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
51 to 75 of 122 Research Studies DisplayedToy D, Braga MS, Greenhawt M
An update on allergic emergencies.
The purpose of this review was to provide an updated framework of management for allergic emergencies. The authors suggest that although fatalities resulting from anaphylaxis and asthma are rare, patient education serves an important role in preparing for unexpected emergencies, instituting prompt and appropriate treatment, and incorporating effective strategies into the lives of children and families.
AHRQ-funded; HS024599.
Citation: Toy D, Braga MS, Greenhawt M .
An update on allergic emergencies.
Curr Opin Pediatr 2019 Jun;31(3):426-32. doi: 10.1097/mop.0000000000000769..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Emergency Department, Patient-Centered Outcomes Research, Evidence-Based Practice
Parikh K, Hinds PS, Teach SJ
Using stakeholder engagement to develop a hospital-initiated, patient-centered intervention to improve hospital-to-home transitions for children with asthma.
The authors demonstrated that multidisciplinary stakeholder engagement can meaningfully influence intervention design. They presented a model of efficient yet substantive engagement of parents and health professionals in developing a hospital-to-home transition intervention for children hospitalized with asthma. Their results suggest that multidimensional stakeholder engagement can meaningfully shape intervention development, and they hope that these tools can be used or adapted to other hospital-based quality improvement, education, or research efforts.
AHRQ-funded; HS024554.
Citation: Parikh K, Hinds PS, Teach SJ .
Using stakeholder engagement to develop a hospital-initiated, patient-centered intervention to improve hospital-to-home transitions for children with asthma.
Hosp Pediatr 2019 Jun;9(6):460-63. doi: 10.1542/hpeds.2018-0261.
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Keywords: Children/Adolescents, Patient-Centered Healthcare, Patient and Family Engagement, Hospital Discharge, Transitions of Care, Asthma, Respiratory Conditions
Heintzman J, Kaufmann J, Ezekiel-Herrera D
Asthma/COPD disparities in diagnosis and basic care utilization among low-income primary care patients.
Obstructive pulmonary disease outcomes in the United States differ between Latinos and non-Hispanic whites. There is little objective data about diagnosis prevalence and primary care visit frequency in these disease processes. In this study, the investigators used electronic health record data to perform a retrospective cohort analysis of 34,849 low-income patients seen at Oregon community health centers between 2009 and 2013 to assess joint racial/ethnic and insurance disparities in diagnosis and visit rates between Latino and non-Hispanic white patients.
AHRQ-funded; HS021522.
Citation: Heintzman J, Kaufmann J, Ezekiel-Herrera D .
Asthma/COPD disparities in diagnosis and basic care utilization among low-income primary care patients.
J Immigr Minor Health 2019 Jun;21(3):659-63. doi: 10.1007/s10903-018-0798-2..
Keywords: Asthma, Respiratory Conditions, Chronic Conditions, Disparities, Healthcare Utilization, Low-Income, Primary Care
Patel MR, Smith A, Leo H
Improving patient-provider communication and therapeutic practice through better integration of electronic health records in the exam room: a pilot study.
This study assessed the effectiveness of providing physicians who use electronic health records (EHRs) education for communication strategies and its impact on patient outcomes. The evidence-based Physician Asthma Care Education (PACE) program was extended in a pilot program using 18 providers and 126 adult patients with persistent asthma. Outcomes were assessed at baseline and 3- and 6-month postintervention intervals. Providers who completed the EHR-PACE program felt more confident in communicating with their patients, but there was no significant changes in patient asthma outcomes or their perceptions of their provider’s communication skills.
AHRQ-funded; HS023786.
Citation: Patel MR, Smith A, Leo H .
Improving patient-provider communication and therapeutic practice through better integration of electronic health records in the exam room: a pilot study.
Health Educ Behav 2019 Jun;46(3):484-93. doi: 10.1177/1090198118796879..
