National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (32)
- Adverse Drug Events (ADE) (287)
- Adverse Events (187)
- Alcohol Use (6)
- Ambulatory Care and Surgery (38)
- Antibiotics (204)
- Antimicrobial Stewardship (112)
- Anxiety (6)
- Arthritis (28)
- Asthma (31)
- Back Health and Pain (8)
- Behavioral Health (135)
- Blood Clots (15)
- Blood Pressure (28)
- Blood Thinners (69)
- Brain Injury (7)
- Burnout (1)
- Cancer (67)
- Cancer: Breast Cancer (17)
- Cancer: Cervical Cancer (1)
- Cancer: Colorectal Cancer (6)
- Cancer: Lung Cancer (5)
- Cancer: Ovarian Cancer (1)
- Cancer: Prostate Cancer (8)
- Cardiovascular Conditions (121)
- Care Coordination (1)
- Caregiving (10)
- Care Management (47)
- Case Study (8)
- Centers for Education and Research on Therapeutics (CERTs) (5)
- Children's Health Insurance Program (CHIP) (2)
- Children/Adolescents (169)
- Chronic Conditions (134)
- Clinical Decision Support (CDS) (40)
- Clinician-Patient Communication (15)
- Clostridium difficile Infections (8)
- Colonoscopy (2)
- Communication (28)
- Community-Acquired Infections (10)
- Community-Based Practice (13)
- Comparative Effectiveness (120)
- Complementary and Alternative Medicine (3)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- COVID-19 (24)
- Critical Care (20)
- Data (8)
- Dementia (21)
- Dental and Oral Health (15)
- Depression (43)
- Diabetes (95)
- Diagnostic Safety and Quality (19)
- Digestive Disease and Health (16)
- Disabilities (1)
- Disparities (21)
- Ear Infections (1)
- Education (1)
- Education: Academic (1)
- Education: Continuing Medical Education (3)
- Education: Patient and Caregiver (22)
- Elderly (186)
- Electronic Health Records (EHRs) (76)
- Electronic Prescribing (E-Prescribing) (21)
- Emergency Department (36)
- Emergency Medical Services (EMS) (15)
- Emergency Preparedness (1)
- Evidence-Based Practice (111)
- Eye Disease and Health (5)
- Falls (11)
- Genetics (15)
- Guidelines (47)
- Healthcare-Associated Infections (HAIs) (31)
- Healthcare Cost and Utilization Project (HCUP) (17)
- Healthcare Costs (108)
- Healthcare Delivery (16)
- Healthcare Utilization (41)
- Health Information Exchange (HIE) (1)
- Health Information Technology (HIT) (147)
- Health Insurance (37)
- Health Literacy (18)
- Health Promotion (2)
- Health Services Research (HSR) (5)
- Health Systems (3)
- Heart Disease and Health (86)
- Hepatitis (15)
- Home Healthcare (8)
- Hospital Discharge (24)
- Hospitalization (41)
- Hospital Readmissions (6)
- Hospitals (35)
- Human Immunodeficiency Virus (HIV) (54)
- Imaging (3)
- Implementation (20)
- Infectious Diseases (29)
- Influenza (1)
- Injuries and Wounds (24)
- Inpatient Care (23)
- Intensive Care Unit (ICU) (26)
- Kidney Disease and Health (22)
- Labor and Delivery (6)
- Learning Health Systems (1)
- Lifestyle Changes (1)
- Long-Term Care (36)
- Low-Income (11)
- Maternal Care (8)
- Medicaid (48)
- Medical Devices (2)
- Medical Errors (54)
- Medical Expenditure Panel Survey (MEPS) (21)
- Medicare (75)
- (-) Medication (1686)
- Medication: Safety (225)
- Men's Health (5)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (10)
- Mortality (31)
- Neonatal Intensive Care Unit (NICU) (2)
- Neurological Disorders (31)
- Newborns/Infants (33)
- Nursing (3)
- Nursing Homes (58)
- Nutrition (1)
- Obesity (16)
- Obesity: Weight Management (7)
- Opioids (257)
- Organizational Change (3)
- Orthopedics (9)
- Osteoporosis (8)
- Outcomes (91)
- Pain (95)
- Palliative Care (7)
- Patient-Centered Healthcare (35)
- Patient-Centered Outcomes Research (155)
- Patient Adherence/Compliance (145)
- Patient and Family Engagement (13)
- Patient Experience (8)
- Patient Safety (276)
- Patient Self-Management (17)
- Payment (3)
- Pneumonia (16)
- Policy (45)
- Practice-Based Research Network (PBRN) (2)
- Practice Improvement (1)
- Practice Patterns (153)
- Pregnancy (27)
- Prevention (89)
- Primary Care (59)
- Primary Care: Models of Care (5)
- Provider (42)
- Provider: Clinician (8)
- Provider: Nurse (8)
- Provider: Pharmacist (74)
- Provider: Physician (20)
- Provider: Physician Assistant (1)
- Public Health (7)
- Public Reporting (1)
- Quality Improvement (26)
- Quality Indicators (QIs) (3)
- Quality Measures (9)
- Quality of Care (45)
- Quality of Life (8)
- Racial and Ethnic Minorities (48)
- Registries (16)
- Rehabilitation (1)
- Research Methodologies (20)
- Respiratory Conditions (57)
- Risk (111)
- Rural/Inner-City Residents (1)
- Rural Health (16)
- Screening (12)
- Sepsis (21)
- Sex Factors (9)
- Sexual Health (2)
- Shared Decision Making (71)
- Sickle Cell Disease (11)
- Skin Conditions (9)
- Sleep Problems (5)
- Social Determinants of Health (13)
- Social Media (2)
- Social Stigma (8)
- Stress (2)
- Stroke (21)
- Substance Abuse (144)
- Surgery (79)
- Teams (2)
- Telehealth (15)
- Tobacco Use (6)
- Tobacco Use: Smoking Cessation (2)
- Tools & Toolkits (9)
- Training (3)
- Transitions of Care (15)
- Transplantation (8)
- Trauma (5)
- Treatments (40)
- U.S. Preventive Services Task Force (USPSTF) (16)
- Uninsured (2)
- Urban Health (4)
- Urinary Tract Infection (UTI) (15)
- Vaccination (9)
- Vitamins and Supplements (1)
- Vulnerable Populations (19)
- Web-Based (4)
- Women (33)
- Workflow (2)
- Young Adults (13)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
26 to 50 of 1686 Research Studies DisplayedKeith A, Jenkins TC, O'Leary S
Reducing length of antibiotics for children with ear infections: protocol for a cluster-randomized trial in the USA.
