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AHRQ Research Studies Date
Topics
- Access to Care (2)
- Adverse Drug Events (ADE) (1)
- Cardiovascular Conditions (1)
- Children/Adolescents (4)
- Chronic Conditions (2)
- Clinical Decision Support (CDS) (1)
- Disparities (5)
- Evidence-Based Practice (1)
- Healthcare Costs (1)
- Healthcare Utilization (2)
- Health Services Research (HSR) (6)
- Heart Disease and Health (1)
- Hospital Readmissions (3)
- Kidney Disease and Health (9)
- Medical Expenditure Panel Survey (MEPS) (1)
- Mortality (1)
- Outcomes (4)
- Patient-Centered Outcomes Research (3)
- Patient Safety (2)
- Policy (7)
- Provider Performance (1)
- Quality of Care (1)
- Racial and Ethnic Minorities (3)
- Registries (4)
- Rehabilitation (1)
- Risk (1)
- Shared Decision Making (1)
- Surgery (2)
- (-) Transplantation (25)
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 25 Research Studies DisplayedKelly MS, Spees L, Vinesett R
Utility of autopsy among pediatric allogeneic hematopoietic stem cell transplant recipients: one last chance to learn?
Researchers conducted a retrospective cohort study of children undergoing allogeneic hematopoietic stem cell transplant (HSCT) at Duke University who died of any cause in 1995 and 2016. They found no associations between autopsy performance and patient age, sex, HSCT indication, or HSCT donor. Additionally, the proportion of autopsies with an unexpected diagnosis did not change during the study period. The researchers conclude that the utility of autopsy in this patient population remains high despite a reduction in the identification of unexpected infections.
AHRQ-funded; HS000032.
Citation: Kelly MS, Spees L, Vinesett R .
Utility of autopsy among pediatric allogeneic hematopoietic stem cell transplant recipients: one last chance to learn?
Biol Blood Marrow Transplant 2018 Sep;24(9):1861-65. doi: 10.1016/j.bbmt.2018.05.030..
Keywords: Children/Adolescents, Transplantation
Wey A, Valapour M, Skeans
Heart and lung organ offer acceptance practices of transplant programs are associated with waitlist mortality and organ yield.
Variation in heart and lung offer acceptance practices may affect numbers of transplanted organs and create variability in waitlist mortality. In this study, the authors examined offered acceptance ratios, or adjusted odds ratios, for heart and lung transplant programs individually and for all programs within donation service areas (DSAs) using offers from donors recovered July 1, 2016, and June 30, 2017.
AHRQ-funded; HS024527.
Citation: Wey A, Valapour M, Skeans .
Heart and lung organ offer acceptance practices of transplant programs are associated with waitlist mortality and organ yield.
Am J Transplant 2018 Aug;18(8):2061-67. doi: 10.1111/ajt.14885..
Keywords: Transplantation, Health Services Research (HSR), Mortality
Kumar K, Tonascia JM, Muzaale AD
Racial differences in completion of the living kidney donor evaluation process.
Racial disparities in living donor kidney transplantation (LDKT) persist, but the most effective target to eliminate these disparities remains unknown. The researchers investigated delays during completion of the live donor evaluation process. They concluded that delays may be a manifestation of the transplant candidate's social network and recommended targeted efforts to optimize networks for identification of donor candidates in order to address LDKT disparities.
AHRQ-funded; HS024600.
Citation: Kumar K, Tonascia JM, Muzaale AD .
Racial differences in completion of the living kidney donor evaluation process.
Clin Transplant 2018 Jul;32(7):e13291. doi: 10.1111/ctr.13291..
Keywords: Transplantation, Racial and Ethnic Minorities, Disparities, Kidney Disease and Health
Henderson ML, DiBrito SR, Thomas AG
Landscape of living multiorgan donation in the United States: a registry-based cohort study.
This registry-based cohort study examined the patient characteristics and outcomes associated with living multiorgan donation in the United States. The authors assert that careful documentation of outcomes is needed to ensure ethical practices in selection, informed consent, and postdonation care of this unique donor community.
AHRQ-funded; HS024600.
Citation: Henderson ML, DiBrito SR, Thomas AG .
Landscape of living multiorgan donation in the United States: a registry-based cohort study.
Transplantation 2018 Jul;102(7):1148-55. doi: 10.1097/tp.0000000000002082..
Keywords: Health Services Research (HSR), Patient-Centered Outcomes Research, Policy, Registries, Transplantation
Wey A, Gustafson SK, Salkowski N
Program-specific transplant rate ratios: association with allocation priority at listing and posttransplant outcomes.
