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 1579 Research Studies DisplayedBeck AF, Henize AW, Klein MD
A data-driven approach to optimizing medical-legal partnership performance and joint advocacy.
This paper discusses ways that medical-legal partnerships (MLPs) have facilitated advocacy at both patient (client) and population levels. MLPs address health-harming legal needs experienced by low-income families. In particular, the article discusses the work of the MLP Cincinnati Child Health-Law Partnership (Child HeLP), a joint initiative that bridges the primary care clinics at Cincinnati Children’s with the Legal Aid Society of Greater Cincinnati (LASGC). The authors found that Child HeLP referral was associated with a 38% reduction in hospitalizations. They discuss their use of quality improvement (QI) methods and statistical process (SPC) charts to optimize their partnership and facilitate identification of patterns amenable to population-level action and policy change. They also discuss how additional clinical-community partnerships have followed the Child HeLP model. There have been 10,190 referrals to legal partners for 7,801 children since Child HeLP’s inception in 2008. The most common reasons for referral are housing instability/adverse housing quality (~40%), public benefit denials or delays (~25%), and unmet educational needs (~20%). Referrals have resulted in an estimated $1,360,000 in recovered benefits and improvements in housing conditions, educational achievement, and other benefits.
AHRQ-funded; HS027996.
Citation: Beck AF, Henize AW, Klein MD .
A data-driven approach to optimizing medical-legal partnership performance and joint advocacy.
J Law Med Ethics 2023 Winter; 51(4):880-88. doi: 10.1017/jme.2023.158..
Keywords: Quality Improvement, Quality of Care, Policy
Solberg LI, Ziegenfuss JY, Rivard RL
Is there room for individual patient-specified preferences in the patient-reported outcome measurement revolution?
The goal of this study was to test the feasibility of collecting qualitative patient-preferred goals and its feasibility as an addition to a standardized process for collecting quantitative composite patient-reported outcome measures (PROMs) from patients undergoing knee joint replacement. The study found that joint replacement patients who responded to quantitative PROMS were willing to report on their other preferred outcomes.
AHRQ-funded; HS025618.
Citation: Solberg LI, Ziegenfuss JY, Rivard RL .
Is there room for individual patient-specified preferences in the patient-reported outcome measurement revolution?
J Patient Cent Res Rev 2023 Fall; 10(4):210-18. doi: 10.17294/2330-0698.2017..
Keywords: Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Isbell LM, Graber ML, Rovenpor DR
Influence of comorbid depression and diagnostic workup on diagnosis of physical illness: a randomized experiment.
The purpose of this randomized experiment study was to investigate the influence of comorbid depression on diagnostic accuracy. The researchers utilized an interactive vignette that described a patient with a complex presentation of pernicious anemia. Fifty-nine physician participants were randomized to diagnose either a patient with or without (control) comorbid depression and related behaviors. All other clinical information was identical. Physicians recorded a differential diagnosis, ordered tests, and rated patient likeability. The study found that the patient with comorbid depression was less likeable than the control patient. Accuracy of diagnosis was lower in the depression condition compared to the control condition, but this difference was not statistically significant. Accuracy was lower in the depression condition (vs. control) when physicians ordered less tests, but there was no variation for physicians who ordered more tests.
AHRQ-funded; HS025752.
Citation: Isbell LM, Graber ML, Rovenpor DR .
Influence of comorbid depression and diagnostic workup on diagnosis of physical illness: a randomized experiment.
Diagnosis 2023 Aug; 10(3):257-66. doi: 10.1515/dx-2020-0106..
Keywords: Depression, Behavioral Health
McGuier EA, Kolko DJ, Stadnick NA
Advancing research on teams and team effectiveness in implementation science: an application of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework.
This article described the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, a flexible tool that can facilitate the application of team effectiveness approaches in implementation science. The authors provided an overview of key constructs in team effectiveness research. They also described ways to conceptualize different types of teams and team constructs relevant to implementation within the EPIS framework, and identify future directions for research. Three case examples are used to illustrate the application of EPIS to implementation studies involving teams.
AHRQ-funded; HS026862.
Citation: McGuier EA, Kolko DJ, Stadnick NA .
Advancing research on teams and team effectiveness in implementation science: an application of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework.
