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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 8142 Research Studies DisplayedKnerr S, West KM, Angelo FA
Organizational readiness to implement population-based screening and genetic service delivery for hereditary cancer prevention and control.
Programs conducting population-based screening and genetic service delivery for hereditary cancer prevention and control are rare in practice. The authors interviewed individuals instrumental in implementing seven unique clinical programs conducting either universal tumor screening for Lynch Syndrome or routine family history screening and provision of genetic services for hereditary breast and ovarian cancer in the United States. Their findings suggest that developing interventions targeting change efficacy and cultivating practice change champions may be two promising ways to increase uptake of population-based hereditary cancer screening and genetic service delivery in clinical practice.
AHRQ-funded; HS022982.
Citation: Knerr S, West KM, Angelo FA .
Organizational readiness to implement population-based screening and genetic service delivery for hereditary cancer prevention and control.
J Genet Couns 2020 Oct;29(5):867-76. doi: 10.1002/jgc4.1216.
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Keywords: Cancer, Screening, Genetics, Prevention, Guidelines, Healthcare Delivery, Organization and Administration
Simpson KR, Lyndon A, Spetz J
Missed nursing care during labor and birth and exclusive breastfeeding during hospitalization for childbirth.
The purpose of this study was to determine associations between missed nursing care and nurse staffing during labor and birth, and exclusive breast milk feeding at hospital discharge. Exclusive breast milk feeding is a national quality indicator of inpatient maternity care. Nurses have substantial responsibility for direct support of infant feeding during the childbirth hospitalization. The investigators indicate that the results support exclusive breast milk feeding as a nurse-sensitive quality indicator.
AHRQ-funded; HS025715.
Citation: Simpson KR, Lyndon A, Spetz J .
Missed nursing care during labor and birth and exclusive breastfeeding during hospitalization for childbirth.
MCN Am J Matern Child Nurs 2020 Sep/Oct;45(5):280-88. doi: 10.1097/nmc.0000000000000644..
Keywords: Labor and Delivery, Pregnancy, Maternal Care, Breast Feeding, Inpatient Care, Nursing
Shoemaker-Hunt S, Hall K, Hoffman L
Advancing patient safety: reviews from the Agency for Healthcare Research and Quality's Making Healthcare Safer III report.
This paper discusses the Making Healthcare Safer (MHS) reports from the Agency for Healthcare Research and Quality (AHRQ). The reports—providing an analysis of the evidence for various patient safety practices (PSPs)—have served as a consolidated and up-to-date source of information for multiple stakeholders, including healthcare providers, health system administrators, researchers, and government agencies.
AHRQ-funded; 233201500013I.
Citation: Shoemaker-Hunt S, Hall K, Hoffman L .
Advancing patient safety: reviews from the Agency for Healthcare Research and Quality's Making Healthcare Safer III report.
J Patient Saf 2020 Sep;16(3S Suppl 1):S1-s2. doi: 10.1097/pts.0000000000000761..
Keywords: Patient Safety, Evidence-based Practice, Quality Improvement, Quality of Care
Rael CT, Giguere R, Lopez-Rios J
Transgender women's experiences using a home HIV-testing kit for partner-testing.
HIV partner-testing (PT) may represent a unique and empowering HIV prevention strategy for groups that face structural and institutional barriers to HIV testing and care, including transgender women. In this study, the investigators reported on in-depth interviews (IDIs) with transgender women who used HIV self-test kits for three months to screen potential sexual partners in a randomized controlled trial that took place in New York City and San Juan, Puerto Rico.
AHRQ-funded; HS026383.
Citation: Rael CT, Giguere R, Lopez-Rios J .
Transgender women's experiences using a home HIV-testing kit for partner-testing.
AIDS Behav 2020 Sep;24(9):2732-41. doi: 10.1007/s10461-020-02829-x..
Keywords: Human Immunodeficiency Virus (HIV), Prevention, Vulnerable Populations, Women, Patient Experience, Screening
Pantell MS, Shields-Zeeman L
Maintaining social connections in the setting of COVID-19 social distancing: a call to action.
The COVID-19 pandemic is an unprecedented public health crisis, with substantial health, social, and economic implications. The devastating direct medical consequences of COVID-19 have been accompanied by far reaching economic and social consequences, including increased risk of social isolation and loneliness. The authors discuss the need to remember that “social distancing” should refer to physical distancing and isolation, but not social isolation as changes to social routines impact the country.
AHRQ-funded; HS019264.
Citation: Pantell MS, Shields-Zeeman L .
