National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (11)
- Adverse Drug Events (ADE) (11)
- Adverse Events (15)
- Alcohol Use (2)
- Ambulatory Care and Surgery (13)
- Antibiotics (6)
- Antimicrobial Stewardship (4)
- Anxiety (4)
- Arthritis (16)
- Asthma (31)
- Autism (3)
- Back Health and Pain (18)
- Behavioral Health (42)
- Blood Clots (1)
- Blood Pressure (23)
- Blood Thinners (2)
- Brain Injury (1)
- Cancer (17)
- Cancer: Breast Cancer (1)
- Cancer: Cervical Cancer (1)
- Cancer: Colorectal Cancer (1)
- Cancer: Prostate Cancer (1)
- Cardiovascular Conditions (42)
- Care Coordination (13)
- Caregiving (13)
- Care Management (48)
- Case Study (1)
- Centers for Education and Research on Therapeutics (CERTs) (1)
- Children/Adolescents (109)
- (-) Chronic Conditions (703)
- Clinical Decision Support (CDS) (8)
- Clinician-Patient Communication (23)
- Communication (17)
- Community-Based Practice (7)
- Community Partnerships (1)
- Comparative Effectiveness (22)
- Complementary and Alternative Medicine (7)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- COVID-19 (11)
- Critical Care (3)
- Cultural Competence (1)
- Data (4)
- Dementia (5)
- Dental and Oral Health (1)
- Depression (17)
- Diabetes (118)
- Diagnostic Safety and Quality (18)
- Dialysis (3)
- Digestive Disease and Health (11)
- Disabilities (1)
- Disparities (31)
- Education (1)
- Education: Continuing Medical Education (1)
- Education: Patient and Caregiver (17)
- Elderly (69)
- Electronic Health Records (EHRs) (30)
- Emergency Department (10)
- Emergency Medical Services (EMS) (1)
- Evidence-Based Practice (41)
- Eye Disease and Health (2)
- Falls (3)
- Family Health and History (4)
- Genetics (3)
- Guidelines (18)
- Healthcare Cost and Utilization Project (HCUP) (19)
- Healthcare Costs (40)
- Healthcare Delivery (30)
- Healthcare Utilization (20)
- Health Information Exchange (HIE) (2)
- Health Information Technology (HIT) (88)
- Health Insurance (12)
- Health Literacy (4)
- Health Promotion (4)
- Health Services Research (HSR) (8)
- Health Status (17)
- Health Systems (2)
- Heart Disease and Health (26)
- Hepatitis (8)
- Home Healthcare (7)
- Hospital Discharge (4)
- Hospitalization (28)
- Hospital Readmissions (16)
- Hospitals (12)
- Human Immunodeficiency Virus (HIV) (26)
- Imaging (3)
- Implementation (6)
- Infectious Diseases (1)
- Influenza (1)
- Injuries and Wounds (2)
- Inpatient Care (6)
- Intensive Care Unit (ICU) (2)
- Kidney Disease and Health (40)
- Lifestyle Changes (11)
- Long-Term Care (6)
- Low-Income (13)
- Maternal Care (4)
- Medicaid (17)
- Medical Devices (4)
- Medical Errors (3)
- Medical Expenditure Panel Survey (MEPS) (15)
- Medicare (16)
- Medication (134)
- Medication: Safety (10)
- Men's Health (1)
- Mortality (14)
- Neurological Disorders (15)
- Newborns/Infants (2)
- Nursing (2)
- Nursing Homes (5)
- Nutrition (10)
- Obesity (11)
- Obesity: Weight Management (3)
- Opioids (44)
- Orthopedics (2)
- Osteoporosis (2)
- Outcomes (44)
- Pain (85)
- Palliative Care (12)
- Patient-Centered Healthcare (50)
- Patient-Centered Outcomes Research (53)
- Patient Adherence/Compliance (35)
- Patient and Family Engagement (22)
- Patient Experience (12)
- Patient Safety (20)
- Patient Self-Management (48)
- Payment (1)
- Pneumonia (1)
- Policy (11)
- Practice-Based Research Network (PBRN) (1)
- Practice Patterns (19)
- Pregnancy (8)
- Pressure Ulcers (1)
- Prevention (27)
- Primary Care (64)
- Primary Care: Models of Care (9)
- Provider (9)
- Provider: Clinician (3)
- Provider: Health Personnel (1)
- Provider: Nurse (2)
- Provider: Pharmacist (3)
- Provider: Physician (5)
- Provider Performance (1)
- Public Health (3)
- Quality Improvement (17)
- Quality Indicators (QIs) (5)
- Quality Measures (11)
- Quality of Care (41)
- Quality of Life (25)
- Racial and Ethnic Minorities (40)
- Registries (4)
- Rehabilitation (3)
- Research Methodologies (7)
- Respiratory Conditions (58)
