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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 154 Research Studies DisplayedAzimi H, Johnson L, Loudermilk C
Medication regimen complexity (MRC-ICU) for in-hospital mortality prediction in COVID-19 patients.
This study’s purpose was to assess if a patient’s medication regimen complexity-intensive care unit (MRC-ICU) score could predict in-hospital mortality in patients with COVID-19. This single-center, observational study was conducted from August 2020 to January 2021. The primary outcome was the area under the receiver operating characteristic (AUROC) for in-hospital mortality for the 48-hour MRC-ICU. The authors assessed age, sequential organ failure assessment (SOFA), and World Health Organization (WHO) COVID-19 Severity Classification. They included 149 patients who had a median SOFA score of 8 (IQR 5-11), and median MRC-ICU score at 48 hours of 15. The in-hospital mortality rate of 36%. The AUROC for MRC-ICU was 0.71 compared to 0.66 for age, 0.81 SOFA, and 0.72 for the WHO Severity Classification. Univariate analysis was used to compare the 4 characteristics. SOFA, MRC-ICU, and WHO Severity Classification all demonstrated significant association with in-hospital mortality, while SOFA, MRC-ICU, and WHO Severity Classification demonstrated significant association with WHO Severity Classification at 7 days. All 4 characteristics showed significant association with mortality; however, only age and SOFA remained significant following multivariate analysis.
AHRQ-funded; HS028485; HS029009.
Citation: Azimi H, Johnson L, Loudermilk C .
Medication regimen complexity (MRC-ICU) for in-hospital mortality prediction in COVID-19 patients.
Hosp Pharm 2023 Dec; 58(6):564-68. doi: 10.1177/00185787231169460..
Keywords: COVID-19, Medication, Mortality, Intensive Care Unit (ICU)
Meiselbach MK, Bai G, Anderson GF
Charges of COVID-19 diagnostic testing and antibody testing across facility types and states.
The authors discuss the practice of high charges for COVID-19 testing by some healthcare providers, with the charges for COVID-19 testing having important implications for uninsured patients, out-of-network services, and other payers without negotiating power. The purpose of this study was to examine the charges for the most commonly performed COVID-19 diagnostic test and antibody test across facility types and states. The study found that for COVID-19 diagnostic testing, the mean, median, and standard deviations of charges were $144.06, $100.00, and $162.18. The most common facility type was independent laboratories (performing 49.7% of all tests), with an average charge of $140.41, followed by hospital outpatient settings (performing 34.5% of all tests), with an average charge of $168.87. For antibody testing, the mean, median, and standard deviations of charges were $63.93, $55.00, and $48.92. Independent laboratories performed 97.2% of all tests, with an average charge of $62.30. In sum, 8.0% of diagnostic testing services and 14.0% of antibody testing claims were charged one standard deviation above the mean ($306.24 for diagnostic testing and $112.85 for antibody testing). The state average testing charges ranged between $64.98 (UT) and $505.65 (DC) for diagnostic testing, and $45.85 (NY) and $195.41 (NM) for antibody testing. AR, LA, MO, and NM had high average charges for both tests. GA, KS, MA, MD, NC, NV, and OK had low charges for both tests. No statistically significant association was found between testing charges and state-level testing rates, infection rates, or mortality rates.
AHRQ-funded; HS000029.
Citation: Meiselbach MK, Bai G, Anderson GF .
Charges of COVID-19 diagnostic testing and antibody testing across facility types and states.
J Gen Intern Med 2023 Dec; 38(16):3640-43. doi: 10.1007/s11606-020-06198-y..
Keywords: COVID-19, Diagnostic Safety and Quality, Healthcare Costs
Meille G, Decker SL, Owens PL
AHRQ Author: Meille G, Decker SL, Owens PL
COVID-19 admission rates and changes in US hospital inpatient and intensive care unit occupancy.
The objective of this cross-sectional study was to measure the relationship between COVID-19 admission rates and hospital occupancy in different US areas at different time periods during 2020. Data were taken from the HCUP State Inpatient Databases for patients in nonfederal acute care hospitals. The results showed that hospital occupancy decreased during weeks with low COVID-19 admissions and increased during weeks with high COVID-19 admissions; the largest changes occurred early in the pandemic. The authors concluded that their findings suggest that COVID-19 surges strained intensive care unit capacity and were associated with decreases in the number of surgical patients. These occupancy fluctuations may have affected quality of care and hospital finances.
AHRQ-authored.
Citation: Meille G, Decker SL, Owens PL .
