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- Access to Care (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 20 of 20 Research Studies DisplayedScott JW, Scott KW, Moniz M
Financial outcomes after traumatic injury among working-age US adults with commercial insurance.
This cross-sectional study linked insurance claims and consumer credit report data to evaluate the experience of financial distress in commercially insured adults after traumatic injury. Data from Blue Cross Blue Shield of Michigan’s preferred provider organization insurance claims from 2019 through 2021 were included. The authors identified working-age adults aged 21 to 64 whose January 2021 credit reports occurred more than 6 months after hospital admission for traumatic injury. This cohort of 3164 adults was compared demographically to 2223 patients in the comparison cohort. Relative to the comparison cohort, the post injury cohort had a 23% higher likelihood of having medical debt in collections, a 70% higher amount of medical debt in collections, and a 110% higher bankruptcy rate. For many commercially insured patients, the burden of out-of-pocket costs after hospitalization exceeded their ability to pay and could be associated with bankruptcy risk.
AHRQ-funded; HS028672; HS025465; HS028817.
Citation: Scott JW, Scott KW, Moniz M .
Financial outcomes after traumatic injury among working-age US adults with commercial insurance.
JAMA Health Forum 2022 Nov;3(11):e224105. doi: 10.1001/jamahealthforum.2022.4105..
Keywords: Trauma, Healthcare Costs, Health Insurance
Bowden CF, Simmel C, Mendez A
The complexity of psychotropic medication prescription and treating trauma among youth in foster care: perspectives from the lived experience.
The purpose of this study was to examine stakeholders' perspectives of the relationship between psychotropic medications and trauma informed care (TIC) for youth in foster care. The researchers recruited foster caseworkers, prescribing clinicians, caregivers, and alumni of the foster care system and conducted semi-structured individual and group interviews. Data were recorded and transcribed verbatim and analyzed using a directed content analysis approach. Five themes emerged across the recorded and transcribed data within stakeholder groups: 1) acknowledging trauma; 2) role of psychotropic medication; 3) psychosocial resources; 4) additional supports; and, 5) training and education. Stakeholders identified TIC as an important component of mental health services for youth in foster care. Most stakeholders felt that psychotropic medication was overused in treating trauma. Respondents suggested including additional supportive team members to help guide youth through the mental health treatment system and stated the importance of support from individuals with common lived experiences. The study concluded that there is a need for: improved training and education for stakeholders, additional sources of support for youth in foster care, and an overall system that emphasizes trauma-sensitive clinical interactions and psychosocial supports.
AHRQ-funded; HS02600101A1.
Citation: Bowden CF, Simmel C, Mendez A .
The complexity of psychotropic medication prescription and treating trauma among youth in foster care: perspectives from the lived experience.
Adm Policy Ment Health 2022 Sep;49(5):821-33. doi: 10.1007/s10488-022-01203-4..
Keywords: Children/Adolescents, Vulnerable Populations, Behavioral Health, Trauma, Medication
Henkhaus LE
The lasting consequences of childhood sexual abuse on human capital and economic well-being.
The objective of this study was to examine impacts on human capital and economic well-being of childhood sexual abuse by estimating likely ranges around causal effects, using a nationally representative U.S. sample. Findings suggested that childhood sexual abuse led to lower educational attainment and worse labor market outcomes. Further, childhood sexual abuse by someone other than a caregiver was as influential or more so than caregiver sexual abuse in predicting worse outcomes.
AHRQ-funded; HS026444.
Citation: Henkhaus LE .
The lasting consequences of childhood sexual abuse on human capital and economic well-being.
Health Econ 2022 Sep;31(9):1954-72. doi: 10.1002/hec.4557..
Keywords: Children/Adolescents, Trauma
Marks MR, Dux MC, Rao V
Treatment patterns of anxiety and posttraumatic stress disorder following traumatic brain injury.
