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 36 Research Studies DisplayedSiegler JE, Albright KC, George AJ
Time to neurological deterioration in ischemic stroke.
This study examined the time to neurological deterioration (ND) in ischemic stroke. The study concluded that despite having similar stroke severity and age, patients with nonreversible causes of ND had significantly shorter median time to ND when compared to patients with reversible causes of ND.
AHRQ-funded; HS013852.
Citation: Siegler JE, Albright KC, George AJ .
Time to neurological deterioration in ischemic stroke.
Med Student Res J 2017 Winter;4:18-24. doi: 10.15404/msrj/03.2016.0005..
Keywords: Neurological Disorders, Outcomes, Stroke
Boehme AK, Carr BG, Kasner SE
Sex differences in rt-PA utilization at hospitals treating stroke: the National Inpatient Sample.
The researchers sought to explore sex and race differences in the utilization of recombinant tissue plasminogen activator (rt-PA) at primary stroke centers (PSCs) compared to non-PSCs across the US. They found that women are less likely to receive rt-PA than men at both PSCs and non-PSCs. Absolute treatment rates are lowest in black women.
AHRQ-funded; HS17960; HS018362; HS013852.
Citation: Boehme AK, Carr BG, Kasner SE .
Sex differences in rt-PA utilization at hospitals treating stroke: the National Inpatient Sample.
Front Neurol 2017 Sep 27;8:500. Original Research. doi: 10.3389/fneur.2017.00500.
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Keywords: Healthcare Delivery, Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities, Sex Factors, Stroke
Albright KC, Howard VJ, Howard G
Age and sex disparities in discharge statin prescribing in the stroke belt: evidence from the reasons for geographic and racial differences in stroke study.
This study analyzed discharge medications for participants hospitalized for an ischemic stroke during follow-up of the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study. It found that statin discharge prescribing may differ among Stroke Belt and non-Stroke Belt residents, particularly in older Americans and men.
AHRQ-funded; HS023009; HS013852.
Citation: Albright KC, Howard VJ, Howard G .
Age and sex disparities in discharge statin prescribing in the stroke belt: evidence from the reasons for geographic and racial differences in stroke study.
J Am Heart Assoc 2017 Aug 2;6(8). doi: 10.1161/jaha.117.005523.
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Keywords: Disparities, Medication, Stroke, Elderly, Sex Factors
Sangha RS, Naidech AM, Corado C
Challenges in the medical management of symptomatic intracranial stenosis in an urban setting.
The researchers hypothesized that recurrent stroke risk among patients treated with aggressive medical management (AMM) is similar to that found in the medical arm of the SAMMPRIS trial (Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis). However, results indicated that recurrent stroke risk within 30 days in patients with symptomatic intracranial atherosclerotic disease was higher than that observed in the medical arm of SAMMPRIS even in the subgroup receiving AMM.
AHRQ-funded; HS023437.
Citation: Sangha RS, Naidech AM, Corado C .
Challenges in the medical management of symptomatic intracranial stenosis in an urban setting.
Stroke 2017 Aug;48(8):2158-63. doi: 10.1161/strokeaha.116.016254.
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Keywords: Brain Injury, Urban Health, Stroke, Patient-Centered Outcomes Research, Care Management
Cramer JD, Patel UA, Maas MB
Is neck dissection associated with an increased risk of postoperative stroke?
The researchers investigated whether neck dissection is an independent risk factor for postoperative stroke. They found that the rate of postoperative stroke was greater with neck dissection than without it and concluded that stroke is a rare but highly morbid complication after head and neck surgery. Compared with other head and neck surgery, neck dissection in patients at risk for carotid artery stenosis is associated with an increased risk of postoperative stroke.
AHRQ-funded; HS023011.
Citation: Cramer JD, Patel UA, Maas MB .
Is neck dissection associated with an increased risk of postoperative stroke?
Otolaryngol Head Neck Surg 2017 Aug;157(2):226-32. doi: 10.1177/0194599817698414.
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Keywords: Orthopedics, Quality Improvement, Risk, Stroke, Surgery
Sauser Zachrison K, Schwamm LH
Implementation of rapid treatment and interfacility transport for patients with suspected stroke by large-vessel occlusion: in one door and out the other.
