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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 28 Research Studies Displayed
Djulbegovic B, Ahmed MM, Hozo I
High quality (certainty) evidence changes less often than low-quality evidence, but the magnitude of effect size does not systematically differ between studies with low versus high-quality evidence.
The study researchers state that assumptions and general beliefs exist about certainty of evidence (CoE) and its impact on estimates of treatment effects, however empirical assessment of those assumptions and beliefs is lacking. The purpose of this study was to evaluate the differences between low CoE (low-quality evidence) and high CoE (high-quality evidence) in precision of estimating treatment effects. The researchers reviewed the Cochrane Database of Systematic Reviews from January 2016 through May 2021 for pairs of original and updated reviews for change in CoE assessments based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. Differences in effect sizes between the original reviews and the updated reviews were assessed as a function of change in CoE. The researchers concluded that low CoE changes more frequently than high CoE, but the effect size in low CoE studies did not differ from the effect size in high CoE studies. The researchers state that the effect size finding is an indicator of the need to further assess and improve the critical appraisal methods currently utilized in evidence-based medicine.
Citation: Djulbegovic B, Ahmed MM, Hozo I . High quality (certainty) evidence changes less often than low-quality evidence, but the magnitude of effect size does not systematically differ between studies with low versus high-quality evidence. J Eval Clin Pract 2022 Jun;28(3):353-62. doi: 10.1111/jep.13657..
Keywords: Research Methodologies, Evidence-Based Practice
Nguyen AM, Cleland CM, Dickinson LM
Considerations before selecting a stepped-wedge cluster randomized trial design for a practice improvement study.
This study’s objective was to identify the advantages and challenges of the stepped-wedge cluster randomized trial (SW-CRT) design for large-scale intervention implementations in primary care settings. The authors interviewed grantees from the EvidenceNOW: Advancing Heart Health initiative, which included a large collection of SW-CRTs. A total of 17 key informants were given qualitative interviews. All interviewees reported that SW-CRT can be an effective study design. The advantages of SW-CRT include incentivized recruitment, staggered resource allocation, and statistical power. The challenges included time-sensitive recruitment, retention, randomization requirements and practice preferences, achieving treatment schedule fidelity, intensive data collection, the Hawthorne effect, and temporal trends.
Citation: Nguyen AM, Cleland CM, Dickinson LM . Considerations before selecting a stepped-wedge cluster randomized trial design for a practice improvement study. Ann Fam Med 2022 May-Jun;20(3):255-61. doi: 10.1370/afm.2810..
Keywords: Research Methodologies
AHRQ Author: Huppert J
Adolescents with vulvar ulcers: COVID-19 disease, COVID-19 vaccines, and the value of case reports.
The author indicates that there are too few cases reporting aphthosis after COVID disease or COVID-19 vaccination to infer a statistical association, but that case reports are a valuable source of rich details about conditions that are difficult to study with more rigorous designs and can be synthesized to help guide medical care. She recommends that it is time for a high-quality systematic review of vulvar aphthosis in order for clinicians to incorporate the existing evidence into decision-making and best care for patients.
Citation: Huppert J . Adolescents with vulvar ulcers: COVID-19 disease, COVID-19 vaccines, and the value of case reports. J Pediatr Adolesc Gynecol 2022 Apr;35(2):109-11. doi: 10.1016/j.jpag.2022.01.006..
Keywords: Children/Adolescents, COVID-19, Vaccination, Research Methodologies
Reeves SL, Dombkowski KJ, Madden B
Considerations when aggregating data to measure performance across levels of the health care system.
Investigators examined attribution when measuring quality at varying levels of the health care system. Using Medicaid claims, they concluded that, when applying attribution models, it was essential to consider the potential to induce health disparities. Further, differential attribution may have unintentional consequences that deepen health disparities, particularly when considering incentive programs for health plans to improve the quality of care.
AHRQ-funded; HS025292; HS025299.
Citation: Reeves SL, Dombkowski KJ, Madden B . Considerations when aggregating data to measure performance across levels of the health care system. Acad Pediatr 2022 Apr;22(3s):S119-s24. doi: 10.1016/j.acap.2021.11.013..
Keywords: Sickle Cell Disease, Research Methodologies, Provider Performance
Kissler K, Breman RB, Carlson N
Innovations in prospective perinatal research as a result of the COVID-19 pandemic.
