National Healthcare Quality and Disparities Report
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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
26 to 50 of 176 Research Studies DisplayedSimpson RL, Lee JA, Li Y
Medicare meets the cloud: the development of a secure platform for the storage and analysis of claims data.
This case report outlines the development and implementation of Amazon Web Services (AWS) at Emory University to securely store and analyze research data from the Centers for Medicare and Medicaid Services (CMS). Several interdisciplinary teams collaborated and ensured compliance with CMS policy. Results showed successful transition to a cloud-based environment with enhanced security measures and regular review processes. User training addressed cloud computing challenges. Lessons learned from challenges benefited CMS and interdisciplinary teams university-wide.
AHRQ-funded; HS026232.
Citation: Simpson RL, Lee JA, Li Y .
Medicare meets the cloud: the development of a secure platform for the storage and analysis of claims data.
JAMIA Open 2024 Apr; 7(1):ooae007. doi: 10.1093/jamiaopen/ooae007.
Keywords: Medicare, Health Information Technology (HIT)
Carey K, Cole MB
Mental health care provision in community health centers and hospital emergency department utilization.
This study examined whether community health centers (CHCs) are effective in offsetting mental health emergency department (ED) visits. The study used the HRSA Uniform Data System and the HCUP State ED Databases for Florida patients during 2012-2019. The authors identified CHC-year-specific service areas using patient origin zip codes, and then estimated panel data models for number of ED mental health visits per capita in a CHC's service area. During 2012-2019, CHC mental health utilization increased 100%. There were small reductions in ED mental health utilization associated with increased CHC mental health provision. An annual increase of 1000 CHC mental health care visits (5%) was associated with 0.44% fewer ED mental health care visits, and an increase of 1000 CHC mental health care patients (15%) with 1.9% fewer ED mental health care visits. An increase of 1 annual mental health visit per patient was associated with 16% fewer ED mental health care visits.
AHRQ-funded; HS028054.
Citation: Carey K, Cole MB .
Mental health care provision in community health centers and hospital emergency department utilization.
Health Serv Res 2024 Apr; 59(2):e14283. doi: 10.1111/1475-6773.14283..
Keywords: Healthcare Cost and Utilization Project (HCUP), Community-Based Practice, Behavioral Health, Emergency Department, Healthcare Utilization
Bradford W, Akselrod H, Bassler J
Hospitalization is a missed opportunity for HIV screening, pre-exposure prophylaxis, and treatment.
This multisite, retrospective cohort study of hospitalized patients with opioid use disorder with infectious complications of injection drug use looked at rates of HIV screening, pre-exposure prophylaxis, and treatment among these patients. The authors included 322 patients, with most (300) now known to have HIV. Of those, only 2 had a documented discussion of PrEP, while only 1 was prescribed PrEP on discharge. Among the 22 people with HIV (PWH), only 13 had a viral load collected during admission of whom all were viremic and 10 were successfully linked to care post-discharge. Both groups had high rates of readmission, Medicaid or uninsured status, and unstable housing.
AHRQ-funded; HS013852.
Citation: Bradford W, Akselrod H, Bassler J .
Hospitalization is a missed opportunity for HIV screening, pre-exposure prophylaxis, and treatment.
Addict Sci Clin Pract 2024 Mar 26; 19(1):22. doi: 10.1186/s13722-024-00451-z..
Keywords: Human Immunodeficiency Virus (HIV), Screening, Prevention, Inpatient Care
Carrel M, Shi Q, Clore GS
Assessing the potential for improved predictive capacity of antimicrobial resistance in outpatient Staphylococcus aureus isolates using seasonal and spatial antibiograms.
This study looked at the potential for improved predictive capacity of antimicrobial resistance in outpatient Staphylococcus aureus isolates using seasonal and spatial anagrams. A total of 338,681 S. aureus isolates were obtained in Veterans Health Administration (VHA) outpatient settings from 2010 to 2019, and 6,817 isolates were obtained in University of Iowa Hospitals and Clinics outpatient settings from 2014 to 2019. Standard, seasonal, and spatial antibiograms were created for five commonly used antibiotic classes: cephalosporins, clindamycin, macrolides, tetracycline, trimethoprim/sulfamethoxazole. All models were found to have low predictive capacity, with areas under the curve of <0.7.
AHRQ-funded; HS027472.
Citation: Carrel M, Shi Q, Clore GS .
