National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Arthritis (1)
- Cancer (4)
- Cancer: Breast Cancer (3)
- Cancer: Prostate Cancer (1)
- Caregiving (1)
- Children/Adolescents (1)
- Clinical Decision Support (CDS) (1)
- Electronic Health Records (EHRs) (1)
- Evidence-Based Practice (2)
- Guidelines (2)
- Health Information Technology (HIT) (2)
- Men's Health (1)
- Neurological Disorders (1)
- Orthopedics (2)
- Patient and Family Engagement (1)
- Pregnancy (1)
- Provider (2)
- Provider: Physician (2)
- (-) Shared Decision Making (11)
- (-) Surgery (11)
- Women (4)
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 11 of 11 Research Studies DisplayedEhlers AP, Vitous CA, Sales A
Exploration of factors associated with surgeon deviation from practice guidelines for management of inguinal hernias.
Investigators explored factors associated with surgeon choice of approach (minimally invasive vs open) in inguinal hernia repair as a tool to gain an understanding of guideline-discordant care. They found that decision-making for the approach to inguinal hernia repair was largely influenced by surgeon preference and access to resources rather than patient factors. Although a one-size-fits-all approach is not recommended, the operative approach should ideally be informed by patient factors, including hernia characteristics. They recommended addressing surgeon preference and available resources with a clinician-facing decision aid to provide an opportunity to optimize care for patients undergoing inguinal hernia repair.
AHRQ-funded; HS025778.
Citation: Ehlers AP, Vitous CA, Sales A .
Exploration of factors associated with surgeon deviation from practice guidelines for management of inguinal hernias.
JAMA Netw Open 2020 Nov 2;3(11):e2023684. doi: 10.1001/jamanetworkopen.2020.23684..
Keywords: Surgery, Guidelines, Provider: Physician, Provider, Shared Decision Making, Evidence-Based Practice
Gutnik L, Allen CM, Presson AP
Breast cancer surgery decision role perceptions and choice of surgery.
This study examined the finding that breast cancer patients who reported more personal responsibility for the surgery decision were more likely to undergo aggressive surgery. Retrospective cohort data was used from 100 newly diagnosed breast cancer patients. Surgery types compared were mastectomy, lumpectomy, and unilateral versus bilateral mastectomy. Patients’ decision-making role was identified using the Patient Preference Scale. Type of surgery and patient role concordance was compared as well as patient decision role performance, role perception, and provider role perception. Patient decision role and perceptions were not associated with type of surgery. Patient role preference depended on the stage of disease. Stage III patients preferred the most active roles with stage I and stage II patients preferring a more collaborative role. Providers perceived more passive patient roles in the mastectomy group.
AHRQ-funded; HS024784.
Citation: Gutnik L, Allen CM, Presson AP .
Breast cancer surgery decision role perceptions and choice of surgery.
Ann Surg Oncol 2020 Oct;27(10):3623-32. doi: 10.1245/s10434-020-08485-8.
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Keywords: Cancer: Breast Cancer, Cancer, Shared Decision Making, Surgery, Women
Giardina JC, Cha T, Atlas SJ
Validation of an electronic coding algorithm to identify the primary indication of orthopedic surgeries from administrative data.
The purpose of this study was to develop and validate an algorithm to identify patients receiving four elective orthopedic surgeries to promote shared decision-making. The surgeries included were: 1) knee arthroplasty to treat knee osteoarthritis (KOA); 2) hip arthroplasty to treat hip osteoarthritis (HOA); 3) spinal surgery to treat lumbar spinal stenosis (SpS); and 4) spinal surgery to treat lumber herniated disc (HD). Electronic medical records were reviewed to ascertain a “gold standard” determination of the procedure and primary indication status. Each case had electronic algorithms consisting of ICD-10 and CPT codes for each combination and indication applied to their record. A total of 790 procedures were included in the study. The sensitivity of the algorithms ranged from 0.70 (HD) to 0.92 (KOA). Specificity ranged from 0.94 (SpS) to 0.99 (HOA, KOA).
