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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 53 Research Studies Displayed
Giannouchos TV, Gómez-Lumbreras A, Malone DC
Risk of tizanidine-induced adverse events after concomitant exposure to ciprofloxacin: a cohort study in the U.S.
This study’s aim was to assess the risk of hypotension with coadministration of tizanidine (a painkiller medicine) and ciprofloxacin (an antibiotic). An observational nested cohort study was conducted using patients 18 years or older on tizanidine using data from electronic health records from 2000 to 2018 in the US. The analysis included 70,110 encounters across 221 hospitals. Most encounters were female (65.7%), whites (82.4%) with an average age of 56 years and an Elixhauser comorbidity index of 1.6. Only 2487 encounters (3.6%) had a co-administration of ciprofloxacin. An increased likelihood of hypotension was associated with co-administration compared to patients who did not receive ciprofloxacin.
Citation: Giannouchos TV, Gómez-Lumbreras A, Malone DC . Risk of tizanidine-induced adverse events after concomitant exposure to ciprofloxacin: a cohort study in the U.S. Am J Emerg Med 2022 May;55:147-51. doi: 10.1016/j.ajem.2022.03.008..
Keywords: Medication, Adverse Drug Events (ADE), Adverse Events, Risk
Kim HN, Nance RM, Lo Re V
Development and validation of a model for prediction of end-stage liver disease in people with HIV.
The authors developed and validated a risk-prediction model for end-stage liver disease (ESLD) among people with HIV (PWH). They developed and validated a risk prediction model for ESLD among PWH who received care in 12 cohorts of the North American AIDS Cohort Collaboration on Research and Design and found that their model of readily accessible clinical parameters predicted ESLD in a large diverse population of PWH.
Citation: Kim HN, Nance RM, Lo Re V . Development and validation of a model for prediction of end-stage liver disease in people with HIV. J Acquir Immune Defic Syndr 2022 Apr;89(4):396-404. doi: 10.1097/qai.0000000000002886..
Keywords: Chronic Conditions, Human Immunodeficiency Virus (HIV), Risk
Jacobsohn GC, Leaf M, Liao F
Collaborative design and implementation of a clinical decision support system for automated fall-risk identification and referrals in emergency departments.
The authors used a collaborative and iterative approach to design and implement an automated clinical decision support system (CDS) for Emergency Department (ED) providers to identify and refer older adult ED patients at high risk of future falls. The system was developed using collaborative input from an interdisciplinary design team and integrated seamlessly into existing ED workflows. A key feature of development was the unique combination of patient experience strategies, human-centered design, and implementation science, which allowed for the CDS tool and intervention implementation strategies to be designed simultaneously. Challenges included: usability problems, data inaccessibility, time constraints, low appointment availability, high volume of patients, and others. The study concluded that using the collaborative, iterative approach was successful in achieving all project goals, and could be applied to other cases.
Citation: Jacobsohn GC, Leaf M, Liao F . Collaborative design and implementation of a clinical decision support system for automated fall-risk identification and referrals in emergency departments. Healthc 2022 Mar;10(1):100598. doi: 10.1016/j.hjdsi.2021.100598..
Keywords: Elderly, Clinical Decision Support (CDS), Decision Making, Falls, Risk, Emergency Department, Health Information Technology (HIT)
Flannery DD, Mukhopadhyay S, Morales KH
Delivery characteristics and the risk of early-onset neonatal sepsis.
This retrospective cohort study identified term and preterm infants at lowest risk of culture-confirmed early-onset sepsis (EOS) using delivery characteristics and also determined antibiotic use among them. The study cohort included term and preterm infants born 2009 to 2014 with blood culture with or without cerebrospinal fluid culture obtained ≤72 hours after birth. Low EOS risk criteria included: cesarean delivery, without labor or membrane rupture before delivery, and no antepartum concern for intraamniotic infection or nonreassuring fetal status. Among 53,575 births, 7549 (14.1%) were evaluated and 41 (0.5%) of those infants had EOS. For 1121 evaluated infants there were low-risk delivery characteristics and none had EOS. Duration of antibiotics administered to infants born with and without low-risk characteristics was not different.