Assessing the potential for improved predictive capacity of antimicrobial resistance in outpatient Staphylococcus aureus isolates using seasonal and spatial antibiograms.
Antimicrob Resist Infect Control 2024 Mar 22; 13(1):34. doi: 10.1186/s13756-024-01388-3..
Keywords: Antibiotics, Medication
Mazurenko O, Hirsh AT, Harle CA
Health-related social needs information in the emergency department: clinician and patient perspectives on availability and use.
The purpose of this qualitative study was to assess what health-related social needs (HRSN) information is available to emergency department (ED) physicians and staff, and how HRSN-related clinical actions align with patient expectations. Researchers conducted in-depth semi-structured interviews guided by HRSN literature, the 5 Rights of Clinical Decision Support (CDS) framework, and the Contextual Information Model. Participants were ED providers, staff, and patients from a health system in the mid-Western U.S. Three themes were identified: HRSN availability, means of collection, and usage. Patients and ED providers and staff differed in their perspectives on how HSRNs should be collected and acted upon. The researchers concluded that accounting for differences in clinical and administrative decisions will be critical for patient acceptance and effective usage of HSRN information.
AHRQ-funded; HS028008.
Citation: Mazurenko O, Hirsh AT, Harle CA .
Health-related social needs information in the emergency department: clinician and patient perspectives on availability and use.
BMC Emerg Med 2024 Mar 18; 24(1):45. doi: 10.1186/s12873-024-00959-2..
Keywords: Emergency Department, Healthcare Delivery, Care Coordination
Jeffery AD, Fabbri D, Reeves RM
Use of noisy labels as weak learners to identify incompletely ascertainable outcomes: a Feasibility study with opioid-induced respiratory depression.
Researchers examined whether ‘noisy’ labels generated from subject matter experts' heuristics using heterogenous data types could provide outcomes labels to a large, observational data set. De-identified electronic health records of over 52,000 post-operative encounters were applied to a data programming paradigm for the development of a machine learning classifier for opioid-induced respiratory depression. All confirmed cases were identified by the classifier. The researchers noted that this finding is encouraging for rare outcomes because it reduces manual reviews needed by excluding visits/patients with low probabilities. They concluded that the application of a data programming paradigm with expert-informed labeling functions might be used for phenotyping clinical phenomena easily ascertainable from highly structured data.
AHRQ-funded; HS026395.
Citation: Jeffery AD, Fabbri D, Reeves RM .
Use of noisy labels as weak learners to identify incompletely ascertainable outcomes: a Feasibility study with opioid-induced respiratory depression.
Heliyon 2024 Mar 15; 10(5):e26434. doi: 10.1016/j.heliyon.2024.e26434..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT)
Aghaei P, Bayramzadeh S
Clinicians’ experience with technology within the physical environment of trauma rooms: a focus group study.
This study’s objective was to investigate how trauma team members perceive technological equipment and tools in the trauma room (TR) environment and to identify how the technological equipment could be optimized in relation to the TR’s space. The authors conducted a total of 21 focus group sessions with 69 trauma team members, all of whom worked in Level I TRs from six teaching hospitals in the USA. Findings were analyzed and categorized into three parent themes: imaging equipment, assistive devices, and room features. The results suggest that trauma team members place high importance on the availability and versatility of the technological equipment in the TR environment. CT-scanners were not usually optimized for easy access to the TR. Other suggestions included the implementation of cameras and screens to accommodate situation awareness, and the rapid sharing of data such as imaging results. This study will inform health-care designers with the knowledge they need to make informed decisions when designing TRs. It covers key considerations such as room layout, equipment selection, lighting and controls.
AHRQ-funded; HS027261.
Citation: Aghaei P, Bayramzadeh S .
Clinicians’ experience with technology within the physical environment of trauma rooms: a focus group study.
Facilities 2024 Mar 12. 2024/02/14..
Keywords: Workflow, Teams, Emergency Department, Trauma
Chen MA, Rubinson C, O'Donnell EM
High-performing teamlets in primary care: a qualitative comparative analysis.
This study’s purpose was to identify the characteristics of high-performing primary care teamlets, defined as teamlets with low rates of ambulatory care sensitive emergency department (ACSED) visits and ambulatory care sensitive hospital admissions (ACSAs). Teamlets consist of a primary care clinician who works consistently with the same clinical staff member. The authors conducted 26 individual qualitative interviews with physicians and their teamlet staff members across 13 teamlets. They identified, calibrated, and analyzed potentially important characteristics related to high-performing primary care teamlets using qualitative comparative analysis (QCA). Key characteristics identified in teamlets with low rates of ACSED visits and to a lesser extent ACSAs were staff proactiveness in anticipating physician needs and physician-reported trust in their staff member.
