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
26 to 50 of 53 Research Studies DisplayedHuang ES
Management of diabetes mellitus in older people with comorbidities.
Guidelines recommend that physicians individualize the intensity of glucose control and treatments on the basis of the prognosis (for example, three tiers based on comorbidities and functional impairments). Very few studies have attempted to study these concepts in clinical practice. To better meet the treatment needs of older patients with diabetes and comorbidities, more research is needed to determine the risks and benefits of intensifying, maintaining, or de-intensifying treatments in this population.
AHRQ-funded; HS018542.
Citation: Huang ES .
Management of diabetes mellitus in older people with comorbidities.
BMJ 2016 Jun 15;353:i2200. doi: 10.1136/bmj.i2200.
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Keywords: Diabetes, Elderly, Patient-Centered Outcomes Research, Chronic Conditions
Ware JE, Jr., Gandek B, Guyer R
Standardizing disease-specific quality of life measures across multiple chronic conditions: development and initial evaluation of the QOL Disease Impact Scale (QDIS(R)).
The researchers document the development and evaluation of the Quality of life Disease Impact Scale (QDIS(R)), a measure that standardizes item content and scoring across chronic conditions and provides a summary, norm-based quality of life (QOL) impact score for each disease. Standardization of content and scoring across diseases was shown to be justified psychometrically and enabled the first summary measure of disease-specific QOL impact normed in the chronically ill population.
AHRQ-funded; HS023117.
Citation: Ware JE, Jr., Gandek B, Guyer R .
Standardizing disease-specific quality of life measures across multiple chronic conditions: development and initial evaluation of the QOL Disease Impact Scale (QDIS(R)).
Health Qual Life Outcomes 2016 Jun 2;14:84. doi: 10.1186/s12955-016-0483-x.
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Keywords: Quality of Life, Chronic Conditions, Outcomes
Ridner SH, Rhoten BA, Radina ME
Breast cancer survivors' perspectives of critical lymphedema self-care support needs.
The purpose of this paper was to solicit breast cancer survivors' perspectives on the variety of issues they face related to lymphedema self-care and to identify support needs perceived as critical for managing their chronic medical condition. The authors found that lack of support and the failure of others to recognize lymphedema as a chronic condition set this patient population apart from other patients with chronic diseases and decreases the amount of help needed to manage the condition.
AHRQ-funded; HS022990.
Citation: Ridner SH, Rhoten BA, Radina ME .
Breast cancer survivors' perspectives of critical lymphedema self-care support needs.
Support Care Cancer 2016 Jun;24(6):2743-50. doi: 10.1007/s00520-016-3089-2.
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Keywords: Cancer: Breast Cancer, Chronic Conditions, Patient-Centered Outcomes Research, Patient Self-Management
Koroukian SM, Schiltz N, Warner DF
Combinations of chronic conditions, functional limitations, and geriatric syndromes that predict health outcomes.
The researchers aimed to identify combinations of chronic conditions, functional limitations, and geriatric syndromes that predict poor health outcomes. They found that functional limitations and/or geriatric syndromes were the most prominent conditions in predicting health outcomes. They concluded that accounting for chronic conditions alone may be less informative than also accounting for the co-occurrence of functional limitations and geriatric syndromes, as the latter conditions appear to drive health outcomes in older individuals.
AHRQ-funded; HS023113.
Citation: Koroukian SM, Schiltz N, Warner DF .
Combinations of chronic conditions, functional limitations, and geriatric syndromes that predict health outcomes.
J Gen Intern Med 2016 Jun;31(6):630-7. doi: 10.1007/s11606-016-3590-9.
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Keywords: Elderly, Chronic Conditions, Risk, Outcomes, Health Status
Basu J, Avila R, Ricciardi R
AHRQ Author: Basu J, Ricciardi R
Hospital readmission rates in U.S. states: are readmissions higher where more patients with multiple chronic conditions cluster?
This study examines small area variations in readmission rates to assess whether higher readmission rate in an area is associated with higher clusters of patients with multiple chronic conditions. It found that areas with higher concentration of patients with increased comorbid conditions are more likely to have higher readmission rates.
AHRQ-authored.
Citation: Basu J, Avila R, Ricciardi R .
Hospital readmission rates in U.S. states: are readmissions higher where more patients with multiple chronic conditions cluster?
Health Serv Res 2016 Jun;51(3):1135-51. doi: 10.1111/1475-6773.12401..
