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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 25 of 30 Research Studies DisplayedLopez K, Li H, Lipkin-Moore Z
Deep learning prediction of hospital readmissions for asthma and COPD.
The purpose of this observational study was to identify Electronic Health Record (EHR) features of severe asthma and COPD exacerbations and assess the performance of four machine learning (ML) and one deep learning (DL) model in predicting readmissions using EHR data. The study included 31, 2017 patients hospitalized with asthma and COPD exacerbations. The study found that Black and Hispanic patients had a greater likelihood of readmission for asthma. Patients with COPD readmissions included a high percentage of Blacks and Hispanics. To identify patients at high risk of readmission, index hospitalization data of a subset of 2,682 patients, 777 with asthma and 1,905 with COPD, was analyzed with four ML models, and one DL model. The researchers discovered that multilayer perceptron, the DL method, had the best sensitivity and specificity compared to the four ML methods implemented in the same dataset.
AHRQ-funded; HS027626.
Citation: Lopez K, Li H, Lipkin-Moore Z .
Deep learning prediction of hospital readmissions for asthma and COPD.
Respir Res 2023 Dec 13; 24(1):311. doi: 10.1186/s12931-023-02628-7..
Keywords: Asthma, Respiratory Conditions, Hospital Readmissions, Electronic Health Records (EHRs), Health Information Technology (HIT)
Morrone K, Andreca M, Silver EJ
Associating a standardized reporting tool for chest radiographs with clinical complications in pediatric acute chest syndrome.
The objective of this retrospective cohort study was to analyze the interobserver agreement among pediatric radiologists' interpretations for pediatric acute chest syndrome (ACS) chest radiographs. The researchers also explored the association of radiographic findings with ACS complications. Data was taken from pediatric ACS admissions from a single institution in 2019. The results showed moderate to near-perfect agreement between radiologists. Left lower opacity, and pleural effusion were associated with increased risk of ACS complications.
AHRQ-funded.
Citation: Morrone K, Andreca M, Silver EJ .
Associating a standardized reporting tool for chest radiographs with clinical complications in pediatric acute chest syndrome.
Pediatr Pulmonol 2023 Nov; 58(11):3139-46. doi: 10.1002/ppul.26634..
Keywords: Children/Adolescents, Imaging, Sickle Cell Disease, Respiratory Conditions
Baghdadi JD, O'Hara LM, Johnson JK
Diagnostic stewardship to support optimal use of multiplex molecular respiratory panels: a survey from the Society for Healthcare Epidemiology of America Research Network.
This study’s objective was to explore current and future approaches to diagnostic stewardship of multiplex polymerase chain reaction (PCR) respiratory panels. The authors conducted a survey of the Society for Healthcare Epidemiology of America Research Network, with 41 sites completing the survey (response rate, 50%). Results of the survey were that multiplex PCR respiratory panels were perceived as supporting accurate diagnoses at 35 sites (85%), supporting more efficient patient care at 33 sites (80%), and improving patient outcomes at 23 sites (56%). Additionally, 24 sites (58%) had implemented diagnostic stewardship, with a median of 3 interventions (interquartile range, 1-4) per site. The interventions most frequently reported as effective were structured order sets to guide test ordering (4 sites), restrictions on test ordering based on clinician or patient characteristics (3 sites), and structured communication of results (2 sites), with 3 sites reporting that education was “helpful” but with limitations.
AHRQ-funded; HS028854.
Citation: Baghdadi JD, O'Hara LM, Johnson JK .
Diagnostic stewardship to support optimal use of multiplex molecular respiratory panels: a survey from the Society for Healthcare Epidemiology of America Research Network.
Infect Control Hosp Epidemiol 2023 Nov; 44(11):1823-28. doi: 10.1017/ice.2023.72..
Keywords: Diagnostic Safety and Quality, Respiratory Conditions
Winer JC, Richardson T, Berg KJ
Effect modifiers of the association of high-flow nasal cannula and bronchiolitis length of stay.
