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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 23 of 23 Research Studies Displayed
Carrel M, Clore GS, Kim S
Health care utilization among Texas Veterans Health Administration enrollees before and after Hurricane Harvey, 2016-2018.
The purpose of this study was to determine how the differential exposure to Hurricane Harvey in August 2017 was associated with changes in utilization of Veterans Health Administration health care. Findings suggested that flood disasters such as Hurricane Harvey may be associated with declines in health care utilization that differ according to flood status, race, and income strata. The patients most exposed to the disaster had the greatest delay or nonreceipt of care.
Citation: Carrel M, Clore GS, Kim S . Health care utilization among Texas Veterans Health Administration enrollees before and after Hurricane Harvey, 2016-2018. JAMA Netw Open 2021 Dec;4(12):e2138535. doi: 10.1001/jamanetworkopen.2021.38535..
Keywords: Healthcare Utilization, Veterans, Emergency Department
Ching JH, Owens DK, Trafton JA
Impact of treatment duration on mortality among Veterans with opioid use disorder in the United States Veterans Health Administration.
This study used simulation of a Veterans Health Administration cohort to identify the opioid use disorder (OUD) treatment durations necessary for the elevated mortality risks during treatment transitions balanced by reductions in mortality while receiving medication-assisted treatment (MAT) with methadone or buprenorphine. A simulated cohort of 10,000 individuals with OUD was created by using parameters obtained through calibration and published meta-analyses of studies from North America, Europe, and Australia. Methadone treatment for 4 months or longer or buprenorphine for 2 months or longer resulted in 54 and 65 fewer deaths relative to not receiving MAT for the same duration. The authors estimated shorter treatment durations necessary to achieve net mortality benefits of 2 months or longer for methadone and 1 month or longer for buprenorphine. Necessary treatment increased more with smaller mortality reductions on treatment with larger relative risks during treatment transitions.
AHRQ-funded; HS027935; HS026128.
Citation: Ching JH, Owens DK, Trafton JA . Impact of treatment duration on mortality among Veterans with opioid use disorder in the United States Veterans Health Administration. Addiction 2021 Dec;116(12):3494-503. doi: 10.1111/add.15574.
AHRQ-funded; HS027935; HS026128..
AHRQ-funded; HS027935; HS026128..
Keywords: Opioids, Substance Abuse, Behavioral Health, Veterans, Mortality
Schuttner L, Haraldsson B, Maynard C
Factors associated with low-value cancer screenings in the Veterans Health Administration.
Most clinical practice guidelines recommend stopping cancer screenings when risks exceed benefits, yet low-value screenings persist. The Veterans Health Administration focuses on improving the value and quality of care, using a patient-centered medical home model that may affect cancer screening behavior. The objective of this study was to understand rates and factors associated with outpatient low-value cancer screenings.
Citation: Schuttner L, Haraldsson B, Maynard C . Factors associated with low-value cancer screenings in the Veterans Health Administration. JAMA Netw Open 2021 Oct;4(10):e2130581. doi: 10.1001/jamanetworkopen.2021.30581..
Keywords: Veterans, Screening, Value, Cancer
Saffo S, Kaplan DE, Mahmud N
Impact of SGLT2 inhibitors in comparison with DPP4 inhibitors on ascites and death in veterans with cirrhosis on metformin.
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) may have favourable neurohumoral and metabolic effects in patients with chronic liver disease. However, studies examining SGLT2i in this population have been limited to patients with non-alcoholic fatty liver disease and have focused on surrogate biomarkers. The aim of this study was to evaluate whether SGLT2i could reduce the incidence of ascites and death over a period of 36 months in patients with cirrhosis and diabetes mellitus.
AHRQ-funded; HS022882; HS025164.
Citation: Saffo S, Kaplan DE, Mahmud N . Impact of SGLT2 inhibitors in comparison with DPP4 inhibitors on ascites and death in veterans with cirrhosis on metformin. Diabetes Obes Metab 2021 Oct;23(10):2402-08. doi: 10.1111/dom.14488..
Keywords: Veterans, Diabetes
Baughman AW, Triantafylidis LK, O'Neil N
Improving medication reconciliation with comprehensive evaluation at a Veterans Affairs skilled nursing facility.
