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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.
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1 to 25 of 134 Research Studies DisplayedBalbin CA, Kawamoto K
The SIMPLE architectural pattern for integrating patient-facing apps into clinical workflows: desiderata and application for lung cancer screening.
To address the need for electronic health record (EHR) systems to accept the connection of any patient-facing digital health app using the SMART on FHIR standard, the authors proposed the Standards-based Implementation Maximizing Portability Leveraging the EHR (SIMPLE). SIMPLE’s architectural pattern was designed to meet several key requirements, such as not requiring patients to install new software; not retaining patient data outside of the EHR; leveraging existing personal health record (PHR) capabilities to optimize user experience; and maximizing portability.
AHRQ-funded; HS028791.
Citation: Balbin CA, Kawamoto K .
The SIMPLE architectural pattern for integrating patient-facing apps into clinical workflows: desiderata and application for lung cancer screening.
AMIA Annu Symp Proc 2024 Jan 11; 2023:844-53..
Keywords: Workflow, Health Information Technology (HIT), Cancer: Lung Cancer, Cancer, Screening
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
Marcotte LM, Deeds S, Wheat C
Automated opt-out vs opt-in patient outreach strategies for breast cancer screening: a randomized clinical trial.
The objective of this study was to evaluate the effect on breast cancer screening of an opt-out automatic mammography referral strategy compared with an opt-in automated telephone message strategy. Participants in the pragmatic randomized clinical trial, conducted at a Veterans Affairs (VA) medical center, were female veterans aged 45-75 eligible for breast cancer screening and enrolled in VA primary care. The results indicated that the opt-out population-based breast cancer screening outreach approach compared with an opt-in approach did not result in a significant difference in mammography completion, but did lead to more canceled mammography referrals, which increased staff burden.
AHRQ-funded; HS026369.
Citation: Marcotte LM, Deeds S, Wheat C .
Automated opt-out vs opt-in patient outreach strategies for breast cancer screening: a randomized clinical trial.
JAMA Intern Med 2023 Nov; 183(11):1187-94. doi: 10.1001/jamainternmed.2023.4321..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Prevention, Health Promotion
Kukhareva PV, Li H, Caverly TJ
Implementation of lung cancer screening in primary care and pulmonary clinics: pragmatic clinical trial of electronic health record-integrated everyday shared decision-making tool and clinician-facing prompts.
The authors conducted pre- and post-intervention analysis in primary care and pulmonary clinics to explore whether clinician-facing electronic health record (EHR) prompts and an EHR-integrated shared decision-making (SDM) tool designed to support incorporation of SDM into primary care could improve low-dose computer tomography scan imaging ordering and completion. Subjects were patients who met US Preventive Services Task Force criteria for lung cancer screening (LCS). The results indicated that EHR prompts and the EHR-integrated SDM tool were promising approaches to improving LCS in the primary care setting. The authors noted that further research is warranted.
AHRQ-funded; HS026198; HS028791.
Citation: Kukhareva PV, Li H, Caverly TJ .
Implementation of lung cancer screening in primary care and pulmonary clinics: pragmatic clinical trial of electronic health record-integrated everyday shared decision-making tool and clinician-facing prompts.
Chest 2023 Nov; 164(5):1325-38. doi: 10.1016/j.chest.2023.04.040..
Keywords: Cancer: Lung Cancer, Cancer, Screening, Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Shared Decision Making
Landy R, Gomez I, Caverly TJ
Methods for using race and ethnicity in prediction models for lung cancer screening eligibility.
The purpose of this study was to compare eligibility for lung cancer screening in a representative United States population by refitting the life-years gained from screening-computed tomography (LYFS-CT) model to exclude race and ethnicity versus a counterfactual eligibility method that recalculates life expectancy for racial and ethnic minority individuals utilizing the same covariates but substitutes White race and utilizes the higher predicted life expectancy, preventing historically underserved groups from being penalized. The National Health Interview Survey (NHIS) 2015-2018 included 25,601 individuals aged 50 to 80 years who ever smoked. The study found that removing race and ethnicity from the submodels underestimated lung cancer death risk and all-cause mortality in African American individuals. It also overestimated mortality in Hispanic American and Asian American individuals. As a result, the LYFS-CT NoRace model increased Hispanic American and Asian American eligibility by 108% and 73%, respectively, while decreasing African American eligibility by 39%. Utilizing LYFS-CT with the counterfactual all-cause mortality model better maintained calibration across groups and increased African American eligibility by 13% without decreasing eligibility for Hispanic American and Asian American individuals.
