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 86 Research Studies DisplayedNorton WE, Zwarenstein M, Czajkowski S
AHRQ Author: Kato E
Building internal capacity in pragmatic trials: a workshop for program scientists at the US National Cancer Institute.
This article describes a workshop put together by the authors for program scientists at the National Cancer Institute (NCI) to help them become better researchers and stewards of research funds. The workshop got good reviews from the attendees and many felt it will help them develop funding opportunities and advise grantees.
AHRQ-authored.
Citation: Norton WE, Zwarenstein M, Czajkowski S .
Building internal capacity in pragmatic trials: a workshop for program scientists at the US National Cancer Institute.
Trials 2019 Dec 27;20(1):779. doi: 10.1186/s13063-019-3934-y..
Keywords: Research Methodologies, Health Services Research (HSR), Cancer, Healthcare Delivery
Broder-Fingert S, Kuhn J, Sheldrick RC
Using the Multiphase Optimization Strategy (MOST) framework to test intervention delivery strategies: a study protocol.
Researchers describe a study protocol for a large randomized controlled trial using the Multiphase Optimization Strategy (MOST), a novel framework developed to optimize interventions. They apply this framework to delivery of Family Navigation (FN), an evidence-based care management strategy designed to reduce disparities and improve access to behavioral health services, and test four components related to its implementation. In this paper, they describe how the MOST framework can be used to improve intervention delivery. These methods will be useful for future studies testing intervention delivery strategies and their impact on implementation.
AHRQ-funded; HS022242.
Citation: Broder-Fingert S, Kuhn J, Sheldrick RC .
Using the Multiphase Optimization Strategy (MOST) framework to test intervention delivery strategies: a study protocol.
Trials 2019 Dec 16;20(1):728. doi: 10.1186/s13063-019-3853-y..
Keywords: Research Methodologies, Health Services Research (HSR), Healthcare Delivery, Behavioral Health, Evidence-Based Practice, Access to Care
Stadnick NA, Sadler E, Sandall J
Comparative case studies in integrated care implementation from across the globe: a quest for action.
There are no formal guidelines for integrated care implementation applicable to diverse healthcare systems. In this paper, the investigators use a multiple case study design to highlight current integrated care implementation efforts through seven international case studies that target a range of healthcare systems, patient populations and implementation strategies and outcomes, and to synthesize the shared and unique challenges and successes across studies using the EPIS framework.
AHRQ-funded; HS024192.
Citation: Stadnick NA, Sadler E, Sandall J .
Comparative case studies in integrated care implementation from across the globe: a quest for action.
BMC Health Serv Res 2019 Nov 27;19(1):899. doi: 10.1186/s12913-019-4661-5..
Keywords: Healthcare Delivery, Health Services Research (HSR), Health Systems, Implementation, Case Study
Gates A, Guitard S, Pillay J
Performance and usability of machine learning for screening in systematic reviews: a comparative evaluation of three tools.
Researchers explored the performance of three machine learning tools designed to facilitate title and abstract screening in systematic reviews (SRs) when used to eliminate irrelevant records and complement the work of a single reviewer. Using Abstrackr, DistillerSR, and RobotAnalyst, they found that the workload savings afforded in the automated simulation came with increased risk of missing relevant records. Supplementing a single reviewer's decisions with relevance predictions sometimes reduced the proportion missed, but performance varied by tool and SR. They recommend designing tools based on reviewers' self-identified preferences to improve compatibility with present workflows.
AHRQ-funded; 290201500001I.
Citation: Gates A, Guitard S, Pillay J .
Performance and usability of machine learning for screening in systematic reviews: a comparative evaluation of three tools.
Syst Rev 2019 Nov 15;8(1):278. doi: 10.1186/s13643-019-1222-2..
Keywords: Patient-Centered Outcomes Research, Health Services Research (HSR), Research Methodologies, Evidence-Based Practice, Comparative Effectiveness
Gartlehner G, Wagner G, Lux L
Assessing the accuracy of machine-assisted abstract screening with DistillerAI: a user study.
