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
101 to 125 of 245 Research Studies DisplayedKenyon CC, Gruschow SM, Haaland WL
Kenyon CC, Gruschow SM, Haaland WL, Desai AD, Adams SA, Hitt TA, Williams DJ, et al. Perceived access to outpatient care and hospital reutilization following acute respiratory illnesses.
The authors’ goal was to assess the relationship between perceived access to timely office-based care and subsequent 30-day pediatric revisits following hospital discharge for asthma, bronchiolitis, croup, and pneumonia. They found that perceived access to timely office-based care was associated with significantly greater odds of subsequent emergency department revisit. They concluded that focusing solely on enhancing timely access to care following discharge for common respiratory illnesses may be insufficient to prevent repeat utilization.
AHRQ-funded; HS024299.
Citation: Kenyon CC, Gruschow SM, Haaland WL .
Kenyon CC, Gruschow SM, Haaland WL, Desai AD, Adams SA, Hitt TA, Williams DJ, et al. Perceived access to outpatient care and hospital reutilization following acute respiratory illnesses.
Acad Pediatr 2019 May - Jun;19(4):370-77. doi: 10.1016/j.acap.2018.07.001..
Keywords: Children/Adolescents, Respiratory Conditions, Ambulatory Care and Surgery, Emergency Department, Access to Care, Hospitals
Asan O, Scanlan MC, Crotty B
Parental perceptions of displayed patient data in a PICU: an example of unintentional empowerment.
The objective of this study was to explore the perceptions of parents of pediatric patients in a PICU regarding real-time open electronic health record data displayed in patient rooms. The investigators suggest that a new health information technology system providing continuous access to open electronic health record data may be an effective way to empower and engage parents in the PICU, but also note potential drawbacks.
AHRQ-funded; HS023626.
Citation: Asan O, Scanlan MC, Crotty B .
Parental perceptions of displayed patient data in a PICU: an example of unintentional empowerment.
Pediatr Crit Care Med 2019 May;20(5):435-41. doi: 10.1097/pcc.0000000000001895..
Keywords: Caregiving, Children/Adolescents, Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitals, Intensive Care Unit (ICU), Patient and Family Engagement
Louisias M, Petty CR, Sheehan W
Use of a school-based survey to screen students for symptoms concerning for asthma.
Researchers sought early identification of asthma in minority children. Their goal was to determine if they could apply screening surveys to an inner-city, school-based cohort. They found a significant number of children with a positive asthma screen and no parent-reported asthma. Children with symptoms suggestive of asthma had elevated rates of hospital care for breathing problems and an atopic background. The researchers conclude that these children without known asthma, but who experience increased morbidity, can be easily identified with a school-based asthma screening survey and should be closely monitored.
AHRQ-funded; HS000063; HS022986.
Citation: Louisias M, Petty CR, Sheehan W .
Use of a school-based survey to screen students for symptoms concerning for asthma.
Clin Pediatr 2019 May;58(5):586-89. doi: 10.1177/0009922819832087..
Keywords: Children/Adolescents, Asthma, Screening, Education, Diagnostic Safety and Quality, Urban Health
Doarn CR, Zacharias S, Keck CS
Design and implementation of an interactive website for pediatric voice therapy-the concept of in-between care: a telehealth model.
The purpose of this article was to describe the design and implementation of a web-based portal that was developed to provide supported home practice between weekly voice therapy sessions delivered through telehealth to children with voice disorders. Participants and speech-language pathologists used the portal effectively, finding it useful for in-between care and reinforcement of therapeutic exercises. The authors add that a versatile individual, who is able to work with all project staff is essential to the development process.
AHRQ-funded; HS021781.
Citation: Doarn CR, Zacharias S, Keck CS .
Design and implementation of an interactive website for pediatric voice therapy-the concept of in-between care: a telehealth model.
Telemed J E Health 2018 May;20(2):e66. doi: 10.1089/tmj.2018.0108..
Keywords: Children/Adolescents, Health Information Technology (HIT), Telehealth
Toomey SL, Elliott MN, Zaslavsky AM
Improving response rates and representation of hard-to-reach groups in family experience surveys.
