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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
1 to 9 of 9 Research Studies DisplayedBonner SN, Powell CA, Stewart JW
Surgical care for racial and ethnic minorities and interventions to address inequities: a narrative review.
The purpose of this review was to explore effective interventions to reduce inequities and identify gaps in intervention-based research with a goal of increasing awareness of surgeons, surgical trainees, researchers, and policy makers of the evidence-based interventions known to reduce racial and ethnic disparities in surgical care for prioritization of resource allocation and implementation. The researchers reviewed the PubMed database for English-language studies published from January 2012 through June 2022 to evaluate interventions to reduce or eliminate racial and ethnic disparities in surgical care. A narrative review of literature was conducted identifying interventions that have been related with reduction in racial and ethnic disparities in surgical care. The study found that attaining surgical equity will necessitate implementing evidence-based interventions to improve quality for racial and ethnic minorities, prioritizing funding for intervention-based research, utilizing implementation science and community based-participatory research methods, and principles of learning health systems.
AHRQ-funded; HS026030.
Citation: Bonner SN, Powell CA, Stewart JW .
Surgical care for racial and ethnic minorities and interventions to address inequities: a narrative review.
Ann Surg 2023 Aug 1; 278(2):184-92. doi: 10.1097/sla.0000000000005858..
Keywords: Racial and Ethnic Minorities, Disparities, Surgery
Taylor KK, Neiman PU, Bonner S
Unmet social health needs as a driver of inequitable outcomes after surgery: a cross-sectional analysis of the National Health Interview Survey.
The objective of this study was to identify opportunities to improve surgical equity by evaluating unmet social health needs by race, ethnicity, and insurance type. Researchers used the National Health Interview Survey for 2008-2018 to identify adults aged 18 and older who reported surgery in the past year. The results indicated that unmet social health needs varied significantly by race, ethnicity, and insurance, and were independently associated with poor health among surgical populations.
AHRQ-funded; HS028672; HS027788.
Citation: Taylor KK, Neiman PU, Bonner S .
Unmet social health needs as a driver of inequitable outcomes after surgery: a cross-sectional analysis of the National Health Interview Survey.
Ann Surg 2023 Aug 1; 278(2):193-200. doi: 10.1097/sla.0000000000005689.
Keywords: Social Determinants of Health, Surgery, Disparities, Outcomes
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
Mota L, Marcaccio CL, Patel PB
The impact of neighborhood social disadvantage on abdominal aortic aneurysm severity and management.
This study measured the impact of neighborhood social disadvantage on abdominal aortic aneurysm (AAA) severity and management. The authors identified all patients who underwent endovascular or open repair of an AAA in the Vascular Quality Initiative registry between 2003 and 2020. An area deprivation index (ADI) score of 1 to 100 was assigned to each patient based on their residential zip code, with higher ADI scores corresponding with increasing deprivation, which was then divided into quintiles. Outcomes looked at were rates of ruptured AAA (rAAA) repair versus an intact AAA repair and rates of endovascular repair (EVAR) versus the open approach. Among the 55,931 patients who underwent AAA repair, 6649 (12%) were in the lowest ADI quintile, 11,692 (21%) in the second, 15,958 (29%) in the third, 15,035 (27%) in the fourth, and 6597 (12%) in the highest ADI quintile. Patients in the two highest ADI quintiles had a higher proportion of rAAA repair (vs intact repair) compared with those in the lowest ADI quintile (8.8% and 9.1% vs 6.2%). They were also less likely to undergo EVAR (vs open approach) when compared with the lowest ADI quintile (81% and 81% vs 88%). Increasing ADI quintiles trended towards increasing rAAA and decreasing EVAR rates. In adjusted analyses, when compared with patients in the lowest ADI quintile, patients in the highest ADI quintile had higher odds of rAAA repair and lower odds of undergoing EVAR.
AHRQ-funded; HS027285.
Citation: Mota L, Marcaccio CL, Patel PB .
The impact of neighborhood social disadvantage on abdominal aortic aneurysm severity and management.
J Vasc Surg 2023 Apr;77(4):1077-86.e2. doi: 10.1016/j.jvs.2022.10.048.
Keywords: Social Determinants of Health, Cardiovascular Conditions, Surgery, Disparities
Ingraham NE, Jones EK, King S
Re-aiming equity evaluation in clinical decision support: a scoping review of equity assessments in surgical decision support systems.
This scoping review explored surgical literature to determine frequency and rigor of clinical decision support (CDS) equity assessments and offer recommendations to improve CDS equity by appending existing frameworks. The authors performed a scoping review of PubMed and Google Scholar and identified 1,415 citations with 229 abstracts meeting criteria for review. A total of 84 papers underwent full review after 145 were excluded if they did not assess outcomes of an electronic CDS tool or have a surgical use case. Only 6% of surgical CDS systems reported equity analyses, suggesting that current methods for optimizing equity in surgical CDS are inadequate. The authors proposed revising the RE-AIM framework to include an Equity element (RE2-AIM) specifying that CDS foundational analyses and algorithms are performed or trained on balanced datasets with sociodemographic characteristics that accurately represent the CDS target population and are assessed by sensitivity analyses focused on vulnerable subpopulations.
