National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (9)
- Adverse Drug Events (ADE) (91)
- Adverse Events (75)
- Alcohol Use (3)
- Ambulatory Care and Surgery (12)
- Antibiotics (77)
- Antimicrobial Stewardship (42)
- Anxiety (2)
- Arthritis (4)
- Asthma (9)
- Behavioral Health (31)
- Blood Clots (6)
- Blood Pressure (5)
- Blood Thinners (35)
- Brain Injury (3)
- Burnout (1)
- Cancer (23)
- Cancer: Breast Cancer (6)
- Cancer: Cervical Cancer (1)
- Cancer: Colorectal Cancer (1)
- Cancer: Lung Cancer (1)
- Cancer: Prostate Cancer (2)
- Cardiovascular Conditions (43)
- Caregiving (2)
- Care Management (15)
- Case Study (4)
- Children/Adolescents (46)
- Chronic Conditions (40)
- Clinical Decision Support (CDS) (12)
- Clinician-Patient Communication (1)
- Clostridium difficile Infections (3)
- Colonoscopy (1)
- Communication (9)
- Community-Acquired Infections (5)
- Community-Based Practice (3)
- Comparative Effectiveness (15)
- Complementary and Alternative Medicine (1)
- COVID-19 (9)
- Critical Care (7)
- Data (2)
- Dementia (7)
- Dental and Oral Health (6)
- Depression (11)
- Diabetes (22)
- Diagnostic Safety and Quality (7)
- Digestive Disease and Health (7)
- Disparities (5)
- Ear Infections (1)
- Education: Continuing Medical Education (1)
- Education: Patient and Caregiver (4)
- Elderly (48)
- Electronic Health Records (EHRs) (21)
- Electronic Prescribing (E-Prescribing) (5)
- Emergency Department (14)
- Emergency Medical Services (EMS) (1)
- Emergency Preparedness (1)
- Evidence-Based Practice (39)
- Falls (2)
- Genetics (4)
- Guidelines (14)
- Healthcare-Associated Infections (HAIs) (9)
- Healthcare Cost and Utilization Project (HCUP) (7)
- Healthcare Costs (34)
- Healthcare Delivery (5)
- Healthcare Utilization (15)
- Health Information Technology (HIT) (45)
- Health Insurance (12)
- Health Literacy (4)
- Health Services Research (HSR) (1)
- Heart Disease and Health (26)
- Hepatitis (1)
- Home Healthcare (1)
- Hospital Discharge (6)
- Hospitalization (12)
- Hospital Readmissions (3)
- Hospitals (11)
- Human Immunodeficiency Virus (HIV) (13)
- Imaging (2)
- Implementation (4)
- Infectious Diseases (11)
- Injuries and Wounds (7)
- Inpatient Care (6)
- Intensive Care Unit (ICU) (10)
- Kidney Disease and Health (7)
- Labor and Delivery (1)
- Long-Term Care (13)
- Low-Income (1)
- Maternal Care (1)
- Medicaid (11)
- Medical Errors (18)
- Medical Expenditure Panel Survey (MEPS) (4)
- Medicare (19)
- (-) Medication (492)
- Medication: Safety (79)
- Men's Health (1)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (4)
- Mortality (11)
- Neurological Disorders (16)
- Newborns/Infants (10)
- Nursing Homes (18)
- Nutrition (1)
- Obesity (2)
- Obesity: Weight Management (1)
- Opioids (86)
- Orthopedics (3)
- Osteoporosis (1)
- Outcomes (29)
- Pain (28)
- Patient-Centered Healthcare (13)
- Patient-Centered Outcomes Research (43)
- Patient Adherence/Compliance (43)
- Patient and Family Engagement (4)
- Patient Experience (2)
- Patient Safety (90)
- Patient Self-Management (4)
- Payment (3)
- Pneumonia (7)
- Policy (17)
- Practice Patterns (44)
- Pregnancy (4)
- Prevention (31)
- Primary Care (19)
- Primary Care: Models of Care (1)
- Provider (17)
- Provider: Clinician (5)
- Provider: Nurse (3)
- Provider: Pharmacist (19)
- Provider: Physician (12)
- Provider: Physician Assistant (1)
- Public Health (4)
- Quality Improvement (6)
- Quality Measures (1)
- Quality of Care (14)
- Quality of Life (2)
- Racial and Ethnic Minorities (11)
- Registries (5)
- Research Methodologies (6)
- Respiratory Conditions (24)
- Risk (37)
- Rural/Inner-City Residents (1)
- Rural Health (6)
- Screening (7)
- Sepsis (4)
- Sex Factors (4)
- Shared Decision Making (24)
- Sickle Cell Disease (7)
- Skin Conditions (3)
- Sleep Problems (2)
- Social Determinants of Health (4)
- Social Stigma (1)
- Stroke (12)
- Substance Abuse (47)
- Surgery (26)
- Telehealth (4)
- Tobacco Use (1)
- Tobacco Use: Smoking Cessation (1)
- Tools & Toolkits (4)
- Training (2)
- Transitions of Care (2)
- Transplantation (1)
- Treatments (14)
- U.S. Preventive Services Task Force (USPSTF) (6)
- Urban Health (1)
- Urinary Tract Infection (UTI) (4)
- Vaccination (2)
- Vulnerable Populations (5)
- Women (7)
- Workflow (1)
- Young Adults (5)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 492 Research Studies DisplayedZhang K, Potter RF, Marino J
Comparative genomics reveals the correlations of stress response genes and bacteriophages in developing antibiotic resistance of Staphylococcus saprophyticus.