Citation: Flannery DD, Mukhopadhyay S, Morales KH . Delivery characteristics and the risk of early-onset neonatal sepsis. Pediatrics 2022 Feb;149(2). doi: 10.1542/peds.2021-052900..
Keywords: Newborns/Infants, Sepsis, Risk, Labor and Delivery, Antibiotics, Medication
Carpenter K, Scavotto M, McGovern A
Early parental knowledge of late effect risks in children with cancer.
This study assessed early parental knowledge of late effect risks in children with cancer. The cohort included parents of children receiving cancer treatment at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center. The parents were surveyed about their knowledge of their child’s likelihood of eight late effects. Only 11 out of 96 parents correctly identified all their child’s risk for the eight late effects. Five of eight effects were the median number of correctly identified late effect risks. Among the 21 parents whose children were at risk for ototoxicity, 95% correctly identified this risk. Conversely, parents were less knowledgeable about risks of second malignancy, cardiac toxicity, neurocognitive impairment, and infertility.
Citation: Carpenter K, Scavotto M, McGovern A . Early parental knowledge of late effect risks in children with cancer. Pediatr Blood Cancer 2022 Feb;69(2):e29473. doi: 10.1002/pbc.29473..
Keywords: Children/Adolescents, Cancer, Risk, Education: Patient and Caregiver, Health Literacy
Yunusa I, Gagne JJ, Yoshida K
Risk of opioid overdose associated with concomitant use of oxycodone and selective serotonin reuptake inhibitors.
Oxycodone is a potent prescription opioid. Some Selective Serotonin Reuptake Inhibitors (SSRIs) inhibit oxycodone metabolism in the body, but the clinical consequences of this interaction on overdose risk have not been adequately determined. The study researchers compared the rates of opioid overdoses in patients who had initiated oxycodone while taking enzyme-inhibiting SSRIs with the overdose rates of patents who had initiated oxycodone while taking non-enzyme inhibiting SSRIs. Data from 3 U.S. health insurance databases was used to analyze a cohort of adults who initiated oxycodone while receiving SSRI therapy between the years 2000 and 2020. Of the total of 2,037,490 who initiated oxycodone, 69.6% were receiving SSRIs at the time of the initiation of the oxycodone. One-thousand-thirty-five overdose events were observed during this time, and the resulting incidence rate in those initiating oxycodone while using enzyme-inhibiting SSRI’s was higher than in those using other SSRIs. The researchers concluded that in the study cohort of U.S. adults, there is a small increased risk of opioid overdose when initiating oxycodone in patients taking enzyme-inhibiting SSRIs.
Citation: Yunusa I, Gagne JJ, Yoshida K . Risk of opioid overdose associated with concomitant use of oxycodone and selective serotonin reuptake inhibitors. JAMA Netw Open 2022 Feb;5(2):e220194. doi: 10.1001/jamanetworkopen.2022.0194..
Keywords: Opioids, Medication, Risk, Depression, Adverse Drug Events (ADE), Adverse Events
Fatemi P, Zhang Y, Han SS
A, et al. External validation of a predictive model of adverse events following spine surgery.
The authors externally validated a previously developed predictive model for common 30-day adverse events after spine surgery, the Risk Assessment Tool for Adverse Events after Spine Surgery (RAT-Spine). Their results are presented as low-, moderate-, and high-risk designations.
Citation: Fatemi P, Zhang Y, Han SS . A, et al. External validation of a predictive model of adverse events following spine surgery. Spine J 2022 Jan;22(1):104-12. doi: 10.1016/j.spinee.2021.06.006..
Keywords: Surgery, Adverse Events, Orthopedics, Risk
Squires A, Ma C, Miner S
Assessing the influence of patient language preference on 30 day hospital readmission risk from home health care: a retrospective analysis.
In home health care, language barriers are understudied. Language barriers between patients and providers are known to affect a variety of patient outcomes. How a patient's language preference influences hospital readmission risk from home health care has yet to be determined. The objective of this retrospective cross-sectional study was to determine if home care patients' language preference is associated with their risk for hospital readmission from home health care within 30 days of hospital discharge.
