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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 115 Research Studies DisplayedAneja S, Chang E, Omuro A
Applications of artificial intelligence in neuro-oncology.
This article explores the promise that artificial intelligence algorithms has for improving understanding of brain tumors and help drive future innovations in neuro-oncology.
AHRQ-funded; HS023000.
Citation: Aneja S, Chang E, Omuro A .
Applications of artificial intelligence in neuro-oncology.
Curr Opin Neurol 2019 Dec;32(6):850-56. doi: 10.1097/wco.0000000000000761.
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Keywords: Health Information Technology (HIT), Cancer, Diagnostic Safety and Quality, Imaging
Shafer G, Singh H, Suresh G
Diagnostic errors in the neonatal intensive care unit: state of the science and new directions.
In this narrative review, the authors discuss how the concept of diagnostic errors framed as missed opportunities can be applied to the non-linear nature of diagnosis in a critical care environment such as the NICU. They then explore how the etiology of an error in diagnosis can be related to both individual cognitive factors as well as organizational and systemic factors - all of which often contribute to the error.
AHRQ-funded; HS022087.
Citation: Shafer G, Singh H, Suresh G .
Diagnostic errors in the neonatal intensive care unit: state of the science and new directions.
Semin Perinatol 2019 Dec;43(8):151175. doi: 10.1053/j.semperi.2019.08.004..
Keywords: Newborns/Infants, Diagnostic Safety and Quality, Neonatal Intensive Care Unit (NICU), Medical Errors, Adverse Events, Patient Safety
Esfandiari NH, Hughes DT, Reyes-Gastelum D
Factors associated with diagnosis and treatment of thyroid microcarcinomas.
The authors sought to determine diagnostic pathways for microcarcinomas versus larger cancers. Surveying patients from the Georgia and Los Angeles Surveillance, Epidemiology, and End Results (SEER) registries with differentiated thyroid cancer, they found that thyroid microcarcinomas are more likely to be detected by ultrasound and less likely to be associated with surgery scheduled for known thyroid cancer. They concluded that understanding diagnostic pathways allows for targeted interventions to decrease overdiagnosis and overtreatment.
AHRQ-funded; HS024512.
Citation: Esfandiari NH, Hughes DT, Reyes-Gastelum D .
Factors associated with diagnosis and treatment of thyroid microcarcinomas.
J Clin Endocrinol Metab 2019 Dec;104(12):6060-68. doi: 10.1210/jc.2019-01219..
Keywords: Cancer, Diagnostic Safety and Quality
Singh H, Graber ML, Hofer TP
Measures to improve diagnostic safety in clinical practice.
In this paper, the investigators discuss how the need to develop measures to improve diagnostic performance could move forward at a time when the scientific foundation needed to inform measurement is still evolving. They highlight challenges and opportunities for developing potential measures of "diagnostic safety" related to clinical diagnostic errors and associated preventable diagnostic harm. In doing so, they propose a starter set of measurement concepts for initial consideration that seem reasonably related to diagnostic safety and call for these to be studied and further refined.
AHRQ-funded; HS022087.
Citation: Singh H, Graber ML, Hofer TP .
Measures to improve diagnostic safety in clinical practice.
J Patient Saf 2019 Dec;15(4):311-16. doi: 10.1097/pts.0000000000000338.
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Keywords: Patient Safety, Diagnostic Safety and Quality, Healthcare Delivery, Quality Improvement, Quality of Care, Medical Errors, Adverse Events
Campione JR, Mardon RE, McDonald KM
Patient safety culture, health information technology implementation, and medical office problems that could lead to diagnostic error.
Researchers investigated the relationship between patient safety culture, health information technology (IT) implementation, and the frequency of problems that could lead to diagnostic errors in the medical office setting. Using survey data from the 2012 Agency for Healthcare Research and Quality Medical Office Surveys on Patient Safety Culture database, they found that the most frequent problem was "results from a lab or imaging test were not available when needed," with 15% of respondents reporting that it happened daily or weekly. Higher overall culture scores were significantly associated with fewer occurrences of each problem assessed, and offices in the process of health IT implementation had higher frequency of problems.
