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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 32 Research Studies DisplayedAuerbach AD, Lee TM, Hubbard CC
Diagnostic errors in hospitalized adults who died or were transferred to intensive care.
The objective of this retrospective cohort study was to determine the prevalence, underlying causes, and harms of diagnostic errors in hospitalized adults who were transferred to an intensive care unit or who died. Data was taken from 29 academic medical centers in the U.S. in a random sample of adults hospitalized with general medical conditions. Errors were found to have contributed to temporary harm, permanent harm, or death in nearly 18% of patients; among patients who died, diagnostic error was judged to have contributed to death in 6.6% of cases. The researchers noted that problems with choosing and interpreting tests and the processes involved with clinician assessment were a high priority for improvement efforts.
AHRQ-funded; HS027369.
Citation: Auerbach AD, Lee TM, Hubbard CC .
Diagnostic errors in hospitalized adults who died or were transferred to intensive care.
JAMA Intern Med 2024 Feb; 184(2):164-73. doi: 10.1001/jamainternmed.2023.7347..
Keywords: Diagnostic Safety and Quality, Medical Errors, Hospitals, Inpatient Care, Quality of Care, Patient Safety, Adverse Events
Dalal AK, Schnipper JL, Raffel K
Identifying and classifying diagnostic errors in acute care across hospitals: early lessons from the Utility of Predictive Systems in Diagnostic Errors (UPSIDE) study.
This paper describes the Utility of Predictive Systems in Diagnostic Errors (UPSIDE) study, whose aim was to define the prevalence and underlying causes of diagnostic errors (DEs) in patients who die in the hospital or are transferred to the intensive care unit (ICU) after the first 48 hours. This study was conducted at 31 hospitals with more than 2500 cases reviewed using electronic health records. The authors identified some insights into key requirements into building a robust DE surveillance program by developing these steps: 1) Develop a shared understanding of what constitutes a diagnostic error; 2) Use validated tools to identify diagnostic errors and classify process failures, but respect your context; 3) Develop a standard approach to using electronic health records for case reviews; 4) Ensure reliability and consistency of the case review process; and 5) Link diagnostic error case reviews to institutional safety programs. They also developed steps to establish a diagnosis error review process at the hospital level with six processes.
AHRQ-funded; HS027369; HS026613.
Citation: Dalal AK, Schnipper JL, Raffel K .
Identifying and classifying diagnostic errors in acute care across hospitals: early lessons from the Utility of Predictive Systems in Diagnostic Errors (UPSIDE) study.
J Hosp Med 2024 Feb; 19(2):140-45. doi: 10.1002/jhm.13136..
Keywords: Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety, Quality of Care, Hospitals
Ali KJ, Goeschel CA, Eckroade MM
The TeamSTEPPS for improving diagnosis team assessment tool: scale development and psychometric evaluation.
The authors developed and evaluated the TeamSTEPPS Improving Diagnosis Team Assessment Tool (TAT), which assesses diagnostic teamwork and communication in five critical domains. The TAT was administered as a cross-sectional survey to health professionals in nine diverse US health systems. A psychometric evaluation demonstrated that the TAT was a reliable and valid instrument for assessing teamwork and communication among and across diagnostic teams. The authors concluded that TAT added a novel, evidence-based measurement tool.
AHRQ-funded; 233201500022I.
Citation: Ali KJ, Goeschel CA, Eckroade MM .
The TeamSTEPPS for improving diagnosis team assessment tool: scale development and psychometric evaluation.
Jt Comm J Qual Patient Saf 2024 Feb; 50(2):95-103. doi: 10.1016/j.jcjq.2023.08.009..
Keywords: Diagnostic Safety and Quality, Teams, TeamSTEPPS
Gyftopoulos S, Simon E, Swartz JL
Efficacy and impact of a multimodal intervention on CT pulmonary angiography ordering behavior in the emergency department.
The objective of this study was to evaluate the efficacy of a multimodal intervention to reduce overutilization of computed tomography pulmonary angiography (CTPA) for suspected pulmonary embolism in the emergency department. Results indicated that guideline concordance increased significantly after intervention. The authors concluded that their success in increasing guideline concordance demonstrated the efficacy of a mixed-methods, human-centered approach to behavior change; however, given that neither of the secondary outcomes improved, the results may demonstrate potential limitations to the guidelines directing the ordering of CTPA studies.
