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
51 to 75 of 197 Research Studies DisplayedThomson J, Hall M, Nelson K
Timing of co-occurring chronic conditions in children with neurologic impairment.
Children with neurologic impairment (NI) are at risk for developing co-occurring chronic conditions, increasing their medical complexity and morbidity. In this study, the authors assessed the prevalence and timing of onset for those conditions in children with NI. They concluded that children with NI enrolled in Medicaid had substantial multimorbidity that developed early in life.
AHRQ-funded; HS025138.
Citation: Thomson J, Hall M, Nelson K .
Timing of co-occurring chronic conditions in children with neurologic impairment.
Pediatrics 2021 Feb;147(2):e2020009217. doi: 10.1542/peds.2020-009217..
Keywords: Children/Adolescents, Neurological Disorders, Chronic Conditions, Medicaid, Health Status
Xu H, Li X, Shi Y
Hospital bed height influences biomechanics during bed egress: a comparative controlled study of patients with Parkinson disease.
Although a significant proportion of patient falls occur during egress from the hospital bed, the biomechanical adaptations during egress from different bed heights are still largely unknown. The purpose of this study was to evaluate the effect of hospital bed height on natural transition during egress in patients with Parkinson disease (PD). The investigators found that low bed height increased demands of balance and postural control during egress which exacerbated the risk of falls for patients with PD.
AHRQ-funded; HS018953; HS025606.
Citation: Xu H, Li X, Shi Y .
Hospital bed height influences biomechanics during bed egress: a comparative controlled study of patients with Parkinson disease.
J Biomech 2021 Jan 22;115:110116. doi: 10.1016/j.jbiomech.2020.110116..
Keywords: Falls, Neurological Disorders, Hospitals
Hill CE, Reynolds EL, Burke JF
Increasing out-of-pocket costs for neurologic care for privately insured patients.
This study examined out-of-pocket (OOP) costs of evaluation and management (E/M) services and common diagnostic testing for neurology patients. Patients with a neurologist visit or diagnostic test from 2001 to 2016 were identified from a large, privately insured health care claims database. Inflation-adjusted OOP costs were assessed. The database identified 3,724,342 patients. The most frequent services used were E/M (78.5%), EMG/nerve conduction studies (NCS) (7.7%), MRIs (5.3%), and EEGs (4.5%). Mean OOP cost increased over time, most substantially for EEG, MRI, and E/M. The range of OOP costs in 2016 varied considerably. For example, for an MRI, the 50th percentile paid $103.10 and the 95th percentile paid $875.40.
AHRQ-funded; HS022258.
Citation: Hill CE, Reynolds EL, Burke JF .
Increasing out-of-pocket costs for neurologic care for privately insured patients.
Neurology 2021 Jan 19;96(3):e322-e32. doi: 10.1212/wnl.0000000000011278..
Keywords: Healthcare Costs, Health Insurance, Neurological Disorders
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
Zmora R, Zmora LL, Bustamante G
Dementia caregivers' experiences and reactions to remote activity monitoring system alerts.
Technology-based tools, including remote activity monitoring (RAM) systems, have been proposed as valuable aids for family caregivers of people with dementia. Previous analyses have shown limited effects of these systems and highlighted a number of barriers, including false alarms. In this study, the investigators used data from an ongoing embedded mixed method randomized controlled intervention to describe patterns of alerts and their association with receipt of the RAM system and caregiver outcomes.
AHRQ-funded; HS022836.
Citation: Zmora R, Zmora LL, Bustamante G .
Dementia caregivers' experiences and reactions to remote activity monitoring system alerts.
J Gerontol Nurs 2021 Jan;47(1):13-20. doi: 10.3928/00989134-20201208-03.
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Keywords: Elderly, Dementia, Neurological Disorders, Caregiving, Telehealth
Munger Clary HM, Croxton RD, Snively BM
Neurologist prescribing versus psychiatry referral: examining patient preferences for anxiety and depression management in a symptomatic epilepsy clinic sample.