AHRQ-funded; 290201200003I.
Citation: Campione JR, Mardon RE, McDonald KM .
Patient safety culture, health information technology implementation, and medical office problems that could lead to diagnostic error.
J Patient Saf 2019 Dec;15(4):267-73. doi: 10.1097/pts.0000000000000531..
Keywords: Surveys on Patient Safety Culture, Health Information Technology (HIT), Diagnostic Safety and Quality, Patient Safety, Ambulatory Care and Surgery
Zins ZP, Wheeler KK, Brink F
Trends in US physician diagnosis of child physical abuse and neglect injuries, 2006-2014.
The purpose of this study was to determine if US child physical abuse and neglect injury rates changed from 2006 to 2014, whether definitive diagnoses of physical abuse and neglect were used more often over time, and what patient factors influenced definitive physical maltreatment diagnoses. The investigators found that definitive diagnoses of physical abuse and neglect increased over the study period and were associated with hospital volume and patient characteristics which may reflect provider experience and possible bias.
AHRQ-funded; HS024263.
Citation: Zins ZP, Wheeler KK, Brink F .
Trends in US physician diagnosis of child physical abuse and neglect injuries, 2006-2014.
Child Abuse Negl 2019 Dec;98:104179. doi: 10.1016/j.chiabu.2019.104179..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Diagnostic Safety and Quality, Domestic Violence, Injuries and Wounds, Emergency Department, Hospitalization
Perkins NJ, Weck J, Mumford SL
AHRQ Author: Mitchell EM
Combining biomarker calibration data to reduce measurement error.
This paper discusses biomarker assay measurement, stating that collapsing calibration information across batches before statistical analysis has been shown to reduce measurement error and improve estimation. Further, these simple and practical procedures are minor adjustments implemented by study personnel without altering laboratory protocols which could have positive estimation and cost-saving implications especially for population-based studies.
AHRQ-authored.
Citation: Perkins NJ, Weck J, Mumford SL .
Combining biomarker calibration data to reduce measurement error.
Epidemiology 2019 Nov;30 Suppl 2:S3-s9. doi: 10.1097/ede.0000000000001094..
Keywords: Diagnostic Safety and Quality
Lacson R, Gujrathi I, Healey M
Closing the loop on unscheduled diagnostic imaging orders: a systems-based approach.
This study looked at the impact of implementing a tool called SCORE (System for Coordinating Orders for Radiology Exams), whose objective is to manage unscheduled orders for outpatient diagnostic imaging in an electronic health record (EHR) with embedded computerized physician order entry. The rate of unscheduled imaging orders was compared before SCORE (October 2017 to September 2018) and after (October 2018 to June 2019). There was a 49% reduction in unscheduled orders after SCORE implementation at a large academic institution.
AHRQ-funded; HS024722.
Citation: Lacson R, Gujrathi I, Healey M .
Closing the loop on unscheduled diagnostic imaging orders: a systems-based approach.
J Am Coll Radiol 2021 Jan;18(1 Pt A):60-67. doi: 10.1016/j.jacr.2020.09.031..
Keywords: Imaging, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Levy AE, Shah NR, Matheny ME
Determining post-test risk in a national sample of stress nuclear myocardial perfusion imaging reports: implications for natural language processing tools.
The authors investigated whether Natural Language Processing (NLP) tools could potentially help estimate myocardial perfusion imaging (MPI) risk. Subjects were VA patients who underwent stress MPI and coronary angiography 2009-11; stress test reports were randomly selected for analysis. The authors found that post-test ischemic risk was determinable but rarely reported in this sample of stress MPI reports. They conclude that this supports the potential use of NLP to help clarify risk and recommend further study of NLP in this context.
AHRQ-funded; HS022998.
Citation: Levy AE, Shah NR, Matheny ME .
