National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
51 to 75 of 857 Research Studies DisplayedBundy DG, Gaur AH, Billett AL
Preventing CLABSIs among pediatric hematology/oncology inpatients: national collaborative results.
This study assessed the feasibility of a multicenter effort to standardize central line (CL) care and central line-associated bloodstream infection (CLABSI) tracking and to quantify the impact of standardizing these processes on CLABSI rates. It found a reduction of 28 percent in the mean CLABSI rate from 2.85 to 2.04 per 1,000 CL days over almost 3 years.
AHRQ-funded; HS019590
Citation: Bundy DG, Gaur AH, Billett AL .
Preventing CLABSIs among pediatric hematology/oncology inpatients: national collaborative results.
Pediatrics. 2014 Dec;134(6):e1678-85. doi: 10.1542/peds.2014-0582..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Quality of Care, Children/Adolescents
Broder-Fingert S, Ferrone CF, Giauque A
Residents' knowledge and comfort with caring for children with autism spectrum disorder.
The authors evaluated a cohort of pediatric residents’ knowledge of and comfort with caring for children with autism spectrum disorder (ASD). Their data suggest that more education is needed to increase resident competence in caring for individuals with ASD. Residents reported very low rates of direct communication with patients with ASD and no residents had used pictures to communicate with these patients. The authors found it concerning that few residents had found resources to help these patients with their communication needs. At the same time, comfort with using pictures to communicate was scored higher than other domains.
AHRQ-funded; HS000063.
Citation: Broder-Fingert S, Ferrone CF, Giauque A .
Residents' knowledge and comfort with caring for children with autism spectrum disorder.
Clin Pediatr 2014 Dec;53(14):1390-2. doi: 10.1177/0009922814526982.
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Keywords: Autism, Children/Adolescents, Education: Continuing Medical Education, Children/Adolescents, Clinician-Patient Communication
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
Saloner B, Matone M, Kreider AR
Second-generation antipsychotic use among stimulant-using children, by organization of Medicaid mental health.
The authors compared differences in second-generation antipsychotic utilization among Medicaid-enrolled children across fee-for-service, integrated managed care, and managed behavioral health carve-out organizational structures. They found that carve-outs, versus other arrangements, were associated with lower second-generation antipsychotic use.
AHRQ-funded; HS020269; HS018550.
Citation: Saloner B, Matone M, Kreider AR .
Second-generation antipsychotic use among stimulant-using children, by organization of Medicaid mental health.
Psychiatr Serv 2014 Dec;65(12):1458-64. doi: 10.1176/appi.ps.201300574.
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Keywords: Children/Adolescents, Healthcare Utilization, Medicaid, Medication, Behavioral Health
Hollingsworth JM, Birkmeyer JD, Ye Z
Specialty-specific trends in the prevalence and distribution of outpatient surgery: implications for payment and delivery system reforms.
The authors sought to assess the prevalence and distribution of outpatient surgery across specialties. They found that several specialties - urology, gastroenterology, plastic surgery, and ophthalmology - perform most of their cases in outpatient settings. They suggested that incorporating these findings into the design of future payment and delivery system reforms will help to ensure adequate surgeon exposure to the efficiency gains that evolve from them.
AHRQ-funded; HS020927; HS018346.
Citation: Hollingsworth JM, Birkmeyer JD, Ye Z .
Specialty-specific trends in the prevalence and distribution of outpatient surgery: implications for payment and delivery system reforms.
Surg Innov 2014 Dec;21(6):560-5. doi: 10.1177/1553350613520515.
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Keywords: Ambulatory Care and Surgery, Surgery, Healthcare Delivery, Payment
King HA, Jeffreys AS, McVay MA
Spouse health behavior outcomes from a randomized controlled trial of a spouse-assisted lifestyle change intervention to improve patient low-density lipoprotein cholesterol.
The authors evaluated spouse health behavior outcomes from a randomized controlled trial of a spouse-assisted lifestyle intervention to reduce patient low-density lipoprotein cholesterol and improve patient health behaviors. Participants were 251 spouses of patients from the Durham Veterans Affairs Medical Center. At 11 months, there were no differences in spouse outcomes between intervention and usual care groups for moderate intensity physical activity or dietary intake. To improve spouse outcomes, the authors recommended couple interventions to include spouse behavior change goals and reciprocal support between patients and spouses.
AHRQ-funded; HS000079.
Citation: King HA, Jeffreys AS, McVay MA .
Spouse health behavior outcomes from a randomized controlled trial of a spouse-assisted lifestyle change intervention to improve patient low-density lipoprotein cholesterol.
J Behav Med 2014 Dec;37(6):1102-7. doi: 10.1007/s10865-014-9559-4.
