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 1771 Research Studies DisplayedJeffery AD, Reale C, Faiman J
Inpatient nurses' preferences and decisions with risk information visualization.
The purpose of this study was to explore the effect of 4 different risk information formats on inpatient nurses' preferences and decisions with an acute clinical deterioration decision-support system. The researchers implemented a comparative usability evaluation in which participants provided responses to multiple user interface options in a simulated setting. Qualitative data was collected using think aloud methods, asking participants which action they would perform after each time point in 3 different patient scenarios. The 6 participants preferred the probability format over relative risk ratios (n = 2), absolute differences (n = 2), and number of persons out of 100 (n = 0). Participants preferred average lines, having a trend graph to supplement the risk estimate, and consistent colors between trend graphs and possible actions. Participants did not prefer too much text information or the presence of confidence intervals. The utilization of the probability format was related with higher concordance in actions taken by participants compared to the other 3 risk information formats.
AHRQ-funded; HS026395.
Citation: Jeffery AD, Reale C, Faiman J .
Inpatient nurses' preferences and decisions with risk information visualization.
J Am Med Inform Assoc 2023 Dec 22; 31(1):61-69. doi: 10.1093/jamia/ocad209..
Keywords: Provider: Nurse, Clinical Decision Support (CDS), Health Information Technology (HIT)
Zhang K, Potter RF, Marino J
Comparative genomics reveals the correlations of stress response genes and bacteriophages in developing antibiotic resistance of Staphylococcus saprophyticus.
The study explored resistance patterns in Staphylococcus saprophyticus, a common cause of UTIs in women. Genomic analysis linked antibiotic resistance genes to susceptibility, identifying associations with SCCmec configurations and phage elements. This database aids in resistance surveillance for precise diagnosis and treatment, potentially curbing resistance transmission.
AHRQ-funded; HS027621.
Citation: Zhang K, Potter RF, Marino J .
Comparative genomics reveals the correlations of stress response genes and bacteriophages in developing antibiotic resistance of Staphylococcus saprophyticus.
mSystems 2023 Dec 21; 8(6):e0069723. doi: 10.1128/msystems.00697-23..
Keywords: Genetics, Antibiotics, Urinary Tract Infection (UTI), Medication
Wurcel AG, Guardado R, Grussing ED
Racial differences in testing for infectious diseases: an analysis of jail intake data.
This analysis examines HIV and hepatitis C virus (HCV) testing in Middlesex House of Corrections (MHOC) in Massachusetts. Only 38% of incarcerated individuals who requested testing received it. Black non-Hispanic and Hispanic individuals were more likely to request and complete testing compared to white individuals. These disparities may reflect broader issues of access to care. The study highlights the need for improved testing completion rates and interdisciplinary collaboration in jails.
AHRQ-funded; HS026008.
Citation: Wurcel AG, Guardado R, Grussing ED .
Racial differences in testing for infectious diseases: an analysis of jail intake data.
PLoS One 2023 Dec 20; 18(12):e0288254. doi: 10.1371/journal.pone.0288254.
Keywords: Hepatitis, Human Immunodeficiency Virus (HIV), Racial and Ethnic Minorities, Vulnerable Populations
Wiehe SE, Nelson TL, Aalsma MC
HIV care continuum among people living with HIV and history of arrest and mental health diagnosis.
The purpose of this retrospective cohort study was to explore relationships between the overlap of justice involvement and psychiatric comorbidities with HIV outcomes among people living with HIV (PLWH). The researchers included 5,730 PLWH 13 years of age and older living in Marion County Indiana in 2018. The study found that linkage to care (LTC) decreased among those with an arrest vs those without an arrest. Mental health diagnoses had no significant impact on LTC. The researchers controlled for demographics and substance use disorder and the resulting analyses indicated a protective effect of arrest history on the likelihood of retention in care (RIC) and undetectable viral load (UVL). Having a diagnosis of a mental health issue also increased the likelihood of RIC and UVL. The study results were mediated by outpatient care use, but an arrest or the diagnosis of a mental health issue increased the likelihood of RIC among PLWH and a history of low use of outpatient services.
