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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 31 Research Studies DisplayedPasalic D, Barocas DA, Huang LC
Five-year outcomes from a prospective comparative effectiveness study evaluating external-beam radiotherapy with or without low-dose-rate brachytherapy boost for localized prostate cancer.
This retrospective cohort study’s objective was to determine if there were differences in treatment-related regret or survival between prostate cancer patients who received external-beam radiation therapy (EBRT) with or without a brachytherapy boost (EBRT-LDR), over a 5-year period. The cohort included 695 men who met inclusion criteria and received either EBRT (n=583) or EBRT-LDR (n=112). Men who received either treatment reported clinically worse urinary irritation and bowel function through 3 years but resolved after 5 years. Men who received EBRT-LDR continued to report moderate- to-big problems with urinary function bother and frequent urination at 5 years. There was no difference in treatment-related regret or survival between patients who received either treatment.
AHRQ-funded; HS019356; HS022640.
Citation: Pasalic D, Barocas DA, Huang LC .
Five-year outcomes from a prospective comparative effectiveness study evaluating external-beam radiotherapy with or without low-dose-rate brachytherapy boost for localized prostate cancer.
Cancer 2021 Jun 1;127(11):1912-25. doi: 10.1002/cncr.33388..
Keywords: Cancer: Prostate Cancer, Cancer, Comparative Effectiveness, Evidence-Based Practice, Outcomes, Patient-Centered Outcomes Research, Treatments
Brown CS, Obi AT, Cronenwett JL
Outcomes after truncal ablation with or without concomitant phlebectomy for isolated symptomatic varicose veins (C2 disease).
This study looked outcomes of patients with varicose veins (C2 disease) who were treated with venous ablation alone or ablation plus phlebectomy using the Vascular Quality Initiative Varicose Vein Registry. Data between January 2015 and March 2015 was used to investigate postoperative as well as long-term clinical and patient-reported outcomes among patients with documented symptomatic C2 disease undergoing truncal endovenous ablations alone and combined ablation and phlebectomy. Out of 3375 patients, 40.1% underwent isolated truncal ablation and the rest had the combined procedure of ablation and phlebectomy. Complications were low for both procedures (8.4% and 8.7%). Overall, improvement in symptoms was experienced by 94.4% of patients with more increases in patients undergoing ablation and phlebectomy than ablation alone. Both procedures are recommended by the authors to be covered by insurance.
AHRQ-funded; HS000053.
Citation: Brown CS, Obi AT, Cronenwett JL .
Outcomes after truncal ablation with or without concomitant phlebectomy for isolated symptomatic varicose veins (C2 disease).
J Vasc Surg Venous Lymphat Disord 2021 Mar;9(2):369-76. doi: 10.1016/j.jvsv.2020.05.016..
Keywords: Cardiovascular Conditions, Chronic Conditions, Surgery, Outcomes, Patient-Centered Outcomes Research, Comparative Effectiveness, Evidence-Based Practice
Kohler-Forsberg O, Sylvia LG, Fung V
Adjunctive antidepressant treatment among 763 outpatients with bipolar disorder: findings from the Bipolar CHOICE and LiTMUS trials.
The purpose of this study was to examine the clinical efficacy of adjunctive antidepressants. In this large cohort of outpatients with bipolar disorder, findings showed that clinically indicated and guideline-based adjunctive antidepressant treatment was not associated with lower depressive symptoms or higher mania symptoms.
AHRQ-funded; HS019371.
Citation: Kohler-Forsberg O, Sylvia LG, Fung V .
Adjunctive antidepressant treatment among 763 outpatients with bipolar disorder: findings from the Bipolar CHOICE and LiTMUS trials.
Depress Anxiety 2021 Feb;38(2):114-23. doi: 10.1002/da.23069..
Keywords: Depression, Behavioral Health, Medication, Comparative Effectiveness, Evidence-Based Practice, Outcomes
Gupta A, Sedhom R, Sharma R
Nonpharmacological interventions for managing breathlessness in patients with advanced cancer: a systematic review.
