National Healthcare Quality and Disparities Report
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Topics
- Access to Care (3)
- (-) Cancer (17)
- Cancer: Breast Cancer (7)
- Cancer: Cervical Cancer (1)
- Cancer: Colorectal Cancer (5)
- Cancer: Ovarian Cancer (1)
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- Case Study (1)
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- Diagnostic Safety and Quality (2)
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- Medicaid (3)
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- Policy (3)
- Prevention (12)
- Primary Care (3)
- Primary Care: Models of Care (2)
- Quality Improvement (1)
- Quality of Care (1)
- Racial and Ethnic Minorities (3)
- (-) Screening (17)
- Social Determinants of Health (1)
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- U.S. Preventive Services Task Force (USPSTF) (2)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 17 of 17 Research Studies DisplayedTracer H, Sanou A
AHRQ Author: Tracer H
Screening for pancreatic cancer.
This “Putting Prevention into Practice: An Evidence Based Approach” case study, is based on the U.S. Preventive Services Task Force (USPSTF) recommendation for pancreatic cancer screening. It describes a patient scenario and poses questions.
AHRQ-authored.
Citation: Tracer H, Sanou A .
Screening for pancreatic cancer.
Am Fam Physician 2019 Dec 15;100(12):771-72..
Keywords: U.S. Preventive Services Task Force (USPSTF), Screening, Prevention, Cancer, Case Study, Primary Care
Chapman CH, Caram MEV, Radhakrishnan A
Association between PSA values and surveillance quality after prostate cancer surgery.
This study examined the association between PSA values and posttreatment surveillance after prostate cancer surgery. Normally the treatment cutoff rate is 0.2 ng/mL but 4.0 ng/mL may be more appropriate. Data from the US Veterans Health Administration was used to perform a retrospective longitudinal cohort study for men diagnosed with nonmetastatic prostate cancer from 2005 to 2008 who underwent radical prostatectomy. Guideline concordance was high at year 1 (95%) but decreased to 79% in year 7. After adjustment, guideline concordance was lowered for the youngest and oldest, Black, and unmarried men.
AHRQ-funded; HS018726.
Citation: Chapman CH, Caram MEV, Radhakrishnan A .
Association between PSA values and surveillance quality after prostate cancer surgery.
Cancer Med 2019 Dec;8(18):7903-12. doi: 10.1002/cam4.2663..
Keywords: Cancer: Prostate Cancer, Cancer, Surgery, Screening, Guidelines, Prevention, Evidence-Based Practice
Hassmiller Lich K, O'Leary MC, Nambiar S
Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis.
Researchers used microsimulation to estimate the health and financial effects of insurance expansion and reduction scenarios in North Carolina (NC) for colorectal cancer screening (CRC). The full lifetime of a simulated population of residents age-eligible for CRC screening (aged 50-75) during a 5-year period were simulated. Findings indicate that the estimated cost savings--balancing increased CRC screening/testing costs against decreased cancer treatment costs--were approximately $30 M and $970 M for Medicaid expansion and Medicare-for-all scenarios, respectively, compared to status quo. The researchers concluded that insurance expansion will likely improve CRC screening both overall and in underserved populations while saving money, with the largest savings realized by Medicare.
AHRQ-funded; HS022981.
Citation: Hassmiller Lich K, O'Leary MC, Nambiar S .
Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis.
Prev Med 2019 Dec;129s:105847. doi: 10.1016/j.ypmed.2019.105847..
Keywords: Health Insurance, Cancer: Colorectal Cancer, Cancer, Healthcare Costs, Screening, Prevention, Medicaid, Medicare, Policy, Access to Care
Wong MS, Arnold CM, Roberts ET
The relationship between federal housing assistance and uptake of cancer screening among low-income adults.
The primary aim of this study was to examine the relationship between participation in federal housing assistance programs and self-reported cancer screening among low-income adults. The investigators concluded that their results reinforced the need to improve rates of screening and suggested that providing housing assistance, in and of itself, may be insufficient to overcome the multiple access barriers that low-income populations face.
AHRQ-funded; HS000029.
Citation: Wong MS, Arnold CM, Roberts ET .
The relationship between federal housing assistance and uptake of cancer screening among low-income adults.
J Gen Intern Med 2019 Dec;34(12):2714-16. doi: 10.1007/s11606-019-05037-z..
Keywords: Cancer, Screening, Low-Income, Vulnerable Populations, Access to Care, Healthcare Utilization, Social Determinants of Health
Henrikson NB, Bowles EJ, Blasi PR
Screening for pancreatic cancer: updated evidence report and systematic review for the US Preventive Services Task Force.
