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
1 to 25 of 77 Research Studies DisplayedKostick-Quenet KM, Lang B, Dorfman N
Patients' and physicians' beliefs and attitudes towards integrating personalized risk estimates into patient education about left ventricular assist device therapy.
This study explored stakeholder attitudes toward the utility, acceptability, usefulness, and best practices for integrating personalized risk (PR) estimates into patient education and decision making about Left Ventricular Assist Device (LVAD). This was a 5-year multi-institutional AHRQ project where the authors conducted 40 interviews with stakeholders (physicians, nurse coordinators, patients, and caregivers) and analyzed using Thematic Content Analysis. All stakeholder groups voiced positive views towards PR integration in decision making. Physicians felt PR can improve their decision making by enhancing insight into outcomes, enhance tailored pre-emptive care, increase confidence in decisions, and reduce bias and subjectivity. All stakeholder groups raised concerns about accuracy, representativeness and relevance of algorithms; predictive uncertainty; utility in relation to physician's expertise; potential negative reactions among patients; and overreliance.
AHRQ-funded; HS027784.
Citation: Kostick-Quenet KM, Lang B, Dorfman N .
Patients' and physicians' beliefs and attitudes towards integrating personalized risk estimates into patient education about left ventricular assist device therapy.
Patient Educ Couns 2024 May; 122:108157. doi: 10.1016/j.pec.2024.108157.
Keywords: Education: Patient and Caregiver, Risk, Cardiovascular Conditions
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
Ashburn NP, McCord JK, Snavely AC
Navigating the observation zone: do risk scores help stratify patients with indeterminate high-sensitivity cardiac troponins?
In this research letter the authors described their secondary analysis of the High-Sensitivity Cardiac Troponin I Assays in the United States (HIGH-US) study; their purpose was to assess the best way to evaluate observation zone patients who did not have an ischemic ECG. Their primary finding was that risk scores were unlikely to identify a subset of observation zone patients for early discharge without further monitoring, additional troponin measures, and stress testing or coronary angiography.
AHRQ-funded; HS029017.
Citation: Ashburn NP, McCord JK, Snavely AC .
Navigating the observation zone: do risk scores help stratify patients with indeterminate high-sensitivity cardiac troponins?
Circulation 2024 Jan 2; 149(1):70-72. doi: 10.1161/circulationaha.123.065030..
Keywords: Cardiovascular Conditions, Risk
Engelberg RS, Scheidell JD, Islam N
Associations between incarceration history and risk of hypertension and hyperglycemia: consideration of differences among Black, Hispanic, Asian and White Subgroups.
This study’s objective was to assess racial/ethnic group differences in the association between incarceration and hypertension and hyperglycemia. The authors performed a secondary data analysis using the National Longitudinal Survey of Adolescent to Adult Health (Add Health). They used Poisson regression to estimate the associations between lifetime history of incarceration reported during early adulthood with hypertension and hyperglycemia outcomes measured in mid-adulthood, including incident diagnosis. They evaluated whether associations varied by self-reported race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, and Asian) with an analytic sample of 4,015 Add Health respondents. Outcome measures included hypertension, systolic blood pressure >130 mmHG, and hyperglycemia. There was no evidence of an association between incarceration and measured health outcomes among non-Hispanic Black and non-Hispanic White participants. Among Hispanic participants, incarceration was associated with hyperglycemia (Adjusted Risk Ratio (ARR): 2.1), but not with hypertension risk. Incarceration was associated with elevated systolic blood pressure (ARR: 3.1) and hypertension (ARR: 1.7) among Asian participants, but not with hyperglycemia risk. Incarceration was associated with incident hypertension (ARR 2.5) among Asian subgroups.
AHRQ-funded; HS026120.
Citation: Engelberg RS, Scheidell JD, Islam N .
Associations between incarceration history and risk of hypertension and hyperglycemia: consideration of differences among Black, Hispanic, Asian and White Subgroups.