- Risk (36)
- Rural Health (6)
- Screening (16)
- Sex Factors (3)
- Sexual Health (1)
- Shared Decision Making (31)
- Sickle Cell Disease (16)
- Skin Conditions (12)
- Sleep Problems (9)
- Social Determinants of Health (25)
- Social Media (2)
- Social Stigma (2)
- Stress (3)
- Stroke (1)
- Substance Abuse (15)
- Surgery (24)
- System Design (1)
- Teams (6)
- Telehealth (30)
- Tobacco Use (3)
- Transitions of Care (14)
- Transplantation (9)
- Trauma (5)
- Treatments (12)
- U.S. Preventive Services Task Force (USPSTF) (9)
- Urban Health (6)
- Vaccination (1)
- Vulnerable Populations (16)
- Web-Based (2)
- Women (15)
- Young Adults (6)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 703 Research Studies DisplayedStarnes LS, Starnes JR, Stopczynski T
Clinical prediction model: multisystem inflammatory syndrome in children versus Kawasaki disease.
This study aimed to develop a prediction model to differentiate between multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD). Using retrospective and prospective cohort data, a logistic regression model was developed, incorporating factors such as age, laboratory values, and clinical indicators. The model showed excellent discrimination (AUC 0.96) and calibration. It offers potential usefulness in aiding the diagnosis of MIS-C but requires further validation.
AHRQ-funded; HS026122.
Citation: Starnes LS, Starnes JR, Stopczynski T .
Clinical prediction model: multisystem inflammatory syndrome in children versus Kawasaki disease.
J Hosp Med 2024 Mar; 19(3):175-84. doi: 10.1002/jhm.13290.
Keywords: Children/Adolescents, Respiratory Conditions, COVID-19, Chronic Conditions
Melton K, Liu J, Sadeghi H
Predictors of transition outcomes in cystic fibrosis: analysis of National Patient Registry and CF RISE (Responsibility. Independence. Self-care. Education) data.
This retrospective cohort study’s goal was to identify predictors of transition outcomes in cystic fibrosis (CF) patients aged 16-25 years who transitioned to adult care from 2013 to 2019. The authors used data from the CF Foundation Patient Registry and the web-based transition program CF RISE (Responsibility. Independence. Self-care. Education). They modeled change in forced expiratory volume in 1 second % predicted and weight using linear regression fit with generalized estimating equations. Predictor variables included gap in care (time between last pediatric and first adult outpatient visit), transition program engagement, and sociodemographic and medical factors. Among 12,420 adolescents and young adults, 3876 transitioned to adult care with a median gap in care of 7.6 months. Patients from CF centers that have greater rates of CF RISE engagement had improved lung function and weight at their first adult outpatient visit. Patients with coverage on a parent's insurance plan and absence of CF complications predicted increased lung function. Sinus disease and history of a nonlung transplant predicted increased weight. Comorbid diabetes mellitus and gaps in care greater than 3 months predicted decreased lung function with longer gaps in care associated with greater decrease. Care gaps of 6 to 9 months predicted decreased weight. Other control variables including baseline forced expiratory volume in 1 second and weight, and exacerbation status were also statistically significant.
AHRQ-funded; HS000063.
Citation: Melton K, Liu J, Sadeghi H .
Predictors of transition outcomes in cystic fibrosis: analysis of National Patient Registry and CF RISE (Responsibility. Independence. Self-care. Education) data.
J Pediatr 2024 Feb; 265:113812. doi: 10.1016/j.jpeds.2023.113812.
Keywords: Chronic Conditions, Respiratory Conditions, Children/Adolescents, Transitions of Care
Kovacevic M, Montes M, Tirone V
Treating a common comorbidity: pain outcomes following a 3-week cognitive processing therapy-based intensive treatment for posttraumatic stress disorder address.