The goal of this project was to conduct a case study to explore a screening approach that temporarily replaces a human screener with a semi-automated screening tool. The authors used DistillerAI as a semi-automated screening tool, and a published comparative effectiveness review served as their reference standard. They found that the accuracy of DistillerAI was not yet adequate to replace a human screener temporarily during abstract screening for systematic reviews.
AHRQ-funded; 290201500011I.
Citation: Gartlehner G, Wagner G, Lux L .
Assessing the accuracy of machine-assisted abstract screening with DistillerAI: a user study.
Syst Rev 2019 Nov 15;8(1):277. doi: 10.1186/s13643-019-1221-3..
Keywords: Patient-Centered Outcomes Research, Health Services Research (HSR), Research Methodologies, Evidence-Based Practice
Boudreaux M, Gangopadhyaya A, Long SK
AHRQ Author: Karaca Z
Using data from the Healthcare Cost and Utilization Project for state health policy research.
Investigators describe the opportunities and challenges of using HCUP data to conduct state health policy research and to provide empirical examples of what can go wrong when using the national HCUP data inappropriately. Analyzing cesarean delivery rates, discharges per capita, and discharges by the payer, they found that state-level estimates are volatile and often provide misleading policy conclusions. They conclude that the Nationwide Inpatient Sample should not be used for state-level research and specified that AHRQ provides resources to assist analysts with state-specific studies using State Inpatient Database files.
AHRQ-authored.
Citation: Boudreaux M, Gangopadhyaya A, Long SK .
Using data from the Healthcare Cost and Utilization Project for state health policy research.
Med Care 2019 Nov;57(11):855-60. doi: 10.1097/mlr.0000000000001196..
Keywords: Healthcare Cost and Utilization Project (HCUP), Policy, Health Services Research (HSR), Healthcare Costs, Data, Research Methodologies
Vanderlaan J, Dunlop A, Rochat R
Methodology for sampling women at high maternal risk in administrative data.
This study compared the net benefits of using the Obstetric Comorbidity Index (OCI) to identify women at high maternal risk compared to conventional risk identification methods. Hospitalization discharge and vital records data for women experience singleton births in George from 2008 to 2012 was used. Results found there was a small but positive net benefit in using the OCI and conventional risk identification methods actually performed worse than using no risk identification methods at all. The researchers suggest that using OCI helps reduce misclassification.
AHRQ-funded; HS024655.
Citation: Vanderlaan J, Dunlop A, Rochat R .
Methodology for sampling women at high maternal risk in administrative data.
BMC Pregnancy Childbirth 2019 Oct 21;19(1):364. doi: 10.1186/s12884-019-2500-7..
Keywords: Research Methodologies, Health Services Research (HSR), Pregnancy, Maternal Care, Risk, Women
Wood SJ, Albertson EM, Conrad DA
Accountable care program implementation and effects on participating health care systems in Washington state: a conceptual model.
This study used key informant interviews with health care executives representing 5 large health systems contracted with the Washington State Health Care Authority to provide accountable care network services under the State Innovation Model initiative. Two rounds of semistructured interviews were conducted, and results indicated the need to present a modified conceptual model aligned better with accountable care program (ACP) implementation.
AHRQ-funded; HS013853.
Citation: Wood SJ, Albertson EM, Conrad DA .
Accountable care program implementation and effects on participating health care systems in Washington state: a conceptual model.
J Ambul Care Manage 2019 Oct/Dec;42(4):321-36. doi: 10.1097/jac.0000000000000302..
Keywords: Health Systems, Provider Performance, Organizational Change, Health Services Research (HSR), Payment, Health Insurance, Implementation
Everson J, Hollingsworth JM, Adler-Milstein J
Comparing methods of grouping hospitals.
The purpose of this study was to compare the performance of widely used approaches for defining groups of hospitals and a new approach based on network analysis of shared patient volume. Results showed that community detection algorithm-defined hospital groups offer high validity, reliability to different specifications, and generalizability to many uses when compared to approaches in widespread use today. They may offer a better choice for efforts seeking to analyze the behaviors and dynamics of groups of hospitals. Measures of modularity, shared information, inclusivity, and shared behavior can be used to evaluate different approaches to grouping providers.
