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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
201 to 225 of 304 Research Studies DisplayedKim SC, Jin Y, Lee YC
Association of preoperative opioid use with mortality and short-term safety outcomes after total knee replacement.
The purpose of this study was to determine the association of preoperative opioid use among patients 65 years and older with mortality and other complications at 30 days post-total knee replacement (TKR). Findings show that continuous opioid users had a higher risk of revision operations, vertebral fractures, and opioid overdose at 30 days post-TKR but not of in-hospital or 30-day mortality, compared with opioid-naive patients. Highlights include the need for better understanding of patient characteristics associated with chronic opioid use to optimize preoperative assessment of overall risk after TKR.
AHRQ-funded; HS018910.
Citation: Kim SC, Jin Y, Lee YC .
Association of preoperative opioid use with mortality and short-term safety outcomes after total knee replacement.
JAMA Netw Open 2019 Jul 3;2(7):e198061. doi: 10.1001/jamanetworkopen.2019.8061..
Keywords: Opioids, Medication, Surgery, Orthopedics, Elderly, Patient-Centered Outcomes Research, Mortality, Outcomes, Arthritis, Evidence-Based Practice
Parchman ML, Penfold RB, Ike B
Team-based clinic redesign of opioid medication management in primary care: effect on opioid prescribing.
This study examined the effect of using an opioid medication management program called Six Building Blocks in primary care practices to help reduce the rate of opioid prescriptions. Six rural-serving organizations with 20 clinic locations received support for 15 months to help them implement the Six Building Blocks. This case-control study compared monthly trends in patients undergoing long-term opioid therapy (LtOT) for patients enrolled in the intervention clinics with those enrolled in a regional health plan who did not receive care at the study sites but resided in the same areas. There was a significant rate of decrease of patients on LtOT at intervention clinics compared with the control group.
AHRQ-funded; HS023750.
Citation: Parchman ML, Penfold RB, Ike B .
Team-based clinic redesign of opioid medication management in primary care: effect on opioid prescribing.
Ann Fam Med 2019 Jul;17(4):319-25. doi: 10.1370/afm.2390..
Keywords: Opioids, Primary Care: Models of Care, Primary Care, Teams, Medication, Pain, Chronic Conditions, Practice Patterns, Patient-Centered Healthcare
Chen YT, Issema RS, Khanna AS
Prescription opioid use in a population-based sample of young black men who have sex with men: a longitudinal cohort study.
This study’s aim was to examine the prevalence and both individual and network characteristics of prescription opioid use (POU) among young black men who have sex with men (YBMSM). A total of 514 YBMSM ages 16-29 in Chicago were surveyed from 2013 to 2016. Approximately 4.2% YBMSM reported POU in the past 12 months. Young men with a criminal history, experiencing violence, or using any illicit drug other than marijuana in the past 12 months, or engaging in condomless anal sex with their named sexual partners were more likely to report POU. The presence of a mother figure was associated with a decreased risk of POU.
AHRQ-funded; HS022433.
Citation: Chen YT, Issema RS, Khanna AS .
Prescription opioid use in a population-based sample of young black men who have sex with men: a longitudinal cohort study.
Subst Use Misuse 2019;54(12):1991-2000. doi: 10.1080/10826084.2019.1625400..
Keywords: Opioids, Medication, Substance Abuse, Racial and Ethnic Minorities, Young Adults
Brummett CM, Steiger R, Englesbe M
Effect of an activated charcoal bag on disposal of unused opioids after an outpatient surgical procedure: a randomized clinical trial.
In this randomized clinical trial, researchers examined the effect of an activated charcoal bag that allows for in-home opioid disposal on the probability of disposal after a surgical procedure, compared with usual care or educational materials detailing disposal resources. They found that receiving such a bag was associated with an adjusted 3.8-fold increase in self-reported disposal among adults who underwent elective surgical procedure, compared with receiving usual care. These findings suggest that simple, low-cost interventions, such as in-home deactivation methods, could reduce the number of unused opioids available for diversion.
AHRQ-funded; HS023313.
Citation: Brummett CM, Steiger R, Englesbe M .
