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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 15 of 15 Research Studies DisplayedIsbell LM, Graber ML, Rovenpor DR
Influence of comorbid depression and diagnostic workup on diagnosis of physical illness: a randomized experiment.
The purpose of this randomized experiment study was to investigate the influence of comorbid depression on diagnostic accuracy. The researchers utilized an interactive vignette that described a patient with a complex presentation of pernicious anemia. Fifty-nine physician participants were randomized to diagnose either a patient with or without (control) comorbid depression and related behaviors. All other clinical information was identical. Physicians recorded a differential diagnosis, ordered tests, and rated patient likeability. The study found that the patient with comorbid depression was less likeable than the control patient. Accuracy of diagnosis was lower in the depression condition compared to the control condition, but this difference was not statistically significant. Accuracy was lower in the depression condition (vs. control) when physicians ordered less tests, but there was no variation for physicians who ordered more tests.
AHRQ-funded; HS025752.
Citation: Isbell LM, Graber ML, Rovenpor DR .
Influence of comorbid depression and diagnostic workup on diagnosis of physical illness: a randomized experiment.
Diagnosis 2023 Aug; 10(3):257-66. doi: 10.1515/dx-2020-0106..
Keywords: Depression, Behavioral Health
Carey K, Cole MB
Mental health care provision in community health centers and hospital emergency department utilization.
This study examined whether community health centers (CHCs) are effective in offsetting mental health emergency department (ED) visits. The study used the HRSA Uniform Data System and the HCUP State ED Databases for Florida patients during 2012-2019. The authors identified CHC-year-specific service areas using patient origin zip codes, and then estimated panel data models for number of ED mental health visits per capita in a CHC's service area. During 2012-2019, CHC mental health utilization increased 100%. There were small reductions in ED mental health utilization associated with increased CHC mental health provision. An annual increase of 1000 CHC mental health care visits (5%) was associated with 0.44% fewer ED mental health care visits, and an increase of 1000 CHC mental health care patients (15%) with 1.9% fewer ED mental health care visits. An increase of 1 annual mental health visit per patient was associated with 16% fewer ED mental health care visits.
AHRQ-funded; HS028054.
Citation: Carey K, Cole MB .
Mental health care provision in community health centers and hospital emergency department utilization.
Health Serv Res 2024 Apr; 59(2):e14283. doi: 10.1111/1475-6773.14283..
Keywords: Healthcare Cost and Utilization Project (HCUP), Community-Based Practice, Behavioral Health, Emergency Department, Healthcare Utilization
Bernstein EY, Bernstein TP, Trivedi S
Outcomes after initiation of medications for alcohol use disorder at hospital discharge.
This study looked at outcomes after initiation of medications for alcohol use disorder (MAUD), which are very underutilized. The primary outcome was a composite of all-cause mortality or return to hospital within 30 days of discharge. Secondary outcomes included the previous components separately, return to hospital for alcohol-related diagnoses, and primary care or mental health follow-up within 30 days of discharge. There were 6794 unique individuals representing 9834 alcohol-related hospitalizations (median [IQR] age, 54 years; 3205 hospitalizations among females [32.6%]; 1754 hospitalizations among Black [17.8%], 712 hospitalizations among Hispanic [7.2%], and 7060 hospitalizations among White [71.8%] patients). Of these, 2% of hospitalizations involved discharged MAUD initiation. Discharge MAUD initiation was associated with a 42% decreased incidence of the primary outcome (incident rate ratio, 0.58). These findings were consistent among secondary outcomes (eg, incident rate ratio for all-cause return to hospital, 0.56) except for mortality, which was rare in both groups. Discharge MAUD initiation was associated with a 51% decreased incidence of alcohol-related return to hospital.
AHRQ-funded; HS026215.
Citation: Bernstein EY, Bernstein TP, Trivedi S .
Outcomes after initiation of medications for alcohol use disorder at hospital discharge.
JAMA Netw Open 2024 Mar 4; 7(3):e243387. doi: 10.1001/jamanetworkopen.2024.3387..
Keywords: Medication, Alcohol Use, Substance Abuse, Behavioral Health, Outcomes, Hospital Discharge
Hughes PM, Easterly CW, Thomas K
North Carolina Medicaid system perspectives on substance use disorder treatment policy changes during the COVID-19 pandemic.
This study’s objective was to describe perspectives from stakeholders involved in North Carolina’s Medicaid system on substance use disorder (SUD) treatment policy changes during the COVID pandemic. Researchers conducted semi-structured interviews with state agency representatives, Medicaid managed care organizations and providers, as well as three focus groups of Medicaid beneficiaries with SUD. Responses indicated that policy changes such as telehealth and take-home methadone were overall considered beneficial; staffing shortages, however, remained a substantial barrier. The researchers concluded that the policy changes should be continued, but additional steps are needed to ensure payment parity for telehealth services.
