability (HRV) was associated with the development of fever in patients with intracerebral hemorrhage (ICH). The study included patients who presented directly to the research team’s emergency department after symptom onset, who had a 10-second electrocardiogram (EKG) performed within 24 hours of admission, and were in sinus rhythm. Patient temperature was recorded every 1 to 4 hours. The authors conclude that HRV measured on 10-second EKGs is associated with fever occurrence after ICH and can be a potential early marker of parasympathetic nervous system dysfunction; detection of parasympathetic dysfunction may afford an opportunity to improve ICH outcome by targeting therapies at fever prevention.
Neurocrit Care 2019 Apr;30(2):244-50. doi: 10.1007/s12028-019-00684-w.
AHRQ-funded; HS023437.
View abstract on the National Library of Medicine site.
Keywords: Patient-Centered Outcomes Research
Rinke ML, German M, Azera B
Effect of mental health screening and integrated mental health on adolescent depression-coded visits.
This article describes a retrospective primary care network natural cohort study to analyze how mental health screening and integrated mental health practitioners affect adolescent depression identification. The percentage of depression-coded adolescent visits were compared between practices with and without mental health screening and with and without integrated mental health practitioners, using difference-in-differences analyses. The authors conclude that adolescent mental health screening and integrated mental health practitioners increase depression-coded visits in primary care.
Clin Pediatr 2019 Apr;58(4):437-45. doi: 10.1177/0009922818821889.
AHRQ-funded; HS0203608.
View abstract on the National Library of Medicine site.
Keywords: Children/Adolescents, Depression, Diagnosis, Primary Care, Screening
Reid R, Rising E, Kaufman A
The influence of a place-based foundation and a public university in growing a rural health workforce.
This article describes a partnership between a private, place-based foundation and the University of New Mexico's Office for Community Health. The university’s resources and the JF Maddox Foundation’s entrepreneurial nature, discretionary grant-making, and local convening capabilities combined to an innovative approach for addressing an acute shortage in the local health care delivery workforce in an isolated, rural setting in New Mexico. Results included a significant increase in recruitment of key health care professionals, a more cohesive medical community, a school-based clinic, and support for other community challenges such as the prevention of teen pregnancy.
J Community Health 2019 Apr;44(2):292-96. doi: 10.1007/s10900-018-0585-y.
AHRQ-funded; HS023904.
View abstract on the National Library of Medicine site.
Keywords: Access to Care, Community-Based Practice, Community Partnerships, Rural Health, Workforce
Post B, Ryan AM, Moloci NM
Physician participation in Medicare Accountable Care Organizations and spillovers in commercial spending.
The purpose of this retrospective, longitudinal study was to determine if physicians who participated in a Medicare Accountable Care Organization (ACO) reduced spending among their commercially insured patients in Michigan. Blue Cross Blue Shield of Michigan (BCBSM) claims data from 2010 to 2015 was used to compare patients who experienced a significant clinical episode and were seen by physicians who participated in a Medicare ACO with those whose physicians were not part of an ACO. The researchers conclude that physicians who participated in Medicare ACOs did not reduce spending among most of their commercially insured patients.
Med Care 2019 Apr;57(4):305-11. doi: 10.1097/mlr.0000000000001081.
AHRQ-funded; HS024525; HS024728.
View abstract on the National Library of Medicine site.
Keywords: Health Insurance, Healthcare Costs, Medicare
Mobley LR, Kuo TM, Zhou M
What happened to disparities in CRC screening among FFS Medicare enrollees following Medicare modernization?
This study examined the effects of the change in policy for colorectal screening that was implemented in 2006 for FFS Medicare beneficiaries. This new policy eliminated copayments for colonoscopies or sigmoidoscopies. Disparities in screening by race (Blacks, Asians and Hispanics relative to Whites), and gender (Males relative to Females). The time periods 2001-2005 and 2006-2009 were compared and while there was some improvement in screening rates for minorities and women, the progress was unevenly distributed across the USA.
J Racial Ethn Health Disparities 2019 Apr;6(2):273-91. doi: 10.1007/s40615-018-0522-x.
AHRQ-funded; HS021752.
View abstract on the National Library of Medicine site.
Keywords: Cancer: Colorectal Cancer, Colonoscopy, Disparities, Medicare, Screening
Maurer M, Carman KL, Yang M
Increasing the use of comparative quality information in maternity care: results from a randomized controlled trial.
The authors tested an intervention to increase uptake of hospital-level maternity care quality reports among 245 pregnant women in North Carolina. They found that intervention participants were significantly more likely to report adopting behaviors to inform care, such as thinking through preferences, talking with their doctor, or creating a birth plan. They concluded that reports designed to put quality information into the larger context of what consumers want and need to know, along with targeted and timely communications, can increase consumer use of quality information and prompt them to talk with providers about care preferences and evidence-based practices.
