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
101 to 125 of 136 Research Studies DisplayedDavies L, Petitti DB, Martin L
Defining, estimating, and communicating overdiagnosis in cancer screening.
Overdiagnosis represents one harm of too much medicine, but the concept can be confusing. Because the U.S. Preventive Services Task Force (USPSTF) issues screening recommendations aimed largely at healthy persons, it has a particular interest in understanding harms related to screening, especially but not limited to overdiagnosis. In support of the USPSTF, the authors summarize the knowledge and provide guidance on defining, estimating, and communicating overdiagnosis in cancer screening.
AHRQ-funded; 290201200015I; 290201600006C.
Citation: Davies L, Petitti DB, Martin L .
Defining, estimating, and communicating overdiagnosis in cancer screening.
Ann Intern Med 2018 Jul 3;169(1):36-43. doi: 10.7326/m18-0694..
Keywords: Cancer, Communication, Diagnostic Safety and Quality, Screening, U.S. Preventive Services Task Force (USPSTF)
Weber NS, Gressitt KL, Cowan DN
AHRQ Author: Niebuhr DW
Monocyte activation detected prior to a diagnosis of schizophrenia in the US Military New Onset Psychosis Project (MNOPP).
Low-grade inflammation is present in some cases of schizophrenia, particularly in the early stages of this disorder. The inflammation source is not known but may be the result of dysbiotic processes occurring in the gut. In this study, the investigators examined peripheral biomarkers of bacterial translocation, soluble CD14 (sCD14) and lipopolysaccharide binding protein (LBP), and of general inflammation, C-reactive protein (CRP), in a unique, pre-onset study of schizophrenia.
AHRQ-authored.
Citation: Weber NS, Gressitt KL, Cowan DN .
Monocyte activation detected prior to a diagnosis of schizophrenia in the US Military New Onset Psychosis Project (MNOPP).
Schizophr Res 2018 Jul;197:465-69. doi: 10.1016/j.schres.2017.12.016..
Keywords: Behavioral Health, Diagnostic Safety and Quality
Olson AP, Graber ML, Singh H
Tracking progress in improving diagnosis: a framework for defining undesirable diagnostic events.
The authors of this paper propose a new framework to identify “undesirable diagnostic events” (UDEs) to help establish reliable and valid measures for diagnostic errors. They proposed an outline for UDEs to identify conditions prone to diagnostic error and the contexts of care in which those errors are likely to occur.
AHRQ-funded; HS022087; HS023602.
Citation: Olson AP, Graber ML, Singh H .
Tracking progress in improving diagnosis: a framework for defining undesirable diagnostic events.
J Gen Intern Med 2018 Jul;33(7):1187-91. doi: 10.1007/s11606-018-4304-2..
Keywords: Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety
Yin S, Connolly Gibbons MB, Diehl C
A self-report version of the ways of responding: reliability and validity in a clinical sample.
This study evaluated the reliability and validity of a modified, self-report version of the Ways of Responding instrument measures (WOR-SR) in a community mental health sample with depressive symptoms. Subjects completed the WOR-SR and other measures of depressive symptoms, dysfunctional cognitions, functioning, quality of life, and interpersonal problems at multiple time points. The authors conclude from their results that the WOR-SR is a reliable and valid measure of compensatory skills in patients receiving treatment for depression at community mental health centers.
AHRQ-funded; HS022124; HS018440.
Citation: Yin S, Connolly Gibbons MB, Diehl C .
A self-report version of the ways of responding: reliability and validity in a clinical sample.
Psychother Res 2018 Jul;28(4):581-92. doi: 10.1080/10503307.2016.1233367..
Keywords: Depression, Diagnostic Safety and Quality, Behavioral Health, Outcomes
Meyer AND, Thompson PJ, Khanna A
Evaluating a mobile application for improving clinical laboratory test ordering and diagnosis.
This study evaluated if a mobile application improved generalist physicians' appropriate laboratory test ordering and diagnosis decisions and assessed if physicians perceive it as useful for learning. The study concluded that a mobile app, PTT (partial thromboplastin times) Advisor, may contribute to better test ordering and diagnosis, serve as a learning tool for diagnostic evaluation of certain clinical disorders, and improve patient outcomes.
AHRQ-funded; HS022087; HS023602.
Citation: Meyer AND, Thompson PJ, Khanna A .
Evaluating a mobile application for improving clinical laboratory test ordering and diagnosis.
J Am Med Inform Assoc 2018 Jul;25(7):841-47. doi: 10.1093/jamia/ocy026..