Keywords: Chronic Conditions, Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Hospitals
Satchidanand N, Withiam-Leitch M, Dickinson M
Positive predictive value of a single assessment of estimated GFR in the diagnosis of chronic kidney disease.
The authors' objective was to determine the positive predictive value (PPV) of a single assessment of estimated glomerular filtration rate (eGFR) among adults with at least one eGFR less than 60 mL/min in their lifetime. Using the Distributed Area Research and Therapeutics Network CKD natural history dataset, they found a cutpoint of less than 45 mL/min, yielding a PPV of 93% with a sensitivity of 28% and a specificity of 94%, thus identifying a valid cutpoint to screen for chronic kidney disease.
AHRQ-funded; HS023656.
Citation: Satchidanand N, Withiam-Leitch M, Dickinson M .
Positive predictive value of a single assessment of estimated GFR in the diagnosis of chronic kidney disease.
South Med J 2016 Jun;109(6):351-5. doi: 10.14423/smj.0000000000000474.
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Keywords: Chronic Conditions, Kidney Disease and Health, Diagnostic Safety and Quality
Hong MK, Wilcox L, Machado D
Care partnerships: toward technology to support teens' participation in their health care.
The authors conducted 38 in-depth interviews along with nine non-participant observations of clinical consultations to better understand common challenges and needs that could be supported through design. They drew their findings to propose design goals for sociotechnical systems to support teens in partnering in their care, highlighting the need for design to support gradually evolving partnerships in care.
AHRQ-funded; HS021393.
Citation: Hong MK, Wilcox L, Machado D .
Care partnerships: toward technology to support teens' participation in their health care.
Proc SIGCHI Conf Hum Factor Comput Syst 2016 May 7;2016:5337-49. doi: 10.1145/2858036.2858508.
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Keywords: Children/Adolescents, Chronic Conditions, Patient and Family Engagement, Patient Self-Management
Thompson CF, Price CP, Huang JH
A pilot study of symptom profiles from a polyp vs an eosinophilic-based classification of chronic rhinosinusitis.
Researchers hypothesized that appropriate chronic rhinosinusitis (CRS) subclassification would increase homogeneity of baseline symptoms, and identify characteristic symptoms of each subtype. They found that subclassifying CRS with symptoms alone is difficult with neither polyp status nor eosinophilia giving a distinctive clinical symptom profile. However, certain symptoms may help otolaryngologists identify CRS subtypes, which may help guide future treatments.
AHRQ-funded; HS023011.
Citation: Thompson CF, Price CP, Huang JH .
A pilot study of symptom profiles from a polyp vs an eosinophilic-based classification of chronic rhinosinusitis.
Int Forum Allergy Rhinol 2016 May;6(5):500-7. doi: 10.1002/alr.21687.
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Keywords: Chronic Conditions, Diagnostic Safety and Quality, Respiratory Conditions
Navarra AM, Schlau R, Murray M
Assessing nursing care needs of children with complex medical conditions: The Nursing-Kids Intensity of Care Survey (N-KICS).
The researchers designed and tested the Nursing-Kids Intensity of Care Survey (N-KICS) tool and describe intensity of nursing care for children with complex medical conditions. Their psychometric evaluation confirmed an acceptable standard for reliability and validity and feasibility. Intensity scores were highest for nursing care related to infection control, medication administration, nutrition, diaper changes, hygiene, neurological and respiratory support, and standing program.
AHRQ-funded; HS021470.
Citation: Navarra AM, Schlau R, Murray M .
Assessing nursing care needs of children with complex medical conditions: The Nursing-Kids Intensity of Care Survey (N-KICS).
J Pediatr Nurs 2016 May-Jun;31(3):299-310. doi: 10.1016/j.pedn.2015.11.012.
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Keywords: Children/Adolescents, Chronic Conditions, Disabilities, Long-Term Care, Nursing, Vulnerable Populations
Balbale SN, Etingen B, Malhiot A
Perceptions of chronic illness care among veterans with multiple chronic conditions.
The purpose of this study was to use the Patient Assessment of Chronic Illness Care (PACIC) instrument to examine perceptions of chronic care among veterans with multiple chronic conditions (MCC). The authors concluded that quality improvements are needed to strengthen care continuity and coordination.
AHRQ-funded; HS000084.
Citation: Balbale SN, Etingen B, Malhiot A .
Perceptions of chronic illness care among veterans with multiple chronic conditions.
Mil Med 2016 May;181(5):439-44. doi: 10.7205/milmed-d-15-00207..