Keywords: Asthma, Clinician-Patient Communication, Communication, Electronic Health Records (EHRs), Evidence-Based Practice, Health Information Technology (HIT), Outcomes, Patient-Centered Healthcare, Patient-Centered Outcomes Research
Forrest CB, Zorc JJ, Moon J
Evaluation of the PROMIS pediatric global health scale (PGH-7) in children with asthma.
The purpose of this study was to evaluate the reliability and validity of the PROMIS Pediatric Global Health scale, a 7-item measure of perceived physical, mental, and social health, in children with asthma. The investigators concluded that the PGH-7 is a reliable and valid patient-reported outcome for assessing general health among children with asthma. It is a useful complement to other asthma-specific outcome measures.
AHRQ-funded; HS020508.
Citation: Forrest CB, Zorc JJ, Moon J .
Evaluation of the PROMIS pediatric global health scale (PGH-7) in children with asthma.
J Asthma 2019 May;56(5):534-42. doi: 10.1080/02770903.2018.1471701..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Health Status
Louisias M, Petty CR, Sheehan W
Use of a school-based survey to screen students for symptoms concerning for asthma.
Researchers sought early identification of asthma in minority children. Their goal was to determine if they could apply screening surveys to an inner-city, school-based cohort. They found a significant number of children with a positive asthma screen and no parent-reported asthma. Children with symptoms suggestive of asthma had elevated rates of hospital care for breathing problems and an atopic background. The researchers conclude that these children without known asthma, but who experience increased morbidity, can be easily identified with a school-based asthma screening survey and should be closely monitored.
AHRQ-funded; HS000063; HS022986.
Citation: Louisias M, Petty CR, Sheehan W .
Use of a school-based survey to screen students for symptoms concerning for asthma.
Clin Pediatr 2019 May;58(5):586-89. doi: 10.1177/0009922819832087..
Keywords: Children/Adolescents, Asthma, Screening, Education, Diagnostic Safety and Quality, Urban Health
Wheatley LM, Wood R, Nadeau K
Mind the gaps: clinical trial concepts to address unanswered questions in aeroallergen immunotherapy-an NIAID/AHRQ workshop.
A joint AHRQ and National Institute of Allergy and Infectious Diseases (NIAAD) workshop was held to develop trial concepts that could improve the use and effectiveness of aeroallergen immunotherapy (AAIT). Four different expert groups were formed to propose different study designs. These study designs would create clinical trials of long duration and would need highly characterized patient populations.
AHRQ-funded; 290200710061I.
Citation: Wheatley LM, Wood R, Nadeau K .
Mind the gaps: clinical trial concepts to address unanswered questions in aeroallergen immunotherapy-an NIAID/AHRQ workshop.
J Allergy Clin Immunol 2019 May;143(5):1711-26. doi: 10.1016/j.jaci.2019.01.032..
Keywords: Asthma, Comparative Effectiveness, Evidence-Based Practice, Prevention, Research Methodologies, Respiratory Conditions
Louisias M, Ramadan A, Naja AS
The effects of the environment on asthma disease activity.
This study discusses environmental factors that trigger or aggravate symptoms of asthma in children. Biological and physical factors include allergens, microbiome, endotoxin, genetics and pollution. Psychosocial environmental factors include stress, neighborhood safety, housing and discrimination. Control of these factors help to reduce prevalence and severity of asthma.
AHRQ-funded; HS022986.
Citation: Louisias M, Ramadan A, Naja AS .
The effects of the environment on asthma disease activity.
Immunol Allergy Clin North Am 2019 May;39(2):163-75. doi: 10.1016/j.iac.2018.12.005..
Keywords: Asthma, Children/Adolescents, Respiratory Conditions, Risk, Social Determinants of Health
Louisias M, Wright L, Phipatanakul W
Asthma in the melting pot.
This article highlights research advances related to asthma health disparities, and offers recommendations regarding innovative approaches to achieve equity and social justice for minority and low-income populations. Since traditional randomized controlled trials may not always be the most appropriate approach to health disparities research interventions, the authors suggest appropriate alternatives, such as the stepped-wedge design; or, because intervention trials are not always feasible, alternative analytic approaches such as mediation analysis or modeling could be used instead. Dissemination and implementation (D&I) research and the use of biomarkers to measure the social disadvantage impact of asthma outcomes are also discussed.