Implement Res Pract 2023 Jan-Dec; 4:26334895231190855. doi: 10.1177/26334895231190855..
Keywords: Teams, Implementation, Health Services Research (HSR)
Catchpole K, Cohen T, Alfred M
Human factors integration in robotic surgery.
This study used the example of robotic-assisted surgery (RAS) to explore the methodological and practical challenges of technology integration in surgery, provide examples of evidence-based improvements, and discuss the importance of systems engineering and clinical human factors research and practice. The authors reviewed studies on workload, communication, workflow, workspace, and coordination in robotic surgery, and then discuss the potential for improvement that these studies suggest within the wider healthcare system. They concluded that there is a growing need to understand and develop approaches to safety and quality improvement through human-systems integration at the frontline of care.
AHRQ-funded; HS026491.
Citation: Catchpole K, Cohen T, Alfred M .
Human factors integration in robotic surgery.
Hum Factors 2024 Mar; 66(3):683-700. doi: 10.1177/00187208211068946..
Keywords: Surgery
Amu-Nnadi CN, Ross ES, Garcia NH
Health system integration and cancer center access for rural hospitals.
This study’s goal was to assess health system integration and cancer center access for rural hospitals. The authors compared health systems with and without cancer centers based on rural hospital presence. They found that 90% of cancer centers are in a health system, and 72% of health systems (434/607) have a cancer center. Larger health systems with more trainees more often have cancer centers but are no more likely to include rural hospitals (11% vs 6%). The minority of cancer centers not in health systems (N = 95) more often serve low complexity patient populations in non-metropolitan areas.
AHRQ-funded; HS013852.
Citation: Amu-Nnadi CN, Ross ES, Garcia NH .
Health system integration and cancer center access for rural hospitals.
Am Surg 2024 May; 90(5):1023-29. doi: 10.1177/00031348231216497..
Keywords: Health Systems, Cancer, Rural Health, Rural/Inner-City Residents, Access to Care
Kistler A, Decker S, Steiger D
AHRQ Author: Decker S
A multimode strategy to contact participants and collect responses in a supplement to a longitudinal household survey.
In seeking to understand connections between Americans’ health care expenditures and use and social determinants of health, The Agency for Healthcare Research and Quality (AHRQ) and Westat conducted a new Medical Expenditure Panel Survey (MEPS) supplemental study in 2021 using a multimode (web and paper) instrument. Participants were encouraged to complete the web survey, but were provided the option of responding by paper. Response was encouraged through a multimode contact strategy, including text messages, emails, and/or mailings. The purpose of this paper was to review the protocol for encouraging web response and the response rates when utilizing various contact modes. The overall unweighted response rate for the survey was 74.2%, with 69.3% of responses submitted via the web. Response rates were 85.5% which was the highest among adults for whom both email and mobile phone information were provided.
AHRQ-authored.
Citation: Kistler A, Decker S, Steiger D .
A multimode strategy to contact participants and collect responses in a supplement to a longitudinal household survey.
Survey Methods: Insights From the Field 2024 May 1. doi: 10.13094/SMIF-2024-00001..
Keywords: Medical Expenditure Panel Survey (MEPS)
Kostick-Quenet KM, Lang B, Dorfman N
Patients' and physicians' beliefs and attitudes towards integrating personalized risk estimates into patient education about left ventricular assist device therapy.
This study explored stakeholder attitudes toward the utility, acceptability, usefulness, and best practices for integrating personalized risk (PR) estimates into patient education and decision making about Left Ventricular Assist Device (LVAD). This was a 5-year multi-institutional AHRQ project where the authors conducted 40 interviews with stakeholders (physicians, nurse coordinators, patients, and caregivers) and analyzed using Thematic Content Analysis. All stakeholder groups voiced positive views towards PR integration in decision making. Physicians felt PR can improve their decision making by enhancing insight into outcomes, enhance tailored pre-emptive care, increase confidence in decisions, and reduce bias and subjectivity. All stakeholder groups raised concerns about accuracy, representativeness and relevance of algorithms; predictive uncertainty; utility in relation to physician's expertise; potential negative reactions among patients; and overreliance.
AHRQ-funded; HS027784.
Citation: Kostick-Quenet KM, Lang B, Dorfman N .
Patients' and physicians' beliefs and attitudes towards integrating personalized risk estimates into patient education about left ventricular assist device therapy.
