National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (2)
- Adverse Drug Events (ADE) (2)
- Adverse Events (2)
- Ambulatory Care and Surgery (4)
- Antibiotics (9)
- Antimicrobial Stewardship (4)
- Anxiety (1)
- Arthritis (1)
- Behavioral Health (5)
- Blood Pressure (1)
- Blood Thinners (1)
- Cancer (7)
- Cancer: Breast Cancer (2)
- Cancer: Prostate Cancer (2)
- Cardiovascular Conditions (4)
- Catheter-Associated Urinary Tract Infection (CAUTI) (2)
- Children/Adolescents (8)
- Chronic Conditions (3)
- Clinical Decision Support (CDS) (1)
- Clinician-Patient Communication (2)
- Clostridium difficile Infections (1)
- Communication (4)
- COVID-19 (2)
- Decision Making (4)
- Dental and Oral Health (4)
- Diabetes (2)
- Diagnostic Safety and Quality (2)
- Disparities (2)
- Education: Patient and Caregiver (1)
- Elderly (3)
- Electronic Health Records (EHRs) (1)
- Emergency Department (6)
- Emergency Medical Services (EMS) (1)
- Evidence-Based Practice (3)
- Guidelines (3)
- Healthcare-Associated Infections (HAIs) (3)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Utilization (1)
- Health Information Exchange (HIE) (1)
- Health Information Technology (HIT) (5)
- Health Status (1)
- Heart Disease and Health (2)
- Hospitalization (3)
- Imaging (4)
- Long-Term Care (1)
- Maternal Care (1)
- Medicaid (1)
- Medical Devices (1)
- Medical Expenditure Panel Survey (MEPS) (1)
- Medicare (3)
- Medication (41)
- Medication: Safety (2)
- Newborns/Infants (2)
- Nursing Homes (1)
- Opioids (21)
- Orthopedics (1)
- Pain (8)
- Palliative Care (1)
- Patient-Centered Outcomes Research (2)
- Patient Experience (1)
- Patient Safety (6)
- Policy (5)
- (-) Practice Patterns (71)
- Pregnancy (2)
- Prevention (4)
- Primary Care (5)
- Provider (1)
- Provider: Health Personnel (1)
- Provider: Nurse (2)
- Provider: Physician (5)
- Quality Improvement (1)
- Quality of Care (1)
- Racial and Ethnic Minorities (2)
- Registries (1)
- Respiratory Conditions (3)
- Risk (2)
- Screening (2)
- Sexual Health (1)
- Stroke (1)
- Substance Abuse (3)
- Surgery (6)
- Telehealth (2)
- Training (1)
- Treatments (1)
- U.S. Preventive Services Task Force (USPSTF) (1)
- Urinary Tract Infection (UTI) (1)
- Women (5)
- Workforce (1)
- Young Adults (2)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
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 DisplayedYan CH, Hubbard CC, Lee TA
Impact of hydrocodone rescheduling on dental prescribing of opioids.
In 2014, the United States Drug Enforcement Administration rescheduled hydrocodone’s controlled substance schedule from III to II, introducing increasing regulations in prescribing and dispensing. In the U.S., dentists often prescribe hydrocodone, and these changes in scheduling may have altered dental prescribing of opioids. The purpose of this study was to assess the impact of the hydrocodone rescheduling on dental prescribing of opioids in the United States. Across the 49-month study period, dentists prescribed 50,412,942 opioid prescriptions. Hydrocodone was the most prescribed opioid, followed by codeine, oxycodone, and tramadol. At index, hydrocodone prescribing immediately decreased by -834.8 Rx/1,000 dentists with increased prescribing of codeine, oxycodone, and tramadol. The mean MME increased at index for all opioids except for hydrocodone, and dosages subsequently decreased during the postindex period.
AHRQ-funded; HS025177.
Citation: Yan CH, Hubbard CC, Lee TA .
Impact of hydrocodone rescheduling on dental prescribing of opioids.