In hospitalized children with bronchiolitis, the use of High-flow nasal cannula (HFNC) therapy is related with a longer length of stay (LOS) when used outside of the ICU. The purpose of this study was to explore the relationship between HFNC and LOS to determine if demographic and clinical factors modify the effect of HFNC usage on LOS. Of 8,060 included patients, 27.0% received HFNC during admission. The study found that age group, weight, complex chronic condition, initial tachypnea, initial desaturation, and ICU services were significantly related with LOS. The effect of HFNC on LOS varied among hospitals (P < .001), with the estimated increase in LOS ranging from 32% to 139%. 1- to 6-month-old infants, patients without initial desaturation, and patients without ICU services had the highest relationship between HFNC and LOS, respectively.
AHRQ-funded; HS026006.
Citation: Winer JC, Richardson T, Berg KJ .
Effect modifiers of the association of high-flow nasal cannula and bronchiolitis length of stay.
Hosp Pediatr 2023 Nov; 13(11):1018-27. doi: 10.1542/hpeds.2023-007295..
Keywords: Children/Adolescents, Respiratory Conditions, Hospitalization
Beck AF, Wymer L, Pinzer E
Reduced prevalence of childhood asthma after housing renovations in an underresourced community.
This study’s goal as to determine whether housing renovations affect the prevalence of asthma in an underresourced community. Between 2010 and 2012, the Fay Apartments (~800 units) in Cincinnati, Ohio, were renovated to "green building" standards and renamed the Villages at Roll Hill. Asthma prevalence among 7-year-olds was determined by accessing Ohio Medicaid data for the years 2013 to 2021. Average prevalence of asthma among 7-year-olds averaged 12.7% in the first 6 years after the renovations (2013-2018). But in postrenovation years 7-9 (2019-221), average prevalence of asthma had dropped to 5.9%.
AHRQ-funded; HS027996.
Citation: Beck AF, Wymer L, Pinzer E .
Reduced prevalence of childhood asthma after housing renovations in an underresourced community.
J Allergy Clin Immunol Glob 2023 Nov; 2(4):1-4. doi: 10.1016/j.jacig.2023.100143..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Vulnerable Populations, Social Determinants of Health
Evans NJ, Arakkal AT, Cavanaugh JE
The incidence, duration, risk factors, and age-based variation of missed opportunities to diagnose pertussis: a population-based cohort study.
This study’s objective was to estimate the incidence, duration and risk factors for diagnostic delays associated with pertussis. The authors used longitudinal retrospective insurance claims from the Marketscan Commercial Claims and Encounters, Medicare Supplemental (2001-2020), and Multi-State Medicaid (2014-2018) databases. They estimated the number of visits with pertussis-related symptoms before diagnosis beyond that expected in the absence of diagnostic delays, including the number of visits representing a delay, the number of missed diagnostic opportunities per patient, and the duration of delays. They identified 20,828 patients meeting inclusion criteria. On average, delay duration was 12 days, and patients had almost 2 missed opportunities prior to diagnosis. The duration of delays increased considerably with age from an average of 5.6 days for patients aged less than 2 years to 13.8 days for patients aged ≥18 years. Factors associated with increased risk of delays included recent prescriptions for antibiotics not effective against pertussis, emergency department visits, and telehealth visits.
AHRQ-funded; HS027375.
Citation: Evans NJ, Arakkal AT, Cavanaugh JE .
The incidence, duration, risk factors, and age-based variation of missed opportunities to diagnose pertussis: a population-based cohort study.
Infect Control Hosp Epidemiol 2023 Oct; 44(10):1629-36. doi: 10.1017/ice.2023.31..
Keywords: Respiratory Conditions, Risk, Diagnostic Safety and Quality
Deshpande A, Walker R, Schulte R
Reducing antimicrobial overuse through targeted therapy for patients with community-acquired pneumonia: a study protocol for a cluster-randomized factorial controlled trial (CARE-CAP).
The authors described a planned cluster-randomized controlled trial in 12 hospitals in the Cleveland Clinic Health System to test two approaches to reducing the use of extended-spectrum antibiotics (ESA) in adult patients with community-acquired pneumonia (CAP): rapid diagnostic assays that provide accurate results within hours, and de-escalation after negative bacterial cultures in clinically stable patients. The purpose will be to establish whether the identification of an etiological agent early and pharmacist-led de-escalation can safely reduce the use of ESA in patients with CAP. The findings may also inform clinical guidelines on the management of CAP.