COVID-19 admission rates and changes in US hospital inpatient and intensive care unit occupancy.
JAMA Health Forum 2023 Dec; 4(12):e234206. doi: 10.1001/jamahealthforum.2023.4206..
Keywords: COVID-19, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Hospitals
Huff NR, Liu G, Chimowitz H
COVID-19 related negative emotions and emotional suppression are associated with greater risk perceptions among emergency nurses: a cross-sectional study.
The objectives of this study were to investigate the relationship between emergency nurses' emotional experiences in response to the COVID-19 pandemic and their perceptions of risk to both patients and themselves, and also to investigate the extent to which the use of suppression and reappraisal processes for emotion management were associated with these perceptions. Nurses' negative emotions in response to the pandemic were associated with greater perceptions of both personal and patient safety risks. Chronic tendencies to suppress emotions uniquely predicted higher perceptions of risk. The authors concluded that understanding the factors that influence perceptions of risk are important, since these perceptions can motivate behaviors that may impact patient safety adversely.
AHRQ-funded; HS025752.
Citation: Huff NR, Liu G, Chimowitz H .
COVID-19 related negative emotions and emotional suppression are associated with greater risk perceptions among emergency nurses: a cross-sectional study.
Int J Nurs Stud Adv 2023 Dec; 5:100111. doi: 10.1016/j.ijnsa.2022.100111.
Keywords: COVID-19, Emergency Department, Provider: Nurse
Zuvekas SH
AHRQ Author: Zuvekas SH
COVID-19, mental health, and mental health treatment among adults.
This AHRQ-authored paper seeks to examine the impact of the COVID-19 pandemic on mental health status and mental health treatment among adults residing in the U.S. civilian, non-institutionalized population. Data from the 2019-2020 MEPS was used. The author examined unadjusted and regression-adjusted differences between 2019 and 2020 in perceived mental health status (excellent, very good, good, fair, poor) and in the K6 general psychological distress, the PHQ-2 depression screener, and the VR-12 mental component summary score. Similarly, using the detailed MEPS data on health care encounters and prescription drug fills, he examined differences in mental health use treatment between 2019 and 2020. He focused specifically on changes in continuity of treatment among those already in treatment in January and February, before the pandemic fully struck, as well differences in the initiation of new episodes of treatment after the pandemic began. Results were that all four mental health scales included in the MEPS showed statistically significant declines in mental health between 2019 and 2020, particularly among younger adults. However, the percentage of US adults receiving mental health treatment did not change significantly. Continuity of treatment increased slightly in 2020, with 87.1% of adults in treatment January or February still receiving care in the second quarter, an increase of 2.5 percentage points. However, there were significant declines in the initiation of new treatment, especially in the second quarter of 2020.
AHRQ-authored.
Citation: Zuvekas SH .
COVID-19, mental health, and mental health treatment among adults.
J Ment Health Policy Econ 2023 Dec 1; 26(4):159-83..
Keywords: Medical Expenditure Panel Survey (MEPS), COVID-19, Behavioral Health
Fingar KR, Weiss AJ, Roemer M
AHRQ Author: Roemer M, Reid LD
Effects of the COVID-19 early pandemic on delivery outcomes among women with and without COVID-19 at birth.
This AHRQ-authored paper examined the early pandemic-related changes in birth outcomes for pregnant women with and without a COVID-19 diagnosis at delivery. They compared four delivery outcomes-preterm delivery (PTD), severe maternal morbidity (SMM), stillbirth, and cesarean birth-between 2017 and 2019 (prepandemic) and between April and December 2020 (early pandemic) using interrupted time series models on 11.8 million deliveries, stratified by COVID-19 infection status at birth with entropy weighting for historical controls, from the HCUP across 43 states and the District of Columbia. Relative to 2017-2019, women without COVID-19 at delivery in 2020 had lower odds of PTD (OR = 0.93) and SMM (OR = 0.88) but increased odds of stillbirth (OR = 1.04). COVID-19 deliveries had an excess of each outcome, by factors of 1.07-1.46 for outcomes except SMM at 4.21. The effect for SMM was more pronounced for Asian/Pacific Islander non-Hispanic (API; OR = 10.51) and Hispanic (OR = 5.09) pregnant women than for White non-Hispanic (OR = 3.28) women.
AHRQ-authored; AHRQ-funded; 290201800001C.
Citation: Fingar KR, Weiss AJ, Roemer M .
Effects of the COVID-19 early pandemic on delivery outcomes among women with and without COVID-19 at birth.