Investigators examined psychotropic medication use and psychotherapy patterns among individuals diagnosed with anxiety disorders and PTSD post-traumatic brain injury (TBI). They found that receipt of pharmacotherapy pre- and post-TBI was considerably more common than receipt of psychotherapy. Individuals diagnosed with anxiety were 66% less likely to receive psychotherapy compared with individuals diagnosed with PTSD. Overall, psychotropic medication use and rates of antidepressant prescription use in the anxiety group were higher compared to those in the PTSD group.
AHRQ-funded; HS024560.
Citation: Marks MR, Dux MC, Rao V .
Treatment patterns of anxiety and posttraumatic stress disorder following traumatic brain injury.
J Neuropsychiatry Clin Neurosci 2022 Summer;34(3):247-53. doi: 10.1176/appi.neuropsych.21040104..
Keywords: Anxiety, Behavioral Health, Trauma, Brain Injury, Treatments, Practice Patterns, Medication
Danan ER, Brunner J, Bergman A
The relationship between sexual assault history and cervical cancer screening completion among women veterans in the Veterans Health Administration.
The purpose of this study was to determine whether a history of sexual assault in women Veterans is associated with decreased cervical cancer screening completion. The researchers analyzed data from a 2015 survey of 1049 women Veterans who accessed primary care services at 12 Veterans health administration facilities (VA’s) in nine states, and linked responses with electronic health data from the VA system. Fifty-seven percent (616) of women Veterans reported lifetime sexual assault, and those who did so had a greater likelihood of reporting a high level of distress associated with pelvic examinations and delaying a gynecologic exam due to distress. However, in the final adjusted model, there was not a significant association between lifetime sexual assault and reduced odds of cervical cancer screening completion. The study concluded that there was no significant association between sexual assault and gaps in cervical cancer screening completion.
AHRQ-funded; HS026379.
Citation: Danan ER, Brunner J, Bergman A .
The relationship between sexual assault history and cervical cancer screening completion among women veterans in the Veterans Health Administration.
J Womens Health 2022 Jul;31(7):1040-47. doi: 10.1089/jwh.2021.0237.AHRQ-funded; HS026379..
Keywords: Women, Cancer: Cervical Cancer, Cancer, Screening, Trauma
Neiman PU, Flaherty MM, Salim A
Evaluating the complex association between social vulnerability index and trauma mortality.
Researchers merged CDC Social Vulnerability Index (SVI) data with a statewide trauma registry and employed three analytic models to evaluate the association between SVI quartile and inpatient trauma mortality. Results showed that, while higher SVI was associated with worse mortality in the unadjusted model, there was no significant association between SVI and inpatient mortality after adjusting for covariates common to trauma. Higher SVI was associated with a higher likelihood of presenting with penetrating injuries. These findings suggested that the burden of trauma mortality is not driven by variation in quality of treatment, but by lethality of injuries. The researchers concluded that improvement in trauma survival among high-risk communities will require interventions and policies which target social and structural inequities upstream of trauma center admission.
AHRQ-funded; HS028672; HS027788.
Citation: Neiman PU, Flaherty MM, Salim A .
Evaluating the complex association between social vulnerability index and trauma mortality.
J Trauma Acute Care Surg 2022 May; 92(5):821-30. doi: 10.1097/ta.0000000000003514..
Keywords: Social Determinants of Health, Trauma, Mortality
Maughan BC, Lin A, Caughey AB
Field trauma triage among older adults: a cost-effectiveness analysis.
The authors evaluated the cost-effectiveness of a high-sensitivity triage strategy for older adults. They used a microsimulation model with a retrospective cohort of community-dwelling Medicare beneficiaries transported by emergency medical services after an acute injury. They found that high-sensitivity trauma field triage is not cost-effective among older adults.
AHRQ-funded; HS023796.
Citation: Maughan BC, Lin A, Caughey AB .
Field trauma triage among older adults: a cost-effectiveness analysis.
J Am Coll Surg 2022 Feb 1;234(2):139-54. doi: 10.1097/xcs.0000000000000025..
Keywords: Elderly, Trauma, Healthcare Costs
Hoonakker PLT, Hose BZ, Carayon P
Scenario-based evaluation of team health information technology to support pediatric trauma care transitions.
