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
1 to 22 of 22 Research Studies DisplayedBossick AS, Katon JG, Gray KE
Concomitant bilateral salpingo-oophorectomy at hysterectomy: differences by race and menopausal status in the Veterans Affairs health care system, 2007-2014.
This study compared race and menopausal status differences in the rate of concomitant bilateral salphino-oopherectomy (BSO) at hysterectomy in the Veterans Affairs health care system from 2007-2014. The authors identified 6,785 Veterans who underwent a hysterectomy, including 2,230 with concomitant BSO. After adjustment premenopausal Black Veterans had 41% lower odds of going through BSO than their White counterparts. There was insufficient evidence in postmenopausal Veterans. Black Veterans were more likely to be single, obese, and undergo abdominal hysterectomy.
AHRQ-funded; HS013853.
Citation: Bossick AS, Katon JG, Gray KE .
Concomitant bilateral salpingo-oophorectomy at hysterectomy: differences by race and menopausal status in the Veterans Affairs health care system, 2007-2014.
J Womens Health 2020 Dec;29(12):1513-19. doi: 10.1089/jwh.2020.8503..
Keywords: Surgery, Women, Racial and Ethnic Minorities
Brown TJ Keshvani, N Gupta, et al.
Rates of appropriate laxative prophylaxis for opioid-induced constipation in veterans with lung cancer: a retrospective cohort study.
This study examined trends in the use of laxatives for opioid-induced constipation (OIC) in patients prescribed opioids for cancer pain treatment. A retrospective study was conducted of lung cancer patients seen in the Veteran’s Affair system from 2003 to 2016. There were 130,990 individuals included in the analysis. The majority (87%) received no prophylaxis (75%) or received docusate alone while 5% received OIC prophylaxis with the unnecessary addition of docusate. Throughout the study period, laxative prescription significantly decreased while categories of OIC prophylaxis were unchanged. The study concluded that almost 90% received inadequate or inappropriate OIC prophylaxis.
AHRQ-funded; HS022418.
Citation: Brown TJ Keshvani, N Gupta, et al..
Rates of appropriate laxative prophylaxis for opioid-induced constipation in veterans with lung cancer: a retrospective cohort study.
Support Care Cancer 2020 Nov;28(11):5315-21. doi: 10.1007/s00520-020-05364-6..
Keywords: Cancer: Lung Cancer, Cancer, Opioids, Medication, Prevention, Pain
Rogal SS, Yakovchenko V, Gonzalez R
Characterizing patient-reported outcomes in veterans with cirrhosis.
The Veterans Health Administration (VA) cares for over 80,000 Veterans with cirrhosis annually. Given the importance of understanding patient reported outcomes in this complex population, the investigators aimed to assess the associations between attitudes towards care, disease knowledge, and health related quality of life (HRQoL) in a national sample. The investigators concluded that hepatic decompensation, lower satisfaction with care, and being unsure about cirrhosis symptoms were associated with reduced QOL scores in this national cohort.
AHRQ-funded; HS019461.
Citation: Rogal SS, Yakovchenko V, Gonzalez R .
Characterizing patient-reported outcomes in veterans with cirrhosis.
PLoS One 2020 Sep 11;15(9):e0238712. doi: 10.1371/journal.pone.0238712..
Keywords: Quality of Life, Education: Patient and Caregiver
Nayfe R, Chansard M, Hynan LS
Comparison of patient-reported outcomes measurement information system and legacy instruments in multiple domains among older veterans with chronic back pain.
This study evaluated construct (convergent and discriminant) validity and time to complete NIH's Patient Reported Outcomes Measurement Information System (PROMIS) as compared to legacy instruments. Results showed that, given time efficiency of using PROMIS, along with strong construct validity, PROMIS instruments are a practical choice for measuring multidimensional patient-reported outcomes in older Veterans with chronic low back pain for both research and clinical purposes.
AHRQ-funded; HS022418.
Citation: Nayfe R, Chansard M, Hynan LS .
Comparison of patient-reported outcomes measurement information system and legacy instruments in multiple domains among older veterans with chronic back pain.
BMC Musculoskelet Disord 2020 Sep 8;21(1):598. doi: 10.1186/s12891-020-03587-6..