AHRQ-funded; HS022986.
Citation: Louisias M, Wright L, Phipatanakul W .
Asthma in the melting pot.
Ann Allergy Asthma Immunol 2019 Feb;122(2):136-39. doi: 10.1016/j.anai.2018.11.009.
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Keywords: Asthma, Disparities, Respiratory Conditions, Low-Income, Racial and Ethnic Minorities
Parikh K, Paul J, Foushee N
Barriers and facilitators to asthma care after hospitalization as reported by caregivers, health providers, and school nurses.
This study focused on developing a comprehensive understanding of asthma care after hospitalization of children as reported by caregivers, health providers, and school nurses. The children had a median age of 7 years, mean hospital length of stay of 1.9 days, and 56% had a previous hospitalization in the last 12 months. Family caregivers and health professionals were given individual interviews while focus groups were conducted with school nurses. There were different health beliefs about asthma knowledge between caregivers and health professionals. School nurses highlighted specific barriers that focused on medication use in schools.
AHRQ-funded; HS024554.
Citation: Parikh K, Paul J, Foushee N .
Barriers and facilitators to asthma care after hospitalization as reported by caregivers, health providers, and school nurses.
Hosp Pediatr 2018 Nov;8(11):706-17. doi: 10.1542/hpeds.2017-0182..
Keywords: Asthma, Hospitalization, Children/Adolescents, Caregiving, Patient Adherence/Compliance, Education
Luthe SK, Hirayama A, Goto T
Association between obesity and acute severity among patients hospitalized for asthma exacerbation.
This study examined the association between obesity and exacerbation of asthma symptoms in hospitalized adults (age 18-54 years). This retrospective cohort study used data from 8 diverse US states from 2010-2013. Among 72,086 patients hospitalized for asthma exacerbation, 24% were considered obese. Obesity was associated with a higher use of mechanical ventilation as well as a longer hospital stay. These findings were consistent among all ages, sex, and race/ethnicity.
AHRQ-funded; HS023305.
Citation: Luthe SK, Hirayama A, Goto T .
Association between obesity and acute severity among patients hospitalized for asthma exacerbation.
J Allergy Clin Immunol Pract 2018 Nov - Dec;6(6):1936-41.e4. doi: 10.1016/j.jaip.2018.02.001..
Keywords: Asthma, Hospitalization, Obesity, Respiratory Conditions
Kuzniewicz MW, Niki H, Walsh EM
Hyperbilirubinemia, phototherapy, and childhood asthma.
The purpose of this retrospective cohort study was to quantify the associations of both hyperbilirubinemia and phototherapy with childhood asthma with total serum bilirubin (TSB) levels. Infants born after at least 35 weeks’ gestation within the Kaiser Permanente Northern California health system between 2010 and 2014 made up the study population. Cox models were used to estimate hazard ratios for a diagnosis of asthma. The researchers conclude that moderate levels of hyperbilirubinemia are associated with increased risk of asthma, but this association was not seen at higher levels. No dose-response relationship was observed.
AHRQ-funded; HS020618.
Citation: Kuzniewicz MW, Niki H, Walsh EM .
Hyperbilirubinemia, phototherapy, and childhood asthma.
Pediatrics 2018 Oct;142(4). doi: 10.1542/peds.2018-0662..
Keywords: Asthma, Children/Adolescents, Treatments
Washington DM, Curtis LM, Waite K
Sociodemographic factors mediate race and ethnicity-associated childhood asthma health disparities: a longitudinal analysis.
This study characterized the longitudinal effects associated with being African-American/Black or Hispanic/Latino on a range of asthma outcomes, and the extent to which sociodemographic factors, caregiver health literacy, education level, and asthma knowledge mediated these associations. The investigators concluded that African-American race and Hispanic/Latino ethnicity are significantly associated with worse asthma compared to Whites in longitudinal analyses.