This study’s objective was to examine if the Teamwork Transition Technology (T(3)) supports teams and team cognition. Using a scenario-based mock-up methodology with 36 clinicians and staff from the different units and departments who are involved in pediatric trauma to examine T(3), results showed that most participants agreed that the technology helped to achieve the goals set out in the design phase. Respondents thought that T(3) organized and presented information in a different way that was helpful to them. The authors concluded that the results of their evaluation showed that participants agreed that T(3) does support them in their work and increases their situation awareness.
AHRQ-funded; HS023837.
Citation: Hoonakker PLT, Hose BZ, Carayon P .
Scenario-based evaluation of team health information technology to support pediatric trauma care transitions.
Appl Clin Inform 2022 Jan;13(1):218-29. doi: 10.1055/s-0042-1742368.
AHRQ-funded; HS023837..
AHRQ-funded; HS023837..
Keywords: Children/Adolescents, Transitions of Care, Health Information Technology (HIT), Teams, Trauma
Albrecht JS, O'Hara LM, Moser KA
Perception of barriers to the diagnosis and receipt of treatment for neuropsychiatric disturbances after traumatic brain injury.
This study explored perceptions of barriers and facilitators to the diagnosis and receipt of treatment for neuropsychiatric disturbances (NPDs) after traumatic brain injury (TBI). Using semistructured interviews and focus groups, it found that barriers included poor provider education on TBI NPDs and limited access to care due to lack of insurance, transportation, and income. Facilitators included patient education on TBI NPDs and strong caregiver support.
AHRQ-funded; HS024560.
Citation: Albrecht JS, O'Hara LM, Moser KA .
Perception of barriers to the diagnosis and receipt of treatment for neuropsychiatric disturbances after traumatic brain injury.
Arch Phys Med Rehabil 2017 Dec;98(12):2548-52. doi: 10.1016/j.apmr.2017.06.007.
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Keywords: Brain Injury, Caregiving, Diagnostic Safety and Quality, Behavioral Health, Trauma
Juriga LL, Murray DJ, Boulet JR
Simulation and the diagnostic process: a pilot study of trauma and rapid response teams.
Simulation can be used to recreate conditions that engage teams in the diagnostic process. In contrast to most instruction about diagnostic error, teams learn through realistic experiences and receive timely feedback about their decision-making skills. The purpose of this study was to assess how trauma teams (TrT) and pediatric rapid response teams (RRT) managed scenarios that included a diagnostic error.
AHRQ-funded; HS022265; HS018731.
Citation: Juriga LL, Murray DJ, Boulet JR .
Simulation and the diagnostic process: a pilot study of trauma and rapid response teams.
Diagnosis 2017 Nov 27;4(4):241-49. doi: 10.1515/dx-2017-0010..
Keywords: Diagnostic Safety and Quality, Emergency Medical Services (EMS), Injuries and Wounds, Training, Trauma
Chenoweth JA, Johnson MA, Shook L
Prevalence of intracranial hemorrhage after blunt head trauma in patients on pre-injury dabigatran.
Dabigatran etexilate was the first direct-acting oral anticoagulant approved in the United States. The researchers aimed to determine the prevalence of intracranial hemorrhage for patients on dabigatran presenting to a Level I trauma center. The intracranial hemorrhage prevalence in their study was similar to previous reports for patients on warfarin.
AHRQ-funded; HS022236.
Citation: Chenoweth JA, Johnson MA, Shook L .
Prevalence of intracranial hemorrhage after blunt head trauma in patients on pre-injury dabigatran.
West J Emerg Med 2017 Aug;18(5):794-99. doi: 10.5811/westjem.2017.5.33092.
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Keywords: Blood Thinners, Brain Injury, Trauma, Risk, Medication
Sauser Zachrison K, Schwamm LH
Implementation of rapid treatment and interfacility transport for patients with suspected stroke by large-vessel occlusion: in one door and out the other.