This study examined changes in pain, posttraumatic stress disorder (PTSD), and depressive symptoms among 125 veterans completing a 3-week cognitive processing therapy (CPT)-based intensive treatment program (ITP) for PTSD. The authors explored whether pretreatment pain interference predicted changes in PTSD and depressive symptom severity and whether larger changes in pain interference over the course of treatment were associated with larger changes in PTSD and depressive symptom severity. Higher levels of pretreatment pain interference were associated with higher PTSD, and depressive symptom severity, over time. Larger reductions in pain interference corresponded to more improvement in PTSD symptoms, but not depressive symptoms.
AHRQ-funded; HS028511.
Citation: Kovacevic M, Montes M, Tirone V .
Treating a common comorbidity: pain outcomes following a 3-week cognitive processing therapy-based intensive treatment for posttraumatic stress disorder address.
J Trauma Stress 2024 Feb; 37(1):47-56. doi: 10.1002/jts.22979.
Keywords: Pain, Behavioral Health, Outcomes, Chronic Conditions
Jolliff A, Coller RJ, Kearney H
An mHealth design to promote medication safety in children with medical complexity.
This study describes an effort to design a health information technology tool to improve medication safety for children with medical complexity (CMC). The study engaged family caregivers, secondary caregivers, and clinicians who work with CMC in a co-design process to identify: 1) medication safety challenges experienced by CMC caregivers and, 2) design requirements for a mobile health application to improve medication safety for CMC in the home. Family caregivers, secondary caregivers, and clinicians from a children's hospital-based pediatric complex care program participated in virtual co-design sessions. During these sessions, the facilitator guided 16 co-designers in generating and converging upon medication safety challenges and design requirements. These sessions were recorded and reviewed after conclusion to confirm that all designer comments had been captured. An analysis yielded 11 challenges to medication safety and 11 corresponding design requirements that fit into three broader challenges: giving the right medication at the right time; communicating with others about medications; and accommodating complex medical routines.
AHRQ-funded; HS028409.
Citation: Jolliff A, Coller RJ, Kearney H .
An mHealth design to promote medication safety in children with medical complexity.
Appl Clin Inform 2024 Jan; 15(1):45-54. doi: 10.1055/a-2214-8000..
Keywords: Children/Adolescents, Medication: Safety, Medication, Health Information Technology (HIT), Chronic Conditions, Telehealth, Caregiving
Cuca YP, Horvat C, Corless IB IB
The social, mental, and physical health impacts of the COVID-19 pandemic on people with HIV: protocol of an observational international multisite study.
The authors described the protocol for an international multisite observational study based on the SPIRIT guidelines to examine impact on the health and HIV outcomes for immunocompromised individuals such as people with HIV (PWH) from COVID-19 and from the strategies enacted to contain it. Investigators will recruit PWH to complete the study online or in-person. Study questions will address demographics, HIV continuum of care indicators, mental and social health, COVID-19 and vaccination knowledge, attitudes, behaviors, and fears; and overall outcomes. Results of this study can inform responses to future public health crises to minimize impacts on vulnerable populations such as PWH.
AHRQ-funded; HS028523.
Citation: Cuca YP, Horvat C, Corless IB IB .
The social, mental, and physical health impacts of the COVID-19 pandemic on people with HIV: protocol of an observational international multisite study.
J Assoc Nurses AIDS Care 2024 Jan-Feb; 35(1):60-74. doi: 10.1097/jnc.0000000000000444..
Keywords: COVID-19, Human Immunodeficiency Virus (HIV), Chronic Conditions
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
Kieren MQ, Kelly MM, Garcia MA
Parent experiences with the process of sharing inpatient safety concerns for children with medical complexity: a qualitative analysis.
The objective of this study was to describe the process of identifying and reporting inpatient safety concerns from the perspective of parents of children with medical complexity (CMC). Researchers conducted a secondary analysis of qualitative data from semi-structured interviews with English and Spanish-speaking parents of CMC at two tertiary children's hospitals. The parents described a multi-step process of reporting their safety concerns and a spectrum of staff response and validation. The researchers concluded that their findings could inform family-centered interventions that support safety concern reporting in the inpatient setting.
AHRQ-funded; HS025781.
Citation: Kieren MQ, Kelly MM, Garcia MA .
Parent experiences with the process of sharing inpatient safety concerns for children with medical complexity: a qualitative analysis.
Acad Pediatr 2023 Nov-Dec; 23(8):1535-41. doi: 10.1016/j.acap.2023.06.008..
Keywords: Children/Adolescents, Patient Safety, Inpatient Care, Chronic Conditions
Soulsby WD, Lawson E, Okumura M
Socioeconomic factors are associated with severity of hospitalization in pediatric lupus: an analysis of the 2016 Kids' Inpatient Database.