JDR Clin Trans Res 2023 Oct; 8(4):402-12. doi: 10.1177/23800844221102830..
Keywords: Opioids, Medication, Dental and Oral Health, Practice Patterns
Sankar A, Everhart AO, Jena AB
Longitudinal patterns in testosterone prescribing after US FDA safety communication in 2014.
This study described changes in testosterone prescribing following a 2014 US Food and Drug Administration (FDA) safety communication and how changes varied by physician characteristics. The authors extracted data from a 20% random sample of Medicare fee-for-service administrative claims data from 2011 through 2019. This unique sample included 1,544,604 unique male beneficiaries who received evaluation and management (E&M) services from 58,819 unique physicians that prescribed testosterone between 2011 and 2013. Patients were classified by presence of coronary artery disease (CAD) and non-age-related hypogonadism. Physician characteristics included specialty and affiliations with teaching hospitals, for-profit hospitals, hospitals in integrated delivery networks, and hospitals in the top decile of case mix index. Among 65,089,560 physician-patient-quarter-year observations, mean (standard deviation) age ranged from 72.16 (5.84 SD) years for observations without CAD or non-age-related hypogonadism to 75.73 (6.92 SD) years with CAD and without non-age-related hypogonadism. Following the safety communication, immediate changes in off-label testosterone prescription levels fell by 0.22 percentage points (pp) for patients with CAD and by -0.16 pp for patients without CAD, with a similar change in on-label prescribing levels. The off-label testosterone prescription quarterly trend increased for patients with CAD and without CAD; on-label testosterone prescription trends declined for both groups. Primary care physicians had larger declines in off-label prescribing then non-primary care physicians, and physicians affiliated with teaching compared to nonteaching hospitals. On-label prescribing found no changes associated with physician and organizational characteristics.
AHRQ-funded; HS025164.
Citation: Sankar A, Everhart AO, Jena AB .
Longitudinal patterns in testosterone prescribing after US FDA safety communication in 2014.
Jt Comm J Qual Patient Saf 2023 Sep; 49(9):458-66. doi: 10.1016/j.jcjq.2023.05.003..
Keywords: Communication, Medication, Practice Patterns
Bongiovanni T, Pletcher MJ, Lau C
A behavioral intervention to promote use of multimodal pain medication for hospitalized patients: a randomized controlled trial.
Administration of nonsteroidal anti-inflammatory drugs (NSAIDs) has become a foundational strategy to decrease the use of opioids, but data is lacking to describe recommending utilization when admitting patients using electronic health record systems. The purpose of this study was to assess an electronic health record system to increase ordering of NSAIDs for hospitalized adults. The researchers conducted a cluster randomized controlled trial of clinicians admitting adult patients to a health system over a period of 9-months. Clinicians in the intervention arm were required to actively order or decline NSAIDs; the control arm was provided the same order but without a required response. A total of 20,085 hospitalizations were included. The study found that among the hospitalizations, 52% were admitted by a clinician randomized to the intervention arm. NSAIDs were ordered in 22% of the interventions and 22% of the control admissions. There were no statistically significant differences in NSAID administration, pain scores, or opioid prescribing. There were no differences in clinical harms, with average pain scores of 3.36 in the control group and 3.39 in the intervention group, on a scale of 0-5.
AHRQ-funded; HS026383.
Citation: Bongiovanni T, Pletcher MJ, Lau C .
A behavioral intervention to promote use of multimodal pain medication for hospitalized patients: a randomized controlled trial.
J Hosp Med 2023 Aug; 18(8):685-92. doi: 10.1002/jhm.13153..
Keywords: Pain, Opioids, Medication, Behavioral Health, Practice Patterns
Miller-Rosales C, Busch SH, Meara ER
Internal and environmental predictors of physician practice use of screening and medications for opioid use disorders.
This study examined the extent of screening for opioid use and availability of medications for opioid use disorder (MOUD) in a national cross-section of multi-physician primary care and multispecialty practices. The authors found that a total of 26.2% of practices offered MOUD, while 69.4% of practices screened for opioid use. Offering of MOUD in a practice was associated with having advanced HIT functionality, while access to on-site behavioral clinicians was positively associated with offering MOUD in adjusted models.
