National Healthcare Quality and Disparities Report
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Topics
- Access to Care (1)
- Adverse Drug Events (ADE) (2)
- Adverse Events (10)
- Antibiotics (2)
- Antimicrobial Stewardship (1)
- Autism (2)
- Back Health and Pain (2)
- Behavioral Health (2)
- Cancer (8)
- Cancer: Breast Cancer (1)
- Cancer: Cervical Cancer (1)
- Cancer: Lung Cancer (1)
- Cardiovascular Conditions (8)
- Care Management (1)
- Case Study (1)
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- Clinical Decision Support (CDS) (2)
- Clinician-Patient Communication (2)
- Colonoscopy (1)
- Communication (4)
- COVID-19 (4)
- Critical Care (2)
- Cultural Competence (1)
- Dementia (2)
- Depression (2)
- Diabetes (2)
- (-) Diagnostic Safety and Quality (71)
- Disparities (4)
- Education: Curriculum (1)
- Elderly (2)
- Electronic Health Records (EHRs) (4)
- Emergency Department (12)
- Emergency Medical Services (EMS) (1)
- Evidence-Based Practice (1)
- Genetics (2)
- Healthcare-Associated Infections (HAIs) (3)
- Healthcare Costs (1)
- Health Information Technology (HIT) (9)
- Heart Disease and Health (4)
- Home Healthcare (1)
- Hospitals (2)
- Human Immunodeficiency Virus (HIV) (1)
- Imaging (8)
- Infectious Diseases (4)
- Intensive Care Unit (ICU) (3)
- Kidney Disease and Health (1)
- Long-Term Care (1)
- Medical Errors (10)
- Medicare (1)
- Medication (2)
- Men's Health (1)
- Neurological Disorders (5)
- Newborns/Infants (2)
- Nursing Homes (1)
- Outcomes (1)
- Pain (2)
- Patient-Centered Outcomes Research (1)
- Patient Safety (9)
- Practice Patterns (1)
- Pregnancy (2)
- Prevention (3)
- Primary Care (2)
- Provider: Health Personnel (1)
- Provider: Nurse (1)
- Public Health (1)
- Quality Improvement (4)
- Quality of Care (4)
- Racial and Ethnic Minorities (5)
- Respiratory Conditions (3)
- Risk (8)
- Screening (5)
- Sepsis (3)
- Sexual Health (1)
- Shared Decision Making (3)
- Skin Conditions (3)
- Social Determinants of Health (2)
- Stroke (4)
- Surgery (2)
- Telehealth (2)
- Treatments (2)
- Urinary Tract Infection (UTI) (2)
- Vulnerable Populations (1)
- Women (3)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
51 to 71 of 71 Research Studies DisplayedWayne MT, Molling D, Wang XQ
Measurement of sepsis in a national cohort using three different methods to define baseline organ function.
In 2017, the U.S. Centers for Disease Control and Prevention (CDC) developed a new surveillance definition of sepsis, the adult sepsis event (ASE), to better track sepsis epidemiology. The objective of this study was to understand how sepsis identification and outcomes differed when using the best laboratory values during hospitalization versus methods that used historical lookbacks to define baseline organ function.
AHRQ-funded; HS026725.
Citation: Wayne MT, Molling D, Wang XQ .
Measurement of sepsis in a national cohort using three different methods to define baseline organ function.
Ann Am Thorac Soc 2021 Apr;18(4):648-55. doi: 10.1513/AnnalsATS.202009-1130OC..
Keywords: Sepsis, Diagnostic Safety and Quality
Davis K, Wilbur K, Metzger S
Symptom and needs assessment screening in oncology patients: alternate outreach methods during COVID-19.
This initiative’s goal was to develop alternate outreach methods to cancer patients without access to an electronic portal during COVID-19. The authors implemented a standardized telephone outreach process targeting patients without active electronic portal accounts to improve remote symptom monitoring. A total of 172 screens were completed, identifying 110 needs for 63 individuals. Twenty-eight patients completed patient enrollment, with outreach calls capturing a higher percentage of Black patients (34%) and older adults age 61-80 years old (69%) compared to portal users.
AHRQ-funded; HS026170.
