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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 13 of 13 Research Studies Displayed
Crandall CJ, Newberry SJ, Diamant A
Comparative effectiveness of pharmacologic treatments to prevent fractures: an updated systematic review.
This article updates a 2007 evidence review focusing on the comparative benefits and risks of short- and long-term pharmacologic treatments for low bone density. It concludes that good quality evidence supports that several medications for bone density in osteoporotic range and/or pre-existing hip or vertebral fracture reduce fracture risk.
Citation: Crandall CJ, Newberry SJ, Diamant A . Comparative effectiveness of pharmacologic treatments to prevent fractures: an updated systematic review. Ann Intern Med. 2014 Nov 18;161(10):711-23. doi: 10.7326/M14-0317..
Keywords: Comparative Effectiveness, Medication, Injuries and Wounds
Sanger P, Hartzler A, Lober WB
Design considerations for post-acute care mHealth: patient perspectives.
The authors are developing an mHealth platform to engage patients in wound tracking to identify and manage surgical site infections (SSI) after hospital discharge. Their key design qualities include: meeting basic accessibility, usability and security needs; encouraging patient-centeredness; facilitating better, more predictable communication; and supporting personalized management by providers. In this article, they illustrated their application of these guiding design considerations and proposed a new framework for mHealth design based on illness duration and intensity.
Citation: Sanger P, Hartzler A, Lober WB . Design considerations for post-acute care mHealth: patient perspectives. AMIA Annu Symp Proc 2014 Nov 14;2014:1920-9.
Keywords: Telehealth, Patient Self-Management, Surgery, Injuries and Wounds, Healthcare-Associated Infections (HAIs), Hospital Discharge, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Adverse Events
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
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
Warren DK, Nickel KB, Wallace AE
Can additional information be obtained from claims data to support surgical site infection diagnosis codes?
The authors sought to confirm a claims algorithm to identify surgical site infections (SSIs) by examining the presence of clinically expected SSI treatment. They found that over 94% of patients identified by their claims algorithm as having an SSI received clinically expected treatment for infection, including antibiotics, surgical treatment, and culture, suggesting that this algorithm has very good positive predictive value. They concluded that their method may facilitate retrospective SSI surveillance and comparison of SSI rates across facilities and providers.
Citation: Warren DK, Nickel KB, Wallace AE . Can additional information be obtained from claims data to support surgical site infection diagnosis codes? Infect Control Hosp Epidemiol 2014 Oct;35 Suppl 3:S124-32. doi: 10.1086/677830.
Keywords: Data, Healthcare-Associated Infections (HAIs), Patient Safety, Surgery, Injuries and Wounds, Adverse Events
Curtin CM, Hernandez-Boussard T
Readmissions after treatment of distal radius fractures.
The authors assessed the rates and associated diagnoses of readmissions for patients having received an intervention for treatment of distal radius fracture. Using AHRQ data sets, they found that many distal radius fracture patients return to the health care system for pain-related issues, and they recommended implementation of better pain management.
Citation: Curtin CM, Hernandez-Boussard T . Readmissions after treatment of distal radius fractures. J Hand Surg Am 2014 Oct;39(10):1926-32. doi: 10.1016/j.jhsa.2014.07.041.
Keywords: Injuries and Wounds, Quality of Care, Healthcare Cost and Utilization Project (HCUP), Pain, Hospital Readmissions
Agos F, Shoda C, Bransford D
Part II: managing perioperative hyperglycemia in total hip and knee replacement surgeries.
Perioperative hyperglycemia management is an important factor in reducing the risk of surgical site infections (SSIs) in all patients whether they have diabetes or not. This article describes the impact of an evidence-based practice standard for perioperative hyperglycemia management in the reduction of SSIs in patients having total hip and knee replacement surgery.
Citation: Agos F, Shoda C, Bransford D . Part II: managing perioperative hyperglycemia in total hip and knee replacement surgeries. Nurs Clin North Am. 2014 Sep;49(3):299-308. doi: 10.1016/j.cnur.2014.05.004..
Keywords: Healthcare-Associated Infections (HAIs), Surgery, Patient Safety, Orthopedics, Injuries and Wounds
Brown JR, Solomon RJ, Sarnak MJ
Reducing contrast-induced acute kidney injury using a regional multicenter quality improvement intervention.
The researchers sought to determine whether a 6-year regional multicenter quality improvement intervention could reduce contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary interventions. They found that benchmark hospitals had no significant changes in CI-AKI, while rates of CI-AKI were significantly reduced in hospitals receiving the intervention. Key qualitative system factors associated with improvement included multidisciplinary teams, limiting contrast volume, standardized fluid orders, intravenous fluid bolus, and patient education about oral hydration.
