National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (40)
- Adverse Events (22)
- Ambulatory Care and Surgery (3)
- Antibiotics (4)
- Antimicrobial Stewardship (1)
- Blood Clots (1)
- Blood Pressure (2)
- Blood Thinners (3)
- Cardiovascular Conditions (2)
- Children/Adolescents (9)
- Chronic Conditions (2)
- Clinical Decision Support (CDS) (3)
- Clinician-Patient Communication (1)
- Clostridium difficile Infections (1)
- Communication (5)
- Comparative Effectiveness (3)
- Decision Making (2)
- Diabetes (3)
- Education: Patient and Caregiver (1)
- Elderly (9)
- Electronic Health Records (EHRs) (9)
- Electronic Prescribing (E-Prescribing) (4)
- Emergency Department (1)
- Evidence-Based Practice (3)
- Guidelines (1)
- Healthcare-Associated Infections (HAIs) (2)
- Healthcare Costs (1)
- Health Information Technology (HIT) (14)
- Heart Disease and Health (1)
- Home Healthcare (1)
- Hospital Discharge (2)
- Hospitalization (2)
- Hospitals (1)
- Implementation (1)
- Intensive Care Unit (ICU) (1)
- Kidney Disease and Health (2)
- Maternal Care (1)
- Medical Errors (11)
- Medicare (1)
- Medication (68)
- (-) Medication: Safety (71)
- Mortality (1)
- Neurological Disorders (1)
- Newborns/Infants (2)
- Opioids (5)
- Outcomes (1)
- Pain (1)
- Patient Adherence/Compliance (2)
- Patient and Family Engagement (1)
- Patient Safety (40)
- Patient Self-Management (1)
- Policy (3)
- Practice-Based Research Network (PBRN) (1)
- Practice Patterns (3)
- Pregnancy (1)
- Prevention (1)
- Provider (5)
- Provider: Clinician (1)
- Provider: Nurse (1)
- Provider: Pharmacist (9)
- Provider: Physician (2)
- Quality Improvement (1)
- Quality of Care (2)
- Racial and Ethnic Minorities (1)
- Research Methodologies (1)
- Risk (8)
- Sepsis (1)
- Sleep Problems (1)
- Stroke (2)
- Substance Abuse (2)
- Surgery (3)
- Telehealth (3)
- Transitions of Care (3)
- Transplantation (2)
- Vaccination (1)
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 71 Research Studies DisplayedVaughan CP, Hwang U, Vandenberg AE
Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme.
Enhancing quality of prescribing practices for older adults discharged from the Emergency Department (EQUIPPED) aims to reduce the monthly proportion of potentially inappropriate medications (PIMs) prescribed to older adults discharged from the ED to 5% or less. In this paper, the investigator described prescribing outcomes at three academic health systems adapting and sequentially implementing the EQUIPPED medication safety programme.
AHRQ-funded; HS024499.
Citation: Vaughan CP, Hwang U, Vandenberg AE .
Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme.
BMJ Open Qual 2021 Nov;10(4). doi: 10.1136/bmjoq-2021-001369..
Keywords: Elderly, Medication: Safety, Medication, Patient Safety, Emergency Department, Quality Improvement, Quality of Care
Reese TJ, Del Fiol G, Morgan K
A shared decision-making tool for drug interactions between warfarin and nonsteroidal anti-inflammatory drugs: design and usability study.
Exposure to life-threatening drug-drug interactions (DDIs) occurs despite the widespread use of clinical decision support. The DDI between warfarin and nonsteroidal anti-inflammatory drugs is common and potentially life-threatening. Patients can play a substantial role in preventing harm from DDIs; however, the current model for DDI decision-making is clinician centric. This study aimed to design and examine the usability of DDInteract, a tool to support shared decision-making (SDM) between a patient and provider for the DDI between warfarin and nonsteroidal anti-inflammatory drugs.
AHRQ-funded; HS026198.
Citation: Reese TJ, Del Fiol G, Morgan K .
A shared decision-making tool for drug interactions between warfarin and nonsteroidal anti-inflammatory drugs: design and usability study.
JMIR Hum Factors 2021 Oct 26;8(4):e28618. doi: 10.2196/28618..
Keywords: Blood Thinners, Medication: Safety, Medication, Clinical Decision Support (CDS), Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT), Adverse Drug Events (ADE), Adverse Events, Patient Safety
Taber DJ, Fleming JN, Su Z
Significant hospitalization cost savings to the payer with a pharmacist-led mobile health intervention to improve medication safety in kidney transplant recipients.