AHRQ-funded; HS028633.
Citation: Deshpande A, Walker R, Schulte R .
Reducing antimicrobial overuse through targeted therapy for patients with community-acquired pneumonia: a study protocol for a cluster-randomized factorial controlled trial (CARE-CAP).
Trials 2023 Sep 16; 24(1):595. doi: 10.1186/s13063-023-07615-3..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Community-Acquired Infections, Pneumonia, Respiratory Conditions
Campbell JI, Tabatneck M, Wilt GE
Area-based sociodemographic factors associated with latent tuberculosis infection in a low-prevalence setting.
Researchers evaluated associations between census tract poverty, crowding, foreign-born population, and the CDC's Social Vulnerability Index (CDC-SVI) ranking and tuberculosis (TB) infection in children tested for TB infection in Boston, MA. Their findings indicated that census tract poverty was associated with increased odds of TB infection; in separate models, increasing CDC-SVI ranking was also associated with increased odds of TB infection. The researchers concluded that these findings suggest area-based sociodemographic factors may be valuable for characterizing TB infection risk and defining social ecology of pediatric TB infection in low-burden settings
AHRQ-funded; HS000063.
Citation: Campbell JI, Tabatneck M, Wilt GE .
Area-based sociodemographic factors associated with latent tuberculosis infection in a low-prevalence setting.
Am J Trop Med Hyg 2023 Sep 6; 109(3):595-99. doi: 10.4269/ajtmh.22-0788..
Keywords: Respiratory Conditions, Infectious Diseases
Waltman A, Konetzka RT, Chia S
Effectiveness of a bundled payments for care improvement program for chronic obstructive pulmonary disease.
This single-site retrospective observational study evaluated the impact of an evidence-based transitions of care program on episode costs and readmission rates, comparing patients hospitalized for COPD exacerbations who received versus those who did not receive the intervention. Between October 2015 and September 2018, 132 received and 161 did not receive the program. Below target mean episode costs were found for six out of eleven quarters for the intervention group, as opposed to only one out of twelve quarters for the control group. Overall, there were non-significant mean savings of $2551 in episode costs relative to target costs for the intervention group, though results varied by index admission diagnosis-related group (DRG). There were additional costs of $4184 per episode for the least-complicated cohort (DRG 192), but savings of $1897 and $1753 for the most complicated index admissions (DRGs 191 and 190, respectively). A significant mean decrease of 0.24 readmissions per episode for intervention was observed in 90-day readmission rates relative to control. Skilled nursing facility readmissions and hospital discharges were factors of higher costs (mean increases of $9098 and $17,095 per episode respectively).
AHRQ-funded; HS027804.
Citation: Waltman A, Konetzka RT, Chia S .
Effectiveness of a bundled payments for care improvement program for chronic obstructive pulmonary disease.
J Gen Intern Med 2023 Sep; 38(12):2662-70. doi: 10.1007/s11606-023-08249-6..
Keywords: Respiratory Conditions, Chronic Conditions, Payment, Quality Improvement, Quality of Care
Rao S, Armistead I, Tyler A
Respiratory syncytial virus, influenza, and coronavirus disease 2019 hospitalizations in children in Colorado during the 2021-2022 respiratory virus season.
This study compared demographic characteristics, clinical features, and outcomes of children hospitalized with respiratory syncytial virus (RSV), influenza, or severe acute respiratory syndrome coronavirus 2 during their cocirculation 2021-2022 respiratory virus season. The authors conducted a retrospective cohort study using Colorado's hospital respiratory surveillance data comparing coronavirus disease 2019 (COVID-19)-, influenza-, and RSV-hospitalized cases < 18 years of age admitted and undergoing standardized molecular testing between October 1, 2021, and April 30, 2022. The cohort consisted of 847 hospitalized cases, of which 490 (57.9%) were RSV associated, 306 (36.1%) were COVID-19 associated, and 51 (6%) were influenza associated. Most RSV cases were children less than 4 years of age (92.9%), whereas influenza hospitalizations were observed in older children. RSV cases were more likely to require oxygen support higher than nasal cannula compared with COVID-19 and influenza cases, although COVID-19 cases were more likely to require invasive mechanical ventilation than influenza and RSV cases. Compared with children with COVID-19, the risk of intensive care unit admission was highest among children with influenza, whereas the risk of pneumonia, bronchiolitis, longer hospital length of stay, and need for oxygen were more likely among children with RSV.