The purpose of this review was to evaluate the advantages and harms of nonpharmacological interventions for managing breathlessness in adults with advanced cancer. PubMed, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials databases were searched for English-language studies about randomized and nonrandomized clinical trials, controlled trials, and observational studies. Findings included the safety and association with improved breathlessness of several nonpharmacological interventions for adults with advanced cancer. Recommendations included incorporating nonpharmacological interventions as first-line treatment for adults with advanced cancer and breathlessness.
AHRQ-funded; 290201500006I.
Citation: Gupta A, Sedhom R, Sharma R .
Nonpharmacological interventions for managing breathlessness in patients with advanced cancer: a systematic review.
JAMA Oncol 2021 Feb;7(2):290-98. doi: 10.1001/jamaoncol.2020.5184..
Keywords: Cancer, Respiratory Conditions, Treatments, Evidence-Based Practice, Comparative Effectiveness, Quality of Life, Outcomes, Patient-Centered Outcomes Research
Feliciano JL, Waldfogel JM, Sharma R
Pharmacologic interventions for breathlessness in patients with advanced cancer: a systematic review and meta-analysis.
This systematic review and meta-analysis examined the use of pharmacological interventions for breathlessness in patients with advanced cancer. Studies were identified from database inception to May 2020 using predefined eligibility criteria. Pharmacologic intervention benefits and harms were compared, focusing on breathlessness, anxiety, exercise capacity and health-related quality of life. Out of 7729 unique citations, 19 studies with a total of 1424 patients were included. Opioids were not associated with more effectiveness than placebo for improving breathlessness or exercise capacity. Anxiolytics were also not associated with more effectiveness than placebo for breathlessness or anxiety. There was limited evidence for other pharmacologic interventions. There was some harm, but it was minimal in those short-term studies.
AHRQ-funded; 290201500006I.
Citation: Feliciano JL, Waldfogel JM, Sharma R .
Pharmacologic interventions for breathlessness in patients with advanced cancer: a systematic review and meta-analysis.
JAMA Netw Open 2021 Feb;4(2):e2037632. doi: 10.1001/jamanetworkopen.2020.37632..
Keywords: Cancer: Lung Cancer, Cancer, Respiratory Conditions, Medication, Treatments, Opioids, Evidence-Based Practice, Comparative Effectiveness, Quality of Life, Outcomes, Patient-Centered Outcomes Research
Brown CS, Osborne NH, Kim GY
Comparison of unilateral vs bilateral and staged bilateral vs concurrent bilateral truncal endovenous ablation in the Vascular Quality Initiative.
This study compares outcomes in patients who have undergone unilateral vs bilateral venous ablation procedures or between staged and concurrent bilateral procedures. Data from the Vascular Quality Initiative from 2015 to 2019 was used to investigate immediate postoperative as well as long-term clinical and patient-reported outcomes. A total of 5029 patients were included, of whom 75.2% underwent unilateral procedures. Follow-up was conducted with a median of 227 days after. Unilateral patients were less likely to be female and white and had lower BMI compared with patients undergoing bilateral procedures. In addition, unilateral patients had fewer prior varicose vein treatments and had higher Venous Clinical Severity Scores (VCSS). There were no differences in complications in patients undergoing unilateral vs bilateral procedures. Systemic complications were rare in both groups.
AHRQ-funded; HS000053.
Citation: Brown CS, Osborne NH, Kim GY .
Comparison of unilateral vs bilateral and staged bilateral vs concurrent bilateral truncal endovenous ablation in the Vascular Quality Initiative.
J Vasc Surg Venous Lymphat Disord 2021 Jan;9(1):113-21.e3. doi: 10.1016/j.jvsv.2020.05.008..
Keywords: Cardiovascular Conditions, Chronic Conditions, Surgery, Outcomes, Patient-Centered Outcomes Research, Comparative Effectiveness, Evidence-Based Practice
Prentice JC, Conlin PR, Gellad WF
Capitalizing on prescribing pattern variation to compare medications for type 2 diabetes.
This study used observational quasi-experimental methods using instrumental variables (IVs) to compare the effect of two hypoglycemic medications, sulfonylureas (SUs) and thiazolidinediones (TZDs), on long-term outcomes. It found that individuals who used an SU as a second-line agent experienced significantly more adverse long-term health outcomes than did individuals who started on a TZD.