This paper provides a review of perinatal research adaptations which took place during the COVID-19 pandemic. Although in-person research activities ceased during the spread of SARS-CoV-2 and the resulting disease called COVID-19, the authors’ team of university scientists across the United States utilized adapted methods to allow prospective perinatal research to continue. Novel approaches included using new and underutilized techniques for distance research such as: online recruitment, enrollment, and consent; data collection via videoconferencing; self-collection of biological samples; and new applications of smart phones and wearable vital signs measurement. The researchers found that these methods may improve recruitment success and the quality of the experience for the participants, as well as provide improved access to historically vulnerable populations, such as low-income, rural, and racially diverse pregnant and postpartum individuals and communities. The researchers concluded that the implementation of these research strategies resulted in broader, more inclusive, and diverse perinatal research access, and many of the strategies will continue to be used and refined long after the pandemic.
Citation: Kissler K, Breman RB, Carlson N . Innovations in prospective perinatal research as a result of the COVID-19 pandemic. J Midwifery Womens Health 2022 Mar;67(2):264-69. doi: 10.1111/jmwh.13329..
Keywords: COVID-19, Research Methodologies
Wang Y, Lin L, Thompson CG
A penalization approach to random-effects meta-analysis.
Systematic reviews and meta-analyses are principal tools to synthesize evidence from multiple independent sources in many research fields. The assessment of heterogeneity among collected studies is a critical step when performing a meta-analysis, given its influence on model selection and conclusions about treatment effects. In this paper, the investigators compared the existing and proposed methods with simulated data and several case studies to illustrate the benefits of the penalization methods.
Citation: Wang Y, Lin L, Thompson CG . A penalization approach to random-effects meta-analysis. Stat Med 2022 Feb;41(3):500-16. doi: 10.1002/sim.9261..
Keywords: Research Methodologies
O'Malley AJ, Landon BE, Zaborski LA
Weak correlations in health services research: weak relationships or common error?
This study examined whether the correlation between a provider's effect on one population of patients and the same provider's effect on another population is underestimated if the effects for each population are estimated separately as opposed to being jointly modeled as random effects, and characterized how the impact of the estimation procedure varies with sample size. The authors used Medicare claims and enrollment data on emergency department (ED) visits, including patient characteristics, the patient’s hospitalization status, and identification of the doctor responsible for the decision to hospitalize the patient. The simulation analysis demonstrated that the joint modeling approach is generally close to unbiased, whereas the stratified approach can be severely biased in small samples. Correlations included 0.98 for female and male patients and only 0.38 using stratified estimation. Correlations for White and non-White patients are 0.99 and 0.28, and for Medicaid dual-eligible and non-dual-eligible patients 0.99 and 0.31, respectively.
Citation: O'Malley AJ, Landon BE, Zaborski LA . Weak correlations in health services research: weak relationships or common error? Health Serv Res 2022 Feb;57(1):182-91. doi: 10.1111/1475-6773.13882..
Keywords: Health Services Research (HSR), Research Methodologies
Silva GC, Gutman R
Multiple imputation procedures for estimating causal effects with multiple treatments with application to the comparison of healthcare providers.
Choosing between multiple healthcare providers requires us to simultaneously compare the expected outcomes under each provider. This comparison is complex because the composition of patients treated by each provider may differ. Similar issues arise when simultaneously comparing the adverse effects of interventions using non-randomized data. To simultaneously estimate the effects of multiple providers/interventions the investigators proposed procedures that explicitly imputed the set of potential outcomes for each subject.
Citation: Silva GC, Gutman R . Multiple imputation procedures for estimating causal effects with multiple treatments with application to the comparison of healthcare providers. Stat Med 2022 Jan 15;41(1):208-26. correct. doi: 10.1002/sim.9231..
Keywords: Research Methodologies
Boland MR, Rusanov A, So Y
From expert-derived user needs to user-perceived ease of use and usefulness: a two-phase mixed-methods evaluation framework.
This paper presents a two-phase evaluation framework involving usability experts (phase 1) and end-users (phase 2). In phase 1, a cross-system functionality alignment between expert-derived user needs and system functions was performed to inform the choice of ‘‘the best available’’ comparison system to enable a cognitive walkthrough in phase 1 and a comparative effectiveness evaluation in phase 2.
Citation: Boland MR, Rusanov A, So Y . From expert-derived user needs to user-perceived ease of use and usefulness: a two-phase mixed-methods evaluation framework. J Biomed Inform 2014 Dec;52:141-50. doi: 10.1016/j.jbi.2013.12.004..