This study’s goal was to investigate the relationship of income level and other socioeconomic factors with length of stay (LOS) in the hospital and severe lupus features using the 2016 Kids' Inpatient Database (KID). The cohort included children aged 2-20 identified with lupus hospitalization in the 2016 KID using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes (M32). A total of 3,367 unweighted lupus hospitalizations were identified. Income level was found to be a statistically significant predictor of increased LOS in the hospital for those in the lowest income quartile. Black race, "other" race, and public insurance were also associated with severe lupus features.
AHRQ-funded; HS026383.
Citation: Soulsby WD, Lawson E, Okumura M .
Socioeconomic factors are associated with severity of hospitalization in pediatric lupus: an analysis of the 2016 Kids' Inpatient Database.
Arthritis Care Res 2023 Oct; 75(10):2073-81. doi: 10.1002/acr.25121..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Hospitalization, Chronic Conditions
Ruderman SA, Odden MC, Webel AR
Tobacco smoking and pack-years are associated with frailty among people with HIV.
This study examines the association of frailty with tobacco smoking and pack-years among people with HIV (PWH). The authors identified 8,608 PWH across 6 Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) sites who completed ≥2 patient-reported outcome assessments, including a frailty phenotype measuring unintentional weight loss, poor mobility, fatigue, and inactivity, scored 0-4. The authors measured smoking as baseline pack-years and time-updated never, former, or current use with cigarettes/day. They used Cox models to associate smoking with risk of incident frailty (score ≥3) and deterioration (frailty score increase by ≥2 points), adjusted for demographics, antiretroviral medication, and time-updated CD4 count. Mean follow-up period of PWH was 5.3 years, the mean age at baseline was 45 years, 15% were female, and 52% were non-White. At baseline, 60% reported current or former smoking and both were associated with higher incident frailty risk, as was higher pack-years. Current smoking (among younger PWH) and pack-years were associated with higher risk of deterioration, but not former smoking.
AHRQ-funded; HS026154.
Citation: Ruderman SA, Odden MC, Webel AR .
Tobacco smoking and pack-years are associated with frailty among people with HIV.
J Acquir Immune Defic Syndr 2023 Oct 1; 94(2):135-42. doi: 10.1097/qai.0000000000003242..
Keywords: Tobacco Use, Human Immunodeficiency Virus (HIV), Chronic Conditions, Health Status
Anderson AJ, Noyes K, Hewner S
Expanding the evidence for cross-sector collaboration in implementation science: creating a collaborative, cross-sector, interagency, multidisciplinary team to serve patients experiencing homelessness and medical complexity at hospital discharge.
This report discussed the challenges for implementing cross-sector collaboration (CSC). A recuperative care collaborative in Buffalo, NY, provided care transition support at an acute care hospital discharge via a medical respite program for people who had experienced homelessness. Using the Expert Recommendations for Implementing Change (ERIC) framework and feedback from the cross-sector collaborative team, implementation strategies were derived from three validated ERIC implementation strategy clusters: development of stakeholder relationships, use of evaluative and iterative strategies, and changes to infrastructure. The authors concluded that future research would address external organizational influences and emphasize CSC as central to interventions.
AHRQ-funded; HS028000.
Citation: Anderson AJ, Noyes K, Hewner S .
Expanding the evidence for cross-sector collaboration in implementation science: creating a collaborative, cross-sector, interagency, multidisciplinary team to serve patients experiencing homelessness and medical complexity at hospital discharge.
Front Health Serv 2023 Sep 8; 3:1124054. doi: 10.3389/frhs.2023.1124054..
Keywords: Hospital Discharge, Chronic Conditions, Vulnerable Populations, Care Coordination, Transitions of Care
Schuttner L, Richardson C, Parikh T
"Low-value" glycemic outcomes among older adults with diabetes cared for by primary care nurse practitioners or physicians: a retrospective cohort study.
The objective of this retrospective cohort study was to compare patients with diabetes reassigned to nurse practitioners to those reassigned to physicians after their previous physician separated from practice in an integrated US health system. Participants were patients aged at least 65 with diabetes who were at increased risk for hypoglycemia, whose primary care physician had left the Veterans Health Administration, and who were reassigned to a new primary care provider in the following year. The results indicated that primary care nurse practitioners delivered equivalent or better rates of low-value diabetes care for older patients, compared to physicians.
AHRQ-funded; HS026369.