AHRQ-funded; HS024376.
Citation: Gyftopoulos S, Simon E, Swartz JL .
Efficacy and impact of a multimodal intervention on CT pulmonary angiography ordering behavior in the emergency department.
J Am Coll Radiol 2024 Feb; 21(2):309-18. doi: 10.1016/j.jacr.2023.02.033.
Keywords: Emergency Department, Respiratory Conditions, Imaging, Diagnostic Safety and Quality, Blood Clots
Ali KJ, Goeschel CA, DeLia DM
The PRIDx framework to engage payers in reducing diagnostic errors in healthcare.
The authors conducted a literature review and interviewed subject matter experts to develop a multi-component Payer Relationships for Improving Diagnoses (PRIDx) framework. The PRIDx framework can be used to encourage public and private payers to take specific actions to improve diagnostic safety. The authors noted that implementation of the PRIDx framework will require new types of partnerships, including external support from public and private payer organizations, and also require the creation of strong provider incentives.
AHRQ-funded; 2332015000221.
Citation: Ali KJ, Goeschel CA, DeLia DM .
The PRIDx framework to engage payers in reducing diagnostic errors in healthcare.
https://www.pubmed.ncbi.nlm.nih.gov/37795579.
Keywords: Diagnostic Safety and Quality, Quality of Care, Patient Safety
Liu SK, Bourgeois F, Dong J
What's going well: a qualitative analysis of positive patient and family feedback in the context of the diagnostic process.
This paper evaluated positive patient/family feedback to generate broader perspectives on what constitutes a "good" diagnostic process (DxP). Eligible participants included patients/families living with chronic conditions with visits in three urban pediatric subspecialty clinics (site 1) and one rural adult primary care clinic (site 2) who were then invited to complete a survey between December 2020 and March 2020. The authors adapted the Healthcare Complaints Analysis Tool (HCAT) to conduct a qualitative analysis on a subset of patient/family responses with ≥20 words. A total of 7,075 surveys were completed before 18,129 visits (39 %) at site 1, and 460 surveys were completed prior to 706 (65 %) visits at site 2. Positive feedback was provided by 1,578 participants, ranging from 1-79 words. Categories of 272 comments with ≥20 words described: Relationships (60 %), Clinical Care (36 %), and Environment (4 %). In the Relationships category patients/families most commonly noted: thorough and competent attention (46 %), clear communication and listening (41 %) and emotional support and human connection (39 %). For Clinical Care, patients highlighted: timeliness (31 %), effective clinical management (30 %), and coordination of care (25 %).
AHRQ-funded; HS027367.
Citation: Liu SK, Bourgeois F, Dong J .
What's going well: a qualitative analysis of positive patient and family feedback in the context of the diagnostic process.
Diagnosis 2024 Feb 1; 11(1):63-72. doi: 10.1515/dx-2023-0075.
Keywords: Diagnostic Safety and Quality, Clinician-Patient Communication, Communication, Patient and Family Engagement
Newman-Toker DE, Nassery N, Schaffer AC
Burden of serious harms from diagnostic error in the USA.
Americans who experience serious harm from misdiagnosis annually. Serious harm is defined as permanent morbidity or morality. This cross-sectional analysis used nationally representative observational data. The authors estimated annual incident vascular events and infections from 21.5 million (M) sampled US hospital discharges (2012-2014). US-based cancer registries were used to find annual new cancers. They derived diagnostic errors and serious harms by multiplying by literature-based rates for disease-specific incidences for 15 major vascular events, infections and cancers ('Big Three' categories). Extrapolating to all diseases (including non-'Big Three' dangerous disease categories), they estimated total serious harms annually in the USA to be 795,000 (plausible range 598,000-1,023,000). Using more conservative assumptions they estimated 549,000 serious harms. These results were compatible with setting-specific serious harm estimates from inpatient, emergency department and ambulatory care. Fifteen dangerous diseases accounted for 50.7% of total serious harms and the top 5 (stroke, sepsis, pneumonia, venous thromboembolism and lung cancer) accounted for 38.7%.
