National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (1)
- Adverse Drug Events (ADE) (1)
- Adverse Events (2)
- Arthritis (3)
- Behavioral Health (1)
- Care Management (3)
- Comparative Effectiveness (1)
- Disparities (2)
- Education: Continuing Medical Education (2)
- Education: Patient and Caregiver (2)
- Elderly (1)
- Evidence-Based Practice (4)
- Healthcare-Associated Infections (HAIs) (1)
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- Imaging (1)
- Lifestyle Changes (1)
- Low-Income (1)
- Medicaid (2)
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- Medication (4)
- Medication: Safety (1)
- Mortality (1)
- Nutrition (1)
- Opioids (2)
- (-) Orthopedics (23)
- Outcomes (6)
- Pain (5)
- Patient-Centered Outcomes Research (8)
- Patient Experience (1)
- Patient Safety (2)
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- Quality of Life (1)
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- Surgery (19)
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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 23 of 23 Research Studies DisplayedBass AR, Mehta B, Szymonifka J
Racial disparities in total knee replacement failure as related to poverty.
The authors sought to determine whether racial disparities in total knee replacement (TKR) failure are explained by poverty. Linking New York state patients to residential census tracts by geocoded addresses, they found that there was a trend toward higher TKR revision risk in blacks, but poverty did not modify the relationship between race and TKR revision or failure.
AHRQ-funded; HS016075.
Citation: Bass AR, Mehta B, Szymonifka J .
Racial disparities in total knee replacement failure as related to poverty.
Arthritis Care Res 2019 Nov;71(11):1488-94. doi: 10.1002/acr.24028..
Keywords: Disparities, Racial and Ethnic Minorities, Low-Income, Surgery, Orthopedics, Social Determinants of Health
Singh JA, Lemay CA, Nobel L
Association of early postoperative pain trajectories with longer-term pain outcome after primary total knee arthroplasty.
Studies to date have not comprehensively examined pain experience after total knee arthroplasty (TKA). Discrete patterns of pain in this period might be associated with pain outcomes at 6 to 12 months after TKA. The purpose of this study was to examine patterns of individual post-TKA pain trajectories and to assess their independent associations with longer-term pain outcome after TKA.
AHRQ-funded; HS021110; HS018910.
Citation: Singh JA, Lemay CA, Nobel L .
Association of early postoperative pain trajectories with longer-term pain outcome after primary total knee arthroplasty.
JAMA Netw Open 2019 Nov;2(11):e1915105. doi: 10.1001/jamanetworkopen.2019.15105..
Keywords: Pain, Surgery, Orthopedics, Patient-Centered Outcomes Research, Outcomes
Long SA, Thomas G, Karam MD
Do skills acquired from training with a wire navigation simulator transfer to a mock operating room environment?
This study compared performance of residents getting traditional and simulation orthopedic surgery training at three medical centers: University of Iowa, University of Minnesota, and the Mayo Clinic. All residents first received traditional training in how to treat an intertrochanteric fracture. Then the groups were divided up with two groups getting additional simulated-based training and another group getting proficiency training for specific components of wire navigation. The two simulation-based training groups performed better in lower tip-apex distance than the traditional training group. Residents in the proficiency training group used more images than the other groups.
AHRQ-funded; HS022077; HS025353.
Citation: Long SA, Thomas G, Karam MD .
Do skills acquired from training with a wire navigation simulator transfer to a mock operating room environment?
Clin Orthop Relat Res 2019 Oct;477(10):2189-98. doi: 10.1097/corr.0000000000000799..
Keywords: Simulation, Training, Education: Continuing Medical Education, Surgery, Orthopedics
Schwarzkopf R, Behery OA, Yu H
Patterns and costs of 90-day readmission for surgical and medical complications following total hip and knee arthroplasty.
