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 185 Research Studies DisplayedChan B, Edwards ST, Devoe M
The SUMMIT ambulatory-ICU primary care model for medically and socially complex patients in an urban federally qualified health center: study design and rationale.
Medically complex urban patients experiencing homelessness comprise a disproportionate number of high-cost, high-need patients. There are few studies of interventions to improve care for these populations; their social complexity makes them difficult to study and requires clinical and research collaboration. In this paper, the authors present a protocol for a trial of the streamlined unified meaningfully managed interdisciplinary team (SUMMIT) team, an ambulatory ICU (A-ICU) intervention to improve utilization and patient experience that uses control populations to address limitations of prior research.
AHRQ-funded; HS022981.
Citation: Chan B, Edwards ST, Devoe M .
The SUMMIT ambulatory-ICU primary care model for medically and socially complex patients in an urban federally qualified health center: study design and rationale.
Addict Sci Clin Pract 2018 Dec 14;13(1):27. doi: 10.1186/s13722-018-0128-y..
Keywords: Primary Care, Healthcare Delivery, Patient-Centered Healthcare, Vulnerable Populations, Chronic Conditions
Swietek KE, Domino ME, Beadles C
Do medical homes improve quality of care for persons with multiple chronic conditions?
The purpose of this study was to examine the association between medical home enrollment and receipt of recommended care for Medicaid beneficiaries with multiple chronic conditions (MCC). The investigators found that patient-centered medical home enrollment was associated with an increased likelihood of receiving eight recommended mental and physical health services, including A1C testing for persons with diabetes, lipid profiles for persons with diabetes and/or hyperlipidemia, and psychotherapy for persons with major depression and persons with schizophrenia.
AHRQ-funded; HS019659.
Citation: Swietek KE, Domino ME, Beadles C .
Do medical homes improve quality of care for persons with multiple chronic conditions?
Health Serv Res 2018 Dec;53(6):4667-81. doi: 10.1111/1475-6773.13024..
Keywords: Chronic Conditions, Quality of Care, Patient-Centered Healthcare, Quality Improvement
Abdus S, Keenan PS
AHRQ Author: Abdus S, Keenan PS
Financial burden of employer-sponsored high-deductible health plans for low-income adults with chronic health conditions.
In this research letter, the authors used 2011-2015 Medical Expenditure Panel Survey Household Component data on adults 19 to 64 years of age enrolled in employer-sponsored insurance plans throughout the year to examine the burden of high deductible health plans on low income adults with chronic health conditions.
AHRQ-authored.
Citation: Abdus S, Keenan PS .
Financial burden of employer-sponsored high-deductible health plans for low-income adults with chronic health conditions.
JAMA Intern Med 2018 Dec;178(12):1706-08. doi: 10.1001/jamainternmed.2018.4706..
Keywords: Chronic Conditions, Healthcare Costs, Health Insurance, Low-Income, Medical Expenditure Panel Survey (MEPS)
Cherrington AL, Khodneva Y, Richman JS
Impact of peer support on acute care visits and hospitalizations for individuals with diabetes and depressive symptoms: a cluster-randomized controlled trial.
This study examined the impact of peer support on the number of acute care visits and hospitalizations for individuals with diabetes with and without depressive symptoms. This randomized controlled trial was conducted from 2010-2012. One year of peer support was given to intervention participants, and the usual care to control participants. A Patient Health Questionnaire (PHQ-8) was given to participants to assess depression symptoms at the beginning of the trial, at 6 months and then at 12 months. There was a lower rate of acute care visits and hospitalizations in those patients with depressive symptoms in the intervention group, but it made no difference for individuals without depressive symptoms.
AHRQ-funded; HS013852.
Citation: Cherrington AL, Khodneva Y, Richman JS .
Impact of peer support on acute care visits and hospitalizations for individuals with diabetes and depressive symptoms: a cluster-randomized controlled trial.
Diabetes Care 2018 Dec;41(12):2463-70. doi: 10.2337/dc18-0550..