AHRQ-funded; HS024525; HS024728; HS024454.
Citation: Everson J, Hollingsworth JM, Adler-Milstein J .
Comparing methods of grouping hospitals.
Health Serv Res 2019 Oct;54(5):1090-98. doi: 10.1111/1475-6773.13188..
Keywords: Health Services Research (HSR), Hospitals, Research Methodologies
Kaufman A, Dickinson WP, Fagnan LJ
The role of health extension in practice transformation and community health improvement: lessons from 5 case studies.
The states of New Mexico, Oklahoma, Oregon, Colorado, and Washington stand out in stretching the boundaries of health extension; their stories reveal lessons learned regarding the successes and challenges. All states saw the need for long-term, sustained fundraising beyond grants in an environment expecting a short-term return on investment, and they were challenged operating in a shifting health system landscape where the creativity and personal relationships built with small primary care practices was hindered when these practices were purchased by larger health delivery systems.
AHRQ-funded; HS020890; HS020972; HS23904; HS023908.
Citation: Kaufman A, Dickinson WP, Fagnan LJ .
The role of health extension in practice transformation and community health improvement: lessons from 5 case studies.
Ann Fam Med 2019 Aug 12;17(Suppl 1):S67-s72. doi: 10.1370/afm.2409..
Keywords: Community-Based Practice, Health Services Research (HSR), Healthcare Delivery, Organizational Change, Primary Care, Social Determinants of Health, Practice Improvement
Polubriaginof FCG, Ryan P, Salmasian H
Challenges with quality of race and ethnicity data in observational databases.
This study assessed the quality of race and ethnicity information in observational health databases as well as electronic health records (EHRs) and to propose patient self-recording as a way to improve accuracy. Data from the Healthcare Cost and Utilization Project (HCUP) and Optum Labs, and from a single New York City healthcare system’s EHR was compared. Among 160 million patients in the HCUP database, no race or ethnicity data was recorded for 25% of the records. Among the 2.4 million patients in the New York City HER, race or ethnicity was unknown for 57%. However, when patients were allowed to directly record their race and ethnicity, percentages rose to 86%.
AHRQ-funded; HS021816; HS023704; HS024713.
Citation: Polubriaginof FCG, Ryan P, Salmasian H .
Challenges with quality of race and ethnicity data in observational databases.
J Am Med Inform Assoc 2019 Aug;26(8-9):730-36. doi: 10.1093/jamia/ocz113..
Keywords: Healthcare Cost and Utilization Project (HCUP), Data, Racial and Ethnic Minorities, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR)
Wooldridge A, Carayon P, Hoonakker P
Complexity of the pediatric trauma care process: implications for multi-level awareness.
Trauma is the leading cause of disability and death in children and young adults in the US. While much is known about the medical aspects of inpatient pediatric trauma care, not much is known about the processes and roles involved in in-hospital care. Using human factors engineering (HFE) methods, the investigators combined interview, archival document and trauma registry data to describe how intra-hospital care transitions affect process and team complexity.
AHRQ-funded; HS023837.
Citation: Wooldridge A, Carayon P, Hoonakker P .
Complexity of the pediatric trauma care process: implications for multi-level awareness.
Cogn Technol Work 2019 Aug;21(3):397-416. doi: 10.1007/s10111-018-0520-0..
Keywords: Care Coordination, Children/Adolescents, Critical Care, Health Services Research (HSR), Healthcare Delivery, Inpatient Care, Patient Safety, Teams, Trauma, Young Adults
Hatch BA, Tillotson CJ, Huguet N
Use of a preventive index to examine clinic-level factors associated with delivery of preventive care.
There is an increasing need for the development of new methods to understand factors affecting delivery of preventive care. This study applied a new measurement approach and assessed clinic-level factors associated with preventive care delivery. The investigators concluded that approaches that use individual preventive ratios and aggregate prevention indices are promising for understanding and improving preventive service delivery over time.
AHRQ-funded; HS024270.
Citation: Hatch BA, Tillotson CJ, Huguet N .
Use of a preventive index to examine clinic-level factors associated with delivery of preventive care.
