National Healthcare Quality and Disparities Report
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Topics
- Access to Care (1)
- (-) Cancer (21)
- Cancer: Breast Cancer (10)
- Cancer: Cervical Cancer (2)
- Cancer: Colorectal Cancer (2)
- Cancer: Lung Cancer (1)
- Case Study (1)
- Colonoscopy (1)
- Comparative Effectiveness (1)
- COVID-19 (2)
- Diagnostic Safety and Quality (21)
- Digestive Disease and Health (1)
- Electronic Health Records (EHRs) (2)
- Evidence-Based Practice (2)
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- Infectious Diseases (1)
- Low-Income (1)
- Medical Expenditure Panel Survey (MEPS) (1)
- Patient-Centered Outcomes Research (1)
- Patient Adherence/Compliance (1)
- Prevention (5)
- Primary Care (2)
- Provider Performance (2)
- Quality Improvement (1)
- Quality Measures (1)
- Quality of Care (1)
- Research Methodologies (1)
- Risk (2)
- Screening (11)
- Sexual Health (1)
- Telehealth (1)
- Treatments (1)
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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 21 of 21 Research Studies DisplayedChoi DT, Davila JA, Sansgiry S
Factors associated with delay of diagnosis of hepatocellular carcinoma in patients with cirrhosis.
Researchers examined the frequency of and factors associated with delays in diagnosis of hepatocellular carcinoma (HCC) in a cohort of patients with cirrhosis in the Veterans Health Administration (VHA). Data was collected and analyzed from VHA electronic health records. They found that nearly half of veterans with cirrhosis have delays in diagnosis of HCC of 60 days or more after a red flag, defined by guidelines. They recommended interventions to improve timely follow-up of red flags and adherence to guidelines in order to increase early detection of HCC.
AHRQ-funded; HS027363.
Citation: Choi DT, Davila JA, Sansgiry S .
Factors associated with delay of diagnosis of hepatocellular carcinoma in patients with cirrhosis.
Clin Gastroenterol Hepatol 2021 Aug;19(8):1679-87. doi: 10.1016/j.cgh.2020.07.026..
Keywords: Cancer, Diagnostic Safety and Quality
Shipe ME, Haddad DN, Deppen SA
Modeling the impact of delaying the diagnosis of non-small cell lung cancer during COVID-19
The novel coronavirus (COVID-19) pandemic has led surgical societies to recommend delaying diagnosis and treatment of suspected lung cancer for lesions less than 2 cm. The COVID-19 infection rate at which immediate operative risk exceeds benefit is unknown. Delaying diagnosis can lead to disease progression, but the impact of this delay on mortality is unknown. In this study, the investigators sought to model immediate versus delayed surgical resection in a suspicious lung nodule less than 2 cm.
AHRQ-funded; HS026122.
Citation: Shipe ME, Haddad DN, Deppen SA .
Modeling the impact of delaying the diagnosis of non-small cell lung cancer during COVID-19
Ann Thorac Surg 2021 Jul;112(1):248-54. doi: 10.1016/j.athoracsur.2020.08.025..
Keywords: COVID-19, Cancer: Lung Cancer, Cancer, Diagnostic Safety and Quality, Case Study, Risk
Maduekwe UN, Herb JN, Esther RJ
Pathologic nodal staging for clinically node negative soft tissue sarcoma of the extremities.
This study looked at the need for pathological nodal staging in patients with extremity synovial, clear cell, angiosarcoma, rhabdomyosarcoma, and epithelioid (SCARE) soft tissue sarcoma. Patients included were without clinical nodal involvement undergoing surgical resection in the National Cancer Database (2004-2017). The cohort included 4158 patients, with 669 patients (16%) undergoing regional lymph node surgery (RLNS). Patients with epithelioid and clear cell sarcomas were most likely to undergo RLNS. Forty-five (7%) had positive nodes with clear cell sarcoma (14%) and angiosarcoma (13%) having the highest rates of nodal positivity. Five-year survival was reduced in patients with positive nodes.
AHRQ-funded; HS000032.
Citation: Maduekwe UN, Herb JN, Esther RJ .
