National Healthcare Quality and Disparities Report
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Topics
- Adverse Drug Events (ADE) (2)
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- Antibiotics (1)
- Asthma (1)
- Back Health and Pain (1)
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- (-) Medication (21)
- Medication: Safety (1)
- Neurological Disorders (1)
- Opioids (6)
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- Provider (1)
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- Quality of Life (1)
- Rehabilitation (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 21 of 21 Research Studies DisplayedRentsch CT, Edelman EJ, Justice AC
Patterns and correlates of prescription opioid receipt among US Veterans: a national, 18-year observational cohort study.
A better understanding of predisposition to transition to high-dose, long-term opioid therapy after initial opioid receipt could facilitate efforts to prevent opioid use disorder (OUD). In this study, the investigators extracted data on 69,268 patients in the Veterans Aging Cohort Study who received any opioid prescription between 1998 and 2015. They identified four distinguishable dose trajectories. The authors indicate that their measures could potentially be used in future prevention research, including genetic discovery.
AHRQ-funded; HS021112; HS023258.
Citation: Rentsch CT, Edelman EJ, Justice AC .
Patterns and correlates of prescription opioid receipt among US Veterans: a national, 18-year observational cohort study.
AIDS Behav 2019 Dec;23(12):3340-49. doi: 10.1007/s10461-019-02608-3..
Keywords: Opioids, Medication, Substance Abuse, Human Immunodeficiency Virus (HIV), Pain, Chronic Conditions
Badawy SM, Payne AB
Association between clinical outcomes and metformin use in adults with sickle cell disease and diabetes mellitus.
This study tested the hypothesis that metformin use for treatment of diabetes mellitus is associated with fewer sickle cell disease (SCD) adverse outcomes and lower health care utilization among patients with SCD and diabetes mellitus. This retrospective cohort study used data from MarketScan Medicaid claims for 2006 to 2016. SCD patients who were metformin users and nonusers were compared. Patients on hydroxyurea, insulin, or iron chelation were excluded. Metformin was found to be associated with significantly fewer inpatient and emergency department encounters in adults with SCD and diabetes mellitus.
AHRQ-funded; HS023011.
Citation: Badawy SM, Payne AB .
Association between clinical outcomes and metformin use in adults with sickle cell disease and diabetes mellitus.
Blood Adv 2019 Nov 12;3(21):3297-306. doi: 10.1182/bloodadvances.2019000838..
Keywords: Sickle Cell Disease, Diabetes, Chronic Conditions, Medication, Outcomes, Patient-Centered Outcomes Research
Goyal P, Gorodeski EZ, Marcum ZA
Cardiac rehabilitation to optimize medication regimens in heart failure.
This paper discusses the use of cardiac rehabilitation (CR) to optimize medication regimens for older adults with heart failure. Challenges in CR are discussed length and strategies were offered for leveraged CR.
AHRQ-funded; HS022982.
Citation: Goyal P, Gorodeski EZ, Marcum ZA .
Cardiac rehabilitation to optimize medication regimens in heart failure.
Clin Geriatr Med 2019 Nov;35(4):549-60. doi: 10.1016/j.cger.2019.06.001..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Rehabilitation, Medication, Patient-Centered Healthcare, Patient Adherence/Compliance, Chronic Conditions
Volerman A, Fierstein J, Boon K
Factors associated with effective inhaler technique among children with moderate to severe asthma.
Guidelines recommend that children and families receive education about and demonstration of effective inhaler technique as part of asthma self-management education. For youth, improved inhaler technique is associated with better quality of life and decreased health care use, yet technique remains suboptimal. To understand potential reasons for differences in inhaler skills, this study examined individual- and health care-level factors associated with effective inhaler technique among children.
AHRQ-funded; HS026385.
Citation: Volerman A, Fierstein J, Boon K .
Factors associated with effective inhaler technique among children with moderate to severe asthma.
Ann Allergy Asthma Immunol 2019 Nov;123(5):511-12.e1. doi: 10.1016/j.anai.2019.08.017.
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Keywords: Children/Adolescents, Asthma, Chronic Conditions, Patient Self-Management, Education: Patient and Caregiver, Medication, Quality of Life
Cole AL, Jazowski SA, Dusetzina SB
Initiation of generic imatinib may improve medication adherence for patients with chronic myeloid leukemia.
