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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
1 to 25 of 108 Research Studies DisplayedFinnerty NM, Rodriguez RM, Carpenter CR
Clinical decision rules for diagnostic imaging in the emergency department: a research agenda.
The objective of this working group and article was to generate a consensus-based research agenda for the development and implementation of clinical decision rules (CDRs) for diagnostic imaging in the emergency department. A research agenda was developed, prioritizing a number of questions, including: what are the optimal methods to justify the derivation and validation of diagnostic imaging CDRs?
AHRQ-funded; HS023498.
Citation: Finnerty NM, Rodriguez RM, Carpenter CR .
Clinical decision rules for diagnostic imaging in the emergency department: a research agenda.
Acad Emerg Med 2015 Dec;22(12):1406-16. doi: 10.1111/acem.12828.
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Keywords: Decision Making, Emergency Department, Health Services Research (HSR), Imaging
Hartling L, Guise JM, Kato E
AHRQ Author: Kato, E, Berliner E
A taxonomy of rapid reviews links report types and methods to specific decision-making contexts.
The researchers described characteristics of rapid reviews and examined the impact of methodological variations on their reliability and validity. They concluded that rapid products have tremendous methodological variation and that categorization based on timeframe or type of synthesis reveals patterns. The similarity across rapid products lies in the close relationship with the end user to meet time-sensitive decision-making needs.
AHRQ-authored; AHRQ-funded; 290201200013I; 290201200010I; 290201200011I; 290201200015I; 290201200007I; 290201200004C.
Citation: Hartling L, Guise JM, Kato E .
A taxonomy of rapid reviews links report types and methods to specific decision-making contexts.
J Clin Epidemiol 2015 Dec;68(12):1451-62.e3. doi: 10.1016/j.jclinepi.2015.05.036.
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Keywords: Decision Making, Evidence-Based Practice, Data, Research Methodologies
Roth JA, Ramsey SD, Carlson JJ
Cost-effectiveness of a biopsy-based 8-protein prostate cancer prognostic assay to optimize treatment decision making in Gleason 3 + 3 and 3 + 4 early stage prostate cancer.
A novel 8-protein prognostic assay generates a risk score at time of biopsy that is predictive of prostate cancer aggressiveness and can inform treatment decisions. The objective of this study was to evaluate the cost-effectiveness of using the assay to inform treatment decisions compared with usual care. The 8-protein assay strategy resulted in 0.04 more quality-adjusted life years and $700 less in costs compared with usual care.
AHRQ-funded; HS022982.
Citation: Roth JA, Ramsey SD, Carlson JJ .
Cost-effectiveness of a biopsy-based 8-protein prostate cancer prognostic assay to optimize treatment decision making in Gleason 3 + 3 and 3 + 4 early stage prostate cancer.
Oncologist 2015 Dec;20(12):1355-64. doi: 10.1634/theoncologist.2015-0214.
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Keywords: Cancer, Cancer: Prostate Cancer, Patient-Centered Outcomes Research, Healthcare Costs, Decision Making
Blackmore CC, Castro A
Improving the quality of imaging in the emergency department.
The six-tier efficacy hierarchy of Fryback and Thornbury enables understanding of the value of imaging on multiple levels, ranging from technical efficacy to medical decision-making and higher-level patient and societal outcomes. In this article, the authors elucidate the Fryback and Thornbury framework to define the value of imaging in the ED and to relate emergency imaging to the IOM quality domains.
AHRQ-funded; HS023498.
Citation: Blackmore CC, Castro A .
Improving the quality of imaging in the emergency department.
Acad Emerg Med 2015 Dec;22(12):1385-92. doi: 10.1111/acem.12816.
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Keywords: Decision Making, Emergency Department, Imaging, Quality Improvement
Melnick ER, Shafer K, Rodulfo N
Understanding overuse of computed tomography for minor head injury in the emergency department: a triangulated qualitative study.
The objective was to identify nonclinical, human factors that promote or inhibit the appropriate use of computed tomography (CT) in patients presenting to the emergency department (ED) with minor head injury. Five core domains emerged from the analysis: establishing trust, anxiety (patient and provider), constraints related to ED practice, the influence of others, and patient expectations.
AHRQ-funded; HS021271.
Citation: Melnick ER, Shafer K, Rodulfo N .
Understanding overuse of computed tomography for minor head injury in the emergency department: a triangulated qualitative study.
Acad Emerg Med 2015 Dec;22(12):1474-83. doi: 10.1111/acem.12824.
