National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Ambulatory Care and Surgery (1)
- Behavioral Health (1)
- Cancer (12)
- Cancer: Lung Cancer (2)
- Cancer: Skin Cancer (1)
- Cardiovascular Conditions (3)
- Caregiving (3)
- Care Management (1)
- Children/Adolescents (4)
- Chronic Conditions (3)
- Clinician-Patient Communication (1)
- Communication (3)
- Comparative Effectiveness (2)
- Critical Care (2)
- Depression (1)
- Disparities (1)
- Education: Continuing Medical Education (3)
- Education: Patient and Caregiver (2)
- Elderly (5)
- Electronic Health Records (EHRs) (1)
- Family Health and History (1)
- Guidelines (1)
- Healthcare Costs (1)
- Healthcare Delivery (4)
- Healthcare Utilization (3)
- Health Information Technology (HIT) (1)
- Health Status (2)
- Heart Disease and Health (2)
- Hospitalization (3)
- Hospital Readmissions (1)
- Hospitals (1)
- Inpatient Care (3)
- Intensive Care Unit (ICU) (1)
- Learning Health Systems (1)
- Long-Term Care (1)
- Medicare (1)
- Medication (3)
- Mortality (3)
- Opioids (1)
- Outcomes (1)
- Pain (3)
- (-) Palliative Care (37)
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- Patient Safety (2)
- Policy (1)
- Practice Patterns (3)
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- Quality Improvement (2)
- Quality Indicators (QIs) (1)
- Quality Measures (2)
- Quality of Care (7)
- Quality of Life (2)
- Racial and Ethnic Minorities (2)
- Registries (2)
- Respiratory Conditions (2)
- Risk (1)
- Shared Decision Making (4)
- Surgery (4)
- Training (1)
- Treatments (1)
- Young Adults (1)
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 37 Research Studies DisplayedCooper Z, Lilley EJ, Bollens-Lund E
High burden of palliative care needs of older adults during emergency major abdominal surgery.
The purpose of this retrospective study was to quantify preoperative illness burden in older adults undergoing emergency major abdominal surgery (EMAS), to examine the association between illness burden and postoperative outcomes, and to describe end-of-life care in the year after discharge. The investigators found that most older adults undergoing EMAS have preexisting high illness burden and experience high mortality and healthcare use in the year after surgery, particularly near the end of life.
AHRQ-funded; HS022763.
Citation: Cooper Z, Lilley EJ, Bollens-Lund E .
High burden of palliative care needs of older adults during emergency major abdominal surgery.
J Am Geriatr Soc 2018 Nov;66(11):2072-78. doi: 10.1111/jgs.15516..
Keywords: Critical Care, Elderly, Palliative Care, Surgery
Bateni SB, Gingrich AA, Stewart SL
Hospital utilization and disposition among patients with malignant bowel obstruction: a population-based comparison of surgical to medical management.
In this study, the investigators sought to compare clinically meaningful outcomes in malignant bowel obstruction (MBO) patients treated with surgical versus medical management using population-based data. In this population-based analysis, medical management was associated with less hospital utilization at 30- and 90-days, fewer in-hospital deaths, and more frequent discharges to home. The authors suggest that these data underscore the potential benefits of medical management for MBO patients at the end-of-life.
AHRQ-funded; HS022236.
Citation: Bateni SB, Gingrich AA, Stewart SL .
Hospital utilization and disposition among patients with malignant bowel obstruction: a population-based comparison of surgical to medical management.
BMC Cancer 2018 Nov 26;18(1):1166. doi: 10.1186/s12885-018-5108-9..
Keywords: Cancer, Comparative Effectiveness, Hospitalization, Palliative Care, Patient-Centered Outcomes Research, Surgery
Wang SY, Hsu SH, Huang S
Regional practice patterns and racial/ethnic differences in intensity of end-of-life care.
