National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (1)
- Cancer (7)
- Cancer: Skin Cancer (1)
- Cardiovascular Conditions (2)
- Care Coordination (1)
- Caregiving (2)
- Children/Adolescents (2)
- Chronic Conditions (3)
- Community-Based Practice (1)
- Comparative Effectiveness (1)
- Dementia (1)
- Disparities (1)
- Elderly (1)
- Healthcare Cost and Utilization Project (HCUP) (1)
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- Inpatient Care (2)
- Long-Term Care (1)
- Medicare (1)
- Medication (1)
- Nursing Homes (2)
- Opioids (1)
- Outcomes (2)
- Pain (2)
- (-) Palliative Care (17)
- Patient-Centered Outcomes Research (2)
- Patient Experience (1)
- Practice Patterns (1)
- Provider: Physician (1)
- Quality Improvement (2)
- Quality Measures (1)
- Quality of Care (3)
- Quality of Life (2)
- Racial and Ethnic Minorities (2)
- Research Methodologies (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 17 of 17 Research Studies DisplayedCzosek RJ, Anderson JB, Baskar S
Predictors and outcomes of heart block during surgical stage I palliation of patients with a single ventricle: a report from the NPC-QIC.
This study investigated patient and surgical risks of heart block and its effect on 12-month transplant-free survival in children with a single ventricle. In total, 1423 patients were identified from the National Pediatric Cardiology Improvement Collaborative with and without heart block. One-year outcomes were analyzed. A very small percentage (2%) developed heart block during their surgical admission. Associated risk factors for block included heterotaxy syndrome and atrial flutter/fibrillation. Patients with complete heart block had lower 12-month survival, which wasn’t true for patients with second degree block. At 12 months of age, 43% of patients with heart block died and were more likely to experience mortality than patients without heart block.
AHRQ-funded; HS021114.
Citation: Czosek RJ, Anderson JB, Baskar S .
Predictors and outcomes of heart block during surgical stage I palliation of patients with a single ventricle: a report from the NPC-QIC.
Heart Rhythm 2021 Nov;18(11):1876-83. doi: 10.1016/j.hrthm.2021.05.019..
Keywords: Children/Adolescents, Heart Disease and Health, Cardiovascular Conditions, Surgery, Palliative Care, Risk, Outcomes
Kaufmann TL, Getz KD, Hsu JY
Identification of patient-reported outcome phenotypes among oncology patients with palliative care needs.
This retrospective study used patient-reported outcome (PRO) data to characterize oncology patients with palliative care needs. The objective was to determine if PRO data can identify latent phenotypes that characterize indications for specialty palliative care referral. Self-reported symptoms were collected on the Edmonton Symptom Assessment Symptom from solid tumor oncology patients (n = 745) referred to outpatient palliative care at eight community and academic sites from October 2012 to October 2018. The authors identified four PRO phenotypes: low symptoms (39.6%); moderate pain/fatigue + mood (24.2%); moderate pain/fatigue + appetite + dypsnea (27%); and high symptoms (9.3%). A secondary analysis of 421 patients found that two brief items assessing social and existential needs aligned with higher severity symptoms and psychological distress phenotypes.
AHRQ-funded; HS023681.
Citation: Kaufmann TL, Getz KD, Hsu JY .
Identification of patient-reported outcome phenotypes among oncology patients with palliative care needs.
JCO Oncol Pract 2021 Oct;17(10):e1473-e88. doi: 10.1200/op.20.00849..
Keywords: Cancer, Palliative Care, Patient-Centered Outcomes Research, Outcomes
Enzinger AC, Ghosh K, Keating NL
US trends in opioid access among patients with poor prognosis cancer near the end-of-life.
This study looked at trends in opioid prescriptions for cancer patients near the end-of-life (EOL) defined as the 30 days before death or hospice enrollment. The authors looked at Medicare part D data from 2007 to 2017 for 270,632 Medicare fee-for-service decedents with poor prognosis cancers. During that time, the proportion of decedents with poor prognosis cancers receiving 1 or greater opioid prescriptions near EOL declined 15.5% and the proportion receiving 1 or greater long-acting opioid prescriptions declined 36.5% to 18.1%. The mean daily dose fell from 24.5%, from 85.6 morphine milligram equivalents per day (MMED) to 64.6. The total amount of opioids prescribed fell from 1,075 morphine milligram equivalents per decedent to 666 morphine milligram equivalents per decedents. At the same time, the proportion of patients with pain-related ED visits increase 50.8% from 13.2% to 19.9%.