AHRQ-funded; HS026198.
Citation: Landy R, Gomez I, Caverly TJ .
Methods for using race and ethnicity in prediction models for lung cancer screening eligibility.
JAMA Netw Open 2023 Sep; 6(9):e2331155. doi: 10.1001/jamanetworkopen.2023.31155..
Keywords: Racial and Ethnic Minorities, Cancer: Lung Cancer, Cancer, Screening, Prevention
Sprague BL, Ichikawa L, Eavey J
Breast cancer risk characteristics of women undergoing whole-breast ultrasound screening versus mammography alone.
This study evaluated mammography screening failure risk among women undergoing supplemental ultrasound screening in clinical practice in comparison with women undergoing mammography alone. Screening ultrasounds and screening mammograms without supplemental screening were identified within three Breast Cancer Surveillance Consortium registries. A clinically significant proportion of women who had undergone mammography screening alone were at high mammography screening failure risk. Ultrasound screening was highly targeted to women with dense breasts, but only a small proportion were high mammography screening failure risk.
AHRQ-funded; HS018366.
Citation: Sprague BL, Ichikawa L, Eavey J .
Breast cancer risk characteristics of women undergoing whole-breast ultrasound screening versus mammography alone.
Cancer 2023 Aug 15; 129(16):2456-68. doi: 10.1002/cncr.34768..
Keywords: Cancer: Breast Cancer, Cancer, Women, Imaging, Screening, Risk
Estenson L, Kim N, Jacobson M
Do age-based discontinuation recommendations influence cervical cancer screening rates? Evidence from the United States' Behavioral Risk Factor Surveillance System, 2016 and 2018.
The purpose of this study was to determine how the United States Preventive Services Task Force (USPSTF) recommendation of discontinuing routine cervical cancer screening for certain women after age 65 affects Papanicolaou (Pap) test rates among women at age 66 in the United States. The researchers utilized nationally representative 2016 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) data for 226,031 women ages 56-76 to calculate changes in annual Pap test rates at age 66. Among women 66-76, 22.5% indicated they had received a Pap test within the past year. At age 66, annual Pap rates decreased by 5.9 percentage points (p.p.) off a pre-66 rate of 39 percent. The change differed by race/ethnicity, education, and marital status. Pap rates did not change discretely for non-Hispanic Black women but did change for women from other racial/ethnic groups. The decrease was larger for women who graduated college than for women without a college degree and for women who were never married than for women who were married/partnered or divorced/separated. The USPSTF recommendation to stop cervical cancer screening after the age of 65 resulted in a substantial decrease in the rate of Pap tests at age 66 but disparately affects women based on marital status, education and race.
AHRQ-funded; HS026488.
Citation: Estenson L, Kim N, Jacobson M .
Do age-based discontinuation recommendations influence cervical cancer screening rates? Evidence from the United States' Behavioral Risk Factor Surveillance System, 2016 and 2018.
Prev Med 2023 Jul; 172:107543. doi: 10.1016/j.ypmed.2023.107543..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Cervical Cancer, Cancer, Screening, Prevention, Evidence-Based Practice, Women, Sexual Health
Lee SJC, Lee J, Zhu H
Assessing barriers and facilitators to lung cancer screening: initial findings from a patient navigation intervention.