This editorial discusses an article in this same issue of JAMA Neurology (McTaggart et al) that describes the results of the implementation of a standard protocol for patients with suspected emergent large-vessel occlusion (ELVO), and the protocol’s impact on both the process of care and patient outcomes. The editorial concludes that the McTaggart article challenges the medical community to develop an interdisciplinary, team-based, protocol-based approach to patients with potential ELVOs, and that work across the disciplines is needed to achieve an acceptable false-positive rate for the system.
AHRQ-funded; HS024561.
Citation: Sauser Zachrison K, Schwamm LH .
Implementation of rapid treatment and interfacility transport for patients with suspected stroke by large-vessel occlusion: in one door and out the other.
JAMA Neurol 2017 Jul;74(7):765-66. doi: 10.1001/jamaneurol.2017.0324..
Keywords: Brain Injury, Health Services Research (HSR), Healthcare Delivery, Stroke, Transitions of Care, Trauma
Krishnan S, Pappadis MR, Weller SC
Needs of stroke survivors as perceived by their caregivers: a scoping review.
Caregivers usually are not involved while planning the stroke survivor's medical and rehabilitation goals and interventions. This review aimed to identify the needs of stroke survivors as perceived by their caregivers. The data synthesis from 66 studies produced the following three metathemes: (a) body functional needs, (b) activity and participatory needs, and (c) environmental needs.
AHRQ-funded; HS022134; HS024711.
Citation: Krishnan S, Pappadis MR, Weller SC .
Needs of stroke survivors as perceived by their caregivers: a scoping review.
Am J Phys Med Rehabil 2017 Jul;96(7):487-505. doi: 10.1097/phm.0000000000000717.
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Keywords: Stroke, Caregiving, Rehabilitation, Cardiovascular Conditions
Lin C, Lee J, Chatterjee N
Predicting domain-specific health-related quality of life using acute infarct volume.
This study evaluated whether acute infarct volume predicts domain-specific Neuro-Quality of Life scores at 3 months after stroke. It found that acute infarct volume is a poor predictor of health-related quality of life (HRQOL) domains after ischemic stroke, with the exception of the cognitive domain. Overall, clinical and imaging variables explained less than 50 percent of the variance in HRQOL outcomes at 3 months.
AHRQ-funded; HS023437.
Citation: Lin C, Lee J, Chatterjee N .
Predicting domain-specific health-related quality of life using acute infarct volume.
Stroke 2017 Jul;48(7):1925-31. doi: 10.1161/strokeaha.117.017094.
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Keywords: Quality of Life, Stroke, Patient-Centered Outcomes Research
Tajeu GS, Mennemeyer S, Menachemi N
Cost-effectiveness of antihypertensive medication: exploring race and sex differences using data from the REasons for Geographic and Racial Differences in Stroke Study.
The researchers compared the cost-effectiveness of antihypertensive medication treatment versus no-treatment in white and black adults. They concluded that antihypertensive medication treatment is cost-saving and increases quality-adjusted life-years (QALYs) for all groups considered in the model, particularly among black adults.
AHRQ-funded; HS013852.
Citation: Tajeu GS, Mennemeyer S, Menachemi N .
Cost-effectiveness of antihypertensive medication: exploring race and sex differences using data from the REasons for Geographic and Racial Differences in Stroke Study.
Med Care 2017 Jun;55(6):552-60. doi: 10.1097/mlr.0000000000000719.
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Keywords: Medication, Blood Pressure, Healthcare Costs, Racial and Ethnic Minorities, Stroke
Wilson JL, Eriksson CO, Williams CN
Endovascular therapy in pediatric stroke: utilization, patient characteristics, and outcomes.
This study aimed to describe endovascular therapy utilization and explore outcomes in a national sample of pediatric arterial ischemic stroke patients. In this sample of children with a diagnosis of arterial ischemic stroke, endovascular therapy was infrequently utilized. Patients with a procedure code for endovascular therapy had significant stroke-related deficits, but outcomes were similar to those in children who did not receive endovascular therapy.
AHRQ-funded; HS022981.
Citation: Wilson JL, Eriksson CO, Williams CN .
Endovascular therapy in pediatric stroke: utilization, patient characteristics, and outcomes.
Pediatr Neurol 2017 Apr;69:87-92.e2. doi: 10.1016/j.pediatrneurol.2017.01.013.
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Keywords: Children/Adolescents, Healthcare Cost and Utilization Project (HCUP), Patient-Centered Outcomes Research, Stroke
Tam MC, Lee R, Cascino TM
Current perspectives on systemic hypertension in heart failure with preserved ejection fraction.