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Keywords: Heart Disease and Health, Family Health and History, Lifestyle Changes, Patient-Centered Outcomes Research
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
Fiscella K
Tackling disparities in influenza vaccination in primary care: it takes a team.
This article discusses a study in the same issue by Maurer. Fiscella describes reasons involving influenza vaccination disparities and points out that the emergence of accountable care organizations creates opportunities for better integration of primary care and public health.
AHRQ-funded; HS022440.
Citation: Fiscella K .
Tackling disparities in influenza vaccination in primary care: it takes a team.
J Gen Intern Med 2014 Dec;29(12):1579-81. doi: 10.1007/s11606-014-2999-2.
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Keywords: Disparities, Influenza, Primary Care, Teams, Vaccination
Vargas Bustamante A, Chen J
The great recession and health spending among uninsured U.S. immigrants: implications for the Affordable Care Act implementation.
This study of the association between the timing of the Great Recession (GR) and health spending among uninsured U.S. immigrants found that the probability of any spending diminished for recent immigrants compared to citizens during the GR. For those with any spending, recent immigrants reported 27 percent higher spending during the GR.
AHRQ-funded; HS022634
Citation: Vargas Bustamante A, Chen J .
The great recession and health spending among uninsured U.S. immigrants: implications for the Affordable Care Act implementation.
Health Serv Res. 2014 Dec;49(6):1900-24. doi: 10.1111/1475-6773.12193..
Keywords: Healthcare Costs, Uninsured, Disparities
Mukamel DB, Haeder SF, Weimer DL
Top-down and bottom-up approaches to health care quality: the impacts of regulation and report cards.
The authors reviewed the extant literature on regulation and report cards. They found evidence of both functional and dysfunctional effects and identified the areas in which additional research would most likely be valuable.
AHRQ-funded; HS021844.
Citation: Mukamel DB, Haeder SF, Weimer DL .
Top-down and bottom-up approaches to health care quality: the impacts of regulation and report cards.
Annu Rev Public Health 2014;35:477-97. doi: 10.1146/annurev-publhealth-082313-115826.
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Keywords: Quality of Care, Policy, Policy, Public Reporting
Trudnak Fowler T, Fairbrother G, Owens P
AHRQ Author: Owens P
Trends in complicated newborn hospital stays & costs, 2002-2009: implications for the future.
The researchers used HCUP data to examine trends from 2002 through 2009 in complicated newborn hospital stays, and to explore the relationship between expected sources of payment and reasons for hospitalizations. They concluded that state Medicaid programs are paying for an increasing proportion of births and costly complicated births, and they suggested that policies to prevent common birth complications have the potential to reduce costs for public programs and improve birth outcomes.
AHRQ-authored.
Citation: Trudnak Fowler T, Fairbrother G, Owens P .
Trends in complicated newborn hospital stays & costs, 2002-2009: implications for the future.
Medicare Medicaid Res Rev 2014;4(4). doi: 10.5600/mmrr.004.04.a03.
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Keywords: Healthcare Costs, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Newborns/Infants
Rangachari P
Using social knowledge networking technology to enable meaningful use of electronic health record technology in hospitals and health systems.
In this paper, Rangachari (1) reviewed the theoretical literatures on technology use & implementation, and identified a framework for understanding & overcoming unintended adverse consequences of implementing Electronic Health Records; (2) outlined a broad project proposal to test the applicability of the framework in enabling "meaningful use" of Electronic Health Records in a healthcare context; and (3) identified strategies for successful implementation of Electronic Health Records in hospitals & health systems, based on the literature review and application.
AHRQ-funded; HS024335.
Citation: Rangachari P .
Using social knowledge networking technology to enable meaningful use of electronic health record technology in hospitals and health systems.
J Hosp Adm 2014 Dec;3(6):66-78. doi: 10.5430/jha.v3n6p66.
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Keywords: Health Systems, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitals, Implementation
Banerjee T, Kim SJ, Astor B
Vascular access type, inflammatory markers, and mortality in incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) study.
The researchers investigated the association between access type and inflammatory marker levels in 583 dialysis patients. They found that central venous catheters, compared with arteriovenous fistulas, are associated with a greater state of inflammation and the association of catheter use and mortality may be mediated by access-induced inflammation.
AHRQ-funded; HS008365
Citation: Banerjee T, Kim SJ, Astor B .
Vascular access type, inflammatory markers, and mortality in incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) study.
Am J Kidney Dis. 2014 Dec;64(6):954-61. doi: 10.1053/j.ajkd.2014.07.010..
Keywords: Kidney Disease and Health, Mortality, Comparative Effectiveness
Pignone MP, Crutchfield TM, Brown PM
Using a discrete choice experiment to inform the design of programs to promote colon cancer screening for vulnerable populations in North Carolina.