AHRQ-funded; HS022242.
Citation: Washington DM, Curtis LM, Waite K .
Sociodemographic factors mediate race and ethnicity-associated childhood asthma health disparities: a longitudinal analysis.
J Racial Ethn Health Disparities 2018 Oct;5(5):928-38. doi: 10.1007/s40615-017-0441-2..
Keywords: Asthma, Children/Adolescents, Disparities, Racial and Ethnic Minorities, Social Determinants of Health
Liu TL, Taylor YJ, Mahabaleshwarkar R
Shared decision making and time to exacerbation in children with asthma.
This study examined the use of shared decision making (SDM) to delay exacerbation in children with asthma. A prospective cohort of children at five primary care practices in Charlotte, North Carolina that serve vulnerable population was studied between 2011 and 2013. The cohort included 746 children, with 60.5% male and 54.2% African American with a mean age of 8.6 years. The final analysis included 100 matched pairs of children for use of SDM and normal care. There was a marginally significant difference in the time of exacerbation between the two groups.
AHRQ-funded; HS019946.
Citation: Liu TL, Taylor YJ, Mahabaleshwarkar R .
Shared decision making and time to exacerbation in children with asthma.
J Asthma 2018 Sep;55(9):949-55. doi: 10.1080/02770903.2017.1378357..
Keywords: Children/Adolescents, Shared Decision Making, Asthma, Respiratory Conditions, Chronic Conditions, Primary Care
Lin SY, Azar A, Suarez-Cuervo C
Role of sublingual immunotherapy in the treatment of asthma: an updated systematic review.
This systematic review analyzed a number of studies on sublingual immunotherapy treatment (SLIT) for asthma caused by allergies. Fourteen randomized control trials (RCTs) studies were identified to analyze effective for allergies of house mites, birch, and grasses. However, a total of 20 RCTs and 10 observational studies were identified and used in this review. The review showed moderate-to-high strength evidence that SLIT is effective in improving allergic asthma symptoms. It also reduced long-term medication use and improved FEV1.
AHRQ-funded; 290201500006I.
Citation: Lin SY, Azar A, Suarez-Cuervo C .
Role of sublingual immunotherapy in the treatment of asthma: an updated systematic review.
Int Forum Allergy Rhinol 2018 Sep;8(9):982-92. doi: 10.1002/alr.22152..
Keywords: Asthma, Evidence-Based Practice, Patient-Centered Outcomes Research, Treatments
Turi KN, Gebretsadik T, Lee RL
Seasonal patterns of asthma medication fills among diverse populations of the United States.
Nonadherence to controller and overuse of reliever asthma medications are associated with exacerbations. In this study, the investigators aimed to determine patterns of seasonal asthma medication use and to identify time period(s) during which interventions to improve medication adherence could reduce asthma morbidity. The investigators concluded that a seasonal pattern of asthma medication fill rates likely represented a reactive response to a loss of disease control and increased symptoms.
AHRQ-funded; HS019669; HS022093.
Citation: Turi KN, Gebretsadik T, Lee RL .
Seasonal patterns of asthma medication fills among diverse populations of the United States.
J Asthma 2018 Jul;55(7):764-70. doi: 10.1080/02770903.2017.1362426..
Keywords: Asthma, Chronic Conditions, Medication, Patient Adherence/Compliance
Taylor YJ, Tapp H, Shade LE
Impact of shared decision making on asthma quality of life and asthma control among children.
This study evaluated the impact of shared decision making (SDM) on quality of life and symptom control in children with asthma. The investigators found that implementation of SDM within clinical practices using a standardized toolkit was associated with improved asthma quality of life and asthma control for low-income children with asthma when compared to usual care with decision support.
AHRQ-funded; HS019946.
Citation: Taylor YJ, Tapp H, Shade LE .
Impact of shared decision making on asthma quality of life and asthma control among children.
J Asthma 2018 Jun;55(6):675-83. doi: 10.1080/02770903.2017.1362423..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Chronic Conditions, Shared Decision Making, Quality of Life
Kaiser SV, Rodean J, Bekmezian A
Effectiveness of pediatric asthma pathways for hospitalized children: a multicenter, national analysis.