AHRQ-funded; HS024075.
Citation: Miller-Rosales C, Busch SH, Meara ER .
Internal and environmental predictors of physician practice use of screening and medications for opioid use disorders.
Med Care Res Rev 2023 Aug; 80(4):410-22. doi: 10.1177/10775587231162681..
Keywords: Opioids, Substance Abuse, Behavioral Health, Screening, Medication, Practice Patterns
Gupta N, Kucirka L, Semerjian A
Practice patterns regarding female reproductive organ-sparing and nerve-sparing radical cystectomy among urologic oncologists in the United States.
The purpose of this study was to describe practice patterns regarding female reproductive organ-sparing (ROS) and nerve-sparing radical cystectomy nerve-sparing radical cystectomy (RC) among US urologists. The researchers conducted a cross-sectional survey of members of the Society of Urologic Oncology to evaluate provider-reported frequency of ROS and nerve-sparing RC in premenopausal and postmenopausal patients with non-muscle-invasive bladder cancer that failed intravesical therapy or clinically localized muscle-invasive bladder cancer. The study found that among 101 urologists, 79.2% reported that they routinely resect the uterus/cervix, 67.3% the neurovascular bundle, 48.5% the ovaries, and 18.8% a portion of the vagina when performing RC in premenopausal patients with organ-confined disease. When asked about changes to approach in postmenopausal patients, 70.3% reported that they were less likely to spare the uterus/cervix, 43.6% were less likely to spare the neurovascular bundle, 69.3% were less likely to spare the ovaries, and 22.8% were less likely to spare a portion of the vagina.
AHRQ-funded; HS026120.
Citation: Gupta N, Kucirka L, Semerjian A .
Practice patterns regarding female reproductive organ-sparing and nerve-sparing radical cystectomy among urologic oncologists in the United States.
Clin Genitourin Cancer 2023 Aug; 21(4):e236-e41. doi: 10.1016/j.clgc.2023.01.010..
Keywords: Practice Patterns, Women, Sexual Health, Surgery, Cancer
Ramanathan S, Evans CT, Hershow RC
Comparison of guideline concordant antibiotic prophylaxis in Veterans Affairs and non-Veterans Affairs dental settings among those with cardiac conditions or prosthetic joints.
The objective of this retrospective study was to compare prescribing of antibiotic prophylaxis in Veterans Affairs (VA) and non-VA settings. Subjects were veteran and non-veteran dental patients with cardiac conditions or prosthetic joints; most were males aged 55 years older. The results showed that VA settings had a higher prevalence of guideline concordant prescribing among those with prosthetic joints, and when assessing dosing errors. The authors recommended that future studies focus on the extent to which integrated electronic health records may be responsible for increased guideline concordant prescribing in the VA setting.
AHRQ-funded; HS025177.
Citation: Ramanathan S, Evans CT, Hershow RC .
Comparison of guideline concordant antibiotic prophylaxis in Veterans Affairs and non-Veterans Affairs dental settings among those with cardiac conditions or prosthetic joints.
BMC Infect Dis 2023 Jun 23; 23(1):427. doi: 10.1186/s12879-023-08400-y..
Keywords: Dental and Oral Health, Antibiotics, Medication, Prevention, Cardiovascular Conditions, Practice Patterns
Kim KC, Khouja T, Burgette JM
Trends in dispensed prescriptions for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children by general dentists, 2012-2019.
This study examined trends in prescription fills for opioids, benzodiazepines, gabapentin, and stimulants to children <18 years from 2012 to 2019 in a national dataset comprising 92% of dispensed outpatient prescriptions by dentists. During this time, 3.8 million children filled prescriptions for high-alert drugs from general dentists. Opioids accounts for 69.4% of high-alert prescriptions, however from 2012 to 2019 fills for opioids, sedatives, benzodiazepines, and stimulants decreased by 65.2%, 43.4%, 43.6% and 89.3%, respectively. Gabapentin prescriptions increased by 8.1%. Older teenagers (15-17 years) received 42.5% of high-alert prescriptions. Low-income counties in Southern states were overrepresented among top-prescribing areas in 2019.