Effect of an activated charcoal bag on disposal of unused opioids after an outpatient surgical procedure: a randomized clinical trial.
JAMA Surg 2019 Jun;154(6):558-61. doi: 10.1001/jamasurg.2019.0155..
Keywords: Opioids, Medication, Ambulatory Care and Surgery, Surgery
Cole ES, DiDomenico E, Cochran G
The role of primary care in improving access to medication-assisted treatment for rural Medicaid enrollees with opioid use disorder.
The authors examined the degree to which rural residents with opioid use disorder (OUD) are engaged with primary care providers (PCPs); they also described the role of rural PCPs in medication-assisted treatment (MAT) delivery, and estimated the association between enrollee distance to MAT prescribers and MAT utilization. They concluded that PCP utilization among rural Medicaid enrollees diagnosed with OUD is high, presenting a potential intervention point to treat OUD, particularly if the enrollee's PCP is located nearer than their MAT prescriber.
AHRQ-funded; HS025072.
Citation: Cole ES, DiDomenico E, Cochran G .
The role of primary care in improving access to medication-assisted treatment for rural Medicaid enrollees with opioid use disorder.
J Gen Intern Med 2019 Jun;34(6):936-43. doi: 10.1007/s11606-019-04943-6..
Keywords: Opioids, Substance Abuse, Rural Health, Medication, Access to Care, Implementation, Primary Care, Healthcare Delivery, Medicaid
Donovan E, Case P, Bratberg JP
Beliefs associated with pharmacy-based naloxone: a qualitative study of pharmacy-based naloxone purchasers and people at risk for opioid overdose.
The purpose of this study was to understand factors that impact the likelihood of obtaining pharmacy-based naloxone. Results showed that several themes emerged from the interview data: individual, interpersonal, pharmacy, community, and societal, suggesting that these factors can be used to inform interventions seeking to increase the provision of pharmacy-based naloxone.
AHRQ-funded; HS024021.
Citation: Donovan E, Case P, Bratberg JP .
Beliefs associated with pharmacy-based naloxone: a qualitative study of pharmacy-based naloxone purchasers and people at risk for opioid overdose.
J Urban Health 2019 Jun;96(3):367-78. doi: 10.1007/s11524-019-00349-1..
Keywords: Medication, Provider, Provider: Pharmacist, Opioids, Risk, Substance Abuse
Vijay A, Rhee TG, Ross JS
U.S. prescribing trends of fentanyl, opioids, and other pain medications in outpatient and emergency department visits from 2006 to 2015.
This retrospective study tracked US prescribing trends of fentanyl, opioids, and other pain medications in outpatient and emergency department (ED) visits from 2006 to 2015. Data from the 2006-2015 National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Surveys was used. During that time period, 17.4% of office-based outpatient visits and 45% of ED visits listed a pain medication prescription. There was an increase of about 5% from 2006-2007 to 2014-2015 for outpatient visits in which any pain medication was prescribed. Fentanyl prescription rates remained stable but doubled at EDs. There was also an increase in non-opioid pain medications in both settings.
AHRQ-funded; HS022882; HS025164.
Citation: Vijay A, Rhee TG, Ross JS .
U.S. prescribing trends of fentanyl, opioids, and other pain medications in outpatient and emergency department visits from 2006 to 2015.
Prev Med 2019 Jun;123:123-29. doi: 10.1016/j.ypmed.2019.03.022..
Keywords: Ambulatory Care and Surgery, Emergency Department, Hospitals, Medication, Opioids, Pain, Practice Patterns
Suda KJ, Durkin MJ, Calip GS
Comparison of opioid prescribing by dentists in the United States and England.
The goal of this cross-sectional study was to compare opioid prescribing rates by dentists in the US and England, using data on prescriptions dispensed from outpatient pharmacies and health care settings in 2016 by dentists in both countries. Findings show that the proportion of prescriptions for opioids written by US dentists was 37 times greater than the proportion written by English dentists. US dentists also had a higher number of opioid prescriptions per 1000 population and number of prescriptions per dentist. Dihydrocodeine was the only opioid prescribed by English dentists, while US dentists prescribed a range of opioids containing hydrocodone, codeine, oxycodone, and tramadol, as well as long-acting opioids. The researchers conclude that US dentists adopt measures similar to those used in England to reduce dental opioid prescribing in the United States.