AHRQ-funded; HS025716.
Citation: Chen MA, Rubinson C, O'Donnell EM .
High-performing teamlets in primary care: a qualitative comparative analysis.
J Am Board Fam Med 2024 Mar 11; 37(1):105-11. doi: 10.3122/jabfm.2023.230105R1..
Keywords: Primary Care, Teams
Hershberger PJ, Pei Y, Bricker DA
Motivational interviewing skills practice enhanced with artificial intelligence: ReadMI.
The authors developed a software-based training tool, Real-time Assessment of Dialogue in Motivational Interviewing (ReadMI), to advance the skills acquisition of medical students learning the MI approach. Third-year medical students in their Family Medicine clerkship participated in a 90-minute MI training session; intervention group students received both facilitator feedback and ReadMI metrics, while control group students received only facilitator feedback. Both groups improved their MI approach, but those in the intervention group used significantly more open-ended questions, fewer closed-ended questions, and had a higher ratio of open to closed questions. The authors concluded that MI skills practice can be gained with relatively small investment of student time, and that artificial intelligence can be used for both measuring MI skill acquisition and as an instructional aid.
AHRQ-funded; HS026548.
Citation: Hershberger PJ, Pei Y, Bricker DA .
Motivational interviewing skills practice enhanced with artificial intelligence: ReadMI.
BMC Med Educ 2024 Mar 5; 24(1):237. doi: 10.1186/s12909-024-05217-4..
Keywords: Health Information Technology (HIT), Education: Academic
Bernstein EY, Bernstein TP, Trivedi S
Outcomes after initiation of medications for alcohol use disorder at hospital discharge.
This study looked at outcomes after initiation of medications for alcohol use disorder (MAUD), which are very underutilized. The primary outcome was a composite of all-cause mortality or return to hospital within 30 days of discharge. Secondary outcomes included the previous components separately, return to hospital for alcohol-related diagnoses, and primary care or mental health follow-up within 30 days of discharge. There were 6794 unique individuals representing 9834 alcohol-related hospitalizations (median [IQR] age, 54 years; 3205 hospitalizations among females [32.6%]; 1754 hospitalizations among Black [17.8%], 712 hospitalizations among Hispanic [7.2%], and 7060 hospitalizations among White [71.8%] patients). Of these, 2% of hospitalizations involved discharged MAUD initiation. Discharge MAUD initiation was associated with a 42% decreased incidence of the primary outcome (incident rate ratio, 0.58). These findings were consistent among secondary outcomes (eg, incident rate ratio for all-cause return to hospital, 0.56) except for mortality, which was rare in both groups. Discharge MAUD initiation was associated with a 51% decreased incidence of alcohol-related return to hospital.
AHRQ-funded; HS026215.
Citation: Bernstein EY, Bernstein TP, Trivedi S .
Outcomes after initiation of medications for alcohol use disorder at hospital discharge.
JAMA Netw Open 2024 Mar 4; 7(3):e243387. doi: 10.1001/jamanetworkopen.2024.3387..
Keywords: Medication, Alcohol Use, Substance Abuse, Behavioral Health, Outcomes, Hospital Discharge
Jiang Henke, RM RM, Fingar KR
AHRQ Author: Jiang HJ, Liang
Mortality for time-sensitive conditions at urban vs rural hospitals during the COVID-19 pandemic.
The objectives of this interrupted time-series analysis cohort study were to examine whether in-hospital mortality not related to COVID-19 changed during the pandemic for time-sensitive conditions and to assess variations by urban versus rural hospital location. Data for adult discharges from 3813 U.S. hospitals was taken from the HCUP State Inpatient Databases. The results indicated that in-hospital mortality for time-sensitive conditions increased during the COVID-19 pandemic, for sepsis, pneumonia in both rural and urban hospitals, acute myocardial infarction and gastrointestinal hemorrhage at urban hospitals, and hip fracture at rural hospitals. No significant change was found in mortality for stroke overall. The researchers concluded that strategies tailored to differing needs of urban and rural hospitals may help reduce the likelihood of excess deaths during future public health crises.
