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
76 to 100 of 209 Research Studies DisplayedBowen E, Nayfe R, Milburn N
Do decision aids benefit patients with chronic musculoskeletal pain? A systematic review.
To review the effect of patient decision aids for adults making treatment decisions regarding the management of chronic musculoskeletal pain. The investigators performed a systematic review of randomized controlled trials of adults using patient decision aids to make treatment decisions for chronic musculoskeletal pain in the outpatient setting. The investigators concluded that decision aids may improve patients' knowledge about treatment options for chronic musculoskeletal pain but largely did not impact other outcomes.
AHRQ-funded; HS022418.
Citation: Bowen E, Nayfe R, Milburn N .
Do decision aids benefit patients with chronic musculoskeletal pain? A systematic review.
Pain Med 2020 May;21(5):951-69. doi: 10.1093/pm/pnz280..
Keywords: Shared Decision Making, Pain, Chronic Conditions
Gaskin DJ, Karmarkar TD, Maurer A
Potential role of cost and quality of life in treatment decisions for arthritis-related knee pain in African American and Latina women.
This study examined whether using a decision-making tool would aid Latina and African-American women over age 45 years with arthritic knee pain in making more informed treatment decisions. The researchers conducted 4 focus groups of Latina and African-American women and 2 focus groups with primary care providers who treated them for knee pain. They found that minority women and primary care providers all endorsed the use of a decision-making tool that provided information on the impact of treatment on quality of life, medical care costs, and work productivity.
AHRQ-funded; HS000029.
Citation: Gaskin DJ, Karmarkar TD, Maurer A .
Potential role of cost and quality of life in treatment decisions for arthritis-related knee pain in African American and Latina women.
Arthritis Care Res 2020 May;72(5):692-98. doi: 10.1002/acr.23903..
Keywords: Arthritis, Orthopedics, Pain, Quality of Life, Healthcare Costs, Shared Decision Making, Racial and Ethnic Minorities, Women
Goyal MK, Johnson TJ, Chamberlain JM
Racial and ethnic differences in emergency department pain management of children with fractures.
Researchers tested the hypotheses that minority children with long-bone fractures are less likely to receive analgesics, to receive opioid analgesics, and to achieve pain reduction. Using data from the Pediatric Emergency Care Applied Research Network Registry, they found that there are differences in process and outcome measures by race and ethnicity in the emergency department management of pain among children with long-bone fractures. Although minority children are more likely to receive analgesics and achieve reduction in pain, they are less likely to receive opioids and achieve optimal pain reduction.
AHRQ-funded; HS020270.
Citation: Goyal MK, Johnson TJ, Chamberlain JM .
Racial and ethnic differences in emergency department pain management of children with fractures.
Pediatrics 2020 May;145(5):e20193370. doi: 10.1542/peds.2019-3370..
Keywords: Children/Adolescents, Racial and Ethnic Minorities, Emergency Department, Pain, Injuries and Wounds, Medication, Opioids, Disparities
Marcial LH, Blumenfeld B, Harle C
Barriers, facilitators, and potential solutions to advancing interoperable clinical decision support: multi-stakeholder consensus recommendations for the opioid use case.
These proceedings report on the AHRQ-sponsored Patient-Centered CDS Learning Network (PCCDS LN) Technical Framework Working Group (TechFWG), which was convened to identify barriers, facilitators, and potential solutions for interoperable clinical decision support, with a specific focus on addressing the opioid epidemic. The key insights were extrapolated to CDS-facilitated care improvement outside of the specific opioid use case. If applied broadly, the recommendations should help advance the availability and impact of interoperable CDS delivered at scale.
AHRQ-funded; HS024849.
Citation: Marcial LH, Blumenfeld B, Harle C .
Barriers, facilitators, and potential solutions to advancing interoperable clinical decision support: multi-stakeholder consensus recommendations for the opioid use case.
AMIA Annu Symp Proc 2020 Mar 4;2019:637-46..
Keywords: Clinical Decision Support (CDS), Shared Decision Making, Opioids, Medication, Pain, Patient-Centered Healthcare, Patient-Centered Outcomes Research
Sobieraj DM, Martinez BK, Miao B
Comparative effectiveness of analgesics to reduce acute pain in the prehospital setting.
