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 53 Research Studies DisplayedCooper LB, Lippmann SJ, Greiner MA
Use of mineralocorticoid receptor antagonists in patients with heart failure and comorbid diabetes mellitus or chronic kidney disease.
Perceived risks of hyperkalemia and acute renal insufficiency may limit use of mineralocorticoid receptor antagonist (MRA) therapy in patients with heart failure, especially those with diabetes mellitus or chronic kidney disease. In their study, the investigators found that among patients with heart failure and diabetes mellitus or chronic kidney disease, MRA use was associated with lower risk of all-cause readmission despite greater risk of hyperkalemia and acute renal insufficiency.
AHRQ-funded; HS021092.
Citation: Cooper LB, Lippmann SJ, Greiner MA .
Use of mineralocorticoid receptor antagonists in patients with heart failure and comorbid diabetes mellitus or chronic kidney disease.
J Am Heart Assoc 2017 Dec 23;6(12):pii: e006540. doi: 10.1161/jaha.117.006540..
Keywords: Cardiovascular Conditions, Chronic Conditions, Diabetes, Evidence-Based Practice, Heart Disease and Health, Kidney Disease and Health, Outcomes, Patient-Centered Outcomes Research, Registries
Bowen ME, Rumana U, Kilgore EA
A user-centered glucose-insulin data display for the inpatient setting.
Researchers sought to develop a set of user-centered displays of capillary glucose data and insulin dose to improve inpatient management of insulin-dependent diabetes. Their proposed conceptual data display prototype is designed to simplify the presentation and visualization of key information needed for treatment decisions. The goal is also to enhance clinician's ability to identify opportunities to optimize insulin dosing and decrease end users' cognitive load and error rates.
AHRQ-funded; HS022895.
Citation: Bowen ME, Rumana U, Kilgore EA .
A user-centered glucose-insulin data display for the inpatient setting.
Stud Health Technol Inform 2017;245:684-88.
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Keywords: Care Management, Diabetes, Health Information Technology (HIT), Inpatient Care, Patient Safety
Taira DA, Seto BK, Davis JW
Examining factors associated with nonadherence and identifying providers caring for nonadherent subgroups.
This study examined racial/ethnic and regional differences in medication adherence in patients with diabetes taking oral anti-diabetic, anti-hypertensive, and cholesterol lowering medications and to identify the pharmacies and prescribers who serve these communities. After adjustment for other factors, Filipinos, Native Hawaiians, and people of other race were significantly less adherent to anti-diabetic and anti-hypertensive medications than Japanese.
AHRQ-funded; HS023185.
Citation: Taira DA, Seto BK, Davis JW .
Examining factors associated with nonadherence and identifying providers caring for nonadherent subgroups.
J Pharm Health Serv Res 2017 Dec;8(4):247-53. doi: 10.1111/jphs.12193.
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Keywords: Diabetes, Medication, Patient Adherence/Compliance, Patient-Centered Healthcare, Racial and Ethnic Minorities
Oakes AH, Garmo VS, Bone LR
Identifying and prioritizing the barriers and facilitators to the self-management of type 2 diabetes mellitus: a community-centered approach.
The researchers sought to develop and test an instrument to identify and quantify the barriers and facilitators to self-management of type 2 diabetes. The study concluded that factors impacting self-management can be quantified and categorized as barriers and facilitators. Further refinement to some factors and investigation into alternative prioritization methods is necessary.
AHRQ-funded; HS000029.
Citation: Oakes AH, Garmo VS, Bone LR .
Identifying and prioritizing the barriers and facilitators to the self-management of type 2 diabetes mellitus: a community-centered approach.
Patient 2017 Dec;10(6):773-83. doi: 10.1007/s40271-017-0248-6..
Keywords: Diabetes, Health Services Research (HSR), Patient-Centered Healthcare, Patient Self-Management
Lee AK, Lee CJ, Huang ES
Risk factors for severe hypoglycemia in black and white adults with diabetes: the Atherosclerosis Risk in Communities (ARIC) study.
Severe hypoglycemia is a rare but important complication of type 2 diabetes. Few studies have examined the epidemiology of hypoglycemia in a community-based population. This study concluded that poor glycemic control, glycemic variability as captured by 1,5-anhydroglucitol, kidney damage, and measures of cognitive and functional impairments were strongly associated with increased risk of severe hypoglycemia.
AHRQ-funded; HS018542.
Citation: Lee AK, Lee CJ, Huang ES .
Risk factors for severe hypoglycemia in black and white adults with diabetes: the Atherosclerosis Risk in Communities (ARIC) study.