AHRQ-funded; HS023318; HS024296.
Citation: Wiehe SE, Nelson TL, Aalsma MC .
HIV care continuum among people living with HIV and history of arrest and mental health diagnosis.
J Acquir Immune Defic Syndr 2023 Dec 15; 94(5):403-11. doi: 10.1097/qai.0000000000003296..
Keywords: Human Immunodeficiency Virus (HIV)
Ray M, Zhao S, Wang S
Improving hospital quality risk-adjustment models using interactions identified by hierarchical group lasso regularisation.
This study’s goal was to see if using hierarchical group lasso regularization (HGLR) improved hospital quality risk adjustment (RA) models. The authors analyzed patient discharge de-identified data from 14 State Inpatient Databases, AHRQ Healthcare Cost and Utilization Project, California Department of Health Care Access and Information, and New York State Department of Health. They used HGLR to identify first-order interactions in several AHRQ inpatient quality indicators (IQI) - IQI 09 (Pancreatic Resection Mortality Rate), IQI 11 (Abdominal Aortic Aneurysm Repair Mortality Rate), and Patient Safety Indicator 14 (Postoperative Wound Dehiscence Rate). These RA models were compared with stratum-specific and composite main effects models with covariates selected by least absolute shrinkage and selection operator (LASSO). HGLR identified clinical meaning interactions for all models, with model performance similar or superior for composite models with HGLR-selected features, compared to those with LASSO-selected features. HGLR was found to be scalable to handle a large number of covariates and their interactions and is customizable to use multiple CPU cores to reduce analysis time.
AHRQ-funded; 290201200003I.
Citation: Ray M, Zhao S, Wang S .
Improving hospital quality risk-adjustment models using interactions identified by hierarchical group lasso regularisation.
BMC Health Serv Res 2023 Dec 15; 23(1):1419. doi: 10.1186/s12913-023-10423-9..
Keywords: Quality of Care, Hospitals, Risk
Ferrari RM, Atkins DL, Wangen M
Patient perspectives on a proposed pharmacy-based colorectal cancer screening program.
The objective of this study was to assess patient perspectives on receiving fecal immunochemical colorectal cancer (CRC) screening tests through pharmacies. Researchers conducted semi-structured interviews with participants in North Carolina and Washington. Survey participants reported pharmacy-based CRC screening programs to be highly acceptable, citing convenience, ease of access, and avoidance of co-pays, but they also had concerns about privacy and coordination with primary care providers. The researchers concluded that CRC screening in pharmacies is potentially a good option, provided patients have privacy and their primary care providers are informed.
AHRQ-funded; HS026122.
Citation: Ferrari RM, Atkins DL, Wangen M .
Patient perspectives on a proposed pharmacy-based colorectal cancer screening program.
Transl Behav Med 2023 Dec 15; 13(12):909-18. doi: 10.1093/tbm/ibad057..
Keywords: Provider: Pharmacist, Cancer: Colorectal Cancer, Colonoscopy, Screening, Prevention
Frimpong JA, Liu X, Liu L
AHRQ Author: Liu L
Adoption of electronic health record among substance use disorder treatment programs: nationwide cross-sectional survey study.
The purpose of this study was to explore the adoption of electronic health record (EHR) systems in substance use disorder (SUD) programs, with an emphasis on changes in adoption from 2014 to 2017, and identify organizational-level variables related with EHR adoption. The researchers utilized data from the 2014 and 2017 National Drug Abuse Treatment System Surveys, and analyzed 1,027 SUD programs. The study found the adoption of EHR increased significantly from 57.6% in 2014 to 69.2% in 2017. Nearly one-third of SUD programs had not yet adopted an EHR system by 2017. The researchers identified a significant increase in technology use and ownership by a parent company and a decrease in the percentage of uninsured patients in 2017 compared to 2014. Further analysis revealed significant differences by adoption status for three main barriers to adoption: 1. Costs of start-up, 2. Ongoing financial costs, and 3. Privacy or security concerns. Programs that used computerized scheduling and billing systems had a greater likelihood of adopting EHR. Ownership type, such as private nonprofit and public, or interest in taking part in a patient-centered medical home were related with a greater likelihood to adopt EHR. Overall, SUD programs were more likely to adopt an EHR system in 2017 compared to 2014.