This editorial discusses an article in this same issue of JAMA Neurology (McTaggart et al) that describes the results of the implementation of a standard protocol for patients with suspected emergent large-vessel occlusion (ELVO), and the protocol’s impact on both the process of care and patient outcomes. The editorial concludes that the McTaggart article challenges the medical community to develop an interdisciplinary, team-based, protocol-based approach to patients with potential ELVOs, and that work across the disciplines is needed to achieve an acceptable false-positive rate for the system.
AHRQ-funded; HS024561.
Citation: Sauser Zachrison K, Schwamm LH .
Implementation of rapid treatment and interfacility transport for patients with suspected stroke by large-vessel occlusion: in one door and out the other.
JAMA Neurol 2017 Jul;74(7):765-66. doi: 10.1001/jamaneurol.2017.0324..
Keywords: Brain Injury, Health Services Research (HSR), Healthcare Delivery, Stroke, Transitions of Care, Trauma
O'Neil ME, Callahan M, Carlson KF
Postconcussion symptoms reported by Operation Enduring Freedom/Operation Iraqi Freedom veterans with and without blast exposure, mild traumatic brain injury, and posttraumatic stress disorder.
This study examined symptom reporting related to the 10th Edition of the International Statistical Classification of Diseases (ICD-10) criteria for postconcussional syndrome (PCS) in veterans. One aim was to examine relationships among PCS symptoms by using the British Columbia Postconcussion Symptom Inventory (BC-PSI). BC-PSI factors were interpreted as cognitive, vestibular, affective, anger, and somatic. Items and factor scores were highest for veterans with blast exposure plus mTBI, and lowest for controls.
AHRQ-funded; HS022981.
Citation: O'Neil ME, Callahan M, Carlson KF .
Postconcussion symptoms reported by Operation Enduring Freedom/Operation Iraqi Freedom veterans with and without blast exposure, mild traumatic brain injury, and posttraumatic stress disorder.
J Clin Exp Neuropsychol 2017 Jun;39(5):449-58. doi: 10.1080/13803395.2016.1232699.
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Keywords: Brain Injury, Diagnostic Safety and Quality, Behavioral Health, Trauma
Albrecht JS, Peters ME, Smith GS
Anxiety and posttraumatic stress disorder among Medicare beneficiaries after traumatic brain injury.
This study estimated rates of anxiety and posttraumatic stress disorder (PTSD) diagnoses after traumatic brain injury (TBI) among Medicare beneficiaries. After TBI, 16,519 (17 percent) beneficiaries were diagnosed with anxiety and 269 (0.3 percent) were diagnosed with PTSD. Rates of anxiety and PTSD diagnoses were highest in the first 5 months post-TBI and decreased over time.
AHRQ-funded; HS024560.
Citation: Albrecht JS, Peters ME, Smith GS .
Anxiety and posttraumatic stress disorder among Medicare beneficiaries after traumatic brain injury.
J Head Trauma Rehabil 2017 May/Jun;32(3):178-84. doi: 10.1097/htr.0000000000000266.
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Keywords: Anxiety, Brain Injury, Medicare, Behavioral Health, Trauma
Goins RT, Noonan C, Gonzales K
Association of depressive symptomology and psychological trauma with diabetes control among older American Indian women: does social support matter?
Among older American Indian women with type 2 diabetes (T2DM), the researchers examined the association between mental health and T2DM control and if social support modifies the association. They found that there was not a significant association between depressive symptomatology and higher HbA1c although increased depressive symptomatology was associated with higher HbA1c values among participants with low social support.
AHRQ-funded; HS000078.
Citation: Goins RT, Noonan C, Gonzales K .
Association of depressive symptomology and psychological trauma with diabetes control among older American Indian women: does social support matter?
J Diabetes Complications 2017 Apr;31(4):669-74. doi: 10.1016/j.jdiacomp.2017.01.004.
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Keywords: Diabetes, Elderly, Behavioral Health, Racial and Ethnic Minorities, Trauma
Wegener ST, Pollak AN, Frey KP
The Trauma Collaborative Care Study (TCCS).