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Keywords: Emergency Medical Services (EMS), Imaging, Brain Injury, Decision Making, Health Services Research (HSR)
Hajizadeh N, Uhler LM, Perez Figueroa RE
Understanding patients' and doctors' attitudes about shared decision making for advance care planning.
The authors sought to gain general insights into the current practice of shared decision making (SDM) and attitudes about patient involvement, and also to gain specific insights into experience with, and attitudes about, SDM for advance care planning. They found that patients were generally open to having end-of-life discussions with their doctors, although their openness sometimes depended on the circumstance. Doctors reported engaging in end-of-life treatment decisions with their patients, although they expressed the need for conversations to take place earlier, in advance of acute illness.
AHRQ-funded; HS022061; HS019473.
Citation: Hajizadeh N, Uhler LM, Perez Figueroa RE .
Understanding patients' and doctors' attitudes about shared decision making for advance care planning.
Health Expect 2015 Dec;18(6):2054-65. doi: 10.1111/hex.12285.
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Keywords: Clinician-Patient Communication, Decision Making, Patient and Family Engagement, Patient-Centered Healthcare
Kerber KA, Meurer WJ, Brown DL
Stroke risk stratification in acute dizziness presentations: a prospective imaging-based study.
The researchers estimated the ability of bedside information to risk stratify stroke in acute dizziness presentations. They found that in acute dizziness presentations, the combination of ABCD(2) score, general neurologic examination, and a specialized ocular motor examination has the capacity to risk-stratify acute stroke on MRI.
AHRQ-funded; HS018334; HS017690; HS022258.
Citation: Kerber KA, Meurer WJ, Brown DL .
Stroke risk stratification in acute dizziness presentations: a prospective imaging-based study.
Neurology 2015 Nov 24;85(21):1869-78. doi: 10.1212/wnl.0000000000002141..
Keywords: Stroke, Risk, Healthcare Utilization, Decision Making
Potosky AL, O'Neill SC, Isaacs C
Population-based study of the effect of gene expression profiling on adjuvant chemotherapy use in breast cancer patients under the age of 65 years.
The authors evaluated the relation between gene expression profiling (GEP) testing and the use of adjuvant chemotherapy by women treated in a general oncology practice. They found that adjuvant chemotherapy use after GEP testing is generally consistent with the recommended test interpretation for women with a high or low predicted risk of recurrence. Chemotherapy use in the intermediate-risk group increased with Recurrence Score values, and evidence from ongoing randomized trials may help to clarify whether this finding reflects optimal interpretation of GEP test results.
AHRQ-funded; HS022915.
Citation: Potosky AL, O'Neill SC, Isaacs C .
Population-based study of the effect of gene expression profiling on adjuvant chemotherapy use in breast cancer patients under the age of 65 years.
Cancer 2015 Nov 15;121(22):4062-70. doi: 10.1002/cncr.29621.
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Keywords: Cancer, Cancer: Breast Cancer, Treatments, Decision Making, Genetics, Practice Patterns, Women
Yi H, Xiao T, Thomas PS
Barriers and facilitators to patient-provider communication when discussing breast cancer risk to aid in the development of decision support tools.
The investigators identified barriers and facilitators to patient-provider communication when discussing breast cancer risk to aid in the development of decision support tools. They found that barriers barriers are time constraints, lack of knowledge, low health literacy, and language barriers, and that facilitators are information needs, desire for personalization, and autonomy when communicating risk in patient-provider encounters. These results will inform the development of a patient-centered decision aid (RealRisks) and a provider-facing breast cancer risk navigation (BNAV) tool.
AHRQ-funded; HS019313.
Citation: Yi H, Xiao T, Thomas PS .
Barriers and facilitators to patient-provider communication when discussing breast cancer risk to aid in the development of decision support tools.
AMIA Annu Symp Proc 2015 Nov 5;2015:1352-60.
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Keywords: Cancer: Breast Cancer, Decision Making, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Clinician-Patient Communication
Turner JA, Comstock BA, Standaert CJ
Can patient characteristics predict benefit from epidural corticosteroid injections for lumbar spinal stenosis symptoms?
The study’s aim was to identify patient characteristics associated with benefits from epidural injections of corticosteroid with lidocaine versus epidural injections of lidocaine only for lumbar spinal stenosis symptoms. It found that among 21 baseline patient characteristics examined, none, including clinician rated spinal stenosis severity, were consistent predictors of benefit from epidural injections of lidocain corticosteroid versus lidocaine only.
AHRQ-funded; HS019222; HS022972.
Citation: Turner JA, Comstock BA, Standaert CJ .