The purpose of this study was to examine whether regional practice patterns impact racial/ethnic differences in intensity of end-of-life care for cancer decedents. The investigators found that there was greater variation in intensity of end-of-life care among Hispanics, Asians, and whites in high-expenditure hospital referral regions (HRRs) than in low-expenditure HRRs.
AHRQ-funded; HS023900.
Citation: Wang SY, Hsu SH, Huang S .
Regional practice patterns and racial/ethnic differences in intensity of end-of-life care.
Health Serv Res 2018 Dec;53(6):4291-309. doi: 10.1111/1475-6773.12998..
Keywords: Cancer, Palliative Care, Practice Patterns, Racial and Ethnic Minorities
Kim K, Heinze K, Xu J
Theories of health care decision making at the end of life: a meta-ethnography.
The aim of this meta-ethnography was to appraise the types and uses of theories relative to end-of-life decision making and to develop a conceptual framework to describe end-of-life decisionmaking among patients with advanced cancers, heart failure, and amyotrophic lateral sclerosis (ALS), and their caregivers or providers. A conceptual framework was developed using themes including context of decision making, communication and negotiation of decisionmaking, characteristics of decision makers, goals of decision making, options and alternatives, and outcomes.
AHRQ-funded; HS022140.
Citation: Kim K, Heinze K, Xu J .
Theories of health care decision making at the end of life: a meta-ethnography.
West J Nurs Res 2018 Dec;40(12):1861-84. doi: 10.1177/0193945917723010..
Keywords: Caregiving, Communication, Shared Decision Making, Palliative Care
Bush RA, Perez A, Baum T
A systematic review of the use of the electronic health record for patient identification, communication, and clinical support in palliative care.
In this study, a systematic review, was conducted, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The data sources PubMed, CINAL, EBSCOhost, and Academic Search Premier were used to identify literature published 1999 - 2017 of human subject peer-reviewed articles in English containing original research about the electronic health record and palliative care. The review identified five major areas in which the EHR is used to support PC.
AHRQ-funded; HS022404.
Citation: Bush RA, Perez A, Baum T .
A systematic review of the use of the electronic health record for patient identification, communication, and clinical support in palliative care.
JAMIA Open 2018 Oct 1;1(2):294-303. doi: 10.1093/jamiaopen/ooy028..
Keywords: Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Palliative Care
Leyenaar JK, Bogetz JF
Child mortality in the United States: bridging palliative care and public health perspectives.
This commentary discusses the findings of the article by Trowbridge et al in this same issue of Pediatrics, which examines modes of death rather than causes of death at a freestanding children’s hospital. Five distinct categories were created: withdrawal of life-sustaining technology; non-escalation of care; failed resuscitation; code then withdrawal; death by neurological criteria. More than 60% of the deaths were infants. The authors of this commentary note that conceptualizing the findings of this study from a public health perspective raises important questions about how causes of death are associated with end-of-life care in hospitals.
AHRQ-funded; HS024133.
Citation: Leyenaar JK, Bogetz JF .
Child mortality in the United States: bridging palliative care and public health perspectives.
Pediatrics 2018 Oct;142(4). doi: 10.1542/peds.2018-1927..
Keywords: Children/Adolescents, Hospitals, Mortality, Palliative Care, Patient-Centered Outcomes Research, Public Health
Johnson AM, Spaete JP, Jowell PS
Top ten tips palliative care clinicians should know about interventional symptom management options when caring for patients with gastrointestinal malignancies.
In this article, the researchers brought together a team of interventional gastroenterologists and palliative care experts to collate practical pearls for the types of endoscopic interventions used for symptom management in patients with GI malignancies.
AHRQ-funded; HS023681.
Citation: Johnson AM, Spaete JP, Jowell PS .
Top ten tips palliative care clinicians should know about interventional symptom management options when caring for patients with gastrointestinal malignancies.
J Palliat Med 2018 Sep;21(9):1339-43. doi: 10.1089/jpm.2018.0251..
