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 64 Research Studies DisplayedPho MT, Jensen DM, Meltzer DO
Clinical impact of treatment timing for chronic hepatitis C infection: a decision model.
The researchers developed a decision model to quantify the trade-offs between immediate, interferon-containing therapy and delayed, interferon-free therapy for patients with chronic, genotype 1 HCV infection. They found that compared to one-time immediate treatment with the interferon-containing regimen, delayed treatment with the interferon-free regimen in 1 year resulted in longer life expectancy.
AHRQ-funded; HS022433.
Citation: Pho MT, Jensen DM, Meltzer DO .
Clinical impact of treatment timing for chronic hepatitis C infection: a decision model.
J Viral Hepat 2015 Aug;22(8):630-8. doi: 10.1111/jvh.12412..
Keywords: Clinical Decision Support (CDS), Shared Decision Making, Hepatitis, Medication, Outcomes
Reschovsky JD, Rich EC, Lake TK
Factors contributing to variations in physicians' use of evidence at the point of care: a conceptual model.
The purpose of this article is to help identify modifiable factors that can influence clinical decisions at the point of care. It presents a conceptual model and literature review of physician decisionmaking. The authors describe the multitude of factors—drawn from different disciplines—that have been shown to influence physician point-of-care decisions. They also present a conceptual framework for organizing these factors.
AHRQ-funded; 23320095642; 23337033T.
Citation: Reschovsky JD, Rich EC, Lake TK .
Factors contributing to variations in physicians' use of evidence at the point of care: a conceptual model.
J Gen Intern Med 2015 Aug;30 Suppl 3:S555-61. doi: 10.1007/s11606-015-3366-7..
Keywords: Healthcare Delivery, Shared Decision Making, Evidence-Based Practice, Primary Care: Models of Care, Practice Patterns
Converse L, Barrett K, Rich E
Methods of observing variations in physicians' decisions: the opportunities of clinical vignettes.
This review described various methods for measuring variations in physicians’ decisions and highlight a range of design features researchers should consider when developing a clinical vignette survey. It concluded by identifying areas for future research.
AHRQ-funded; 23320095642WC; 23337033T.
Citation: Converse L, Barrett K, Rich E .
Methods of observing variations in physicians' decisions: the opportunities of clinical vignettes.
J Gen Intern Med 2015 Aug;30 Suppl 3:S586-94. doi: 10.1007/s11606-015-3365-8..
Keywords: Shared Decision Making, Evidence-Based Practice, Practice Patterns
Roberts MC, Weinberger M, Dusetzina SB
Racial variation in adjuvant chemotherapy initiation among breast cancer patients receiving oncotype DX testing.
The researchers examined whether adjuvant chemotherapy initiation varied by race. No racial differences were found in adjuvant chemotherapy initiation among women receiving ODX testing. As treatment decision-making becomes increasingly targeted with the use of genetic technologies, these results provide evidence that test results may drive treatment in a similar way across racial subgroups.
AHRQ-funded; HS022189.
Citation: Roberts MC, Weinberger M, Dusetzina SB .
Racial variation in adjuvant chemotherapy initiation among breast cancer patients receiving oncotype DX testing.
Breast Cancer Res Treat 2015 Aug;153(1):191-200. doi: 10.1007/s10549-015-3518-9..
Keywords: Cancer: Breast Cancer, Treatments, Shared Decision Making, Genetics, Racial and Ethnic Minorities
Shorten A, Fagerlin A, Illuzzi J
Developing an Internet-based decision aid for women choosing between vaginal birth after cesarean and planned repeat cesarean.
This article is part of a series that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health. The authors outlined a framework and process used to create an Internet-based decision aid about birth choices after previous cesarean. They transformed a paper-based decision aid into a secure, interactive Web site to meet the diverse needs of women and providers.
AHRQ-funded; HS022114.
Citation: Shorten A, Fagerlin A, Illuzzi J .
Developing an Internet-based decision aid for women choosing between vaginal birth after cesarean and planned repeat cesarean.
J Midwifery Womens Health 2015 Jul-Aug;60(4):390-400. doi: 10.1111/jmwh.12298.
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Keywords: Shared Decision Making, Health Information Technology (HIT), Pregnancy, Web-Based, Women
Carrington JM, Gephart SM, Verran JA
Development of an instrument to measure the unintended consequences of EHRs.