Am J Prev Med 2019 Aug;57(2):241-49. doi: 10.1016/j.amepre.2019.03.016..
Keywords: Prevention, Healthcare Delivery, Health Services Research (HSR)
Hsuan C, Hsia RY, Horwitz JR
Ambulance diversions following public hospital emergency department closures.
The purpose of this study was to examine whether hospitals are more likely to temporarily close their emergency departments to ambulances, through ambulance diversions, if neighboring diverting hospitals are public vs private. Results showed that sample hospitals respond differently to diversions by neighboring public (vs private) hospitals. The authors conclude that these findings suggest that these hospitals might be strategically declaring ambulance diversions to avoid treating low-paying patients served by public hospitals.
AHRQ-funded; HS024247.
Citation: Hsuan C, Hsia RY, Horwitz JR .
Ambulance diversions following public hospital emergency department closures.
Health Serv Res 2019 Aug;54(4):870-79. doi: 10.1111/1475-6773.13147..
Keywords: Access to Care, Emergency Department, Emergency Medical Services (EMS), Health Services Research (HSR), Hospitals
Markovitz AA, Hollingsworth JM, Ayanian JZ
Performance in the Medicare Shared Savings Program after accounting for nonrandom exit: an instrumental variable analysis.
The purpose of this study was to evaluate the effect of the Medicare Shared Savings Program (MSSP) on spending and quality while accounting for clinicians' nonrandom exit. MSSP ACO participants were compared with control beneficiaries using adjusted longitudinal models that accounted for secular trends, market factors, and beneficiary characteristics. Results showed that, after adjustment for clinicians' nonrandom exit, the MSSP was not associated with improvements in spending or quality. Selection effects, including exit of high-cost clinicians, may drive estimates of savings in the MSSP.
AHRQ-funded; HS025615; HS024728; HS024525.
Citation: Markovitz AA, Hollingsworth JM, Ayanian JZ .
Performance in the Medicare Shared Savings Program after accounting for nonrandom exit: an instrumental variable analysis.
Ann Intern Med 2019 Jul 2;171(1):27-36. doi: 10.7326/m18-2539..
Keywords: Healthcare Costs, Health Services Research (HSR), Medicare, Quality of Care
Ji X, Shen HW, Ritter A
Visual exploration of neural document embedding in information retrieval: semantics and feature selection.
Researchers proposed visual exploration of neural document embedding to gain insights into the underlying embedding space and to promote the utilization in prevalent information retrieval applications. They demonstrated the usefulness and effectiveness of their application-driven view and presented inspiring findings in use cases. They indicated that their work will help designers/developers of downstream applications gain insights and confidence in neural document embedding.
AHRQ-funded; HS025047.
Citation: Ji X, Shen HW, Ritter A .
Visual exploration of neural document embedding in information retrieval: semantics and feature selection.
IEEE Trans Vis Comput Graph 2019 Jun;25(6):2181-92. doi: 10.1109/tvcg.2019.2903946..
Keywords: Health Services Research (HSR), Research Methodologies
Austin JM, Kirley EM, Rosen MA
A comparison of two structured taxonomic strategies in capturing adverse events in U.S. hospitals.
The purpose of this study was to compare the ability of AHRQ’s Quality and Safety Review System (QSRS) and the proposed triadic structure for the 11th version of the International Classification of Disease (ICD-11) to capture adverse events in U.S. hospitals. One thousand admissions were chosen for this study in a random sample from 3 general, acute care hospitals in Maryland and Washington D.C. and abstracted by two different sets of coding specialists for QSRS and the ICD-11. The results showed less than 20 percent agreement between QSRS and ICD-11 in their ability to identify the same adverse events. The sensitivity of ICD-11 improved when coders were given a list of potential adverse events. The authors conclude that in its draft form, ICD-11 has a limited ability to capture the same types of events as QSRS and that coders may need more training to improve its ability to identify adverse events.
AHRQ-funded; 233201500020I.
Citation: Austin JM, Kirley EM, Rosen MA .
A comparison of two structured taxonomic strategies in capturing adverse events in U.S. hospitals.
Health Serv Res 2019 Jun;54(3):613-22. doi: 10.1111/1475-6773.13090..