This study’s objective was to examine the challenges to providing lung cancer screening using low-dose computed tomography for patients, particularly minority, under-, and uninsured populations. The authors conducted a pragmatic randomized controlled trial of telephone-based navigation for lung cancer screening in an integrated, urban safety-net health care system. They used bilingual navigators (Spanish and English) to make systematic contact with patients, recording standardized call characteristics in a study-specific database. A total of 225 patients (mean age 63 years, 46% female, 70% racial/ethnic minority) were assigned navigators, with a total of 559 barriers to screening identified during 806 telephone calls. The most common barrier types were personal (46%), provider (30%), and practical (17%). System (6%) and psychosocial (1%) barriers were described by English-speaking patients, but not by Spanish-speaking patients. Provider-related barriers decreased by 80% over the course of the lung cancer screening process.
AHRQ-funded; HS022418.
Citation: Lee SJC, Lee J, Zhu H .
Assessing barriers and facilitators to lung cancer screening: initial findings from a patient navigation intervention.
Popul Health Manag 2023 Jun; 26(3):177-84. doi: 10.1089/pop.2023.0053..
Keywords: Cancer: Lung Cancer, Cancer, Screening, Prevention, Imaging
Lee CI, Abraham L, Miglioretti DL
National performance benchmarks for screening digital breast tomosynthesis: update from the Breast Cancer Surveillance Consortium.
The purpose of this study was to develop performance benchmarks for digital breast tomosynthesis (DBT) screening and assess longitudinal performance patterns in United States community practice. Between 2011 and 2018 the researchers collected DBT screening examinations from five Breast Cancer Surveillance Consortium (BCSC) registries. Measures of performance were calculated based on the American College of Radiology Breast Imaging Reporting and Data System, fifth edition and included abnormal interpretation rate (AIR), cancer detection rate (CDR), sensitivity, specificity, and false-negative rate (FNR). These rates were compared with previously published BCSC and National Mammography Database benchmarks, concurrent BCSC DM screening examinations, and expert opinion acceptable performance ranges. The study included a total of 896,101 women undergoing 2,301,766 screening examinations and 1,843,591 DM examinations were included in this study. All performance measures were higher for DBT except sensitivity and FNR, when compared with BCSC DM screening examinations from the same time period and previously published BCSC and National Mammography Database performance benchmarks. The following rates of radiologists received acceptable performance ranges with DBT: 97.6% for CDR, 91.8% for sensitivity, 75.0% for AIR, and 74.0% for specificity.
AHRQ-funded; HS018366.
Citation: Lee CI, Abraham L, Miglioretti DL .
National performance benchmarks for screening digital breast tomosynthesis: update from the Breast Cancer Surveillance Consortium.
Radiology 2023 May; 307(4):e222499. doi: 10.1148/radiol.222499..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Imaging, Prevention, Women
Henrikson NB, Ivlev I, Blasi PR
Skin cancer screening: updated evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this study was to investigate the advantages and potential risks of skin cancer screening to assist the decision-making of the US Preventive Services Task Force. The researchers utilized the data sources MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials, dated between June 1, 2015, and January 7, 2022. Two independent reviewers evaluated the articles and extracted pertinent data from studies of fair or good quality; the findings were summarized narratively. The primary outcomes and indicators were morbidity; mortality; stage, precursor lesions, or lesion thickness of skin cancer at detection; potential harms of screening. Twenty studies from 29 articles were included (N = 6,053,411). Direct evidence on the effectiveness of screening was obtained from 3 nonrandomized analyses of 2 population-based skin cancer screening initiatives in Germany (n = 1,791,615), indicating no significant reduction in melanoma mortality benefit at the population level over a period of 4 to 10 years of follow up activities. Six studies (n = 2,935,513) offered inconclusive evidence on the relationship between physician-conducted skin examination and lesion thickness or stage at diagnosis. Usual care vs. routine physician-conducted skin examination was not associated with increased detection of skin cancer or precursor lesions (5 studies) or stage at melanoma detection (3 studies). The correlation between physician-conducted skin examination and lesion thickness at detection was inconsistent (3 studies). Nine studies (n = 1 326 051) found a consistent positive association between more advanced stage at melanoma detection and increasing risk of melanoma-associated and all-cause mortality. Two studies (n = 232) found negligible enduring cosmetic or psychosocial harms related to screening.