This study described a quality improvement (QI) approach to improve medication reconciliation in a skilled nursing facility (SNF) setting as part of the Multi-Center Medication Reconciliation Quality Improvement Study 2 (MARQUIS2). Findings showed that SNFs represent a critical setting for medication reconciliation efforts due to challenges completing the reconciliation process and the concomitant high risk of adverse drug events in this population. Initial baseline assessments effectively identified existing problems and can be used to guide targeted interventions.
Citation: Baughman AW, Triantafylidis LK, O'Neil N . Improving medication reconciliation with comprehensive evaluation at a Veterans Affairs skilled nursing facility. Jt Comm J Qual Patient Saf 2021 Oct;47(10):646-53. doi: 10.1016/j.jcjq.2021.06.001..
Keywords: Medication, Veterans, Quality Improvement, Quality of Care
Wayne MT, Seelye S, Molling D
Temporal trends and hospital variation in time-to-antibiotics among veterans hospitalized with sepsis.
It is unclear whether antimicrobial timing for sepsis has changed outside of performance incentive initiatives. The purpose of this study was to examine temporal trends and variation in time-to-antibiotics for sepsis in the US Department of Veterans Affairs (VA) health care system. The investigators concluded that this cohort study found that time-to-antibiotics for sepsis has declined over time. However, there remained significant variability in time-to-antibiotics not explained by patient characteristics, suggesting potential unwarranted practice variation in sepsis treatment.
Citation: Wayne MT, Seelye S, Molling D . Temporal trends and hospital variation in time-to-antibiotics among veterans hospitalized with sepsis. JAMA Netw Open 2021 Sep 4(9):e2123950. doi: 10.1001/jamanetworkopen.2021.23950..
Keywords: Sepsis, Veterans
Sico JJ, Kundu S, So-Armah K
Depression as a risk factor for incident ischemic stroke among HIV-positive veterans in the veterans aging cohort study.
Background HIV infection and depression are each associated with increased ischemic stroke risk. Whether depression is a risk factor for stroke within the HIV population is unknown. In this study the investigators examined depression as a risk factor for incident ischemic stroke among HIV-positive veterans in the veterans aging cohort study. The investigators concluded that depression is associated with an increased risk of stroke among HIV-positive people after adjusting for sociodemographic characteristics, traditional cerebrovascular risk factors, and HIV-specific factors.
Citation: Sico JJ, Kundu S, So-Armah K . Depression as a risk factor for incident ischemic stroke among HIV-positive veterans in the veterans aging cohort study. J Am Heart Assoc 2021 Jul 6;10(13):e017637. doi: 10.1161/jaha.119.017637..
Keywords: Depression, Behavioral Health, Risk, Veterans, Human Immunodeficiency Virus (HIV), Stroke, Cardiovascular Conditions
Caram MEV, Burns J, Kumbier K
Factors influencing treatment of veterans with advanced prostate cancer.
This study examined factors influencing treatment of veterans with metastatic castration-resistant prostate cancer (CRPC). Clinician and nonclinical factors associated with the first-line treatment for CPRC using data from the Veterans Health Administration was used. Almost 5000 patients who received abiraterone, enzalutamide, docetaxel, or ketoconazole from 2010 through 2017 were identified. Increasing age was associated with receipt of abiraterone or enzalutamide versus docetaxel. Greater preexisting comorbidity was associated with enzalutamide versus abiraterone. Patients with higher PSA values at the start of treatment were more likely to receive docetaxel than the other three treatments. African American men were more likely to receive ketoconazole.
Citation: Caram MEV, Burns J, Kumbier K . Factors influencing treatment of veterans with advanced prostate cancer. Cancer 2021 Jul 1;127(13):2311-18. doi: 10.1002/cncr.33485..
Keywords: Cancer: Prostate Cancer, Cancer, Veterans, Men's Health, Treatments
Rogal S, Youk A, Agbalajobi O
Medication treatment of active opioid use disorder in veterans with cirrhosis.
Although opioid use disorder (OUD) is common in patients with cirrhosis, it is unclear how medication treatment for OUD (MOUD) is used in this population. In this study, the investigators aimed to assess the factors associated with MOUD and mortality in a cohort of Veterans with cirrhosis and OUD. The investigators found that few Veterans with active OUD and cirrhosis received MOUD, and those with alcohol use disorder, schizophrenia, and previous prescriptions for opioids were least likely to receive these effective therapies.
Citation: Rogal S, Youk A, Agbalajobi O . Medication treatment of active opioid use disorder in veterans with cirrhosis. Am J Gastroenterol 2021 Jul;116(7):1406-13. doi: 10.14309/ajg.0000000000001228..