AHRQ-funded; HS025177.
Citation: Suda KJ, Durkin MJ, Calip GS .
Comparison of opioid prescribing by dentists in the United States and England.
JAMA Netw Open 2019 May 3;2(5):e194303. doi: 10.1001/jamanetworkopen.2019.4303..
Keywords: Dental and Oral Health, Medication, Opioids, Pain, Practice Patterns, Provider
Rogal SS, Beste LA, Youk A
Characteristics of opioid prescriptions to veterans with cirrhosis.
The goal of this study was to assess time trends in the prescribing of opioids and factors associated with patients with cirrhosis receiving opioids. National Veterans Health Administration data was used to assess characteristics of cirrhosis patients and their prescriptions for opioids.
AHRQ-funded; HS019461.
Citation: Rogal SS, Beste LA, Youk A .
Characteristics of opioid prescriptions to veterans with cirrhosis.
Clin Gastroenterol Hepatol 2019 May;17(6):1165-74.e3. doi: 10.1016/j.cgh.2018.10.021..
Keywords: Medication, Medication: Safety, Opioids, Patient Safety, Practice Patterns
McClellan CB
Disparities in opioid related mortality between United States counties from 2000 to 2014.
This study examines disparities in opioid related mortality between United States counties from 2000 to 2014. Unfortunately, counties that had lower rates in 2000 had caught up by 2014. The authors suggest that prevention measures need to be broader in scope and be implemented in areas where the opioid crisis doesn’t seem as prevalent.
AHRQ-authored.
Citation: McClellan CB .
Disparities in opioid related mortality between United States counties from 2000 to 2014.
Drug Alcohol Depend 2019 Apr 25;199:151-58. doi: 10.1016/j.drugalcdep.2019.03.005..
Keywords: Disparities, Medication, Mortality, Opioids, Substance Abuse
Callaghan BC, Reynolds E, Banerjee M
Longitudinal pattern of pain medication utilization in peripheral neuropathy patients.
The authors of this article investigated the pattern and utilization of neuropathic pain medications in peripheral neuropathy patients. They found that opioid initiation and transition to chronic opioid therapy were frequent in the studied population despite few patients receiving more than one guideline-recommended medication. They concluded that efforts are needed to decrease opioid utilization and to increase guideline-recommended medication use in order to improve current neuropathic pain treatment.
AHRQ-funded; HS017690.
Citation: Callaghan BC, Reynolds E, Banerjee M .
Longitudinal pattern of pain medication utilization in peripheral neuropathy patients.
Pain 2019 Mar;160(3):592-99. doi: 10.1097/j.pain.0000000000001439..
Keywords: Chronic Conditions, Guidelines, Healthcare Utilization, Medication, Neurological Disorders, Opioids, Pain, Practice Patterns
Hartung DM, Johnston K, Geddes J
Buprenorphine coverage in the Medicare Part D program for 2007 to 2018.
This letter discusses a study which looked into coverage of buprenorphine for opioid use disorder (OUP) with Medicare. The majority of plans do cover the generic version. However, the number of plans which require previous authorization has increased over from 2007 to 2018. This may hamper treatment by primary care physicians.
AHRQ-funded; HS024227.
Citation: Hartung DM, Johnston K, Geddes J .
Buprenorphine coverage in the Medicare Part D program for 2007 to 2018.
JAMA 2019 Feb 12;321(6):607-09. doi: 10.1001/jama.2018.20391..
Keywords: Health Insurance, Medicare, Medication, Opioids, Substance Abuse
Parthipan A, Banerjee I, Humphreys K
Predicting inadequate postoperative pain management in depressed patients: a machine learning approach.
