National Healthcare Quality and Disparities Report
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- Behavioral Health (3)
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- (-) Diagnostic Safety and Quality (15)
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- Primary Care: Models of Care (1)
- (-) Racial and Ethnic Minorities (15)
- Risk (1)
- Screening (3)
- Sex Factors (1)
- Social Determinants of Health (2)
- Social Stigma (1)
- Stroke (1)
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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 15 of 15 Research Studies DisplayedBonner SN, Lagisetty K, Reddy RM
Clinical implications of removing race-corrected pulmonary function tests for African American patients requiring surgery for lung cancer.
This study’s objective was to identify how many hospitals providing lung cancer surgery use race correction in pulmonary function tests (PFTs), examine the association of race correction with predicted lung function, and test the effect of decorrection on surgeons' treatment recommendations. Percent predicted preoperative and postoperative forced expiratory volume in 1 second (FEV1) was calculated for African American patients who underwent lung cancer resection between January 1, 2015, and September 31, 2022, using race-corrected and race-neutral equations for hospitals performing race correction. Randomization of US cardiothoracic surgeons was conducted to receive 1 clinical vignette that differed by the use of Global Lung Function Initiative equations for (1) African American patients (percent predicted postoperative FEV1, 49%), (2) other race or multiracial patients (percent predicted postoperative FEV1, 45%), and (3) race-neutral patients (percent predicted postoperative FEV1, 42%). A total of 515 African American patients (308 [59.8%] female; mean age, 66.2 years) were included in the study. Among these patients, the percent predicted preoperative FEV1 and postoperative FEV1 would have decreased by 9.2% and 7.6%, respectively, if race-neutral equations had been used. A total of 225 surgeons (194 male [87.8%]; mean time in practice, 19.4 years) were successfully randomized and completed the vignette items regarding risk perception and treatment outcomes (76% completion rate). Surgeons randomized to the vignette with African American race-corrected PFTs were more likely to recommend lobectomy (79.2%) compared with surgeons randomized to the other race or multiracial-corrected (61.7%) or race-neutral PFTs (52.8%).
AHRQ-funded; HS028038.
Citation: Bonner SN, Lagisetty K, Reddy RM .
Clinical implications of removing race-corrected pulmonary function tests for African American patients requiring surgery for lung cancer.
JAMA Surg 2023 Oct; 158(10):1061-68. doi: 10.1001/jamasurg.2023.3239..
Keywords: Racial and Ethnic Minorities, Cancer: Lung Cancer, Cancer, Surgery, Diagnostic Safety and Quality
Bourgeois FC, Hart NJ, Dong Z
Partnering with patients and families to improve diagnostic safety through the OurDX tool: effects of race, ethnicity, and language preference.
This study’s objective was to explore differences in race, ethnicity, and language preference associated with patient and family contributions and concerns using an electronic previsit tool designed to engage pediatric patients and their families in the diagnostic process (DxP). This cross-sectional study included 5,731 patients and families presenting to three subspecialty clinics at an urban pediatric hospital May to December 2021 who completed a previsit tool, which was codeveloped and tested with patients and families. Patients/families were invited to share visit priorities, recent histories, and potential diagnostic concerns prior to each visit. The authors conducted chart review on a random subset of visits to review concerns and determine whether patient/family contributions were included in the visit note. Compared with patients self-identifying as White, those self-identifying as Black (odds ratio [OR]: 1.70) or "other" race (OR: 1.48) were more likely to report a diagnostic concern. Participants who preferred a language other than English were more likely to report a diagnostic concern than English-preferring patients (OR: 2.53). No significant differences were found in physician-verified diagnostic concerns or in integration of patient contributions into the note based on race, ethnicity, or language preference.
AHRQ-funded; HS027367.
Citation: Bourgeois FC, Hart NJ, Dong Z .
Partnering with patients and families to improve diagnostic safety through the OurDX tool: effects of race, ethnicity, and language preference.
Appl Clin Inform 2023 Oct; 14(5):903-12. doi: 10.1055/s-0043-1776055..
Keywords: Diagnostic Safety and Quality, Patient Safety, Racial and Ethnic Minorities
Umeukeje EM, Koonce TY, Kusnoor SV
Systematic review of international studies evaluating MDRD and CKD-EPI estimated glomerular filtration rate (eGFR) equations in Black adults.
The authors conducted a systematic review to assess how well estimating glomerular filtration rate (eGFR), with and without race adjustment, estimates measured GFR (mGFR) in Black adults globally. They identified 12 studies which included patients with and without kidney disease from Africa, the United States, Europe, and Brazil. They found that the majority of these studies determined that removal of race adjustment improved bias, accuracy, and precision of eGFR equations for Black adults. They concluded that their systematic review supports the need for future studies to be conducted in diverse populations to assess the possibility of alternative approaches for estimating GFR.