Investigators compared adherence to tyrosine kinase inhibitors (TKIs) between patients with chronic myeloid leukemia (CML) who initiated branded or generic imatinib using MarketScan commercial claims data. They found that patients initiating generic imatinib achieved clinically significant improvements in adherence to TKI therapy relative to branded drug users, presumably due to lower out-of-pocket costs. Given the importance of optimal adherence in CML, considering barriers to adherence when selecting initial treatment may improve long-term medication adherence.
AHRQ-funded; HS000032.
Citation: Cole AL, Jazowski SA, Dusetzina SB .
Initiation of generic imatinib may improve medication adherence for patients with chronic myeloid leukemia.
Pharmacoepidemiol Drug Saf 2019 Nov;28(11):1529-33. doi: 10.1002/pds.4893..
Keywords: Patient Adherence/Compliance, Medication, Chronic Conditions, Cancer
Bassett SM, Schuette SA, O'Dwyer LC
Positive affect and medication adherence in chronic conditions: a systematic review.
This systematic evidence review was conducted to determine the current state of knowledge on the relationship between positive affect and medication adherence in persons living with chronic conditions. The review was conducted using PsycINFO, PubMed MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL and Embase. Nine studies met the inclusion criteria and examined the correlation in people living with HIV or cardiovascular conditions. The review further proved a link between positive affect and medication adherence for chronic conditions.
AHRQ-funded; HS000078.
Citation: Bassett SM, Schuette SA, O'Dwyer LC .
Positive affect and medication adherence in chronic conditions: a systematic review.
Health Psychol 2019 Nov;38(11):960-74. doi: 10.1037/hea0000778..
Keywords: Patient Adherence/Compliance, Medication, Chronic Conditions
Colloca L, Lee SE, Luhowy MN
Relieving acute pain (RAP) study: a proof-of-concept protocol for a randomised, double-blind, placebo-controlled trial
This study hypothesizes that dose-extending placebos can be an effective treatment in relieving clinical acute pain in trauma patients who take opioids. Publishing this study protocol will enable researchers and funding bodies to stay up to date in their fields by providing exposure to research activity that may not be otherwise widely publicized.
AHRQ-funded; HS022135.
Citation: Colloca L, Lee SE, Luhowy MN .
Relieving acute pain (RAP) study: a proof-of-concept protocol for a randomised, double-blind, placebo-controlled trial
BMJ Open 2019 Nov 11;9(11):e030623. doi: 10.1136/bmjopen-2019-030623..
Keywords: Back Health and Pain, Pain, Chronic Conditions, Opioids, Medication
Fung VC, Overhage LN, Sylvia LG
Complex polypharmacy in bipolar disorder: side effect burden, adherence, and response predictors.
Investigators assessed the associations between complex polypharmacy (CP), adherence, and side effect burden, and patient traits associated with clinical improvement in relationship to CP in patients with bipolar disorder. They found that bipolar disorder patients with CP were less likely to adhere to therapy, and those with worse adherence to CP were less likely to clinically respond. They recommended that clinicians assess medication adherence prior to adding another agent to medication regimens.
AHRQ-funded; HS019371.
Citation: Fung VC, Overhage LN, Sylvia LG .
Complex polypharmacy in bipolar disorder: side effect burden, adherence, and response predictors.
J Affect Disord 2019 Oct 1;257:17-22. doi: 10.1016/j.jad.2019.06.050..
Keywords: Adverse Drug Events (ADE), Adverse Events, Medication, Behavioral Health, Chronic Conditions, Patient Adherence/Compliance
Fredericksen RJ, Yang FM, Gibbons LE
Development and content validation of measures assessing adherence barriers and behaviors for use in clinical care.
The authors developed brief, computer-administered patient-reported measures in English and Spanish assessing prescribed medication adherence behaviors and barriers for use with patients living with chronic diseases focusing on clinical relevance, brevity, and content validity for use in clinical care.
AHRQ-funded; HS022242.
Citation: Fredericksen RJ, Yang FM, Gibbons LE .
Development and content validation of measures assessing adherence barriers and behaviors for use in clinical care.
Res Social Adm Pharm 2019 Sep;15(9):1168-76. doi: 10.1016/j.sapharm.2018.10.001..