Pathologic nodal staging for clinically node negative soft tissue sarcoma of the extremities.
J Surg Oncol 2021 May;123(8):1792-800. doi: 10.1002/jso.26465..
Keywords: Cancer, Diagnostic Safety and Quality, Treatments
Asti L, Hopley C, Avelis C
The potential clinical and economic value of a human papillomavirus primary screening test that additionally identifies genotypes 31, 45, 51, and 52 individually.
This study looked at the potential clinical and economic value of a human papillomavirus (HPV) primary screening test that additionally identified genotypes 31,45,51, and 52 along with genotypes 16 and 18. The authors developed a Markov model of the HPV disease course and evaluated the clinical and economic value of HPV primary screening with Onclarity. Currently HPV primary screening results in 25,194 invasive procedures and 48 invasive cervical cancer (ICC) cases per 100,000 women. Screening with extended genotyping and later screening women with certain genotypes averted 903 to 3163 invasive procedures and results in 0 to 3 more ICC cases compared with current primary screening tests. Extended genotyping was cost effective when costing $75 and cost saving when costing $43. When the probabilities of disease progression increased 2-4 times, it was not cost-effective because it resulted in more ICC cases and accrued fewer quality-adjusted life-years.
AHRQ-funded; HS023317.
Citation: Asti L, Hopley C, Avelis C .
The potential clinical and economic value of a human papillomavirus primary screening test that additionally identifies genotypes 31, 45, 51, and 52 individually.
Sex Transm Dis 2021 May;48(5):370-80. doi: 10.1097/olq.0000000000001327.
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Keywords: Sexual Health, Infectious Diseases, Screening, Diagnostic Safety and Quality, Genetics, Cancer: Cervical Cancer, Cancer, Women
Davis K, Wilbur K, Metzger S
Symptom and needs assessment screening in oncology patients: alternate outreach methods during COVID-19.
This initiative’s goal was to develop alternate outreach methods to cancer patients without access to an electronic portal during COVID-19. The authors implemented a standardized telephone outreach process targeting patients without active electronic portal accounts to improve remote symptom monitoring. A total of 172 screens were completed, identifying 110 needs for 63 individuals. Twenty-eight patients completed patient enrollment, with outreach calls capturing a higher percentage of Black patients (34%) and older adults age 61-80 years old (69%) compared to portal users.
AHRQ-funded; HS026170.
Citation: Davis K, Wilbur K, Metzger S .
Symptom and needs assessment screening in oncology patients: alternate outreach methods during COVID-19.
J Psychosoc Oncol 2021;39(3):452-60. doi: 10.1080/07347332.2021.1890663..
Keywords: COVID-19, Cancer, Access to Care, Telehealth, Health Information Technology (HIT), Diagnostic Safety and Quality
Rauscher GH, Murphy AM, Qiu Q
The "sweet spot" revisited: optimal recall rates for cancer detection with 2D and 3D digital screening mammography in the Metro Chicago Breast Cancer Registry.
The authors examined the trade-offs for higher recall rates in terms of biopsy recommendations and cancer detection in mammography in a single large health care organization. 2D analog, 2D digital, and 3D digital mammography screenings among women 40-79 years old with cancer follow-up were examined. They found that the results of their investigation were in contrast to those of a recent study suggesting appropriateness of higher recall rates. They concluded that optimal cancer detection appeared to be in the recall rate range of 7-9% for both 2D digital mammography and 3D tomosynthesis.
AHRQ-funded; HS018366.
Citation: Rauscher GH, Murphy AM, Qiu Q .
The "sweet spot" revisited: optimal recall rates for cancer detection with 2D and 3D digital screening mammography in the Metro Chicago Breast Cancer Registry.
AJR Am J Roentgenol 2021 Apr;216(4):894-902. doi: 10.2214/ajr.19.22429.
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Keywords: Cancer: Breast Cancer, Cancer, Imaging, Screening, Diagnostic Safety and Quality, Women, Prevention
Jones OT, Calanzani N, Saji S
Artificial intelligence techniques that may be applied to primary care data to facilitate earlier diagnosis of cancer: systematic review.