The study explored resistance patterns in Staphylococcus saprophyticus, a common cause of UTIs in women. Genomic analysis linked antibiotic resistance genes to susceptibility, identifying associations with SCCmec configurations and phage elements. This database aids in resistance surveillance for precise diagnosis and treatment, potentially curbing resistance transmission.
AHRQ-funded; HS027621.
Citation: Zhang K, Potter RF, Marino J .
Comparative genomics reveals the correlations of stress response genes and bacteriophages in developing antibiotic resistance of Staphylococcus saprophyticus.
mSystems 2023 Dec 21; 8(6):e0069723. doi: 10.1128/msystems.00697-23..
Keywords: Genetics, Antibiotics, Urinary Tract Infection (UTI), Medication
Watterson TL, Stone JA, Kleinschmidt PC
CancelRx case study: implications for clinic and community pharmacy work systems.
This study examined the impact of implementation of CancelRx, a health IT system that automatically communicates medication discontinuations from the clinic electronic health record to the community pharmacy dispensing platform, theoretically improving communication. The system was implemented across a Midwest academic health system in October 2017, using their 15 outpatient community pharmacies to test it. Interviews were conducted with 9 medical assistants, 12 community pharmacists, and 3 pharmacy administrators employed by the health system across 3-time periods between 2017 and 2018: 3-months prior to CancelRx implementation, 3-months after CancelRx implementation, and 9-months after CancelRx implementation. While CancelRx automated and streamlined how medication discontinuation messages were received and processed, it also increased workload and introduced new errors.
AHRQ-funded; HS025793.
Citation: Watterson TL, Stone JA, Kleinschmidt PC .
CancelRx case study: implications for clinic and community pharmacy work systems.
BMC Health Serv Res 2023 Dec 6; 23(1):1360. doi: 10.1186/s12913-023-10396-9..
Keywords: Cancer, Provider: Pharmacist, Medication
Azimi H, Johnson L, Loudermilk C
Medication regimen complexity (MRC-ICU) for in-hospital mortality prediction in COVID-19 patients.
This study’s purpose was to assess if a patient’s medication regimen complexity-intensive care unit (MRC-ICU) score could predict in-hospital mortality in patients with COVID-19. This single-center, observational study was conducted from August 2020 to January 2021. The primary outcome was the area under the receiver operating characteristic (AUROC) for in-hospital mortality for the 48-hour MRC-ICU. The authors assessed age, sequential organ failure assessment (SOFA), and World Health Organization (WHO) COVID-19 Severity Classification. They included 149 patients who had a median SOFA score of 8 (IQR 5-11), and median MRC-ICU score at 48 hours of 15. The in-hospital mortality rate of 36%. The AUROC for MRC-ICU was 0.71 compared to 0.66 for age, 0.81 SOFA, and 0.72 for the WHO Severity Classification. Univariate analysis was used to compare the 4 characteristics. SOFA, MRC-ICU, and WHO Severity Classification all demonstrated significant association with in-hospital mortality, while SOFA, MRC-ICU, and WHO Severity Classification demonstrated significant association with WHO Severity Classification at 7 days. All 4 characteristics showed significant association with mortality; however, only age and SOFA remained significant following multivariate analysis.
AHRQ-funded; HS028485; HS029009.
Citation: Azimi H, Johnson L, Loudermilk C .
Medication regimen complexity (MRC-ICU) for in-hospital mortality prediction in COVID-19 patients.
Hosp Pharm 2023 Dec; 58(6):564-68. doi: 10.1177/00185787231169460..
Keywords: COVID-19, Medication, Mortality, Intensive Care Unit (ICU)
Flannery DD, Zevallos Barboza A, Mukhopadhyay S
Antibiotic use among infants admitted to neonatal intensive care units.