Heart failure with preserved ejection fraction (HFpEF) is a prevalent but incompletely understood syndrome. Traditional models of HFpEF pathophysiology revolve around systemic hypertension (HTN) and other causes of increased left ventricular afterload leading to left ventricular hypertrophy (LVH) and diastolic dysfunction. However, emerging models attribute the development of HFpEF to systemic proinflammatory changes secondary to common comorbidities which include HTN.
AHRQ-funded; HS024567.
Citation: Tam MC, Lee R, Cascino TM .
Current perspectives on systemic hypertension in heart failure with preserved ejection fraction.
Curr Hypertens Rep 2017 Feb;19(2):12. doi: 10.1007/s11906-017-0709-2.
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Keywords: Blood Pressure, Heart Disease and Health, Cardiovascular Conditions, Stroke, Outcomes
Sumner JA, Khodneva Y, Muntner P
Effects of concurrent depressive symptoms and perceived stress on cardiovascular risk in low- and high-income participants: findings from the Reasons for Geographical and Racial Differences in Stroke (REGARDS) study.
Using data from the Reasons for Geographical and Racial Differences in Stroke (REGARDS) study, the authors examined associations among depressive symptoms and stress, alone and in combination, and incident cardiovascular disease (CVD) and all-cause mortality as a function of socioeconomic status. They found that screening for a combination of elevated depressive symptoms and stress in low-income persons may help identify those at increased risk of incident CVD and mortality.
AHRQ-funded; HS023009.
Citation: Sumner JA, Khodneva Y, Muntner P .
Effects of concurrent depressive symptoms and perceived stress on cardiovascular risk in low- and high-income participants: findings from the Reasons for Geographical and Racial Differences in Stroke (REGARDS) study.
J Am Heart Assoc 2016 Oct 10;5(10). doi: 10.1161/jaha.116.003930.
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Keywords: Cardiovascular Conditions, Depression, Social Determinants of Health, Stress, Stroke
Nakagawa K, Ahn HJ, Taira DA
Ethnic comparison of 30-day potentially preventable readmissions after stroke in Hawaii.
The authors sought to compare potentially preventable readmissions (PPR) among a multiethnic population in Hawaii. They concluded that the Chinese ethnicity may have a higher risk of 30-day PPR after stroke compared to whites. Other associated factors include mental illness, Medicaid, and Hawaii county.
AHRQ-funded; HS019990.
Citation: Nakagawa K, Ahn HJ, Taira DA .
Ethnic comparison of 30-day potentially preventable readmissions after stroke in Hawaii.
Stroke 2016 Oct;47(10):2611-7. doi: 10.1161/strokeaha.116.013669.
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Keywords: Stroke, Racial and Ethnic Minorities, Hospital Readmissions, Hospitalization, Risk
Kabra R, Girotra S, Vaughan Sarrazin M
Refining stroke prediction in atrial fibrillation patients by addition of African-American ethnicity to CHA2DS2-VASc score.
The authors hypothesized that the addition of African-American ethnicity to the CHA2DS2-VASc score might improve stroke prediction in patients with atrial fibrillation (AF). They found that, in patients over age 65 with newly diagnosed AF, the addition of ethnicity to CHA2DS2-VASc score significantly improved stroke prediction.
AHRQ-funded; HS023104.
Citation: Kabra R, Girotra S, Vaughan Sarrazin M .
Refining stroke prediction in atrial fibrillation patients by addition of African-American ethnicity to CHA2DS2-VASc score.
J Am Coll Cardiol 2016 Aug 2;68(5):461-70. doi: 10.1016/j.jacc.2016.05.044.
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Keywords: Stroke, Heart Disease and Health, Racial and Ethnic Minorities, Risk, Cardiovascular Conditions
Lima FO, Silva GS, Furie KL
Field assessment stroke triage for emergency destination: a simple and accurate prehospital scale to detect large vessel occlusion strokes.
The authors aimed to develop a simple field scale to identify large vessel occlusion strokes (LVOS). They found that Field Assessment Stroke Triage for Emergency Destination (FAST-ED) is a simple scale that, if successfully validated in the field, may be used by medical emergency professionals to identify LVOS in the prehospital setting enabling rapid triage of patients.
AHRQ-funded; HS011392.