The objectives of this study were to assess comparative effectiveness and harms of opioid and nonopioid analgesics for the treatment of moderate to severe acute pain in the prehospital setting. Among the investigators’ conclusions were that as initial analgesia, opioids were no different than ketamine, APAP, and NSAIDs in reducing acute pain in the prehospital setting. Opioids may cause fewer total side effects than ketamine, but more than APAP or NSAIDs.
AHRQ-funded; 290201500012I.
Citation: Sobieraj DM, Martinez BK, Miao B .
Comparative effectiveness of analgesics to reduce acute pain in the prehospital setting.
Prehosp Emerg Care 2020 Mar-Apr;24(2):163-74. doi: 10.1080/10903127.2019.1657213..
Keywords: Opioids, Medication, Pain, Emergency Medical Services (EMS), Comparative Effectiveness, Patient-Centered Outcomes Research
Rundell SD, Resnik L, Heagerty PJ
Comparing the performance of comorbidity indices in predicting functional status, health-related quality of life, and total health care use in older adults with back pain.
The purpose of this prospective cohort study was to determine how well the functional comorbidity index (FCI) predicted outcomes in older adults with back pain compared to Quan's modification of the Charlson comorbidity index (Quan-Charlson comorbidity index) and the Elixhauser comorbidity index. The investigators concluded that all indices performed similarly in predicting outcomes. The authors indicated that there is still a need to develop better function-based risk-adjustment models that improve prediction of functional outcomes versus standard comorbidity indices.
AHRQ-funded; HS019222; HS022972.
Citation: Rundell SD, Resnik L, Heagerty PJ .
Comparing the performance of comorbidity indices in predicting functional status, health-related quality of life, and total health care use in older adults with back pain.
J Orthop Sports Phys Ther 2020 Mar;50(3):143-48. doi: 10.2519/jospt.2020.8764..
Keywords: Elderly, Back Health and Pain, Pain, Chronic Conditions, Quality of Life, Healthcare Utilization, Health Status
Newberry CI, Casazza GC, Pruitt LC
Prescription patterns and opioid usage in sinonasal surgery.
The goal of this study was to identify factors associated with variable opioid usage and to delineate optimal prescription patterns for sinonasal surgery. The researchers found that patients used 9.3% of their full prescription and only 2.6% required a refill. The amount used was not associated with complexity of endoscopic sinus surgery, type of opiate prescribed, gender, distance living from hospital, or current opioid usage before surgery. They concluded that opioids are overprescribed after sinonasal surgery and that the amount of postoperative opiate prescribed should be greatly reduced and may be based on the specific procedures performed.
AHRQ-funded; HS024638.
Citation: Newberry CI, Casazza GC, Pruitt LC .
Prescription patterns and opioid usage in sinonasal surgery.
Int Forum Allergy Rhinol 2020 Mar;10(3):381-87. doi: 10.1002/alr.22478..
Keywords: Opioids, Medication, Pain, Surgery, Respiratory Conditions, Healthcare Utilization, Practice Patterns, Substance Abuse
De Roo AC, Vu JV, Regenbogen SE
Statewide utilization of multimodal analgesia and length of stay after colectomy.
This study examined statewide utilization of multimodal analgesia after colectomy. Multimodal analgesia shortens length of stay and hastens recovery. The researchers conducted a statewide, 72-hospital collaborative quality initiative and evaluated postoperative analgesia regimens among adult elective colectomy patients between 2012 and 2015. One-third of patients received opioids alone, and 2.8% received one nonopioid pain medication alone. The researchers suggest that these numbers must be improved particularly with the current opioid crisis.
AHRQ-funded; HS000053.
Citation: De Roo AC, Vu JV, Regenbogen SE .
Statewide utilization of multimodal analgesia and length of stay after colectomy.
J Surg Res 2020 Mar;247:264-70. doi: 10.1016/j.jss.2019.10.014..
