National Healthcare Quality and Disparities Report
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- Access to Care (1)
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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
51 to 68 of 68 Research Studies DisplayedFernandez FG, Furnary AP, Kosinski AS
Longitudinal follow-up of lung cancer resection from the Society of Thoracic Surgeons General Thoracic Surgery Database in patients 65 years and older.
The purpose of this paper was to provide longitudinal follow-up to the Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTSD) through linkage to the Centers for Medicare and Medicaid Services (CMS) data for patients 65 years of age or older. The researchers found that median survival after lung cancer resection was 6.7 years for pathologic stage I, 3.5 years for stage II, 2.4 years for stage III, and 2.2 years for stage IV. They concluded that CMS data complement the STS GTSD data by enabling examination of long-term survival and resource utilization in patients 65 years or older.
AHRQ-funded; HS022279.
Citation: Fernandez FG, Furnary AP, Kosinski AS .
Longitudinal follow-up of lung cancer resection from the Society of Thoracic Surgeons General Thoracic Surgery Database in patients 65 years and older.
Ann Thorac Surg 2016 Jun;101(6):2067-76. doi: 10.1016/j.athoracsur.2016.03.034.
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Keywords: Cancer: Lung Cancer, Surgery, Elderly, Outcomes, Mortality
Sheetz KH, Dimick JB, Ghaferi AA
Impact of hospital characteristics on failure to rescue following major surgery.
This study determined the effect of hospital characteristics on failure to rescue after high-risk surgery in Medicare beneficiaries. It found that although several hospital characteristics are associated with lower failure to rescue rates, these macrosystem factors explain a small proportion of the variability between hospitals. This suggests that microsystem characteristics may play a larger role in improving a hospital's ability to manage postoperative complications.
AHRQ-funded; HS023621.
Citation: Sheetz KH, Dimick JB, Ghaferi AA .
Impact of hospital characteristics on failure to rescue following major surgery.
Ann Surg 2016 Apr;263(4):692-7. doi: 10.1097/sla.0000000000001414.
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Keywords: Surgery, Elderly, Adverse Events, Disparities, Mortality
Fritz JM, Rundell SD, Dougherty P
Deconstructing chronic low back pain in the older adult-step by step evidence and expert-based recommendations for evaluation and treatment. Part vi: Lumbar spinal stenosis.
This article is the sixth in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. It focuses on the evaluation and management of lumbar spinal stenosis (LSS), the most common condition for which older adults undergo spinal surgery. It concluded that lumbar spinal stenosis exists not uncommonly in older adults with CLBP and management often can be accomplished without surgery.
AHRQ-funded; HS022982.
Citation: Fritz JM, Rundell SD, Dougherty P .
Deconstructing chronic low back pain in the older adult-step by step evidence and expert-based recommendations for evaluation and treatment. Part vi: Lumbar spinal stenosis.
Pain Med 2016 Mar;17(3):501-10. doi: 10.1093/pm/pnw011..
Keywords: Back Health and Pain, Elderly, Chronic Conditions, Treatments, Surgery
Tamirisa NP, Parmar AD, Vargas GM
Relative contributions of complications and failure to rescue on mortality in older patients undergoing pancreatectomy.
This study evaluated the relative contribution of overall postoperative complications and failure to rescue rates on the observed increased mortality in older patients undergoing pancreatic resection at specialized centers. In experienced hands, the rates of complications after pancreatectomy in patients 80 years or older compared to patients younger than 80 years were similar. However, when complications occurred, older patients were more likely to die.
AHRQ-funded; HS022134.
Citation: Tamirisa NP, Parmar AD, Vargas GM .
Relative contributions of complications and failure to rescue on mortality in older patients undergoing pancreatectomy.
Ann Surg 2016 Feb;263(2):385-91. doi: 10.1097/sla.0000000000001093..
Keywords: Elderly, Mortality, Surgery, Adverse Events, Patient-Centered Outcomes Research
Ghaferi AA, Dimick JB
Importance of teamwork, communication and culture on failure-to-rescue in the elderly.