This paper examined hospitalization cost savings to the payer with a pharmacist-led mobile health intervention to improve medication safety in kidney transplant recipients. This study was an economic analysis of a 12-month, parallel arm, randomized controlled trial in adult kidney recipients 6 to 36 months posttransplant (NCT03247322). All participants received usual posttransplant care, while the intervention arm received supplemental clinical pharmacist-led medication therapy monitoring and management, via a smartphone-enabled mHealth app, integrated with risk-based televisits.
AHRQ-funded; HS023754.
Citation: Taber DJ, Fleming JN, Su Z .
Significant hospitalization cost savings to the payer with a pharmacist-led mobile health intervention to improve medication safety in kidney transplant recipients.
Am J Transplant 2021 Oct;21(10):3428-35. doi: 10.1111/ajt.16737..
Keywords: Healthcare Costs, Provider: Pharmacist, Telehealth, Health Information Technology (HIT), Transplantation, Hospitalization, Medication: Safety, Medication
Herzig SJ, Anderson TS, Jung Y
Relative risks of adverse events among older adults receiving opioids versus NSAIDs after hospital discharge: a nationwide cohort study.
This retrospective cohort study’s objective was to determine the incidence and risk of post-discharge adverse events among opioid claims in the week after hospital discharge, compared to those with nonsteroidal anti-inflammatory drugs (NSAIDs) claims alone. A national sample of Medicare beneficiaries age 65 and older who were hospitalized in the United States in 2016 was used. Beneficiaries who were admitted from or discharged to a facility were excluded. The authors used 3:1 propensity matching to match beneficiaries with an opioid claim in the week after discharge (13,385) with beneficiaries with NSAID claim alone (4,677). Beneficiaries receiving opioids had a higher incidence of death, healthcare utilization, and any potential adverse effect compared to those with an NSAID claim only. Specific adverse effects included higher relative risk of fall/fracture, nausea/vomiting, and slowed colonic motility.
AHRQ-funded; HS026215.
Citation: Herzig SJ, Anderson TS, Jung Y .
Relative risks of adverse events among older adults receiving opioids versus NSAIDs after hospital discharge: a nationwide cohort study.
PLoS Med 2021 Sep 27;18(9):e1003804. doi: 10.1371/journal.pmed.1003804..
Keywords: Elderly, Opioids, Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Risk, Hospital Discharge
Papaleontiou M, Levine DA, Reyes-Gastelum D
Thyroid hormone therapy and incident stroke.
This study’s objective was to determine the relationship between thyroid hormone treatment intensity and incidence of atrial fibrillation (AFIB) and stroke. This retrospective cohort study used data from the Veterans Health Administration between 2004 and 2017, with a median follow-up of 59 months. Total study population was comprised of 733,208 thyroid hormone users aged ≥18 years with at least 2 thyroid stimulating hormone (TSH) measurements between thyroid hormone initiation and incident event (atrial fibrillation or stroke) or study conclusion. Overall, 71,333 (11.08%) developed incident atrial fibrillation and 41,931 (6.32%) stroke. Higher incidence of stroke was associated with low thyroid-stimulation hormone (TSH) or high free thyroxine (T4) levels compared to patients with normal TSH or T4 levels. Risk of developing AFIB and stroke was cumulative over time for patients with exogenous hyperthyroidism or hypothyroidism.
AHRQ-funded; HS024512.
Citation: Papaleontiou M, Levine DA, Reyes-Gastelum D .
Thyroid hormone therapy and incident stroke.
J Clin Endocrinol Metab 2021 Sep 27;106(10):e3890-e900. doi: 10.1210/clinem/dgab444..
Keywords: Medication, Medication: Safety, Risk, Stroke
Gilson AM, Stone JA, Morris AO
Impact of a pilot community pharmacy system redesign on reducing over-the-counter medication misuse in older adults.
This pilot study’s goal was to decrease misuse of over-the-counter (OTC) medications by older adults aged 65 years or older by creating a pharmacy “Senior Section”. The Senior Section contains a curated selection of OTC medications and it located close to the prescription department to facilitate pharmacy staff-patient engagement to reduce misuse. The study recruited 87 older adults from 3 pharmacies. Misuse outcomes measured were drug-drug, drug-disease, drug-age, and drug-label, with 5 subtypes. The Senior Section reduced drug-label misuse for different models. Misuse was found to decrease after implementation for 7 of 11 comparisons.