Unplanned readmissions following elective total hip (THA) and knee (TKA) arthroplasty as a result of surgical complications likely have different quality improvement targets and cost implications than those for nonsurgical readmissions. In this study, the investigators compared payments, timing, and location of unplanned readmissions with Center for Medicare and Medicaid Services (CMS)-defined surgical complications to readmissions without such complications.
AHRQ-funded; HS022882.
Citation: Schwarzkopf R, Behery OA, Yu H .
Patterns and costs of 90-day readmission for surgical and medical complications following total hip and knee arthroplasty.
J Arthroplasty 2019 Oct;34(10):2304-07. doi: 10.1016/j.arth.2019.05.046..
Keywords: Orthopedics, Surgery, Hospital Readmissions, Adverse Events, Quality Improvement, Quality of Care, Medicare, Hospitals
Long S, Thomas GW, Anderson DD
An extensible orthopaedic wire navigation simulation platform.
The demand for simulation-based skills training in orthopaedics is steadily growing. Wire navigation, or the ability to use 2D images to place an implant through a specified path in bone, is an area of training that has been difficult to simulate given its reliance on radiation based fluoroscopy. The investigators group previously presented on the development of a wire navigation simulator for a hip fracture module. In this paper, they present a new methodology for extending the simulator to other surgical applications of wire navigation.
AHRQ-funded; HS022077; HS025353.
Citation: Long S, Thomas GW, Anderson DD .
An extensible orthopaedic wire navigation simulation platform.
J Med Device 2019 Sep;13(3):031001-310017. doi: 10.1115/1.4043461..
Keywords: Orthopedics, Simulation, Training, Surgery, Education: Continuing Medical Education
Lemay CA, Saag KG, Franklin PD
A qualitative study of the postoperative pain management educational needs of total joint replacement patients.
This study examined the challenges of pain management education for post-surgery of total joint replacement patients. The majority of patients have pain in the postoperative period and managing pain can be challenging. Nine orthopedic surgeons’ offices in 8 states recruited patients and 27 patients completed the interview. They were interviewed with open-ended questions on their experiences with pain after surgery, pain management, experiences with pain medicine, experience using non-medicine-related pain reduction methods, and suggestions for better pain management education. Challenges included lack of pain control and lack of information about prescribed opioid and nonopioid methods of managing pain.
AHRQ-funded; HS018910; HS021110.
Citation: Lemay CA, Saag KG, Franklin PD .
A qualitative study of the postoperative pain management educational needs of total joint replacement patients.
Pain Manag Nurs 2019 Aug;20(4):345-51. doi: 10.1016/j.pmn.2018.12.009..
Keywords: Pain, Orthopedics, Surgery, Education: Patient and Caregiver
Dy CJ, Tipping AD, Nickel KB
Variation in the delivery of inpatient orthopaedic care to Medicaid beneficiaries within a single metropolitan region.
This study examined rates of Medicaid-funded surgical procedures for orthopedic patients. The authors hypothesized that orthopedists and hospitals are often unwilling to perform surgery on underinsured patients. The payer mix was examined for select inpatient orthopedic surgical procedures within a single region, including elective cases (total knee or hip arthroplasty; spinal decompression or fusion) and trauma cases (hip hemiarthroplasty; femoral or tibial or fibular fracture repair) among 22 hospitals from 2011 to 2016 for patients aged 18 to 64 years. For all cases (n = 19,204) the mean percentage of Medicaid-funded surgical procedures was 7.6%. Elective surgery cases were 5.5% and trauma cases 14.7% which supports their beliefs about delivery rates of orthopedic care on the basis of socioeconomic markers.
AHRQ-funded; HS019455.
Citation: Dy CJ, Tipping AD, Nickel KB .
Variation in the delivery of inpatient orthopaedic care to Medicaid beneficiaries within a single metropolitan region.
J Bone Joint Surg Am 2019 Aug 21;101(16):1451-59. doi: 10.2106/jbjs.18.01198.