This study used a discrete choice experiment (DCE) to learn about how vulnerable individuals in North Carolina value different aspects of CRC screening programs. It found that follow-up cost coverage was most frequently found to be the most important attribute from the DCE (47 percent); followed by test reward/copayment (33 percent).
AHRQ-funded; HS019468.
Citation: Pignone MP, Crutchfield TM, Brown PM .
Using a discrete choice experiment to inform the design of programs to promote colon cancer screening for vulnerable populations in North Carolina.
BMC Health Serv Res 2014 Nov 30;14:611. doi: 10.1186/s12913-014-0611-4..
Keywords: Cancer: Colorectal Cancer, Health Promotion, Rural Health, Screening, Social Determinants of Health
Rodrigue JR, Fleishman A, Fitzpatrick S
Organ donation knowledge, willingness, and beliefs of motor vehicle clerks.
This study assessed the donation knowledge, willingness, and beliefs of MV clerks and their association with demographic characteristics. It found that most clerks believed that people should register as organ donors. Whites and already registered donors were more likely than minorities and nonregistered clerks to believe others should register as donors.
AHRQ-funded; HS022061; HS024204.
Citation: Rodrigue JR, Fleishman A, Fitzpatrick S .
Organ donation knowledge, willingness, and beliefs of motor vehicle clerks.
Transplantation 2014 Nov 27;98(10):1025-8. doi: 10.1097/tp.0000000000000424..
Keywords: Racial and Ethnic Minorities, Registries, Education: Patient and Caregiver
Gerber DE, Laccetti AL, Xuan L
Impact of prior cancer on eligibility for lung cancer clinical trials.
A prior cancer diagnosis often excludes patients from cancer clinical trials. Lung cancer patients were used to determine estimated impact on trial accrual. This study found that patients previously diagnosed with cancer were excluded in more than two-thirds of lung cancer trials. More research is needed to understand the basis of this policy.
AHRQ-funded; HS022418
Citation: Gerber DE, Laccetti AL, Xuan L .
Impact of prior cancer on eligibility for lung cancer clinical trials.
J Natl Cancer Inst. 2014 Nov;106(11). doi: 10.1093/jnci/dju302..
Keywords: Cancer: Lung Cancer, Policy, Cancer, Diagnostic Safety and Quality
Mold JW, Aspy CB, Smith PD
Leveraging practice-based research networks to accelerate implementation and diffusion of chronic kidney disease guidelines in primary care practices: a prospective cohort study.
This study was conducted to determine whether practice-based research networks (PBRNs) could increase dissemination, implementation, and diffusion of evidence-based treatment guidelines for chronic kidney disease by leveraging early adopter practices. After the intervention, the initial four PBRNs increased the use of ACEIs/ARBs, discontinuation of NSAIDs, testing for anemia, and testing and/or treatment for vitamin D deficiency. Most were able to recruit two additional practices, which also increased their use of ACEIs/ARBs and testing and/or treatment of vitamin D deficiency. The researchers concluded that, with some assistance, early adopter practices can facilitate the diffusion of evidence-based approaches to other practices.
AHRQ-funded; HS019945.
Citation: Mold JW, Aspy CB, Smith PD .
Leveraging practice-based research networks to accelerate implementation and diffusion of chronic kidney disease guidelines in primary care practices: a prospective cohort study.
Implement Sci 2014 Nov 23;9:169. doi: 10.1186/s13012-014-0169-x.
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Keywords: Practice-Based Research Network (PBRN), Primary Care, Kidney Disease and Health, Chronic Conditions, Guidelines, Implementation
Henke RM, Wier LM, Marder WD
AHRQ Author: Friedman BS, Wong HS
Geographic variation in cesarean delivery in the United States by payer.
This study aimed (1) to determine whether the geographic variation in cesarean delivery rate is consistent for private insurance and Medicaid, and (2) to identify the patient, population, and market factors associated with cesarean rate and determine if these factors vary by payer. It concluded that factors associated with geographic variation in cesarean delivery, a frequent and high-resource inpatient procedure, vary somewhat by payer.
AHRQ-authored; AHRQ-funded; 290200600009C.
Citation: Henke RM, Wier LM, Marder WD .
Geographic variation in cesarean delivery in the United States by payer.
BMC Pregnancy Childbirth 2014 Nov 19;14:387. doi: 10.1186/s12884-014-0387-x.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Health Insurance, Labor and Delivery, Medicaid, Pregnancy
Angier H, Gregg J, Gold R
Understanding how low-income families prioritize elements of health care access for their children via the optimal care model.
The researchers explored low-income parents’ perspectives on accessing health care. Interviews with 29 Oregon parents revealed that affordability and limited availability were seen as barriers to care; while a continuous relationship with a health care provider helped them overcome these barriers. Parents also described the difficult decisions they made between affordability and acceptability in order to get the best care they could for their children.