Citation: Squires A, Ma C, Miner S . Assessing the influence of patient language preference on 30 day hospital readmission risk from home health care: a retrospective analysis. Int J Nurs Stud 2022 Jan;125:104093. doi: 10.1016/j.ijnurstu.2021.104093..
Keywords: Cultural Competence, Home Healthcare, Hospital Readmissions, Risk, Communication
Mallela DP, Canner JK, Zarkowsky DS
Association between race and perioperative outcomes after carotid endarterectomy for asymptomatic carotid artery stenosis in NSQIP.
This study investigated the association of race on carotid endarterectomy (CEA) outcomes. Perioperative outcomes (at 30 days) were compared for Black vs. White patients adjusting for age/sex, comorbidities and disease characteristics. Out of 16,764 patients from the ACS-NSQIP targeted vascular database (2011-2019), 95.2% were White and 4.8% were Black. Black patients were slightly younger and more frequently (79.5% vs 74.0%) had high-grade carotid artery stenosis compared to White patients. Comorbidities including hypertension, diabetes, kidney disease, congestive heart failure, and coronary artery disease were all more prevalent among Black patients. Crude perioperative stroke and stroke/death were higher for Black patients, but myocardial infarction leading to death were similar. After adjusting for baseline differences between groups, the risk of perioperative stroke and stroke/death remained significantly higher for Black patients than White patients.
Citation: Mallela DP, Canner JK, Zarkowsky DS . Association between race and perioperative outcomes after carotid endarterectomy for asymptomatic carotid artery stenosis in NSQIP. J Am Coll Surg 2022 Jan;234(1):65-73. doi: 10.1097/xcs.0000000000000016..
Keywords: Racial / Ethnic Minorities, Surgery, Cardiovascular Conditions, Stroke, Risk, Adverse Events
Frehn JL, Brewster AL, Shortell SM
Comparing health care system and physician practice influences on social risk screening.
This study examined the association of multilevel organizational capabilities and adoption of social risk screening among system-owned physician practices. A secondary analysis of the 2018 National Survey of Healthcare Organizations and Systems data was conducted. Five social risks were used as measures for physician and system screening: food insecurity, housing instability, utility needs, interpersonal violence, and transportation needs. System-owned practices screened an average of 1.7 of the 5 social risks assessed. The differences were 16% attributable to practice variation between their health system owners, and 84% attributable to differences between individual practices. Practices owned by hospital systems screened for an additional 0.44 social risks relative to practices of systems without hospitals. Characteristics associated with more social risk screening included health information technology capacity, innovation culture, and patient engagement strategies.
AHRQ-funded; HS024075; HS022241.
Citation: Frehn JL, Brewster AL, Shortell SM . Comparing health care system and physician practice influences on social risk screening. Health Care Manage Rev 2022 Jan-Mar;47(1):E1-e10. doi: 10.1097/hmr.0000000000000309..
Keywords: Healthcare Systems, Social Determinants of Health, Screening, Risk
Boehme AK, Oka M, Cohen B
Readmission rates in stroke patients with and without infections: incidence and risk factors.
Investigators examined whether an infection acquired during the initial stroke admission contributed to increased risk of readmission and infection during readmission. Their a retrospective cohort study incorporated all adult ischemic stroke patients 2006-2016 from three New York City hospitals. They found that, among stroke patients, healthcare-associated infections and infections present on admission were predictors of readmission within 60 days and infection during readmission.
Citation: Boehme AK, Oka M, Cohen B . Readmission rates in stroke patients with and without infections: incidence and risk factors. J Stroke Cerebrovasc Dis 2022 Jan;31(1):106172. doi: 10.1016/j.jstrokecerebrovasdis.2021.106172..
Keywords: Stroke, Cardiovascular Conditions, Hospital Readmissions, Risk, Healthcare-Associated Infections (HAIs)
Herzig SJ, Anderson TS,, Jung y
Risk factors for opioid-related adverse drug events among older adults after hospital discharge.
This study examined patient- and prescribing-related risk factors for opioid-related adverse drug events (ADEs) after hospital discharge among medical patients. Administrative billing codes and medication claims were used to define potential opioid-related ADEs within 30 days of hospital discharge. Findings showed that potential opioid-related ADEs occurred in 7% of older adults discharged from a medical hospitalization with an opioid prescription. Recommendations included using identified risk factors to inform physician decision-making, having conversations with older adults about risk, and increasing development and targeting of harm reduction strategies.