The authors systematically reviewed the benefits and harms of screening for pancreatic adenocarcinoma in order to inform the USPSTF. They found that imaging-based screening in groups at high familial risk can detect pancreatic adenocarcinoma with limited evidence of minimal harms. However, the effect of screening on morbidity and mortality in groups at high familial risk has not been studied, and no data are available in average-risk populations. They conclude that there is limited evidence to assess benefits or harms of surgical intervention for screen-detected pancreatic adenocarcinoma.
AHRQ-funded; 2902015000071.
Citation: Henrikson NB, Bowles EJ, Blasi PR .
Screening for pancreatic cancer: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2019 Aug 6;322(5):445-54. doi: 10.1001/jama.2019.6190..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer, Screening, Evidence-Based Practice, Guidelines, Prevention
Davis MM, Gunn R, Pham R
Key collaborative factors when Medicaid Accountable Care Organizations work with primary care clinics to improve colorectal cancer screening: relationships, data, and quality improvement infrastructure.
This study focused on ways that Medicaid Accountable Care Organizations (ACOs) are implementing interventions with primary care clinics to improve colorectal cancer screening. The researchers conducted a comparative case study of 14 Medicaid ACOs in Oregon and their contracted primary care clinics. They focused on interventions that reduced structural barriers (12 ACOs), delivered provider assessment and feedback (11 ACOs), and provided patient reminders (7 ACOs). There was an unintended consequence of potential exclusion of smaller clinics and metric focus and fatigue.
AHRQ-funded; HS022981.
Citation: Davis MM, Gunn R, Pham R .
Key collaborative factors when Medicaid Accountable Care Organizations work with primary care clinics to improve colorectal cancer screening: relationships, data, and quality improvement infrastructure.
Prev Chronic Dis 2019 Aug 15;16:E107. doi: 10.5888/pcd16.180395..
Keywords: Primary Care: Models of Care, Primary Care, Screening, Colonoscopy, Cancer: Colorectal Cancer, Cancer, Quality Improvement, Quality of Care, Care Coordination, Patient-Centered Healthcare
Knerr S, Bowles EJA, Leppig KA
Trends in BRCA test utilization in an integrated health system, 2005-2015.
The authors reported 10-year trends in BRCA testing in an integrated health-care system with long-standing access to genetic services. They found that many eligible women did not receive BRCA testing despite having insurance coverage and access to specialty genetic services, thus underscoring challenges to primary and secondary hereditary cancer prevention.
AHRQ-funded; HS022982.
Citation: Knerr S, Bowles EJA, Leppig KA .
Trends in BRCA test utilization in an integrated health system, 2005-2015.
J Natl Cancer Inst 2019 Aug;111(8):795-802. doi: 10.1093/jnci/djz008..
Keywords: Cancer: Breast Cancer, Cancer: Ovarian Cancer, Cancer, Genetics, Screening, Prevention, Healthcare Utilization, Healthcare Delivery, Women
Bravo RI, Kietzman KG, Toy P
Linking primary care and community organizations to increase colorectal cancer screening rates: the HAPPI project.
This paper describes the Healthy Aging Partnerships in Prevention Initiative (HAPPI) which aims to increase colorectal cancer screening and other preventive services among underserved Latinos and African-Americans in South Los Angeles who are 50 years and older. It uses an evidence-based model (SPARC) to leverage existing resources and has multi-sectoral partnerships among different agencies, community health centers (CHCs), and a university. The authors engaged five CHCs in quality improvement activities and eight non-governmental organizations in networking and programming to increase awareness of these preventive services.
AHRQ-funded; HS010858.
Citation: Bravo RI, Kietzman KG, Toy P .
Linking primary care and community organizations to increase colorectal cancer screening rates: the HAPPI project.
Salud Publica Mex 2019 Jul-Aug;61(4):427-35. doi: 10.21149/9450..
Keywords: Cancer: Colorectal Cancer, Cancer, Screening, Prevention, Primary Care: Models of Care, Primary Care, Elderly, Racial and Ethnic Minorities, Vulnerable Populations, Patient-Centered Healthcare
Huguet N, Angier H, Rdesinski R
Cervical and colorectal cancer screening prevalence before and after Affordable Care Act Medicaid expansion.
This study assessed changes in the prevalence of cervical and colorectal cancer screening from before and after the Affordable Care Act in Medicaid expansion and non-expansion states among patients seen in community health centers. Results showed that, despite increased prevalences of cervical and colorectal cancer screening in both expansion and non-expansion states across all race/ethnicity groups, rates remained suboptimal for this population of socioeconomically disadvantaged patients.
AHRQ-funded; HS024270.
Citation: Huguet N, Angier H, Rdesinski R .
