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 (1)
- Adverse Drug Events (ADE) (4)
- Adverse Events (7)
- Antibiotics (3)
- Anxiety (2)
- Asthma (2)
- Behavioral Health (7)
- Blood Pressure (2)
- Blood Thinners (2)
- Brain Injury (1)
- Cancer (17)
- Cancer: Breast Cancer (4)
- Cancer: Colorectal Cancer (1)
- Cancer: Lung Cancer (1)
- Cancer: Prostate Cancer (5)
- Cancer: Skin Cancer (1)
- Cardiovascular Conditions (18)
- Caregiving (2)
- Care Management (5)
- Case Study (3)
- Catheter-Associated Urinary Tract Infection (CAUTI) (1)
- Central Line-Associated Bloodstream Infections (CLABSI) (1)
- Children/Adolescents (18)
- Chronic Conditions (8)
- Clinical Decision Support (CDS) (4)
- Clinician-Patient Communication (1)
- Community-Based Practice (2)
- Comparative Effectiveness (21)
- COVID-19 (4)
- Critical Care (2)
- Cultural Competence (1)
- Data (1)
- Decision Making (10)
- Dementia (6)
- Depression (4)
- Diabetes (4)
- Diagnostic Safety and Quality (9)
- Digestive Disease and Health (2)
- Disabilities (1)
- Education: Patient and Caregiver (2)
- Elderly (10)
- Electronic Health Records (EHRs) (5)
- Emergency Department (3)
- (-) Evidence-Based Practice (142)
- Falls (1)
- Guidelines (32)
- Healthcare-Associated Infections (HAIs) (3)
- Healthcare Costs (1)
- Healthcare Delivery (6)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (9)
- Health Literacy (3)
- Health Services Research (HSR) (4)
- Health Systems (2)
- Heart Disease and Health (8)
- Hepatitis (1)
- Home Healthcare (1)
- Hospitalization (2)
- Hospitals (6)
- Human Immunodeficiency Virus (HIV) (1)
- Imaging (5)
- Implementation (16)
- Infectious Diseases (5)
- Influenza (1)
- Injuries and Wounds (3)
- Inpatient Care (6)
- Intensive Care Unit (ICU) (2)
- Kidney Disease and Health (1)
- Learning Health Systems (3)
- Lifestyle Changes (1)
- Long-Term Care (3)
- Maternal Care (2)
- Medicaid (1)
- Medical Devices (1)
- Medicare (1)
- Medication (16)
- Medication: Safety (4)
- Men's Health (4)
- Mortality (2)
- Neurological Disorders (7)
- Newborns/Infants (4)
- Nursing Homes (5)
- Nutrition (3)
- Obesity (3)
- Obesity: Weight Management (2)
- Opioids (4)
- Orthopedics (1)
- Outcomes (33)
- Pain (1)
- Palliative Care (1)
- Patient-Centered Healthcare (13)
- Patient-Centered Outcomes Research (60)
- Patient Adherence/Compliance (1)
- Patient and Family Engagement (5)
- Patient Safety (12)
- Patient Self-Management (1)
- Pneumonia (1)
- Policy (1)
- Practice Improvement (1)
- Practice Patterns (4)
- Pregnancy (3)
- Prevention (28)
- Primary Care (19)
- Primary Care: Models of Care (5)
- Provider (5)
- Provider: Clinician (1)
- Provider: Nurse (1)
- Provider: Pharmacist (1)
- Provider: Physician (3)
- Provider Performance (2)
- Public Health (2)
- Quality Improvement (15)
- Quality Indicators (QIs) (2)
- Quality Measures (2)
- Quality of Care (16)
- Quality of Life (5)
- Racial and Ethnic Minorities (3)
- Registries (4)
- Rehabilitation (1)
- Research Methodologies (11)
- Respiratory Conditions (11)
- Risk (8)
- Screening (13)
- Sepsis (2)
- Skin Conditions (3)
- Sleep Problems (1)
- Social Determinants of Health (1)
- Stroke (2)
- Substance Abuse (6)
- Surgery (16)
- Teams (3)
- Telehealth (1)
- Tobacco Use (1)
- Tobacco Use: Smoking Cessation (1)
- Training (1)
- Transitions of Care (2)
- Transplantation (3)
- Trauma (1)
- Treatments (7)
- U.S. Preventive Services Task Force (USPSTF) (16)
- Urinary Tract Infection (UTI) (1)
- Vaccination (1)
- Women (8)
- Workforce (1)
- Young Adults (2)
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 142 Research Studies DisplayedNavis A, George MC, Nmashie A
Validation of the Safer Opioid Prescribing Evaluation Tool (SOPET) for assessing adherence to the Centers for Disease Control opioid prescribing guidelines.