Citation: Herzig SJ, Anderson TS,, Jung y . Risk factors for opioid-related adverse drug events among older adults after hospital discharge. J Am Geriatr Soc 2022 Jan;70(1):228-34. doi: 10.1111/jgs.17453..
Keywords: Elderly, Opioids, Risk, Adverse Drug Events (ADE), Adverse Events, Medication, Hospital Discharge
Holcomb CN, Graham LA, Richman JS
The incremental risk of noncardiac surgery on adverse cardiac events following coronary stenting.
The investigators sought to determine the incremental risk of noncardiac surgery on myocardial infarction (MI) and coronary revascularization following coronary stenting. They found that the incremental risk of noncardiac surgery on adverse cardiac events among post-stent patients is highest in the initial 6 months following stent implantation and stabilizes at 1.0% after 6 months.
Citation: Holcomb CN, Graham LA, Richman JS . The incremental risk of noncardiac surgery on adverse cardiac events following coronary stenting. J Am Coll Cardiol 2014 Dec 30;64(25):2730-9. doi: 10.1016/j.jacc.2014.09.072.
Keywords: Adverse Events, Cardiovascular Conditions, Patient-Centered Healthcare, Risk, Surgery
Bobb JF, Obermeyer Z, Wang Y
Cause-specific risk of hospital admission related to extreme heat in older adults.
The purpose of this study was to identify possible causes of hospital admissions during extreme heat events and to estimate their risks using historical data. The investigators found that among older adults, periods of extreme heat were associated with increased risk of hospitalization for fluid and electrolyte disorders, renal failure, urinary tract infection, septicemia, and heat stroke. They noted however, that the absolute risk increase was small and of uncertain clinical importance.
Citation: Bobb JF, Obermeyer Z, Wang Y . Cause-specific risk of hospital admission related to extreme heat in older adults. JAMA 2014 Dec 24-31;312(24):2659-67. doi: 10.1001/jama.2014.15715..
Keywords: Elderly, Hospitalization, Risk
Singh JA, Lewallen DG
Increasing obesity and comorbidity in patients undergoing primary total hip arthroplasty in the U.S.: a 13-year study of time trends.
The researchers examined the time-trends in key demographic and clinical characteristics of patients undergoing primary total hip arthroplasty (THA). They found that obesity, medical and psychological comorbidity increased and the underlying diagnosis of RA/inflammatory arthritis decreased rapidly in primary THA patients over 13-years.
Citation: Singh JA, Lewallen DG . Increasing obesity and comorbidity in patients undergoing primary total hip arthroplasty in the U.S.: a 13-year study of time trends. BMC Musculoskelet Disord 2014 Dec 17;15:441. doi: 10.1186/1471-2474-15-441..
Keywords: Surgery, Obesity, Risk, Registries, Arthritis
Bhavsar NA, Bream JH, Meeker AK
A peripheral circulating TH1 cytokine profile is inversely associated with prostate cancer risk in CLUE II.
The authors evaluated the association between peripheral-cytokine concentrations and prostate cancer. They found that men with a prediagnostic circulating TH1 profile and higher IL6 may have a lower risk of prostate cancer, including aggressive disease. They concluded that identifying specific inflammatory cytokines associated with prostate cancer may lead to improved prevention and treatment strategies.
Citation: Bhavsar NA, Bream JH, Meeker AK . A peripheral circulating TH1 cytokine profile is inversely associated with prostate cancer risk in CLUE II. Cancer Epidemiol Biomarkers Prev 2014 Nov;23(11):2561-7. doi: 10.1158/1055-9965.epi-14-0010.
Keywords: Patient-Centered Outcomes Research, Cancer: Prostate Cancer, Risk
Segal CG, Waller DK, Tilley B
An evaluation of differences in risk factors for individual types of surgical site infections after colon surgery.