Keywords: Ambulatory Care and Surgery, Chronic Conditions, Depression, Diabetes, Hospitalization, Behavioral Health, Patient Self-Management
Dodd JH, Hall TA, Guilliams K
Optimizing neurocritical care follow-up through the integration of neuropsychology.
The authors proposed that integration of neuropsychology into neurocritical care follow-up provides incremental benefit to the identification and treatment of persisting complications and reduction in co-morbidities. Studying sixteen patients over six months, they found that integration of neuropsychology into follow-up care resulted in recommendations being made for services or concerns not already addressed. Parents reported high satisfaction, indicating that neuropsychological consultation improved their understanding and communication with their child, aiding them in knowing what to expect from their child during post-acute recovery. The authors conclude that these results indicate that integration of neuropsychology into neurocritical care follow-up programs contributes not only to parent satisfaction, but may provide incremental benefits to patient care.
AHRQ-funded; HS022981.
Citation: Dodd JH, Hall TA, Guilliams K .
Optimizing neurocritical care follow-up through the integration of neuropsychology.
Pediatr Neurol 2018 Dec;89:58-62. doi: 10.1016/j.pediatrneurol.2018.09.007..
Keywords: Children/Adolescents, Chronic Conditions, Patient-Centered Healthcare, Primary Care: Models of Care
Chudy-Onwugaje K, Abutaleb A, Buchwald A
Age modifies the association between depressive symptoms and adherence to self-testing with telemedicine in patients with inflammatory bowel disease.
This study researched the association between age and increased depressive symptoms and adherence to self-testing with telemedicine in patients with inflammatory bowel disease (IBD). It was found that patients 40 and older had worse adherence than patients younger than 40 with depressive symptoms.
AHRQ-funded; HS018975.
Citation: Chudy-Onwugaje K, Abutaleb A, Buchwald A .
Age modifies the association between depressive symptoms and adherence to self-testing with telemedicine in patients with inflammatory bowel disease.
Inflamm Bowel Dis 2018 Nov 29;24(12):2648-54. doi: 10.1093/ibd/izy194..
Keywords: Chronic Conditions, Depression, Digestive Disease and Health, Patient Adherence/Compliance, Patient Self-Management, Telehealth
Silbverberg JI, Kantor RW, Dalal P
A comprehensive conceptual model of the experience of chronic itch in adults.
This study sought to develop a comprehensive conceptual model of itch to improve the understanding of itch for clinicians and to serve as a framework for development of efficient and valid patient-reported outcome measures (PROMs) of itch. The study’s conceptual model demonstrated the profound patient-burden of itch and identified unmet needs in the evaluation and management of itch.
AHRQ-funded; HS023011.
Citation: Silbverberg JI, Kantor RW, Dalal P .
A comprehensive conceptual model of the experience of chronic itch in adults.
Am J Clin Dermatol 2018 Oct;19(5):759-69. doi: 10.1007/s40257-018-0381-6..
Keywords: Chronic Conditions, Patient Experience
Tung EL, Johnson TA, O'Neal Y
Experiences of community violence among adults with chronic conditions: qualitative findings from Chicago.
The purpose of this study was to explore and characterize, using a qualitative study design, self-described experiences of community violence among adults with chronic health conditions. Investigators found that patients often struggled to balance the challenges imposed by community violence with the demands of living with and managing their chronic conditions.
AHRQ-funded; HS023007.
Citation: Tung EL, Johnson TA, O'Neal Y .
Experiences of community violence among adults with chronic conditions: qualitative findings from Chicago.
J Gen Intern Med 2018 Nov;33(11):1913-20. doi: 10.1007/s11606-018-4607-3..
Keywords: Chronic Conditions, Disparities, Social Determinants of Health
Wang A, Pollack T, Kadziel LA
Impact of practice facilitation in primary care on chronic disease care processes and outcomes: a systematic review.