Maintaining social connections in the setting of COVID-19 social distancing: a call to action.
Health Educ Behav 2020 Aug;47(4):569-80. doi: 10.1177/1090198120920529..
Keywords: Infectious Diseases, Public Health, Emergency Preparedness, Communications, Social Media
Baik D, Liu J, Cho H
Factors related to biological sex differences in engagement with healthcare providers in persons living with HIV.
Investigators conducted a secondary analysis of data collected from four projects focused on improving health outcomes in persons living with HIV (PLWH). They found that male patients displayed negative association between depression and engagement with healthcare providers and positive association between engagement with healthcare providers and medication adherence, while female patients showed no association between any of these factors. Anxiety and stigma were not significantly associated with medication adherence. They concluded that adherence interventions for PLWH should be tailored by biological sex.
AHRQ-funded; HS025071.
Citation: Baik D, Liu J, Cho H .
Factors related to biological sex differences in engagement with healthcare providers in persons living with HIV.
AIDS Behav 2020 Sep;24(9):2656-65. doi: 10.1007/s10461-020-02823-3..
Keywords: Human Immunodeficiency Virus (HIV), Sex Factors, Patient and Family Engagement, Patient Adherence/Compliance, Depression, Mental Health, Medication
Narla 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
Koopman RJ, Canfield SM, Belden JL
Home blood pressure data visualization for the management of hypertension: designing for patient and physician information needs.
This study examined whether using home blood pressure visualization tools helps management of hypertension for both patients and physicians. A multidisciplinary team used iterative user-centered design to create a blood pressure visualization EHR prototype that included patient-generated blood pressure data. The study included an attitude and behavior survey and 10 focus groups with 16 patients and 24 physicians. Most patients measured their blood pressure at home, but only half shared data with their physician. Data visualization helped patients and physicians have a fuller understanding of the blood pressure “story” and helped with patient-physician interactions to better control hypertension.
AHRQ-funded; HS023328.
Citation: Koopman RJ, Canfield SM, Belden JL .
Home blood pressure data visualization for the management of hypertension: designing for patient and physician information needs.
BMC Med Inform Decis Mak 2020 Aug 18;20(1):195. doi: 10.1186/s12911-020-01194-y..
Keywords: Hypertension, Blood Pressure, Chronic Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT), Clinician-Patient Communication, Communications, Patient Self-Management, Care Management
Fan T, Smith HJ
Primary care interventions for prevention and cessation of tobacco use in children and adolescents.
In this case study, three questions are posed concerning a 13-year-old girl presenting for a routine well-child visit who reports that she has never used tobacco products in any form.
AHRQ-authored.
Citation: Fan T, Smith HJ .
Primary care interventions for prevention and cessation of tobacco use in children and adolescents.
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Keywords: U.S. Preventive Services Task Force (USPSTF), Case Study, Children/Adolescents, Tobacco Use: Smoking Cessation, Tobacco Use, Primary Care, Prevention, Substance Abuse
Conover CJ, Bailey J
Certificate of need laws: a systematic review and cost-effectiveness analysis.
Researchers conducted a systematic review and cost-effectiveness analysis of Certificate of Need (CON) laws. Ninety articles were reviewed to summarize the evidence on how CON laws affect regulatory costs, health expenditures, health outcomes, and access to care; the researchers found that the literature has not yet reached a definitive conclusion. They state that while more and higher quality research is needed to reach confident conclusions, their cost-effectiveness analysis based on the existing literature indicates that the expected costs of CON exceeded its benefits.
AHRQ-funded; 290020025.
Citation: Conover CJ, Bailey J .
Certificate of need laws: a systematic review and cost-effectiveness analysis.
BMC Health Serv Res 2020 Aug 14;20(1):748. doi: 10.1186/s12913-020-05563-1..
Keywords: Healthcare Costs, Policy
Bolstad CJ, Moak R, Brown CJ
Neighborhood disadvantage is associated with depressive symptoms but not depression diagnosis in older adults.
This study tested how neighborhood disadvantage (ND) relates to depressive symptomology and diagnosis to assess for neighborhood disparities in mental health care cross-sectionally. Using data from the University of Alabama at Birmingham Study of Aging, the investigators found living in the high and mid-ND tertiles to be associated with depressive symptomology, yet ND had no significant relation to depression diagnosis. They concluded that older adults living in high and mid-disadvantaged neighborhoods may be more likely to experience depressive symptomology but not receive a diagnosis, indicating a possible disparity in mental health care.