Keywords: Chronic Conditions, Patient Experience, Quality Improvement
Shirley DK, Kaner RJ, Glesby MJ
Screening for chronic obstructive pulmonary disease (COPD) in an urban HIV clinic: a pilot study.
This study aimed to determine the predictive value of a COPD screening strategy validated in the general population and to identify HIV-related factors associated with decreased lung function. It found that questionnaire and peak flow together had low sensitivity, but abnormal peak flow shows potential as a screening tool for COPD in HIV/AIDS. These data suggest that lung function may be influenced by HIV-related factors.
AHRQ-funded; HS000066.
Citation: Shirley DK, Kaner RJ, Glesby MJ .
Screening for chronic obstructive pulmonary disease (COPD) in an urban HIV clinic: a pilot study.
AIDS Patient Care STDS 2015 May;29(5):232-9. doi: 10.1089/apc.2014.0265..
Keywords: Human Immunodeficiency Virus (HIV), Screening, Chronic Conditions, Respiratory Conditions, Urban Health
Ryu E, Chamberlain AM, Pendergraft RS
Quantifying the impact of chronic conditions on a diagnosis of major depressive disorder in adults: a cohort study using linked electronic medical records.
In this study, the researchers aimed to quantify the relative contribution of selected chronic conditions to identify the conditions most influential to major depressive disorder (MDD) risk in adults and identify differences by age. Their results suggest that specific chronic conditions such as diabetes mellitus and rheumatoid arthritis/osteoarthritis may have greater influence than others on the risk of MDD.
AHRQ-funded; HS023077.
Citation: Ryu E, Chamberlain AM, Pendergraft RS .
Quantifying the impact of chronic conditions on a diagnosis of major depressive disorder in adults: a cohort study using linked electronic medical records.
BMC Psychiatry 2016 Apr 26;16:114. doi: 10.1186/s12888-016-0821-x.
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Keywords: Chronic Conditions, Depression, Electronic Health Records (EHRs), Primary Care
Bernard D, Selden T, Yeh S
AHRQ Author: Bernard D, Selden T
Financial burdens and barriers to care among nonelderly adults: the role of functional limitations and chronic conditions.
The researchers examined the financial burdens and barriers to care among nonelderly adults, focusing on the role of functional limitations and chronic conditions. Functional limitations and chronic conditions were associated with increased prevalence of burdens and financial barriers in all insurance categories, with the exception that an association between functional limitations and the prevalence of burdens was not observed for public coverage.
AHRQ-authored.
Citation: Bernard D, Selden T, Yeh S .
Financial burdens and barriers to care among nonelderly adults: the role of functional limitations and chronic conditions.
Disabil Health J 2016 Apr;9(2):256-64. doi: 10.1016/j.dhjo.2015.09.003.
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Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Chronic Conditions, Access to Care, Health Services Research (HSR)
Budiman-Mak E, Epstein N, Brennan M
Systolic blood pressure variability and lower extremity amputation in a non-elderly population with diabetes.
This study's objective is to examine whether systolic blood pressure has any prognostic value for lower-extremity amputations. The authors concluded that this study showed a significant graded relationship between systolic blood pressure variability and risk of major amputation among non-elderly persons with diabetes.
AHRQ-funded; HS018542.
Citation: Budiman-Mak E, Epstein N, Brennan M .
Systolic blood pressure variability and lower extremity amputation in a non-elderly population with diabetes.
Diabetes Res Clin Pract 2016 Apr;114:75-82. doi: 10.1016/j.diabres.2016.01.010.
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Keywords: Diabetes, Blood Pressure, Risk, Chronic Conditions
Zullig LL, Whitson HE, Hastings SN
A systematic review of conceptual frameworks of medical complexity and new model development.
The authors sought to develop a conceptual model of complexity addressing gaps identified in a review of published conceptual models. Their Cycle of Complexity model illustrated relationships between acute shocks and medical events, healthcare access and utilization, workload and capacity, and patient preferences in the context of interpersonal, organizational, and community factors.
AHRQ-funded; HS023085; HS023099.
Citation: Zullig LL, Whitson HE, Hastings SN .
A systematic review of conceptual frameworks of medical complexity and new model development.
J Gen Intern Med 2016 Mar;31(3):329-37. doi: 10.1007/s11606-015-3512-2.
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Keywords: Access to Care, Chronic Conditions, Health Services Research (HSR)
Wilson KC, Gould MK, Krishnan JA
An official American Thoracic Society workshop report. A framework for addressing multimorbidity in clinical practice guidelines for pulmonary disease, critical illness, and sleep disorders.