Patient Educ Couns 2024 May; 122:108157. doi: 10.1016/j.pec.2024.108157.
Keywords: Education: Patient and Caregiver, Risk, Cardiovascular Conditions
Bouchelle Z, Menko SG, Yazdani M
Parent perspectives on documentation and sharing of health-related social needs data.
This survey aimed to examine parents of pediatric patients’ preferences regarding how health-related social needs (HRSN) screening program data are documented and shared. The authors conducted semi-structured interviews with parents of hospitalized children participating in an HRSN screening program at a quaternary care children's hospital. Interviews were then coded to identify emergent themes. A total of 20 parents were interviewed with all being female, 55% identifying as Black or African American and 20% identifying as Hispanic or Latino. Parents expressed comfort with electronic health record documentation of HRSN data and the use of ICD-10 Revision Z codes as long as this information was used to provide families with meaningful support. Most parents viewed social workers and medical teams as being the most appropriate recipients of the data, with few parents feeling comfortable with HRSN data being shared with payors. Parents wanted transparency around HRSN data sharing, with many expressing concerns that documentation and sharing of HRSN data could lead to unwanted or unsafe disclosures or result in child welfare referrals.
AHRQ-funded; HS028555.
Citation: Bouchelle Z, Menko SG, Yazdani M .
Parent perspectives on documentation and sharing of health-related social needs data.
Hosp Pediatr 2024 Apr; 14(4):308-16. doi: 10.1542/hpeds.2023-007478..
Keywords: Children/Adolescents, Screening, Electronic Health Records (EHRs), Health Information Technology (HIT)
Kalwani NM, Osmanlliu E, Parameswaran V
Changes in telemedicine use and ambulatory visit volumes at a multispecialty cardiovascular center during the COVID-19 pandemic.
Researchers conducted a retrospective cohort study to examine trends in telemedicine use and visit volumes across cardiology subspecialties during the early months of the COVID-19 pandemic. Data from patients with ambulatory visits at a multispecialty cardiovascular center in Northern California were analyzed. Results showed that telemedicine visits increased dramatically during the COVID period; usage was above 75% of visits in all cardiology subspecialties in April 2020, stabilizing at rates ranging from over 95% (electrophysiology) to under 25% (heart transplant and vascular medicine). Visit volumes were below pre-COVID levels from March to May 2020, but exceeded pre-COVID levels after June 2020. The researchers concluded that telemedicine can be used to deliver a significant proportion of outpatient cardiovascular care and may increase access to care in cardiology clinics.
AHRQ-funded; HS026128.
Citation: Kalwani NM, Osmanlliu E, Parameswaran V .
Changes in telemedicine use and ambulatory visit volumes at a multispecialty cardiovascular center during the COVID-19 pandemic.
J Telemed Telecare 2024 Apr; 30(3):543-48. doi: 10.1177/1357633x211073428..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Cardiovascular Conditions, Ambulatory Care and Surgery
Devine JW, Tadrous M, Hernandez I
Effects of the valsartan recall on heart failure patients: a nationwide analysis.
This study’s objective was to determine if the 2018 generic valsartan recall created a higher likelihood of unfavorable outcomes to heart failure patients receiving valsartan at the recall date than patients using comparable antihypertensives. The authors conducted a cohort study of Optum's de-identified Clinformatics® Datamart (July 2017-January 2019). They compared heart failure patients with commercial or Medicare Advantage insurance who received valsartan to patients who received non-recalled angiotensin receptor blockers (ARBs) and angiotensin converting enzyme-inhibitors (ACE-Is) for 1 year prior and including the recall date. Outcomes examined included a composite for all-cause hospitalization, emergency department (ED), and urgent care (UC) use and a measure of cardiac events which included hospitalizations for acute myocardial infarction and hospitalizations/ED/UC visits for stroke/transient ischemic attack, heart failure or hypertension at 6-months post-recall. Of the 87,130 adherent patients, 15% were valsartan users and 85% were users of non-recalled ARBs/ACE-Is. Valsartan use was not associated with an increased risk of all-cause hospitalization/ED/UC use six-months post-recall (HR 1.00), compared with individuals taking non-recalled ARBs/ACE-Is. Similarly, cardiac events 6-months post-recall did not differ between individuals on valsartan and non-recalled ARBs/ACE-Is.
