National Healthcare Quality and Disparities Report
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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 25 of 118 Research Studies DisplayedCooper Z, Lilley EJ, Bollens-Lund E
High burden of palliative care needs of older adults during emergency major abdominal surgery.
The purpose of this retrospective study was to quantify preoperative illness burden in older adults undergoing emergency major abdominal surgery (EMAS), to examine the association between illness burden and postoperative outcomes, and to describe end-of-life care in the year after discharge. The investigators found that most older adults undergoing EMAS have preexisting high illness burden and experience high mortality and healthcare use in the year after surgery, particularly near the end of life.
AHRQ-funded; HS022763.
Citation: Cooper Z, Lilley EJ, Bollens-Lund E .
High burden of palliative care needs of older adults during emergency major abdominal surgery.
J Am Geriatr Soc 2018 Nov;66(11):2072-78. doi: 10.1111/jgs.15516..
Keywords: Critical Care, Elderly, Palliative Care, Surgery
Dombrowsky A, Borg B, Xie R
Why is hyperparathyroidism underdiagnosed and undertreated in older adults?
The purpose of this study was to determine why older patients with hyperparathyroidism were not appropriately diagnosed and referred for parathyroidectomy. They reviewed charts for a random sample of 25 patients aged 75 and older who had hyperparathyroidism and were referred for surgical evaluation, and 25 who were not referred. The investigators concluded that substantial gaps existed in processes for diagnosis and referral of patients with hyperparathyroidism that led to underdiagnosis and undertreatment.
AHRQ-funded; HS023009.
Citation: Dombrowsky A, Borg B, Xie R .
Why is hyperparathyroidism underdiagnosed and undertreated in older adults?
Clin Med Insights Endocrinol Diabetes 2018 Dec 12;11:1179551418815916. doi: 10.1177/1179551418815916..
Keywords: Diagnostic Safety and Quality, Elderly
Turner AM, Osterhage KP, Taylor JO, et al.
A closer look at health information seeking by older adults and involved family and friends: design considerations for health information technologies.
Older adults are the largest consumers of healthcare. As part of a broader study of personal health information management (PHIM), the investigators interviewed older adults in King County, Washington, and their involved family and friends (FF), regarding health information (HI) sources they seek and utilize. The authors indicated that design considerations include: facilitating access to quality provider-vetted HI, incorporating older adults and FF in the design process, and creating shared spaces for communication of HI among older adults, FF, and providers.
AHRQ-funded; HS022106.
Citation: Turner AM, Osterhage KP, Taylor JO, et al..
A closer look at health information seeking by older adults and involved family and friends: design considerations for health information technologies.
AMIA Annu Symp Proc 2018 Dec 5;2018:1036-45..
Keywords: Elderly, Health Information Technology (HIT), Caregiving, Education: Patient and Caregiver, Health Literacy
Quintana Y, Fahy D, Crotty B
InfoSAGE: Supporting elders and families through online family networks.
With an increasingly elderly population, families are finding it increasingly challenging to coordinate care for their older family members. This paper reports on the findings of InfoSAGE, an online private social network that has tools for communication and care coordination for elders and their families.
AHRQ-funded; HS021495; HS024869.
Citation: Quintana Y, Fahy D, Crotty B .
InfoSAGE: Supporting elders and families through online family networks.
AMIA Annu Symp Proc 2018 Dec 5;2018:932-41..
Keywords: Elderly, Caregiving, Health Information Technology (HIT), Communication, Clinician-Patient Communication, Care Coordination
Sheetz KH, Ibrahim AM, Regenbogen SE
Surgeon experience and Medicare expenditures for laparoscopic compared to open colectomy.
This population-based study examined whether surgeon experience with laparoscopy influenced payments for laparoscopy versus open surgery colectomies. The study used 182,852 national Medicare beneficiaries undergoing colectomies between 2010 and 2012. Surgeons with the most laparoscopic experience did experience an average payment savings of $5456 per patient in laparoscopic versus open cases. For surgeons in the lowest quartile of experience there was no difference.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Ibrahim AM, Regenbogen SE .
Surgeon experience and Medicare expenditures for laparoscopic compared to open colectomy.
Ann Surg 2018 Dec;268(6):1036-42. doi: 10.1097/sla.0000000000002312..
Keywords: Elderly, Surgery, Medicare, Healthcare Costs, Provider: Physician
Weintraub JA, Zimmerman S, Ward K
Improving nursing home residents' oral hygiene: results of a cluster randomized intervention trial.