Cervical and colorectal cancer screening prevalence before and after Affordable Care Act Medicaid expansion.
Prev Med 2019 Jul;124:91-97. doi: 10.1016/j.ypmed.2019.05.003..
Keywords: Cancer, Cancer: Cervical Cancer, Cancer: Colorectal Cancer, Healthcare Delivery, Healthcare Utilization, Medicaid, Policy, Prevention, Screening
Rotter J, Wilson L, Greiner MA
Shared-patient physician networks and their impact on the uptake of genomic testing in breast cancer.
This study examined the impact of physician networks have on the adoption of genomic testing for women with early stage breast cancer. The genomic assay discussed in this paper is Oncotype DX (ODX) which stratifies risk. The study used retrospective data from the SEER-Medicare database from 2008 to 2012. Early adoption was more likely if the oncologists shared two or more patients during that period. There was a 1.7-fold increase in providers’ adoption of ODX in 2008-2009, and a 1.5-fold increase in their patients receiving ODX in 2010-2012.
AHRQ-funded; HS022189.
Citation: Rotter J, Wilson L, Greiner MA .
Shared-patient physician networks and their impact on the uptake of genomic testing in breast cancer.
Breast Cancer Res Treat 2019 Jul;176(2):445-51. doi: 10.1007/s10549-019-05248-2..
Keywords: Cancer, Cancer: Breast Cancer, Genetics, Screening
Miglioretti DL, Abraham L, Lee CI
Digital breast tomosynthesis: radiologist learning curve.
This study examined if detect rates and lower recall rates occurred with the adoption of digital breast tomosynthesis (DBT) than for traditional breast mammography. Performance was compared before and after DBT adoption using data from the Breast Cancer Surveillance Consortium cohort. There was a small improvement in recall rates, with more improvement in women with nondense breasts. Cancer detection rates were similar.
AHRQ-funded; HS018366.
Citation: Miglioretti DL, Abraham L, Lee CI .
Digital breast tomosynthesis: radiologist learning curve.
Radiology 2019 Apr;291(1):34-42. doi: 10.1148/radiol.2019182305..
Keywords: Cancer, Cancer: Breast Cancer, Diagnostic Safety and Quality, Imaging, Screening, Women
Sprague BL, Kerlikowske K, Bowles EJA
Trends in clinical breast density assessment from the Breast Cancer Surveillance Consortium.
Changes to mammography practice, including revised Breast Imaging Reporting and Data System (BI-RADS) density classification guidelines and implementation of digital breast tomosynthesis (DBT), may impact clinical breast density assessment. In this study, the authors investigated temporal trends in clinical breast density assessment among 2 990 291 digital mammography (DM) screens and 221 063 DBT screens interpreted by 722 radiologists from 144 facilities in the Breast Cancer Surveillance Consortium.
AHRQ-funded; HS018366.
Citation: Sprague BL, Kerlikowske K, Bowles EJA .
Trends in clinical breast density assessment from the Breast Cancer Surveillance Consortium.
J Natl Cancer Inst 2019 Jun;111(6):629-32. doi: 10.1093/jnci/djy210..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Imaging, Women
Hoover DS, Pappadis MR, Housten AJ
Preferences for communicating about breast cancer screening among racially/ethnically diverse older women.
The purpose of this study was to examine preferences for communicating about screening mammography among racially/ethnically diverse older women. Through in-depth interviews, findings revealed that older women desire information about the benefits and harms of screening mammography and would prefer to learn this information through discussions with healthcare providers and multiple other formats. Results were consistent regardless of participants' age, race/ethnicity, or education.
AHRQ-funded; HS022134.
Citation: Hoover DS, Pappadis MR, Housten AJ .
Preferences for communicating about breast cancer screening among racially/ethnically diverse older women.
Health Commun 2019 Jun;34(7):702-06. doi: 10.1080/10410236.2018.1431026..
Keywords: Cancer, Cancer: Breast Cancer, Clinician-Patient Communication, Communication, Elderly, Women, Prevention, Racial and Ethnic Minorities, Screening
O'Leary MC, Lich KH, Gu Y
Colorectal cancer screening in newly insured Medicaid members: a review of concurrent federal and state policies.
The goal of this study was to determine the impact of national and state policies enacted to increase access to Medicaid and to promote colorectal cancer (CRC) screening on newly enrolled, age-eligible Oregon Medicaid beneficiaries. 2010 - 2015 Oregon Medicaid claims data was used to conduct a cohort analysis of enrollees who turned 50 and became age-eligible for CRC screening. Individuals newly enrolled in Medicaid in 2013 or 2014 were more likely to initiate CRC screening than those enrolled by 2010, associated with the timing of policies such as Medicaid expansion and federal matching for preventive services. A primary care visit during the calendar year, one or more chronic conditions, and Hispanic ethnicity were also associated with CRC screening initiation.
