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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 25 of 104 Research Studies DisplayedSchoenfeld EM, Shieh MS, Pekow PS
Association of patient and visit characteristics with rate and timing of urologic procedures for patients discharged from the emergency department with renal colic.
Little is known about the timing of urologic interventions in patients with renal colic discharged from the emergency department. Understanding patients' likelihood of a subsequent urologic intervention could inform decision-making in this population. The objective of this study was to examine the rate and timing of urologic procedures performed after an emergency department visit for renal colic and the factors associated with receipt of an intervention.
AHRQ-funded; HS025701.
Citation: Schoenfeld EM, Shieh MS, Pekow PS .
Association of patient and visit characteristics with rate and timing of urologic procedures for patients discharged from the emergency department with renal colic.
JAMA Netw Open 2019 Dec 2;2(12):e1916454. doi: 10.1001/jamanetworkopen.2019.16454..
Keywords: Emergency Department, Kidney Disease and Health, Decision Making
Almasri J, Tello M, Benkhadra R
A systematic review for variables to be collected in a transplant database for improving risk prediction.
This study is a systematic review that was commissioned to identify new variables associated with transplant outcomes that are not currently collected by the Organ Procurement and Transplantation Network. They identified 81 unique studies including almost 1.2 million patients with median follow-up of 36 months posttransplant. A total of 108 unique risk factors were reported with most (104) recipient related and only 4 donor related. Most risk factors were small to moderate (ranging between 1.0 and 2.0). There were four relative association measures that were the strongest: 1) heart transplant recipients with a previous Fontan operation (8.6); 2) kidney transplant recipients with sickle cell nephropathy as primary cause of end-stage renal disease (2.8); 3) liver transplant recipients with serum ferritin >500 microg/L (14.3); and 4) lung transplant recipients with Burkholderia cepacia complex infection for 1 year or less (63.). These four risk factors were considered candidates for collection in databases and registries.
AHRQ-funded; HS024527.
Citation: Almasri J, Tello M, Benkhadra R .
A systematic review for variables to be collected in a transplant database for improving risk prediction.
Transplantation 2019 Dec;103(12):2591-601. doi: 10.1097/tp.0000000000002652..
Keywords: Transplantation, Risk, Decision Making
Schoenfeld EM, Probst MA, Quigley
Does shared decision making actually occur in the emergency department? Looking at it from the patients' perspective.
In this study the investigators sought to assess the frequency, content, and quality of shared decision making (SDM) in the emergency department (ED), from patients' perspectives. The investigators found that fewer than half of ED patients surveyed reported they were involved in SDM. The most common decision for which SDM was used was around ED disposition (admission vs. discharge). When SDM was employed, patients generally rated the discussion highly.
AHRQ-funded; HS025701.
Citation: Schoenfeld EM, Probst MA, Quigley .
Does shared decision making actually occur in the emergency department? Looking at it from the patients' perspective.
Acad Emerg Med 2019 Dec;26(12):1369-78. doi: 10.1111/acem.13850..
Keywords: Decision Making, Emergency Department, Clinician-Patient Communication, Patient and Family Engagement
Downs SM, Bauer NS, Saha C
Effect of a computer-based decision support intervention on autism spectrum disorder screening in pediatric primary care clinics: a cluster randomized clinical trial.
This study examined outcomes for implementation of a decision support system called CHICA (Child Health Improvement Through Computer Automation) to improve screening rates for autism in children aged 18 to 24 months. A random sample of 274 children in four urban clinics was used. Two clinics participated in the intervention, and two served as controls. Because participating clinics requested intervention be discontinued for children aged 18 months, only results for those aged 24 months was analyzed. Of the 263 children with reviewed results, 92% were enrolled in Medicaid, 52.5% were African American, and 36.5% were Hispanic. Screening rates increased from 0% at baseline to 100% in 24 months during the study period of November 2010 to November 2012. Screening results were positive for 265 of 980 children screened by CHICA in the time period, with 2 children from the intervention group positively diagnosed in the time frame of the study.
AHRQ-funded; HS018453.
Citation: Downs SM, Bauer NS, Saha C .
Effect of a computer-based decision support intervention on autism spectrum disorder screening in pediatric primary care clinics: a cluster randomized clinical trial.
