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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.

Henke RM, Karaca Z, Gibson TB
Medicare Advantage penetration and hospital costs before and after the Affordable Care Act.
This study investigated the relationship between Medicare Advantage (MA) program growth and inpatient hospital costs and utilization before and after the ACA. Its results suggest that MA enrollment growth is associated with diminished spillover reductions in hospital admission costs after the ACA. Researchers did not observe a strong relationship between MA enrollment and inpatient days per enrollee
Med Care 2018 Apr;56(4):321-28. doi: 10.1097/mlr.0000000000000885.
AHRQ-authored; AHRQ-funded; 290201300002C.
View abstract on the National Library of Medicine site.
Keywords: Health Care Costs, Health Reform, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Medicare
AHRQ Author: Karaca Z, Wong HS
Grout RW, Cheng ER, Carroll AE
A six-year repeated evaluation of computerized clinical decision support system user acceptability.
This study examined user acceptance patterns over six years of a continuous computerized clinical decision support system (CDSS) integration and updated a long-term, repeated follow-up of user acceptability of a CDSS. It found that favorable opinions of the CDSS were more likely in frequent users, physicians and advanced practitioners, and full-time workers.
Int J Med Inform 2018 Apr;112:74-81. doi: 10.1016/j.ijmedinf.2018.01.011.
AHRQ-funded; HS017939; HS018453; HS020640.
View abstract on the National Library of Medicine site.
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Health Personnel, Medical Informatics, Quality Improvement
Grossman LV, Choi SW, Collins S
Implementation of acute care patient portals: recommendations on utility and use from six early adopters.
This paper provides recommendations on how to most effectively implement advanced features of acute care patient portals, including: (1) patient-provider communication, (2) care plan information, (3) clinical data viewing, (4) patient education, (5) patient safety, (6) caregiver access, and (7) hospital amenities. One specific recommendation was that stakeholders in acute care patient portals should consider the benefits and challenges of generic and structured electronic care team messaging.
J Am Med Inform Assoc 2018 Apr;25(4):370-79. doi: 10.1093/jamia/ocx074.
AHRQ-funded; HS021816; HS023613; HS023535; HS024349.
View abstract on the National Library of Medicine site.
Keywords: Acute Care, Electronic Health Records, Patient Safety, Provider-Patient Communication, Web-Based
Giardina TD, Baldwin J, Nystrom DT
Patient perceptions of receiving test results via online portals: a mixed-methods study.
The researchers conducted a mixed-methods study to explore patients' experiences and preferences when accessing their test results via online portals. They found that nearly two-thirds (63 percent) did not receive any explanatory information or test result interpretation at the time they received the result. Patients experienced negative emotions often with abnormal results, but sometimes even with normal results.
J Am Med Inform Assoc 2018 Apr;25(4):440-46. doi: 10.1093/jamia/ocx140.
AHRQ-funded; HS023602; HS022087.
View abstract on the National Library of Medicine site.
Keywords: Electronic Health Records, Patient Experience, Patient & Family Engagement, Provider-Patient Communication, Web-Based
de Cordova PB
Excess mortality associated with weekend hospital admissions may be due to patient-level differences, rather than reduced staffing or services.
The author comments on a study by Walker that explained the weekend effect as arising from differences in patient characteristics among patients who present to the emergency department on the weekend. For staffing, Walker used a proxy measure because staffing information was not available. The author cautions that, although a clear rationale was provided, there should be acknowledgement that use of a proxy, whether for illness severity or staffing, may alter results.
Evid Based Nurs 2018 Apr;21(2):49. doi: 10.1136/eb-2017-102779.
AHRQ-funded; HS024339.
View abstract on the National Library of Medicine site.
Keywords: health care delivery, Health Services Research (HSR), Hospitalization, Mortality, Staffing
Crossman MK, Warfield ME, Kotelchuck M
Associations between early intervention home visits, family relationships and competence for mothers of children with developmental disabilities.
The researchers examined the association between intensity of home visits in early intervention (EI), perceived helpfulness of home visits in EI, and positive family relationships as predictors of maternal competence at age 3, as well as moderating effects of predictors, controlling for child characteristics, family demographics, and negative life events. They found that the intensity of home visits was not significantly associated with maternal competence at age 3.
Matern Child Health J 2018 Apr;22(4):599-607. doi: 10.1007/s10995-018-2429-x.
AHRQ-funded; HS000063.
View abstract on the National Library of Medicine site.
Keywords: Children, Disabilities, Family Health and History, Patient & Family Engagement, Prevention and Care Management
Costa DK, Valley TS, Miller MA
ICU team composition and its association with ABCDE implementation in a quality collaborative.
Awakening, Breathing Coordination, Delirium, and Early Mobility bundle (ABCDE) should involve an interprofessional team, yet no studies describe what team composition supports implementation. This study found that ABCDE implementation was associated with frequent involvement of team members, suggesting a need for role articulation and coordination.