Keywords: Surgery, Opioids, Medication, Medication: Safety, Practice Patterns, Pain
Heins SE, Castillo RC
The impact of morphine equivalent daily dose threshold guidelines on prescribed dose in a workers' compensation population.
This study evaluated the impact of dissemination Morphine Equivalent Daily Dose (MEDD) guidelines to state workers’ compensation boards to discourage high-dose opioid use among injured workers receiving workers’ compensation. The study used workers compensations claims data from 2010-2013 from 2 guideline states and 3 control states. The policy implementation showed a 9.26 mg decrease in MEDD after adjusting for covariates, state fixed-effects, and time trends. The decreases became more pronounced over the study period.
AHRQ-funded; HS025557.
Citation: Heins SE, Castillo RC .
The impact of morphine equivalent daily dose threshold guidelines on prescribed dose in a workers' compensation population.
Med Care 2020 Mar;58(3):241-47. doi: 10.1097/mlr.0000000000001269..
Keywords: Opioids, Medication, Pain, Chronic Conditions, Practice Patterns, Guidelines
Shoemaker-Hunt SJ, Evans L, Swan H
Study protocol for evaluating Six Building Blocks for opioid management implementation in primary care practices.
AHRQ-funded; 233201500013I.
Citation: Shoemaker-Hunt SJ, Evans L, Swan H .
Study protocol for evaluating Six Building Blocks for opioid management implementation in primary care practices.
Implement Sci Commun 2020 Feb 26;1:16. doi: 10.1186/s43058-020-00008-6..
Keywords: Opioids, Medication, Primary Care, Care Management, Pain, Chronic Conditions
Parchman ML, Ike B, Osterhage KP
Barriers and facilitators to implementing changes in opioid prescribing in rural primary care clinics.
This paper discusses the barriers and facilitators to implementing changes in opioid prescription in rural areas using the Six Building Blocks evidence-based program to reduce opioid prescription in primary care practices. The program was implemented at 6 rural and rural-serving organizations with 20 clinic locations over a 15-month period. Interviews and focus groups with conducted with the organizations at the end of the program period. Facilitators included a desire to help patients and their community; external pressures to make changes in opioid management; a desire to reduce workplace stress; external support for the clinic; supportive clinic leadership; and receptivity of patients. Barriers included competing demands on clinicians and staff; a culture of clinician autonomy; inadequate data systems; and a lack of patient resources in rural areas.
AHRQ-funded; HS023750.
Citation: Parchman ML, Ike B, Osterhage KP .
Barriers and facilitators to implementing changes in opioid prescribing in rural primary care clinics.
J Clin Transl Sci 2020 Jan 10;4(5):425-30. doi: 10.1017/cts.2019.448..
Keywords: Opioids, Medication, Rural Health, Primary Care, Primary Care: Models of Care, Implementation, Pain, Chronic Conditions, Healthcare Delivery
Diiulio J, Militello LG, Andraka-Christou BT
Factors that influence changes to existing chronic pain management plans.
This study focused on factors that influence changes to existing chronic management plans by primary care clinicians (PCCs). The researchers conducted 89 interviews with PCCs to gain their perspectives. The interview transcripts were analyzed thematically and found seven themes that emerged. The main factors that influenced changes in plans were: 1) change in patient condition; 2) outcomes related to treatment; 3) patient nonadherence; 4) insurance constraints; 5) changes in guidelines, laws, or policies, 6) new patient approaches; and 7) specialist recommendations.
AHRQ-funded; HS023306.
Citation: Diiulio J, Militello LG, Andraka-Christou BT .
Factors that influence changes to existing chronic pain management plans.
J Am Board Fam Med 2020 Jan-Feb;33(1):42-50. doi: 10.3122/jabfm.2020.01.190284..
Keywords: Pain, Chronic Conditions, Care Management, Primary Care
Chin KK, Carroll I, Desai K
Integrating adjuvant analgesics into perioperative pain practice: results from an academic medical center.
