National Healthcare Quality and Disparities Report
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Topics
- Access to Care (2)
- Ambulatory Care and Surgery (1)
- Autism (1)
- Cancer (6)
- Cancer: Breast Cancer (2)
- Cancer: Colorectal Cancer (4)
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- Children/Adolescents (2)
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- Diagnostic Safety and Quality (1)
- Disabilities (1)
- Domestic Violence (2)
- Elderly (2)
- Evidence-Based Practice (2)
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- Health Promotion (1)
- Hepatitis (1)
- Human Immunodeficiency Virus (HIV) (1)
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- Patient Adherence/Compliance (2)
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- Prevention (6)
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- Primary Care: Models of Care (1)
- Public Health (1)
- Racial and Ethnic Minorities (2)
- Risk (1)
- (-) Screening (17)
- Shared Decision Making (2)
- Social Determinants of Health (4)
- Social Stigma (1)
- Substance Abuse (1)
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- (-) Vulnerable Populations (17)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 17 of 17 Research Studies DisplayedHolcomb J, Rajan SS, Ferguson GM
Implementation of an evidence-based intervention with safety net clinics to improve mammography appointment adherence among underserved women.
This study evaluated the implementation of an evidence-based intervention in safety-net clinics to improve mammography appointment adherence in underserved women called the Peace of Mind Program. The intervention was implemented in 19 Federally Qualified Health centers and charity care clinics within the Greater Houston area. Surveys were given prior to adoption and at eight weeks post implementation to assess Consolidated Framework for Implementation Research constructs. A total of 4402 women were surveyed (baseline period 2078, intervention period 2324). Women in the intervention period or who completed the intervention were more likely to attend or reschedule their mammography appointment than those who did not complete the intervention. A total of 15 clinics prior to adoption and eight clinics completed the survey post implementation.
AHRQ-funded; HS023255.
Citation: Holcomb J, Rajan SS, Ferguson GM .
Implementation of an evidence-based intervention with safety net clinics to improve mammography appointment adherence among underserved women.
J Cancer Educ 2023 Feb; 38(1):309-18. doi: 10.1007/s13187-021-02116-w..
Keywords: Evidence-Based Practice, Screening, Patient Adherence/Compliance, Imaging, Vulnerable Populations, Ambulatory Care and Surgery
Schwartz HEM, Abel MK, Lin JA, et al. HEM, Abel MK, Lin JA
Barriers to colorectal cancer screening and surveillance in homeless patients: a case report and policy recommendations.
Researchers described the barriers encountered by a homeless patient with a history of colorectal cancer who was lost to follow up and presented 11 years later with a new primary colon cancer. They provided policy solutions to increase the use of primary and secondary screening, including essential private bathroom access for colonoscopy preparation in patients who had a positive screening or who require surveillance after diagnosis and treatment. They concluded that increasing early detection and treatment may be cost-effective and could reduce disparities in morbidity and mortality in homeless patients.
AHRQ-funded; HS024532.
Citation: Schwartz HEM, Abel MK, Lin JA, et al. HEM, Abel MK, Lin JA .
Barriers to colorectal cancer screening and surveillance in homeless patients: a case report and policy recommendations.
Ann Surg Open 2022 Sep;3(3):e183. doi: 10.1097/as9.0000000000000183..
Keywords: Cancer: Colorectal Cancer, Colonoscopy, Vulnerable Populations, Screening, Access to Care, Case Study
Cole MB, Nguyen KH, Byhoff E, Byhoff E
Screening for social risk at federally qualified health centers: a national study.
In the United States, millions of low-income patients have unaddressed social risks. Federally Qualified Health Centers (FQHCs) provide services to approximately 29.8 million low-income patients, and data on social risk screening capabilities had never been collected across all FQHCs until 2019. The purpose of this study was to analyze the social risk screening capabilities across the FQHCs, report the national rates, identify screening predictors, and compare rates between states. The researchers collected data from the 2019 Uniform Data System from all 1,384 FQHCs across the U.S., with a primary outcome of determining whether each FQHC collected data on their patients’ social risk factors. The researchers also estimated the relationship between the characteristics of 7 FQHCs (such as their size, and various Medicare features), and their probability of conducting social risk screening. The study reported that 71% of FQHCs collected information on social risks, with variances between states. The researchers concluded that while the majority of FQHCs collect data on social risk factors, there are disparities between different states, and that smaller FQHCs may benefit from having social risk screening resources focused on them and may increase their use of screening tools and practices.
