National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (1)
- Adverse Drug Events (ADE) (1)
- Adverse Events (1)
- Behavioral Health (1)
- Blood Thinners (1)
- (-) Brain Injury (12)
- Children/Adolescents (4)
- Critical Care (1)
- Diagnostic Safety and Quality (2)
- Disparities (1)
- Domestic Violence (1)
- Electronic Health Records (EHRs) (1)
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- Evidence-Based Practice (2)
- Falls (1)
- Health Information Technology (HIT) (1)
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- Health Services Research (HSR) (1)
- Imaging (3)
- Implementation (1)
- Injuries and Wounds (3)
- Medication (1)
- Medication: Safety (1)
- Neurological Disorders (4)
- Newborns/Infants (1)
- Outcomes (3)
- Patient-Centered Outcomes Research (1)
- Quality of Life (1)
- Racial and Ethnic Minorities (1)
- Registries (1)
- Risk (2)
- Shared Decision Making (1)
- Sleep Problems (2)
- Trauma (4)
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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 12 of 12 Research Studies DisplayedLuther M, Poppert Cordts KM, Williams CN
Sleep disturbances after pediatric traumatic brain injury: a systematic review of prevalence, risk factors, and association with recovery.
This is a systematic review to quantify sleep wake disturbances (SWD) after pediatric traumatic brain injury (TBI). These SWD can place children at risk for worse outcomes since sleep is needed for brain development and healing after injury. They also evaluated interventions for SWD and the association between SWD and other post-traumatic outcomes. Literature was searched from 1999-2019 evaluating sleep or fatigue in children hospitalized for TBI. Two independent reviewers assessed quality of the studies using the Newcastle-Ottowa Score for observational studies. Out of 966 identified articles, 126 full text articles were reviewed and 24 studies were included. Studies showed at least 20% of children with TBI had some degree of SWD including trouble falling or staying asleep, fatigue, daytime fatigue, and nightmares. SWD was negatively correlated with cognitive, behavioral, and quality of life outcomes. There was moderate-high risk of bias for all studies due to small sample size and lack of validated or objective SWD measures.
AHRQ-funded; HS022981.
Citation: Luther M, Poppert Cordts KM, Williams CN .
Sleep disturbances after pediatric traumatic brain injury: a systematic review of prevalence, risk factors, and association with recovery.
Sleep 2020 Oct;43(10):zsaa083. doi: 10.1093/sleep/zsaa083..
Keywords: Children/Adolescents, Sleep Problems, Brain Injury, Neurological Disorders, Trauma, Risk, Patient-Centered Outcomes Research, Outcomes, Quality of Life, Evidence-Based Practice
Porter A, Brown CC, Tilford JM
Association of insurance status with treatment and outcomes in pediatric patients with severe traumatic brain injury.
This study’s objective was to determine if a health insurance disparity exists among pediatric patients with severe traumatic brain injury using data from the National Trauma Data Bank. The Bank contains data from more than 800 trauma centers in the United States. Isolated traumatic brain injury was defined as patients with a head Abbreviated Injury Scale score of 3+. Procedure codes were used to identify four primary treatment approaches combined into 2 classifications: craniotomy or craniectomy and external or intracranial ventricular draining. Condition at admission was defined including hypotension, Glasgow Coma Scale, mechanism and intent of injury, and Injury Severity Scale. Among the cohort of 12,449 patients, 91% had insurance and 9% were uninsured. Children without insurance had worse condition at admission with higher rates of hypotension and higher Injury Severity Score when compared with publicly and privately insured patients. Having insurance was associated with a 32% increase in the odds of cranial procedures, and 54% increase in the odds of monitor placement. Insurance coverage was associated 25% lower odds of inpatient mortality. Further study is needed to determine what factors lead to worse condition at admission.
Citation: Porter A, Brown CC, Tilford JM .
Association of insurance status with treatment and outcomes in pediatric patients with severe traumatic brain injury.
Crit Care Med 2020 Jul;48(7):e584-e91. doi: 10.1097/ccm.0000000000004398..
Keywords: Children/Adolescents, Brain Injury, Trauma, Health Insurance, Access to Care, Uninsured, Outcomes
Henry MK, Feudtner C, Fortin K
Occult head injuries in infants evaluated for physical abuse.