Citation: Schuttner L, Richardson C, Parikh T .
"Low-value" glycemic outcomes among older adults with diabetes cared for by primary care nurse practitioners or physicians: a retrospective cohort study.
Int J Nurs Stud 2023 Sep; 145:104532. doi: 10.1016/j.ijnurstu.2023.104532..
Keywords: Elderly, Primary Care, Diabetes, Chronic Conditions
Holland JE, Rettew DC, Varni SE
Associations between mental and physical illness comorbidity and hospital utilization.
The purpose of this study was to describe the prevalence of chronic physical illness types and mental illness and their comorbidity among adolescents and young adults (AYA) and evaluate the relationship of comorbidity on hospital use. The sample analyzed was 50% female, 63% Medicaid, and 43% had 1 or more chronic illness. The study found that mental illness was common (31%) and highly comorbid with multiple physical illnesses. In AYA with pulmonary illness, those with comorbid mental illness had 1.74-times higher odds of ED use and 2.9-times higher odds of hospitalization than those without mental illness. Comorbid endocrine and mental illness had 1.84-times higher odds of ED use and 2.1-times higher odds of hospitalization, comorbid neurologic and mental illness had 1.36-times higher odds of ED use and 2.4-times higher odds of hospitalization and comorbid musculoskeletal and mental illness had 1.38-times higher odds of ED use and 2.1-times higher odds of hospitalization.
AHRQ-funded; HS024575.
Citation: Holland JE, Rettew DC, Varni SE .
Associations between mental and physical illness comorbidity and hospital utilization.
Hosp Pediatr 2023 Sep; 13(9):841-48. doi: 10.1542/hpeds.2022-006984..
Keywords: Behavioral Health, Chronic Conditions, Hospitalization
Waltman A, Konetzka RT, Chia S
Effectiveness of a bundled payments for care improvement program for chronic obstructive pulmonary disease.
This single-site retrospective observational study evaluated the impact of an evidence-based transitions of care program on episode costs and readmission rates, comparing patients hospitalized for COPD exacerbations who received versus those who did not receive the intervention. Between October 2015 and September 2018, 132 received and 161 did not receive the program. Below target mean episode costs were found for six out of eleven quarters for the intervention group, as opposed to only one out of twelve quarters for the control group. Overall, there were non-significant mean savings of $2551 in episode costs relative to target costs for the intervention group, though results varied by index admission diagnosis-related group (DRG). There were additional costs of $4184 per episode for the least-complicated cohort (DRG 192), but savings of $1897 and $1753 for the most complicated index admissions (DRGs 191 and 190, respectively). A significant mean decrease of 0.24 readmissions per episode for intervention was observed in 90-day readmission rates relative to control. Skilled nursing facility readmissions and hospital discharges were factors of higher costs (mean increases of $9098 and $17,095 per episode respectively).
AHRQ-funded; HS027804.
Citation: Waltman A, Konetzka RT, Chia S .
Effectiveness of a bundled payments for care improvement program for chronic obstructive pulmonary disease.
J Gen Intern Med 2023 Sep; 38(12):2662-70. doi: 10.1007/s11606-023-08249-6..
Keywords: Respiratory Conditions, Chronic Conditions, Payment, Quality Improvement, Quality of Care
Mauskar S, Ngo T, Haskell H
In their own words: safety and quality perspectives from families of hospitalized children with medical complexity.
The purpose of this study was to address the gap of research on inpatient safety/quality experience of Children with medical complexity (CMC) and identify otherwise unrecognized, family-prioritized areas for improving safety/quality of children with medical complexity (CMC). Out of 208 families surveyed, 237 (88%) families completed surveys; 83 families offered 138 free-text safety responses about medications, feeds, cares, and other categories. The study found that themes included unmet expectations of hospital care/environment, lack of consistency, provider-patient communication lapses, families' expertise about care, and the value of transparency.
AHRQ-funded; HS025781.
Citation: Mauskar S, Ngo T, Haskell H .
In their own words: safety and quality perspectives from families of hospitalized children with medical complexity.
J Hosp Med 2023 Sep; 18(9):777-86. doi: 10.1002/jhm.13178..
Keywords: Children/Adolescents, Patient Safety, Quality of Care, Chronic Conditions
Somohano VC, Smith CL, Saha S
Patient-provider shared decision-making, trust, and opioid misuse among US veterans prescribed long-term opioid therapy for chronic pain.