Citation: Davis K, Wilbur K, Metzger S .
Symptom and needs assessment screening in oncology patients: alternate outreach methods during COVID-19.
J Psychosoc Oncol 2021;39(3):452-60. doi: 10.1080/07347332.2021.1890663..
Keywords: COVID-19, Cancer, Access to Care, Telehealth, Health Information Technology (HIT), Diagnostic Safety and Quality
Rauscher GH, Murphy AM, Qiu Q
The "sweet spot" revisited: optimal recall rates for cancer detection with 2D and 3D digital screening mammography in the Metro Chicago Breast Cancer Registry.
The authors examined the trade-offs for higher recall rates in terms of biopsy recommendations and cancer detection in mammography in a single large health care organization. 2D analog, 2D digital, and 3D digital mammography screenings among women 40-79 years old with cancer follow-up were examined. They found that the results of their investigation were in contrast to those of a recent study suggesting appropriateness of higher recall rates. They concluded that optimal cancer detection appeared to be in the recall rate range of 7-9% for both 2D digital mammography and 3D tomosynthesis.
AHRQ-funded; HS018366.
Citation: Rauscher GH, Murphy AM, Qiu Q .
The "sweet spot" revisited: optimal recall rates for cancer detection with 2D and 3D digital screening mammography in the Metro Chicago Breast Cancer Registry.
AJR Am J Roentgenol 2021 Apr;216(4):894-902. doi: 10.2214/ajr.19.22429.
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Keywords: Cancer: Breast Cancer, Cancer, Imaging, Screening, Diagnostic Safety and Quality, Women, Prevention
Vemulakonda VM
Ureteropelvic junction obstruction: diagnosis and management.
Ureteropelvic junction obstruction (UPJO) is the most common cause of prenatally diagnosed hydronephrosis. Although associated with obstruction of the kidney, the natural history is variable, ranging from spontaneous resolution to progressive loss of function over the first few years of life. The purpose of this article is to review recent literature focused on the prenatal and postnatal evaluation of infants with prenatally diagnosed hydronephrosis suspicious for UPJO.
AHRQ-funded; HS024597.
Citation: Vemulakonda VM .
Ureteropelvic junction obstruction: diagnosis and management.
Curr Opin Pediatr 2021 Apr 1;33(2):227-34. doi: 10.1097/mop.0000000000000994..
Keywords: Newborns/Infants, Pregnancy, Diagnostic Safety and Quality
Jones OT, Calanzani N, Saji S
Artificial intelligence techniques that may be applied to primary care data to facilitate earlier diagnosis of cancer: systematic review.
This study’s objective was a systematic review of artificial intelligence (AI) techniques that might facilitate earlier diagnosis of cancer and could be applied to primary care electronic health record (EHR) data. Findings showed that AI techniques have been applied to EHR-type data to facilitate early diagnosis of cancer, but their use in primary care settings is still at an early stage of maturity. Further evidence is needed on their performance using primary care data, implementation barriers, and cost-effectiveness before widespread adoption into routine primary care clinical practice can be recommended.
AHRQ-funded; HS027363.
Citation: Jones OT, Calanzani N, Saji S .
Artificial intelligence techniques that may be applied to primary care data to facilitate earlier diagnosis of cancer: systematic review.
J Med Internet Res 2021 Mar 3;23(3):e23483. doi: 10.2196/23483..
Keywords: Cancer, Diagnostic Safety and Quality, Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT)
Schoenfeld EM, Poronsky KE, Westafer LM
Feasibility and efficacy of a decision aid for emergency department patients with suspected ureterolithiasis: protocol for an adaptive randomized controlled trial.
Both ultrasound and CT scan can be used for diagnosis of ureterolithiasis (or renal colic, the pain from an obstructing kidney stone), but the majority of patients receive a CT scan. Diagnostic pathways utilizing ultrasound have been shown to decrease radiation exposure to patients but are potentially less accurate. The investigators developed a decision aid to facilitate SDM in this scenario. The objective of this study was to determine the effects of this decision aid, as compared to usual care, on patient knowledge, radiation exposure, engagement, safety, and healthcare utilization.
AHRQ-funded; HS025701.
