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
1 to 25 of 69 Research Studies DisplayedLi SA, Alexander PE, Reljic T
Evidence to decision framework provides a structured "roadmap" for making GRADE guidelines recommendations.
It is unclear how guidelines panelists discuss and consider factors (criteria) that are formally and not formally included in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. To describe the use of decision criteria, the investigators explored how panelists adhered to GRADE criteria and sought to identify any emerging non-GRADE criteria when the panelists used the Evidence to Decision (EtD) framework as part of GRADE application.
AHRQ-funded; HS024917.
Citation: Li SA, Alexander PE, Reljic T .
Evidence to decision framework provides a structured "roadmap" for making GRADE guidelines recommendations.
J Clin Epidemiol 2018 Dec;104:103-12. doi: 10.1016/j.jclinepi.2018.09.007..
Keywords: Evidence-Based Practice, Guidelines, Shared Decision Making
Vermandere M, Kuijpers T, Burgers JS
Alpha-Blockers for uncomplicated ureteric stones: a clinical practice guideline.
This paper develops an evidence-based recommendation for the use of alpha-blockers for treating uncomplicated ureteric stones. It is based on an up-to-date Cochran review and applies the Rapid Recommendations approach to guideline development. An international panel of clinicians, researchers, methodologists and patient representatives was created and a recommendation was created. There is only low-quality evidence for using alpha-blockers and the net benefit was found to be small.
AHRQ-funded; HS025701.
Citation: Vermandere M, Kuijpers T, Burgers JS .
Alpha-Blockers for uncomplicated ureteric stones: a clinical practice guideline.
BJU Int 2018 Dec;122(6):924-31. doi: 10.1111/bju.14457..
Keywords: Evidence-Based Practice, Guidelines, Medication
Neal JL, Lowe NK, Phillippi JC
Likelihood of cesarean birth among parous women after applying leading active labor diagnostic guidelines.
The goals of this study were: Determine the proportions of women admitted to the hospital before or in active labor per the leading National Institute for Health and Care Excellence (NICE), and the American College of Obstetricians and Gynecologists/Society for Maternal-Fetal Medicine (ACOG/SMFM) guidelines; Compare associations of labor status at admission with oxytocin augmentation, cesarean birth, and adverse birth outcomes when using the different active labor diagnostic guidelines. Active labor diagnostic guidelines were applied retrospectively to cervical examination data. The authors conclude that many parous women with spontaneous labor onset are admitted to the hospital before active labor, and these women are more likely to receive oxytocin augmentation during labor and to have a cesarean birth. Implications for practice are discussed.
AHRQ-funded; HS024733.
Citation: Neal JL, Lowe NK, Phillippi JC .
Likelihood of cesarean birth among parous women after applying leading active labor diagnostic guidelines.
Midwifery 2018 Dec;67:64-69. doi: 10.1016/j.midw.2018.09.007..
Keywords: Shared Decision Making, Guidelines, Hospitalization, Labor and Delivery, Pregnancy, Women
Magrath M, Yang E, Ahn C
Impact of a clinical decision support system on guideline adherence of surveillance recommendations for colonoscopy after polypectomy.
The goal of this study was to characterize guideline adherence of surveillance recommendations after implementation of an electronic medical record (EMR)-based Colonoscopy Pathology Reporting and Clinical Decision Support System (CoRS). Results showed that an EMR-based CoRS was widely used and significantly improved guideline adherence of surveillance recommendations.
AHRQ-funded; HS022418.
Citation: Magrath M, Yang E, Ahn C .
Impact of a clinical decision support system on guideline adherence of surveillance recommendations for colonoscopy after polypectomy.
J Natl Compr Canc Netw 2018 Nov;16(11):1321-28. doi: 10.6004/jnccn.2018.7050..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Colonoscopy, Cancer: Colorectal Cancer, Screening, Cancer, Guidelines, Evidence-Based Practice, Patient-Centered Outcomes Research, Prevention
Wolff T, Jadotte YJ
AHRQ Author: Wolff T
Screening for prostate cancer.