This study assessed the use of the Safer Opioid Prescribing Evaluation Tool (SOPET) which was designed to improve the implementation of the 2016 Centers for Disease Control Guidelines on the prescription of opioids for chronic pain. Four raters with varying levels of clinical experience were trained to use the SOPET and then used it to evaluate 21 baseline patient scenarios. Inter-rater reliability was measured using intraclass correlation coefficient (ICC) estimates and their 95% confidence intervals for the total SOPET score based on a mean-rating absolute-agreement, two-way random-effects model. Inter-rater reliability was found to be good for the three physician raters (0.92, 0.97, and 0.99). However, inter-rater reliability for the non-physician rater was lower (0.67).
AHRQ-funded; HS025641.
Citation: Navis A, George MC, Nmashie A .
Validation of the Safer Opioid Prescribing Evaluation Tool (SOPET) for assessing adherence to the Centers for Disease Control opioid prescribing guidelines.
Pain Med 2020 Dec 25;21(12):3655-59. doi: 10.1093/pm/pnaa138..
Keywords: Opioids, Medication, Medication: Safety, Patient Safety, Guidelines, Practice Patterns, Pain, Chronic Conditions, Evidence-Based Practice
Stillman AE, Gatsonis C, Lima JAC
Coronary computed tomography angiography compared with single photon emission computed tomography myocardial perfusion imaging as a guide to optimal medical therapy in patients presenting with stable angina: the RESCUE trial.
Coronary computed tomography angiography compared with single photon emission computed tomography myocardial perfusion imaging as a guide to optimal medical therapy in patients presenting with stable angina: the RESCUE trial.
AHRQ-funded; HS019403.
Citation: Stillman AE, Gatsonis C, Lima JAC .
Coronary computed tomography angiography compared with single photon emission computed tomography myocardial perfusion imaging as a guide to optimal medical therapy in patients presenting with stable angina: the RESCUE trial.
J Am Heart Assoc 2020 Dec 15;9(24):e017993. doi: 10.1161/jaha.120.017993..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Imaging, Comparative Effectiveness, Evidence-Based Practice
Chou R, Blazina I, Bougatsos C
Screening for hepatitis B virus infection in nonpregnant adolescents and adults: updated evidence report and systematic review for the US Preventive Services Task Force.
The authors updated the 2014 hepatitis B virus (HBV) screening review in nonpregnant adolescents and adults to inform the USPSTF. They found no direct evidence for the clinical benefits and harms of HBV screening vs no screening. Antiviral therapy for HBV infection was associated with improved intermediate outcomes and may improve clinical outcomes.
AHRQ-funded; 290201500009I.
Citation: Chou R, Blazina I, Bougatsos C .
Screening for hepatitis B virus infection in nonpregnant adolescents and adults: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2020 Dec 15;324(23):2423-36. doi: 10.1001/jama.2020.19750..
Keywords: U.S. Preventive Services Task Force (USPSTF), Children/Adolescents, Hepatitis, Chronic Conditions, Screening, Evidence-Based Practice, Prevention
Cykert S, Keyserling TC, Pignone M
A controlled trial of dissemination and implementation of a cardiovascular risk reduction strategy in small primary care practices.
Researchers assessed the effect of dissemination and implementation of an intervention consisting of practice facilitation and a risk-stratified, population management dashboard on cardiovascular risk reduction for patients at high risk in small, primary care practices. They found that a risk-stratified, population management dashboard combined with practice facilitation led to substantial reductions of 10-year atherosclerotic cardiovascular disease risk for patients at high risk. They recommended utilizing similar approaches to lead to effective dissemination and implementation of other new evidence, especially in rural and other under-resourced practices.