Keywords: Elderly, Back Health and Pain, Pain, Chronic Conditions, Patient-Centered Outcomes Research, Research Methodologies
Katon JG, Callegari LS, Bossick AS
Association of depression and post-traumatic stress disorder with receipt of minimally invasive hysterectomy for uterine fibroids: findings from the U.S. Department of Veterans Affairs.
Researchers sought to examine whether depression and PTSD are associated with minimally invasive hysterectomy (MIH). Studying veterans with uterine fibroids undergoing hysterectomy in the Department of Veterans Affairs between 2012 and 2014, they found that veterans with depression or PTSD were more likely that those without to have a MIH, possibly owing to smaller uterine size, suggesting that they may be undergoing hysterectomy earlier in the disease process. They recommended further research to understand whether this reflects high-quality, patient-centered care.
AHRQ-funded; HS013853.
Citation: Katon JG, Callegari LS, Bossick AS .
Association of depression and post-traumatic stress disorder with receipt of minimally invasive hysterectomy for uterine fibroids: findings from the U.S. Department of Veterans Affairs.
Womens Health Issues 2020 Sep-Oct;30(5):359-65. doi: 10.1016/j.whi.2020.06.005..
Keywords: Depression, Behavioral Health, Women
Burke RE, Canamucio A, Medvedeva E
External validation of the skilled nursing facility prognosis score for predicting mortality, hospital readmission, and community discharge in veterans.
The goal of this study was to evaluate the Skilled Nursing Facility (SNF) Prognosis Score’s performance in an external validation cohort. Participants were previously community-dwelling veterans who received post-acute care in a SNF; both VA and non-VA hospitals and SNFs were included. Findings showed that the SNF Prognosis Score had reasonable discrimination and calibration, and it was simple to calculate using an admission SNF assessment and a nomogram. Recommendations included future work embedding the score into practice in order to determine real-world feasibility, acceptability, and effectiveness.
AHRQ-funded; HS026116.
Citation: Burke RE, Canamucio A, Medvedeva E .
External validation of the skilled nursing facility prognosis score for predicting mortality, hospital readmission, and community discharge in veterans.
J Am Geriatr Soc 2020 Sep;68(9):2090-94. doi: 10.1111/jgs.16650..
Keywords: Nursing Homes, Risk, Health Services Research (HSR)
Wyse JJ, Ono SS, Kabat M
Supporting family caregivers of Veterans: participant perceptions of a federally-mandated caregiver support program.
The objective of this study was to understand patients' and caregivers' experiences with and perceptions of a federally-mandated program within the Department of Veterans Affairs (VA) that provides educational and monetary support to family caregivers of post-9/11 Veterans. Implications and policy recommendations for programs to support family caregivers, both within the VA and in the context of the broader national movement to support family caregivers, are discussed.
AHRQ-funded; HS026370.
Citation: Wyse JJ, Ono SS, Kabat M .
Supporting family caregivers of Veterans: participant perceptions of a federally-mandated caregiver support program.
Healthc 2020 Sep;8(3):100441. doi: 10.1016/j.hjdsi.2020.100441..
Keywords: Caregiving
Rogal S, Youk A, Zhang H
Impact of alcohol use disorder treatment on clinical outcomes among patients with cirrhosis.
Despite significant medical and economic consequences of coexisting alcohol use disorder (AUD) in patients with cirrhosis, little is known about AUD treatment patterns and their impact on clinical outcomes in this population. In this study the investigators aimed to characterize the use of and outcomes associated with AUD treatment in patients with cirrhosis. This retrospective cohort study included Veterans with cirrhosis who received Veterans Health Administration (VA) care and had an index diagnosis of AUD between 2011 and 2015.
AHRQ-funded; HS019461.
Citation: Rogal S, Youk A, Zhang H .
Impact of alcohol use disorder treatment on clinical outcomes among patients with cirrhosis.
Hepatology 2020 Jun;71(6):2080-92. doi: 10.1002/hep.31042..
Keywords: Alcohol Use, Substance Abuse, Patient-Centered Outcomes Research, Outcomes
Hernandez-Boussard T, Graham LA, Carroll I
Perioperative opioid use and pain-related outcomes in the Veterans Health Administration.