The researchers reviewed the literature evaluating surgery, mortality, failure-to-rescue and the elderly. This was followed by a review of ongoing studies and unpublished work aiming to understand better the mechanisms underlying variations in surgical mortality in elderly patients. They concluded that although elderly surgical patients experienced failure-to-rescue events at much higher rates than their younger counterparts, patient-level effects did not sufficiently explain these differences.
AHRQ-funded; HS023621; HS024403; HS023597.
Citation: Ghaferi AA, Dimick JB .
Importance of teamwork, communication and culture on failure-to-rescue in the elderly.
Br J Surg 2016 Jan;103(2):e47-51. doi: 10.1002/bjs.10031.
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Keywords: Elderly, Mortality, Surgery, Teams, Patient Safety
Singh JA, Ramachandran R
Age-related differences in the use of total shoulder arthroplasty over time: use and outcomes.
The authors assessed the age-related differences in the use of total shoulder arthroplasty (TSA) and outcomes, and associated time-trends using the United States Nationwide Inpatient Sample (NIS) between 1998 and 2010. They noted a time-related increase in the use of TSA and increasing age-related differences in outcomes indicating a changing epidemiology of the use of TSA and concluded that age-related differences in outcomes suggest that attention should focus on groups with the worst outcomes.
AHRQ-funded; HS021110.
Citation: Singh JA, Ramachandran R .
Age-related differences in the use of total shoulder arthroplasty over time: use and outcomes.
Bone Joint J 2015 Oct;97-b(10):1385-9. doi: 10.1302/0301-620x.97b10.35696.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Elderly, Orthopedics, Surgery
Beffa LR, Petroski GF, Kruse RL
Functional status of nursing home residents before and after abdominal aortic aneurysm repair.
The authors evaluated the effects of elective open AAA repair (OAR) and endovascular AAA repair (EVAR) and evaluated comorbidities for their impact on functional trajectories after discharge. They found that procedure type was not significantly related to postoperative function or to the subsequent rate of improvement. OAR and EVAR were associated with similar initial declines and comparable postoperative trajectories, suggesting that less invasive EVAR was not associated with improved functional preservation compared with OAR. Longer stays were associated with poorer functional trajectories.
AHRQ-funded; HS022140.
Citation: Beffa LR, Petroski GF, Kruse RL .
Functional status of nursing home residents before and after abdominal aortic aneurysm repair.
J Vasc Nurs 2015 Sep;33(3):106-11. doi: 10.1016/j.jvn.2015.02.003.
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Keywords: Adverse Events, Elderly, Nursing Homes, Patient-Centered Outcomes Research, Surgery
Brooke BS, Goodney PP, Kraiss LW
Readmission destination and risk of mortality after major surgery: an observational cohort study.
This study examined the association between readmission destination and mortality risk in the USA in Medicare beneficiaries after a range of common operations. It found that patients who are readmitted to hospital after various major operations consistently achieve improved survival if they return to the hospital where their surgery took place.
AHRQ-funded; HS021581.
Citation: Brooke BS, Goodney PP, Kraiss LW .
Readmission destination and risk of mortality after major surgery: an observational cohort study.
Lancet 2015 Aug 29;386(9996):884-95. doi: 10.1016/s0140-6736(15)60087-3..
Keywords: Hospital Readmissions, Mortality, Surgery, Elderly, Outcomes, Hospitals
Fink HA, Hemmy LS, MacDonald R
Intermediate- and long-term cognitive outcomes after cardiovascular procedures in older adults: a systematic review.
This study summarized evidence about cognitive outcomes in adults aged 65 years or older at least 3 months after coronary or carotid revascularization, cardiac valve procedures, or ablation for atrial fibrillation. It concluded that intermediate- and long-term cognitive impairment in older adults attributable to the studied cardiovascular procedures may be uncommon.
AHRQ-funded; 2902007100641.
Citation: Fink HA, Hemmy LS, MacDonald R .
Intermediate- and long-term cognitive outcomes after cardiovascular procedures in older adults: a systematic review.
Ann Intern Med 2015 Jul 21;163(2):107-17. doi: 10.7326/m14-2793..