The objective of the planned study described in this article will be to evaluate two low-cost interventions to increase guideline-concordant antibiotic durations in children with acute otitis media (AOM). The authors will explore differences in implementation effectiveness by patient population, clinician type, clinical setting, and organization as well as by intervention type. They will also conduct formative qualitative interviews with clinicians and administrators and focus groups with the parents of patients. The results of the study will provide a framework for healthcare systems to address the problem of excessive durations of therapy for AOM and to inform national antibiotic stewardship policy development.
AHRQ-funded; HS029153.
Citation: Keith A, Jenkins TC, O'Leary S .
Reducing length of antibiotics for children with ear infections: protocol for a cluster-randomized trial in the USA.
J Comp Eff Res 2023 Nov; 12(11):e230088. doi: 10.57264/cer-2023-0088..
Keywords: Children/Adolescents, Antibiotics, Medication, Ear Infections
Wu L, Chang C, Lo K
Telephone-based social health screening by pharmacists in the nonadherent Medicare population.
The study examined social health needs among Medicare patients and pharmacist-led screening's impact on medication adherence and healthcare use. Using a predictive algorithm, higher-risk patients were identified. Patients accepting referrals had better statin adherence, while those declining had more hospital stays and fewer primary care visits. The findings suggest pharmacist interventions can improve medication adherence without worsening healthcare use or plan membership.
AHRQ-funded; HS027343.
Citation: Wu L, Chang C, Lo K .
Telephone-based social health screening by pharmacists in the nonadherent Medicare population.
J Manag Care Spec Pharm 2023 Nov; 29(11):1184-92. doi: 10.18553/jmcp.2023.29.11.1184..
Keywords: Provider: Pharmacist, Patient Adherence/Compliance, Social Determinants of Health, Medication
Boxley C, Fujimoto M, Ratwani RM
A text mining approach to categorize patient safety event reports by medication error type.
This study examined whether natural language processing can be used to better categorize medication related patient safety event reports. A total of 3,861 medication related patient safety event reports that were previously annotated using a consolidated medication error taxonomy were used to develop three models using the following algorithms: (1) logistic regression, (2) elastic net, and (3) XGBoost. The models were tested and performance was analyzed. The authors found the XGBoost model performed best across all medication error categories. 'Wrong Drug', 'Wrong Dosage Form or Technique or Route', and 'Improper Dose/Dose Omission' categories performed best across the three models. In addition, they identified five words most closely associated with each medication error category and which medication error categories were most likely to co-occur.
AHRQ-funded; HS026481.
Citation: Boxley C, Fujimoto M, Ratwani RM .
A text mining approach to categorize patient safety event reports by medication error type.
Sci Rep 2023 Oct 26; 13(1):18354. doi: 10.1038/s41598-023-45152-w..
Keywords: Health Information Technology (HIT), Patient Safety, Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events
Ranusch A, Lin YJ, Dorsch MP
Role of individual clinician authority in the implementation of informatics tools for population-based medication management: qualitative semistructured interview study.
The objective of this study was to examine how individual authority of clinical pharmacists and anticoagulation nurses is affected by the implementation success of an electronic health record (EHR) direct oral anticoagulant (DOAC) Dashboard for safe DOAC medication prescribing. Researchers conducted semistructured interviews with pharmacists and nurses after the implementation of the EHR DOAC Dashboard at three clinical sites. Results showed that a high level of individual clinician authority was associated with high levels of key facilitators for effective use of the DOAC Dashboard; conversely, a lack of individual authority was associated with key barriers to effective use. The researchers concluded that increased individual clinician authority is a necessary antecedent to the effective implementation of an EHR DOAC Population Management Dashboard.
AHRQ-funded; HS026874.
Citation: Ranusch A, Lin YJ, Dorsch MP .