The authors examined the creation and design of an instrument measuring unintended consequences of electronic health records. They suggested that other researchers will find their methods article informative for similar undertakings.
AHRQ-funded; HS022908.
Citation: Carrington JM, Gephart SM, Verran JA .
Development of an instrument to measure the unintended consequences of EHRs.
West J Nurs Res 2015 Jul;37(7):842-58. doi: 10.1177/0193945915576083.
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Keywords: Communication, Shared Decision Making, Electronic Health Records (EHRs), Nursing, Patient Safety
Melnick ER, Keegan J, Taylor RA
Redefining overuse to include costs: a decision analysis for computed tomography in minor head injury.
This study was conducted to (1) determine the testing threshold for head computed tomography (CT) in minor head injury in the emergency department using decision analysis with and without costs included in the analysis. If only effectiveness is considered, current clinical decision rules might not provide a sufficient degree of certainty to ensure identification of all patients for whom the benefits of CT outweigh its risks.
AHRQ-funded; HS021271.
Citation: Melnick ER, Keegan J, Taylor RA .
Redefining overuse to include costs: a decision analysis for computed tomography in minor head injury.
Jt Comm J Qual Patient Saf 2015 Jul;41(7):313-22..
Keywords: Clinical Decision Support (CDS), Shared Decision Making, Imaging, Emergency Medical Services (EMS)
Tamirisa NP, Sheffield KM, Parmar AD
Surgeon and facility variation in the use of minimally invasive breast biopsy in Texas.
The researchers aimed to determine the variation in use attributable to the surgeon and facility and determine the patient, surgeon, and facility characteristics associated with the use of minimally invasive breast biopsy (MIBB). They found that lower surgeon and facility volume, longer surgeon years in practice, and smaller facility bed size were associated with lower rates of MIBB use.
AHRQ-funded; HS022134.
Citation: Tamirisa NP, Sheffield KM, Parmar AD .
Surgeon and facility variation in the use of minimally invasive breast biopsy in Texas.
Ann Surg 2015 Jul;262(1):171-8. doi: 10.1097/sla.0000000000000883..
Keywords: Cancer: Breast Cancer, Shared Decision Making, Patient-Centered Outcomes Research, Surgery
Bennette CS, Gallego CJ, Burke W
The cost-effectiveness of returning incidental findings from next-generation genomic sequencing.
The researchers developed a decision-analytic policy model to project the quality-adjusted life-years and lifetime costs associated with returning ACMG-recommended incidental findings in three hypothetical cohorts of 10,000 patients. They found that returning incidental findings are likely cost-effective for certain patient populations. Screening of generally healthy individuals is likely not cost-effective based on current data.
AHRQ-funded; HS023340.
Citation: Bennette CS, Gallego CJ, Burke W .
The cost-effectiveness of returning incidental findings from next-generation genomic sequencing.
Genet Med 2015 Jul;17(7):587-95. doi: 10.1038/gim.2014.156..
Keywords: Healthcare Costs, Genetics, Shared Decision Making
Gallego CJ, Shirts BH, Bennette CS
Next-generation sequencing panels for the diagnosis of colorectal cancer and polyposis syndromes: a cost-effectiveness analysis.
The researchers evaluated the cost effectiveness of next-generation sequencing (NGS) panels for the diagnosis of colorectal cancer and polyposis (CRCP) syndromes in patients referred to cancer genetics clinics. They concluded that the use of an NGS panel that includes genes associated with highly penetrant CRCP syndromes in addition to Lynch syndrome genes as a first-line test is likely to provide meaningful clinical benefits in a cost-effective manner.
AHRQ-funded; HS021686.
Citation: Gallego CJ, Shirts BH, Bennette CS .
Next-generation sequencing panels for the diagnosis of colorectal cancer and polyposis syndromes: a cost-effectiveness analysis.
J Clin Oncol 2015 Jun 20;33(18):2084-91. doi: 10.1200/jco.2014.59.3665..
Keywords: Cancer, Cancer: Colorectal Cancer, Shared Decision Making, Diagnostic Safety and Quality, Genetics, Healthcare Costs, Screening
Murray DJ, Freeman BD, Boulet JR
Decision making in trauma settings: simulation to improve diagnostic skills.