Keywords: Cardiovascular Conditions, Elderly, Neurological Disorders, Outcomes, Patient-Centered Outcomes Research, Risk, Surgery
Vemana G, Vetter J, Chen L
Sources of variation in follow-up expenditure after radical cystectomy.
Follow-up care after radical cystectomy is poorly defined, with extensive variation in practice patterns. The researchers sought to determine sources of these variations in care as well as examine the economic effect of standardization of care on guideline-recommended care. The most variation in expenditure on follow-up care was at the patient level, largely based on node positivity, chemotherapy status, and final cancer stage.
AHRQ-funded; HS019455.
Citation: Vemana G, Vetter J, Chen L .
Sources of variation in follow-up expenditure after radical cystectomy.
Urol Oncol 2015 Jun;33(6):267.e31-7. doi: 10.1016/j.urolonc.2015.03.009..
Keywords: Cancer, Surgery, Healthcare Costs, Elderly
Huo J, Du XL, Lairson DR
Utilization of surgery, chemotherapy, radiation therapy, and hospice at the end of life for patients diagnosed with metastatic melanoma.
The authors examined the patterns of utilization of radiation therapy, chemotherapy, surgery, and hospice at the end-of-life care for patients diagnosed with metastatic melanoma. They found that surgery and hospice care use increased over the 8 years of this study, whereas the use of chemotherapy and radiation therapy remained consistent for patients diagnosed with metastatic melanoma.
AHRQ-funded; HS018956.
Citation: Huo J, Du XL, Lairson DR .
Utilization of surgery, chemotherapy, radiation therapy, and hospice at the end of life for patients diagnosed with metastatic melanoma.
Am J Clin Oncol 2015 Jun;38(3):235-41. doi: 10.1097/COC.0b013e31829378f9.
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Keywords: Cancer, Cancer: Skin Cancer, Treatments, Elderly, Healthcare Utilization, Palliative Care, Patient-Centered Outcomes Research, Surgery
Kumamaru H, Jalbert JJ, Nguyen LL
Surgeon case volume and 30-day mortality after carotid endarterectomy among contemporary medicare beneficiaries: before and after national coverage determination for carotid artery stenting.
The objective of this study is to examine the decline in past-year case-volumes of surgeons performing carotid endarterectomy (CEA) before and after the National Coverage Determination (NCD) for carotid artery stenting (CAS) and to assess its effect on 30-day post-CEA mortality. It found that the rate of CEA procedures decreased substantially during 2001 to 2008. The postprocedural mortality in Medicare beneficiaries was high compared with trial patients.
AHRQ-funded; 29020050016I.
Citation: Kumamaru H, Jalbert JJ, Nguyen LL .
Surgeon case volume and 30-day mortality after carotid endarterectomy among contemporary medicare beneficiaries: before and after national coverage determination for carotid artery stenting.
Stroke 2015 May;46(5):1288-94. doi: 10.1161/strokeaha.114.006276..
Keywords: Surgery, Mortality, Patient-Centered Outcomes Research, Outcomes, Elderly
Riall TS, Adhikari D, Parmar AD
The risk paradox: use of elective cholecystectomy in older patients is independent of their risk of developing complications.
For older patients with newly diagnosed symptomatic gallstones, researchers calculated their 2-year risk of emergent gallstone-related hospitalization. They found that patients in the high-risk group were less likely to receive elective cholecystectomy than those in the low-risk group. The study used Texas Medicare data for 161,568 patients with an episode of symptomatic gallstones.
AHRQ-funded; HS022134
Citation: Riall TS, Adhikari D, Parmar AD .
The risk paradox: use of elective cholecystectomy in older patients is independent of their risk of developing complications.
J Am Coll Surg. 2015 Apr;220(4):682-90. doi: 10.1016/j.jamcollsurg.2014.12.012..
Keywords: Hospitalization, Elderly, Medicare, Surgery
Tamirisa NP, Parmar AD, Vargas GM
Relative contributions of complications and failure to rescue on mortality in older patients undergoing pancreatectomy.