Diabetes Care 2017 Dec;40(12):1661-67. doi: 10.2337/dc17-0819.
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Keywords: Cardiovascular Conditions, Elderly, Diabetes, Racial and Ethnic Minorities, Risk
Ratanawongsa N, Chan LL, Fouts MM
The challenges of electronic health records and diabetes electronic prescribing: implications for safety net care for diverse populations.
This review highlights how the EHR electronic prescribing transformation has affected diabetes care for vulnerable patients and offers recommendations for improving patient safety through EHR electronic prescribing design, implementation, policy, and research. Specifically, it presents evidence for the adoption of RxNorm and standardized naming and picklist options for high alert medications such as insulin.
AHRQ-funded; HS022561; HS023558.
Citation: Ratanawongsa N, Chan LL, Fouts MM .
The challenges of electronic health records and diabetes electronic prescribing: implications for safety net care for diverse populations.
J Diabetes Res 2017;2017:8983237. doi: 10.1155/2017/8983237.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Vulnerable Populations, Diabetes, Patient Safety, Chronic Conditions
Zhou M, Wang SV, Leonard CE
Sentinel modular program for propensity score-matched cohort analyses: application to glyburide, glipizide, and serious hypoglycemia.
Sentinel is a program sponsored by the US Food and Drug Administration to monitor the safety of medical products. This cohort assessment was conducted to evaluate the ability of the Sentinel Propensity Score Matching Tool to reproduce, in an expedited fashion, the known association between glyburide (vs. glipizide) and serious hypoglycemia. The study’s findings were consistent with the literature, and demonstrated the ability of the tool to reproduce this known association in an expedited.
AHRQ-funded; HS022193.
Citation: Zhou M, Wang SV, Leonard CE .
Sentinel modular program for propensity score-matched cohort analyses: application to glyburide, glipizide, and serious hypoglycemia.
Epidemiology 2017 Nov;28(6):838-46. doi: 10.1097/ede.0000000000000709..
Keywords: Adverse Drug Events (ADE), Diabetes, Medication: Safety, Medication, Patient Safety
Taylor HA, Morales C, Wilfond BS
A trial to test a novel approach to diabetes prevention.
This report presents a case introduction and summary in which the study under consideration planned to randomize patients at risk of diabetes (Type 2) to positive airway pressure (PAP) therapy to prevent the progression from prediabetes to diabetes (Type 2).
AHRQ-funded; HS000029.
Citation: Taylor HA, Morales C, Wilfond BS .
A trial to test a novel approach to diabetes prevention.
Am J Bioeth 2017 Oct;17(10):74-75. doi: 10.1080/15265161.2017.1366200..
Keywords: Diabetes, Prevention, Chronic Conditions
Chung S, Panattoni L, Chi J
Can secure patient-provider messaging improve diabetes care?
The authors examined whether messaging with physicians for medical advice is associated with fewer face-to-face visits and better diabetes management. Patients with diabetes using an online portal were studied; 72% used messaging, and those who made frequent visits were also more likely to message. No messaging at all was negatively associated with the likelihood of meeting an HbA1c target. Among message users, additional messages were associated with better outcome, with a stronger relationship for noninsulin users. Physician-initiated messages had effects similar to those for patient-initiated messages.
AHRQ-funded; HS019815.
Citation: Chung S, Panattoni L, Chi J .
Can secure patient-provider messaging improve diabetes care?
Diabetes Care 2017 Oct;40(10):1342-48. doi: 10.2337/dc17-0140.
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Keywords: Communication, Diabetes, Clinician-Patient Communication, Electronic Health Records (EHRs)
Letourneau LR, Carmody D, Wroblewski K
Diabetes presentation in infancy: high risk of diabetic ketoacidosis.
In this study, the largest of its kind, diabetic ketoacidosis (DKA) was more frequent than in other early-onset U.S. studies or other cohorts of patients with neonatal diabetes. The authors argue that continuing to educate pediatric providers about the many ways that infants can present with diabetes may help to diagnose cases more efficiently and ultimately decrease the frequency of DKA at diagnosis.
AHRQ-funded; HS023007.
Citation: Letourneau LR, Carmody D, Wroblewski K .
Diabetes presentation in infancy: high risk of diabetic ketoacidosis.
Diabetes Care 2017 Oct;40(10):e147-e48. doi: 10.2337/dc17-1145.
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Keywords: Diabetes, Diagnostic Safety and Quality, Newborns/Infants, Children/Adolescents
Ehrlich SF, Hedderson MM, Brown SD
Moderate intensity sports and exercise is associated with glycaemic control in women with gestational diabetes.