Keywords: Veterans, Opioids, Substance Abuse, Medication
Clair K, Ijadi-Maghsoodi R, Nazinyan M
Veteran perspectives on adaptations to a VA residential rehabilitation program for substance use disorders during the novel coronavirus pandemic.
This paper looks at veterans’ perspectives on adaptations made to a VA residential rehabilitation program for substance use disorders during the novel coronavirus pandemic. Adaptations to services are described within a large residential rehabilitation program for under-resourced veterans; reports veterans’ experiences; and outlines successes and challenges encountered. Data was collected from two focus groups with nine veterans in the program. The groups highlighted experiences of inconsistent communication about residential policies, interruptions to medical and addiction services, and feelings of confinement and social isolation.
Citation: Clair K, Ijadi-Maghsoodi R, Nazinyan M . Veteran perspectives on adaptations to a VA residential rehabilitation program for substance use disorders during the novel coronavirus pandemic. Community Ment Health J 2021 Jul;57(5):801-07. doi: 10.1007/s10597-021-00810-z..
Keywords: Veterans, Substance Abuse, Rehabilitation, COVID-19, Healthcare Delivery, Access to Care, Patient Experience
Spalluto LB, Lewis JA, Stolldorf D
Organizational readiness for lung cancer screening: a cross-sectional evaluation at a Veterans Affairs medical center.
Lung cancer has the highest cancer-related mortality in the United States and among Veterans. Screening of high-risk individuals with low-dose CT (LDCT) can improve survival through detection of early-stage lung cancer. Organizational factors that aid or impede implementation of this evidence-based practice in diverse populations are not well described. In this study, the investigators evaluated organizational readiness for change and change valence (belief that change is beneficial and valuable) for implementation of LDCT screening.
Citation: Spalluto LB, Lewis JA, Stolldorf D . Organizational readiness for lung cancer screening: a cross-sectional evaluation at a Veterans Affairs medical center. J Am Coll Radiol 2021 Jun;18(6):809-19. doi: 10.1016/j.jacr.2020.12.010..
Keywords: Cancer: Lung Cancer, Cancer, Screening, Veterans, Implementation, Organizational Change
Danan ER, White KM, Wilt TJ
Reactions to recommendations and evidence about prostate cancer screening among White and Black male veterans.
This study looked at differences in attitudes about recommendations and evidence on prostate cancer screening among White and Black male veterans. The authors provided a draft educational pamphlet about the benefits and harms of Prostate Specific Antigen (PSA) screening to 44 men, ages 55-81 at a midwestern VA medical center in 2013 and 2015. The groups were divided into four White and two Black focus groups. Three universal themes were low baseline familiarity with prostate cancer, surprise and resistance to the guidelines not to test routinely, and negative emotions in response to ambiguity. Discussions in the White groups highlighted the potential benefits of screening, minimized the harms, and emphasized personal choice in screening decisions. Discussions in Black groups devoted almost no time to benefits, considered harms significant, and emphasized personal and collective responsibility for cancer prevention through diet, exercise, and alternative medicine. Discussion in Black groups also emphasized the history of racism and discrimination in healthcare and medical research.
Citation: Danan ER, White KM, Wilt TJ . Reactions to recommendations and evidence about prostate cancer screening among White and Black male veterans. Am J Mens Health 2021 May-Jun;15(3):15579883211022110. doi: 10.1177/15579883211022110..
Keywords: Veterans, Cancer: Prostate Cancer, Cancer, Screening, Prevention, Racial / Ethnic Minorities, Evidence-Based Practice, Health Promotion, Education: Patient and Caregiver
Dworsky JQ, Shenoy R, Childers CP
Older veterans undergoing inpatient surgery: what is the compliance with best practice guidelines?
This study’s objective was to determine the documented compliance with best practice guidelines for optimal perioperative care for the older adult surgical patient that were created by the American College of Surgeons Quality Improvement Program and the American Geriatrics Society. The guidelines include 38 measures. A retrospective chart review was conducted on 86 older adults undergoing elective inpatient coronary artery bypass graft, prostatectomy, or colectomy over a 2-year period at a single Veterans Affairs hospital. Mean reported compliance across measures was 41% ± 4%. Of the 38 analyzed measures, 10 measures were achieved for 0 patients, and only 1 patient for 7 measures. Future work is needed to understand barriers for implementation.