This article describes the Trauma Collaborative Care (TCC) program and the design of a multicenter study to evaluate its effectiveness for improving patient outcomes after major, high-energy orthopaedic trauma at level 1 trauma centers. Compared with standard treatment alone, it is hypothesized that access to the TCC program plus standard treatment will result in lower rates of poor patient-reported function, depression, and posttraumatic stress disorder.
AHRQ-funded; HS000029.
Citation: Wegener ST, Pollak AN, Frey KP .
The Trauma Collaborative Care Study (TCCS).
J Orthop Trauma 2017 Apr;31 Suppl 1:S78-s87. doi: 10.1097/bot.0000000000000792.
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Keywords: Injuries and Wounds, Outcomes, Patient-Centered Outcomes Research, Behavioral Health, Screening, Trauma
Corrado MM, Shi J, Wheeler KK
Emergency medical services (EMS) versus non-EMS transport among injured children in the United States.
This study assessed the proportions of injured children transported to trauma centers by different transportation modes and evaluated the effect of transportation mode on inter-facility transfer rates using the US national trauma registry. Over one third of US pediatric trauma patients used non-EMS transport to arrive at trauma centers. Moderate to severely injured children benefit from EMS transport and professional field triage.
AHRQ-funded; HS024263.
Citation: Corrado MM, Shi J, Wheeler KK .
Emergency medical services (EMS) versus non-EMS transport among injured children in the United States.
Am J Emerg Med 2017 Mar;35(3):475-78. doi: 10.1016/j.ajem.2016.11.059.
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Keywords: Emergency Medical Services (EMS), Children/Adolescents, Trauma, Critical Care
Carr BG, Bowman AJ, Wolff CS
Disparities in access to trauma care in the United States: a population-based analysis.
This study examined the association between geographic, demographic, and socioeconomic factors and trauma center access, with subgroup analyses of urban-rural disparities. It concluded that, while the majority of the United States has access to trauma care within an hour, almost 30 million US residents do not. Significant disparities in access were evident for vulnerable populations defined by insurance status, income, and rurality.
AHRQ-funded; HS017960.
Citation: Carr BG, Bowman AJ, Wolff CS .
Disparities in access to trauma care in the United States: a population-based analysis.
Injury 2017 Feb;48(2):332-38. doi: 10.1016/j.injury.2017.01.008.
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Keywords: Access to Care, Disparities, Health Services Research (HSR), Social Determinants of Health, Trauma
McDonald V, Hauner KK, Chau A
Networks underlying trait impulsivity: evidence from voxel-based lesion-symptom mapping.
In order to determine the extent to which impulsivity and its components share a common network, a voxel-based lesion-symptom mapping analysis was performed in a large sample of patients with focal, penetrating traumatic brain injuries. The researchers found that heightened global impulsivity was associated with damage to multiple areas in bilateral prefrontal cortex , left superior, middle and inferior temporal gyrus, and left hippocampus.
AHRQ-funded; HS023011.
Citation: McDonald V, Hauner KK, Chau A .
Networks underlying trait impulsivity: evidence from voxel-based lesion-symptom mapping.
Hum Brain Mapp 2017 Feb;38(2):656-65. doi: 10.1002/hbm.23406.
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Keywords: Brain Injury, Imaging, Trauma
Storzbach D, Twamley EW, Roost MS
Compensatory cognitive training for Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans with mild traumatic brain injury.
The purpose of the study was to evaluate the efficacy of group-based compensatory cognitive training (CCT) for veterans with a history of mild traumatic brain injury. Veterans who participated in CCT reported significantly fewer cognitive and memory difficulties and greater use of cognitive strategies. They also demonstrated significant improvements on neurocognitive tests of attention, learning, and executive functioning, which were 3 of the cognitive domains targeted in CCT.
AHRQ-funded; HS022981.
Citation: Storzbach D, Twamley EW, Roost MS .
Compensatory cognitive training for Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans with mild traumatic brain injury.
J Head Trauma Rehabil 2017 Jan/Feb;32(1):16-24. doi: 10.1097/htr.0000000000000228.
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Keywords: Brain Injury, Neurological Disorders, Patient-Centered Outcomes Research, Trauma