Can patient characteristics predict benefit from epidural corticosteroid injections for lumbar spinal stenosis symptoms?
Spine J 2015 Nov;15(11):2319-31. doi: 10.1016/j.spinee.2015.06.050..
Keywords: Patient-Centered Outcomes Research, Decision Making, Medication, Back Health and Pain, Chronic Conditions
Callaghan BC, Kerber KA, Pace RJ
Headache neuroimaging: routine testing when guidelines recommend against them.
The aim of this article was to determine the patient-level factors associated with headache neuroimaging in outpatient practice. It concluded that neuroimaging is routinely ordered in outpatient headache patients including populations where guidelines specifically recommend against their use (migraines, chronic headaches, no red flags).
AHRQ-funded; HS017690.
Citation: Callaghan BC, Kerber KA, Pace RJ .
Headache neuroimaging: routine testing when guidelines recommend against them.
Cephalalgia 2015 Nov;35(13):1144-52. doi: 10.1177/0333102415572918.
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Keywords: Neurological Disorders, Imaging, Decision Making, Guidelines, Diagnostic Safety and Quality
Wright A, Sittig DF, Ash JS
Lessons learned from implementing service-oriented clinical decision support at four sites: a qualitative study.
This study identified challenges, lessons learned and best practices for service-oriented clinical decision support, based on the results of the Clinical Decision Support Consortium, a multi-site study which developed, implemented and evaluated clinical decision support services in a diverse range of electronic health records. Based on the challenges and lessons learned, there were eight best practices for developers and implementers of service-oriented clinical decision support.
AHRQ-funded; 290200810010.
Citation: Wright A, Sittig DF, Ash JS .
Lessons learned from implementing service-oriented clinical decision support at four sites: a qualitative study.
Int J Med Inform 2015 Nov;84(11):901-11. doi: 10.1016/j.ijmedinf.2015.08.008.
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Keywords: Clinical Decision Support (CDS), Electronic Health Records (EHRs), Decision Making, Health Information Technology (HIT)
LeBlanc A, Herrin J, Williams MD
Shared decision making for antidepressants in primary care: a cluster randomized trial.
The researchers estimated the effect of the Depression Medication Choice (DMC) encounter decision aid on quality of the decision‐making process and depression outcomes. They found that the DMC decision aid helped primary care clinicians and patients with moderate to severe depression select antidepressants together, improving the decision-making process without extending the visit.
AHRQ-funded; HS019214.
Citation: LeBlanc A, Herrin J, Williams MD .
Shared decision making for antidepressants in primary care: a cluster randomized trial.
JAMA Intern Med 2015 Nov;175(11):1761-70. doi: 10.1001/jamainternmed.2015.5214..
Keywords: Medication, Comparative Effectiveness, Decision Making, Primary Care
Shortell SM, Sehgal NJ, Bibi S
An early assessment of accountable care organizations' efforts to engage patients and their families.
The authors sought to examine the extent to which ACOs actively engage patients and their families, explore challenges involved, and consider approaches for dealing with those challenges. They identified important practices associated with greater patient activation and engagement, including high-level leadership commitment, goal-setting supported by adequate resources, extensive provider training, use of interdisciplinary care teams, and frequent monitoring and reporting on progress.
AHRQ-funded; HS022241.
Citation: Shortell SM, Sehgal NJ, Bibi S .
An early assessment of accountable care organizations' efforts to engage patients and their families.
Med Care Res Rev 2015 Oct;72(5):580-604. doi: 10.1177/1077558715588874.
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Keywords: Decision Making, Quality of Care, Patient and Family Engagement, Clinician-Patient Communication
Whicher DM, Miller JE, Dunham KM
Gatekeepers for pragmatic clinical trials.
The authors provided a framework to help guide gatekeepers' decision-making related to the use of resources for pragmatic clinical trials. They stated that recognition of the complex set of considerations that should inform decision-making will guide gatekeepers in making justifiable choices regarding the use of limited and valuable resources.
AHRQ-funded; HS000029.
Citation: Whicher DM, Miller JE, Dunham KM .
Gatekeepers for pragmatic clinical trials.
Clin Trials 2015 Oct;12(5):442-8. doi: 10.1177/1740774515597699.
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Keywords: Decision Making, Evidence-Based Practice, Comparative Effectiveness, Patient-Centered Outcomes Research, Research Methodologies
Fumo DE, Kapoor V, Reece LJ
Historical matching strategies in kidney paired donation: the 7-year evolution of a web-based virtual matching system.