AHRQ-funded; HS024490.
Citation: Gilson AM, Stone JA, Morris AO .
Impact of a pilot community pharmacy system redesign on reducing over-the-counter medication misuse in older adults.
J Am Pharm Assoc (2003) 2021 Sep-Oct;61(5):555-64. doi: 10.1016/j.japh.2021.04.007..
Keywords: Elderly, Provider: Pharmacist, Medication, Medication: Safety
De Oliveira GS, Castro-Alves LJ, Kendall MC
Effectiveness of pharmacist intervention to reduce medication errors and health-care resources utilization after transitions of care: a meta-analysis of randomized controlled trials.
The main objective of the current investigation was to examine the effectiveness of pharmacist-based transition-of-care interventions on the reduction of medication errors after hospital discharge. Findings showed that pharmacist transition-of-care intervention is an effective strategy to reduce medication errors after hospital discharge and also reduces subsequent emergency room visits.
AHRQ-funded; HS024158.
Citation: De Oliveira GS, Castro-Alves LJ, Kendall MC .
Effectiveness of pharmacist intervention to reduce medication errors and health-care resources utilization after transitions of care: a meta-analysis of randomized controlled trials.
J Patient Saf 2021 Aug 1;17(5):375-80. doi: 10.1097/pts.0000000000000283..
Keywords: Medication: Safety, Medication, Adverse Drug Events (ADE), Adverse Events, Medical Errors, Patient Safety, Provider: Pharmacist, Transitions of Care
Caballero ML, Krantz MS, Quirce S
Hidden dangers: recognizing excipients as potential causes of drug and vaccine hypersensitivity reactions.
In this paper, the authors provided a review of the evidence-based literature outlining epidemiology and mechanisms of excipient reactions and provided strategies for heightened recognition and allergy testing.
AHRQ-funded; HS026395.
Citation: Caballero ML, Krantz MS, Quirce S .
Hidden dangers: recognizing excipients as potential causes of drug and vaccine hypersensitivity reactions.
J Allergy Clin Immunol Pract 2021 Aug;9(8):2968-82. doi: 10.1016/j.jaip.2021.03.002..
Keywords: Adverse Drug Events (ADE), Adverse Events, Medication, Medication: Safety, Vaccination, Patient Safety
Vu K, Zhou J, Everhart A
Uptake of evidence by physicians: de-adoption of erythropoiesis-stimulating agents after the TREAT trial.
Variation in de-adoption of ineffective or unsafe treatments is not well-understood. In this study the investigators examined de-adoption of erythropoiesis-stimulating agents (ESA) in anemia treatment among patients with chronic kidney disease (CKD) following new clinical evidence of harm and ineffectiveness (the TREAT trial) and the FDA's revision of its safety warning. The investigators found that physician specialty had a dominant role in prescribing decision, and specializations with higher use of treatment (nephrologists) were more responsive to new evidence of unsafety and ineffectiveness.
AHRQ-funded; HS025164.
Citation: Vu K, Zhou J, Everhart A .
Uptake of evidence by physicians: de-adoption of erythropoiesis-stimulating agents after the TREAT trial.
BMC Nephrol 2021 Aug 21;22(1):284. doi: 10.1186/s12882-021-02491-y..
Keywords: Evidence-Based Practice, Medication: Safety, Medication, Patient Safety, Practice Patterns, Provider: Physician
Watterson TL, Stone JA, Brown R
CancelRx: a health IT tool to reduce medication discrepancies in the outpatient setting.
Medication list discrepancies between outpatient clinics and pharmacies can lead to medication errors. Within the last decade, a new health information technology (IT), CancelRx, emerged to send a medication cancellation message from the clinic's electronic health record (EHR) to the outpatient pharmacy's software. The objective of this study was to measure the impact of CancelRx on reducing medication discrepancies between the EHR and pharmacy dispensing software.
AHRQ-funded; HS025793.
Citation: Watterson TL, Stone JA, Brown R .
CancelRx: a health IT tool to reduce medication discrepancies in the outpatient setting.
J Am Med Inform Assoc 2021 Jul 14;28(7):1526-33. doi: 10.1093/jamia/ocab038..