Birth 2023 Dec; 50(4):996-1008. doi: 10.1111/birt.12753..
Keywords: Healthcare Cost and Utilization Project (HCUP), COVID-19, Maternal Care, Women, Outcomes
Hails KA, Wellen BC, Simoni M
Parents' preferences for primary care-based behavioral services and the COVID-19 pandemic: a mixed method study.
This mixed method study examined how family factors impacted parents' attitudes toward integrated behavioral health (IBH) in pediatric primary care during the COVID-19 pandemic. The authors hypothesized that COVID-19 impact would predict family functioning challenges, and that pre-existing familial contextual factors would predict parents' interest in IBH modalities. A survey was completed by parents of children ages 1.5-5 years (N = 301) from five primary care clinics with measures assessing familial contextual factors (income, race and ethnicity, and parents' childhood adversity), COVID-19 impact on family relationships and wellbeing, family functioning (child behavior, parenting self-efficacy, and parent psychological functioning), and parents' preferences for behavioral support in primary care. A subsample of 23 parents completed qualitative interviews to provide deeper insights into quantitative relationships. The higher the COVID-19 impact, the more it was significantly associated with worse parent mental health and child behavior problems, as well as lower interest in IBH virtual support options. Lower SES and racial and/or ethnic minority parents both indicated greater interest in IBH modalities compared to higher SES and White parents, respectively. Qualitative interviews conducted found that pandemic stressors led to increases in parents’ desire for behavioral support from pediatricians, with parents sharing perspectives on the nature of support they desired, including proactive communication from providers and variety and flexibility in the behavioral supports offered.
AHRQ-funded; HS022981.
Citation: Hails KA, Wellen BC, Simoni M .
Parents' preferences for primary care-based behavioral services and the COVID-19 pandemic: a mixed method study.
J Pediatr Psychol 2023 Nov 16; 48(11):879-92. doi: 10.1093/jpepsy/jsad034..
Keywords: Children/Adolescents, COVID-19, Behavioral Health, Primary Care
MacMartin M, Zeng A, Chelen J
'The burden of wanting to make it right': thematic analysis of semistructured interviews to explore experiences of planning for crisis standards of care and ventilator allocation during the COVID-19 pandemic in the USA.
The objective of this study was to examine the experience of healthcare professionals who created policies for crisis standards of care. Researchers conducted semistructured interviews with healthcare professionals involved in institutional planning for resource shortages in the setting of the COVID-19 pandemic, specifically regarding the allocation of ventilators in the event of a shortage. One overarching theme developed: planning for resource shortages imposed a psychological burden on many planners. Four subthemes that influenced that burden were also identified. The researchers concluded that improved leadership strategies and cross-institutional collaboration can reduce the psychological burden of planning and can facilitate the update of plans in anticipation of future shortages.
AHRQ-funded; HS024075.
Citation: MacMartin M, Zeng A, Chelen J .
'The burden of wanting to make it right': thematic analysis of semistructured interviews to explore experiences of planning for crisis standards of care and ventilator allocation during the COVID-19 pandemic in the USA.
BMJ Open 2023 Nov 9; 13(11):e076674. doi: 10.1136/bmjopen-2023-076674..
Keywords: COVID-19, Public Health, Policy
Miller MJ, Miller MJ, Pak SS, Keller DR SS, Keller DR
Physical therapist telehealth delivery at 1 year into COVID-19.
This study’s purpose was to examine telehealth physical therapy utilization 1 year into the COVID-19 pandemic and identify factors that influence physical therapists' delivery of telehealth in an urban academic medical center. Data was extracted from electronic medical records from March 22 to May 15, 2021. The proportion of physical therapy sessions delivered via telehealth were identified, and patient characteristics were compared by telehealth volume (0 vs ≥1 session, 1 vs >1 session). Telehealth was used for 3793 of 8038 (47.2%) physical therapist sessions, and 1028 unique patients had at least 2 physical therapist sessions (without telehealth: 6.6%, telehealth once: 39.1%, telehealth more than once: 54.3%). Patients who did not use telehealth were older, non-English speaking, had non-commercial insurance, and had at least 1 chronic health condition. Patients who used telehealth more than once had a neurologic diagnosis and lived farther from the treating clinic. Factors that influenced telehealth delivery were physical therapist clinical skills and knowledge, technical proficiency, telehealth-specific interpersonal skills, and cognitive flexibility. External factors outside of the physical therapist that influenced telehealth delivery included the environment, patient equipment and technology proficiency, physical therapist equipment, clinic factors, and patient and referring provider perspectives.