AHRQ-funded; HS000032.
Citation: Hughes PM, Easterly CW, Thomas K .
North Carolina Medicaid system perspectives on substance use disorder treatment policy changes during the COVID-19 pandemic.
J Addict Med 2024 Mar-Apr; 18(2):e1-e7. doi: 10.1097/adm.0000000000001272..
Keywords: COVID-19, Medicaid, Substance Abuse, Behavioral Health, Policy
Bui LN, Knox M, Miller-Rosales C
Hospital capabilities associated with behavioral health integration within emergency departments.
The objective of this study was to identify hospital capabilities associated with behavioral health processes in emergency departments. Responses to the National Survey of Healthcare Organizations and Systems were linked American Hospital Association Annual Survey data. Most hospitals reported screening for behavioral health conditions and provided direct referrals to community-based clinicians. Approximately half the hospitals used team approaches to behavioral health. Hospitals that reported more barriers to care delivery innovations also reported less screening and usage of a team approach. The authors concluded that research and interventions which focus on removing barriers or adding processes to disseminate best practices offer a path to accelerate behavioral health integration in emergency departments.
AHRQ-funded; HS024075.
Citation: Bui LN, Knox M, Miller-Rosales C .
Hospital capabilities associated with behavioral health integration within emergency departments.
Med Care 2024 Mar; 62(3):170-74. doi: 10.1097/mlr.0000000000001973.
Keywords: Behavioral Health, Emergency Department, Hospitals, Substance Abuse, Teams, Telehealth, Health Information Technology (HIT)
Kalofonos I, Zito M, Fletcher E
A pilot trial examining the effects of veteran voices and visions, an adaptation of hearing voices groups for a large public health system in the United States.
This paper described the effects of participation of a pilot trial of Veterans Voices and Visions (VVV) groups, which is an adaptation of the Hearing Voices (HV) groups which were created to assist patients undergoing psychosis. The trial was conducted at the VA and were co-led by clinicians and Veteran peer support specialists. Over a 16-week period, quantitative analysis showed a statistically significant reduction in distress, due to auditory hallucinations, as measured by the Psychotic Symptom Rating Scales (PSYRATS). A reduction in malevolence and omnipotence and an increase in benevolence related to auditory hallucinations was shown with the Beliefs about Voices Questionnaire- Revised (BAVQ-R), but there was no change in resistance. Qualitative data from Week 8 and the endpoint (Week 16) interviews revealed several perceived benefits from groups: 1) normalization and camaraderie, 2) increased hope and confidence, 3) self-understanding and reframing of experiences, and 4) building relationships outside of groups.
AHRQ-funded.
Citation: Kalofonos I, Zito M, Fletcher E .
A pilot trial examining the effects of veteran voices and visions, an adaptation of hearing voices groups for a large public health system in the United States.
Int J Soc Psychiatry 2024 Feb; 70(1):122-31. doi: 10.1177/00207640231196747.
Keywords: Community-Based Practice, Behavioral Health
Wnorowska JH, Naik V, Ramgopal S
Characteristics of pediatric behavioral health emergencies in the prehospital setting.
This retrospective cross-sectional study aimed to characterize pediatric behavioral health encounters in the United States and assess factors associated with sedative medication administration and physical restraint use. Analyzing data from 2019 to 2020, among 2,740,271 pediatric EMS encounters, 11.3% were for behavioral health. Sedatives were used in 2.2% and restraints in 3.0% of these encounters. Factors influencing medication and restraint use included age, disabilities, geographic region, and EMS system type.
AHRQ-funded; HS026385.
Citation: Wnorowska JH, Naik V, Ramgopal S .
Characteristics of pediatric behavioral health emergencies in the prehospital setting.
Acad Emerg Med 2024 Feb; 31(2):129-39. doi: 10.1111/acem.14833.
Keywords: Children/Adolescents, Behavioral Health, Emergency Medical Services (EMS)
Kovacevic M, Montes M, Tirone V
Treating a common comorbidity: pain outcomes following a 3-week cognitive processing therapy-based intensive treatment for posttraumatic stress disorder address.