AHRQ-funded; HS024072.
Citation: Enzinger AC, Ghosh K, Keating NL .
US trends in opioid access among patients with poor prognosis cancer near the end-of-life.
J Clin Oncol 2021 Sep 10;39(26):2948-58. doi: 10.1200/jco.21.00476..
Keywords: Cancer, Opioids, Palliative Care, Pain, Access to Care, Medication, Practice Patterns
Wells R, Dionne-Odom JN, Azuero A
Examining adherence and dose effect of an early palliative care intervention for advanced heart failure patients.
The objective of this study was to examine the "dose" effect of PC intervention completion vs. noncompletion on quality of life (QoL) and healthcare use in patients with advanced heart failure (HF) over 32 weeks. The investigators concluded that higher intervention completion rates of an early PC intervention was associated with QoL improvements in patients with advanced HF.
AHRQ-funded; HS013852.
Citation: Wells R, Dionne-Odom JN, Azuero A .
Examining adherence and dose effect of an early palliative care intervention for advanced heart failure patients.
J Pain Symptom Manage 2021 Sep;62(3):471-81. doi: 10.1016/j.jpainsymman.2021.01.136..
Keywords: Palliative Care, Heart Disease and Health, Cardiovascular Conditions, Quality of Life, Telehealth, Health Information Technology (HIT)
Wells RD, Guastaferro K, Azuero A
Applying the multiphase optimization strategy for the development of optimized interventions in palliative care.
This article provides a brief overview and application of Multiphase Optimization Strategy, a framework informed by engineering principles, that uses a systematic process to empirically identify an intervention comprised of components that positively contribute to desired outcomes under real-life constraints. The paper includes the authors’ insights from conducting a pilot factorial trial of an early palliative care intervention to enhance the decision support skills of advanced cancer family caregivers (Project CASCADE).
AHRQ-funded; HS013852.
Citation: Wells RD, Guastaferro K, Azuero A .
Applying the multiphase optimization strategy for the development of optimized interventions in palliative care.
J Pain Symptom Manage 2021 Jul;62(1):174-82. doi: 10.1016/j.jpainsymman.2020.11.017..
Keywords: Palliative Care, Research Methodologies
Bogetz JF, Revette A, DeCourcey DD
Clinical care strategies that support parents of children with complex chronic conditions.
This paper examines the best clinical care strategies that support parents of children with complex chronic conditions facing inpatient and end-of-life care in the ICU. Qualitative analysis of 21 open-response items from the cross-sectional “Survey of Caring for Children with Complex Chronic Conditions” was done. Open-ended responses from 110 of 114 survey respondents who were parents of children who received care at a large academic institution and died between 2006 and 2015 were analyzed. Most of the children had congenital/chromosomal complex chronic conditions and had died an average of 3.9 years prior to their parents’ study participation. The respondents emphasized the relational aspects of clinical care including inclusivity of their expertise on their child’s needs, recognition of their unique experiences as parents, and maintenance of connection with clinicians through bereavement.
AHRQ-funded; HS022986.
Citation: Bogetz JF, Revette A, DeCourcey DD .
Clinical care strategies that support parents of children with complex chronic conditions.
Pediatr Crit Care Med 2021 Jul;22(7):595-602. doi: 10.1097/pcc.0000000000002726..
Keywords: Children/Adolescents, Chronic Conditions, Palliative Care, Inpatient Care
Lee K, Gani F, Canner JK
Racial disparities in utilization of palliative care among patients admitted with advanced solid organ malignancies.
The primary objective of this study was to describe racial differences in the use of inpatient palliative care consultations (IPCC) for patients with advanced cancer who are admitted to a hospital in the United States. Hospital admissions of patients with advanced cancers were identified through the National Inpatient Dataset. Findings showed that death during hospitalization was a significant modifier of the relationship between race and receipt of palliative care consultation. There were significant racial disparities in the utilization of IPCC for patients with advanced cancer.
AHRQ-funded; HS024736.
Citation: Lee K, Gani F, Canner JK .
Racial disparities in utilization of palliative care among patients admitted with advanced solid organ malignancies.
Am J Hosp Palliat Care 2021 Jun;38(6):539-46. doi: 10.1177/1049909120922779..