This study examined the use of an audio-enabled tablet to survey parents of children discharged from 4 units of a children’s hospital. Normal mail survey response rates are very low, especially for black, Latino, and low-income respondents. This survey was done day of discharge at the hospital and there was a response rate of 71.1% via tablet versus 16.3% for mail only. The Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was used. Tablet response rates were highest with fathers, those more likely to have a high school education or less, less likely to be white, and more likely to be publicly insured. The results are promising for future surveys using tablet administration.
AHRQ-funded; HS020513; HS025299.
Citation: Toomey SL, Elliott MN, Zaslavsky AM .
Improving response rates and representation of hard-to-reach groups in family experience surveys.
Acad Pediatr 2019 May - Jun;19(4):446-53. doi: 10.1016/j.acap.2018.07.007..
Keywords: Caregiving, Children/Adolescents, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Health Information Technology (HIT), Hospitals, Low-Income, Patient Experience, Quality of Care, Quality Improvement, Racial and Ethnic Minorities
Knutsen J, Crossman M, Perrin J
Sex differences in restricted repetitive behaviors and interests in children with autism spectrum disorder: an Autism Treatment Network study.
Researchers examined sex differences in clinically identified (Autism Diagnostic Observation Schedule) restricted and repetitive behavior symptoms of age-matched and intelligence quotient-matched female and male children with autism spectrum disorder. Their findings identified key restricted and repetitive behavior similarities and differences among young females and males with autism spectrum disorder and emphasized the need for a deeper understanding of the female autism phenotype.
AHRQ-funded; HS022986; HS000063.
Citation: Knutsen J, Crossman M, Perrin J .
Sex differences in restricted repetitive behaviors and interests in children with autism spectrum disorder: an Autism Treatment Network study.
Autism 2019 May;23(4):858-68. doi: 10.1177/1362361318786490..
Keywords: Autism, Behavioral Health, Children/Adolescents, Patient-Centered Outcomes Research, Sex Factors
Childers CP, Dworsky JQ, Massoumi RL
The contemporary appendectomy for acute uncomplicated appendicitis in children.
The purpose of this research was to study cases of acute, uncomplicated appendicitis in children. The researchers found that, in a population of 9,507 patients, the children have excellent clinical outcomes, although children aged 5 and under have an increased risk of negative appendectomy. Also, more than one-third of children received a computed tomography prior to the operation despite guidelines against their use.
AHRQ-funded; HS025079.
Citation: Childers CP, Dworsky JQ, Massoumi RL .
The contemporary appendectomy for acute uncomplicated appendicitis in children.
Surgery 2019 May;165(5):1027-34. doi: 10.1016/j.surg.2018.12.019..
Keywords: Case Study, Children/Adolescents, Surgery
Louisias M, Ramadan A, Naja AS
The effects of the environment on asthma disease activity.
This study discusses environmental factors that trigger or aggravate symptoms of asthma in children. Biological and physical factors include allergens, microbiome, endotoxin, genetics and pollution. Psychosocial environmental factors include stress, neighborhood safety, housing and discrimination. Control of these factors help to reduce prevalence and severity of asthma.
AHRQ-funded; HS022986.
Citation: Louisias M, Ramadan A, Naja AS .
The effects of the environment on asthma disease activity.
Immunol Allergy Clin North Am 2019 May;39(2):163-75. doi: 10.1016/j.iac.2018.12.005..
Keywords: Asthma, Children/Adolescents, Respiratory Conditions, Risk, Social Determinants of Health
Cantor AG, Hendrickson R, Blazina I
Screening for elevated blood lead levels in childhood and pregnancy: updated evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this study was to synthesize evidence on the effects of screening, testing, and treatment for elevated blood lead level in pregnant women and children aged 5 years and younger in the primary care setting to inform the US Preventive Services Task Force. The investigators found that screening questionnaires were not accurate for identifying children with elevated blood lead levels. Additionally, chelating agents in children were not significantly associated with sustained effects on blood level levels but were associated with harms.