The objective of this study was to determine whether simulation could be used to provide teams the experiences in managing scenarios that require the use of heuristic as well as analytic diagnostic skills to effectively recognize and treat potentially life-threatening injuries. The results of this preliminary study indicates that teams led by more senior residents received higher scores when managing heuristic scenarios but were less effective when managing the scenarios that require a more analytic approach.
AHRQ-funded; HS018734; HS022265.
Citation: Murray DJ, Freeman BD, Boulet JR .
Decision making in trauma settings: simulation to improve diagnostic skills.
Simul Healthc 2015 Jun;10(3):139-45. doi: 10.1097/sih.0000000000000073..
Keywords: Shared Decision Making, Diagnostic Safety and Quality, Critical Care, Patient Safety, Medical Errors
Ricci KA, Griffin AR, Heslin KC
AHRQ Author: Heslin KC
Evacuate or shelter-in-place? The role of corporate memory and political environment in hospital-evacuation decision making.
This study was conducted to identify factors that most heavily influenced the decisions to evacuate the Manhattan Veterans Administration Medical Center before Hurricane Irene in 2011 and Hurricane Sandy in 2012. The researchers conducted semi-structured interviews with 11 senior leaders on the processes and factors that influenced their evacuation decisions.
AHRQ-authored
Citation: Ricci KA, Griffin AR, Heslin KC .
Evacuate or shelter-in-place? The role of corporate memory and political environment in hospital-evacuation decision making.
Prehosp Disaster Med. 2015 Jun;30(3):233-8. doi: 10.1017/s1049023x15000229..
Keywords: Emergency Preparedness, Shared Decision Making, Hospitals
Smith RJ, Kilaru AS, Perrone J
How, why, and for whom do emergency medicine providers use prescription drug monitoring programs?
The authors examined how emergency physicians use Prescription Drug Monitoring Programs (PDMPs), for which patients, and for what reasons. They found that providers use the information in PDMPs to alter clinical decisions and guide opioid prescribing patterns. Physicians used the databases additionally for improving their ability to facilitate discussions on addiction and for providing patient education. The authors recommended minimizing administrative barriers to PDMP access and suggested that alternative PDMP uses be further studied to determine their appropriateness and potentially expand their role in clinical practice.
AHRQ-funded; HS021956.
Citation: Smith RJ, Kilaru AS, Perrone J .
How, why, and for whom do emergency medicine providers use prescription drug monitoring programs?
Pain Med 2015 Jun;16(6):1122-31. doi: 10.1111/pme.12700.
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Keywords: Shared Decision Making, Emergency Medical Services (EMS), Medication, Practice Patterns, Substance Abuse
Gupta K, Mueller SK
Interhospital transfers: the need for standards.
Patient transfers from one hospital to another are common and occur for a multitude of reasons with varied outcomes. The authors discuss interhospital transfers and difficulties encountered by the providers who care for these patients. They recommend further research to identify more clearly which patients are most likely to benefit from transfer and why.
AHRQ-funded; HS023331.
Citation: Gupta K, Mueller SK .
Interhospital transfers: the need for standards.
J Hosp Med 2015 Jun;10(6):415-7. doi: 10.1002/jhm.2320.
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Keywords: Case Study, Shared Decision Making, Elderly, Patient Safety, Transitions of Care
DeCamp M, Sugarman J, Berkowitz SA
Meaningfully engaging patients in ACO decision making.
In this article, the authors describe how ACOs can achieve meaningful system-level patient engagement. They specify a three-step engagement framework: identifying beneficiary representatives, cultivating relationships, and evaluating engagement. They conclude that their proposed three-step framework can help accountable care organizations (ACOs) conceptualize a plan for meaningfully engaging patients in ACO governance.
AHRQ-funded; HS023684.
Citation: DeCamp M, Sugarman J, Berkowitz SA .
Meaningfully engaging patients in ACO decision making.
Am J Accountable Care 2015 Jun;3(2):30-33.
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Keywords: Patient and Family Engagement, Shared Decision Making, Health Insurance, Healthcare Delivery
Reiter-Palmon R, Kennel V, Allen JA
Naturalistic decision making in after-action review meetings: the implementation of and learning from post-fall huddles.