AHRQ-funded; HS025177.
Citation: Kim KC, Khouja T, Burgette JM .
Trends in dispensed prescriptions for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children by general dentists, 2012-2019.
Pharmacoepidemiol Drug Saf 2023 Jun; 32(6):625-34. doi: 10.1002/pds.5589..
Keywords: Children/Adolescents, Dental and Oral Health, Opioids, Medication, Practice Patterns
Sun EC, Rishel CA, Waljee JF
Association between state limits on opioid prescribing and the incidence of persistent postoperative opioid use among surgical patients.
The objective of this study was to examine whether laws limiting opioid prescribing were associated with reductions in the incidence of persistent postoperative opioid use. Over identified 950,000 privately insured patients who had undergone one of 10 procedures were identified; researchers then estimated the association between persistent postoperative opioid use and whether state opioid prescribing limits were in effect on the day of surgery. The findings suggested that laws limiting opioid prescriptions were not associated with subsequent reductions in persistent postoperative opioid use.
AHRQ-funded; HS026753.
Citation: Sun EC, Rishel CA, Waljee JF .
Association between state limits on opioid prescribing and the incidence of persistent postoperative opioid use among surgical patients.
Ann Surg 2023 Apr;277(4):e759-e65. doi: 10.1097/sla.0000000000005283.
Keywords: Opioids, Medication, Surgery, Substance Abuse, Practice Patterns
Nguyen T, Meille G, Buchmueller T
AHRQ Author: Meille G
Mandatory prescription drug monitoring programs and overlapping prescriptions of opioids and benzodiazepines: evidence from Kentucky.
This AHRQ-authored study examined how overlapping benzodiazepine and opioid prescription rates changed after Kentucky implemented a PDMP mandate in July 2012 in response to the opioid epidemic. The authors conducted an interrupted time series analysis using monthly data from Kentucky's PDMP from 2010 to 2016. They also conducted an individual-level longitudinal analysis that compared changes in utilization patterns after the mandate went into effect to changes in earlier periods during which the mandate was not in effect. The PDMP mandate was associated with an immediate 7.5 % decline in the rate of overlapping benzodiazepine and opioid prescriptions and a significant change in the trend from increasing to decreasing. A single provider was responsible for approximately half of the immediate effect in level terms who was writing overlapping benzodiazepine and opioid prescriptions. Their longitudinal analysis suggests that over one year the mandate reduced initiation of overlapping prescriptions by 29.3 % and reduced continuation of overlapping prescriptions by 9.4 %, with effects of the policy being largest for women and men aged 36-50.
AHRQ-authored.
Citation: Nguyen T, Meille G, Buchmueller T .
Mandatory prescription drug monitoring programs and overlapping prescriptions of opioids and benzodiazepines: evidence from Kentucky.
Drug Alcohol Depend 2023 Feb 1; 243:109759. doi: 10.1016/j.drugalcdep.2022.109759..
Keywords: Opioids, Medication, Practice Patterns
Agbalajobi OM, Gmelin T, Moon AM
Characteristics of opioid prescribing to outpatients with chronic liver diseases: a call for action.
This retrospective cohort study investigated opioid prescribing patterns among patients with chronic liver disease (CLD) at a single medical center. These patients (12,425) were followed for one year from October 2015 to September 2016. Nearly half (47%) were prescribed opioids over a one-year period, with 17% receiving high-risk prescriptions. Characteristics associated with high-risk opioid prescriptions included female gender, Medicaid insurance, cirrhosis and baseline chronic pain, depression, anxiety, substance use disorder, and Charlson comorbidity score. Non-alcoholic fatty liver disease was associated with decreased high-risk opioid prescriptions.