AHRQ-funded; 290201500009I.
Citation: Cantor AG, Hendrickson R, Blazina I .
Screening for elevated blood lead levels in childhood and pregnancy: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2019 Apr 16;321(15):1510-26. doi: 10.1001/jama.2019.1004..
Keywords: Children/Adolescents, Evidence-Based Practice, Pregnancy, Prevention, Screening, U.S. Preventive Services Task Force (USPSTF), Women
Schaffer SJ, Rand CM, Humiston SG
Practical considerations in developing a successful school-located influenza vaccination (SLIV) program.
This paper discussed strategies in developing a successful school-located influenza vaccination (SLIV) program. The authors indicate that adequate planning is crucial for SLIV success. In addition, they delineate several components that are important for a SLIV program to be successful: 1. Buy-in from school districts and school nurses, 2. Timing of SLIV clinics, 3. Publicizing SLIV to parents, 4. Obtaining vaccination consent, 5. Adequacy of resources, 6. Billing, and 7. Sustainability
AHRQ-funded; HS021163.
Citation: Schaffer SJ, Rand CM, Humiston SG .
Practical considerations in developing a successful school-located influenza vaccination (SLIV) program.
Vaccine 2019 Apr 10;37(16):2171-73. doi: 10.1016/j.vaccine.2019.01.088..
Keywords: Vaccination, Influenza, Infectious Diseases, Children/Adolescents
Chien AT, Toomey SL, Kuo DZ
Care quality and spending among commercially insured children with disabilities.
Researchers examined the prevalence of children with disabilities (CWD) within a commercially insured population and compared outpatient care quality and annual health plan spending levels for CWD relative to children with complex medical conditions without disabilities; children with chronic conditions that are not complex; and children without disabling, complex, or chronic conditions. The cross-sectional study comprised over 1M person-years of Blue Cross Blue Shield Massachusetts data for beneficiaries aged from 1 to 19 years. The researchers found that CWD were prevalent in the commercially insured population, with these children experiencing suboptimal levels of care which were comparable to non-CWD groups. They concluded that improving the care value for CWD involves a deeper understanding of what higher spending delivers and additional aspects of care quality.
AHRQ-funded; HS025299.
Citation: Chien AT, Toomey SL, Kuo DZ .
Care quality and spending among commercially insured children with disabilities.
Acad Pediatr 2019 Apr;19(3):291-99. doi: 10.1016/j.acap.2018.06.004..
Keywords: Quality of Care, Children/Adolescents, Disabilities, Healthcare Costs, Health Insurance
Krah NM, Bardsley T, Nelson R
Economic burden of home antimicrobial therapy: OPAT versus oral therapy.
There is increasing evidence that outpatient parenteral antimicrobial therapy (OPAT) is overused for children and that outcomes with oral therapy are equivalent. The objective of this study was to compare economic burden between OPAT and oral therapy, accounting for direct and indirect costs and caregiver quality of life (QoL). The investigators concluded that the overall burden of OPAT was substantially higher than that of oral therapy, including higher direct and indirect costs and greater impact on caregiver QoL.
AHRQ-funded; HS023320.
Citation: Krah NM, Bardsley T, Nelson R .
Economic burden of home antimicrobial therapy: OPAT versus oral therapy.
Hosp Pediatr 2019 Apr;9(4):234-40. doi: 10.1542/hpeds.201-0193.
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Keywords: Healthcare Costs, Children/Adolescents, Caregiving, Home Healthcare, Antimicrobial Stewardship, Antibiotics, Medication
Kelly MM, Thurber AS, Coller RJ
Parent perceptions of real-time access to their hospitalized child's medical records using an inpatient portal: a qualitative study.
In this study, the authors’ objectives were to identify why parents used an inpatient portal application on a tablet computer during their child's hospitalization and identify their perspectives of ways to optimize the technology. The investigators concluded that providing parents with real-time clinical information during their child's hospitalization using an inpatient portal may enhance their ability to engage in caregiving tasks critical to ensuring inpatient care quality and safety.
