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AHRQ Research Studies Date
Topics
- Access to Care (1)
- Adverse Events (1)
- Cancer (2)
- Children's Health Insurance Program (CHIP) (1)
- (-) Children/Adolescents (6)
- COVID-19 (1)
- Diagnostic Safety and Quality (1)
- (-) Disparities (6)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 6 of 6 Research Studies DisplayedSeverance TS, Njuguna F, Olbara G
An evaluation of the disparities affecting the underdiagnosis of pediatric cancer in Western Kenya.
This study described the international collaboration to investigate disparities affecting the underdiagnosis of pediatric cancer in Western Kenya. Estimates of cancer incidence in similar populations around the world would indicate approximately 1500 patients should be diagnosed each year. However, internal review at a large tertiary hospital noted 200-250 patients were diagnosed annually, suggesting the remaining 75-80% of patients go undiagnosed and do not receive treatment. The authors reviewed 41 malaria slides at a local referring hospital that demonstrated both morphologic and genetic evidence of leukemia. This disparity suggested a lack of education and training that were the lead factors contributing to lower rates of diagnosis.
AHRQ-funded; HS026390.
Citation: Severance TS, Njuguna F, Olbara G .
An evaluation of the disparities affecting the underdiagnosis of pediatric cancer in Western Kenya.
Pediatr Blood Cancer 2022 Oct;69(10):e29768. doi: 10.1002/pbc.29768..
Keywords: Children/Adolescents, Cancer, Disparities, Diagnostic Safety and Quality
Halvorson EE, Thurtle DP, Easter A
Disparities in adverse event reporting for hospitalized children.
The authors compared the adverse event (AE) rate identified by voluntary event reporting (VER) with that identified using the Global Assessment of Pediatric Patient Safety (GAPPS) between hospitalized children by weight category, race, and English proficiency. In the population studied, they identified 288 total AEs, 270 by the GAPPS and 18 by VER. They found a disparity in AE reporting for children with limited English proficiency, with fewer AEs by VER compared with no difference in AEs by GAPPS. They identified no disparities by weight category or race. They concluded that voluntary event reporting may systematically underreport AEs in hospitalized children with limited English proficiency.
AHRQ-funded; HS026038.
Citation: Halvorson EE, Thurtle DP, Easter A .
Disparities in adverse event reporting for hospitalized children.
J Patient Saf 2022 Sep 1;18(6):e928-e33. doi: 10.1097/pts.0000000000001049..
Keywords: Children/Adolescents, Disparities, Adverse Events, Medical Errors, Patient Safety, Hospitals, Hospitalization, Inpatient Care
Mobley EM, Moke DJ, Milam J
Interventions to address disparities and barriers to pediatric cancer survivorship care: a scoping review.
This scoping review’s aim was to demonstrate evidence-based approaches to alleviate barriers and decrease disparities among childhood cancer survivors. A literature review identified 16 proposed strategies to address disparities and barriers endorsed by professional organizations including 9 clinical practice guidelines, 4 policy statements, and 3 recommendations. Twenty-seven published studies evaluated an intervention; however these evaluated interventions were not well aligned with the proposed strategies endorsed by professional organizations. Interventions most commonly evaluated survivorship care plans (n = 11), or models of care (n = 11) followed by individual survivorship care services (n= 9). Interventions predominantly targeted patients rather than providers or systems.
AHRQ-funded; 75Q80120D00009
Citation: Mobley EM, Moke DJ, Milam J .
Interventions to address disparities and barriers to pediatric cancer survivorship care: a scoping review.
J Cancer Surviv 2022 Jun;16(3):667-76. doi: 10.1007/s11764-021-01060-4..
Keywords: Children/Adolescents, Disparities, Cancer
Kemme S, Yoeli D, Sundaram SS
Decreased access to pediatric liver transplantation during the COVID-19 pandemic.