The aim of the study was to assess the association of regular, unsupervised sports and exercise during pregnancy, by intensity level, with glycaemic control in women with gestational diabetes (GDM). The study concluded that higher volumes of moderate intensity sports and exercise, reported shortly after GDM diagnosis, were significantly associated with increased odds of achieving glycaemic control.
AHRQ-funded; HS019367.
Citation: Ehrlich SF, Hedderson MM, Brown SD .
Moderate intensity sports and exercise is associated with glycaemic control in women with gestational diabetes.
Diabetes Metab 2017 Oct;43(5):416-23. doi: 10.1016/j.diabet.2017.01.006..
Keywords: Diabetes, Lifestyle Changes, Outcomes, Patient-Centered Outcomes Research, Pregnancy, Women
Ndefo UA, Moultry AM, Davis PN
Provision of medication therapy management by pharmacists to patients with type-2 diabetes mellitus in a federally qualified health center.
This article describes a medication therapy management (MTM) pilot program that was implemented at a federally qualified health center. This program was implemented at three clinics involving patients with uncontrolled diabetes, defined as hemoglobin A1c (HbA1c) greater than 8 percent. Fifty-seven patients met the established criteria and were enrolled in the six-month program. Thirty-seven patients completed the program and had an average 15 percent reduction in HbA1c.
AHRQ-funded; 290201100001C.
Citation: Ndefo UA, Moultry AM, Davis PN .
Provision of medication therapy management by pharmacists to patients with type-2 diabetes mellitus in a federally qualified health center.
P&T 2017 Oct;42(10):632-37.
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Keywords: Diabetes, Medication, Chronic Conditions, Patient-Centered Healthcare, Provider: Pharmacist
Handley MA, Quan J, Chao MT
Use of complementary health approaches among diverse primary care patients with type 2 diabetes and association with cardiometabolic outcomes: from the SF Bay Collaborative Research Network (SF Bay CRN).
The purpose of this study is to describe use of complementary health approaches (CHAs) among patients with type 2 diabetes, and independent associations between CHA use and Hemoglobin A1c (A1C) and lower-density lipoprotein (LDL) cholesterol. The study concluded that CHA use is common among patients with type 2 diabetes and may be associated with poor cardiometabolic control and medication adherence.
AHRQ-funded; HS022561.
Citation: Handley MA, Quan J, Chao MT .
Use of complementary health approaches among diverse primary care patients with type 2 diabetes and association with cardiometabolic outcomes: from the SF Bay Collaborative Research Network (SF Bay CRN).
J Am Board Fam Med 2017 Sep-Oct;30(5):624-31. doi: 10.3122/jabfm.2017.05.170030..
Keywords: Heart Disease and Health, Complementary and Alternative Medicine, Diabetes, Outcomes, Patient Self-Management
Bowen ME, Merchant Z, Abdullah K
Patient, provider, and system factors associated with failure to follow-up elevated glucose results in patients without diagnosed diabetes.
Patient, provider, and system factors associated with failure to follow-up elevated glucose values in electronic medical records (EMRs) are not well described. The researchers conducted a chart review in a comprehensive EMR with a patient portal and results management features but found no associations between patient characteristics, diabetes risk factors, or provider characteristics and follow-up failures.
AHRQ-funded; HS022418.
Citation: Bowen ME, Merchant Z, Abdullah K .
Patient, provider, and system factors associated with failure to follow-up elevated glucose results in patients without diagnosed diabetes.
Health Serv Res Manag Epidemiol 2017 Aug 29;4:2333392817721647. doi: 10.1177/2333392817721647.
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Keywords: Diabetes, Electronic Health Records (EHRs), Web-Based, Patient-Centered Healthcare, Diagnostic Safety and Quality
Mehta HB, Mehta V, Goodwin JS
Association of hypoglycemia with subsequent dementia in older patients with type 2 diabetes mellitus.
This study evaluated an association of hypoglycemia with subsequent dementia in patients with type 2 diabetes. Hypoglycemia is associated with a higher risk of dementia and may be responsible in part for the higher risk of dementia in patients with diabetes. Alternatively, hypoglycemia may be a marker for undiagnosed cognitive impairment, and we cannot rule out the possibility of reverse causation between hypoglycemia and dementia.
AHRQ-funded; HS022134.
Citation: Mehta HB, Mehta V, Goodwin JS .
Association of hypoglycemia with subsequent dementia in older patients with type 2 diabetes mellitus.
J Gerontol A Biol Sci Med Sci 2017 Aug;72(8):1110-16. doi: 10.1093/gerona/glw217.