Citation: Kelly MM, Thurber AS, Coller RJ .
Parent perceptions of real-time access to their hospitalized child's medical records using an inpatient portal: a qualitative study.
Hosp Pediatr 2019 Apr;9(4):273-80. doi: 10.1542/hpeds.2018-0166..
Keywords: Children/Adolescents, Caregiving, Hospitalization, Electronic Health Records (EHRs), Health Information Technology (HIT), Clinician-Patient Communication
Spees LP, Martin PL, Kurtzberg J
Reduction in mortality after umbilical cord blood transplantation in children over a 20-year period (1995-2014).
Infections and graft-versus-host disease (GVHD) have historically resulted in high mortality among children undergoing umbilical cord blood transplantation (UCBT). However, recent advances in clinical practice have likely improved outcomes of these patients. In this paper, the authors report on a retrospective cohort study, they conducted, of children (<18years of age) undergoing UCBT at Duke University between January 1, 1995 and December 31, 2014.
AHRQ-funded; HS000032.
Citation: Spees LP, Martin PL, Kurtzberg J .
Reduction in mortality after umbilical cord blood transplantation in children over a 20-year period (1995-2014).
Biol Blood Marrow Transplant 2019 Apr;25(4):756-63. doi: 10.1016/j.bbmt.2018.11.018..
Keywords: Children/Adolescents, Mortality, Outcomes
Perito ER, Mogul DB, VanDerwerken D
The impact of increased allocation priority for children awaiting liver transplant: a Liver Simulated Allocation Model (LSAM) analysis.
This study examined the impact of prioritizing infants, children, adolescents, and the sickest adults (designated Status 1) for deceased donor livers. They compared outcomes for two “SharePeds” allocation schema to the allocation plan approved by the Organ Procurement and Transplant Network (OPTN) in December 2017. Both schemas would decrease waitlist deaths for infants, children, and Status 1 adults and increase access to all donors younger than 35 years.
AHRQ-funded; HS023876.
Citation: Perito ER, Mogul DB, VanDerwerken D .
The impact of increased allocation priority for children awaiting liver transplant: a Liver Simulated Allocation Model (LSAM) analysis.
J Pediatr Gastroenterol Nutr 2019 Apr;68(4):472-79. doi: 10.1097/mpg.0000000000002287.
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Keywords: Children/Adolescents, Transplantation, Policy
Nasol E, Lindly OJ, Chavez AE
Unmet need and financial impact disparities for US children with ADHD.
The 5.1million US children with attention-deficit/hyperactivity disorder (ADHD) have pronounced needs in education, occupational and speech therapy, and medical and behavioral treatments. Given known associations of ADHD diagnosis with race/ethnicity and parent education, this study aimed to assess how measures of socioeconomic status correlate with both adverse family financial impact of ADHD and disparities in unmet treatment need for ADHD.
AHRQ-funded; HS000063.
Citation: Nasol E, Lindly OJ, Chavez AE .
Unmet need and financial impact disparities for US children with ADHD.
Acad Pediatr 2019 Apr;19(3):315-24. doi: 10.1016/j.acap.2018.09.001..
Keywords: Children/Adolescents, Behavioral Health, Healthcare Costs, Social Determinants of Health
Sick-Samuels AC, Woods-Hill CZ, Fackler JC
Association of a blood culture utilization intervention on antibiotic use in a pediatric intensive care unit.
The goal of this study was to evaluate whether the use of antibiotics at the Johns Hopkins pediatric intensive care unit (PICU) changed in relation to a reduction in utilization of blood culture. Antibiotic usage is used as a balancing measure, because a reduction in blood cultures could lead to an increase in antibiotic treatment if clinicians continued treatment in scenarios when blood culture results were not available. The authors examined the administration of antibiotics over 12 months while a locally developed blood-culture guideline was being implemented. The distribution of antibiotics remained similar over the pre- and post-implementation periods.
AHRQ-funded; HS025642.
Citation: Sick-Samuels AC, Woods-Hill CZ, Fackler JC .