Keywords: Medication: Safety, Medication, Medical Errors, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Electronic Health Records (EHRs), Health Information Technology (HIT), Ambulatory Care and Surgery
Wu P, Nelson SD, Zhao J
DDIWAS: high-throughput electronic health record-based screening of drug-drug interactions.
In this study, the investigators developed and evaluated Drug-Drug Interaction Wide Association Study (DDIWAS). This novel method detected potential drug-drug interactions (DDIs) by leveraging data from the electronic health record (EHR) allergy list. The investigators concluded that they demonstrated the value of incorporating information mined from existing allergy lists to detect DDIs in a real-world clinical setting. They indicate that since allergy lists are routinely collected in EHRs, DDIWAS has the potential to detect and validate DDI signals across institutions.
AHRQ-funded; HS026395.
Citation: Wu P, Nelson SD, Zhao J .
DDIWAS: high-throughput electronic health record-based screening of drug-drug interactions.
J Am Med Inform Assoc 2021 Jul 14;28(7):1421-30. doi: 10.1093/jamia/ocab019..
Keywords: Adverse Drug Events (ADE), Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Medication: Safety, Patient Safety
King CR, Abraham J, Fritz BA
Predicting self-intercepted medication ordering errors using machine learning.
Current approaches to understanding medication ordering errors rely on relatively small manually captured error samples. These approaches are resource-intensive, do not scale for computerized provider order entry (CPOE) systems, and are likely to miss important risk factors associated with medication ordering errors. Previously, the investigators described a dataset of CPOE-based medication voiding accompanied by univariable and multivariable regression analyses. In this paper, they updated the analysis using machine learning (ML) models to predict erroneous medication orders and identify its contributing factors.
AHRQ-funded; HS025443.
Citation: King CR, Abraham J, Fritz BA .
Predicting self-intercepted medication ordering errors using machine learning.
PLoS One 2021 Jul 14;16(7):e0254358. doi: 10.1371/journal.pone.0254358..
Keywords: Medication, Medical Errors, Adverse Drug Events (ADE), Adverse Events, Medication: Safety, Patient Safety, Electronic Prescribing (E-Prescribing), Health Information Technology (HIT)
Chou LN, Kuo YF, Raji MA
Potentially inappropriate medication prescribing by nurse practitioners and physicians.
This study compared prescribing rates for potentially inappropriate medications (PIMs) by physicians and nurse practitioners (NPs). The authors used 100% Texas Medicare data to define physician and NP visits in 2016. Rates of visits with a PIM prescription from the same provider was measured by initial and refill visits. There were 24.1 per 1000 visits for PIM prescriptions, 9.0 per 1000 visits for an initial PM and 15.1 per 1000 visits for a refill PIM. Visits to an NP was less likely to result in an initial and refill PIM visit than a visit to a physician. There was a strong association of lower odds of a black enrollee receiving a PIM by an NP than white enrollees. There was also less likelihood of receiving a PIM refill from an NP in older patients and in those with more comorbidities.
AHRQ-funded; HS020642; HS020642.
Citation: Chou LN, Kuo YF, Raji MA .
Potentially inappropriate medication prescribing by nurse practitioners and physicians.
J Am Geriatr Soc 2021 Jul;69(7):1916-24. doi: 10.1111/jgs.17120..
Keywords: Medication: Safety, Medication, Provider: Physician, Provider: Nurse, Hospitalization, Practice Patterns, Ambulatory Care and Surgery
Mackie TI, Kovacs KM, Simmel C
A best-worst scaling experiment to identify patient-centered claims-based outcomes for evaluation of pediatric antipsychotic monitoring programs.
This study utilized a best-worst scaling (BWS) experiment to identify the claims-based outcomes that matter most to patients and other relevant parties when evaluating pediatric antipsychotic monitoring programs, specifically in foster care children. Relevant parties included policymakers (n = 31), foster care alumni (n = 28), caseworkers (n=23), prescribing clinicians (n = 32), and caregivers (n = 18). Participants received surveys with a scenario on antipsychotic monitoring programs and ranked 11 candidate claims-based outcomes as most and least important. Safety indicators ranked among the top three candidate outcomes across respondent groups. Foster care alumni put “antipsychotic treatment reduction” and “increased psychosocial treatment” as the highest ranking. Caseworkers, prescribers, and caregivers gave top priority to “increased follow-up after treatment initiation”. Potential unintended consequences ranked lowest, including increased use of other psychotropic medication classes, increased psychiatric hospital stays, and increased emergency room utilization.