This study evaluated adjuvant analgesic gabapentin use after total knee arthroplasty (TKA) surgery and its effects on opioid use, pain, and readmissions. This retrospective observational study included 4,046 TKA recipients from 2009 to 2017 using electronic health records from an academic tertiary care medical institute. Overall, there was an 8.72% annual increase in gabapentin use which was associated with a significant decrease in opioid consumption in modeled estimates. Patients receiving gabapentin had similar discharge and follow-up pain scores, and 30-day unplanned readmission rates compared with patients receiving no adjuvant analgesics.
AHRQ-funded; HS024096.
Citation: Chin KK, Carroll I, Desai K .
Integrating adjuvant analgesics into perioperative pain practice: results from an academic medical center.
Pain Med 2020 Jan;21(1):161-70. doi: 10.1093/pm/pnz053..
Keywords: Opioids, Medication, Pain, Surgery, Orthopedics
Andreae SJ, Andreae LJ, Richman JS
Peer-delivered cognitive behavioral training to improve functioning in patients with diabetes: a cluster-randomized trial.
Cognitive behavioral therapy (CBT)-based programs delivered by trained community members could improve functioning and pain in individuals who lack access to such programs. In this study, the investigators tested the effectiveness of a peer-delivered diabetes self-management program integrating CBT principles in improving physical activity, functional status, pain, quality of life (QOL), and health outcomes in individuals with diabetes and chronic pain.
AHRQ-funded; HS019239.
Citation: Andreae SJ, Andreae LJ, Richman JS .
Peer-delivered cognitive behavioral training to improve functioning in patients with diabetes: a cluster-randomized trial.
Ann Fam Med 2020 Jan;18(1):15-23. doi: 10.1370/afm.2469..
Keywords: Diabetes, Chronic Conditions, Pain, Patient Self-Management, Quality of Life
Rentsch CT, Edelman EJ, Justice AC
Patterns and correlates of prescription opioid receipt among US Veterans: a national, 18-year observational cohort study.
A better understanding of predisposition to transition to high-dose, long-term opioid therapy after initial opioid receipt could facilitate efforts to prevent opioid use disorder (OUD). In this study, the investigators extracted data on 69,268 patients in the Veterans Aging Cohort Study who received any opioid prescription between 1998 and 2015. They identified four distinguishable dose trajectories. The authors indicate that their measures could potentially be used in future prevention research, including genetic discovery.
AHRQ-funded; HS021112; HS023258.
Citation: Rentsch CT, Edelman EJ, Justice AC .
Patterns and correlates of prescription opioid receipt among US Veterans: a national, 18-year observational cohort study.
AIDS Behav 2019 Dec;23(12):3340-49. doi: 10.1007/s10461-019-02608-3..
Keywords: Opioids, Medication, Substance Abuse, Human Immunodeficiency Virus (HIV), Pain, Chronic Conditions
Aroke EN, Jackson P, Overstreet DS
Race, social status, and depressive symptoms: a moderated mediation analysis of chronic low back pain interference and severity.
Clin J Pain 2020 Sep;36(9):658-66. doi: 10.1097/ajp.0000000000000849.
Citation: Aroke EN, Jackson P, Overstreet DS .
Race, social status, and depressive symptoms: a moderated mediation analysis of chronic low back pain interference and severity.
Clin J Pain 2020 Sep;36(9):658-66. doi: 10.1097/ajp.0000000000000849.
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Keywords: Back Health and Pain, Chronic Conditions, Pain, Racial and Ethnic Minorities
Singh JA, Lemay CA, Nobel L
Association of early postoperative pain trajectories with longer-term pain outcome after primary total knee arthroplasty.
Studies to date have not comprehensively examined pain experience after total knee arthroplasty (TKA). Discrete patterns of pain in this period might be associated with pain outcomes at 6 to 12 months after TKA. The purpose of this study was to examine patterns of individual post-TKA pain trajectories and to assess their independent associations with longer-term pain outcome after TKA.
AHRQ-funded; HS021110; HS018910.
Citation: Singh JA, Lemay CA, Nobel L .
Association of early postoperative pain trajectories with longer-term pain outcome after primary total knee arthroplasty.
JAMA Netw Open 2019 Nov;2(11):e1915105. doi: 10.1001/jamanetworkopen.2019.15105..