Keywords: Palliative Care, Education: Continuing Medical Education, Cancer
Satchidanand N, Servoss TJ, Singh R
Development of a risk tool to support discussions of care for older adults admitted to the ICU with pneumonia.
The purpose of this study was to develop a 30-day mortality prediction tool for older patients in intensive care unit (ICU) with pneumonia that will initiate palliative care earlier in hospital course. The authors suggest that their risk tool can help care teams make more informed decisions among care options by identifying a patient group for whom a careful review of goals of care is indicated both during and after hospitalization.
AHRQ-funded; HS023656.
Citation: Satchidanand N, Servoss TJ, Singh R .
Development of a risk tool to support discussions of care for older adults admitted to the ICU with pneumonia.
Am J Hosp Palliat Care 2018 Sep;35(9):1201-06. doi: 10.1177/1049909118764093..
Keywords: Shared Decision Making, Elderly, Health Status, Intensive Care Unit (ICU), Palliative Care, Risk
Gelfman LP, Barron Y, Moore S
Predictors of hospice enrollment for patients with advanced heart failure and effects on health care use.
This study sought to identify the predictors of hospice enrollment for patients with heart failure (HF) and determine the impact of hospice enrollment on health care use. The study found that beneficiaries' characteristics, including symptom burden and functional status, do not predict hospice enrollment. Those patients who enrolled in hospice used less health care, survived longer, and were less likely to die in the hospital.
AHRQ-funded; HS020257.
Citation: Gelfman LP, Barron Y, Moore S .
Predictors of hospice enrollment for patients with advanced heart failure and effects on health care use.
JACC Heart Fail 2018 Sep;6(9):780-89. doi: 10.1016/j.jchf.2018.04.009..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Palliative Care, Patient-Centered Outcomes Research
Bateni SB, Canter RJ, Meyers FJ
Palliative care training and decision-making for patients with advanced cancer: a comparison of surgeons and medical physicians.
Surgical decision-making in patients with advanced cancer requires careful thought and deliberation to balance the high risks with the potential palliative benefits. In this study, the investigators sought to compare surgical decision-making and palliative care training among surgeons and medical physicians who commonly treat advanced cancer patients. The investigators concluded that substantial deficiencies in palliative care training persised among surgeons and were associated with more aggressive recommendations for treatment for the selected scenarios presented in patients with advanced cancer.
AHRQ-funded; HS022236.
Citation: Bateni SB, Canter RJ, Meyers FJ .
Palliative care training and decision-making for patients with advanced cancer: a comparison of surgeons and medical physicians.
Surgery 2018 Jul;164(1):77-85. doi: 10.1016/j.surg.2018.01.021..
Keywords: Shared Decision Making, Palliative Care, Cancer, Surgery, Education: Continuing Medical Education, Training
Iyer AS, Benzo RP, Bakitas MA
Easing the tension between palliative care and intensive care in chronic obstructive pulmonary disease.
This editorial discusses palliative care and intensive care in chronic obstructive pulmonary disease and comments on an article by Shen, et al., published, in 2018, in the Journal of Palliative Care, entitled “Life-sustaining procedures, palliative care consultation, and do-not resuscitate status in dying patients with COPD in US hospitals: 2010-2014.”
AHRQ-funded; HS023009.
Citation: Iyer AS, Benzo RP, Bakitas MA .
Easing the tension between palliative care and intensive care in chronic obstructive pulmonary disease.
J Palliat Care 2018 Jul;33(3):123-24. doi: 10.1177/0825859718782505..
Keywords: Chronic Conditions, Respiratory Conditions, Critical Care, Elderly, Palliative Care, Quality of Care
Hudson KE, Wolf SP, Samsa GP
The surprise question and identification of palliative care needs among hospitalized patients with advanced hematologic or solid malignancies.