The American Thoracic Society convened a workshop to establish a strategy to address multimorbidity within clinical practice guidelines. This report describes a framework that addresses multimorbidity in each of the key steps of guideline development: topic selection, panel composition, identifying clinical questions, searching for and synthesizing evidence, rating the quality of that evidence, summarizing benefits and harms, formulating recommendations, and rating the strength of the recommendations.
AHRQ-funded; HS020672.
Citation: Wilson KC, Gould MK, Krishnan JA .
An official American Thoracic Society workshop report. A framework for addressing multimorbidity in clinical practice guidelines for pulmonary disease, critical illness, and sleep disorders.
Ann Am Thorac Soc 2016 Mar;13(3):S12-21. doi: 10.1513/AnnalsATS.201601-007ST.
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Keywords: Sleep Problems, Guidelines, Evidence-Based Practice, Chronic Conditions, Respiratory Conditions
Fritz JM, Rundell SD, Dougherty P
Deconstructing chronic low back pain in the older adult-step by step evidence and expert-based recommendations for evaluation and treatment. Part vi: Lumbar spinal stenosis.
This article is the sixth in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. It focuses on the evaluation and management of lumbar spinal stenosis (LSS), the most common condition for which older adults undergo spinal surgery. It concluded that lumbar spinal stenosis exists not uncommonly in older adults with CLBP and management often can be accomplished without surgery.
AHRQ-funded; HS022982.
Citation: Fritz JM, Rundell SD, Dougherty P .
Deconstructing chronic low back pain in the older adult-step by step evidence and expert-based recommendations for evaluation and treatment. Part vi: Lumbar spinal stenosis.
Pain Med 2016 Mar;17(3):501-10. doi: 10.1093/pm/pnw011..
Keywords: Back Health and Pain, Elderly, Chronic Conditions, Treatments, Surgery
Domino ME, Jackson C, Beadles CA
Do primary care medical homes facilitate care transitions after psychiatric discharge for patients with multiple chronic conditions?
The purpose of this manuscript is to assess outpatient follow-up rates with primary care and mental health providers following psychiatric discharge by medical home enrollment and medical complexity. Hospitalized persons with multiple chronic conditions including serious mental illness enrolled in a medical home were more likely to receive timely outpatient follow-up with a primary care provider but not with a mental health specialist.
AHRQ-funded; HS000032; HS019659.
Citation: Domino ME, Jackson C, Beadles CA .
Do primary care medical homes facilitate care transitions after psychiatric discharge for patients with multiple chronic conditions?
Gen Hosp Psychiatry 2016 Mar-Apr;39:59-65. doi: 10.1016/j.genhosppsych.2015.11.002.
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Keywords: Primary Care, Patient-Centered Healthcare, Behavioral Health, Hospitalization, Chronic Conditions
Lo Re V, 3rd, Carbonari DM, Lewis JD
Oral azole antifungal medications and risk of acute liver injury, overall and by chronic liver disease status.
The researchers evaluated incidence rates of acute liver injury associated with oral azole antifungals. They concluded that rates of acute liver injury were similarly low for fluconazole, ketoconazole, and itraconazole. Events were more common among voriconazole and posaconazole users but were comparable. Pre-existing chronic liver disease increased risk of azole-induced liver injury.
AHRQ-funded; HS018372.
Citation: Lo Re V, 3rd, Carbonari DM, Lewis JD .
Oral azole antifungal medications and risk of acute liver injury, overall and by chronic liver disease status.
Am J Med 2016 Mar;129(3):283-91.e5. doi: 10.1016/j.amjmed.2015.10.029.
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Keywords: Antimicrobial Stewardship, Medication, Kidney Disease and Health, Chronic Conditions, Adverse Drug Events (ADE)
Skinner HG, Coffey R, Jones J
AHRQ Author: Heslin KC, Moy E
The effects of multiple chronic conditions on hospitalization costs and utilization for ambulatory care sensitive conditions in the United States: a nationally representative cross-sectional study.
A purpose of this study was to evaluate how multiple chronic conditions relate to inpatient hospitalization costs. It found that compared with costs for patients with 0 or 1 chronic condition, hospitalization costs per stay for overall ambulatory care sensitive conditions were 19 percent higher for those with 2 or 3 , 32 percent higher for those with 4 or 5, and 31 percent higher for those with 6+ conditions.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Skinner HG, Coffey R, Jones J .