The objective of this study was to determine patient preference for anxiety and/or depression prescribing by neurologists versus psychiatry referral among an adult epilepsy clinic sample of symptomatic patients. Findings showed that most patients indicated a preference for neurologists to prescribe for anxiety or depression symptoms in the epilepsy clinic. Care models involving neurologist prescribing for anxiety and depression symptoms merit further investigation and potential adoption in clinical practice.
AHRQ-funded; HS025723.
Citation: Munger Clary HM, Croxton RD, Snively BM .
Neurologist prescribing versus psychiatry referral: examining patient preferences for anxiety and depression management in a symptomatic epilepsy clinic sample.
Epilepsy Behav 2021 Jan;114(Pt A):107543. doi: 10.1016/j.yebeh.2020.107543..
Keywords: Anxiety, Depression, Behavioral Health, Neurological Disorders
Sangal RB, Fodeh S, Taylor A
Identification of patients with nontraumatic intracranial hemorrhage using administrative claims data.
Nontraumatic intracranial hemorrhage (ICH) is a neurological emergency of research interest; however, unlike ischemic stroke, has not been well studied in large datasets due to the lack of an established administrative claims-based definition. In this study, the investigators aimed to evaluate both explicit diagnosis codes and machine learning methods to create a claims-based definition for this clinical phenotype.
AHRQ-funded; HS023554.
Citation: Sangal RB, Fodeh S, Taylor A .
Identification of patients with nontraumatic intracranial hemorrhage using administrative claims data.
J Stroke Cerebrovasc Dis 2020 Dec;29(12):105306. doi: 10.1016/j.jstrokecerebrovasdis.2020.105306..
Keywords: Cardiovascular Conditions, Neurological Disorders, Diagnostic Safety and Quality, Data
Bajaj JS, Duarte-Rojo A, Xie JJ
Minimal hepatic encephalopathy and mild cognitive impairment worsen quality of life in elderly patients with cirrhosis.
Researchers investigated the performance of elderly patients with cirrhosis on tests for minimal hepatic encephalopathy (MHE) and predementia mild cognitive impairment (MCI) and their effects on quality of life (QOL). They found that, in a multicenter study of elderly patients with cirrhosis and controls, the presence of MHE, regardless of MCI, was associated with poor cognition and QOL. They created adjusted norms that defined the high sensitivity of EncephalApp for the detection of MHE in older individuals and validated it in a separate cohort.
AHRQ-funded; HS025412.
Citation: Bajaj JS, Duarte-Rojo A, Xie JJ .
Minimal hepatic encephalopathy and mild cognitive impairment worsen quality of life in elderly patients with cirrhosis.
Clin Gastroenterol Hepatol 2020 Dec;18(13):3008-16.e2. doi: 10.1016/j.cgh.2020.03.033..
Keywords: Elderly, Chronic Conditions, Quality of Life, Dementia, Neurological Disorders
Sharma D
Perioperative management of aneurysmal subarachnoid hemorrhage.
This article discusses aneurysmal subarachnoid hemorrhage, an acute neurologic emergency. Extracranial manifestations of aneurysmal subarachnoid hemorrhage include cardiac dysfunction, neurogenic pulmonary edema, fluid and electrolyte imbalances, and hyperglycemia. The author indicates that prompt definitive treatment of the aneurysm by craniotomy and clipping or endovascular intervention with coils and/or stents is needed to prevent rebleeding. The author also notes that data on the impact of anesthesia on long-term neurologic outcomes of aneurysmal subarachnoid hemorrhage do not exist.
AHRQ-funded; HS026690.
Citation: Sharma D .
Perioperative management of aneurysmal subarachnoid hemorrhage.
Anesthesiology 2020 Dec;133(6):1283-305. doi: 10.1097/aln.0000000000003558..
Keywords: Cardiovascular Conditions, Neurological Disorders, Surgery, Care Management
Roberts ET, McGarry BE, Glynn A
Cognition and take-up of the Medicare Savings Programs.