AHRQ-funded; HS019708.
Citation: Prentice JC, Conlin PR, Gellad WF .
Capitalizing on prescribing pattern variation to compare medications for type 2 diabetes.
Value Health 2014 Dec;17(8):854-62. doi: 10.1016/j.jval.2014.08.2674..
Keywords: Diabetes, Medication, Outcomes, Comparative Effectiveness
Dulai PS, Siegel CA, Colombel JF
Systematic review: monotherapy with antitumour necrosis factor alpha agents versus combination therapy with an immunosuppressive for IBD.
The authors discussed the efficacy and the risks of anti-TNF monotherapy versus combination therapy with an immunosuppressive in patients with IBD. They concluded that the addition of an immunosuppressive to anti-TNF therapy improves treatment efficacy for infliximab in ulcerative colitis and Crohn’s disease. Further, the use of combination therapy appears to add no significant incremental risk for serious infections above that seen with anti-TNF or immunosuppressive monotherapy in most patients.
AHRQ-funded; HS021747.
Citation: Dulai PS, Siegel CA, Colombel JF .
Systematic review: monotherapy with antitumour necrosis factor alpha agents versus combination therapy with an immunosuppressive for IBD.
Gut 2014 Dec;63(12):1843-53. doi: 10.1136/gutjnl-2014-307126.
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Keywords: Comparative Effectiveness, Evidence-Based Practice, Medication, Outcomes, Patient-Centered Outcomes Research, Treatments
Bilchick KC, Stukenborg GJ
Comparative effectiveness of cardiac resynchronization therapy in combination with implantable defibrillator in patients with heart failure and wide QRS duration.
The researchers examined the long-term outcomes among Medicare patients with cardiac resynchronization therapy defibrillators (CRT-D) compared with those receiving standard implantable cardioverter defibrillators. They found that the greatest benefit of CRT-D was in patients with guideline-based class I recommendations for CRT-D. For these patients, there was a 17 percent reduction in risk of death.
AHRQ-funded; HS017693
Citation: Bilchick KC, Stukenborg GJ .
Comparative effectiveness of cardiac resynchronization therapy in combination with implantable defibrillator in patients with heart failure and wide QRS duration.
Am J Cardiol. 2014 Nov 15;114(10):1537-42. doi: 10.1016/j.amjcard.2014.08.017..
Keywords: Comparative Effectiveness, Medicare, Outcomes, Cardiovascular Conditions, Medical Devices
Khazanie P, Hammill BG, Qualls LG
Clinical effectiveness of cardiac resynchronization therapy versus medical therapy alone among patients with heart failure: analysis of the ICD Registry and ADHERE.
The researchers examined associations between cardiac resynchronization therapy with defibrillator (CRT-D) and mortality and readmission among patients with heart failure who received CRT-D in clinical practice, compared with those who received medical therapy alone. They found that CRT-D was associated with lower risks of mortality and readmission than medical therapy alone.
AHRQ-funded; HS021092
Citation: Khazanie P, Hammill BG, Qualls LG .
Clinical effectiveness of cardiac resynchronization therapy versus medical therapy alone among patients with heart failure: analysis of the ICD Registry and ADHERE.
Circ Heart Fail. 2014 Nov;7(6):926-34. doi: 10.1161/circheartfailure.113.000838..
Keywords: Comparative Effectiveness, Heart Disease and Health, Medical Devices, Hospital Readmissions, Outcomes
Spangler EL, Goodney PP, Schanzer A
Outcomes of carotid endarterectomy versus stenting in comparable medical risk patients.
The purpose of this study was to compare risk-stratified outcomes of carotid artery stenting (CAS) and carotid endarterectomy (CEA). Included in the study group were 11,336 patients who underwent isolated primary CEA and 544 who underwent primary CAS. The researchers found that asymptomatic normal- and high-risk patients do equally well after CEA or CAS. However, normal- and high-risk symptomatic patients have substantially worse outcomes with CAS compared with CEA.
AHRQ-funded; HS021581.
Citation: Spangler EL, Goodney PP, Schanzer A .
Outcomes of carotid endarterectomy versus stenting in comparable medical risk patients.