This case study describes a 57-year-old black man, non-smoker, who has a history of diabetes mellitus, currently well-controlled. He would like to discuss the prostate-specific antigen (PSA) test even though he has no family history of prostate cancer. The case study questions are based on USPSTF recommendations for prostate cancer screening.
AHRQ-authored.
Citation: Wolff T, Jadotte YJ .
Screening for prostate cancer.
Am Fam Physician 2018 Oct 15;98(8):537-38..
Keywords: Cancer: Prostate Cancer, Case Study, Guidelines, Prevention, Screening
Admon AJ, Gupta A, Williams M
Appraising the evidence supporting Choosing Wisely(R) recommendations.
This study’s objective was to appraise the evidence supporting the Choosing Wisely® campaign initiated by the American Board of Internal Medicine (ABIM) Foundation to advance dialogue on prevention of unnecessary medical tests, treatments, and procedures. The authors extracted all 320 recommendations that were published through August 2014. The recommendations were then categorized by evidence strength and then a sample of referenced clinical practice guidelines (CPGs) using the validated Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Overall, 70.3% of recommendations cited CPGs, whereas 22.2% cited primary research as their highest evidence level. Hospital medicine recommendations cited CPGs 90% of the time. However, the median overall score using AGREE II was 54.2% and even for hospital medicine-referenced CPGs was 58.3%.
AHRQ-funded; HS020672.
Citation: Admon AJ, Gupta A, Williams M .
Appraising the evidence supporting Choosing Wisely(R) recommendations.
J Hosp Med 2018 Oct;13(10):688-91. doi: 10.12788/jhm.2964..
Keywords: Shared Decision Making, Evidence-Based Practice, Guidelines, Prevention, Quality of Care, Quality Improvement
Tracer H, Jadotte YT
AHRQ Author: Tracer H
Screening for cardiovascular disease risk with electrocardiography.
This paper presents a case study, along with questions and answers, related to the U.S. Preventive Services Task Force (USPSTF) recommendations for screening for cardiovascular disease risk with electrocardiography.
AHRQ-authored.
Citation: Tracer H, Jadotte YT .
Screening for cardiovascular disease risk with electrocardiography.
Am Fam Physician 2018 Sep 15;98(6):375-76..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cardiovascular Conditions, Screening, Risk, Prevention, Guidelines, Evidence-Based Practice, Case Study
Koziatek CA, Simon E, Horwitz LI
Automated pulmonary embolism risk classification and guideline adherence for computed tomography pulmonary angiography ordering.
The objective of this study was to measure the performance of automated, structured data-only versions of the Wells and revised Geneva risk scores in emergency department encounters during which a computed tomography pulmonary angiography was ordered. The hypothesis was that such an automated method would classify a patient's pulmonary embolism risk with high accuracy compared to manual chart review.
AHRQ-funded; HS024376.
Citation: Koziatek CA, Simon E, Horwitz LI .
Automated pulmonary embolism risk classification and guideline adherence for computed tomography pulmonary angiography ordering.
Acad Emerg Med 2018 Sep;25(9):1053-61. doi: 10.1111/acem.13442..
Keywords: Respiratory Conditions, Risk, Diagnostic Safety and Quality, Emergency Department, Imaging, Guidelines
Durkin MJ, Keller M, Butler AM
An assessment of inappropriate antibiotic use and guideline adherence for uncomplicated urinary tract infections.
In 2011, The Infectious Diseases Society of America released a clinical practice guideline (CPG) that recommended short-course antibiotic therapy and avoidance of fluoroquinolones for uncomplicated urinary tract infections (UTIs). This study assessed whether the CPG had an impact on national antibiotic prescribing practices. The study found that CPG was not associated with a clinically meaningful change in national antibiotic prescribing practices for UTIs.
AHRQ-funded; HS019455.
Citation: Durkin MJ, Keller M, Butler AM .
An assessment of inappropriate antibiotic use and guideline adherence for uncomplicated urinary tract infections.
Open Forum Infect Dis 2018 Sep;5(9):ofy198. doi: 10.1093/ofid/ofy198..