Keywords: Comparative Effectiveness, Evidence-Based Practice, Research Methodologies
Viswanathan M, Carey TS, Belinson SE
AHRQ Author: Berliner E, Chang SM
A proposed approach may help systematic reviews retain needed expertise while minimizing bias from nonfinancial conflicts of interest.
The researchers sought to create practical guidance on ensuring adequate clinical or content expertise while maintaining independence of judgment on systematic review teams. They discussed their approach and concluded that the feasibility and utility of this approach to ensuring needed expertise on systematic reviews and minimizing bias from nonfinancial conflicts of interest must be investigated.
Citation: Viswanathan M, Carey TS, Belinson SE . A proposed approach may help systematic reviews retain needed expertise while minimizing bias from nonfinancial conflicts of interest. J Clin Epidemiol 2014 Nov;67(11):1229-38. doi: 10.1016/j.jclinepi.2014.02.023.
Keywords: Comparative Effectiveness, Evidence-Based Practice, Research Methodologies
Guise JM, Chang C, Viswanathan M
AHRQ Author: Chang C, Berliner E
Agency for Healthcare Research and Quality Evidence-based Practice Center methods for systematically reviewing complex multicomponent health care interventions.
The purpose of this AHRQ EPC methods white paper was to outline approaches to conducting systematic reviews of complex multicomponent health care interventions. It provided a framework for synthesizing studies of multicomponent interventions and also provided an initial list of critical reporting elements for such studies in order to help systematic reviewers understand the options and tradeoffs available for such reviews.
AHRQ-authored; AHRQ-funded; 290201200010I; 290201200012I; 290201200011I; 290201200015I; 290201200008I; 290201200004C.
Citation: Guise JM, Chang C, Viswanathan M . Agency for Healthcare Research and Quality Evidence-based Practice Center methods for systematically reviewing complex multicomponent health care interventions. J Clin Epidemiol 2014 Nov;67(11):1181-91. doi: 10.1016/j.jclinepi.2014.06.010.
Keywords: Evidence-Based Practice, Healthcare Delivery, Health Services Research (HSR), Patient-Centered Outcomes Research, Research Methodologies
Jalbert JJ, Ritchey ME, Mi X
Methodological considerations in observational comparative effectiveness research for implantable medical devices: an epidemiologic perspective.
This article discusses some of the most salient issues encountered in conducting comparative effectiveness research on implantable devices. Included in this discussion are special methodological considerations regarding the use of data sources, exposure and outcome definitions, timing of exposure, and sources of bias.
AHRQ-funded; 29020050016; HS017731
Citation: Jalbert JJ, Ritchey ME, Mi X . Methodological considerations in observational comparative effectiveness research for implantable medical devices: an epidemiologic perspective. Am J Epidemiol. 2014 Nov 1;180(9):949-58. doi: 10.1093/aje/kwu206..
Keywords: Comparative Effectiveness, Research Methodologies, Data
Carayon P, Li Y, Kelly MM
Stimulated recall methodology for assessing work system barriers and facilitators in family-centered rounds in a pediatric hospital.
In this study, the researchers implemented and evaluated the use of a stimulated recall methodology for collective confrontation in the context of family-centered rounds (FCRs). They concluded that their study demonstrated the value of the stimulated recall methodology to identify a range of work system factors that either positively or negatively influence family engagement during FCRs.
Citation: Carayon P, Li Y, Kelly MM . Stimulated recall methodology for assessing work system barriers and facilitators in family-centered rounds in a pediatric hospital. Appl Ergon 2014 Nov;45(6):1540-6. doi: 10.1016/j.apergo.2014.05.001..
Keywords: Hospitals, Children/Adolescents, Teams, Research Methodologies
Valdez RS, Guterbock TM, Thompson MJ
Beyond traditional advertisements: leveraging Facebook's social structures for research recruitment.
This study aimed to develop and assess the feasibility, benefits, and challenges of recruiting for research studies related to consumer health information technology (IT) by leveraging the social structures embedded in the social networking platform, Facebook. It demonstrated that leveraging the social structures of Facebook for health-related research was feasible for obtaining small samples appropriate for qualitative research but not for obtaining large samples needed for quantitative research.
Citation: Valdez RS, Guterbock TM, Thompson MJ . Beyond traditional advertisements: leveraging Facebook's social structures for research recruitment. J Med Internet Res 2014 Oct 27;16(10):e243. doi: 10.2196/jmir.3786..