AHRQ-funded; HS000055.
Citation: Giardina JC, Cha T, Atlas SJ .
Validation of an electronic coding algorithm to identify the primary indication of orthopedic surgeries from administrative data.
BMC Med Inform Decis Mak 2020 Aug 12;20(1):187. doi: 10.1186/s12911-020-01175-1.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Orthopedics, Surgery, Arthritis, Shared Decision Making
Smith ME, Vitous CA, Hughes TM
Barriers and facilitators to de-implementation of the Choosing Wisely((R)) guidelines for low-value breast cancer surgery.
The objective of this study was to understand why surgeons stop performing certain unnecessary cancer operations but not others and how best to de-implement entrenched and emerging unnecessary procedures. The investigators concluded that with a growing focus on the elimination of ineffective, unproven or low value practices, it is imperative that the behavioral determinants are understood and targeted with specific interventions to decrease utilization rapidly.
AHRQ-funded; HS026030.
Citation: Smith ME, Vitous CA, Hughes TM .
Barriers and facilitators to de-implementation of the Choosing Wisely((R)) guidelines for low-value breast cancer surgery.
Ann Surg Oncol 2020 Aug;27(8):2653-63. doi: 10.1245/s10434-020-08285-0..
Keywords: Cancer: Breast Cancer, Cancer, Surgery, Shared Decision Making, Guidelines, Women
Wang T, Baskin AS, Dossett LA
Deimplementation of the choosing wisely recommendations for low-value breast cancer surgery: a systematic review.
Overtreatment of early-stage breast cancer results in increased morbidity and cost without improving survival. Major surgical organizations participating in the Choosing Wisely campaign identified 4 breast cancer operations as low value. The purpose of this study was to evaluate the extent to which these procedures have been deimplemented, determine the implications of decreased use, and recognize possible barriers and facilitators to deimplementation.
AHRQ-funded; HS026030.
Citation: Wang T, Baskin AS, Dossett LA .
Deimplementation of the choosing wisely recommendations for low-value breast cancer surgery: a systematic review.
JAMA Surg 2020 Aug;155(8):759-70. doi: 10.1001/jamasurg.2020.0322..
Keywords: Cancer: Breast Cancer, Cancer, Surgery, Shared Decision Making, Women, Evidence-Based Practice
Jafri SM, Vitous CA, Dossett LA
Surgeon attitudes and beliefs toward abdominal wall hernia repair in female patients of childbearing age.
This qualitative study examined surgeons’ thoughts on decision-making in repairing an abdominal wall hernia in a woman or girl of childbearing age.
AHRQ-funded; HS026030.
Citation: Jafri SM, Vitous CA, Dossett LA .
Surgeon attitudes and beliefs toward abdominal wall hernia repair in female patients of childbearing age.
JAMA Surg 2020 Jun;155(6):528-30. doi: 10.1001/jamasurg.2020.0099..
Keywords: Provider: Physician, Provider, Surgery, Women, Pregnancy, Shared Decision Making
Berlin NL, Skolarus TA, Kerr EA
Too much surgery: overcoming barriers to deimplementation of low-value surgery.
The objectives of this surgical perspective are to discuss the unique aspects of surgical care delivery acting as barriers to de-implementation and to suggest potential strategies to reduce low-value surgery in the United States. Successful de-implementation of low-value surgery will depend on understanding why low-value procedures persist, leveraging quality collaboratives to monitor appropriateness, implementing clinical decision support systems, and developing incentives for de-implementation.
AHRQ-funded; HS026030.
Citation: Berlin NL, Skolarus TA, Kerr EA .
Too much surgery: overcoming barriers to deimplementation of low-value surgery.
Ann Surg 2020 Jun;271(6):1020-22. doi: 10.1097/sla.0000000000003792..