Abusive head injuries in infants may be occult but clinically or forensically important. Data conflict regarding yield of neuroimaging in detecting occult head injuries in infants evaluated for physical abuse, with prior studies identifying yields of 4.3-37.3 %. The objectives of this study were (1) To quantify yield of computed tomography or magnetic resonance imaging in identification of occult head injuries in infants with concerns for physical abuse and (2) To evaluate risk factors for occult head injuries.
AHRQ-funded; HS024194.
Citation: Henry MK, Feudtner C, Fortin K .
Occult head injuries in infants evaluated for physical abuse.
Child Abuse Negl 2020 May;103:104431. doi: 10.1016/j.chiabu.2020.104431..
Keywords: Newborns/Infants, Brain Injury, Domestic Violence, Imaging, Diagnostic Safety and Quality, Injuries and Wounds
Probst MA, Gupta M, Hendey GW
Prevalence of intracranial injury in adult patients with blunt head trauma with and without anticoagulant or antiplatelet use.
In this study, the investigators determined the prevalence of significant intracranial injury among adults with blunt head trauma who are receiving preinjury anticoagulant or antiplatelet medications. The investigators concluded that patients receiving preinjury warfarin or a combination of aspirin and clopidogrel were at increased risk for significant intracranial injury, but not those receiving aspirin alone. They suggested that clinicians should have a low threshold for neuroimaging when evaluating patients receiving warfarin or a combination of aspirin and clopidogrel.
AHRQ-funded; HS009699.
Citation: Probst MA, Gupta M, Hendey GW .
Prevalence of intracranial injury in adult patients with blunt head trauma with and without anticoagulant or antiplatelet use.
Ann Emerg Med 2020 Mar;75(3):354-64. doi: 10.1016/j.annemergmed.2019.10.004..
Keywords: Brain Injury, Injuries and Wounds, Blood Thinners, Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events, Risk
Williams CN, Hartman ME, McEvoy CT
Sleep-wake disturbances after acquired brain injury in children surviving critical care.
Sleep-wake disturbances are underevaluated among children with acquired brain injury surviving critical care. In this prospective cohort study, the investigators aimed to quantify severity, phenotypes, and risk factors for sleep-wake disturbances. The investigators concluded that over half of children surviving critical care with acquired brain injury have sleep-wake disturbances. They indicated that many sleep-wake disturbances phenotypes were identified, but most children had disturbance in initiation and maintenance of sleep.
AHRQ-funded; HS022981.
Citation: Williams CN, Hartman ME, McEvoy CT .
Sleep-wake disturbances after acquired brain injury in children surviving critical care.
Pediatr Neurol 2020 Feb;103:43-51. doi: 10.1016/j.pediatrneurol.2019.08.010..
Keywords: Children/Adolescents, Brain Injury, Critical Care, Sleep Problems, Trauma, Injuries and Wounds, Neurological Disorders
Simon KC, Reams N, Beltran E
Optimizing the electronic medical record to improve patient care and conduct quality improvement initiatives in a concussion specialty clinic.
The purpose of this study was to use the electronic medical record (EMR) to optimize patient care, facilitate documentation, and support quality improvement and practice-based research in a concussion (mild traumatic brain injury; mTBI) clinic. The investigators built a customized structured clinical documentation support (SCDS) toolkit for patients in a concussion specialty clinic. The toolkit collected hundreds of fields of discrete,
AHRQ-funded; HS024057.
Citation: Simon KC, Reams N, Beltran E .
Optimizing the electronic medical record to improve patient care and conduct quality improvement initiatives in a concussion specialty clinic.
Brain Inj 2020;34(1):62-67. doi: 10.1080/02699052.2019.1680867..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Brain Injury, Neurological Disorders
McCabe AM, Kuppermann N
Generation of evidence and translation into practice: Lessons learned and future directions.
This article describes the experience of the Pediatric Emergency Care Applied Research Network (PECARN) in deriving and validating the traumatic brain injury prediction rules and how PECARN is translating these prediction rules into clinical practice. Furthermore, it discusses the potential for patient/parent shared decision-making with a focus on patient-centered outcomes in Emergency department research.
AHRQ-funded; HS023498.
Citation: McCabe AM, Kuppermann N .
Generation of evidence and translation into practice: Lessons learned and future directions.
Acad Emerg Med 2015 Dec;22(12):1372-9. doi: 10.1111/acem.12819.
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Keywords: Implementation, Evidence-Based Practice, Emergency Medical Services (EMS), Brain Injury, Children/Adolescents
Melnick ER, Shafer K, Rodulfo N
Understanding overuse of computed tomography for minor head injury in the emergency department: a triangulated qualitative study.
