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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 327 Research Studies DisplayedMassarweh NN, LeMaire SA, Merkow RP
Preserving an academic mission in the face of clinical productivity targets: where is the academic surgeon's carrot?
This article discusses the emphasis on financial productivity at academic institutions and how it does and will impact the educational and research missions of academic departments and their faculty. Discussions include potential consequences and potential solutions, concluding that academic surgery departments, hospitals, and health systems should work collaboratively toward the common goal of supporting a unified mission of innovation, creativity, and clinical excellence.
AHRQ-funded; HS023011.
Citation: Massarweh NN, LeMaire SA, Merkow RP .
Preserving an academic mission in the face of clinical productivity targets: where is the academic surgeon's carrot?
Ann Surg 2020 Feb;271(2):223-24. doi: 10.1097/sla.0000000000003380..
Keywords: Education: Academic, Health Services Research (HSR)
Takvorian SU, Oganisian A, Mamtani R
Association of Medicaid expansion under the Affordable Care Act with insurance status, cancer stage, and timely treatment among patients with breast, colon, and lung cancer.
The effect of the Patient Protection and Affordable Care Act's Medicaid expansion on cancer care delivery and outcomes is unknown. Patients with cancer are a high-risk group for whom treatment delays are particularly detrimental. The objective of this study was to examine the association between Medicaid expansion and changes in insurance status, stage at diagnosis, and timely treatment among patients with incident breast, colon, and non-small cell lung cancer.
AHRQ-funded; HS026116.
Citation: Takvorian SU, Oganisian A, Mamtani R .
Association of Medicaid expansion under the Affordable Care Act with insurance status, cancer stage, and timely treatment among patients with breast, colon, and lung cancer.
JAMA Netw Open 2020 Feb 5;3(2):e1921653. doi: 10.1001/jamanetworkopen.2019.21653.
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Keywords: Cancer: Breast Cancer, Cancer: Colorectal Cancer, Cancer: Lung Cancer, Cancer, Health Insurance, Medicaid, Policy, Health Services Research (HSR)
Murray GF, Rodriguez HP, Lewis VA
Upstream with a small paddle: how ACOs are working against the current to meet patients' social needs.
This study’s goal was to understand how health care providers with strong motivation and commitment fared at addressing patients' social needs. Researchers found that the 22 accountable care organizations studied were frequently lacking data on both their patients' social needs and the capabilities of potential community partners. Additionally, partnerships between accountable care organizations and community-based organizations were only in the early stages of development. The researchers concluded that policies that could facilitate the integration of social determinants included providing sustainable funding, implementing local and regional networking initiatives to facilitate partnership development, and developing standardized data on community-based organizations' services and quality to aid providers that seek partners.
AHRQ-funded; HS024792.
Citation: Murray GF, Rodriguez HP, Lewis VA .
Upstream with a small paddle: how ACOs are working against the current to meet patients' social needs.
Health Aff 2020 Feb;39(2):199-206. doi: 10.1377/hlthaff.2019.01266..
Keywords: Social Determinants of Health, Health Services Research (HSR)
Michelson KA, Nigrovic LE, Nagler J
Research interest in pediatric emergency medicine fellows.
The authors sought to determine the prevalence and determinants of interest in research careers among pediatric emergency medicine (PEM) fellows. They performed an electronically distributed national survey of current PEM fellows, assessing demographics, barriers to successful research, and beliefs about research using 4-point ordinal scales. The authors found that most fellows expect to devote a minority of their career to clinical research. Enthusiasm about research was strongly correlated with career research interest.
AHRQ-funded; HS000063.
Citation: Michelson KA, Nigrovic LE, Nagler J .
Research interest in pediatric emergency medicine fellows.
Pediatr Emerg Care 2020 Feb;36(2):e38-e42. doi: 10.1097/pec.0000000000001085..