AHRQ-funded; HS019461.
Citation: Agbalajobi OM, Gmelin T, Moon AM .
Characteristics of opioid prescribing to outpatients with chronic liver diseases: a call for action.
PLoS One 2021 Dec 17;16(12):e0261377. doi: 10.1371/journal.pone.0261377..
Keywords: Opioids, Medication, Practice Patterns, Pain, Chronic Conditions
Sankar A, Swanson KM, Zhou J
Association of fluoroquinolone prescribing rates with black box warnings from the US Food and Drug Administration.
This study examined the association of black box warnings in 2013 and 2016 with prescribing rates for fluoroquinolone. This cross-sectional study used Medicare fee-for-service beneficiaries and OneKey data on physicians and their organizations from 2011 through 2017. Sample eligibility was restricted to outpatient visits for sinusitis, bronchitis, and uncomplicated urinary tract infections. Prescription rates were compared with the prewarning period (baseline period), before and after the 2013 warning (postwarning period 1), and before and after the 2016 warning (postwarning period 2). The sample consisted of 1,238,397 unique patients with a total of 2,720,071 outpatient acute care visits. The immediate prescribing levels in postwarning period 1 increased by 3.42 percentage points and declined by -0.77 percentage points in postwarning period 2. In postwarning period 1, prescribing levels for physicians who were affiliated with hospitals with a top 10th percentile case mix index compared to those without an affiliation decreased by -1.13 percentage points, whereas the levels for primary care physicians declined by -1.34 percentage points compared with non-primary care physicians in postwarning period 2. Physicians at teaching hospitals were the only clinicians who showed a decline in postwarning period 1.
AHRQ-funded; HS025164; HS025402.
Citation: Sankar A, Swanson KM, Zhou J .
Association of fluoroquinolone prescribing rates with black box warnings from the US Food and Drug Administration.
JAMA Netw Open 2021 Dec;4(12):e2136662. doi: 10.1001/jamanetworkopen.2021.36662..
Keywords: Antibiotics, Medication, Practice Patterns
Clark AW, Durkin MJ, Olsen MA
Rural-urban differences in antibiotic prescribing for uncomplicated urinary tract infection.
This study examined rural-urban differences in temporal trends and risk of inappropriate antibiotic use by agent and duration among women with uncomplicated urinary tract infection (UTI). This observational cohort study identified US commercially insured women aged 18-44 coded for uncomplicated UTI and prescribed an antibiotic from the IBM MarketScan Commercial Database (2010-2015). Of the 670,450 women with uncomplicated UTIs, a large proportion received antibiotic prescriptions for inappropriate agents (46.7%) or durations (76.1%). Rural women were more likely to receive prescriptions with inappropriately long durations than urban women. There was a slight decline in patients who received inappropriate agents and durations from 2011 to 2015. Rural-urban differences varied over time by agent, geographic region, and provider specialty.
AHRQ-funded; HS019455.
Citation: Clark AW, Durkin MJ, Olsen MA .
Rural-urban differences in antibiotic prescribing for uncomplicated urinary tract infection.
Infect Control Hosp Epidemiol 2021 Dec;42(12):1437-44. doi: 10.1017/ice.2021.21..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Urinary Tract Infection (UTI), Practice Patterns
Cerda M, Wheeler-Martin K, Bruzelius E
Spatiotemporal analysis of the association between pain management clinic laws and opioid prescribing and overdose deaths.
The authors investigated the impact of pain management clinic laws. They analyzed data on county-level, opioid overdose deaths via the National Vital Statistics System and patients filling long-duration or high-dose opioid prescriptions in the US 2010-2018. Their findings suggested that laws with criminal penalties were associated with intended reductions in high-risk opioid prescribing and some opioid overdoses but raised concerns regarding unintended consequences on heroin/synthetic overdoses.
AHRQ-funded; HS023258.
Citation: Cerda M, Wheeler-Martin K, Bruzelius E .
