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AHRQ Research Studies Date
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- Access to Care (3)
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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 16 of 16 Research Studies DisplayedFeldman AG, Marsh R, Kempe A
Barriers to pretransplant immunization: a qualitative interview study of pediatric solid organ transplant stakeholders.
Investigators described the experiences and beliefs of pediatric transplant stakeholders regarding factors that contribute to low pre-transplant immunization rates. Five central themes emerged: gaps in knowledge about timing and safety of pre-transplant immunizations; lack of communication, coordination, and follow-up between team members; lack of centralized immunization records; subspecialty clinics functioning as the medical home for transplant candidates, but not able to provide all needed immunizations; and differences between organ type in prioritization and completion of pre-transplant immunization. The authors recommended new tools to overcome these barriers and to increase immunization rates in transplant candidates.
AHRQ-funded; HS026510.
Citation: Feldman AG, Marsh R, Kempe A .
Barriers to pretransplant immunization: a qualitative interview study of pediatric solid organ transplant stakeholders.
J Pediatr 2020 Dec;227:60-68. doi: 10.1016/j.jpeds.2020.07.038..
Keywords: Children/Adolescents, Transplantation, Surgery, Healthcare Delivery, Healthcare Utilization
Kemme S, Sundaram SS, Curtis DJ
A community divided: post-transplant live vaccine practices among Society of Pediatric Liver Transplantation (SPLIT) centers.
The goal of this study was to assess current post-transplant live vaccine practices at individual pediatric liver transplant centers following the updated AST guidelines. Using email surveys with a 93% response rate, findings showed that only 29% of centers offered live vaccines post-transplant, with each center using different eligibility criteria for live vaccines. The main reasons for a center not offering post-transplant live vaccines were safety concerns and inability to reach group consensus.
AHRQ-funded; HS026510.
Citation: Kemme S, Sundaram SS, Curtis DJ .
A community divided: post-transplant live vaccine practices among Society of Pediatric Liver Transplantation (SPLIT) centers.
Pediatr Transplant 2020 Aug 26:e13804. doi: 10.1111/petr.13804..
Keywords: Children/Adolescents, Transplantation, Surgery, Vaccination, Practice Patterns
Mogul DB, Perito ER, Wood N
Impact of acuity circles on outcomes for pediatric liver transplant candidates.
In December 2018, UNOS approved an allocation scheme based on recipients' geographic distance from a deceased donor ("acuity circles"). Previous analyses suggested acuity circles (AC) would reduce waitlist mortality overall, but their impact on pediatric subgroups was not considered. In this study, the investigators applied Scientific Registry of Transplant Recipients data from 2011-2016 towards the Liver Simulated Allocation Model (LSAM) to compare outcomes by age and illness severity for the UNOS-approved AC and the existing Donor Service Area (DSA)/Region-based allocation schemes.
AHRQ-funded; HS023876.
Citation: Mogul DB, Perito ER, Wood N .
Impact of acuity circles on outcomes for pediatric liver transplant candidates.
Transplantation 2020 Aug;104(8):1627-32. doi: 10.1097/tp.0000000000003079..
Keywords: Children/Adolescents, Transplantation, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice, Registries, Surgery, Access to Care
Covarrubias K, Luo X, Massie A
Determinants of length of stay after pediatric liver transplantation.
In this study, the investigators sought to identify factors that were associated with LOS following pediatric (<18 years) liver transplantation in order to provide personalized counseling and discharge planning for recipients and their families. They concluded that while center-level practices accounted for substantial variation in LOS, consideration of donor and recipient factors could help clinicians provide more personalized counseling for families of pediatric liver transplant candidates.
AHRQ-funded; HS023876.
Citation: Covarrubias K, Luo X, Massie A .
Determinants of length of stay after pediatric liver transplantation.
Pediatr Transplant 2020 Jun;24(4):e13702. doi: 10.1111/petr.13702..
Keywords: Children/Adolescents, Transplantation
Bowring MG, Massie AB, Chu NM
Projected 20- and 30-year outcomes for pediatric liver transplant recipients in the United States.
Researchers aimed to use national registry data and parametric models to project 20- and 30-year post-transplant outcomes for recently transplanted pediatric liver transplant (LT) recipients. Using Scientific Registry of Transplant Recipients data, they found that projected long-term outcomes for recently transplanted pediatric LT recipients are excellent, reflective of substantial improvements in medical care, and informative for physician-patient education and decision making in the current era.
AHRQ-funded; HS023876.
Citation: Bowring MG, Massie AB, Chu NM .
Projected 20- and 30-year outcomes for pediatric liver transplant recipients in the United States.
J Pediatr Gastroenterol Nutr 2020 Mar;70(3):356-63. doi: 10.1097/mpg.0000000000002592..
Keywords: Children/Adolescents, Transplantation, Patient-Centered Outcomes Research, Outcomes, Surgery, Registries, Evidence-Based Practice
Feldman AG, Curtis DJ, Moore SL
Under-immunization of pediatric transplant recipients: a call to action for the pediatric community.