This paper describes a 2-year cluster randomized trial of Mouth Care Without a Battle (MCWB) that was conducted in nursing homes (NHs) to determine if recommended mouth care practices provided by NH staff could improve residents' oral hygiene and denture outcomes. The investigators found that training NH staff to attend to residents' oral hygiene and denture care had a sustained, favorable impact on residents' oral and denture hygiene after 24 months compared with usual care.
AHRQ-funded; HS022298.
Citation: Weintraub JA, Zimmerman S, Ward K .
Improving nursing home residents' oral hygiene: results of a cluster randomized intervention trial.
J Am Med Dir Assoc 2018 Dec;19(12):1086-91. doi: 10.1016/j.jamda.2018.09.036.
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Keywords: Dental and Oral Health, Elderly, Nursing Homes
Zullo AR, Hersey M, Lee Y
Outcomes of "diabetes-friendly" vs "diabetes-unfriendly" beta-blockers in older nursing home residents with diabetes after acute myocardial infarction.
This study analyzed outcomes of using beta-blockers that are considered “diabetes-friendly” vs “diabetes-unfriendly” in older nursing home residents with diabetes after acute myocardial infarction (AMI). Primary outcomes included hospitalizations for hypoglycemia and hyperglycemia in the 90 days after AMI and secondary outcomes functional decline, death, all-cause re-hospitalization and fracture hospitalization. Out of 2855 nursing home residents with type-2 diabetes (T2D), 29% were prescribed a diabetes-friendly beta-blocker vs. 24% without. T2D medicine showed a reduction in hospitalization for hyperglycemia but was unassociated with hypoglycemia. For secondary outcomes T2D-friendly beta-blocks were associated with a greater rate of re-hospitalization but not death, functional decline, or fracture.
AHRQ-funded; HS022998.
Citation: Zullo AR, Hersey M, Lee Y .
Outcomes of "diabetes-friendly" vs "diabetes-unfriendly" beta-blockers in older nursing home residents with diabetes after acute myocardial infarction.
Diabetes Obes Metab 2018 Dec;20(12):2724-32. doi: 10.1111/dom.13451..
Keywords: Cardiovascular Conditions, Diabetes, Elderly, Heart Disease and Health, Hospitalization, Medication, Nursing Homes, Outcomes, Patient-Centered Outcomes Research
Zhou M, Oakes AH, Bridges JFP
Regional supply of medical resources and systemic overuse of health care among Medicare beneficiaries.
The goal of this study was to explore health care system factors associated with regional variation in overuse of resources, as measured by the Johns Hopkins Overuse Index (JHOI). Medicare fee-for-service claims data from beneficiaries age 65 was used to calculate the JHOI for 306 hospital referral regions in the U.S. Regions with a higher density of primary care physicians had a lower JHOI, which indicates less systemic overuse. Regional characteristics associated with higher JHOI included the number of acute care hospital beds per 1000 residents and number of hospital-based anesthesiologists, pathologists, and radiologists. The authors conclude that regional variations in health care resources are associated with the level of systemic overuse of health care, and that the role of primary care doctors in reducing overuse deserves further attention.
AHRQ-funded; T32 HS000029.
Citation: Zhou M, Oakes AH, Bridges JFP .
Regional supply of medical resources and systemic overuse of health care among Medicare beneficiaries.
J Gen Intern Med 2018 Dec;33(12):2127-31. doi: 10.1007/s11606-018-4638-9..
Keywords: Access to Care, Elderly, Healthcare Delivery, Healthcare Utilization, Medicare, Practice Patterns
Marcum ZA, Walker R, Bobb JF
Serum cholesterol and incident Alzheimer's disease: findings from the adult changes in thought study.
The purpose of this prospective population-based cohort study was to evaluate associations between high-density lipoprotein cholesterol (HDL) and non-HDL-C levels at specific ages and subsequent Alzheimer's disease (AD) risk. The investigators concluded that people with low (120 mg/dL) and high (210 mg/dL) non-HDL-C levels during their 60s and 70s had modestly higher risk of AD than those with intermediate (160 mg/dL) levels.
AHRQ-funded; HS022982.
Citation: Marcum ZA, Walker R, Bobb JF .
Serum cholesterol and incident Alzheimer's disease: findings from the adult changes in thought study.
J Am Geriatr Soc 2018 Dec;66(12):2344-52. doi: 10.1111/jgs.15581..
Keywords: Heart Disease and Health, Dementia, Elderly, Risk
Shuman CJ, Xie XJ, Herr KA
Sustainability of evidence-based acute pain management practices for hospitalized older adults.