Citation: Dworsky JQ, Shenoy R, Childers CP . Older veterans undergoing inpatient surgery: what is the compliance with best practice guidelines? Surgery 2021 Feb;169(2):356-61. doi: 10.1016/j.surg.2020.08.033..
Keywords: Elderly, Veterans, Surgery, Guidelines, Evidence-Based Practice, Quality Improvement, Quality of Care, Quality Measures
Donnelly JP, Wang XQ, Iwashyna TJ
Readmission and death after initial hospital discharge among patients with COVID-19 in a large multihospital system.
This study describes reasons for readmission, use of intensive care unit (ICU) interventions during readmission, and proportions of death after initial hospital discharge of COVID-19 patients from US Veterans Affairs (VA) hospitals March-June 2020.
Citation: Donnelly JP, Wang XQ, Iwashyna TJ . Readmission and death after initial hospital discharge among patients with COVID-19 in a large multihospital system. JAMA 2021 Jan 19;325(3):304-06. doi: 10.1001/jama.2020.21465.
Keywords: Respiratory Conditions, COVID-19, Hospital Readmissions, Hospital Discharge, Mortality, Outcomes, Veterans
Lewis JA, Senft N, Chen H
Evidence-based smoking cessation treatment: a comparison by healthcare system.
The authors surveyed general medicine providers and specialists in a large academic health center (AHC) and its affiliated Veterans Health Administration (VHA) in the Mid-South in 2017 to determine the cross-sectional association of healthcare system in which the provider practiced (AHC versus VHA) with self-reported provision of evidence-based smoking cessation treatment at least once in the past 12 months. They found that VHA healthcare providers were significantly more likely to provide evidence-based smoking cessation treatment compared to AHC healthcare providers.
Citation: Lewis JA, Senft N, Chen H . Evidence-based smoking cessation treatment: a comparison by healthcare system. BMC Health Serv Res 2021 Jan 7;21(1):33. doi: 10.1186/s12913-020-06016-5..
Keywords: Healthcare Systems, Tobacco Use: Smoking Cessation, Tobacco Use, Evidence-Based Practice, Veterans, Substance Abuse
Vaughan Sarrazin MS, Jones M, Mazur A
Bleeding rates in Veterans Affairs patients with atrial fibrillation who switch from warfarin to dabigatran.
This study evaluated the relative risks of any, gastrointestinal, intracranial, and other bleeding for Veterans Affairs patients who switched to dabigatran after at least 6 months on warfarin. It found that among veterans with atrial fibrillation who switched to dabigatran, dabigatran increased the risk of gastrointestinal hemorrhage by 54% and was not associated with rates of other bleeding or death.
Citation: Vaughan Sarrazin MS, Jones M, Mazur A . Bleeding rates in Veterans Affairs patients with atrial fibrillation who switch from warfarin to dabigatran. Am J Med. 2014 Dec;127(12):1179-85. doi: 10.1016/j.amjmed.2014.07.024..
Keywords: Blood Thinners, Adverse Events, Patient Safety, Veterans
Meeks DW, Meyer AN, Rose B
Exploring new avenues to assess the sharp end of patient safety: an analysis of nationally aggregated peer review data.
The researchers described outcomes of peer review within the Department of Veterans Affairs (VA) healthcare system and identified opportunities to leverage peer review data for measurement and improvement of safety. Results showed that the most common process contributing to substandard care was 'timing and appropriateness of treatment'; approximately 16% had diagnosis-related performance concerns. The authors concluded that peer review may be a useful tool for healthcare organizations to assess their sharp end clinical performance, particularly safety events related to diagnostic and treatment errors.
Citation: Meeks DW, Meyer AN, Rose B . Exploring new avenues to assess the sharp end of patient safety: an analysis of nationally aggregated peer review data. BMJ Qual Saf 2014 Dec;23(12):1023-30. doi: 10.1136/bmjqs-2014-003239.
Keywords: Adverse Events, Medical Errors, Patient Safety, Quality Improvement, Veterans
Voils CI, Sleath B, Maciejewski ML
Patient perspectives on having multiple versus single prescribers of chronic disease medications: results of a qualitative study in a veteran population.
The researchers sought to understand the reasons why patients have increasing numbers of prescribers of medications and to understand patient perspectives on advantages and disadvantages of having multiple prescribers, including effects on medication supply. They found that, with patients from a Veterans Affairs (VA) Medical Center, multiple prescribers arose through referrals and patients actively seeking non-VA prescribers to maximize timeliness and access to medications, to provide access to medications not on the VA formulary, and to minimize out-of-pocket costs.