Keywords: Emergency Department, Children/Adolescents, Health Services Research (HSR), Provider: Physician, Provider, Education: Continuing Medical Education
Squires A, Sadarangani T, Jones S
Strategies for overcoming language barriers in research.
This study synthesized methodological recommendations for cross-language research studies with the goal to improve the quality of future research and expand the evidence-base for clinical practice. Clear methodological recommendations were generated that can improve research rigor and quality of cross-language qualitative and quantitative studies. The authors suggest that the recommendations generated in their paper have the potential to have an impact on the health and well-being of migrants around the world.
AHRQ-funded; HS023593.
Citation: Squires A, Sadarangani T, Jones S .
Strategies for overcoming language barriers in research.
J Adv Nurs 2020 Feb;76(2):706-14. doi: 10.1111/jan.14007..
Keywords: Health Services Research (HSR), Research Methodologies, Communication, Cultural Competence
Adler-Milstein J, Adelman JS, Tai-Seale M
EHR audit logs: a new goldmine for health services research?
This article discusses the possible usefulness of electronic health record (EHR) audit log data to support health services research and for those studying healthcare processes and outcomes. The authors offer a framework for the potential uses in quality domains as defined by the National Academy of Medicine. The article also discusses challenges of working with audit log data.
AHRQ-funded; HS022670; HS023704; HS024538; HS019167.
Citation: Adler-Milstein J, Adelman JS, Tai-Seale M .
EHR audit logs: a new goldmine for health services research?
J Biomed Inform 2020 Jan;101:103343. doi: 10.1016/j.jbi.2019.103343..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR)
Keeney T, Belanger E, Jones RN
High-need phenotypes in Medicare beneficiaries: drivers of variation in utilization and outcomes.
The goal of this study was to identify distinct clinical phenotypes present within high-need Medicare beneficiaries and to examine differences in outcomes between phenotypes. Researchers identified five phenotypes and concluded that their findings represented a first step toward classifying the heterogeneity among high-need Medicare beneficiaries. They recommend further work to identify modifiable utilization patterns between phenotypes to improve the value of healthcare provided to these subpopulations.
AHRQ-funded; HS000011.
Citation: Keeney T, Belanger E, Jones RN .
High-need phenotypes in Medicare beneficiaries: drivers of variation in utilization and outcomes.
J Am Geriatr Soc 2020 Jan;68(1):70-77. doi: 10.1111/jgs.16146..
Keywords: Medicare, Research Methodologies, Outcomes, Health Services Research (HSR)
Holden RJ, Cornet VP, Valdez RS
Patient ergonomics: 10-year mapping review of patient-centered human factors.
The authors performed a mapping review of 212 full-text patient ergonomics publications in two conference proceedings, 2007-2017. They found gaps deserving future research, including research with understudied populations and marginalized populations; on topics such as health promotion and transitions of care; and using longitudinal and experimental study designs. They recommended more focused reviews, new primary research, and developing a roadmap for future patient ergonomics research.
AHRQ-funded; HS025232.
Citation: Holden RJ, Cornet VP, Valdez RS .
Patient ergonomics: 10-year mapping review of patient-centered human factors.
Appl Ergon 2020 Jan;82:102972. doi: 10.1016/j.apergo.2019.102972.
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Keywords: Patient-Centered Healthcare, Patient and Family Engagement, Health Services Research (HSR)
Kirby JB, Yabroff KR
AHRQ Author: Kirby JB
Rural-urban differences in access to primary care: beyond the usual source of care provider.
This study used 2014-2016 MEPS data to analyze differences between rural and urban areas to primary care access beyond the usual source of care provider. While rural residents were more likely to have a usual source of care, they were less likely to have a provider with office hours on nights and weekends.
AHRQ-authored.
Citation: Kirby JB, Yabroff KR .
Rural-urban differences in access to primary care: beyond the usual source of care provider.
Am J Prev Med 2020 Jan;58(1):89-96. doi: 10.1016/j.amepre.2019.08.026..