Little is known about quality of life (QOL), depression, and end-of-life (EOL) outcomes among hospitalized patients with advanced cancer. The objective of this study was to assess whether a surprise question identified inpatients with advanced cancer likely to have unmet palliative care needs. The investigators indicated that hospitalized patients with advanced cancer may benefit from palliative care interventions to improve mood, QOL, and EOL care, and the surprise question is a practical method to identify those with unmet needs.
AHRQ-funded; HS023681.
Citation: Hudson KE, Wolf SP, Samsa GP .
The surprise question and identification of palliative care needs among hospitalized patients with advanced hematologic or solid malignancies.
J Palliat Med 2018 Jun;21(6):789-95. doi: 10.1089/jpm.2017.0509..
Keywords: Palliative Care, Cancer, Inpatient Care, Quality of Life, Depression, Behavioral Health
Ahluwalia SC, Harris BJ, Lewis VA
End-of-life care planning in accountable care organizations: associations with organizational characteristics and capabilities.
The authors measured the extent to which accountable care organizations (ACOs) have adopted end-of-life (EOL) care planning processes and characterize those ACOs that have established processes related to EOL. Using National Survey of ACOs data, they found that 21 percent of ACOs had few or no EOL care planning processes, 60 percent had some processes, and 19.6 percent had advanced processes.
AHRQ-funded; HS024075.
Citation: Ahluwalia SC, Harris BJ, Lewis VA .
End-of-life care planning in accountable care organizations: associations with organizational characteristics and capabilities.
Health Serv Res 2018 Jun;53(3):1662-81. doi: 10.1111/1475-6773.12720.
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Keywords: Palliative Care, Policy
Wiesenthal AC, Patel SP, LeBlanc TW
Top ten tips for palliative care clinicians caring for cancer patients receiving immunotherapies.
In this study, the investigators aim to further engage palliative care specialists in the active care of cancer patients receiving immunotherapeutics and use a "Top 10" tips format to concisely present practical learning points to busy clinicians.
AHRQ-funded; HS023681.
Citation: Wiesenthal AC, Patel SP, LeBlanc TW .
Top ten tips for palliative care clinicians caring for cancer patients receiving immunotherapies.
J Palliat Med 2018 May;21(5):694-99. doi: 10.1089/jpm.2018.0107..
Keywords: Palliative Care, Cancer, Guidelines
Gani F, Enumah ZO, Conca-Cheng AM
Palliative care utilization among patients admitted for gastrointestinal and thoracic cancers.
Although a growing body of literature recommends the early initiation of palliative care (PC), the use of PC remains variable. The current study sought to describe the use of PC and to identify factors associated with the use of inpatient PC. The investigators found that among patients admitted for cancer, PC services were used in 8.5% of patients during their inpatient admission with surgical patients being 79% less likely to receive a PC consultation.
AHRQ-funded; HS024736.
Citation: Gani F, Enumah ZO, Conca-Cheng AM .
Palliative care utilization among patients admitted for gastrointestinal and thoracic cancers.
J Palliat Med 2018 Apr;21(4):428-37. doi: 10.1089/jpm.2017.0295..
Keywords: Cancer, Palliative Care, Healthcare Utilization, Inpatient Care
Swetz KM, Kamal AH
Palliative Care
This article reviews the basics of effective communication, symptom management, and end-of-life care and provides an overview of current evidence to support patient-centered palliative care.
AHRQ-funded; HS023681.
Citation: Swetz KM, Kamal AH .
Palliative Care
Ann Intern Med 2018 Mar 6;168(5):Itc33-itc48. doi: 10.7326/aitc201803060..
Keywords: Clinician-Patient Communication, Communication, Palliative Care, Patient-Centered Healthcare
Kamal AH, Kirkland KB, Meier DE
A person-centered, registry-based learning health system for palliative care: a path to coproducing better outcomes, experience, value, and science.