In this study, the investigators examined the association between cognition and Medicare Savings Program (MSP) enrollment among elderly Medicare beneficiaries who qualified for these programs. They also examined enrollment in the Low-Income Subsidy (LIS), a separate program that provides premium and cost-sharing assistance in Medicare Part D that Medicare beneficiaries automatically received if they are enrolled in an MSP.
AHRQ-funded; HS026727.
Citation: Roberts ET, McGarry BE, Glynn A .
Cognition and take-up of the Medicare Savings Programs.
JAMA Intern Med 2020 Nov;180(11):1529-31. doi: 10.1001/jamainternmed.2020.2783..
Keywords: Elderly, Medicare, Health Insurance, Healthcare Costs, Low-Income, Dementia, Neurological Disorders
Jacobs M, Briley P, Ellis C
Quantifying experiences with telepractice for aphasia therapy: a text mining analysis of client response data.
The investigators’ goal was to use content analysis (CA) to measure posttreatment satisfaction with a telepractice approach for aphasia treatment. Seventeen persons with aphasia (PWA) received 12 treatment sessions over a 6-week period, after which CA was utilized to explore patient satisfaction with this treatment approach. The investigators concluded that their study demonstrated that CA can be an effective approach for determining satisfaction with aphasia treatment, particularly among PWA with limited verbal abilities.
AHRQ-funded; HS025043.
Citation: Jacobs M, Briley P, Ellis C .
Quantifying experiences with telepractice for aphasia therapy: a text mining analysis of client response data.
Semin Speech Lang 2020 Nov;41(5):414-32. doi: 10.1055/s-0040-1716887..
Keywords: Telehealth, Health Information Technology (HIT), Patient Experience, Neurological Disorders
Armstrong MJ, Gamez N, Alliance S
Research priorities of caregivers and individuals with dementia with Lewy bodies: an interview study.
The authors investigated the research priorities of individuals and caregivers living with dementia with Lewy bodies (DLB). Through telephone interviews, they found that individuals with DLB and caregivers identified research needs and highlighted DLB symptoms needing additional research. They recommended that funding be informed by the priorities of all relevant stakeholders and support research investigating causes, natural history, biomarkers, and treatment in addition to research targeting themes regarding living with disease.
AHRQ-funded; HS024159.
Citation: Armstrong MJ, Gamez N, Alliance S .
Research priorities of caregivers and individuals with dementia with Lewy bodies: an interview study.
PLoS One 2020 Oct 7;15(10):e0239279. doi: 10.1371/journal.pone.0239279..
Keywords: Caregiving, Dementia, Neurological Disorders, Patient and Family Engagement, Elderly, Research Methodologies
Luther M, Poppert Cordts KM, Williams CN
Sleep disturbances after pediatric traumatic brain injury: a systematic review of prevalence, risk factors, and association with recovery.
This is a systematic review to quantify sleep wake disturbances (SWD) after pediatric traumatic brain injury (TBI). These SWD can place children at risk for worse outcomes since sleep is needed for brain development and healing after injury. They also evaluated interventions for SWD and the association between SWD and other post-traumatic outcomes. Literature was searched from 1999-2019 evaluating sleep or fatigue in children hospitalized for TBI. Two independent reviewers assessed quality of the studies using the Newcastle-Ottowa Score for observational studies. Out of 966 identified articles, 126 full text articles were reviewed and 24 studies were included. Studies showed at least 20% of children with TBI had some degree of SWD including trouble falling or staying asleep, fatigue, daytime fatigue, and nightmares. SWD was negatively correlated with cognitive, behavioral, and quality of life outcomes. There was moderate-high risk of bias for all studies due to small sample size and lack of validated or objective SWD measures.
AHRQ-funded; HS022981.
Citation: Luther M, Poppert Cordts KM, Williams CN .
Sleep disturbances after pediatric traumatic brain injury: a systematic review of prevalence, risk factors, and association with recovery.
Sleep 2020 Oct;43(10):zsaa083. doi: 10.1093/sleep/zsaa083..