Determining post-test risk in a national sample of stress nuclear myocardial perfusion imaging reports: implications for natural language processing tools.
J Nucl Cardiol 2019 Dec;26(6):1878-85. doi: 10.1007/s12350-018-1275-y..
Keywords: Imaging, Risk, Clinical Decision Support (CDS), Health Information Technology (HIT), Diagnostic Safety and Quality, Cardiovascular Conditions, Heart Disease and Health
Papaleontiou M, Chen DW, Banerjee M
Thyrotropin suppression for papillary thyroid cancer: a physician survey study.
AHRQ-funded; HS024512.
Citation: Papaleontiou M, Chen DW, Banerjee M .
Thyrotropin suppression for papillary thyroid cancer: a physician survey study.
Thyroid 2021 Sep;31(9):1383-90. doi: 10.1089/thy.2021.0033..
Keywords: Cancer, Diagnostic Safety and Quality
Gray DT, Mizrahi T
AHRQ Author: Gray DT, Mizrahi T
Trends in appendicitis and perforated appendicitis prevalence in children in the United States, 2001-2015,
This cross-sectional study examined trends in appendicitis and perforated appendicitis in children in the United States from 2001 to 2015 using State Inpatient Databases (SIDS) HCUP data. Investigators found that rates of perforated appendicitis rose during that time period.
AHRQ-authored.
Citation: Gray DT, Mizrahi T .
Trends in appendicitis and perforated appendicitis prevalence in children in the United States, 2001-2015,
JAMA Netw Open 2020 Oct;3(10):e2023484. doi: 10.1001/jamanetworkopen.2020.23484..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Diagnostic Safety and Quality
Danforth KN, Hahn EE, Slezak JM
Follow-up of abnormal estimated GFR results within a large integrated health care delivery system: a mixed-methods study.
This study examined the rates of follow-up with patients after abnormal estimated glomular filtration rate (eGFR) laboratory results, which may indicate chronic kidney disease. A large integrated health system was used with a total of 244,540 patients aged 21 or older with abnormal eGFRs were included from January 2010 through December 2015. Timely follow-up was defined as repeat eGFR testing within 60 to 150 days, follow-up testing before 60 days that indicated normal kidney function, or diagnosis before 60 days of chronic kidney disease or kidney cancer. Follow-up was found to be poor, with 58% of patients lacking timely follow-up. Fifteen physicians were also interviewed and it was found that both system-level and provider-level factors influenced follow-up rates.
AHRQ-funded; HS024437.
Citation: Danforth KN, Hahn EE, Slezak JM .
Follow-up of abnormal estimated GFR results within a large integrated health care delivery system: a mixed-methods study.
Am J Kidney Dis 2019 Nov;74(5):589-600. doi: 10.1053/j.ajkd.2019.05.003..
Keywords: Healthcare Delivery, Diagnostic Safety and Quality, Kidney Disease and Health, Electronic Health Records (EHRs), Health Information Technology (HIT), Chronic Conditions
Keshvani N, Berger K, Gupta A
Improving respiratory rate accuracy in the hospital: a quality improvement initiative.
Researchers initiated a quality improvement (QI) initiative in hospitals to improve respiratory rate measurement accuracy. Time-keeping devices were added to vital sign carts and patient care assistants were retrained on a newly modified workflow that included concomitant respiratory rate (RR) measurement during automated blood pressure measurement. The median RR measurement rate increased postintervention. This intervention was associated with a 7.8% reduced incidence of tachypnea-specific systemic inflammatory response syndrome. This QI initiative was interdisciplinary, low-cost, and low-tech.
AHRQ-funded; HS022418.
Citation: Keshvani N, Berger K, Gupta A .
Improving respiratory rate accuracy in the hospital: a quality improvement initiative.
J Hosp Med 2019 Nov 1;14(10):673-77. doi: 10.12788/jhm.3232..
