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.
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1 to 25 of 61 Research Studies DisplayedTracer H, Lorei NC
AHRQ Author: Tracer H
Preexposure prophylaxis to prevent acquisition of HIV.
This case study described a 28-year-old woman presented to a community health clinic for sexually transmitted infection (STI) testing. Case study questions related to the USPSTF recommendation on Preexposure Prophylaxis (PrEP) to prevent acquisition of HIV, guidelines for candidacy for PrEP, guidelines for the use of PrEP for the primary prevention of HIV in adults.
AHRQ-authored.
Citation: Tracer H, Lorei NC .
Preexposure prophylaxis to prevent acquisition of HIV.
Am Fam Physician 2023 Dec; 108(6):617-18..
Keywords: U.S. Preventive Services Task Force (USPSTF), Human Immunodeficiency Virus (HIV), Prevention, Evidence-Based Practice
Chou R, Selph SS, Bougatsos C
Screening, referral, behavioral counseling, and preventive interventions for oral health in adults: a systematic review for the US Preventive Services Task Force.
The purpose of this study was to conduct a systematic evidence review on the effectiveness of primary care screening and prevention of dental caries and periodontal disease in adults to inform the US Preventive Services Task Force. The main outcomes were dental caries, periodontal disease, morbidity, quality of life, harms; and diagnostic test accuracy. Five randomized clinical trials, 5 nonrandomized trials, and 6 observational studies with a total 3,300 participants were included. There were no trials that evaluated primary care counseling or dental referral. There was very limited evidence on screening accuracy, silver diamine fluoride, xylitol; and harms were very limited, although serious harms were not reported. One small study (n = 86) found oral health examination by 2 primary care clinicians associated with low sensitivity and high specificity for periodontal disease and with variable sensitivity and high specificity for dental caries. Four studies (n = 965) found screening questionnaires associated with a pooled sensitivity of 0.72 and specificity of 0.74 for periodontal disease. For preventive interventions there were no studies that evaluated primary care counseling or dental referral, and evidence from 2 poor-quality trials (n = 178) of sealants, and 1 fair-quality and 4 poor-quality trials (n = 971) of topical fluorides, was found to be insufficient. Three fair-quality trials (n = 590) of persons with mean age 72 to 80 years found silver diamine fluoride solution associated with fewer new root caries lesions or fillings vs placebo (mean reduction, -0.33 to -1.3) and decreased likelihood of new root caries lesion (2 trials). There were no trials that evaluated primary care-administered preventive interventions.
AHRQ-funded; 75Q80120D00006.
Citation: Chou R, Selph SS, Bougatsos C .
Screening, referral, behavioral counseling, and preventive interventions for oral health in adults: a systematic review for the US Preventive Services Task Force.
JAMA 2023 Nov 14; 330(18):1780-90. doi: 10.1001/jama.2023.20685..
Keywords: U.S. Preventive Services Task Force (USPSTF), Screening, Dental and Oral Health, Prevention, Evidence-Based Practice, Guidelines
Chou R, Bougatsos C, Griffin J
Screening, referral, behavioral counseling, and preventive interventions for oral health in children and adolescents aged 5 to 17 years: a systematic review for the US Preventive Services Task Force.
The purpose of this study was to conduct a systematic evidence review on the effectiveness of primary care screening and prevention of dental caries in children and adolescents aged 5 to 17 years to inform the US Preventive Services Task Force. The main outcomes were dental caries, morbidity, functional status, quality of life, harms; and diagnostic test accuracy. Three systematic reviews with a total of 20,684 participants were included along with 19 randomized clinical trials, 3 nonrandomized trials, and 1 observational study with a total of 15,026 participants. When administered by dental professionals or in school settings, fluoride supplements compared with placebo or no intervention were associated with decreased change from baseline in the number of decayed, missing, or filled permanent teeth (DMFT index) or decayed or filled permanent teeth (DFT index) at 1.5 to 3 years (6 trials; n = 1395). Fluoride gels were associated with a DMFT- or DFT-prevented fraction of 0.18 at outcomes closest to 3 years (4 trials; n = 1525); fluoride varnish was associated with a DMFT- or DFT-prevented fraction of 0.44 at 1 to 4.5 years (5 trials; n = 3902); and resin-based sealants were associated with decreased risk of carious first molars at 48 to 54 months (4 trials; n = 440). There were no trials that evaluated primary care counseling or dental referral. There was very limited evidence on screening accuracy, silver diamine fluoride, xylitol; and harms were very limited, although serious harms were not reported.