This article reported on the sustainability of evidence-based acute pain management practices in hospitalized older adults following testing of a multifaceted Translating Research Into Practice (TRIP) implementation intervention. Results revealed most evidence-based acute pain management practices were sustained for 18 months following implementation.
AHRQ-funded; HS010482.
Citation: Shuman CJ, Xie XJ, Herr KA .
Sustainability of evidence-based acute pain management practices for hospitalized older adults.
West J Nurs Res 2018 Dec;40(12):1749-64. doi: 10.1177/0193945917738781..
Keywords: Care Management, Elderly, Evidence-Based Practice, Inpatient Care, Pain, Implementation
Gray SL, Marcum ZA, Schmader KE
Update on medication use quality and safety in older adults, 2017.
Improving the quality of medication use and medication safety in older adults is an important public health priority and is of paramount importance for clinicians who care for them. In this paper, the investigators selected four important articles (from 2017), that address these issues, to annotate and critique. In addition, they discuss the broader implications for optimizing medication use.
AHRQ-funded; HS023779; HS022982.
Citation: Gray SL, Marcum ZA, Schmader KE .
Update on medication use quality and safety in older adults, 2017.
J Am Geriatr Soc 2018 Dec;66(12):2254-58. doi: 10.1111/jgs.15665..
Keywords: Elderly, Quality of Care, Medication, Medication: Safety, Patient Safety
Quintana Y, Crotty B, Fahy D
Information sharing across generations and environments (InfoSAGE): study design and methodology protocol.
This open prospective cohort study aimed to assess a novel, Internet based, family-centric communication and collaboration platform created to address the information needs of elders and their informal caregivers in a community setting. It used a mixed methods approach, utilizing qualitative survey data along with website usage analytic data.
AHRQ-funded; HS021495.
Citation: Quintana Y, Crotty B, Fahy D .
Information sharing across generations and environments (InfoSAGE): study design and methodology protocol.
BMC Med Inform Decis Mak 2018 Nov 20;18(1):105. doi: 10.1186/s12911-018-0697-4.
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BMC Med Inform Decis Mak 2018 Nov 20;18(1):105. doi: 10.1186/s12911-018-0697-4.
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Keywords: Caregiving, Communication, Decision Making, Elderly, Health Information Technology (HIT), Patient-Centered Healthcare, Clinician-Patient Communication, Web-Based
McConeghy KW, Lee Y, Zullo AR
Influenza illness and hip fracture hospitalizations in nursing home residents: are they related?
In this retrospective cohort study, the investigators evaluated the association between influenza and hip fracture hospitalizations in long-stay (LS) nursing home (NH) residents. The study authors found that influenza like illness (ILI) hospitalizations were associated with a 13% average increase in hip fracture hospitalization risk. In a given NH week, an increase in the number ILI hospitalizations from none to two was associated with an approximate one percentage point increase in hip fracture hospitalization risk.
AHRQ-funded; HS022998.
Citation: McConeghy KW, Lee Y, Zullo AR .
Influenza illness and hip fracture hospitalizations in nursing home residents: are they related?
J Gerontol A Biol Sci Med Sci 2018 Nov 10;73(12):1638-42. doi: 10.1093/gerona/glx200..
Keywords: Elderly, Injuries and Wounds, Hospitalization, Influenza, Long-Term Care, Nursing Homes
Latulipe C, Quandt SA, Melius KA
Insights into older adult patient concerns around the caregiver proxy portal use: qualitative interview study.
The objective of this study was to examine how older adult patients perceive the benefits and risks of proxy patient portal access by their caregivers. The investigators concluded that patients shared their electronic patient portal credentials with caregivers to receive the benefits of those caregivers having access to important medical information but were unaware of all the information those caregivers could access. They suggest that better portal design could alleviate these unwanted information disclosures.
AHRQ-funded; HS021679.
Citation: Latulipe C, Quandt SA, Melius KA .
Insights into older adult patient concerns around the caregiver proxy portal use: qualitative interview study.
J Med Internet Res 2018 Nov 2;20(11):e10524. doi: 10.2196/10524..
Keywords: Electronic Health Records (EHRs), Elderly, Health Information Technology (HIT), Caregiving
Jayadevappa R, Chhatre S, Newman DK
Association between overactive bladder treatment and falls among older adults.
The purpose of this study was to analyze the risk of falls associated with overactive bladder (OAB) and the effects of OAB treatment on falls among older adult Medicare fee-for-service enrollees. Results showed that a diagnosis of OAB was associated with higher odds of falls compared to those without OAB and that treatment for OAB was associated with lower odds of falls compared to those untreated.