This study characterized perioperative exposure to morphine and its association with postoperative pain and 30-day readmissions. Utilizing nationwide Veterans Healthcare Administration (VHA) data on four high-volume surgical procedures, the researchers found that patients receiving high perioperative oral morphine equivalents were more likely to return to care for pain-related problems.
AHRQ-funded; HS024096.
Citation: Hernandez-Boussard T, Graham LA, Carroll I .
Perioperative opioid use and pain-related outcomes in the Veterans Health Administration.
Am J Surg 2020 Jun;219(6):969-75. doi: 10.1016/j.amjsurg.2019.06.022..
Keywords: Opioids, Medication, Pain, Substance Abuse, Surgery, Hospital Readmissions
Mahtta D, Ahmed ST, Shah NR
Facility-level variation in cardiac stress test use among patients with diabetes: findings from the Veterans Affairs national database.
The authors evaluate facility-level variation in cardiac stress test use among patients with diabetes mellitus (DM) across the Veterans Affairs (VA) health care system. Their results suggest that significant residual variation in overall stress test use exists among veterans with DM. They recommend future studies to assess system-wide appropriateness of stress testing, to assess patient-level symptom data, and to conduct qualitative analyses in order to understand individual provider-level drivers behind such variation.
AHRQ-funded; HS022998.
Citation: Mahtta D, Ahmed ST, Shah NR .
Facility-level variation in cardiac stress test use among patients with diabetes: findings from the Veterans Affairs national database.
Diabetes Care 2020 May;43(5):e58-e60. doi: 10.2337/dc19-2160..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Diabetes, Decision Making, Diagnostic Safety and Quality, Chronic Conditions
Ngo-Metzger Q, Mabry-Hernandez IR
AHRQ Author: Ngo-Metzger Q, Mabry-Hernandez
Implementation of evidence-based recommendations for preventive services in the Veterans Health Administration.
The Veterans Health Administration (VHA) is the largest integrated health care system in the United States. To date, there has been scant research on how VHA adopts clinical preventive services guidelines and how U.S. Preventive Services Task Force recommendations factor into the process. In this study, the investigators conducted semistructured interviews with eight VHA leaders to examine how they adopt, disseminate, and measure adherence to recommendations. They concluded that provision of evidence-based clinical preventive services is an important part of VHA's effort to provide high-quality care for Veterans.
AHRQ-authored.
Citation: Ngo-Metzger Q, Mabry-Hernandez IR .
Implementation of evidence-based recommendations for preventive services in the Veterans Health Administration.
J Healthc Qual 2020 May/Jun;42(3):148-56. doi: 10.1097/jhq.0000000000000217..
Keywords: U.S. Preventive Services Task Force (USPSTF), Prevention, Evidence-Based Practice, Guidelines, Implementation
Mastarone GL, Wyse JJ, Wilbur ER
Barriers to utilization of prescription drug monitoring programs among prescribing physicians and advanced practice registered nurses at Veterans Health Administration facilities in Oregon.
The authors sought to identify barriers to using state prescription drug monitoring programs (PDMPs) among prescribing physicians and advanced practice registered nurses across a variety of Veterans Health Administration (VA) settings in Oregon. They found that physicians and advanced practice registered nurses across diverse VA settings reported that PDMPs are an important tool and contribute to patient safety, but issues regarding organizational processes and software design impede optimal use of these resources.
AHRQ-funded; HS026370.
Citation: Mastarone GL, Wyse JJ, Wilbur ER .
Barriers to utilization of prescription drug monitoring programs among prescribing physicians and advanced practice registered nurses at Veterans Health Administration facilities in Oregon.
Pain Med 2020 Apr;21(4):695-703. doi: 10.1093/pm/pnz289..
Keywords: Opioids, Medication: Safety, Medication, Patient Safety
Than C, Chuang E, Washington DL
Understanding gender sensitivity of the health care workforce at the Veterans Health Administration.
Gender sensitivity of providers and staff has assumed increasing importance in closing historical gender disparities in health care quality and outcomes. The Department of Veterans Affairs (VA) has implemented several initiatives intended to improve gender sensitivity of its health care workforce. The current study examined practice- and individual-level characteristics associated with gender sensitivity of primary care providers (PCPs) and staff.
AHRQ-funded; HS000046.
