National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Events (1)
- Antibiotics (3)
- Back Health and Pain (1)
- Blood Clots (1)
- Cancer (1)
- Cancer: Prostate Cancer (2)
- Cardiovascular Conditions (1)
- Care Management (3)
- Children/Adolescents (3)
- Chronic Conditions (3)
- Clinician-Patient Communication (1)
- Comparative Effectiveness (1)
- Complementary and Alternative Medicine (1)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- Diabetes (1)
- Disparities (1)
- Education: Continuing Medical Education (1)
- Education: Curriculum (1)
- Elderly (6)
- Electronic Health Records (EHRs) (4)
- Emergency Department (1)
- Guidelines (2)
- Healthcare Costs (2)
- Healthcare Delivery (1)
- Healthcare Utilization (2)
- Health Information Technology (HIT) (1)
- Heart Disease and Health (1)
- Intensive Care Unit (ICU) (1)
- Kidney Disease and Health (1)
- Long-Term Care (2)
- Medication (6)
- Nursing (1)
- Nursing Homes (4)
- Obesity (1)
- Obesity: Weight Management (1)
- Opioids (3)
- Pain (2)
- Patient-Centered Outcomes Research (2)
- Patient Adherence/Compliance (1)
- Patient Safety (4)
- Payment (1)
- (-) Practice Patterns (25)
- Prevention (1)
- Primary Care (5)
- Provider: Health Personnel (2)
- Provider: Nurse (1)
- Provider Performance (1)
- Quality Improvement (1)
- Quality of Care (2)
- Racial and Ethnic Minorities (1)
- Respiratory Conditions (2)
- Screening (1)
- Shared Decision Making (3)
- Surgery (2)
- U.S. Preventive Services Task Force (USPSTF) (1)
- Vulnerable Populations (1)
- Web-Based (1)
- Women (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 25 Research Studies DisplayedMcElligott M, Welham G, Pop-Vicas A
Antibiotic stewardship in nursing facilities.
The authors review the determinants of antibiotic prescribing in nursing facilities, strategies to improve antibiotic prescribing in this setting, current status of ASPs in nursing facilities, and steps that facilities can take to enhance existing ASP structure and process.
AHRQ-funded; HS022465.
Citation: McElligott M, Welham G, Pop-Vicas A .
Antibiotic stewardship in nursing facilities.
Antibiotics, Elderly, Nursing Homes, Patient Safety, Provider Practice Patterns.
Keywords: Antibiotics, Elderly, Nursing Homes, Patient Safety, Practice Patterns
Paddock SM, Damberg CL, Yanagihara D
What role does efficiency play in understanding the relationship between cost and quality in physician organizations?
Previous studies demonstrate overuse of a narrow set of services, suggesting provider inefficiency, but existing studies neither quantify inefficiency more broadly nor assess its variation across physician organizations (POs). This study found that POs had substantial variation in efficiency, producing widely differing levels of quality for the same cost.
AHRQ-funded; HS021860.
Citation: Paddock SM, Damberg CL, Yanagihara D .
What role does efficiency play in understanding the relationship between cost and quality in physician organizations?
Med Care 2017 Dec;55(12):1039-45. doi: 10.1097/mlr.0000000000000823.
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Keywords: Practice Patterns, Healthcare Costs, Quality of Care, Quality Improvement, Payment, Provider Performance
Lapham GT, Lee AK, Caldeiro RM
Frequency of cannabis use among primary care patients in Washington state.
This study describes the prevalence and frequency of past-year cannabis use among primary care patients assessed for use during a primary care visit. The study concluded that cannabis use was common in adult primary care patients, especially among younger patients and those with behavioral health conditions. Results highlight the need for primary care approaches to address cannabis use.
AHRQ-funded; HS023173.
Citation: Lapham GT, Lee AK, Caldeiro RM .
Frequency of cannabis use among primary care patients in Washington state.