AHRQ-funded; HS024106.
Citation: Jayadevappa R, Chhatre S, Newman DK .
Association between overactive bladder treatment and falls among older adults.
Neurourol Urodyn 2018 Nov;37(8):2688-94. doi: 10.1002/nau.23719..
Keywords: Falls, Elderly, Patient Safety
Newgard CD, Malveau S, Zive D
Building a longitudinal cohort from 9-1-1 to 1-year using existing data sources, probabilistic linkage, and multiple imputation: a validation study.
The objective of this seven-county study was to describe and validate construction of a population-based, longitudinal cohort of injured older adults from 9-1-1 call to 1-year follow-up. Results showed that a population-based emergency care cohort with long-term outcomes can be constructed from existing data sources with high accuracy and reasonable validity of resulting variables.
AHRQ-funded; HS023796.
Citation: Newgard CD, Malveau S, Zive D .
Building a longitudinal cohort from 9-1-1 to 1-year using existing data sources, probabilistic linkage, and multiple imputation: a validation study.
Acad Emerg Med 2018 Nov;25(11):1268-83. doi: 10.1111/acem.13512..
Keywords: Data, Research Methodologies, Elderly, Emergency Department, Injuries and Wounds
Makam AN, Nguyen OK, Kirby B
Effect of site-neutral payment policy on long-term acute care hospital use.
The purpose of this study was to assess the projected effect of the Centers for Medicare and Medicaid Services new site-neutral payment policy, which aims to decrease unnecessary long-term acute care hospital (LTACH) admissions by reducing reimbursements for less-ill individuals by 2020. The investigators concluded that the site-neutral payment policy may limit LTACH access in existing LTAC-scarce markets, with potential adverse implications for recovery of hospitalized older adults.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Kirby B .
Effect of site-neutral payment policy on long-term acute care hospital use.
J Am Geriatr Soc 2018 Nov;66(11):2104-11. doi: 10.1111/jgs.15539..
Keywords: Policy, Hospitalization, Payment, Long-Term Care, Healthcare Costs, Medicare, Elderly, Hospitals
Kenzik KM, Mehta A, Richman JS
Congestive heart failure in older adults diagnosed with follicular lymphoma: a population-based study.
This population-based study examined congestive heart failure in older adults diagnosed with follicular lymphoma. The investigators concluded that patients with follicular lymphoma who were exposed to anthracyclines between the ages of 66 years and 75 years were found to be at an increased risk of new-onset CHF; preexisting hypertension and diabetes appeared to increase this risk.
AHRQ-funded; HS023009.
Citation: Kenzik KM, Mehta A, Richman JS .
Congestive heart failure in older adults diagnosed with follicular lymphoma: a population-based study.
Cancer 2018 Nov 1;124(21):4221-30. doi: 10.1002/cncr.31695..
Keywords: Cancer, Elderly, Heart Disease and Health
Noureldin M, Hass Z, Abrahamson K
Fall risk, supports and services, and falls following a nursing home discharge.
The purpose of this study was to examine whether the presence of supports and services have an impact on the relationship between fall-related risk factors and fall occurrence following a nursing-home discharge. The study sample was comprised of 1459 participants in the Minnesota Return to Community Initiative, who had been assisted in achieving a community discharge; 15 percent of participants fell within 30 days of nursing-home discharge. A structural equation model was used to determine relationship between emerging latent variables and falls. Results indicated that use of high-risk medications and fall concerns/history had a direct, positive effect on falling. Receiving supports/services did not have a direct effect on falls, but the authors note that it reduced the effect of high-risk medication use on falling.
AHRQ-funded; HS020224.
Citation: Noureldin M, Hass Z, Abrahamson K .
Fall risk, supports and services, and falls following a nursing home discharge.
Gerontologist 2018 Nov 3;58(6):1075-84. doi: 10.1093/geront/gnx133..
Keywords: Adverse Events, Elderly, Falls, Nursing Homes, Risk
Makam AN, Nguyen OK, Xuan L
Long-term acute care hospital use of non-mechanically ventilated hospitalized older adults.
In this observational cohort study, the investigators sought to determine why non-mechanically ventilated hospitalized older adults are transferred to long-term acute care (LTAC) hospitals rather than remaining in the hospital. The authors found that nearly half of the variation in LTAC use is independent of illness severity and is explained by which hospital and what region the individual was hospitalized in.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Xuan L .
Long-term acute care hospital use of non-mechanically ventilated hospitalized older adults.
J Am Geriatr Soc 2018 Nov;66(11):2112-19. doi: 10.1111/jgs.15564..