AHRQ-funded; 75Q80120D00004.
Citation: Henrikson NB, Ivlev I, Blasi PR .
Skin cancer screening: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2023 Apr 18; 329(15):1296-307. doi: 10.1001/jama.2023.3262..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Skin Cancer, Cancer, Screening, Prevention, Evidence-Based Practice, Guidelines
Vo H, Valentine KD, Barry MJ
Evaluation of the shared decision-making process scale in cancer screening and medication decisions.
The objectives of this study were to examine the reliability and validity of the Shared Decision-Making (SDM) Process scale for cancer screening and medication decisions. Researchers conducted a secondary data analysis of more than 6,000 participants who made decisions about breast, colon, or prostate cancer screening or taking medication for menopause, depression, hypertension or high cholesterol. They concluded that the SDM Process scale demonstrated construct validity and retest reliability.
AHRQ-funded; HS025718.
Citation: Vo H, Valentine KD, Barry MJ .
Evaluation of the shared decision-making process scale in cancer screening and medication decisions.
Patient Educ Couns 2023 Mar;108:107617. doi: 10.1016/j.pec.2022.107617.
Keywords: Shared Decision Making, Cancer, Medication, Screening
Ho TH, Bissell MCS, Lee CI
Prioritizing screening mammograms for immediate interpretation and diagnostic evaluation on the basis of risk for recall.
The purpose of this study was to establish a prioritization method for immediate interpretation of screening mammograms and potential diagnostic assessment. A cohort based on the population, comprising screening mammograms conducted from 2012 to 2020 at 126 radiology centers from 7 Breast Cancer Surveillance Consortium registries, was examined. Classification trees were used to identify combinations of clinical history (age, BI-RADS density, time elapsed since the previous mammogram, history of false-positive recall or biopsy outcome), screening technique (digital mammography, digital breast tomosynthesis), and facility features (profit status, location, screening volume, practice type, academic affiliation) that grouped screening mammograms by recall rate, with ≥12/100 classified as high and ≥16/100 as very high. The efficiency ratio was calculated as the percentage of recalls divided by the percentage of mammograms. The research cohort consisted of 2,674,051 screening mammograms in 925,777 women, with 235,569 recalls. The study found that the primary predictor of recall was the time interval since the last mammogram, followed by age, history of false-positive recall, breast density, history of benign biopsy, and screening method. Recall rates were extremely high for baseline mammograms and high for women with ≥5 years since their previous mammogram. The 9.2% of mammograms in subgroups with very high and high recall rates represented 19.2% of recalls, yielding an efficiency ratio of 2.1 compared to a random strategy. Including women under 50 with dense breasts accounted for 20.3% of mammograms and 33.9% of recalls (efficiency ratio = 1.7). Findings incorporating facility-level characteristics were analogous.
AHRQ-funded; HS018366
Citation: Ho TH, Bissell MCS, Lee CI .
Prioritizing screening mammograms for immediate interpretation and diagnostic evaluation on the basis of risk for recall.
J Am Coll Radiol 2023 Mar;20(3):299-310. doi: 10.1016/j.jacr.2022.09.030.
Keywords: Cancer: Breast Cancer, Cancer, Screening, Imaging, Women, Prevention, Diagnostic Safety and Quality
Strayer TE, Spalluto LB, Burns A
Using the framework for reporting adaptations and modifications-expanded (frame) to study adaptations in lung cancer screening delivery in the Veterans Health Administration: a cohort study.
The purpose of this study was to apply the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to study adaptations in lung cancer screening delivery processes in a Veterans Health Administration (VHA) Initiative. Between 2019 and 2021 the researchers prospectively administered semi-structured interviews with lung cancer screening program navigators at 10 Veterans Affairs Medical Centers (VAMCs). Baseline process maps were developed for each program, and each program navigator reviewed process maps in subsequent years 1 and 2. Researchers then identified, documented, and mapped adaptations in screening processes to the FRAME categories. 16 interviews were conducted across 10 VHA lung cancer screening programs, with 6 of these being operational, and of those 3 reported adaptations to their screening processes that were planned or in response to COVID-19. In year 2 all 10 programs were operational and eligible. Programs reported 14 adaptations in year 2. The adaptations identified were both planned and unplanned and often prompted by increased workload; 57% of year 2 adaptations were associated with the identification and eligibility of Veterans and 43% were associated with follow-up with Veterans for screening results. During the 2 years, adaptations associated with data management and patient tracking took place in 60% of programs to improve the data collection and tracking of Veterans in the screening process. The study concluded that adaptations took place predominantly in the categories of patient identification and communication of results due to increased workload.