J Am Board Fam Med 2017 Nov/Dec;30(6):795-805. doi: 10.3122/jabfm.2017.06.170062..
Keywords: Complementary and Alternative Medicine, Primary Care, Practice Patterns
Linder JA, Meeker D, Fox CR
Effects of behavioral interventions on inappropriate antibiotic prescribing in primary care 12 months after stopping interventions.
This study examines the persistence of effects 12 months after stopping behavioral interventions on inappropriate antibiotic prescribing. In the 12 months after removing behavioral interventions, inappropriate antibiotic prescribing for acute respiratory infections (ARIs) increased relative to control practices—whose inappropriate prescribing rates continued to decrease.
AHRQ-funded; HS019913.
Citation: Linder JA, Meeker D, Fox CR .
Effects of behavioral interventions on inappropriate antibiotic prescribing in primary care 12 months after stopping interventions.
JAMA 2017 Oct 10;318(14):1391-92. doi: 10.1001/jama.2017.11152.
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Keywords: Antibiotics, Practice Patterns, Primary Care, Comparative Effectiveness, Respiratory Conditions
Halbert CH, Jefferson M, Melvin CL
Provider advice about weight loss in a primary care sample of obese and overweight patients.
In this study the investigators examined receipt of provider advice to lose weight among primary care patients who were overweight and obese. The investigators found that patient beliefs about their weight status and perceptions about shared decision-making are important to receiving provider advice about weight loss/management among primary care patients.
AHRQ-funded; HS023047.
Citation: Halbert CH, Jefferson M, Melvin CL .
Provider advice about weight loss in a primary care sample of obese and overweight patients.
J Prim Care Community Health 2017 Oct;8(4):239-46. doi: 10.1177/2150131917715336..
Keywords: Shared Decision Making, Obesity, Obesity: Weight Management, Practice Patterns, Primary Care
Zullo AR, Dore DD, Gutman R
Metformin safety warnings and diabetes drug prescribing patterns for older nursing home residents.
Diabetes mellitus is common in US nursing homes (NHs), and the mainstay treatment, metformin, has US Food and Drug Administration (FDA) boxed warnings indicating safety concerns in those with advanced age, heart failure, or renal disease. The researchers quantified the determinants of initiating sulfonylureas over metformin with the aim of understanding the impact of FDA-labeled boxed warnings in older NH residents.
AHRQ-funded; HS022998.
Citation: Zullo AR, Dore DD, Gutman R .
Metformin safety warnings and diabetes drug prescribing patterns for older nursing home residents.
J Am Med Dir Assoc 2017 Oct;18(10):879-84.e7. doi: 10.1016/j.jamda.2017.05.020..
Keywords: Elderly, Medication, Nursing Homes, Patient Safety, Practice Patterns
Goyal MK, Johnson TJ, Chamberlain JM
Racial and ethnic differences in antibiotic use for viral illness in emergency departments.
The researchers sought to investigate whether patient race and ethnicity was associated with differences in antibiotic prescribing for viral acute respiratory tract infections (ARTIs) in the pediatric emergency department (PED). They found that compared with non-Hispanic (NH) white children, NH black and Hispanic children were less likely to receive antibiotics for viral ARTIs in the PED.
AHRQ-funded; HS020270.
Citation: Goyal MK, Johnson TJ, Chamberlain JM .
Racial and ethnic differences in antibiotic use for viral illness in emergency departments.
Pediatrics 2017 Oct;140(4). doi: 10.1542/peds.2017-0203.
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Keywords: Racial and Ethnic Minorities, Emergency Department, Children/Adolescents, Disparities, Practice Patterns
Ross WT, Meister MR, Shepherd JP
Utilization of apical vaginal support procedures at time of inpatient hysterectomy performed for benign conditions: a national estimate.
The researchers sought to estimate trends and factors associated with use of apical support procedures at time of inpatient hysterectomy for benign indications in a large national database. Their study demonstrated that apical support procedures are not routinely performed at time of inpatient hysterectomy regardless of presence of prolapse diagnosis.