AHRQ-funded; HS027614; HS029350.
Citation: Newman-Toker DE, Nassery N, Schaffer AC .
Burden of serious harms from diagnostic error in the USA.
BMJ Qual Saf 2024 Jan 19; 33(2):109-20. doi: 10.1136/bmjqs-2021-014130..
Keywords: Healthcare Cost and Utilization Project (HCUP), Diagnostic Safety and Quality, Medical Errors, Patient Safety, Quality of Care, Adverse Events
Vyas A, Madhavan S, Sambamoorthi U
Association between persistence with mammography screening and stage at diagnosis among elderly women diagnosed with breast cancer.
The objective of this study is to determine the association between persistence with mammography screening and stage at breast cancer (BC) diagnosis among elderly women. It found that, as compared to women who were not persistent with mammography screening, women who were persistent with mammography screening were significantly more likely to be diagnosed at earlier stages of BC.
AHRQ-funded; HS018622.
Citation: Vyas A, Madhavan S, Sambamoorthi U .
Association between persistence with mammography screening and stage at diagnosis among elderly women diagnosed with breast cancer.
Breast Cancer Res Treat 2014 Dec;148(3):645-54. doi: 10.1007/s10549-014-3204-3..
Keywords: Cancer, Cancer: Breast Cancer, Diagnostic Safety and Quality, Elderly, Prevention, Screening, Women
Gerber DE, Laccetti AL, Xuan L
Impact of prior cancer on eligibility for lung cancer clinical trials.
A prior cancer diagnosis often excludes patients from cancer clinical trials. Lung cancer patients were used to determine estimated impact on trial accrual. This study found that patients previously diagnosed with cancer were excluded in more than two-thirds of lung cancer trials. More research is needed to understand the basis of this policy.
AHRQ-funded; HS022418
Citation: Gerber DE, Laccetti AL, Xuan L .
Impact of prior cancer on eligibility for lung cancer clinical trials.
J Natl Cancer Inst. 2014 Nov;106(11). doi: 10.1093/jnci/dju302..
Keywords: Cancer: Lung Cancer, Policy, Cancer, Diagnostic Safety and Quality
Mohanan S, Tapp H, McWilliams A
Obesity and asthma: pathophysiology and implications for diagnosis and management in primary care.
This review summarizes existing data that support the pathophysiologic mechanisms underlying the association between obesity and asthma, as well as the current and future state of treatment for the obese patient with asthma. It suggests that evidence of chronic inflammatory response linking obesity and asthma indicates a need to address obesity during asthma management, possibly by using patient-centered approaches such as shared decisionmaking.
AHRQ-funded; HS019946
Citation: Mohanan S, Tapp H, McWilliams A .
Obesity and asthma: pathophysiology and implications for diagnosis and management in primary care.
Exp Biol Med. 2014 Nov;239(11):1531-40. doi: 10.1177/1535370214525302..
Keywords: Obesity, Asthma, Diagnostic Safety and Quality, Primary Care, Chronic Conditions
Young RS, Gobel BH, Schumacher M
Use of the modified early warning score and serum lactate to prevent cardiopulmonary arrest in hematology-oncology patients: a quality improvement study.
The authors aimed to improve the early identification of clinically deteriorating hematology-oncology patients in order to prevent the development of critical illness and to facilitate timely intensive care unit (ICU) transfers. They used a protocol employing the Modified Early Warning Score and found that implementation of this protocol reduced codes and preventable codes without an associated increase in ICU transfers.
AHRQ-funded; HS000078.
Citation: Young RS, Gobel BH, Schumacher M .
Use of the modified early warning score and serum lactate to prevent cardiopulmonary arrest in hematology-oncology patients: a quality improvement study.
Am J Med Qual 2014 Nov-Dec;29(6):530-7. doi: 10.1177/1062860613508305.
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Keywords: Adverse Events, Cancer, Diagnostic Safety and Quality, Prevention, Quality Improvement
Furuno JP, Comer AC, Johnson JK
Using antibiograms to improve antibiotic prescribing in skilled nursing facilities.