AHRQ-funded; HS022242.
Citation: Cole MB, Nguyen KH, Byhoff E, Byhoff E .
Screening for social risk at federally qualified health centers: a national study.
Am J Prev Med 2022 May;62(5):670-78. doi: 10.1016/j.amepre.2021.11.008..
Keywords: Social Determinants of Health, Vulnerable Populations, Screening
Mojica CM, Gunn R, Pham R
An observational study of workflows to support fecal testing for colorectal cancer screening in primary care practices serving Medicaid enrollees.
This study was conducted to describe clinical workflows for fecal immunochemical tests/fecal occult blood tests (FIT/FOBT) in Oregon primary care practices and to identify specific workflow processes that might be associated with higher colorectal cancer (CRC) screening rates. Findings showed that primary care practices with higher CRC screening rates among newly age-eligible Medicaid enrollees had more established visit-based and population outreach workflows to support identifying patients due for screening, FIT/FOBT distribution, reminders, and follow up. Higher CRC screening was associated with having medical assistants discuss and review FIT/FOBT screening and instructions with patients.
AHRQ-funded; HS022981.
Citation: Mojica CM, Gunn R, Pham R .
An observational study of workflows to support fecal testing for colorectal cancer screening in primary care practices serving Medicaid enrollees.
BMC Cancer 2022 Jan 25;22(1):106. doi: 10.1186/s12885-021-09106-7..
Keywords: Workflow, Screening, Cancer: Colorectal Cancer, Cancer, Primary Care, Vulnerable Populations
Kuhn J, Levinson Udhnani, MD
What happens after a positive primary care autism screen among historically underserved families? Predictors of evaluation and autism diagnosis.
This study examined predictors of receiving a recommended diagnostic evaluation after a recommended primary care-administered autism screen, and of those who screen positive, who is most likely to be diagnosed with autism. Participants were 309 predominantly low-income, racial/ethnic minority parents and their child aged 15-27 months who screened positive with the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F). Significant predictors of diagnostic evaluation included older parental age, being non-Hispanic and the child having private insurance, lower child communication functioning, or receiving Early Intervention services. Significant predictors of an autism diagnosis included being male, having lower child communication functioning, screening directly in the parent’s preferred language, White/non-Hispanic parent, and no parent history of mood disorder.
AHRQ-funded; HS022242.
Citation: Kuhn J, Levinson Udhnani, MD .
What happens after a positive primary care autism screen among historically underserved families? Predictors of evaluation and autism diagnosis.
J Dev Behav Pediatr 2021 Sep;42(7):515-23. doi: 10.1097/dbp.0000000000000928..
Keywords: Children/Adolescents, Autism, Screening, Vulnerable Populations, Diagnostic Safety and Quality
Wurcel AG, Reyes J, Zubiago J
"I'm not gonna be able to do anything about it, then what's the point?": A broad group of stakeholders identify barriers and facilitators to HCV testing in a Massachusetts jail.
Despite national guidelines promoting hepatitis C virus (HCV) testing in prisons, there is substantial heterogeneity on the implementation of HCV testing in jails. IN this study, the investigators sought to better understand barriers and opportunities for HCV testing by interviewing a broad group of stakeholders involved in HCV testing and treatment policies and procedures in Massachusetts jails.
AHRQ-funded; HS026008.
Citation: Wurcel AG, Reyes J, Zubiago J .
"I'm not gonna be able to do anything about it, then what's the point?": A broad group of stakeholders identify barriers and facilitators to HCV testing in a Massachusetts jail.
PLoS One 2021 May 26;16(5):e0250901. doi: 10.1371/journal.pone.0250901..
Keywords: Hepatitis, Vulnerable Populations, Screening, Prevention, Public Health, Social Stigma
Brewster AL, Fraze TK, Gottlieb LM
The role of value-based payment in promoting innovation to address social risks: a cross-sectional study of social risk screening by US physicians.
The authors studied the conditions under which value-based payment will encourage health care providers to innovate to address upstream social risks. Their results indicated that implementation of social risk screening was not associated with overall exposure to value-based payment for physician practices. They recommended expanding social risk screening in order to reduce the level of innovative capacity required.
AHRQ-funded; HS024075.
Citation: Brewster AL, Fraze TK, Gottlieb LM .
The role of value-based payment in promoting innovation to address social risks: a cross-sectional study of social risk screening by US physicians.
Milbank Q 2020 Dec;98(4):1114-33. doi: 10.1111/1468-0009.12480..