AHRQ-funded; HS026001.
Citation: Mackie TI, Kovacs KM, Simmel C .
A best-worst scaling experiment to identify patient-centered claims-based outcomes for evaluation of pediatric antipsychotic monitoring programs.
Health Serv Res 2021 Jun;56(3):418-31. doi: 10.1111/1475-6773.13610..
Keywords: Children/Adolescents, Medication, Medication: Safety, Patient Safety, Policy
Lyson HC, Sharma AE, Cherian R
A qualitative analysis of outpatient medication use in community settings: observed safety vulnerabilities and recommendations for improved patient safety.
Researchers sought to analyze diverse patients' experiences throughout the medication use process to inform the development of overarching interventions that support safe medication use in community settings. They conducted approximately 18 hours of direct observation of the medication use process across multiple settings and also conducted 6 semistructured interviews with medication safety experts. Their findings underscored a need for overarching, comprehensive interventions that span the entire process of medication use, including integrated communication systems between clinicians, pharmacies, and patients, and a "patient navigator" program that assists patients in navigating the entire medication-taking process.
AHRQ-funded; HS023558.
Citation: Lyson HC, Sharma AE, Cherian R .
A qualitative analysis of outpatient medication use in community settings: observed safety vulnerabilities and recommendations for improved patient safety.
J Patient Saf 2021 Jun 1;17(4):e335-e42. doi: 10.1097/pts.0000000000000590..
Keywords: Medication: Safety, Medication, Patient Safety
Stolldorf DP, Ridner SH, Vogus TJ
Implementation strategies in the context of medication reconciliation: a qualitative study.
Medication reconciliation (MedRec) is an important patient safety initiative that aims to prevent patient harm from medication errors. Yet, the implementation and sustainability of MedRec interventions have been challenging due to contextual barriers like the lack of interprofessional communication (among pharmacists, nurses, and providers) and limited organizational capacity. Guided by the Expert Recommendations for Implementing Change (ERIC) taxonomy, the authors report the differing strategies hospital implementation teams used to implement an evidence-based MedRec Toolkit (the MARQUIS Toolkit).
AHRQ-funded; HS025486.
Citation: Stolldorf DP, Ridner SH, Vogus TJ .
Implementation strategies in the context of medication reconciliation: a qualitative study.
Implement Sci Commun 2021 Jun 10;2(1):63. doi: 10.1186/s43058-021-00162-5..
Keywords: Medication: Safety, Medication, Adverse Drug Events (ADE), Medical Errors, Adverse Events, Patient Safety, Implementation, Communication
Harben AL, Kashy DA, Esfahanian S
Using change detection to objectively evaluate whether novel over-the-counter drug labels can increase attention to critical health information among older adults.
Over-the-counter (OTC) drugs have many benefits but also carry risks, such as adverse drug reactions, which are more prevalent in older adults. Because these products do not require the oversight of a physician or pharmacist, labeling plays a key role in communicating information required for their safe and effective use. In two experiments, the investigators used a change detection task to objectively evaluate how novel label designs that employ highlighting and a warning label placed on the package's front impact attention to critical information among older participants (65 and older).
AHRQ-funded; HS025386.
Citation: Harben AL, Kashy DA, Esfahanian S .
Using change detection to objectively evaluate whether novel over-the-counter drug labels can increase attention to critical health information among older adults.
Cogn Res Princ Implic 2021 May 26;6(1):40. doi: 10.1186/s41235-021-00307-z..
Keywords: Elderly, Medication: Safety, Medication, Adverse Drug Events (ADE), Adverse Events, Patient Safety
Gonzales HM, Fleming JN, Gebregziabher M
Pharmacist-led mobile health intervention and transplant medication safety: a randomized controlled clinical trial.
The goal of this study was to examine the efficacy of improving medication safety through a pharmacist-led, mobile health-based intervention. In this single-center study of adult kidney recipients 6-36 months post-transplant, findings showed that participants receiving the intervention experienced a significant reduction in medication errors and a significantly lower incidence risk of Grade 3 or higher adverse events. The intervention arm also demonstrated significantly lower rates of hospitalizations.
AHRQ-funded; HS023754.
Citation: Gonzales HM, Fleming JN, Gebregziabher M .
Pharmacist-led mobile health intervention and transplant medication safety: a randomized controlled clinical trial.