J Gen Intern Med 2024 Jan; 39(1):5-12. doi: 10.1007/s11606-023-08327-9..
Keywords: Vulnerable Populations, Racial and Ethnic Minorities, Blood Pressure, Cardiovascular Conditions, Risk
Haimovich AD, Shah MN, Southerland LT
Automating risk stratification for geriatric syndromes in the emergency department.
This study discussed using automated risk stratification to implement screening programs for geriatric syndromes in the emergency department (ED). This method would reduce significant workloads at a time of record-breaking ED patient volumes, staff shortages, and hospital boarding crises. The authors defined the concept of automated risk stratification and screening using existing electronic health record (EHR) data. They discussed progress made in three potential use cases in the ED: falls, cognitive impairment, and end-of-life and palliative care; emphasizing the importance of linking automated screening with systems of healthcare delivery. They found that research progress and operational deployment vary by use case, ranging from deployed solutions in falls screening to algorithmic validation in cognitive impairment and end-of-life care, but should still be considered a potential solution.
AHRQ-funded; HS027735.
Citation: Haimovich AD, Shah MN, Southerland LT .
Automating risk stratification for geriatric syndromes in the emergency department.
J Am Geriatr Soc 2024 Jan; 72(1):258-67. doi: 10.1111/jgs.18594..
Keywords: Elderly, Emergency Department, Risk, Health Information Technology (HIT)
Oke I, Elze T, Miller JW
Surgical approach and reoperation risk in intermittent exotropia in the IRIS Registry.
This cohort study compared the 5-year reoperation rates for children with intermittent exotropia (IXT). Reoperation rates for children with IXT treated with horizontal muscle strabismus surgery using bilateral lateral rectus recession (BLR) vs unilateral lateral rectus recession with medial rectus resection (RR) were compared. The authors examined data obtained from the Intelligent Research in Sight (IRIS) Registry on 7482 children (age, <18 years) with IXT who underwent horizontal eye muscle strabismus surgery, excluding children undergoing initial surgeries involving 3 or more horizontal muscles, vertical muscles, or reoperations. Primary outcome was the adjusted cumulative incidence of repeat horizontal muscle surgery within 5 years after the initial surgery. BLR was performed more frequently than RR (85.3% vs 14.7%), especially in younger children. After data adjustment, the 5-year cumulative incidence of reoperation was 21.3%. The adjusted 5-year cumulative incidence of reoperation was higher for BLR than for RR. Unilateral lateral rectus recession with medial rectus resection was associated with a lower 5-year reoperation risk compared with BLR. Younger age at time of initial surgery was associated with a higher reoperation risk.
AHRQ-funded; HS000063.
Citation: Oke I, Elze T, Miller JW .
Surgical approach and reoperation risk in intermittent exotropia in the IRIS Registry.
JAMA Ophthalmol 2024 Jan; 142(1):48-52. doi: 10.1001/jamaophthalmol.2023.5288..
Keywords: Surgery, Risk
Kwa MC, Silverberg JI
Association between inflammatory skin disease and cardiovascular and cerebrovascular co-morbidities in US adults: analysis of Nationwide Inpatient Sample data.
The objective of this study was to determine whether these inflammatory skin diseases are associated with increased cardiovascular/cerebrovascular risk and/or disease. It concluded that atopic dermatitis or eczema (AD-E), pemphigus, bullous pemphigoid (BP), and hidradenitis were all associated with increased cardiovascular and cerebrovascular risk, especially at younger age.
AHRQ-funded; HS023011.
Citation: Kwa MC, Silverberg JI .
Association between inflammatory skin disease and cardiovascular and cerebrovascular co-morbidities in US adults: analysis of Nationwide Inpatient Sample data.
Am J Clin Dermatol 2017 Dec;18(6):813-23. doi: 10.1007/s40257-017-0293-x.