AHRQ-funded; HS023912.
Citation: Cykert S, Keyserling TC, Pignone M .
A controlled trial of dissemination and implementation of a cardiovascular risk reduction strategy in small primary care practices.
Health Serv Res 2020 Dec;55(6):944-53. doi: 10.1111/1475-6773.13571..
Keywords: Cardiovascular Conditions, Risk, Prevention, Primary Care, Implementation, Evidence-Based Practice, Patient-Centered Healthcare, Patient-Centered Outcomes Research
Hong MR, Lei D, Yousaf M
A real-world study of the longitudinal course of adult atopic dermatitis severity in clinical practice.
This study examined the longitudinal course of adult atopic dermatitis (AD) severity in clinical practice. Dermatology patients were assessed at approximately 6,12, 18, and 24 months by the scoring systems Eczema Area and Severity Index (EASI) and objective-Scoring Atopic Dermatitis (objective-SCORAD). At any visit, 36.2% of cases were scored as moderate, and 18.2% were severe. Among those patients, 25% and 18.6% continued to have moderate or severe scores at 1 or more follow-up visits for EASI, and 22.6% and 24.5% moderate or severe objective-SCORAD scores respectively. Many patients had fluctuating severity scores over time and a minority had persistently moderate or severe lesions over time, and most of those patients were unable to achieve persistent lesional clearance.
AHRQ-funded; HS023011.
Citation: Hong MR, Lei D, Yousaf M .
A real-world study of the longitudinal course of adult atopic dermatitis severity in clinical practice.
Ann Allergy Asthma Immunol 2020 Dec;125(6):686-92.e3. doi: 10.1016/j.anai.2020.07.005.
.
.
Keywords: Skin Conditions, Patient-Centered Outcomes Research, Evidence-Based Practice
Reisz PA, Laviana AA, Zhao Z
Assessing the quality of surgical care for clinically localized prostate cancer: results from the CEASAR study.
Prior studies suggest that nationally endorsed quality measures for prostate cancer care are not linked closely with outcomes. Using a prospective, population based cohort the investigators measured clinically relevant variation in structure, process and outcome measures in men undergoing radical prostatectomy. The authors did not identify and meaningful variation in quality of care across racial groups, age groups and surgeon volume strata, in this cohort, suggesting that men were receiving comparable quality of care across these strata.
AHRQ-funded; HS019356.
Citation: Reisz PA, Laviana AA, Zhao Z .
Assessing the quality of surgical care for clinically localized prostate cancer: results from the CEASAR study.
J Urol 2020 Dec;204(6):1236-41. doi: 10.1097/ju.0000000000001198..
Keywords: Surgery, Cancer: Prostate Cancer, Cancer, Quality of Care, Quality of Life, Patient-Centered Outcomes Research, Comparative Effectiveness, Evidence-Based Practice
Nguyen AM, Cuthel AM, Rogers ES
Attributes of high-performing small practices in a guideline implementation: a multiple-case study.
This study called HealthyHearts NYC was a stepped wedge randomized control trial that tested the effectiveness of practice facilitation in small primary care practices in adopting cardiovascular disease guidelines. The practice-level benchmark desired was having 70% or greater of hypertensive patients having controlled blood pressure. A mixed methods multiple-case study design was used and implemented at 6 small practices. The investigator’s first key finding was that the high-performing and improved practices in their study looked and acted similarly during the intervention implementation. Three key attributes of these practices were found to be: 1) advanced use of electronic health records; 2) dedicated resources and commitment to quality improvement; and 3) an actively engaged lead clinician and office manager.
AHRQ-funded; HS023922.
Citation: Nguyen AM, Cuthel AM, Rogers ES .
Attributes of high-performing small practices in a guideline implementation: a multiple-case study.
J Prim Care Community Health 2020 Jan-Dec;11. doi: 10.1177/2150132720984411..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Primary Care, Evidence-Based Practice, Guidelines, Implementation
Yeung K, Richards J, Goemer E
Costs of using evidence-based implementation strategies for behavioral health integration in a large primary care system.