Keywords: Payment, Social Determinants of Health, Practice Patterns, Vulnerable Populations, Screening, Risk, Nutrition
Dir AL, Clifton RL
Patterns of drug screen results and court-ordered substance use treatment referrals and completion among justice-involved youth
This study examined court records of drug screens among youth to explore patterns of substance use as well as rates of court-ordered referral to substance use treatment and treatment completion. Of the studied youth with a positive oral drug screen, 96% tested positive for cannabis and 9.8% for opioids at least once; 48.5% were court-ordered to substance use treatment. Of those referred, 67% had history of completing at least one treatment episode. These results underscore the need to utilize objective measures as well as validated self-reports of substance use history in both research and justice system decision-making to aid in identifying youth in need of services.
AHRQ-funded; HS022681; HS023318.
Citation: Dir AL, Clifton RL .
Patterns of drug screen results and court-ordered substance use treatment referrals and completion among justice-involved youth
J Subst Abuse Treat 2020 Nov;118:108095. doi: 10.1016/j.jsat.2020.108095..
Keywords: Children/Adolescents, Substance Abuse, Screening, Vulnerable Populations
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
Arana-Chicas E, Kioumarsi A, Carroll-Scott A
Barriers and facilitators to mammography among women with intellectual disabilities: a qualitative approach.
The purpose of this qualitative study was to examine barriers and facilitators to mammography among women with intellectual disabilities. During 2015-2016 the researchers administered in-depth interviews with 30 women with intellectual disabilities and their caregivers in Philadelphia. The study found additional evidence supporting prior research on barriers to mammography among women with intellectual disabilities as well as novel barriers (e.g., lack of awareness of breast ultrasound, sedation failing to work, and lack of mammogram education) and novel facilitators (e.g., extended family support and positive attitudes.) The researchers concluded that the study results support the need to address barriers and focus on facilitators to improve the mammography experience in women with intellectual disabilities.
AHRQ-funded; HS023966.
Citation: Arana-Chicas E, Kioumarsi A, Carroll-Scott A .
Barriers and facilitators to mammography among women with intellectual disabilities: a qualitative approach.
Disabil Soc 2020;35(8):1290-314. doi: 10.1080/09687599.2019.1680348..
Keywords: Women, Disabilities, Vulnerable Populations, Screening, Prevention, Cancer: Breast Cancer, Cancer, Imaging
Acree ME, McNulty M, Blocker O
Shared decision-making around anal cancer screening among black bisexual and gay men in the USA.
This study focused on shared decision-making on anal cancer screening among black gay and bisexual men in the US. The researchers conducted 30 semi-structured one-on-one interviews and two focus groups in 2016-2017. Out of forty-five participants, all were black and male, with 13 identified as bisexual and 32 as gay. Barriers to screening include internalized racism, biphobia/homophobia, provider bias lead to reduced healthcare engagement and discomfort discussing sexual practices which hindered shared decision-making.
AHRQ-funded; HS023050.
Citation: Acree ME, McNulty M, Blocker O .
Shared decision-making around anal cancer screening among black bisexual and gay men in the USA.
Cult Health Sex 2020 Feb;22(2):201-16. doi: 10.1080/13691058.2019.1581897..
Keywords: Shared Decision Making, Cancer, Screening, Prevention, Racial and Ethnic Minorities, Vulnerable Populations
Wong MS, Arnold CM, Roberts ET
The relationship between federal housing assistance and uptake of cancer screening among low-income adults.
The primary aim of this study was to examine the relationship between participation in federal housing assistance programs and self-reported cancer screening among low-income adults. The investigators concluded that their results reinforced the need to improve rates of screening and suggested that providing housing assistance, in and of itself, may be insufficient to overcome the multiple access barriers that low-income populations face.
AHRQ-funded; HS000029.
Citation: Wong MS, Arnold CM, Roberts ET .
The relationship between federal housing assistance and uptake of cancer screening among low-income adults.
J Gen Intern Med 2019 Dec;34(12):2714-16. doi: 10.1007/s11606-019-05037-z..
Keywords: Cancer, Screening, Low-Income, Vulnerable Populations, Access to Care, Healthcare Utilization, Social Determinants of Health
Fraze TK, Brewster AL, Lewis VA
Prevalence of screening for food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence by US physician practices and hospitals.
The purpose of this study was to characterize screening for social needs by physician practices and hospitals. The authors indicated that their study's findings suggest: that few US physician practices and hospitals screen patients for all 5 key social needs associated with health outcomes; that practices that serve disadvantaged patients reported higher screening rates.