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Keywords: Dementia, Diabetes, Elderly, Risk
Flory J, Gerhard T, Stempniewicz N
Comparative adherence to diabetes drugs: an analysis of electronic health records and claims data.
The objective of this brief report is to compare adherence rates for 6 major classes of diabetes medications: metformin, sulfonylurea, thiazolidinedione, basal insulin, DPP-4 inhibitors, and GLP-1 receptor agonists. The authors note that the rates at which diabetes drugs are prescribed, and the rates at which patients actually take them, differ substantially. The authors also note that the physicians should be aware of potentially significant challenges concerning adherence to newer agents.
AHRQ-funded; HS023898.
Citation: Flory J, Gerhard T, Stempniewicz N .
Comparative adherence to diabetes drugs: an analysis of electronic health records and claims data.
Diabetes Obes Metab 2017 Aug;19(8):1184-87. doi: 10.1111/dom.12931..
Keywords: Diabetes, Electronic Health Records (EHRs), Patient Adherence/Compliance, Practice Patterns, Medication
Olesiuk WJ, Farley JF, Domino ME
Do medical homes offer improved diabetes care for Medicaid enrollees with co-occurring schizophrenia?
The purpose of this study was to determine whether Medicaid recipients with co-occurring diabetes and schizophrenia that are medical-home-enrolled are more likely to receive guideline-concordant diabetes care than those who are not medical-home-enrolled, controlling for confounders. The study concluded that medical-home enrollment is generally associated with greater likelihood of receiving guideline-concordant diabetes care for Medicaid enrollees with diabetes and schizophrenia.
AHRQ-funded; HS023099; HS019659; HS000032.
Citation: Olesiuk WJ, Farley JF, Domino ME .
Do medical homes offer improved diabetes care for Medicaid enrollees with co-occurring schizophrenia?
J Health Care Poor Underserved 2017;28(3):1030-41. doi: 10.1353/hpu.2017.0094..
Keywords: Care Management, Diabetes, Medicaid, Behavioral Health, Patient-Centered Healthcare
Leonard CE, Hennessy S, Han X
Pro- and antiarrhythmic actions of sulfonylureas: Mechanistic and clinical evidence.
In this review, the authors explore the influence of sulfonylureas on the risk of serious arrhythmias, with specific foci on ischemic preconditioning, cardiac excitability, and serious hypoglycemia as putative mechanisms. They argue that elucidating the relationship between individual sulfonylureas and serious arrhythmias is critical, especially as the diabetes epidemic intensifies and sudden cardiac arrest (SCA) incidence increases in persons with diabetes.
AHRQ-funded; HS023898.
Citation: Leonard CE, Hennessy S, Han X .
Pro- and antiarrhythmic actions of sulfonylureas: Mechanistic and clinical evidence.
Trends Endocrinol Metab 2017 Aug;28(8):561-86. doi: 10.1016/j.tem.2017.04.003.
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Keywords: Adverse Drug Events (ADE), Cardiovascular Conditions, Diabetes, Medication, Mortality
Brown SD, Grijalva CS, Ferrara A
Leveraging EHRs for patient engagement: perspectives on tailored program outreach.
Electronic health records (EHRs) present healthcare delivery systems with scalable, cost-effective opportunities to promote lifestyle programs among patients at high risk for type 2 diabetes, yet little consensus exists on strategies to enhance patient engagement. In this study, the investigators explored patient perspectives on program outreach messages containing content tailored to EHR-derived diabetes risk factors--a theory-driven strategy to increase the persuasiveness of health communications.
AHRQ-funded; HS019367.
Citation: Brown SD, Grijalva CS, Ferrara A .
Leveraging EHRs for patient engagement: perspectives on tailored program outreach.
Am J of Manag Care 2017 Jul;23(7):e223-e30..
Keywords: Diabetes, Communication, Education: Patient and Caregiver, Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare Delivery, Lifestyle Changes, Patient and Family Engagement
Salber GJ, Wang YB, Lynch JT
Metformin use in practice: compliance with guidelines for patients with diabetes and preserved renal function.
This article reports on an examination of a population of patients with diabetes with preserved renal function to evaluate provider compliance with guidelines on metformin use and to identify factors that contributed when practice diverged from recommendations. It found that although providers generally follow current recommendations for the use of metformin, deviations from guidelines in practice are common.
AHRQ-funded; HS019474.
Citation: Salber GJ, Wang YB, Lynch JT .
Metformin use in practice: compliance with guidelines for patients with diabetes and preserved renal function.
Clin Diabetes 2017 Jul;35(3):154-61. doi: 10.2337/cd15-0045.