AHRQ-funded; HS026122; HS026395.
Citation: Strayer TE, Spalluto LB, Burns A .
Using the framework for reporting adaptations and modifications-expanded (frame) to study adaptations in lung cancer screening delivery in the Veterans Health Administration: a cohort study.
Implement Sci Commun 2023 Jan 12; 4(1):5. doi: 10.1186/s43058-022-00388-x..
Keywords: Cancer: Lung Cancer, Cancer, Screening, Evidence-Based Practice, Learning Health Systems
Khoong EC, Rivadeneira NA, Pacca L
Extent of follow-up on abnormal cancer screening in multiple California public hospital systems: a retrospective review.
This report’s objective was to describes patterns of performance on follow-up of abnormal colon and breast cancer screening tests and explores the extent to which racial/ethnic disparities exist in public hospital systems. The authors conducted a retrospective cohort study using data from five California public hospital systems between July 2015 and June 2017. The authors assessed follow-up rates of colonoscopy after positive fecal immunochemical tests (FIT) and breast tissue biopsy within 21 days after a BIRADS 4/5 mammogram. Negative associations with follow-up colonoscopy were associated with older age, Medicaid insurance, lack of insurance, English language and site; while Hispanic ethnicity and Asian race were positively associated with follow-up colonoscopy. Of 1702 BIRADS 4/5 mammograms, 64% received a timely biopsy; only site was associated with timely follow-up biopsy. Site-level factors were found to have a larger, more consistent impact on follow-up rates than patient sociodemographic traits.
AHRQ-funded; HS024412.
Citation: Khoong EC, Rivadeneira NA, Pacca L .
Extent of follow-up on abnormal cancer screening in multiple California public hospital systems: a retrospective review.
J Gen Intern Med 2023 Jan; 38(1):21-29. doi: 10.1007/s11606-022-07657-4..
Keywords: Cancer: Breast Cancer, Cancer: Colorectal Cancer, Cancer, Screening, Disparities, Women
Kim HS, Hernaez R, Sansgiry S
Comparative effectiveness of surveillance colonoscopy intervals on colorectal cancer outcomes in a national cohort of patients with inflammatory bowel disease.
The purpose of this study was to determine the comparative effectiveness of varying colonoscopy intervals on colorectal cancer (CRC) outcomes among patients with inflammatory bowel disease (IBD). Data was from the National Veterans Health Administration. Findings showed that, in a national cohort of patients with CRC-IBD, colonoscopy within 3 years prior to CRC diagnosis was associated with early tumor stage at diagnosis, and colonoscopy within 1 year was associated with a reduced all-cause mortality compared with no colonoscopy, supporting colonoscopy intervals of 1 to 3 years in patients with IBD in order to reduce late-stage CRC and all-cause mortality.
AHRQ-funded; HS024122.
Citation: Kim HS, Hernaez R, Sansgiry S .
Comparative effectiveness of surveillance colonoscopy intervals on colorectal cancer outcomes in a national cohort of patients with inflammatory bowel disease.
Clin Gastroenterol Hepatol 2022 Dec;20(12):2848-57.e2. doi: 10.1016/j.cgh.2022.02.048..
Keywords: Cancer: Colorectal Cancer, Cancer, Digestive Disease and Health, Imaging, Screening, Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research
Dalton AF, Golin CE, Morris C
Effect of a patient decision aid on preferences for colorectal cancer screening among older adults: a secondary analysis of a randomized clinical trial.