The Scientific Registry of Transplant Recipients (SRTR) is considering more prominent reporting of program-specific adjusted transplant rate ratios (TRRs). To enable more useful reporting of TRRs, SRTR updated the transplant rate models to adjust explicitly for components of allocation priority. In this study, the investigators evaluated potential associations between TRRs and components of allocation priority that could indicate programs' ability to manipulate TRRs by denying or delaying access to low-priority candidates.
AHRQ-funded; HS024527.
Citation: Wey A, Gustafson SK, Salkowski N .
Program-specific transplant rate ratios: association with allocation priority at listing and posttransplant outcomes.
Am J Transplant 2018 Jun;18(6):1360-69. doi: 10.1111/ajt.14684..
Keywords: Transplantation, Registries, Health Services Research (HSR)
Wey A, Salkowski N, Kasiske BL
A five-tier system for improving the categorization of transplant program performance.
The purpose of this study was to better inform health care consumers by identifying the differences in transplant program performance. Researchers compared the differentiation of program performance and a simulated misclassification rate of the five-tier system with the previous three-tier system based on the 95 percent credible interval, using data on adult kidney transplants collected from the Scientific Registry of Transplant Recipients database. The study finds that the five-tier system improved differentiation and maintained a lower misclassification rate than programs differing by two tiers, and concludes that the five-tier system can improve the informing of health care consumers about transplant program performance.
AHRQ-funded; HS024527.
Citation: Wey A, Salkowski N, Kasiske BL .
A five-tier system for improving the categorization of transplant program performance.
Health Serv Res 2018 Jun;53(3):1979-91. doi: 10.1111/1475-6773.12726..
Keywords: Transplantation, Provider Performance, Quality of Care, Registries
Ashlagi I, Bingaman A, Burq M
Effect of match-run frequencies on the number of transplants and waiting times in kidney exchange.
Many U.S. kidney paired donation (KPD) registries have gradually shifted to high-frequency match-runs, raising the question of whether this harms the number of transplants. The authors conducted simulations and found that longer intervals between match-runs do not increase the total number of transplants, and that prioritizing highly sensitized patients is more effective than waiting longer between match-runs for transplanting these patients. Further, increasing arrival rates of new pairs improves both the fraction of transplanted pairs and waiting times.
AHRQ-funded; HS020610.
Citation: Ashlagi I, Bingaman A, Burq M .
Effect of match-run frequencies on the number of transplants and waiting times in kidney exchange.
Am J Transplant 2018 May;18(5):1177-86. doi: 10.1111/ajt.14566..
Keywords: Transplantation, Kidney Disease and Health, Health Services Research (HSR), Policy, Registries
Mogul DB, Luo X, Bowring MG
Fifteen-year trends in pediatric liver transplants: split, whole deceased, and living donor grafts.
This study evaluated changes in patient and graft survival for pediatric liver transplant recipients since 2002, and to determine if these outcomes vary by graft type (whole liver transplant, split liver transplant [SLT], and living donor liver transplant [LDLT]). It concluded that in recent years, outcomes after the use of technical variant grafts are comparable with whole grafts, and may be superior for LDLT.
AHRQ-funded; HS023876.
Citation: Mogul DB, Luo X, Bowring MG .
Fifteen-year trends in pediatric liver transplants: split, whole deceased, and living donor grafts.
J Pediatr 2018 May;196:148-53.e2. doi: 10.1016/j.jpeds.2017.11.015.
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Keywords: Children/Adolescents, Patient-Centered Outcomes Research, Children/Adolescents, Transplantation
Bachmann JM, Shah AS, Duncan MS
Cardiac rehabilitation and readmissions after heart transplantation.
Cardiac transplant recipients always are referred to cardiac rehabilitation (CR) after transplantation, and is associated with a lower 1-year readmission risk. This study’s objective was to determine rates of CR for heart transplant recipients in the US and also 1-year readmission rates using 2013-2014 Medicare data. Out of the 2,531 heart transplant patients in the US in 2013, about 24% received Medicare coverage and were included in the study. Rates of CR utilization was only, with only 55% participating in the program. Younger transplant patients ages 35 to 49 years were less likely to initiate CR than patients 65 and older. In all groups patients did not attend all 36 prescribed sessions, with a mean of 26.7 sessions attended. The 1-year readmission risk was 29% lower for CR participation patients.
AHRQ-funded; HS022990.
Citation: Bachmann JM, Shah AS, Duncan MS .
Cardiac rehabilitation and readmissions after heart transplantation.
J Heart Lung Transplant 2018 Apr;37(4):467-76. doi: 10.1016/j.healun.2017.0.017.