Role of individual clinician authority in the implementation of informatics tools for population-based medication management: qualitative semistructured interview study.
JMIR Hum Factors 2023 Oct 24; 10:e49025. doi: 10.2196/49025..
Keywords: Medication, Provider: Pharmacist, Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Nurse, Blood Thinners
Shapiro HFJ, Loder E, Shapiro DJ
Association between clinician specialty and prescription of preventive medication for young adults with migraine: a retrospective cohort study.
The purpose of this multicenter retrospective cohort study was to compare prescribing patterns of preventive medications between pediatric and adult neurologists for young adults with migraine. The primary study outcome was whether the patient received a prescription for any preventive medication during the study period. Among the 767 included patients, 37.8% were seen by a pediatric neurologist. Preventive medications were prescribed for 45.2% of patients seen by a pediatric neurologist and 43.2% of patients seen by an adult neurologist. In the mixed effects logistic regression model, clinician specialty was not related with preventive medication use Female sex and number of visits during the study period were related with receiving preventive medication. The study concluded that proportion of young adults being prescribed migraine medications did not differ according to clinician specialty.
AHRQ-funded; HS000063.
Citation: Shapiro HFJ, Loder E, Shapiro DJ .
Association between clinician specialty and prescription of preventive medication for young adults with migraine: a retrospective cohort study.
Headache 2023 Oct; 63(9):1232-39. doi: 10.1111/head.14628..
Keywords: Young Adults, Medication, Pain, Neurological Disorders
Ojala F, Sater MRA, Miller LG
Bayesian modeling of the impact of antibiotic resistance on the efficiency of MRSA decolonization.
The authors analyzed how the persistence of methicillin-resistant Staphylococcus aureus (MRSA) colonization correlates with the genomic presence of antibiotic resistance genes. Using a Bayesian mixed effects survival model, they found that genetic determinants of high-level resistance to mupirocin was strongly associated with failure of the decolonization protocol, but they did not find a similar effect with genetic resistance to chlorhexidine or other antibiotics. They concluded that these results highlight the need to consider the properties of the colonizing MRSA strain when deciding which treatments to include in the decolonization protocol.
AHRQ-funded; HS019388.
Citation: Ojala F, Sater MRA, Miller LG .
Bayesian modeling of the impact of antibiotic resistance on the efficiency of MRSA decolonization.
PLoS Comput Biol 2023 Oct; 19(10):e1010898. doi: 10.1371/journal.pcbi.1010898..
Keywords: Antibiotics, Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Medication
Gómez-Lumbreras A, Boyce RD, Villa-Zapata L
Drugs that interact with colchicine via inhibition of cytochrome P450 3A4 and P-glycoprotein: a signal detection analysis using a database of spontaneously reported adverse events (FAERS).
The objective of this study was to examine clinical outcomes associated with colchicine drug interactions. Researchers conducted a disproportionality analysis using the spontaneous reports of the FDA Adverse Event Reporting System (FAERS). The study’s results identified numerous safety signals for colchicine and CYP3A4/P-gp inhibitor drugs. The authors concluded that avoiding interactions or monitoring for toxicity in patients when co-prescribing colchicine and these agents is highly recommended.
AHRQ-funded; HS025984.
Citation: Gómez-Lumbreras A, Boyce RD, Villa-Zapata L .
Drugs that interact with colchicine via inhibition of cytochrome P450 3A4 and P-glycoprotein: a signal detection analysis using a database of spontaneously reported adverse events (FAERS).
Ann Pharmacother 2023 Oct; 57(10):1137-46. doi: 10.1177/10600280221148031..
Keywords: Medication, Adverse Drug Events (ADE), Adverse Events, Patient Safety
Yan CH, Hubbard CC, Lee TA
Impact of hydrocodone rescheduling on dental prescribing of opioids.
In 2014, the United States Drug Enforcement Administration rescheduled hydrocodone’s controlled substance schedule from III to II, introducing increasing regulations in prescribing and dispensing. In the U.S., dentists often prescribe hydrocodone, and these changes in scheduling may have altered dental prescribing of opioids. The purpose of this study was to assess the impact of the hydrocodone rescheduling on dental prescribing of opioids in the United States. Across the 49-month study period, dentists prescribed 50,412,942 opioid prescriptions. Hydrocodone was the most prescribed opioid, followed by codeine, oxycodone, and tramadol. At index, hydrocodone prescribing immediately decreased by -834.8 Rx/1,000 dentists with increased prescribing of codeine, oxycodone, and tramadol. The mean MME increased at index for all opioids except for hydrocodone, and dosages subsequently decreased during the postindex period.
AHRQ-funded; HS025177.
Citation: Yan CH, Hubbard CC, Lee TA .
Impact of hydrocodone rescheduling on dental prescribing of opioids.
JDR Clin Trans Res 2023 Oct; 8(4):402-12. doi: 10.1177/23800844221102830..
Keywords: Opioids, Medication, Dental and Oral Health, Practice Patterns
Deardorff WJ, Jing B, Growdon ME
Medication misuse and overuse in community-dwelling persons with dementia.