Keywords: Patient-Centered Outcomes Research, Quality Improvement, Inpatient Care, Diagnostic Safety and Quality, Hospitals, Quality of Care, Outcomes
Kang SK, Garry K, Chung R
Natural language processing for identification of incidental pulmonary nodules in radiology reports.
The authors developed natural language processing (NLP) to identify incidental lung nodules (ILNs) in radiology reports for assessment of management recommendations using the electronic health records for patients who underwent chest CT before and after implementation of a department-wide dictation macro of the Fleischner Society recommendations. They concluded that NLP reliably automates identification of ILNs in unstructured reports, pertinent to quality improvement efforts for ILN management.
AHRQ-funded; HS024376.
Citation: Kang SK, Garry K, Chung R .
Natural language processing for identification of incidental pulmonary nodules in radiology reports.
J Am Coll Radiol 2019 Nov;16(11):1587-94. doi: 10.1016/j.jacr.2019.04.026..
Keywords: Imaging, Diagnostic Safety and Quality, Health Information Technology (HIT), Electronic Health Records (EHRs), Quality Improvement, Quality of Care
Fu Y, Wu X, Thomas AM
Automatic large quantity landmark pairs detection in 4DCT lung images.
A new method was developed to automatically and precisely detect a large quantity of landmark pairs between lung computed tomography (CT) image pairs. The detected landmark pairs could be used as benchmark datasets for more accurate and informative quantitative evaluation of DIR algorithms. Target registration errors (TREs) were measured for 300 manually labeled landmark pairs in 10 lung 4DCT benchmark datasets (DIRLAB) with 97% of landmark pairs having a TRE smaller than 2 mm.
AHRQ-funded; HS022888.
Citation: Fu Y, Wu X, Thomas AM .
Automatic large quantity landmark pairs detection in 4DCT lung images.
Med Phys 2019 Oct;46(10):4490-501. doi: 10.1002/mp.13726..
Keywords: Imaging, Diagnostic Safety and Quality
Niu X, Amendola LM, Hart R
Clinical exome sequencing vs. usual care for hereditary colorectal cancer diagnosis: a pilot comparative effectiveness study.
The purpose of this study was to evaluate clinical exome sequencing (CES) compared to usual care (UC) in the diagnostic work-up of inherited colorectal cancer/polyposis (CRCP) in a randomized controlled trial (RCT). The investigators indicate that their results suggest that CES provides similar clinical benefits to multi-gene panels in the diagnosis of hereditary CRCP.
AHRQ-funded; HS021686.
Citation: Niu X, Amendola LM, Hart R .
Clinical exome sequencing vs. usual care for hereditary colorectal cancer diagnosis: a pilot comparative effectiveness study.
Contemp Clin Trials 2019 Sep;84:105820. doi: 10.1016/j.cct.2019.105820..
Keywords: Cancer: Colorectal Cancer, Cancer, Diagnostic Safety and Quality, Comparative Effectiveness, Patient-Centered Outcomes Research, Evidence-Based Practice
Moore CL, Carpenter CR, Heilbrun ME
Imaging in suspected renal colic: systematic review of the literature and multispecialty consensus.
This study conducted a Delphi process consensus on 29 specific clinical scenarios when kidney stones are suspected due to renal colic. The authors wanted to create an evidence-based, multispecialty consensus on optimal imaging for suspected renal colic in the acute setting. A 9-member panel was conducted with 3 physician representatives from the American College of Emergency Physicians (ACEP), 3 from the American College of Radiology, and 3 from the American Urology Association. First a systematic literature review was conducted. Out of 6,337 records, there were 232 relevant articles. Out of the 29 clinical scenarios examined, 15 were rated as perfect, 8 were excellent, and 3 good and 3 moderate.
AHRQ-funded; HS023778.
Citation: Moore CL, Carpenter CR, Heilbrun ME .
Imaging in suspected renal colic: systematic review of the literature and multispecialty consensus.
Ann Emerg Med 2019 Sep;74(3):391-99. doi: 10.1016/j.annemergmed.2019.04.021..