Clin J Am Soc Nephrol 2021 May 8;16(5):776-84. doi: 10.2215/cjn.15911020..
Keywords: Medication: Safety, Medication, Patient Safety, Transplantation, Telehealth, Health Information Technology (HIT), Provider: Pharmacist, Provider, Medical Errors, Adverse Drug Events (ADE), Adverse Events
Feng Y, Pai CW, Seiler K
Adverse outcomes associated with inappropriate direct oral anticoagulant starter pack prescription among patients with atrial fibrillation: a retrospective claims-based study.
This retrospective analysis investigated the risk for bleeding events with higher dosing of direct oral anticoagulant (DOAC) in the first 1-3 weeks of treatment for patients with atrial fibrillation (AF). Findings showed that patients who received an inappropriate DOAC prescription were more likely to identify as Black. Rates of ED visits, hospitalizations, and deaths overall were numerically lower in patients with starter pack DOAC prescriptions. In contrast, rates of ED visits and hospitalizations related to significant bleeding were numerically higher in patients with starter pack DOAC prescriptions. Among patients with AF but without acute venous thromboembolism, those who received an inappropriate DOAC starter pack had numerically higher rates of severe bleeding leading to ED visits and hospitalizations compared to those prescribed an appropriate non-starter pack DOAC anticoagulant.
AHRQ-funded; HS026874.
Citation: Feng Y, Pai CW, Seiler K .
Adverse outcomes associated with inappropriate direct oral anticoagulant starter pack prescription among patients with atrial fibrillation: a retrospective claims-based study.
J Thromb Thrombolysis 2021 May;51(4):1144-49. doi: 10.1007/s11239-020-02358-3..
Keywords: Blood Thinners, Medication, Medication: Safety, Medical Errors, Adverse Drug Events (ADE), Adverse Events, Heart Disease and Health, Cardiovascular Conditions
Kandaswamy S, Pruitt Z, Kazi S
Clinician perceptions on the use of free-text communication orders.
The aim of this study was to investigate (1) why ordering clinicians use free-text orders to communicate medication information; (2) what risks physicians and nurses perceive when free-text orders are used for communicating medication information; and (3) how electronic health records (EHRs) could be improved to encourage the safe communication of medication information. The investigators concluded that clinicians' use of free-text orders as a workaround to insufficient structured order entry can create unintended patient safety risks.
AHRQ-funded; HS025136; HS024755.
Citation: Kandaswamy S, Pruitt Z, Kazi S .
Clinician perceptions on the use of free-text communication orders.
Appl Clin Inform 2021 May;12(3):484-94. doi: 10.1055/s-0041-1731002..
Keywords: Electronic Prescribing (E-Prescribing), Health Information Technology (HIT), Electronic Health Records (EHRs), Medication: Safety, Medication, Patient Safety, Communication, Provider: Clinician, Provider, Risk
Herrin J, Abraham NS, Yao X
Comparative effectiveness of machine learning approaches for predicting gastrointestinal bleeds in patients receiving antithrombotic treatment.
The purpose of this retrospective cross-sectional study was to compare the performance of 3 machine learning approaches with the commonly-used HAS-BLED (hypertension, abnormal kidney and liver function, stroke, bleeding, labile international normalized ratio, older age, and drug or alcohol use) risk score in predicting antithrombotic-related gastrointestinal bleeding (GIB). The machine-learning models were regularized Cox proportional hazards regression (RegCox), random survival forests, and extreme gradient boosting (XGBoost). Findings showed that the machine learning models revealed similar performance in identifying patients at high risk for GIB after being prescribed antithrombotic agents. Two models (RegCox and XGBoost) performed modestly better than the HAS-BLED score.
AHRQ-funded; HS025402.
Citation: Herrin J, Abraham NS, Yao X .
Comparative effectiveness of machine learning approaches for predicting gastrointestinal bleeds in patients receiving antithrombotic treatment.
JAMA Netw Open 2021 May;4(5):e2110703. doi: 10.1001/jamanetworkopen.2021.10703..
Keywords: Blood Thinners, Medication, Risk, Adverse Drug Events (ADE), Adverse Events, Medication: Safety, Patient Safety, Comparative Effectiveness
Gurwitz JH, Kapoor A, Garber L
Effect of a multifaceted clinical pharmacist intervention on medication safety after hospitalization in persons prescribed high-risk medications: a randomized clinical trial.