This study examined changes in pain, posttraumatic stress disorder (PTSD), and depressive symptoms among 125 veterans completing a 3-week cognitive processing therapy (CPT)-based intensive treatment program (ITP) for PTSD. The authors explored whether pretreatment pain interference predicted changes in PTSD and depressive symptom severity and whether larger changes in pain interference over the course of treatment were associated with larger changes in PTSD and depressive symptom severity. Higher levels of pretreatment pain interference were associated with higher PTSD, and depressive symptom severity, over time. Larger reductions in pain interference corresponded to more improvement in PTSD symptoms, but not depressive symptoms.
AHRQ-funded; HS028511.
Citation: Kovacevic M, Montes M, Tirone V .
Treating a common comorbidity: pain outcomes following a 3-week cognitive processing therapy-based intensive treatment for posttraumatic stress disorder address.
J Trauma Stress 2024 Feb; 37(1):47-56. doi: 10.1002/jts.22979.
Keywords: Pain, Behavioral Health, Outcomes, Chronic Conditions
Kaplan J, Somohano VC, Zaccari B
Randomized controlled trials of mind-body interventions for posttraumatic stress disorder: a systematic review.
This systematic review examined strength of evidence for use of mind-body interventions (MBIs), including mindfulness-based interventions (MiBIs), meditation- and mantra-based interventions (MMIs), and movement-based interventions (MoBIs) for treatment of post-traumatic stress disorder (PTSD). The authors used the AHRQ-funded evidence tables for the PTSD-Repository to identify relevant studies and assess the risk of bias. The search was conducted between June 2018 and June 2022 using a number of relevant databases. They found 26 randomized controlled trials that met their inclusion criteria. Strength of evidence was rated as low for MiBIs and MMIs, largely due to contradicting results, inconsistent use of active versus passive comparators, and high risk of bias. It was rated as moderate for MoBIs due to individual studies consistently favoring the intervention and a relatively large number of studies and participants. Only two of the included studies had objective outcome measures.
AHRQ-funded; HS026370.
Citation: Kaplan J, Somohano VC, Zaccari B .
Randomized controlled trials of mind-body interventions for posttraumatic stress disorder: a systematic review.
Front Psychol 2024 Jan 24; 14:1219296. doi: 10.3389/fpsyg.2023.1219296.
Keywords: Complementary and Alternative Medicine, Behavioral Health
Foot C, Korthuis PT, Tsui JI
Associations between stimulant use and return to illicit opioid use following initiation onto medication for opioid use disorder.
The objective of this secondary analysis of data from two clinical trials comparing buprenorphine and extended-release naltrexone was to estimate the effect of ongoing stimulant use on return to illicit opioid use after initiation of medication for opioid use disorder (MOUD). The findings indicated that people on medication for opioid use disorder who subsequently used stimulants appeared more likely to return to non-prescribed opioids use compared with those without stimulant use; this association appeared stronger among patients who initiated buprenorphine compared with those who initiated extended-release naltrexone.
AHRQ-funded; HS026370.
Citation: Foot C, Korthuis PT, Tsui JI .
Associations between stimulant use and return to illicit opioid use following initiation onto medication for opioid use disorder.
Addiction 2024 Jan; 119(1):149-57. doi: 10.1111/add.16334..
Keywords: Opioids, Substance Abuse, Medication, Behavioral Health
Adams DR
Availability and accessibility of mental health services for youth: a descriptive survey of safety-net health centers during the COVID-19 pandemic.
The goal of this study was to assess the availability of outpatient mental health services for children and adolescents at safety-net health centers in a large metropolitan county. A comprehensive sample of Community Mental Health Centers (CMHCs) and Federally Qualified Health Centers (FQHCs) received a 5-minute survey approximately one year after the beginning of the COVID-19 pandemic. The response indicated that 10% of health centers had closed and 20% reported that they were not offering outpatient mental health services. Reported wait times were longer at CMHCs than FQHCs. The author concluded that these findings suggested that online directories such as the SAMHSA Treatment Locator are often inaccurate or out-of-date.
AHRQ-funded; HS000084.
Citation: Adams DR .
Availability and accessibility of mental health services for youth: a descriptive survey of safety-net health centers during the COVID-19 pandemic.
Community Ment Health J 2024 Jan; 60(1):88-97. doi: 10.1007/s10597-023-01127-9..
Keywords: Children/Adolescents, Behavioral Health, Access to Care, COVID-19, Public Health
Wolf RM, Hall M, Williams DJ
Disparities in pharmacologic restraint for children hospitalized in mental health crisis.