Citation: Voils CI, Sleath B, Maciejewski ML . Patient perspectives on having multiple versus single prescribers of chronic disease medications: results of a qualitative study in a veteran population. BMC Health Serv Res 2014 Oct 25;14:490. doi: 10.1186/s12913-014-0490-8.
Keywords: Chronic Conditions, Medication, Veterans
Lapham GT, Rubinsky AD, Williams EC
Decreasing sensitivity of clinical alcohol screening with the AUDIT-C after repeated negative screens in VA clinics.
The purpose of this study was to evaluate the performance of repeat annual clinical alcohol screening in 4 samples of VA outpatients with 1–4 prior consecutive negative annual screens. It found that among patients with repeated negative clinical alcohol screens, the proportion who subsequently screened positive a year later was low and decreased as patients had more prior negative screens.
Citation: Lapham GT, Rubinsky AD, Williams EC . Decreasing sensitivity of clinical alcohol screening with the AUDIT-C after repeated negative screens in VA clinics. Drug Alcohol Depend 2014 Sep 1;142:209-15. doi: 10.1016/j.drugalcdep.2014.06.017..
Keywords: Screening, Alcohol Use, Substance Abuse, Veterans
Schweizer ML, Cullen JJ, Perencevich EN
Costs associated with surgical site infections in Veterans Affairs hospitals.
This study evaluated surgical site infections(SSIs) in 1,756 Veterans Administration patients to determine the excess costs associated with total, deep, and superficial SSIs. It found that the highest risk-adjusted costs occurred with deep SSIs and SSIs associated with neurosurgery patients.
Citation: Schweizer ML, Cullen JJ, Perencevich EN . Costs associated with surgical site infections in Veterans Affairs hospitals. JAMA Surg. 2014 Jun;149(6):575-581. doi:10.1001/jamasurg.2013.4663..
Keywords: Surgery, Healthcare-Associated Infections (HAIs), Patient Safety, Healthcare Costs, Veterans
Voils CI, Gierisch JM, Yancy WS, Jr.
Differentiating behavior initiation and maintenance: theoretical framework and proof of concept.
The authors posited that health behavior initiation and maintenance require separate psychological processes and skills. They found evidence of improvement in dietary intake and of maintenance of physical activity and low-density lipoprotein cholesterol during the 4-month maintenance study. Participants found it helpful to plan for relapses, self-monitor, and obtain social support, but they had mixed reactions about reflecting on satisfaction with outcomes.
Citation: Voils CI, Gierisch JM, Yancy WS, Jr. . Differentiating behavior initiation and maintenance: theoretical framework and proof of concept. Health Educ Behav 2014 Jun;41(3):325-36. doi: 10.1177/1090198113515242.
Keywords: Behavioral Health, Heart Disease and Health, Lifestyle Changes, Nutrition, Veterans
Bates BE, Xie D, Kwong PL
One-year all-cause mortality after stroke: a prediction model.
Using data from Department of Veterans Affairs (VA) national databases, the researchers present and internally validate a 1-year all-cause mortality prediction index after hospitalization for acute stroke. They conclude that a simple index using readily available data that stratifies stroke patients at the time of discharge according to low, moderate, high, and highest likelihood of all-cause 1-year mortality is feasible.
Citation: Bates BE, Xie D, Kwong PL . One-year all-cause mortality after stroke: a prediction model. PM R 2014 Jun;6(6):473-83. doi: 10.1016/j.pmrj.2013.11.006..
Keywords: Stroke, Mortality, Hospitalization, Veterans
Stineman MG, Xie D, Kurichi JE
Comprehensive versus consultative rehabilitation services postacute stroke: outcomes differ.
The researchers compared outcomes of veteran patients provided with comprehensive rehabilitation with those provided with consultative rehabilitation services after acute stroke using propensity scores. They found that comprehensive rehabilitation services are associated with greater recovery of physical and cognitive independence, improved home discharge likelihood, and improved 1 yr. survival.
Citation: Stineman MG, Xie D, Kurichi JE . Comprehensive versus consultative rehabilitation services postacute stroke: outcomes differ. J Rehabil Res Dev 2014;51(7):1143-54. doi: 10.1682/jrrd.2014.03.0084..
Keywords: Comparative Effectiveness, Rehabilitation, Stroke, Patient-Centered Outcomes Research, Veterans