Keywords: Shared Decision Making, Diagnostic Safety and Quality, Health Information Technology (HIT)
Martinez M, Thomas KC, Williams CS
Family experiences with the diagnosis of autism spectrum Disorder: system barriers and facilitators of efficient diagnosis.
This paper examines family experiences with the efficiency of Autism Spectrum Disorder diagnosis. Screening, travel distance, and delay in diagnosis were associated with shifting diagnoses and being told child did not have ASD. Physician and parent training in communication and addressing mental health professional shortages and maldistribution may improve the diagnosis experiences of families of children with ASD.
AHRQ-funded; HS000032.
Citation: Martinez M, Thomas KC, Williams CS .
Family experiences with the diagnosis of autism spectrum Disorder: system barriers and facilitators of efficient diagnosis.
J Autism Dev Disord 2018 Jul;48(7):2368-78. doi: 10.1007/s10803-018-3493-1..
Keywords: Autism, Children/Adolescents, Diagnostic Safety and Quality, Patient-Centered Healthcare, Patient Experience
Haukoos JS, Lyons MS, Rothman RE
The evolving landscape of HIV screening in the emergency department.
This article is a summary of two studies that appear in the same edition of the journal. The two studies describe the value of using targeted vs. non-targeted screening for HIV in emergency departments (EDs). New diagnosis rates were relatively small, which suggested that the use of targeted screening may be need to be refined more in terms of selection criteria.
AHRQ-funded; HS021749.
Citation: Haukoos JS, Lyons MS, Rothman RE .
The evolving landscape of HIV screening in the emergency department.
Ann Emerg Med 2018 Jul;72(1):54-56. doi: 10.1016/j.annemergmed.2018.01.041..
Keywords: Diagnostic Safety and Quality, Emergency Department, Human Immunodeficiency Virus (HIV), Prevention, Screening
Sloane PD, Ward K, Weber DJ
Can sepsis be detected in the nursing home prior to the need for hospital transfer?
The purpose of this study was to determine whether and to what extent simple screening tools might identify nursing home (NH) residents who are at high risk of becoming septic. The authors concluded that NHs need better systems to monitor NH residents whose status is changing, and to present that information to medical providers in real time, either through rapid medical response programs or telemetry.
AHRQ-funded; HS022846.
Citation: Sloane PD, Ward K, Weber DJ .
Can sepsis be detected in the nursing home prior to the need for hospital transfer?
J Am Med Dir Assoc 2018 Jun;19(6):492-96.e1. doi: 10.1016/j.jamda.2018.02.001..
Keywords: Sepsis, Nursing Homes, Long-Term Care, Diagnostic Safety and Quality, Elderly
Blecker S, Sontag D, Horwitz LI
Early identification of patients with acute decompensated heart failure.
The purpose of this study was to develop and test accuracies of various approaches to identify patients with acute decompensated heart failure (ADHF) with the use of data derived from the electronic health record. The authors concluded that machine learning algorithms with unstructured notes had the best performance for identification of ADHF and can improve provider efficiency for delivery of quality improvement interventions.
AHRQ-funded; HS023683.
Citation: Blecker S, Sontag D, Horwitz LI .
Early identification of patients with acute decompensated heart failure.
J Card Fail 2018 Jun;24(6):357-62. doi: 10.1016/j.cardfail.2017.08.458..
Keywords: Cardiovascular Conditions, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Heart Disease and Health
Bardach NS, Burkhart Q, Richardson LP
Hospital-based quality measures for pediatric mental health care.
The objective of this study was to develop and test medical record-based measures used to assess quality of pediatric mental health care in the emergency department (ED) and inpatient settings. The investigators drafted an evidence-based set of pediatric mental health care quality measures for the ED and inpatient settings and used them to identify sex and race disparities and substantial hospital variation.
AHRQ-funded; HS020506.
Citation: Bardach NS, Burkhart Q, Richardson LP .
Hospital-based quality measures for pediatric mental health care.
Pediatrics 2018 Jun;141(6). doi: 10.1542/peds.2017-3554..
Keywords: Cancer, Caregiving, Children/Adolescents, Clinician-Patient Communication, Communication, Shared Decision Making, Diagnostic Safety and Quality, Patient Experience, Patient and Family Engagement
Levis B, Benedetti A, Riehm KE
Probability of major depression diagnostic classification using semi-structured versus fully structured diagnostic interviews.