The effects of multiple chronic conditions on hospitalization costs and utilization for ambulatory care sensitive conditions in the United States: a nationally representative cross-sectional study.
BMC Health Serv Res 2016 Mar 1;16:77. doi: 10.1186/s12913-016-1304-y.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Chronic Conditions, Hospitalization, Healthcare Utilization, Healthcare Costs
Chung CF, Dew K, Cole A
Boundary negotiating artifacts in personal informatics: patient-provider collaboration with patient-generated data.
This paper examines patient expectations and current collaboration practices around patient-generated data. It finds that collaboration occurs in every stage of self- tracking and that patients and providers create boundary negotiating artifacts to support the collaboration. Building upon current practices with patient-generated data, the authors use these theories of patient and provider collaboration to analyze misunderstandings and privacy concerns.
AHRQ-funded; HS023654.
Citation: Chung CF, Dew K, Cole A .
Boundary negotiating artifacts in personal informatics: patient-provider collaboration with patient-generated data.
CSCW 2016 Feb 27:770-86. doi: 10.1145/2818048.2819926..
Keywords: Chronic Conditions, Health Information Technology (HIT), Clinician-Patient Communication, Patient Self-Management
Kuo YF, Raji MA, Chen NW
Trends in opioid prescriptions among Part D Medicare recipients From 2007 to 2012.
The researchers used national Medicare data from 2007-2012 to assess temporal and geographic trends in rates of opioid prescription and relationship to opioid toxicity and different state regulations in Part D Medicare recipients. Their analyses of the Medicare data demonstrated substantial growth in opioid prescriptions from 2007 to 2011 and large variation in opioid prescriptions across states.
AHRQ-funded; HS022134.
Citation: Kuo YF, Raji MA, Chen NW .
Trends in opioid prescriptions among Part D Medicare recipients From 2007 to 2012.
Am J Med 2016 Feb;129(2):221.e21-30. doi: 10.1016/j.amjmed.2015.10.002..
Keywords: Chronic Conditions, Elderly, Medicare, Medication, Opioids, Pain
Bogner HR, Joo JH, Hwang S
Does a depression management program decrease mortality in older adults with specific medical conditions in primary care? An exploratory analysis.
The objective of this study was to determine whether treating depression decreases mortality from various chronic medical conditions. It found evidence of a statistically significant intervention effect on mortality for diabetes mellitus in persons with major depression.
AHRQ-funded; HS023445.
Citation: Bogner HR, Joo JH, Hwang S .
Does a depression management program decrease mortality in older adults with specific medical conditions in primary care? An exploratory analysis.
J Am Geriatr Soc 2016 Jan;64(1):126-31. doi: 10.1111/jgs.13711..
Keywords: Chronic Conditions, Depression, Elderly, Mortality, Primary Care
Cleynen I, Boucher G, Jostins L
Inherited determinants of Crohn's disease and ulcerative colitis phenotypes: a genetic association study.
The researchers undertook the largest genotype association study, to date, in widely used clinical subphenotypes of inflammatory bowel disease with the goal of further understanding the biological relations between between Crohn's disease and ulcerative colitis. Their data support a continuum of disorders within inflammatory bowel disease, much better explained by three groups (ileal Crohn's disease, colonic Crohn's disease, and ulcerative colitis) than by Crohn's disease and ulcerative colitis as currently defined.
AHRQ-funded; HS021747.
Citation: Cleynen I, Boucher G, Jostins L .
Inherited determinants of Crohn's disease and ulcerative colitis phenotypes: a genetic association study.
Lancet 2016 Jan 9;387(10014):156-67. doi: 10.1016/s0140-6736(15)00465-1.
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Keywords: Genetics, Digestive Disease and Health, Chronic Conditions
Drury KE, Schaeffer M, Silverberg JL
Association between atopic disease and anemia in US children.
Atopic disease is associated with chronic inflammation, food allergen avoidance, and use of systemic immunosuppressant medications. All these factors have been shown to be associated with anemia. This study investigated whether atopic disease is associated with increased risk of childhood anemia. It concluded that the association between atopic disease and anemia was reproducible in multiple cohorts.
AHRQ-funded; HS023011.
Citation: Drury KE, Schaeffer M, Silverberg JL .
Association between atopic disease and anemia in US children.
JAMA Pediatr 2016 Jan;170(1):29-34. doi: 10.1001/jamapediatrics.2015.3065..
Keywords: Asthma, Children/Adolescents, Chronic Conditions, Risk