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 102 Research Studies DisplayedGartlehner G, Patel SV, Feltner C
Hormone therapy for the primary prevention of chronic conditions in postmenopausal women: evidence report and systematic review for the US Preventive Services Task Force.
This review updated evidence for the US Preventive Services Task Force on the benefits and harms of hormone therapy in reducing risks for chronic conditions. It concluded that hormone therapy for the primary prevention of chronic conditions in menopausal women is associated with some beneficial effects but also with a substantial increase of risks for harms. The available evidence regarding benefits and harms of early initiation of hormone therapy is inconclusive.
AHRQ-funded; 290201200015I.
Citation: Gartlehner G, Patel SV, Feltner C .
Hormone therapy for the primary prevention of chronic conditions in postmenopausal women: evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2017 Dec 12;318(22):2234-49. doi: 10.1001/jama.2017.16952.
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Keywords: Chronic Conditions, Evidence-Based Practice, Guidelines, Prevention, U.S. Preventive Services Task Force (USPSTF), Women
Carson NJ, Progovac AM, Wang Y
A decline in depression treatment following FDA antidepressant warnings largely explains racial/ethnic disparities in prescription fills.
The Food and Drug Administration's 2004 antidepressant warning was followed by decreases in antidepressant prescribing for youth. Little is known about how antidepressant prescribing patterns varied by race/ethnicity. This study analyzed Medicaid claims data from four U.S. states (2002-2009) for youth ages 5-17. The authors found that antidepressant prescription fills declined most post-warning for White youth, suggesting that risk information may have diffused less rapidly to prescribers or caregivers of minorities.
AHRQ-funded; HS021486.
Citation: Carson NJ, Progovac AM, Wang Y .
A decline in depression treatment following FDA antidepressant warnings largely explains racial/ethnic disparities in prescription fills.
Depress Anxiety 2017 Dec;34(12):1147-56. doi: 10.1002/da.22681..
Keywords: Medication, Children/Adolescents, Depression, Guidelines, Racial and Ethnic Minorities
Cosgrove L, Krimsky S, Wheeler EE
Conflict of interest policies and industry relationships of guideline development group members: A cross-sectional study of clinical practice guidelines for depression.
The purpose of the present study was to assess a) the disclosure requirements of guideline development groups in a cross-section of guidelines for major depression; and, b) the extent and type of conflicts of panel members. It found that most of the guidelines were developed by panels that had members with industry financial ties to drug companies that manufacture antidepressant medication.
AHRQ-funded; HS022940.
Citation: Cosgrove L, Krimsky S, Wheeler EE .
Conflict of interest policies and industry relationships of guideline development group members: A cross-sectional study of clinical practice guidelines for depression.
Account Res 2017;24(2):99-115. doi: 10.1080/08989621.2016.1251319.
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Keywords: Medication, Depression, Guidelines, Behavioral Health, Research Methodologies
Rundell SD, Gold LS, Hansen RN
Impact of co-morbidities on resource use and adherence to guidelines among commercially insured adults with new visits for back pain.
The purpose of this study was to assess if co-morbidity is associated with higher use of back-related care and adherence to back pain guidelines. The investigators found that co-morbidity burden and the presence of specific chronic conditions, such as musculoskeletal conditions, were associated with high long-term use of back-related care and care inconsistent with guidelines.
AHRQ-funded; HS022982.
Citation: Rundell SD, Gold LS, Hansen RN .
Impact of co-morbidities on resource use and adherence to guidelines among commercially insured adults with new visits for back pain.
J Eval Clin Pract 2017 Dec;23(6):1218-26. doi: 10.1111/jep.12763..
Keywords: Back Health and Pain, Guidelines, Health Services Research (HSR), Healthcare Utilization, Patient Adherence/Compliance
Gephart SM, Hanson C, Wetzel CM
NEC-zero recommendations from scoping review of evidence to prevent and foster timely recognition of necrotizing enterocolitis.
The purpose of this paper is to present a scoping review with two new meta-analyses, clinical recommendations, and implementation strategies to prevent and foster timely recognition of necrotizing enterocolitis. The researchers conducted a stakeholder-engaged scoping review to classify strength of evidence and form implementation recommendations across subgroup areas: 1) promoting human milk, 2) feeding protocols and transfusion, 3) timely recognition strategies, and 4) medication stewardship.
AHRQ-funded; HS022908.
Citation: Gephart SM, Hanson C, Wetzel CM .