AHRQ-funded; HS026512.
Citation: Rao S, Armistead I, Tyler A .
Respiratory syncytial virus, influenza, and coronavirus disease 2019 hospitalizations in children in Colorado during the 2021-2022 respiratory virus season.
J Pediatr 2023 Sep; 260:113491. doi: 10.1016/j.jpeds.2023.113491..
Keywords: Children/Adolescents, COVID-19, Respiratory Conditions, Influenza, Hospitalization, Infectious Diseases
Silverstein GD, Styke SC, Kaur S
The relationship between depressive symptoms, eHealth literacy, and asthma outcomes in the context of a mobile health intervention.
This study’s objective was to evaluate the associations between health/eHealth literacy and depressive symptoms with app usage and clinical outcomes. The authors recruited adults with persistent asthma to utilize the ASTHMAXcel PRO mobile app. Participants completed the following questionnaires: Patient Health Questionnaire-9 (PHQ-9) to assess for depressive symptoms, Asthma Control Test (ACT), Mini Asthma Quality of Life (QOL) Questionnaire, and the Newest Vital Sign (NVS) tool to measure health literacy. Subsets of participant data were available on eHealth literacy (eHeals) (n = 24) and average number of app logins across 2 months (n = 40). The average participant age was 44.0 years, with 74% identifying as female. Increased depressive symptoms were associated with worse asthma control and asthma QOL, but not eHealth literacy. Higher eHealth literacy was associated with worse asthma QOL and more app logins. NVS scores weren’t associated with any measures.
AHRQ-funded; HS025645.
Citation: Silverstein GD, Styke SC, Kaur S .
The relationship between depressive symptoms, eHealth literacy, and asthma outcomes in the context of a mobile health intervention.
Psychosom Med 2023 Sep 1; 85(7):605-11. doi: 10.1097/psy.0000000000001170..
Keywords: Health Literacy, Asthma, Telehealth, Health Information Technology (HIT), Education: Patient and Caregiver, Outcomes, Respiratory Conditions, Chronic Conditions
Plombon S, Rudin RS, Sulca Flores J
Assessing equitable recruitment in a digital health trial for asthma.
This study’s objective was to assess a multipronged strategy that primarily used digital methods to recruit asthma patients into a clinical trial for a digital health intervention. Eligible patients completed a web-based eligibility questionnaire reported during a verbal consent phone call. Study team members conducted monthly sessions using a structured guide to identify recruitment barriers and facilitators. The results indicated that primarily digital strategy patients recruitment is unlikely to achieve equitable participation, even in a population overrepresented by patient portal enrollees. The authors concluded that nondigital recruitment methods that address racial and educational disparities and less active portal enrollees are necessary to ensure equity in clinical trial enrollment.
AHRQ-funded; HS026432.
Citation: Plombon S, Rudin RS, Sulca Flores J .
Assessing equitable recruitment in a digital health trial for asthma.
Appl Clin Inform 2023 Aug; 14(4):620-31. doi: 10.1055/a-2090-5745..
Keywords: Asthma, Respiratory Conditions, Health Information Technology (HIT)
Krishnan JA, Margellos-Anast H, Kumar R
Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan.
The purpose of this clinical trial was to compare an emergency-department- (ED) only intervention and home visits by community health workers for 6 months (ED-plus-home) and enhanced usual care (UC). The study enrolled children aged 5 to 11 years with uncontrolled asthma. The primary outcomes were change over 6 months in the Patient-Reported Outcomes Measurement Information System Asthma Impact Scale score in children and Satisfaction with Participation in Social Roles score in caregivers. The secondary outcomes included guideline-recommended ED discharge care and self-management. The study found that of the 373 children recruited, only 63% completed the 6-month follow-up visit. Differences in Asthma Impact Scores or caregivers' Satisfaction with Participation in Social Roles scores were not significant. However, in the intervention groups guideline-recommended ED discharge care improved significantly versus in the UC group, and self-management behaviors were significantly improved in the ED-plus-home group versus in the ED-only and UC groups.