AHRQ-funded; 75Q80120D00006.
Citation: Chou R, Bougatsos C, Griffin J .
Screening, referral, behavioral counseling, and preventive interventions for oral health in children and adolescents aged 5 to 17 years: a systematic review for the US Preventive Services Task Force.
JAMA 2023 Nov 7; 330(17):1674-86. doi: 10.1001/jama.2023.20435..
Keywords: Children/Adolescents, Dental and Oral Health, Screening, Prevention, Evidence-Based Practice, U.S. Preventive Services Task Force (USPSTF), Guidelines
Henderson JT, Webber EM, Thomas RG
Screening for hypertensive disorders of pregnancy: updated evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this study was to conduct a systematic review to update the evidence on the effectiveness of screening for hypertensive disorders of pregnancy with the purpose of informing the U.S. Preventive Services Task Force. The main outcome was Morbidity or mortality, with measures of health-related quality of life. The review included 6 fair-quality studies comparing changes in prenatal screening practices with routine screening at in-person office visits (usual care). This systematic review did not find evidence that any alternate screening strategies for hypertensive disorders of pregnancy had increased effectiveness over routine blood pressure measurement at in-person prenatal visits. No harms of the different screening strategies were identified.
AHRQ-funded; 75Q80120D00004.
Citation: Henderson JT, Webber EM, Thomas RG .
Screening for hypertensive disorders of pregnancy: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2023 Sep 19; 330(11):1083-91. doi: 10.1001/jama.2023.4934..
Keywords: U.S. Preventive Services Task Force (USPSTF), Blood Pressure, Screening, Prevention, Evidence-Based Practice, Guidelines, Maternal Care, Women
Chou R, Spencer H, Bougatsos C
Preexposure prophylaxis for the prevention of HIV: updated evidence report and systematic review for the US Preventive Services Task Force.
This article updates research used in the 2019 US Preventive Services Task Force final recommendation on use of oral preexposure prophylaxis (PrEP) to prevent HIV in adults at increased risk. The summary includes newer PrEP regimens that were not available for the 2019 final recommendation. A literature review was conducted that included randomized clinical trials of PrEP vs placebo or no PrEP or newer vs older PrEP regimens and diagnostic accuracy studies of instruments for predicting incident HIV infection. Thirty-two studies were included in the review (20 randomized clinical trials [n = 36,543] and 12 studies of diagnostic accuracy [n = 5,544,500]). Eleven trials in the 2019 review found oral PrEP associated with decreased HIV infection risk vs placebo or no PrEP. One new trial (n = 5335) found oral tenofovir alafenamide/emtricitabine (TAF/FTC) to be noninferior to tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) in men who have sex with men. Two new trials found long-acting injectable cabotegravir associated with decreased risk of HIV infection vs oral TDF/FTC in cisgender men who have sex with men and transgender women [n = 4490] and RR, 0.11 in cisgender women [n = 3178]). Discrimination of instruments for predicting incident HIV infection was found to be moderate in men who have sex with men (5 studies; n = 25,488) and moderate to high in general populations of persons without HIV (2 studies; n = 5,477,291).
AHRQ-funded; 75Q80120D00006.
Citation: Chou R, Spencer H, Bougatsos C .
Preexposure prophylaxis for the prevention of HIV: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2023 Aug 22; 330(8):746-63. doi: 10.1001/jama.2023.9865..
Keywords: U.S. Preventive Services Task Force (USPSTF), Human Immunodeficiency Virus (HIV), Prevention, Medication, Evidence-Based Practice
Roberts MM, Marino M, Wells R
Differences in use of clinical decision support tools and implementation of aspirin, blood pressure control, cholesterol management, and smoking cessation quality metrics in small practices by race and sex.
The objective of this cross-sectional study was to evaluate the association between population-based clinical decision support (CDS) tools and racial and sex disparities in the aspirin use, blood pressure control, cholesterol management, and smoking cessation (ABCS) care quality metrics among smaller primary care practices. Researchers used practice-level data from the EvidenceNOW initiative, from practices that submitted both survey data and electronic health record (EHR)-derived ABCS data stratified by race and sex. Their findings suggested that practices using CDS tools had small disparities but were not statistically significant; however, CDS tools were not associated with reductions in disparities. They concluded that more research was needed on effective practice-level interventions to mitigate disparities.