Keywords: Health Information Technology (HIT), Social Media, Research Methodologies
Cook EA, Schneider KM, Robinson J
Field methods in medical record abstraction: assessing the properties of comparative effectiveness estimates.
Comparative effectiveness studies using Medicare claims data are vulnerable to treatment selection biases and supplemental data from a sample of patients has been recommended for examining the magnitude of this bias. The investigators collected medical record data from a subsample of patients to assess the validity of assumptions and to aid in the interpretation of our estimates. In this paper, they sought to describe and document the process used to collect and validate this supplemental information.
Citation: Cook EA, Schneider KM, Robinson J . Field methods in medical record abstraction: assessing the properties of comparative effectiveness estimates. BMC Health Serv Res 2014 Sep 15;14:391. doi: 10.1186/1472-6963-14-391..
Keywords: Comparative Effectiveness, Medicare, Evidence-Based Practice, Research Methodologies
Jaana M, Vartak S, Ward MM
Evidence-based health care management: what is the research evidence available for health care managers?
The authors conducted a scoping review of systematic reviews and meta-analyses to determine the availability and accessibility of evidence for health care managers. They found that 96.5% of their search results were not on target, and they suggested a better classification within PubMed to increase the accessibility of meaningful resources and to facilitate evidence retrieval. They recommended that health care journals take initiatives encouraging the publication of reviews in relevant management areas.
Citation: Jaana M, Vartak S, Ward MM . Evidence-based health care management: what is the research evidence available for health care managers? Eval Health Prof 2014 Sep;37(3):314-34. doi: 10.1177/0163278713511325.
Keywords: Evidence-Based Practice, Health Services Research (HSR), Research Methodologies
AHRQ Author: Smith SR
Preface to the AHRQ supplement.
AHRQ, through its Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) Research Network, sponsored this supplement to present various strategies in the design, analysis, and conduct of health outcomes studies relevant to rare diseases. The purpose of this supplement is to disseminate illustrative examples of research methods that can be applied to understand health outcomes and potentially to stimulate new patient-centered outcomes studies for rare diseases.
Citation: Smith SR . Preface to the AHRQ supplement. J Gen Intern Med 2014 Aug;29 Suppl 3:S712-3. doi: 10.1007/s11606-014-2922-x.
Keywords: Comparative Effectiveness, Evidence-Based Practice, Outcomes, Patient-Centered Outcomes Research, Research Methodologies
Holzer JK, Ellis L, Merritt MW
Why we need community engagement in medical research.
The aim of this article was to illustrate how community engagement can help to remedy shortfalls of community trust, participant enrollment, and uptake of research findings. After briefly describing these shortfalls, the authors considered 3 case examples that demonstrate the potential of community engagement to address each. They also discussed the ethical importance and implications of demonstrating respect for the community.
Citation: Holzer JK, Ellis L, Merritt MW . Why we need community engagement in medical research. J Investig Med 2014 Aug;62(6):851-5. doi: 10.1097/jim.0000000000000097..
Keywords: Health Services Research (HSR), Patient-Centered Outcomes Research, Research Methodologies, Implementation
Garabedian LF, Chu P, Toh S
Potential bias of instrumental variable analyses for observational comparative effectiveness research.
Results of instrumental variable analyses may be biased if the instrument and outcome are related through an unadjusted third variable, an instrument-outcome confounder. The authors review of 187 comparative effectiveness studies using this type of analysis, only 4 considered potential instrument-outcome confounders outside the study data.
Citation: Garabedian LF, Chu P, Toh S . Potential bias of instrumental variable analyses for observational comparative effectiveness research. Ann Intern Med. 2014 Jul 15;161(2):131-8. doi: 10.7326/M13-1887..
Keywords: Comparative Effectiveness, Outcomes, Research Methodologies
Darney BG, Caughey AB
Elective induction of labor symposium: nomenclature, research methodological issues, and outcomes.
This article focuses on key method issues in studies of elective induction of labor. The authors first identify methodological concerns with the existing literature and discuss each in return. They then review existing evidence about the relationship between elective induction and cesarean delivery.
Citation: Darney BG, Caughey AB . Elective induction of labor symposium: nomenclature, research methodological issues, and outcomes. Clin Obstet Gynecol. 2014 Jun;57(2):343-62. doi: 10.1097/GRF.0000000000000029..