AHRQ-funded; HS019455.
Citation: Ross WT, Meister MR, Shepherd JP .
Utilization of apical vaginal support procedures at time of inpatient hysterectomy performed for benign conditions: a national estimate.
Am J Obstet Gynecol 2017 Oct;217(4):436.e1-36.e8. doi: 10.1016/j.ajog.2017.07.010.
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Keywords: Healthcare Utilization, Practice Patterns, Surgery, Women
Amin AP, Bach RG, Caruso ML
Association of variation in contrast volume with acute kidney injury in patients undergoing percutaneous coronary intervention.
The purpose of this study was to examine the national variation in acute kidney injury (AKI) incidence and contrast use among US physicians and the variation's association with patients' risk of developing AKI after percutaneous coronary intervention (PCI). This cross-sectional study used the American College of Cardiology National Cardiovascular Data Registry (NCDR) CathPCI Registry to identify in-hospital care for percutaneous coronary intervention (PCI) in the United States.
AHRQ-funded; HS022481.
Citation: Amin AP, Bach RG, Caruso ML .
Association of variation in contrast volume with acute kidney injury in patients undergoing percutaneous coronary intervention.
JAMA Cardiol 2017 Sep;2(9):1007-12. doi: 10.1001/jamacardio.2017.2156..
Keywords: Adverse Events, Kidney Disease and Health, Cardiovascular Conditions, Patient Safety, Heart Disease and Health, Practice Patterns
Miake-Lye IM, Chuang E, Rodriguez HP
Random or predictable?: Adoption patterns of chronic care management practices in physician organizations.
This exploratory paper leverages the natural variation in uptake to describe inter-organizational patterns in adoption of care management practices (CMPs) and to better understand how adoption choices may be related to one another. Within disease focus scales, patient reminders were ranked as the most adoptable CMP, while clinician feedback and patient education were ranked the least adoptable.
AHRQ-funded; HS024176.
Citation: Miake-Lye IM, Chuang E, Rodriguez HP .
Random or predictable?: Adoption patterns of chronic care management practices in physician organizations.
Implement Sci 2017 Aug 24;12(1):106. doi: 10.1186/s13012-017-0639-z.
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Keywords: Care Management, Chronic Conditions, Practice Patterns
Lau BD, Shaffer DL, Hobson DB
Effectiveness of two distinct web-based education tools for bedside nurses on medication administration practice for venous thromboembolism prevention: a randomized clinical trial.
Effectiveness of two distinct web-based education tools for bedside nurses on medication administration practice for venous thromboembolism prevention: a randomized clinical trial.
AHRQ-funded; HS024547.
Citation: Lau BD, Shaffer DL, Hobson DB .
Effectiveness of two distinct web-based education tools for bedside nurses on medication administration practice for venous thromboembolism prevention: a randomized clinical trial.
PLoS One 2017 Aug 16;12(8):e0181664. doi: 10.1371/journal.pone.0181664.
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Keywords: Blood Clots, Education: Continuing Medical Education, Medication, Nursing, Prevention, Provider: Nurse, Web-Based, Practice Patterns
Flory J, Gerhard T, Stempniewicz N
Comparative adherence to diabetes drugs: an analysis of electronic health records and claims data.
The objective of this brief report is to compare adherence rates for 6 major classes of diabetes medications: metformin, sulfonylurea, thiazolidinedione, basal insulin, DPP-4 inhibitors, and GLP-1 receptor agonists. The authors note that the rates at which diabetes drugs are prescribed, and the rates at which patients actually take them, differ substantially. The authors also note that the physicians should be aware of potentially significant challenges concerning adherence to newer agents.
AHRQ-funded; HS023898.
Citation: Flory J, Gerhard T, Stempniewicz N .
Comparative adherence to diabetes drugs: an analysis of electronic health records and claims data.
Diabetes Obes Metab 2017 Aug;19(8):1184-87. doi: 10.1111/dom.12931..