Researchers employed a machine-learning approach to identify patients who were prescribed a combination of selective serotonin reuptake inhibitors (SSRIs) and prodrug opioids in order to examine the effect of this combination on postoperative pain control. They identified patients who received surgery over a 9-year period by using EHR data from an academic medical center, then developed and validated natural language processing (NLP) algorithms to extract depression-related information from both structured and unstructured data elements. The machine-learning algorithm accurately predicted the increase or decrease of the discharge, 3-week, and 8-week follow-up pain scores when compared to the pre-operative pain score; pre-operative pain, surgery type, and opioid tolerance were the strongest predictors of postoperative pain control. The researchers conclude that their study results provide the first direct clinical evidence that the known ability of SSRIs to inhibit prodrug opioid effectiveness is associated with worse pain control among depressed patients. They suggest that prescribers might choose direct acting opioids such as oxycodone or morphine for depressed patients on SSRIs instead of prodrug opioids.
AHRQ-funded; HS024096.
Citation: Parthipan A, Banerjee I, Humphreys K .
Predicting inadequate postoperative pain management in depressed patients: a machine learning approach.
PLoS One 2019 Feb 6;14(2):e0210575. doi: 10.1371/journal.pone.0210575..
Keywords: Care Management, Depression, Medication, Opioids, Pain, Surgery
Rees DI, Sabia JJ, Argys LM
With a little help from my friends: the effects of good samaritan and naloxone access laws on opioid-related deaths.
This study examined the effect of good Samaritan and naxolone access laws (NALs) on opioid-related mortality. Most states have adopted these laws, and the early adopters had the most negative association between NALs and overdose deaths. There was a negative but not statistically significant effect on opioid-related deaths for states with Good Samaritan laws.
AHRQ-funded; HS025014.
Citation: Rees DI, Sabia JJ, Argys LM .
With a little help from my friends: the effects of good samaritan and naloxone access laws on opioid-related deaths.
J Law Econ 2019 Feb;62(1). doi: 10.1086/700703..
Keywords: Opioids, Mortality, Policy, Medication
Abbasi AB, Salisbury-Afshar E, Jovanov D
Health care utilization of opioid overdose decedents with no opioid analgesic prescription history.
In this study, to better understand the role of prescription opioids and health care utilization prior to opioid-related overdose, the investigators analyzed the death records of decedents who died of an opioid overdose in Illinois in 2016 and linked to any existing controlled substance monitoring program (CSMP) and emergency department (ED) or hospital discharge records.
AHRQ-funded; HS022433.
Citation: Abbasi AB, Salisbury-Afshar E, Jovanov D .
Health care utilization of opioid overdose decedents with no opioid analgesic prescription history.
J Urban Health 2019 Feb;96(1):38-48. doi: 10.1007/s11524-018-00329-x..
Keywords: Adverse Drug Events (ADE), Healthcare Utilization, Medication, Opioids, Substance Abuse
Blanchard J, Weiss AJ, Barrett ML
AHRQ Author: Stocks C, Owens PL, Heslin KC
Readmissions following inpatient treatment for opioid-related conditions.
This study analyzed the relationship between hospital admission for inpatient drug detoxification and/or rehabilitation services and subsequent opioid-related readmission. The study used hospital inpatient discharge and emergency department visit data from the AHRQ Healthcare Cost and Utilization Project (HCUP) survey. The sample consisted of 329,037 patients from seven states with an opioid-related index hospitalization from March 2010 to September 2013. A relatively small percentage (19.4%) of patients received treatment for drug use during their hospital stay. Those patients that did receive treatment had a lower 90-day readmission rate than those patients who did not.
AHRQ-authored; AHRQ-funded.
Citation: Blanchard J, Weiss AJ, Barrett ML .
Readmissions following inpatient treatment for opioid-related conditions.
Subst Use Misuse 2019;54(3):473-81. doi: 10.1080/10826084.2018.1517174..
Keywords: Healthcare Cost and Utilization Project (HCUP), Opioids, Hospital Readmissions, Hospitalization, Inpatient Care, Substance Abuse, Medication
Knight LMJ, Onsomu EO, Bosworth HB
Exploring emergency department provider experiences with and perceptions of weight-based versus individualized vaso-occlusive treatment protocols in sickle cell disease.
This study compared perceptions of nurses and physicians on protocols to treat sickle cell disease vaso-occlusive episodes (VOEs) in emergency rooms (ERs). Two different protocols were used for VOEs: weight –based and individualized vaso-occlusive. Nurses were less satisfied with clarity of the protocols than physicians. Pain management protocol perceptions differed widely between physicians, residents, physician assistants, nurse practitioners and nurses.