Med Care Res Rev 2019 Apr;76(2):208-28. doi: 10.1177/1077558717712290.
AHRQ-funded; HS021873.
View abstract on the National Library of Medicine site.
Keywords: Maternal Care, Patient and Family Engagement, Quality Improvement, Value, Women
Mahalingam M, Moore Jx, Donnelly JP
Frailty syndrome and risk of sepsis in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort.
This study examined the association between frailty (weakness, exhaustion, and low physical activity) and the risk of sepsis in stroke patients. Data from the cohort study Reasons for Geographic and Racial Differences in Stroke (REGARDS) was used. There was an associated increase in sepsis hospitalizations and 30-day case fatalities from sepsis in stroke patients with more frailty indicators.
J Intensive Care Med 2019 Apr;34(4):292-300. doi: 10.1177/0885066617715251.
AHRQ-funded; HS013852.
View abstract on the National Library of Medicine site.
Keywords: Elderly, Racial / Ethnic Minorities, Risk, Sepsis, Stroke
Machta RM, Maurer KA, Jones DJ
A systematic review of vertical integration and quality of care, efficiency, and patient-centered outcomes.
This systematic review examined the effects of small independent practices becoming part of larger provider organizations and hospital systems. A literature review was done for studies from 1996 to 2016. Out of 7,559 articles generated, 29 articles were included in this review. Vertical integration was associated with better quality but there were no differences or even lower efficiency than prior to the integration measured by utilization, spending and prices. Patient-centered outcome was measured by only a few studies so was not included.
Health Care Manage Rev 2019 Apr/Jun;44(2):159-73. doi: 10.1097/hmr.0000000000000197.
AHRQ-authored; AHRQ-funded; 290201600001C.
View abstract on the National Library of Medicine site.
Keywords: Evidence-based Practice, Patient-Centered Outcomes Research, Quality of Care
AHRQ Author: Furukawa MF
Leeds IL, Meyers PM, Enumah ZO
Psychosocial risks are independently associated with cancer surgery outcomes in medically comorbid patients.
The purpose of this prospective observational study was to assess the association of preoperative psychosocial risk factors and 30-day complications following cancer surgery. The investigators demonstrated a more than threefold odds of a complication in medically comorbid patients with multiple psychosocial risks. They suggest that their findings support the use of psychosocial risks in preoperative assessment and consideration for inclusion in preoperative optimization efforts.
Ann Surg Oncol 2019 Apr;26(4):936-44. doi: 10.1245/s10434-018-07136-3.
AHRQ-funded; HS024736.
View abstract on the National Library of Medicine site.
Keywords: Adverse Events, Cancer, Outcomes, Risk, Surgery
Ita AJ, Olden HA, Kippen KE
A flexible model for patient engagement: achieving quality outcomes and building a research agenda for head and neck cancer.
This article describes the work of a head and neck cancer survivors who became advisors on a multidisciplinary team of providers. The survivors provided feedback to providers on areas of improvement for clinical flow and they also have provided advice on efforts to increase public awareness. They have also been very active at cancer symposiums and other local presentations.
Head Neck 2019 Apr;41(4):1087-93. doi: 10.1002/hed.25584.
AHRQ-funded; HS022417.
View abstract on the National Library of Medicine site.
Keywords: Cancer, Health Services Research (HSR), Patient-Centered Outcomes Research, Patient and Family Engagement
Hoffman SA, Ledford G, Cameron KA
A qualitative exploration of social and environmental factors affecting diet and activity in knee replacement patients.
This study examined perceived social and environmental barriers and encouragers for patients undergoing knee replacement surgery who are overweight or obese. Twenty patients were surveyed about factors that helped or hindered healthy behaviors. Many mentioned availability of healthy food, attending social gatherings, social support, and the weather.
J Clin Nurs 2019 Apr;28(7-8):1156-63. doi: 10.1111/jocn.14719.
AHRQ-funded; HS023011.
View abstract on the National Library of Medicine site.
Keywords: Lifestyle Concerns, Nutrition, Orthopedics, Surgery
Dalglish SL, Sriram V, Scott K
A framework for medical power in two case studies of health policymaking in India and Niger.
Medical professionals influence health policymaking but the power they exercise is not well understood in low- and middle-income countries. In this study, the authors explore medical power in national health policymaking for child survival in Niger (late 1990s-2012) and emergency medicine specialisation in India (early 1990s-2015). Both case studies used document review, in-depth interviews and non-participant observation; combined analysis traced policy processes and established theoretical categories around power to build a conceptual framework of medical power in health policymaking.
Glob Public Health 2019 Apr;14(4):542-54. doi: 10.1080/17441692.2018.1457705.
AHRQ-funded; HS000078.
View abstract on the National Library of Medicine site.
Keywords: Case Study, Policy
Chukmaitov AS, Harless DW, Bazzoli GJ
Factors associated with hospital participation in Centers for Medicare and Medicaid Services' Accountable Care Organization programs.