This study compared two interview methods that are used to diagnose depression in patients. It was found that the odds of diagnosing for depression were high for the Mini International Neuropsychiatric Interview (MINI) than the Composite International Diagnostic Interview (CIDI).
AHRQ-funded; HS018246.
Citation: Levis B, Benedetti A, Riehm KE .
Probability of major depression diagnostic classification using semi-structured versus fully structured diagnostic interviews.
Br J Psychiatry 2018 Jun;212(6):377-85. doi: 10.1192/bjp.2018.54..
Keywords: Depression, Diagnostic Safety and Quality, Behavioral Health
Owen JL, Vakharia PP, Silverberg JI
The role and diagnosis of allergic contact dermatitis in patients with atopic dermatitis.
Recent systematic reviews have suggested that allergic contact dermatitis (ACD) is a significant clinical problem in both children and adults with atopic dermatitis (AD). The authors review the clinical scenarios where patch testing is indicated in AD. In addition, they review the contraindications, preferred patch-testing series, pitfalls, and challenges determining the relevance of positive patch-test reactions in AD patients.
AHRQ-funded; HS023011.
Citation: Owen JL, Vakharia PP, Silverberg JI .
The role and diagnosis of allergic contact dermatitis in patients with atopic dermatitis.
Am J Clin Dermatol 2018 Jun;19(3):293-302. doi: 10.1007/s40257-017-0340-7.
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Keywords: Diagnostic Safety and Quality, Skin Conditions
Parikh ND, Scaglione S, Li Y
A comparison of staging systems for hepatocellular carcinoma in a multicenter US cohort.
This study compared different staging systems for hepatocellular carcinoma at 4 US health systems between June 2012 and May 2013. The most commonly used staging system is the Barcelona Clinic Liver Cancer (BCLC) system. A total of 320 patients were included in the study. The cohort were predominantly male (75.3%), white (48.8%), and had a mean age of 61.0 years. Prognostic performance was compared with BCLC, as well as the Italian Liver Cancer, Hong Kong Liver Cancer (HKLC), the Cancer of the Liver Italian Program, and the model to estimate survival in ambulatory patients with hepatocellular carcinoma (MESIAH) systems. They concluded that the HKLC and MESIAH systems were superior to BCLC in the multicenter cohort.
AHRQ-funded; HS022418.
Citation: Parikh ND, Scaglione S, Li Y .
A comparison of staging systems for hepatocellular carcinoma in a multicenter US cohort.
Clin Gastroenterol Hepatol 2018 May;16(5):781-82. doi: 10.1016/j.cgh.2017.10.001..
Keywords: Cancer, Diagnostic Safety and Quality
Gray SW, Gagan J, cerami E
Interactive or static reports to guide clinical interpretation of cancer genomics.
Misinterpretation of complex genomic data presents a major challenge in the implementation of precision oncology. In this randomized, vignette-based survey study, the investigators sought to determine whether interactive genomic reports with embedded clinician education and optimized data visualization improved genomic data interpretation. The investigators concluded that interactive genomic reports may improve physicians' ability to accurately assess genomic data and increase report-related satisfaction.
AHRQ-funded; HS024984.
Citation: Gray SW, Gagan J, cerami E .
Interactive or static reports to guide clinical interpretation of cancer genomics.
J Am Med Inform Assoc 2018 May;25(5):458-64. doi: 10.1093/jamia/ocx150..
Keywords: Genetics, Cancer, Diagnostic Safety and Quality
Singal AG, Corley DA, Kamineni A
Patterns and predictors of repeat fecal immunochemical and occult blood test screening in four large health care systems in the United States.
The objectives of this study were to characterize screening patterns and identify factors associated with repeat screening among patients who completed an index guaiac fecal occult blood test (gFOBT) or fecal immunochemical test (FIT). The investigators found that screening patterns varied substantially across healthcare systems, with consistent screening proportions ranging from 1 to 54.3% and no repeat screening proportions ranging from 6.9 to 42.8%. Consistent screening increased with older age but was less common among racial/ethnic minorities and patients with more comorbidities.
AHRQ-funded; HS022418.
Citation: Singal AG, Corley DA, Kamineni A .
Patterns and predictors of repeat fecal immunochemical and occult blood test screening in four large health care systems in the United States.
Am J Gastroenterol 2018 May;113(5):746-54. doi: 10.1038/s41395-018-0023-x..
Keywords: Screening, Cancer: Colorectal Cancer, Cancer, Practice Patterns, Diagnostic Safety and Quality
Richards CT, Huebinger R, Tataris KL
Cincinnati prehospital stroke scale can identify large vessel occlusion stroke.