AHRQ-authored; AHRQ-funded; 290201800001C.
Citation: Jiang Henke, RM RM, Fingar KR .
Mortality for time-sensitive conditions at urban vs rural hospitals during the COVID-19 pandemic.
JAMA Netw Open 2024 Mar 4; 7(3):e241838. doi: 10.1001/jamanetworkopen.2024.1838..
Keywords: Healthcare Cost and Utilization Project (HCUP), COVID-19, Mortality, Rural Health, Urban Health, Rural/Inner-City Residents
Daw JR, MacCallum-Bridges CL, Kozhimannil KB
Continuous Medicaid eligibility during the COVID-19 pandemic and postpartum coverage, health care, and outcomes.
This study’s objective was to evaluate the association of continuous Medicaid eligibility due to the Families First Coronavirus Response Act (FFCRA) during the COVID-19 public health emergency (PHE) with postpartum health insurance, health care use, breastfeeding, and depressive symptoms. This cohort study included 47,716 respondents from the Pregnancy Risk Assessment Monitoring System (PRAMS) comparing 21 states with continuous prepolicy (2017-2019) and postpolicy (2020-2021) participation. Based on adjusted estimates, a 100% federal poverty level (FPL) increase in postpartum Medicaid eligibility was associated with a 5.1 percentage point (pp) increase in reported postpartum Medicaid enrollment, no change in commercial coverage, and a 6.6 pp decline in uninsurance, which represents a 40% reduction in postpartum uninsurance after a Medicaid-paid birth compared with the prepolicy baseline of 16.7%. Continuous Medicaid eligibility during the COVID-19 PHE was associated with significantly reduced postpartum uninsurance for people with Medicaid-paid births, but was not associated with postpartum visit attendance, contraception use, breastfeeding, or depressive symptoms at approximately 4 months postpartum. Uninsurance reductions were observed only among White and Black non-Hispanic individuals and Hispanic individuals had no change with no policy-associated changes in other outcomes.
AHRQ-funded; HS029159.
Citation: Daw JR, MacCallum-Bridges CL, Kozhimannil KB .
Continuous Medicaid eligibility during the COVID-19 pandemic and postpartum coverage, health care, and outcomes.
JAMA Health Forum 2024 Mar; 5(3):e240004. doi: 10.1001/jamahealthforum.2024.0004..
Keywords: COVID-19, Medicaid, Maternal Care, Women, Access to Care
Bratches RWR, Onsando W, Puga F
Family caregiver comfort with telehealth technologies: differences by race and ethnicity in a cross-sectional survey.
This study’s objective was to analyze a demographically representative survey of U.S. family caregivers to understand the level of comfort using telehealth technologies among family caregivers. The authors conducted a secondary analysis of survey data collected during the COVID-19 pandemic in 2020. Likert-style questions were used to determine the level of caregiver comfort using computers, smartphones, and tablets. There was a total of 340 caregivers included in the analysis. Compared with non-Hispanic white caregivers, Asian caregivers had higher odds (odds ratio [OR] 3.1) of expressing comfort using computers; black caregivers (OR 0.46) and Hispanic caregivers (OR 0.36) expressed lower odds of comfort using smartphones; and Asian caregivers had higher odds (OR 4.64) of expressing comfort using tablets.
AHRQ-funded; HS013852.
Citation: Bratches RWR, Onsando W, Puga F .
Family caregiver comfort with telehealth technologies: differences by race and ethnicity in a cross-sectional survey.
Telemed J E Health 2024 Mar; 30(3):685-91. doi: 10.1089/tmj.2023.0314..
Keywords: Telehealth, Health Information Technology (HIT), Caregiving, Racial and Ethnic Minorities
Chen VW, Rosen T, Dong Y
Case sampling for evaluating hospital postoperative morbidity in US surgical quality improvement programs.
This study examined whether US surgical quality improvement (QI) programs using case sampling is robust enough for identifying hospitals with higher than expected complications. Eligible patients were 18 years and older who underwent a noncardiac operation at US Department of Veterans Affairs (VA) hospitals with a record in the VA Surgical Quality Improvement Program (systematic sample) and the VA Corporate Data Warehouse surgical domain (100% of surgical cases). Most patients in both samples were men (90.2% vs 91.2%) and White (74.7% vs 74.5%). Overall, 30-day complication rates were 7.6% and 5.3% for the sample and universal review cohorts, respectively. Using over 2145 hospital quarters of data, hospitals were identified as an outlier in 15.0% of quarters using the sample and 18.2% with universal review. Average hospital quarterly complication rates were 4.7% for outliers identified using the sample only, 7.2% for universal only, and 7.4% for concurrent identification in both sources. For nonsampled cases, average hospital quarterly complication rates were 7.0% at outliers and 4.4% at nonoutliers. Among outlier hospital quarters in the sample, 54.2% were concurrently identified with universal review, and for those identified with universal review, 44.6% were concurrently identified using the sample.