The goal of this systematic review was to evaluate the impact of practice facilitation on chronic disease outcomes in the primary care setting. Researchers extracted and assessed the quality of the data on chronic disease process and clinical outcome measures from U.S. studies that implemented practice facilitation and reported quantifiable care processes and chronic disease outcomes. The results of this evaluation suggest that practice facilitation may improve chronic disease care measures; practices across all studies were aware of practice facilitation. The authors conclude that the results support the potential expansion of practice facilitation in primary care, but that future work will need to investigate potential opportunities to improve chronic disease outcomes in other health care settings.
AHRQ-funded; HS000084.
Citation: Wang A, Pollack T, Kadziel LA .
Impact of practice facilitation in primary care on chronic disease care processes and outcomes: a systematic review.
J Gen Intern Med 2018 Nov;33(11):1968-77. doi: 10.1007/s11606-018-4581-9.
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Keywords: Care Management, Chronic Conditions, Primary Care, Quality of Care, Quality Improvement
Bettenhausen JL, Richardson TE, Shah SS
Medicaid expenditures among children with noncomplex chronic diseases.
This study analyzed Medicaid use by children with noncomplex chronic diseases (NC-CDs). The objective was to describe patient characteristics, expenditures, and use patterns. The researchers used the 2014 Truven Medicaid MarketScan Database to analyze claims from 11 states. Mental health conditions accounted for half of the inpatient diagnosis, with the expenditures high as well. One-percent of children with the highest expenditures accounted for 20% of the total Medicaid expenditures.
AHRQ-funded; HS024735.
Citation: Bettenhausen JL, Richardson TE, Shah SS .
Medicaid expenditures among children with noncomplex chronic diseases.
Pediatrics 2018 Nov;142(5). doi: 10.1542/peds.2018-0286..
Keywords: Children/Adolescents, Chronic Conditions, Healthcare Costs, Medicaid
Militello LG, Anders S, Downs SM
Understanding how primary care clinicians make sense of chronic pain.
This research explored how primary care clinicians manage their patients with chronic noncancer pain. They conducted Critical Decision Method interviews with 10 clinicians about 30 individual patients. Findings suggested that clinicians should focus on supporting sensemaking in the content of clinical evidence rather than trying to provide them with rules.
AHRQ-funded; HS023306.
Citation: Militello LG, Anders S, Downs SM .
Understanding how primary care clinicians make sense of chronic pain.
Cogn Technol Work 2018 Nov;20(4):575-84. doi: 10.1007/s10111-018-0491-1..
Keywords: Pain, Chronic Conditions, Opioids, Medication, Decision Making, Primary Care, Care Management
Bauer NS, Azer N, Sullivan PD
Acceptability of group visits for attention-deficit hyperactivity disorder in pediatric clinics.
The objective of the study was to describe the acceptability of ADHD group visits in busy pediatric clinics based on caregivers, child participants and facilitators. The authors found that the majority of comments from families and facilitators highlighted a variety of benefits of the use of a group visit model for ADHD chronic care. Despite systems-level barriers to implementation, families and facilitators felt the benefits outweighed the challenges.
AHRQ-funded; HS022434.
Citation: Bauer NS, Azer N, Sullivan PD .
Acceptability of group visits for attention-deficit hyperactivity disorder in pediatric clinics.
J Dev Behav Pediatr 2017 Oct;38(8):565-72. doi: 10.1097/dbp.0000000000000492..
Keywords: Children/Adolescents, Behavioral Health, Patient-Centered Outcomes Research, Chronic Conditions
Weitzman ER, Magane KM, Wisk LE
Alcohol use and alcohol-interactive medications among medically vulnerable youth.
Information about the prevalence of alcohol use among youth with chronic medical conditions (YCMCs) who take alcohol-interactive (AI) medications is scant. This study attempts to address gaps and inform interventions by quantifying simultaneous exposure to alcohol use and AI medications among YCMCs. Participants were adolescents with a variety of chronic conditions: type 1 diabetes, juvenile idiopathic arthritis, moderate persistent asthma, cystic fibrosis, attention-deficit/hyperactivity disorder, inflammatory bowel disease. Participants completed an electronic survey designed to measure prevalence of exposure to AI medications and associations with alcohol usage in the past year. Many of the participants reported alcohol use, but drinking was less likely among those who took AI medications. The authors conclude that perceptions about alcohol-medication interference mediated the association between drinking and AI medication exposure.