J Vasc Surg 2014 Nov;60(5):1227-31, 31.e1. doi: 10.1016/j.jvs.2014.05.044..
Keywords: Outcomes, Comparative Effectiveness, Risk, Cardiovascular Conditions, Heart Disease and Health
Smith SR
AHRQ Author: Smith SR
Preface to the AHRQ supplement.
AHRQ, through its Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) Research Network, sponsored this supplement to present various strategies in the design, analysis, and conduct of health outcomes studies relevant to rare diseases. The purpose of this supplement is to disseminate illustrative examples of research methods that can be applied to understand health outcomes and potentially to stimulate new patient-centered outcomes studies for rare diseases.
AHRQ-authored.
Citation: Smith SR .
Preface to the AHRQ supplement.
J Gen Intern Med 2014 Aug;29 Suppl 3:S712-3. doi: 10.1007/s11606-014-2922-x.
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Keywords: Comparative Effectiveness, Evidence-Based Practice, Outcomes, Patient-Centered Outcomes Research, Research Methodologies
Garabedian LF, Chu P, Toh S
Potential bias of instrumental variable analyses for observational comparative effectiveness research.
Results of instrumental variable analyses may be biased if the instrument and outcome are related through an unadjusted third variable, an instrument-outcome confounder. The authors review of 187 comparative effectiveness studies using this type of analysis, only 4 considered potential instrument-outcome confounders outside the study data.
AHRQ-funded; 290050016I
Citation: Garabedian LF, Chu P, Toh S .
Potential bias of instrumental variable analyses for observational comparative effectiveness research.
Ann Intern Med. 2014 Jul 15;161(2):131-8. doi: 10.7326/M13-1887..
Keywords: Comparative Effectiveness, Outcomes, Research Methodologies
Friedly JL, Comstock BA, Turner JA
A randomized trial of epidural glucocorticoid injections for spinal stenosis.
The researchers designed the Lumbar Epidural Steroid Injections for Spinal Stenosis trial to compare the effectiveness of epidural injections of glucocorticoids plus anesthetic with injections of anesthetic alone in patients with lumbar spinal stenosis. They found that epidural injection of glucocorticoids plus lidocaine offered minimal or no short-term benefit as compared with lidocaine alone.
AHRQ-funded; HS019222
Citation: Friedly JL, Comstock BA, Turner JA .
A randomized trial of epidural glucocorticoid injections for spinal stenosis.
N Engl J Med. 2014 Jul 3;371(1):11-21. doi: 10.1056/NEJMoa1313265..
Keywords: Comparative Effectiveness, Chronic Conditions, Elderly, Outcomes
Kumamaru H, Judd SE, Curtis JR
Validity of claims-based stroke algorithms in contemporary Medicare data: reasons for geographic and racial differences in stroke (REGARDS) study linked with medicare claims.
The researchers assessed the validity of diagnostic coding algorithms for identifying stroke in the Medicare population by linking data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study to Medicare claims. They found that claims-based algorithms to identify stroke in a contemporary Medicare cohort had high positive predictive value and specificity, supporting their use as outcomes for etiologic and comparative effectiveness studies in similar populations.
AHRQ-funded; HS017731; HS018517.
Citation: Kumamaru H, Judd SE, Curtis JR .
Validity of claims-based stroke algorithms in contemporary Medicare data: reasons for geographic and racial differences in stroke (REGARDS) study linked with medicare claims.
Circ Cardiovasc Qual Outcomes 2014 Jul;7(4):611-9. doi: 10.1161/circoutcomes.113.000743..
Keywords: Stroke, Medicare, Comparative Effectiveness, Outcomes
Schmid CH, Trikalinos Olkin, I
Bayesian network meta-analysis for unordered categorical outcomes with incomplete data.
The researchers developed a Bayesian multinomial network meta-analysis model for unordered (nominal) categorical outcomes that allows for partially observed data in which exact event counts may not be known for each category. Their model properly accounts for correlations of counts in mutually exclusive categories and enables proper comparison and ranking of treatment effects across multiple treatments and multiple outcomes categories.
AHRQ-funded; HS018574.
Citation: Schmid CH, Trikalinos Olkin, I .
Bayesian network meta-analysis for unordered categorical outcomes with incomplete data.