JAMA Netw Open 2019 Dec 2;2(12):e1917676. doi: 10.1001/jamanetworkopen.2019.17676..
Keywords: Autism, Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT), Primary Care, Children/Adolescents, Screening
Bi S, Gunter KE, Lopez FY
Improving shared decision making for Asian American Pacific Islander sexual and gender minorities.
This study examined the challenges Asian American Pacific Islander (AAPI) sexual and gender minorities (SGM) encounter with shared decision making (SDM) with their providers, especially concerning mental health. Focus groups were conducted in San Francisco and interviews were conducted in Chicago and San Francisco. The participants were surveyed about attitudes towards SGM disclosure and preferences about providers. Many participants felt that providers either ignored or overemphasized their identities. Some shared the stigma of SGM identities and effects on mental health in their own families.
AHRQ-funded; HS023050.
Citation: Bi S, Gunter KE, Lopez FY .
Improving shared decision making for Asian American Pacific Islander sexual and gender minorities.
Med Care 2019 Dec;57(12):937-44. doi: 10.1097/mlr.0000000000001212..
Keywords: Decision Making, Racial and Ethnic Minorities, Vulnerable Populations, Patient and Family Engagement, Patient-Centered Healthcare, Behavioral Health, Social Stigma
Strassle PD, Kinlaw AC, Chaumont N
Rates of elective colectomy for diverticulitis continued to increase after 2006 guideline change.
Gastroenterology 2019 Dec;157(6):1679-81.e11. doi: 10.1053/j.gastro.2019.08.045.
The purpose of this retrospective cohort study was to assess whether trends in elective and urgent/emergent colectomy changed after July 2006. The authors suggest that given the risks associated with elective colectomy, their findings demonstrate the need for a more evidence-based decision-making process, incorporating both patient preferences and patient-reported outcomes, for those considering elective colectomy for uncomplicated and some cases of complicated diverticulitis.
The purpose of this retrospective cohort study was to assess whether trends in elective and urgent/emergent colectomy changed after July 2006. The authors suggest that given the risks associated with elective colectomy, their findings demonstrate the need for a more evidence-based decision-making process, incorporating both patient preferences and patient-reported outcomes, for those considering elective colectomy for uncomplicated and some cases of complicated diverticulitis.
AHRQ-funded; HS026363.
Citation: Strassle PD, Kinlaw AC, Chaumont N .
Rates of elective colectomy for diverticulitis continued to increase after 2006 guideline change.
Gastroenterology 2019 Dec;157(6):1679-81.e11. doi: 10.1053/j.gastro.2019.08.045..
Keywords: Healthcare Cost and Utilization Project (HCUP), Surgery, Healthcare Utilization, Guidelines, Decision Making, Digestive Disease and Health
Jones YO, Hubbell BB, Thomson J
Things we do for no reason: systemic corticosteroids for wheezing in preschool-aged children.
This installment of the “Things We Do For No Reason” series presents and discusses a case study concerning the administration of systemic corticosteroids in a 4-year-old child presenting with wheezing, tachypnea, and respiratory distress. The authors conclude that current evidence does not support the routine use of systemic corticosteroids for preschool-aged children admitted for mild to moderate wheezing episodes, and that the patient in the introductory case would likely receive no clinical benefit from dexamethasone treatment.
AHRQ-funded; HS025138.
Citation: Jones YO, Hubbell BB, Thomson J .
Things we do for no reason: systemic corticosteroids for wheezing in preschool-aged children.
J Hosp Med 2019 Dec;14(12):774-76. doi: 10.12788/jhm.3255..
Keywords: Children/Adolescents, Respiratory Conditions, Asthma, Case Study, Decision Making, Medication
Leeds IL, DiBrito SR, Canner JK
Cost-benefit limitations of extended, outpatient venous thromboembolism prophylaxis following surgery for Crohn's disease.
This goal of this study was to assess the cost-effectiveness of extended prophylaxis in patients with Crohn's disease after abdominal surgery. A decision tree model was used to assess cost-effectiveness and cost-per-case averted with extended-duration venous thromboembolism prophylaxis following abdominal surgery. Results showed that extended prophylaxis in patients with Crohn's disease postoperatively is not cost-effective when the cumulative incidence of posthospital thrombosis remains less than 4.9%. These findings are driven by the low absolute risk of thrombosis in this population and the considerable cost of universal treatment.