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Keywords: Cardiovascular Conditions, Healthcare Cost and Utilization Project (HCUP), Risk, Skin Conditions
Lee AK, Lee CJ, Huang ES
Risk factors for severe hypoglycemia in black and white adults with diabetes: the Atherosclerosis Risk in Communities (ARIC) study.
Severe hypoglycemia is a rare but important complication of type 2 diabetes. Few studies have examined the epidemiology of hypoglycemia in a community-based population. This study concluded that poor glycemic control, glycemic variability as captured by 1,5-anhydroglucitol, kidney damage, and measures of cognitive and functional impairments were strongly associated with increased risk of severe hypoglycemia.
AHRQ-funded; HS018542.
Citation: Lee AK, Lee CJ, Huang ES .
Risk factors for severe hypoglycemia in black and white adults with diabetes: the Atherosclerosis Risk in Communities (ARIC) study.
Diabetes Care 2017 Dec;40(12):1661-67. doi: 10.2337/dc17-0819.
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Keywords: Cardiovascular Conditions, Elderly, Diabetes, Racial and Ethnic Minorities, Risk
van den Bogert CA, Miller MJ, Cobaugh DJ
Screening questions for nonsteroidal anti-inflammatory drug risk knowledge.
The aim of this study was to evaluate screening questions for estimating nonsteroidal anti-inflammatory drug (NSAID) risk knowledge. It concluded that screening questions for subjective NSAID risk awareness and health literacy are predictive of objectively tested NSAID knowledge and can be used to triage patients as well as subsequently initiate and direct a conversation about NSAID risk.
AHRQ-funded; HS016956.
Citation: van den Bogert CA, Miller MJ, Cobaugh DJ .
Screening questions for nonsteroidal anti-inflammatory drug risk knowledge.
J Patient Saf 2017 Dec;13(4):217-22. doi: 10.1097/pts.0000000000000143.
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Keywords: Adverse Drug Events (ADE), Health Literacy, Medication, Risk
Leeds IL, Canner JK, Efron JE
The independent effect of cancer on outcomes: a potential limitation of surgical risk prediction.
This study aims to compare the use of common risk models for benign versus malignant gastrointestinal disease. It found that the National Surgical Quality Improvement Program (NSQIP) prediction models less effectively evaluate the risk of death in cancer patients as compared to patients with benign disease. A diagnosis of cancer is independently associated with an increased risk of surgical complications.
AHRQ-funded; HS024736.
Citation: Leeds IL, Canner JK, Efron JE .
The independent effect of cancer on outcomes: a potential limitation of surgical risk prediction.
J Surg Res 2017 Dec;220:402-09.e6. doi: 10.1016/j.jss.2017.08.039.
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Keywords: Adverse Events, Cancer, Digestive Disease and Health, Risk, Surgery
Prochaska MT, Newcomb R, Block G
Association between anemia and fatigue in hospitalized patients: does the measure of anemia matter?
This study assessed multiple Hb-based measures of anemia in hospitalized patients and test whether these are associated with fatigue. Mean Hb had a less robust association with fatigue than minimum Hb, and no other measure of Hb was associated with patients' fatigue levels. Minimum Hb is associated with fatigue while hospitalized and may help identify patients for interventions to address anemia-related fatigue.
AHRQ-funded; HS023007.
Citation: Prochaska MT, Newcomb R, Block G .
Association between anemia and fatigue in hospitalized patients: does the measure of anemia matter?
J Hosp Med 2017 Nov;12(11):898-904. doi: 10.12788/jhm.2832.
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Keywords: Hospitalization, Patient-Centered Healthcare, Risk
Britton MC, Ouellet GM, Minges KE
Care transitions between hospitals and skilled nursing facilities: perspectives of sending and receiving providers.
This study was conducted to identify the perspectives of sending and receiving providers regarding care transitions between the hospital and skilled nursing facilities. Four main themes emerged: increasing patient complexity, identifying an optimal care setting, rising financial pressure, and barriers to effective communication. The investigators indicated that the data highlighted hospital and SNF providers' shared concerns about patient-level risk factors and escalating costs of care.