The purpose of the study was to explore and understand the impact of the COVID-19 pandemic on nationwide pediatric liver transplants. The researchers compared data for transplant waiting list additions, removals, and liver transplants during pre-COVID-19 (March-November 2016-2019), early COVID-19 (March-May 2020), and late COVID-19 (June-November 2020). The study results showed a 38% decrease in liver transplantations during early COVID-19, recovering to pre-pandemic rates during late COVID-19. White children had a 30% decrease in overall liver transplantation, while non-White children had a 44% decrease in overall liver transplantation. Additions to the waiting list decreased 25% during COVID-19, with Black transplant candidates the most affected, and children spent longer on the waiting list during early COVID-19 compared to pre-COVID-19 (140 vs. 96 days). The study concluded that the COVID-19 pandemic decreased access to pediatric liver transplants, especially during early COVID-19. The researchers discussed that although the rate of pediatric liver transplants has resumed to pre-COVID-19 levels, racial disparities must be addressed.
AHRQ-funded; HS026510.
Citation: Kemme S, Yoeli D, Sundaram SS .
Decreased access to pediatric liver transplantation during the COVID-19 pandemic.
Pediatr Transplant 2022 Mar;26(2):e14162. doi: 10.1111/petr.14162..
Keywords: Children/Adolescents, COVID-19, Transplantation, Access to Care, Disparities
Kleinman LC, Howell EA
Equity and the hazard of veiled injustice: a methodological reflection on risk adjustment.
The researchers report that in the context of quality improvement research, risk adjustment (RA) methods can obscure disparities in health care. In this study the researchers address the impact of considering equity when conducting risk adjustments in pediatric health, and describe the danger of veiled justice, a type of overadjustment that takes place when risk adjustments obscure real disparities because more than one covariate, such as race and socioeconomic status, are on related causal paths. Underadjustment can occur when these same structural characteristics are not addressed when calculating models of payment. The purpose of this study was to describe the literature and present a conceptual framework that identifies these two problems for validity related to the interactions between risk adjustment and health equity in pediatric health care. The researchers conclude that the science of quality improvement must address issues of health equity as an essential construct, with the development of a specific conceptual model. Statistical analysis should be interpreted using the conceptual model, and the dynamics of child development and life course should also be addressed, as well as additional contextual and process factors such as the role of caregivers and public insurance, the epidemiology of the disease, family financial status, and others. The goal of RA is to make valid conclusions such that observed differences can be attributed to the relevant causes. When higher risk is attributed to social determinants and not disease differences, RA can obscure disparities (veiled injustice) and differences at the population level and experienced by individuals are falsely hidden. Not addressing these same structural characteristics when calculating models of payment can lead to patterns of underadjustment. The authors advise that these 2 sides of a similar coin reveal the critical importance of both the underlying model and the capacity to reliably evaluate disparities and quality.
AHRQ-funded; HS020518; 233201550088A.
Citation: Kleinman LC, Howell EA .
Equity and the hazard of veiled injustice: a methodological reflection on risk adjustment.
Pediatrics 2022 Mar;149(Suppl 3). doi: 10.1542/peds.2020-045948G.
Keywords: Children/Adolescents, Disparities, Racial and Ethnic Minorities, Risk
Dougherty D, Chen X, Gray DT
AHRQ Author: Dougherty D, Gray DT
Child and adolescent health care quality and disparities: are we making progress?
The authors sought to examine trends over time in health care quality and disparities by race, Hispanic ethnicity, income, insurance, gender, rurality, and special health care needs. Using data from the 2011 National Healthcare Quality Report and Naitonal Healthcare Disparities Reprot, they found that there was some progress in health care quality and reducing disparities in children's health care quality from 2000 to 2009, but opportunities for targeting improvement strategies remain.
AHRQ-authored.
Citation: Dougherty D, Chen X, Gray DT .
Child and adolescent health care quality and disparities: are we making progress?
Acad Pediatr 2014 Mar-Apr;14(2):137-48. doi: 10.1016/j.acap.2013.11.008.
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Keywords: Children/Adolescents, Children's Health Insurance Program (CHIP), Disparities, Quality of Care