The purpose of this study was to describe the cost of using evidence-based implementation strategies for sustained behavioral health integration (BHI) involving population-based screening, assessment, and identification at 25 primary care sites of Kaiser Permanente Washington (2015-2018). The investigators concluded that when spread across patients screened in a single year, BHI implementation costs were well within the range for commonly used diagnostic assessments in primary care (eg, laboratory tests).
AHRQ-funded; HS023173.
Citation: Yeung K, Richards J, Goemer E .
Costs of using evidence-based implementation strategies for behavioral health integration in a large primary care system.
Health Serv Res 2020 Dec;55(6):913-23. doi: 10.1111/1475-6773.13592..
Keywords: Healthcare Costs, Evidence-Based Practice, Implementation, Behavioral Health, Primary Care: Models of Care, Primary Care, Patient-Centered Healthcare
Rosas LG, Lv N, Xiao L
Effect of a culturally adapted behavioral intervention for Latino adults on weight loss over 2 years: a randomized clinical trial.
Identifying effective weight loss interventions for Latino adults at risk of diabetes is of critical public health importance. The purpose of this study was to determine whether a culturally adapted behavioral intervention for Latino adults was more effective than usual care for weight loss over 24 months. The investigators concluded that among Latino adults with high diabetes risk, a culturally adapted behavioral lifestyle intervention was effective for weight loss over 12 months but not 24 months.
AHRQ-funded; HS022702.
Citation: Rosas LG, Lv N, Xiao L .
Effect of a culturally adapted behavioral intervention for Latino adults on weight loss over 2 years: a randomized clinical trial.
JAMA Netw Open 2020 Dec;3(12):e2027744. doi: 10.1001/jamanetworkopen.2020.27744..
Keywords: Racial and Ethnic Minorities, Obesity: Weight Management, Obesity, Cultural Competence, Diabetes, Primary Care, Outcomes, Patient-Centered Outcomes Research, Comparative Effectiveness, Evidence-Based Practice
Onaitis MW, Furnary AP, Kosinski AS
Equivalent survival between lobectomy and segmentectomy for clinical stage IA lung cancer.
This study compared the effectiveness of lobectomy and segmentectomy for treatment of clinical stage IA (T1N0) lung cancer patients. The Society of Thoracic Surgeons General Thoracic Surgery Database was linked to Medicare data in 14,286 lung cancer patients who underwent segmentectomy (n = 1654) or lobectomy (n = 12,632) from 2002 to 2015. Survival rates were found to be similar.
AHRQ-funded; HS022279.
Citation: Onaitis MW, Furnary AP, Kosinski AS .
Equivalent survival between lobectomy and segmentectomy for clinical stage IA lung cancer.
Ann Thorac Surg 2020 Dec;110(6):1882-91. doi: 10.1016/j.athoracsur.2020.01.020..
Keywords: Cancer: Lung Cancer, Cancer, Surgery, Mortality, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Gelfand JM, Armstrong AW, Bell S
National Psoriasis Foundation COVID-19 Task Force guidance for management of psoriatic disease during the pandemic: Vversion 1.
This article describes the process that was used to create the first version of a guidance document for management of psoriatic disease during the COVID-19 pandemic developed by the National Psoriasis Foundation. A task force of 18 physician voting members with expertise in dermatology, rheumatology, epidemiology, infectious diseases, and critical care was created with supplementation by nonvoting members. A Delphi process was created, out of which 22 guidance statements were approved. All guidance statements were recommended, with 9 of them high consensus, and the remaining 13 were moderate consensus. Topics covered included how COVID-19 can impact patients, how medical care can be optimized during the pandemic, and what patients can do to lower their risk of getting infected with COVID-19. This guidance will be updated by the TF as new data emerges.
AHRQ-funded; HS026372.
Citation: Gelfand JM, Armstrong AW, Bell S .
National Psoriasis Foundation COVID-19 Task Force guidance for management of psoriatic disease during the pandemic: Vversion 1.
J Am Acad Dermatol 2020 Dec;83(6):1704-16. doi: 10.1016/j.jaad.2020.09.001..
Keywords: Skin Conditions, Chronic Conditions, Care Management, Evidence-Based Practice, Guidelines, COVID-19
Huelster Huelster, Laviana AA, Joyce DD
Radiotherapy after radical prostatectomy: effect of timing of postprostatectomy radiation on functional outcomes.
