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 61 Research Studies DisplayedMcCoy RG, Dykhoff HJ, Sangaralingham L
Adoption of new glucose-lowering medications in the U.S.-the case of SGLT2 inhibitors: nationwide cohort study.
This study examined use of new glucose-lowering medications called sodium-glucose cotransporter-2 inhibitors (SGLT2i) that was the most recently approved class of medications for diabetes type 1 and 2 patients. This class of medications have shown additional cardio- and renal-protective benefits as well as lower risk of hypoglycemia. A retrospective analysis of medical and pharmacy claims data from OptumLabs Data Warehouse was conducted for commercially insured and Medicare Advantage adult beneficiaries who filled any glucose-lowering medication from 2013-2016. Among a cohort of over 1 million, only 7.2% initiated a SGLT2i prescription. Patients with other complications, age 75 or older, black, and those with Medicare Advantage were less likely to start a SGLT2i.
AHRQ-funded; HS024075; HS025164; HS025402; HS025517; HS022882.
Citation: McCoy RG, Dykhoff HJ, Sangaralingham L .
Adoption of new glucose-lowering medications in the U.S.-the case of SGLT2 inhibitors: nationwide cohort study.
Diabetes Technol Ther 2019 Dec;21(12):702-12. doi: 10.1089/dia.2019.0213.
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Keywords: Medication, Diabetes, Practice Patterns
Tam CA, Dauw CA, Ghani KR
New persistent opioid use after outpatient ureteroscopy for upper tract stone treatment.
The purpose of this study was to measure the incidence of persistent opioid use following ureteroscopy (URS). Over 100 Americans die every day from opioid overdose. Recent studies suggest that many opioid addictions surface after surgery. The investigators concluded that nearly 1 in 16 opioid-naive patients developed new persistent opioid use after URS. New persistent opioid use was associated with the amount of opioid prescribed at the time of URS. The authors suggest that, given these findings, urologists should re-evaluate their post-URS opioid prescribing patterns.
AHRQ-funded; HS024525; HS024728.
Citation: Tam CA, Dauw CA, Ghani KR .
New persistent opioid use after outpatient ureteroscopy for upper tract stone treatment.
Urology 2019 Dec;134:103-08. doi: 10.1016/j.urology.2019.08.042..
Keywords: Opioids, Medication, Substance Abuse, Surgery, Practice Patterns
Hu T, Decker SL, Chou SY
AHRQ Author: Decker SL
The impact of health insurance expansion on physician treatment choice: Medicare Part D and physician prescribing.
Researchers tested the effect of the introduction of Medicare Part D on physician prescribing behavior using data on physician visits from the National Ambulatory Medical Care Survey (NAMCS). Subjects were patients aged 60-69. The researchers found a 32% increase in the number of prescription drugs prescribed or continued per visit and a 46% increase in the number of generic drugs prescribed or continued for the elderly after the introduction of Medicare Part D.
AHRQ-authored.
Citation: Hu T, Decker SL, Chou SY .
The impact of health insurance expansion on physician treatment choice: Medicare Part D and physician prescribing.
https://www.ncbi.nlm.nih.gov/pubmed/28168448.
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Medicare, Medication, Practice Patterns, Elderly
Chiotos K, Rock C, Schweizer ML
Current infection prevention and antibiotic stewardship program practices: a survey of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN).
This survey compares results with a similar 2013 survey that characterizes contemporary infection prevention and antibiotic stewardship program practices across 64 healthcare facilities. There was decreased frequency of active surveillance for MRSA, frequent active surveillance for carbapenem-resistant Enterobacteriaceae, and increased support for antibiotic stewardship programs.
AHRQ-funded; HS026393.
Citation: Chiotos K, Rock C, Schweizer ML .
Current infection prevention and antibiotic stewardship program practices: a survey of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN).
Infect Control Hosp Epidemiol 2019 Sep;40(9):1046-49. doi: 10.1017/ice.2019.172.
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Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Infectious Diseases, Prevention, Practice Patterns
Esfandiari NH, Reyes-Gastelum D, Hawley ST
Patient requests for tests and treatments impact physician management of hypothyroidism.