AHRQ-authored.
Citation: Frimpong JA, Liu X, Liu L .
Adoption of electronic health record among substance use disorder treatment programs: nationwide cross-sectional survey study.
J Med Internet Res 2023 Dec 14; 25:e45238. doi: 10.2196/45238..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Substance Abuse, Behavioral Health
Lopez K, Li H, Lipkin-Moore Z
Deep learning prediction of hospital readmissions for asthma and COPD.
The purpose of this observational study was to identify Electronic Health Record (EHR) features of severe asthma and COPD exacerbations and assess the performance of four machine learning (ML) and one deep learning (DL) model in predicting readmissions using EHR data. The study included 31, 2017 patients hospitalized with asthma and COPD exacerbations. The study found that Black and Hispanic patients had a greater likelihood of readmission for asthma. Patients with COPD readmissions included a high percentage of Blacks and Hispanics. To identify patients at high risk of readmission, index hospitalization data of a subset of 2,682 patients, 777 with asthma and 1,905 with COPD, was analyzed with four ML models, and one DL model. The researchers discovered that multilayer perceptron, the DL method, had the best sensitivity and specificity compared to the four ML methods implemented in the same dataset.
AHRQ-funded; HS027626.
Citation: Lopez K, Li H, Lipkin-Moore Z .
Deep learning prediction of hospital readmissions for asthma and COPD.
Respir Res 2023 Dec 13; 24(1):311. doi: 10.1186/s12931-023-02628-7..
Keywords: Asthma, Respiratory Conditions, Hospital Readmissions, Electronic Health Records (EHRs), Health Information Technology (HIT)
Bhaumik D, Schlesinger MJ
How exposure to patient narratives affects stereotyped choices of primary care clinicians.
Researchers examined whether patient narratives alter the impact of stereotyping on choice of primary care clinicians, specifically the assumption that female doctors will be more attentive to empathic relationships with patients. Individuals selected from a nationally representative Internet panel participated in a survey that provided performance data about 12 fictitious primary care physicians and included a randomized set of narrative feedback from patients. The results showed that exposure to patient narratives that do not disrupt gendered stereotypes increased the likelihood of choosing a female clinician; however, when a sufficient proportion of patient comments run counter to stereotypes, even a minority of narratives is sufficient to disrupt gendered-expectations and alter choices.
AHRQ-funded; HS016978.
Citation: Bhaumik D, Schlesinger MJ .
How exposure to patient narratives affects stereotyped choices of primary care clinicians.
PLoS One 2023 Dec 7; 18(12):e0295243. doi: 10.1371/journal.pone.0295243..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Primary Care
Watterson TL, Stone JA, Kleinschmidt PC
CancelRx case study: implications for clinic and community pharmacy work systems.
This study examined the impact of implementation of CancelRx, a health IT system that automatically communicates medication discontinuations from the clinic electronic health record to the community pharmacy dispensing platform, theoretically improving communication. The system was implemented across a Midwest academic health system in October 2017, using their 15 outpatient community pharmacies to test it. Interviews were conducted with 9 medical assistants, 12 community pharmacists, and 3 pharmacy administrators employed by the health system across 3-time periods between 2017 and 2018: 3-months prior to CancelRx implementation, 3-months after CancelRx implementation, and 9-months after CancelRx implementation. While CancelRx automated and streamlined how medication discontinuation messages were received and processed, it also increased workload and introduced new errors.