AHRQ-funded; HS027985.
Citation: Devine JW, Tadrous M, Hernandez I .
Effects of the valsartan recall on heart failure patients: a nationwide analysis.
Pharmacoepidemiol Drug Saf 2024 Apr; 33(4):e5777. doi: 10.1002/pds.5777..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Medication
Hechtman RK, Kipnis P, Cano J
Heterogeneity of benefit from earlier time-to-antibiotics for sepsis.
The objectives of this observational cohort study were to identify patient characteristics associated with greater benefit from shorter time-to-antibiotics. Subjects were patients hospitalized with community-onset sepsis and treated with antimicrobials within 12 hours. The findings indicated that metastatic cancer and shock were associated with the greatest benefit. The researchers concluded that shorter time-to-antibiotics for sepsis is particularly important among patients with these conditions.
AHRQ-funded; HS026725.
Citation: Hechtman RK, Kipnis P, Cano J .
Heterogeneity of benefit from earlier time-to-antibiotics for sepsis.
Am J Respir Crit Care Med 2024 Apr 1; 209(7):852-60. doi: 10.1164/rccm.202310-1800OC..
Keywords: Antibiotics, Sepsis, Medication
Fowler ME, Murdaugh D, Harmon C
Longitudinal changes in patient-reported cognitive complaints among older adults with gastrointestinal malignancies - results from the Cancer and Aging Resilience Evaluation (CARE) Registry.
This longitudinal study evaluated early cognitive complaints (CC) in older adults and predictors among older adults with cancer. The authors examined early CC change on the PROMIS® Short Form4a Cognitive Function among adults ≥ 60 years with GI cancer enrolled in the Cancer and Aging Resilience Evaluation (CARE) undergoing geriatric assessment (GA) at baseline and one 3-6-month follow-up. They included 218 participants. The median follow-up time was 3.7 months, the mean age was 69.2 ± 7.1, and 57.3% were male. They most commonly had colorectal cancer (30.7%) with most stage at III/IV (73.7%). About half (51.8%) had stable cognition baseline to follow-up, 20.6% improved (≥ 5 increase), and 27.5% declined (≥ 5 decrease). Using follow-up t-score, there were no significant baseline predictors. The baseline t-score was the best-fitting predictor of follow-up t-score.
AHRQ-funded; HS013852.
Citation: Fowler ME, Murdaugh D, Harmon C .
Longitudinal changes in patient-reported cognitive complaints among older adults with gastrointestinal malignancies - results from the Cancer and Aging Resilience Evaluation (CARE) Registry.
J Cancer Surviv 2024 Apr; 18(2):521-30. doi: 10.1007/s11764-022-01254-4..
Keywords: Elderly, Cancer
Howard RA, Thelen Ae, Chen X
Mortality and severe complications among newly graduated surgeons in the United States.
The objective of study was to evaluate severe complications and mortality over years of independent practice among general surgeons to discover if patient outcomes differed between early and later career surgeons. Medicare claims data was evaluated for 30-day outcomes for 26 operations. The results indicated that rates of mortality and severe complications were higher among newly graduated surgeons compared to later career surgeons.
AHRQ-funded; HS027653.
Citation: Howard RA, Thelen Ae, Chen X .
Mortality and severe complications among newly graduated surgeons in the United States.
Ann Surg 2024 Apr; 279(4):555-60. doi: 10.1097/sla.0000000000006128..
Keywords: Mortality, Provider: Physician, Surgery, Adverse Events
Dualeh SHA, Powell CA, Kunnath N
Rate of emergency lower extremity amputations in the United States among Medicare beneficiaries.
This study’s objective was to determine the rate of emergency versus elective lower extremity amputations in the US. The study evaluated Medicare beneficiaries who underwent lower extremity amputation between 2015 and 2020. The authors determined the rate for each zip code and placed into rank order from lowest to highest rate. They merged each beneficiary's place of residence and location of care with the American Hospital Association Annual Survey using Google Maps Application Programming Interface to determine the travel distance for patients to undergo their procedure. Of 233,084 patients, 66.3% were men, 69.8% were White. The average age at amputation was 74 years. There was wide variation in rates of emergency lower extremity amputation, with the quintile of zip codes demonstrating an emergency amputation rate of 3.7%, whereas the highest quintile demonstrating 90%. The median travel distance in the lowest emergency surgery rate quintile was 34.6 miles compared with 10.5 miles in the highest quintile of emergency surgery, suggesting variable access to essential vascular care.