Researchers investigated physician-reported barriers to managing thyroid hormone therapy; randomly surveyed physicians were members of the Endocrine Society, the American Academy of Family Practice, and the American Geriatrics Society. The researchers found that physicians reported patient requests for tests and treatments as a common barrier to appropriate thyroid hormone management. They concluded that understanding physician-reported barriers to thyroid hormone management and factors associated with physician perception that patient requests are a barrier is key to improving patient care.
AHRQ-funded; HS024512.
Citation: Esfandiari NH, Reyes-Gastelum D, Hawley ST .
Patient requests for tests and treatments impact physician management of hypothyroidism.
Thyroid 2019 Nov;29(11):1536-44. doi: 10.1089/thy.2019.0383..
Keywords: Care Management, Provider: Physician, Provider, Practice Patterns
DiBrito SR, Bowring MG, Holscher CM
Acute care surgery for transplant recipients: a national survey of surgeon perspectives and practices.
This study is a survey of acute care surgeons (ACS) and transplant surgeons on their attitudes as to who would feel comfortable operating on transplant patients for nontransplant-related issues. The researchers conducted a national survey of ACS and transplant surgeons and obtained 230 ACS responses and 240 from transplant surgeons. While both ACS and transplant surgeons felt care is better at transplant centers and if the patient requires acute surgery they should be transferred to a transplant center, the ACS still felt comfortable operating and performing laparoscopy on transplant recipients.
Citation: DiBrito SR, Bowring MG, Holscher CM .
Acute care surgery for transplant recipients: a national survey of surgeon perspectives and practices.
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Keywords: Transplantation, Surgery, Provider: Physician, Provider, Practice Patterns
Yarrington ME, Anderson DJ, Dodds Ashley E
Impact of FDA black box warning on fluoroquinolone and alternative antibiotic use in southeastern US hospitals.
This study’s objective was the quantify the effect of the 2016 FDA “black box” update on the use of fluoroquinolone antibiotics among a cohort of southeastern US hospitals. Fluoroquinolone was given a black box warning after many serious adverse events were reported. Antibiotic use data from 29 southeastern US hospitals over a 5-year period was analyzed. Fluoroquinolone use declined both and before after the FDA advisory update in 2016.
AHRQ-funded; HS023866.
Citation: Yarrington ME, Anderson DJ, Dodds Ashley E .
Impact of FDA black box warning on fluoroquinolone and alternative antibiotic use in southeastern US hospitals.
Infect Control Hosp Epidemiol 2019 Nov;40(11):1297-300. doi: 10.1017/ice.2019.247..
Keywords: Antibiotics, Medication, Practice Patterns, Healthcare Utilization, Hospitals, Adverse Drug Events (ADE), Adverse Events
Klueh MP, Sloss KR, Dossett LA
Postoperative opioid prescribing is not my job: a qualitative analysis of care transitions.
This qualitative study aimed to describe transitions of care for postoperative opioid prescribing and to identify barriers and facilitators of ideal transitions for potential intervention targets. Results identified potential interventions aimed at changing physician behaviors regarding transitions of care for postoperative opioid prescribing. Implementation of these interventions could improve coordination of care for patients with persistent postoperative opioid use.
AHRQ-funded; HS026030.
Citation: Klueh MP, Sloss KR, Dossett LA .
Postoperative opioid prescribing is not my job: a qualitative analysis of care transitions.
Surgery 2019 Nov;166(5):744-51. doi: 10.1016/j.surg.2019.05.033..
Keywords: Opioids, Medication, Pain, Transitions of Care, Practice Patterns
Andereck JW, Reuter QR, Allen KC
A quality improvement initiative featuring peer-comparison prescribing feedback reduces emergency department opioid prescribing.
This study compared opioid prescribing rates in emergency departments before and after a quality improvement initiative featuring peer-comparison feedback. All 117 ED prescribers at an urban academic medical center were provided regular feedback on their opioid prescribing rate compared to their de-identified peers. Pre-intervention rates were 8.6% compared to post-intervention at 4.8%.
AHRQ-funded; HS023011.