J Crit Care 2018 Apr;44:1-6. doi: 10.1016/j.jcrc.2017.09.180.
AHRQ-authored; AHRQ-funded; HS024552.
View abstract on the National Library of Medicine site.
Keywords: Critical Care, Intensive Care Unit (ICU), Patient Safety, Quality Improvement, Team Work
AHRQ Author: Miller MA
Blaz JW, Doig AK, Cloyes KG
The symbolic functions of nurses' cognitive artifacts on a medical oncology unit.
Acute care nurses continue to rely on personally created paper-based tools-their "paper brains"-to support work during a shift, although standardized handoff tools are recommended. This interpretive descriptive study examines the functions these paper brains serve beyond handoff in the medical oncology unit at a cancer specialty hospital.
West J Nurs Res 2018 Apr;40(4):520-36. doi: 10.1177/0193945916683683.
AHRQ-funded; HS022183.
View abstract on the National Library of Medicine site.
Keywords: Acute Care, Cancer, Nursing, Prevention and Care Management, Workflow
Buys DR, Kennedy RE, Williams CP
Social and demographic predictors of nutritional risk: cross-sectional analyses from the UAB Study of Aging II.
Social factors may disparately affect access to food and nutritional risk among older adults by race and gender. This study assesses these associations using the Mini Nutritional Assessment among 414 community-dwelling persons 75+ years of age in Alabama. Multivariable analyses indicated that social factors affect nutritional risk differently by race and gender. Nutritional risk interventions are warranted for older adults.
Fam Community Health 2018 Apr/Jun;41 Suppl 2 Suppl, Food Insecurity and Obesity:S33-s45. doi: 10.1097/fch.0000000000000180.
AHRQ-funded; HS013852.
View abstract on the National Library of Medicine site.
Keywords: Elderly, Nutrition, Obesity, Risk Factors, Socioeconomic Factors
Kochkodan J, Telem DA, Ghaferi AA
Physiologic and psychological gender differences in bariatric surgery.
This paper aims to describe differences in bariatric surgery outcomes by gender and to understand the physiologic and psychological differences that may explain this gender gap. It concludes that, despite significantly lower weight loss and increased complication rates, males tend to have markedly higher satisfaction and psychological well-being scores than females.
Surg Endosc 2018 Mar;32(3):1382-88. doi: 10.1007/s00464-017-5819-z.
AHRQ-funded; HS023621; HS024403.
View abstract on the National Library of Medicine site.
Keywords: Obesity, Outcomes, Sex Factors, Surgery, Weight Management
Huber MT, Highland JD, Krishnamoorthi VR
Utilizing the electronic health record to improve advance care planning: a systematic review.
This review aimed to identify EHR interventions previously utilized to improve advance care plans. The most common reported outcomes were documentation of an advance care planning conversation in the EHR (n = 7) and the placement of code status orders (n = 7). All studies reporting efficacy (n = 9) demonstrated an improvement in 1 or more advance care planning outcomes.
Am J Hosp Palliat Care 2018 Mar;35(3):532-41. doi: 10.1177/1049909117715217.
AHRQ-funded; HS000078.
View abstract on the National Library of Medicine site.
Keywords: Electronic Health Records, End-of-Life Care, Health Services Research (HSR), Prevention and Care Management, Provider-Patient Communication
Gunter RL, Fernandes-Taylor S, Rahman S
Feasibility of an image-based mobile health protocol for postoperative wound monitoring.
Many surgical site infections (SSIs) develop in the postdischarge period and are inadequately recognized by patients. To address this, the authors developed a mobile health protocol of remote wound monitoring using smartphone technology. The current study aims to establish its feasibility among patients and providers. It found that participant and provider satisfaction was universally high.
J Am Coll Surg 2018 Mar;226(3):277-86. doi: 10.1016/j.jamcollsurg.2017.12.013.
AHRQ-funded; HS023395.
View abstract on the National Library of Medicine site.
Keywords: Healthcare-Associated Infections, Injuries/Wounds, Prevention and Care Management, Surgery, Telemedicine
Wong A, Seger DL, Slight SP
Evaluation of 'definite' anaphylaxis drug allergy alert overrides in inpatient and outpatient settings.
The aim of this study was to determine the rate of anaphylaxis overrides, the reasons for these overrides, whether the overrides were appropriate, and if harm occurred from overrides. Overrides of 'definite' anaphylaxis drug-allergy interactions were common and often appropriate. Most overrides were due to desensitizations.
Drug Saf 2018 Mar;41(3):297-302. doi: 10.1007/s40264-017-0615-1.
AHRQ-funded; HS021094.
View abstract on the National Library of Medicine site.
Keywords: Adverse Drug Events, Clinical Decision Support (CDS), Electronic Health Records, Medication Safety, Medications
Thomas HN, Hamm M, Hess R
Changes in sexual function among midlife women: "I'm older... and I'm wiser".