AHRQ-funded; HS025793.
Citation: Watterson TL, Stone JA, Kleinschmidt PC .
CancelRx case study: implications for clinic and community pharmacy work systems.
BMC Health Serv Res 2023 Dec 6; 23(1):1360. doi: 10.1186/s12913-023-10396-9..
Keywords: Cancer, Provider: Pharmacist, Medication
Cartujano-Barrera F, Mejia RM, Radusky PD
Prevalence and correlates of current cigarette smoking among transgender women in Argentina.
AHRQ-funded; HS000011.
Citation: Cartujano-Barrera F, Mejia RM, Radusky PD .
Prevalence and correlates of current cigarette smoking among transgender women in Argentina.
Front Public Health 2023 Dec 5; 11:1279969. doi: 10.3389/fpubh.2023.1279969..
Keywords: Tobacco Use, Tobacco Use: Smoking Cessation
Azimi H, Johnson L, Loudermilk C
Medication regimen complexity (MRC-ICU) for in-hospital mortality prediction in COVID-19 patients.
This study’s purpose was to assess if a patient’s medication regimen complexity-intensive care unit (MRC-ICU) score could predict in-hospital mortality in patients with COVID-19. This single-center, observational study was conducted from August 2020 to January 2021. The primary outcome was the area under the receiver operating characteristic (AUROC) for in-hospital mortality for the 48-hour MRC-ICU. The authors assessed age, sequential organ failure assessment (SOFA), and World Health Organization (WHO) COVID-19 Severity Classification. They included 149 patients who had a median SOFA score of 8 (IQR 5-11), and median MRC-ICU score at 48 hours of 15. The in-hospital mortality rate of 36%. The AUROC for MRC-ICU was 0.71 compared to 0.66 for age, 0.81 SOFA, and 0.72 for the WHO Severity Classification. Univariate analysis was used to compare the 4 characteristics. SOFA, MRC-ICU, and WHO Severity Classification all demonstrated significant association with in-hospital mortality, while SOFA, MRC-ICU, and WHO Severity Classification demonstrated significant association with WHO Severity Classification at 7 days. All 4 characteristics showed significant association with mortality; however, only age and SOFA remained significant following multivariate analysis.
AHRQ-funded; HS028485; HS029009.
Citation: Azimi H, Johnson L, Loudermilk C .
Medication regimen complexity (MRC-ICU) for in-hospital mortality prediction in COVID-19 patients.
Hosp Pharm 2023 Dec; 58(6):564-68. doi: 10.1177/00185787231169460..
Keywords: COVID-19, Medication, Mortality, Intensive Care Unit (ICU)
Rains A, Sibley AL, Levander XA
"I would do anything but that": attitudes towards sex work among rural people who use drugs.
This study explored how people who use drugs in rural counties across the United States appraise sex work by themselves or other community members. The authors used qualitative interview data that came from the Rural Opioid Initiative (ROI), a project coordinated by research teams across 65 rural counties in 10 states. These interviews were individual and conducted from 2018 to 2020, with all participants reporting past 30-day opioid use and/or any injection drug use. Across sites, 355 interviews were conducted with a mean participant age of 36, 55% male, and 93% white. Negative attitudes were expressed towards sex work as a function of its criminal-legal repercussions or was framed as morally transgressive. Many appraisals were gendered, with the behavior described as being “easier” for women who were often described as "whores," with more neutral terms used to describe men. Some participants viewed sex work as an implicit “exchange” for drugs.
AHRQ-funded; HS026370.
Citation: Rains A, Sibley AL, Levander XA .
"I would do anything but that": attitudes towards sex work among rural people who use drugs.
Int J Drug Policy 2023 Dec; 122:104237. doi: 10.1016/j.drugpo.2023.104237..
Keywords: Rural Health, Vulnerable Populations, Substance Abuse, Behavioral Health
Squires A, Gerchow L, Ma C
A multi-language qualitative study of limited English proficiency patient experiences in the United States.