Citation: Andereck JW, Reuter QR, Allen KC .
A quality improvement initiative featuring peer-comparison prescribing feedback reduces emergency department opioid prescribing.
Jt Comm J Qual Patient Saf 2019 Oct;45(10):669-79. doi: 10.1016/j.jcjq.2019.07.008..
Keywords: Emergency Department, Opioids, Medication, Practice Patterns, Quality Improvement, Quality of Care
Angraal S, Nuti SV, Masoudi FA
Digoxin use and associated adverse events among older adults.
The authors describe national-level trends of digoxin use, hospitalizations for toxicity, and subsequent outcomes over the past two decades. They found that, while digoxin prescriptions have decreased, the drug is still widely prescribed. However, the rate of hospitalizations for digoxin toxicity and adverse outcomes associated with these hospitalizations have decreased. They concluded that these findings reflect the changing clinical practice of digoxin use, aligned with the changes in clinical guidelines.
AHRQ-funded; HS025164; HS025402; HS025517.
Citation: Angraal S, Nuti SV, Masoudi FA .
Digoxin use and associated adverse events among older adults.
Am J Med 2019 Oct;132(10):1191-98. doi: 10.1016/j.amjmed.2019.04.022.
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Keywords: Medication, Elderly, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Heart Disease and Health, Cardiovascular Conditions, Hospitalization, Practice Patterns
Modi PK, Kaufman SR, Herrel LA
Practice-level adoption of conservative management for prostate cancer.
In this study, the authors describe the longitudinal adoption of conservative management (ie, the absence of treatment) for prostate cancer among urology group practices in the United States and identify group practice features that influence this adoption. The investigators found that there was increasing variation among group practices in the use of conservative management for prostate cancer. They indicated that this underscores the need for a better understanding of practice-level factors that influence prostate cancer management.
AHRQ-funded; HS025707.
Citation: Modi PK, Kaufman SR, Herrel LA .
Practice-level adoption of conservative management for prostate cancer.
J Oncol Pract 2019 Oct;15(10):e863-e69. doi: 10.1200/jop.19.00088.
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Keywords: Cancer: Prostate Cancer, Cancer, Practice Patterns, Care Management
Springer R, Marino M,, Bailey SR
Prescription opioid use patterns, use disorder diagnoses and addiction treatment receipt after the 2014 Medicaid expansion in Oregon.
This study compared the prevalence of receipt of opioid prescriptions and opioid use disorder (OUD), along with time from OUD diagnosis to medication-assisted treatment (MAT) receipt between Oregon residents who had been continuously insured by Medicaid, were newly insured after Medicaid expansion in 2014 or returned to Medicaid coverage after expansion.
AHRQ-funded; HS024270.
Citation: Springer R, Marino M,, Bailey SR .
Prescription opioid use patterns, use disorder diagnoses and addiction treatment receipt after the 2014 Medicaid expansion in Oregon.
Addiction 2019 Oct;114(10):1775-84. doi: 10.1111/add.14667..
Keywords: Opioids, Medication, Substance Abuse, Medicaid, Practice Patterns, Health Insurance, Access to Care, Policy
Wang SV, Rogers JR, Jin Y
Stepped-wedge randomised trial to evaluate population health intervention designed to increase appropriate anticoagulation in patients with atrial fibrillation.
Clinical guidelines recommend anticoagulation for patients with atrial fibrillation (AF) at high risk of stroke; however, studies report 40% of this population is not anticoagulated. The purpose of this study was to evaluate a population health intervention to increase anticoagulation use in high-risk patients with AF. The investigators concluded that algorithms to identify underuse of anticoagulation among patients with AF in healthcare databases may not capture clinical subtleties or patient preferences and may overestimate the extent of undertreatment.
AHRQ-funded; HS022193.
Citation: Wang SV, Rogers JR, Jin Y .
Stepped-wedge randomised trial to evaluate population health intervention designed to increase appropriate anticoagulation in patients with atrial fibrillation.
BMJ Qual Saf 2019 Oct;28(10):835-42. doi: 10.1136/bmjqs-2019-009367..