AHRQ-funded; HS023554.
Citation: Britton MC, Ouellet GM, Minges KE .
Care transitions between hospitals and skilled nursing facilities: perspectives of sending and receiving providers.
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Keywords: Communication, Long-Term Care, Nursing Homes, Risk, Transitions of Care
Zeitler EP, Al-Khatib SM, Friedman DJ
Predicting appropriate shocks in patients with heart failure: patient level meta-analysis from SCD-HeFT and MADIT II.
The study authors sought to identify characteristics predictive of appropriate shocks in patients with a primary prevention implantable cardioverter defibrillator (ICD). In this meta-analysis of patient level data from Multicenter Automatic Defibrillator Implantation Trial II and Sudden Cardiac Death in Heart Failure Trial, higher NYHA class, lower LVEF, no beta-blocker therapy, and single chamber ICD (vs. dual chamber) were significant predictors of appropriate shocks.
AHRQ-funded; HS018505.
Citation: Zeitler EP, Al-Khatib SM, Friedman DJ .
Predicting appropriate shocks in patients with heart failure: patient level meta-analysis from SCD-HeFT and MADIT II.
J Cardiovasc Electrophysiol 2017 Nov;28(11):1345-51. doi: 10.1111/jce.13307.
Keywords: Comparative Effectiveness, Heart Disease and Health, Medical Devices, Medical Devices, Risk
Gianfrancesco MA, Schmajuk G, Haserodt S
Hydroxychloroquine dosing in immune-mediated diseases: implications for patient safety.
Evidence suggests that hydroxychloroquine (HCQ) retinal toxicity is more common than previously thought. Adhering to careful weight-based dosing can significantly reduce the risk of this adverse event and is recommended in recent guidelines. The study authors used electronic health record data from a large health system to examine HCQ dosing over a 5-year period and identify risk factors associated with higher dosage of HCQ.
AHRQ-funded; HS024412.
Citation: Gianfrancesco MA, Schmajuk G, Haserodt S .
Hydroxychloroquine dosing in immune-mediated diseases: implications for patient safety.
Rheumatol Int 2017 Oct;37(10):1611-18. doi: 10.1007/s00296-017-3782-6..
Keywords: Adverse Drug Events (ADE), Patient Safety, Risk, Skin Conditions
Zenga J, Suko J, Kallogjeri D
Postoperative hemorrhage and hospital revisit after transoral robotic surgery.
The researchers investigated the incidence and complications related to postoperative hemorrhage (POH) after transoral robotic surgery (TORS). Using HCUP data, they found that the incidence of POH after TORS was low, and few of these patients had a severe complication related to this event. Medical comorbidity and tonsillar subsite may be independent risk factors for POH.
AHRQ-funded; HS019455.
Citation: Zenga J, Suko J, Kallogjeri D .
Postoperative hemorrhage and hospital revisit after transoral robotic surgery.
Laryngoscope 2017 Oct;127(10):2287-92. doi: 10.1002/lary.26626.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Surgery, Adverse Events, Risk
Bucholz EM, Strait KM, Dreyer RP
Sex differences in young patients with acute myocardial infarction: a VIRGO study analysis.
This study sought to compare young women and men at the time of acute myocardial infarction (AMI) on six domains of demographic and clinical factors in order to determine whether they have distinct profiles. The authors concluded that young women with AMI represent a distinct, higher-risk population that is different from young men.
AHRQ-funded; HS023000.
Citation: Bucholz EM, Strait KM, Dreyer RP .
Sex differences in young patients with acute myocardial infarction: a VIRGO study analysis.
Eur Heart J Acute Cardiovasc Care 2017 Oct;6(7):610-22. doi: 10.1177/2048872616661847..
Keywords: Heart Disease and Health, Patient-Centered Outcomes Research, Risk, Sex Factors
Nelson HD, Denneson LM, Low AR
Suicide risk assessment and prevention: a systematic review focusing on veterans.
