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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 26 Research Studies Displayed
Castaneda-Guarderas A, Glassbereg J, Grudzen CR
Shared decision making with vulnerable populations in the emergency department.
The authors introduce a research agenda that includes community-engaged approaches, mixed-methods studies, and cost-effectiveness analyses to address questions of shared decision making (SDM) among vulnerable groups at a disadvantage in the healthcare system, as well as changes that are needed, and how to cultivate and teach these competencies.
Citation: Castaneda-Guarderas A, Glassbereg J, Grudzen CR . Shared decision making with vulnerable populations in the emergency department. Acad Emerg Med 2016 Dec;23(12):1410-16. doi: 10.1111/acem.13134.
Keywords: Cultural Competence, Decision Making, Emergency Department, Patient and Family Engagement, Vulnerable Populations
Sarkar U, Gourley GI, Lyles CR
Usability of commercially available mobile applications for diverse patients.
The objective of this study was to investigate the usability of existing mobile health applications ("apps") for diabetes, depression, and caregiving, in order to facilitate development and tailoring of patient-facing apps for diverse populations. Participants completed 43 percent of tasks across 11 apps without assistance. Three themes emerged from participant comments: lack of confidence with technology, frustration with design features and navigation, and interest in having technology to support their self-management.
Citation: Sarkar U, Gourley GI, Lyles CR . Usability of commercially available mobile applications for diverse patients. J Gen Intern Med 2016 Dec;31(12):1417-26. doi: 10.1007/s11606-016-3771-6.
Keywords: Chronic Conditions, Health Information Technology (HIT), Patient Self-Management, Telehealth, Vulnerable Populations
Heerman WJ, Mitchell SJ, Thompson J
Parental perception of built environment characteristics and built environment use among Latino families: a cross-sectional study.
The researchers examined the association of perceived availability, condition, and safety of the built environment with its self-reported use for physical activity among underserved families with children at risk for obesity. In their sample of underserved families, perceived availability and condition of built environment structures were associated with use rather than perceived safety.
Citation: Heerman WJ, Mitchell SJ, Thompson J . Parental perception of built environment characteristics and built environment use among Latino families: a cross-sectional study. BMC Public Health 2016 Nov 22;16(1):1180. doi: 10.1186/s12889-016-3854-7.
Keywords: Obesity, Social Determinants of Health, Children/Adolescents, Racial / Ethnic Minorities, Vulnerable Populations
Sobotka SA, Msall ME
Supporting vulnerable children after life-threatening neonatal illness: opportunities for improving outcomes.
This article discusses two articles in the same issue, one involving kindergarten readiness after prematurity, and the other examining medical and surgical factors impacting children with congenital heart disease (CHD) and their later school age achievement test performance. The authors state that these two articles provide evidence for longitudinal support of infants who survive critical illness.
Citation: Sobotka SA, Msall ME . Supporting vulnerable children after life-threatening neonatal illness: opportunities for improving outcomes. J Pediatr 2016 Nov;178:12-14. doi: 10.1016/j.jpeds.2016.07.037.
Keywords: Children/Adolescents, Newborns/Infants, Patient-Centered Outcomes Research, Children/Adolescents, Vulnerable Populations
Beckman AL, Bilinski A, Boyko R
New hepatitis C drugs are very costly and unavailable to many state prisoners.
This study found that in the forty-one states whose departments of corrections reported data, 106,266 inmates (10 percent of their prisoners) were known to have hepatitis C on or about January 1, 2015. Only 949 of those inmates were being treated. Prices for a twelve-week course of direct-acting antivirals such as sofosbuvir and the combination drug ledipasvir/sofosbuvir varied widely as of September 30, 2015 ($43,418-$84,000 and $44,421-$94,500, respectively).
Citation: Beckman AL, Bilinski A, Boyko R . New hepatitis C drugs are very costly and unavailable to many state prisoners. Health Aff 2016 Oct;35(10):1893-901. doi: 10.1377/hlthaff.2016.0296.
Keywords: Access to Care, Healthcare Costs, Hepatitis, Medication, Vulnerable Populations
Goff SL, Mazor KM, Pekow PS
Patient navigators and parent use of quality data: a randomized trial.