This study evaluated the relative contribution of overall postoperative complications and failure to rescue rates on the observed increased mortality in older patients undergoing pancreatic resection at specialized centers. The study found that patients 80 years and older had no difference in complication rates but higher failure to rescue rates compared to patients younger than 80.
AHRQ-funded; HS022134
Citation: Tamirisa NP, Parmar AD, Vargas GM .
Relative contributions of complications and failure to rescue on mortality in older patients undergoing pancreatectomy.
Ann Surg. 2016 Feb;263(2):385-91. doi: 10.1097/SLA.0000000000001093..
Keywords: Surgery, Mortality, Patient Safety, Quality of Care, Elderly
Parmar AD, Coutin MD, Vargas GM
Cost-effectiveness of elective laparoscopic cholecystectomy versus observation in older patients presenting with mild biliary disease.
The objective was to determine the threshold for probability of recurrent symptoms at which elective cholecystectomy became the most effective and cost-effective options for older patients with mild biliary disease. This procedure was more effective than observation when the probability of continued symptoms exceeded 45.3 percent; when the probability exceeded 82.7 percent, the procedure became more cost-effective as well.
AHRQ-funded; HS022134
Citation: Parmar AD, Coutin MD, Vargas GM .
Cost-effectiveness of elective laparoscopic cholecystectomy versus observation in older patients presenting with mild biliary disease.
J Gastrointest Surg. 2014 Sep;18(9):1616-22. doi: 10.1007/s11605-014-2570-9..
Keywords: Comparative Effectiveness, Healthcare Costs, Elderly, Surgery
Vargas GM, Parmar AD, Sheffield KM
Impact of liver-directed therapy in colorectal cancer liver metastases.
This study evaluated the use of liver resection, ablation, and chemoembolization (LDT) in older patients presenting with metastatic colorectal cancer in the setting of improved chemotherapy. It found that many older patients deemed to be appropriate candidates for resection of the primary tumor and receipt of systemic chemotherapy did not receive LDT.
AHRQ-funded; HS022134
Citation: Vargas GM, Parmar AD, Sheffield KM .
Impact of liver-directed therapy in colorectal cancer liver metastases.
J Surg Res. 2014 Sep;191(1):42-50. doi: 10.1016/j.jss.2014.05.070..
Keywords: Comparative Effectiveness, Patient-Centered Outcomes Research, Elderly, Surgery
Daniels AH, Daiello LA, Lareau CR
Preoperative cognitive impairment and psychological distress in hospitalized elderly hip fracture patients.
The authors conducted a study to evaluate the prevalence of cognitive impairment (CI) compared with normal cognition (NC) in elderly hip fracture patients 65 years and older. Results showed many patients had unrecognized CI before surgery and had significantly more pain and fear than the NC group.
AHRQ-funded; HS017735
Citation: Daniels AH, Daiello LA, Lareau CR .
Preoperative cognitive impairment and psychological distress in hospitalized elderly hip fracture patients.
Ame J Orthop. 2014 Jul; 43(7):E146-52..
Keywords: Elderly, Injuries and Wounds, Neurological Disorders, Surgery
Suskind AM, Clemens JQ, Dunn RL
Effectiveness of mesh compared with nonmesh sling surgery in Medicare beneficiaries.
This study assessed the effectiveness of mesh compared to nonmesh slings in the surgical treatment of female incontinence. It found that overall rates of complications were similar for patients undergoing either mesh or nonmesh sling procedures. However, patients undergoing the nonmesh procedure were more likely to require a subsequent intervention for bladder outlet obstruction.
AHRQ-funded; HS018726.
Citation: Suskind AM, Clemens JQ, Dunn RL .
Effectiveness of mesh compared with nonmesh sling surgery in Medicare beneficiaries.
Obstet Gynecol. 2013 Sep;122(3):546-52. doi: 10.1097/AOG.0b013e31829e8543..
Keywords: Comparative Effectiveness, Elderly, Patient-Centered Outcomes Research, Surgery, Women, Outcomes, Medicare, Evidence-Based Practice