Keywords: Healthcare Cost and Utilization Project (HCUP), Palliative Care, Cancer, Disparities, Racial and Ethnic Minorities, Healthcare Utilization, Inpatient Care, Chronic Conditions
Sedhom R, Nudotor R, Freund KM
Can community health workers increase palliative care use for African American patients? A pilot study.
African American patients with cancer underutilize advance care planning (ACP) and palliative care (PC). This feasibility study investigated whether community health workers (CHWs) could improve ACP and PC utilization for African American patients with advanced cancer. The investigators concluded that utilization of CHWs to address PC domains and social determinants of health was feasible. Although study enrollment was identified as a potential barrier, most recruited patients were retained on study.
AHRQ-funded; HS024736.
Citation: Sedhom R, Nudotor R, Freund KM .
Can community health workers increase palliative care use for African American patients? A pilot study.
JCO Oncol Pract 2021 Feb;17(2):e158-e67. doi: 10.1200/op.20.00574..
Keywords: Palliative Care, Community-Based Practice, Racial and Ethnic Minorities
Orth J, Li Y, Simning A
End-of-life care among nursing home residents with dementia varies by nursing home and market characteristics.
This study’s objectives were to examine variations in end-of-life (EOL) care/outcomes among decedents with Alzheimer's disease/related dementias (ADRD) and to identify associations with nursing home (NH)/market characteristics. Findings showed that decedents with ADRD in NHs that were nonprofit, had Alzheimer's units, higher licensed nurse staffing, and in more competitive markets, had better EOL care/outcomes. Recommendations included modifications to state Medicaid NH payments to promote better EOL care/outcomes and future research to understand NH care practices associated with presence of Alzheimer's units in order to identify mechanisms possibly promoting higher-quality EOL care.
AHRQ-funded; HS024923.
Citation: Orth J, Li Y, Simning A .
End-of-life care among nursing home residents with dementia varies by nursing home and market characteristics.
J Am Med Dir Assoc 2021 Feb;22(2):320-28.e4. doi: 10.1016/j.jamda.2020.06.021..
Keywords: Elderly, Palliative Care, Dementia, Nursing Homes, Long-Term Care
Kamal AH, Check DK, Bull J
Associations of patient characteristics and care setting with complexity of specialty palliative care visits.
Information routinely collected during a palliative care consultation request may help predict the level of complexity of that patient encounter. In this retrospective cohort analysis, the investigators examined whether patient and consultation characteristics, as captured in consultation requests, were associated with the number of unmet palliative care needs that emerge during consultation, as an indicator of complexity.
AHRQ-funded; HS023681.
Citation: Kamal AH, Check DK, Bull J .
Associations of patient characteristics and care setting with complexity of specialty palliative care visits.
J Palliat Med 2021 Jan;24(1):83-90. doi: 10.1089/jpm.2020.0149..
Keywords: Palliative Care
Quigley DD, McCleskey SG
Improving care experiences for patients and caregivers at end of life: a systematic review.
End-of-life care is increasing as the US population ages. Approaches to providing high-quality end-of-life care vary across setting, diseases, and populations. Several data collection tools measure patient and/or caregiver care experiences at end of life and can be used for quality improvement. Previous reviews examined palliative care improvements or available measures but none explicitly on improving care experiences. In this study, the researchers reviewed literature on improving patient and/or caregiver end-of-life care experiences.
AHRQ-funded; HS025920.
Citation: Quigley DD, McCleskey SG .
Improving care experiences for patients and caregivers at end of life: a systematic review.
Am J Hosp Palliat Care 2021 Jan;38(1):84-93. doi: 10.1177/1049909120931468..
Keywords: Palliative Care, Caregiving, Patient Experience, Quality Improvement, Quality of Care
Hwang D, Teno JM, Clark M
Family perceptions of quality of hospice care in the nursing home.
The investigators examined bereaved family members' perceptions of nursing home-hospice collaborations in terms of what family members believe went well or could have been improved. The focus group participants identified three major aspects of collaboration as important to care delivery: knowing who (nursing home or hospice) is responsible for which aspects of patient care, concern about information coordination between the nursing home and hospice, and the need for hospice to advocate for high-quality care rather than their having to directly do so on behalf of their family members. These concerns have been incorporated into the revised Family Evaluation of Hospice Care, a post-death survey used to evaluate quality of hospice care.
AHRQ-funded; HS019675.
Citation: Hwang D, Teno JM, Clark M .