This article reviews studies of the accuracy of methods to identify individuals at increased risk of suicide and the effectiveness and adverse effects of health care interventions relevant to U.S. veteran and military populations in reducing suicide and suicide attempts. It concludes that risk assessment methods have been shown to be sensitive predictors of suicide and suicide attempts, but the frequency of false positives limits their clinical utility.
AHRQ-funded; HS019456.
Citation: Nelson HD, Denneson LM, Low AR .
Suicide risk assessment and prevention: a systematic review focusing on veterans.
Psychiatr Serv 2017 Oct;68(10):1003-15. doi: 10.1176/appi.ps.201600384.
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Keywords: Comparative Effectiveness, Behavioral Health, Prevention, Risk
Sittig DF, Singh H
Toward more proactive approaches to safety in the electronic health record era.
This article discusses a proactive approach to safety in the electronic health record era. It discusses an updated health IT Sentinel Event Alert, released in March 2015 by the Joint Commission which took a broad, sociotechnical approach in exploring the factors involved in the safe use of health IT.
AHRQ-funded; HS023602; HS022087.
Citation: Sittig DF, Singh H .
Toward more proactive approaches to safety in the electronic health record era.
Jt Comm J Qual Patient Saf 2017 Oct;43(10):540-47. doi: 10.1016/j.jcjq.2017.06.005..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety, Guidelines, Organizational Change, Risk
Jackson SS, Leekha S, Magder LS
Electronically available comorbidities should be used in surgical site infection risk adjustment.
A multicenter retrospective cohort study of patients undergoing surgical procedures at 28 US hospitals was performed. The authors developed a well-performing risk adjustment model for surgical site infections (SSI) using electronically available comorbidities. Healthcare-associated infections, such as SSIs, are used by the Centers for Medicare and Medicaid Services (CMS) as pay-for-performance metrics. The authors recommended that comorbidity-based risk adjustment should be strongly considered by the Centers for Disease Control and Prevention and CMS to adequately compare SSI rates across hospitals.
AHRQ-funded; HS022291.
Citation: Jackson SS, Leekha S, Magder LS .
Electronically available comorbidities should be used in surgical site infection risk adjustment.
Clin Infect Dis 2017 Sep 1;65(5):803-10. doi: 10.1093/cid/cix431..
Keywords: Healthcare-Associated Infections (HAIs), Surgery, Patient Safety, Risk, Injuries and Wounds, Adverse Events
Saiman L, Maykowski P, Murray M
Incidence, risks, and types of infections in pediatric long-term care facilities.
The researchers described the types of infections diagnosed in residents of pediatric long-term care facilities, calculate infection rates, and identified risk factors for respiratory tract infections (RTIs). RTIs were the most common infections diagnosed, but modifiable risk factors for RTIs were not identified. Also included in the study were skin and soft-tissue infections; chronic comorbid conditions, including neurologic and respiratory disorders; and device use.
AHRQ-funded; HS021470.
Citation: Saiman L, Maykowski P, Murray M .
Incidence, risks, and types of infections in pediatric long-term care facilities.
JAMA Pediatr 2017 Sep;171(9):872-78. doi: 10.1001/jamapediatrics.2017.1482.
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Keywords: Healthcare-Associated Infections (HAIs), Long-Term Care, Patient Safety, Children/Adolescents, Risk
Olsen MA, Nickel KB, Fraser VJ
Prevalence and predictors of postdischarge antibiotic use following mastectomy.
This study determined utilization, predictors, and outcomes of postdischarge prophylactic antibiotics after mastectomy with or without immediate breast reconstruction. The study conclude that prophylactic postdischarge antibiotics are commonly prescribed after mastectomy; immediate reconstruction is the strongest predictor. The authors recommended stewardship efforts in this population to limit continuation of prophylactic antibiotics after discharge are needed to limit antimicrobial resistance.
AHRQ-funded; HS019455.
Citation: Olsen MA, Nickel KB, Fraser VJ .
