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 25 of 57 Research Studies DisplayedBobb JF, Obermeyer Z, Wang Y
Cause-specific risk of hospital admission related to extreme heat in older adults.
The purpose of this study was to identify possible causes of hospital admissions during extreme heat events and to estimate their risks using historical data. The investigators found that among older adults, periods of extreme heat were associated with increased risk of hospitalization for fluid and electrolyte disorders, renal failure, urinary tract infection, septicemia, and heat stroke. They noted however, that the absolute risk increase was small and of uncertain clinical importance.
AHRQ-funded; HS021991.
Citation: Bobb JF, Obermeyer Z, Wang Y .
Cause-specific risk of hospital admission related to extreme heat in older adults.
JAMA 2014 Dec 24-31;312(24):2659-67. doi: 10.1001/jama.2014.15715..
Keywords: Elderly, Hospitalization, Risk
Vyas A, Madhavan S, Sambamoorthi U
Association between persistence with mammography screening and stage at diagnosis among elderly women diagnosed with breast cancer.
The objective of this study is to determine the association between persistence with mammography screening and stage at breast cancer (BC) diagnosis among elderly women. It found that, as compared to women who were not persistent with mammography screening, women who were persistent with mammography screening were significantly more likely to be diagnosed at earlier stages of BC.
AHRQ-funded; HS018622.
Citation: Vyas A, Madhavan S, Sambamoorthi U .
Association between persistence with mammography screening and stage at diagnosis among elderly women diagnosed with breast cancer.
Breast Cancer Res Treat 2014 Dec;148(3):645-54. doi: 10.1007/s10549-014-3204-3..
Keywords: Cancer, Cancer: Breast Cancer, Diagnostic Safety and Quality, Elderly, Prevention, Screening, Women
McGarry BE, Temkin-Greener H, Li Y
Role of race and ethnicity in private long-term care insurance ownership.
The authors sought to determine if racial/ethnic disparities exist in the ownership of private long-term care insurance (LTCI) among current Medicare beneficiaries. They found that 12.3% of Blacks and 5.8% of Hispanics, compared with 20.2% of Whites, reported having LTCI coverage and that Hispanics were 48% less likely to have LTCI compared with Whites. Hispanic women were 81% less likely to be insured compared with White women.
AHRQ-funded; HS000044.
Citation: McGarry BE, Temkin-Greener H, Li Y .
Role of race and ethnicity in private long-term care insurance ownership.
Gerontologist 2014 Dec;54(6):1001-12. doi: 10.1093/geront/gnt102.
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Keywords: Disparities, Elderly, Health Insurance, Long-Term Care, Racial and Ethnic Minorities
Aschbrenner KA, Pepin R, Mueser KT
A mixed methods exploration of family involvement in medical care for older adults with serious mental illness.
This study explored family involvement in medical care for older adults with serious mental illness (SMI). The investigators found that approximately 89% of older adults with SMI reported family involvement in at least one aspect of their medical care (e.g., medication reminders, medical decision making). However, many family members reported that they were rarely involved in their relative's medical visits, and most did not perceive a need to be involved during routine care.
AHRQ-funded; HS021695.
Citation: Aschbrenner KA, Pepin R, Mueser KT .
A mixed methods exploration of family involvement in medical care for older adults with serious mental illness.
Int J Psychiatry Med 2014;48(2):121-33. doi: 10.2190/PM.48.2.e..
Keywords: Caregiving, Elderly, Behavioral Health, Patient and Family Engagement
Albrecht JS, Gruber-Baldini AL, Hirshon JM
Hospital discharge instructions: comprehension and compliance among older adults.
The purpose of this prospective cohort study was to quantify the prevalence of non-comprehension and non-compliance with discharge instructions and to identify associated patient characteristics. The investigators concluded that non-comprehension of discharge instructions among older adults was prevalent, multi-factorial, and varies by domain.
AHRQ-funded; HS021068.
Citation: Albrecht JS, Gruber-Baldini AL, Hirshon JM .
Hospital discharge instructions: comprehension and compliance among older adults.
J Gen Intern Med 2014 Nov;29(11):1491-8. doi: 10.1007/s11606-014-2956-0..