AHRQ-funded; HS022986.
Citation: Weitzman ER, Magane KM, Wisk LE .
Alcohol use and alcohol-interactive medications among medically vulnerable youth.
Pediatrics 2018 Oct;142(4). doi: 10.1542/peds.2017-4026..
Keywords: Alcohol Use, Children/Adolescents, Chronic Conditions, Medication, Medication: Safety, Patient Safety, Vulnerable Populations
Ren Z, Narla S, Hsu DY
Association of serious infections with pemphigus and pemphigoid: analysis of the Nationwide Inpatient Sample.
The purpose of this study was to determine if the blistering disorders pemphigus and pemphigoid are associated with the increased likelihood of serious infections and with the impact of such infections on mortality and cost of care. Data from the 2002 - 2012 Nationwide Inpatient Sample was analyzed. The researchers conclude that adults with pemphigus or pemphigoid had increased infections - cutaneous, respiratory, multi-organ and systemic - associated with considerable inpatient mortality and cost burden. There were also significant clinical and healthcare disparities with respect to infections in patients with pemphigus or pemphigoid.
AHRQ-funded; HS023011.
Citation: Ren Z, Narla S, Hsu DY .
Association of serious infections with pemphigus and pemphigoid: analysis of the Nationwide Inpatient Sample.
J Eur Acad Dermatol Venereol 2018 Oct;32(10):1768-76. doi: 10.1111/jdv.14961..
Keywords: Chronic Conditions, Healthcare Cost and Utilization Project (HCUP)
Schnall R, Cho H, Mangone A
Mobile health technology for improving symptom management in low income persons living with HIV.
This study aimed to examine the impact of an mHealth application (app), comprised of evidence-based self-care strategies, on the symptom experience of persons living with HIV (PLWH). In this 12-week trial, an mHealth app, mobile Video Information Provider (mVIP), was associated with improved symptom burden and increased medication adherence in PLWH.
AHRQ-funded; HS023963.
Citation: Schnall R, Cho H, Mangone A .
Mobile health technology for improving symptom management in low income persons living with HIV.
AIDS Behav 2018 Oct;22(10):3373-83. doi: 10.1007/s10461-017-2014-0..
Keywords: Chronic Conditions, Health Information Technology (HIT), Human Immunodeficiency Virus (HIV), Low-Income, Vulnerable Populations
Basu J, Hanchate A, Koroukian S
AHRQ Author: Basu, J
Multiple chronic conditions and disparities in 30-Day hospital readmissions among nonelderly adults.
This study examined the patterns of 30-day hospital readmissions by race/ethnicity and multiple chronic conditions (MCC) burden among nonelderly adult patients. The authors found considerable heterogeneity in levels of readmission risk among racial/ethnic subgroups stratified by chronic conditions. Among patients with a lowest MCC burden, African Americans had the highest risk of readmission, but with a higher MCC burden, the risk of readmission increased most for Hispanics.
AHRQ-authored.
Citation: Basu J, Hanchate A, Koroukian S .
Multiple chronic conditions and disparities in 30-Day hospital readmissions among nonelderly adults.
J Ambul Care Manage 2018 Oct/Dec;41(4):262-73. doi: 10.1097/jac.0000000000000246..
Keywords: Chronic Conditions, Disparities, Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Racial and Ethnic Minorities
Jonassaint CR, Kang C, Abrams DM
Understanding patterns and correlates of daily pain using the Sickle cell disease Mobile Application to Record Symptoms via Technology (SMART).
The authors used a mobile e-diary app to describe day-to-day patterns in sickle cell disease (SCD)-related pain symptoms and to identify the clinical and demographic factors associated with differences in daily pain level among adult patients with SCD. They suggest that future studies of the app would benefit from implementation of strategies to increase engagement. They also conclude that, despite a limited sample size, this study provides strong evidence supporting the use of mobile technology for measuring daily pain and symptoms in SCD.
AHRQ-funded; HS023989.
Citation: Jonassaint CR, Kang C, Abrams DM .