Spatiotemporal analysis of the association between pain management clinic laws and opioid prescribing and overdose deaths.
Am J Epidemiol 2021 Dec;190(12):2592-603. doi: 10.1093/aje/kwab192..
Keywords: Opioids, Pain, Chronic Conditions, Medication, Practice Patterns, Policy
Bushnell GA, Rynn MA, Crystal S
Simultaneous benzodiazepine and SSRI initiation in young people with anxiety disorders.
Researchers investigated how often adolescents and young adults with anxiety disorders simultaneously initiate benzodiazepine (BZD) treatment with selective serotonin reuptake inhibitor (SSRI) treatment and examined whether SSRI treatment duration varies by simultaneous BZD initiation. Using a commercial claims database, they found that 4% of adolescents and 17% of young adults simultaneously initiated BZD treatment, varying by age, anxiety disorder, comorbidities, health care utilization, and provider type. They concluded that simultaneous initiation of both treatments is relatively common in young adults with anxiety disorders and was not associated with longer SSRI persistence.
AHRQ-funded; HS026001.
Citation: Bushnell GA, Rynn MA, Crystal S .
Simultaneous benzodiazepine and SSRI initiation in young people with anxiety disorders.
J Clin Psychiatry 2021 Oct 19;82(6). doi: 10.4088/JCP.20m13863..
Keywords: Anxiety, Behavioral Health, Medication, Practice Patterns, Children/Adolescents, Young Adults
Richards AR, Linder JA
Behavioral economics and ambulatory antibiotic stewardship: a narrative review.
Behavioral economics recognizes that contextual, psychological, social, and emotional factors powerfully influence decision-making. Behavioral economics has the potential to provide a better understanding of, and, through subtle environmental changes, or "nudges," improve persistent quality-of-care challenges, like ambulatory antibiotic overprescribing. In this study, the investigators conducted a Medline search and performed a narrative review that examined the use of behavioral economics to understand the rationale for, and improvement of, ambulatory antibiotic prescribing.
AHRQ-funded; 2332015000201; HS026506; HS028127.
Citation: Richards AR, Linder JA .
Behavioral economics and ambulatory antibiotic stewardship: a narrative review.
Clin Ther 2021 Oct;43(10):1654-67. doi: 10.1016/j.clinthera.2021.08.004..
Keywords: Antimicrobial Stewardship, Antibiotics, Practice Patterns, Respiratory Conditions
Zachrison KS, Sharma R, Wang Y
National trends in telestroke utilization in a US commercial platform prior to the COVID-19 pandemic.
In this study, the objective was to describe characteristics of telestroke consultations among a national sample of telestroke sites on one of the most commonly used common vendor platforms, prior to the COVID-19 public health emergency. The investigators concluded that among spoke sites using a commercial telestroke platform over a seven-year time horizon, times to consult start and alteplase bolus decreased over time. Similar to academic networks, duration of telestroke participation in this commercial network was associated with faster alteplase delivery, suggesting practice improves performance.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Sharma R, Wang Y .
National trends in telestroke utilization in a US commercial platform prior to the COVID-19 pandemic.
J Stroke Cerebrovasc Dis 2021 Oct;30(10):106035. doi: 10.1016/j.jstrokecerebrovasdis.2021.106035..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Stroke, Cardiovascular Conditions, Practice Patterns
Everhart A, Desai NR, Dowd B
Physician variation in the de-adoption of ineffective statin and fibrate therapy.
The objective of this study was to describe physicians' variation in de-adopting concurrent statin and fibrate therapy for type 2 diabetic patients following a reversal in clinical evidence. Researchers modeled fibrate use among Medicare Advantage and commercially insured type 2 diabetic statin users before and after the publication of the ACCORD lipid trial. Findings showed that, on average, physicians decreased fibrate prescribing following the trial; however, many physicians increased prescribing following the trial. Observable physician characteristics did not explain variations in prescribing.
AHRQ-funded; HS025164; HS000036.
Citation: Everhart A, Desai NR, Dowd B .