AHRQ-funded; HS024547.
Citation: Leeds IL, DiBrito SR, Canner JK .
Cost-benefit limitations of extended, outpatient venous thromboembolism prophylaxis following surgery for Crohn's disease.
Dis Colon Rectum 2019 Nov;62(11):1371-80. doi: 10.1097/dcr.0000000000001461..
Keywords: Prevention, Digestive Disease and Health, Surgery, Healthcare Costs, Adverse Events, Patient Safety, Blood Clots, Decision Making, Medication
Blecker S, Austrian JS, Horwitz LI
Interrupting providers with clinical decision support to improve care for heart failure.
The goal of this study was to develop a clinical decision support (CDS) system to recommend an angiotenson converting enzyme (ACE) inhibitor during hospitalization so it could be promoted for continuation at discharge. Patients who were hospitalized with reduced ejection fraction were pseudo-randomized to deliver interruptive or non-interruptive CDS alerts to providers based on the patients’ even or odd medical record number. The utilization rate was higher for interruptive alert versus non-interruptive alert hospitalizations for a sample of 958. This resulted in improved quality of care for heart failure patients.
AHRQ-funded; HS023683.
Citation: Blecker S, Austrian JS, Horwitz LI .
Interrupting providers with clinical decision support to improve care for heart failure.
Int J Med Inform 2019 Nov;131:103956. doi: 10.1016/j.ijmedinf.2019.103956..
Keywords: Clinical Decision Support (CDS), Decision Making, Heart Disease and Health, Cardiovascular Conditions, Medication, Medication: Safety, Patient Safety, Quality Improvement, Quality of Care
Moore AB, Navarrett S, Herzig SJ
Potentially inappropriate use of intravenous opioids in hospitalized patients.
This study examined the frequency of potentially inappropriate intravenous (IV) opioid use in hospitalized patients. The researchers looked at patients hospitalized at a tertiary medical center. Patients with cancer, receiving comfort care, or gastrointestinal dysfunction were excluded. Using guidelines from the Society of Hospital Medicine IV doses were defined as potentially inappropriate if administered more than an initial IV does in patients who did not have nil per os status. Of the 200 patients in the study, 31% were administered potentially inappropriate IV opioids at least once during hospitalization, and 33% of all IV doses were potentially administered inappropriately.
AHRQ-funded; HS026215.
Citation: Moore AB, Navarrett S, Herzig SJ .
Potentially inappropriate use of intravenous opioids in hospitalized patients.
J Hosp Med 2019 Nov 1;14(10):678-80. doi: 10.12788/jhm.3225..
Keywords: Opioids, Medication, Inpatient Care, Decision Making
Vogel JA, Rising KL, Jones J
Reasons patients choose the emergency department over primary care: a qualitative metasynthesis.
To enhance the acute care delivery system, a comprehensive understanding of the patient's perspectives for seeking care in the emergency department (ED) versus primary care (PC) is necessary. In this study, the investigators conducted a qualitative metasynthesis on reasons patients sought care in the ED instead of PC. The investigators concluded that reasons included: (1) urgency of the medical condition, (2) barriers to accessing primary care, (3) advantages of the ED, and (4) fulfillment of medical needs and quality of care in the ED.
AHRQ-funded; HS023901.
Citation: Vogel JA, Rising KL, Jones J .
Reasons patients choose the emergency department over primary care: a qualitative metasynthesis.
J Gen Intern Med 2019 Nov;34(11):2610-19. doi: 10.1007/s11606-019-05128-x..
Keywords: Emergency Department, Primary Care, Decision Making, Healthcare Delivery
Kunst NR, Alarid-Escudero F, Paltiel AD
A value of information analysis of research on the 21-gene assay for breast cancer management.
The authors aimed to quantify the value of conducting further research to reduce decision uncertainty in the use of the 21-gene assay Oncotype DX (21-GA). They found that current evidence strongly supports the use of the 21-GA in intermediate- and high-risk women and recommended that further research focus on low-risk women.
AHRQ-funded; HS023900.