The purpose of this cross-sectional study was to examine antibiotic exposure, days of therapy, types of antibiotics, and changes in use patterns among newborns in neonatal intensive care units (NICUs) across the U.S. Data for almost 1.4 million infants were taken from the Premier Healthcare Database. The most common antibiotics prescribed during the study period were ampicillin, gentamicin, vancomycin, and cefotaxime. Antibiotic use declined substantially over time, primarily because of reductions in ampicillin and gentamicin. The authors noted that these findings probably reflect the penetration of national calls for neonatal antibiotic stewardship efforts and refined early-onset infection risk-assessment strategies; shortage and subsequent discontinuation of cefotaxime may have played a role in the sharp decline in its use and the related increase in ceftazidime use.
AHRQ-funded; HS027468.
Citation: Flannery DD, Zevallos Barboza A, Mukhopadhyay S .
Antibiotic use among infants admitted to neonatal intensive care units.
JAMA Pediatr 2023 Dec; 177(12):1354-56. doi: 10.1001/jamapediatrics.2023.3664..
Keywords: Newborns/Infants, Antibiotics, Medication, Intensive Care Unit (ICU), Critical Care
Kaufman BG, Holland DE, Vanderboom CE
Multicomponent pharmacist intervention did not reduce clinically important medication errors for ambulatory patients initiating direct oral anticoagulants.
The aim of this randomized controlled trial study was to evaluate the effectiveness of a multicomponent intervention for decreasing clinically important medication errors (CIMEs). The researchers included ambulatory patients beginning a DOAC or resuming one after a complication. The intervention included pharmacist evaluation and monitoring based on the implementation of a recently published checklist. The primary measure was anticoagulant-related CIMEs and non-anticoagulant-related CIMEs over 90 days from DOAC initiation. Primary variables included evaluation of the appropriateness of DOAC, need for DOAC affordability assistance, three pharmacist-initiated telephone consultations, access to a DOAC hotline, documented hand-off to the patient's continuity provider, and monitoring of follow-up laboratory tests. A total of 561 patients contributed 479 anticoagulant-CIMEs including 31 preventable and ameliorable ADEs and 448 significant anticoagulant medication errors without subsequent documented ADEs. The most common anticoagulant-related CIMEs were failure to perform required blood tests and concurrent, inappropriate usage of a DOAC with aspirin or NSAIDs despite pharmacist documentation systematically identifying these issues when present. There was no reduction in anticoagulant-related CIMEs among intervention patients or non-anticoagulant-related CIMEs.
AHRQ-funded; HS02592401.
Citation: Kaufman BG, Holland DE, Vanderboom CE .
Multicomponent pharmacist intervention did not reduce clinically important medication errors for ambulatory patients initiating direct oral anticoagulants.
J Gen Intern Med 2023 Dec; 38(16):3526-34. doi: 10.1007/s11606-023-08315-z..
Keywords: Provider: Pharmacist, Medication, Adverse Drug Events (ADE), Adverse Events, Medical Errors, Blood Thinners, Medication: Safety, Patient Safety
Taylor LN, Wilson BM, Singh M
Syndromic antibiograms and nursing home clinicians' antibiotic choices for urinary tract infections.
The goal of this survey study was to determine if providing nursing home (NH) clinicians with syndromic antibiograms improves antibiotic treatment urinary tract infections (UTIs). The researchers concluded providing the NH clinicians with urinary antibiograms is associated with selection of active and optimal antibiotics when empirically treating UTIs under simulated conditions.
AHRQ-funded; HS027820.
Citation: Taylor LN, Wilson BM, Singh M .
Syndromic antibiograms and nursing home clinicians' antibiotic choices for urinary tract infections.
JAMA Netw Open 2023 Dec; 6(12):e2349544. doi: 10.1001/jamanetworkopen.2023.49544..
Keywords: Nursing Homes, Antibiotics, Medication, Urinary Tract Infection (UTI)
Pak TR, Young J, McKenna CS
Risk of misleading conclusions in observational studies of time-to-antibiotics and mortality in suspected sepsis.
Important studies indicate that every hour of sepsis that elapses until antibiotics are administered increases mortality. The researchers of this study found determined that analyses in the influential studies often adjusted for limited covariates, included patients with long delays until antibiotic administration, combined sepsis and septic shock, and used linear models presuming each hour of delay has equal impact on the sepsis and the patient. The purpose of this study was to assess the effect of the analytic decisions on the relationships between time-to-antibiotics and mortality. The researchers retrospectively identified 104,248 adults admitted from 2015-2022 to five hospitals with suspected infection. The patients included 25,990 with suspected septic shock and 23,619 with sepsis without shock. The study found that changing covariates, maximum time-to-antibiotics, and severity stratification altered the magnitude, direction, and significance of observed relationships between time-to-antibiotics and mortality. In a fully adjusted model of patients treated within 6 hours, every hour related with higher mortality for septic shock, but not sepsis without shock or suspected infection alone. Modeling every hour independently confirmed that every hour delay was related with greater mortality for septic shock, but only delays of greater than 6 hours were related with greater mortality for sepsis without shock.