Keywords: Adverse Events, Health Services Research (HSR), Hospitals, Patient Safety
Aouad M, Brown TT, Whaley CM
Reference pricing: the case of screening colonoscopies.
In this study, the investigators studied the introduction of reference pricing to the California Public Employees' Retirement System. The investigators found a 10 percentage point increase in the share of patients using an ambulatory surgery center (ASC), leading to a $2300 to $1700 reduction in prices paid for patients who switched to ASCs. They indicated that their results suggested the use of ASCs had a causal effect on prices paid and had no negative effect on patient health outcomes.
AHRQ-funded; HS022098.
Citation: Aouad M, Brown TT, Whaley CM .
Reference pricing: the case of screening colonoscopies.
J Health Econ 2019 May;65:246-59. doi: 10.1016/j.jhealeco.2019.03.002..
Keywords: Colonoscopy, Decision Making, Health Services Research (HSR), Healthcare Costs, Healthcare Delivery, Screening
Wisk LE, Nelson EB, Magane KM
Clinical trial recruitment and retention of college students with type 1 diabetes via social media: an implementation case study.
The purpose of this study was to quantify the efficiency and acceptability of Internet-based recruitment for engaging college-students with type 1 diabetes (T1D) and to describe the approach used for implementing a health-related trial entirely online using off-the-shelf Internet tools. Young people aged 17-25 years with T1D were recruited through social media platforms and other outreach channels; Facebook was the highest yield recruitment source. Demographics differed by platform. Response rate and participant characteristics were quantified and engagement metrics tracked via Google Analytics and participant survey data. The researchers conclude that recruitment of college students with T1D for a trial via social media is feasible, efficient, acceptable, and yields a sample that represents the user-base from which they were drawn.
AHRQ-funded; HS022986.
Citation: Wisk LE, Nelson EB, Magane KM .
Clinical trial recruitment and retention of college students with type 1 diabetes via social media: an implementation case study.
J Diabetes Sci Technol 2019 May;13(3):445-56. doi: 10.1177/1932296819839503..
Keywords: Diabetes, Health Services Research (HSR), Research Methodologies, Social Media, Young Adults
Althoff KN, Wong C, Hogan B
Mind the gap: observation windows to define periods of event ascertainment as a quality control method for longitudinal electronic health record data.
Under the hypothesis that use of electronic health records in health research may lead to false assumptions of complete event ascertainment, the authors of this article estimated "observation windows" (OWs) as a quality-control approach to reduce the likelihood of false assumption. The impact of OWs on estimating rates of type II diabetes mellitus from HIV clinical cohorts are demonstrated. Data from 16 HIV clinical cohorts to the NA-ACCORD were used to identify and evaluate OWs for an operationalized definition of diabetes occurrence. The authors conclude that OWs have utility as a quality-control approach to complete event ascertainment and help to improve the accuracy of estimates.
AHRQ-funded; 90047713.
Citation: Althoff KN, Wong C, Hogan B .
Mind the gap: observation windows to define periods of event ascertainment as a quality control method for longitudinal electronic health record data.
Ann Epidemiol 2019 May;33:54-63. doi: 10.1016/j.annepidem.2019.01.015..
Keywords: Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR), Quality of Care
Marshall IJ, Marshall R, Wallace BC
Rapid reviews may produce different results to systematic reviews: a meta-epidemiological study.
Researchers analyzed the difference in results between systematic reviews and rapid reviews. They stimulated searching only PubMed, excluding older articles, smaller trials, and using the largest trial only. They examined percentage changes in pooled odds ratios (ORs), statistical significance, and biases between systematic reviews and rapid reviews. A total of 2,512 systematic reviews were included. Using only PubMed had the smallest risk of changed ORs. There were also changes in statistical significance but no evidence of bias. They concluded that rapid reviews can be considered where approximately 10% risk of the primary outcome or by changing greater than 20% could be tolerated.
AHRQ-funded; HS025024.
Citation: Marshall IJ, Marshall R, Wallace BC .
Rapid reviews may produce different results to systematic reviews: a meta-epidemiological study.