In this study, the authors added to our understanding of Naturalistic Decision Making (NDM) in healthcare and how After Action Reviews (AARs) can be utilized as a learning tool to reduce errors. They found that the use of self-guided post-fall huddles increased over the time of the project, the types of errors identified as contributing to the patient fall changed, and the proportion of falls with less adverse effects increased during the project time period. They concluded that , over time, self-guided AARs can be useful for some aspects of learning from errors.
AHRQ-funded; HS021429.
Citation: Reiter-Palmon R, Kennel V, Allen JA .
Naturalistic decision making in after-action review meetings: the implementation of and learning from post-fall huddles.
J Occup Organ Psychol 2015 Jun;88(2):322-40. doi: 10.1111/joop.12084.
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Keywords: Adverse Events, Falls, Shared Decision Making, Medical Errors, Patient Safety
Parmar AD, Sheffield KM, Adhikari D
PREOP-Gallstones: a prognostic nomogram for the management of symptomatic cholelithiasis in older patients.
The objective of this study was to develop and validate a risk prediction model that would identify older patients who are at highest risk for recurrent episodes. It concluded that surgeons can use a prognostic nomogram to accurately provide patients with their 2-year risk of developing gallstone-related complications, allowing patients and physicians to make informed decisions in the context of their symptom severity and its impact on their quality of life.
AHRQ-funded; HS022134
Citation: Parmar AD, Sheffield KM, Adhikari D .
PREOP-Gallstones: a prognostic nomogram for the management of symptomatic cholelithiasis in older patients.
Ann Surg. 2015 Jun;261(6):1184-90. doi: 10.1097/sla.0000000000000868..
Keywords: Comparative Effectiveness, Risk, Elderly, Shared Decision Making
Smith B, McDuff J, Naierman N
What consumers want to know about quality when choosing a hospice provider.
This study drew on focus group and survey data collected in 5 metropolitan areas to learn more about hospice quality data. The researchers found that participants placed top priority on measures related to pain and symptom management. The National Quality Forum-approved measures resonate well with consumers, who also appear to be ready for access to data on the quality of hospice providers.
AHRQ-funded; HS021870.
Citation: Smith B, McDuff J, Naierman N .
What consumers want to know about quality when choosing a hospice provider.
Am J Hosp Palliat Care 2015 Jun;32(4):393-400. doi: 10.1177/1049909114524475.
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Keywords: Caregiving, Education: Patient and Caregiver, Shared Decision Making, Palliative Care, Provider Performance, Public Reporting, Quality of Care, Quality Indicators (QIs)
Meddings J, Saint S, Fowler KE
The Ann Arbor criteria for appropriate urinary catheter use in hospitalized medical patients: results obtained by using the RAND/UCLA Appropriateness Method.
A 15-member multidisciplinary panel used the RAND/UCLA Appropriateness Method to assess the appropriateness of using Foley catheters, intermittent straight catheters, and external condom catheters for hospitalized adults on medical services in 299 scenarios, including urinary retention, incontinence, and wounds. The panel concluded that these new appropriateness criteria can inform large-scale collaborative and bedside efforts to reduce inappropriate urinary catheter use.
AHRQ-funded; 290201000025I; HS019767
Citation: Meddings J, Saint S, Fowler KE .
The Ann Arbor criteria for appropriate urinary catheter use in hospitalized medical patients: results obtained by using the RAND/UCLA Appropriateness Method.
Ann Intern Med. 2015 May 5;162(9 Suppl):S1-34. doi: 10.7326/m14-1304..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Shared Decision Making, Guidelines, Healthcare-Associated Infections (HAIs), Inpatient Care, Patient Safety
Baier RR, Wysocki A, Gravenstein S
A qualitative study of choosing home health care after hospitalization: the unintended consequences of 'patient choice' requirements.
The purpose of this qualitative study is to learn how quality reports are used when choosing home care. Focus groups with 13 home health consumers and interviews with 28 hospital case managers from five hospitals revealed that both groups were unaware of public reports about home care quality.
AHRQ-funded; HS021879
Citation: Baier RR, Wysocki A, Gravenstein S .
A qualitative study of choosing home health care after hospitalization: the unintended consequences of 'patient choice' requirements.
J Gen Intern Med. 2015 May;30(5):634-40. doi: 10.1007/s11606-014-3164-7..