AHRQ-funded; HS027804.
Citation: Krishnan JA, Margellos-Anast H, Kumar R .
Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan.
J Allergy Clin Immunol Glob 2023 Aug; 2(3). doi: 10.1016/j.jacig.2023.100100..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice, Emergency Department, Clinical Decision Support (CDS), Health Information Technology (HIT), Racial and Ethnic Minorities
Volerman A, Balachandran U, Zhu M
Evaluating inhaler education interventions for hospitalized children with asthma: a randomized controlled trial.
The objective of this study was to evaluate whether the technology-based intervention-Virtual Teach-to-Goal (V-TTG) could lead to less inhaler misuse among children hospitalized with asthma. A single-center randomized controlled trial of V-TTG vs brief intervention was conducted with children aged 5-10 with asthma. At baseline, nearly all children misused inhalers; inhaler misuse decreased significantly in both V-TTG and brief intervention. The researchers suggested that future studies evaluate V-TTG intervention across diverse populations and disease severities to identify its greatest impact.
AHRQ-funded; HS027804.
Citation: Volerman A, Balachandran U, Zhu M .
Evaluating inhaler education interventions for hospitalized children with asthma: a randomized controlled trial.
Ann Allergy Asthma Immunol 2023 Aug; 131(2):217-23.e1. doi: 10.1016/j.anai.2023.02.023..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Education: Patient and Caregiver, Inpatient Care
Weekes AJ, Davison J, Lupez K
Quality of life 1 month after acute pulmonary embolism in emergency department patients.
The objective of this prospective multicenter registry study was to determine whether any clinical or pathophysiologic features of pulmonary embolism were associated with worse Pulmonary Embolism Quality-of-Life (PEmb-QoL) scores after one month. Pulmonary embolism patients participated in QoL assessments and received PEmb-QoL questionnaires conducted by the researchers. Results indicated that acute clinical deterioration, right ventricular dysfunction, and pulmonary embolism PE severity were not predictors of QoL at 1 month post-embolism. Independent predictors of worsened QoL were COPD, rehospitalization, and hospital length of stay.
AHRQ-funded; HS025979.
Citation: Weekes AJ, Davison J, Lupez K .
Quality of life 1 month after acute pulmonary embolism in emergency department patients.
Acad Emerg Med 2023 Aug; 30(8):819-31. doi: 10.1111/acem.14692..
Keywords: Quality of Life, Respiratory Conditions, Emergency Department
Metersky ML, Wang Y, Klompas M
Temporal trends in postoperative and ventilator-associated pneumonia in the United States.
The purpose of this retrospective cohort study was to assess change in rates of postoperative pneumonia and ventilator-associated pneumonia among patients hospitalized in the United States during 2009-2019. The study found that among 58,618 patients undergoing major surgical procedures between 2009 and 2019, the observed rate of postoperative pneumonia from 2009-2011 was 1.9% and decreased to 1.3% during 2017-2019. The adjusted annual risk each year, compared to the prior year, was 0.94. Among 4,007 patients hospitalized for any of the 4 conditions at risk for ventilator-associated pneumonia during 2009-2019, the researchers did not detect a significant change in observed or adjusted rates. Observed rates clustered around 10%, and adjusted annual risk compared to the prior year was 0.99.
AHRQ-funded; 290201800005C.
Citation: Metersky ML, Wang Y, Klompas M .
Temporal trends in postoperative and ventilator-associated pneumonia in the United States.
Infect Control Hosp Epidemiol 2023 Aug; 44(8):1247-54. doi: 10.1017/ice.2022.264..
Keywords: Pneumonia, Respiratory Conditions, Healthcare-Associated Infections (HAIs), Healthcare Cost and Utilization Project (HCUP)
Deshpande A, Klompas M, Guo N
Intravenous to oral antibiotic switch therapy among patients hospitalized with community-acquired pneumonia.