AHRQ-funded; HS026122.
Citation: Umeukeje EM, Koonce TY, Kusnoor SV .
Systematic review of international studies evaluating MDRD and CKD-EPI estimated glomerular filtration rate (eGFR) equations in Black adults.
PLoS One 2022 Oct 18;17(10):e0276252. doi: 10.1371/journal.pone.0276252..
Keywords: Kidney Disease and Health, Chronic Conditions, Racial and Ethnic Minorities, Diagnostic Safety and Quality
Goyal MK, Chamberlain JM, Webb M
Racial and ethnic disparities in the delayed diagnosis of appendicitis among children.
The objective of this 3-year multicenter retrospective cohort study of children was to determine if there are race/ethnicity differences in rates of appendiceal perforation, delayed diagnosis of appendicitis, and diagnostic imaging during prior visit(s). Delayed diagnosis was defined as having at least one emergency department (ED) visit within 7 days preceding the appendicitis diagnosis. Out of 7,298 patients diagnosed with appendicitis and documented race/ethnicity, 2,567 had appendiceal perforation. Non-Hispanic (NH) Black children had a higher likelihood of perforation (36.5% versus 34.9%) then non-Hispanic whites. They also were over twice as likely to have delayed diagnosis (4.7% versus 2.0%). Eighty-nine patients (43.2%) patients with delayed diagnosis had abdominal imaging during the prior visits. However, NH-Black children were less likely to have any imaging (28.2% versus 46.2%) or definitive imaging (10.3% versus 35.9%).
Acad Emerg Med 2021 Sep;28(9):949-56. doi: 10.1111/acem.14142.
Citation: Goyal MK, Chamberlain JM, Webb M .
Racial and ethnic disparities in the delayed diagnosis of appendicitis among children.
Acad Emerg Med 2021 Sep;28(9):949-56. doi: 10.1111/acem.14142..
Keywords: Children/Adolescents, Racial and Ethnic Minorities, Disparities, Diagnostic Safety and Quality
Thomas TW, Golin C, Samuel-Hodge CD
Race and gender differences in abnormal blood glucose screening and clinician response to prediabetes: a mixed-methods assessment.
The projected three-fold increase in diabetes burden by 2060 in the United States will affect certain race and gender groups disproportionately. The objective of this mixed-methods study was to assess differences in prediabetes screening and clinician response to prediabetes by patient race and gender. The investigators found that qualitatively, physicians reported a non-systematic approach to prediabetes screening and follow-up care related to: 1) System-level barriers to screening and treatment; 2) Implicit bias; 3) Patient factors; and 4) Physician preferences for prediabetes treatment.
AHRQ-funded; HS025561; HS000032.
Citation: Thomas TW, Golin C, Samuel-Hodge CD .
Race and gender differences in abnormal blood glucose screening and clinician response to prediabetes: a mixed-methods assessment.
Prev Med 2021 Jul;148:106587. doi: 10.1016/j.ypmed.2021.106587..
Keywords: Diabetes, Racial and Ethnic Minorities, Screening, Diagnostic Safety and Quality
Adams LB, Baxter SLK, Lightfoot AF
Refining Black men's depression measurement using participatory approaches: a concept mapping study.
This study’s goal was to look at why prevalence of depression is lower for Black males despite cumulative socioeconomic disadvantage and risk factors. For Black men, emotional vulnerability is often seen as a sign of weakness which may potentially mask the timely identification of mental health needs in this population. The authors use concept mapping, which is a structured mixed methods approach to determine how stakeholders of Black men’s health conceptualize their depressive symptoms. Thirty-six stakeholders comprised of Black men, Black women, and primary care providers participated in separate stakeholder groups in 2018. Participants generated 68 characteristics of Black men’s depression reflected in six conceptual clusters: 1) physical states; 2) emotional states; 3) diminished drive; 4) internal conflicts; 5) communication with others; and 6) social pressures. Using a content analysis approach, they found that items comprising the “social pressures” cluster were not reflected in any common depression scales.
AHRQ-funded; HS000032.
Citation: Adams LB, Baxter SLK, Lightfoot AF .
Refining Black men's depression measurement using participatory approaches: a concept mapping study.
BMC Public Health 2021 Jun 22;21(1):1194. doi: 10.1186/s12889-021-11137-5..
Keywords: Men's Health, Racial and Ethnic Minorities, Depression, Behavioral Health, Diagnostic Safety and Quality
Lacson R, Shi J, Kapoor N
Exacerbation of inequities in use of diagnostic radiology during the early stages of reopening after COVID-19.