AHRQ-funded; HS028560.
Citation: Chen VW, Rosen T, Dong Y .
Case sampling for evaluating hospital postoperative morbidity in US surgical quality improvement programs.
JAMA Surg 2024 Mar; 159(3):315-22. doi: 10.1001/jamasurg.2023.6524..
Keywords: Surgery, Quality Improvement, Quality of Care, Hospitals
Lang K, Atchison TJ, Singh P
Describing the monthly variability of hospital-onset Clostridioides difficile during early coronavirus disease 2019 (COVID-19) using electronic health record data.
The objectives of this retrospective cohort study were to assess the relative risk of hospital-onset Clostridioides difficile (HO-CDI) during the early months of the coronavirus 2019 (COVID-19) pandemic and to compare it with historical expectation based on patient characteristics. Secondary data was collected from the Ohio State University Wexner Medical Center electronic health records on adult patients admitted to the inpatient setting between January 2018 and May 2021. The results indicated that variations in HO-CDI incidence seemed to trend with COVID-19 incidence, but were not fully explained by the study’s case mix. The authors concluded that other factors contributing to variability in HO-CDI incidence needed to be explored.
AHRQ-funded; HS027200.
Citation: Lang K, Atchison TJ, Singh P .
Describing the monthly variability of hospital-onset Clostridioides difficile during early coronavirus disease 2019 (COVID-19) using electronic health record data.
Infect Control Hosp Epidemiol 2024 Mar; 45(3):329-34. doi: 10.1017/ice.2023.171.
Keywords: Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), COVID-19, Infectious Diseases
Lin JS, Webber EM, Bean SI
Development of a health equity framework for the US Preventive Services Task Force.
The objective of this study was to develop a framework to allow the U.S. Preventive Services Task Force (USPSTF) to incorporate a health equity lens spanning the entirety of its recommendation-making process. Key guidance, policy, and explanatory frameworks related to health equity were identified, and their recommendations and findings mapped to current USPSTF methods. An equity framework was developed that could be applied to all phases of the recommendation process. The authors concluded that executing this framework will be challenging and take additional time and resources, but it will offer guidance to the USPSTF and other evidence-based guideline entities in developing a more transparent, consistent, and intentional approach to addressing health equity in their recommendations.
AHRQ-funded; 75Q80121C00001.
Citation: Lin JS, Webber EM, Bean SI .
Development of a health equity framework for the US Preventive Services Task Force.
JAMA Netw Open 2024 Mar 4; 7(3):e241875. doi: 10.1001/jamanetworkopen.2024.1875..
Keywords: U.S. Preventive Services Task Force (USPSTF), Disparities, Evidence-Based Practice, Guidelines
Goldman S, Zhao J, Bieber B
Gastric acid suppression therapy and its association with peritoneal dialysis-associated peritonitis in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS).
This study’s goal was to determine whether gastric acid suppression (GAS) (proton pump inhibitor (PPI) or histamine-2 receptor antagonists (H2RA)) use was associated with all-cause and organism-specific peritonitis in peritoneal dialysis (PD) patients. The authors used data from the Peritoneal Dialysis Outcomes and Practice Patterns Study (595 facilities, 8 countries, years 2014-2022), and associations between GAS use and time to first episode of all-cause peritonitis was examined. Out of a total of 23,797 baseline study patients, 6020 (25.3%) used PPIs, and 1382 (5.8%) used H2RAs. Overall risks of GAS use and peritonitis risk [adjusted hazard ratio (AHR)=1.05), and use of PPI (AHR 1.06) or H2RA (AHR 1.02) did not reach statistical significance. In organism-specific analyses, GAS users displayed higher peritonitis risks for gram-negative (AHR 1.29), gram-positive (AHR 1.15), culture-negative (AHR 1.20), enteric (AHR 1.23), and particularly Streptococcal (AHR 1.47) peritonitis episodes. GAS was also associated with higher overall mortality (AHR 1.13).