This article examined the role that trust in a prescribing provider has on shared decision-making and opioid misuse in opioid-specific pain management. A secondary analysis of data from a prospective cohort study was conducted of US Veterans (N = 1273) prescribed long-term opioid therapy (LTOT) for chronic non-cancer pain. Patient-provider shared decision-making had a total significant effect on opioid misuse, in the absence of the mediator, such that higher levels of shared decision-making were associated with lower levels of reported opioid misuse. When trust in provider was added to the mediation model, the indirect effect of shared decision-making on opioid misuse through trust in provider remained significant.
AHRQ-funded; HS026370.
Citation: Somohano VC, Smith CL, Saha S .
Patient-provider shared decision-making, trust, and opioid misuse among US veterans prescribed long-term opioid therapy for chronic pain.
J Gen Intern Med 2023 Sep; 38(12):2755-60. doi: 10.1007/s11606-023-08212-5..
Keywords: Shared Decision Making, Opioids, Medication, Substance Abuse, Behavioral Health, Pain, Chronic Conditions
Silverstein GD, Styke SC, Kaur S
The relationship between depressive symptoms, eHealth literacy, and asthma outcomes in the context of a mobile health intervention.
This study’s objective was to evaluate the associations between health/eHealth literacy and depressive symptoms with app usage and clinical outcomes. The authors recruited adults with persistent asthma to utilize the ASTHMAXcel PRO mobile app. Participants completed the following questionnaires: Patient Health Questionnaire-9 (PHQ-9) to assess for depressive symptoms, Asthma Control Test (ACT), Mini Asthma Quality of Life (QOL) Questionnaire, and the Newest Vital Sign (NVS) tool to measure health literacy. Subsets of participant data were available on eHealth literacy (eHeals) (n = 24) and average number of app logins across 2 months (n = 40). The average participant age was 44.0 years, with 74% identifying as female. Increased depressive symptoms were associated with worse asthma control and asthma QOL, but not eHealth literacy. Higher eHealth literacy was associated with worse asthma QOL and more app logins. NVS scores weren’t associated with any measures.
AHRQ-funded; HS025645.
Citation: Silverstein GD, Styke SC, Kaur S .
The relationship between depressive symptoms, eHealth literacy, and asthma outcomes in the context of a mobile health intervention.
Psychosom Med 2023 Sep 1; 85(7):605-11. doi: 10.1097/psy.0000000000001170..
Keywords: Health Literacy, Asthma, Telehealth, Health Information Technology (HIT), Education: Patient and Caregiver, Outcomes, Respiratory Conditions, Chronic Conditions
Mehta S, Lyles CR, Rubinsky AD
Social determinants of health documentation in structured and unstructured clinical data of patients with diabetes: comparative analysis.
It is not clear how accurately Electronic health records (HER) data reflect patients' lived experience of social determinants of health (SDOH). The process of manually reviewing clinical notes to retrieve SDOH information is not feasible. The purpose of this study was to apply two tools, PatientExploreR and Electronic Medical Record Search Engine (EMERSE), to identify SDOH mappings for structured and unstructured patient data. The researchers included 4,283 adult patients receiving primary care for diabetes at UCSF. The study results revealed that SDOH may be more significant in the lives of patients with diabetes than is evident from structured data recorded on EHRs. When researchers applied EMERSE NLP rules, additional information was uncovered from patient clinical notes on problems related to social connections isolation, employment, financial insecurity, housing insecurity, food insecurity, education, and stress.
AHRQ-funded; HS026383.
Citation: Mehta S, Lyles CR, Rubinsky AD .
Social determinants of health documentation in structured and unstructured clinical data of patients with diabetes: comparative analysis.
JMIR Med Inform 2023 Aug 22; 11:e46159. doi: 10.2196/46159..
Keywords: Social Determinants of Health, Diabetes, Chronic Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT)
Warnick J, Darling KE, Topor LS
Formative development of a weight management intervention for adolescents with type 1 diabetes mellitus and obesity.
Researchers interviewed overweight or obese adolescents with type 1 diabetes mellitus (T1D), their caregivers, and pediatric endocrinologists to understand if they would be interested in a weight management intervention adapted for youth with T1D. The results provided detailed recommendations for the adaptation of a behavioral weight management intervention. Five central themes emerged: program content, programmatic messaging, program structure, social support, and risk of eating disorders.
AHRQ-funded; HS027071.
Citation: Warnick J, Darling KE, Topor LS .