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Keywords: Orthopedics, Healthcare Delivery, Medicaid, Surgery, Access to Care, Disparities, Health Insurance
Kim SC, Jin Y, Lee YC
Association of preoperative opioid use with mortality and short-term safety outcomes after total knee replacement.
The purpose of this study was to determine the association of preoperative opioid use among patients 65 years and older with mortality and other complications at 30 days post-total knee replacement (TKR). Findings show that continuous opioid users had a higher risk of revision operations, vertebral fractures, and opioid overdose at 30 days post-TKR but not of in-hospital or 30-day mortality, compared with opioid-naive patients. Highlights include the need for better understanding of patient characteristics associated with chronic opioid use to optimize preoperative assessment of overall risk after TKR.
AHRQ-funded; HS018910.
Citation: Kim SC, Jin Y, Lee YC .
Association of preoperative opioid use with mortality and short-term safety outcomes after total knee replacement.
JAMA Netw Open 2019 Jul 3;2(7):e198061. doi: 10.1001/jamanetworkopen.2019.8061..
Keywords: Opioids, Medication, Surgery, Orthopedics, Elderly, Patient-Centered Outcomes Research, Mortality, Outcomes, Arthritis, Evidence-Based Practice
Chhabra KR, Ibrahim AM, Thumma JR
Impact of Medicare readmissions penalties on targeted surgical conditions.
The authors used Medicare claims to evaluate the effects of the 2013 expansion of the Hospital Readmissions Reduction Program on risk-adjusted readmission rates, episode payments, lengths-of-stay, and observation status use for hip and knee replacement surgery. They found that medical readmission penalties led to readmission reductions for surgical patients, that targeted surgical penalties did not have an additional effect, and that readmission reductions are approaching a point below which further reductions may be unlikely.
AHRQ-funded; HS000053.
Citation: Chhabra KR, Ibrahim AM, Thumma JR .
Impact of Medicare readmissions penalties on targeted surgical conditions.
Health Aff 2019 Jul;38(7):1207-15. doi: 10.1377/hlthaff.2019.00096..
Keywords: Surgery, Hospital Readmissions, Orthopedics, Payment
Nguyen UDT, Perneger T, Franklin PD
Improvement in mental health following total hip arthroplasty: the role of pain and function.
This prospective study examined whether mental health improved in patients who had total hip arthroplasty (THA) due to improvement in pain and function 1 year post-surgery. Patients enrolled in a THA registry from 2010 to 2014 were included and the mental component score (MCS) was examined before and 1 year post-surgery. There was a significant improvement in mental health due to less pain and improved function.
AHRQ-funded; HS018910.
Citation: Nguyen UDT, Perneger T, Franklin PD .
Improvement in mental health following total hip arthroplasty: the role of pain and function.
BMC Musculoskelet Disord 2019 Jun 29;20(1):307. doi: 10.1186/s12891-019-2669-y..
Keywords: Health Status, Behavioral Health, Orthopedics, Outcomes, Pain, Patient-Centered Outcomes Research, Quality of Life, Surgery
Soffin EM, Gibbons MM, Wick EC
Evidence review conducted for the Agency for Healthcare Research and Quality Safety Program for I
This evidence review was conducted as part of AHRQ’s Safety Program for Improving Surgical Care and Recovery. An evidence review of interventions was conducted to create an enhanced recovery after surgery (ERAS) protocol for anesthesiology for hip fracture repair surgery. The researchers identified anesthesiology components of care and evaluated them across the perioperative continuum. They created ERAS protocols for the preoperative, intraoperative, and postoperative phases.
AHRQ-funded; 233201500020I.
Citation: Soffin EM, Gibbons MM, Wick EC .
Evidence review conducted for the Agency for Healthcare Research and Quality Safety Program for I
Anesth Analg 2019 Jun;128(6):1107-17. doi: 10.1213/ane.0000000000003925..