This retrospective cohort study examined associations between pharmacologic restraint use and race and ethnicity among children (aged 5-≤18 years) admitted for mental health conditions to acute care nonpsychiatric children's hospitals. Study period was 2018 to 2022 and was conducted at 41 US children’s hospitals and included a cohort of 61,503 hospitalizations. Compared with non-Hispanic Black children, children of non-Hispanic White (adjusted odds ratio [aOR], 0.81), Asian (aOR, 0.82), or other race and ethnicity (aOR, 0.68) were less likely to receive pharmacologic restraint, with no significant difference with Hispanic children. When stratified by sex, racial/ethnic differences were magnified in males, except for Hispanic males, and not found in females. Sensitivity analysis revealed amplified disparities for all racial/ethnic groups, including Hispanic youth.
AHRQ-funded; HS026122.
Citation: Wolf RM, Hall M, Williams DJ .
Disparities in pharmacologic restraint for children hospitalized in mental health crisis.
Pediatrics 2024 Jan; 153(1). doi: 10.1542/peds.2023-061353..
Keywords: Disparities, Children/Adolescents, Behavioral Health, Inpatient Care, Hospitals, Medication
Goyal NK, Sood E, Gannon MA
Priorities for well child care of families affected by parental opioid use disorder.
This study’s objective was to explore priorities for well childcare (WCC) visit content for women in treatment with opioid use disorder to inform primary care recommendations for this population. Eligible participants had children 2 years or younger and were English speaking. Among the 30 parent participants, they were overwhelmingly White (83%) and unmarried (90%). Thirteen clinicians participated, of whom 9 were attending physicians. Interviews were conducted with parents and clinicians which led to five emerging themes: (1) improving knowledge and confidence related to child development, behavior, and nutrition; (2) mitigating safety concerns; (3) addressing complex health and subspecialty needs through care coordination; (4) acknowledging parental health and wellbeing in the pediatric encounter; and (5) supporting health education and care related to neonatal opioid withdrawal syndrome. These issues were expressed as hard to address by parents and clinicians due to time constraints, social determinants of health, and significant informational needs.
AHRQ-funded; HS027399.
Citation: Goyal NK, Sood E, Gannon MA .
Priorities for well child care of families affected by parental opioid use disorder.
J Addict Med 2024 Jan-Feb; 18(1):48-54. doi: 10.1097/adm.0000000000001243..
Keywords: Opioids, Substance Abuse, Behavioral Health, Caregiving, Children/Adolescents
Martwick J, Kaufmann J, Bailey S
Impact of healthcare location concordance on receipt of preventive care among children whose parents have a substance use and/or mental health diagnosis.
This study examined the association of children with parents with >1 substance use and/or other mental health (SU/MH) diagnoses and parent-child clinic concordance with rates of well-child checks (WCCs) and childhood vaccinations. This retrospective cohort study used electronic health record data from the OCHIN network of community health organizations (CHOs) from 2010 to 2018. This included 280 CHOs across 17 states and 41,413 parents with >1 SU/MH diagnosis linked to 65,417 children ages 0 to 17 years, each with >1 visit to an OCHIN clinic during the study period. The authors found that among children utilizing the same clinic as their parent versus children using a different clinic (reference group), there were greater WCC rates in the first 15 months of life; no difference in WCC rates in ages 3 to 17; higher odds for vaccine completion before age 2; and lower odds for vaccine completion before age 18.
AHRQ-funded; HS025962.
Citation: Martwick J, Kaufmann J, Bailey S .
Impact of healthcare location concordance on receipt of preventive care among children whose parents have a substance use and/or mental health diagnosis.
J Prim Care Community Health 2024 Jan-Dec; 15. doi: 10.1177/21501319241229925.
Keywords: Children/Adolescents, Prevention, Substance Abuse, Behavioral Health, Vaccination, Healthcare Utilization
Graaf G, Hughes PM, deJong NA
Family support services and reported parent coping among caregivers of children with emotional, behavioral, or developmental disorders.
Researchers examined the association of family support services with caregiver mental health and well-being, as well as caregiver coping, among families of children with special health care needs (CSHCN). Data was taken from the National Survey of Children's Health. Results showed that adequate care coordination was associated with higher rates of caregiver-reported positive coping for CSHCN caregivers who had no source of emotional support. Emotional support services were also associated with increased reports of positive coping. The researchers concluded that mobilization of resources that can aid caregivers in coordinating care and provide emotional support may play a key role in positive caregiver coping for families of CSHCN.
AHRQ-funded; HS000032.
Citation: Graaf G, Hughes PM, deJong NA .
Family support services and reported parent coping among caregivers of children with emotional, behavioral, or developmental disorders.
J Dev Behav Pediatr 2024 Jan; 45(1):e54-e62. doi: 10.1097/dbp.0000000000001230.
Keywords: Children/Adolescents, Caregiving, Disabilities, Behavioral Health