Keywords: Research Methodologies, Outcomes, Labor and Delivery, Women
Keenan GM, Wilkie DJ
Integration of NNN into EHRS: how are we doing?: IJNK virtual issue.
This commentary introduces a virtual edition of IJNK, hosted on the Journal’s website. It includes six articles published in the last 20 years that provide a snapshot of efforts to integrate one or more of the standardized terminologies, NANDA-I, NOC, NIC (NNN), into electronic health records (EHRs).
Citation: Keenan GM, Wilkie DJ . Integration of NNN into EHRS: how are we doing?: IJNK virtual issue. Int J Nurs Knowl 2014 Jun;25(2):68-9. doi: 10.1111/2047-3095.12039..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Research Methodologies
Camp KM, Parisi MA, Acosta PB
AHRQ Author: Chang CS
Phenylketonuria Scientific Review Conference: state of the science and future research needs.
An NIH State-of-the-Science Conference was convened in 2012 to address new findings, particularly the use of the medication sapropterin to treat some individuals with phenylketonuria (PKU), and to develop a research agenda. An AHRQ Evidence-based Practice Center conducted a systematic review of adjuvant treatments for PKU and presented its conclusions at the conference. New drugs that are safe, efficacious, and impact a larger proportion of individuals with PKU are needed. The identification of a research agenda has facilitated the development of clinical practice guidelines by professional organizations and serves as a model for other inborn errors of metabolism.
Citation: Camp KM, Parisi MA, Acosta PB . Phenylketonuria Scientific Review Conference: state of the science and future research needs. Mol Genet Metab 2014 Jun;112(2):87-122. doi: 10.1016/j.ymgme.2014.02.013.
Keywords: Comparative Effectiveness, Evidence-Based Practice, Guidelines, Medication, Research Methodologies
Cappelleri JC, Lundy JJ, Hays RD
Overview of classical test theory and item response theory for the quantitative assessment of items in developing patient-reported outcomes measures.
This article presents an overview of classical test theory and item response theory in the quantitative assessment of items and scales during the content-validity phase of patient-reported outcomes (PRO) measure development. The researchers concluded that depending on the particular type of measure and specific circumstances, either approach or both may be useful to help maximize the content validity of a PRO measure.
Citation: Cappelleri JC, Lundy JJ, Hays RD . Overview of classical test theory and item response theory for the quantitative assessment of items in developing patient-reported outcomes measures. Clin Ther. 2014 May;36(5):648-662. doi: 10.1016/j.clinthera.2014.04.006..
Keywords: Outcomes, Research Methodologies
Valencia V, Moghadassi M, Kriesel DR
Study of Tomography Of Nephrolithiasis Evaluation (STONE): methodology, approach and rationale.
This paper describes the rationale and methods of STONE (Study of Tomography Of Nephrolithiasis Evaluation), a pragmatic randomized comparative effectiveness trial comparing different imaging strategies for patients with suspected urolithiasis. It concluded that the detailed methodology of STONE will provide a roadmap for comparative effectiveness studies of diagnostic imaging conducted in an ED setting.
Citation: Valencia V, Moghadassi M, Kriesel DR . Study of Tomography Of Nephrolithiasis Evaluation (STONE): methodology, approach and rationale. Contemp Clin Trials 2014 May;38(1):92-101. doi: 10.1016/j.cct.2014.03.006..
Keywords: Comparative Effectiveness, Imaging, Kidney Disease and Health, Research Methodologies
Tugwell P, Boers M, D'Agostino MA
Updating the OMERACT filter: implications of filter 2.0 to select outcome instruments through assessment of "truth": content, face, and construct validity.
Two discussion groups critically reviewed the variety of ways in which five case studies of current OMERACT Working Groups complied with the ‘Truth’ component of the Filter and what issues remained to be resolved. The case studies showed that there is broad agreement on criteria for meeting the ‘Truth’ criteria through demonstration of content, face and construct validity; however several issues were identified that the Filter Working Group will need to address.
Citation: Tugwell P, Boers M, D'Agostino MA . Updating the OMERACT filter: implications of filter 2.0 to select outcome instruments through assessment of "truth": content, face, and construct validity. J Rheumatol. 2014 May;41(5):1000-4. doi: 10.3899/jrheum.131310..
Keywords: Evidence-Based Practice, Patient-Centered Outcomes Research, Research Methodologies