Keywords: Blood Thinners, Heart Disease and Health, Cardiovascular Conditions, Medication, Health Information Technology (HIT), Shared Decision Making, Electronic Health Records (EHRs), Practice Patterns, Healthcare Utilization
Fraze TK, Brewster AL, Lewis VA
Prevalence of screening for food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence by US physician practices and hospitals.
The purpose of this study was to characterize screening for social needs by physician practices and hospitals. The authors indicated that their study's findings suggest: that few US physician practices and hospitals screen patients for all 5 key social needs associated with health outcomes; that practices that serve disadvantaged patients reported higher screening rates.
AHRQ-funded; HS024075.
Citation: Fraze TK, Brewster AL, Lewis VA .
Prevalence of screening for food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence by US physician practices and hospitals.
JAMA Netw Open 2019 Sep 4;2(9):e1911514. doi: 10.1001/jamanetworkopen.2019.11514..
Keywords: Domestic Violence, Nutrition, Practice Patterns, Screening, Social Determinants of Health, Vulnerable Populations
Law AC, Stevens JP, Walkey AJ
Hospital variation in gastrostomy tube use among the critically ill.
This article describes an analysis of hospital variation in gastrostomy tube use among critically ill patients in hospitals. The investigators used the AHRQ National Inpatient Sample Database from 2014. They identified hospitalized patients using ICD-9, Clinical Modification codes consistent with critical illness who received gastrostomy tubes. Overall, the median rate was 2.0 per 100 critically ill patients with no variation between hospital size.
AHRQ-funded; HS024288.
Citation: Law AC, Stevens JP, Walkey AJ .
Hospital variation in gastrostomy tube use among the critically ill.
Ann Am Thorac Soc 2019 Sep;16(9):1201-03. doi: 10.1513/AnnalsATS.201903-250RL..
Keywords: Surgery, Critical Care, Practice Patterns, Hospitals
Wilkinson ST, Howard DH, Busch SH
Psychiatric practice patterns and barriers to the adoption of esketamine.
This paper discusses the psychiatric practice patterns and barriers to the adoption of esketamine in the treatment of depression. The authors indicate that the discovery of ketamine’s rapid-acting properties, culminating most recently with the FDA’s approval of esketamine, offers hope to the large numbers of patients whose symptoms do not resolve with traditional treatments. However, they suggest, many traditional psychiatric practices may be reluctant to invest in the costly infrastructure necessary to provide this therapy, especially because of the uncertainty regarding the reimbursement for patient monitoring.
AHRQ-funded; HS023000.
Citation: Wilkinson ST, Howard DH, Busch SH .
Psychiatric practice patterns and barriers to the adoption of esketamine.
JAMA 2019 Sep 17;322(11):1039-40. doi: 10.1001/jama.2019.10728.
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Keywords: Depression, Behavioral Health, Practice Patterns, Medication
Chopra V, Kaatz S, Swaminathan L
Variation in use and outcomes related to midline catheters: results from a multicentre pilot study.
This study examined complication rates from placement of midline vascular catheters. They have become more common in use recently. Complications were analyzed using medical records from hospitalized patients in 12 hospitals from January 2017 to February 2018. Most midline catheters were placed in general ward settings for difficult intravenous access. About half were removed within 5 days of insertion. Major or minor complications occurred in 10.3% of midlines with minor complications accounting for 71% of all adverse events. These minor complications included dislodgement, leaking, and infiltration. Major complications included occlusion, upper-extremity DVT and BSI. Use of midlines and outcomes varied widely across hospitals.
AHRQ-funded; HS025891.
Citation: Chopra V, Kaatz S, Swaminathan L .
Variation in use and outcomes related to midline catheters: results from a multicentre pilot study.
BMJ Qual Saf 2019 Sep;28(9):714-20. doi: 10.1136/bmjqs-2018-008554..
Keywords: Patient Safety, Healthcare-Associated Infections (HAIs), Infectious Diseases, Adverse Events, Practice Patterns, Outcomes, Hospitals
Durstenfeld MS, Katz SD, Park H
Mineralocorticoid receptor antagonist use after hospitalization of patients with heart failure and post-discharge outcomes: a single-center retrospective cohort study.