AHRQ-funded; HS026379.
Citation: Miller MJ, Miller MJ, Pak SS, Keller DR SS, Keller DR .
Physical therapist telehealth delivery at 1 year into COVID-19.
Phys Ther 2022 Nov 6; 102(11). doi: 10.1093/ptj/pzac121..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT)
Daw JR, Yekta S, Jacobson-Davies FE
Consistency and adequacy of public and commercial health insurance for US children, 2016 to 2021.
This study used the 2016 to 2021 National Survey of Children’s Health to compare overall rates, COVID-19 public health emergency-related changes, and child and family characteristics associated with inconsistent and inadequate coverage for publicly and commercially insured children. The authors were looking at inconsistent insurance, defined by failure to meet 3 criteria: (1) benefits usually/always sufficient to meet child's needs; (2) coverage usually/always allows child to access needed health care practitioners; and (3) no or usually/always reasonable annual out-of-pocket payments for child's health care. Of this nationally representative sample of 203,691 insured children, 34.5% were publicly insured (mean age 8.4 [4.1] years; 47.4% female) and 65.5% were commercially insured (mean age, 8.7 [5.6]; 49.1% female). Most publicly insured children were either non-Hispanic Black (20.9%) or Hispanic (36.4%); living with 2 married parents (38.4%) or a single parent (33.1%); and had a household income less than 200% of the federal poverty level (79%); and most commercially insured children were non-Hispanic White (62.8%), living with 2 married parents (79.0%); and had a household income of 400% of the federal poverty level or higher (49.1%). Compared with commercially insured children, publicly insured children had higher rates of inconsistent coverage (4.2% vs 1.4%; difference, 2.7 percentage points [pp]) and lower rates of inadequate coverage (12.2% vs 33.0%; difference). Compared with the period from 2016 to 2019, inconsistent insurance decreased by 42% for publicly insured children and inadequate insurance decreased by 6% for commercially insured children during the COVID-19 public health emergency (PHE) (2020-2021).
AHRQ-funded; HS029159.
Citation: Daw JR, Yekta S, Jacobson-Davies FE .
Consistency and adequacy of public and commercial health insurance for US children, 2016 to 2021.
JAMA Health Forum 2023 Nov; 4(11):e234179. doi: 10.1001/jamahealthforum.2023.4179..
Keywords: Children/Adolescents, Health Insurance, COVID-19
Molloy MJ, Auger KA, Hall M
Epidemiology and severity of illness of MIS-C and Kawasaki Disease during the COVID-19 pandemic.
Researchers sought to understand the illness severity of multisystem inflammatory syndrome in children (MIS-C) compared with Kawasaki disease (KD) and to evaluate changes in MIS-C illness severity over time during the coronavirus pandemic. Data on the hospitalization of children with MIS-C and KD were taken from the Pediatric Health Information System administrative database. The results showed a higher proportion of hospitalizations with shock for MIS-C compared with KD, but a significant decrease in the odds of shock in MIS-C patients was observed over time; MIS-C was a source of lower morbidity than KD as the pandemic progressed. The researchers concluded that their findings provide evidence that MIS-C is a distinct condition from KD.
AHRQ-funded; HS026763; HS028102.
Citation: Molloy MJ, Auger KA, Hall M .
Epidemiology and severity of illness of MIS-C and Kawasaki Disease during the COVID-19 pandemic.
Pediatrics 2023 Nov 1; 152(5). doi: 10.1542/peds.2023-062101..
Keywords: Children/Adolescents, COVID-19
Millman A, Huang J, Graetz I
Patient-reported primary care video and telephone telemedicine preference shifts during the COVID-19 pandemic.
This study used patient surveys to understand the health care experience of patients seeking primary care through telemedicine and how patients expected their preferences to shift as a result of the COVID-19 pandemic. The authors sampled patients monthly and collected 1000 surveys from adults with primary care telemedicine visits scheduled through the online patient portal between 3/16/2020 and 10/31/2020. Participants reported their preferred primary care visit modality (telephone, video, or in-person visits) across 3 time points: before, during and after the COVID-19 pandemic and reported their general assessment of these visits. The majority of participant preferred in-person visits before (69%) and after (57%) the pandemic. During the pandemic most participants reported a preference for telemedicine and continued to prefer telemedicine visits at a 12% higher rate post-pandemic. Most participants (63%) expressed interested in using telemedicine at least some of the time. The majority of participants who reported a recent telemedicine visit (83%) agreed that the visit addressed their health needs.