Prevalence and predictors of postdischarge antibiotic use following mastectomy.
Infect Control Hosp Epidemiol 2017 Sep;38(9):1048-54. doi: 10.1017/ice.2017.128.
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Keywords: Antibiotics, Healthcare-Associated Infections (HAIs), Medication, Patient Safety, Surgery, Injuries and Wounds, Prevention, Adverse Events, Risk
Jackson SS, Leekha S, Magder LS
The effect of adding comorbidities to current Centers for Disease Control and Prevention central-line-associated bloodstream infection risk-adjustment methodology.
The authors of this study hypothesized that risk adjustment would be improved by including patient demographics and comorbidities from electronically available hospital discharge codes to current Centers for Disease Control and Prevention central-line-associated bloodstream infection risk-adjustment methodology. They concluded that their risk-adjustment model for CLABSI using electronically available comorbidities demonstrated better discrimination than did the CDC model.
AHRQ-funded; HS022291.
Citation: Jackson SS, Leekha S, Magder LS .
The effect of adding comorbidities to current Centers for Disease Control and Prevention central-line-associated bloodstream infection risk-adjustment methodology.
Infect Control Hosp Epidemiol 2017 Sep;38(9):1019-24. doi: 10.1017/ice.2017.129..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Hospitals, Patient Safety, Risk
Park JS, Bateni SB, Bold RJ
The modified frailty index to predict morbidity and mortality for retroperitoneal sarcoma resections.
The researchers performed a retrospective analysis of patients with a diagnosis of primary malignant retroperitoneal neoplasm who underwent surgical resection. The modified frailty index (mFI) was calculated according to standard published methods. Their data demonstrate that the majority of patients undergoing retroperitoneal sarcoma resections have few, if any, comorbidities. The mFI was a limited predictor of overall and serious complications and was not a significant predictor of mortality.
AHRQ-funded; HS022236.
Citation: Park JS, Bateni SB, Bold RJ .
The modified frailty index to predict morbidity and mortality for retroperitoneal sarcoma resections.
J Surg Res 2017 Sep;217:191-97. doi: 10.1016/j.jss.2017.05.025.
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Keywords: Cancer, Elderly, Health Status, Mortality, Risk
Mehta HB, Mehta V, Goodwin JS
Association of hypoglycemia with subsequent dementia in older patients with type 2 diabetes mellitus.
This study evaluated an association of hypoglycemia with subsequent dementia in patients with type 2 diabetes. Hypoglycemia is associated with a higher risk of dementia and may be responsible in part for the higher risk of dementia in patients with diabetes. Alternatively, hypoglycemia may be a marker for undiagnosed cognitive impairment, and we cannot rule out the possibility of reverse causation between hypoglycemia and dementia.
AHRQ-funded; HS022134.
Citation: Mehta HB, Mehta V, Goodwin JS .
Association of hypoglycemia with subsequent dementia in older patients with type 2 diabetes mellitus.
J Gerontol A Biol Sci Med Sci 2017 Aug;72(8):1110-16. doi: 10.1093/gerona/glw217.
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Keywords: Dementia, Diabetes, Elderly, Risk
Macapagal K, Birkett M, Janulis P
HIV prevention fatigue and HIV treatment optimism among young men who have sex with men.
Young men who have sex with men (YMSM) and are at high risk for HIV completed measures of prevention fatigue, treatment optimism, HIV risk behaviors, and HIV-related knowledge and attitudes during a longitudinal study. Overall, YMSM reported low levels of HIV prevention fatigue and treatment optimism.
AHRQ-funded; HS000078.
Citation: Macapagal K, Birkett M, Janulis P .
HIV prevention fatigue and HIV treatment optimism among young men who have sex with men.
AIDS Educ Prev 2017 Aug;29(4):289-301. doi: 10.1521/aeap.2017.29.4.289.
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Keywords: Human Immunodeficiency Virus (HIV), Prevention, Risk