NEC-zero recommendations from scoping review of evidence to prevent and foster timely recognition of necrotizing enterocolitis.
Matern Health Neonatol Perinatol 2017 Dec;3:23. doi: 10.1186/s40748-017-0062-0.
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Keywords: Adverse Events, Digestive Disease and Health, Guidelines, Newborns/Infants, Prevention
Dykewicz MS, Wallace DV, Baroody F
Treatment of seasonal allergic rhinitis: an evidence-based focused 2017 guideline update.
This article provides an evidence-based focused 2017 guideline update for the treatment of seasonal allergic rhinitis.
AHRQ-funded; HS024599
Citation: Dykewicz MS, Wallace DV, Baroody F .
Treatment of seasonal allergic rhinitis: an evidence-based focused 2017 guideline update.
Ann Allergy Asthma Immunol 2017 Dec;119(6):489-511.e41. doi: 10.1016/j.anai.2017.08.012..
Keywords: Evidence-Based Practice, Guidelines, Patient-Centered Outcomes Research
Colla CH, Mainor AJ
Choosing Wisely Campaign: valuable for providers who knew about it, but awareness remained constant, 2014-17.
The Choosing Wisely campaign has codified recommendations of which health care services' use should be questioned and discussed with patients. The ABIM Foundation administered surveys in 2014 and 2017 to examine physicians' attitudes toward and awareness of the use of low-value care. There were no significant changes between 2014 and 2017 in awareness of the campaign among physicians or physician-reported difficulty in talking to patients about avoiding a low-value service.
AHRQ-funded; HS023812.
Citation: Colla CH, Mainor AJ .
Choosing Wisely Campaign: valuable for providers who knew about it, but awareness remained constant, 2014-17.
Health Aff 2017 Nov;36(11):2005-11. doi: 10.1377/hlthaff.2017.0945.
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Keywords: Decision Making, Guidelines, Quality of Care, Health Services Research (HSR), Clinician-Patient Communication
Probst MA, Kanzaria HK, Schoenfeld EM
Shared decisionmaking in the emergency department: a guiding framework for clinicians.
The authors developed a simple framework to illustrate how shared decisionmaking should be approached in clinical practice. They believe it should be the preferred or default approach to decisionmaking, except in clinical situations in which 3 factors interfere. These 3 factors are lack of clinical uncertainty or equipoise, patient decisionmaking ability, and time, all of which can render shared decisionmaking infeasible. The authors next discuss how to address each factor.
AHRQ-funded; HS021271; HS024311.
Citation: Probst MA, Kanzaria HK, Schoenfeld EM .
Shared decisionmaking in the emergency department: a guiding framework for clinicians.
Ann Emerg Med 2017 Nov;70(5):688-95. doi: 10.1016/j.annemergmed.2017.03.063.
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Keywords: Decision Making, Emergency Department, Emergency Medical Services (EMS), Evidence-Based Practice, Guidelines
Guise JM, Chang C, Butler M
AHRQ Author: Chang C
AHRQ series on complex intervention systematic reviews-paper 1: an introduction to a series of articles that provide guidance and tools for reviews of complex interventions.
The seven articles in this series reflect and distill the discussions from the in-person meeting and follow-up workgroups on tools and approaches to systematic reviews of complex interventions. The first three articles address how systematic reviews for complex interventions are conceptualized and operationalized for the protocol. The next two articles discuss how to choose appropriate analytic methods to implement analyses of complex interventions. The final two articles describe proposed reporting elements for systematic reviews of complex interventions.
AHRQ-authored; AHRQ-funded; 290201200004C; 290201200016I; 290201500011I.
Citation: Guise JM, Chang C, Butler M .
AHRQ series on complex intervention systematic reviews-paper 1: an introduction to a series of articles that provide guidance and tools for reviews of complex interventions.
J Clin Epidemiol 2017 Oct;90:6-10. doi: 10.1016/j.jclinepi.2017.06.011.
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Keywords: Data, Evidence-Based Practice, Guidelines, Research Methodologies
Kelly MP, Noyes J, Kane RL
AHRQ Author: Chang C
AHRQ series on complex intervention systematic reviews-paper 2: defining complexity, formulating scope, and questions.
This paper builds on concepts introduced in paper 1 of this series. It describes the methodological, practical, and philosophical challenges and potential approaches for formulating the questions and scope of systematic reviews of complex interventions. Furthermore, it discusses the use of theory to help organize reviews of complex interventions.
AHRQ-authored; AHRQ-funded; 290-2012-00004-C; 290-2015-00008I; 290-2015-00011I.