Researchers conducted 20 individual interviews and three focus groups among sexually active women aged 45 to 60 years (total n = 39) to explore how sexual function changes during midlife. Women described experiencing both positive and negative changes in sexual function during midlife. When negative changes occurred, women often adapted behaviorally and psychologically.
Menopause 2018 Mar;25(3):286-92. doi: 10.1097/gme.0000000000000988.
AHRQ-funded; HS022989.
View abstract on the National Library of Medicine site.
Keywords: Aging, Sexual Health, Women's Health
Sorkin DH, Amin A, Weimer DL
Hospital discharge and selecting a skilled nursing facility: a comparison of experiences and perspectives of patients and their families.
This article seeks to examine and compare the experiences and perspectives of patients and others involved in the selection of the nursing home (predominately adult children and spouses). It found that patients were the primary decision makers about 23 percent of the time but were often involved in the decision even when family members/involved others were primarily making decisions in the discharge process.
Prof Case Manag 2018 Mar/Apr;23(2):50-59. doi: 10.1097/ncm.0000000000000252.
AHRQ-funded; HS021844.
View abstract on the National Library of Medicine site.
Keywords: Decisionmaking, Hospital Discharge, Long-Term Care, Nursing Homes, Patient Experience
Ng X, dosReis S, Beardsley R
Understanding systemic lupus erythematosus patients' desired outcomes and their perceptions of the risks and benefits of using corticosteroids.
This qualitative study examined systemic lupus erythematosus (SLE) patients' most desired outcomes and their concerns with corticosteroid use in SLE treatment. The SLE patients' most desired outcomes: reduction in flares, maintenance of normal activities, minimization of treatment side effects, prevention of future organ damage, and finding a cure. The patients’ primary concerns with the adverse effects of corticosteroids: weight gain, organ damage, mood swings/irritability, sleep disturbances, and dental issues.
Lupus 2018 Mar;27(3):475-83. doi: 10.1177/0961203317726375.
AHRQ-funded; HS022135.
View abstract on the National Library of Medicine site.
Keywords: Adverse Drug Events, Medications, Patient-Centered Outcomes Research
DuGoff EH, Walden E, Ronk K
Can claims data algorithms identify the physician of record?
This study sought to determine the agreement of the primary care physician (PCP) identified by claims algorithms with the PCP of record in electronic health record data. It concluded that researchers may be more likely to identify a patient's PCP when focusing on primary care visits only; however, these algorithms perform less well among vulnerable populations and those experiencing fragmented care.
Med Care 2018 Mar;56(3):e16-e20. doi: 10.1097/mlr.0000000000000709.
AHRQ-funded; HS021899.
View abstract on the National Library of Medicine site.
Keywords: Diabetes, Elderly, Electronic Health Records, Primary Care
Berry JG, Gay JC, Joynt Maddox K
Age trends in 30 day hospital readmissions: US national retrospective analysis.
This study assessed trends in and risk factors for readmission to hospital across the age continuum. It concluded that the likelihood of readmission was elevated for children transitioning to adulthood, children and younger adults with mental health disorders, and patients of all ages with multiple chronic conditions.
BMJ 2018 Feb 27;360:k497. doi: 10.1136/bmj.k497.
AHRQ-funded; HS023092.
View abstract on the National Library of Medicine site.
Keywords: Aging, Healthcare Cost and Utilization Project (HCUP), Readmissions, Risk Factors
Agimi Y, Albert SM, Youk AO
Dementia and motor vehicle crash hospitalizations: role of physician reporting laws.
This study sought to determine the effect of physician reporting laws and state licensing requirements on crash hospitalizations among drivers with dementia. It concluded that physician reporting laws, mandated or legally protected, were not associated with a lower likelihood of dementia among crash hospitalized drivers. Vision testing at in-person renewal and in-person renewal requirements were significantly related with a lower prevalence of dementia in hospitalized older drivers.
Neurology 2018 Feb 27;90(9):e808-e13. doi: 10.1212/wnl.0000000000005022.
AHRQ-authored.
View abstract on the National Library of Medicine site.
Keywords: Dementia, Elderly, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Legislation/Regulations
AHRQ Author: Steiner CA
Deans KJ, Minneci PC, Nacion KM
Health care quality measures for children and adolescents in foster care: feasibility testing in electronic records.
The objective of the study is to identify healthcare quality measures for young children and adolescents in foster care and to test whether the data required to calculate these measures can be feasibly extracted and interpreted within an electronic health records or within the Statewide Automated Child Welfare Information System. It found that electronic health records and the Statewide System data frequently lacked important information on foster care youth essential for calculating the measures.
BMC Pediatr 2018 Feb 22;18(1):79. doi: 10.1186/s12887-018-1064-4.
AHRQ-funded; HS020503.
View abstract on the National Library of Medicine site.
Keywords: Adolescents, Children, Electronic Health Records, Quality Measures, Vulnerable Populations

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