AHRQ-funded; HS023940.
Citation: Roberts MM, Marino M, Wells R .
Differences in use of clinical decision support tools and implementation of aspirin, blood pressure control, cholesterol management, and smoking cessation quality metrics in small practices by race and sex.
JAMA Netw Open 2023 Aug; 6(8):e2326905. doi: 10.1001/jamanetworkopen.2023.26905..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Cardiovascular Conditions, Tobacco Use, Tobacco Use: Smoking Cessation, Primary Care, Evidence-Based Practice, Prevention
Guirguis-Blake JM, Evans CV, Coppola EL
Screening for lipid disorders in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this study was to examine benefits and harms of screening and treatment of pediatric dyslipidemia due to familial hypercholesterolemia (FH) and multifactorial dyslipidemia. Forty-three studies were included (n = 491,516). The study found that No RCTs directly addressed screening effectiveness and harms. Three US studies (n = 395,465) reported prevalence of phenotypically defined FH of 0.2% to 0.4% (1:250 to 1:500). Five studies (n = 142,257) reported multifactorial dyslipidemia prevalence; the prevalence of elevated total cholesterol level was 7.1% to 9.4% and of any lipid abnormality was 19.2%. Ten RCTs in children and adolescents with FH (n = 1,230) demonstrated that statins were related with an 81- to 82-mg/dL higher mean reduction in levels of total cholesterol and LDL-C compared with placebo at up to 2 years. Nonstatin-drug trials showed statistically significant lowering of lipid levels in FH populations, but few studies were available for any single drug. Observational studies indicate that starting statin treatment for FH in childhood or adolescence decreases long-term cardiovascular disease risk. Two multifactorial dyslipidemia behavioral counseling trials (n = 934) showed 3- to 6-mg/dL greater reductions in total cholesterol levels compared with the control group, but findings did not continue at longest follow-up. Harms reported in the short-term drug trials were similar in the intervention and control groups.
AHRQ-funded; 75Q80120D00004.
Citation: Guirguis-Blake JM, Evans CV, Coppola EL .
Screening for lipid disorders in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2023 Jul 18; 330(3):261-74. doi: 10.1001/jama.2023.8867..
Keywords: U.S. Preventive Services Task Force (USPSTF), Screening, Prevention, Evidence-Based Practice, Guidelines, Children/Adolescents
Estenson L, Kim N, Jacobson M
Do age-based discontinuation recommendations influence cervical cancer screening rates? Evidence from the United States' Behavioral Risk Factor Surveillance System, 2016 and 2018.
The purpose of this study was to determine how the United States Preventive Services Task Force (USPSTF) recommendation of discontinuing routine cervical cancer screening for certain women after age 65 affects Papanicolaou (Pap) test rates among women at age 66 in the United States. The researchers utilized nationally representative 2016 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) data for 226,031 women ages 56-76 to calculate changes in annual Pap test rates at age 66. Among women 66-76, 22.5% indicated they had received a Pap test within the past year. At age 66, annual Pap rates decreased by 5.9 percentage points (p.p.) off a pre-66 rate of 39 percent. The change differed by race/ethnicity, education, and marital status. Pap rates did not change discretely for non-Hispanic Black women but did change for women from other racial/ethnic groups. The decrease was larger for women who graduated college than for women without a college degree and for women who were never married than for women who were married/partnered or divorced/separated. The USPSTF recommendation to stop cervical cancer screening after the age of 65 resulted in a substantial decrease in the rate of Pap tests at age 66 but disparately affects women based on marital status, education and race.
AHRQ-funded; HS026488.
Citation: Estenson L, Kim N, Jacobson M .
Do age-based discontinuation recommendations influence cervical cancer screening rates? Evidence from the United States' Behavioral Risk Factor Surveillance System, 2016 and 2018.
Prev Med 2023 Jul; 172:107543. doi: 10.1016/j.ypmed.2023.107543..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Cervical Cancer, Cancer, Screening, Prevention, Evidence-Based Practice, Women, Sexual Health
O'Connor EA, Henninger ML, Perdue LA
Anxiety screening: evidence report and systematic review for the US Preventive Services Task Force.