Citation: Schoenfeld EM, Poronsky KE, Westafer LM .
Feasibility and efficacy of a decision aid for emergency department patients with suspected ureterolithiasis: protocol for an adaptive randomized controlled trial.
Trials 2021 Mar 10;22(1):201. doi: 10.1186/s13063-021-05140-9..
Keywords: Emergency Department, Shared Decision Making, Kidney Disease and Health, Imaging, Diagnostic Safety and Quality
Cook A, Quinn ED, Rowland C
Exploring expressive communication skills in a cross-sectional sample of individuals with a dual diagnosis of autism spectrum disorder and down syndrome.
The authors hypothesized that individuals with a comorbid diagnosis of Down syndrome (DS) and autism spectrum disorder would have significantly lower Communication Matrix scores and specifically social communication scores than individuals with DS alone. They found that, in a sample of 4,782 individuals with DS, scores for individuals with a comorbid diagnosis were on average 18.01 points and 7.26 points lower for total score and social score, respectively, as compared to individuals with DS alone.
AHRQ-funded; K12 HS026370; 1013200.
Citation: Cook A, Quinn ED, Rowland C .
Exploring expressive communication skills in a cross-sectional sample of individuals with a dual diagnosis of autism spectrum disorder and down syndrome.
Am J Intellect Dev Disabil 2021 Mar 1;126(2):97-113. doi: 10.1352/1944-7558-126.2.97..
Keywords: Autism, Communication, Diagnostic Safety and Quality
Fenton JJ, Jerant A, Franks P
Watchful waiting as a strategy to reduce low-value spinal imaging: study protocol for a randomized trial.
This paper describes the protocol that will be used for an upcoming randomized control trial to determine the effectiveness of teaching clinicians how to advise watchful waiting when patients request low-value spinal imaging for acute low back pain. The authors will recruit 8-10 primary care and urgent care clinics in Sacramento, California. The study will last 3-6 months and during this time clinicians in the intervention group with receive 3 visits with standardized patient instructors (SPIs) portraying patients with acute back pain. The SPIs will instruct clinicians in a 3-step model emphasizing trust, empathic communication, and negotiation of a watchful waiting approach. The primary outcome looked for will a decreased post-intervention rate of spinal imaging among actual patients with acute back pain compared to the rate of imaging during the baseline period. Secondary outcomes will include use of targeted communication techniques during a follow-up visit with an SP.
AHRQ-funded; HS026415.
Citation: Fenton JJ, Jerant A, Franks P .
Watchful waiting as a strategy to reduce low-value spinal imaging: study protocol for a randomized trial.
Trials 2021 Feb 27;22(1):167. doi: 10.1186/s13063-021-05106-x..
Keywords: Back Health and Pain, Pain, Chronic Conditions, Imaging, Diagnostic Safety and Quality, Clinician-Patient Communication, Communication
Miller AC, Arakkal AT, Koeneman S
Incidence, duration and risk factors associated with delayed and missed diagnostic opportunities related to tuberculosis: a population-based longitudinal study.
Missed opportunities to diagnose tuberculosis are costly to patients and society. In this retrospective cohort study, the investigators (1) estimated the frequency and duration of diagnostic delays among patients with active pulmonary tuberculosis and (2) determined the risk factors for experiencing a diagnostic delay. The investigators found that many patients with tuberculosis experience multiple missed diagnostic opportunities prior to diagnosis.
AHRQ-funded; HS027375.
Citation: Miller AC, Arakkal AT, Koeneman S .
Incidence, duration and risk factors associated with delayed and missed diagnostic opportunities related to tuberculosis: a population-based longitudinal study.
BMJ Open 2021 Feb 18;11(2):e045605. doi: 10.1136/bmjopen-2020-045605..
Keywords: Respiratory Conditions, Diagnostic Safety and Quality, Risk
Shah NR, Eisman AS, Winchester DE
E-consult protocoling to improve the quality of cardiac stress tests.
Rarely appropriate cardiac stress tests remain prevalent in the range of 10% to 20% and unnecessarily prolong wait times. To address this ongoing problem, the investigators designed the EPIQ-Stress workflow, which included a structured electronic consult (“econsult”) with all outpatient stress test orders. In this study, the investigators assessed whether EPIQ-Stress implementation was associated with a reduction in rarely appropriate testing and in order-to-report wait times.