Citation: Kunst NR, Alarid-Escudero F, Paltiel AD .
A value of information analysis of research on the 21-gene assay for breast cancer management.
Value Health 2019 Oct;22(10):1102-10. doi: 10.1016/j.jval.2019.05.004..
Keywords: Genetics, Cancer: Breast Cancer, Cancer, Decision Making, Research Methodologies
Linsky A, Gellad WF, Linder JA
Advancing the science of deprescribing: a novel comprehensive conceptual framework.
Polypharmacy is common in older adults and associated with inappropriate medication use, adverse drug events, medication nonadherence, higher costs, and increased mortality compared with those without polypharmacy. Deprescribing, the clinically supervised process of stopping or reducing the dose of medications when they cause harm or no longer provide benefit, may improve outcomes. This article discusses a novel comprehensive conceptual framework for deprescribing.
AHRQ-funded; 2332015000201; HS026506; HS024930.
Citation: Linsky A, Gellad WF, Linder JA .
Advancing the science of deprescribing: a novel comprehensive conceptual framework.
J Am Geriatr Soc 2019 Oct;67(10):2018-22. doi: 10.1111/jgs.16136..
Keywords: Medication, Elderly, Decision Making
Antunez AG, Telem DA DA, Dossett LA
Assessment of surgical specialty societies' Choosing Wisely recommendations.
This research study assesses the Choosing Wisely initiative from the American Board of Internal Medicine Foundation which aims to reduce the use of low-value practices using evidence-based recommendation. The initiative has included participation from more than 80 specialty societies. The goal of this study was to assess deimplementation recommendations from surgical specialty societies to ascertain how many are directly applicable to surgical procedures or under surgeons’ control. They reviewed the recommendations proposed by surgical societies and requested participation from the eligible ones. Seventeen surgical societies submitted 110 recommendations on their surgical specialty. Out of those recommendations, more than (55%) were identified as perioperative care decisions and not under a surgeons’ control.
AHRQ-funded; HS026030.
Citation: Antunez AG, Telem DA DA, Dossett LA .
Assessment of surgical specialty societies' Choosing Wisely recommendations.
JAMA Surg 2019 Oct;154(10):971-73. doi: 10.1001/jamasurg.2019.2309..
Keywords: Surgery, Decision Making, Guidelines
Martino SC, Grob R, Davis S
Choosing doctors wisely: can assisted choice enhance patients' selection of clinicians?
In this study, the investigators conducted a simulated clinician-choice experiment, comparing choices and decision-making processes of participants (N = 688) randomized among four experimental arms: a conventional website reporting only quantitative performance information, a website reporting both qualitative (patient comments) and quantitative information, the second website augmented by a decision aid (labeling of patient comments), and the decision-aided website further augmented by the presence of a trained navigator.
AHRQ-funded; HS016978.
Citation: Martino SC, Grob R, Davis S .
Choosing doctors wisely: can assisted choice enhance patients' selection of clinicians?
Med Care Res Rev 2019 Oct;76(5):572-96. doi: 10.1177/1077558717743822..
Keywords: Patient Experience, Decision Making
Garrity B, Berry Crofton, C
Parent-to-parent advice on considering spinal fusion in children with neuromuscular scoliosis.
The purpose of this study was to convey advice from families whose children recently underwent spinal fusion to families whose children are under consideration for initial spinal fusion for neuromuscular scoliosis and to providers who counsel families on this decision. Results showed that parents of children who had recently undergone spinal fusion had strong perceptions about what information to convey to families considering surgery, which may improve communication between future parents and physicians. Further investigation is needed to assess how best to incorporate the wisdom and experiences of parent peers into shared decisionmaking and preparation for spinal fusion in children with neuromuscular scoliosis.
AHRQ-funded; HS024453.
Citation: Garrity B, Berry Crofton, C .
Parent-to-parent advice on considering spinal fusion in children with neuromuscular scoliosis.
J Pediatr 2019 Oct;213:149-54. doi: 10.1016/j.jpeds.2019.05.055..
Keywords: Decision Making, Patient and Family Engagement, Caregiving, Children/Adolescents, Back Health and Pain, Surgery
Wang SV, Rogers JR, Jin Y
Stepped-wedge randomised trial to evaluate population health intervention designed to increase appropriate anticoagulation in patients with atrial fibrillation.