The authors developed four independent, multivariate, predictive models to assess the unique associations between risk factors and each surgical site infection (SSI) group: superficial, deep, organ space, and an aggregate of all 3 types of SSIs. They found that unique risks for superficial SSIs include diabetes, chronic obstructive pulmonary disease, and dyspnea; deep SSIs had the greatest magnitude of association with BMI and the greatest incidence of wound disruption; and organ space SSIs were often owing to anastomotic leaks and were uniquely associated with disseminated cancer, preoperative dialysis, preoperative radiation treatment, and a bleeding disorder. They concluded that more effective prevention strategies may be developed by reporting and examining each type of SSI separately.
Citation: Segal CG, Waller DK, Tilley B . An evaluation of differences in risk factors for individual types of surgical site infections after colon surgery. Surgery 2014 Nov;156(5):1253-60. doi: 10.1016/j.surg.2014.05.010.
Keywords: Risk, Healthcare-Associated Infections (HAIs), Adverse Events, Surgery, Patient Safety
Spangler EL, Goodney PP, Schanzer A
Outcomes of carotid endarterectomy versus stenting in comparable medical risk patients.
The purpose of this study was to compare risk-stratified outcomes of carotid artery stenting (CAS) and carotid endarterectomy (CEA). Included in the study group were 11,336 patients who underwent isolated primary CEA and 544 who underwent primary CAS. The researchers found that asymptomatic normal- and high-risk patients do equally well after CEA or CAS. However, normal- and high-risk symptomatic patients have substantially worse outcomes with CAS compared with CEA.
Citation: Spangler EL, Goodney PP, Schanzer A . Outcomes of carotid endarterectomy versus stenting in comparable medical risk patients. J Vasc Surg 2014 Nov;60(5):1227-31, 31.e1. doi: 10.1016/j.jvs.2014.05.044..
Keywords: Outcomes, Comparative Effectiveness, Risk, Cardiovascular Conditions, Heart Disease and Health
Shear TC, Balachandran JS, Mokhlesi B
Risk of sleep apnea in hospitalized older patients.
This study assessed the prevalence of undiagnosed obstructive sleep apnea (OSA) among general medical inpatients and to investigate whether OSA risk is associated with in-hospital sleep quantity and quality. It found that two of every 5 inpatients older than 50 years screened at high risk for OSA. Those screening at high risk have worse in-hospital sleep quantity and quality.
Citation: Shear TC, Balachandran JS, Mokhlesi B . Risk of sleep apnea in hospitalized older patients. J Clin Sleep Med 2014 Oct 15;10(10):1061-6. doi: 10.5664/jcsm.4098..
Keywords: Sleep Apnea, Risk, Hospitalization, Elderly
Bish EK, El-Amine H, Steighner LA
A socio-technical, probabilistic risk assessment model for surgical site infections in ambulatory surgery centers.
The researchers sought to identify the risk factors associated with surgical site infections (SSIs) resulting from procedures performed at ambulatory surgery centers (ASCs) and to design an intervention to mitigate the likelihood of SSIs for the most common risk factors that were identified by the socio-technical probabilistic risk assessment (ST-PRA) tool for a particular surgical procedure. They found that failure to protect the patient effectively accounted for 51.9% of SSIs in the ambulatory care setting. Critical components of this event included skin preparation, antibiotic administration, staff training, proper response to glove punctures during surgery, and adherence to surgical preparation rules related to the wearing of jewelry, watches, and artificial nails. They determined that, assuming a 75% reduction in noncompliance on any combination of 2 of these 5 components, the risk for an SSI decreased.
Citation: Bish EK, El-Amine H, Steighner LA . A socio-technical, probabilistic risk assessment model for surgical site infections in ambulatory surgery centers. Infect Control Hosp Epidemiol 2014 Oct;35 Suppl 3:S133-41. doi: 10.1086/677824.
Keywords: Ambulatory Care and Surgery, Risk, Surgery, Healthcare-Associated Infections (HAIs), Patient Safety, Injuries and Wounds, Adverse Events
Patel M, Phillips-Caesar E, Boutin-Foster C
Attitudes and beliefs regarding cardiovascular risk factors among Bangladeshi immigrants in the US.
The researchers conducted a qualitative study using individual in-depth interviews to explore attitudes towards and difficulties with modifying cardiovascular disease related behaviors among a Bangladeshi cohort. Bangladeshi individuals in this study cited a combination of internal and external factors as barriers to lifestyle modification. The authors recommended interventions to address these barriers that simultaneously address self-efficacy and work-life balance.