This study sought to compare patient-reported functional outcomes after radical prostatectomy (RP) and postprostatectomy radiation as well as elucidate the timing of radiation to allow optimal recovery of function. Findings showed that, in men with localized prostate cancer, post-RP radiotherapy was associated with significantly worse sexual, urinary, and bowel function domain scores at 5 years compared to RP alone. Radiation delayed for approximately 24 months after RP may be optimal for preserving erectile function compared to radiation administered closer to the time of RP.
AHRQ-funded; HS019356; HS022640.
Citation: Huelster Huelster, Laviana AA, Joyce DD .
Radiotherapy after radical prostatectomy: effect of timing of postprostatectomy radiation on functional outcomes.
Urol Oncol 2020 Dec;38(12):930.e23-30.e32. doi: 10.1016/j.urolonc.2020.06.022..
Keywords: Cancer: Prostate Cancer, Cancer, Men's Health, Surgery, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice, Comparative Effectiveness
Hu QL, Grant MC, Hornor MA
Technical evidence review for emergency major abdominal operation conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
This technical evidence review focuses on the use of enhanced recovery pathways (ERPs) for emergency major abdominal surgery conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery (ISCR). This national ERP initiative is funded by AHRQ and implemented in 2017 through a collaboration with American College of Surgeons, and Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality. Five common emergency general surgery (EGS) procedures were focused on: perforated peptic ulcer repair, colectomy, lysis of adhesions, small bowel resection, and exploratory laparotomy. The authors identified seventeen candidate components for emergency major abdominal ERP. The components span the continuum of care from preoperative setting to hospital discharge. For every component they conducted a systematic literature review to find relevant studies. Each component was examined for rationale, evidence, and summary and recommendations. Many were supported by evidence and guidelines specific to their particular operation. Key gaps in literature were highlighted, specifically lack of evidence specific to these operations across many ERP processes.
AHRQ-funded; 233201500020I.
Citation: Hu QL, Grant MC, Hornor MA .
Technical evidence review for emergency major abdominal operation conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
J Am Coll Surg 2020 Dec;231(6):743-64.e5. doi: 10.1016/j.jamcollsurg.2020.08.772..
Keywords: Evidence-Based Practice, Surgery, Patient Safety, Quality Improvement, Quality of Care, Patient-Centered Outcomes Research
O'Connor EA, Evans CV, Rushkin MC
Behavioral counseling to pomote a healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: updated evidence report and systematic review for the US Preventive Services Task Force.
Researchers reviewed the benefits and harms of behavioral counseling interventions to improve diet and physical activity in adults with cardiovascular risk factors. They found that medium- and high-contact multisession behavioral counseling interventions to improve diet and increase physical activity for people with elevated blood pressure and lipid levels were effective in reducing cardiovascular events, blood pressure, low-density lipoproteins, and adiposity-related outcomes, with little to no risk of serious harm.
AHRQ-funded; 290201200015I.
Citation: O'Connor EA, Evans CV, Rushkin MC .
Behavioral counseling to pomote a healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2020 Nov 24;324(20):2076-94. doi: 10.1001/jama.2020.17108..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cardiovascular Conditions, Nutrition, Lifestyle Changes, Risk, Prevention, Evidence-Based Practice, Guidelines
Hextrum S, Minhas JS, Liotta EM
Hypocapnia, ischemic lesions, and outcomes after intracerebral hemorrhage.
This research evaluated the relationship between early pCO(2) changes, ischemic lesions and outcomes in patients with intracerebral hemorrhage (ICH). This observational cohort study ran from 2006 to 2019. Arterial blood gas (ABG) measurements and mechanical ventilation settings in the first 72 hours after admission were collected. ABG data was analyzed from 220 patients. Hyperventilation occurred in 52 (28%) of cases and was not associated with clinical severity. Lower initial pCO(2) was associated with greater risk of in-hospital death. MRI images from 33 patients was used to measure the risk of developing ischemic lesions with lower pCO(2). Lower pCO(2) was also associated with a higher risk, except in patients with low initial systolic blood pressure.