AHRQ-funded; HS013852.
Citation: Bolstad CJ, Moak R, Brown CJ .
Neighborhood disadvantage is associated with depressive symptoms but not depression diagnosis in older adults.
Int J Environ Res Public Health 2020 Aug 8;17(16). doi: 10.3390/ijerph17165745..
Keywords: Elderly, Depression, Mental Health, Diagnosis, Disparities, Socioeconomic Factors
Bonawitz K, Wetmore M, Heisler M
Champions in context: which attributes matter for change efforts in healthcare?
The authors sought to identify and describe champion attributes influencing outcomes of healthcare change efforts. Using postpartum contraceptive care as a case study, they found that effective champions appear to leverage six key attributes to facilitate healthcare change efforts. They concluded that prospective evaluations of the interactions among champion attributes, context, and outcomes may further elucidate how champions exert their effects.
AHRQ-funded; HS025465.
Citation: Bonawitz K, Wetmore M, Heisler M .
Champions in context: which attributes matter for change efforts in healthcare?
Implement Sci 2020 Aug 6;15(1):62. doi: 10.1186/s13012-020-01024-9..
Keywords: Implementation, Contraception, Women, Maternal Care
Yakusheva O, Hoffman GJ
Does a reduction in readmissions result in net savings for most hospitals? An examination of Medicare's hospital readmissions reduction program.
This study aimed (1) to estimate the impact of an incremental reduction in excess readmissions on a hospital's Medicare reimbursement revenue, for hospitals subject to penalties under the Medicare's Hospital Readmissions Reduction Program and (2) to evaluate the economic case for an investment in a readmission reduction program.
AHRQ-funded; HS025838.
Citation: Yakusheva O, Hoffman GJ .
Does a reduction in readmissions result in net savings for most hospitals? An examination of Medicare's hospital readmissions reduction program.
Med Care Res Rev 2020 Aug;77(4):334-44. doi: 10.1177/1077558718795745..
Keywords: Medicare, Hospital Readmissions, Hospitals, Healthcare Costs, Policy
Swietek KE, Gaynes BN, Jackson GL
Effect of the patient-centered medical home on racial disparities in quality of care.
Research demonstrates that the patient-centered medical home (PCMH) is associated with improved clinical outcomes and quality of care, and the populations that can most benefit from this model require long-term management, e.g., persons with chronic illness and behavioral health conditions. The objective of this study was to estimate the association between enrollment in National Committee for Quality Assurance (NCQA)-recognized PCMHs and racial disparities in quality of care for adults with major depressive disorder (MDD) and comorbid medical conditions.
AHRQ-funded; HS025562.
Citation: Swietek KE, Gaynes BN, Jackson GL .
Effect of the patient-centered medical home on racial disparities in quality of care.
J Gen Intern Med 2020 Aug;35(8):2304-13. doi: 10.1007/s11606-020-05729-x.
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Keywords: Patient-Centered Healthcare, Disparities, Racial / Ethnic Minorities, Quality of Care, Chronic Conditions
Schroeder EB, Adams JL, Chonchol M
Predictors of hyperkalemia and hypokalemia in individuals with diabetes: a classification and regression tree analysis.
Both hyperkalemia and hypokalemia can lead to cardiac arrhythmias and are associated with increased mortality. Information on the predictors of potassium in individuals with diabetes in routine clinical practice is lacking. The objective of this study was to identify predictors of hyperkalemia and hypokalemia in adults with diabetes.
AHRQ-funded; HS022963; HS019859.
Citation: Schroeder EB, Adams JL, Chonchol M .
Predictors of hyperkalemia and hypokalemia in individuals with diabetes: a classification and regression tree analysis.
J Gen Intern Med 2020 Aug;35(8):2321-28. doi: 10.1007/s11606-020-05799-x..
Keywords: Diabetes, Diagnosis
Samost-Williams A, Nanji KC
A systems theoretic process analysis of the medication use process in the operating room.
While 4 to 10% of medications administered in the operating room may involve an error, few investigations have prospectively modeled how these errors might occur. Systems theoretic process analysis is a prospective risk analysis technique that uses systems theory to identify hazards. The purpose of this study was to demonstrate the use of systems theoretic process analysis in a healthcare organization to prospectively identify causal factors for medication errors in the operating room.
AHRQ-funded; HS024764.
Citation: Samost-Williams A, Nanji KC .
A systems theoretic process analysis of the medication use process in the operating room.