Keywords: Diabetes, Electronic Health Records (EHRs), Patient Adherence/Compliance, Practice Patterns, Medication
Singal AG, Tiro J, Li X
Hepatocellular carcinoma surveillance among patients with cirrhosis in a population-based integrated health care delivery system.
This study characterized guideline-concordant hepatocellular carcinoma (HCC) surveillance rates and patient-level factors associated with surveillance among a population-based cohort of patients with cirrhosis. It concluded that, although one third of patients undergo inconsistent HCC surveillance, less than 2 percent of patients receive guideline-concordant biannual HCC surveillance.
AHRQ-funded; HS022418.
Citation: Singal AG, Tiro J, Li X .
Hepatocellular carcinoma surveillance among patients with cirrhosis in a population-based integrated health care delivery system.
J Clin Gastroenterol 2017 Aug;51(7):650-55. doi: 10.1097/mcg.0000000000000708.
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Keywords: Cancer, Guidelines, Healthcare Delivery, Patient-Centered Outcomes Research, Practice Patterns
Kruse GR, Hays H, Orav EJ
Meaningful use of the Indian Health Service electronic health record.
This study sought to understand the use of electronic health record (EHR) functionalities by physicians practicing in an underserved setting. Physicians routinely used a median 7 of 10 EHR functionalities targeted by the Meaningful Use program, but only 5 percent used all 10. Most (63 percent) felt the EHR improved quality of care. Many (76 percent) reported increased documentation time and poorer quality patient-physician interactions (45 percent).
AHRQ-funded; 290200900023I.
Citation: Kruse GR, Hays H, Orav EJ .
Meaningful use of the Indian Health Service electronic health record.
Health Serv Res 2017 Aug;52(4):1349-63. doi: 10.1111/1475-6773.12531.
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Keywords: Electronic Health Records (EHRs), Provider: Health Personnel, Practice Patterns, Vulnerable Populations
Misra-Hebert AD, Hu B, Klein EA
Prostate cancer screening practices in a large, integrated health system: 2007-2014.
The researchers assessed prostate cancer screening practices in primary care since the initial United States Preventive Services Task Force (USPSTF) recommendation against prostate-specific antigen (PSA) testing for older men. Prostate cancer screening declined from 2007 to 2014 even in higher-risk groups and follow-up screening rates were not related to previous PSA level.
AHRQ-funded; HS024128.
Citation: Misra-Hebert AD, Hu B, Klein EA .
Prostate cancer screening practices in a large, integrated health system: 2007-2014.
BJU Int 2017 Aug;120(2):257-64. doi: 10.1111/bju.13793.
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Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Prostate Cancer, Screening, Primary Care, Practice Patterns
Grunwell JR, Kamat PP, Miksa M
Trend and outcomes of video laryngoscope use across PICUs.
The use of video laryngoscopy for tracheal intubation is now common for adult ICUs, but has not been quantified in pediatric ICUs (PICUs). A retrospective review was conducted of PICUs across the US and four other countries. There was a wide variability of use of video laryngoscopy across PICUs. There has been a significant increase in the use of video laryngoscopy versus direct laryngoscopy from 2011 to 2015, which has resulted in a decrease in adverse outcomes.
AHRQ-funded; HS021583; HS022464.
Citation: Grunwell JR, Kamat PP, Miksa M .
Trend and outcomes of video laryngoscope use across PICUs.
Pediatr Crit Care Med 2017 Aug;18(8):741-49. doi: 10.1097/pcc.0000000000001175..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Patient Safety, Practice Patterns, Respiratory Conditions
Hanley K, Zabar S, Altshuler L
Opioid vs nonopioid prescribers: variations in care for a standardized acute back pain case.