AHRQ-funded; HS024501.
Citation: Knight LMJ, Onsomu EO, Bosworth HB .
Exploring emergency department provider experiences with and perceptions of weight-based versus individualized vaso-occlusive treatment protocols in sickle cell disease.
Adv Emerg Nurs J 2019 Jan/Mar;41(1):86-97. doi: 10.1097/tme.0000000000000232..
Keywords: Emergency Department, Medication, Opioids, Pain, Provider, Sickle Cell Disease
Blanchard J, Weiss AJ, Barrett ML
State variation in opioid treatment policies and opioid-related hospital readmissions.
In this study, the investigators used 2013-2015 hospital inpatient discharge data from 13 states from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project to examine the relationship between state opioid treatment policies and 90-day opioid-related readmissions after a stay involving an opioid diagnosis. The concluded that differences in index hospitalization rates suggested that states with opioid treatment policies had a higher level of need for opioid-related intervention, which also may account for higher rates of readmission.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Blanchard J, Weiss AJ, Barrett ML .
State variation in opioid treatment policies and opioid-related hospital readmissions.
BMC Health Serv Res 2018 Dec 17;18(1):971. doi: 10.1186/s12913-018-3703-8..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Medication, Opioids, Substance Abuse
Zhang Y, Johnson P, Jeng PJ
First opioid prescription and subsequent high-risk opioid use: a national study of privately insured and Medicare Advantage adults.
This study examined the association between a first opioid prescription and high-risk opioid use in the 18 months following the first prescription. A retrospective cohort study was conducted using data from a large commercial insurance claims database for patients aged 18-64 and also Medicare Advantage patients aged 65 or older for 2011-2014. The patients initially had not used opioids. The features the researchers were looking for were: 1) opioid or benzodiazepine prescriptions overlapping 7 days or more, 2) opioid prescriptions overlapping for 7 days or more; 3) three or more prescribers of opioids; and 4) a daily dosage exceeding 120 morphine milligram equivalents, in each of the six quarters following the first prescription. All of those features were strongly associated with high-risk use.
AHRQ-funded; HS021531.
Citation: Zhang Y, Johnson P, Jeng PJ .
First opioid prescription and subsequent high-risk opioid use: a national study of privately insured and Medicare Advantage adults.
J Gen Intern Med 2018 Dec;33(12):2156-62. doi: 10.1007/s11606-018-4628-y..
Keywords: Opioids, Substance Abuse, Medication, Risk, Medicare, Health Insurance
Samples H, Williams AR, Olfson M
Risk factors for discontinuation of buprenorphine treatment for opioid use disorders in a multi-state sample of Medicaid enrollees.
The purpose of this study was to examine duration of buprenorphine treatment for opioid use disorder (OUD) following the initiation of treatment in order to identify risk factors for early discontinuation. Researchers analyzed insurance claims from the MarketScan multi-state Medicaid database for 2013 through 2015; their sample included adults aged 18-64 years who had an OUD diagnosis 6 months before initiating buprenorphine treatment. More than 1/4 of the sample discontinued buprenorphine in the first month of treatment, and most of the sample discontinued before 180 days. Risk factors for discontinuation were associated with significantly lower odds of treatment retention for at least 180 days. The study concludes that there is need to implement treatment models that address barriers to treatment retention more effectively.
AHRQ-funded; HS021112.
Citation: Samples H, Williams AR, Olfson M .
Risk factors for discontinuation of buprenorphine treatment for opioid use disorders in a multi-state sample of Medicaid enrollees.
J Subst Abuse Treat 2018 Dec;95:9-17. doi: 10.1016/j.jsat.2018.09.001..
Keywords: Medicaid, Medication, Opioids, Risk, Substance Abuse
Militello LG, Anders S, Downs SM
Understanding how primary care clinicians make sense of chronic pain.
This research explored how primary care clinicians manage their patients with chronic noncancer pain. They conducted Critical Decision Method interviews with 10 clinicians about 30 individual patients. Findings suggested that clinicians should focus on supporting sensemaking in the content of clinical evidence rather than trying to provide them with rules.