The authors explored the effectiveness of strategies to overcome barriers in vulnerable populations. They found that an intervention to reduce barriers to using publicly reported health care quality data had a modest effect on patient choice, suggesting that factors other than performance on common publicly reported quality metrics have a stronger influence on which pediatric practices women choose.
Citation: Goff SL, Mazor KM, Pekow PS . Patient navigators and parent use of quality data: a randomized trial. Pediatrics 2016 Oct;138(4). doi: 10.1542/peds.2016-1140.
Keywords: Decision Making, Quality of Care, Public Reporting, Quality Indicators (QIs), Vulnerable Populations
Gao Y, Nocon RS, Gunter KE
AHRQ Author: Ngo-Metzger Q
Characteristics associated with patient-centered medical home capability in health centers: a cross-sectional analysis.
The patient-centered medical home (PCMH) model is being implemented in health centers (HCs) that provide comprehensive primary care to vulnerable populations. The researchers identified characteristics associated with HCs' PCMH capability. EHR adoption likely played a role in HCs' improvement in PCMH capability. Other factors include a greater number of types of financial performance incentives, more types of hospital-HC affiliations, and state-level support and payment for PCMH activities.
AHRQ-authored; AHRQ-funded; HS000084.
Citation: Gao Y, Nocon RS, Gunter KE . Characteristics associated with patient-centered medical home capability in health centers: a cross-sectional analysis. J Gen Intern Med 2016 Sep;31(9):1041-51. doi: 10.1007/s11606-016-3729-8.
Keywords: Patient-Centered Healthcare, Electronic Health Records (EHRs), Primary Care, Community-Based Practice, Vulnerable Populations
Saab D, Nisenbaum R, Dhalla I
Hospital readmissions in a community-based sample of homeless adults: a matched-cohort study.
The objective of this study was to compare the hospital readmission rate among individuals experiencing homelessness with that of a low-income matched control group, and to identify risk factors associated with readmission within the group experiencing homelessness. It concluded that homeless patients had nearly four times the odds of being readmitted within 30-days as compared to low-income controls matched on age, sex and primary reason for admission to hospital.
Citation: Saab D, Nisenbaum R, Dhalla I . Hospital readmissions in a community-based sample of homeless adults: a matched-cohort study. J Gen Intern Med 2016 Sep;31(9):1011-8. doi: 10.1007/s11606-016-3680-8.
Keywords: Low-Income, Hospital Readmissions, Vulnerable Populations
Colla CH, Lewis VA, Kao LS
Association between Medicare accountable care organization implementation and spending among clinically vulnerable beneficiaries.
This paper's objective is to estimate the effect of Medicare accountable care organization (ACO) contracts on spending and high-cost institutional use for all Medicare beneficiaries and for clinically vulnerable beneficiaries. The authors found that changes in total spending associated with ACOs did not vary by clinical condition of beneficiaries.
Citation: Colla CH, Lewis VA, Kao LS . Association between Medicare accountable care organization implementation and spending among clinically vulnerable beneficiaries. JAMA Intern Med 2016 Aug;176(8):1167-75. doi: 10.1001/jamainternmed.2016.2827.
Keywords: Medicare, Policy, Healthcare Costs, Payment, Vulnerable Populations
Longo DR, Crabtree BF, Pellerano MB
A qualitative study of vulnerable patient views of type 2 diabetes consumer reports.
This study aims to identify whether vulnerable populations with type 2 diabetes perceive consumer reports as helpful in making decisions about diabetes care. It found that participants in 18 focus groups expressed minimal interest in currently available consumer reports. They instead listed personal referrals and interpersonal interactions among the most important factors when choosing a physician.
Citation: Longo DR, Crabtree BF, Pellerano MB . A qualitative study of vulnerable patient views of type 2 diabetes consumer reports. Patient 2016 Jun;9(3):231-40. doi: 10.1007/s40271-015-0146-8..
Keywords: Education: Patient and Caregiver, Decision Making, Diabetes, Quality of Care, Vulnerable Populations
Raghavan R, Allaire BT, Brown DS
Medicaid disenrollment patterns among children coming into contact with child welfare agencies.