This study explores the hypothesize that a cut-off score of the Cincinnati Prehospital Stroke Scale (CPSS), an assessment tool currently used by emergency medical services (EMS) providers, can be used to identify large vessel occlusion (LVO). Patients with acute ischemic stroke arriving via EMS at a high-volume stroke center in a large city were identified in a prospective, single-center registry. LVO was confirmed via head and neck vessel imaging and CPSS scores were abstracted from pre-hospital EMS records. The researchers conclude that a CPSS score of 3 identifies LVO in AIS patients reliably, and that EMS providers may be able to use the CPSS with a cut-off score to screen for patients with suspected LVO.
AHRQ-funded; HS000078.
Citation: Richards CT, Huebinger R, Tataris KL .
Cincinnati prehospital stroke scale can identify large vessel occlusion stroke.
Prehosp Emerg Care 2018 May-Jun;22(3):312-18. doi: 10.1080/10903127.2017.1387629..
Keywords: Diagnostic Safety and Quality, Emergency Department, Emergency Medical Services (EMS), Stroke
Muldoon MF, Kronish IM, Shimbo D
Of signal and noise: overcoming challenges in blood pressure measurement to optimize hypertension care.
This paper reviews the manifestations and consequences of BP mismeasurement and misinterpretation in clinical practice and draw on recent research to propose a set of solutions that leverage available technologies to optimize hypertension care.
AHRQ-funded; HS024262.
Citation: Muldoon MF, Kronish IM, Shimbo D .
Of signal and noise: overcoming challenges in blood pressure measurement to optimize hypertension care.
Circ Cardiovasc Qual Outcomes 2018 May;11(5):e004543. doi: 10.1161/circoutcomes.117.004543..
Keywords: Blood Pressure, Diagnostic Safety and Quality, Adverse Events, Medical Errors, Electronic Health Records (EHRs), Health Information Technology (HIT), Quality of Care
Dabbous F, Dolecek TA, Friedewald SM
Performance characteristics of digital vs film screen mammography in community practice.
In this study, the investigators examined performance characteristics of digital vs film screen mammography in community practice by comparing the performance characteristics of 297 629 full field digital (FFDM) and 416 791 screen film mammograms (SFM). In their study, modest gains in performance were achieved with the introduction of FFDM as a replacement for SFM, in a large health care organization.
AHRQ-funded; HS018366.
Citation: Dabbous F, Dolecek TA, Friedewald SM .
Performance characteristics of digital vs film screen mammography in community practice.
Breast J 2018 May;24(3):369-72. doi: 10.1111/tbj.12942..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Imaging, Women, Prevention, Comparative Effectiveness, Diagnostic Safety and Quality
Brunwasser SM, Gebretsadik T, Gold DR
A new model of wheezing severity in young children using the validated ISAAC wheezing module: a latent variable approach with validation in independent cohorts.
The authors of this paper developed an easily applicable continuous latent variable model of pediatric wheezing severity based on items from the well-validated International Study of Asthma and Allergies in Children (ISAAC) Wheezing Module. Their model prospectively associates with asthma morbidity, as demonstrated in two ECHO birth cohort studies, and provides a more statistically powerful method of testing etiologic hypotheses of childhood wheezing illness and asthma.
AHRQ-funded; HS022990.
Citation: Brunwasser SM, Gebretsadik T, Gold DR .
A new model of wheezing severity in young children using the validated ISAAC wheezing module: a latent variable approach with validation in independent cohorts.
PLoS One 2018 Apr 17;13(4):e0194739. doi: 10.1371/journal.pone.0194739..
Keywords: Asthma, Children/Adolescents, Diagnostic Safety and Quality, Patient-Centered Outcomes Research
Mohan V, Scholl G, Gold JA
Use of EHR-based simulation to diagnose aetiology of information gathering issues in struggling learners: a proof of concept study.
The researchers previously documented that high-fidelity EHR-based simulation improves EHR usability and, when combined with eye and screen tracking, generates important measures of usability. They hypothesised that the same simulation exercise could help distinguish whether learners had difficulty in knowledge, information gathering or information processing. In this paper, they report the results of the first three struggling learners who participated in this exercise.
AHRQ-funded; HS023793; HS021637.
Citation: Mohan V, Scholl G, Gold JA .
Use of EHR-based simulation to diagnose aetiology of information gathering issues in struggling learners: a proof of concept study.