AHRQ-funded; HS023437.
Citation: Hextrum S, Minhas JS, Liotta EM .
Hypocapnia, ischemic lesions, and outcomes after intracerebral hemorrhage.
J Neurol Sci 2020 Nov 15;418:117139. doi: 10.1016/j.jns.2020.117139..
Keywords: Stroke, Cardiovascular Conditions, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Makam AN, Nguyen OK, Miller ME
Comparative effectiveness of long-term acute care hospital versus skilled nursing facility transfer.
This study compared the effectiveness of long-term acute care hospital (LTACH) use versus skilled nursing facility (SNF) transfer after hospitalization. Medicare claims linked to electronic health record (EHR) data from six Texas hospitals between 2009 and 2010 were used to conduct a retrospective cohort study of hospitalized patients transferred to either an LTACH or SNF and followed for one year. Out of 3505 patients, 18% were transferred to an LTACH and overall were younger, less likely to be female, and white, but sicker than transfers to an SNF. Patients transferred to an LTACH were less likely to survive (59 vs. 65%) or recover (62.5 vs 66%). Adjusting for demographic and clinical confounders found in Medicare claims and EHR data, transfer location was not significantly associated with differences in mortality but was associated with greater Medicare spending.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Miller ME .
Comparative effectiveness of long-term acute care hospital versus skilled nursing facility transfer.
BMC Health Serv Res 2020 Nov 11;20(1):1032. doi: 10.1186/s12913-020-05847-6..
Keywords: Comparative Effectiveness, Evidence-Based Practice, Long-Term Care, Elderly, Medicare, Transitions of Care, Nursing Homes, Hospitals
Gartlehner G, Vander Schaaf EB, Orr C
Gartlehner G, Vander Schaaf EB, Orr C, Kennedy SM, Clark R, Viswanathan M. Screening for hypertension in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
This paper is an evidence update that accompanies the final recommendation from the U.S. Preventive Services Task Force (USPSTF) on screening and treatment of hypertension in childhood and adolescence. The update confirmed the previous update that the evidence is inconclusive whether the diagnostic accuracy of blood pressure measurements is adequate for screening asymptomatic children and adolescents in primary care. Forty-two studies from 43 publications were included in the final review.
AHRQ-funded; 290201500011I.
Citation: Gartlehner G, Vander Schaaf EB, Orr C .
Gartlehner G, Vander Schaaf EB, Orr C, Kennedy SM, Clark R, Viswanathan M. Screening for hypertension in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2020 Nov 10;324(18):1884-95. doi: 10.1001/jama.2020.11119..
Keywords: Children/Adolescents, U.S. Preventive Services Task Force (USPSTF), Blood Pressure, Screening, Evidence-Based Practice, Prevention, Cardiovascular Conditions
Ehlers AP, Vitous CA, Sales A
Exploration of factors associated with surgeon deviation from practice guidelines for management of inguinal hernias.
Investigators explored factors associated with surgeon choice of approach (minimally invasive vs open) in inguinal hernia repair as a tool to gain an understanding of guideline-discordant care. They found that decision-making for the approach to inguinal hernia repair was largely influenced by surgeon preference and access to resources rather than patient factors. Although a one-size-fits-all approach is not recommended, the operative approach should ideally be informed by patient factors, including hernia characteristics. They recommended addressing surgeon preference and available resources with a clinician-facing decision aid to provide an opportunity to optimize care for patients undergoing inguinal hernia repair.
AHRQ-funded; HS025778.
Citation: Ehlers AP, Vitous CA, Sales A .
Exploration of factors associated with surgeon deviation from practice guidelines for management of inguinal hernias.
JAMA Netw Open 2020 Nov 2;3(11):e2023684. doi: 10.1001/jamanetworkopen.2020.23684..
Keywords: Surgery, Guidelines, Provider: Physician, Provider, Decision Making, Evidence-Based Practice
Chan B, Freeman M, Ayers C
A systematic review and meta-analysis of medications for stimulant use disorders in patients with co-occurring opioid use disorders.