Keywords: Antibiotics, Shared Decision Making, Guidelines, Practice Patterns, Urinary Tract Infection (UTI)
Lee DJ, Barocas DA, Zhao Z
Contemporary prostate cancer radiation therapy in the United States: patterns of care and compliance with quality measures.
This study measured compliance with quality measures for radiation therapy treatment of prostate cancer. The Comparative Effectiveness Analysis of Surgery and Radiation Study enrolled men who were treated for localized prostate cancer from 2011 and 2012. Medical records were reviewed, and patients completed surveys. Researchers concluded that men who received external beam radiation therapy (EBRT) were treated more appropriately than those treated with brachytherapy (BT). White men were also more likely to receive appropriate treatment than African-American and other minorities.
AHRQ-funded; HS019356; HS022640.
Citation: Lee DJ, Barocas DA, Zhao Z .
Contemporary prostate cancer radiation therapy in the United States: patterns of care and compliance with quality measures.
Pract Radiat Oncol 2018 Sep-Oct;8(5):307-16. doi: 10.1016/j.prro.2018.04.009..
Keywords: Cancer, Cancer: Prostate Cancer, Comparative Effectiveness, Evidence-Based Practice, Guidelines, Patient-Centered Outcomes Research, Practice Patterns, Quality Measures
Jonas DE, Kahwati LC, Yun JDY
Screening for atrial fibrillation with electrocardiography: evidence report and systematic review for the US Preventive Services Task Force.
The objective of this study was to review the evidence on screening for nonvalvular atrial fibrillation with electrocardiography (ECG) and stroke prevention treatment in asymptomatic adults 65 years or older to inform the US Preventive Services Task Force. The authors concluded that although screening with ECG can detect previously unknown cases of atrial fibrillation, it has not been shown to detect more cases than screening focused on pulse palpation.
AHRQ-funded; 290201500011I.
Citation: Jonas DE, Kahwati LC, Yun JDY .
Screening for atrial fibrillation with electrocardiography: evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2018 Aug 7;320(5):485-98. doi: 10.1001/jama.2018.4190..
Keywords: U.S. Preventive Services Task Force (USPSTF), Heart Disease and Health, Cardiovascular Conditions, Screening, Evidence-Based Practice, Guidelines, Prevention
Trent SA, Johnson MA, Morse EA
Patient, provider, and environmental factors associated with adherence to cardiovascular and cerebrovascular clinical practice guidelines in the ED.
The primary objectives of this study were to estimate differences in emergency department (ED) adherence across coronary-related clinical practice guidelines (CPGs) and identify patient, provider, and environmental factors associated with adherence. The investigators found that adherence to ED CPGs for acute coronary syndrome, ST-elevation myocardial infarction, or acute ischemic stroke, differs significantly between cardiovascular and cerebrovascular diseases and is more likely to occur when the diagnosis is highly suggested by the patient's complaint and acknowledged as the primary diagnosis by the treating ED physician.
AHRQ-funded; HS022400.
Citation: Trent SA, Johnson MA, Morse EA .
Patient, provider, and environmental factors associated with adherence to cardiovascular and cerebrovascular clinical practice guidelines in the ED.
Am J Emerg Med 2018 Aug;36(8):1397-404. doi: 10.1016/j.ajem.2017.12.062..
Keywords: Cardiovascular Conditions, Emergency Department, Guidelines, Practice Patterns
Rhee C, Brown SR, Jones TM
Variability in determining sepsis time zero and bundle compliance rates for the Centers for Medicare and Medicaid services SEP-1 measure.
This study compared sepsis ‘time zero’ and CMS SEP-1 pass rates among 3 abstractors in 3 hospitals. Abstractors agreed on time zero in 29 out of 80 cases, and the perceived pass rates ranged from 9 to 19 out of 80 cases (23%). The authors conclude that this variability in time zero and perceived pass rates limits the utility of SEP-1 for measuring quality.
AHRQ-funded; HS025008.
Citation: Rhee C, Brown SR, Jones TM .