AHRQ-funded; HS025189.
Citation: Millman A, Huang J, Graetz I .
Patient-reported primary care video and telephone telemedicine preference shifts during the COVID-19 pandemic.
Med Care 2023 Nov; 61(11):772-78. doi: 10.1097/mlr.0000000000001916.
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Primary Care
Fernandez JR, Strassle PD, Richmond J
County-level barriers in the COVID-19 vaccine coverage index and their associations with willingness to receive the COVID-19 vaccine across racial/ethnic groups in the U.S.
This study examined whether county-level vaccination barriers varied across racial/ethnic groups in the U.S., if they were associated with willingness to receive the COVID-19 vaccine, and if they differed across racial/ethnic groups. Data was taken from the REACH-US study. County-level vaccination barriers were measured using the COVID-19 Vaccine Coverage Index. Results showed that American Indian/Alaska Native, African American, Hispanic/Latino, and Multiracial adults were more likely than White adults to live in counties with higher overall county-level vaccination barriers. Higher sociodemographic barriers were associated with less willingness to receive the COVID-19 vaccine. History of low vaccination was associated with less willingness to receive the COVID-19 vaccine among African American adults. The researchers concluded that future vaccination programs should include efforts accounting for structural barriers to preventive healthcare and their intersection with sociodemographic factors.
AHRQ-funded; HS026122.
Citation: Fernandez JR, Strassle PD, Richmond J .
County-level barriers in the COVID-19 vaccine coverage index and their associations with willingness to receive the COVID-19 vaccine across racial/ethnic groups in the U.S.
Front Public Health 2023 Oct 12; 11:1192748. doi: 10.3389/fpubh.2023.1192748..
Keywords: COVID-19, Vaccination, Patient Adherence/Compliance, Racial and Ethnic Minorities
Ahmed N, Sanghavi K, Mathur S
Patient portal use: persistent disparities from pre- to post-onset of the COVID-19 pandemic.
This study examined patient portal usage from pre- to post-onset of the COVID-19 pandemic to determine what impact the pandemic had on portal usage by patient sub-populations. The authors included a total of 153,628 unique patients. They assessed patient portal usage from pre-onset (March 2019-February 2020) to post-onset of the COVID-19 pandemic (March 2020-February 2021). They examined usage by patient sub-populations (age, sex, race, ethnicity), comorbid conditions, and health insurance type. Differences were seen in specific patient portal actions. Increases were seen in immunization views (0.43) and health record views (0.43) from post-onset compared to pre-onset. A decrease was noted in prescription renewal (medication) views (-0.07) from pre- to post-onset There was a decrease in both immunization views and health record views among Black patients (-0.07) in comparison to White patients, but an increase in prescription renewal (medication) views (0.07) amongst Black patients compared to White patients.
AHRQ-funded; HS026298.
Citation: Ahmed N, Sanghavi K, Mathur S .
Patient portal use: persistent disparities from pre- to post-onset of the COVID-19 pandemic.
Int J Med Inform 2023 Oct; 178:105204. doi: 10.1016/j.ijmedinf.2023.105204..
Keywords: COVID-19, Disparities, Electronic Health Records (EHRs), Health Information Technology (HIT)
Ferranna M, Robinson LA, Cadarette D
The benefits and costs of U.S. employer COVID-19 vaccine mandates.
This study examined the benefits and costs of U.S. employer COVID-19 mandates for federal employees and contractors and for some healthcare and private sector workers if there had not been major challenges in court that halted or delayed the mandates. The authors estimated the direct costs and health-related benefits that would have accrued if these vaccination requirements had been implemented as intended. Compared with the January 2022 vaccination rates, they found that the mandates could have led to 15 million additional vaccinated individuals, increasing the overall proportion of the fully vaccinated U.S. population from 64% to 68%. They examined scenarios involving the emergence of a novel, more transmissible variant, against which vaccination and previous infection offer moderate protection, and found that the estimated net benefits are potentially large. They estimated that they reach almost $20,000 per additional vaccinated individual, with more than 20,000 total deaths averted over the 6-month period assessed. For other scenarios involving a fading pandemic, existing vaccination-acquired or infection-acquired immunity provides sufficient protection, and the mandates' benefits are unlikely to exceed their costs. They believe that mandates may be most useful when the consequences of inaction are catastrophic. However, they did not compare the effects of mandates with alternative policies for increasing vaccination rates or for promoting other protective measures, which may receive stronger public support and be less likely to be overturned by litigation.