Keywords: Evidence-Based Practice, Patient-Centered Outcomes Research, Surgery, Orthopedics, Quality Improvement, Quality of Care, Outcomes, Care Management
Gandek B, Roos EM, Franklin PD
A 12-item short form of the Hip disability and Osteoarthritis Outcome Score (HOOS-12): tests of reliability, validity and responsiveness.
The goal of this study was to measure validity, reliability and responsiveness of the 12-item version of the 40-item Hip disability and Osteoarthritis Outcome Score (HOOS) surveys that measure joint-specific pain, function and quality of life (QOL) for patients. The shorter forms were given to 1,281 hip OA patients from the FORCE-TJR cohort who had previously completed the HOOS surveys before and after total joint replacement surgery. The HOOS-12 survey was compared to the full-length HOOS, HOOS-PS, and HOOS, JR surveys. Internal consistency reliability was above 0.70 for all HOOS-12 scales and above 0.90 for the Summary score. Validity and responsiveness were also found to be comparable to full-length HOOS scales.
AHRQ-funded; HS024632; HS018910.
Citation: Gandek B, Roos EM, Franklin PD .
A 12-item short form of the Hip disability and Osteoarthritis Outcome Score (HOOS-12): tests of reliability, validity and responsiveness.
Osteoarthritis Cartilage 2019 May;27(5):754-61. doi: 10.1016/j.joca.2018.09.017..
Keywords: Patient-Centered Outcomes Research, Registries, Arthritis, Orthopedics
Calderwood MS, Yokoe DS, Murphy MV
Effectiveness of a multistate quality improvement campaign in reducing risk of surgical site infections following hip and knee arthroplasty.
The authors assessed the effect of a multistate quality improvement campaign to promote the adoption of evidence-based surgical site infection (SSI) prevention practices. Rates of SSI among Medicare beneficiaries undergoing hip and knee arthroplasty during pre-intervention and post-intervention in five states included in a multistate trial of the Project JOINTS campaign and five matched comparison states were analyzed. The authors found a larger reduction of SSI rates following hip and knee arthroplasty in intervention states than in the matched control states.
AHRQ-funded; HS021424.
Citation: Calderwood MS, Yokoe DS, Murphy MV .
Effectiveness of a multistate quality improvement campaign in reducing risk of surgical site infections following hip and knee arthroplasty.
BMJ Qual Saf 2019 May;28(5):374-81. doi: 10.1136/bmjqs-2018-007982..
Keywords: Healthcare-Associated Infections (HAIs), Surgery, Orthopedics, Quality Improvement, Quality of Care, Evidence-Based Practice, Prevention, Patient Safety
Gandek B, Roos EM, Franklin PD
Item selection for 12-item short forms of the Knee injury and Osteoarthritis Outcome Score (KOOS-12) and Hip disability and Osteoarthritis Outcome Score (HOOS-12).
The goal of this study was to develop 12-item versions of the 42-item Knee injury and Osteoarthritis Outcome Score (KOOS) and 40-item Hip disability and Osteoarthritis Outcome Score (HOOS) surveys that measure joint-specific pain, function and quality of life (QOL) for patients. The shorter forms were given to 1,395 knee osteoarthritis (OA) and 1,281 hip OA patients from the FORCE-TJR cohort who had previously completed the KOOS and HOOS surveys before and after total joint replacement surgery. The KOOS-12 and HOOS-12 surveys were found to successfully measure pain and function items of the patients as well as the 42-item versions.
AHRQ-funded; HS024632; HS018910.
Citation: Gandek B, Roos EM, Franklin PD .
Item selection for 12-item short forms of the Knee injury and Osteoarthritis Outcome Score (KOOS-12) and Hip disability and Osteoarthritis Outcome Score (HOOS-12).
Osteoarthritis Cartilage 2019 May;27(5):746-53. doi: 10.1016/j.joca.2018.11.011..
Keywords: Patient-Centered Outcomes Research, Registries, Arthritis, Orthopedics
Perez FA, Quinet S, Jarvik JG
Lumbar spinal stenosis severity by CT or MRI does not predict response to epidural corticosteroid versus lidocaine injections.