AHRQ-funded; HS028606.
Citation: Dualeh SHA, Powell CA, Kunnath N .
Rate of emergency lower extremity amputations in the United States among Medicare beneficiaries.
Ann Surg 2024 Apr; 279(4):714-19. doi: 10.1097/sla.0000000000006105..
Keywords: Medicare, Surgery
Fowler ME, Harmon C, Sharafeldin N
The association between food access and frailty among older adults with gastrointestinal malignancies-the CARE Registry.
This study examined the association between food access and frailty among older adults with gastrointestinal malignancies. Eligible participants in the study included 880 adults aged 60 years and older who were recently diagnosed with GI cancers and were undergoing self-reported geriatric assessment at their first prechemotherapy visit to the University of Alabama at Birmingham oncology clinic. The authors measured food access using the 2019 US Department of Agriculture Economic Research Service designation low-income, low-access (LILA), classifying census tracts based on income and/or access to food stores at various distances. Primary outcome was frailty on the CARE (Cancer and Aging Resilience Evaluation) Frailty Index, a composite of the proportion of impaired geriatric assessment measures. A higher proportion in LILA areas were non-Hispanic Black (44.1% vs. 10.8%) and had less education (high school or less: 48.1% vs. 37.9%). Adjusting for age, race and ethnicity, sex, cancer type and stage, and education, a LILA designation was associated with 58% greater odds of worsening frailty status.
AHRQ-funded; HS013852.
Citation: Fowler ME, Harmon C, Sharafeldin N .
The association between food access and frailty among older adults with gastrointestinal malignancies-the CARE Registry.
Cancer 2024 Apr 1; 130(7):1083-91. doi: 10.1002/cncr.35144..
Keywords: Elderly, Digestive Disease and Health, Nutrition
Achola EM, Griffith KN, Wrenn JO
Injuries from legal interventions involving conducted energy devices.
This cross-sectional study evaluated emergency department (ED) visits for physical injuries from use of conducted energy devices (CEDs) such as TASERs by police departments. The authors evaluated sociodemographic and clinical characteristics of patients presenting with law enforcement-related CED injuries. They sampled US ED visits from the Nationwide Emergency Department Sample, which provided a 20% stratified sample of all EDs and weights to allow calculation of national representative estimates for all ED visits. They identified 1276 visits with the ICD-10 Y35.83X codes for CED injuries. Patients included 1186 males and 91 females with a mean age of 32.9 years residing in zip codes below the 50th percentile for median household income (67.5%). Most presented to teaching hospitals (70.8%) in metropolitan areas (86.1%) and were Asian or Pacific Islander (1.4%), Black (35.7%), Hispanic (17.6%), Native American (1.8%), White (39.2%), or other (4.3%) race and ethnicity. Among patients with serious injuries (70.8%), most (61.1%) were minor, 25.4% were moderate, 2.9% were severe, and 1.6% were critical injuries. The most common area of injury was extremities (36.9%), followed by chest (27.4%), head and neck (25.6%), abdomen (24.2%), and face (8.7%). Patients with lower income were more likely to receive serious, severe, or critical injuries, but these differences were not statistically significant.
AHRQ-funded; HS026395.
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Citation: Achola EM, Griffith KN, Wrenn JO .
Injuries from legal interventions involving conducted energy devices.
JAMA Intern Med 2024 Apr; 184(4):440-43. doi: 10.1001/jamainternmed.2023.8012..
Keywords: Healthcare Cost and Utilization Project (HCUP), Injuries and Wounds, Emergency Department
Chase AM, Forehand CC, Keats KR
Evaluation of critical care pharmacist evening services at an academic medical center.
This study’s purpose was to investigate the number of interventions, type of interventions, and associated cost savings with the addition of 1 board certified critical care clinical pharmacist to evening shift. Over a 12-week period, a prospective collection and characterization of 1 evening shift critical care pharmacist’s clinical interventions was conducted. Interventions were collected and categorized daily from 1 pm to 11 pm Monday through Friday. The authors collected a total of 510 interventions with an average of 9.8 interventions accepted per day. The highest proportion of interventions occurred in the medical intensive care unit, and the most common interventions included transitions of care, medication dose adjustment, and antibiotic de-escalation. They calculated an estimated cost avoidance of $66,537.80 for an average of $1279.57 saved per day. Additionally, 4.1% of interventions were considered high yield interventions upon independent review by 2 pharmacists.