Keywords: Elderly, Health Literacy, Hospital Discharge, Patient Adherence/Compliance
Arvold ND, Wang Y, Zigler C
Hospitalization burden and survival among older glioblastoma patients.
The researchers performed a retrospective cohort study among patients aged 65 years and older with glioblastoma diagnosed between 1999 and 2007. They found that higher comorbidity score and black race were associated with an increased risk of being hospitalized for at least 25% of remaining life, whereas radiation, temozolomide, and extensive surgery were associated with a decreased risk.
AHRQ-funded; HS021991.
Citation: Arvold ND, Wang Y, Zigler C .
Hospitalization burden and survival among older glioblastoma patients.
Neuro Oncol 2014 Nov;16(11):1530-40. doi: 10.1093/neuonc/nou060.
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Keywords: Cancer, Elderly, Hospitalization, Mortality, Quality of Life
Lyles CR, Schafer AL, Seligman HK
Income, food insecurity, and osteoporosis among older adults in the 2007-2008 National Health and Nutrition Examination Survey (NHANES).
The researchers investigated osteoporosis and low socioeconomic status (SES). They concluded that income and food insecurity may have significant implications not just for immediate nutritional outcomes, but also for conditions such as osteoporosis that develop over the lifespan.
AHRQ-funded; HS022408.
Citation: Lyles CR, Schafer AL, Seligman HK .
Income, food insecurity, and osteoporosis among older adults in the 2007-2008 National Health and Nutrition Examination Survey (NHANES).
J Health Care Poor Underserved 2014 Nov;25(4):1530-41. doi: 10.1353/hpu.2014.0174.
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Keywords: Elderly, Nutrition, Osteoporosis, Social Determinants of Health, Low-Income
Abara WE, Smith L, Zhang S
The influence of race and comorbidity on the timely initiation of antiretroviral therapy among older persons living with HIV/AIDS.
In this article, the investigators examined whether the timely initiation of antiretroviral therapy (ART) differed by race and comorbidity among older (>/= 50 years) people living with HIV/AIDS (PLWHA). The investigators concluded that comorbidities affected timely ART initiation in older PLWHA. They asserted that older PLWHA may benefit from integrating and coordinating HIV care with care for other comorbidities and the development of ART treatment guidelines specific to this population.
AHRQ-funded; HS019470.
Citation: Abara WE, Smith L, Zhang S .
The influence of race and comorbidity on the timely initiation of antiretroviral therapy among older persons living with HIV/AIDS.
Am J Public Health 2014 Nov;104(11):e135-41. doi: 10.2105/ajph.2014.302227..
Keywords: Elderly, Human Immunodeficiency Virus (HIV), Racial and Ethnic Minorities
Shear TC, Balachandran JS, Mokhlesi B
Risk of sleep apnea in hospitalized older patients.
This study assessed the prevalence of undiagnosed obstructive sleep apnea (OSA) among general medical inpatients and to investigate whether OSA risk is associated with in-hospital sleep quantity and quality. It found that two of every 5 inpatients older than 50 years screened at high risk for OSA. Those screening at high risk have worse in-hospital sleep quantity and quality.
AHRQ-funded; HS016967.
Citation: Shear TC, Balachandran JS, Mokhlesi B .
Risk of sleep apnea in hospitalized older patients.
J Clin Sleep Med 2014 Oct 15;10(10):1061-6. doi: 10.5664/jcsm.4098..
Keywords: Elderly, Sleep Problems, Risk, Respiratory Conditions
Goldman LE, Sarkar U, Kessell E
Support from hospital to home for elders: a randomized trial.
The researchers studied a peridischarge, nurse-led intervention combined with telephone follow-up designed to reduce readmissions among patients who were 55 or older. They found that the nurse-led, in-hospital discharge support intervention did not show a reduction in readmissions or ED visits among 700 diverse, low-income older adults at a safety-net hospital.
AHRQ-funded; HS018090.
Citation: Goldman LE, Sarkar U, Kessell E .
Support from hospital to home for elders: a randomized trial.
Ann Intern Med 2014 Oct 7;161(7):472-81. doi: 10.7326/m14-0094..