Keywords: Children/Adolescents, Sleep Problems, Brain Injury, Neurological Disorders, Trauma, Risk, Patient-Centered Outcomes Research, Outcomes, Quality of Life, Evidence-Based Practice
Feldman AG, Parsons JA, Dutmer CM
Subacute liver failure following gene replacement therapy for spinal muscular atrophy type 1.
This paper reports on two cases of transient, drug-induced liver failure after gene replacement therapy using an adeno-associated virus vector containing the survival motor neuron 1 gene.
AHRQ-funded; HS026510.
Citation: Feldman AG, Parsons JA, Dutmer CM .
Subacute liver failure following gene replacement therapy for spinal muscular atrophy type 1.
J Pediatr 2020 Oct;225:252-58.e1. doi: 10.1016/j.jpeds.2020.05.044..
Keywords: Newborns/Infants, Neurological Disorders, Genetics, Treatments, Adverse Drug Events (ADE), Adverse Events, Medication, Medication: Safety, Patient Safety, Case Study
Askew RL, Capo-Lugo CE, Sangha R
Trade-offs in quality-of-life assessment between the modified Rankin Scale and Neuro-QoL measures.
The objective of this study was to describe the physical and cognitive health of patients with differing levels of post-stroke disability as defined by modified Rankin Scale (mRS) scores. Cross-sectional correlations were also compared between the mRS and the Quality of Life in Neurological Disorders (Neuro-QoL) T-scores to longitudinal correlations of change estimates for each measure. A total of 745 patients with ischemic stroke (79%) or transient ischemic attack (21%) were enrolled in this study. There were larger differences observed in cognitive function for the severe mRS groups. Larger differences in physical function were observed in the mild-moderate mRS groups. These findings undermine the validity and utility as an outcome measure in longitudinal studies in ischemic stroke patients. But it is still efficient at capturing important differences in patient-reported quality of life, and is useful for identifying meaning cross-sectional differences among clinical subgroups.
AHRQ-funded; HS024366; HS023437; HS000078.
Citation: Askew RL, Capo-Lugo CE, Sangha R .
Trade-offs in quality-of-life assessment between the modified Rankin Scale and Neuro-QoL measures.
Value Health 2020 Oct;23(10):1366-72. doi: 10.1016/j.jval.2020.06.011..
Keywords: Quality of Life, Stroke, Outcomes, Neurological Disorders, Cardiovascular Conditions
Steuart R, Tan R, Melink K
Discharge before return to respiratory baseline in children with neurologic impairment.
Children with neurologic impairment (NI) are commonly hospitalized with acute respiratory infections (ARI). These children frequently require respiratory support at baseline and are often discharged before return to respiratory baseline. The purpose of this study was to determine if discharge before return to respiratory baseline was associated with reutilization among children with NI hospitalized with ARI.
AHRQ-funded; HS025138.
Citation: Steuart R, Tan R, Melink K .
Discharge before return to respiratory baseline in children with neurologic impairment.
J Hosp Med 2020 Sep;15(9):531-37. doi: 10.12788/jhm.3394..
Keywords: Children/Adolescents, Neurological Disorders, Respiratory Conditions, Hospital Readmissions, Hospital Discharge, Hospitals
Khan U, Stoff L, Yahuaca JD
Evaluation of an interdisciplinary screening program for people with Parkinson disease and movement disorders.
Researchers described the characteristics of people with Parkinson disease and movement disorders referred by neurologist to a physiatrist-led interdisciplinary rehabilitation screening program. They found that the interdisciplinary rehabilitation screening program was sustained with increased numbers of referrals over time, occurring earlier in the disease in more recent years. Further, key strategies used to sustain the program over time included development of a unique referral order set for the neurologists, implementation of a comprehensive screen tool in the rehabilitation hospital electronic health records, and centralized communication through social workers at both facilities.
AHRQ-funded; HS025077.
Citation: Khan U, Stoff L, Yahuaca JD .