The purpose of this retrospective, multicenter cohort study was to determine if clinical pathways affect care and outcomes for children hospitalized with asthma, using an administrative database, the Pediatric Health Information System. The investigators found that clinical pathways can decrease length of stay, costs, and unnecessary antibiotic use without increasing rates of readmissions, leading to higher value care.
AHRQ-funded; HS024554.
Citation: Kaiser SV, Rodean J, Bekmezian A .
Effectiveness of pediatric asthma pathways for hospitalized children: a multicenter, national analysis.
J Pediatr 2018 Jun;197:165-71.e2. doi: 10.1016/j.jpeds.2018.01.084..
Keywords: Asthma, Children/Adolescents, Evidence-Based Practice, Hospitalization, Patient-Centered Outcomes Research, Children/Adolescents
Parikh K, Keller S, Ralston S
Inpatient quality improvement interventions for asthma: a meta-analysis.
This article reviewed interventional studies of inpatient-initiated asthma quality improvement (QI) to synthesize its impact on health care utilization. Thirty articles were included; 12 provided data on health care reutilization outcomes. The selected studies were categorized by intervention type and outcome. Risk ratios for readmissions were examined and a subanalyis of multimodal interventions conducted; the latter suggested lower readmission rates. A subanalysis of education and discharge planning interventions did not show an effect. The authors did not identify any inpatient strategies that impacted health care reutilization within 30 days of index hospitalization, but note that multimodal interventions demonstrated impact over the longer interval.
AHRQ-funded; HS024554.
Citation: Parikh K, Keller S, Ralston S .
Inpatient quality improvement interventions for asthma: a meta-analysis.
Pediatrics 2018 May;141(5). doi: 10.1542/peds.2017-3334.
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Keywords: Asthma, Children/Adolescents, Hospitalization, Inpatient Care, Quality Improvement
Brunwasser SM, Gebretsadik T, Gold DR
A new model of wheezing severity in young children using the validated ISAAC wheezing module: a latent variable approach with validation in independent cohorts.
The authors of this paper developed an easily applicable continuous latent variable model of pediatric wheezing severity based on items from the well-validated International Study of Asthma and Allergies in Children (ISAAC) Wheezing Module. Their model prospectively associates with asthma morbidity, as demonstrated in two ECHO birth cohort studies, and provides a more statistically powerful method of testing etiologic hypotheses of childhood wheezing illness and asthma.
AHRQ-funded; HS022990.
Citation: Brunwasser SM, Gebretsadik T, Gold DR .
A new model of wheezing severity in young children using the validated ISAAC wheezing module: a latent variable approach with validation in independent cohorts.
PLoS One 2018 Apr 17;13(4):e0194739. doi: 10.1371/journal.pone.0194739..
Keywords: Asthma, Children/Adolescents, Diagnostic Safety and Quality, Patient-Centered Outcomes Research
Sobieraj DM, Weeda ER, Nguyen E
Association of inhaled corticosteroids and long-acting beta-agonists as controller and quick relief therapy with exacerbations and symptom control in persistent asthma: a systematic review and meta-analysis.
The authors conducted a systematic review and meta-analysis of the effects of single maintenance and reliever therapy (SMART) in patients with persistent asthma. They found that in patients with persistent asthma, the use of single maintenance and reliever therapy compared with inhaled corticosteroids as the controller therapy (with or without a long-acting beta-agonist) and short-acting beta-agonists as the relief therapy was associated with a lower risk of asthma exacerbations.
AHRQ-funded; 290201500012I.
Citation: Sobieraj DM, Weeda ER, Nguyen E .
Association of inhaled corticosteroids and long-acting beta-agonists as controller and quick relief therapy with exacerbations and symptom control in persistent asthma: a systematic review and meta-analysis.
JAMA 2018 Apr 10;319(14):1485-96. doi: 10.1001/jama.2018.2769.