The purpose of this retrospective cohort study was to examine clinical practice guidelines which recommend switching from intravenous (IV) to oral antibiotics once patients are clinically stable. The researchers conducted a study of adults admitted with CAP from 2010 through 2015 and initially treated with IV antibiotics at 642 US hospitals. Switching was defined as discontinuation of IV and initiation of oral antibiotics without interrupting therapy. Patients switched by hospital day 3 were considered early switchers. The study found that of 78,041 CAP patients, 6% were switched early, most frequently to fluoroquinolones. Patients switched early had fewer days on IV antibiotics, shorter duration of inpatient antibiotic treatment, shorter LOS, and lower hospitalization costs, but no significant excesses in 14-day in-hospital mortality or late ICU admission. Patients at a greater mortality risk were less likely to be switched. However, even in hospitals with relatively high switch rates, less than 15% of very low-risk patients were switched early.
AHRQ-funded; HS029477; HS025026.
Citation: Deshpande A, Klompas M, Guo N .
Intravenous to oral antibiotic switch therapy among patients hospitalized with community-acquired pneumonia.
Clin Infect Dis 2023 Jul 26; 77(2):174-85. doi: 10.1093/cid/ciad196..
Keywords: Antibiotics, Community-Acquired Infections, Pneumonia, Respiratory Conditions, Medication
Geanacopoulos AT, Neuman MI, Lipsett SC
Association of chest radiography with outcomes in pediatric pneumonia: a population-based study.
This study’s objective was to evaluate the association of performing a chest radiograph (CXR) with 7-day hospitalization after emergency department (ED) discharge among pediatric patients with community-acquired pneumonia (CAP). This retrospective cohort study included 206,694 children aged 3 months to 17 years discharged from any ED within 8 states from 2014 to 2019. Secondary outcomes included 7-day ED revisits and a 7-day hospitalization with severe CAP. Among these children diagnosed with CAP, rates of 7-day ED revisit, hospitalization, and severe CAP were 8.9%, 1.6%, and 0.4%, respectively. After adjusting for illness severity, CXR was associated with fewer 7-day hospitalizations (1.6% vs 1.7%). CXR performance varied somewhat between EDs (median 91.5%). EDs in the highest quartile had fewer 7-day hospitalizations (1.4% vs 1.9%), ED revisits (8.5% vs 9.4%), and hospitalizations for severe CAP (0.3% vs 0.5%) as compared to EDs with the lowest quartile of CXR utilization.
AHRQ-funded; HS026503.
Citation: Geanacopoulos AT, Neuman MI, Lipsett SC .
Association of chest radiography with outcomes in pediatric pneumonia: a population-based study.
Hosp Pediatr 2023 Jul; 13(7):614-23. doi: 10.1542/hpeds.2023-007142..
Keywords: Children/Adolescents, Imaging, Pneumonia, Respiratory Conditions, Community-Acquired Infections
Navanandan N, McNulty MC, Suresh K
Factors associated with clinician self-reported resource use in acute care and ambulatory pediatrics.
This study’s objective was to determine predictors of resource use among pediatric providers for common respiratory illnesses. The authors surveyed pediatric primary care, emergency department (ED)/urgent care (UC), and hospital medicine providers at a free-standing children's hospital system. Five clinical vignettes were created to assess factors affecting resource use for upper respiratory infections, bronchiolitis, and pneumonia, including provider-type, practice location, tolerance to uncertainty, and medical decision-making behaviors. Response rate was 75.3%. The ED and UC and primary care providers had higher vignette scores, indicating higher resource use, compared with inpatient providers; advanced practice providers (APPs) had higher vignette scores compared with physicians. Being an ED/UC provider, an APP, and greater concern for bad outcomes were associated with higher vignette scores.
AHRQ-funded; HS026512.
Citation: Navanandan N, McNulty MC, Suresh K .
Factors associated with clinician self-reported resource use in acute care and ambulatory pediatrics.
Clin Pediatr 2023 May; 62(4):329-37. doi: 10.1177/00099228221128074..
Keywords: Children/Adolescents, Respiratory Conditions
Steuart R, Ale GB, Woolums A
Respiratory culture organism isolation and test characteristics in children with tracheostomies with and without acute respiratory infection.