AHRQ-funded; HS029009; HS028485.
Citation: Chase AM, Forehand CC, Keats KR .
Evaluation of critical care pharmacist evening services at an academic medical center.
Hosp Pharm 2024 Apr; 59(2):228-33. doi: 10.1177/00185787231207996..
Keywords: Provider: Pharmacist, Medication, Critical Care
Hasegawa S, Harris CM, Gupta V
Clinicians' interpretation of thresholds in hospital antibiograms for gram-negative rod infections: a survey and contingent valuation study of hospitalists.
The authors surveyed hospitalists at seven U.S. healthcare systems on their reported practices related to antibiograms and their hypothetical prescribing for four clinical scenarios. The responses showed that only half of the respondents used antibiograms more than monthly. There was no evidence across the four clinical scenarios that antibiogram susceptibility levels influenced antibiotic prescribing practices. The authors concluded that antibiograms may have a limited role in hospitalist care delivery for common gram-negative rod infections.
AHRQ-funded; HS027472.
Citation: Hasegawa S, Harris CM, Gupta V .
Clinicians' interpretation of thresholds in hospital antibiograms for gram-negative rod infections: a survey and contingent valuation study of hospitalists.
J Hosp Med 2024 Apr; 19(4):297-301. doi: 10.1002/jhm.13303..
Keywords: Antibiotics
Jallow F, Stehling E, Sajwani-Merchant Z
Medication management strategies by community-dwelling older adults: a multisite qualitative analysis.
The purpose of this study was to assess how older adults understand and develop strategies to mitigate risks of harm from medication use in the home environment. Researchers conducted semi-structured interviews with community-dwelling adults aged 65 and older who took five or more prescription medications. They also compared two organizations' medication safety guidelines for concordance and discordance. Findings revealed that older adults followed some of the published guidelines, although there were areas of discord; some of the strategies older adults used were unintentionally contrary to recommended guidelines. The researchers concluded that patient-provider collaboration and positive patient outcomes can be improved by understanding and respecting medication strategies used by older adults at home.
AHRQ-funded; HS027277.
Citation: Jallow F, Stehling E, Sajwani-Merchant Z .
Medication management strategies by community-dwelling older adults: a multisite qualitative analysis.
J Patient Saf 2024 Apr; 20(3):192-97. doi: 10.1097/pts.0000000000001200..
Keywords: Medication, Elderly, Caregiving, Medication: Safety, Patient Safety
Aklilu AM, Kumar S, Nugent J
COVID-19-associated acute kidney injury and longitudinal kidney outcomes.
This retrospective longitudinal multicenter cohort study’s objective was to assess long-term kidney outcomes of patient who had COVID-19-associated acute kidney injury (AKI). This study was conducted in a large hospital system using electronic health records data on adult hospitalized patients with AKI and COVID-19 or other illnesses. Included patients were those 1) who were hospitalized during the COVID-19 pandemic (March 2020-June 2022), were screened for SARS-CoV-2, had AKI, and survived to discharge, or 2) had been hospitalized during the 5 years before the pandemic (October 2016-January 2020), had a positive influenza A or B test result, had AKI, and survived to discharge. The study cohort included 9624 hospitalized patients (mean age, 69.0 years; 4955 females) with AKI, including 987 patients with COVID-AKI, 276 with influenza-associated AKI, and 8361 with AKI associated with other illnesses (other-AKI). When compared with the other 2 groups, patients with COVID-19-associated AKI were slightly younger in age, had a higher baseline eGFR, worse baseline comorbidity scores, higher markers of illness severity, and longer hospital stay. Compared with the other-AKI group, the COVID-AKI group had lower major adverse kidney events (MAKE) (adjusted hazard ratio [aHR], 0.67) due to lower all-cause mortality (aHR, 0.31) and lower rates of worsened kidney function.
AHRQ-funded; HS027626.
Citation: Aklilu AM, Kumar S, Nugent J .