Citation: Patel M, Phillips-Caesar E, Boutin-Foster C . Attitudes and beliefs regarding cardiovascular risk factors among Bangladeshi immigrants in the US. J Immigr Minor Health 2014 Oct;16(5):994-1000. doi: 10.1007/s10903-013-9868-7.
Keywords: Cardiovascular Conditions, Lifestyle Changes, Racial / Ethnic Minorities, Risk
Safford MM, Barasch A, Curtis JR
Bisphosphonates and hip and nontraumatic subtrochanteric femoral fractures in the Veterans Health Administration.
This study examined associations between bisphosphonate use and nontraumatic subtrochanteric (NTST) femoral fractures and hip fractures in the Veterans Health Administration. It found that nontraumatic subtrochanteric femoral fractures were uncommon, and longer bisphosphonate use was associated with lower (not higher) risk. In men, risks of NTST femoral fractures associated with bisphosphonate treatment may be low in contrast to substantial protective benefits for hip fracture.
AHRQ-funded; HS016956; HS018517.
Citation: Safford MM, Barasch A, Curtis JR . Bisphosphonates and hip and nontraumatic subtrochanteric femoral fractures in the Veterans Health Administration. J Clin Rheumatol 2014 Oct;20(7):357-62. doi: 10.1097/rhu.0000000000000170..
Keywords: Elderly, Injuries and Wounds, Risk, Medication, Adverse Events
Chaudhry SI, Khan RF, Chen J
National trends in recurrent AMI hospitalizations 1 year after acute myocardial infarction in Medicare beneficiaries: 1999-2010.
The investigators evaluated changes in the incidence of 1-year recurrent acute myocardial infarction (AMI) hospitalization and mortality. In a national sample of Medicare beneficiaries hospitalized for AMI from 1999 to 2010, they found that hospitalization for recurrent AMI decreased, as did subsequent mortality, albeit to a lesser extent. The risk of recurrent AMI hospitalization declined less in black patients than in whites, increasing observed racial disparities by the end of the study period.
Citation: Chaudhry SI, Khan RF, Chen J . National trends in recurrent AMI hospitalizations 1 year after acute myocardial infarction in Medicare beneficiaries: 1999-2010. J Am Heart Assoc 2014 Oct;3(5):e001197. doi: 10.1161/jaha.114.001197.
Keywords: Hospitalization, Medicare, Mortality, Heart Disease and Health, Risk
Holzer J, Canavan M, Bradley E
County-level correlation between adult obesity rates and prevalence of dentists.
The researchers conducted a study to examine the association between the prevalence of dentists and the rates of adult obesity. They found that having one additional dentist per 10,000 population was associated significantly with a 1-percentage point reduction in the rate of obesity. This effect was significantly larger in counties in which 25 percent of children or more (versus less than 25 percent of children) lived in poverty and in counties that had more primary care physicians per 10,000 population.
Citation: Holzer J, Canavan M, Bradley E . County-level correlation between adult obesity rates and prevalence of dentists. J Am Dent Assoc 2014 Sep;145(9):932-9. doi: 10.14219/jada.2014.48.
Keywords: Dental and Oral Health, Obesity, Risk, Social Determinants of Health, Value
Boehme AK, Rawal PV, Lyerly MJ
Investigating the utility of previously developed prediction scores in acute ischemic stroke patients in the stroke belt.
The researchers compared several scoring systems among patients receiving systemic and endovascular treatments. They concluded that their study demonstrated that although highly predictive of outcome in the original study design treatment groups, prediction scores may not generalize to all patient samples, highlighting the importance of validating prediction scores in diverse samples.
Citation: Boehme AK, Rawal PV, Lyerly MJ . Investigating the utility of previously developed prediction scores in acute ischemic stroke patients in the stroke belt. J Stroke Cerebrovasc Dis 2014 Sep;23(8):2001-6. doi: 10.1016/j.jstrokecerebrovasdis.2014.02.003.
Keywords: Decision Making, Diagnostic Safety and Quality, Risk, Stroke