Formative development of a weight management intervention for adolescents with type 1 diabetes mellitus and obesity.
Pediatr Diabetes 2023; 2023. doi: 10.1155/2023/9584419..
Keywords: Children/Adolescents, Obesity, Chronic Conditions, Obesity: Weight Management
Fuery MA, Kadhim B, Samsky MD
Electronic health record embedded strategies for improving care of patients with heart failure.
This article reviews recent findings from randomized clinical trials examining the impact of electronic health record (HER) alerts (called nudges) on quality of care for heart failure patients. These clinical trials demonstrated that some EHR alerts can improve care for heart failure patients. The trials described utilized default options, involved clinicians in the alert design process, provided actionable recommendations, and aimed to minimize disruptions to typical workflow.
AHRQ-funded; HS027626.
Citation: Fuery MA, Kadhim B, Samsky MD .
Electronic health record embedded strategies for improving care of patients with heart failure.
Curr Heart Fail Rep 2023 Aug; 20(4):280-86. doi: 10.1007/s11897-023-00614-0..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Heart Disease and Health, Cardiovascular Conditions, Chronic Conditions
Jones PD, Lai JC, Bajaj JS
Actionable solutions to achieve health equity in chronic liver disease.
To achieve health equity in access to treatment for liver diseases, including liver transplantation, the root causes that drive the inequities must be addressed. It is critical to understand the role that social determinants of health play in the disparate health outcomes that are currently observed in the populations most at risk for various forms of liver disease burden as well as access to treatments. The purpose of this paper was to provide a review of current disparities in chronic liver disease and describe actionable strategies that have potential to improve quality, address gaps, and encourage equity in liver care.
AHRQ-funded; HS025412.
Citation: Jones PD, Lai JC, Bajaj JS .
Actionable solutions to achieve health equity in chronic liver disease.
Clin Gastroenterol Hepatol 2023 Jul; 21(8):1992-2000. doi: 10.1016/j.cgh.2023.03.043..
Keywords: Chronic Conditions, Disparities
Chu CD, Xia F, Du Y
Estimated prevalence and testing for albuminuria in US adults at risk for chronic kidney disease.
The purpose of this cohort study was to assess the extent of albuminuria underdetection from lack of testing and examine its association with CKD treatment. Researchers examined records of adults with hypertension or diabetes, utilizing data from the 2007 to 2018 National Health and Nutrition Examination Surveys (NHANES) and the Optum deidentified electronic health record (EHR) data set of US health care organizations. The total EHR study population included 192,108 patients; 96.6% with hypertension, and 26.2% with diabetes. The study found that 17.5% of patients had albuminuria testing; of whom 34.3% had albuminuria. Among 158,479 patients who were untested, the estimated albuminuria prevalence rate was 13.4%. Thus, only 35.2% of the projected population with albuminuria had been tested. Albuminuria testing was associated with higher adjusted odds of receiving ACEi or ARB treatment, SGLT2i treatment, and having blood pressure controlled to less than 140/90 mm Hg. The researchers concluded that approximately two-thirds of patients with albuminuria were undetected due to lack of testing.
AHRQ-funded; HS026383.
Citation: Chu CD, Xia F, Du Y .
Estimated prevalence and testing for albuminuria in US adults at risk for chronic kidney disease.
JAMA Netw Open 2023 Jul; 6(7):e2326230. doi: 10.1001/jamanetworkopen.2023.26230..
Keywords: Kidney Disease and Health, Chronic Conditions, Diabetes, Blood Pressure, Evidence-Based Practice
Narindrarangkura P, Alafaireet PE, Khan U
Predicting suicide attempts among people with diabetes using a large multicenter electronic health records dataset.
This study’s goal was to determine the risk factors for suicidal behaviors of people with diabetes as they have a higher risk than the general population. The authors investigated risk factors and predicted suicide attempts in people with diabetes using the Least Absolute Shrinkage and Selection Operator (LASSO) regression. They used data from Cerner Real-World Data™ and included over 3 million diabetes patients in the study. They analyzed gender-, diabetes-type, and depression-specific LASSO regression models. The study included 7764 subjects diagnosed with suicide attempts with an average age of 45. They found risk factors for suicide attempts in diabetes patients, such as being an American Indian or Alaska Native, atypical agents, benzodiazepines, and antihistamines. Amyotrophy had a negative coefficient for suicide attempts with males with diabetes but had a positive coefficient for females. Using MAOI had a negative coefficient for suicide attempts in T1DM patients. Patients less than 20 years of age had a positive coefficient for suicide in depressed and non-depressed patients with diabetes.