Keywords: Medical Expenditure Panel Survey (MEPS), Access to Care, Primary Care, Rural Health, Urban Health, Health Services Research (HSR)
Norton WE, Zwarenstein M, Czajkowski S
AHRQ Author: Kato E
Building internal capacity in pragmatic trials: a workshop for program scientists at the US National Cancer Institute.
This article describes a workshop put together by the authors for program scientists at the National Cancer Institute (NCI) to help them become better researchers and stewards of research funds. The workshop got good reviews from the attendees and many felt it will help them develop funding opportunities and advise grantees.
AHRQ-authored.
Citation: Norton WE, Zwarenstein M, Czajkowski S .
Building internal capacity in pragmatic trials: a workshop for program scientists at the US National Cancer Institute.
Trials 2019 Dec 27;20(1):779. doi: 10.1186/s13063-019-3934-y..
Keywords: Research Methodologies, Health Services Research (HSR), Cancer, Healthcare Delivery
Broder-Fingert S, Kuhn J, Sheldrick RC
Using the Multiphase Optimization Strategy (MOST) framework to test intervention delivery strategies: a study protocol.
Researchers describe a study protocol for a large randomized controlled trial using the Multiphase Optimization Strategy (MOST), a novel framework developed to optimize interventions. They apply this framework to delivery of Family Navigation (FN), an evidence-based care management strategy designed to reduce disparities and improve access to behavioral health services, and test four components related to its implementation. In this paper, they describe how the MOST framework can be used to improve intervention delivery. These methods will be useful for future studies testing intervention delivery strategies and their impact on implementation.
AHRQ-funded; HS022242.
Citation: Broder-Fingert S, Kuhn J, Sheldrick RC .
Using the Multiphase Optimization Strategy (MOST) framework to test intervention delivery strategies: a study protocol.
Trials 2019 Dec 16;20(1):728. doi: 10.1186/s13063-019-3853-y..
Keywords: Research Methodologies, Health Services Research (HSR), Healthcare Delivery, Behavioral Health, Evidence-Based Practice, Access to Care
Stadnick NA, Sadler E, Sandall J
Comparative case studies in integrated care implementation from across the globe: a quest for action.
There are no formal guidelines for integrated care implementation applicable to diverse healthcare systems. In this paper, the investigators use a multiple case study design to highlight current integrated care implementation efforts through seven international case studies that target a range of healthcare systems, patient populations and implementation strategies and outcomes, and to synthesize the shared and unique challenges and successes across studies using the EPIS framework.
AHRQ-funded; HS024192.
Citation: Stadnick NA, Sadler E, Sandall J .
Comparative case studies in integrated care implementation from across the globe: a quest for action.
BMC Health Serv Res 2019 Nov 27;19(1):899. doi: 10.1186/s12913-019-4661-5..
Keywords: Healthcare Delivery, Health Services Research (HSR), Health Systems, Implementation, Case Study
Gates A, Guitard S, Pillay J
Performance and usability of machine learning for screening in systematic reviews: a comparative evaluation of three tools.
Researchers explored the performance of three machine learning tools designed to facilitate title and abstract screening in systematic reviews (SRs) when used to eliminate irrelevant records and complement the work of a single reviewer. Using Abstrackr, DistillerSR, and RobotAnalyst, they found that the workload savings afforded in the automated simulation came with increased risk of missing relevant records. Supplementing a single reviewer's decisions with relevance predictions sometimes reduced the proportion missed, but performance varied by tool and SR. They recommend designing tools based on reviewers' self-identified preferences to improve compatibility with present workflows.
AHRQ-funded; 290201500001I.
Citation: Gates A, Guitard S, Pillay J .
Performance and usability of machine learning for screening in systematic reviews: a comparative evaluation of three tools.
Syst Rev 2019 Nov 15;8(1):278. doi: 10.1186/s13643-019-1222-2..