AHRQ-funded; HS000055.
Citation: Ferranna M, Robinson LA, Cadarette D .
The benefits and costs of U.S. employer COVID-19 vaccine mandates.
Risk Anal 2023 Oct; 43(10):2053-68. doi: 10.1111/risa.14090..
Keywords: COVID-19, Vaccination, Healthcare Costs
Oke I, Hunter DG, Mantagos IS
The impact of the COVID-19 pandemic on the surgical volume of pediatric ophthalmology and strabismus fellows.
This article described a study that used data from the annual fellowship survey to describe trends in surgical experience for pediatric ophthalmology and strabismus fellows, and to quantify the impact of the COVID-19 pandemic on trainee surgical volume. The findings showed that the overall number of procedures performed by fellows in the primary surgeon role declined during the first academic year of the pandemic but recovered in the second year. The number of intraocular cases performed per year increased during the study’s 7-year interval.
AHRQ-funded; HS000063.
Citation: Oke I, Hunter DG, Mantagos IS .
The impact of the COVID-19 pandemic on the surgical volume of pediatric ophthalmology and strabismus fellows.
J AAPOS 2023 Oct; 27(5):305-07. doi: 10.1016/j.jaapos.2023.06.006..
Keywords: COVID-19, Children/Adolescents, Surgery
Hooper M, Reinhart M, Dusetzina SB
Trends in U.S. self-reported health and self-care behaviors during the COVID-19 pandemic.
The purpose of this study was to evaluate changes in self-reported health outcomes during the COVID-19 pandemic, and to examine trends in health-related behaviors that may be associated with the observed health changes. The researchers utilized an interrupted time series design stratified by age, gender, race/ethnicity, educational attainment, household income, and employment status. Health outcomes were self-reported by participants and included the number of days per month that respondents spent in poor mental health, physical health, or when poor health prevented their usual activities of daily living. The study found that the national rate of days spent in poor physical health decreased. The researchers also witnessed overall increases in average sleep hours per day, the percentage of adults who report any exercise activity, increased alcohol consumption days, and decreased prevalence of smoking.
AHRQ-funded; HS026395.
Citation: Hooper M, Reinhart M, Dusetzina SB .
Trends in U.S. self-reported health and self-care behaviors during the COVID-19 pandemic.
PLoS One 2023 Sep 19; 18(9):e0291667. doi: 10.1371/journal.pone.0291667..
Keywords: COVID-19, Patient Self-Management
Kilaru AS, Scheulen JJ, Harbertson CA
Boarding in US academic emergency departments during the COVID-19 pandemic.
The purpose of this retrospective study was to characterize changes in emergency department (ED) boarding among U.S. academic EDs across the duration of the COVID-19 pandemic. From January 2019 to December 2021 the researchers utilized a convenience sample of academic departments of emergency medicine to conduct an analysis of monthly data. The primary outcome was total boarding hours, and secondary outcomes included patient volume stratified by ED disposition. Of the 73 academic departments of emergency medicine contacted, 46.6% participated, a total of 43 individual EDs in 25 states. The study found that the adjusted mean total boarding hours per month were significantly lower during the second quarter of 2020 compared to the first quarter of 2019. Beginning in the second quarter of 2021, total boarding hours were significantly higher than pre-pandemic levels, peaking during the fourth quarter of 2021.
AHRQ-funded; HS026372.
Citation: Kilaru AS, Scheulen JJ, Harbertson CA .
Boarding in US academic emergency departments during the COVID-19 pandemic.
Ann Emerg Med 2023 Sep; 82(3):247-54. doi: 10.1016/j.annemergmed.2022.12.004..
Keywords: COVID-19, Emergency Department, Public Health
Menez S, Coca Moledina, Moledina DG
Evaluation of plasma biomarkers to predict major adverse kidney events in hospitalized patients with COVID-19.
There is an increased risk for major adverse kidney events (MAKE) in patients hospitalized with COVID-19. The purpose of this prospective cohort study was to identify plasma biomarkers predictive of MAKE in patients hospitalized with COVID-19. The study found that in total, 95 patients (16%) experienced MAKE. Each 1 SD increase in soluble tumor necrosis factor receptor 1 (sTNFR1) and sTNFR2 was significantly associated with an increased risk of MAKE. A limitation of the study was a lack of control group of hospitalized patients without COVID-19.
AHRQ-funded; HS027626.
Citation: Menez S, Coca Moledina, Moledina DG .
Evaluation of plasma biomarkers to predict major adverse kidney events in hospitalized patients with COVID-19.