This article is a call to action for pediatric solid organ transplant recipients to receive their recommended immunizations. Vaccine-preventable infections (VIPs) occur in 1 in 6 pediatric transplant recipients and these hospitalizations result in significant morbidity, mortality, graft injury, and cost. There has been an increase in the overall population in non-medical vaccine exemptions, which reduces herd immunity and creates greater risk for patients undergoing or already having received transplants.
AHRQ-funded; HS026510.
Citation: Feldman AG, Curtis DJ, Moore SL .
Under-immunization of pediatric transplant recipients: a call to action for the pediatric community.
Pediatr Res 2020 Jan;87(2):277-81. doi: 10.1038/s41390-019-0507-4..
Keywords: Children/Adolescents, Transplantation, Vaccination, Adverse Events, Patient Safety
Feldman AG, Sundaram SS, Beaty BL
Immunization status at the time of liver transplant in children and adolescents.
In this research letter, the authors quantified the percentage of patients at Society of Pediatric Liver Transplantation centers who were up to date for their age on immunizations at the time of transplant, and determined whether demographic and clinical factors were associated with immunization status at the time of transplant. They concluded that further research is needed to understand barriers to immunization in the pediatric transplant population and called for novel tools that provide pretransplant vaccine education and enhance communication between primary care and subspecialty clinicians.
AHRQ-funded; HS026510.
Citation: Feldman AG, Sundaram SS, Beaty BL .
Immunization status at the time of liver transplant in children and adolescents.
JAMA 2019 Nov 12;322(18):1822-24. doi: 10.1001/jama.2019.14386..
Keywords: Transplantation, Children/Adolescents, Vaccination, Surgery
Luo X, Mogul DB, Massie AB
Predicting chance of liver transplantation for pediatric wait-list candidates.
The authors sought to predict the chance of receiving a deceased donor liver transplant (DDLT) for pediatric patients. Their model accurately predicted chance of transplant and was able to predict DDLT at specific follow-up times. They conclude that their model can serve as the basis for an online tool that would provide useful information for pediatric wait-list candidates.
AHRQ-funded; HS023876.
Citation: Luo X, Mogul DB, Massie AB .
Predicting chance of liver transplantation for pediatric wait-list candidates.
Pediatr Transplant 2019 Nov;23(7):e13542. doi: 10.1111/petr.13542..
Keywords: Children/Adolescents, Transplantation, Healthcare Delivery, Access to Care
Mogul DB, Fredericks EM, Brady TM
Digital wings: innovations in transition readiness for adolescent and young adult transplant recipients.
This article reports on two multi-stakeholder symposia organized by The Johns Hopkins University School of Medicine on February 2, 2018, and January 11, 2019, to address the problem of high graft failure in adolescent and young adult solid organ transplant recipients. Additionally, data collected from recipients demonstrated a substantial gap in how this population uses technologies for health-related activities, alongside an increased interest in an app to help them manage their transplant.
AHRQ-funded; HS023876.
Citation: Mogul DB, Fredericks EM, Brady TM .
Digital wings: innovations in transition readiness for adolescent and young adult transplant recipients.
Transplantation 2019 Oct;103(10):1970-74. doi: 10.1097/tp.0000000000002749..
Keywords: Transplantation, Children/Adolescents, Young Adults, Surgery, Patient-Centered Outcomes Research, Evidence-Based Practice
Mogul DB, Lee J, Purnell TS
Barriers to access in pediatric living-donor liver transplantation.
This study examined knowledge and attitudes about living donor liver transplantation (LDLT) among patients/caregivers for children awaiting or having received a liver transplant. LDLT is only used for 10% of transplant recipients, but has a much better outcome. A survey was conducted among 217 respondents. While 97% of respondents knew an individual could donate a portion of their kidney, only 72% knew evaluation steps, and 69% knew the donor surgery was covered by the recipient’s insurance. Individuals receiving public insurance and without a college degree were less likely to know someone who had been a living donor. This gap in knowledge can create barriers to increasing LDLT for children.
AHRQ-funded; HS023876; HS024600.
Citation: Mogul DB, Lee J, Purnell TS .
Barriers to access in pediatric living-donor liver transplantation.
Pediatr Transplant 2019 Sep;23(6):e13513. doi: 10.1111/petr.13513..
Keywords: Children/Adolescents, Access to Care, Transplantation
Yanik MV, Seifert ME MV, Seifert ME, Locke JE
CYP3A5 genotype affects time to therapeutic tacrolimus level in pediatric kidney transplant recipients.
Optimal management of immunosuppression in kidney transplantation requires a delicate balance of efficacy and toxicity. Tacrolimus (TAC) dose requirements are significantly impacted by genetic variation in CYP3A5 polymorphisms, however the impact that genotype has on clinical outcomes in the pediatric kidney transplant population remains unclear. In this study, the investigators evaluated a retrospective cohort of 98 pediatric kidney transplant recipients. In this paper, they report on their findings.
AHRQ-funded; HS013852.
Citation: Yanik MV, Seifert ME MV, Seifert ME, Locke JE .
CYP3A5 genotype affects time to therapeutic tacrolimus level in pediatric kidney transplant recipients.