AHRQ-funded; HS026379; HS024532.
Citation: Ingraham NE, Jones EK, King S .
Re-aiming equity evaluation in clinical decision support: a scoping review of equity assessments in surgical decision support systems.
Ann Surg 2023 Mar; 277(3):359-64. doi: 10.1097/sla.0000000000005661..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Disparities, Surgery
Logan CD, Feinglass J, Halverson AL
Rural-urban disparities in receipt of surgery for potentially resectable non-small cell lung cancer.
This study examined the reasons there are lower rates of surgical treatment for potentially resectable non-small cell lung cancer (NSCLC) for patients living in rural areas than in urban areas. The National Cancer Database was used to identify patients with clinical stage I-IIIA NSCLC between 2004 and 2018. Reasons for nonreceipt of surgery was evaluated for rural and urban area patients. The study included 328,785 patients with NSCLC with 13% from rural areas. Overall, 62.4% of patients from urban areas and 58.8% of patients from rural areas underwent surgery. Patients from rural areas had increased odds of (1) being recommended primary nonsurgical management, (2) surgery being deemed contraindicated due to risk, (3) surgery being recommended but not performed, and (4) overall failure to receive surgery.
AHRQ-funded; HS026385.
Citation: Logan CD, Feinglass J, Halverson AL .
Rural-urban disparities in receipt of surgery for potentially resectable non-small cell lung cancer.
J Surg Res 2023 Mar;283:1053-63. doi: 10.1016/j.jss.2022.10.097.
Keywords: Cancer: Lung Cancer, Cancer, Disparities, Surgery, Rural Health, Access to Care
Iantorno SE, Ulugia JG, Kastenberg ZJ
Postdischarge racial and ethnic disparities in pediatric appendicitis: a mediation analysis.
This retrospective cohort study sought to explore whether racial and ethnic disparities for children presenting with acute appendicitis persist after initial management and hospital discharge. The cohort included children under 18 years who underwent treatment for acute appendicitis in 47 U.S. Children's Hospitals from 2017 to 2019. Findings showed that children of racial and ethnic minorities were more likely to visit the emergency department after treatment for acute appendicitis, but Hispanic/Latinx patients did not have a corresponding increase in readmission. These differences were mediated mainly by insurance status and urban residence.
AHRQ-funded; HS025776.
Citation: Iantorno SE, Ulugia JG, Kastenberg ZJ .
Postdischarge racial and ethnic disparities in pediatric appendicitis: a mediation analysis.
J Surg Res 2023 Feb;282:174-82. doi: 10.1016/j.jss.2022.09.027..
Keywords: Children/Adolescents, Racial and Ethnic Minorities, Disparities, Hospital Discharge, Surgery
Theiss LM, Wood L, Shao C
Disparities in perioperative use of patient engagement technologies - not all use is equal.
The objective of this retrospective cohort study was to determine the association of patient-level characteristics and the use of a patient engagement technology during the perioperative period. Patients who had undergone elective colorectal surgery were enrolled in a patient engagement technology at a single institution and received educational content, healthcare reminders, patient reported outcome surveys, and health checks. Findings indicated that use of a patient engagement technology in the perioperative period differs significantly by sex, race/ethnicity, and insurance status. The authors concluded that this diverse usage should be considered during implementation of interventions to improve surgical outcomes.
AHRQ-funded; HS023009.
Citation: Theiss LM, Wood L, Shao C .
Disparities in perioperative use of patient engagement technologies - not all use is equal.
Ann Surg 2023 Jan;277(1):e218-e25. doi: 10.1097/sla.0000000000004970.
Keywords: Patient and Family Engagement, Disparities, Surgery, Hospital Discharge
Shen MR, Jiang S, Millis MA
Racial variation in baseline characteristics and wait times among patients undergoing bariatric surgery.
The purpose of this study was to examine whether differences exist in baseline characteristics or access to care between white and non-white patients of bariatric surgery. The researchers utilized a statewide bariatric-specific data registry and assessed all patients of bariatric surgery who completed a baseline questionnaire prior to the operation and compared data among racial groups. A total of 73,141 patients were included with 25.5% self-identifying as non-white. Non-white males were the least represented group with 4% of all bariatric surgery cases performed. Despite having higher rates of college education, when compared to white patients non-white patients were more likely to be younger, disabled, and have Medicaid. Despite having higher rates of patients with a body mass index above 50 kg/m the median time from the first evaluation to surgery was longer among non-white patients (157 days vs. 127 days.) The study concluded that despite presenting with higher rates of severe obesity, when compared with white patients non-white patients of bariatric surgery are an extremely diverse group with greater socioeconomic disadvantages and longer wait times.
AHRQ-funded; HS000053.
Citation: Shen MR, Jiang S, Millis MA .
Racial variation in baseline characteristics and wait times among patients undergoing bariatric surgery.
Surg Endosc 2023 Jan; 37(1):564-70. doi: 10.1007/s00464-022-09292-w..
Keywords: Racial and Ethnic Minorities, Surgery, Obesity: Weight Management, Obesity, Disparities