AHRQ-funded; HS022981.
Citation: O'Leary MC, Lich KH, Gu Y .
Colorectal cancer screening in newly insured Medicaid members: a review of concurrent federal and state policies.
BMC Health Serv Res 2019 May 9;19(1):298. doi: 10.1186/s12913-019-4113-2..
Keywords: Access to Care, Cancer, Cancer: Colorectal Cancer, Medicaid, Policy, Prevention, Screening
Giess CS, Wang A, Ip IK
Patient, radiologist, and examination characteristics affecting screening mammography recall rates in a large academic practice.
This retrospective study examined patient, radiologist and examination characteristics affecting screening mammography recall rates. This study used 61,198 examinations from an academic center and two outpatient centers from October 1, 2012 to May 31, 2015. Radiologists’ risk aversion, stress from uncertainty, and malpractice concerns and cancer detection rates were derived from the survey. Their annual screening volumes, clinical experience, and concentration in breast imaging was calculated. About 9.3% of screening examinations were recalled. There was no association found with radiologists’ risk aversion, stress from uncertainty, malpractice concerns and cancer detection rates and high recall rates. The most variation was found with radiologists’ annual reading volume and experience.
AHRQ-funded; HS24722.
Citation: Giess CS, Wang A, Ip IK .
Patient, radiologist, and examination characteristics affecting screening mammography recall rates in a large academic practice.
J Am Coll Radiol 2019 Apr;16(4 Pt A):411-18. doi: 10.1016/j.jacr.2018.06.016..
Keywords: Cancer, Cancer: Breast Cancer, Diagnostic Safety and Quality, Imaging, Prevention, Screening, Women
Tina Shih YC, Dong W, Xu Y
Assessing the cost-effectiveness of updated breast cancer screening guidelines for average-risk women.
The goal of this study was to evaluate the cost-effectiveness of recently updated US-based mammography screening guidelines. Researchers developed a microsimulation model to generate the natural history of invasive breast cancer and capture how screening and treatment modified the natural course of the disease, and used the model to assess the cost-effectiveness of screening strategies. Results indicated that the hybrid screening strategy that starts annual mammography at the age of 45 years and switches to biennial screening between the ages of 55 and 75 years was the most cost-effective.
AHRQ-funded; HS020263.
Citation: Tina Shih YC, Dong W, Xu Y .
Assessing the cost-effectiveness of updated breast cancer screening guidelines for average-risk women.
Value Health 2019 Feb;22(2):185-93. doi: 10.1016/j.jval.2018.07.880..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Evidence-Based Practice, Prevention, Healthcare Costs
Singal AG, Tiro JA, Murphy CC
Mailed outreach invitations significantly improve HCC surveillance rates in patients with cirrhosis: a randomized clinical trial.
Mailed outreach invitations significantly improve HCC surveillance rates in patients with cirrhosis: a randomized clinical trial.
Hepatology 2019 Jan;69(1):121-30. doi: 10.1002/hep.30129.
In this study, the investigators compared the effectiveness of mailed outreach and patient navigation strategies to increase hepatocellular carcinoma (HCC) surveillance in a racially diverse cohort of patients with cirrhosis. They conducted a pragmatic randomized clinical trial comparing mailed outreach for screening ultrasound, mailed outreach plus patient navigation, or usual care with visit-based screening. The investigators concluded that mailed outreach invitations and navigation significantly increased HCC surveillance versus usual care in patients with cirrhosis.
Hepatology 2019 Jan;69(1):121-30. doi: 10.1002/hep.30129.
In this study, the investigators compared the effectiveness of mailed outreach and patient navigation strategies to increase hepatocellular carcinoma (HCC) surveillance in a racially diverse cohort of patients with cirrhosis. They conducted a pragmatic randomized clinical trial comparing mailed outreach for screening ultrasound, mailed outreach plus patient navigation, or usual care with visit-based screening. The investigators concluded that mailed outreach invitations and navigation significantly increased HCC surveillance versus usual care in patients with cirrhosis.
AHRQ-funded; HS022418.
Citation: Singal AG, Tiro JA, Murphy CC .
Mailed outreach invitations significantly improve HCC surveillance rates in patients with cirrhosis: a randomized clinical trial.
Hepatology 2019 Jan;69(1):121-30. doi: 10.1002/hep.30129..
Keywords: Cancer, Racial and Ethnic Minorities, Prevention, Comparative Effectiveness, Screening