The researchers describe the design and implementation of a skilled nursing facility (SNF) specific antibiogram to improve empirical antibiotic prescribing. They estimated the frequency of inappropriate antibiotic prescribing in 3 Maryland SNFs and measured the effectiveness of the antibiograms on antibiotic prescribing in 1 of the SNFs.
AHRQ-funded; 290200600020I
Citation: Furuno JP, Comer AC, Johnson JK .
Using antibiograms to improve antibiotic prescribing in skilled nursing facilities.
Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S56-61. doi: 10.1086/677818..
Keywords: Long-Term Care, Antimicrobial Stewardship, Nursing Homes, Diagnostic Safety and Quality
Fierro JL, Prasad PA, Localio AR
Variability in the diagnosis and treatment of group a streptococcal pharyngitis by primary care pediatricians.
The researchers compared practice patterns regarding the diagnosis and management of streptococcal pharyngitis across 25 pediatric primary care practices sharing an electronic health record. They found that only 18 of 222 clinicians wrote 50 percent of all broad-spectrum antibiotic prescriptions for children with group a streptococcus pharyngitis. They suggested targeted interventions to improve adherence to prescribing guidelines.
AHRQ-funded; 290200710013
Citation: Fierro JL, Prasad PA, Localio AR .
Variability in the diagnosis and treatment of group a streptococcal pharyngitis by primary care pediatricians.
Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S79-85. doi: 10.1086/677820..
Keywords: Antibiotics, Children/Adolescents, Diagnostic Safety and Quality, Primary Care, Practice Patterns
Deppen SA, Blume JD, Kensinger CD
Accuracy of FDG-PET to diagnose lung cancer in areas with infectious lung disease: a meta-analysis.
The purpose of this study was to estimate the diagnostic accuracy of positron emission tomography (PET) combined with fludeoxyglucose F18 (FDG) for pulmonary modules suspicious for lung cancer in regions where infectious lung disease is endemic and compare the accuracy in regions where such disease is rare. It found that the accuracy of FDG-PET was extremely heterogeneous.
AHRQ-funded; HS021554.
Citation: Deppen SA, Blume JD, Kensinger CD .
Accuracy of FDG-PET to diagnose lung cancer in areas with infectious lung disease: a meta-analysis.
JAMA 2014 Sep 24;312(12):1227-36. doi: 10.1001/jama.2014.11488..
Keywords: Cancer, Cancer: Lung Cancer, Diagnostic Safety and Quality, Respiratory Conditions, Imaging
Dood RL, Gracia CR, Sammel MD
Endometrial cancer after endometrial ablation vs medical management of abnormal uterine bleeding.
The authors investigated whether endometrial ablation is associated with increased risk or delayed diagnosis of endometrial cancer compared with medical management of abnormal uterine bleeding. They observed no difference in endometrial cancer rates, nor was there a delay in diagnosis when comparing endometrial ablation vs medical management.
AHRQ-funded; HS021336.
Citation: Dood RL, Gracia CR, Sammel MD .
Endometrial cancer after endometrial ablation vs medical management of abnormal uterine bleeding.
J Minim Invasive Gynecol 2014 Sep-Oct;21(5):744-52. doi: 10.1016/j.jmig.2014.02.012.
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Keywords: Cancer, Comparative Effectiveness, Diagnostic Safety and Quality, Patient-Centered Outcomes Research, Women
Haines CF, Fleishman JA, Yehia BR
AHRQ Author: Fleishman JA
Increase in CD4 count among new enrollees in HIV care in the modern antiretroviral therapy era.
The authors sought to determine whether the CD4 count at presentation, a surrogate for time to presentation, increased from 2003 to 2011. They demonstrated a small, but statistically significant, increase in CD4 at presentation after the 2006 CDC HIV-screening guideline revision.
AHRQ-authored; AHRQ-funded; 290201100007C.
Citation: Haines CF, Fleishman JA, Yehia BR .
Increase in CD4 count among new enrollees in HIV care in the modern antiretroviral therapy era.
J Acquir Immune Defic Syndr 2014 Sep 1;67(1):84-90. doi: 10.1097/qai.0000000000000228.