The objectives of this single-center, retrospective cohort study were to determine the association of respiratory culture organism isolation with diagnosis of acute respiratory infections (ARI), and to assess test characteristics of respiratory cultures in the diagnosis of bacterial ARI. The study included respiratory cultures of children with tracheostomies obtained from 2010 to 2018. Results indicated that children with ARI diagnosis had higher odds of organism identification. The authors concluded that the utility of respiratory culture testing to screen for, diagnose, and direct treatment of ARI in children with tracheostomies is limited.
AHRQ-funded; HS025138.
Citation: Steuart R, Ale GB, Woolums A .
Respiratory culture organism isolation and test characteristics in children with tracheostomies with and without acute respiratory infection.
https://www.pubmed.ncbi.nlm.nih.gov/36751142
Pediatr Pulmonol 2023 May; 58(5):1481-91. doi: 10.1002/ppul.26349..
Pediatr Pulmonol 2023 May; 58(5):1481-91. doi: 10.1002/ppul.26349..
Keywords: Children/Adolescents, Respiratory Conditions
Willer RJ, Brady PW, Tyler AN
The current state of high-flow nasal cannula protocols at children's hospitals.
The objectives of this cross-sectional study of the Pediatric Health Information Systems (PHIS) database were to describe the state of non-ICU high flow nasal cannula (HFNC) protocols at children's hospitals and to explore associations between HFNC protocol types and utilization outcomes. Results showed a steady increase in adopting non-ICU HFNC protocols during the study period, but no differences in hospital characteristics were observed between ICU-only hospitals, age-based hospitals, and weight-based hospitals. Weight-based HFNC protocols were associated with decreased ICU utilization in comparison with age-based HFNC protocols. The researchers concluded children's hospitals have adopted non-ICU HFNC protocols for patients with bronchiolitis, the majority of which are now utilizing weight-based maximum flow rates.
AHRQ-funded; HS026512.
Citation: Willer RJ, Brady PW, Tyler AN .
The current state of high-flow nasal cannula protocols at children's hospitals.
Hosp Pediatr 2023 May; 13(5):e109-e13. doi: 10.1542/hpeds.2022-006969..
Keywords: Children/Adolescents, Respiratory Conditions
Shero ST, Ammary-Risch NJ, Lomotan EA
AHRQ Author: Lomotan EA
Creating implementable clinical practice guidelines: the 2020 focused updates to the National Heart, Lung, and Blood Institute's Asthma Management Guidelines.
The authors developed evidence-based clinical practice guideline updates for asthma management focused on six topic areas. Their guideline development processes, and the implementation and dissemination activities undertaken, sought to enhance implementation ability by focusing on intrinsic factors. They concluded that enhanced collaboration during guideline development between authors, informaticists, and scientists may facilitate development of tools to support the application of recommendations to further improve guideline implementation.
AHRQ-authored.
Citation: Shero ST, Ammary-Risch NJ, Lomotan EA .
Creating implementable clinical practice guidelines: the 2020 focused updates to the National Heart, Lung, and Blood Institute's Asthma Management Guidelines.
Implement Sci Commun 2023 Mar 31; 4(1):36. doi: 10.1186/s43058-023-00417-3..
Keywords: Asthma, Respiratory Conditions, Guidelines, Evidence-Based Practice
Anesi GL, Dres E, Chowdhury M
Among-hospital variation in ICU admission practices and associated outcomes for patients with acute respiratory failure.
Prior research has demonstrated a connection between hospital strain and ICU admission, and has suggested that ICU admission, compared to ward admission, could be advantageous for certain patients with acute respiratory failure (ARF). The purpose of this study was to explore how strain-process-outcomes relationships in ARF patients may differ among hospitals and to identify hospital practice discrepancies that may explain such variation. The researchers analyzed high-acuity ARF patients who did not necessitate mechanical ventilation or vasopressors in the emergency department (ED) and were admitted to 27 US hospitals between 2013 and 2018. The researchers compared hospital strain-ICU admission relationships and hospital length of stay (LOS) and mortality for patients initially admitted to the ICU versus the ward. Additionally, they investigated hospital practices and assessed their associations with those processes and outcomes. The study found that substantial variation was observed among hospitals in ICU admission rates, hospital strain-ICU admission relationships, and the impact of ICU admission on hospital LOS and mortality. Overall, ED patients with ARF had a median hospital LOS that was 0.82 days shorter if initially admitted to the ICU rather than the ward. However, among the 27 hospitals this effect ranged from 5.85 days shorter to 4.38 days longer. In exploratory analyses, only a limited number of identified hospital practices—such as the presence of sepsis ED disposition guidelines and maximum ED patient capacity—were potentially linked to hospital strain-ICU admission relationships.