Failure to convert computer-identified possible kidney paired donation (KPD) exchanges into transplants has prohibited KPD from reaching its full potential. This study analyzes the progress of exchanges in moving from "offers" to completed transplants. The "offer" and 1-way success rates were 21.9 and 15.5 percent, respectively. Three reasons for failure were found that could be prospectively prevented by changes in protocol or software.
AHRQ-funded; HS020610.
Citation: Fumo DE, Kapoor V, Reece LJ .
Historical matching strategies in kidney paired donation: the 7-year evolution of a web-based virtual matching system.
Am J Transplant 2015 Oct;15(10):2646-54. doi: 10.1111/ajt.13337.
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Keywords: Health Information Technology (HIT), Transplantation, Decision Making, Clinical Decision Support (CDS)
Cantor SB, Deshmukh AA, Krahn MD
Use of forecasted assessment of quality of life to validate time-trade-off utilities and a prostate cancer screening decision-analytic model.
The researchers sought to determine whether the forecasted assessment of how someone would feel in a future health state can be predictive of utilities (e.g. as elicited by the time-trade-off method) and also predictive of optimal decisions as determined by a decision-analytic model. They concluded that anticipated difficulty adjusting to adverse health effects were highly related to preferences and could be used as a proxy measure of utility.
AHRQ-funded; HS08992.
Citation: Cantor SB, Deshmukh AA, Krahn MD .
Use of forecasted assessment of quality of life to validate time-trade-off utilities and a prostate cancer screening decision-analytic model.
Health Expect 2015 Oct;18(5):1610-20. doi: 10.1111/hex.12150.
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Keywords: Decision Making, Cancer: Prostate Cancer, Elderly, Quality of Life, Screening
Fendler TJ, Spertus JA, Kennedy KF
Alignment of do-not-resuscitate status with patients' likelihood of favorable neurological survival after in-hospital cardiac arrest.
This study assessed whether patients’ decisions for do-not-resuscitate (DNR) orders after a successful resuscitation from in-hospital cardiac arrest are aligned with their expected prognosis. It concluded that although DNR orders after in-hospital cardiac arrest were generally aligned with patients’ likelihood of favorable neurological survival, only one-third of patients with the worst prognosis had DNR orders.
AHRQ-funded; HS020671.
Citation: Fendler TJ, Spertus JA, Kennedy KF .
Alignment of do-not-resuscitate status with patients' likelihood of favorable neurological survival after in-hospital cardiac arrest.
JAMA 2015 Sep 22-29;314(12):1264-71. doi: 10.1001/jama.2015.11069.
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Keywords: Decision Making, Mortality
Blumenthal-Barby JS, Kostick KM, Delgado ED
Assessment of patients' and caregivers' informational and decisional needs for left ventricular assist device placement: implications for informed consent and shared decision-making.
The authors investigated the decision-making process and informational and decisional needs of patients and their caregivers regarding left ventricular assist device (LVAD) placement. They found that participants easily and clearly identified their values: life extension; family; and mobility. Participants reported the need to meet other patients and caregivers before device placement and to have an involved caregiver to synthesize information. They further found that some participants demonstrated a lack of clarity regarding transplant probability.
AHRQ-funded; HS024849.
Citation: Blumenthal-Barby JS, Kostick KM, Delgado ED .
Assessment of patients' and caregivers' informational and decisional needs for left ventricular assist device placement: implications for informed consent and shared decision-making.
J Heart Lung Transplant 2015 Sep;34(9):1182-9. doi: 10.1016/j.healun.2015.03.026.
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Keywords: Caregiving, Decision Making, Heart Disease and Health, Medical Devices, Patient and Family Engagement
Singh JA, Qu H, Yazdany J
Barriers to medication decision making in women with lupus nephritis: a formative study using nominal group technique.
The researchers assessed the perspectives of women with lupus nephritis on barriers to medication decision making. The most salient perceived barriers, as indicated by percent-weighted votes assigned, were known/anticipated side effects (15.6 percent), medication expense/ability to afford medications (8.2 percent), and the fear that the medication could cause other diseases (7.8 percent).
AHRQ-funded; HS021110.
Citation: Singh JA, Qu H, Yazdany J .
Barriers to medication decision making in women with lupus nephritis: a formative study using nominal group technique.
J Rheumatol 2015 Sep;42(9):1616-23. doi: 10.3899/jrheum.150168.