Citation: Lima FO, Silva GS, Furie KL .
Field assessment stroke triage for emergency destination: a simple and accurate prehospital scale to detect large vessel occlusion strokes.
Stroke 2016 Aug;47(8):1997-2002. doi: 10.1161/strokeaha.116.013301.
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Keywords: Care Management, Elderly, Emergency Department, Stroke
Karp DN, Wolff CS, Wiebe DJ
Reassessing the stroke belt: using small area spatial statistics to identify clusters of high stroke mortality in the United States.
The researchers identified clusters of high stroke mortality and adjacent areas of low stroke mortality for US counties and evaluated for regional differences in county-level risk factors. They found that clusters of high stroke mortality exist beyond the 8-state stroke belt, and variation exists within the stroke belt. They recommended reconsideration of the stroke belt definition and suggested increased attention to local determinants of health underlying small area regional variability to inform targeted healthcare interventions.
AHRQ-funded; HS018362.
Citation: Karp DN, Wolff CS, Wiebe DJ .
Reassessing the stroke belt: using small area spatial statistics to identify clusters of high stroke mortality in the United States.
Stroke 2016 Jul;47(7):1939-42. doi: 10.1161/strokeaha.116.012997.
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Keywords: Mortality, Risk, Stroke, Social Determinants of Health
Du XL, Zhang Y, Hardy D
Associations between hematopoietic growth factors and risks of venous thromboembolism, stroke, ischemic heart disease and myelodysplastic syndrome: findings from a large population-based cohort of women with breast cancer.
The researchers sought to determine the risk of venous thromboembolism (VTE), stroke, ischemic heart disease, and myelodysplastic syndrome (MDS) in association with the receipt of colony-stimulating factors (CSFs) and/or erythropoiesis-stimulating agents (ESAs) in women with breast cancer. They found that receipts of CSFs and ESAs were significantly associated with an increased risk of VTE in women with breast cancer.
AHRQ-funded; HS018956.
Citation: Du XL, Zhang Y, Hardy D .
Associations between hematopoietic growth factors and risks of venous thromboembolism, stroke, ischemic heart disease and myelodysplastic syndrome: findings from a large population-based cohort of women with breast cancer.
Cancer Causes Control 2016 May;27(5):695-707. doi: 10.1007/s10552-016-0742-5.
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Keywords: Blood Clots, Cancer: Breast Cancer, Cardiovascular Conditions, Risk, Stroke
Hodell E, Hughes SD, Corry M
Paramedic perspectives on barriers to prehospital acute stroke recognition.
The researchers aimed to understand systematically the challenges and barriers faced by paramedics in recognizing stroke presentations in the field. They concluded that while challenges to stroke recognition in the field were slightly different for rural and urban emergency medical service providers, participants concurred that timely, systematic feedback on individual patients and case-based training would strengthen early stroke recognition skills.
AHRQ-funded; HS017965.
Citation: Hodell E, Hughes SD, Corry M .
Paramedic perspectives on barriers to prehospital acute stroke recognition.
Prehosp Emerg Care 2016 May-Jun;20(3):415-24. doi: 10.3109/10903127.2015.1115933.
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Keywords: Diagnostic Safety and Quality, Emergency Medical Services (EMS), Healthcare Delivery, Stroke, Training
Brach C
AHRQ Author: Brach C
Even in an emergency, doctors must make informed consent an informed choice.
When a stroke is suspected, a daughter is pressured to consent to her father's treatment without fully understanding the risks.
AHRQ-authored.
Citation: Brach C .
Even in an emergency, doctors must make informed consent an informed choice.
Health Aff 2016 Apr;35(4):739-43. doi: 10.1377/hlthaff.2015.1407.
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Keywords: Case Study, Decision Making, Emergency Department, Health Literacy, Patient and Family Engagement, Stroke
Fonarow GG, Liang L, Thomas L
Assessment of home-time after acute ischemic stroke in Medicare beneficiaries.
The researchers evaluated home-time as a patient-centered outcome in Medicare beneficiaries with ischemic stroke in comparison with modified Rankin Scale (mRS) score at 90 days and at 1 year post event. They concluded that in a population of older patients with ischemic stroke, home-time was readily available from administrative data and associated with mRS at 90 days and 1 year.
AHRQ-funded; HS019479; HS016964.
Citation: Fonarow GG, Liang L, Thomas L .