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Keywords: Transplantation, Surgery, Rehabilitation, Cardiovascular Conditions, Heart Disease and Health, Hospital Readmissions, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Wey A, Salkowski N, Kremers WK
A kidney offer acceptance decision tool to inform the decision to accept an offer or wait for a better kidney.
The researchers developed a kidney offer acceptance decision tool to predict the probability of graft survival and patient survival for first-time kidney-alone candidates after an offer is accepted or declined, and they characterized the effect of restricting the donor pool with a maximum acceptable kidney donor profile index (KDPI). Donor pool restrictions were associated with worse 3-year outcomes, especially for candidates with high allocation priority.
AHRQ-funded; HS024527.
Citation: Wey A, Salkowski N, Kremers WK .
A kidney offer acceptance decision tool to inform the decision to accept an offer or wait for a better kidney.
Am J Transplant 2018 Apr;18(4):897-906. doi: 10.1111/ajt.14506.
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Keywords: Clinical Decision Support (CDS), Shared Decision Making, Kidney Disease and Health, Medical Expenditure Panel Survey (MEPS), Transplantation
Wey A, Pyke J, Schladt DP
Offer acceptance practices and geographic variability in allocation model for end-stage liver disease at transplant.
Offer acceptance practices may cause geographic variability in allocation Model for End-Stage Liver Disease (aMELD) score at transplant and could magnify the effect of donor supply and demand on aMELD variability. To evaluate these issues, offer acceptance practices of liver transplant programs and donation service areas (DSAs) were estimated using offers of livers from donors recovered between January 1, 2016, and December 31, 2016.
AHRQ-funded; HS024527.
Citation: Wey A, Pyke J, Schladt DP .
Offer acceptance practices and geographic variability in allocation model for end-stage liver disease at transplant.
Liver Transpl 2018 Apr;24(4):478-87. doi: 10.1002/lt.25010..
Keywords: Health Services Research (HSR), Policy, Transplantation
Ruck JM, Holscher CM, Purnell TS
https://www.ncbi.nlm.nih.gov/pubmed/29068176
Factors associated with perceived donation-related financial burden among living kidney donors.
The perception of living kidney donation-related financial burden affects willingness to donate and the experience of donation, yet no existing tools identify donors who are at higher risk of perceived financial burden. In this study, the investigators sought to identify characteristics that predicted higher risk of perceived financial burden.
AHRQ-funded; HS024600.
Citation: Ruck JM, Holscher CM, Purnell TS .
Factors associated with perceived donation-related financial burden among living kidney donors.
Am J Transplant 2018 Mar;18(3):715-19. doi: 10.1111/ajt.14548..
Keywords: Transplantation, Healthcare Costs, Kidney Disease and Health
Bozek DN, Dunn TB, Kuhr CS
Complete chain of the first global kidney exchange transplant and 3-yr follow-up.
While the promise of Global Kidney Exchange (GKE) is significant, it has been met with ethical criticism since its inception in 2015. This paper aims to demonstrate the selection process and provide >3 yr of follow-up on the first GKE donor and recipient from the Philippines. The authors concluded that, although criticisms of GKE highlight concerns for possible exploitation of financially disadvantaged groups, their results demonstrated that these concerns did not come to fruition.
AHRQ-funded; HS020610.
Citation: Bozek DN, Dunn TB, Kuhr CS .
Complete chain of the first global kidney exchange transplant and 3-yr follow-up.
Eur Urol Focus 2018 Mar;4(2):190-97. doi: 10.1016/j.euf.2018.07.021..
Keywords: Kidney Disease and Health, Transplantation
Mogul DB, Luo X, Chow EK
Impact of race and ethnicity on outcomes for children waitlisted for pediatric liver transplantation.
This study sought to determine whether outcomes on the waitlist (ie, mortality, deceased donor liver transplantation [DDLT], and living-donor liver transplantation [LDLT]) varied by race/ethnicity. It concluded that, compared to Caucasian children, African-American children are less likely to use LDLT but have higher rates of DDLT and similar survival on the waitlist.
AHRQ-funded; HS024600; HS023876.
Citation: Mogul DB, Luo X, Chow EK .
Impact of race and ethnicity on outcomes for children waitlisted for pediatric liver transplantation.
J Pediatr Gastroenterol Nutr 2018 Mar;66(3):436-41. doi: 10.1097/mpg.0000000000001793.
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Keywords: Children/Adolescents, Healthcare Utilization, Racial and Ethnic Minorities, Outcomes, Transplantation
Mehrotra S, Kilambi V, Bui K
A concentric neighborhood solution to disparity in liver access that contains current UNOS districts.