This evidence summary was published in conjunction with the final recommendation statement for the US Preventive Services Task Force on benefits and harms of screening and treatment for anxiety disorders in adults. A literature review was conducted with 59 publications included, 40 were original studies and 19 were systematic reviews. Two screening studies found no benefit for screening for anxiety. Only the Generalized Anxiety Disorder (GAD) GAD-2 and GAD-7 screening instruments were evaluated by more than 1 study. Both screening instruments had adequate accuracy for detecting generalized anxiety disorder with a pooled sensitivity of 0.79 and specificity of 0.89. Evidence was limited for other instruments and other anxiety disorders. Evidence was insufficient on the benefits or harms of anxiety screening programs. However, there is a large body of evidence supporting the benefit of treatment for anxiety.
AHRQ-funded; 290201500011I; 75Q80120D00004.
Citation: O'Connor EA, Henninger ML, Perdue LA .
Anxiety screening: evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2023 Jun 27; 329(24):2171-84. doi: 10.1001/jama.2023.6369..
Keywords: U.S. Preventive Services Task Force (USPSTF), Anxiety, Behavioral Health, Screening, Evidence-Based Practice, Guidelines, Prevention
Weinstein R, Brohinsky J, Meltzer A
AHRQ Author: Weinstein R
Establishing and maintaining trust: how the U.S. Preventive Services Task Force uses strategic communications to build confidence in and disseminate its evidence-based recommendations.
This article examined ways in which strategic communications support for the United States Preventive Services Task Force helped to fulfill its mission to improve the health of people nationwide through evidence-based preventive services recommendations. Communications challenges specific to the USPSTF are described, and two case examples of strategic communications approaches provided.
AHRQ-authored.
Citation: Weinstein R, Brohinsky J, Meltzer A .
Establishing and maintaining trust: how the U.S. Preventive Services Task Force uses strategic communications to build confidence in and disseminate its evidence-based recommendations.
J Health Commun 2023 Jun 3; 28(6):344-48. doi: 10.1080/10810730.2023.2208532..
Keywords: U.S. Preventive Services Task Force (USPSTF), Communication, Evidence-Based Practice, Guidelines, Prevention
Jenkins JL, Hsu EB, Zhang A
Current evidence for infection prevention and control interventions in emergency medical services: a scoping review.
This study’s aim was to summarize current evidence from the United States on the effectiveness of practices and interventions for preventing, recognizing, and controlling occupationally acquired infectious diseases in Emergency Medical Service (EMS) clinicians. A database search was conducted for literature published January 2006 through March 15, 2022 to search for studies in the United States that involved EMS clinicians and firefighters, reported on one or more workplace practices or interventions that prevented or controlled infectious diseases, and included outcome measures. Eleven observational studies reported on infection prevention and control (IPC) practices providing evidence that hand hygiene, standard precautions, mandatory vaccine policies, and on-site vaccine clinics are effective. Less frequent handwashing and less frequent hand hygiene after glove use were positively correlated with nasal colonization of Methicillin-resistant Staphylococcus aureus (MRSA). Lack of personal protective equipment (PPE) or PPE breach were correlated with higher severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity and virus 2 (SARS-CoV-2) seropositivity. Workers were more likely to be vaccinated against influenza if their employer offered the vaccine. Vaccination rates for H1N1 influenza increased with the use of active, targeted education modules.
AHRQ-funded; 75Q80120D00003.
Citation: Jenkins JL, Hsu EB, Zhang A .
Current evidence for infection prevention and control interventions in emergency medical services: a scoping review.
Prehosp Disaster Med 2023 Jun; 38(3):371-77. doi: 10.1017/s1049023x23000389..
Keywords: COVID-19, Emergency Department, Evidence-Based Practice, Prevention, Public Health, Infectious Diseases
Tracer H, Haselby C
AHRQ Author: Tracer H
Hormone therapy for the primary prevention of chronic conditions in postmenopausal people.
This case study described a 50-year-old woman whose last menstrual cycle was more than a year previous. Case study questions related to the USPSTF recommendation on hormone therapy addressed whether this patient would benefit from hormone therapy to prevent the onset of chronic conditions that become more common after menopause.
AHRQ-authored.
Citation: Tracer H, Haselby C .
Hormone therapy for the primary prevention of chronic conditions in postmenopausal people.
Am Fam Physician 2023 Jun; 107(6):645-46..
Keywords: U.S. Preventive Services Task Force (USPSTF), Guidelines, Evidence-Based Practice, Prevention, Chronic Conditions, Women
Jonas DE, Riley SR, Lee LC
Screening for latent tuberculosis infection in adults: updated evidence report and systematic review for the US Preventive Services Task Force.