This study compared the results of patients with lumbar spinal stenosis injected epidurally with corticosteroids and lidocaine, or lidocaine alone. A prospective, double-blind study was conducted on 350 patients who were then evaluated for qualitative or quantitative MR imaging or CT measures of lumbar spinal stenosis. There were no differences in improvement of disability or leg pain scores at 3 weeks between the two subgroups.
AHRQ-funded; HS019222; HS022972.
Citation: Perez FA, Quinet S, Jarvik JG .
Lumbar spinal stenosis severity by CT or MRI does not predict response to epidural corticosteroid versus lidocaine injections.
AJNR Am J Neuroradiol 2019 May;40(5):908-15. doi: 10.3174/ajnr.A6050..
Keywords: Comparative Effectiveness, Evidence-Based Practice, Imaging, Medication, Orthopedics, Outcomes, Patient-Centered Outcomes Research
Hoffman SA, Ledford G, Cameron KA
A qualitative exploration of social and environmental factors affecting diet and activity in knee replacement patients.
This study examined perceived social and environmental barriers and encouragers for patients undergoing knee replacement surgery who are overweight or obese. Twenty patients were surveyed about factors that helped or hindered healthy behaviors. Many mentioned availability of healthy food, attending social gatherings, social support, and the weather.
AHRQ-funded; HS023011.
Citation: Hoffman SA, Ledford G, Cameron KA .
A qualitative exploration of social and environmental factors affecting diet and activity in knee replacement patients.
J Clin Nurs 2019 Apr;28(7-8):1156-63. doi: 10.1111/jocn.14719..
Keywords: Lifestyle Changes, Nutrition, Orthopedics, Surgery
Dy CJ, Brown DS, Maryam H
Two-state comparison of total joint arthroplasty utilization following Medicaid expansion.
The aim of this study was to determine whether Medicaid expansion was associated with increased utilization rates of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in Illinois (which expanded Medicaid) relative to Missouri (which did not expand Medicaid). The investigators concluded that their study demonstrated that Medicaid expansion in Illinois was associated with increased utilization of THA and TKA. They suggested that further study is needed to understand the impact of Medicaid expansion in other states and for other procedures.
AHRQ-funded; HS019455.
Citation: Dy CJ, Brown DS, Maryam H .
Two-state comparison of total joint arthroplasty utilization following Medicaid expansion.
J Arthroplasty 2019 Apr;34(4):619-25.e1. doi: 10.1016/j.arth.2018.12.019..
Keywords: Healthcare Utilization, Medicaid, Orthopedics, Surgery
Bell KM, Onyeukwu C, McClincy MP
Verification of a portable motion tracking system for remote management of physical rehabilitation of the knee.
The authors of this paper developed a remote rehabilitation management system combining two wireless inertial measurement units (IMUs) with an interactive mobile application and a web-based clinician portal (interACTION). The aim of their study was to verify the accuracy of the IMU-based knee angle measurement system during three common physical therapy exercises, quantify the effect of visual feedback on exercise performance, and understand the qualitative experience of the user interface through survey data.
AHRQ-funded; HS022989.
Citation: Bell KM, Onyeukwu C, McClincy MP .
Verification of a portable motion tracking system for remote management of physical rehabilitation of the knee.
Sensors 2019 Feb 28;19(5). doi: 10.3390/s19051021..
Keywords: Care Management, Health Information Technology (HIT), Orthopedics, Rehabilitation, Telehealth
George MD, Baker JF, Hsu JY
Perioperative timing of infliximab and the risk of serious infection after elective hip and knee arthroplasty.
The purpose of this retrospective cohort study was to evaluate the association between infliximab timing and serious infection after elective hip or knee arthroplasty. The investigators concluded that administering infliximab within 4 weeks of elective knee or hip arthroplasty was not associated with a higher risk of short- or long-term serious infection compared to withholding infliximab for longer time periods. They also concluded that glucocorticoid use, especially >10 mg/day, was associated with an increased infection risk.