Clinical guidelines recommend anticoagulation for patients with atrial fibrillation (AF) at high risk of stroke; however, studies report 40% of this population is not anticoagulated. The purpose of this study was to evaluate a population health intervention to increase anticoagulation use in high-risk patients with AF. The investigators concluded that algorithms to identify underuse of anticoagulation among patients with AF in healthcare databases may not capture clinical subtleties or patient preferences and may overestimate the extent of undertreatment.
AHRQ-funded; HS022193.
Citation: Wang SV, Rogers JR, Jin Y .
Stepped-wedge randomised trial to evaluate population health intervention designed to increase appropriate anticoagulation in patients with atrial fibrillation.
BMJ Qual Saf 2019 Oct;28(10):835-42. doi: 10.1136/bmjqs-2019-009367..
Keywords: Blood Thinners, Heart Disease and Health, Cardiovascular Conditions, Medication, Health Information Technology (HIT), Decision Making, Electronic Health Records (EHRs), Practice Patterns, Healthcare Utilization
Vemulakonda VM, Hamer MK, Kempe A
Surgical decision-making in infants with suspected UPJ obstruction: stakeholder perspectives.
Although there are significant demographic and clinical variations in treatment decisions for infants with high-grade hydronephrosis concerning for ureteropelvic junction obstruction (UPJO), there has been little research on the roles of parents and surgeons in the surgical decision-making (DM) process. The purpose of this study was to understand parents' and surgeons' perceived roles in the surgical DM process for infants with high-grade hydronephrosis.
AHRQ-funded; HS024597.
Citation: Vemulakonda VM, Hamer MK, Kempe A .
Surgical decision-making in infants with suspected UPJ obstruction: stakeholder perspectives.
J Pediatr Urol 2019 Oct;15(5):469.e1-69.e9. doi: 10.1016/j.jpurol.2019.05.027..
Keywords: Newborns/Infants, Decision Making, Surgery, Kidney Disease and Health, Caregiving, Provider: Physician, Provider, Patient and Family Engagement
McGinn T, Cohen S, Khan S
The high cost of low value care.
The main focus of this study was bridging the "evidence gap" between frontline decision-making in health care and the actual evidence, with the hope of reducing unnecessary diagnostic testing and treatments. From their work in pulmonary embolism (PE) and over ordering of computed tomography pulmonary angiography, the investigators integrated the highly validated Wells' criteria into the electronic health record at two of their major academic tertiary hospitals.
AHRQ-funded; HS022061.
Citation: McGinn T, Cohen S, Khan S .
The high cost of low value care.
Trans Am Clin Climatol Assoc 2019;130:60-70..
Keywords: Healthcare Costs, Evidence-Based Practice, Patient-Centered Outcomes Research, Decision Making, Comparative Effectiveness
Cochran AL, Rathouz PJ, Kocher KE
A latent variable approach to potential outcomes for emergency department admission decisions.
The authors sought to provide a general framework to evaluate admission decisions from electronic healthcare records. They estimated that while admitting a patient with higher latent needs reduced the 30-day risk of revisiting the emergency department or later being admitted through the emergency department by over 79%, admitting a patient with lower latent needs actually increased these 30-day risks by 3.0% and 7.6%, respectively.
AHRQ-funded; HS024160.
Citation: Cochran AL, Rathouz PJ, Kocher KE .
A latent variable approach to potential outcomes for emergency department admission decisions.
Stat Med 2019 Sep 10;38(20):3911-35. doi: 10.1002/sim.8210..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Emergency Department, Clinical Decision Support (CDS), Decision Making, Hospitalization
Wissel BD, Greiner HM, Glauser TA
Investigation of bias in an epilepsy machine learning algorithm trained on physician notes.
Racial disparities in the utilization of epilepsy surgery are well documented, but it is unknown whether a natural language processing (NLP) algorithm trained on physician notes would produce biased recommendations for epilepsy presurgical evaluations. To assess this, an NLP algorithm was trained to identify potential surgical candidates using 1097 notes from 175 epilepsy patients with a history of resective epilepsy surgery and 268 patients who achieved seizure freedom without surgery (total N = 443 patients).