Citation: Kelly MP, Noyes J, Kane RL .
AHRQ series on complex intervention systematic reviews-paper 2: defining complexity, formulating scope, and questions.
J Clin Epidemiol 2017 Oct;90:11-18. doi: 10.1016/j.jclinepi.2017.06.012.
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Keywords: Data, Evidence-Based Practice, Guidelines, Research Methodologies
Viswanathan M, McPheeters ML, Murad MH
AHRQ series on complex intervention systematic reviews-paper 4: selecting analytic approaches.
This article addresses the uncertainty that systematic reviewers face in selecting methods for reviews of complex interventions. Specifically, it lays out parameters for systematic reviewers to consider when selecting analytic approaches that best answer the questions at hand and suggests analytic techniques that may be appropriate in different circumstances.
AHRQ-funded; 290201200004C.
Citation: Viswanathan M, McPheeters ML, Murad MH .
AHRQ series on complex intervention systematic reviews-paper 4: selecting analytic approaches.
J Clin Epidemiol 2017 Oct;90:28-36. doi: 10.1016/j.jclinepi.2017.06.014.
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Keywords: Data, Evidence-Based Practice, Guidelines, Research Methodologies
Pigott T, Noyes J, Umscheid CA
AHRQ series on complex intervention systematic reviews-paper 5: advanced analytic methods.
In this paper, the authors emphasize that the specific research question posed in the review should be used as a guide for choosing the appropriate analytic method. They present advanced analytic approaches that address some common questions that guide reviews of complex interventions such as: (1) How effective is the intervention? and (2) For whom does the intervention work and in what contexts?
AHRQ-funded; 290-2012-00004C; 290-2015-00005I; 290-2015-00004I; 290-2015-00009I; 290-2015-00013I; 290-2015-00011I; 290-2015-00003I.
Citation: Pigott T, Noyes J, Umscheid CA .
AHRQ series on complex intervention systematic reviews-paper 5: advanced analytic methods.
J Clin Epidemiol 2017 Oct;90:37-42. doi: 10.1016/j.jclinepi.2017.06.015.
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Keywords: Decision Making, Evidence-Based Practice, Guidelines, Research Methodologies
Guise JM, Butler ME, Chang C
AHRQ series on complex intervention systematic reviews-paper 6: PRISMA-CI extension statement and checklist.
This paper provides a stand-alone extension to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting tool for complex interventions-PRISMA-CI-to help authors, publishers, and readers understand and apply to systematic reviews of complex interventions. PRISMA-CI development followed the Enhancing the QUAlity and Transparency Of health Research Network guidance for extensions and focused on adding or modifying only essential items.
AHRQ-funded; 290201200004C; 290201200016I; 290201500011I.
Citation: Guise JM, Butler ME, Chang C .
AHRQ series on complex intervention systematic reviews-paper 6: PRISMA-CI extension statement and checklist.
J Clin Epidemiol 2017 Oct;90:43-50. doi: 10.1016/j.jclinepi.2017.06.016.
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Keywords: Evidence-Based Practice, Guidelines, Patient-Centered Outcomes Research, Research Methodologies
Guise JM, Butler M, Chang C
AHRQ Author: Chang C
AHRQ series on complex intervention systematic reviews-paper 7: PRISMA-CI elaboration and explanation.
The Complex Interventions Methods Workgroup developed an extension to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Complex Interventions (PRISMA-CI). Following the guidance for Preferred Reporting Items for Systematic Reviews and Meta-Analysis extensions, this Explanation and Elaboration (EE) document accompanies the PRISMA-CI checklist to promote consistency in reporting of systematic reviews of complex interventions.
AHRQ-authored; AHRQ-funded; 290201200004C; 290201200016I; 290201500011I.
Citation: Guise JM, Butler M, Chang C .
AHRQ series on complex intervention systematic reviews-paper 7: PRISMA-CI elaboration and explanation.
J Clin Epidemiol 2017 Oct;90:51-58. doi: 10.1016/j.jclinepi.2017.06.017.
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Keywords: Data, Evidence-Based Practice, Guidelines, Research Methodologies
Roghmann MC, Andronescu LR, Stucke EM
Clostridium difficile colonization of nursing home residents.
This letter to the editor notes that Clostridum difficile is a leading cause of infectious diarrhea in nursing homes and asserts that evidence-based infection control guidelines are needed to reduce transmission of C. difficile in these settings.