This research studied the effects of a patient decision aid on preferences for colorectal cancer (CRC) screening among adults aged 76 to 84 years. Participants were recruited from 14 community-based primary care practices who were not up to date with screening and had an appointment within 6 weeks. They were randomized to receive the intervention or control. Among the 424 participants, mean age was 76.8, 248 were women, and 333 were White. There were no statistically significant differences found in patient preferences between the health groups. Additional studies that are appropriately powered were recommended.
AHRQ-funded; HS021133.
Citation: Dalton AF, Golin CE, Morris C .
Effect of a patient decision aid on preferences for colorectal cancer screening among older adults: a secondary analysis of a randomized clinical trial.
JAMA Netw Open 2022 Dec;5(12):e2244982. doi: 10.1001/jamanetworkopen.2022.44982..
Keywords: Elderly, Shared Decision Making, Screening, Cancer: Colorectal Cancer, Cancer
Ross RL, Rubio K, Rodriguez HP
Mammography and decision aid use for breast cancer screening in older women.
This study examines the association between practice-level decision-aid use and mammography use among older women. Physician practice responses to the 2017/2018 National Survey of Healthcare Organizations and Systems were linked to 2016-17 Medicare fee-for-service beneficiary data from eligible beneficiaries aged 65-74 years. Findings showed that health information technology-enabled automation of mammography reminders and other advanced health information technology functions may support mammography, whereas breast cancer decision aids may reduce patients' propensities to be screened through the alignment of their preferences and screening decision.
AHRQ-funded; HS022241; HS024075.
Citation: Ross RL, Rubio K, Rodriguez HP .
Mammography and decision aid use for breast cancer screening in older women.
Am J Prev Med 2022 Oct;63(4):630-35. doi: 10.1016/j.amepre.2022.04.014..
Keywords: Imaging, Screening, Shared Decision Making, Cancer: Breast Cancer, Women, Prevention, Cancer, Elderly
Hicklin K, O'Leary MC, Nambiar S
Assessing the impact of multicomponent interventions on colorectal cancer screening through simulation: what would it take to reach national screening targets in North Carolina?
The authors simulated the impact of multicomponent interventions in North Carolina over 5 years to assess the potential for meeting national screening targets for colorectal cancer (CRC). They reported that each multicomponent intervention was associated with increased CRC screening and averted both CRC cases and deaths, while three had the potential to reach screening targets.
AHRQ-funded; HS022981.
Citation: Hicklin K, O'Leary MC, Nambiar S .
Assessing the impact of multicomponent interventions on colorectal cancer screening through simulation: what would it take to reach national screening targets in North Carolina?
Prev Med 2022 Sep;162:107126. doi: 10.1016/j.ypmed.2022.107126..
Keywords: Cancer: Colorectal Cancer, Cancer, Screening, Colonoscopy, Prevention
Golmakani MK, Hubbard RA, Miglioretti DL
Nonhomogeneous Markov chain for estimating the cumulative risk of multiple false positive screening tests.
This study addressed the general challenge of estimating the cumulative risk of multiple false positive test results. The authors proposed a nonhomogeneous multistate model to describe the screening process including competing events and developed alternative approaches for estimating the cumulative risk of multiple false positive results using this multistate model based on existing estimators for the cumulative risk of a single false positive. The multistate model was based on existing estimators for the cumulative risk of a single false positive. They compared the performance of the newly proposed models through simulation studies and illustrated model performance using data on screening mammography from the Breast Cancer Surveillance Consortium. They found that in the context of screening mammography that the cumulative risk of multiple false positive results is high. For a high-risk individual, the cumulative probability of at least two false positive mammography results after 10 rounds of annual screening is 40.4.
AHRQ-funded; HS018366.
Citation: Golmakani MK, Hubbard RA, Miglioretti DL .
Nonhomogeneous Markov chain for estimating the cumulative risk of multiple false positive screening tests.
Biometrics 2022 Sep;78(3):1244-56. doi: 10.1111/biom.13484..