This study sought to characterize a broad spectrum of medication misuse and overuse among community-dwelling persons with dementia (PWD). The authors included community-dwelling adults aged ≥66 in the Health and Retirement Study from 2008 to 2018 linked to Medicare and classified as having dementia using a validated algorithm. Potentially problematic medications were identified as: (1) medication overuse including over-aggressive treatment of diabetes/hypertension (e.g., insulin/sulfonylurea with hemoglobin A1c < 7.5%) and medications inappropriate near end of life based on STOPPFrail and (2) medication misuse including medications that negatively affect cognition and medications from 2019 Beers and STOPP Version 2 criteria. To contextualize, they compared medication use to people without dementia through a propensity-matched cohort by age, sex, comorbidities, and interview year. Among 1441 PWD, median age was 84, 67% female, and 14% Black. Overall, 73% of PWD were prescribed ≥1 potentially problematic medication with a mean of 2.09 per individual in the prior year. This was notable across several domains, as 41% were prescribed ≥1 medications that negatively affects cognition. Frequently prescribed problematic medications identified included proton pump inhibitors (PPIs), non-steroidal anti-inflammatory drugs (NSAIDs), opioids, antihypertensives, and antidiabetic agents. Problematic medication use was higher among PWD compared to those without dementia with 73% versus 67% prescribed ≥1 problematic medication and a mean of 2.09 versus 1.62, respectively.
AHRQ-funded; HS02638.
Citation: Deardorff WJ, Jing B, Growdon ME .
Medication misuse and overuse in community-dwelling persons with dementia.
J Am Geriatr Soc 2023 Oct; 71(10):3086-98. doi: 10.1111/jgs.18463..
Keywords: Medication, Dementia, Elderly
Aklilu AM, Kumar S, Yamamoto Y
Outcomes associated with sodium-glucose cotransporter-2 inhibitor use in acute heart failure hospitalizations complicated by AKI.
This retrospective study examined the association of sodium-glucose cotransporter-2 inhibitor (SGLT2i) use with patients who have KDIGO-defined acute kidney injury (AKI) during acute heart failure (AHF) hospitalizations and their kidney function recovery at 14 days and 30 days using time-varying multivariable Cox-regression analyses. The study looked at 3305 adults hospitalized across 5 Yale New Haven Health Systems between January 2020 and May 2022 with AHF complicated by KDIGO-defined AKI. Of those individuals hospitalized with AHF and AKI, 356 received SGLT2i following AKI diagnosis either as initiation or continuation. The rate of renal recovery was not significantly different among those exposed and unexposed to SGLT2i following AKI (adjusted HR 0.94). SGLT2i exposure was associated with lower risk of 30-day mortality (adjusted HR 0.45). Rates of renal recovery were similar between the exposed and nonexposed cohorts regardless of the proximity of SGLT2i exposure to AKI diagnosis.
AHRQ-funded; HS027626.
Citation: Aklilu AM, Kumar S, Yamamoto Y .
Outcomes associated with sodium-glucose cotransporter-2 inhibitor use in acute heart failure hospitalizations complicated by AKI.
Kidney360 2023 Oct; 4(10):1371-81. doi: 10.34067/kid.0000000000000250..
Keywords: Kidney Disease and Health, Heart Disease and Health, Cardiovascular Conditions, Inpatient Care, Medication, Outcomes
Pitts SI, Olson s, Yanek LR
Pharmacy e-prescription dispensing before and after CancelRx implementation.
The objective of this study was to evaluate the association of implementation of e-prescription cancellation messaging (CancelRx) with medication dispensing after discontinuation of e-prescriptions in electronic health records (EHRs). Patients who had at least one medication e-prescribed in ambulatory care to a health system pharmacy and discontinued within the study period participated in a case series with interrupted time series analysis. Findings indicated that CancelRx implementation was associated with an immediate and sustained reduction in the proportion of e-prescriptions sold after discontinuation in the EHR. The authors concluded that widespread implementation of CancelRx could significantly improve medication safety through the reduction of medication dispensing after discontinuation by prescribers.
AHRQ-funded; HS026584.
Citation: Pitts SI, Olson s, Yanek LR .
Pharmacy e-prescription dispensing before and after CancelRx implementation.
JAMA Intern Med 2023 Oct; 183(10):1120-26. doi: 10.1001/jamainternmed.2023.4192..
Keywords: Medication, Electronic Prescribing (E-Prescribing), Health Information Technology (HIT), Provider: Pharmacist
Herzig SJ, Anderson TS, Urman RD
Risk factors for opioid-related adverse drug events among older adults after hospitalization for major orthopedic procedures.
The purpose of this retrospective cohort study was to identify risk factors for opioid-related adverse drug events (ORADEs) after hospital discharge following orthopedic procedures. The participants of this study included a national sample of Medicare beneficiaries who underwent major orthopedic surgery during hospitalization in 2016 and had an opioid prescription filled within 2 days of discharge. The study found that among 30,514 hospitalizations with a major orthopedic procedure and an opioid claim, a potential ORADE requiring hospital revisit occurred in 2.5%. After adjustment for patient characteristics, prior opioid use, co-prescribed sedating medications, and opioid prescription characteristics were not related with ORADEs. Independent risk factors did include age of 80 years or older, female sex, and clinical conditions, including heart failure, respiratory illness, kidney disease, dementia/delirium, anxiety disorder, and musculoskeletal/nervous system injuries.