Physician variation in the de-adoption of ineffective statin and fibrate therapy.
Health Serv Res 2021 Oct;56(5):919-31. doi: 10.1111/1475-6773.13630..
Keywords: Diabetes, Medication, Practice Patterns, Chronic Conditions
Renny MH, Yin HS, Jent V
Temporal trends in opioid prescribing practices in children, adolescents, and younger adults in the US from 2006 to 2018.
Prescription opioids are involved in more than half of opioid overdoses among younger persons. Understanding opioid prescribing practices is essential for developing appropriate interventions for this population. The objective of this study was to examine temporal trends in opioid prescribing practices in children, adolescents, and younger adults in the US from 2006 to 2018.
AHRQ-funded; HS026120.
Citation: Renny MH, Yin HS, Jent V .
Temporal trends in opioid prescribing practices in children, adolescents, and younger adults in the US from 2006 to 2018.
JAMA Pediatr 2021 Oct;175(10):1043-52. doi: 10.1001/jamapediatrics.2021.1832..
Keywords: Children/Adolescents, Young Adults, Opioids, Practice Patterns, Medication
Smulowitz PB, O'Malley AJ, McWilliams JM
Variation in rates of hospital admission from the emergency department among Medicare patients at the regional, hospital, and physician levels.
Rates of admission from the emergency department (ED) vary widely across regions of the country, hospitals within regions, and physicians within hospitals. The study objective was to determine the extent to which variation in admission decisions was described by differences in admission rates at these 3 levels. The investigators concluded that within-area variation, both across hospitals within a region and across physicians within a hospital, was a more substantial component of observed variation in admission rates from the ED than regional level variation.
AHRQ-funded; HS025408.
Citation: Smulowitz PB, O'Malley AJ, McWilliams JM .
Variation in rates of hospital admission from the emergency department among Medicare patients at the regional, hospital, and physician levels.
Ann Emerg Med 2021 Oct;78(4):474-83. doi: 10.1016/j.annemergmed.2021.03.020..
Keywords: Medicare, Hospitalization, Emergency Department, Practice Patterns
Enzinger AC, Ghosh K, Keating NL
US trends in opioid access among patients with poor prognosis cancer near the end-of-life.
This study looked at trends in opioid prescriptions for cancer patients near the end-of-life (EOL) defined as the 30 days before death or hospice enrollment. The authors looked at Medicare part D data from 2007 to 2017 for 270,632 Medicare fee-for-service decedents with poor prognosis cancers. During that time, the proportion of decedents with poor prognosis cancers receiving 1 or greater opioid prescriptions near EOL declined 15.5% and the proportion receiving 1 or greater long-acting opioid prescriptions declined 36.5% to 18.1%. The mean daily dose fell from 24.5%, from 85.6 morphine milligram equivalents per day (MMED) to 64.6. The total amount of opioids prescribed fell from 1,075 morphine milligram equivalents per decedent to 666 morphine milligram equivalents per decedents. At the same time, the proportion of patients with pain-related ED visits increase 50.8% from 13.2% to 19.9%.
AHRQ-funded; HS024072.
Citation: Enzinger AC, Ghosh K, Keating NL .
US trends in opioid access among patients with poor prognosis cancer near the end-of-life.
J Clin Oncol 2021 Sep 10;39(26):2948-58. doi: 10.1200/jco.21.00476..
Keywords: Cancer, Opioids, Palliative Care, Pain, Access to Care, Medication, Practice Patterns
Khidir H, McWilliams JM, O'Malley AJ
Analysis of consistency in emergency department physician variation in propensity for admission across patient sociodemographic groups.
The authors estimated the consistency of ED physician admission propensities across categories of patient sex, race and ethnicity, and Medicaid enrollment. They found that, although overall rates of admission differ systematically by patient sociodemographic factors, an individual physician's propensity to admit relative to other physicians appears to be applied consistently across sociodemographic groups of patients.
AHRQ-funded; HS025408.
Citation: Khidir H, McWilliams JM, O'Malley AJ .