Family perceptions of quality of hospice care in the nursing home.
J Pain Symptom Manage 2014 Dec;48(6):1100-7. doi: 10.1016/j.jpainsymman.2014.04.003.
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Keywords: Care Coordination, Nursing Homes, Palliative Care, Quality of Care
Rocke DJ, Beumer HW, Taylor DH, Jr.
Physician and patient and caregiver health attitudes and their effect on Medicare resource allocation for patients with advanced cancer.
The investigators sought to determine how baseline attitudes toward quality vs quantity of life affect end-of-life resource allocation. They found that, compared with patients and caregivers, otolaryngology-head and neck surgery (OHNS) physician allocations differed significantly in all 15 benefit categories except home care. They concluded that understanding the effect of baseline attitudes is important for effective end-of-life discussions.
AHRQ-funded; HS018360.
Citation: Rocke DJ, Beumer HW, Taylor DH, Jr. .
Physician and patient and caregiver health attitudes and their effect on Medicare resource allocation for patients with advanced cancer.
JAMA Otolaryngol Head Neck Surg 2014 Jun;140(6):497-503. doi: 10.1001/jamaoto.2014.494.
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Keywords: Cancer, Caregiving, Medicare, Palliative Care, Provider: Physician, Quality of Life
Huo J, Lairson DR, Du XL
Survival and cost-effectiveness of hospice care for metastatic melanoma patients.
The authors analyzed the association of hospice use with survival and health care costs among patients diagnosed with metastatic melanoma. They found that the median survival time was 6.1 months for patients with no hospice care, 6.5 months for patients enrolled in hospice for 1 to 3 days, and 10.2 months for patients enrolled for 4 or more days. Patients with 4 or more days of hospice care incurred lower end-of-life costs than the comparison groups.
AHRQ-funded; HS018956.
Citation: Huo J, Lairson DR, Du XL .
Survival and cost-effectiveness of hospice care for metastatic melanoma patients.
Am J Manag Care 2014 May;20(5):366-73.
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Keywords: Cancer, Cancer: Skin Cancer, Healthcare Costs, Palliative Care, Patient-Centered Outcomes Research
Kavalieratos D, Kamal AH, Abernethy AP
Comparing unmet needs between community-based palliative care patients with heart failure and patients with cancer.
This study characterized the unresolved symptom and treatment needs which patients with heart failure and those with cancer present to palliative care. It found that patients with HF presented with fewer unresolved symptoms; however, they were more likely to report dyspnea and more commonly experienced dyspnea-related treatment gaps.
AHRQ-funded; HS000032; HS017587
Citation: Kavalieratos D, Kamal AH, Abernethy AP .
Comparing unmet needs between community-based palliative care patients with heart failure and patients with cancer.
J Palliat Med. 2014 Apr;17(4):475-81. doi: 10.1089/jpm.2013.0526..
Keywords: Palliative Care, Cancer, Heart Disease and Health, Chronic Conditions
Martinez KA, Aslakson RA, Wilson RF
A systematic review of health care interventions for pain in patients with advanced cancer.
The authors sought to synthesize the evidence on the effectiveness of pain-focused interventions in patients with advanced cancer. In nineteen studies, they found moderate strength of evidence that pain management in advanced cancer can be improved using health care interventions, particularly nurse-led patient-centered interventions.
AHRQ-funded; 290200710061.
Citation: Martinez KA, Aslakson RA, Wilson RF .
A systematic review of health care interventions for pain in patients with advanced cancer.
Am J Hosp Palliat Care 2014 Feb;31(1):79-86. doi: 10.1177/1049909113476129.
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Keywords: Cancer, Comparative Effectiveness, Pain, Palliative Care, Quality Improvement
Kamal AH
Getting to proven: evaluating quality across all of palliative care.
In this letter, Kamal calls for the development of quality measures for palliative care, paying attention to procedures, multidisciplinary team members who perform multidomain assessments, the new settings of care where quality measurement should be tailored, and the care models that transition across generalist and specialist palliative care.
AHRQ-funded; HS022763.
Citation: Kamal AH .
Getting to proven: evaluating quality across all of palliative care.
J Pain Symptom Manage 2014 Jan;47(1):e1-2. doi: 10.1016/j.jpainsymman.2013.09.007.
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Keywords: Quality of Care, Health Services Research (HSR), Palliative Care, Quality Measures, Quality Measures