Keywords: Hospital Discharge, Hospital Readmissions, Emergency Department, Elderly, Social Determinants of Health, Nursing
Lucas JA, Chakravarty S, Bowblis JR
Antipsychotic medication use in nursing homes: a proposed measure of quality.
There is an important need for a more specific measure of quality related to antipsychotic medication (APM) use. This paper proposes such a measure, compares it with the APM quality measure introduced by CMS in 2012 and examines variation in these two measures across resident and facility characteristics using a multi-state case demonstration of long-stay NH residents.
AHRQ-funded; HS021112.
Citation: Lucas JA, Chakravarty S, Bowblis JR .
Antipsychotic medication use in nursing homes: a proposed measure of quality.
Int J Geriatr Psychiatry 2014 Oct;29(10):1049-61. doi: 10.1002/gps.4098..
Keywords: Medication, Nursing Homes, Elderly, Quality Measures, Quality Measures
Safford MM, Barasch A, Curtis JR
Bisphosphonates and hip and nontraumatic subtrochanteric femoral fractures in the Veterans Health Administration.
This study examined associations between bisphosphonate use and nontraumatic subtrochanteric (NTST) femoral fractures and hip fractures in the Veterans Health Administration. It found that nontraumatic subtrochanteric femoral fractures were uncommon, and longer bisphosphonate use was associated with lower (not higher) risk. In men, risks of NTST femoral fractures associated with bisphosphonate treatment may be low in contrast to substantial protective benefits for hip fracture.
AHRQ-funded; HS016956; HS018517.
Citation: Safford MM, Barasch A, Curtis JR .
Bisphosphonates and hip and nontraumatic subtrochanteric femoral fractures in the Veterans Health Administration.
J Clin Rheumatol 2014 Oct;20(7):357-62. doi: 10.1097/rhu.0000000000000170..
Keywords: Elderly, Injuries and Wounds, Risk, Medication, Adverse Events
Lairson DR, Parikh RC, Cormier JN
Cost-utility analysis of chemotherapy regimens in elderly patients with stage III colon cancer.
The authors investigated community-level evidence on the effectiveness and cost effectiveness of treatment for stage III colon cancer for elderly patients among those receiving no chemotherapy, 5-fluorouracil (5-FU), and FOLFOX (5-FU + oxaliplatin). They concluded that FOLFOX appears more effective and cost effective than other strategies for colon cancer treatment of older patients, with results being sensitive to age.
AHRQ-funded; HS018956.
Citation: Lairson DR, Parikh RC, Cormier JN .
Cost-utility analysis of chemotherapy regimens in elderly patients with stage III colon cancer.
Pharmacoeconomics 2014 Oct;32(10):1005-13. doi: 10.1007/s40273-014-0180-8.
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Keywords: Cancer: Colorectal Cancer, Comparative Effectiveness, Healthcare Costs, Elderly, Patient-Centered Outcomes Research
Kahvecioglu D, Ramiah K, McMaughan D
Multidrug-resistant organism infections in US nursing homes: a national study of prevalence, onset, and transmission across care settings, October 1, 2010-December 31, 2011.
The investigators sought to understand the prevalence of multidrug-resistant organism (MDRO) infections among nursing home (NH) residents and the potential for their spread between NHs and acute care hospitals (ACHs). They found that, although NHs are the most likely setting where residents would acquire MDROs after admission to an NH, a significant fraction of NH residents acquire MDRO infection at ACHs, suggesting a need for effective MDRO infection control for NH residents with simultaneous, cooperative interventions among NHs and ACHs in the same community.
AHRQ-funded; HS019989.
Citation: Kahvecioglu D, Ramiah K, McMaughan D .
Multidrug-resistant organism infections in US nursing homes: a national study of prevalence, onset, and transmission across care settings, October 1, 2010-December 31, 2011.
Infect Control Hosp Epidemiol 2014 Oct;35 Suppl 3:S48-55. doi: 10.1086/677835.
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Keywords: Elderly, Healthcare-Associated Infections (HAIs), Medication, Nursing Homes, Patient Safety
Mixon AS, Neal E, Bell S
Care transitions: a leverage point for safe and effective medication use in older adults--a mini-review.