AHRQ-funded; HS022998.
Citation: Shah NR, Eisman AS, Winchester DE .
E-consult protocoling to improve the quality of cardiac stress tests.
JACC Cardiovasc Imaging 2021 Feb;14(2):512-14. doi: 10.1016/j.jcmg.2020.08.009..
Keywords: Telehealth, Health Information Technology (HIT), Heart Disease and Health, Cardiovascular Conditions, Diagnostic Safety and Quality
Zachrison KS, Natsui S, Luan Erfe BM
Language preference does not influence stroke patients' symptom recognition or emergency care time metrics.
The objective of this study was to determine whether acute ischemic stroke (AIS) patients' language preference was associated with differences in time from symptom discovery to hospital arrival, activation of emergency medical services, door-to-imaging time (DTI), and door-to-needle (DTN) time. The investigators concluded that consistent with prior reports examining disparities in care, a systems-based approach to acute stroke prevents differences in hospital-based metrics.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Natsui S, Luan Erfe BM .
Language preference does not influence stroke patients' symptom recognition or emergency care time metrics.
Am J Emerg Med 2021 Feb;40:177-80. doi: 10.1016/j.ajem.2020.10.064..
Keywords: Stroke, Cardiovascular Conditions, Emergency Department, Cultural Competence, Diagnostic Safety and Quality
Shipe ME, Deppen SA, Sullivan S
Validation of histoplasmosis enzyme immunoassay to evaluate suspicious lung nodules.
Granulomas caused by infectious lung diseases can present as indeterminate pulmonary nodules (IPN). This study aimed to validate an enzyme immunoassay (EIA) for histoplasma immunoglobulins G and M (IgG, IgM) for diagnosing benign IPN in areas with endemic histoplasmosis. The investigators concluded that this study confirmed that histoplasma EIA testing could be useful for diagnosing benign IPN in areas with endemic histoplasmosis in a population at high risk for lung cancer.
AHRQ-funded; HS026122.
Citation: Shipe ME, Deppen SA, Sullivan S .
Validation of histoplasmosis enzyme immunoassay to evaluate suspicious lung nodules.
Ann Thorac Surg 2021 Feb;111(2):416-20. doi: 10.1016/j.athoracsur.2020.05.101..
Keywords: Diagnostic Safety and Quality, Respiratory Conditions
Lacson R, Cochon L, Ching PR
Integrity of clinical information in radiology reports documenting pulmonary nodules.
Researchers sought to quantify the integrity, measured as completeness and concordance with a thoracic radiologist, of documenting pulmonary nodule characteristics in CT reports, and to assess impact on making follow-up recommendations. Their retrospective cohort study was performed at an academic medical center and natural language processing was used on radiology reports of CT scans of chest, abdomen, or spine to assess presence of pulmonary nodules. They found that essential pulmonary nodule characteristics were under-reported, potentially impacting recommendations for pulmonary nodule follow-up. They concluded that the lack of documentation of pulmonary nodule characteristics in radiology reports was common, with the potential for compromising patient care and clinical decision support tools.
AHRQ-funded; HS024722.
Citation: Lacson R, Cochon L, Ching PR .
Integrity of clinical information in radiology reports documenting pulmonary nodules.
J Am Med Inform Assoc 2021 Jan 15;28(1):80-85. doi: 10.1093/jamia/ocaa209..
Keywords: Imaging, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Zhou Y, Walter FM, Singh H
Prolonged diagnostic intervals as marker of missed diagnostic opportunities in bladder and kidney cancer patients with alarm features: a longitudinal linked data study.
In England, patients who meet National Institute for Health and Care Excellence (NICE) guideline criteria for suspected cancer should receive a specialist assessment within 14 days. In this study, the researchers examined how quickly bladder and kidney cancer patients who met fast-track referral criteria were actually diagnosed. The investigators found that more than a quarter of patients presenting with fast-track referral features did not achieve a timely diagnosis, suggesting inadequate guideline adherence for some patients.