Variability in determining sepsis time zero and bundle compliance rates for the Centers for Medicare and Medicaid services SEP-1 measure.
Infect Control Hosp Epidemiol 2018 Aug;39(8):994-96. doi: 10.1017/ice.2018.134..
Keywords: Guidelines, Quality of Care, Quality Measures, Sepsis
Sittig DF, Salimi M, Aiyagari R
Adherence to recommended electronic health record safety practices across eight health care organizations.
The Safety Assurance Factors for EHR Resilience (SAFER) guides were released in 2014 to help health systems conduct proactive risk assessment of electronic health record (EHR)- safety related policies, processes, procedures, and configurations. This study examined the extent to which SAFER recommendations are followed. The study concluded that despite availability of recommendations on how to improve use of EHRs, most recommendations were not fully implemented. New national policy initiatives are needed to stimulate implementation of these best practices.
AHRQ-funded; HS024459; HS022087; HS023602.
Citation: Sittig DF, Salimi M, Aiyagari R .
Adherence to recommended electronic health record safety practices across eight health care organizations.
J Am Med Inform Assoc 2018 Jul;25(7):913-18. doi: 10.1093/jamia/ocy033..
Keywords: Electronic Health Records (EHRs), Guidelines, Health Information Technology (HIT), Patient Safety, Provider
Leyenaar JK, Shevenell M, Rizzo PA
Multi-stakeholder informed guidelines for direct admission of children to hospital.
The purpose of this study is to develop pediatric direct admission guidelines and prioritize outcomes to evaluate the safety and effectiveness of hospital admission processes. The investigators concluded that these direct admission guidelines can be adapted by hospitals and health systems to inform hospital admission policies and protocols. Multistakeholder engagement in evaluation of hospital admission processes may improve transitions of care and health system integration.
AHRQ-funded; HS024133.
Citation: Leyenaar JK, Shevenell M, Rizzo PA .
Multi-stakeholder informed guidelines for direct admission of children to hospital.
J Pediatr 2018 Jul;198:273-78.e7. doi: 10.1016/j.jpeds.2018.03.007..
Keywords: Children/Adolescents, Guidelines, Hospitalization, Hospitals, Patient Safety
Kanters AE, Morris AM, Albrahamse PH
The effect of peer support on colorectal cancer patients' adherence to guideline-concordant multidisciplinary care.
Dis Colon Rectum 2018 Jul;61(7):817-23. doi: 10.1097/dcr.0000000000001067.
The purpose of this study was to evaluate the effect of peer support on the attitudes of patients with colorectal cancer toward chemotherapy and their adherence to it. The study demonstrated that exposure to peer support is associated with higher adjuvant chemotherapy adherence.
The purpose of this study was to evaluate the effect of peer support on the attitudes of patients with colorectal cancer toward chemotherapy and their adherence to it. The study demonstrated that exposure to peer support is associated with higher adjuvant chemotherapy adherence.
AHRQ-funded; HS000053.
Citation: Kanters AE, Morris AM, Albrahamse PH .
The effect of peer support on colorectal cancer patients' adherence to guideline-concordant multidisciplinary care.
Dis Colon Rectum 2018 Jul;61(7):817-23. doi: 10.1097/dcr.0000000000001067..
Keywords: Cancer: Colorectal Cancer, Treatments, Guidelines, Medication, Patient Adherence/Compliance
Egan BM, Li J, Davis RA
Differences in primary cardiovascular disease prevention between the 2013 and 2016 cholesterol guidelines and impact of the 2017 hypertension guideline in the United States.
The US Preventive Services Task Force cholesterol guideline recommended statins for fewer adults than the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline by setting a higher 10-year atherosclerotic cardiovascular disease threshold and requiring concomitant diabetes mellitus, hypertension, dyslipidemia, or cigarette smoking. The 2017 ACC/AHA hypertension guideline lowered the hypertension threshold, increasing 2016 guideline statin-eligible adults. This article discusses differences in primary cardiovascular disease prevention between the 2013 and 2016 cholesterol guidelines and impact of the 2017 hypertension guideline in the United States.