This paper describes the design and use of an opioid-related unannounced standardized patient case (USP) used in a residency curriculum. Researchers designed and fielded an unannounced standardized patient case involving a patient with acute back pain who requested Vicodin (5/325 mg). They described residents' case management and examined whether their management decisions, including opioid prescribing, were related to their core clinical skills. The case designers found that most Vicodin prescribers did not follow prescribing guidelines, and demonstrated better communication and assessment skills than the nonprescribers. Results suggest the need to guide residents in using a systematic approach to prescribing opioids safely and to develop an acceptable alternative pain management plan when they decide against prescribing.
AHRQ-funded; HS021176.
Citation: Hanley K, Zabar S, Altshuler L .
Opioid vs nonopioid prescribers: variations in care for a standardized acute back pain case.
Subst Abus 2017 Jul-Sep;38(3):324-29. doi: 10.1080/08897077.2017.1319894..
Keywords: Back Health and Pain, Education: Curriculum, Opioids, Practice Patterns
Roberts ET, Mehrotra A, McWilliams JM
High-price and low-price physician practices do not differ significantly on care quality or efficiency.
The researchers examined the relationship between physician practice prices for outpatient services and practices' quality and efficiency of care. Patients of high-price practices reported significantly higher scores on some measures of care coordination and management but did not differ meaningfully in their overall care ratings, receipt of preventive services, acute care use, or total Medicare spending.
AHRQ-funded; HS024072.
Citation: Roberts ET, Mehrotra A, McWilliams JM .
High-price and low-price physician practices do not differ significantly on care quality or efficiency.
Health Aff 2017 May;36(5):855-64. doi: 10.1377/hlthaff.2016.1266.
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Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Quality of Care, Healthcare Costs, Practice Patterns
Tai-Seale M, Olson CW, Li J
Electronic health record logs indicate that physicians split time evenly between seeing patients and desktop medicine.
The researchers used data on physicians' time allocation patterns captured by over thirty-one million EHR transactions in the period 2011-14 recorded by 471 primary care physicians, who collectively worked on 765,129 patients' EHRs. Their results suggest that the physicians logged an average of 3.08 hours on office visits and 3.17 hours on desktop medicine each day.
AHRQ-funded; HS019167.
Citation: Tai-Seale M, Olson CW, Li J .
Electronic health record logs indicate that physicians split time evenly between seeing patients and desktop medicine.
Health Aff 2017 Apr;36(4):655-62. doi: 10.1377/hlthaff.2016.0811.
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Keywords: Clinician-Patient Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Practice Patterns
Hersh AL, Kronman MP
Inappropriate antibiotic prescribing: wind at our backs or flapping in the breeze?
Much work in improving antibiotic prescribing remains to be done, although the authors believe they have the wind at their backs. The work of Handy et al highlights the fact that both clinical and nonclinical factors may contribute to inappropriate prescribing and that all domains of inappropriate antibiotic use must be targeted to achieve national goals for reducing inappropriate use.
AHRQ-funded; HS023320.
Citation: Hersh AL, Kronman MP .
Inappropriate antibiotic prescribing: wind at our backs or flapping in the breeze?
Pediatrics 2017 Apr;139(4). doi: 10.1542/peds.2017-0027.
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Keywords: Antibiotics, Shared Decision Making, Medication, Practice Patterns
Dimou FM, Adhikari D, Mehta HB
Outcomes in older patients with grade III cholecystitis and cholecystostomy tube placement: a propensity score analysis.
The Tokyo Guidelines recommend initial cholecystostomy tube drainage, antibiotics, and delayed cholecystectomy in patients with grade III cholecystitis. The researchers compared mortality, readmission, and complication rates with and without cholecystostomy tube placement in a cohort of patients with grade III cholecystitis. Cholecystostomy tube placement was associated with lower rates of definitive treatment with cholecystectomy, higher mortality, and higher readmission rates.
AHRQ-funded; HS022134.
Citation: Dimou FM, Adhikari D, Mehta HB .
Outcomes in older patients with grade III cholecystitis and cholecystostomy tube placement: a propensity score analysis.
J Am Coll Surg 2017 Apr;224(4):502-11.e1. doi: 10.1016/j.jamcollsurg.2016.12.021.