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Keywords: Diagnostic Safety and Quality, Human Immunodeficiency Virus (HIV)
Boehme AK, Rawal PV, Lyerly MJ
Investigating the utility of previously developed prediction scores in acute ischemic stroke patients in the stroke belt.
The researchers compared several scoring systems among patients receiving systemic and endovascular treatments. They concluded that their study demonstrated that although highly predictive of outcome in the original study design treatment groups, prediction scores may not generalize to all patient samples, highlighting the importance of validating prediction scores in diverse samples.
AHRQ-funded; HS013852.
Citation: Boehme AK, Rawal PV, Lyerly MJ .
Investigating the utility of previously developed prediction scores in acute ischemic stroke patients in the stroke belt.
J Stroke Cerebrovasc Dis 2014 Sep;23(8):2001-6. doi: 10.1016/j.jstrokecerebrovasdis.2014.02.003.
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Keywords: Shared Decision Making, Diagnostic Safety and Quality, Risk, Stroke
Patel PA, Schora DM, Peterson KE
Performance of the Cepheid Xpert(R) SA Nasal Complete PCR assay compared to culture for detection of methicillin-sensitive and methicillin-resistant Staphylococcus aureus colonization.
Conventional culture-based methods, including several chromogenic agars, are available for SA and MRSA surveillance but they can take several days and have reduced sensitivity compared to amplification assays. Overall, the Cepheid assay proved a rapid, sensitive, and clinically useful test for the early detection and differentiation of MRSA and MSSA colonization on patients.
AHRQ-funded; HS019968.
Citation: Patel PA, Schora DM, Peterson KE .
Performance of the Cepheid Xpert(R) SA Nasal Complete PCR assay compared to culture for detection of methicillin-sensitive and methicillin-resistant Staphylococcus aureus colonization.
Diagn Microbiol Infect Dis 2014 Sep;80(1):32-4. doi: 10.1016/j.diagmicrobio.2014.05.019..
Keywords: Diagnostic Safety and Quality, Genetics, Methicillin-Resistant Staphylococcus aureus (MRSA)
Cadnum JL, Hurless KN, Deshpande A
Sensitive and selective culture medium for detection of environmental Clostridium difficile isolates without requirement for anaerobic culture conditions.
The researchers developed a low-cost selective broth medium containing thioglycolic acid and L-cystine, termed C. difficile Brucella broth with thioglycolic acid and L-cystine (CDBB-TC), for the detection of C. difficile from environmental specimens under aerobic culture conditions. Their findings demonstrate that a broth medium containing thioglycolic acid and L-cystine provides a sensitive and selective method for the culture of C. difficile from environmental specimens without the need for anaerobic culture conditions.
AHRQ-funded; HS020004.
Citation: Cadnum JL, Hurless KN, Deshpande A .
Sensitive and selective culture medium for detection of environmental Clostridium difficile isolates without requirement for anaerobic culture conditions.
J Clin Microbiol 2014 Sep;52(9):3259-63. doi: 10.1128/jcm.00793-14..
Keywords: Clostridium difficile Infections, Diagnostic Safety and Quality
Kelly JD, Hartman C, Graham J
Social support as a predictor of early diagnosis, linkage, retention, and adherence to HIV care: results from the steps study.
The researchers studied 168 persons newly diagnosed with AIDS to determine if social support contributes to various aspects of HIV care. They found that higher social support scores were associated with earlier HIV diagnosis, linkage to care, and adherence to antiretroviral therapy (ART). However, social support did not contribute to use of ART or retention in HIV care.
AHRQ-funded; HS016093
Citation: Kelly JD, Hartman C, Graham J .
Social support as a predictor of early diagnosis, linkage, retention, and adherence to HIV care: results from the steps study.
J Assoc Nurses AIDS Care. 2014 Sep-Oct;25(5):405-13. doi: 10.1016/j.jana.2013.12.002..
Keywords: Human Immunodeficiency Virus (HIV), Patient Adherence/Compliance, Diagnostic Safety and Quality
Leung LA, Swaminathan S, Trivedi AN
Diabetes diagnosis and exercise initiation among older Americans.