In this paper, the authors discuss measurement of the impact of palliative care, which is critical for determining what works for which patients in what settings, to learn, improve care, and ensure access to high value care for people with serious illness. The authors described an approach to codesigning and implementing a palliative care registry that functions as a learning health system, by combining patient and family inputs and clinical data to support person-centered care, quality improvement, accountability, transparency, and scientific research.
AHRQ-funded; HS023681.
Citation: Kamal AH, Kirkland KB, Meier DE .
A person-centered, registry-based learning health system for palliative care: a path to coproducing better outcomes, experience, value, and science.
J Palliat Med 2018 Mar;21(S2):S61-s67. doi: 10.1089/jpm.2017.0354..
Keywords: Palliative Care, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Outcomes, Learning Health Systems, Registries, Patient and Family Engagement
Chen LM, Levine DA, Hayward R
Relationship between hospital 30-day mortality rates for heart failure and patterns of early inpatient comfort care.
This study describes the use of early comfort care for patients with heart failure (HF), and whether hospitals that more commonly initiate comfort care have higher 30-day mortality rates. It found that hospital use of early comfort care for HF varies, has not increased over time, and on average, is not correlated with 30-day risk-standardized mortality rates.
AHRQ-funded; HS020671.
Citation: Chen LM, Levine DA, Hayward R .
Relationship between hospital 30-day mortality rates for heart failure and patterns of early inpatient comfort care.
J Hosp Med 2018 Mar;13(3):170-76. doi: 10.12788/jhm.2862.
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Keywords: Cardiovascular Conditions, Elderly, Heart Disease and Health, Inpatient Care, Mortality, Palliative Care
Fulton JJ, LeBlanc TW, Cutson TM
Integrated outpatient palliative care for patients with advanced cancer: a systematic review and meta-analysis.
In this study, the authors evaluated the effects of integrated outpatient palliative and oncology care for advanced cancer on patient and caregiver outcomes. The investigators found that moderately integrated palliative and oncology outpatient interventions had positive effects on short-term quality of life, symptom burden, and survival.
AHRQ-funded; HS023681.
Citation: Fulton JJ, LeBlanc TW, Cutson TM .
Integrated outpatient palliative care for patients with advanced cancer: a systematic review and meta-analysis.
Palliat Med 2018 Feb;33(2):123-34. doi: 10.1177/0269216318812633..
Keywords: Cancer, Ambulatory Care and Surgery, Palliative Care
Dabbouseh NM, Kaushal S, Peltier W
Palliative care training in cardiology fellowship: a national survey of the fellows.
The purpose of this study was to address perspectives of cardiology fellows on the current state of palliative education and palliative and hospice resource utilization within their fellowship experiences. The survey results highlighted a need for enhanced palliative care and end-of-life training experiences for cardiology fellows and also suggested underutilization of hospice and palliative care resources for patients with advanced cardiac diseases.
AHRQ-funded; HS024736.
Citation: Dabbouseh NM, Kaushal S, Peltier W .
Palliative care training in cardiology fellowship: a national survey of the fellows.
Am J Hosp Palliat Care 2018 Feb;35(2):284-92. doi: 10.1177/1049909117703728..
Keywords: Cardiovascular Conditions, Education: Continuing Medical Education, Palliative Care
DeCourcey DD, Silverman M, Oladunjoye A
Patterns of care at the end of life for children and young adults with life-threatening complex chronic conditions.
The purpose of this study, which used a cross sectional survey, was to characterize patterns of care at the end of life for children and young adults with life-threatening complex chronic conditions (LT-CCCs) and to compare them by LT-CCC type. The investigators concluded that significant differences in patterns of care at the end of life existed depending on LT-CCC type. They suggest that attention to these patterns is important to ensure equal access to palliative care and targeted improvements in end-of-life care for these populations.
AHRQ-funded; HS022986.
Citation: DeCourcey DD, Silverman M, Oladunjoye A .
Patterns of care at the end of life for children and young adults with life-threatening complex chronic conditions.