Assessment of home-time after acute ischemic stroke in Medicare beneficiaries.
Stroke 2016 Mar;47(3):836-42. doi: 10.1161/strokeaha.115.011599.
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Keywords: Medicare, Stroke, Elderly, Home Healthcare, Patient-Centered Outcomes Research
Lyerly MJ, Wu TC, Mullen MT
The effects of telemedicine on racial and ethnic disparities in access to acute stroke care.
The authors sought to determine the effect of telemedicine on access to acute stroke care for racial and ethnic minorities in the state of Texas. They found that telemedicine increased access to acute stroke care for 1.5 million Texans, and they found no evidence of disparities in access to the acute stroke expertise afforded by telemedicine.
AHRQ-funded; HS013852.
Citation: Lyerly MJ, Wu TC, Mullen MT .
The effects of telemedicine on racial and ethnic disparities in access to acute stroke care.
J Telemed Telecare 2016 Mar;22(2):114-20. doi: 10.1177/1357633x15589534.
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Keywords: Access to Care, Disparities, Racial and Ethnic Minorities, Stroke, Telehealth
Navarro-Millan I, Yang S, DuVall SL
Association of hyperlipidaemia, inflammation and serological status and coronary heart disease among patients with rheumatoid arthritis: data from the National Veterans Health Administration.
The researchers studied the association of serum lipids, inflammation, and seropositivity on coronary heart disease (CHD) and stroke in patients with rheumatoid arthritis. They found that in the study population of predominantly male veterans, higher levels of erythrocyte sedimentation rate and C-reactive protein were associated with increased risk of heart attack and stroke, and higher levels of HDL-C were inversely associated with heart attack and stroke.
AHRQ-funded; HS018517
Citation: Navarro-Millan I, Yang S, DuVall SL .
Association of hyperlipidaemia, inflammation and serological status and coronary heart disease among patients with rheumatoid arthritis: data from the National Veterans Health Administration.
Ann Rheum Dis. 2016 Feb;75(2):341-7. doi: 10.1136/annrheumdis-2013-204987..
Keywords: Stroke, Cardiovascular Conditions, Arthritis
Albright KC, Boehme AK, Tanner RM
Addressing stroke risk factors in black and white Americans: Findings from the National Health and Nutrition Examination Survey, 2009-2010.
The authors examined racial differences in risk factors being addressed among stroke survivors and those at risk for stroke. They found that addressed hypertension and hyperlipidemia in stroke-naïve participants were significantly lower in blacks than in whites. They concluded that a better understanding of this information is critical to preventing stroke and other vascular diseases.
AHRQ-funded; HS023009; HS013852.
Citation: Albright KC, Boehme AK, Tanner RM .
Addressing stroke risk factors in black and white Americans: Findings from the National Health and Nutrition Examination Survey, 2009-2010.
Ethn Dis 2016 Jan 21;26(1):9-16. doi: 10.18865/ed.26.1.9.
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Keywords: Disparities, Racial and Ethnic Minorities, Patient-Centered Outcomes Research, Prevention, Stroke
Mullen MT, Wiebe DJ, Bowman A
Disparities in accessibility of certified primary stroke centers.
These authors examined the proportion of the U.S. population with less than 60-minute access to Primary Stroke Centers (PSCs). They found significant geographic disparities in access to the PSCs. Stroke belt States have a higher burden of stroke and more limited access to PSCs.
AHRQ-funded; HS013852; HS017960; HS010914
Citation: Mullen MT, Wiebe DJ, Bowman A .
Disparities in accessibility of certified primary stroke centers.
Stroke. 2014 Nov;45(11):3381-8. doi: 10.1161/strokeaha.114.006021..
Keywords: Stroke, Access to Care, Disparities
Adeoye O, Albright KC, Carr BG
Geographic access to acute stroke care in the United States.
In this article the authors describe access of the US population to all facilities that actually provide intravenous recombinant tissue-type plasminogen activator (r-tPA) or endovascular therapy for acute ischemic stroke. The investigators concluded that more than half of the US population has geographic access to hospitals that actually deliver acute stroke care but treatment rates remain low.
AHRQ-funded; HS013852.
Citation: Adeoye O, Albright KC, Carr BG .
Geographic access to acute stroke care in the United States.
Stroke 2014 Oct;45(10):3019-24. doi: 10.1161/strokeaha.114.006293.
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Keywords: Access to Care, Stroke