AHRQ-funded; HS025756.
Citation: Goldman S, Zhao J, Bieber B .
Gastric acid suppression therapy and its association with peritoneal dialysis-associated peritonitis in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS).
Kidney360 2024 Mar 1; 5(3):370-79. doi: 10.34067/kid.0000000000000325..
Keywords: Kidney Disease and Health, Adverse Events, Risk
Mao Y, Li Y, McGarry B
Home time and state regulations among Medicare beneficiaries in assisted living communities.
The objectives of this study were to assess variation in home time among assisted living (AL) residents in the year following admission and to examine associations with state regulations for direct care workers (DCW) training and staffing and for licensed nurse staffing. The study sample included new Medicare beneficiary residents in over 12,000 AL facilities. Findings showed that home time varied substantially among AL residents depending on resident characteristics and state-level regulatory specificity; residents eligible for Medicare and Medicaid had shorter home time than the Medicare-only residents. The authors concluded that their findings could guide AL operators and state legislators toward improvements in this important quality of life metric.
AHRQ-funded; HS026893.
Citation: Mao Y, Li Y, McGarry B .
Home time and state regulations among Medicare beneficiaries in assisted living communities.
J Am Geriatr Soc 2024 Mar; 72(3):742-52. doi: 10.1111/jgs.18709..
Keywords: Medicare, Policy, Long-Term Care, Quality of Life
Lee YSH, Grob R, Nembhard I
Leveraging patients' creative ideas for innovation in health care.
The authors of this article developed and assessed a methodological strategy to validate question wording that elicits ideas from patients. Testing strategies involved 600 patients from New York state. The authors noted that patients generated more actionable and creative ideas when explicitly invited, especially patients with negative health care experiences, patients from minority racial/ethnic backgrounds or with chronic illness. Responses focused on solving challenges, proposing interventions, highlighting exceptional practices, and expressing hopes for the future. This data can be used by health care organizations in health care delivery and quality improvement, and policymakers should consider use of narrative feedback to better understand and respond to patients' experiences.
AHRQ-funded; HS016978.
Citation: Lee YSH, Grob R, Nembhard I .
Leveraging patients' creative ideas for innovation in health care.
Milbank Q 2024 Mar; 102(1):233-69. doi: 10.1111/1468-0009.12682..
Keywords: Learning Health Systems, Patient-Centered Healthcare
Hughes PM, Easterly CW, Thomas K
North Carolina Medicaid system perspectives on substance use disorder treatment policy changes during the COVID-19 pandemic.
This study’s objective was to describe perspectives from stakeholders involved in North Carolina’s Medicaid system on substance use disorder (SUD) treatment policy changes during the COVID pandemic. Researchers conducted semi-structured interviews with state agency representatives, Medicaid managed care organizations and providers, as well as three focus groups of Medicaid beneficiaries with SUD. Responses indicated that policy changes such as telehealth and take-home methadone were overall considered beneficial; staffing shortages, however, remained a substantial barrier. The researchers concluded that the policy changes should be continued, but additional steps are needed to ensure payment parity for telehealth services.
AHRQ-funded; HS000032.
Citation: Hughes PM, Easterly CW, Thomas K .
North Carolina Medicaid system perspectives on substance use disorder treatment policy changes during the COVID-19 pandemic.
J Addict Med 2024 Mar-Apr; 18(2):e1-e7. doi: 10.1097/adm.0000000000001272..
Keywords: COVID-19, Medicaid, Substance Abuse, Behavioral Health, Policy
Feinberg E, Eilenberg JS
Role of community health workers in promoting health equity in pediatrics.
This progress report describes 2 pilot RCTs that examined the feasibility and acceptability of using a community health worker (CHW) implemented intervention as a strategy to improve timely completion of autism diagnostic evaluations among young children from historically marginalized communities. The authors describe the research that has been published on the topic since they submitted their original study report on November 17, 2019. Their team conducted a subsequent large multisite RCT (“Project EARLY”) as part of National Institute of Mental Health’s Autism Spectrum Disorder Pediatric Early Detection, Engagement and Services Network, whose aim was to develop and test interventions that coordinate early autism screening, evaluation, and engagement in services. Their findings confirmed the efficacy of family navigation to reduce time to autism diagnostic resolution while also uncovering family navigation’s differential impact by ethnicity. Positive effects of using a CHW were significantly greater for Hispanic families compared to non-Hispanic families, suggesting that the intervention may be an effective strategy to reduce disparities by minoritized subgroups. The authors also discussed recent funding through grants, and the fact that Medicaid reimburses CHWs for patient education and health care navigation in 29 US states. They also discuss future directions for investigating the impact of CHWs on autism outcomes specifically, and child well-being more generally.