AHRQ-funded; HS023306.
Citation: Militello LG, Anders S, Downs SM .
Understanding how primary care clinicians make sense of chronic pain.
Cogn Technol Work 2018 Nov;20(4):575-84. doi: 10.1007/s10111-018-0491-1..
Keywords: Pain, Chronic Conditions, Opioids, Medication, Shared Decision Making, Primary Care, Care Management
Hilliard PE, Waljee J, Moser S
Prevalence of preoperative opioid use and characteristics associated with opioid use among patients presenting for surgery.
Researchers assessed the prevalence of preoperative opioid use and the characteristics of patients in a broadly representative surgical cohort. They found that patients undergoing lower extremity procedures were most likely to report preoperative opioid use, with 1 in 4 of all patients presenting for surgery reporting such use. They concluded that the data provided important insights into this population and would appear to help guide future preoperative optimization and perioperative opioid-weaning interventions.
AHRQ-funded; HS023313.
Citation: Hilliard PE, Waljee J, Moser S .
Prevalence of preoperative opioid use and characteristics associated with opioid use among patients presenting for surgery.
JAMA Surg 2018 Oct;153(10):929-37. doi: 10.1001/jamasurg.2018.2102..
Keywords: Opioids, Surgery, Pain, Medication, Healthcare Utilization, Orthopedics
Klueh MP, Hu HM, Howard RA
Transitions of care for postoperative opioid prescribing in previously opioid-naive patients in the USA: a retrospective review.
The purpose of this study was to identify specialties prescribing opioids to surgical patients who develop new persistent opioid use. Results showed that, among surgical patients who developed new persistent opioid use, surgeons provided the majority of opioid prescriptions during the first 3 months after surgery, but by 9 to 12 months after surgery, the majority of opioid prescriptions were provided by primary care physicians. Recommendations included enhanced care coordination between surgeons and primary care physicians to allow earlier identification of patients at risk for new persistent opioid use in order to prevent misuse and dependence.
AHRQ-funded; HS023313.
Citation: Klueh MP, Hu HM, Howard RA .
Transitions of care for postoperative opioid prescribing in previously opioid-naive patients in the USA: a retrospective review.
J Gen Intern Med 2018 Oct;33(10):1685-91. doi: 10.1007/s11606-018-4463-1..
Keywords: Transitions of Care, Opioids, Substance Abuse, Surgery, Pain, Medication, Patient-Centered Outcomes Research
Barry DT, Marshall BDL, Becker WC
Duration of opioid prescriptions predicts incident nonmedical use of prescription opioids among U.S. veterans receiving medical care.
Although nonmedical use of prescription opioids (NMUPO) is a public health problem, few studies have examined the new-onset NMUPO in clinical populations. This prospective cohort study estimated NMUPO incidence among veterans in medical care who had received prescription opioid medication and examined correlates of new-onset NMUPO. The investigators concluded that duration of prescription opioid receipt was a risk factor for incident NMUPO among veterans receiving medical care.
AHRQ-funded; HS021112; HS023258.
Citation: Barry DT, Marshall BDL, Becker WC .
Duration of opioid prescriptions predicts incident nonmedical use of prescription opioids among U.S. veterans receiving medical care.
Drug Alcohol Depend 2018 Oct 1;191:348-54. doi: 10.1016/j.drugalcdep.2018.07.008..
Keywords: Medication, Opioids, Substance Abuse
Axeen S
Trends in opioid use and prescribing in Medicare, 2006-2012.
The purpose of this study was to determine characteristics and trends in opioid use, questionable use, and prescribing in Medicare. The investigators conducted a retrospective analysis of a 20 percent sample of Medicare claims data. Estimates were adjusted using multivariable regression analysis. They found that opioid utilization and prescribing were increasingly heterogeneous from 2006 to 2012.
AHRQ-funded; HS024251.
Citation: Axeen S .
Trends in opioid use and prescribing in Medicare, 2006-2012.
Health Serv Res 2018 Oct;53(5):3309-28. doi: 10.1111/1475-6773.12846..
Keywords: Medicare, Medication, Opioids, Practice Patterns