Researchers assessed diagnostic radiology examination utilization and associated social determinants of health during the early stages of reopening after state-mandated shutdown of nonurgent services because of COVID-19. They found that, despite resumption of nonurgent services, a marked decrease in radiology examination utilization persisted in all care settings post-shutdown, with more significantly decreased odds ratios for having examinations in inpatient and outpatient settings versus in the emergency department. Inequities worsened, with patients from communities with high rates of poverty, unemployment, and chronic disease having significantly lower odds of undergoing radiology examinations post-shutdown. Patients of Asian race and Hispanic ethnicity had significantly lower odds ratios for having examinations post-shutdown compared with White and non-Hispanic patients, respectively.
AHRQ-funded; HS024722.
Citation: Lacson R, Shi J, Kapoor N .
Exacerbation of inequities in use of diagnostic radiology during the early stages of reopening after COVID-19.
J Am Coll Radiol 2021 May;18(5):696-703. doi: 10.1016/j.jacr.2020.12.009..
Keywords: COVID-19, Disparities, Diagnostic Safety and Quality, Racial and Ethnic Minorities, Social Determinants of Health
Marin JR, Rodean J, Hall M
Racial and ethnic differences in emergency department diagnostic imaging at US children's hospitals, 2016-2019.
Researchers evaluated racial and ethnic differences in the performance of common ED imaging studies and examined patterns across diagnoses. In this study, which evaluated visits by nonhospitalized patients younger than 18 years in 44 US children's hospital EDs, they found that non-Hispanic Black and Hispanic children were less likely to receive diagnostic imaging during ED visits compared with non-Hispanic White children. They recommended further investigation to understand and mitigate these potential disparities in health care delivery and to evaluate the effect of these differential imaging patterns on patient outcomes.
AHRQ-funded; HS026006.
Citation: Marin JR, Rodean J, Hall M .
Racial and ethnic differences in emergency department diagnostic imaging at US children's hospitals, 2016-2019.
JAMA Netw Open 2021 Jan 4(1):e2033710. doi: 10.1001/jamanetworkopen.2020.33710..
Keywords: Children/Adolescents, Hospitals, Emergency Department, Imaging, Racial and Ethnic Minorities, Disparities, Diagnostic Safety and Quality
Koller KR, Day GE, Hiratsuka VY
Increase in diabetes among urban Alaska Native people in the Alaska EARTH follow-up study: a call for prediabetes screening, diagnosis, and referral for intervention.
This study estimated incidence of diabetes (DM) and pre-DM relative to DM risk factors among relatively healthy Alaska Native and American Indian (AN) adults living in urban south-central Alaska. Results showed that, controlling for age and sex, obesity, abdominal adiposity, pre-DM, and metabolic syndrome independently increased DM risk. Recommendations included advising health care providers of AN populations to seize the opportunity to screen, refer, and treat individuals with pre-DM and other modifiable DM risk factors prior to DM diagnosis in order to alter the epidemiologic course of disease progression in this urban AN population.
AHRQ-funded; HS000084.
Citation: Koller KR, Day GE, Hiratsuka VY .
Increase in diabetes among urban Alaska Native people in the Alaska EARTH follow-up study: a call for prediabetes screening, diagnosis, and referral for intervention.
Diabetes Res Clin Pract 2020 Sep;167:108357. doi: 10.1016/j.diabres.2020.108357..
Keywords: Diabetes, Racial and Ethnic Minorities, Urban Health, Risk, Prevention, Screening, Diagnostic Safety and Quality, Chronic Conditions
Sorkin DH, Rizzo S, Biegler K
AHRQ Author: Ngo-Metzger Q
Novel health information technology to aid provider recognition and treatment of major depressive disorder and posttraumatic stress disorder in primary care.
This article describes a multicomponent health information technology screening tool designed to aid provider recognition and treatment of major depressive disorder and posttraumatic stress disorder (PTSD) in the primary care setting, with an eye toward meeting the mental health needs of traumatized refugees in the US Cambodian community. In a randomized controlled trial, 18 primary care providers were randomized to receive access to the mental health screening intervention, or to a minimal intervention control group. Cambodian American patients empaneled to participating providers were assigned to the providers' randomized group. From the results, the authors conclude that this approach offers the potential for training providers to diagnose and treat traumatized patients seeking mental health care in primary care.
AHRQ-authored.
Citation: Sorkin DH, Rizzo S, Biegler K .
Novel health information technology to aid provider recognition and treatment of major depressive disorder and posttraumatic stress disorder in primary care.
Med Care 2019 Jun;57 Suppl 6 Suppl 2:S190-s96. doi: 10.1097/mlr.0000000000001036..
Keywords: Depression, Diagnostic Safety and Quality, Health Information Technology (HIT), Behavioral Health, Primary Care, Primary Care: Models of Care, Racial and Ethnic Minorities, Screening
Shah SC, Nakata C, Polydorides AD
Upper endoscopy up to 3 years prior to a diagnosis of gastric cancer is associated with lower stage of disease in a USA multiethnic urban population, a retrospective study.