Evaluation of an interdisciplinary screening program for people with Parkinson disease and movement disorders.
Arch Rehabil Res Clin Transl 2020 Sep;2(3):100067. doi: 10.1016/j.arrct.2020.100067..
Keywords: Neurological Disorders, Rehabilitation, Screening
Fleischer E, Aronson PL
Rapid diagnostic tests for meningitis and encephalitis-BioFire.
This article reports on the BioFire FilmArray Meningitis/Encephalitis Panel, the first FDA-cleared multiplex polymerase chain reaction for the evaluation of cerebrospinal fluid samples. This newer rapid diagnostic tool has an overall high sensitivity and specificity for the diagnosis of meningitis and encephalitis (ME), with a fast turnaround time and the potential to improve resource utilization for patients presenting with suspicion of ME. However, further research is recommended to determine its optimal use in the evaluation of patients with suspected ME.
AHRQ-funded; HS026006.
Citation: Fleischer E, Aronson PL .
Rapid diagnostic tests for meningitis and encephalitis-BioFire.
Pediatr Emerg Care 2020 Aug;36(8):397-401. doi: 10.1097/pec.0000000000002180..
Keywords: Diagnostic Safety and Quality, Neurological Disorders, Infectious Diseases
Poppert Cordts KM, Hall TA, Hartman ME
Sleep measure validation in a pediatric neurocritical care acquired brain injury population.
Lingering morbidities including physical, cognitive, emotional, and psychosocial sequelae, termed the Post-Intensive Care Syndrome, persist years after pediatric neurocritical care (PNCC) hospitalization. Sleep disturbances impact other Post-Intensive Care Syndrome domains and are under-evaluated to date due to a lack of appropriate measurement tools. The present study evaluated the validity of the Sleep Disturbance Scale for Children (SDSC) to address the growing need for assessing sleep problems after PNCC.
AHRQ-funded; HS022981.
Citation: Poppert Cordts KM, Hall TA, Hartman ME .
Sleep measure validation in a pediatric neurocritical care acquired brain injury population.
Neurocrit Care 2020 Aug;33(1):196-206. doi: 10.1007/s12028-019-00883-5..
Keywords: Children/Adolescents, Sleep Problems, Neurological Disorders, Intensive Care Unit (ICU), Hospitalization, Quality of Life
Thomson J, Hall M, Ambroggio L
Antibiotics for aspiration pneumonia in neurologically impaired children.
The objective of the study was to compare hospital outcomes associated with commonly used antibiotic therapies for aspiration pneumonia in children with neurologic impairment (NI). The investigators concluded that anaerobic therapy appeared to be important in the treatment of aspiration pneumonia in children with NI. They suggested that while Gram-negative coverage alone was associated with worse outcomes, its addition to anaerobic therapy may not yield improved outcomes.
AHRQ-funded; HS025138.
Citation: Thomson J, Hall M, Ambroggio L .
Antibiotics for aspiration pneumonia in neurologically impaired children.
J Hosp Med 2020 Jul;15(7):395-402. doi: 10.12788/jhm.3338..
Keywords: Children/Adolescents, Pneumonia, Respiratory Conditions, Neurological Disorders, Antibiotics, Medication, Outcomes
Hartman ME, Williams CN, Hall TA
Post-intensive-care syndrome for the pediatric neurologist.
The investigators are working to create awareness and help mitigate post-intensive-care syndrome in pediatric patients who had experienced primary neurological injury and also help their parents and siblings. In this paper they review current knowledge regarding post-intensive-care syndrome in pediatrics and its risk factors. They describe their experience establishing Pediatric Neurocritical Care Recovery Programs at two large academic centers. They also provide a battery of validated tests to identify and manage the different aspects of post-intensive-care syndrome in pediatrics.
AHRQ-funded; HS022981.
Citation: Hartman ME, Williams CN, Hall TA .
Post-intensive-care syndrome for the pediatric neurologist.
Pediatr Neurol 2020 Jul;108:47-53. doi: 10.1016/j.pediatrneurol.2020.02.003..