Keywords: Research Methodologies, Screening, Imaging, Cancer: Breast Cancer, Cancer
Singal AG, Chen Y, Sridhar S
Novel application of predictive modeling: a tailored approach to promoting hcc surveillance in patients with cirrhosis.
Researchers conducted a secondary analysis of a randomized clinical trial evaluating a mailed outreach strategy to promote hepatocellular carcinoma (HCC) surveillance among cirrhosis patients at a safety-net health system. They found that predictive models can help stratify patients' likelihood to respond to surveillance outreach invitations, facilitating tailored strategies to maximize effectiveness and cost-effectiveness of HCC surveillance population health programs.
AHRQ-funded; HS022418.
Citation: Singal AG, Chen Y, Sridhar S .
Novel application of predictive modeling: a tailored approach to promoting hcc surveillance in patients with cirrhosis.
Clin Gastroenterol Hepatol 2022 Aug;20(8):1795-802.e2. doi: 10.1016/j.cgh.2021.02.038..
Keywords: Cancer, Chronic Conditions, Screening
Danan ER, Brunner J, Bergman A
The relationship between sexual assault history and cervical cancer screening completion among women veterans in the Veterans Health Administration.
The purpose of this study was to determine whether a history of sexual assault in women Veterans is associated with decreased cervical cancer screening completion. The researchers analyzed data from a 2015 survey of 1049 women Veterans who accessed primary care services at 12 Veterans health administration facilities (VA’s) in nine states, and linked responses with electronic health data from the VA system. Fifty-seven percent (616) of women Veterans reported lifetime sexual assault, and those who did so had a greater likelihood of reporting a high level of distress associated with pelvic examinations and delaying a gynecologic exam due to distress. However, in the final adjusted model, there was not a significant association between lifetime sexual assault and reduced odds of cervical cancer screening completion. The study concluded that there was no significant association between sexual assault and gaps in cervical cancer screening completion.
AHRQ-funded; HS026379.
Citation: Danan ER, Brunner J, Bergman A .
The relationship between sexual assault history and cervical cancer screening completion among women veterans in the Veterans Health Administration.
J Womens Health 2022 Jul;31(7):1040-47. doi: 10.1089/jwh.2021.0237.AHRQ-funded; HS026379..
Keywords: Women, Cancer: Cervical Cancer, Cancer, Screening, Trauma
Kerlikowske K, Su YR, Sprague BL
Association of screening with digital breast tomosynthesis vs digital mammography with risk of interval invasive and advanced breast cancer.
The purpose of this study was to compare digital breast tomosynthesis (DBT) with digital mammography to determine whether DBT was correlated with lower rates of internal invasive cancer and advanced breast cancer, taking into consideration breast density and breast cancer risk. From 2011 through 2018, the researchers studied a cohort of 504,427 women between the ages of 40 and 79 who underwent 375,189 screening DBT exams and 1,003,900 screening digital mammography exams, and who were then followed up for cancer diagnoses between 2011 and 2019 after being identified via linkage to state or regional cancer registries. The median age at the time of screening was 58 years (IQR 50-65 years) and the diagnostic screenings took place at 44 Breast Cancer Surveillance Consortium (BCSC) facilities in the United States. The study found that among women at low to average risk, or at high risk with almost entirely fatty, scattered fibroglandular densities, or heterogeneously dense breasts, advanced cancer rates were not significantly different for DBT vs digital mammography. There was no significant difference between DBT and digital mammography for interval cancer rates per 1000 exams. Interval invasive cancer rates were also not significantly different among the 413,061 examinations with BCSC 5-year risk of 1.67% or higher (high risk) across breast density categories, or among all the 836,250 examinations with BCSC 5-year risk less than 1.67% (low to average-risk). For the 3.6% of women with extremely dense breasts and at high risk of breast cancer (13,291 examinations in the DBT group and 31,300 in the digital mammography group) advanced cancer rates per 1000 examinations were significantly lower for DBT vs digital mammography, but not for women at low to average risk (10,611 examinations in the DBT group and 37,796 in the digital mammography group). The researchers reported that there was no significant difference in the 96.4% of women with extremely dense breasts not at high risk, heterogeneously dense breasts, or nondense breasts, and concluded that screening with DBT vs digital mammography was associated with a significantly lower risk of advanced breast cancer among the 3.6% of women with extremely dense breasts and at high risk of breast cancer, and was not associated with a significant difference in risk of interval invasive cancer.