The purpose of this paper was to describe contemporary mineralocorticoid receptor antagonists (MRA) prescription for heart failure patients before and after the full scope of hospitalizations and the association between MRA discharge prescription and post-hospitalization outcomes. Results showed that, among hospitalized patients with heart failure with a reduced ejection fraction, 75% did not receive MRA before or after hospitalization, and nearly 90% of eligible patients did not have MRA initiated. These results suggest that hospitalization may represent an opportunity to initiate guideline-directed heart failure therapy.
AHRQ-funded; HS023683.
Citation: Durstenfeld MS, Katz SD, Park H .
Mineralocorticoid receptor antagonist use after hospitalization of patients with heart failure and post-discharge outcomes: a single-center retrospective cohort study.
BMC Cardiovasc Disord 2019 Aug 9;19(1):194. doi: 10.1186/s12872-019-1175-3..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Medication, Practice Patterns, Outcomes
Dy CJ, Peacock K, Olsen MA
Frequency and risk factors for prolonged opioid prescriptions after surgery for brachial plexus injury.
This study examined risk of prolonged opioid prescription use after surgery for brachial plexus injury (BPI). A cohort of BPI surgery patients was compared to a control group of non-BPI patients, matching for age, sex, and year. Pharmacy claims for prescriptions filled for opioids and neuropathic pain methods were examined 1 year before surgery to 180 days after surgery. The primary outcome studied was prolonged opioid prescription, which is defined as receiving a prescription 90 to 180 days after the surgery or randomly selected date of service for controls. Among BPI patients, a subgroup analysis was also performed on opioid-naïve patients between 30 days to 1 year before surgery. Among BPI surgery patients, 27.7% had prolonged opioid prescriptions, but only 10.8% of opioid-naïve patients had prolonged opioid prescriptions. The rate for controls was 0.11%. The rates of prolonged opioid prescriptions for BPI patients was higher than previous estimates among other surgical patients.
AHRQ-funded; HS019455.
Citation: Dy CJ, Peacock K, Olsen MA .
Frequency and risk factors for prolonged opioid prescriptions after surgery for brachial plexus injury.
J Hand Surg Am 2019 Aug;44(8):662-68.e1. doi: 10.1016/j.jhsa.2019.04.001..
Keywords: Opioids, Medication, Surgery, Pain, Practice Patterns, Risk, Chronic Conditions
Jeffery MM, Hooten WM, Jena AB
Rates of physician coprescribing of opioids and benzodiazepines after the release of the Centers for Disease Control and Prevention guidelines in 2016.
Researchers sought to determine whether the release of the CDC guidelines was associated with changes in co-prescription of opioids and benzodiazepines. Their study showed a reduction in the extent, but not the intensity, of co-prescribing of benzodiazepines for patients with long-term opioid use.
AHRQ-funded; HS025164.
Citation: Jeffery MM, Hooten WM, Jena AB .
Rates of physician coprescribing of opioids and benzodiazepines after the release of the Centers for Disease Control and Prevention guidelines in 2016.
JAMA Netw Open 2019 Aug 2;2(8):e198325. doi: 10.1001/jamanetworkopen.2019.8325..
Keywords: Opioids, Medication, Practice Patterns, Pain, Evidence-Based Practice, Guidelines
Kim HS, Kaplan SH, McCarthy DM
A comparison of analgesic prescribing among ED back and neck pain visits receiving physical therapy versus usual care.
Researchers used a retrospective cohort study to examine whether physical therapy (PT) is associated with lower analgesic prescribing in the emergency department (ED) setting. They found that, in this single center study, ED back and neck pain visits receiving PT were no less likely to receive an opioid prescription and were more likely to receive a benzodiazepine than visits receiving usual care. They conclude that, although prior studies demonstrated that PT may reduce opioid utilization in the subsequent year, these results indicated that analgesic prescribing is not reduced at the initial ED encounter.
AHRQ-funded; HS023011.
Citation: Kim HS, Kaplan SH, McCarthy DM .
A comparison of analgesic prescribing among ED back and neck pain visits receiving physical therapy versus usual care.