Citation: Brown JR, Solomon RJ, Sarnak MJ . Reducing contrast-induced acute kidney injury using a regional multicenter quality improvement intervention. Circ Cardiovasc Qual Outcomes 2014 Sep;7(5):693-700. doi: 10.1161/circoutcomes.114.000903.
Keywords: Adverse Drug Events (ADE), Injuries and Wounds, Patient Safety, Heart Disease and Health, Quality Improvement
Cleveland N, Colwell C, Douglass E
Motor vehicle crash severity estimations by physicians and prehospital personnel.
The purpose of this study was to determine whether emergency physicians (EPs) and EMS personnel differ in their assessment of motor vehicle collision severity and the potential for serious injury when viewing crash scene photographs. They found excellent crash and injury agreement at both ends of the severity spectrum but only modest agreement, and therefore greater variability, in the middle of the severity spectrum.
Citation: Cleveland N, Colwell C, Douglass E . Motor vehicle crash severity estimations by physicians and prehospital personnel. Prehosp Emerg Care. 2014 Jul-Sep;18(3):402-7. doi: 10.3109/10903127.2014.891065..
Keywords: Emergency Medical Services (EMS), Trauma, Injuries and Wounds, Provider: Health Personnel, Diagnostic Safety and Quality
Daniels AH, Daiello LA, Lareau CR
Preoperative cognitive impairment and psychological distress in hospitalized elderly hip fracture patients.
The authors conducted a study to evaluate the prevalence of cognitive impairment (CI) compared with normal cognition (NC) in elderly hip fracture patients 65 years and older. Results showed many patients had unrecognized CI before surgery and had significantly more pain and fear than the NC group.
Citation: Daniels AH, Daiello LA, Lareau CR . Preoperative cognitive impairment and psychological distress in hospitalized elderly hip fracture patients. Ame J Orthop. 2014 Jul; 43(7):E146-52..
Keywords: Elderly, Injuries and Wounds, Neurological Disorders, Surgery
Wang CY, Graham JE, Karmarkar AM
FIM motor scores for classifying community discharge after inpatient rehabilitation for hip fracture.
A major goal of this study was to identify which discharge functional independence measure (FIM)--total, motor, or cognition--best discriminates community versus institutional discharges. It found that the FIM motor scale yields the best overall discrimination of patients discharged to the community versus those discharged to an institution after inpatient rehabilitation for hip fracture.
Citation: Wang CY, Graham JE, Karmarkar AM . FIM motor scores for classifying community discharge after inpatient rehabilitation for hip fracture. PM & R : the journal of injury, function, and rehabilitation 2014 Jun;6(6):493-7. doi: 10.1016/j.pmrj.2013.12.008..
Keywords: Hospital Discharge, Rehabilitation, Injuries and Wounds, Elderly
Band RA, Salhi RA, Holena DN
Severity-adjusted mortality in trauma patients transported by police.
Two decades ago, Philadelphia began allowing police transport of patients with penetrating trauma. In this retrospective cohort study, the investigators conduct a large, multiyear, citywide analysis of this policy. They examine the association between mode of out-of-hospital transport (police department versus emergency medical services [EMS]) and mortality among patients with penetrating trauma in Philadelphia.
Citation: Band RA, Salhi RA, Holena DN . Severity-adjusted mortality in trauma patients transported by police. Ann Emerg Med 2014 May;63(5):608-14.e3. doi: 10.1016/j.annemergmed.2013.11.008..
Keywords: Injuries and Wounds, Mortality, Patient-Centered Outcomes Research, Trauma
Owens PL, Barrett ML, Raetzman S
AHRQ Author: Owens PL, Steiner CA
Surgical site infections following ambulatory surgery procedures.
The authors determined the incidence of clinically significant surgical site infections (CS-SSIs) following low- to moderate-risk ambulatory surgery in patients with low risk for surgical complications. They found that among patients in 8 states undergoing ambulatory surgery, rates of postsurgical visits for CS-SSIs were low relative to all causes but may represent a substantial number of adverse outcomes in aggregate, thus meriting quality improvement efforts to minimize their occurrence.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Owens PL, Barrett ML, Raetzman S . Surgical site infections following ambulatory surgery procedures. JAMA 2014 Feb 19;311(7):709-16. doi: 10.1001/jama.2014.4.
Keywords: Healthcare Cost and Utilization Project (HCUP), Healthcare-Associated Infections (HAIs), Injuries and Wounds, Ambulatory Care and Surgery, Surgery, Hospitalization, Patient Safety, Adverse Events