Keywords: Patient-Centered Outcomes Research, Health Services Research (HSR), Research Methodologies, Evidence-Based Practice, Comparative Effectiveness
Gartlehner G, Wagner G, Lux L
Assessing the accuracy of machine-assisted abstract screening with DistillerAI: a user study.
The goal of this project was to conduct a case study to explore a screening approach that temporarily replaces a human screener with a semi-automated screening tool. The authors used DistillerAI as a semi-automated screening tool, and a published comparative effectiveness review served as their reference standard. They found that the accuracy of DistillerAI was not yet adequate to replace a human screener temporarily during abstract screening for systematic reviews.
AHRQ-funded; 290201500011I.
Citation: Gartlehner G, Wagner G, Lux L .
Assessing the accuracy of machine-assisted abstract screening with DistillerAI: a user study.
Syst Rev 2019 Nov 15;8(1):277. doi: 10.1186/s13643-019-1221-3..
Keywords: Patient-Centered Outcomes Research, Health Services Research (HSR), Research Methodologies, Evidence-Based Practice
Boudreaux M, Gangopadhyaya A, Long SK
AHRQ Author: Karaca Z
Using data from the Healthcare Cost and Utilization Project for state health policy research.
Investigators describe the opportunities and challenges of using HCUP data to conduct state health policy research and to provide empirical examples of what can go wrong when using the national HCUP data inappropriately. Analyzing cesarean delivery rates, discharges per capita, and discharges by the payer, they found that state-level estimates are volatile and often provide misleading policy conclusions. They conclude that the Nationwide Inpatient Sample should not be used for state-level research and specified that AHRQ provides resources to assist analysts with state-specific studies using State Inpatient Database files.
AHRQ-authored.
Citation: Boudreaux M, Gangopadhyaya A, Long SK .
Using data from the Healthcare Cost and Utilization Project for state health policy research.
Med Care 2019 Nov;57(11):855-60. doi: 10.1097/mlr.0000000000001196..
Keywords: Healthcare Cost and Utilization Project (HCUP), Policy, Health Services Research (HSR), Healthcare Costs, Data, Research Methodologies
Vanderlaan J, Dunlop A, Rochat R
Methodology for sampling women at high maternal risk in administrative data.
This study compared the net benefits of using the Obstetric Comorbidity Index (OCI) to identify women at high maternal risk compared to conventional risk identification methods. Hospitalization discharge and vital records data for women experience singleton births in George from 2008 to 2012 was used. Results found there was a small but positive net benefit in using the OCI and conventional risk identification methods actually performed worse than using no risk identification methods at all. The researchers suggest that using OCI helps reduce misclassification.
AHRQ-funded; HS024655.
Citation: Vanderlaan J, Dunlop A, Rochat R .
Methodology for sampling women at high maternal risk in administrative data.
BMC Pregnancy Childbirth 2019 Oct 21;19(1):364. doi: 10.1186/s12884-019-2500-7..
Keywords: Research Methodologies, Health Services Research (HSR), Pregnancy, Maternal Care, Risk, Women
Wood SJ, Albertson EM, Conrad DA
Accountable care program implementation and effects on participating health care systems in Washington state: a conceptual model.
This study used key informant interviews with health care executives representing 5 large health systems contracted with the Washington State Health Care Authority to provide accountable care network services under the State Innovation Model initiative. Two rounds of semistructured interviews were conducted, and results indicated the need to present a modified conceptual model aligned better with accountable care program (ACP) implementation.
AHRQ-funded; HS013853.
Citation: Wood SJ, Albertson EM, Conrad DA .
Accountable care program implementation and effects on participating health care systems in Washington state: a conceptual model.
J Ambul Care Manage 2019 Oct/Dec;42(4):321-36. doi: 10.1097/jac.0000000000000302..