Keywords: Children/Adolescents, Neurological Disorders, Intensive Care Unit (ICU), Critical Care, Risk
Andrews PS, Wang S, Perkins AJ
Relationship between intensive care unit delirium severity and 2-year mortality and health care utilization.
Critical care patients with delirium are at an increased risk of functional decline and mortality long term. The objective of this study was to determine the relationship between delirium severity in the intensive care unit and mortality and acute health care utilization within 2 years after hospital discharge. The investigators concluded that increased delirium severity and days of delirium or coma were associated with higher mortality risk 2 years after discharge.
AHRQ-funded; P30 HS024384.
Citation: Andrews PS, Wang S, Perkins AJ .
Relationship between intensive care unit delirium severity and 2-year mortality and health care utilization.
Am J Crit Care 2020 Jul 1;29(4):311-17. doi: 10.4037/ajcc2020498..
Keywords: Intensive Care Unit (ICU), Neurological Disorders, Mortality, Risk
Shetty KD, Robbins M, Aragaki D
The quality of electrodiagnostic tests for carpal tunnel syndrome: Implications for surgery, outcomes, and expenditures.
The quality of electrodiagnostic tests may influence treatment decisions, particularly regarding surgery, affecting health outcomes and health-care expenditures. In this study, the investigators evaluated test quality among 338 adults with workers' compensation claims for carpal tunnel syndrome. The investigators found that in simulations, suboptimal quality tests rendered surgery inappropriate for 99 of 309 patients (+32 percentage points). They also found that test quality was not associated with overall health, actual receipt of surgery, or expenditures.
AHRQ-funded; HS018982.
Citation: Shetty KD, Robbins M, Aragaki D .
The quality of electrodiagnostic tests for carpal tunnel syndrome: Implications for surgery, outcomes, and expenditures.
Muscle Nerve 2020 Jul;62(1):60-69. doi: 10.1002/mus.26874..
Keywords: Diagnostic Safety and Quality, Neurological Disorders, Surgery, Quality Indicators (QIs), Quality Measures, Quality of Care
H H, Caton Gilstrap L
AHRQ Author: Tracer H
Screening for cognitive impairment in older adults.
This evidence-based approach paper focuses on putting prevention into action. It discusses screening for cognitive impairment in older adults. It provides case study, case study questions and a discussion.
AHRQ-authored.
Citation: H H, Caton Gilstrap L .
Screening for cognitive impairment in older adults.
Am Fam Physician 2020 Jun 15;101(12):753-54..
Keywords: U.S. Preventive Services Task Force (USPSTF), Dementia, Neurological Disorders, Elderly, Screening, Prevention, Case Study, Evidence-Based Practice, Guidelines
Crystal S, Jarrín OF, Rosenthal M
National partnership to improve dementia care in nursing homes campaign: state and facility strategies, impact, and antipsychotic reduction outcomes.
This study examines the success of the national partnership campaign to reduce prescription of antipsychotic medications to elderly nursing home residents with dementia. Antipsychotic medications have been shown to increase mortality. Use of these medications had increased 23.9% in dementia patients by 2011. The campaign reduced use by 40.1% to 14.3% by the second quarter of 2019. The campaign measured progress with public reporting of quality measures, increased regulatory scrutiny, and accompanying state and facility initiatives. Sedative-hypnotic medication use also decreased in tandem with antipsychotic reduction suggesting that the campaign increased attention to the use of other risky psychotropic medications.
AHRQ-funded; HS023464; HS022406; HS023258; HS021112.
Citation: Crystal S, Jarrín OF, Rosenthal M .
National partnership to improve dementia care in nursing homes campaign: state and facility strategies, impact, and antipsychotic reduction outcomes.
Innov Aging 2020 Jun 2;4(3):igaa018. doi: 10.1093/geroni/igaa018..
Keywords: Elderly, Nursing Homes, Long-Term Care, Dementia, Neurological Disorders, Quality Improvement, Quality of Care, Medication, Mortality