Understanding patterns and correlates of daily pain using the Sickle cell disease Mobile Application to Record Symptoms via Technology (SMART).
Br J Haematol 2018 Oct;183(2):306-08. doi: 10.1111/bjh.14956..
Keywords: Chronic Conditions, Health Information Technology (HIT), Pain, Sickle Cell Disease, Telehealth
Mentias A, Shantha G, Chaudhury P
Assessment of outcomes of treatment with oral anticoagulants in patients with atrial fibrillation and multiple chronic conditions: a comparative effectiveness analysis.
The purpose of this retrospective comparative effectiveness analysis was to determine whether there are differences in efficacy and safety of dabigatran, rivaroxaban, and warfarin regarding stroke prevention and bleeding rates, respectively, in elderly patients with atrial fibrillation (AF) with multiple chronic conditions (MCC). The investigators concluded that oral anticoagulants were similarly effective in stroke prevention among patients with AF with MCC. However, the indicate that dabigatran and rivaroxaban use may be associated with lower rates of mortality in patients with MCC.
AHRQ-funded; HS023104.
Citation: Mentias A, Shantha G, Chaudhury P .
Assessment of outcomes of treatment with oral anticoagulants in patients with atrial fibrillation and multiple chronic conditions: a comparative effectiveness analysis.
JAMA Netw Open 2018 Sep 7;1(5):e182870. doi: 10.1001/jamanetworkopen.2018.2870..
Keywords: Blood Thinners, Heart Disease and Health, Cardiovascular Conditions, Outcomes, Patient-Centered Outcomes Research, Medication, Evidence-Based Practice, Comparative Effectiveness, Chronic Conditions
Griffith LE, Gruneir A, Fisher KA
AHRQ Author: Bierman AS
Key factors to consider when measuring multimorbidity: Results from an expert panel and online survey.
The purpose of this paper was to share insights gained from discussions with experts in the fields of ageing research and multimorbidity on key factors to consider when measuring multimorbidity. The authors found that the suitability of existing multimorbidity measures for use in a specific research study depends on factors such as the purpose of the study, outcomes examined and preferences of the involved stakeholders.
AHRQ-authored.
Citation: Griffith LE, Gruneir A, Fisher KA .
Key factors to consider when measuring multimorbidity: Results from an expert panel and online survey.
J Comorb 2018 Sep 3;8(1):2235042x18795306. doi: 10.1177/2235042x18795306..
Keywords: Chronic Conditions, Research Methodologies
Hirayama A, Goto T, Shimada YJ
Acute exacerbation of chronic obstructive pulmonary disease and subsequent risk of emergency department visits and hospitalizations for atrial fibrillation.
Although emerging evidence has suggested the relationship of chronic obstructive pulmonary disease with atrial fibrillation (AF), little is known about whether acute exacerbation of chronic obstructive pulmonary disease (AECOPD) increases the risk of repeated AF-related healthcare utilization. The investigators found that among patients with existing AF, AECOPD was associated with a higher risk of AF-related ED visit or hospitalization in the first 90-day post-AECOPD period.
AHRQ-funded; HS023305.
Citation: Hirayama A, Goto T, Shimada YJ .
Acute exacerbation of chronic obstructive pulmonary disease and subsequent risk of emergency department visits and hospitalizations for atrial fibrillation.
Circ Arrhythm Electrophysiol 2018 Sep;11(9):e006322. doi: 10.1161/circep.118.006322..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Respiratory Conditions, Heart Disease and Health, Cardiovascular Conditions, Chronic Conditions, Hospitalization, Risk, Healthcare Utilization
Goto T, Shimada YJ, Faridi MK
Incidence of acute cardiovascular event after acute exacerbation of COPD.
There is a lack of comprehensive view of the association between acute exacerbation of COPD (AECOPD) and the risk of acute cardiovascular events. The purpose of this study was to determine the association of AECOPD with 30-day and 1-year incidences of acute cardiovascular event. The investigators concluded that AECOPD was associated with increased 30-day and 1-year incidences of acute cardiovascular event.