This systematic review and evidence report analyzed the benefits and harms of screening for latent tuberculosis infection (LTBI) of adults, which was used to inform the U.S. Preventive Services Task Force for their final recommendation. A systematic review was conducted of English-language studies of LTBI screening, LTBI treatment, or accuracy of the tuberculin skin test (TST) or interferon-gamma release assays (IGRAs). A total of 113 publications were identified, with no studies directly evaluating the benefits and harms of screening. For treatment of LTBI, a large (n = 27,830), good-quality randomized clinical trial found a relative risk (RR) for progression to active tuberculosis at 5 years of 0.35 for 24 weeks of isoniazid compared with placebo (number needed to treat, 112) and an increase in hepatotoxicity (RR, 4.59; number needed to harm, 279). Meta-analysis found greater risk for hepatotoxicity with isoniazid than with rifampin (pooled RR, 4.22; n = 7339).
AHRQ-funded; 75Q80120D00007.
Citation: Jonas DE, Riley SR, Lee LC .
Screening for latent tuberculosis infection in adults: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2023 May 2; 329(17):1495-509. doi: 10.1001/jama.2023.3954..
Keywords: U.S. Preventive Services Task Force (USPSTF), Infectious Diseases, Screening, Prevention, Evidence-Based Practice
Cantor AG, Nelson HD, Pappas M
Telehealth for women's preventive services for reproductive health and intimate partner violence: a comparative effectiveness review.
This comparative effectiveness review was conducted on the effectiveness and harms of telehealth interventions for women's reproductive health and intimate partner violence (IPV) services. A literature search was conducted for randomized controlled trials (RCTs) and observational studies of telehealth strategies for women's reproductive health and IPV versus usual care for the period July 2016 to May 2022. Eight RCTs, 1 nonrandomized trial, and 7 observational studies were included (7 studies of contraceptive care and 9 of IPV services). Telehealth services demonstrated similar care as usual care for contraceptive use, sexually transmitted infections, and pregnancy (low strength of evidence [SOE]). Evidence on abortion was insufficient. Outcomes were also similar between telehealth and usual care interventions to replace or supplement IPV services and comparators for repeat IPV, depression, posttraumatic stress disorder, fear of partner, coercive control, self-efficacy, and safety behaviors (low SOE). Telehealth barriers identified included limited internet access, digital literacy, technical challenges, and confidentiality concerns. Safety strategies increased telehealth use for IPV services. Evidence lacked on access, health equity, or harms.
AHRQ-funded; 75Q80120D00006.
Citation: Cantor AG, Nelson HD, Pappas M .
Telehealth for women's preventive services for reproductive health and intimate partner violence: a comparative effectiveness review.
J Gen Intern Med 2023 May; 38(7):1735-43. doi: 10.1007/s11606-023-08033-6..
Keywords: Telehealth, Health Information Technology (HIT), Women, Prevention, Domestic Violence, Evidence-Based Practice, Maternal Care, Sexual Health, Patient-Centered Outcomes Research, Comparative Effectiveness
Henrikson NB, Ivlev I, Blasi PR
Skin cancer screening: updated evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this study was to investigate the advantages and potential risks of skin cancer screening to assist the decision-making of the US Preventive Services Task Force. The researchers utilized the data sources MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials, dated between June 1, 2015, and January 7, 2022. Two independent reviewers evaluated the articles and extracted pertinent data from studies of fair or good quality; the findings were summarized narratively. The primary outcomes and indicators were morbidity; mortality; stage, precursor lesions, or lesion thickness of skin cancer at detection; potential harms of screening. Twenty studies from 29 articles were included (N = 6,053,411). Direct evidence on the effectiveness of screening was obtained from 3 nonrandomized analyses of 2 population-based skin cancer screening initiatives in Germany (n = 1,791,615), indicating no significant reduction in melanoma mortality benefit at the population level over a period of 4 to 10 years of follow up activities. Six studies (n = 2,935,513) offered inconclusive evidence on the relationship between physician-conducted skin examination and lesion thickness or stage at diagnosis. Usual care vs. routine physician-conducted skin examination was not associated with increased detection of skin cancer or precursor lesions (5 studies) or stage at melanoma detection (3 studies). The correlation between physician-conducted skin examination and lesion thickness at detection was inconsistent (3 studies). Nine studies (n = 1 326 051) found a consistent positive association between more advanced stage at melanoma detection and increasing risk of melanoma-associated and all-cause mortality. Two studies (n = 232) found negligible enduring cosmetic or psychosocial harms related to screening.