AHRQ-funded; HS018569.
Citation: Angier H, Gregg J, Gold R .
Understanding how low-income families prioritize elements of health care access for their children via the optimal care model.
BMC Health Serv Res 2014 Nov 19;14:585. doi: 10.1186/s12913-014-0585-2..
Keywords: Access to Care, Children/Adolescents, Low-Income, Social Determinants of Health, Healthcare Costs
Crandall CJ, Newberry SJ, Diamant A
Comparative effectiveness of pharmacologic treatments to prevent fractures: an updated systematic review.
This article updates a 2007 evidence review focusing on the comparative benefits and risks of short- and long-term pharmacologic treatments for low bone density. It concludes that good quality evidence supports that several medications for bone density in osteoporotic range and/or pre-existing hip or vertebral fracture reduce fracture risk.
AHRQ-funded; 290200710062I
Citation: Crandall CJ, Newberry SJ, Diamant A .
Comparative effectiveness of pharmacologic treatments to prevent fractures: an updated systematic review.
Ann Intern Med. 2014 Nov 18;161(10):711-23. doi: 10.7326/M14-0317..
Keywords: Comparative Effectiveness, Medication, Injuries and Wounds
Heisler M, Choi H, Palmisano G
Comparison of community health worker-led diabetes medication decision-making support for low-income Latino and African American adults with diabetes using e-health tools versus print materials: a randomized, controlled trial.
This study compared outcomes between community health worker (CHW) use of a tailored, interactive, Web-based, tablet computer-delivered tool specifically developed for the study and use of printed educational materials. In a population of low-income Latino and African American adults with diabetes and relatively low levels of formal education, participants in both CHW-led interventions reported mostly similar improvements in outcomes over 3 months.
AHRQ-funded; HS019256
Citation: Heisler M, Choi H, Palmisano G .
Comparison of community health worker-led diabetes medication decision-making support for low-income Latino and African American adults with diabetes using e-health tools versus print materials: a randomized, controlled trial.
Ann Intern Med. 2014 Nov 18;161(10 Suppl):S13-22. doi: 10.7326/m13-3012..
Keywords: Health Information Technology (HIT), Diabetes, Decision Making, Outcomes, Social Determinants of Health
Davis AE, Mehrotra S, Ladner DP
Changes in geographic disparity in kidney transplantation since the final rule.
The researchers assessed the significance of changes of geographic disparities for four metrics since the 1998 adoption of HHS Final Rule’s emphasizing objective priority criteria: waiting times, transplant rates, pre-transplant mortality, and organ quality. They found that the ranges of the four metrics have worsened by approximately 30% or more after the Final Rule at both the regional and donor service area levels.
AHRQ-funded; HS021078.
Citation: Davis AE, Mehrotra S, Ladner DP .
Changes in geographic disparity in kidney transplantation since the final rule.
Transplantation 2014 Nov 15;98(9):931-6. doi: 10.1097/tp.0000000000000446..
Keywords: Transplantation, Disparities, Policy, Outcomes
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
Sumner W, Stwalley DL, Asaro PV
Adding flexible temporal constraints to identify chronic comorbid conditions in ambulatory claims data.
The researchers particularly wanted to increase the temporal flexibility of comorbidity definitions in response to common documentation patterns. They report the development and testing of a chronic disease list with temporal criteria for analyzing outpatient claims data. They concluded that temporal constraints applied to ambulatory claims may improve comorbid condition categorization.
AHRQ-funded; HS019455.
Citation: Sumner W, Stwalley DL, Asaro PV .
Adding flexible temporal constraints to identify chronic comorbid conditions in ambulatory claims data.
AMIA Annu Symp Proc 2014 Nov 14;2014:1088-97..
Keywords: Chronic Conditions, Data, Health Insurance
Goss FR, Plasek JM, Lau JJ
An evaluation of a natural language processing tool for identifying and encoding allergy information in emergency department clinical notes.
This paper presents early experience and preliminary findings in developing an allergy module for a general natural language processing (NLP) system, named Medical Text Extraction, Reasoning, and Mapping System (MTERMS), to extract and encode allergy information from clinical text. The preliminary results demonstrate the feasibility using NLP to extract and encode allergy information from clinical notes.
AHRQ-funded; HS022728.
Citation: Goss FR, Plasek JM, Lau JJ .
An evaluation of a natural language processing tool for identifying and encoding allergy information in emergency department clinical notes.
AMIA Annu Symp Proc 2014 Nov 14;2014:580-8..
Keywords: Health Information Technology (HIT), Electronic Health Records (EHRs), Emergency Medical Services (EMS), Emergency Department