This study’s objective was a systematic review of artificial intelligence (AI) techniques that might facilitate earlier diagnosis of cancer and could be applied to primary care electronic health record (EHR) data. Findings showed that AI techniques have been applied to EHR-type data to facilitate early diagnosis of cancer, but their use in primary care settings is still at an early stage of maturity. Further evidence is needed on their performance using primary care data, implementation barriers, and cost-effectiveness before widespread adoption into routine primary care clinical practice can be recommended.
AHRQ-funded; HS027363.
Citation: Jones OT, Calanzani N, Saji S .
Artificial intelligence techniques that may be applied to primary care data to facilitate earlier diagnosis of cancer: systematic review.
J Med Internet Res 2021 Mar 3;23(3):e23483. doi: 10.2196/23483..
Keywords: Cancer, Diagnostic Safety and Quality, Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT)
Zhou Y, Walter FM, Singh H
Prolonged diagnostic intervals as marker of missed diagnostic opportunities in bladder and kidney cancer patients with alarm features: a longitudinal linked data study.
In England, patients who meet National Institute for Health and Care Excellence (NICE) guideline criteria for suspected cancer should receive a specialist assessment within 14 days. In this study, the researchers examined how quickly bladder and kidney cancer patients who met fast-track referral criteria were actually diagnosed. The investigators found that more than a quarter of patients presenting with fast-track referral features did not achieve a timely diagnosis, suggesting inadequate guideline adherence for some patients.
AHRQ-funded; HS022087.
Citation: Zhou Y, Walter FM, Singh H .
Prolonged diagnostic intervals as marker of missed diagnostic opportunities in bladder and kidney cancer patients with alarm features: a longitudinal linked data study.
Cancers 2021 Jan 5;13(1). doi: 10.3390/cancers13010156..
Keywords: Cancer, Diagnostic Safety and Quality
Rauscher GH, Tossas-Milligan K, Macarol T
Trends in attaining mammography quality benchmarks with repeated participation in a quality measurement program: going beyond the mammography quality standards act to address breast cancer disparities.
The Mammography Quality Standards Act requires that mammography facilities conduct audits, but there are no specifications on the metrics to be measured. In this study, the authors present trends from the first 5 years of data collection to examine whether continued participation in this quality improvement program was associated with an increase in the number of benchmarks met for breast cancer screening.
AHRQ-funded; HS018366.
Citation: Rauscher GH, Tossas-Milligan K, Macarol T .
Trends in attaining mammography quality benchmarks with repeated participation in a quality measurement program: going beyond the mammography quality standards act to address breast cancer disparities.
J Am Coll Radiol 2020 Nov;17(11):1420-28. doi: 10.1016/j.jacr.2020.07.019..
Keywords: Cancer: Breast Cancer, Cancer, Women, Screening, Quality Measures, Quality Improvement, Quality of Care, Diagnostic Safety and Quality
Shah SC, Itzkowitz SH
Reappraising risk factors for inflammatory bowel disease-associated neoplasia: implications for colonoscopic surveillance in IBD.
One of the most feared complications of inflammatory bowel disease [IBD]-associated colitis is colorectal cancer. An opportunity for early detection is being missed in a group that is overlooked as high-risk, as a substantial proportion of colorectal cancers are being diagnosed in individuals with colonic IBD who have disease duration shorter than when guidelines recommend surveillance initiation. In this study, the investigators discuss a viewpoint that supports a paradigm shift that will ideally result in a more effective and higher-value colorectal cancer prevention approach in IBD.
AHRQ-funded; HS026395.
Citation: Shah SC, Itzkowitz SH .
Reappraising risk factors for inflammatory bowel disease-associated neoplasia: implications for colonoscopic surveillance in IBD.
J Crohns Colitis 2020 Sep 7;14(8):1172-77. doi: 10.1093/ecco-jcc/jjaa040..
Keywords: Digestive Disease and Health, Risk, Cancer: Colorectal Cancer, Cancer, Colonoscopy, Prevention, Diagnostic Safety and Quality, Screening
Haymart MR, Reyes-Gastelum D, Caoili E
The relationship between imaging and thyroid cancer diagnosis and survival.