BMJ Simul Technol Enhanc Learn 2018 Apr;4(2):92-94. doi: 10.1136/bmjstel-2017-000217.
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Keywords: Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Services Research (HSR), Training
Saber Tehrani AS, Kattah JC, Kerber KA
Diagnosing stroke in acute dizziness and vertigo: pitfalls and pearls.
Diagnosing cerebrovascular causes of acute dizziness and vertigo is both important and difficult. It is not routinely done well in current clinical ED practice. Current best evidence suggests an approach emphasizing dizziness timing and triggers, focused ocular motor examinations, and MRI, as needed. Alternative strategies to disseminate this approach may be required.
AHRQ-funded; HS022258.
Citation: Saber Tehrani AS, Kattah JC, Kerber KA .
Diagnosing stroke in acute dizziness and vertigo: pitfalls and pearls.
Stroke 2018 Mar;49(3):788-95. doi: 10.1161/strokeaha.117.016979.
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Keywords: Diagnostic Safety and Quality, Imaging, Stroke
Rinke ML, Singh H, Heo M
Diagnostic errors in primary care pediatrics: Project RedDE.
The objective of this study was to investigate the frequency of two high-frequency/subacute diagnostic errors (DEs), and one missed opportunity for diagnosis (MOD) in primary care pediatrics. DE or MOD rates in pediatric primary care were found to be 54 percent for patients with elevated BP, 11 percent for patients with abnormal laboratory values, and 62 percent for adolescents with an opportunity to evaluate for depression.
AHRQ-funded; HS022087; HS023608; HS023602.
Citation: Rinke ML, Singh H, Heo M .
Diagnostic errors in primary care pediatrics: Project RedDE.
Acad Pediatr 2018 Mar;18(2):220-27. doi: 10.1016/j.acap.2017.08.005.
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Keywords: Children/Adolescents, Diagnostic Safety and Quality, Medical Errors, Primary Care, Quality Improvement
Gephart SM, Wyles C, Canvasser J
Expert consensus to weight an adherence score for audit and feedback of practices that prevent necrotizing enterocolitis in very low birth weight infants.
Necrotizing enterocolitis (NEC) is a catastrophic abdominal complication threatening the life of premature infants, but adoption of prevention and early recognition practices differs as do NEC rates in Neonatal Intensive Care Units (NICUs). The purpose of this research was to validate and weight an evidence-based adherence score (aka NEC-Zero Adherence Score) to prevent and foster timely recognition of NEC.
AHRQ-funded; HS022908.
Citation: Gephart SM, Wyles C, Canvasser J .
Expert consensus to weight an adherence score for audit and feedback of practices that prevent necrotizing enterocolitis in very low birth weight infants.
Appl Nurs Res 2018 Feb;39:182-88. doi: 10.1016/j.apnr.2017.11.021..
Keywords: Newborns/Infants, Digestive Disease and Health, Diagnostic Safety and Quality, Intensive Care Unit (ICU)
Geis GL, Wheeler DS, Bunger A
A validation argument for a simulation-based training course centered on assessment, recognition, and early management of pediatric sepsis.
The aim of this study was to create a validity argument for the use of a simulation-based training course centered on assessment, recognition, and early management of sepsis in a laboratory-based setting. The authors concluded that, although incomplete, evidence from initial testing suggests that the simulations of pediatric sepsis were sufficiently valid to justify their use in training novice pediatric physicians in the assessment, recognition, and management of pediatric sepsis.
AHRQ-funded; HS020455.
Citation: Geis GL, Wheeler DS, Bunger A .
A validation argument for a simulation-based training course centered on assessment, recognition, and early management of pediatric sepsis.
Simul Healthc 2018 Feb;13(1):16-26. doi: 10.1097/sih.0000000000000271..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Sepsis, Training
Fu Y, Liu S, Li HH
An adaptive motion regularization technique to support sliding motion in deformable image registration.
To accurately model and estimate sliding tissue motion, an adaptive direction-dependent DVF regularization technique was developed in this study to model the sliding tissue motion of the thoracic and abdominal organs. The overall motion estimation accuracy was improved especially near the chest wall and abdominal wall where large organ sliding motion occurs.
AHRQ-funded; HS022888.
Citation: Fu Y, Liu S, Li HH .
An adaptive motion regularization technique to support sliding motion in deformable image registration.
Med Phys 2018 Feb;45(2):735-47. doi: 10.1002/mp.12734..
Keywords: Diagnostic Safety and Quality, Imaging, Patient Safety