The investigators sought to determine whether exercise participation increased following a new diagnosis of diabetes using a sample of U.S. individuals aged 50 and over who did not report exercise prior to diagnosis. They found that over 35% of persons with a new diagnosis of diabetes initiated moderate or vigorous exercise in the year following their diagnosis.
AHRQ-funded; HS000011.
Citation: Leung LA, Swaminathan S, Trivedi AN .
Diabetes diagnosis and exercise initiation among older Americans.
Prev Med 2014 Aug;65:128-32. doi: 10.1016/j.ypmed.2014.05.001.
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Keywords: Diabetes, Diagnostic Safety and Quality, Elderly, Lifestyle Changes, Patient Self-Management
Cole B, Dickerson JA, Graber ML
AHRQ Author: Henriksen K
A prospective tool for risk assessment of sendout testing.
The authors developed a tool to assess risk of diagnostic errors involving laboratory sendout testing. The tool was determined, through testing at nine pilot sites, to be both useful and easy to use. It could be used by other laboratories to identify the areas of highest risk to patients, which in turn may guide them in focusing their quality improvement efforts and resources.
AHRQ-authored; AHRQ-funded; 29032001T.
Citation: Cole B, Dickerson JA, Graber ML .
A prospective tool for risk assessment of sendout testing.
Clin Chim Acta 2014 Jul 1;434:1-5. doi: 10.1016/j.cca.2014.03.028.
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Keywords: Diagnostic Safety and Quality, Quality of Care, Medical Errors, Patient Safety
Cleveland N, Colwell C, Douglass E
Motor vehicle crash severity estimations by physicians and prehospital personnel.
The purpose of this study was to determine whether emergency physicians (EPs) and EMS personnel differ in their assessment of motor vehicle collision severity and the potential for serious injury when viewing crash scene photographs. They found excellent crash and injury agreement at both ends of the severity spectrum but only modest agreement, and therefore greater variability, in the middle of the severity spectrum.
AHRQ-funded; HS017526
Citation: Cleveland N, Colwell C, Douglass E .
Motor vehicle crash severity estimations by physicians and prehospital personnel.
Prehosp Emerg Care. 2014 Jul-Sep;18(3):402-7. doi: 10.3109/10903127.2014.891065..
Keywords: Emergency Medical Services (EMS), Trauma, Injuries and Wounds, Provider: Health Personnel, Diagnostic Safety and Quality
Wernli KJ, Hubbard RA, Johnson E
Patterns of colorectal cancer screening uptake in newly eligible men and women.
The researchers describe patterns of colorectal cancer screening uptake in a U.S. insured population as individuals become newly eligible for screening at age 50 and assess temporal trends and patient characteristics with screening uptake. Their results suggest that characteristics of newly eligible individuals who initiate colorectal cancer screening are similar to the characteristics of all U.S. adults who receive colorectal cancer screening tests.
AHRQ-funded; HS019482.
Citation: Wernli KJ, Hubbard RA, Johnson E .
Patterns of colorectal cancer screening uptake in newly eligible men and women.
Cancer Epidemiol Biomarkers Prev 2014 Jul;23(7):1230-7. doi: 10.1158/1055-9965.epi-13-1360..
Keywords: Screening, Colonoscopy, Diagnostic Safety and Quality, Healthcare Utilization
Pruitt SL, Leonard T, Zhang S
Physicians, clinics, and neighborhoods: multiple levels of influence on colorectal cancer screening.
The researchers described variability in colorectal cancer (CRC) test use across multiple levels, including physician, clinic, and neighborhood; and (ii) compared the performance of novel cross-classified models versus traditional hierarchical models. Significant variability was observed across all levels in both hierarchical and cross-classified models that was unexplained by measured covariates. For colonoscopy, variance was similar across all levels.
AHRQ-funded; HS022418.
Citation: Pruitt SL, Leonard T, Zhang S .
Physicians, clinics, and neighborhoods: multiple levels of influence on colorectal cancer screening.
Cancer Epidemiol Biomarkers Prev 2014 Jul;23(7):1346-55. doi: 10.1158/1055-9965.epi-13-1130..
Keywords: Cancer: Colorectal Cancer, Diagnostic Safety and Quality, Screening