Keywords: Imaging, Diagnostic Safety and Quality, Emergency Department
Quinn M, Forman J, Harrod M
Electronic health records, communication, and data sharing: challenges and opportunities for improving the diagnostic process.
Diagnosis requires that clinicians communicate and share patient information in an efficient manner. Advances in electronic health records (EHRs) and health information technologies have created challenges and opportunities for such communication. In this multi-method, focused ethnographic study of physicians on general medicine inpatient units in two teaching hospitals, the investigators found that existing communication technologies and EHR-based data sharing processes were perceived as barriers to diagnosis. In particular, reliance on paging systems and lack of face-to-face communication among clinicians created obstacles to sustained thinking and discussion of diagnostic decision-making.
AHRQ-funded; HS022835; HS024385.
Citation: Quinn M, Forman J, Harrod M .
Electronic health records, communication, and data sharing: challenges and opportunities for improving the diagnostic process.
Diagnosis 2019 Aug 27;6(3):241-48. doi: 10.1515/dx-2018-0036.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Diagnostic Safety and Quality, Communication
Hoonakker PLT, Carayon P, Salwei ME
The design of PE Dx, a CDS to support pulmonary embolism diagnosis in the ED.
One possible explanation for user resistance to clinical decision support (CDS) procedures may be poor CDS design. This study describes the design of PE Dx, a CDS built to aid in the diagnosis of pulmonary embolism in the emergency department using human factors methods.
AHRQ-funded; HS022086.
Citation: Hoonakker PLT, Carayon P, Salwei ME .
The design of PE Dx, a CDS to support pulmonary embolism diagnosis in the ED.
Stud Health Technol Inform 2019 Aug 9;265:134-40. doi: 10.3233/shti190152..
Keywords: Blood Clots, Clinical Decision Support (CDS), Shared Decision Making, Diagnostic Safety and Quality, Emergency Department, Respiratory Conditions
Emani S, Sequist TD, Lacson R
Ambulatory safety nets to reduce missed and delayed diagnoses of cancer.
An ambulatory safety net (ASN) is an innovative organizational intervention for addressing patient safety related to missed and delayed diagnoses of abnormal test results. ASNs consist of a set of tools, reports and registries, and associated work flows to create a high-reliability system for abnormal test result management. In this paper, two ASNs implemented at an academic medical center are described, one focusing on colon cancer and the other on lung cancer.
AHRQ-funded; HS024722.
Citation: Emani S, Sequist TD, Lacson R .
Ambulatory safety nets to reduce missed and delayed diagnoses of cancer.
Jt Comm J Qual Patient Saf 2019 Aug;45(8):552-57. doi: 10.1016/j.jcjq.2019.05.010.
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Keywords: Cancer, Diagnostic Safety and Quality, Cancer: Lung Cancer, Cancer: Colorectal Cancer, Ambulatory Care and Surgery
Aronson PL, Cruz AT, Freedman SB
Association of herpes simplex virus testing with hospital length of stay for infants </=60 days of age undergoing evaluation for meningitis.
The objective of this study was to examine the association of cerebrospinal fluid herpes simplex virus polymerase chain reaction (CSF HSV PCR) testing with length of stay in a 20-center retrospective cohort of hospitalized infants aged </=60 days undergoing evaluation for meningitis after adjustment for patient-level factors and clustering by center. The investigators found that of 20,496 eligible infants, 7,399 (36.1%) had a CSF HSV PCR test performed, and 46 (0.6% of those tested) had a positive test.
AHRQ-funded; HS026006.
Citation: Aronson PL, Cruz AT, Freedman SB .
Association of herpes simplex virus testing with hospital length of stay for infants </=60 days of age undergoing evaluation for meningitis.
J Hosp Med 2019 Aug;14(8):492-95. doi: 10.12788/jhm.3202..
Keywords: Diagnostic Safety and Quality, Infectious Diseases, Newborns/Infants
Anand V, Zhang Z, Kadri SS
Epidemiology of quick sequential organ failure assessment criteria in undifferentiated patients and association with suspected infection and sepsis.