AHRQ-funded; HS022155.
Citation: Feinberg E, Eilenberg JS .
Role of community health workers in promoting health equity in pediatrics.
Acad Pediatr 2024 Mar; 24(2):199-200. doi: 10.1016/j.acap.2023.09.005..
Keywords: Children/Adolescents, Disparities, Access to Care
Levander XA, VanDerSchaaf H, Barragán VG
The role of human-centered design in healthcare innovation: a digital health equity case study.
This article described a human-centered design (HCD) approach to developing solutions to health care delivery technology issues that may exacerbate existing disparities. HCD used collaborative, team-based, and empathetic approaches focused on end-user experiences. The authors shared lessons learned about implementing HCD into clinical care settings and how HCD can result in developing site-specific, patient-centered innovations to address disparities and to improve digital health equity.
AHRQ-funded; HS026370.
Citation: Levander XA, VanDerSchaaf H, Barragán VG .
The role of human-centered design in healthcare innovation: a digital health equity case study.
J Gen Intern Med 2024 Mar; 39(4):690-95. doi: 10.1007/s11606-023-08500-0..
Keywords: Telehealth, COVID-19, Health Information Technology (HIT)
Gurewitsch Allen E
Prescriptive and proscriptive lessons for managing shoulder dystocia: a technical and videographical tutorial.
This tutorial employs illustrations and videos of simulated and actual deliveries to demonstrate the biomechanical principles of specialized delivery maneuvers for intrapartum management of shoulder dystocia and to examine mistakes associated with brachial plexus injury. The tutorial presents a stepwise approach that focuses on the delivering clinician's tasks while including the role of assistive techniques. Demonstrations of each maneuver are accompanied by specific examples of what not to do.
AHRQ-funded; HS026689.
Citation: Gurewitsch Allen E .
Prescriptive and proscriptive lessons for managing shoulder dystocia: a technical and videographical tutorial.
Am J Obstet Gynecol 2024 Mar; 230(3S):S1014-s26. doi: 10.1016/j.ajog.2022.03.016..
Keywords: Maternal Care, Newborns/Infants
Rosenberg SM, McCue S, He J
Alliance A151945: accrual and characteristics of adolescent and young adult patients in Alliance trials from 2000 to 2017.
Alliance trials analyzed factors influencing clinical trial enrollment among adolescents and young adults (AYAs) with cancer. Among 188 Alliance trials, AYAs comprised 11% of accrual, varying by cancer type. Hispanic and non-White AYAs were more represented in breast and colorectal cancer trials compared to non-AYAs. Disease characteristics differed by age in selected trials. AYA-specific survival showed no significant age-based differences. The results emphasize the challenge of ensuring equitable access to trials for AYAs.
AHRQ-funded; HS023680.
Citation: Rosenberg SM, McCue S, He J .
Alliance A151945: accrual and characteristics of adolescent and young adult patients in Alliance trials from 2000 to 2017.
Cancer 2024 Mar 1; 130(5):750-69. doi: 10.1002/cncr.35078.
Keywords: Children/Adolescents, Cancer
Neerland C, Slaughter-Acey J, Behrens K
An evidence map for social and structural determinants for maternal morbidity and mortality: a systematic review.
The study aimed to identify social and structural determinants of maternal morbidity and mortality during prenatal and postpartum periods in the U.S. Out of 8,378 references screened, 118 studies were included, covering domains like identity, socioeconomic factors, violence, and trauma. Findings revealed mixed patterns between risk factors and outcomes, with notable attention to depression and mental health. Advancing the field long-term should involve developing comprehensive datasets to thoroughly investigate intersections with biological and medical risk factors.
AHRQ-funded; 75Q80120D00008.
Citation: Neerland C, Slaughter-Acey J, Behrens K .
An evidence map for social and structural determinants for maternal morbidity and mortality: a systematic review.
Obstet Gynecol 2024 Mar; 143(3):383-92. doi: 10.1097/aog.0000000000005489.
Keywords: Social Determinants of Health, Maternal Care, Mortality, Evidence-Based Practice, Risk, Women, Outcomes