Keywords: Surgery, Shared Decision Making
Links AR, Callon W, Wasserman C
Parental role in decision-making for pediatric surgery: perceptions of involvement in consultations for tonsillectomy.
This study examined the parental role in decision-making for pediatric surgery, in particular perceptions of involvement in consultations for tonsillectomy. The investigators analyzed consults between 63 parents and 8 otolaryngologists. Over a third (37%) of clinicians and parent ratings showed inadequate agreement of preferred roles. Parents perceived greater involvement when clinicians discussed reasons to have or not have the surgery. There was less perception of parental involvement when clinicians used jargon, parents trusted clinicians, or experienced greater decisional conflict.
AHRQ-funded; HS022932.
Citation: Links AR, Callon W, Wasserman C .
Parental role in decision-making for pediatric surgery: perceptions of involvement in consultations for tonsillectomy.
Patient Educ Couns 2020 May;103(5):944-51. doi: 10.1016/j.pec.2019.12.012..
Keywords: Children/Adolescents, Shared Decision Making, Surgery, Caregiving
Kierkegaard P, Vale MD, Garrison S
Mechanisms of decision-making in preoperative assessment for older adult prostate cancer patients-a qualitative study.
The purpose of this study was to identify and examine the underlying mechanisms that uniquely shape preoperative surgical decision-making strategies concerning older adult prostate cancer patients. Results showed that surgeons’ personal experiences had a significant impact on the decision-making processes during preoperative assessments. However, non-patient factors such as institutional microcultures passively and actively influenced the decision-making process during preoperative assessment.
AHRQ-funded; HS025707.
Citation: Kierkegaard P, Vale MD, Garrison S .
Mechanisms of decision-making in preoperative assessment for older adult prostate cancer patients-a qualitative study.
J Surg Oncol 2020 Mar;121(3):561-69. doi: 10.1002/jso.25819..
Keywords: Shared Decision Making, Cancer: Prostate Cancer, Cancer, Surgery, Men's Health
Wissel BD, Greiner TA, Holland-Bouley KD
Prospective validation of a machine learning model that uses provider notes to identify candidates for resective epilepsy surgery.
Delay to resective epilepsy surgery results in avoidable disease burden and increased risk of mortality. The objective of this study was to prospectively validate a natural language processing (NLP) application that uses provider notes to assign epilepsy surgery candidacy scores. The authors suggest that an electronic health record-integrated NLP application can accurately assign surgical candidacy scores to patients in a clinical setting.
AHRQ-funded; HS024977.
Citation: Wissel BD, Greiner TA, Holland-Bouley KD .
Prospective validation of a machine learning model that uses provider notes to identify candidates for resective epilepsy surgery.
Epilepsia 2020 Jan;61(1):39-48. doi: 10.1111/epi.16398..
Keywords: Neurological Disorders, Surgery, Health Information Technology (HIT), Clinical Decision Support (CDS), Shared Decision Making
Hurley VB, Rodriguez HP, Kearing S
The impact of decision aids on adults considering hip or knee surgery.
Investigators analyzed data for 2012-2015 about patients within the ten High Value Healthcare Collaborative member systems who were exposed to condition-specific decision aids in the context of consultations for hip and knee osteoarthritis, with the intention that the aids be used to support shared decision making. They found that, compared to matched patients not exposed to the decision aids, those exposed had two-and-a-half times the odds of undergoing hip replacement surgery and nearly twice the odds of undergoing knee replacement surgery within six months of the consultation. Their findings suggest that health care systems adopting decision aids developed for use in shared decisionmaking, and used in conjunction with hip and knee osteoarthritis consultations, should not expect reduced surgical utilization.
AHRQ-funded; HS024075.
Citation: Hurley VB, Rodriguez HP, Kearing S .
The impact of decision aids on adults considering hip or knee surgery.
Health Aff 2020 Jan;39(1):100-07. doi: 10.1377/hlthaff.2019.00100..
Keywords: Shared Decision Making, Surgery, Orthopedics, Patient and Family Engagement