AHRQ-funded; HS024075.
Citation: Fraze TK, Brewster AL, Lewis VA .
Prevalence of screening for food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence by US physician practices and hospitals.
JAMA Netw Open 2019 Sep 4;2(9):e1911514. doi: 10.1001/jamanetworkopen.2019.11514..
Keywords: Domestic Violence, Nutrition, Practice Patterns, Screening, Social Determinants of Health, Vulnerable Populations
Bravo RI, Kietzman KG, Toy P
Linking primary care and community organizations to increase colorectal cancer screening rates: the HAPPI project.
This paper describes the Healthy Aging Partnerships in Prevention Initiative (HAPPI) which aims to increase colorectal cancer screening and other preventive services among underserved Latinos and African-Americans in South Los Angeles who are 50 years and older. It uses an evidence-based model (SPARC) to leverage existing resources and has multi-sectoral partnerships among different agencies, community health centers (CHCs), and a university. The authors engaged five CHCs in quality improvement activities and eight non-governmental organizations in networking and programming to increase awareness of these preventive services.
AHRQ-funded; HS010858.
Citation: Bravo RI, Kietzman KG, Toy P .
Linking primary care and community organizations to increase colorectal cancer screening rates: the HAPPI project.
Salud Publica Mex 2019 Jul-Aug;61(4):427-35. doi: 10.21149/9450..
Keywords: Cancer: Colorectal Cancer, Cancer, Screening, Prevention, Primary Care: Models of Care, Primary Care, Elderly, Racial and Ethnic Minorities, Vulnerable Populations, Patient-Centered Healthcare
Borsky AE, Zhang E
AHRQ Author: Borsky AE
Screening for intimate partner violence, elder abuse, and abuse of vulnerable adults.
This Putting Prevention into Practice case study demonstrates how a U.S. Preventive Services Task Force (USPSTF) recommendation can used by clinicians. This case study uses the Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults recommendation as an example. Three quiz questions are given which directly link to the recommendations. The questions involve screening guidelines, screening instruments, and follow-up if there is a positive screening and detailed answers are provided.
AHRQ-authored.
Citation: Borsky AE, Zhang E .
Screening for intimate partner violence, elder abuse, and abuse of vulnerable adults.
Am Fam Physician 2019 May 15;99(10):649-50..
Keywords: Case Study, Domestic Violence, Elderly, Evidence-Based Practice, Screening, U.S. Preventive Services Task Force (USPSTF), Vulnerable Populations
Brenner AT, Gupta S, Ko LK
Development of a practical model for targeting patient decision support interventions to promote colorectal cancer screening in vulnerable populations.
The authors sought to develop a practical model for predicting probability of colorectal cancer (CRC) screening completion in a diverse safety-net population and a subsequent framework for targeting screening promotion interventions. Their model and framework may be useful for designing and delivering targeted interventions to promote CRC screening.
AHRQ-funded; HS013853.
Citation: Brenner AT, Gupta S, Ko LK .
Development of a practical model for targeting patient decision support interventions to promote colorectal cancer screening in vulnerable populations.
J Health Care Poor Underserved 2016;27(2):465-78. doi: 10.1353/hpu.2016.0090.
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Keywords: Cancer: Colorectal Cancer, Shared Decision Making, Health Promotion, Screening, Vulnerable Populations
Highfield L, Rajan SS, Valerio MA
A non-randomized controlled stepped wedge trial to evaluate the effectiveness of a multi-level mammography intervention in improving appointment adherence in underserved women.
This study evaluated a theoretically based, systematically designed implementation strategy to support adoption and implementation of a patient navigation-based intervention, called Peace of Mind Program (PMP), aimed at improving breast cancer screening among underserved women.. Any potential confounding or bias will be controlled in the analysis. Outcomes such as appointment adherence, patient referral to diagnostics, time to diagnostic referral, patient referral to treatment, time to treatment referral, and budget impact of the intervention will be assessed.
AHRQ-funded; HS023255.
Citation: Highfield L, Rajan SS, Valerio MA .
A non-randomized controlled stepped wedge trial to evaluate the effectiveness of a multi-level mammography intervention in improving appointment adherence in underserved women.
Implement Sci 2015 Oct 14;10:143. doi: 10.1186/s13012-015-0334-x.
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Keywords: Cancer: Breast Cancer, Cancer, Screening, Patient Adherence/Compliance, Women, Vulnerable Populations, Prevention, Imaging