Keywords: Patient Adherence/Compliance, Medication, Chronic Conditions, Human Immunodeficiency Virus (HIV)
Ike B, Baldwin LM, Sutton S
Staff and clinician work-life perceptions after implementing systems-based improvements to opioid management.
The authors assessed the impact of implementing the Six Building Blocks on the work-life of primary care providers and staff. Six rural and rural-serving primary care organizations implemented the Six Building Blocks, with assistance from practice facilitators, clinical experts, and informatics specialists. The authors found that clinicians and staff reported improvement in their work-life after implementing the Six Building Blocks Program to improve opioid medication management and recommended further research on patient experiences specific to practice redesign programs.
AHRQ-funded; HS023750.
Citation: Ike B, Baldwin LM, Sutton S .
Staff and clinician work-life perceptions after implementing systems-based improvements to opioid management.
J Am Board Fam Med 2019 Sep-Oct;32(5):715-23. doi: 10.3122/jabfm.2019.05.190027.
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Keywords: Opioids, Pain, Chronic Conditions, Primary Care: Models of Care, Primary Care, Care Management, Ambulatory Care and Surgery, Quality Improvement, Medication, Provider, Clinician-Patient Communication
Dy CJ, Peacock K, Olsen MA
Frequency and risk factors for prolonged opioid prescriptions after surgery for brachial plexus injury.
This study examined risk of prolonged opioid prescription use after surgery for brachial plexus injury (BPI). A cohort of BPI surgery patients was compared to a control group of non-BPI patients, matching for age, sex, and year. Pharmacy claims for prescriptions filled for opioids and neuropathic pain methods were examined 1 year before surgery to 180 days after surgery. The primary outcome studied was prolonged opioid prescription, which is defined as receiving a prescription 90 to 180 days after the surgery or randomly selected date of service for controls. Among BPI patients, a subgroup analysis was also performed on opioid-naïve patients between 30 days to 1 year before surgery. Among BPI surgery patients, 27.7% had prolonged opioid prescriptions, but only 10.8% of opioid-naïve patients had prolonged opioid prescriptions. The rate for controls was 0.11%. The rates of prolonged opioid prescriptions for BPI patients was higher than previous estimates among other surgical patients.
AHRQ-funded; HS019455.
Citation: Dy CJ, Peacock K, Olsen MA .
Frequency and risk factors for prolonged opioid prescriptions after surgery for brachial plexus injury.
J Hand Surg Am 2019 Aug;44(8):662-68.e1. doi: 10.1016/j.jhsa.2019.04.001..
Keywords: Opioids, Medication, Surgery, Pain, Practice Patterns, Risk, Chronic Conditions
Parchman ML, Penfold RB, Ike B
Team-based clinic redesign of opioid medication management in primary care: effect on opioid prescribing.
This study examined the effect of using an opioid medication management program called Six Building Blocks in primary care practices to help reduce the rate of opioid prescriptions. Six rural-serving organizations with 20 clinic locations received support for 15 months to help them implement the Six Building Blocks. This case-control study compared monthly trends in patients undergoing long-term opioid therapy (LtOT) for patients enrolled in the intervention clinics with those enrolled in a regional health plan who did not receive care at the study sites but resided in the same areas. There was a significant rate of decrease of patients on LtOT at intervention clinics compared with the control group.
AHRQ-funded; HS023750.
Citation: Parchman ML, Penfold RB, Ike B .
Team-based clinic redesign of opioid medication management in primary care: effect on opioid prescribing.
Ann Fam Med 2019 Jul;17(4):319-25. doi: 10.1370/afm.2390..
Keywords: Opioids, Primary Care: Models of Care, Primary Care, Teams, Medication, Pain, Chronic Conditions, Practice Patterns, Patient-Centered Healthcare
Wyatt DL
AHRQ Author: Wyatt DL
Employing technology to make care transitions safer.
This commentary discusses the potential for errors in patient handoffs; important information about medications and instructions regarding patient care may be overlooked when the patient is referred to special care, moved to a new hospital setting, or discharged. The problem is especially acute for patients with multiple chronic conditions who often undergo frequent transitions to new care settings and healthcare providers. The author describes AHRQ’s funding opportunities for health information technology interventions that aim to improve communication and coordination during care transitions, such as location-based smartphone alerts, a patient-centered discharge toolkit, and a ‘smart pillbox’ electronic medication adherence reporting project.