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Keywords: Asthma, Comparative Effectiveness, Medication, Patient-Centered Outcomes Research, Respiratory Conditions
Sobieraj DM, Baker WL, Nguyen E
Association of inhaled corticosteroids and long-acting muscarinic antagonists with asthma control in patients with uncontrolled, persistent asthma: a systematic review and meta-analysis.
The authors conducted a systematic review and meta-analysis of the effects associated with long-acting muscarinic antagonists (LAMAs) vs placebo or vs other controllers as an add-on therapy to inhaled corticosteroids. They concluded that use of LAMA compared with placebo as add-on therapy to inhaled corticosteroids was associated with a lower risk of asthma exacerbations.
AHRQ-funded; 290201500012I.
Citation: Sobieraj DM, Baker WL, Nguyen E .
Association of inhaled corticosteroids and long-acting muscarinic antagonists with asthma control in patients with uncontrolled, persistent asthma: a systematic review and meta-analysis.
JAMA 2018 Apr 10;319(14):1473-84. doi: 10.1001/jama.2018.2757.
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Keywords: Asthma, Evidence-Based Practice, Medication, Patient-Centered Outcomes Research, Respiratory Conditions
Parikh K, Hall M, Kenyon CC
Impact of discharge components on readmission rates for children hospitalized with asthma.
This study described hospital-based asthma-specific discharge components at children's hospitals and determine the association of these discharge components with pediatric asthma readmission rates. No individual or combination discharge components were associated with lower 30-day adjusted readmission rates. The only single-component significantly associated with a lower rate of readmission at 3 months was having comprehensive content of education.
AHRQ-funded; HS024554.
Citation: Parikh K, Hall M, Kenyon CC .
Impact of discharge components on readmission rates for children hospitalized with asthma.
J Pediatr. 2018 Apr;195:175-181.e2. doi: 10.1016/j.jpeds.2017.11.062..
Keywords: Asthma, Children/Adolescents, Hospital Discharge, Hospital Readmissions, Patient-Centered Outcomes Research
Trivedi M, Fung V, Kharbanda EO
Racial disparities in family-provider interactions for pediatric asthma care.
The purpose of this study was to investigate differences in family-provider interactions for pediatric asthma, based on race/ethnicity and using parent surveys of asthmatic children within the Population-Based Effectiveness in Asthma and Lung Diseases Network. 647 parents provided survey response data and self-reported race/ethnicity of the child. The outcomes studied were responses to questions about family-provider interactions in the previous 12 months including number of visits with asthma provider, number of times provider reviewed asthma medications with patient/family, review of written asthma treatment plans, and preferences about asthma care decisionmaking. The study concludes that black children with asthma have fewer visits with their providers than white children and are less likely to have a written asthma treatment plan. The authors suggest that asthma providers could focus on improving these specific family-provider interactions.
AHRQ-funded; HS019669.
Citation: Trivedi M, Fung V, Kharbanda EO .
Racial disparities in family-provider interactions for pediatric asthma care.
J Asthma 2018 Apr;55(4):424-29. doi: 10.1080/02770903.2017.1337790..
Keywords: Asthma, Children/Adolescents, Clinician-Patient Communication, Disparities, Racial and Ethnic Minorities
Alexander GL, Olden HA, Troy T
Overweight adolescents and asthma: revealing motivations and challenges with adolescent-provider communication.
This mixed-methods study assessed teens' awareness of the link between weight and asthma management, and perspectives on how medical providers might open a discussion about managing weight. The investigators found that most teens responded favorably to initiating weight loss if it impacted asthma management, valued their provider addressing weight and family participation in weight management efforts.
AHRQ-funded; HS022417.
Citation: Alexander GL, Olden HA, Troy T .
Overweight adolescents and asthma: revealing motivations and challenges with adolescent-provider communication.
J Asthma 2018 Mar;55(3):266-74. doi: 10.1080/02770903.2017.1323921..
Keywords: Asthma, Children/Adolescents, Clinician-Patient Communication, Communication, Obesity, Obesity: Weight Management