AHRQ-funded; HS019979.
Citation: Roghmann MC, Andronescu LR, Stucke EM .
Clostridium difficile colonization of nursing home residents.
Infect Control Hosp Epidemiol 2017 Oct;38(10):1267-68. doi: 10.1017/ice.2017.172..
Keywords: Clostridium difficile Infections, Evidence-Based Practice, Guidelines, Nursing Homes
Ban KA, Gibbons MM, Ko CY
Surgical technical evidence review for colorectal surgery conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
The objective of this article is to provide a comprehensive review of the evidence supporting the surgical components of the Improving Surgical Care and Recovery (ISCR) colorectal (CR) pathway. This review will evaluate the evidence supporting CR pathways and develop an evidence-based CR protocol to help hospitals participating in the ISCR program implement evidence-based practices.
AHRQ-funded; 233201500020I.
Citation: Ban KA, Gibbons MM, Ko CY .
Surgical technical evidence review for colorectal surgery conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
J Am Coll Surg 2017 Oct;225(4):548-57.e3. doi: 10.1016/j.jamcollsurg.2017.06.017.
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Keywords: Evidence-Based Practice, Hospitals, Patient Safety, Quality Improvement, Surgery, Quality of Care, Guidelines
Sittig DF, Singh H
Toward more proactive approaches to safety in the electronic health record era.
This article discusses a proactive approach to safety in the electronic health record era. It discusses an updated health IT Sentinel Event Alert, released in March 2015 by the Joint Commission which took a broad, sociotechnical approach in exploring the factors involved in the safe use of health IT.
AHRQ-funded; HS023602; HS022087.
Citation: Sittig DF, Singh H .
Toward more proactive approaches to safety in the electronic health record era.
Jt Comm J Qual Patient Saf 2017 Oct;43(10):540-47. doi: 10.1016/j.jcjq.2017.06.005..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety, Guidelines, Organizational Change, Risk
Shaughnessy AF, Vaswani A, Andrews BK
Developing a clinician friendly tool to identify useful clinical practice guidelines: G-TRUST.
The goal of this project was to develop a simple, easy-to-use checklist for clinicians to use to identify trustworthy, relevant, and useful practice guidelines, the Guideline Trustworthiness, Relevance, and Utility Scoring Tool (G-TRUST). They concluded that the 8-item G-TRUST developed by the project is potentially helpful as a tool for clinicians to identify useful guidelines.
AHRQ-funded; HS022940.
Citation: Shaughnessy AF, Vaswani A, Andrews BK .
Developing a clinician friendly tool to identify useful clinical practice guidelines: G-TRUST.
Ann Fam Med 2017 Sep;15(5):413-18. doi: 10.1370/afm.2119.
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Keywords: Evidence-Based Practice, Guidelines, Quality of Care, Patient-Centered Healthcare
Wasserman S, Avilla E, Ben-Shoshan M
Epinephrine autoinjectors: new data, new problems.
This paper reviews new data, and new problems in recently published literature on epinephrine autoinjectors. The authors emphasize that existing gaps in anaphylaxis management remain unaddressed. Patient needs are largely unmet, and very few studies are being designed to clarify and instill best practice, and to determine how to increase adherence to existing anaphylaxis guidelines through integrated knowledge translation strategies.
AHRQ-funded; HS024599.
Citation: Wasserman S, Avilla E, Ben-Shoshan M .
Epinephrine autoinjectors: new data, new problems.
J Allergy Clin Immunol Pract 2017 Sep - Oct;5(5):1180-91. doi: 10.1016/j.jaip.2017.06.027.
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Keywords: Evidence-Based Practice, Guidelines, Medication, Patient-Centered Outcomes Research, Patient Self-Management
Greenhawt M, Bird JA, Nowak-Wegrzyn AH
Trends in provider management of patients with food protein-induced enterocolitis syndrome.
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy. This study sought to better understand provider-level variation in FPIES knowledge and management. It found that nearly one-third of respondents reported poor familiarity with FPIES. Considerable variation exists in the use of diagnostic tests, management, and choice of "safe" nutrition, indicating a strong need for FPIES practice guidelines.
AHRQ-funded; HS024599.
Citation: Greenhawt M, Bird JA, Nowak-Wegrzyn AH .
Trends in provider management of patients with food protein-induced enterocolitis syndrome.
J Allergy Clin Immunol Pract 2017 Sep - Oct;5(5):1319-24.e12. doi: 10.1016/j.jaip.2016.11.036.