AHRQ-funded; HS026215.
Citation: Herzig SJ, Anderson TS, Urman RD .
Risk factors for opioid-related adverse drug events among older adults after hospitalization for major orthopedic procedures.
J Patient Saf 2023 Oct 1; 19(6):379-85. doi: 10.1097/pts.0000000000001144..
Keywords: Elderly, Opioids, Adverse Drug Events (ADE), Adverse Events, Hospitalization, Orthopedics, Surgery, Medication, Risk, Medication: Safety, Patient Safety
Langlieb ME, Sharma P, Hocevar M
The additional cost of perioperative medication errors.
The aim of this study was to calculate the additional annual cost to the U.S. healthcare system attributable to preventable medication errors (MEs) in the operating room. The ME types were grouped into 13 categories by their related harm (or potential harm), and researchers calculated the incidence of operations involving each ME category: 1) delayed or missed required perioperative antibiotic; 2) prolonged hemodynamic swings; 3) untreated postoperative pain; 4) residual neuromuscular blockade; 5) oxygen saturation <90% due to ME; 6) delayed emergence; 7) untreated new onset intraoperative cardiac arrhythmia; 8) medication documentation errors; 9) syringe swaps; 10) presumed hypotension with inability to obtain a blood pressure reading; 11) potential for bacterial contamination due to expired medication syringes; 12) untreated bradycardia <40 beats/min; and 13) other. Through a PubMed search, the researchers established the possibility that the ME category would cause downstream patient harm such as surgical site infection or acute kidney injury, and the additional fully allocated cost of care for each potential downstream patient harm event. The cost of the MEs across the U.S. healthcare system was then calculated by scaling the number of MEs to the total number of annual operations in the United States. The total additional fully allocated annual cost of care due to perioperative MEs was estimated to be $5.33 billion U.S. dollars.
AHRQ-funded; HS024764.
Citation: Langlieb ME, Sharma P, Hocevar M .
The additional cost of perioperative medication errors.
J Patient Saf 2023 Oct 1; 19(6):375-78. doi: 10.1097/pts.0000000000001136..
Keywords: Medication: Safety, Medication, Medical Errors, Adverse Drug Events (ADE), Adverse Events, Surgery, Patient Safety
Sikora A, Jeong H, Yu M
Cluster analysis driven by unsupervised latent feature learning of medications to identify novel pharmacophenotypes of critically ill patients.
This study used a machine learning approach (Restricted Boltzmann Machine) to perform an unsupervised analysis of 991 medication profiles of patients managed in the intensive care unit (ICU) to explore pharmacophenotypes that correlated with ICU complications (e.g., mechanical ventilation) and patient-centered outcomes (e.g., length of stay, mortality). The authors observed six unique pharmacophenotypes, with unique medication profiles and clinically relevant differences in ICU complications and patient-centered outcomes. While pharmacophenotypes 2 and 4 had no statistically significant difference in ICU length of stay, duration of mechanical ventilation, or duration of vasopressor use, their mortality differed significantly (9.0% vs. 21.9%). All but pharmacophenotype 4 had a mortality rate ranging from 2.5 to 9%. This approach has shown promise in classifying the heterogenous syndromes of critical illness to predict treatment response and guide clinical decision support systems but have never included comprehensive medication information.
AHRQ-funded; HS028485.
Citation: Sikora A, Jeong H, Yu M .
Cluster analysis driven by unsupervised latent feature learning of medications to identify novel pharmacophenotypes of critically ill patients.
Sci Rep 2023 Sep 20; 13(1):15562. doi: 10.1038/s41598-023-42657-2..
Keywords: Medication, Critical Care
Deshpande A, Walker R, Schulte R
Reducing antimicrobial overuse through targeted therapy for patients with community-acquired pneumonia: a study protocol for a cluster-randomized factorial controlled trial (CARE-CAP).
The authors described a planned cluster-randomized controlled trial in 12 hospitals in the Cleveland Clinic Health System to test two approaches to reducing the use of extended-spectrum antibiotics (ESA) in adult patients with community-acquired pneumonia (CAP): rapid diagnostic assays that provide accurate results within hours, and de-escalation after negative bacterial cultures in clinically stable patients. The purpose will be to establish whether the identification of an etiological agent early and pharmacist-led de-escalation can safely reduce the use of ESA in patients with CAP. The findings may also inform clinical guidelines on the management of CAP.
AHRQ-funded; HS028633.
Citation: Deshpande A, Walker R, Schulte R .
Reducing antimicrobial overuse through targeted therapy for patients with community-acquired pneumonia: a study protocol for a cluster-randomized factorial controlled trial (CARE-CAP).
Trials 2023 Sep 16; 24(1):595. doi: 10.1186/s13063-023-07615-3..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Community-Acquired Infections, Pneumonia, Respiratory Conditions
Laytner LA, Olmeda K, Salinas J
Acculturation and subjective norms impact non-prescription antibiotic use among Hispanic patients in the United States.