Keywords: Pain, Surgery, Orthopedics, Patient-Centered Outcomes Research, Outcomes
O'Reilly-Jacob M, Perloff J, Buerhaus P
Comparing the rates of low-value back images ordered by physicians and nurse practitioners for Medicare beneficiaries in primary care.
This study measures the rates of low-value back images ordered by primary care physicians and nurse practitioners for Medicare beneficiaries, and there was no detectable difference between the two groups in 2012 and 2013.
AHRQ-funded; HS00062.
Citation: O'Reilly-Jacob M, Perloff J, Buerhaus P .
Comparing the rates of low-value back images ordered by physicians and nurse practitioners for Medicare beneficiaries in primary care.
Nurs Outlook 2019 Nov - Dec;67(6):713-24. doi: 10.1016/j.outlook.2019.05.005..
Keywords: Imaging, Back Health and Pain, Primary Care, Imaging, Pain
Klueh MP, Sloss KR, Dossett LA
Postoperative opioid prescribing is not my job: a qualitative analysis of care transitions.
This qualitative study aimed to describe transitions of care for postoperative opioid prescribing and to identify barriers and facilitators of ideal transitions for potential intervention targets. Results identified potential interventions aimed at changing physician behaviors regarding transitions of care for postoperative opioid prescribing. Implementation of these interventions could improve coordination of care for patients with persistent postoperative opioid use.
AHRQ-funded; HS026030.
Citation: Klueh MP, Sloss KR, Dossett LA .
Postoperative opioid prescribing is not my job: a qualitative analysis of care transitions.
Surgery 2019 Nov;166(5):744-51. doi: 10.1016/j.surg.2019.05.033..
Keywords: Opioids, Medication, Pain, Transitions of Care, Practice Patterns
Colloca L, Lee SE, Luhowy MN
Relieving acute pain (RAP) study: a proof-of-concept protocol for a randomised, double-blind, placebo-controlled trial
This study hypothesizes that dose-extending placebos can be an effective treatment in relieving clinical acute pain in trauma patients who take opioids. Publishing this study protocol will enable researchers and funding bodies to stay up to date in their fields by providing exposure to research activity that may not be otherwise widely publicized.
AHRQ-funded; HS022135.
Citation: Colloca L, Lee SE, Luhowy MN .
Relieving acute pain (RAP) study: a proof-of-concept protocol for a randomised, double-blind, placebo-controlled trial
BMJ Open 2019 Nov 11;9(11):e030623. doi: 10.1136/bmjopen-2019-030623..
Keywords: Back Health and Pain, Pain, Chronic Conditions, Opioids, Medication
Ike B, Baldwin LM, Sutton S
Staff and clinician work-life perceptions after implementing systems-based improvements to opioid management.
The authors assessed the impact of implementing the Six Building Blocks on the work-life of primary care providers and staff. Six rural and rural-serving primary care organizations implemented the Six Building Blocks, with assistance from practice facilitators, clinical experts, and informatics specialists. The authors found that clinicians and staff reported improvement in their work-life after implementing the Six Building Blocks Program to improve opioid medication management and recommended further research on patient experiences specific to practice redesign programs.
AHRQ-funded; HS023750.
Citation: Ike B, Baldwin LM, Sutton S .
Staff and clinician work-life perceptions after implementing systems-based improvements to opioid management.
J Am Board Fam Med 2019 Sep-Oct;32(5):715-23. doi: 10.3122/jabfm.2019.05.190027.
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Keywords: Opioids, Pain, Chronic Conditions, Primary Care: Models of Care, Primary Care, Care Management, Ambulatory Care and Surgery, Quality Improvement, Medication, Provider, Clinician-Patient Communication
Lemay CA, Saag KG, Franklin PD
A qualitative study of the postoperative pain management educational needs of total joint replacement patients.
This study examined the challenges of pain management education for post-surgery of total joint replacement patients. The majority of patients have pain in the postoperative period and managing pain can be challenging. Nine orthopedic surgeons’ offices in 8 states recruited patients and 27 patients completed the interview. They were interviewed with open-ended questions on their experiences with pain after surgery, pain management, experiences with pain medicine, experience using non-medicine-related pain reduction methods, and suggestions for better pain management education. Challenges included lack of pain control and lack of information about prescribed opioid and nonopioid methods of managing pain.