Am J Emerg Med 2019 Jul;37(7):1322-26. doi: 10.1016/j.ajem.2018.10.009..
Keywords: Opioids, Medication, Practice Patterns, Emergency Department, Patient-Centered Outcomes Research, Pain, Back Health and Pain, Outcomes, Evidence-Based Practice
Shah NR, Ahmed ST, Winchester DE
Facility-level variation in stress test utilization in veterans with ischemic heart disease.
The aim of this study was to quantify variation in cardiac stress test utilization across the Veterans Health Administration (VA) in patients with established ischemic heart disease (IHD). The investigators used VA datasets to identify adults with IHD (myocardial infarction, percutaneous coronary intervention, and/or coronary artery bypass grafting) with a primary care clinic visit at the VA in fiscal year 2014.
AHRQ-funded; HS022998.
Citation: Shah NR, Ahmed ST, Winchester DE .
Facility-level variation in stress test utilization in veterans with ischemic heart disease.
JACC Cardiovasc Imaging 2019 Jul;12(7 Pt 1):1292-93. doi: 10.1016/j.jcmg.2019.02.020..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Diagnostic Safety and Quality, Healthcare Utilization, Practice Patterns, Imaging
Zhu JM, Navathe A, Yuan Y
Medicare's bundled payment model did not change skilled nursing facility discharge patterns.
The purpose of this study was to evaluate whether participation in Medicare's voluntary Bundled Payments for Care Improvement (BPCI) model was associated with changes in discharge referral patterns to skilled nursing facilities (SNFs), specifically number of SNF partners and discharge concentration. The investigators concluded that hospital participation in BPCI was not associated with changes in the number of SNF partners or in discharge concentration relative to non-BPCI hospitals.
AHRQ-funded; HS024266.
Citation: Zhu JM, Navathe A, Yuan Y .
Medicare's bundled payment model did not change skilled nursing facility discharge patterns.
Am J Manag Care 2019 Jul;25(7):329-34..
Keywords: Medicare, Payment, Practice Patterns, Hospital Discharge, Nursing Homes
Parchman ML, Penfold RB, Ike B
Team-based clinic redesign of opioid medication management in primary care: effect on opioid prescribing.
This study examined the effect of using an opioid medication management program called Six Building Blocks in primary care practices to help reduce the rate of opioid prescriptions. Six rural-serving organizations with 20 clinic locations received support for 15 months to help them implement the Six Building Blocks. This case-control study compared monthly trends in patients undergoing long-term opioid therapy (LtOT) for patients enrolled in the intervention clinics with those enrolled in a regional health plan who did not receive care at the study sites but resided in the same areas. There was a significant rate of decrease of patients on LtOT at intervention clinics compared with the control group.
AHRQ-funded; HS023750.
Citation: Parchman ML, Penfold RB, Ike B .
Team-based clinic redesign of opioid medication management in primary care: effect on opioid prescribing.
Ann Fam Med 2019 Jul;17(4):319-25. doi: 10.1370/afm.2390..
Keywords: Opioids, Primary Care: Models of Care, Primary Care, Teams, Medication, Pain, Chronic Conditions, Practice Patterns, Patient-Centered Healthcare
Mitchell AP, Rotter JS, Patel E
Association between reimbursement incentives and physician practice in oncology: a systematic review.
Investigators sought to evaluate whether the financial incentives presented by oncology reimbursement policies affect physician practice patterns. Following a literature search, 18 observational cohort studies were included, most with moderate risk of bias. The findings suggested that some oncologists may, in certain circumstances, alter treatment recommendations based on personal revenue considerations. The authors concluded that an implication of this finding is that value-based reimbursement policies may be a useful tool to better align physician incentives with patient need and increase the value of oncology care.
AHRQ-funded; HS000032.
Citation: Mitchell AP, Rotter JS, Patel E .
Association between reimbursement incentives and physician practice in oncology: a systematic review.
JAMA Oncol 2019 Jun;5(6):893-99. doi: 10.1001/jamaoncol.2018.6196..
Keywords: Practice Patterns, Payment, Provider: Physician, Provider