Keywords: Shared Decision Making, Elderly, Home Healthcare, Hospital Discharge, Transitions of Care
Carman KL, Mallery C, Maurer M
Effectiveness of public deliberation methods for gathering input on issues in healthcare: results from a randomized trial.
The researchers conducted a 5-arm randomized controlled trial, assigning participants to one of four deliberative methods or to a reading materials only control group. They found that participating in deliberation increased participants' knowledge of evidence and comparative effectiveness research and shifted participants' attitudes regarding the role of evidence in decision-making.
AHRQ-funded; 290201000005C.
Citation: Carman KL, Mallery C, Maurer M .
Effectiveness of public deliberation methods for gathering input on issues in healthcare: results from a randomized trial.
Soc Sci Med 2015 May;133:11-20. doi: 10.1016/j.socscimed.2015.03.024..
Keywords: Comparative Effectiveness, Evidence-Based Practice, Research Methodologies, Shared Decision Making
Abrahamson K, Miech E, Davila HW
Pay-for-performance policy and data-driven decision making within nursing homes: a qualitative study.
The researchers explored ways in which data were collected, thought about and used by nursing home employees as a result of participation in a pay-for-performance (P4P) program. Their findings indicated that participants in the Minnesota Performance-based Incentive Payment Program’s quality improvement (QI) projects perceived a change in the rate and manner in which they gathered, used, and considered data in their QI decisions.
AHRQ-funded; HS018464
Citation: Abrahamson K, Miech E, Davila HW .
Pay-for-performance policy and data-driven decision making within nursing homes: a qualitative study.
BMJ Qual Saf. 2015 May;24(5):311-7. doi: 10.1136/bmjqs-2014-003362..
Keywords: Nursing Homes, Long-Term Care, Payment, Provider Performance, Shared Decision Making, Policy, Quality Improvement, Quality of Care
Courtney DM, Mills AM, Marin JR
To test or not to test ... decision analysis of decision support.
In this article, the authors comment on a study by Troyer and colleagues in the same issue that presents a provocative decision analysis study exploring the cost and benefits associated with a web-based quantitative pretest probability calculator. Their discussion centers around the decision to test or not test in the emergency department setting for a condition. Such decisions are among the most consequential that physicians make and often hinge on advanced imaging.
AHRQ-funded; HS023498.
Citation: Courtney DM, Mills AM, Marin JR .
To test or not to test ... decision analysis of decision support.
Acad Emerg Med 2015 May;22(5):594-6. doi: 10.1111/acem.12663..
Keywords: Shared Decision Making, Emergency Department, Emergency Medical Services (EMS)
Moore JE, Titler MG, Kane Low L
AHRQ Author: Moore JE
Transforming patient-centered care: development of the evidence informed decision making through engagement model.
The purpose of this article is to set forth a new patient-centered implementation model informed by a qualitative study that explored women’s decisions, perceptions, and experiences of elective induction of labor. Through a process of theory evaluation and development, the authors explore patient-centered concepts (patient activation and shared decision making) within an implementation model by mapping qualitative data from an elective induction of labor study to assess the model’s ability to capture these key concepts.
AHRQ-authored.
Citation: Moore JE, Titler MG, Kane Low L .
Transforming patient-centered care: development of the evidence informed decision making through engagement model.
Womens Health Issues 2015 May-Jun;25(3):276-82. doi: 10.1016/j.whi.2015.02.002..
Keywords: Shared Decision Making, Patient and Family Engagement, Patient-Centered Healthcare, Primary Care: Models of Care, Women
Eapen ZJ, McCoy LA, Fonarow CG
Utility of socioeconomic status in predicting 30-day outcomes after heart failure hospitalization.
The researchers investigated whether accounting for socioeconomic status (SES) can improve risk-adjusted models for 30-day outcomes among CMS beneficiaries hospitalized with heart failure. They found that county-level SES data are modestly associated with 30-day outcomes but do not improve risk adjustment models based on patient characteristics alone.
AHRQ-funded; HS021092.
Citation: Eapen ZJ, McCoy LA, Fonarow CG .
Utility of socioeconomic status in predicting 30-day outcomes after heart failure hospitalization.
Circ Heart Fail 2015 May;8(3):473-80. doi: 10.1161/circheartfailure.114.001879.
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Keywords: Shared Decision Making, Heart Disease and Health, Hospitalization, Patient-Centered Outcomes Research, Social Determinants of Health