AHRQ-funded; HS024977.
Citation: Wissel BD, Greiner HM, Glauser TA .
Investigation of bias in an epilepsy machine learning algorithm trained on physician notes.
Epilepsia 2019 Sep;60(9):e93-e98. doi: 10.1111/epi.16320..
Keywords: Neurological Disorders, Surgery, Clinical Decision Support (CDS), Healthcare Utilization, Health Information Technology (HIT), Decision Making
Gance-Cleveland B, Leiferman J, Aldrich H
Using the technology acceptance model to develop startsmart: mHealth for screening, brief intervention, and referral for risk and protective factors in pregnancy.
The purpose of this study was to develop StartSmart, a mobile health (mHealth) intervention to support evidence-based prenatal screening, brief intervention, and referral to treatment for risk and protective factors in pregnancy. Expert clinicians provided guidance on the screening instruments, resources, and practice guidelines. Clinicians suggested identifying specific prenatal visits for the screening. Patients reported that the tablet-based screening was useful to promote adherence to guidelines and provided suggestions for improvement.
AHRQ-funded; HS024738.
Citation: Gance-Cleveland B, Leiferman J, Aldrich H .
Using the technology acceptance model to develop startsmart: mHealth for screening, brief intervention, and referral for risk and protective factors in pregnancy.
J Midwifery Womens Health 2019 Sep;64(5):630-40. doi: 10.1111/jmwh.13009..
Keywords: Health Information Technology (HIT), Domestic Violence, Clinical Decision Support (CDS), Decision Making, Pregnancy, Women, Evidence-Based Practice, Screening, Prevention
Schroeder AD, Tubre DJ, Fitzgibbons RJ
Watchful waiting for inguinal hernia.
In this article, the authors examine the available evidence regarding nonoperative treatment or ‘‘watchful waiting’’ of inguinal hernias. The goal was to develop evidence-based recommendations to provide patients with inguinal hernia the treatment strategy that will maximize benefit while minimizing potential risks.
AHRQ-funded; HS009860.
Citation: Schroeder AD, Tubre DJ, Fitzgibbons RJ .
Watchful waiting for inguinal hernia.
Adv Surg 2019 Sep;53:293-303. doi: 10.1016/j.yasu.2019.04.014.
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Keywords: Care Management, Evidence-Based Practice, Decision Making
Hoonakker PLT, Carayon P, Salwei ME
The design of PE Dx, a CDS to support pulmonary embolism diagnosis in the ED.
One possible explanation for user resistance to clinical decision support (CDS) procedures may be poor CDS design. This study describes the design of PE Dx, a CDS built to aid in the diagnosis of pulmonary embolism in the emergency department using human factors methods.
AHRQ-funded; HS022086.
Citation: Hoonakker PLT, Carayon P, Salwei ME .
The design of PE Dx, a CDS to support pulmonary embolism diagnosis in the ED.
Stud Health Technol Inform 2019 Aug 9;265:134-40. doi: 10.3233/shti190152..
Keywords: Blood Clots, Clinical Decision Support (CDS), Decision Making, Diagnostic Safety and Quality, Emergency Department, Respiratory Conditions
Brodney S, Fowler FJ, Barry MJ
Comparison of three measures of shared decision making: SDM Process_4, CollaboRATE, and SURE scales.
This study compared 3 different shared decision making (SDM) aids for patients facing surgery for hip or knee osteoarthritis, lumbar herniated disc or lumber spinal stenosis (backs). Patients were surveys after they used one of the following patient decision aids (PDAs): SMD Process_4, CollaboRATE, or SURE. The sample size was 649 with a mean age of 63.3 years, 51% female, and 60% were college educated. Most patients (69%) were facing hip or knee surgery. Results showed that the PDAs did aid patients – especially for hips/knees and were different for each PDA.
AHRQ-funded; HS025718.
Citation: Brodney S, Fowler FJ, Barry MJ .
Comparison of three measures of shared decision making: SDM Process_4, CollaboRATE, and SURE scales.
Med Decis Making 2019 Aug;39(6):673-80. doi: 10.1177/0272989x19855951..
Keywords: Decision Making, Surgery, Arthritis, Back Health and Pain