The objective of this study was to understand the experience of limited English proficiency patients with health care services in an urban setting. Individuals who spoke either Spanish, Russian, Cantonese, Mandarin, or Korean shared their experiences through semi-structured interviews. A major theme that emerged throughout all interviews was a sense that the language barrier with clinicians posed a threat to safety when receiving healthcare. Participants also identified factors they felt would improve their sense of security specific to clinician interactions. The authors concluded that these findings highlight ongoing challenges that spoken language barriers pose at multiple points of care in the US health care system.
AHRQ-funded; HS023593.
Citation: Squires A, Gerchow L, Ma C .
A multi-language qualitative study of limited English proficiency patient experiences in the United States.
PEC Innov 2023 Dec; 2:100177. doi: 10.1016/j.pecinn.2023.100177..
Keywords: Patient Experience, Disparities, Vulnerable Populations
Danan ER, Than C, Chawla N
Abnormal cervical cancer screening results among US veteran and non-veteran participants in the National Health Interview Survey (NHIS).
Researchers tested whether Veterans with a recent cervical cancer screening test were more likely than non-Veterans to have received an abnormal result. Data was taken from the National Health Interview Survey (NHIS). An adjusted regression model of the date indicated that a previously observed association between Veteran status and abnormal screening result was explained by differences in sociodemographic and health factors between Veterans and non-Veterans. The researchers concluded that clinicians should address modifiable risk factors and provide evidence-based follow-up for abnormal results.
AHRQ-funded; HS026379.
Citation: Danan ER, Than C, Chawla N .
Abnormal cervical cancer screening results among US veteran and non-veteran participants in the National Health Interview Survey (NHIS).
Prev Med Rep 2023 Dec; 36:102472. doi: 10.1016/j.pmedr.2023.102472..
Keywords: Cancer: Cervical Cancer, Cancer, Screening, Women, Prevention
Schnipper JL, Raffel KE, Keniston A
Achieving diagnostic excellence through prevention and teamwork (ADEPT) study protocol: a multicenter, prospective quality and safety program to improve diagnostic processes in medical inpatients.
This paper describes the protocol for a study that will build surveillance for hospital diagnostic errors into usual care, benchmark diagnostic performance across sites, pilot test interventions, and evaluate the program's impact on diagnostic error rates. The authors will test achieving diagnostic excellence through prevention and teamwork (ADEPT), a multicenter, real-world quality and safety program utilizing interrupted time-series techniques to evaluate outcomes. They will use a randomly sampled population of medical patients hospitalized at 16 US hospitals who died, were transferred to intensive care, or had a rapid response during the hospitalization. There will be surveillance for diagnostic errors on 10 events per month per site using a previously established two-person adjudication process. With guidance from national experts in quality and safety, study sites will report and benchmark diagnostic error rates, share lessons regarding underlying causes, and design, implement, and pilot test interventions using both Safety I and Safety II approaches aimed at patients, providers, and health systems. The primary outcome sought after will be the number of diagnostic errors per patient, using segmented multivariable regression to evaluate change in y-intercept and change in slope after initiation of the program.
AHRQ-funded; HS029366.
Citation: Schnipper JL, Raffel KE, Keniston A .
Achieving diagnostic excellence through prevention and teamwork (ADEPT) study protocol: a multicenter, prospective quality and safety program to improve diagnostic processes in medical inpatients.
J Hosp Med 2023 Dec; 18(12):1072-81. doi: 10.1002/jhm.13230..
Keywords: Diagnostic Safety and Quality, Patient Safety, Quality of Care, Hospitals, Inpatient Care
Timbie JW, Reynolds KA, Evans EL
AHRQ Author: Cohen JW
Advancing data capacity for economic outcomes in patient-centered outcomes research: challenges and opportunities.