This study focused on the feasibility of earlier diagnosis of non-cardia gastic cancer (NCGC) for high-risk populations in the US who include multiracial and ethnic populations. A retrospective study was conducted with patients who were positively identified endoscopically with NCGC at Mount Sinai Hospital in New York City. The primary outcome was an increased frequency of patients diagnosed with stage 0-Ia (38%) as opposed to stage Ib-III (34%) and stage IV (20.3%). For patients with stage 0-Ia if they had a prior negative endoscopy there was a 94% higher likelihood of the NCGC being in a curable stage.
AHRQ-funded; HS026395.
Citation: Shah SC, Nakata C, Polydorides AD .
Upper endoscopy up to 3 years prior to a diagnosis of gastric cancer is associated with lower stage of disease in a USA multiethnic urban population, a retrospective study.
J Prev Med Public Health 2019 May;52(3):179-87. doi: 10.3961/jpmph.18.262..
Keywords: Cancer, Diagnostic Safety and Quality, Digestive Disease and Health, Imaging, Racial and Ethnic Minorities, Urban Health
Adams LB, Gottfredson N, Lightfoot AF
Factor analysis of the CES-D 12 among a community sample of black men.
The Center for Epidemiologic Studies Depression (CES-D) scale is one of the most widely used measures for assessing depression in population-based research. This study assessed the dimensional structure of the CES-D 12-item scale using exploratory and confirmatory factor analysis in a community-based sample of Black men. Findings suggested that the "effort" item from the CES-D 12 should be interpreted with caution among Black men.
AHRQ-funded; HS000032.
Citation: Adams LB, Gottfredson N, Lightfoot AF .
Factor analysis of the CES-D 12 among a community sample of black men.
Am J Mens Health 2019 Mar-Apr;13(2):1557988319834105. doi: 10.1177/1557988319834105..
Keywords: Depression, Diagnostic Safety and Quality, Men's Health, Behavioral Health, Racial and Ethnic Minorities
Payan DD, Florez KR, Bogart LM
Promoting health from the pulpit: a process evaluation of HIV sermons to reduce HIV stigma and promote testing in African American and Latino churches.
This study explored implementation of an HIV sermon as part of a multi-component intervention in three churches (Latino Catholic, Latino Pentecostal, and African American Baptist) in high HIV prevalence areas of Los Angeles County, California. The investigators found large variation in fidelity to communicating key HIV messages from the sermon guide. They concluded that structured training of clergy may be necessary to implement the more theoretically driven stigma reduction cues included in the sermon guide.
AHRQ-funded; HS000046.
Citation: Payan DD, Florez KR, Bogart LM .
Promoting health from the pulpit: a process evaluation of HIV sermons to reduce HIV stigma and promote testing in African American and Latino churches.
Health Commun 2019 Jan;34(1):11-20. doi: 10.1080/10410236.2017.1384352..
Keywords: Human Immunodeficiency Virus (HIV), Social Stigma, Racial and Ethnic Minorities, Diagnostic Safety and Quality, Health Promotion, Education: Patient and Caregiver, Communication, Prevention
Hidalgo B, Kaphingst KA, Stafford J
Diagnostic accuracy of self-reported racial composition of residential neighborhood.
The purpose of this study was to examine the diagnostic accuracy of self-reported measures of individuals’ perceptions of the racial and ethnic composition of their communities with objective data (i.e., census). It found that respondents who self-identified as white were more likely to self-report racial composition of their neighborhood consistent with 2010 Census estimates.
AHRQ-funded; HS020309.
Citation: Hidalgo B, Kaphingst KA, Stafford J .
Diagnostic accuracy of self-reported racial composition of residential neighborhood.
Ann Epidemiol 2015 Aug;25(8):597-604. doi: 10.1016/j.annepidem.2015.04.003..
Keywords: Diagnostic Safety and Quality, Social Determinants of Health, Racial and Ethnic Minorities
Govindarajan P, Friedman BT, Delgadillo JQ
Race and sex disparities in prehospital recognition of acute stroke.
The investigators examined prehospital provider recognition of stroke by race and sex. They found that correct prehospital recognition of stroke was lower among Hispanic patients, Asians, and others, when compared with non-Hispanic whites, and also in women compared with men. They concluded that significant disparities exist in prehospital stroke recognition.
AHRQ-funded; HS017965.
Citation: Govindarajan P, Friedman BT, Delgadillo JQ .
Race and sex disparities in prehospital recognition of acute stroke.
Acad Emerg Med 2015 Mar;22(3):264-72. doi: 10.1111/acem.12595.
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Keywords: Diagnostic Safety and Quality, Disparities, Racial and Ethnic Minorities, Sex Factors, Stroke