The authors examined retention of Medicaid coverage over time for children in the child welfare system. Using Medicaid claims files from 36 states, they found that half retained Medicaid coverage across 4 years of follow up, with most disenrollments happening in year 4. They recommend finding ways to promote entry of child welfare-involved children into health insurance coverage in order to assure services.
Citation: Raghavan R, Allaire BT, Brown DS . Medicaid disenrollment patterns among children coming into contact with child welfare agencies. Matern Child Health J 2016 Jun;20(6):1280-7. doi: 10.1007/s10995-016-1929-9.
Keywords: Children/Adolescents, Family Health and History, Medicaid, Uninsured, Vulnerable Populations
Booth JM, Jonassaint CR
The role of disadvantaged neighborhood environments in the association of John Henryism with hypertension and obesity.
In this study, the investigators tested the The John Henryism hypothesis which proposes that high-effort, active coping in impoverished, low-resource environments is associated with an increased risk of cardiovascular disease, but a lower risk of disease in a high-resource environment. They found that in their study, which modeled objective measures of neighborhood disadvantage, John Henryism Active Coping was associated with increased risk for cardiovascular disease among individuals living in highly disadvantaged neighborhoods which lack resources and opportunities for upward social mobility.
Citation: Booth JM, Jonassaint CR . The role of disadvantaged neighborhood environments in the association of John Henryism with hypertension and obesity. Psychosom Med 2016 Jun;78(5):552-61. doi: 10.1097/psy.0000000000000308..
Keywords: Hypertension, Obesity, Vulnerable Populations
Navarra AM, Schlau R, Murray M
Assessing nursing care needs of children with complex medical conditions: The Nursing-Kids Intensity of Care Survey (N-KICS).
The researchers designed and tested the Nursing-Kids Intensity of Care Survey (N-KICS) tool and describe intensity of nursing care for children with complex medical conditions. Their psychometric evaluation confirmed an acceptable standard for reliability and validity and feasibility. Intensity scores were highest for nursing care related to infection control, medication administration, nutrition, diaper changes, hygiene, neurological and respiratory support, and standing program.
Citation: Navarra AM, Schlau R, Murray M . Assessing nursing care needs of children with complex medical conditions: The Nursing-Kids Intensity of Care Survey (N-KICS). J Pediatr Nurs 2016 May-Jun;31(3):299-310. doi: 10.1016/j.pedn.2015.11.012.
Keywords: Children/Adolescents, Chronic Conditions, Disabilities, Long-Term Care, Nursing, Vulnerable Populations
Peltz A, Wu CL, White ML
Characteristics of rural children admitted to pediatric hospitals.
The researchers assessed characteristics and hospitalizations of rural children admitted to US children's hospitals in 2012. They found that rural children more often resided in low-income ZIP codes and Health Professional Shortage Areas; they further noted that rural children had a higher prevalence of complex chronic conditions and medical technology assistance. Rural children also experienced higher inpatient costs and higher odds of 30-day readmission.
Citation: Peltz A, Wu CL, White ML . Characteristics of rural children admitted to pediatric hospitals. Pediatrics 2016 May;137(5). doi: 10.1542/peds.2015-3156.
Keywords: Children/Adolescents, Hospitalization, Children/Adolescents, Rural Health, Vulnerable Populations
Brenner AT, Gupta S, Ko LK
Development of a practical model for targeting patient decision support interventions to promote colorectal cancer screening in vulnerable populations.
The authors sought to develop a practical model for predicting probability of colorectal cancer (CRC) screening completion in a diverse safety-net population and a subsequent framework for targeting screening promotion interventions. Their model and framework may be useful for designing and delivering targeted interventions to promote CRC screening.
Citation: Brenner AT, Gupta S, Ko LK . Development of a practical model for targeting patient decision support interventions to promote colorectal cancer screening in vulnerable populations. J Health Care Poor Underserved 2016;27(2):465-78. doi: 10.1353/hpu.2016.0090.
Keywords: Cancer: Colorectal Cancer, Decision Making, Health Promotion, Screening, Vulnerable Populations
Figueiredo R, Dempster L, Quinonez C
Emergency department use for dental problems among homeless individuals: a population-based cohort study.