Res Synth Methods 2014 Jun;5(2):162-85. doi: 10.1002/jrsm.1103..
Keywords: Comparative Effectiveness, Outcomes, Data
Friedly JL, Bauer Z, Comstock BA
AHRQ Author: Zhan C, Hsia DC, Trontell A
Challenges conducting comparative effectiveness research: the Clinical and Health Outcomes Initiative in Comparative Effectiveness (CHOICE) experience.
This paper explores the collective experience of the Clinical and Health Outcomes Initiative in Comparative (CHOICE) program, which includes 12 ongoing comparative effectiveness research trials funded by AHRQ. It describes the common features of the CHOICE award studies to summarize the strategies undertaken to address the challenges in conducting comparative effectiveness pragmatic trials and observational studies from various perspectives.
AHRQ-authored; AHRQ-funded; HS019222
Citation: Friedly JL, Bauer Z, Comstock BA .
Challenges conducting comparative effectiveness research: the Clinical and Health Outcomes Initiative in Comparative Effectiveness (CHOICE) experience.
Comp Eff Res. 2014 May;4:1-12..
Keywords: Comparative Effectiveness, Patient-Centered Outcomes Research, Outcomes
Osterman MT, Haynes K, Delzell E
Comparative effectiveness of infliximab and adalimumab for Crohn's disease.
This study compared the effectiveness of infliximab and adalimumab, the two most commonly used anti-tumor necrosis factor agents in patients with Crohn’s disease (CD). It found that both drugs were of similar effectiveness with respect to surgical rates, hospitalization rates, and the percentage of patients remaining on the drugs after 26 weeks.
AHRQ-funded; HS018517
Citation: Osterman MT, Haynes K, Delzell E .
Comparative effectiveness of infliximab and adalimumab for Crohn's disease.
Clin Gastroenterol Hepatol. 2014 May;12(5):811-817.e3. doi: 10.1016/j.cgh.2013.06.010..
Keywords: Comparative Effectiveness, Outcomes, Patient-Centered Outcomes Research, Treatments
Martin BI, Lurie JD, Tosteson AN
Indications for spine surgery: validation of an administrative coding algorithm to classify degenerative diagnoses.
The Spine Patient Outcomes Research Trial (SPORT) provided a unique opportunity to examine the validity of a claims-based algorithm for grouping patients by surgical indication. SPORT enrolled patients for lumbar disc herniation, spinal stenosis, and degenerative spondylolisthesis. The researchers found that their claims-based hierarchical coding algorithm of spine-related medical encounters correctly classified more than 90 percent of Medicare patients into their respective SPORT cohorts.
AHRQ-funded; HS018405
Citation: Martin BI, Lurie JD, Tosteson AN .
Indications for spine surgery: validation of an administrative coding algorithm to classify degenerative diagnoses.
Spine. 2014 Apr 20;39(9):769-79. doi: 10.1097/brs.0000000000000275..
Keywords: Comparative Effectiveness, Surgery, Outcomes, Medicare
Bressler B, Siegel CA
Beware of the swinging pendulum: anti-tumor necrosis factor monotherapy vs combination therapy for inflammatory bowel disease.
An editorial commenting on a study in the same issue by Osterman, et al. in the context of related studies concludes that it is more reasonable to consider slightly modifying the approach to anti-tumor necrosis factor combination therapy as opposed to a full pendulum swing back to monotherapy.
AHRQ-funded; HS021747
Citation: Bressler B, Siegel CA .
Beware of the swinging pendulum: anti-tumor necrosis factor monotherapy vs combination therapy for inflammatory bowel disease.
Gastroenterolog.y 2014 Apr;146(4):884-7. doi: 10.1053/j.gastro.2014.02.018..
Keywords: Comparative Effectiveness, Outcomes, Patient-Centered Outcomes Research, Medication, Chronic Conditions
Jones WS, Dolor RJ, Hasselblad V
Comparative effectiveness of endovascular and surgical revascularization for patients with peripheral artery disease and critical limb ischemia: systematic review of revascularization in critical limb ischemia.
This systematic review found that there is no difference in clinical outcomes for patients with critical limb ischemia treated with endovascular or surgical revascularization. This review of 23 studies found no differences in overall death, amputation, or amputation-free survival at 2 or more years following treatment.