Am J Kidney Dis 2023 Sep; 82(3):322-32.e1. doi: 10.1053/j.ajkd.2023.03.010..
Keywords: COVID-19, Kidney Disease and Health, Inpatient Care
Chen JT, Mehrizi R, Aasman B
Long short-term memory model identifies ARDS and in-hospital mortality in both non-COVID-19 and COVID-19 cohort.
The objective of this study was to identify risk of acute respiratory distress syndrome (ARDS) and in-hospital mortality using a long short-term memory (LSTM) framework in mechanically ventilated (MV) COVID-19 and non-COVID-19 cohorts. The results indicated that the LSTM algorithm accurately identified the risk of ARDS or death in both non-COVID-19 and COVID MV patients. The researchers concluded that a tool that alerts to the risk of ARDS or death can improve the implementation of evidence-based ARDS management and facilitate goals-of-care discussions involving high-risk patients.
AHRQ-funded; HS026188.
Citation: Chen JT, Mehrizi R, Aasman B .
Long short-term memory model identifies ARDS and in-hospital mortality in both non-COVID-19 and COVID-19 cohort.
BMJ Health Care Inform 2023 Sep; 30(1). doi: 10.1136/bmjhci-2023-100782..
Keywords: COVID-19, Mortality, Hospitals, Inpatient Care
Kim D, Swaminathan S, Lee Y
Racial and ethnic disparities in excess deaths after COVID-19 vaccine deployment among persons with kidney failure.
COVID-19 resulted in clear racial/ethnic disparities in excess deaths among persons with kidney failure. It is not clear whether or how these disparities changed throughout the pandemic, especially after the deployment of COVID-19 vaccines. The purpose of this study was to examine disparities in excess mortality for the Medicare population with kidney failure from March 2020, through December 2021. The study found that there were 686,719 patients with kidney failure in January 2020. Researchers reported an increase in excess deaths beginning March 1, 2020, with a peak in January 2021. From March 1, 2020, through January 30, 2021, and there were substantial disparities in excess deaths across racial/ethnic groups. The number of excess deaths was 5582, 4303, and 2679 for non-Hispanic White, non-Hispanic Black, and Hispanic patients, respectively. The percent excess deaths was 31.9% for Hispanic patients, 27.5% for non-Hispanic Black patients, and 16.4% for non-Hispanic White patients. After the wide distribution of COVID-19 vaccines since the end of January 2021, the lowest percent excess deaths was observed among Hispanic patients, followed by Black patients, and White patients.
AHRQ-funded; HS028285.
Citation: Kim D, Swaminathan S, Lee Y .
Racial and ethnic disparities in excess deaths after COVID-19 vaccine deployment among persons with kidney failure.
Clin J Am Soc Nephrol 2023 Sep; 18(9):1207-09. doi: 10.2215/cjn.0000000000000226..
Keywords: COVID-19, Racial and Ethnic Minorities, Disparities, Vaccination, Kidney Disease and Health, Mortality
Rao S, Armistead I, Tyler A
Respiratory syncytial virus, influenza, and coronavirus disease 2019 hospitalizations in children in Colorado during the 2021-2022 respiratory virus season.
This study compared demographic characteristics, clinical features, and outcomes of children hospitalized with respiratory syncytial virus (RSV), influenza, or severe acute respiratory syndrome coronavirus 2 during their cocirculation 2021-2022 respiratory virus season. The authors conducted a retrospective cohort study using Colorado's hospital respiratory surveillance data comparing coronavirus disease 2019 (COVID-19)-, influenza-, and RSV-hospitalized cases < 18 years of age admitted and undergoing standardized molecular testing between October 1, 2021, and April 30, 2022. The cohort consisted of 847 hospitalized cases, of which 490 (57.9%) were RSV associated, 306 (36.1%) were COVID-19 associated, and 51 (6%) were influenza associated. Most RSV cases were children less than 4 years of age (92.9%), whereas influenza hospitalizations were observed in older children. RSV cases were more likely to require oxygen support higher than nasal cannula compared with COVID-19 and influenza cases, although COVID-19 cases were more likely to require invasive mechanical ventilation than influenza and RSV cases. Compared with children with COVID-19, the risk of intensive care unit admission was highest among children with influenza, whereas the risk of pneumonia, bronchiolitis, longer hospital length of stay, and need for oxygen were more likely among children with RSV.
AHRQ-funded; HS026512.
Citation: Rao S, Armistead I, Tyler A .