Keywords: Health Systems, Provider Performance, Organizational Change, Health Services Research (HSR), Payment, Health Insurance, Implementation
Everson J, Hollingsworth JM, Adler-Milstein J
Comparing methods of grouping hospitals.
The purpose of this study was to compare the performance of widely used approaches for defining groups of hospitals and a new approach based on network analysis of shared patient volume. Results showed that community detection algorithm-defined hospital groups offer high validity, reliability to different specifications, and generalizability to many uses when compared to approaches in widespread use today. They may offer a better choice for efforts seeking to analyze the behaviors and dynamics of groups of hospitals. Measures of modularity, shared information, inclusivity, and shared behavior can be used to evaluate different approaches to grouping providers.
AHRQ-funded; HS024525; HS024728; HS024454.
Citation: Everson J, Hollingsworth JM, Adler-Milstein J .
Comparing methods of grouping hospitals.
Health Serv Res 2019 Oct;54(5):1090-98. doi: 10.1111/1475-6773.13188..
Keywords: Health Services Research (HSR), Hospitals, Research Methodologies
Kaufman A, Dickinson WP, Fagnan LJ
The role of health extension in practice transformation and community health improvement: lessons from 5 case studies.
The states of New Mexico, Oklahoma, Oregon, Colorado, and Washington stand out in stretching the boundaries of health extension; their stories reveal lessons learned regarding the successes and challenges. All states saw the need for long-term, sustained fundraising beyond grants in an environment expecting a short-term return on investment, and they were challenged operating in a shifting health system landscape where the creativity and personal relationships built with small primary care practices was hindered when these practices were purchased by larger health delivery systems.
AHRQ-funded; HS020890; HS020972; HS23904; HS023908.
Citation: Kaufman A, Dickinson WP, Fagnan LJ .
The role of health extension in practice transformation and community health improvement: lessons from 5 case studies.
Ann Fam Med 2019 Aug 12;17(Suppl 1):S67-s72. doi: 10.1370/afm.2409..
Keywords: Community-Based Practice, Health Services Research (HSR), Healthcare Delivery, Organizational Change, Primary Care, Social Determinants of Health, Practice Improvement
Polubriaginof FCG, Ryan P, Salmasian H
Challenges with quality of race and ethnicity data in observational databases.
This study assessed the quality of race and ethnicity information in observational health databases as well as electronic health records (EHRs) and to propose patient self-recording as a way to improve accuracy. Data from the Healthcare Cost and Utilization Project (HCUP) and Optum Labs, and from a single New York City healthcare system’s EHR was compared. Among 160 million patients in the HCUP database, no race or ethnicity data was recorded for 25% of the records. Among the 2.4 million patients in the New York City HER, race or ethnicity was unknown for 57%. However, when patients were allowed to directly record their race and ethnicity, percentages rose to 86%.
AHRQ-funded; HS021816; HS023704; HS024713.
Citation: Polubriaginof FCG, Ryan P, Salmasian H .
Challenges with quality of race and ethnicity data in observational databases.
J Am Med Inform Assoc 2019 Aug;26(8-9):730-36. doi: 10.1093/jamia/ocz113..
Keywords: Healthcare Cost and Utilization Project (HCUP), Data, Racial and Ethnic Minorities, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR)
Wooldridge A, Carayon P, Hoonakker P
Complexity of the pediatric trauma care process: implications for multi-level awareness.
Trauma is the leading cause of disability and death in children and young adults in the US. While much is known about the medical aspects of inpatient pediatric trauma care, not much is known about the processes and roles involved in in-hospital care. Using human factors engineering (HFE) methods, the investigators combined interview, archival document and trauma registry data to describe how intra-hospital care transitions affect process and team complexity.
AHRQ-funded; HS023837.
Citation: Wooldridge A, Carayon P, Hoonakker P .
Complexity of the pediatric trauma care process: implications for multi-level awareness.
Cogn Technol Work 2019 Aug;21(3):397-416. doi: 10.1007/s10111-018-0520-0..