AHRQ-funded; 75Q80120D00004.
Citation: Henrikson NB, Ivlev I, Blasi PR .
Skin cancer screening: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2023 Apr 18; 329(15):1296-307. doi: 10.1001/jama.2023.3262..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Skin Cancer, Cancer, Screening, Prevention, Evidence-Based Practice, Guidelines
Barry MJ, Wolff TA, Pbert L
AHRQ Author: Wolff TA, Fan TM, Mabry-Hernandez IR, Mills J
Putting evidence into practice: an update on the US Preventive Services Task Force methods for developing recommendations for preventive services
The purpose of this study was to outline the current methodologies employed by the US Preventive Services Task Force (USPSTF) evidence-based recommendations regarding preventive services to improve health for people nationwide, discuss the evolution of these methods to address health equity in preventive care, and identify areas requiring further research. The researchers found that the USPSTF selects subjects based on disease impact, the availability of novel evidence, and the feasibility of implementing the service within primary care settings. In the future, health equity will be increasingly taken into account. Analytical frameworks delineate the crucial questions and associations linking preventive measures to health outcomes. Contextual inquiries offer insights into the natural course of diseases, prevailing practices, health outcomes in vulnerable populations, and health equity considerations. The USPSTF allocates a certainty level to the net benefit estimation of a preventive service (high, moderate, or low) and assesses the net benefit magnitude (considerable, moderate, minimal, or none/negative). Utilizing these evaluations, the USPSTF assigns an alphabetic grade ranging from A (endorse) to D (advise against). When evidence is inadequate, an "I" statement is issued. The USPSTF aims to further refine its simulation modeling techniques and apply evidence to address conditions with limited data in populations disproportionately affected by disease. The authors concluded that exploratory efforts are in progress to gain a deeper understanding of the relationships between social constructs such as race, ethnicity, and gender and their impact on health outcomes, ultimately informing the creation of a USPSTF health equity framework.
Citation: Barry MJ, Wolff TA, Pbert L .
Putting evidence into practice: an update on the US Preventive Services Task Force methods for developing recommendations for preventive services
Ann Fam Med 2023 Mar-Apr;21(2):165-71. doi: 10.1370/afm.2946.
Keywords: U.S. Preventive Services Task Force (USPSTF), Evidence-Based Practice, Guidelines, Prevention, Screening
Mills J, Harding MC
AHRQ Author: Mills J
Screening for obstructive sleep apnea in adults.
This Putting Prevention into Practice case study was created to increase understanding of the USPSTF final recommendation on screening for obstructive sleep apnea (OSA) in adults. A case study was presented using a 41-year-old man with a history of class 1 obesity but was otherwise feeling well. The patient has an uncle who was recently diagnosed with OSA, and the patient has some questions. Three multiple-choice questions are presented regarding USPSTF recommendations whether to screen for OSA for that patient.
AHRQ-authored.
Citation: Mills J, Harding MC .
Screening for obstructive sleep apnea in adults.
Am Fam Physician 2023 Mar;107(3):297-98.
Keywords: U.S. Preventive Services Task Force (USPSTF), Sleep Problems, Guidelines, Prevention, Evidence-Based Practice, Case Study
Asher GN, Feltner C, Harrison WN
Serologic screening for genital herpes: updated evidence report and systematic review for the US Preventive Services Task Force.
Genital herpes, a viral sexually transmitted infection (STI) caused by herpes simplex virus (HSV) subtypes HSV-1 or HSV-2, is a prevalent STI in the US. Early identification of unrecognized HSV-2 infection could reduce transmission and morbidity. In 2016, the US Preventive Services Task Force (USPSTF) recommended against routine serologic screening for genital herpes in asymptomatic individuals. This updated evidence report aimed to identify studies published since the previous 2016 evidence review. A literature search was conducted from September 30, 2015, through January 16, 2022, with ongoing surveillance through July 22, 2022. The review identified no new eligible studies, leading to unchanged overall conclusions from the 2016 recommendation against screening. The prior recommendation was based on psychosocial harms from false-positive test results due to poor screening test accuracy and uncertain benefit of preventive viral medications for reducing viral shedding or improving health outcomes. The review focused on the general population of asymptomatic adolescents and adults and may not be applicable to populations at higher risk for infection, such as those with HIV or other immunosuppressive conditions.