AHRQ-authored.
Citation: Wyatt DL .
Employing technology to make care transitions safer.
J Nurs Care Qual 2019 Jul/Sep;34(3):185-88. doi: 10.1097/ncq.0000000000000417..
Keywords: Adverse Events, Care Coordination, Chronic Conditions, Communication, Health Information Technology (HIT), Healthcare Delivery, Hospital Discharge, Medical Errors, Medication, Patient Safety, Transitions of Care
Ulrich RJ, McClung D, Wang BR
Introduction of procalcitonin testing and antibiotic utilization for acute exacerbations of chronic obstructive pulmonary disease.
This study measured the amount of procalcitonin testing (PCT) done for hospital inpatients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). PCT tests for presence of bacterial infection, which the majority of AECOPD inpatients did not have. Out of 238 AECOPD admissions, 31% had PCT performed. The patients who were tested were more likely to meet systemic inflammatory response syndrome (SIRS) criteria, require intensive-care unit (ICU)-level care, and have a longer length of stay compared with those not tested. However, testing was not associated with a decrease in total antibiotic days of therapy.
AHRQ-funded.
Citation: Ulrich RJ, McClung D, Wang BR .
Introduction of procalcitonin testing and antibiotic utilization for acute exacerbations of chronic obstructive pulmonary disease.
Infect Dis 2019 Jun 12;12:1178633719852626. doi: 10.1177/1178633719852626..
Keywords: Antibiotics, Chronic Conditions, Respiratory Conditions, Medication
Assimon MM, Brookhart MA, Flythe JE
Comparative cardiac safety of selective serotonin reuptake inhibitors among individuals receiving maintenance hemodialysis.
This retrospective cohort study compared cardiac safety of selective serotonin reuptake inhibitors (SSRIs) among individuals receiving maintenance hemodialysis. These individuals may be particularly susceptible to lethal cardiac consequences of drug-induced QT prolongation due to a substantial cardiovascular disease burden and their use of many medications. Data from a cohort of Medicare beneficiaries receiving hemodialysis included in the US Renal Data system registry from 2007-2014 was used. Researchers compared the 1-year risk of death among hemodialysis patients taking different SSRIs. Use of higher QT-prolonging potential SSRIs (citalopram, escitalopram) was associated with a higher risk of sudden cardiac death than patients taking lower risk SSRIs (fluoxetine, fluvoxamine, paroxetine, sertraline). The association was higher among elderly individuals, females, patients with conduction disorders, and those treated with other non-SSRI QT-prolonging medications.
AHRQ-funded; HS026801.
Citation: Assimon MM, Brookhart MA, Flythe JE .
Comparative cardiac safety of selective serotonin reuptake inhibitors among individuals receiving maintenance hemodialysis.
J Am Soc Nephrol 2019 Apr;30(4):611-23. doi: 10.1681/asn.2018101032..
Keywords: Medication, Medication: Safety, Patient Safety, Adverse Drug Events (ADE), Adverse Events, Kidney Disease and Health, Cardiovascular Conditions, Chronic Conditions
Feinstein JA, Hall M, Antoon JW
Chronic medication use in children insured by Medicaid: a multistate retrospective cohort study.
This retrospective cohort study examined the use of chronic medication (CM) use in children insured by Medicaid. The cohort included children ages 1 to 18 years from 10 states in 2014. It was grouped by the annual number of CMs (0, 1, 2-4, 5-9, and >=10). Of the over 4.5 million subjects, 18.8% used CMs, and 44% in children with a complex chronic condition. The most common CM therapeutic class was neurologic (28.8%). For children prescribed only 1 CM, the most common class is amphetamine stimulants. For children with 10 or greater CMs prescribed, antiepileptics were the most common. Increased CM use was associated with increased hospitalization and emergency department use.
AHRQ-funded; HS025138.
Citation: Feinstein JA, Hall M, Antoon JW .
Chronic medication use in children insured by Medicaid: a multistate retrospective cohort study.
Pediatrics 2019 Apr;143(4). doi: 10.1542/peds.2018-3397..
Keywords: Children/Adolescents, Chronic Conditions, Medicaid, Medication
Shaffer VA, Wegier P, Valentine KD
Patient judgments about hypertension control: the role of variability, trends, and outliers in visualized blood pressure data.