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Keywords: Diagnostic Safety and Quality, Evidence-Based Practice, Guidelines, Nutrition, Provider
Singal AG, Tiro J, Li X
Hepatocellular carcinoma surveillance among patients with cirrhosis in a population-based integrated health care delivery system.
This study characterized guideline-concordant hepatocellular carcinoma (HCC) surveillance rates and patient-level factors associated with surveillance among a population-based cohort of patients with cirrhosis. It concluded that, although one third of patients undergo inconsistent HCC surveillance, less than 2 percent of patients receive guideline-concordant biannual HCC surveillance.
AHRQ-funded; HS022418.
Citation: Singal AG, Tiro J, Li X .
Hepatocellular carcinoma surveillance among patients with cirrhosis in a population-based integrated health care delivery system.
J Clin Gastroenterol 2017 Aug;51(7):650-55. doi: 10.1097/mcg.0000000000000708.
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Keywords: Cancer, Guidelines, Healthcare Delivery, Patient-Centered Outcomes Research, Practice Patterns
Quattrin Wilfley, DE
The promise and opportunities for screening and treating childhood obesity: USPSTF recommendation statement.
This editorial discusses the updated recommendation statement and evidence review released by the United States Preventive Services Task Force (USPSTF) on screening for obesity in children. The Task Force recommendations are called ‘a call to arms’ against a condition that has immediate as well as long-term consequences for the health of the children affected. The authors note that the evaluation techniques for screening for obesity carry very few risks. Family-based behavioral treatment and the effectiveness of behavioral interventions, as well as pharmacotherapies, are also discussed.
AHRQ-funded; HS022816.
Citation: Quattrin Wilfley, DE .
The promise and opportunities for screening and treating childhood obesity: USPSTF recommendation statement.
JAMA Pediatr 2017 Aug;171(8):733-35. doi: 10.1001/jamapediatrics.2017.1604..
Keywords: Children/Adolescents, Guidelines, Obesity, Prevention, Screening, U.S. Preventive Services Task Force (USPSTF)
McNellis RJ, Thomas S
AHRQ Author: McNellis RJ
Screening for obstructive sleep apnea in adults.
This case study involves a 52-year-old white man who presents to your office for a preventive health visit. He is overweight and has a history of hypertension and hyperlipidemia, which are stable and well controlled with medication. The study poses three multiple choice questions together with the U.S. Preventive Services Task Force recommendations and related background information.
AHRQ-authored.
Citation: McNellis RJ, Thomas S .
Screening for obstructive sleep apnea in adults.
Am Fam Physician 2017 Jul 15;96(2):123-24.
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Keywords: U.S. Preventive Services Task Force (USPSTF), Sleep Problems, Screening, Evidence-Based Practice, Case Study, Guidelines
Salber GJ, Wang YB, Lynch JT
Metformin use in practice: compliance with guidelines for patients with diabetes and preserved renal function.
This article reports on an examination of a population of patients with diabetes with preserved renal function to evaluate provider compliance with guidelines on metformin use and to identify factors that contributed when practice diverged from recommendations. It found that although providers generally follow current recommendations for the use of metformin, deviations from guidelines in practice are common.
AHRQ-funded; HS019474.
Citation: Salber GJ, Wang YB, Lynch JT .
Metformin use in practice: compliance with guidelines for patients with diabetes and preserved renal function.
Clin Diabetes 2017 Jul;35(3):154-61. doi: 10.2337/cd15-0045.
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Keywords: Medication, Guidelines, Diabetes, Adverse Drug Events (ADE)
Niles DE, Cines C, Insley E
Incidence and characteristics of positive pressure ventilation delivered to newborns in a US tertiary academic hospital.
The Neonatal Resuscitation Program (NRP) guidelines recommend positive pressure ventilation (PPV) in the first 60s of life to support perinatal transition in non-breathing newborns. The aim of this study was to describe the incidence and characteristics of newborn PPV using real-time observation in the delivery unit. The authors suggest that compliance with current NRP guidelines is difficult, and assert that it's not clear whether it is the recommendations or the training to achieve PPV recommendations that should be modified.
AHRQ-funded; HS022469.
Citation: Niles DE, Cines C, Insley E .
Incidence and characteristics of positive pressure ventilation delivered to newborns in a US tertiary academic hospital.
Resuscitation 2017 Jun;115:102-09. doi: 10.1016/j.resuscitation.2017.03.035..
Keywords: Guidelines, Newborns/Infants, Respiratory Conditions