AHRQ-funded; P30 HS021667.
Citation: Egan BM, Li J, Davis RA .
Differences in primary cardiovascular disease prevention between the 2013 and 2016 cholesterol guidelines and impact of the 2017 hypertension guideline in the United States.
J Clin Hypertens 2018 Jun;20(6):991-1000. doi: 10.1111/jch.13314..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Evidence-Based Practice, Guidelines, Blood Pressure, Medication, Prevention, Primary Care, U.S. Preventive Services Task Force (USPSTF)
Greenhawt M, Chan ES, Fleischer DM
Caregiver and expecting caregiver support for early peanut introduction guidelines.
This study investigates caregiver preferences for early peanut introduction (EPI) recommendations. The study concluded that among new and expecting caregivers, there is poor current willingness and questionable support for early allergenic solid food recommendations, including in-office allergy risk assessment before introduction. Willingness was better among expecting vs current caregivers.
AHRQ-funded; HS024599.
Citation: Greenhawt M, Chan ES, Fleischer DM .
Caregiver and expecting caregiver support for early peanut introduction guidelines.
Ann Allergy Asthma Immunol 2018 Jun;120(6):620-25. doi: 10.1016/j.anai.2018.03.001..
Keywords: Caregiving, Children/Adolescents, Guidelines, Newborns/Infants, Patient-Centered Outcomes Research
Engelgau MM, Narayan KMV, Ezzati M
AHRQ Author: Meyers D
Implementation research to address the United States health disadvantage: report of a National Heart, Lung, and Blood Institute workshop.
This paper discusses the meeting of a panel of national and international health experts and stakeholders for a Think Tank meeting to explore the U.S. health disadvantage and to seek specific recommendations for implementation research opportunities for heart, lung, blood, and sleep disorders, convened by the National Heart, Lung, and Blood Institute.
AHRQ-authored.
Citation: Engelgau MM, Narayan KMV, Ezzati M .
Implementation research to address the United States health disadvantage: report of a National Heart, Lung, and Blood Institute workshop.
Glob Heart 2018 Jun;13(2):65-72. doi: 10.1016/j.gheart.2018.03.003.
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Keywords: Cardiovascular Conditions, Guidelines, Research Methodologies
Villani J, Ngo-Metzger Q, Vincent IS
AHRQ Author: Ngo-Metzger Q
Sources of funding for research in evidence reviews that inform recommendations of the US Preventive Services Task Force.
This study characterizes the sources of funding for the scientific evidence base used by the USPSTF. One or more funding sources were identified for 79 percent of the 1,650 research articles. Government agencies provided support for 931 articles (56 percent). The remaining support came from nonprofits or universities (530 articles, 32 percent) and industry (282 articles, 17 percent).The sources of funding varied by recommendation topic.
AHRQ-authored.
Citation: Villani J, Ngo-Metzger Q, Vincent IS .
Sources of funding for research in evidence reviews that inform recommendations of the US Preventive Services Task Force.
JAMA 2018 May 22;319(20):2132-33. doi: 10.1001/jama.2018.5404.
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Keywords: Evidence-Based Practice, Guidelines, Prevention, Research Methodologies, U.S. Preventive Services Task Force (USPSTF)
Klara K, Kim J, Ross JS
Direct-to-consumer broadcast advertisements for pharmaceuticals: off-label promotion and adherence to FDA guidelines.
Direct-to-consumer (DTC) advertisements for prescription drugs in the United States are regulated by the Food and Drug Administration (FDA). Off-label promotion, or the advertisement of a drug for an indication not approved by the FDA, is prohibited. The objective of this study was to examine the presence of off-label promotion in broadcast DTC ads and to assess their adherence to FDA guidelines mandating fair balance in presentation of risks and benefits and prohibiting misleading advertisement claims.
AHRQ-funded; HS022882.
Citation: Klara K, Kim J, Ross JS .
Direct-to-consumer broadcast advertisements for pharmaceuticals: off-label promotion and adherence to FDA guidelines.
J Gen Intern Med 2018 May;33(5):651-58. doi: 10.1007/s11606-017-4274-9..