AHRQ-funded; HS027170.
Citation: Pak TR, Young J, McKenna CS .
Risk of misleading conclusions in observational studies of time-to-antibiotics and mortality in suspected sepsis.
Clin Infect Dis 2023 Nov 30; 77(11):1534-43. doi: 10.1093/cid/ciad450..
Keywords: Antibiotics, Medication, Sepsis, Mortality, Quality of Care
Armstrong M, Groner JI, Samora J
Impact of opioid law on prescriptions and satisfaction of pediatric burn and orthopedic patients: an epidemiologic study.
This retrospective chart review study’s goal was to determine the reduction in prescribed opioid pain dosage units to pediatric patients experiencing acute pain and to assess patient satisfaction with pain control 90-day post discharge following the 2017 Ohio opioid prescribing cap law. The cohort included 960 pediatric (age 0-18 years) burn injury and knee arthroscopy patients treated between August 1, 2015-August 31, 2019. In addition, legal guardians prospectively completed a survey for a convenience sample of 50 patients. From pre-law to post-law, there was a significant decrease within the burn and knee cohorts in the median days (1.7 to 1.0 and 5.0 to 3.8, respectively) and median total morphine milligram equivalents (MMEs) prescribed (15.0 to 2.5 and 150.0 to 90.0, respectively). Results from the prospective survey showed that more than half of participants were satisfied (72% burn and 68% knee) with their pain control and felt they received the right amount of medication (84% burn and 56% knee).
AHRQ-funded; HS029183.
Citation: Armstrong M, Groner JI, Samora J .
Impact of opioid law on prescriptions and satisfaction of pediatric burn and orthopedic patients: an epidemiologic study.
PLoS One 2023 Nov 16; 18(11):e0294279. doi: 10.1371/journal.pone.0294279..
Keywords: Children/Adolescents, Opioids, Policy, Medication
McPheeters M, O'Connor EA, Riley S
Pharmacotherapy for alcohol use disorder: a systematic review and meta-analysis.
Researchers conducted a literature review and analysis to compare efficacy of therapies for alcohol use disorder. Their findings supported the use of oral naltrexone at 50 mg/d and acamprosate as first-line pharmacotherapies in conjunction with psychosocial interventions for treating alcohol use disorder.
AHRQ-funded; 75Q80120D00007.
Citation: McPheeters M, O'Connor EA, Riley S .
Pharmacotherapy for alcohol use disorder: a systematic review and meta-analysis.
JAMA 2023 Nov 7; 330(17):1653-65. doi: 10.1001/jama.2023.19761..
Keywords: Medication, Alcohol Use, Evidence-Based Practice, Patient-Centered Outcomes Research
Ramanathan S, Yan CH, Hubbard C
Changes in antibiotic prescribing by dentists in the United States, 2012-2019.
Dentists are the top specialty prescriber of antibiotics in the United States, prescribing 10% of all outpatient antibiotics. The purpose of this retrospective study was to assess trends in the rates of antibiotic prescribing by dentists. The researchers also evaluated if trends varied by agent, specialty, and patient characteristics. The study found that between 2012 and 2019 dentists wrote more than 216 million antibiotic prescriptions. The annual rate of dental antibiotic prescribing remained steady over time. However, the dental prescribing rate increased in the Northeast, among oral and maxillofacial surgeons, prosthodontists, endodontists, periodontists, and for amoxicillin. The mean days' supply significantly decreased over the study period by 0.023 days per 1,000 dentists per year.
AHRQ-funded; HS025177.
Citation: Ramanathan S, Yan CH, Hubbard C .
Changes in antibiotic prescribing by dentists in the United States, 2012-2019.
Infect Control Hosp Epidemiol 2023 Nov; 44(11):1725-30. doi: 10.1017/ice.2023.151..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Dental and Oral Health
Kelm JD, Aubry ST, Cain-Nielsen AH
Impact of state opioid laws on prescribing in trauma patients.
In this cross-sectional study, researchers compared oral morphine equivalents prescribed at discharge before and after the implementation of Michigan's Public Act 251, which established a state-wide policy that limited opioid prescriptions for acute pain to a 7-day supply. Subjects were adult patients who received oral opioids at discharge from a Level 1 trauma center. The findings indicated that prescription amounts for opioids in trauma patients decreased by approximately one-half following the implementation of Public Act 251; there was no compensatory increase in subsequent refill prescriptions. The researchers concluded that further work is needed to evaluate the effect of such policies on pain management and functional recovery after injury.