Association of a blood culture utilization intervention on antibiotic use in a pediatric intensive care unit.
Infect Control Hosp Epidemiol 2019 Apr;40(4):482-84. doi: 10.1017/ice.2019.10..
Keywords: Antibiotics, Children/Adolescents, Intensive Care Unit (ICU), Medication, Practice Patterns
Berry JG, Goodman DM, Coller RJ
Association of home respiratory equipment and supply use with health care resource utilization in children.
The purpose of this cohort study was to compare health care use and spending in children using vs not using respiratory medical equipment and supplies (RMES). The investigators found that the use of RMES was associated with high health care spending, especially with hospital and home health care. They suggest that population health initiatives in children may benefit from consideration of RMES in comprehensive risk assessment for health care spending.
AHRQ-funded; HS02513.
Citation: Berry JG, Goodman DM, Coller RJ .
Association of home respiratory equipment and supply use with health care resource utilization in children.
J Pediatr 2019 Apr;207:169-75.e2. doi: 10.1016/j.jpeds.2018.11.046..
Keywords: Children/Adolescents, Healthcare Costs, Healthcare Utilization, Home Healthcare, Respiratory Conditions
Feinstein JA, Hall M, Antoon JW
Chronic medication use in children insured by Medicaid: a multistate retrospective cohort study.
This retrospective cohort study examined the use of chronic medication (CM) use in children insured by Medicaid. The cohort included children ages 1 to 18 years from 10 states in 2014. It was grouped by the annual number of CMs (0, 1, 2-4, 5-9, and >=10). Of the over 4.5 million subjects, 18.8% used CMs, and 44% in children with a complex chronic condition. The most common CM therapeutic class was neurologic (28.8%). For children prescribed only 1 CM, the most common class is amphetamine stimulants. For children with 10 or greater CMs prescribed, antiepileptics were the most common. Increased CM use was associated with increased hospitalization and emergency department use.
AHRQ-funded; HS025138.
Citation: Feinstein JA, Hall M, Antoon JW .
Chronic medication use in children insured by Medicaid: a multistate retrospective cohort study.
Pediatrics 2019 Apr;143(4). doi: 10.1542/peds.2018-3397..
Keywords: Children/Adolescents, Chronic Conditions, Medicaid, Medication
Rinke ML, German M, Azera B
Effect of mental health screening and integrated mental health on adolescent depression-coded visits.
This article describes a retrospective primary care network natural cohort study to analyze how mental health screening and integrated mental health practitioners affect adolescent depression identification. The percentage of depression-coded adolescent visits were compared between practices with and without mental health screening and with and without integrated mental health practitioners, using difference-in-differences analyses. The authors conclude that adolescent mental health screening and integrated mental health practitioners increase depression-coded visits in primary care.
AHRQ-funded; HS0203608.
Citation: Rinke ML, German M, Azera B .
Effect of mental health screening and integrated mental health on adolescent depression-coded visits.
Clin Pediatr 2019 Apr;58(4):437-45. doi: 10.1177/0009922818821889..
Keywords: Children/Adolescents, Depression, Diagnostic Safety and Quality, Primary Care, Screening
Brand McCarthy SR, Kang TI, Mack JW
Inclusion of children in the initial conversation about their cancer diagnosis: impact on parent experiences of the communication process.
The current study examined the frequency and impact of child presence during a serious medical conversation on the parent's communication experience in pediatric oncology. The investigators concluded that the parent's communication experience is not diminished by the choice to include the child. They suggest that given the bioethical imperative to include children in conversations about serious illness whenever possible, this concern should not be used to exclude children, but rather to give parents additional time of their own when needed to fully process decisions.
AHRQ-funded; HS000063.
Citation: Brand McCarthy SR, Kang TI, Mack JW .
Inclusion of children in the initial conversation about their cancer diagnosis: impact on parent experiences of the communication process.
Support Care Cancer 2019 Apr;27(4):1319-24. doi: 10.1007/s00520-019-4653-3..