AHRQ-funded; 290200710066I
Citation: Jones WS, Dolor RJ, Hasselblad V .
Comparative effectiveness of endovascular and surgical revascularization for patients with peripheral artery disease and critical limb ischemia: systematic review of revascularization in critical limb ischemia.
Am Heart J. 2014 Apr;167(4):489-498.e7. doi: 10.1016/j.ahj.2013.12.012..
Keywords: Comparative Effectiveness, Outcomes, Surgery, Mortality
Shah TR, Rockman CB, Adelman MA
Nationwide comparative impact of thoracic endovascular aortic repair of acute uncomplicated type B aortic dissections.
The objective of this study was to evaluate the impact of thoracic endovascular aortic repair (TEVAR) on mortality, morbidity, length of stay (LOS), and discharge status on patients with acute uncomplicated Type B aortic dissections (TBAD). It found that TEVAR for acute uncomplicated TBAD was associated with similar in-hospital mortality and renal failure as compared to medical management.
AHRQ-funded; HS019473.
Citation: Shah TR, Rockman CB, Adelman MA .
Nationwide comparative impact of thoracic endovascular aortic repair of acute uncomplicated type B aortic dissections.
Vasc Endovascular Surg. 2014 Apr;48(3):230-3. doi: 10.1177/1538574413518122..
Keywords: Comparative Effectiveness, Outcomes, Cardiovascular Conditions, Healthcare Cost and Utilization Project (HCUP)
Schwenk H, Ramirez-Avila L, Sheu SH
Progressive multifocal leukoencephalopathy in pediatric patients: case report and literature review.
Progressive multifocal leukoencephalopathy is a rare, demyelinating disease of the central nervous system caused by JC virus. Fewer than 30 cases have been reported in HIV- and non-infected children. The researchers report the case of a 15-year-old girl with progressive multifocal leukoencephalopathy and AIDS who presented with nystagmus, dysarthria and ataxia. They also include a literature review.
AHRQ-funded; HS019485.
Citation: Schwenk H, Ramirez-Avila L, Sheu SH .
Progressive multifocal leukoencephalopathy in pediatric patients: case report and literature review.
Pediatr Infect Dis J 2014 Apr;33(4):e99-105. doi: 10.1097/inf.0000000000000237..
Keywords: Comparative Effectiveness, Children/Adolescents, Case Study, Outcomes
Li L, Vollmer WM, Butler MG
A comparison of confounding adjustment methods for assessment of asthma controller medication effectiveness.
Using three confounding adjustment procedures—covariate-adjusted regression, propensity score regression, and high-dimemsional propensity score regression—on a population of 24,680 children with asthma, researchers found that patients treated with leukotriene antagonists were no more likely than those treated with inhaled corticosteroids to experience adverse outcomes.
AHRQ-funded; HS019669
Citation: Li L, Vollmer WM, Butler MG .
A comparison of confounding adjustment methods for assessment of asthma controller medication effectiveness.
Am J Epidemiol. 2014 Mar 1;179(5):648-59. doi: 10.1093/aje/kwt323..
Keywords: Comparative Effectiveness, Outcomes, Children/Adolescents, Asthma, Medication
Al-Khatib SM, Han JY, Edwards R
Do patients with a left ventricular ejection fraction between 30% and 35% benefit from a primary prevention implantable cardioverter defibrillator?
The researchers used data from randomized clinical trials involving patients with systolic heart failure who had received implantable cardioverter-defibrillators and compared outcomes for those whose left ventricular ejection fractions (LVEFs) was between 30 percent and 35 percent with those whose LVEF was less than 30 percent. The sample size was too small to permit any important conclusions.
AHRQ-funded; HS018505
Citation: Al-Khatib SM, Han JY, Edwards R .
Do patients with a left ventricular ejection fraction between 30% and 35% benefit from a primary prevention implantable cardioverter defibrillator?
Int J Cardiol. 2014 Mar 1;172(1):253-4. doi: 10.1016/j.ijcard.2013.12.278..
Keywords: Comparative Effectiveness, Outcomes, Medical Devices, Heart Disease and Health, Chronic Conditions