AHRQ-funded; HS028672; HS027788.
Citation: Kelm JD, Aubry ST, Cain-Nielsen AH .
Impact of state opioid laws on prescribing in trauma patients.
Surgery 2023 Nov; 174(5):1255-62. doi: 10.1016/j.surg.2023.08.006..
Keywords: Opioids, Policy, Medication
Bridges NC, Taber R, Foulds AL
Medications for opioid use disorder in rural primary care practices: patient and provider experiences.
This study’s purpose was to gain a better understanding of the barriers and facilitators operating at multiple levels to access or provide medications for opioid use disorder (MOUD) in rural Pennsylvania. The authors interviewed patients and providers who were involved in the Rural Access to Medication Assisted Treatment in Pennsylvania (RAMP) Project, which facilitated adoption of MOUD in rural primary care clinics. The study conducted 35 semi-structured interviews with MOUD patients and MOUD providers participating in RAMP. The interviews were coded by the study team. Themes from the qualitative interviews were organized in five nested levels: individual, interpersonal, health care setting, community, and public policy. Patients and providers agreed on many barriers (such as lack of providers, lack of transportation, insufficient rapport and trust in patient-provider relationship, and cost, etc.); however, their interpretation of the barrier, or indicated solution, diverged in meaningful ways. Patients described their experiences in broad terms pointing to the social determinants of health while providers focused on their professional roles, responsibilities, and operations within the primary care setting.
AHRQ-funded; HS025072.
Citation: Bridges NC, Taber R, Foulds AL .
Medications for opioid use disorder in rural primary care practices: patient and provider experiences.
J Subst Use Addict Treat 2023 Nov; 154:209133. doi: 10.1016/j.josat.2023.209133..
Keywords: Rural Health, Rural/Inner-City Residents, Opioids, Medication, Substance Abuse, Behavioral Health, Primary Care
Keith A, Jenkins TC, O'Leary S
Reducing length of antibiotics for children with ear infections: protocol for a cluster-randomized trial in the USA.
The objective of the planned study described in this article will be to evaluate two low-cost interventions to increase guideline-concordant antibiotic durations in children with acute otitis media (AOM). The authors will explore differences in implementation effectiveness by patient population, clinician type, clinical setting, and organization as well as by intervention type. They will also conduct formative qualitative interviews with clinicians and administrators and focus groups with the parents of patients. The results of the study will provide a framework for healthcare systems to address the problem of excessive durations of therapy for AOM and to inform national antibiotic stewardship policy development.
AHRQ-funded; HS029153.
Citation: Keith A, Jenkins TC, O'Leary S .
Reducing length of antibiotics for children with ear infections: protocol for a cluster-randomized trial in the USA.
J Comp Eff Res 2023 Nov; 12(11):e230088. doi: 10.57264/cer-2023-0088..
Keywords: Children/Adolescents, Antibiotics, Medication, Ear Infections
Wu L, Chang C, Lo K
Telephone-based social health screening by pharmacists in the nonadherent Medicare population.
The study examined social health needs among Medicare patients and pharmacist-led screening's impact on medication adherence and healthcare use. Using a predictive algorithm, higher-risk patients were identified. Patients accepting referrals had better statin adherence, while those declining had more hospital stays and fewer primary care visits. The findings suggest pharmacist interventions can improve medication adherence without worsening healthcare use or plan membership.
AHRQ-funded; HS027343.
Citation: Wu L, Chang C, Lo K .
Telephone-based social health screening by pharmacists in the nonadherent Medicare population.
J Manag Care Spec Pharm 2023 Nov; 29(11):1184-92. doi: 10.18553/jmcp.2023.29.11.1184..
Keywords: Provider: Pharmacist, Patient Adherence/Compliance, Social Determinants of Health, Medication
Boxley C, Fujimoto M, Ratwani RM
A text mining approach to categorize patient safety event reports by medication error type.
This study examined whether natural language processing can be used to better categorize medication related patient safety event reports. A total of 3,861 medication related patient safety event reports that were previously annotated using a consolidated medication error taxonomy were used to develop three models using the following algorithms: (1) logistic regression, (2) elastic net, and (3) XGBoost. The models were tested and performance was analyzed. The authors found the XGBoost model performed best across all medication error categories. 'Wrong Drug', 'Wrong Dosage Form or Technique or Route', and 'Improper Dose/Dose Omission' categories performed best across the three models. In addition, they identified five words most closely associated with each medication error category and which medication error categories were most likely to co-occur.