AHRQ-funded; HS026372.
Citation: Anesi GL, Dres E, Chowdhury M .
Among-hospital variation in ICU admission practices and associated outcomes for patients with acute respiratory failure.
Ann Am Thorac Soc 2023 Mar; 20(3):406-13. doi: 10.1513/AnnalsATS.202205-429OC.
Keywords: Intensive Care Unit (ICU), Respiratory Conditions, Hospital Discharge
Donovan LM, Parsons EC, McCall CA
Impact of mail-based continuous positive airway pressure initiation on treatment usage and effectiveness.
Traditional care for patients starting continuous positive airway pressure (CPAP) therapy has involved face-to-face visits with a trained professional for hands-on guidance and mask fitting assessment. However, in an effort to increase accessibility, numerous healthcare systems are transitioning to remote CPAP initiation by mailing equipment to patients. Although this method offers potential advantages, the impact on patient outcomes remains uncertain. Specifically, concerns have been raised about the potential decrease in CPAP adherence due to the absence of in-person training. The purpose of this study was to evaluate treatment usage following either in-person or mailed CPAP initiation. In response to the COVID-19 pandemic, the researcher’s medical center transitioned from in-person to mailed CPAP distribution in March 2020. A cohort of newly diagnosed obstructive sleep apnea (OSA) patients who began CPAP therapy in the months preceding (n = 433) and following (n = 186) this shift was form. The researchers then compared 90-day adherence between the two groups. The study found the average nightly PAP usage was moderate in both cohorts. No significant differences were observed in unadjusted or adjusted analyses.
AHRQ-funded; HS026369
Citation: Donovan LM, Parsons EC, McCall CA .
Impact of mail-based continuous positive airway pressure initiation on treatment usage and effectiveness.
Sleep Breath 2023 Mar;27(1):303-08. doi: 10.1007/s11325-022-02608-z.
Keywords: Respiratory Conditions, Sleep Problems, Patient Adherence/Compliance
Dunbar PJ, Sobotka SA, Rodean J
Prevalence of and spending on ear, nose, throat, and respiratory infections among children with chronic complex conditions.
The impact of ear, nose, throat, and respiratory infections (ENTRIs) on children with complex chronic conditions (CCCs) may vary from that of their counterparts. The purpose of this study was to examine the prevalence and expenditure of ENTRIs in children with and without CCCs. A retrospective evaluation of 3,880,456 children aged 0-18 years enrolled in 9 US state Medicaid programs in 2018, as recorded in the IBM Watson Marketscan Database, was conducted. Feudtner's classification system was employed to identify the type and quantity of CCCs. The prevalence of ENTRIs, defined as one or more healthcare visits for ENTRIs, and Medicaid expenditure on ENTRIs were compared based on CCC status using chi-square tests and logistic regression. The study found that ENTRIs were more prevalent in children with CCCs than in those without. Children with a CCC represented approximately one-fourth ($145.8 million [US]) of the total ENTRI expenditure. Excluding throat and sinus infections, the prevalence of ENTRIs rose with the number of CCCs. For instance, the prevalence of lower-airway infections increased from 12.5% to 37.5% as the number of CCCs grew from zero to ≥3. Inpatient care-associated ENTRI expenditure rose from 9.7% to 92.8% as the number of CCCs increased from zero to ≥3.
AHRQ-funded; HS025138
Citation: Dunbar PJ, Sobotka SA, Rodean J .
Prevalence of and spending on ear, nose, throat, and respiratory infections among children with chronic complex conditions.
Acad Pediatr 2023 Mar;23(2):434-40. doi: 10.1016/j.acap.2022.07.004.
Keywords: Children/Adolescents, Respiratory Conditions, Chronic Conditions, Healthcare Costs