AHRQ-funded; HS028032.
Citation: Narindrarangkura P, Alafaireet PE, Khan U .
Predicting suicide attempts among people with diabetes using a large multicenter electronic health records dataset.
Int J Psychiatry Med 2023 Jul; 58(4):302-24. doi: 10.1177/00912174231162477..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Behavioral Health, Diabetes, Chronic Conditions
Morrow EL, Mayberry LS, Duff MC
The growing gap: a study of sleep, encoding, and consolidation of new words in chronic traumatic brain injury.
Evidence from neuroscience emphasizes sleep as a crucial support for longitudinal memory and word learning. In numerous lab-based word learning experiments, participants encode and then retrieve new words within the same session. Single session designs are not adequate for capturing the full word learning process. Single session studies also inhibit exploration of the role of behavioral and lifestyle factors such as sleep in supporting longitudinal word learning. Adults with a history of traumatic brain injury (TBI), who experience challenges in the memory systems that support word learning and report related sleep disturbance, provide a unique opportunity to explore linkages between memory, sleep, and word learning. The purpose of this study was to evaluate longitudinal word learning and the influence of sleep on short- and long-term word recall in 50 adults with chronic moderate-severe traumatic brain injury (TBI) and 50 demographically matched neurotypical peers. Participants took part in the study over a two week period in their homes in an attempt to capture the process of real-world word learning and to measure sleep within normal living conditions. The study found that participants with TBI demonstrated a deficit in word learning that started at encoding, continued across time, and increased over the course of the week. The gap in performance between groups was greater at the 1-week post-test than the immediate post-test. Participants with and without TBI recalled more words when they slept after learning.
AHRQ-funded; HS026122.
Citation: Morrow EL, Mayberry LS, Duff MC .
The growing gap: a study of sleep, encoding, and consolidation of new words in chronic traumatic brain injury.
Neuropsychologia 2023 Jun 6; 184:108518. doi: 10.1016/j.neuropsychologia.2023.108518..
Keywords: Brain Injury, Chronic Conditions, Sleep Problems, Trauma
Johnson CL, Colley A, Pierce L
Disparities in advance care planning rates persist among emergency general surgery patients: current state and recommendations for improvement.
A sudden shift in health condition and the intensification of chronic conditions often necessitate the consideration of emergency general surgery (EGS). While goal-oriented care discussions can enhance goal-concordant care and mitigate feelings of depression and anxiety in patients and caregivers, such conversations, along with standardized documentation, are seldom conducted for EGS patients. The researchers conducted a retrospective cohort study employing data from electronic health records of patients admitted to the EGS service in a high-level academic center to ascertain the frequency of significant advance care planning (ACP) documentation (discussions and legal ACP forms) during EGS hospitalization. Multivariable regression was used to identify patient, clinician, and procedural elements contributing to the absence of ACP. The study found that out of the 681 patients admitted to the EGS service in 2019, only 20.1% had ACP documentation in the electronic health record at any stage during their hospital stay. Two-thirds (65.8%) of the entire cohort underwent surgery during their admission, but none of them had an ACP conversation documented with the surgical team before the operation. Patients with ACP documentation were likely to be insured by Medicare and had a higher incidence of comorbid conditions.
AHRQ-funded; HS024532.
Citation: Johnson CL, Colley A, Pierce L .
Disparities in advance care planning rates persist among emergency general surgery patients: current state and recommendations for improvement.
J Trauma Acute Care Surg 2023 Jun; 94(6):863-69. doi: 10.1097/ta.0000000000003909..
Keywords: Disparities, Surgery, Emergency Department, Chronic Conditions
Tracer H, Haselby C
AHRQ Author: Tracer H
Hormone therapy for the primary prevention of chronic conditions in postmenopausal people.
This case study described a 50-year-old woman whose last menstrual cycle was more than a year previous. Case study questions related to the USPSTF recommendation on hormone therapy addressed whether this patient would benefit from hormone therapy to prevent the onset of chronic conditions that become more common after menopause.
AHRQ-authored.
Citation: Tracer H, Haselby C .
Hormone therapy for the primary prevention of chronic conditions in postmenopausal people.
Am Fam Physician 2023 Jun; 107(6):645-46..
Keywords: U.S. Preventive Services Task Force (USPSTF), Guidelines, Evidence-Based Practice, Prevention, Chronic Conditions, Women