The HHS Office of the Assistant Secretary for Planning and Evaluation convened a symposium that brought together patients, researchers, federal agency representatives, and other stakeholders to discuss research on the collection, linkage, and analysis of economic outcomes data for patient-centered outcomes research (PCOR) studies. The purpose of this paper was to synthesize the information gathered in the symposium to guide efforts to build data capacity. The authors then emphasize preliminary opportunities to expand the availability and use of relevant, high-quality economic outcomes data as part of evidence generation in patient-centered outcomes research. Across panel discussions, 4 overarching themes arose to guide efforts to build data capacity for PCOR studies with economic outcomes: 1) Measurement and data collection for economic outcomes should enable a comprehensive, person-centered, and longitudinal understanding of health and other impacts; 2) Research data on economic outcomes should be high quality, accessible, timely, interoperable, and linkable. 3) Collaborative partnerships across stakeholder groups are essential for aligning, advancing, and sustaining efforts to improve the measurement and use of economic outcomes in PCOR; and 5) Economic outcomes in PCOR studies should be defined, collected, and analyzed in ways that advance health equity. With those factors in mind, the researchers explored opportunities to build data capacity for economic outcomes in patient-centered outcomes research in 4 domains: measurement, data collection, data linkage, and data access and use. Within each domain the researchers emphasize opportunities for meaningful, impactful improvements.
AHRQ-authored.
Citation: Timbie JW, Reynolds KA, Evans EL .
Advancing data capacity for economic outcomes in patient-centered outcomes research: challenges and opportunities.
Med Care 2023 Dec; 61(12 Suppl 2):s161-s65. doi: 10.1097/mlr.0000000000001901..
Keywords: Patient-Centered Outcomes Research, Evidence-Based Practice, Patient-Centered Healthcare
Mistry KB, Chesley FD, Chin MH
AHRQ Author: Msitry KB, Chesley FD, Valdez RB
Advancing health equity-Agency for Healthcare Research and Quality research and action agenda.
This article described the agenda-building process developed by a multistakeholder Health Equity Summit held by AHRQ; AHRQ invited summaries of the state of evidence in order to provide input for an equity research agenda in five action domains which could drive more equitable care. This commentary also described the Research and Action Health Equity Framework used by Summit participants to explore the action domains and highlighted key cross-cutting themes that emerged from the five domain papers.
AHRQ-authored.
Citation: Mistry KB, Chesley FD, Chin MH .
Advancing health equity-Agency for Healthcare Research and Quality research and action agenda.
Health Serv Res 2023 Dec; 58(suppl 3):275-80. doi: 10.1111/1475-6773.14230..
Keywords: Vulnerable Populations
Mueller SK, Garabedian P, Goralnick E
Advancing health information during interhospital transfer: an interrupted time series.
The researchers report that health information exchange (HIE) during the interhospital transfer (IHT) of patients between acute care hospitals is subject to fragmented communication and unreliable access to clinical information. This proposed study will design, implement, and rigorously evaluate the implementation of a HIE platform to improve data access during IHT. The four-fold purposes of this study are to: 1) optimize clinician workflow, data visualization, and interoperability through user-centered design sessions for HIE platform development; 2) evaluate the impact of the intervention on clinician-reported medical errors among 500 pre- and 500 postintervention IHT patients using interrupted time series methodology; 3) evaluate intervention fidelity, use, and perceived usability of the platform, and barriers and facilitators of implementation from interprofessional stakeholder input, using mixed-methods evaluation; and 4) combine primary findings to develop a toolkit for spread and sustainability.
AHRQ-funded; HS028982.
Citation: Mueller SK, Garabedian P, Goralnick E .
Advancing health information during interhospital transfer: an interrupted time series.
J Hosp Med 2023 Dec; 18(12):1063-71. doi: 10.1002/jhm.13221..
Keywords: Health Information Exchange (HIE), Health Information Technology (HIT), Hospitals, Transitions of Care
Flannery DD, Zevallos Barboza A, Mukhopadhyay S
Antibiotic use among infants admitted to neonatal intensive care units.