Policymakers are deliberating policy reforms to reduce geographic disparity in liver allocation. This study conducted simulations comparing current allocation with the neighborhoods and sharing policies. The study concluded that the current 11 districts can be adapted systematically by adding neighboring donor service areas (DSAs) to improve geographic disparity, mortality, and airplane travel distance. Modifications to Share 35 and Share 15 policies result in further improvements.
AHRQ-funded; HS024840.
Citation: Mehrotra S, Kilambi V, Bui K .
A concentric neighborhood solution to disparity in liver access that contains current UNOS districts.
Transplantation 2018 Feb;102(2):255-78. doi: 10.1097/tp.0000000000001934..
Keywords: Access to Care, Disparities, Policy, Transplantation
Vranian SC, Covert KL, Mardis CR
Assessment of risk factors for increased resource utilization in kidney transplantation.
The purpose of this study was to identify risk factors for increased health care resource utilization in kidney transplant recipients, based on drug-related problems and self-administered surveys. Adult kidney transplant recipients seen in the transplant clinic were surveyed for self-reported demographics, then assessed for associations between survey results, pharmacist-derived drug-related problems, and health resource utilization over a minimum 6-month follow-up period. The authors conclude that Medicaid insurance, self-rated poor health status, and errors in the medication regimen were significant risk factors for increased health care utilization in kidney transplant recipients. Further research is warranted to validate these potential risk factors.
AHRQ-funded; HS023754.
Citation: Vranian SC, Covert KL, Mardis CR .
Assessment of risk factors for increased resource utilization in kidney transplantation.
J Surg Res 2018 Feb;222:195-202.e2. doi: 10.1016/j.jss.2017.09.037..
Keywords: Healthcare Utilization, Kidney Disease and Health, Transplantation
Arms MA, Fleming J, Sangani DB
Incidence and impact of adverse drug events contributing to hospital readmissions in kidney transplant recipients.
This longitudinal cohort study examined 3 cohorts (no readmissions, readmissions not due to an adverse drug event, and adverse drug events contributing to readmissions) of adult kidney recipients transplanted between 2005 and 2010 and followed through 2013. The study results demonstrated that adverse drug events may be associated with a significant increase in the risk of hospital readmission after kidney transplant and subsequent graft loss.
AHRQ-funded; HS023754
Citation: Arms MA, Fleming J, Sangani DB .
Incidence and impact of adverse drug events contributing to hospital readmissions in kidney transplant recipients.
Surgery 2018 Feb;163(2):430-35. doi: 10.1016/j.surg.2017.09.027..
Keywords: Adverse Drug Events (ADE), Patient Safety, Hospital Readmissions, Transplantation
Kilambi V, Bui K, Mehrotra S
LivSim: An open-source simulation software platform for community research and development for liver allocation policies.
This brief discusses LivSim, an open-source software alternative to the Liver Simulated Allocation Model (LSAM) created by the Scientific Registry of Transplant Recipients. LivSim is an open-source simulation software platform for community research and development for liver allocation policies.
AHRQ-funded; HS024840.
Citation: Kilambi V, Bui K, Mehrotra S .
LivSim: An open-source simulation software platform for community research and development for liver allocation policies.
Transplantation 2018 Feb;102(2):e47-e48. doi: 10.1097/tp.0000000000002000..
Keywords: Health Services Research (HSR), Policy, Transplantation
Purnell TS, Luo X, Cooper LA
Association of race and ethnicity with live donor kidney transplantation in the United States from 1995 to 2014.
This study estimated changes over time in racial/ethnic disparities in live donor kidney transplantation (LDKT) in the United States, accounting for differences in death and deceased donor kidney transplantation. Among adult first-time kidney transplantation candidates in the United States who were added to the deceased donor kidney transplantation waiting list between 1995 and 2014, disparities in the receipt of live donor kidney transplantation increased from 1995-1999 to 2010-2014.
AHRQ-funded; HS024600.
Citation: Purnell TS, Luo X, Cooper LA .
Association of race and ethnicity with live donor kidney transplantation in the United States from 1995 to 2014.
JAMA 2018 Jan 2;319(1):49-61. doi: 10.1001/jama.2017.19152.
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Keywords: Disparities, Kidney Disease and Health, Kidney Disease and Health, Racial and Ethnic Minorities, Transplantation
Davis AE, Mehrotra S, Ladner DP
Changes in geographic disparity in kidney transplantation since the final rule.