This systematic review and meta-analysis looked at medication efficacy for stimulant use disorders in patients with co-occurring opioid use disorders. Multiple databases were searched through April 2019 for randomized controlled trials, and dual-screened studies using pre-specified inclusion criteria. Thirty-four trials of 22 medications focused on cocaine use disorder in patients with opioid use disorder. Most studies used methadone treatment for patients with opioid use disorder. Primary outcomes were abstinence, defined as stimulant-negative urine for three or more consecutive weeks. However, none of the six studies that assessed abstinence found significant differences among groups. The authors found moderate strength evidence that antidepressants and disulfiram worsened treatment retention. There was low-strength evidence that psychostimulants reduced cocaine use. There was only 1 trial for methamphetamine use disorder which had insufficient strength evidence for naltrexone.
AHRQ-funded; HS022981.
Citation: Chan B, Freeman M, Ayers C .
A systematic review and meta-analysis of medications for stimulant use disorders in patients with co-occurring opioid use disorders.
Drug Alcohol Depend 2020 Nov 1;216:108193. doi: 10.1016/j.drugalcdep.2020.108193..
Keywords: Opioids, Substance Abuse, Medication, Evidence-Based Practice
Hu QL, Fischer CP, Wescott AB
Evidence review for the American College of Surgeons Quality Verification part I: building quality and safety resources and infrastructure.
The goal of this review was to synthesize the evidence supporting the first 4 of 12 American College of Surgeons (ACS) Quality Verification Program core principles of building quality and safety resources and infrastructure. Findings showed that, despite heterogeneous study design and lack of randomized controlled trials, the available literature supports the importance of committed top-level hospital leadership, mid-level leadership, and committee dedicated to surgical quality and culture of safety and high reliability. In conclusion, adequate resources and infrastructure integral to the ACS Quality Verification Program are critical to achieving safe and high-quality surgical outcomes.
AHRQ-funded; 233201500020I.
Citation: Hu QL, Fischer CP, Wescott AB .
Evidence review for the American College of Surgeons Quality Verification part I: building quality and safety resources and infrastructure.
J Am Coll Surg 2020 Nov;231(5):557-69.e1. doi: 10.1016/j.jamcollsurg.2020.08.758..
Keywords: Quality Improvement, Quality of Care, Patient Safety, Surgery, Evidence-Based Practice
Fernald DH, Mullen R,, Hall T
Exemplary practices in cardiovascular care: results on clinical quality measures from the EvidenceNOW Southwest Cooperative.
The authors identified practice characteristics associated with high performance on four cardiovascular disease cardiovascular clinical quality measures (CQMs). They found that multiple strategies - registries, prompts and protocols, patient self-management support, and patient-team partnership activities - were associated with delivering high-quality cardiovascular care over time, measured by CQMs.
AHRQ-funded; HS023904.
Citation: Fernald DH, Mullen R,, Hall T .
Exemplary practices in cardiovascular care: results on clinical quality measures from the EvidenceNOW Southwest Cooperative.
J Gen Intern Med 2020 Nov;35(11):3197-204. doi: 10.1007/s11606-020-06094-5..
Keywords: Cardiovascular Conditions, Quality Indicators (QIs), Quality Measures, Quality Improvement, Quality of Care, Evidence-Based Practice, Patient-Centered Outcomes Research, Primary Care
Zimmerman S, Wretman CJ, Ward K
Fidelity and sustainability of Mouth Care Without a Battle and lessons for other innovations in care.
This project examined the fidelity and sustainability of Mouth Care Without a Battle (MCWB), an evidence-based program conducted in a two-year cluster randomized trial in 14 nursing homes. The investigators found that results that triangulated two sources of data indicated that fidelity decreased after the first year; results provided guidance to promote fidelity and sustainability of this and other new care practices in nursing homes, including ongoing education, coaching, evaluation, feedback, and sufficient resources.
AHRQ-funded; HS022298.
Citation: Zimmerman S, Wretman CJ, Ward K .
Fidelity and sustainability of Mouth Care Without a Battle and lessons for other innovations in care.
Geriatr Nurs 2020 Nov-Dec;41(6):878-84. doi: 10.1016/j.gerinurse.2020.06.002..