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Keywords: Medication, Guidelines, Diabetes, Adverse Drug Events (ADE)
Chandakkar PS, Venkatesan R, Li B
MIRank-KNN: multiple-instance retrieval of clinically relevant diabetic retinopathy images.
Computer-aided diagnosis has the potential of improving diabetic retinopathy (DR) screening or diagnosis. The researchers developed a feature space of a modified color correlogram appended with statistics of steerable Gaussian filter responses selected by fast radial symmetric transform points. Experiments with real DR images collected from five different datasets demonstrate that the proposed approach is able to outperform existing methods.
AHRQ-funded; HS019792.
Citation: Chandakkar PS, Venkatesan R, Li B .
MIRank-KNN: multiple-instance retrieval of clinically relevant diabetic retinopathy images.
J Med Imaging 2017 Jul;4(3):034003. doi: 10.1117/1.jmi.4.3.034003.
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Keywords: Diabetes, Imaging, Eye Disease and Health, Health Information Technology (HIT), Diagnostic Safety and Quality
Schroeder EB, Xu S, Goodrich GK
Predicting the 6-month risk of severe hypoglycemia among adults with diabetes: development and external validation of a prediction model.
Researchers developed and validated two prediction models for predicting the 6-month risk of hypoglycemia. The 16-variable model had slightly better performance than the 6-variable model, but in some practice settings, use of the simpler model may be preferred.
AHRQ-funded; HS019859; HS022963.
Citation: Schroeder EB, Xu S, Goodrich GK .
Predicting the 6-month risk of severe hypoglycemia among adults with diabetes: development and external validation of a prediction model.
J Diabetes Complications 2017 Jul;31(7):1158-63. doi: 10.1016/j.jdiacomp.2017.04.004.
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Keywords: Adverse Drug Events (ADE), Diabetes, Medication, Risk
Beckman AL, Herrin J, Nasir K
Trends in cardiovascular health of US adults by income, 2005-2014.
This research letter discusses the trends in cardiovascular health of US adults by income from 2005-2014. The investigators assessed national trends in cardiovascular risk factors by income level among adults aged 25 years and older using data from the National Health and Nutrition Examination Surveys, a nationally representative, multistage probability sample of the US population, across 5 periods: 2005 to 2006, 2007 to 2008, 2009 to 2010, 2011 to 2012, and 2013 to 2014.
AHRQ-funded; HS023000.
Citation: Beckman AL, Herrin J, Nasir K .
Trends in cardiovascular health of US adults by income, 2005-2014.
JAMA Cardiol 2017 Jul;2(7):814-16. doi: 10.1001/jamacardio.2017.1654..
Keywords: Cardiovascular Conditions, Risk, Disparities, Health Status, Blood Pressure, Obesity, Diabetes, Low-Income, Tobacco Use
Shortell SM, Poon BY, Ramsay PP
A multilevel analysis of patient engagement and patient-reported outcomes in primary care practices of accountable care organizations.
For adult primary care practices seeing patients with diabetes and/or cardiovascular disease, researchers examined the relationship between selected practice characteristics, patient engagement, and patient-reported outcomes of care. They found that having a patient-centered culture was positively associated with fewer depression symptoms and better physical function scores. Patient activation was positively associated with fewer depression symptoms.
AHRQ-funded; HS024075.
Citation: Shortell SM, Poon BY, Ramsay PP .
A multilevel analysis of patient engagement and patient-reported outcomes in primary care practices of accountable care organizations.
J Gen Intern Med 2017 Jun;32(6):640-47. doi: 10.1007/s11606-016-3980-z.
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Keywords: Patient and Family Engagement, Patient-Centered Outcomes Research, Primary Care, Chronic Conditions, Diabetes, Cardiovascular Conditions
Bowen ME, Xuan L, Lingvay I
Performance of a random glucose case-finding strategy to detect undiagnosed diabetes.
This study describes a case-finding approach using non-diagnostic random glucose values to identify individuals in need of diabetes testing and compares its performance to current screening guidelines. Using random glucose >/=100 mg/dL to identify individuals in need of diabetes, it determined that screening is highly sensitive and specific, performing better than current screening guidelines. Case-finding strategies informed by random glucose data may improve diabetes detection.
AHRQ-funded; HS022418.
Citation: Bowen ME, Xuan L, Lingvay I .
Performance of a random glucose case-finding strategy to detect undiagnosed diabetes.
Am J Prev Med 2017 Jun;52(6):710-16. doi: 10.1016/j.amepre.2017.01.023.
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Keywords: Diabetes, Diagnostic Safety and Quality, Risk, Screening