AHRQ-funded; HS026481.
Citation: Boxley C, Fujimoto M, Ratwani RM .
A text mining approach to categorize patient safety event reports by medication error type.
Sci Rep 2023 Oct 26; 13(1):18354. doi: 10.1038/s41598-023-45152-w..
Keywords: Health Information Technology (HIT), Patient Safety, Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events
Ranusch A, Lin YJ, Dorsch MP
Role of individual clinician authority in the implementation of informatics tools for population-based medication management: qualitative semistructured interview study.
The objective of this study was to examine how individual authority of clinical pharmacists and anticoagulation nurses is affected by the implementation success of an electronic health record (EHR) direct oral anticoagulant (DOAC) Dashboard for safe DOAC medication prescribing. Researchers conducted semistructured interviews with pharmacists and nurses after the implementation of the EHR DOAC Dashboard at three clinical sites. Results showed that a high level of individual clinician authority was associated with high levels of key facilitators for effective use of the DOAC Dashboard; conversely, a lack of individual authority was associated with key barriers to effective use. The researchers concluded that increased individual clinician authority is a necessary antecedent to the effective implementation of an EHR DOAC Population Management Dashboard.
AHRQ-funded; HS026874.
Citation: Ranusch A, Lin YJ, Dorsch MP .
Role of individual clinician authority in the implementation of informatics tools for population-based medication management: qualitative semistructured interview study.
JMIR Hum Factors 2023 Oct 24; 10:e49025. doi: 10.2196/49025..
Keywords: Medication, Provider: Pharmacist, Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Nurse, Blood Thinners
Shapiro HFJ, Loder E, Shapiro DJ
Association between clinician specialty and prescription of preventive medication for young adults with migraine: a retrospective cohort study.
The purpose of this multicenter retrospective cohort study was to compare prescribing patterns of preventive medications between pediatric and adult neurologists for young adults with migraine. The primary study outcome was whether the patient received a prescription for any preventive medication during the study period. Among the 767 included patients, 37.8% were seen by a pediatric neurologist. Preventive medications were prescribed for 45.2% of patients seen by a pediatric neurologist and 43.2% of patients seen by an adult neurologist. In the mixed effects logistic regression model, clinician specialty was not related with preventive medication use Female sex and number of visits during the study period were related with receiving preventive medication. The study concluded that proportion of young adults being prescribed migraine medications did not differ according to clinician specialty.
AHRQ-funded; HS000063.
Citation: Shapiro HFJ, Loder E, Shapiro DJ .
Association between clinician specialty and prescription of preventive medication for young adults with migraine: a retrospective cohort study.
Headache 2023 Oct; 63(9):1232-39. doi: 10.1111/head.14628..
Keywords: Young Adults, Medication, Pain, Neurological Disorders
Ojala F, Sater MRA, Miller LG
Bayesian modeling of the impact of antibiotic resistance on the efficiency of MRSA decolonization.
The authors analyzed how the persistence of methicillin-resistant Staphylococcus aureus (MRSA) colonization correlates with the genomic presence of antibiotic resistance genes. Using a Bayesian mixed effects survival model, they found that genetic determinants of high-level resistance to mupirocin was strongly associated with failure of the decolonization protocol, but they did not find a similar effect with genetic resistance to chlorhexidine or other antibiotics. They concluded that these results highlight the need to consider the properties of the colonizing MRSA strain when deciding which treatments to include in the decolonization protocol.
AHRQ-funded; HS019388.
Citation: Ojala F, Sater MRA, Miller LG .
Bayesian modeling of the impact of antibiotic resistance on the efficiency of MRSA decolonization.
PLoS Comput Biol 2023 Oct; 19(10):e1010898. doi: 10.1371/journal.pcbi.1010898..
Keywords: Antibiotics, Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Medication
Gómez-Lumbreras A, Boyce RD, Villa-Zapata L
Drugs that interact with colchicine via inhibition of cytochrome P450 3A4 and P-glycoprotein: a signal detection analysis using a database of spontaneously reported adverse events (FAERS).
The objective of this study was to examine clinical outcomes associated with colchicine drug interactions. Researchers conducted a disproportionality analysis using the spontaneous reports of the FDA Adverse Event Reporting System (FAERS). The study’s results identified numerous safety signals for colchicine and CYP3A4/P-gp inhibitor drugs. The authors concluded that avoiding interactions or monitoring for toxicity in patients when co-prescribing colchicine and these agents is highly recommended.
AHRQ-funded; HS025984.
Citation: Gómez-Lumbreras A, Boyce RD, Villa-Zapata L .