Pediatr Transplant 2019 Aug;23(5):e13494. doi: 10.1111/petr.13494..
Keywords: Children/Adolescents, Transplantation, Kidney Disease and Health, Genetics
Fauer AJ, Hoodin F, Lalonde E
Impact of a health information technology tool addressing information needs of caregivers of adult and pediatric hematopoietic stem cell transplantation patients.
The authors of this article developed BMT Roadmap, a health information technology application on a tablet, to address caregivers' unmet needs with patient-specific information from the electronic health record. They conducted a preliminary feasibility study of BMT Roadmap in caregivers of adult and pediatric hematopoietic stem cell transplantation (HSCT) patients and registered the study on ClinicalTrials.gov. They found that BMT Roadmap was a feasible intervention to implement in HSCT caregivers, associated with increased activation and decreased burden; quality of life, however, was lowered across hospitalization. The authors conclude that their findings support the need for further development of caregiver-specific self-directed resources and provision for both inpatient and outpatient across the HSCT trajectory.
AHRQ-funded; HS023613.
Citation: Fauer AJ, Hoodin F, Lalonde E .
Impact of a health information technology tool addressing information needs of caregivers of adult and pediatric hematopoietic stem cell transplantation patients.
Support Care Cancer 2019 Jun;27(6):2103-12. doi: 10.1007/s00520-018-4450-4..
Keywords: Cancer, Caregiving, Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Quality of Life, Transplantation
Perito ER, Mogul DB, VanDerwerken D
The impact of increased allocation priority for children awaiting liver transplant: a Liver Simulated Allocation Model (LSAM) analysis.
This study examined the impact of prioritizing infants, children, adolescents, and the sickest adults (designated Status 1) for deceased donor livers. They compared outcomes for two “SharePeds” allocation schema to the allocation plan approved by the Organ Procurement and Transplant Network (OPTN) in December 2017. Both schemas would decrease waitlist deaths for infants, children, and Status 1 adults and increase access to all donors younger than 35 years.
AHRQ-funded; HS023876.
Citation: Perito ER, Mogul DB, VanDerwerken D .
The impact of increased allocation priority for children awaiting liver transplant: a Liver Simulated Allocation Model (LSAM) analysis.
J Pediatr Gastroenterol Nutr 2019 Apr;68(4):472-79. doi: 10.1097/mpg.0000000000002287.
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Keywords: Children/Adolescents, Transplantation, Policy
Mogul DB, Luo X, Garonzik-Wang J
Expansion of the liver donor supply through greater use of split-liver transplantation: identifying optimal recipients.
While the outcomes of split liver transplantation (SLT) and whole liver transplantation (WLT) are similar among pediatric recipients, the authors hypothesize that the relationship between graft type and outcomes may vary by patient, donor, or surgical characteristics. The study evaluated graft survival among transplant recipients using data from the Scientific Registry of Transplant Recipients to identify similar conditions for risk of graft loss between SLT and WLT. Characteristics associated with graft loss include: donor age, recipient weight, acute hepatic necrosis, autoimmune diseases, tumors, insurance type, and cold ischemia time.
AHRQ-funded; HS023876.
Citation: Mogul DB, Luo X, Garonzik-Wang J .
Expansion of the liver donor supply through greater use of split-liver transplantation: identifying optimal recipients.
Liver Transpl 2019 Jan;25(1):119-27. doi: 10.1002/lt.25340..
Keywords: Children/Adolescents, Patient-Centered Outcomes Research, Transplantation
Platt J, Thiel DB, Kardia SL
Innovating consent for pediatric HCT patients.
The authors discussed hematopoietic cell transplantation (HCT) and informed consent for pediatric patients.
AHRQ-funded; HS023613.
Citation: Platt J, Thiel DB, Kardia SL .
Innovating consent for pediatric HCT patients.
Bone Marrow Transplant 2016 Jun;51(6):885-8. doi: 10.1038/bmt.2016.10.
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Keywords: Children/Adolescents, Transplantation
Kaziunas E, Hanauer DA, Ackerman MS
Identifying unmet informational needs in the inpatient setting to increase patient and caregiver engagement in the context of pediatric hematopoietic stem cell transplantation.
The researchers conducted field observations and semi-structured interviews of pediatric hematopoietic stem cell transplantation (HSCT) caregivers and patients to identify informational challenges in the inpatient hospital setting. Theyn concluded that pediatric HSCT caregivers and patients have multiple informational needs that could be met with a health information technology system that integrates data from several sources, including electronic health records. Meeting these needs could reduce patients' and caregivers' anxiety surrounding the care process.
AHRQ-funded; HS023613.
Citation: Kaziunas E, Hanauer DA, Ackerman MS .
Identifying unmet informational needs in the inpatient setting to increase patient and caregiver engagement in the context of pediatric hematopoietic stem cell transplantation.
J Am Med Inform Assoc 2016 Jan;23(1):94-104. doi: 10.1093/jamia/ocv116.
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Keywords: Caregiving, Children/Adolescents, Electronic Health Records (EHRs), Patient and Family Engagement, Transplantation