Anesthesiology 2020 Aug;133(2):332-41. doi: 10.1097/aln.0000000000003376..
Keywords: Medication, Surgery, Medical Errors, Adverse Drug Events (ADE), Adverse Events
Poppert Cordts KM, Hall TA, Hartman ME
Sleep measure validation in a pediatric neurocritical care acquired brain injury population.
Lingering morbidities including physical, cognitive, emotional, and psychosocial sequelae, termed the Post-Intensive Care Syndrome, persist years after pediatric neurocritical care (PNCC) hospitalization. Sleep disturbances impact other Post-Intensive Care Syndrome domains and are under-evaluated to date due to a lack of appropriate measurement tools. The present study evaluated the validity of the Sleep Disturbance Scale for Children (SDSC) to address the growing need for assessing sleep problems after PNCC.
AHRQ-funded; HS022981.
Citation: Poppert Cordts KM, Hall TA, Hartman ME .
Sleep measure validation in a pediatric neurocritical care acquired brain injury population.
Neurocrit Care 2020 Aug;33(1):196-206. doi: 10.1007/s12028-019-00883-5..
Keywords: Children/Adolescents, Sleep, Neurological Disorders, Intensive Care Unit (ICU), Hospitalization, Quality of Life
Payán DD, Maggard-Gibbons M, Flórez KR
Taking Care of Yourself and Your Risk for Breast Cancer (CUIDARSE): a randomized controlled trial of a health communication intervention for Latinas.
Latinas in the United States are more likely to be diagnosed with late-stage breast cancer (BC) compared to non-Latinas. Literacy-appropriate and culturally sensitive cancer communication interventions can help address existing racial/ethnic BC disparities. In this study, the investigators formatively developed a new BC prevention brochure for Spanish-speaking Latinas (≥35 years) and conducted a randomized controlled trial of a health communication intervention for Latinas.
AHRQ-funded; HS019264.
Citation: Payán DD, Maggard-Gibbons M, Flórez KR .
Taking Care of Yourself and Your Risk for Breast Cancer (CUIDARSE): a randomized controlled trial of a health communication intervention for Latinas.
Health Educ Behav 2020 Aug;47(4):569-80. doi: 10.1177/1090198120920529..
Keywords: Cancer: Breast Cancer, Cancer, Racial / Ethnic Minorities, Health Literacy, Education: Patient and Caregiver, Cultural Competence, Health Promotion, Communications, Women, Community-Based Practice
Moise N, Phillips E, Carter E
Design and study protocol for a cluster randomized trial of a multi-faceted implementation strategy to increase the uptake of the USPSTF hypertension screening recommendations: the EMBRACE study.
The US Preventive Services Task Force (USPSTF) recommends out-of-office blood pressure (BP) testing to exclude white coat hypertension prior to hypertension diagnosis. Despite improved availability and coverage of home and 24-h ambulatory BP monitoring (HBPM, ABPM), both are infrequently used to confirm diagnoses. In this study, the investigators used the Behavior Change Wheel (BCW) framework, a multi-step process for mapping barriers to theory-informed behavior change techniques, to develop a multi-component implementation strategy for increasing out-of-office BP testing for hypertension diagnosis.
AHRQ-funded; HS025198; HS024262.
Citation: Moise N, Phillips E, Carter E .
Design and study protocol for a cluster randomized trial of a multi-faceted implementation strategy to increase the uptake of the USPSTF hypertension screening recommendations: the EMBRACE study.
Implement Sci 2020 Aug 8;15(1):63. doi: 10.1186/s13012-020-01017-8..
Keywords: U.S. Preventive Services Task Force (USPSTF), Guidelines, Evidence-based Practice, Hypertension, Implementation, Blood Pressure, Screening
Mohapatra A, Strope SA, Liu N
Importance of long-term follow-up after endoscopic management for upper tract urothelial carcinoma and factors leading to surgical management.
Patients undergoing endoscopic management for upper tract urothelial carcinoma often progress to definitive therapy with radical nephroureterectomy. This study examined the rate of progression as well as risk factors for transitions in treatment over time. The investigators found that patients who progressed to radical nephroureterectomy after endoscopic management had fewer comorbid conditions and changes in disease status including visible lesions on ureteroscopy and positive biopsies.
AHRQ-funded; HS19455.
Citation: Mohapatra A, Strope SA, Liu N .
Importance of long-term follow-up after endoscopic management for upper tract urothelial carcinoma and factors leading to surgical management.
Int Urol Nephrol 2020 Aug;52(8):1465-69. doi: 10.1007/s11255-020-02439-5..