AHRQ-funded; HS018517.
Citation: George MD, Baker JF, Hsu JY .
Perioperative timing of infliximab and the risk of serious infection after elective hip and knee arthroplasty.
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Keywords: Adverse Drug Events (ADE), Adverse Events, Medication, Medication: Safety, Orthopedics, Patient Safety, Surgery
Tedesco D, Gori D, Desai KR
Drug-free interventions to reduce pain or opioid consumption after total knee arthroplasty: a systematic review and meta-analysis.
The authors systematically reviewed and meta-analyzed evidence of nonpharmacological interventions for postoperative pain management after total knee arthroplasty. The most commonly performed interventions included in the review were continuous passive motion, preoperative exercise, cryotherapy, electrotherapy, and acupuncture. In the meta-analysis, electrotherapy and acupuncture after total knee arthroplasty were associated with reduced and delayed opioid consumption.
AHRQ-funded; HS024096.
Citation: Tedesco D, Gori D, Desai KR .
Drug-free interventions to reduce pain or opioid consumption after total knee arthroplasty: a systematic review and meta-analysis.
JAMA Surg 2017 Oct 18;152(10):e172872. doi: 10.1001/jamasurg.2017.2872.
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Keywords: Care Management, Medication, Opioids, Orthopedics, Pain, Surgery
Ehlers AP, Khor S, Cizik AM
Use of patient-reported outcomes and satisfaction for quality assessments.
This study investigated the relationship between PROs and satisfaction among spine surgery patients. The authors hypothesized that there would be significant disparities between patient satisfaction and PROs at the 1-year postoperative time point. The study found that overall, patients undergoing elective lumbar spine surgery reported being satisfied with outcomes, but the reported responses in PROs were much more variable.
AHRQ-funded; HS020025.
Citation: Ehlers AP, Khor S, Cizik AM .
Use of patient-reported outcomes and satisfaction for quality assessments.
Am J Manag Care 2017 Oct;23(10):618-22..
Keywords: Patient-Centered Outcomes Research, Patient Experience, Quality of Care, Surgery, Outcomes, Orthopedics
Cramer JD, Patel UA, Maas MB
Is neck dissection associated with an increased risk of postoperative stroke?
The researchers investigated whether neck dissection is an independent risk factor for postoperative stroke. They found that the rate of postoperative stroke was greater with neck dissection than without it and concluded that stroke is a rare but highly morbid complication after head and neck surgery. Compared with other head and neck surgery, neck dissection in patients at risk for carotid artery stenosis is associated with an increased risk of postoperative stroke.
AHRQ-funded; HS023011.
Citation: Cramer JD, Patel UA, Maas MB .
Is neck dissection associated with an increased risk of postoperative stroke?
Otolaryngol Head Neck Surg 2017 Aug;157(2):226-32. doi: 10.1177/0194599817698414.
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Keywords: Orthopedics, Quality Improvement, Risk, Stroke, Surgery
Lemay CA, Lewis CG, Singh JA
Receipt of pain management information preoperatively is associated with improved functional gain after elective total joint arthroplasty.
This study evaluated patient-reported receipt of preoperative pain management information in a national prospective cohort evaluating postoperative pain and function following elective TJA. It found that patients who received pain information reported less pain 2 weeks postoperatively, greater use of non-narcotic pain care strategies, and better physical function scores at 6 months postoperatively.
AHRQ-funded; HS018910; HS021110.
Citation: Lemay CA, Lewis CG, Singh JA .
Receipt of pain management information preoperatively is associated with improved functional gain after elective total joint arthroplasty.
J Arthroplasty 2017 Jun;32(6):1763-68. doi: 10.1016/j.arth.2017.01.028.
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Keywords: Education: Patient and Caregiver, Orthopedics, Surgery, Pain