AHRQ-funded; 75Q80120D00007.
Citation: Asher GN, Feltner C, Harrison WN .
Serologic screening for genital herpes: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2023 Feb 14; 329(6):510-12. doi: 10.1001/jama.2022.20356..
Keywords: U.S. Preventive Services Task Force (USPSTF), Sexual Health, Infectious Diseases, Screening, Guidelines, Evidence-Based Practice, Prevention
Dykes PC, Curtin-Bowen M, Lipsitz S
Cost of inpatient falls and cost-benefit analysis of implementation of an evidence-based fall prevention program.
The financial implications of patient falls within healthcare settings, a primary cause of nonreimbursable negative incidents, have not been thoroughly investigated. The aim of this study was to determine the expenses related to inpatient falls and the potential cost savings achieved through the adoption of a proven fall prevention program. This economic assessment employed a matched case-control approach, utilizing results from an interrupted time series analysis that evaluated the alterations in fall rates after the introduction of an evidence-based fall prevention program to estimate inpatient fall expenses. Subsequently, an economic analysis was conducted to evaluate the cost advantages of implementing the program across two American healthcare systems from June 1, 2013, to August 31, 2019, in New York, New York, and Boston, Massachusetts. All adult patients admitted to the participating units were included in the analysis. Data analysis took place between October 2021 and November 2022. The fall prevention program, based on evidence, was introduced in 33 medical and surgical departments across eight hospitals. The primary outcome was the expense related to inpatient falls. Secondary outcomes included costs and savings linked to the evidence-based fall prevention program. The study found that the case-control study and economic analysis included 10,176 patients who experienced a fall event (with or without injury) and 29,161 matched controls without a fall event (51.9% aged 65-74 years, 67.1% White, and 53.6% male). Prior to the intervention, there were 2,503 falls and 900 injuries; following the intervention, there were 2,078 falls and 758 injuries. Based on a 19% decrease in falls and a 20% decrease in injury-causing falls from the beginning to the end of the post-intervention period, the economic analysis revealed that noninjurious and injurious falls led to cost increases of $35,365 and $36,776, respectively. The introduction of the evidence-based fall prevention program resulted in $14,600 in net avoided expenses for every 1000 patient-days.
AHRQ-funded; HS027557; HS025128
Citation: Dykes PC, Curtin-Bowen M, Lipsitz S .
Cost of inpatient falls and cost-benefit analysis of implementation of an evidence-based fall prevention program.
JAMA Health Forum 2023 Jan 6;4(1):e225125. doi: 10.1001/jamahealthforum.2022.5125.
Keywords: Falls, Healthcare Delivery, Evidence-Based Practice, Prevention
Mills J, Barnhart H
AHRQ Author: Mills J
Screening for prediabetes and type 2 diabetes in children and adolescents.
This Putting Prevention into Practice case study is used to increase understanding of the USPSTF final recommendation on screening for prediabetes and type 2 diabetes in children and adolescents. A case study was presented using a 12-year-old-patient with no specific concerns but had gained 18 pounds since their last wellness visit and lives a sedentary lifestyle. The patient’s family history of type 2 diabetes mellitus in maternal and paternal grandparents is described. Three multiple-choice questions are presented regarding harms and benefits of screening for prediabetes and type 2 diabetes for that patient.
AHRQ-authored.
Citation: Mills J, Barnhart H .
Screening for prediabetes and type 2 diabetes in children and adolescents.
Am Fam Physician 2023 Jan; 107(1):79-80..
Keywords: U.S. Preventive Services Task Force (USPSTF), Children/Adolescents, Diabetes, Screening, Evidence-Based Practice, Guidelines, Prevention, Chronic Conditions, Case Study
Chou R, Blazina I, Bougatsos C
Screening for hepatitis B virus infection in nonpregnant adolescents and adults: updated evidence report and systematic review for the US Preventive Services Task Force.
The authors updated the 2014 hepatitis B virus (HBV) screening review in nonpregnant adolescents and adults to inform the USPSTF. They found no direct evidence for the clinical benefits and harms of HBV screening vs no screening. Antiviral therapy for HBV infection was associated with improved intermediate outcomes and may improve clinical outcomes.
AHRQ-funded; 290201500009I.
Citation: Chou R, Blazina I, Bougatsos C .