AHRQ-funded; HS023305.
Citation: Goto T, Shimada YJ, Faridi MK .
Incidence of acute cardiovascular event after acute exacerbation of COPD.
J Gen Intern Med 2018 Sep;33(9):1461-68. doi: 10.1007/s11606-018-4518-3.
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Keywords: Respiratory Conditions, Cardiovascular Conditions, Risk, Chronic Conditions, Heart Disease and Health, Outcomes
Liu TL, Taylor YJ, Mahabaleshwarkar R
Shared decision making and time to exacerbation in children with asthma.
This study examined the use of shared decision making (SDM) to delay exacerbation in children with asthma. A prospective cohort of children at five primary care practices in Charlotte, North Carolina that serve vulnerable population was studied between 2011 and 2013. The cohort included 746 children, with 60.5% male and 54.2% African American with a mean age of 8.6 years. The final analysis included 100 matched pairs of children for use of SDM and normal care. There was a marginally significant difference in the time of exacerbation between the two groups.
AHRQ-funded; HS019946.
Citation: Liu TL, Taylor YJ, Mahabaleshwarkar R .
Shared decision making and time to exacerbation in children with asthma.
J Asthma 2018 Sep;55(9):949-55. doi: 10.1080/02770903.2017.1378357..
Keywords: Children/Adolescents, Decision Making, Asthma, Respiratory Conditions, Chronic Conditions, Primary Care
Naylor MD, Hirschman KB, Toles MP
Adaptations of the evidence-based Transitional Care Model in the U.S.
The goal of this study was to describe and classify common local adaptations of the evidence-based intervention Transitional Care Model (TCM); this model is comprised of 10 components that have been proven in multiple clinical trials to improve care and outcomes for chronically ill older adults who are transitioning home from hospitals. 582 U.S.-based transitional care clinicians in health systems and community-based organizations were asked to complete a survey, then researchers interviewed a subset of survey respondents regarding implementation of TCM in their distinct organizations. The results suggest hypotheses that can be used to guide rigorous examination of the association between adaptations of TCM components and desired outcomes, and reinforce a need for investment in adaptation science.
AHRQ-funded; HS022406.
Citation: Naylor MD, Hirschman KB, Toles MP .
Adaptations of the evidence-based Transitional Care Model in the U.S.
Soc Sci Med 2018 Sep;213:28-36. doi: 10.1016/j.socscimed.2018.07.023..
Keywords: Elderly, Chronic Conditions, Evidence-Based Practice, Transitions of Care
Hirayama A, Goto T, Faridi MK
Association of obstructive sleep apnoea with acute severity of chronic obstructive pulmonary disease exacerbation: a population-based study.
This retrospective cohort study investigated the association of coexistent obstructive sleep apnoea with acute severity markers (i.e. invasive positive pressure ventilation use and hospital length of stay) among adults hospitalised for acute exacerbation of chronic obstructive pulmonary disease.
AHRQ-funded; HS023305.
Citation: Hirayama A, Goto T, Faridi MK .
Association of obstructive sleep apnoea with acute severity of chronic obstructive pulmonary disease exacerbation: a population-based study.
Intern Med J 2018 Sep;48(9):1150-53. doi: 10.1111/imj.14016..
Keywords: Respiratory Conditions, Hospitalization, Sleep Problems, Chronic Conditions
Poghosyan L, Norful AA, Liu J
Nurse practitioner practice environments in primary care and quality of care for chronic diseases.
In this study, the authors investigated the relationship between nurse practitioner (NP) practice environments and quality of care for chronic diseases. The investigators found that NP practice environment affected the quality of care for 2 chronic conditions. They assert that efforts should be implemented to improve NP practice environment to potentially improve care quality.
AHRQ-funded; HS020999.
Citation: Poghosyan L, Norful AA, Liu J .
Nurse practitioner practice environments in primary care and quality of care for chronic diseases.
Med Care 2018 Sep;56(9):791-97. doi: 10.1097/mlr.0000000000000961..
Keywords: Chronic Conditions, Quality of Care, Primary Care, Provider