AHRQ-funded; HS022087.
Citation: Zhou Y, Walter FM, Singh H .
Prolonged diagnostic intervals as marker of missed diagnostic opportunities in bladder and kidney cancer patients with alarm features: a longitudinal linked data study.
Cancers 2021 Jan 5;13(1). doi: 10.3390/cancers13010156..
Keywords: Cancer, Diagnostic Safety and Quality
Marin JR, Rodean J, Hall M
Racial and ethnic differences in emergency department diagnostic imaging at US children's hospitals, 2016-2019.
Researchers evaluated racial and ethnic differences in the performance of common ED imaging studies and examined patterns across diagnoses. In this study, which evaluated visits by nonhospitalized patients younger than 18 years in 44 US children's hospital EDs, they found that non-Hispanic Black and Hispanic children were less likely to receive diagnostic imaging during ED visits compared with non-Hispanic White children. They recommended further investigation to understand and mitigate these potential disparities in health care delivery and to evaluate the effect of these differential imaging patterns on patient outcomes.
AHRQ-funded; HS026006.
Citation: Marin JR, Rodean J, Hall M .
Racial and ethnic differences in emergency department diagnostic imaging at US children's hospitals, 2016-2019.
JAMA Netw Open 2021 Jan 4(1):e2033710. doi: 10.1001/jamanetworkopen.2020.33710..
Keywords: Children/Adolescents, Hospitals, Emergency Department, Imaging, Racial and Ethnic Minorities, Disparities, Diagnostic Safety and Quality
Armstrong Armstrong, Irwin DJ, Leverenz JB
Biomarker use for dementia with Lewy body diagnosis: survey of US experts.
Researchers investigated clinical practice patterns of dementia with Lewy body (DLB) diagnostic criteria. An anonymous survey was sent to 38 center of excellence investigators inquiring about clinical use of diagnostic tests/biomarkers. They found that neuropsychological testing and MRI remained the most widely used diagnostic tests by DLB specialists. Other tests, particularly, indicative biomarkers, are used only selectively. They recommended research to validate existing potential DLB biomarkers, to develop new biomarkers, and to investigate mechanisms to improve DLB diagnosis.
Citation: Armstrong Armstrong, Irwin DJ, Leverenz JB .
Biomarker use for dementia with Lewy body diagnosis: survey of US experts.
Alzheimer Dis Assoc Disord 2021 Jan-Mar;35(1):55-61. doi: 10.1097/wad.0000000000000414..
Keywords: Dementia, Neurological Disorders, Diagnostic Safety and Quality
Rodriguez PJ, Roberts DA, Meisner J
Cost-effectiveness of dual maternal HIV and syphilis testing strategies in high and low HIV prevalence countries: a modelling study.
Dual HIV and syphilis testing might help to prevent mother-to-child transmission (MTCT) of HIV and syphilis through increased case detection and treatment. In this study, the investigators aimed to model and assess the cost-effectiveness of dual testing during antenatal care in four countries with varying HIV and syphilis prevalence. The authors concluded that incorporating dual rapid diagnostic tests in antenatal care could be cost-saving across countries with varying HIV prevalence.
AHRQ-funded; HS013853.
Citation: Rodriguez PJ, Roberts DA, Meisner J .
Cost-effectiveness of dual maternal HIV and syphilis testing strategies in high and low HIV prevalence countries: a modelling study.
Lancet Glob Health 2021 Jan;9(1):e61-e71. doi: 10.1016/s2214-109x(20)30395-8..
Keywords: Human Immunodeficiency Virus (HIV), Infectious Diseases, Prevention, Pregnancy, Women, Diagnostic Safety and Quality, Healthcare Costs
Marshall TL, Ipsaro AJ, Le M
Increasing physician reporting of diagnostic learning opportunities.