Citation: Than C, Chuang E, Washington DL .
Understanding gender sensitivity of the health care workforce at the Veterans Health Administration.
Womens Health Issues 2020 Mar-Apr;30(2):120-27. doi: 10.1016/j.whi.2020.01.001..
Keywords: Workforce, Provider, Primary Care, Disparities, Quality of Care
Mohr NM, Wu C, Ward MJ
Potentially avoidable inter-facilit transfer from Veterans Health Administration emergency departments: a cohort study.
The objective of this study was to describe ED-based inter-facility transfer practices within the Veterans Health Administration (VHA) and to estimate the proportion of potentially avoidable transfers. Results showed that VHA inter-facility transfer was commonly performed for mental health and cardiac evaluation, particularly for patients in rural settings. The proportion that are potentially avoidable is small. Future work should focus on improving capabilities to provide specialty evaluation locally for these conditions, possibly using telehealth solutions.
AHRQ-funded; HS025753.
Citation: Mohr NM, Wu C, Ward MJ .
Potentially avoidable inter-facilit transfer from Veterans Health Administration emergency departments: a cohort study.
BMC Health Serv Res 2020 Feb 12;20(1):110. doi: 10.1186/s12913-020-4956-6..
Keywords: Emergency Department, Hospitals, Healthcare Delivery, Access to Care, Rural Health
BJ BJ, McGinnis KA, Edelman EJ
Predictors of initiation of and retention on medications for alcohol use disorder among people living with and without HIV.
Researchers examined predictors of medications for alcohol use disorder initiation and retention across HIV status. Data from the Veterans Aging Cohort Study data was used to identify new alcohol use disorder diagnoses among 163,339 individuals from 1998 to 2015. The researchers found that the low frequency of retention precluded multivariable analyses for retention. They concluded that, for people living with HIV and uninfected individuals, targeted implementation strategies to expand medications for alcohol use disorder are needed, particularly for specific subpopulations.
AHRQ-funded; HS021112.
Citation: BJ BJ, McGinnis KA, Edelman EJ .
Predictors of initiation of and retention on medications for alcohol use disorder among people living with and without HIV.
J Subst Abuse Treat 2020 Feb;109:14-22. doi: 10.1016/j.jsat.2019.11.002..
Keywords: Alcohol Use, Substance Abuse, Medication, Human Immunodeficiency Virus (HIV)
Langhoff E, Siu A, Boockvar K
The VA and Non-VA experience of tracking good care.
This study compared how well Department of Veterans Affairs (VA) hospitals perform against non-VA hospitals. Three widely referenced public health care ranking models: the U.S. News America’s Best Hospitals, Truven Health Analytics, and Hospital Compare along with the VA model were examined. The authors found that the metrics used across the 4 models are neither comparable nor transparent. They found there were 6-46% reporting deficiencies in reporting hospital metrics in non-VA hospitals, while VA reporting is 100% of their metrics. VA inpatient satisfaction fell far short of the private sector, but both sets of rankings increased over time.
AHRQ-funded; HS022924.
Citation: Langhoff E, Siu A, Boockvar K .
The VA and Non-VA experience of tracking good care.
Popul Health Manag 2020 Feb;23(1):92-100. doi: 10.1089/pop.2019.0039..
Keywords: Hospitals, Provider Performance, Patient Experience, Quality of Care
Vaughan Sarrazin MS, Jones M, Mazur A
Bleeding rates in Veterans Affairs patients with atrial fibrillation who switch from warfarin to dabigatran.
This study evaluated the relative risks of any, gastrointestinal, intracranial, and other bleeding for Veterans Affairs patients who switched to dabigatran after at least 6 months on warfarin. It found that among veterans with atrial fibrillation who switched to dabigatran, dabigatran increased the risk of gastrointestinal hemorrhage by 54% and was not associated with rates of other bleeding or death.
AHRQ-funded; HS021992
Citation: Vaughan Sarrazin MS, Jones M, Mazur A .
Bleeding rates in Veterans Affairs patients with atrial fibrillation who switch from warfarin to dabigatran.
Am J Med. 2014 Dec;127(12):1179-85. doi: 10.1016/j.amjmed.2014.07.024..