The purpose of this study was to explore the effects of acculturation and subjective norms on Hispanic individuals' intentions to use antibiotics without a prescription from the following sources: 1) United States markets (not legal), 2) other countries, 3) leftovers from previous prescriptions, and 4) friends/relatives. The study found that of the 263 patients surveyed, 47% reported previous non-prescription use, and 54% expressed intention to use non-prescription antibiotics if feeling sick. Individuals with lower acculturation (Spanish-speaking preferences) expressed greater intentions to utilize antibiotics from abroad and from any source. Individuals with more friends/relatives who obtain antibiotics abroad were over 2.5 times more likely to intend to utilize non-prescription antibiotics from friends/relatives. Other predictors of intention to utilize non-prescription antibiotics included high costs of doctor visits and perceived language barriers in the clinic.
AHRQ-funded; HS026901.
Citation: Laytner LA, Olmeda K, Salinas J .
Acculturation and subjective norms impact non-prescription antibiotic use among Hispanic patients in the United States.
Antibiotics 2023 Sep 8; 12(9). doi: 10.3390/antibiotics12091419..
Keywords: Racial and Ethnic Minorities, Antibiotics, Medication, Antimicrobial Stewardship
Hughes PM, Carda-Auten J, DiRosa EA
"You can get a couple of ramen noodle packs for a Buspar(Ⓡ)": a qualitative examination of medication access, policy, and procedures in southern jails.
Over10 million people are being incarcerated every year in the US, and jails are required to provide health care to them, a substantial percentage of whom require medications. However, not much is known about the medication prescription, acquisition, and administration process for incarcerated persons in jails. The purpose of this study was to characterize access to medication and related medication policies and procedures in jails. The researchers administered semi-structured interviews with administrators and health workers from 34 jails (of 125 contacted) across 5 states in the southeastern US. The qualitative interview guide encompassed all facets of healthcare in jails from entry to release, but the current study focused only on medications. The study found that 4 processes characterized medication utilization from intake to release: 1) jail entry and health screening, 2) pharmacy and medication protocols, 3) protocols specific to medication dispensing and administration, and 4) medications upon release. Many jails had processes for utilizing medications brought to the jail from home, although some jails did not agree to use those medications. Researchers discovered that contracted healthcare providers were the primary medication decision-makers in jails, and most medications were obtained from contract pharmacies. The study also found almost all jails banned narcotics, but other medication restrictions varied by jail. Most jails charged a copay for medications. Study participants shared a variety of privacy practices related to the distribution of medication, as well as approaches to the prevention of diversion of medications away from intended recipients and into the prison population. Transition planning for pre-release medication management processes ranged from no planning to sending additional prescriptions to the patient's pharmacy.
AHRQ-funded; HS000032.
Citation: Hughes PM, Carda-Auten J, DiRosa EA .
"You can get a couple of ramen noodle packs for a Buspar(Ⓡ)": a qualitative examination of medication access, policy, and procedures in southern jails.
Res Social Adm Pharm 2023 Sep; 19(9):1298-306. doi: 10.1016/j.sapharm.2023.05.013..
Keywords: Medication, Vulnerable Populations, Access to Care
Smith MW, Carrel M, Goto M
County-level spatiotemporal distribution of fluoroquinolone-resistant Enterobacteriaceae in outpatient settings of the Veterans' Health Administration, 2000-2017.
This study’s goal was to describe the spatial distribution of fluoroquinolone resistance against Enterobacteriaceae and its chronological change between 2000 and 2017 in the nationwide Veterans' Health Administration system. Primary outcome was the county-level fluoroquinolone resistance rate, calculated as the proportion of number of unique patients with at least 1 positive fluoroquinolone-resistant Enterobacteriaceae clinical culture divided by the total number of unique patients with at least one positive Enterobacteriaceae culture in the county for each calendar year. The authors found spatially concentrated increasing prevalence in the 2000s, followed by spatial dispersion in the 2010s. Of the 107 million patient years of care in the VHA from 2000 to 2017, 1,621,762 patient years included at least 1 positive culture for Enterobacteriaceae, with 2,545,430 unique culture specimens. The resistance rate among all Enterobacteriaceae was 8% in the year 2000, with resistance peaking at 22% in 2011. This rate plateaued during 2011 to 2017. Initial resistance rates were higher in portions of the South region and southern California, with higher rates becoming widespread nationally during 2012 to 2017.
AHRQ-funded; HS027472.
Citation: Smith MW, Carrel M, Goto M .
County-level spatiotemporal distribution of fluoroquinolone-resistant Enterobacteriaceae in outpatient settings of the Veterans' Health Administration, 2000-2017.
Infect Control Hosp Epidemiol 2023 Sep; 44(9):1497-99. doi: 10.1017/ice.2022.291..
Keywords: Medication, Antibiotics
Anderson KE, DiStefano MJ, Liu A
Incorporating added therapeutic benefit and domestic reference pricing into Medicare payment for expensive part B drugs.
The objective of this retrospective analysis was to identify expensive Part B drugs and to consider the evidence for each drug's added benefit in order to model a reimbursement policy for Medicare that integrates added benefit assessment and domestic reference pricing. Data were taken from a nationally representative sample of traditional Medicare Part B claims. The analysis showed that more than one-third of the expensive Part B drugs prescribed in 2019 offered low added benefit. The authors concluded that reference pricing based on added benefit assessment could be used to address the launch prices for expensive Part B drugs with low added benefit.