Keywords: Care Coordination, Children/Adolescents, Critical Care, Health Services Research (HSR), Healthcare Delivery, Inpatient Care, Patient Safety, Teams, Trauma, Young Adults
Hatch BA, Tillotson CJ, Huguet N
Use of a preventive index to examine clinic-level factors associated with delivery of preventive care.
There is an increasing need for the development of new methods to understand factors affecting delivery of preventive care. This study applied a new measurement approach and assessed clinic-level factors associated with preventive care delivery. The investigators concluded that approaches that use individual preventive ratios and aggregate prevention indices are promising for understanding and improving preventive service delivery over time.
AHRQ-funded; HS024270.
Citation: Hatch BA, Tillotson CJ, Huguet N .
Use of a preventive index to examine clinic-level factors associated with delivery of preventive care.
Am J Prev Med 2019 Aug;57(2):241-49. doi: 10.1016/j.amepre.2019.03.016..
Keywords: Prevention, Healthcare Delivery, Health Services Research (HSR)
Hsuan C, Hsia RY, Horwitz JR
Ambulance diversions following public hospital emergency department closures.
The purpose of this study was to examine whether hospitals are more likely to temporarily close their emergency departments to ambulances, through ambulance diversions, if neighboring diverting hospitals are public vs private. Results showed that sample hospitals respond differently to diversions by neighboring public (vs private) hospitals. The authors conclude that these findings suggest that these hospitals might be strategically declaring ambulance diversions to avoid treating low-paying patients served by public hospitals.
AHRQ-funded; HS024247.
Citation: Hsuan C, Hsia RY, Horwitz JR .
Ambulance diversions following public hospital emergency department closures.
Health Serv Res 2019 Aug;54(4):870-79. doi: 10.1111/1475-6773.13147..
Keywords: Access to Care, Emergency Department, Emergency Medical Services (EMS), Health Services Research (HSR), Hospitals
Markovitz AA, Hollingsworth JM, Ayanian JZ
Performance in the Medicare Shared Savings Program after accounting for nonrandom exit: an instrumental variable analysis.
The purpose of this study was to evaluate the effect of the Medicare Shared Savings Program (MSSP) on spending and quality while accounting for clinicians' nonrandom exit. MSSP ACO participants were compared with control beneficiaries using adjusted longitudinal models that accounted for secular trends, market factors, and beneficiary characteristics. Results showed that, after adjustment for clinicians' nonrandom exit, the MSSP was not associated with improvements in spending or quality. Selection effects, including exit of high-cost clinicians, may drive estimates of savings in the MSSP.
AHRQ-funded; HS025615; HS024728; HS024525.
Citation: Markovitz AA, Hollingsworth JM, Ayanian JZ .
Performance in the Medicare Shared Savings Program after accounting for nonrandom exit: an instrumental variable analysis.
Ann Intern Med 2019 Jul 2;171(1):27-36. doi: 10.7326/m18-2539..
Keywords: Healthcare Costs, Health Services Research (HSR), Medicare, Quality of Care
Ji X, Shen HW, Ritter A
Visual exploration of neural document embedding in information retrieval: semantics and feature selection.
Researchers proposed visual exploration of neural document embedding to gain insights into the underlying embedding space and to promote the utilization in prevalent information retrieval applications. They demonstrated the usefulness and effectiveness of their application-driven view and presented inspiring findings in use cases. They indicated that their work will help designers/developers of downstream applications gain insights and confidence in neural document embedding.
AHRQ-funded; HS025047.
Citation: Ji X, Shen HW, Ritter A .
Visual exploration of neural document embedding in information retrieval: semantics and feature selection.
IEEE Trans Vis Comput Graph 2019 Jun;25(6):2181-92. doi: 10.1109/tvcg.2019.2903946..
Keywords: Health Services Research (HSR), Research Methodologies