Drugs that interact with colchicine via inhibition of cytochrome P450 3A4 and P-glycoprotein: a signal detection analysis using a database of spontaneously reported adverse events (FAERS).
Ann Pharmacother 2023 Oct; 57(10):1137-46. doi: 10.1177/10600280221148031..
Keywords: Medication, Adverse Drug Events (ADE), Adverse Events, Patient Safety
Yan CH, Hubbard CC, Lee TA
Impact of hydrocodone rescheduling on dental prescribing of opioids.
In 2014, the United States Drug Enforcement Administration rescheduled hydrocodone’s controlled substance schedule from III to II, introducing increasing regulations in prescribing and dispensing. In the U.S., dentists often prescribe hydrocodone, and these changes in scheduling may have altered dental prescribing of opioids. The purpose of this study was to assess the impact of the hydrocodone rescheduling on dental prescribing of opioids in the United States. Across the 49-month study period, dentists prescribed 50,412,942 opioid prescriptions. Hydrocodone was the most prescribed opioid, followed by codeine, oxycodone, and tramadol. At index, hydrocodone prescribing immediately decreased by -834.8 Rx/1,000 dentists with increased prescribing of codeine, oxycodone, and tramadol. The mean MME increased at index for all opioids except for hydrocodone, and dosages subsequently decreased during the postindex period.
AHRQ-funded; HS025177.
Citation: Yan CH, Hubbard CC, Lee TA .
Impact of hydrocodone rescheduling on dental prescribing of opioids.
JDR Clin Trans Res 2023 Oct; 8(4):402-12. doi: 10.1177/23800844221102830..
Keywords: Opioids, Medication, Dental and Oral Health, Practice Patterns
Deardorff WJ, Jing B, Growdon ME
Medication misuse and overuse in community-dwelling persons with dementia.
This study sought to characterize a broad spectrum of medication misuse and overuse among community-dwelling persons with dementia (PWD). The authors included community-dwelling adults aged ≥66 in the Health and Retirement Study from 2008 to 2018 linked to Medicare and classified as having dementia using a validated algorithm. Potentially problematic medications were identified as: (1) medication overuse including over-aggressive treatment of diabetes/hypertension (e.g., insulin/sulfonylurea with hemoglobin A1c < 7.5%) and medications inappropriate near end of life based on STOPPFrail and (2) medication misuse including medications that negatively affect cognition and medications from 2019 Beers and STOPP Version 2 criteria. To contextualize, they compared medication use to people without dementia through a propensity-matched cohort by age, sex, comorbidities, and interview year. Among 1441 PWD, median age was 84, 67% female, and 14% Black. Overall, 73% of PWD were prescribed ≥1 potentially problematic medication with a mean of 2.09 per individual in the prior year. This was notable across several domains, as 41% were prescribed ≥1 medications that negatively affects cognition. Frequently prescribed problematic medications identified included proton pump inhibitors (PPIs), non-steroidal anti-inflammatory drugs (NSAIDs), opioids, antihypertensives, and antidiabetic agents. Problematic medication use was higher among PWD compared to those without dementia with 73% versus 67% prescribed ≥1 problematic medication and a mean of 2.09 versus 1.62, respectively.
AHRQ-funded; HS02638.
Citation: Deardorff WJ, Jing B, Growdon ME .
Medication misuse and overuse in community-dwelling persons with dementia.
J Am Geriatr Soc 2023 Oct; 71(10):3086-98. doi: 10.1111/jgs.18463..
Keywords: Medication, Dementia, Elderly
Aklilu AM, Kumar S, Yamamoto Y
Outcomes associated with sodium-glucose cotransporter-2 inhibitor use in acute heart failure hospitalizations complicated by AKI.
This retrospective study examined the association of sodium-glucose cotransporter-2 inhibitor (SGLT2i) use with patients who have KDIGO-defined acute kidney injury (AKI) during acute heart failure (AHF) hospitalizations and their kidney function recovery at 14 days and 30 days using time-varying multivariable Cox-regression analyses. The study looked at 3305 adults hospitalized across 5 Yale New Haven Health Systems between January 2020 and May 2022 with AHF complicated by KDIGO-defined AKI. Of those individuals hospitalized with AHF and AKI, 356 received SGLT2i following AKI diagnosis either as initiation or continuation. The rate of renal recovery was not significantly different among those exposed and unexposed to SGLT2i following AKI (adjusted HR 0.94). SGLT2i exposure was associated with lower risk of 30-day mortality (adjusted HR 0.45). Rates of renal recovery were similar between the exposed and nonexposed cohorts regardless of the proximity of SGLT2i exposure to AKI diagnosis.
AHRQ-funded; HS027626.
Citation: Aklilu AM, Kumar S, Yamamoto Y .