Keywords: Cancer, Caregiving, Children/Adolescents, Clinician-Patient Communication, Patient and Family Engagement
Ashcraft LE, Asato M, Houtrow AJ
Parent empowerment in pediatric healthcare settings: a systematic review of observational studies.
The objective of this systematic review was to synthesize potential antecedents and consequences of parent empowerment in healthcare settings. The authors identified six themes within consequences of empowerment: increased parent involvement in daily care, improved symptom management, enhanced informational needs and tools, increased involvement in care decisions, increased advocacy for child, and engagement in empowering others. Six themes summarizing antecedents of empowerment also emerged: parent-provider relationships.
AHRQ-funded; HS022989.
Citation: Ashcraft LE, Asato M, Houtrow AJ .
Parent empowerment in pediatric healthcare settings: a systematic review of observational studies.
Patient 2019 Apr;12(2):199-212. doi: 10.1007/s40271-018-0336-2..
Keywords: Caregiving, Children/Adolescents, Clinician-Patient Communication, Decision Making, Patient and Family Engagement
Berry JG, Johnson C, Crofton C
Predicting postoperative physiologic decline after surgery.
This prospective study looked at postoperative physiologic decline (PoPD) in pediatric surgical patients at a freestanding children’s hospital. Median age of the child at surgery was 8 years, 70.9% had a complex chronic condition (CCC), and 7.3% used 11 or more home medications. The odds of a patient experiencing PoPD increases if the child has an active health problem, takes 11 or more home medications and has 3 or more CCCs. More than 25% of pediatric patients undergoing elective surgery experienced PoPD.
AHRQ-funded; HS024453.
Citation: Berry JG, Johnson C, Crofton C .
Predicting postoperative physiologic decline after surgery.
Pediatrics 2019 Apr;143(4). doi: 10.1542/peds.2018-2042..
Keywords: Adverse Events, Children/Adolescents, Patient Safety, Surgery
Szilagyi PG, Schaffer S, Rand CM
Text message reminders for child influenza vaccination in the setting of school-located influenza vaccination: a randomized clinical trial.
This study assessed whether text message reminders to parents could raise rates for children receiving school-located influenza vaccination (SLIV). Researchers randomized families with children in urban elementary schools to receive either text message plus SLIV (intervention) or SLIV alone (comparison). All parents were also sent two ‘backpack’ notifications and two autodialer phone reminders about SLIV at a single SLIV clinic. The text message reminders did not raise influenza vaccination rates above those observed with SLIV alone, and the authors conclude that more intensive interventions are needed to raise influenza vaccination rates.
AHRQ-funded; HS021163.
Citation: Szilagyi PG, Schaffer S, Rand CM .
Text message reminders for child influenza vaccination in the setting of school-located influenza vaccination: a randomized clinical trial.
Clin Pediatr 2019 Apr;58(4):428-36. doi: 10.1177/0009922818821878..
Keywords: Children/Adolescents, Influenza, Health Information Technology (HIT), Vaccination
Bundy DG, Singh H, Stein RE
The design and conduct of Project RedDE: a cluster-randomized trial to reduce diagnostic errors in pediatric primary care.
This paper discusses the results of Project RedDE, which was a virtual collaborative quality improvement study to reduce diagnostic errors in pediatric primary care practices. Forty-three practices were initially recruited, with a total of 31 practices left at the end due to practice dropout and two participating practices merging. This study was a randomized controlled trial targeting three common diagnostic errors (missed diagnoses of adolescent depression, abnormal blood pressure, and lack of followup for abnormal laboratory results). Contamination across study groups was a recurring problem, but risk mitigations were used. Electronic health records contributed to teams’ success.
AHRQ-funded; HS203608.
Citation: Bundy DG, Singh H, Stein RE .
The design and conduct of Project RedDE: a cluster-randomized trial to reduce diagnostic errors in pediatric primary care.
Clin Trials 2019 Apr;16(2):154-64. doi: 10.1177/1740774518820522..
Keywords: Adverse Events, Children/Adolescents, Diagnostic Safety and Quality, Medical Errors, Prevention, Primary Care, Quality of Care, Quality Improvement