The researchers assessed the significance of changes of geographic disparities for four metrics since the 1998 adoption of HHS Final Rule’s emphasizing objective priority criteria: waiting times, transplant rates, pre-transplant mortality, and organ quality. They found that the ranges of the four metrics have worsened by approximately 30% or more after the Final Rule at both the regional and donor service area levels.
AHRQ-funded; HS021078.
Citation: Davis AE, Mehrotra S, Ladner DP .
Changes in geographic disparity in kidney transplantation since the final rule.
Transplantation 2014 Nov 15;98(9):931-6. doi: 10.1097/tp.0000000000000446..
Keywords: Transplantation, Disparities, Policy, Outcomes
Zhang Y, Thamer M, Kshirsagar O
Dialysis chains and placement on the waiting list for a cadaveric kidney transplant.
The purpose of this paper is to investigate the effect of dialysis facility chain status on renal transplantation therapy. The researchers concluded that dialysis chain affiliation expands previously observed ownership-related differences in placement on the waiting list, and for-profit ownership of dialysis chain facilities appears to be a significant impediment to access to renal transplants.
AHRQ-funded; HS020243.
Citation: Zhang Y, Thamer M, Kshirsagar O .
Dialysis chains and placement on the waiting list for a cadaveric kidney transplant.
Transplantation 2014 Sep 15;98(5):543-51. doi: 10.1097/tp.0000000000000106.
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Keywords: Kidney Disease and Health, Transplantation, Access to Care
Feudtner C, Feinstein JA, Zhong W
Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation.
In order to update the pediatric complex chronic conditions (CCC) classification system, the authors incorporated ICD-9 diagnostic codes that had been either omitted or incorrectly specified in the original system, and then translated between ICD-9 and ICD-10 using General Equivalence Mappings (GEMs). They concluded that the updated CCC version 2 system is comprehensive and multidimensional, providing a necessary update to accommodate widespread implementation of ICD-10.
AHRQ-funded; HS018425.
Citation: Feudtner C, Feinstein JA, Zhong W .
Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation.
BMC Pediatr 2014 Aug 8;14:199. doi: 10.1186/1471-2431-14-199.
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Keywords: Children/Adolescents, Chronic Conditions, Transplantation
Davis AE, Mehrotra S, Kilambi V
The effect of the Statewide Sharing variance on geographic disparity in kidney transplantation in the United States.
This study examined the effect of Statewide Sharing on geographic allocation disparity over time between donor service areas (DSAs) within Tennessee and Florida and compared them with geographic disparity between the DSAs within a state for all states with more than one DSA (California, New York, North Carolina, Ohio, Pennsylvania, Texas, and Wisconsin). Findings suggested that changes which are untested run the risk of unintended consequences, and Statewide Sharing should be further studied and considered.
AHRQ-funded; HS021078.
Citation: Davis AE, Mehrotra S, Kilambi V .
The effect of the Statewide Sharing variance on geographic disparity in kidney transplantation in the United States.
Clin J Am Soc Nephrol 2014 Aug 7;9(8):1449-60. doi: 10.2215/cjn.05350513.
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Keywords: Chronic Conditions, Disparities, Kidney Disease and Health, Policy, Transplantation
Santos CA, Brennan DC, Fraser VJ
Delayed-onset cytomegalovirus disease coded during hospital readmission after kidney transplantation.
The researchers sought to expand understanding of the scope, risk factors and outcomes associated with delayed-onset cytomegalovirus (CMV) disease among kidney transplant reci
AHRQ-funded; HS019455
Citation: Santos CA, Brennan DC, Fraser VJ .
Delayed-onset cytomegalovirus disease coded during hospital readmission after kidney transplantation.
Transplantation. 2014 Jul 27;98(2):187-94. doi: 10.1097/TP.0000000000000030..
Keywords: Transplantation, Hospital Readmissions, Risk, Outcomes
Echenique IA, Cohen D, Rudow DL
Impact of repeat testing of living kidney donors within 14 days of the transplant procedure: a multicenter retrospective survey.
The researchers surveyed 15 living donor kidney and/or liver transplant programs in New York State to determine if the requirement for re-testing of the donor within 14 days of the transplant procedure would result in delays and cancelled transplants. They found that no cancellations occurred but 2 centers experienced delays.
AHRQ-funded; HS021060
Citation: Echenique IA, Cohen D, Rudow DL .
Impact of repeat testing of living kidney donors within 14 days of the transplant procedure: a multicenter retrospective survey.
Transpl Infect Dis. 2014 Jun;16(3):403-11. doi: 10.1111/tid.12219..
Keywords: Transplantation, Patient Safety, Surgery