The objective was to identify nonclinical, human factors that promote or inhibit the appropriate use of computed tomography (CT) in patients presenting to the emergency department (ED) with minor head injury. Five core domains emerged from the analysis: establishing trust, anxiety (patient and provider), constraints related to ED practice, the influence of others, and patient expectations.
AHRQ-funded; HS021271.
Citation: Melnick ER, Shafer K, Rodulfo N .
Understanding overuse of computed tomography for minor head injury in the emergency department: a triangulated qualitative study.
Acad Emerg Med 2015 Dec;22(12):1474-83. doi: 10.1111/acem.12824.
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Keywords: Emergency Medical Services (EMS), Imaging, Brain Injury, Shared Decision Making, Health Services Research (HSR)
Easter JS, Haukoos JS, Meehan WP
Will neuroimaging reveal a severe intracranial injury in this adult with minor head trauma?: The rational clinical examination systematic review.
The study objective was to assess systematically the accuracy of symptoms and signs in adults with minor head trauma in order to identify those with severe intracranial injuries. It found that combinations of history and physical examination features in clinical decision rules can identify patients with minor head trauma at low risk of severe intracranial injuries.
AHRQ-funded; HS017526.
Citation: Easter JS, Haukoos JS, Meehan WP .
Will neuroimaging reveal a severe intracranial injury in this adult with minor head trauma?: The rational clinical examination systematic review.
JAMA 2015 Dec 22-29;314(24):2672-81. doi: 10.1001/jama.2015.16316..
Keywords: Falls, Brain Injury, Imaging, Trauma, Diagnostic Safety and Quality
Patel MB, Wilson LD, Bregman JA
Neurologic functional and quality of life outcomes after TBI: clinic attendees versus non-attendees.
This study describes the relationship between TBI patient demographics, quality of life outcome, and functional status outcome among clinic attendees and non-attendees. All participants were telephone surveyed using the Extended-Glasgow Outcome Scale (GOSE), the Quality of Life after Brain Injury (QOLIBRI) scale, and a post-discharge therapy questionnaire. Risk factors for GOSE and QOLIBRI outcomes included age, injury characteristics, clinic attendance, insurance status, post-discharge rehabilitation, and time from injury.
AHRQ-funded; HS013833.
Citation: Patel MB, Wilson LD, Bregman JA .
Neurologic functional and quality of life outcomes after TBI: clinic attendees versus non-attendees.
J Neurotrauma 2015 Jul 1;32(13):984-9. doi: 10.1089/neu.2014.3652..
Keywords: Brain Injury, Registries, Outcomes
Storzbach D, O'Neil ME, Roost SM
Comparing the neuropsychological test performance of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans with and without blast exposure, mild traumatic brain injury, and posttraumatic stress symptoms.
The purpose of this paper was to compare neuropsychological test performance of veterans with and without mild traumatic brain injury (MTBI), blast exposure, and posttraumatic stress disorder (PTSD) symptoms. The authors found that, although some mild neurocognitive effects were associated with blast exposure, these neurocognitive effects might be better explained by PTSD symptom severity rather than blast exposure or MTBI history alone.
AHRQ-funded; HS022981; HS019456.
Citation: Storzbach D, O'Neil ME, Roost SM .
Comparing the neuropsychological test performance of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans with and without blast exposure, mild traumatic brain injury, and posttraumatic stress symptoms.
J Int Neuropsychol Soc 2015 May;21(5):353-63. doi: 10.1017/s1355617715000326.
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Keywords: Brain Injury, Behavioral Health, Neurological Disorders
Meagher AD, Beadles CA, Doorey J
Racial and ethnic disparities in discharge to rehabilitation following traumatic brain injury.
The authors investigate racial disparities in discharge destination (inpatient rehabilitation vs skilled nursing facility vs home health vs home) following traumatic brain injury. They found that Hispanic and black patients were significantly less likely to be discharged to a higher level of rehabilitation than similarly matched non-Hispanic white patients. This disparity persisted in the subgroup examination of older adults with uniform Medicare coverage.
AHRQ-funded; HS000032.
Citation: Meagher AD, Beadles CA, Doorey J .
Racial and ethnic disparities in discharge to rehabilitation following traumatic brain injury.
J Neurosurg 2015 Mar;122(3):595-601. doi: 10.3171/2014.10.jns14187..
Keywords: Disparities, Racial and Ethnic Minorities, Brain Injury