The authors discuss medication adherence in older adults across the continuum of care, describing reasons for nonadherence, methods to assess adherence, and tools to improve adherence, with particular focus on emerging techniques and technologies.
AHRQ-funded; HS019598.
Citation: Mixon AS, Neal E, Bell S .
Care transitions: a leverage point for safe and effective medication use in older adults--a mini-review.
Gerontology 2015;61(1):32-40. doi: 10.1159/000363765.
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Keywords: Elderly, Hospital Discharge, Medication: Safety, Medication, Patient Adherence/Compliance
Parmar AD, Coutin MD, Vargas GM
Cost-effectiveness of elective laparoscopic cholecystectomy versus observation in older patients presenting with mild biliary disease.
The objective was to determine the threshold for probability of recurrent symptoms at which elective cholecystectomy became the most effective and cost-effective options for older patients with mild biliary disease. This procedure was more effective than observation when the probability of continued symptoms exceeded 45.3 percent; when the probability exceeded 82.7 percent, the procedure became more cost-effective as well.
AHRQ-funded; HS022134
Citation: Parmar AD, Coutin MD, Vargas GM .
Cost-effectiveness of elective laparoscopic cholecystectomy versus observation in older patients presenting with mild biliary disease.
J Gastrointest Surg. 2014 Sep;18(9):1616-22. doi: 10.1007/s11605-014-2570-9..
Keywords: Comparative Effectiveness, Healthcare Costs, Elderly, Surgery
Vargas GM, Parmar AD, Sheffield KM
Impact of liver-directed therapy in colorectal cancer liver metastases.
This study evaluated the use of liver resection, ablation, and chemoembolization (LDT) in older patients presenting with metastatic colorectal cancer in the setting of improved chemotherapy. It found that many older patients deemed to be appropriate candidates for resection of the primary tumor and receipt of systemic chemotherapy did not receive LDT.
AHRQ-funded; HS022134
Citation: Vargas GM, Parmar AD, Sheffield KM .
Impact of liver-directed therapy in colorectal cancer liver metastases.
J Surg Res. 2014 Sep;191(1):42-50. doi: 10.1016/j.jss.2014.05.070..
Keywords: Comparative Effectiveness, Patient-Centered Outcomes Research, Elderly, Surgery
Abrahamson K, Mueller C, Davila HW
Nurses as boundary-spanners in reducing avoidable hospitalizations among nursing home residents.
The researchers interviewed 76 nurses working at 38 nursing homes that were implementing quality improvement projects to reduce avoidable hospitalizations. They explored the role of the nurse as boundary-spanner between the organizational goals of the nursing home and external stakeholder systems and how that influences the nursing staff experience.
AHRQ-funded; HS018464
Citation: Abrahamson K, Mueller C, Davila HW .
Nurses as boundary-spanners in reducing avoidable hospitalizations among nursing home residents.
Res Gerontol Nurs. 2014 Sep-Oct;7(5):235-43. doi: 10.3928/19404921-20140519-01..
Keywords: Nursing Homes, Long-Term Care, Elderly, Quality of Care, Quality Improvement
Buys DR, Roth DL, Ritchie CS
Nutritional risk and body mass index predict hospitalization, nursing home admissions, and mortality in community-dwelling older adults: results from the UAB Study of Aging with 8.5 years of follow-up.
This study finds that nutritional risk was prospectively associated with all-cause and nonsurgical hospitalizations and with nursing home admission and mortality in unadjusted models. After adjusting for other risk factors, the association between high nutritional risk and all-cause and nonsurgical hospitalizations remained significant.
AHRQ-funded; HS013852
Citation: Buys DR, Roth DL, Ritchie CS .
Nutritional risk and body mass index predict hospitalization, nursing home admissions, and mortality in community-dwelling older adults: results from the UAB Study of Aging with 8.5 years of follow-up.
J Gerontol A Biol Sci Med Sci. 2014 Sep;69(9):1146-53. doi: 10.1093/gerona/glu024..