The aim of this study was to assess the organizational and environmental characteristics associated with hospital participation in the Medicare Shared Savings Program (MSSP) and Pioneer Accountable Care Organizations (ACOs). The investigators found that hospital participation in both Centers for Medicare and Medicaid Services ACO programs was associated with prior experience with risk-based payments and care management programs, advanced health information technology, and location in higher-income and more competitive areas.
Health Care Manage Rev 2019 Apr/Jun;44(2):104-14. doi: 10.1097/hmr.0000000000000182.
AHRQ-funded; HS023332.
View abstract on the National Library of Medicine site.
Keywords: Hospitals, Medicare, Organization and Administration, Payment
Chapman WC, Subramanian M, Jayarajan S
First, do no harm: rethinking routine diversion in sphincter-preserving rectal cancer resection.
While diverting stomas have reduced anastomotic leak rates after sphincter-preserving proctectomy in some series, the effectiveness of routine diversion among a broad population of rectal cancer patients remains controversial. In this study, the authors investigated whether routine temporary diversion was associated with decreased rates of leak or reintervention in cancer patients at-large undergoing sphincter-sparing procedures. The authors did not find an association between diversion and anastomotic leak. However, temporary diversion was associated with increased incidence of non-elective reinterventions, readmissions, and higher costs.
J Am Coll Surg 2019 Apr;228(4):547-56.e8. doi: 10.1016/j.jamcollsurg.2018.12.012.
AHRQ-funded; HS019455.
View abstract on the National Library of Medicine site.
Keywords: Adverse Events, Cancer, Healthcare Cost and Utilization Project (HCUP), Patient Safety, Surgery
Cefalu MS, Elliott MN, Setodji CM
Hospital quality indicators are not unidimensional: a reanalysis of Lieberthal and Comer.
The objective of this study was to evaluate the dimensionality of hospital quality indicators treated as unidimensional in a prior publication. The investigators found that there were four underlying dimensions of hospital quality: patient experience, mortality, and two clinical process dimensions. They concluded that hospital quality should be measured using a variety of indicators reflecting different dimensions of quality.
Health Serv Res 2019 Apr;54(2):502-08. doi: 10.1111/1475-6773.13056.
AHRQ-funded; HS016980; HS016978.
View abstract on the National Library of Medicine site.
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Hospitals, Patient Experience, Provider Performance, Quality Indicators (QIs)
Brand McCarthy SR, Kang TI, Mack JW
Inclusion of children in the initial conversation about their cancer diagnosis: impact on parent experiences of the communication process.
The current study examined the frequency and impact of child presence during a serious medical conversation on the parent's communication experience in pediatric oncology. The investigators concluded that the parent's communication experience is not diminished by the choice to include the child. They suggest that given the bioethical imperative to include children in conversations about serious illness whenever possible, this concern should not be used to exclude children, but rather to give parents additional time of their own when needed to fully process decisions.
Support Care Cancer 2019 Apr;27(4):1319-24. doi: 10.1007/s00520-019-4653-3.
AHRQ-funded; HS000063.
View abstract on the National Library of Medicine site.
Keywords: Cancer, Caregiver, Children/Adolescents, Clinician-Patient Communication, Patient and Family Engagement
Bazzoli GJ, Harless DW, Chukmaitov AS
A taxonomy of hospitals participating in Medicare accountable care organizations.
In this study, the investigators identified hospital ACO participant subgroups that share certain capabilities and competencies to provide deeper understanding of the structure and operation of these organizations. Their findings provide a baseline to track the evolution of accountable care organization (ACO) hospitals over time. The authors suggest that ACOs need to consider not only geographic and service mix when selecting hospital participants but also their vertical integration features and management competencies.
Health Care Manage Rev 2019 Apr/Jun;44(2):93-103. doi: 10.1097/hmr.0000000000000159.
AHRQ-funded; HS023332.
View abstract on the National Library of Medicine site.
Keywords: Healthcare: Delivery, Hospitals, Medicare
Ashcraft LE, Asato M, Houtrow AJ
Parent empowerment in pediatric healthcare settings: a systematic review of observational studies.
The objective of this systematic review was to synthesize potential antecedents and consequences of parent empowerment in healthcare settings. The authors identified six themes within consequences of empowerment: increased parent involvement in daily care, improved symptom management, enhanced informational needs and tools, increased involvement in care decisions, increased advocacy for child, and engagement in empowering others. Six themes summarizing antecedents of empowerment also emerged: parent-provider relationships.
Patient 2019 Apr;12(2):199-212. doi: 10.1007/s40271-018-0336-2.
AHRQ-funded; HS022989.
View abstract on the National Library of Medicine site.
Keywords: Caregiver, Children/Adolescents, Clinician-Patient Communication, Decisionmaking, Patient and Family Engagement

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