Keywords: Blood Thinners, Adverse Events, Patient Safety
Meeks DW, Meyer AN, Rose B
Exploring new avenues to assess the sharp end of patient safety: an analysis of nationally aggregated peer review data.
The researchers described outcomes of peer review within the Department of Veterans Affairs (VA) healthcare system and identified opportunities to leverage peer review data for measurement and improvement of safety. Results showed that the most common process contributing to substandard care was 'timing and appropriateness of treatment'; approximately 16% had diagnosis-related performance concerns. The authors concluded that peer review may be a useful tool for healthcare organizations to assess their sharp end clinical performance, particularly safety events related to diagnostic and treatment errors.
AHRQ-funded; HS022087.
Citation: Meeks DW, Meyer AN, Rose B .
Exploring new avenues to assess the sharp end of patient safety: an analysis of nationally aggregated peer review data.
BMJ Qual Saf 2014 Dec;23(12):1023-30. doi: 10.1136/bmjqs-2014-003239.
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Keywords: Adverse Events, Medical Errors, Patient Safety, Quality Improvement
Schweizer ML, Cullen JJ, Perencevich EN
Costs associated with surgical site infections in Veterans Affairs hospitals.
This study evaluated surgical site infections(SSIs) in 1,756 Veterans Administration patients to determine the excess costs associated with total, deep, and superficial SSIs. It found that the highest risk-adjusted costs occurred with deep SSIs and SSIs associated with neurosurgery patients.
AHRQ-funded; HS021992
Citation: Schweizer ML, Cullen JJ, Perencevich EN .
Costs associated with surgical site infections in Veterans Affairs hospitals.
JAMA Surg. 2014 Jun;149(6):575-581. doi:10.1001/jamasurg.2013.4663..
Keywords: Surgery, Healthcare-Associated Infections (HAIs), Patient Safety, Healthcare Costs
Bates BE, Xie D, Kwong PL
One-year all-cause mortality after stroke: a prediction model.
Using data from Department of Veterans Affairs (VA) national databases, the researchers present and internally validate a 1-year all-cause mortality prediction index after hospitalization for acute stroke. They conclude that a simple index using readily available data that stratifies stroke patients at the time of discharge according to low, moderate, high, and highest likelihood of all-cause 1-year mortality is feasible.
AHRQ-funded; HS018540.
Citation: Bates BE, Xie D, Kwong PL .
One-year all-cause mortality after stroke: a prediction model.
PM R 2014 Jun;6(6):473-83. doi: 10.1016/j.pmrj.2013.11.006..
Keywords: Stroke, Mortality, Hospitalization
Stineman MG, Xie D, Kurichi JE
Comprehensive versus consultative rehabilitation services postacute stroke: outcomes differ.
The researchers compared outcomes of veteran patients provided with comprehensive rehabilitation with those provided with consultative rehabilitation services after acute stroke using propensity scores. They found that comprehensive rehabilitation services are associated with greater recovery of physical and cognitive independence, improved home discharge likelihood, and improved 1 yr. survival.
AHRQ-funded; HS018540.
Citation: Stineman MG, Xie D, Kurichi JE .
Comprehensive versus consultative rehabilitation services postacute stroke: outcomes differ.
J Rehabil Res Dev 2014;51(7):1143-54. doi: 10.1682/jrrd.2014.03.0084..
Keywords: Comparative Effectiveness, Rehabilitation, Stroke, Patient-Centered Outcomes Research
Moga DC, Carnahan RM, Lund BC
Risks and benefits of bladder antimuscarinics among elderly residents of Veterans Affairs Community Living Centers.
This study evaluated the risks and benefits of drugs to reduce urinary incontinence that were used by elderly VA nursing home residents. It found that the use of these drugs, known as bladder antimuscarinics, resulted in improved continence rates and better social engagement but also led to a higher risk of fractures in new users.
AHRQ-funded; HS016094
Citation: Moga DC, Carnahan RM, Lund BC .
Risks and benefits of bladder antimuscarinics among elderly residents of Veterans Affairs Community Living Centers.
J Am Med Dir Assoc. 2013 Oct;14(10):749-60. doi: 10.1016/j.jamda.2013.03.008..
Keywords: Elderly, Medication, Medication: Safety, Nursing Homes, Long-Term Care, Injuries and Wounds, Patient Safety