The purpose of this study was to determine whether a multifaceted clinical pharmacist intervention improves medication safety for patients who are discharged from the hospital and prescribed medications within 1 or more of these high-risk drug classes: anticoagulants, diabetes agents, and opioids. The randomized clinical trial was conducted at a large multidisciplinary group practice in Massachusetts and included patients 50 years or older. Findings showed that there was not an observed lower rate of adverse drug-related incidents or clinically important medication errors during the posthospitalization period that was associated with a clinical pharmacist intervention.
AHRQ-funded; HS023774.
Citation: Gurwitz JH, Kapoor A, Garber L .
Effect of a multifaceted clinical pharmacist intervention on medication safety after hospitalization in persons prescribed high-risk medications: a randomized clinical trial.
JAMA Intern Med 2021 May;181(5):610-18. doi: 10.1001/jamainternmed.2020.9285..
Keywords: Elderly, Medication: Safety, Medication, Patient Safety, Adverse Drug Events (ADE), Adverse Events, Provider: Pharmacist, Provider
Champion C, Sockolow PS, Bowles KH
Getting to complete and accurate medication lists during the transition to home health care.
This observational field study looked at the work that home health care (HHC) admissions nurses complete related to medication reconciliation tasks, explored the impact of shared electronic medication data (interoperability), and highlight opportunities to enhance medication reconciliation with respect to transition in care to HHC agencies. Three diverse Pennsylvania HHC agencies participated, with each using different electronic health record systems. Six nurses per site admitted 2 patients each (36 patients total) and their tasks were examined in depth. Medication reconciliation tasks included changes in number of medications and change types and calls to the health provider (doctor or pharmacy) to resolve medication-related issues. A high percentage of patients used multiple medications (more than 12 medications on average), and were high-risk (on average more than 8 medications per patient). Medication reconciliation decreased the number of prescriptions between pre- and post-reconciliation for 91% of patients with 41% of the medications requiring changes. Two-thirds of the nurses called a provider to facilitate medication changes. Interoperability reduced the number of changes required but did not eliminate changes or calls to providers.
AHRQ-funded; R01 HS024537.
Citation: Champion C, Sockolow PS, Bowles KH .
Getting to complete and accurate medication lists during the transition to home health care.
J Am Med Dir Assoc 2021 May;22(5):1003-08. doi: 10.1016/j.jamda.2020.06.024..
Keywords: Medication, Medication: Safety, Transitions of Care, Home Healthcare, Patient Safety
Bongiovanni T, Lancaster E, Ledesma Y
Systematic review and meta-analysis of the association between non-steroidal anti-inflammatory drugs and operative bleeding in the perioperative period.
Investigators sought to understand the risk of bleeding caused by NSAIDs in the perioperative period. They performed a systematic review of articles on the use of NSAIDs and outcomes of interest such as surgical complications and bleeding, then conducted a meta-analysis of the data. They concluded that NSAIDs were unlikely to be the cause of postoperative bleeding complications. The literature studied covered a large number of patients and remained consistent across types of NSAIDs and operations.
AHRQ-funded; HS027369; HS026383; 233201500020I.
Citation: Bongiovanni T, Lancaster E, Ledesma Y .
Systematic review and meta-analysis of the association between non-steroidal anti-inflammatory drugs and operative bleeding in the perioperative period.
J Am Coll Surg 2021 May;232(5):765-90.e1. doi: 10.1016/j.jamcollsurg.2021.01.005..
Keywords: Adverse Drug Events (ADE), Adverse Events, Medication, Surgery, Medication: Safety
Walsh KE, Bacic J, Phillips BD
Misuse of pediatric medications and parent-physician communication: an interactive voice response intervention.
Children take 1 medication each week on average at home. Better communication between parents and providers could support safer home medication use and prevent misuse of pediatric medications, such as intentional underdosing or overdosing. The primary objective of the study was to assess the impact of an interactive voice response system on parent-provider communication about medications. The investigators concluded that pediatric medication misuse was common in this study.
AHRQ-funded; HS017248.
Citation: Walsh KE, Bacic J, Phillips BD .
Misuse of pediatric medications and parent-physician communication: an interactive voice response intervention.
J Patient Saf 2021 Apr 1;17(3):e207-e13. doi: 10.1097/pts.0000000000000375..
Keywords: Children/Adolescents, Medication: Safety, Medication, Clinician-Patient Communication