Controversy exists over whether there has been a true increase in the occurrence of thyroid cancer or overdiagnosis secondary to imaging practices. Because cancer overdiagnosis is associated with detection of indolent disease, overdiagnosis can be associated with perceived improvement in survival. The investigators concluded that there was improved disease-specific survival in patients diagnosed with thyroid cancer after thyroid ultrasound as compared with after other imaging.
AHRQ-funded; HS024512.
Citation: Haymart MR, Reyes-Gastelum D, Caoili E .
The relationship between imaging and thyroid cancer diagnosis and survival.
Oncologist 2020 Sep;25(9):765-71. doi: 10.1634/theoncologist.2020-0159..
Keywords: Cancer, Imaging, Diagnostic Safety and Quality
Sprague BL, Miglioretti DL, Lee CI
New mammography screening performance metrics based on the entire screening episode.
Established mammography screening performance metrics use the initial screening mammography assessment because they were developed for radiologist performance auditing, yet these metrics are frequently used to inform health policy and screening decision making. The authors developed new performance metrics based on the final assessment that consider the entire screening episode, including diagnostic workup. They concluded that established screening performance metrics underestimated the interval cancer rate of a mammography screening episode, particularly for women with dense breasts or an elevated breast cancer risk.
AHRQ-funded; HS018366.
Citation: Sprague BL, Miglioretti DL, Lee CI .
New mammography screening performance metrics based on the entire screening episode.
Cancer 2020 Jul 15;126(14):3289-96. doi: 10.1002/cncr.32939..
Keywords: Screening, Diagnostic Safety and Quality, Cancer: Breast Cancer, Cancer, Prevention, Women, Provider Performance, Imaging
Pollack LM, Ekwueme DU, Hung MC Pollack LM, Ekwueme DU, Hung MC, Pollack LM, Ekwueme DU, Hung MC Pollack LM, Ekwueme DU, Hung MC, Hung MC
Estimating the impact of increasing cervical cancer screening in the National Breast and Cervical Cancer Early Detection Program among low-income women in the USA.
The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides free cervical cancer screening to low-income women. This study estimated the health benefits gained in terms of life years (LYs) saved and quality-adjusted life years (QALYs) gained if cervical cancer screening by the NBCCEDP increased to reach more eligible women. The investigators found that the reported estimates emphasized the value of cervical cancer screening program by extending LE in low-income women.
Citation: Pollack LM, Ekwueme DU, Hung MC Pollack LM, Ekwueme DU, Hung MC, Pollack LM, Ekwueme DU, Hung MC Pollack LM, Ekwueme DU, Hung MC, Hung MC .
Estimating the impact of increasing cervical cancer screening in the National Breast and Cervical Cancer Early Detection Program among low-income women in the USA.
Cancer Causes Control 2020 Jul;31(7):691-702. doi: 10.1007/s10552-020-01314-z..
Keywords: Medical Expenditure Panel Survey (MEPS), Cancer: Cervical Cancer, Cancer: Breast Cancer, Cancer, Screening, Women, Diagnostic Safety and Quality, Low-Income
Lowry KP, Coley RY, Miglioretti DL
Screening performance of digital breast tomosynthesis vs digital mammography in community practice by patient age, screening round, and breast density.
The purpose of this study was to compare digital mammography (DM) vs digital breast tomosynthesis (DBT) performance by age, baseline vs subsequent screening round, and breast density category. Information was taken from screening examinations at participating Breast Cancer Surveillance Consortium facilities of 1.5 million women aged 40 to 79 with no prior history of breast cancer. Findings showed that improvements in recall and cancer detection rates with DBT were greatest on baseline mammograms. On subsequent screening mammograms, the benefits of DBT varied by age and breast density, and women with extremely dense breasts did not benefit from improved recall or cancer detection with DBT on subsequent screening rounds.
AHRQ-funded; HS018366.
Citation: Lowry KP, Coley RY, Miglioretti DL .