AHRQ-funded; HS018366.
Citation: Kerlikowske K, Su YR, Sprague BL .
Association of screening with digital breast tomosynthesis vs digital mammography with risk of interval invasive and advanced breast cancer.
JAMA 2022 Jun 14;327(22):2220-30. doi: 10.1001/jama.2022.7672..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Women, Imaging, Risk
Kukhareva PV, Caverly TJ, Li H
Inaccuracies in electronic health records smoking data and a potential approach to address resulting underestimation in determining lung cancer screening eligibility.
The authors sought to characterize EHR smoking data issues and to propose an approach to addressing these issues using longitudinal smoking data. They found that over 80% of evaluated records had inaccuracies, including missing packs-per-day or years-smoked, outdated data, missing years-quit, and a recent change in packs-per-day resulting in inaccurate lifetime pack-years estimation. Further, addressing these issues by using longitudinal data enabled the identification of 49.4% more patients potentially eligible for lung cancer screening.
AHRQ-funded; HS026198.
Citation: Kukhareva PV, Caverly TJ, Li H .
Inaccuracies in electronic health records smoking data and a potential approach to address resulting underestimation in determining lung cancer screening eligibility.
J Am Med Inform Assoc 2022 Apr 13;29(5):779-88. doi: 10.1093/jamia/ocac020..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Screening, Cancer: Lung Cancer, Cancer
Reese TJ, Schlechter CR, Kramer H
Implementing lung cancer screening in primary care: needs assessment and implementation strategy design.
This study explored the implementation of lung cancer screening with low-dose computed tomography (CT) in primary care. The study’s two goals included exploring the implementation of lung cancer screening primary care in the context of integrating a decision aid into the electronic health record and a designing of implementation strategies that target hypothesized mechanics of change and context-specific barriers. The two phases included a Qualitative Analysis phase including semi-structured interviews with primary care physicians to elicit key task behaviors, and an Implementation Strategy Design phase consisting of defining implementation strategies and hypothesizing causal pathways to improve screening with a decision aid. Fourteen interviews were conducted and out of that 3 key task behaviors and four behavioral determinants emerged. Strategies included increasing provider self-efficacy toward performing shared decision making and using the decision aid, improving provider performance expectancy, increasing social influence, and addressing key facilitators to using the decision aid.
AHRQ-funded; HS026198.
Citation: Reese TJ, Schlechter CR, Kramer H .
Implementing lung cancer screening in primary care: needs assessment and implementation strategy design.
Transl Behav Med 2022 Feb 16;12(2):187-97. doi: 10.1093/tbm/ibab115..
Keywords: Cancer: Lung Cancer, Cancer, Primary Care, Screening, Implementation, Shared Decision Making
Higashi RT, Rodriguez SA, Betts AC
Anal cancer screening among women with HIV: provider experiences and system-level challenges.
This article described current practices and barriers met in conducting anal cancer screenings for women living with HIV (WLWH) in an urban integrated safety-net system and in a non-profit community-based HIV clinic. Semi-structured interviews with clinical and administrative stakeholders were conducted to assess their screening for anal cancer experiences, knowledge, clinic practices and procedures. Barriers included limited knowledge of guidelines by providers and system-level issues such as lack of coordination between clinics and limitations on available resources. The authors concluded that screenings and follow-up require organization and coordination between multiple care teams, as well as improved clinical information systems to facilitate communication and infrastructure for managing abnormal results.
AHRQ-funded; HS022418.
Citation: Higashi RT, Rodriguez SA, Betts AC .
Anal cancer screening among women with HIV: provider experiences and system-level challenges.
AIDS Care 2022 Feb; 34(2):220-26. doi: 10.1080/09540121.2021.1883512..
Keywords: Cancer, Human Immunodeficiency Virus (HIV), Women, Screening