AHRQ-funded; HS000029.
Citation: Anderson KE, DiStefano MJ, Liu A .
Incorporating added therapeutic benefit and domestic reference pricing into Medicare payment for expensive part B drugs.
Value Health 2023 Sep; 26(9):1381-88. doi: 10.1016/j.jval.2023.05.018..
Keywords: Medicare, Payment, Medication, Healthcare Costs
Troy AL, Herzig SJ, Trivedi S
Initiation of oral anticoagulation in US older adults newly diagnosed with atrial fibrillation during hospitalization.
This study investigated prevalence of oral anticoagulant initiation for newly diagnosed US older adults with atrial fibrillation within 7 days of hospital discharge. The authors used a 20% national sample of Medicare fee-for-service beneficiaries, identifying patients aged 65 years or older newly diagnosed with atrial fibrillation while hospitalized in 2016. Among 38,379 older adults newly diagnosed with atrial fibrillation while hospitalized (mean age 78.2; 51.8% female; 83.3% white), 36,633 (95.4%) had an indication for anticoagulation and 24.6% (9011) of those initiated an oral anticoagulant following discharge. Higher CHA(2) DS(2) -VASc score was associated with a small increase in oral anticoagulant initiation (predicted probability 20.5% for scores <2 and 24.9% for ≥4). Elevated HAS-BLED score was associated with a small decrease in probability of anticoagulant initiation (25.4% for score <2 and 23.1% for ≥3). Frailty was associated with decreased likelihood of oral anticoagulant initiation (24.7% for non-frail and 18.1% for moderately-severely frail). Anticoagulant initiation varied by primary reason for hospitalization, with predicted probability highest among patients with a primary diagnosis of atrial fibrillation (46.1%) and lowest among those with non-cardiovascular conditions (13.8%) and bleeds (3.6%).
AHRQ-funded; HS026215.
Citation: Troy AL, Herzig SJ, Trivedi S .
Initiation of oral anticoagulation in US older adults newly diagnosed with atrial fibrillation during hospitalization.
J Am Geriatr Soc 2023 Sep; 71(9):2748-58. doi: 10.1111/jgs.18375..
Keywords: Elderly, Blood Thinners, Medication, Heart Disease and Health, Cardiovascular Conditions, Stroke
Sankar A, Everhart AO, Jena AB
Longitudinal patterns in testosterone prescribing after US FDA safety communication in 2014.
This study described changes in testosterone prescribing following a 2014 US Food and Drug Administration (FDA) safety communication and how changes varied by physician characteristics. The authors extracted data from a 20% random sample of Medicare fee-for-service administrative claims data from 2011 through 2019. This unique sample included 1,544,604 unique male beneficiaries who received evaluation and management (E&M) services from 58,819 unique physicians that prescribed testosterone between 2011 and 2013. Patients were classified by presence of coronary artery disease (CAD) and non-age-related hypogonadism. Physician characteristics included specialty and affiliations with teaching hospitals, for-profit hospitals, hospitals in integrated delivery networks, and hospitals in the top decile of case mix index. Among 65,089,560 physician-patient-quarter-year observations, mean (standard deviation) age ranged from 72.16 (5.84 SD) years for observations without CAD or non-age-related hypogonadism to 75.73 (6.92 SD) years with CAD and without non-age-related hypogonadism. Following the safety communication, immediate changes in off-label testosterone prescription levels fell by 0.22 percentage points (pp) for patients with CAD and by -0.16 pp for patients without CAD, with a similar change in on-label prescribing levels. The off-label testosterone prescription quarterly trend increased for patients with CAD and without CAD; on-label testosterone prescription trends declined for both groups. Primary care physicians had larger declines in off-label prescribing then non-primary care physicians, and physicians affiliated with teaching compared to nonteaching hospitals. On-label prescribing found no changes associated with physician and organizational characteristics.
AHRQ-funded; HS025164.
Citation: Sankar A, Everhart AO, Jena AB .
Longitudinal patterns in testosterone prescribing after US FDA safety communication in 2014.
Jt Comm J Qual Patient Saf 2023 Sep; 49(9):458-66. doi: 10.1016/j.jcjq.2023.05.003..
Keywords: Communication, Medication, Practice Patterns
Somohano VC, Smith CL, Saha S
Patient-provider shared decision-making, trust, and opioid misuse among US veterans prescribed long-term opioid therapy for chronic pain.
This article examined the role that trust in a prescribing provider has on shared decision-making and opioid misuse in opioid-specific pain management. A secondary analysis of data from a prospective cohort study was conducted of US Veterans (N = 1273) prescribed long-term opioid therapy (LTOT) for chronic non-cancer pain. Patient-provider shared decision-making had a total significant effect on opioid misuse, in the absence of the mediator, such that higher levels of shared decision-making were associated with lower levels of reported opioid misuse. When trust in provider was added to the mediation model, the indirect effect of shared decision-making on opioid misuse through trust in provider remained significant.
AHRQ-funded; HS026370.
Citation: Somohano VC, Smith CL, Saha S .