Analysis of consistency in emergency department physician variation in propensity for admission across patient sociodemographic groups.
JAMA Netw Open 2021 Sep;4(9):e2125193. doi: 10.1001/jamanetworkopen.2021.25193..
Keywords: Emergency Department, Practice Patterns
Heins SE, Castillo RC
Changes in opioid prescribing following the implementation of state policies limiting morphine equivalent daily dose in a commercially insured population.
The study’s objective was to evaluate the impact of state-level morphine equivalent daily dose (MEDD) policies on opioid prescribing among the privately insured using claims data from 9 policy states and 2 control states and a comparative interrupted time series design. Findings showed that MEDD policies were associated with decreased use of any opioids relative to control states, but with no change in high-dose prescribing. Recommendations included further research to understand the mechanisms through which MEDD policies may influence prescribing behavior.
AHRQ-funded; HS025557.
Citation: Heins SE, Castillo RC .
Changes in opioid prescribing following the implementation of state policies limiting morphine equivalent daily dose in a commercially insured population.
Med Care 2021 Sep;59(9):801-07. doi: 10.1097/mlr.0000000000001587..
Keywords: Opioids, Medication, Policy, Practice Patterns
Patel E, Kandrack R
Differences in the number of services provided by nurse practitioners and physicians during primary care visits.
Due to differential training, nurse practitioners (NPs) and physicians may provide different quantities of services to patients. The purpose of this study was to assess differences in the number of laboratory, imagining, and procedural services provided by primary care NPs and physicians. The investigators found that NPs provided fewer laboratory and imaging services than physicians during primary care visits.
AHRQ-funded; HS000032.
Citation: Patel E, Kandrack R .
Differences in the number of services provided by nurse practitioners and physicians during primary care visits.
Nurs Outlook 2021 Sep-Oct;69(5):886-91. doi: 10.1016/j.outlook.2021.04.003..
Keywords: Primary Care, Practice Patterns, Provider: Physician, Provider: Nurse
Schondelmeyer AC, Bettencourt AP, Xiao R
Evaluation of an educational outreach and audit and feedback program to reduce continuous pulse oximetry use in hospitalized infants with stable bronchiolitis: a nonrandomized clinical trial.
National guidelines recommend against continuous pulse oximetry use for hospitalized children with bronchiolitis who are not receiving supplemental oxygen, yet guideline-discordant use remains high. The objective of this study was to evaluate deimplementation outcomes of educational outreach and audit and feedback strategies aiming to reduce guideline-discordant continuous pulse oximetry use in children hospitalized with bronchiolitis who are not receiving supplemental oxygen.
AHRQ-funded; HS026763.
Citation: Schondelmeyer AC, Bettencourt AP, Xiao R .
Evaluation of an educational outreach and audit and feedback program to reduce continuous pulse oximetry use in hospitalized infants with stable bronchiolitis: a nonrandomized clinical trial.
JAMA Netw Open 2021 Sep;4(9):e2122826. doi: 10.1001/jamanetworkopen.2021.22826..
Keywords: Newborns/Infants, Hospitalization, Guidelines, Practice Patterns, Training, Respiratory Conditions
Marchetti KA, Oerline M, Hollenbeck BK
Urology workforce changes and implications for prostate cancer care among Medicare enrollees.
The purpose of this study was to characterize national trends in urologist workforce, practice organization, and management of incident prostate cancer. The investigators characterized shifts in urologist membership from smaller, independent groups to larger, multispecialty or hospital-owned practices. They indicated that this trend coincided with higher utilization of observation and surgical treatment for prostate cancer.
AHRQ-funded; HS025707.
Citation: Marchetti KA, Oerline M, Hollenbeck BK .
Urology workforce changes and implications for prostate cancer care among Medicare enrollees.
Urology 2021 Sep;155:77-82. doi: 10.1016/j.urology.2020.12.051..
Keywords: Cancer: Prostate Cancer, Cancer, Workforce, Practice Patterns