Respiratory syncytial virus, influenza, and coronavirus disease 2019 hospitalizations in children in Colorado during the 2021-2022 respiratory virus season.
J Pediatr 2023 Sep; 260:113491. doi: 10.1016/j.jpeds.2023.113491..
Keywords: Children/Adolescents, COVID-19, Respiratory Conditions, Influenza, Hospitalization, Infectious Diseases
Osmanlliu E, Kalwani NM, Parameswaran V
Sociodemographic disparities in the use of cardiovascular ambulatory care and telemedicine during the COVID-19 pandemic.
Researchers examined adult cardiology visits at an academic and affiliated community practice in Northern California to assess the persistence sociodemographic disparities in telemedicine use before and during the COVID pandemic. Results indicated that sociodemographic characteristics of patients receiving cardiovascular care remained stable during both periods, but the modality of care diverged across groups. Observed disparities in the use of video-based telemedicine were greatest for patients 80 years or older, Black, with limited English proficiency, or on Medicaid. The researchers recommended that future studies examine barriers and outcomes in digital healthcare access across diverse patient groups.
AHRQ-funded; HS026128.
Citation: Osmanlliu E, Kalwani NM, Parameswaran V .
Sociodemographic disparities in the use of cardiovascular ambulatory care and telemedicine during the COVID-19 pandemic.
Am Heart J 2023 Sep; 263:169-76. doi: 10.1016/j.ahj.2023.06.011..
Keywords: COVID-19, Cardiovascular Conditions, Telehealth, Health Information Technology (HIT), Disparities, Ambulatory Care and Surgery
Feldman AG, Beaty B, Everitt M
Survey of pediatric transplant center practices regarding COVID-19 vaccine mandates for transplant candidates and living donors and use of COVID-19-positive deceased organs.
This study’s objective was to assess COVID-19 policies at US pediatric solid organ transplant centers. A 79-item survey was created and emailed between March and April 2022 to 200 UNOS Medical Directors detailing center COVID-19 vaccine policies for transplant candidates and living donors and use of grafts from COVID-19-positive deceased donors. The response rate was 77%. For children aged 5-15 years, 23% of centers have a COVID-19 vaccine mandate, 27% anticipate implementing a future mandate, and 47% have not considered or do not anticipate implementing a mandate. For children ≥16 years, 32% of centers have a COVID-19 vaccine mandate, 25% anticipate implementing a future mandate, and 40% have not considered or do not anticipate implementing a mandate. The top two reasons provided for not implementing a COVID-19 vaccine mandate were concerns about penalizing a child for their parent's decision and worsening inequities in transplant. Almost a third of 85 (27/85) kidney and liver living donor centers require vaccinations of donors. Twenty percent of centers accept organs from COVID-19-positive deceased donors.
AHRQ-funded; HS026510.
Citation: Feldman AG, Beaty B, Everitt M .
Survey of pediatric transplant center practices regarding COVID-19 vaccine mandates for transplant candidates and living donors and use of COVID-19-positive deceased organs.
Pediatr Transplant 2023 Sep; 27(6):e14513. doi: 10.1111/petr.14513..
Keywords: COVID-19, Children/Adolescents, Transplantation
Overhage L, Hailu R, Busch AB
Trends in acute care use for mental health conditions among youth during the COVID-19 pandemic.
This study’s objective was to examine youth acute mental health care use (emergency department [ED], boarding, and subsequent inpatient care) during the second year of the COVID-19 pandemic. This cross-sectional analysis used data from national, deidentified commercial health insurance claims of youth mental health ED and hospital care that took place between March 2019 and February 2022. Among 4.1 million commercial insurance enrollees aged 5 to 17 years, 17,614 in the baseline year (March 2019-February 2020) and 16,815 youth in pandemic year 2 (March 2021-February 2022) had at least 1 mental health ED visit. Comparing baseline to pandemic year 2, there was a 6.7% increase in youth with any mental health ED visits. Among adolescent females, there was a larger increase (22.1%). The fraction of ED visits that resulted in a psychiatric admission increased by 8.4%. Mean length of inpatient psychiatric stay increased 3.8%. The fraction of episodes with prolonged boarding increased 76.4%.
AHRQ-funded; HS026503.
Citation: Overhage L, Hailu R, Busch AB .
Trends in acute care use for mental health conditions among youth during the COVID-19 pandemic.
JAMA Psychiatry 2023 Sep; 80(9):924-32. doi: 10.1001/jamapsychiatry.2023.2195..
Keywords: COVID-19, Behavioral Health, Children/Adolescents