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Keywords: Elderly, Patient-Centered Outcomes Research, Surgery, Guidelines, Practice Patterns
Tsai HT, Philips G, Taylor KL
Utilization and predictors of expectant management among elderly men with low-and intermediate-risk localized prostate cancer in U.S. urological practice.
Researchers assessed the use and predictors of expectant management (EM) to understand its uptake in U.S. practice. In U.S. practice, the utilization of EM steadily increased in low-risk prostate cancer and remained low in the intermediate-risk group over time. While patients with advanced age or comorbidities were more likely to receive EM, its use varied substantially by geographic region.
AHRQ-funded; HS022915.
Citation: Tsai HT, Philips G, Taylor KL .
Utilization and predictors of expectant management among elderly men with low-and intermediate-risk localized prostate cancer in U.S. urological practice.
Urol Pract 2017 Mar;4(2):132-39. doi: 10.1016/j.urpr.2016.05.005.
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Keywords: Shared Decision Making, Elderly, Healthcare Utilization, Cancer: Prostate Cancer, Practice Patterns
Fain KM, Alexander GC, Dore DD
Frequency and predictors of analgesic prescribing in U.S. nursing home residents with persistent pain.
The purpose of this study was to quantify prescription analgesic use of elderly nursing home (NH) residents with persistent noncancer pain and to identify individual and facility traits associated with no treatment. The investigators concluded that through 2008, pain remained undertreated in NHs, especially in certain subpopulations, including cognitively impaired and older residents. The authors suggest that changes in pain management practice and policies may be necessary to target these vulnerable residents.
AHRQ-funded; HS022998.
Citation: Fain KM, Alexander GC, Dore DD .
Frequency and predictors of analgesic prescribing in U.S. nursing home residents with persistent pain.
J Am Geriatr Soc 2017 Feb;65(2):286-93. doi: 10.1111/jgs.14512..
Keywords: Care Management, Chronic Conditions, Elderly, Long-Term Care, Medication, Nursing Homes, Opioids, Pain, Practice Patterns
Fain KM, Castillo-Salgado C, Dore DD
Inappropriate fentanyl prescribing among nursing home residents in the United States.
In this cross-sectional study, the investigators quantified transdermal fentanyl prescribing in elderly nursing home residents without prior opioid use or persistent pain, and the association of individual and facility traits with opioid-naive prescribing. The investigators concluded that most nursing home residents initiating transdermal fentanyl did not have persistent pain and many were opioid-naive. They suggest that changes in prescribing practices may be necessary to ensure Food and Drug Administration warnings are followed, particularly for vulnerable subgroups, such as the cognitively impaired.
AHRQ-funded; HS018960.
Citation: Fain KM, Castillo-Salgado C, Dore DD .
Inappropriate fentanyl prescribing among nursing home residents in the United States.
J Am Med Dir Assoc 2017 Feb;18(2):138-44. doi: 10.1016/j.jamda.2016.08.015..
Keywords: Care Management, Chronic Conditions, Elderly, Long-Term Care, Medication, Nursing Homes, Opioids, Pain, Practice Patterns
Doberne JW, Redd T, Lattin D
Perspectives and uses of the electronic health record among US pediatricians: a national survey.
This survey found that the electronic health record (EHR) was the most commonly used source of initial patient information. Seventy-two percent of 808 pediatricians participating reported requiring between 2 and 10 minutes to complete an initial review of the EHR. Several moderately severe information barriers were reported regarding the display of information in the EHR.
AHRQ-funded; HS022981.
Citation: Doberne JW, Redd T, Lattin D .
Perspectives and uses of the electronic health record among US pediatricians: a national survey.
J Ambul Care Manage 2017 Jan/Mar;40(1):59-68. doi: 10.1097/jac.0000000000000167.
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Keywords: Electronic Health Records (EHRs), Provider: Health Personnel, Children/Adolescents, Practice Patterns