Outcomes associated with sodium-glucose cotransporter-2 inhibitor use in acute heart failure hospitalizations complicated by AKI.
Kidney360 2023 Oct; 4(10):1371-81. doi: 10.34067/kid.0000000000000250..
Keywords: Kidney Disease and Health, Heart Disease and Health, Cardiovascular Conditions, Inpatient Care, Medication, Outcomes
Pitts SI, Olson s, Yanek LR
Pharmacy e-prescription dispensing before and after CancelRx implementation.
The objective of this study was to evaluate the association of implementation of e-prescription cancellation messaging (CancelRx) with medication dispensing after discontinuation of e-prescriptions in electronic health records (EHRs). Patients who had at least one medication e-prescribed in ambulatory care to a health system pharmacy and discontinued within the study period participated in a case series with interrupted time series analysis. Findings indicated that CancelRx implementation was associated with an immediate and sustained reduction in the proportion of e-prescriptions sold after discontinuation in the EHR. The authors concluded that widespread implementation of CancelRx could significantly improve medication safety through the reduction of medication dispensing after discontinuation by prescribers.
AHRQ-funded; HS026584.
Citation: Pitts SI, Olson s, Yanek LR .
Pharmacy e-prescription dispensing before and after CancelRx implementation.
JAMA Intern Med 2023 Oct; 183(10):1120-26. doi: 10.1001/jamainternmed.2023.4192..
Keywords: Medication, Electronic Prescribing (E-Prescribing), Health Information Technology (HIT), Provider: Pharmacist
Herzig SJ, Anderson TS, Urman RD
Risk factors for opioid-related adverse drug events among older adults after hospitalization for major orthopedic procedures.
The purpose of this retrospective cohort study was to identify risk factors for opioid-related adverse drug events (ORADEs) after hospital discharge following orthopedic procedures. The participants of this study included a national sample of Medicare beneficiaries who underwent major orthopedic surgery during hospitalization in 2016 and had an opioid prescription filled within 2 days of discharge. The study found that among 30,514 hospitalizations with a major orthopedic procedure and an opioid claim, a potential ORADE requiring hospital revisit occurred in 2.5%. After adjustment for patient characteristics, prior opioid use, co-prescribed sedating medications, and opioid prescription characteristics were not related with ORADEs. Independent risk factors did include age of 80 years or older, female sex, and clinical conditions, including heart failure, respiratory illness, kidney disease, dementia/delirium, anxiety disorder, and musculoskeletal/nervous system injuries.
AHRQ-funded; HS026215.
Citation: Herzig SJ, Anderson TS, Urman RD .
Risk factors for opioid-related adverse drug events among older adults after hospitalization for major orthopedic procedures.
J Patient Saf 2023 Oct 1; 19(6):379-85. doi: 10.1097/pts.0000000000001144..
Keywords: Elderly, Opioids, Adverse Drug Events (ADE), Adverse Events, Hospitalization, Orthopedics, Surgery, Medication, Risk, Medication: Safety, Patient Safety
Langlieb ME, Sharma P, Hocevar M
The additional cost of perioperative medication errors.
The aim of this study was to calculate the additional annual cost to the U.S. healthcare system attributable to preventable medication errors (MEs) in the operating room. The ME types were grouped into 13 categories by their related harm (or potential harm), and researchers calculated the incidence of operations involving each ME category: 1) delayed or missed required perioperative antibiotic; 2) prolonged hemodynamic swings; 3) untreated postoperative pain; 4) residual neuromuscular blockade; 5) oxygen saturation <90% due to ME; 6) delayed emergence; 7) untreated new onset intraoperative cardiac arrhythmia; 8) medication documentation errors; 9) syringe swaps; 10) presumed hypotension with inability to obtain a blood pressure reading; 11) potential for bacterial contamination due to expired medication syringes; 12) untreated bradycardia <40 beats/min; and 13) other. Through a PubMed search, the researchers established the possibility that the ME category would cause downstream patient harm such as surgical site infection or acute kidney injury, and the additional fully allocated cost of care for each potential downstream patient harm event. The cost of the MEs across the U.S. healthcare system was then calculated by scaling the number of MEs to the total number of annual operations in the United States. The total additional fully allocated annual cost of care due to perioperative MEs was estimated to be $5.33 billion U.S. dollars.
AHRQ-funded; HS024764.
Citation: Langlieb ME, Sharma P, Hocevar M .
The additional cost of perioperative medication errors.
J Patient Saf 2023 Oct 1; 19(6):375-78. doi: 10.1097/pts.0000000000001136..
Keywords: Medication: Safety, Medication, Medical Errors, Adverse Drug Events (ADE), Adverse Events, Surgery, Patient Safety