The purpose of this cross-sectional study was to examine antibiotic exposure, days of therapy, types of antibiotics, and changes in use patterns among newborns in neonatal intensive care units (NICUs) across the U.S. Data for almost 1.4 million infants were taken from the Premier Healthcare Database. The most common antibiotics prescribed during the study period were ampicillin, gentamicin, vancomycin, and cefotaxime. Antibiotic use declined substantially over time, primarily because of reductions in ampicillin and gentamicin. The authors noted that these findings probably reflect the penetration of national calls for neonatal antibiotic stewardship efforts and refined early-onset infection risk-assessment strategies; shortage and subsequent discontinuation of cefotaxime may have played a role in the sharp decline in its use and the related increase in ceftazidime use.
AHRQ-funded; HS027468.
Citation: Flannery DD, Zevallos Barboza A, Mukhopadhyay S .
Antibiotic use among infants admitted to neonatal intensive care units.
JAMA Pediatr 2023 Dec; 177(12):1354-56. doi: 10.1001/jamapediatrics.2023.3664..
Keywords: Newborns/Infants, Antibiotics, Medication, Intensive Care Unit (ICU), Critical Care
Joyce NR, Robertson SE, McCreedy E
Assessing the representativeness of cluster randomized trials: evidence from two large pragmatic trials in United States nursing homes.
Researchers linked data from two large nursing home-based pragmatic cluster randomized trials, the high-dose influenza vaccine trial and the Music & Memory Pragmatic TRIal for Nursing Home Residents with ALzheimer's Disease (METRICaL), to nursing home assessments and Medicare fee-for-service claims. Their objective was to compare nursing home and resident characteristics in randomized facilities to non-randomized and ineligible facilities. Facility-level characteristics of randomized nursing homes in both trials were found to differ considerably from those of non-randomized and ineligible facilities; little difference was found in resident-level characteristics between the three groups. The researchers concluded that future investigation should assess the characteristics of clusters that participate in cluster randomized trials when examining the applicability of trial results beyond participating clusters.
AHRQ-funded; HS022998.
Citation: Joyce NR, Robertson SE, McCreedy E .
Assessing the representativeness of cluster randomized trials: evidence from two large pragmatic trials in United States nursing homes.
Clin Trials 2023 Dec; 20(6):613-23. doi: 10.1177/17407745231185055..
Keywords: Nursing Homes, Research Methodologies
Patel KR, Justiz AM, Ahmed AM
Association of vitiligo and inflammatory arthropathy in hospitalized US adults.
The purpose of this study was to explore the relationships between vitiligo and autoimmune arthropathies. The researchers analyzed data from the 2002-2016 Nationwide Inpatient Sample (NIS) according to Healthcare Cost and Utilization Project (HCUP) policies. Between 2002 and 2016, 96,970,768 admissions were captured, including 18,231 (0.02%) with vitiligo. The study found that vitiligo was significantly associated with higher odds of any inflammatory arthritis, psoriatic arthritis, rheumatoid arthritis, and other inflammatory arthritis, with a trend toward significance with reactive arthritis and ankylosing spondylitis.
AHRQ-funded; HS023011.
Citation: Patel KR, Justiz AM, Ahmed AM .
Association of vitiligo and inflammatory arthropathy in hospitalized US adults.
J Am Acad Dermatol 2023 Dec; 89(6):1256-57. doi: 10.1016/j.jaad.2023.07.1015..
Keywords: Arthritis, Chronic Conditions, Skin Conditions
Engelberg R, Hood Q, Shah K
Challenges unique to transgender persons in US correctional settings: a scoping review.
The authors conducted a literature review on challenges unique to transgender individuals within US correctional settings. Themes that emerged revealed challenges in key domains of violence, health, healthcare access, housing, and a pervasive culture of transphobia. Legal analyses supported policy changes such as case-by-case housing classification systems, gender-affirming care, and safeguarding gender expression.