J Clin Epidemiol 2019 May;109:30-41. doi: 10.1016/j.jclinepi.2018.12.015..
Keywords: Evidence-Based Practice, Health Services Research (HSR), Research Methodologies
Chopra V, Burden M, Jones CD
State of research in adult hospital medicine: results of a national survey.
This study examined the state of research in academic hospital medicine by conducting a survey of members of the Society of Hospital Medicine (SHM). A total of 100 programs were considered eligible and surveys sent to corresponding individuals. Among those programs, 28 completed the survey. There was a total 1,586 faculty members represented with 12% identified as engaging or having obtained extramural funding with 41% as engaging in quality improvement efforts. Most of the programs (61%) received $500,000 or less and 29% received >$1 million in funding. The major federal funders were AHRQ, NIH, and the Veterans Health Administration. Only five programs currently have a research fellow program in hospital medicine, with many programs citing a lack of funding as the major barrier to establishing a program. Almost half of the respondents indicated their faculty were publishing between 11-50 peer-reviewed manuscripts each year.
AHRQ-funded; HS024569.
Citation: Chopra V, Burden M, Jones CD .
State of research in adult hospital medicine: results of a national survey.
J Hosp Med 2019 Apr;14(4):207-11. doi: 10.12788/jhm.3136.
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Keywords: Hospitals, Health Services Research (HSR)
Ita AJ, Olden HA, Kippen KE
A flexible model for patient engagement: achieving quality outcomes and building a research agenda for head and neck cancer.
This article describes the work of a head and neck cancer survivors who became advisors on a multidisciplinary team of providers. The survivors provided feedback to providers on areas of improvement for clinical flow and they also have provided advice on efforts to increase public awareness. They have also been very active at cancer symposiums and other local presentations.
AHRQ-funded; HS022417.
Citation: Ita AJ, Olden HA, Kippen KE .
A flexible model for patient engagement: achieving quality outcomes and building a research agenda for head and neck cancer.
Head Neck 2019 Apr;41(4):1087-93. doi: 10.1002/hed.25584..
Keywords: Cancer, Health Services Research (HSR), Patient-Centered Outcomes Research, Patient and Family Engagement
Schroeder J, Karkar R, Fogarty J
A patient-centered proposal for bayesian analysis of self-experiments for health.
This article describes the types of questions people want to answer via self-experimentation in order to develop a complementary patient-centered perspective on the potential benefits of Bayesian analysis. Information was gathered via the authors’ experiences in engaging with irritable bowel syndrome patients and their healthcare providers and a survey that investigated what questions individuals want to answer about their health and wellness. The authors find that the majority of the questions people want to answer with self-tracking data are better answered with Bayesian methods than with frequentist methods. Examples of how those questions might be answered using frequentist null hypothesis significance testing, frequentist estimation, and Bayesian estimation and prediction, as well as design recommendations for analyses and visualizations to help people answer and interpret such questions are also provided.
AHRQ-funded; HS023654.
Citation: Schroeder J, Karkar R, Fogarty J .
A patient-centered proposal for bayesian analysis of self-experiments for health.
J Healthc Inform Res 2019 Mar;3(1):124-55. doi: 10.1007/s41666-018-0033-x..
Keywords: Health Information Technology (HIT), Health Services Research (HSR)
Adrian M, Moreno M, Nicodimos S
Research strategy for health sciences: Facebook friend request is non-differentially accepted in a diverse, young adult population.
The aim of this study was to report on overall success of recruiting young adults in diverse settings, with respect to education and employment, into a study using Facebook (FB). The investigators assert that friending through FB is a feasible way to reach young adults involved in health and behavioral research, and could be a way to expand the populations that are studied in health science research to maximize generalizability of the conclusions drawn.
AHRQ-funded; HS022982.
Citation: Adrian M, Moreno M, Nicodimos S .
Research strategy for health sciences: Facebook friend request is non-differentially accepted in a diverse, young adult population.
Nurs Health Sci 2019 Mar;21(1):71-77. doi: 10.1111/nhs.12557..
Keywords: Health Services Research (HSR), Research Methodologies, Social Media, Young Adults