AHRQ-funded; HS018910; HS021110.
Citation: Lemay CA, Saag KG, Franklin PD .
A qualitative study of the postoperative pain management educational needs of total joint replacement patients.
Pain Manag Nurs 2019 Aug;20(4):345-51. doi: 10.1016/j.pmn.2018.12.009..
Keywords: Pain, Orthopedics, Surgery, Education: Patient and Caregiver
Harle CA, DiIulio J, Downs SM
Decision-centered design of patient information visualizations to support chronic pain care.
The objective of this study was to describe a decision-centered design process, and resultant interactive patient information displays, to support key clinical decision requirements in chronic noncancer pain care. Through critical decision method interviews and a half-day multidisciplinary design workshop, researchers designed an interactive prototype, the Chronic Pain Treatment Tracker. This prototype summarizes the current treatment plan, past treatment history, potential future treatments, and treatment options that require caution. The researchers concluded that the Chronic Pain Treatment Tracker presents clinicians with the information they need in a structure that promotes quick uptake, understanding, and action.
AHRQ-funded; HS023306.
Citation: Harle CA, DiIulio J, Downs SM .
Decision-centered design of patient information visualizations to support chronic pain care.
Appl Clin Inform 2019 Aug;10(4):719-28. doi: 10.1055/s-0039-1696668..
Keywords: Pain, Chronic Conditions, Shared Decision Making, Health Information Technology (HIT), Clinical Decision Support (CDS), Care Management, Healthcare Delivery
Smith ME, Lee JS, Bonham A
Effect of new persistent opioid use on physiologic and psychologic outcomes following bariatric surgery.
In this study, the investigators sought to determine the relationship between new persistent opioid use and 1-year postoperative outcomes for patients undergoing bariatric surgery. The investigators concluded that new persistent opioid use is common following bariatric surgery and associated with significantly worse physiologic and psychologic outcomes. More effective screening and postoperative surveillance tools are needed to identify these patients, who likely require more aggressive counseling and treatment to maximize the benefits of bariatric surgery.
AHRQ-funded; HS024403.
Citation: Smith ME, Lee JS, Bonham A .
Effect of new persistent opioid use on physiologic and psychologic outcomes following bariatric surgery.
Surg Endosc 2019 Aug;33(8):2649-56. doi: 10.1007/s00464-018-6542-0..
Keywords: Opioids, Surgery, Medication, Obesity: Weight Management, Obesity, Obesity: Weight Management, Pain, Outcomes
Dy CJ, Peacock K, Olsen MA
Frequency and risk factors for prolonged opioid prescriptions after surgery for brachial plexus injury.
This study examined risk of prolonged opioid prescription use after surgery for brachial plexus injury (BPI). A cohort of BPI surgery patients was compared to a control group of non-BPI patients, matching for age, sex, and year. Pharmacy claims for prescriptions filled for opioids and neuropathic pain methods were examined 1 year before surgery to 180 days after surgery. The primary outcome studied was prolonged opioid prescription, which is defined as receiving a prescription 90 to 180 days after the surgery or randomly selected date of service for controls. Among BPI patients, a subgroup analysis was also performed on opioid-naïve patients between 30 days to 1 year before surgery. Among BPI surgery patients, 27.7% had prolonged opioid prescriptions, but only 10.8% of opioid-naïve patients had prolonged opioid prescriptions. The rate for controls was 0.11%. The rates of prolonged opioid prescriptions for BPI patients was higher than previous estimates among other surgical patients.
AHRQ-funded; HS019455.
Citation: Dy CJ, Peacock K, Olsen MA .
Frequency and risk factors for prolonged opioid prescriptions after surgery for brachial plexus injury.
J Hand Surg Am 2019 Aug;44(8):662-68.e1. doi: 10.1016/j.jhsa.2019.04.001..
Keywords: Opioids, Medication, Surgery, Pain, Practice Patterns, Risk, Chronic Conditions