Keywords: Elderly, Nursing Homes, Long-Term Care, Evidence-Based Practice
Nijhawan AE, Bhattatiry M, Chansard M
HIV care cascade before and after hospitalization: impact of a multidisciplinary inpatient team in the US South.
Hospitalization represents an opportunity to re-engage out-of-care individuals, improve HIV outcomes, and reduce health disparities. The authors reviewed electronic health records of HIV-positive individuals hospitalized at an urban, public hospital between September 2013 and December 2015. They found that hospitalized patients with HIV had low rates of engagement in care, retention in care, and virologic suppression, though all three outcomes improved after hospitalization. A multidisciplinary transitions team improved care engagement and virologic suppression in those who received the intervention.
AHRQ-funded; HS022418.
Citation: Nijhawan AE, Bhattatiry M, Chansard M .
HIV care cascade before and after hospitalization: impact of a multidisciplinary inpatient team in the US South.
AIDS Care 2020 Nov;32(11):1343-52. doi: 10.1080/09540121.2019.1698704.
.
.
Keywords: Human Immunodeficiency Virus (HIV), Transitions of Care, Inpatient Care, Teams, Hospitalization, Patient and Family Engagement, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Silverberg JI, Lai JS, Patel KR
Measurement properties of the Patient-Reported Outcomes Information System (PROMIS(®) ) Itch Questionnaire: itch severity assessments in adults with atopic dermatitis.
This study evaluated the validity of numeric rating scales (NRS) and verbal rating scales (VRS) for itch and itch frequency for assessing itch severity in atopic dermatitis (AD). The authors evaluated the Patient-Reported Outcomes Information System (PROMIS(®) ) Itch Questionnaire (PIQ) - itch severity assessment, including multiple NRS, VRS and frequency of itch assessments, in adults with AD and compared their performance. The evaluation involved self-administered questionnaires and skin examinations performed in 410 patients with AD (aged 18-90 years) in a dermatology practice setting. PIQ NRS, VRS and frequency of itch had good content validity, strong correlations with one another and weak-to-moderate correlations with patient-oriented eczema measure (POEM), Eczema Area and Severity Index (EASI), objective SCORing AD (SCORAD) and Dermatology Life Quality Index (DLQI) and very good discriminant validity.
AHRQ-funded; HS023011.
Citation: Silverberg JI, Lai JS, Patel KR .
Measurement properties of the Patient-Reported Outcomes Information System (PROMIS(®) ) Itch Questionnaire: itch severity assessments in adults with atopic dermatitis.
Br J Dermatol 2020 Nov;183(5):891-98. doi: 10.1111/bjd.18978..
Keywords: Skin Conditions, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes
Kapoor N, Lacson R, Hammer M
Physician agreement with recommendations contained in a national guideline for the management of incidental pulmonary nodules: a case study.
This survey of physicians was used to determine agreement with recommendations in the national guideline for the management of incidental pulmonary nodules from the 2017 Fleischner Society Guidelines for Management of Incident Pulmonary Nodules (FSG). The FSG contains 18 unique recommendations which were codified into a clinical evidence logic statement (CELS) for this study. The FSG also included ratings for strength of evidence based on the American Society of Chest Physicians grading system. In order to internally grade the strength of evidence behind each recommendation, two medical librarians from the Harvard Library of Evidence analyzed each CELS independently and graded the recommendations based on the supporting clinical studies using the Oxford Centre for Evidence-Based levels of evidence and the US Preventive Service Task Force I-scores. Nine physicians from a single large academic institution were then surveyed via SurveyMonkey to assess agreement with each of the 18 CELS. Agreement on each recommendation ranged from 0 to 100%. This study was meant to be exploratory and to test the hypothesis that guideline nonadherence may be partly affected by lack of physician agreement with guideline component recommendations.
AHRQ-funded; HS024722.
Citation: Kapoor N, Lacson R, Hammer M .
Physician agreement with recommendations contained in a national guideline for the management of incidental pulmonary nodules: a case study.
J Am Coll Radiol 2020 Nov;17(11):1437-42. doi: 10.1016/j.jacr.2020.07.020..
Keywords: U.S. Preventive Services Task Force (USPSTF), Guidelines, Evidence-Based Practice, Respiratory Conditions, Practice Patterns, Provider: Physician, Provider