This study investigated methods to improve physician reporting of diagnostic errors at the pediatric division of a hospital. In that pediatric hospital medicine (PHM) division only 1 diagnostic-related safety event was reported in the preceding 4 years. The authors aimed to improve attending physician reporting of suspected diagnostic errors from 0 to 2 per 100 PHM patient admissions within 6 months. The improvement team used the Model for Improvement and used the term diagnostic learning opportunity (DLO) with clinicians as opposed to diagnostic error to lessen the stigma. They developed an electronic reporting form and encouraged its use through reminders, scheduled reflection time, and monthly progress reports. Over the course of 13 weeks, there was an increase from 0 to 1.6 per patient admission reports files. Most events (66%) were true diagnostic errors.
AHRQ-funded; HS023827.
Citation: Marshall TL, Ipsaro AJ, Le M .
Increasing physician reporting of diagnostic learning opportunities.
Pediatrics 2021 Jan;147(1). doi: 10.1542/peds.2019-2400..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety, Hospitals, Quality Improvement, Quality of Care
Beeber AS, Kistler CE, Zimmerman S
Nurse decision-making for suspected urinary tract infections in nursing homes: potential targets to reduce antibiotic overuse.
This study’s goal was to determine what information is most important to registered nurses (RNs) decisions to call clinicians about suspected urinary tract infections (UTIs) in nursing home residents. An online survey was conducted with a convenience sample of 881 RNs recruited from a health care research panel. Clinical scenarios from 10 categories of resident characteristics were used: UTI risk, resident type, functional status, mental status, lower urinary tract status, body temperature, physical exam, urinalysis, antibiotic request, and goals of care. Participants were randomized into 2 deliberation conditions: self-paced (n=437) and forced deliberation (n=444). Painful or difficult urinary, obvious blood in urine and temperature at 101.5° had the highest odds of a RN calling a clinician by the forced-deliberation group. For the self-paced group, painful or difficult urination had the highest odds.
AHRQ-funded; HS024519.
Citation: Beeber AS, Kistler CE, Zimmerman S .
Nurse decision-making for suspected urinary tract infections in nursing homes: potential targets to reduce antibiotic overuse.
J Am Med Dir Assoc 2021 Jan;22(1):156-63. doi: 10.1016/j.jamda.2020.06.053..
Keywords: Urinary Tract Infection (UTI), Antibiotics, Antimicrobial Stewardship, Medication, Nursing Homes, Long-Term Care, Shared Decision Making, Diagnostic Safety and Quality
Stone CA, Trubiano JA, Phillips EJ
Testing strategies and predictors for evaluating immediate and delayed reactions to cephalosporins.
Although 1% to 2% of the general population carries a cephalosporin allergy label (CAL), there is a lack of validated testing strategies and predictors of true allergy. The objective of this study was to identify cross-reactivity patterns and predictors of skin test positive (STP) in geographically disparate patients with a CAL. The investigators found that cephalosporin cross-reactivity was based on shared R1 groupings. Increasing time since the original reaction and the presence of a PAL with unknown cephalosporin tolerance predicted a lower likelihood of cephalosporin STP.
AHRQ-funded; HS026395.
Citation: Stone CA, Trubiano JA, Phillips EJ .
Testing strategies and predictors for evaluating immediate and delayed reactions to cephalosporins.
J Allergy Clin Immunol Pract 2021 Jan;9(1):435-44e13. doi: 10.1016/j.jaip.2020.07.056..
Keywords: Antibiotics, Medication, Adverse Drug Events (ADE), Adverse Events, Skin Conditions, Diagnostic Safety and Quality
Fraiman YS, Wojcik MH
The influence of social determinants of health on the genetic diagnostic odyssey: who remains undiagnosed, why, and to what effect?
This review article synthesizes the available evidence regarding population disparities in genetic testing for pediatric rare disease diagnosis and identifies gaps in care. The influence of social determinants of health is known, but this study’s goal is to examine the prevalence and nature of disparities in diagnostic testing. It synthesizes the available evidence regarding disparities, defining the need for further, prospective studies.
AHRQ-funded; HS000063.
Citation: Fraiman YS, Wojcik MH .
The influence of social determinants of health on the genetic diagnostic odyssey: who remains undiagnosed, why, and to what effect?
Pediatr Res 2021 Jan;89(2):295-300. doi: 10.1038/s41390-020-01151-5..
Keywords: Children/Adolescents, Social Determinants of Health, Genetics, Diagnostic Safety and Quality, Screening, Disparities