Keywords: Cancer, Surgery, Risk, Care Management
Kim JH, Fine DR, Li L
Disparities in United States hospitalizations for serious infections in patients with and without opioid use disorder: a nationwide observational study.
This study examined the differences in patients with and without opioid use disorder (OUD) who were hospitalized for serious infections focusing on infective endocarditis, epidural abscess, septic arthritis or osteomyelitis. The authors used the 2016 National Inpatient Sample to examine differences in length of stay (LOS), discharge disposition, and charges. Patients with OUD had a lower probability of discharge at any given LOS, and lower odds of discharge to home with higher odds of discharge to a post-acute care facility. There were no significant differences in average total hospital charges.
AHRQ-funded; HS026215.
Citation: Kim JH, Fine DR, Li L .
Disparities in United States hospitalizations for serious infections in patients with and without opioid use disorder: a nationwide observational study.
PLoS Med 2020 Aug;17(8):e1003247. doi: 10.1371/ournal.pmed.1003247.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Disparities, Opioids, Substance Abuse, Hospitalization, Medication, Infectious Diseases
Kennedy G, Lewis VA, Kundu S
Kennedy G, Lewis VA, Kundu S, Mousqués J, Colla CH. Accountable care organizations and post-acute care: a focus on preferred SNF networks.
This study examined the relationship between accountable care organizations (ACOs) and skilled nursing facilities (SNFs) for patients who are discharged from a hospital into a SNF. A mixed-method design was used and survey data was examined from 366 respondents to the National Survey of ACOs along with 16 semi-structured interviews with ACOs who performed well on cost and quality measures. Over half of ACOs had no formal relationship with SNFs; however the majority of ACO interviewees had preferred SNF networks. These preferred networks are beginning to transform the ACO post-acute care landscape.
AHRQ-funded; HS024075.
Citation: Kennedy G, Lewis VA, Kundu S .
Kennedy G, Lewis VA, Kundu S, Mousqués J, Colla CH. Accountable care organizations and post-acute care: a focus on preferred SNF networks.
Med Care Res Rev 2020 Aug;77(4):312-23. doi: 10.1177/1077558718781117..
Keywords: Nursing Homes, Healthcare Costs, Payment, Value
Joshi RP, Pejaver V, Hammarlund NE
A predictive tool for identification of SARS-CoV-2 PCR-negative emergency department patients using routine test results.
This retrospective case-control study investigated whether the use of a prediction tool based on complete blood count results and patient sex can better allocate testing for SARS-CoV-2 PCR testing in hospital emergency departments. Participants were emergency department patients who had concurrent complete blood counts and SARS-CoV-2 PCR testing in Northern California, Seattle, Washington, Chicago Illinois, and South Korea. A hypothetical scenario of 1000 patients requiring testing was developed, but in this scenario testing resources are limited to 60% of patients. This tool would allow a 33% increase in properly allocated resources.
AHRQ-funded; HS026385.
Citation: Joshi RP, Pejaver V, Hammarlund NE .
A predictive tool for identification of SARS-CoV-2 PCR-negative emergency department patients using routine test results.
J Clin Virol 2020 Aug;129:104502. doi: 10.1016/j.jcv.2020.104502..
Keywords: Emergency Department, Infectious Diseases, Pneumonia, Respiratory Conditions, Diagnosis, Clinical Decision Support (CDS)
Hoffman GJ, Tilson S, Yakusheva O
The financial impact of an avoided readmission for teaching and safety-net hospitals under Medicare's hospital readmission reduction program.
This study examined the financial incentives to avoid readmissions under Medicare’s Hospital Readmission Reduction Program for teaching hospitals (THs) and safety-net hospitals (SNHs). Readmissions data for 2,465 hospitals was analyzed using Medicare’s FY 2016 Hospital Compare. The authors tested for differential revenue gains for SNHs relative to non-SNHs and for major and minor THs relative to non-THs. They found that revenue gains of an avoided readmission were 10-15% greater for major THs compared with non-THs, but no different for SNHs compared with non-SNHs.
AHRQ-funded; HS025838.
Citation: Hoffman GJ, Tilson S, Yakusheva O .
The financial impact of an avoided readmission for teaching and safety-net hospitals under Medicare's hospital readmission reduction program.
Med Care Res Rev 2020 Aug;77(4):324-33. doi: 10.1177/1077558718795733..
Keywords: Medicare, Hospital Readmissions, Hospitals, Healthcare Costs, Safety Net