Patient-provider shared decision-making, trust, and opioid misuse among US veterans prescribed long-term opioid therapy for chronic pain.
J Gen Intern Med 2023 Sep; 38(12):2755-60. doi: 10.1007/s11606-023-08212-5..
Keywords: Shared Decision Making, Opioids, Medication, Substance Abuse, Behavioral Health, Pain, Chronic Conditions
Young RA, Gurses AP, Fulda KG
Primary care teams' reported actions to improve medication safety: a qualitative study with insights in high reliability organising.
The purpose of this qualitative study was to examine actions by primary care teams to improve medication safety. During 2019-2020, the researchers utilized one-on-one, semi-structured interviews with 21 primary care physicians and their team members at four primary care sites serving patients with mostly low socioeconomic status in the Southwest United States. The study found that primary care teams described their actions in medication safety primarily in making standard-of-care medical decisions, patient-shared decision-making, educating patients and their caregivers, providing asynchronous care separate from office visits and providing clinical infrastructure. The majority of the actions required individual-level customization, such as restricting the supply of specific medications prescribed and simplifying the medication regimens of specific patients. Primary care teams engaged high reliability organization principles taking steps to improve resilience in patient work systems and by anticipating and moderating risks. The actions of the primary care teams demonstrated their safety organizing efforts as responses to many other agents in multiple settings that they could neither control nor coordinate easily.
AHRQ-funded; HS027277.
Citation: Young RA, Gurses AP, Fulda KG .
Primary care teams' reported actions to improve medication safety: a qualitative study with insights in high reliability organising.
BMJ Open Qual 2023 Sep; 12(3). doi: 10.1136/bmjoq-2023-002350..
Keywords: Medication: Safety, Medication, Primary Care, Patient Safety
Grigoryan L, Paasche-Orlow MK, Alquicira O
Antibiotic use without a prescription: a multi-site survey of patient, health system, and encounter characteristics.
The purpose of this study was to assess the impact of factors of patient, health system, and clinical encounters on intention to utilize antibiotics without a prescription. Use cases included antibiotics that were 1) bought in the United States, 2) provided by relatives or friends, 3) purchased in another country, or 4) from any of these sources. Between January 2020 through June 2021, a survey was administered in 6 publicly funded primary care clinics and 2 private emergency departments in Texas, United States. Study participants included adult patients visiting 1 of the clinical settings. The study found that of the 564 survey respondents 43.6% reported previous use of antibiotics without a prescription, and 31.4% reported intent to take antibiotics without a prescription. Survey respondents reported they would take antibiotics obtained from relatives or friends (22.3%), bought in the United States without a prescription (19.1%), or purchased in another country without a prescription (17.9%). Perceived high cost of doctor visits, lack of health insurance, and younger age were all predictors of intended use of nonprescription antibiotics from any of the sources. Hispanic or Latino ethnicity, being interviewed in Spanish, language barrier to medical care, and lack of transportation for medical appointments.
AHRQ-funded; HS026901.
Citation: Grigoryan L, Paasche-Orlow MK, Alquicira O .
Antibiotic use without a prescription: a multi-site survey of patient, health system, and encounter characteristics.
Clin Infect Dis 2023 Aug 22; 77(4):510-17. doi: 10.1093/cid/ciad241..
Keywords: Antibiotics, Medication, Antimicrobial Stewardship
Chou R, Spencer H, Bougatsos C
Preexposure prophylaxis for the prevention of HIV: updated evidence report and systematic review for the US Preventive Services Task Force.
This article updates research used in the 2019 US Preventive Services Task Force final recommendation on use of oral preexposure prophylaxis (PrEP) to prevent HIV in adults at increased risk. The summary includes newer PrEP regimens that were not available for the 2019 final recommendation. A literature review was conducted that included randomized clinical trials of PrEP vs placebo or no PrEP or newer vs older PrEP regimens and diagnostic accuracy studies of instruments for predicting incident HIV infection. Thirty-two studies were included in the review (20 randomized clinical trials [n = 36,543] and 12 studies of diagnostic accuracy [n = 5,544,500]). Eleven trials in the 2019 review found oral PrEP associated with decreased HIV infection risk vs placebo or no PrEP. One new trial (n = 5335) found oral tenofovir alafenamide/emtricitabine (TAF/FTC) to be noninferior to tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) in men who have sex with men. Two new trials found long-acting injectable cabotegravir associated with decreased risk of HIV infection vs oral TDF/FTC in cisgender men who have sex with men and transgender women [n = 4490] and RR, 0.11 in cisgender women [n = 3178]). Discrimination of instruments for predicting incident HIV infection was found to be moderate in men who have sex with men (5 studies; n = 25,488) and moderate to high in general populations of persons without HIV (2 studies; n = 5,477,291).
AHRQ-funded; 75Q80120D00006.
Citation: Chou R, Spencer H, Bougatsos C .
Preexposure prophylaxis for the prevention of HIV: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2023 Aug 22; 330(8):746-63. doi: 10.1001/jama.2023.9865..
Keywords: U.S. Preventive Services Task Force (USPSTF), Human Immunodeficiency Virus (HIV), Prevention, Medication, Evidence-Based Practice