Screening for hepatitis B virus infection in nonpregnant adolescents and adults: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2020 Dec 15;324(23):2423-36. doi: 10.1001/jama.2020.19750..
Keywords: U.S. Preventive Services Task Force (USPSTF), Children/Adolescents, Hepatitis, Chronic Conditions, Screening, Evidence-Based Practice, Prevention
Cykert S, Keyserling TC, Pignone M
A controlled trial of dissemination and implementation of a cardiovascular risk reduction strategy in small primary care practices.
Researchers assessed the effect of dissemination and implementation of an intervention consisting of practice facilitation and a risk-stratified, population management dashboard on cardiovascular risk reduction for patients at high risk in small, primary care practices. They found that a risk-stratified, population management dashboard combined with practice facilitation led to substantial reductions of 10-year atherosclerotic cardiovascular disease risk for patients at high risk. They recommended utilizing similar approaches to lead to effective dissemination and implementation of other new evidence, especially in rural and other under-resourced practices.
AHRQ-funded; HS023912.
Citation: Cykert S, Keyserling TC, Pignone M .
A controlled trial of dissemination and implementation of a cardiovascular risk reduction strategy in small primary care practices.
Health Serv Res 2020 Dec;55(6):944-53. doi: 10.1111/1475-6773.13571..
Keywords: Cardiovascular Conditions, Risk, Prevention, Primary Care, Implementation, Evidence-Based Practice, Patient-Centered Healthcare, Patient-Centered Outcomes Research
O'Connor EA, Evans CV, Rushkin MC
Behavioral counseling to pomote a healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: updated evidence report and systematic review for the US Preventive Services Task Force.
Researchers reviewed the benefits and harms of behavioral counseling interventions to improve diet and physical activity in adults with cardiovascular risk factors. They found that medium- and high-contact multisession behavioral counseling interventions to improve diet and increase physical activity for people with elevated blood pressure and lipid levels were effective in reducing cardiovascular events, blood pressure, low-density lipoproteins, and adiposity-related outcomes, with little to no risk of serious harm.
AHRQ-funded; 290201200015I.
Citation: O'Connor EA, Evans CV, Rushkin MC .
Behavioral counseling to pomote a healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2020 Nov 24;324(20):2076-94. doi: 10.1001/jama.2020.17108..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cardiovascular Conditions, Nutrition, Lifestyle Changes, Risk, Prevention, Evidence-Based Practice, Guidelines
Gartlehner G, Vander Schaaf EB, Orr C
Gartlehner G, Vander Schaaf EB, Orr C, Kennedy SM, Clark R, Viswanathan M. Screening for hypertension in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
This paper is an evidence update that accompanies the final recommendation from the U.S. Preventive Services Task Force (USPSTF) on screening and treatment of hypertension in childhood and adolescence. The update confirmed the previous update that the evidence is inconclusive whether the diagnostic accuracy of blood pressure measurements is adequate for screening asymptomatic children and adolescents in primary care. Forty-two studies from 43 publications were included in the final review.
AHRQ-funded; 290201500011I.
Citation: Gartlehner G, Vander Schaaf EB, Orr C .
Gartlehner G, Vander Schaaf EB, Orr C, Kennedy SM, Clark R, Viswanathan M. Screening for hypertension in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2020 Nov 10;324(18):1884-95. doi: 10.1001/jama.2020.11119..
Keywords: Children/Adolescents, U.S. Preventive Services Task Force (USPSTF), Blood Pressure, Screening, Evidence-Based Practice, Prevention, Cardiovascular Conditions
Mills J, Wonoprabowo L
AHRQ Author: Mills J
Primary care-based interventions to prevent illicit drug use in children, adolescents, and young adults.
This case study concerns a 14-year-old patient who presents for a well-child visit. The patient eats a healthy diet, is part of a local soccer league, is an overall good student, and just started high school in the fall. The patient denies trying any illicit substances but reports trying to “get high” from cough syrup. Three questions are presented, and answers provided.
AHRQ-authored.
Citation: Mills J, Wonoprabowo L .
Primary care-based interventions to prevent illicit drug use in children, adolescents, and young adults.
Am Fam Physician 2020 Oct 15;102(8):493-94..
Keywords: Children/Adolescents, Young Adults, Substance Abuse, Primary Care, Prevention, U.S. Preventive Services Task Force (USPSTF), Case Study, Guidelines, Evidence-Based Practice