Keywords: Elderly, Hospitalization, Long-Term Care, Respiratory Conditions
Chen LM, Nallamothu BK, Spertus JA
Racial differences in long-term outcomes among older survivors of in-hospital cardiac arrest.
Black patients have worse in-hospital survival than white patients after in-hospital cardiac arrest (IHCA), but less is known about longterm outcomes. In this study, the investigators sought to assess among IHCA survivors whether there are additional racial differences in survival after hospital discharge and to explore potential reasons for differences. The investigators determined that black survivors of IHCA have lower long-term survival compared with white patients, and about half of this difference is not explained by patient factors or treatments after IHCA.
AHRQ-funded; HS020671; HS024698.
Citation: Chen LM, Nallamothu BK, Spertus JA .
Racial differences in long-term outcomes among older survivors of in-hospital cardiac arrest.
Circulation 2018 Oct 16;138(16):1643-50. doi: 10.1161/circulationaha.117.033211..
Keywords: Cardiovascular Conditions, Elderly, Racial and Ethnic Minorities, Outcomes
D'Agata EMC, Varu A, Geffert SF
Acquisition of multidrug-resistant organisms in the absence of antimicrobials.
This nested case-control study was conducted among 137 nursing home residents who did not receive antimicrobials, with 44 acquiring a multi-drug resistant organism. Risk factors identified included receiving gastrointestinal medication that affected the gut microbiome, the number of visits from healthcare workers, pressure ulcers, and not residing in a dementia unit.
AHRQ-funded; HS021666.
Citation: D'Agata EMC, Varu A, Geffert SF .
Acquisition of multidrug-resistant organisms in the absence of antimicrobials.
Clin Infect Dis 2018 Oct 15;67(9):1437-40. doi: 10.1093/cid/ciy358..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Nursing Homes, Long-Term Care, Elderly, Digestive Disease and Health, Case Study
Skolarus TA, Caram ME, Chapman CH
Castration remains despite decreasing definitive treatment of localized prostate cancer in the elderly: a case for de-implementation.
In this editorial, the authors discuss a study by Yang, et al., published in 2017 in Cancer, in which they used the National Cancer Data Base to examine definitive therapy (prostatectomy or radiotherapy) among 400,000 patients who were diagnosed with intermediate-risk or high-risk prostate cancer between 2004 and 2012.
AHRQ-funded; HS025707.
Citation: Skolarus TA, Caram ME, Chapman CH .
Castration remains despite decreasing definitive treatment of localized prostate cancer in the elderly: a case for de-implementation.
Cancer 2018 Oct 15;124(20):3971-74. doi: 10.1002/cncr.31665..
Keywords: Cancer: Prostate Cancer, Elderly, Men's Health
Desai NR, Ott LS, George EJ
Variation in and hospital characteristics associated with the value of care for Medicare beneficiaries with acute myocardial infarction, heart failure, and pneumonia.
The objectives of this study were to investigate the association between hospital-level 30-day risk-standardized mortality rates (RSMRs) and 30-day risk-standardized payments (RSPs) for acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PNA); to characterize patterns of value in care; and to identify hospital characteristics associated with high-value care (defined by having lower than median RSMRs and RSPs).
AHRQ-funded; HS023000.
Citation: Desai NR, Ott LS, George EJ .
Variation in and hospital characteristics associated with the value of care for Medicare beneficiaries with acute myocardial infarction, heart failure, and pneumonia.
JAMA Netw Open 2018 Oct 5;1(6):e183519. doi: 10.1001/jamanetworkopen.2018.3519..
Keywords: Cardiovascular Conditions, Elderly, Hospitalization, Hospitals, Heart Disease and Health, Inpatient Care, Medicare, Mortality, Pneumonia
Goodwin JS, Li S, Middleton A
Differences between skilled nursing facilities in risk of subsequent long-term care placement.
The objective of this study was to determine how the risk of subsequent long-term care (LTC) placement varied between skilled nursing facilities (SNFs) and the SNF characteristics associated with this risk. The investigators concluded that risk of subsequent LTC placement, an important and negatively viewed outcome for older adults, varied substantially between SNFs. Individuals in higher-quality SNFs were at lower risk.
AHRQ-funded; HS022134.
Citation: Goodwin JS, Li S, Middleton A .
Differences between skilled nursing facilities in risk of subsequent long-term care placement.
J Am Geriatr Soc 2018 Oct;66(10):1880-86. doi: 10.1111/jgs.15377..
Keywords: Nursing Homes, Long-Term Care, Elderly, Medicare