COVID-19-associated acute kidney injury and longitudinal kidney outcomes.
JAMA Intern Med 2024 Apr; 18(4):414-23. doi: 10.1001/jamainternmed.2023.8225..
Keywords: COVID-19, Kidney Disease and Health, Outcomes
Li J
Public reporting and consumer demand in the home health sector.
The author used a natural experiment in the home health sector to assess whether a higher rating under the star ratings program affected patient choice. Findings indicated that higher rated agencies increased their market share by a statistically insignificant amount. No evidence of heterogeneous effects across the rating distribution or over time was discovered. The author concluded that star ratings are unlikely to improve home health quality despite continued policymaker interest.
AHRQ-funded; HS026836.
Citation: Li J .
Public reporting and consumer demand in the home health sector.
AHRQ-funded; HS026836..
Keywords: Home Healthcare, Nursing Homes, Provider Performance, Patient Experience, Quality of Care
Brokamp C, Jones MN, Duan Q
Causal mediation of neighborhood-level pediatric hospitalization inequities.
This study’s objective was to estimate the total inequities in population-level hospitalization rates of children and determine how much is mediated by place-based exposures and community characteristics. The authors employed a population-wide, neighborhood-level study that included youth <18 years hospitalized between July 1, 2016 and June 30, 2022. They defined a causal directed acyclic graph a priori to estimate the mediating pathways by which marginalized population composition causes census tract-level hospitalization rates. They analyzed 50,719 hospitalizations experienced by 28,390 patients and calculated census tract-level hospitalization rates per 1000 children, which ranged from 10.9 to 143.0 across included tracts. For every 10% increase in the marginalized population, the tract-level hospitalization rate increased by 6.2%. After adjustment for tract-level community material deprivation, crime risk, English usage, housing tenure, family composition, hospital access, greenspace, traffic-related air pollution, and housing conditions, no inequity remained (0.2%). There were different results when considering subsets of asthma, type 1 diabetes, sickle cell anemia, and psychiatric disorders.
AHRQ-funded; HS027996.
Citation: Brokamp C, Jones MN, Duan Q .
Causal mediation of neighborhood-level pediatric hospitalization inequities.
Pediatrics 2024 Apr; 153(4):e2023064432. doi: 10.1542/peds.2023-064432..
Keywords: Children/Adolescents, Medication, Disparities, Hospitalization
Decker SL, Zuvekas SH
AHRQ Author: Decker SL, Zuvekas SH
A nationally representative summary of 2020 changes in the use of health care in the United States.
The authors used Medical Expenditure Panel Survey data to summarize changes in all types of health care from 2018 to 2020. The results showed that outpatient and emergency department visits, as well as inpatient admissions each fell ~35% in April 2020; dental visits fell by over 80%, and mammograms 82%. By the end of 2020, specialist physician visits recovered, though primary care and dental visits remained 12% lower than in 2019. Psychiatric visits, however, rose slightly.
AHRQ-authored.
Citation: Decker SL, Zuvekas SH .
A nationally representative summary of 2020 changes in the use of health care in the United States.
J Ambul Care Manage 2024 Apr-Jun; 47(2):64-83. doi: 10.1097/jac.0000000000000488.
Keywords: Medical Expenditure Panel Survey (MEPS), COVID-19, Healthcare Delivery, Public Health
Hahn AL, Michaels CL, Khawly G
Comparison of evaluation methods for improving the usability of a Spanish mHealth tool.
The purpose of this study was to compare two usability evaluation methods for adapting an evidence-based mHealth tool from English into Spanish. The authors conducted cognitive interviews and usability assessments using a think-aloud protocol to evaluate the usability of an HIV mHealth application among 40 Spanish-speaking adults with HIV in New York City and in La Romana in the Dominican Republic. Findings highlighted contributions and limitations of including these methods in mHealth usability testing. The authors concluded that future research should employ a multi-method approach that incorporated complementary usability evaluation methods and engaged participants in multiple assessments.
AHRQ-funded; HS028523.
Citation: Hahn AL, Michaels CL, Khawly G .
Comparison of evaluation methods for improving the usability of a Spanish mHealth tool.
Int J Med Inform 2024 Apr; 184:105355. doi: 10.1016/j.ijmedinf.2024.105355.
Keywords: Telehealth, Health Information Technology (HIT)