In this study, researchers examined the epidemiology and prognostic value of Quick Sequential Organ Failure Assessment (qSOFA) in undifferentiated patients. They found that only one in three patients who were qSOFA-positive on admission had suspected infection, and one in six had sepsis. They further found that qSOFA had low sensitivity for identifying suspected infection and sepsis, and its prognostic significance was not specific to infection. They recommended a need for more sensitive and specific tools for sepsis screening and risk stratification.
AHRQ-funded; HS025008.
Citation: Anand V, Zhang Z, Kadri SS .
Epidemiology of quick sequential organ failure assessment criteria in undifferentiated patients and association with suspected infection and sepsis.
Chest 2019 Aug;156(2):289-97. doi: 10.1016/j.chest.2019.03.032..
Keywords: Sepsis, Diagnostic Safety and Quality
Richards JE, Bobb JF, Lee AK
Integration of screening, assessment, and treatment for cannabis and other drug use disorders in primary care: an evaluation in three pilot sites.
This pilot study examined whether integrating evidence-based implementation strategies to implement Behavioral Health Integration (BHI) into primary care to increase diagnosis and treatment of substance use disorders (SUDs). Three pilot sites were used and patients were given annual screening for past-year cannabis and drug use, a Symptom Checklist for DSM-5 SUDs, and shared decision-making about different treatment options. Out of 39,599 eligible patients, almost 60% were screened for cannabis and other drug use. Daily cannabis use was reported with 2% of patients, and other drug use 1%. Of those patients, 51% and 37% completed an SUD Symptom Checklist. There was a higher proportion of patients diagnosed with cannabis use disorder (CUD) but not drug use disorder. However, the reverse was true for patients receiving treatment for drug-use disorders.
AHRQ-funded; HS023173.
Citation: Richards JE, Bobb JF, Lee AK .
Integration of screening, assessment, and treatment for cannabis and other drug use disorders in primary care: an evaluation in three pilot sites.
Drug Alcohol Depend 2019 Aug 1;201:134-41. doi: 10.1016/j.drugalcdep.2019.04.015..
Keywords: Substance Abuse, Behavioral Health, Evidence-Based Practice, Primary Care, Patient-Centered Healthcare, Screening, Diagnostic Safety and Quality
Cohen E, Rodean J, Dong C
Low-value diagnostic imaging use in the pediatric emergency department in the United States and Canada.
This study compared rates of diagnostic imaging for pediatric emergency department (ED) patients in the United States and Canada. Rates were compared for 4 pediatric EDs in Ontario and 26 in the United States from 2006 through 2016. Overall, Canada had lower rates of diagnostic imaging of all types than the United Sates. Adverse outcomes were compared as well and lower use in Canada was not associated with highr rates of adverse outcomes.
AHRQ-funded; HS026006.
Citation: Cohen E, Rodean J, Dong C .
Low-value diagnostic imaging use in the pediatric emergency department in the United States and Canada.
JAMA Pediatr 2019 Aug;173(8):e191439. doi: 10.1001/jamapediatrics.2019.1439..
Keywords: Children/Adolescents, Emergency Department, Diagnostic Safety and Quality
Deng F, Li MD, Wong A
Quality of documentation of contrast agent allergies in electronic health records.
The purpose of this study was to describe and appraise contrast agent allergy documentation in the electronic health record (EHR). The investigators concluded that contrast allergy records in EHRs were diverse and commonly low quality. They suggest that continued EHR enhancements and training are needed to support contrast allergy documentation to facilitate improved patient care and medical research.
AHRQ-funded; HS025375.
Citation: Deng F, Li MD, Wong A .
Quality of documentation of contrast agent allergies in electronic health records.
J Am Coll Radiol 2019 Aug;16(8):1027-35. doi: 10.1016/j.jacr.2019.01.027..
Keywords: Adverse Drug Events (ADE), Adverse Events, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Imaging