J Pediatr 2018 Feb;193:196-203.e2. doi: 10.1016/j.jpeds.2017.09.078..
Keywords: Children/Adolescents, Chronic Conditions, Palliative Care, Practice Patterns, Young Adults
Hochman MJ, Yu Y, Wolf SP
Comparing the palliative care needs of patients with hematologic and solid malignancies.
The objective of the study is to compare unmet symptom needs in a cohort of hematologic and solid tumor patients referred to specialty palliative care services. The study concluded that hematologic and solid tumor patients have significant symptom burden at time of referral to palliative care services. Blood cancer patients may have unique concerns warranting targeted attention, including substantial drowsiness and tiredness. The findings suggest a need to optimize palliative care usage in the hematologic cancer population.
AHRQ-funded; HS023681; HS022763.
Citation: Hochman MJ, Yu Y, Wolf SP .
Comparing the palliative care needs of patients with hematologic and solid malignancies.
J Pain Symptom Manage 2018 Jan;55(1):82-88.e1. doi: 10.1016/j.jpainsymman.2017.08.030..
Keywords: Cancer, Palliative Care, Patient-Centered Outcomes Research
Du XL, Parikh RC, Lairson DR
Racial and geographic disparities in the patterns of care and costs at the end of life for patients with lung cancer in 2007-2010 after the 2006 introduction of bevacizumab.
The authors examined racial/ethnic and geographical disparities in cancer care and costs during the last 6 months of life for lung cancer decedents after the FDA's approval of bevacizumab. They found that there were substantial racial/ethnic and geographic disparities in the types of cancer care and costs in the last 6 months of life among lung cancer decedents, regardless of the length of survival times and hospice care status.
AHRQ-funded; HS018956.
Citation: Du XL, Parikh RC, Lairson DR .
Racial and geographic disparities in the patterns of care and costs at the end of life for patients with lung cancer in 2007-2010 after the 2006 introduction of bevacizumab.
Lung Cancer 2015 Dec;90(3):442-50. doi: 10.1016/j.lungcan.2015.09.017.
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Keywords: Cancer, Cancer: Lung Cancer, Disparities, Healthcare Costs, Medication, Palliative Care, Patient-Centered Outcomes Research, Practice Patterns, Racial and Ethnic Minorities
Ananth P, Melvin P, Feudtner C
Hospital use in the last year of life for children with life-threatening complex chronic conditions.
The researchers assessed hospital resource use in children by type and number of life-threatening complex chronic conditions (LT-CCCs). They found that hospital use for children with LT-CCCs in the last year of life varies significantly across the type and number of conditions. Children with hematologic/ immunologic or multiple conditions have the greatest hospital use.
AHRQ-funded; HS023092.
Citation: Ananth P, Melvin P, Feudtner C .
Hospital use in the last year of life for children with life-threatening complex chronic conditions.
Pediatrics 2015 Nov;136(5):938-46. doi: 10.1542/peds.2015-0260..
Keywords: Chronic Conditions, Children/Adolescents, Hospitalization, Palliative Care
Kamal AH, Kavalieratos D, Bull J
Usability and acceptability of the QDACT-PC, an electronic point-of-care system for standardized quality monitoring in palliative care.
The researchers performed usability testing of the Quality Data Collection Tool for Palliative Care (QDACT-PC), a novel, point-of-care quality monitoring tool for palliative care. They found that testing the QDACT-PC reveals equivalence with paper for data collection time, but with less burden overall for electronic methods across other domains of usability.
AHRQ-funded; HS022989.
Citation: Kamal AH, Kavalieratos D, Bull J .
Usability and acceptability of the QDACT-PC, an electronic point-of-care system for standardized quality monitoring in palliative care.
J Pain Symptom Manage 2015 Nov;50(5):615-21. doi: 10.1016/j.jpainsymman.2015.05.013.
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Keywords: Healthcare Delivery, Quality of Care, Palliative Care, Patient-Centered Healthcare, Quality Measures