The researchers evaluated emergency department (ED) visits for dental problems among Toronto's homeless population (Ontario, Canada). They found that over 80% of the ED visits by homeless people were for odontogenic infections, and 46% of homeless people had more than one such visit. They concluded that access to dental care is inadequate and that ED settings are ineffective for treatment of dental problems.
Citation: Figueiredo R, Dempster L, Quinonez C . Emergency department use for dental problems among homeless individuals: a population-based cohort study. J Health Care Poor Underserved 2016;27(2):860-8. doi: 10.1353/hpu.2016.0081.
Keywords: Access to Care, Dental and Oral Health, Emergency Department, Value, Vulnerable Populations
Qato DM, Trivedi AN, Mor V
Disparities in discontinuing rosiglitazone following the 2007 FDA safety alert.
The researchers compared time to discontinuation of rosiglitazone after the safety alert between black and white elderly persons, and across sociodemographic and economic subgroups. They found that white race and a history of low personal income modestly predicted later discontinuation of rosiglitazone after the FDA's safety advisory in 2007.
Citation: Qato DM, Trivedi AN, Mor V . Disparities in discontinuing rosiglitazone following the 2007 FDA safety alert. Med Care 2016 Apr;54(4):406-13. doi: 10.1097/mlr.0000000000000502..
Keywords: Medication, Disparities, Elderly, Social Determinants of Health, Vulnerable Populations
Nadpara PA, Madhavan SS, Tworek C
Disparities in lung cancer care and outcomes among elderly in a medically underserved state population-a cancer registry-linked database study.
The purpose of this study was to evaluate the patterns of lung cancer care and associated health outcomes among elderly residing in a rural and medically underserved area. The authors found that delays in diagnosis and treatment varied significantly: survival outcomes significantly improved with appropriate care but did not improve with timely care. They concluded that their study highlights the critical need to address disparities in receipt of guideline-concordant lung cancer care among the elderly residing in rural and medically underserved areas.
Citation: Nadpara PA, Madhavan SS, Tworek C . Disparities in lung cancer care and outcomes among elderly in a medically underserved state population-a cancer registry-linked database study. Popul Health Manag 2016 Apr;19(2):109-19. doi: 10.1089/pop.2015.0027.
Keywords: Disparities, Elderly, Cancer: Lung Cancer, Outcomes, Vulnerable Populations
Weintraub JA, Burgette JM, Chadwick DG
Educating North Carolina's oral health workforce in an evolving environment.
In 2014, North Carolina had 4,681 actively practicing dentists and ranked 47th among US states in dentist-to-population ratio. The need for dentists is increasing as the population grows, and underserved areas persist. This commentary discusses the impact of the state's 2 dental schools and external factors on dental workforce trends.
Citation: Weintraub JA, Burgette JM, Chadwick DG . Educating North Carolina's oral health workforce in an evolving environment. N C Med J 2016 Mar-Apr;77(2):107-11. doi: 10.18043/ncm.77.2.107..
Keywords: Dental and Oral Health, Education, Access to Care, Rural Health, Vulnerable Populations
Bares S, Eavou R, Bertozzi-Villa C
Expanded HIV testing and linkage to care: Conventional vs. Point-of-care testing and assignment of patient notification and linkage to care to an HIV care program.
This study examined the X-TLC program that used standard blood-based laboratory testing vs. point-of-care rapid testing or rapid laboratory testing with point-of-care results notification. Site coordinators and the linkage-to-care coordinator oversaw testing, test notification, and linkage to care. It concluded that HIV screening and linkage to care can be accomplished by incorporating standard testing for HIV into routine medical care.
Citation: Bares S, Eavou R, Bertozzi-Villa C . Expanded HIV testing and linkage to care: Conventional vs. Point-of-care testing and assignment of patient notification and linkage to care to an HIV care program. Public Health Rep 2016 Jan-Feb;131 Suppl 1:107-20.
Keywords: Healthcare Delivery, Diagnostic Safety and Quality, Human Immunodeficiency Virus (HIV), Urban Health, Vulnerable Populations
Kriegel LS, Henwood BF, Gilmer TP
Implementation and outcomes of forensic housing first programs.