Keywords: Nutrition, Hospitalization, Elderly, Long-Term Care, Mortality
Wang F, Skubic M, Rantz M
Quantitative gait measurement with pulse-Doppler radar for passive in-home gait assessment.
The researchers proposed and validated a low-cost Doppler radar system for passive and continuous in-home gait assessment. Using signal processing techniques, they estimated human torso velocity and leg swing for step recognition. They found that the radar system has achieved a high accuracy on the step time estimation, while the walking speed estimation is systematically affected by the walking path direction.
AHRQ-funded; HS018477.
Citation: Wang F, Skubic M, Rantz M .
Quantitative gait measurement with pulse-Doppler radar for passive in-home gait assessment.
IEEE Trans Biomed Eng 2014 Sep;61(9):2434-43. doi: 10.1109/tbme.2014.2319333..
Keywords: Health Information Technology (HIT), Patient Safety, Falls, Elderly
Baillargeon J, Urban RJ, Kuo YF
Risk of myocardial infarction in older men receiving testosterone therapy.
The purpose of this paper was to examine the risk of myocardial infarction (MI) in a population-based cohort of older men receiving intramuscular testosterone. The investigators found that older men who were treated with intramuscular testosterone did not appear to have an increased risk of MI. For men with high MI risk, testosterone use was modestly protective against MI.
AHRQ-funded; HS022134.
Citation: Baillargeon J, Urban RJ, Kuo YF .
Risk of myocardial infarction in older men receiving testosterone therapy.
Ann Pharmacother 2014 Sep;48(9):1138-44. doi: 10.1177/1060028014539918..
Keywords: Cardiovascular Conditions, Elderly, Men's Health, Heart Disease and Health, Risk
Makris UE, Abrams RC, Gurland B
Management of persistent pain in the older patient: a clinical review.
The purpose of this study was to 1.) Describe barriers to the management of persistent pain among older adults; 2.) Summarize current management approaches, including pharmacologic and nonpharmacologic modalities; 3.) Present rehabilitative approaches; and 4.) Highlight aspects of the patient-physician relationship that can help to improve treatment outcomes.
AHRQ-funded; HS020648.
Citation: Makris UE, Abrams RC, Gurland B .
Management of persistent pain in the older patient: a clinical review.
JAMA 2014 Aug 27;312(8):825-36. doi: 10.1001/jama.2014.9405..
Keywords: Care Management, Chronic Conditions, Elderly, Medication, Treatments
Leung LA, Swaminathan S, Trivedi AN
Diabetes diagnosis and exercise initiation among older Americans.
The investigators sought to determine whether exercise participation increased following a new diagnosis of diabetes using a sample of U.S. individuals aged 50 and over who did not report exercise prior to diagnosis. They found that over 35% of persons with a new diagnosis of diabetes initiated moderate or vigorous exercise in the year following their diagnosis.
AHRQ-funded; HS000011.
Citation: Leung LA, Swaminathan S, Trivedi AN .
Diabetes diagnosis and exercise initiation among older Americans.
Prev Med 2014 Aug;65:128-32. doi: 10.1016/j.ypmed.2014.05.001.
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Keywords: Diabetes, Diagnostic Safety and Quality, Elderly, Lifestyle Changes, Patient Self-Management
Austrom MG, Lu YY, Perkins AJ
Impact of noncaregiving-related stressors on informal caregiver outcomes.
The researchers studied the most stressful events experienced by spouse caregivers of older adults with Alzheimer s disease during a 6-month period. They found that caregivers reported no stressors 21.5% of the time, 1-2 stressors 25% of the time, and 3 stressors 53% of the time with 318 stressors reported in total. They concluded that their results can be used to develop targeted intervention and support strategies for spouse caregivers experiencing non-caregiving related stressors as well as the traditional challenges with caregiving-related issues.
AHRQ-funded; HS010884.
Citation: Austrom MG, Lu YY, Perkins AJ .
Impact of noncaregiving-related stressors on informal caregiver outcomes.
Am J Alzheimers Dis Other Demen 2014 Aug;29(5):426-32. doi: 10.1177/1533317513518652.
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Keywords: Caregiving, Dementia, Elderly, Stress
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