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Keywords: Centers for Education and Research on Therapeutics (CERTs), Decision Making, Education: Patient and Caregiver, Medication, Patient and Family Engagement
Siegel CA, Lofland JH, Naim A
Gastroenterologists' views of shared decision making for patients with inflammatory bowel disease.
The researchers examined gastroenterologists' perspectives about shared decision making (SDM) with patients with inflammatory bowel disease (IBD). They found three key barriers to practicing SDM were lack of time, reimbursement, and tools. They concluded that gastroenterologists lack the systematic approaches and tools for implementing SDM within their IBD practices.
AHRQ-funded; HS021747.
Citation: Siegel CA, Lofland JH, Naim A .
Gastroenterologists' views of shared decision making for patients with inflammatory bowel disease.
Dig Dis Sci 2015 Sep;60(9):2636-45. doi: 10.1007/s10620-015-3675-z.
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Keywords: Decision Making, Digestive Disease and Health, Patient and Family Engagement, Practice Patterns
Cohen DJ, Davis M, Balasubramanian BA
Integrating behavioral health and primary care: consulting, coordinating and collaborating among professionals.
This paper sought to describe how clinicians from different backgrounds interact to deliver integrated behavioral and primary health care, and the contextual factors that shape such interactions. It concluded that primary care and behavioral health clinicians, through their interactions, consult, coordinate, and collaborate with each other to solve patients' problems.
AHRQ-funded; HS022981.
Citation: Cohen DJ, Davis M, Balasubramanian BA .
Integrating behavioral health and primary care: consulting, coordinating and collaborating among professionals.
J Am Board Fam Med 2015 Sep-Oct;28 Suppl 1:S21-31. doi: 10.3122/jabfm.2015.S1.150042.
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Keywords: Healthcare Delivery, Community-Based Practice, Decision Making, Behavioral Health, Primary Care
Fernandes-Taylor S, Adesoye T, Bloom JR
Managing psychosocial issues faced by young women with breast cancer at the time of diagnosis and during active treatment.
This review examines recent literature on the psychosocial needs of and interventions for young women. It focuses on the active treatment period given the toxicity of treatment, the incidence of anxiety, and depressive symptoms in these women during treatment. It concluded that shared decision-making, balancing body image, fear of recurrence, and recommended treatment, and palliative care for metastasis are essential research priorities for the clinical setting.
AHRQ-funded; HS023395.
Citation: Fernandes-Taylor S, Adesoye T, Bloom JR .
Managing psychosocial issues faced by young women with breast cancer at the time of diagnosis and during active treatment.
Curr Opin Support Palliat Care 2015 Sep;9(3):279-84. doi: 10.1097/spc.0000000000000161..
Keywords: Anxiety, Cancer: Breast Cancer, Decision Making, Depression, Quality of Life
Fischer MA, Allen-Coleman C, Farrell SF
Stakeholder assessment of comparative effectiveness research needs for Medicaid populations.
Because children, pregnant women and people with mental illness have generally been underrepresented in research discussions, comparative effectiveness rsearch (CER) questions for these groups may be understudied. To address this problem, AHRQ commissioned a team to work with Medicaid Medical Directors and other stakeholders to identify relevant CER questions. Through an iterative process of topic identification and refinement, they developed relevant, feasible and actionable questions based on issues affecting Medicaid programs nationwide.
AHRQ-funded; 290200500161.
Citation: Fischer MA, Allen-Coleman C, Farrell SF .
Stakeholder assessment of comparative effectiveness research needs for Medicaid populations.
J Comp Eff Res 2015 Sep;4(5):465-71. doi: 10.2217/cer.15.26.
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Keywords: Comparative Effectiveness, Medicaid, Research Methodologies, Decision Making, Vulnerable Populations
El-Jawahri A, Mitchell SL, Paasche-Orlow MK
A randomized controlled trial of a CPR and intubation video decision support tool for hospitalized patients.
The researchers examined the impact of a video decision tool for CPR and intubation on patients’ choices, knowledge, medical orders, and discussions with providers. They found that seriously ill patients who viewed a video about CPR and intubation were more likely not to want these treatments, be better informed about their options, have orders to forgo CPR/ intubation, and discuss preferences with providers.
AHRQ-funded; HS018780.
Citation: El-Jawahri A, Mitchell SL, Paasche-Orlow MK .
A randomized controlled trial of a CPR and intubation video decision support tool for hospitalized patients.
J Gen Intern Med 2015 Aug;30(8):1071-80. doi: 10.1007/s11606-015-3200-2..
Keywords: Patient-Centered Outcomes Research, Clinical Decision Support (CDS), Decision Making, Clinician-Patient Communication