AHRQ-funded; HS026120.
Citation: Engelberg R, Hood Q, Shah K .
Challenges unique to transgender persons in US correctional settings: a scoping review.
J Urban Health 2023 Dec; 100(6):1170-89. doi: 10.1007/s11524-023-00794-z..
Keywords: Vulnerable Populations
Roberts ET, Xue L, Lovelace J
Changes in care associated with integrating Medicare and Medicaid for dual-eligible individuals.
This study’s objective was to evaluate changes in care associated with integrating Medicare and Medicaid coverage in a fully integrated dual-eligible special needs plan (FIDE-SNP) in Pennsylvania. This cohort study used a difference-in-differences analysis compared changes in care between 2 cohorts of dual-eligible individuals: (1) an integration cohort composed of Medicare Dual Eligible Special Needs Plan enrollees who joined a companion Medicaid plan following a 2018 state reform mandating Medicaid managed care (leading to integration), and (2) a comparison cohort with nonintegrated coverage before and after the start of Medicaid managed care. Analyses were conducted of outcomes in 4 domains: use of home- and community-based services (HCBS), care management and coordination, hospital stays and postacute care, and long-term nursing home stays. The study included 7967 individuals in the integration cohort and 3832 individuals in the comparison cohort. HCBS use increased differentially in the integration vs comparison cohorts by 0.61 days/person-month. However, integration was not associated with changes in care management and coordination, including medication use for chronic conditions (-0.02 fills/person-month) or follow-up outpatient care after a hospital stay (-0.01 visits/hospital stay). There was no significant difference in hospital stays between the cohorts.
AHRQ-funded; HS026727.
Citation: Roberts ET, Xue L, Lovelace J .
Changes in care associated with integrating Medicare and Medicaid for dual-eligible individuals.
JAMA Health Forum 2023 Dec; 4(12):e234583. doi: 10.1001/jamahealthforum.2023.4583..
Keywords: Medicare, Medicaid, Health Insurance, Surgery, Outcomes
Meiselbach MK, Bai G, Anderson GF
Charges of COVID-19 diagnostic testing and antibody testing across facility types and states.
The authors discuss the practice of high charges for COVID-19 testing by some healthcare providers, with the charges for COVID-19 testing having important implications for uninsured patients, out-of-network services, and other payers without negotiating power. The purpose of this study was to examine the charges for the most commonly performed COVID-19 diagnostic test and antibody test across facility types and states. The study found that for COVID-19 diagnostic testing, the mean, median, and standard deviations of charges were $144.06, $100.00, and $162.18. The most common facility type was independent laboratories (performing 49.7% of all tests), with an average charge of $140.41, followed by hospital outpatient settings (performing 34.5% of all tests), with an average charge of $168.87. For antibody testing, the mean, median, and standard deviations of charges were $63.93, $55.00, and $48.92. Independent laboratories performed 97.2% of all tests, with an average charge of $62.30. In sum, 8.0% of diagnostic testing services and 14.0% of antibody testing claims were charged one standard deviation above the mean ($306.24 for diagnostic testing and $112.85 for antibody testing). The state average testing charges ranged between $64.98 (UT) and $505.65 (DC) for diagnostic testing, and $45.85 (NY) and $195.41 (NM) for antibody testing. AR, LA, MO, and NM had high average charges for both tests. GA, KS, MA, MD, NC, NV, and OK had low charges for both tests. No statistically significant association was found between testing charges and state-level testing rates, infection rates, or mortality rates.
AHRQ-funded; HS000029.
Citation: Meiselbach MK, Bai G, Anderson GF .
Charges of COVID-19 diagnostic testing and antibody testing across facility types and states.
J Gen Intern Med 2023 Dec; 38(16):3640-43. doi: 10.1007/s11606-020-06198-y..
Keywords: COVID-19, Diagnostic Safety and Quality, Healthcare Costs