Screening performance of digital breast tomosynthesis vs digital mammography in community practice by patient age, screening round, and breast density.
JAMA Netw Open 2020 Jul;3(7):e2011792. doi: 10.1001/jamanetworkopen.2020.11792..
Keywords: Imaging, Screening, Cancer: Breast Cancer, Cancer, Women, Evidence-Based Practice, Comparative Effectiveness, Diagnostic Safety and Quality
Franc BL, Thombley R, Luo Y
Using diagnosis codes in claims data to identify cohorts of breast cancer patients following initial treatment.
This article describes how researchers trying to study patterns of care and medical service utilization can use diagnosis codes to help identify patients who had undergone initial breast cancer treatment during the first 5 years after treatment for the primary cancer. The authors used claims data of 51,278 newly diagnosed breast cancer (BC) patients from the BC subset of the 2000-2014 SEER-Medicare linked database. From that database they determined the fraction of BC patients who could be identified using BC-specific does 174.x and v10.3 during the year of diagnosis/treatment and during each of the following 5 years after treatment. They then developed a list of diagnosis codes that were found more often in claims from BC patients than in claims of a cohort of patients without a BC diagnosis. They were able to identify BC patients as belonging to 5 different subgroups. In any single year 72.8-99.1% of BC patients had a claim with a174.x diagnosis code. Another 0-11% of BC patients had a v10.3 code. From their findings they concluded that BC patients can be robustly identified within claims databases.
AHRQ-funded; HS024936.
Citation: Franc BL, Thombley R, Luo Y .
Using diagnosis codes in claims data to identify cohorts of breast cancer patients following initial treatment.
Breast J 2020 Jul;26(7):1472-74. doi: 10.1111/tbj.13758..
Keywords: Cancer: Breast Cancer, Cancer, Diagnostic Safety and Quality, Women, Research Methodologies
DiPiro PJ, Alper DP, Giess CS
Comparing breast and abdominal subspecialists' follow-up recommendations for incidental liver lesions on breast MRI.
This study compared breast and abdominal subspecialists’ follow-up recommendations following discovery of incidental liver lesions (ILLs) after breast MRI. When breast subspecialists recommended no follow-up abdominal subspecialists agreed with them in 29 out of 30 cases examined, but disagreed with 28 or 30 breast subspecialists’ follow-up recommendations. When breast imagers reported no ILLs, there was 93% agreement with abdominal subspecialists.
AHRQ-funded; HS024722.
Citation: DiPiro PJ, Alper DP, Giess CS .
Comparing breast and abdominal subspecialists' follow-up recommendations for incidental liver lesions on breast MRI.
J Am Coll Radiol 2020 Jun;17(6):773-78. doi: 10.1016/j.jacr.2019.12.024..
Keywords: Imaging, Diagnostic Safety and Quality, Screening, Cancer: Breast Cancer, Cancer, Women
Franc BL, Thombley R, Luo BL, Franc BL, Thombley R, Luo R, Luo Y
Identifying tests related to breast cancer care in claims data.
The goal of this study was to develop a method for calculating rates of testing for breast cancer recurrence in patients who have already undergone initial treatment for breast cancer. Rates were calculated from a cohort of Medicare breast cancer patients and an age-matched noncancer cohort. They calculated testing rates in the breast cancer cohort above the background rate in the noncancer population. There were similar estimates of testing prevalence and frequency in the two groups, with exception of prevalence of computed tomography (CT).
AHRQ-funded; HS024936.
Citation: Franc BL, Thombley R, Luo BL, Franc BL, Thombley R, Luo R, Luo Y .
Identifying tests related to breast cancer care in claims data.
Breast J 2020 Jun;26(6):1227-30. doi: 10.1111/tbj.13691..
Keywords: Cancer: Breast Cancer, Cancer, Imaging, Diagnostic Safety and Quality, Healthcare Utilization
Zhou Y, Abel GA, Hamilton W
Imaging activity possibly signalling missed diagnostic opportunities in bladder and kidney cancer: a longitudinal data-linkage study using primary care electronic health records.