Uncontrolled hypertension is a significant health problem in the United States, even though multiple drugs exist to effectively treat this chronic disease. As part of a larger project developing data visualizations to support shared decision making about hypertension treatment, the investigators conducted a series of studies to understand how perceptions of hypertension control were impacted by data variations inherent in the visualization of blood pressure (BP) data.
AHRQ-funded; HS023328.
Citation: Shaffer VA, Wegier P, Valentine KD .
Patient judgments about hypertension control: the role of variability, trends, and outliers in visualized blood pressure data.
J Med Internet Res 2019 Mar 26;21(3):e11366. doi: 10.2196/11366..
Keywords: Blood Pressure, Shared Decision Making, Patient-Centered Healthcare, Medication, Chronic Conditions
Callaghan BC, Reynolds E, Banerjee M
Longitudinal pattern of pain medication utilization in peripheral neuropathy patients.
The authors of this article investigated the pattern and utilization of neuropathic pain medications in peripheral neuropathy patients. They found that opioid initiation and transition to chronic opioid therapy were frequent in the studied population despite few patients receiving more than one guideline-recommended medication. They concluded that efforts are needed to decrease opioid utilization and to increase guideline-recommended medication use in order to improve current neuropathic pain treatment.
AHRQ-funded; HS017690.
Citation: Callaghan BC, Reynolds E, Banerjee M .
Longitudinal pattern of pain medication utilization in peripheral neuropathy patients.
Pain 2019 Mar;160(3):592-99. doi: 10.1097/j.pain.0000000000001439..
Keywords: Chronic Conditions, Guidelines, Healthcare Utilization, Medication, Neurological Disorders, Opioids, Pain, Practice Patterns
Belden JL, Wegier P, Patel J
Designing a medication timeline for patients and physicians.
Researchers designed a prototype medication timeline visualization for physicians which can be used in the care of chronic disease. It was designed using open source software. A small pilot evaluation of the design was used with physicians. It was designed to improve physician performance by reducing temporal and cognitive load.
AHRQ-funded; HS023328.
Citation: Belden JL, Wegier P, Patel J .
Designing a medication timeline for patients and physicians.
J Am Med Inform Assoc 2019 Feb;26(2):95-105. doi: 10.1093/jamia/ocy143..
Keywords: Chronic Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication
Smith GH, Shore S, Allen LA
Discussing out-of-pocket costs with patients: shared decision making for sacubitril-valsartan in heart failure.
This study examined how prescription costs can greatly impact decision-making in patients with serious medical conditions. Forty-nine patients with heart failure with reduced ejection fracture were recruited and interviewed about a drug sacrubitril-valsartan. The drug is considered effective but can be costly. Most patients (45/49) said they would take the medicine if the out-of-pocket cost was only $5 per month more than their current medication. But if the costs increased to $100 more per month then only 43% would switch to sacrubritil-valsartan. Only 20% of participants said their physician had discussed medication costs in the past year.
AHRQ-funded; HS026081.
Citation: Smith GH, Shore S, Allen LA .
Discussing out-of-pocket costs with patients: shared decision making for sacubitril-valsartan in heart failure.
J Am Heart Assoc 2019 Jan 8;8(1):e010635. doi: 10.1161/jaha.118.010635..
Keywords: Healthcare Costs, Shared Decision Making, Heart Disease and Health, Cardiovascular Conditions, Medication, Chronic Conditions
Crosby LE, Walton A, Shook LM
Development of a hydroxyurea decision aid for parents of children with sickle cell anemia.
This study developed a decision aid for use of hydroxyurea for parents of children with sickle cell anemia. There are national evidence-based guidelines, but they do not offer strategies for implementation. A multicomponent decision aid was developed via a needs assessment, clinic observations and iterative feedback. The decision aid was considered useful by the 75 parents and 28 clinicians who participated in all phases of the study.
AHRQ-funded; HS021114.
Citation: Crosby LE, Walton A, Shook LM .
Development of a hydroxyurea decision aid for parents of children with sickle cell anemia.
J Pediatr Hematol Oncol 2019 Jan;41(1):56-63. doi: 10.1097/mph.0000000000001257..
Keywords: Caregiving, Children/Adolescents, Chronic Conditions, Shared Decision Making, Education: Patient and Caregiver, Medication, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Sickle Cell Disease