The authors used administrative data and evaluative and qualitative site visit data to compare fidelity to the Housing First model and residential client outcomes between forensic and nonforensic programs and to investigate whether and how providers working in forensic programs can navigate competing Housing First principles and criminal justice mandates. They found that existing mental health and criminal justice collaborations necessitate adaptation to the Housing First model to accommodate client needs.
Citation: Kriegel LS, Henwood BF, Gilmer TP . Implementation and outcomes of forensic housing first programs. Community Ment Health J 2016 Jan;52(1):46-55. doi: 10.1007/s10597-015-9946-5.
Keywords: Healthcare Delivery, Behavioral Health, Vulnerable Populations
Gilmer TP, Stefancic A, Katz ML
Fidelity to the housing first model and effectiveness of permanent supported housing programs in California.
This paper examined the relationship between fidelity to the Housing First model and residential outcomes among clients of full service partnerships (FSPs) in California. They concluded that programs with greater fidelity to the Housing First model enrolled clients with longer histories of homelessness and placed most of them in apartments.
Citation: Gilmer TP, Stefancic A, Katz ML . Fidelity to the housing first model and effectiveness of permanent supported housing programs in California. Psychiatr Serv 2014 Nov;65(11):1311-7. doi: 10.1176/appi.ps.201300447.
Keywords: Value, Vulnerable Populations
Vanderwerker L, Akincigil A, Olfson M
Foster care, externalizing disorders, and antipsychotic use among Medicaid-enrolled youths.
The researchers investigated the extent to which clinical diagnoses of externalizing disorders explain higher rates of antipsychotic use by foster care youths. They found that foster care youths had higher rates of externalizing disorders than the comparison group and greater antipsychotic use. Foster care remained a significant predictor of antipsychotic use after control for demographic and diagnostic covariates.
AHRQ-funded; HS017918; HS019937; HS021112.
Citation: Vanderwerker L, Akincigil A, Olfson M . Foster care, externalizing disorders, and antipsychotic use among Medicaid-enrolled youths. Psychiatr Serv 2014 Oct;65(10):1281-4. doi: 10.1176/appi.ps.201300455.
Keywords: Children/Adolescents, Medication, Medicaid, Vulnerable Populations, Behavioral Health
Lebrun-Harris LA, Tomoyasu N, Ngo-Metzger Q
AHRQ Author: Ngo-Metzger Q
Substance use, risk of dependence, counseling and treatment among adult health center patients.
The authors examined the prevalence of substance use and risk of dependence among health center patients, and identified factors associated with desire for counseling/treatment and discussions about substance use with a clinician. They found that 84% of patients who desired substance use counseling or treatment reported receiving it, and those patients most likely to desire substance use counseling or treatment were male, unmarried, insured, current smokers, and indicated mental health problems.
Citation: Lebrun-Harris LA, Tomoyasu N, Ngo-Metzger Q . Substance use, risk of dependence, counseling and treatment among adult health center patients. J Health Care Poor Underserved 2014 Aug;25(3):1217-30. doi: 10.1353/hpu.2014.0130.
Keywords: Behavioral Health, Community-Based Practice, Substance Abuse, Vulnerable Populations
Allgood KL, Rauscher GH, Whitman S
Validating self-reported mammography use in vulnerable communities: findings and recommendations.
The researchers examined the potential extent of overreporting of mammography use in low-income African-American and Latina women, and whether self-report inaccuracies might bias estimated associations between patient characteristics and mammography use. They found that although 73% of women self-reported a mammogram in the last 2 years, only 44% of self-reports were documented. Overreporting of mammography use was observed for all ethnic groups studied.
Citation: Allgood KL, Rauscher GH, Whitman S . Validating self-reported mammography use in vulnerable communities: findings and recommendations. Cancer Epidemiol Biomarkers Prev 2014 Aug;23(8):1649-58. doi: 10.1158/1055-9965.epi-13-1253.
Keywords: Healthcare Utilization, Mammogram, Racial / Ethnic Minorities, Vulnerable Populations, Low-Income, Urban Health, Women