Sub-optimal use or interpretation of imaging investigations prior to diagnosis of certain cancers may be associated with less timely diagnosis, but pre-diagnostic imaging activity for urological cancer is unknown. In this study, the investigators analysed linked data derived from primary and secondary care records and cancer registration to evaluate the use of clinically relevant imaging tests pre-diagnosis, in patients with bladder and kidney cancer diagnosed in 2012-15 in England.
AHRQ-funded; HS022087.
Citation: Zhou Y, Abel GA, Hamilton W .
Imaging activity possibly signalling missed diagnostic opportunities in bladder and kidney cancer: a longitudinal data-linkage study using primary care electronic health records.
Cancer Epidemiol 2020 Jun;66:101703. doi: 10.1016/j.canep.2020.101703..
Keywords: Cancer, Diagnostic Safety and Quality, Imaging, Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT)
Lacson R, Wang A, Cochon L
Factors associated with optimal follow-up in women with BI-RADS 3 breast findings.
Investigators assessed the rate of and the factors associated with optimal follow-up in patients with BI-RADS 3 breast findings. They found that follow-up of BI-RADS 3 breast imaging findings is optimal in only 74% of women. They recommended further interventions to promote follow-up targeting younger, unmarried women, those with Hispanic ethnicity, and women without history of breast cancer and without insurance coverage.
AHRQ-funded; HS024722.
Citation: Lacson R, Wang A, Cochon L .
Factors associated with optimal follow-up in women with BI-RADS 3 breast findings.
J Am Coll Radiol 2020 Apr;17(4):469-74. doi: 10.1016/j.jacr.2019.10.003..
Keywords: Cancer: Breast Cancer, Cancer, Imaging, Screening, Women, Diagnostic Safety and Quality
Sprague BL, Coley RY, Kerlikowske K
Assessment of radiologist performance in breast cancer screening using digital breast tomosynthesis vs digital mammography.
Many US radiologists have screening mammography recall rates above the expert-recommended threshold of 12%. The influence of digital breast tomosynthesis (DBT) on the distribution of radiologist recall rates is uncertain. The objective of this study was to evaluate radiologists' recall and cancer detection rates before and after beginning interpretation of DBT examinations.
AHRQ-funded; HS018366.
Citation: Sprague BL, Coley RY, Kerlikowske K .
Assessment of radiologist performance in breast cancer screening using digital breast tomosynthesis vs digital mammography.
JAMA Netw Open 2020 Mar 2;3(3):e201759. doi: 10.1001/jamanetworkopen.2020.1759..
Keywords: Cancer: Breast Cancer, Cancer, Diagnostic Safety and Quality, Imaging, Screening, Women, Prevention, Provider Performance
Murphy CC, Sen A, Watson B
A systematic review of repeat fecal occult blood tests for colorectal cancer screening.
This systematic review examined the prevalence of repeat fecal occult blood tests (FOBT) for colorectal cancer screening. MEDLINE, Embase, and the Cochrane Library were searched for studies published from 1997 to 2017 and reported repeat FOBT over 2 and more screening rounds. Thirty-five articles (n=27) were identified which measured repeat FOBT as 1) proportion of Round 1 participants completing repeat FOBT in Round 2; 2) proportion completing two, consecutive FOBTs; or 3) proportion completing 3 or more rounds. The number of participants completing Round 1 ranged from 24.6% to 89.6%. Those who completed Round 2 ranged from 16.4% to 80%; and completion of 3 or more rounds ranged from 0.8% to 64.1%. Repeat FOBT was higher in mailed outreach than opportunistic screening.
AHRQ-funded; HS022418.
Citation: Murphy CC, Sen A, Watson B .
A systematic review of repeat fecal occult blood tests for colorectal cancer screening.
Cancer Epidemiol Biomarkers Prev 2020 Feb;29(2):278-87. doi: 10.1158/1055-9965.Epi-19-0775..
Keywords: Cancer: Colorectal Cancer, Cancer, Screening, Diagnostic Safety and Quality, Prevention, Patient Adherence/Compliance, Patient-Centered Outcomes Research, Evidence-Based Practice