Keywords: Medication, Guidelines, Policy, Communication
Wiesenthal AC, Patel SP, LeBlanc TW
Top ten tips for palliative care clinicians caring for cancer patients receiving immunotherapies.
In this study, the investigators aim to further engage palliative care specialists in the active care of cancer patients receiving immunotherapeutics and use a "Top 10" tips format to concisely present practical learning points to busy clinicians.
AHRQ-funded; HS023681.
Citation: Wiesenthal AC, Patel SP, LeBlanc TW .
Top ten tips for palliative care clinicians caring for cancer patients receiving immunotherapies.
J Palliat Med 2018 May;21(5):694-99. doi: 10.1089/jpm.2018.0107..
Keywords: Palliative Care, Cancer, Guidelines
Gilmore-Bykovskyi A, Johnson R, Walljasper L
Underreporting of gender and race/ethnicity differences in NIH-funded dementia caregiver support interventions.
The objective of this study was to determine the inclusion and reporting rates among NIH-funded dementia caregiver support interventions. Findings suggested limited NIH guideline compliance that may reflect a lack of awareness regarding potential gender disparities in caregiving roles. In order to ensure NIH guideline compliance, shared investments from researchers, editors, and reviewers to make certain that group differences are systematically identified and reported are recommended.
AHRQ-funded; HS022548.
Citation: Gilmore-Bykovskyi A, Johnson R, Walljasper L .
Underreporting of gender and race/ethnicity differences in NIH-funded dementia caregiver support interventions.
Am J Alzheimers Dis Other Demen 2018 May;33(3):145-52. doi: 10.1177/1533317517749465..
Keywords: Caregiving, Sex Factors, Racial and Ethnic Minorities, Guidelines, Dementia, Disparities
Hoffman AS, Sepucha KR, Abhyankar P
Explanation and elaboration of the Standards for UNiversal reporting of patient Decision Aid Evaluations (SUNDAE) guidelines: examples of reporting SUNDAE items from patient decision aid evaluation literature.
This Explanation and Elaboration article expands on the 26 items in the SUNDAE guidelines, providing a rationale for each item, and including examples for how each item has been reported in published papers evaluating patient decision aids. Authors and reviewers may wish to use it broadly to inform structuring of patient decision aid evaluation reports, or use it as a reference to obtain details about how to report individual checklist items.
AHRQ-funded; HS024250.
Citation: Hoffman AS, Sepucha KR, Abhyankar P .
Explanation and elaboration of the Standards for UNiversal reporting of patient Decision Aid Evaluations (SUNDAE) guidelines: examples of reporting SUNDAE items from patient decision aid evaluation literature.
BMJ Qual Saf 2018 May;27(5):389-412. doi: 10.1136/bmjqs-2017-006985..
Keywords: Shared Decision Making, Guidelines, Patient-Centered Healthcare, Patient and Family Engagement, Quality of Care
Hoffman AS, Sepucha KR, Abhyankar P
Explanation and elaboration of the Standards for UNiversal reporting of patient Decision Aid Evaluations (SUNDAE) guidelines: examples of reporting SUNDAE items from patient decision aid evaluation literature.
This Explanation and Elaboration article expands on the 26 items in the SUNDAE guidelines, providing a rationale for each item, and including examples for how each item has been reported in published papers evaluating patient decision aids. Authors and reviewers may wish to use it broadly to inform structuring of patient decision aid evaluation reports, or use it as a reference to obtain details about how to report individual checklist items.
AHRQ-funded; HS024250.
Citation: Hoffman AS, Sepucha KR, Abhyankar P .
Explanation and elaboration of the Standards for UNiversal reporting of patient Decision Aid Evaluations (SUNDAE) guidelines: examples of reporting SUNDAE items from patient decision aid evaluation literature.
BMJ Qual Saf 2018 May;27(5):389-412. doi: 10.1136/bmjqs-2017-006985..
Keywords: Shared Decision Making, Guidelines, Patient-Centered Healthcare, Patient and Family Engagement, Quality of Care