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Topics
- Children/Adolescents (1)
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- Evidence-Based Practice (4)
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- (-) Health Services Research (HSR) (13)
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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 13 of 13 Research Studies DisplayedTyler A, Jolles M
Methodological progress note: implementation science contributions to healthcare research and practice.
Existing research reflects that specific populations such as senior citizens, minorities, and rural Americans have proportionally less access to telehealth when compared to the average American. The purpose of this study was to explore specific strategies for overcoming barriers to telehealth access through an evaluation of data collected by a medical student-run telehealth education program. During the study period the researchers contacted 47 patients by telephone through the GET (Geriatric Education On Telehealth) Access Program. The study found 4 main themes during the discussions with patients, including: completion of registration steps, familiarity with accessing and using video conferencing software, attainment of proxy access for parents of a pediatric patient, and resolution of miscellaneous technical queries.
AHRQ-funded; HS026512.
Citation: Tyler A, Jolles M .
Methodological progress note: implementation science contributions to healthcare research and practice.
J Hosp Med 2023 Oct; 18(10):920-25. doi: 10.1002/jhm.13147..
Keywords: Implementation, Health Services Research (HSR), Evidence-Based Practice
Tugwell P, Welch V, Magwood O
AHRQ Author: Chang C
Protocol for the development of guidance for collaborator and partner engagement in health care evidence syntheses.
The objectives of this protocol were to: Identify, map, and synthesize findings related to engagement in evidence syntheses; Explore how engagement in evidence synthesis promotes health equity; Develop equity-oriented guidance on methods for conducting, evaluating, and reporting engagement. The authors intended to use their findings to develop draft guidance checklists and assess agreement with each item through an international survey. The guidance checklists will be co-produced and after being finalized at a consensus meeting, an international team will develop guidance for collaborators and partner engagement. The authors concluded that incorporating partnership values and expectations may result in better uptake, potentially reducing health inequities.
AHRQ-authored.
Citation: Tugwell P, Welch V, Magwood O .
Protocol for the development of guidance for collaborator and partner engagement in health care evidence syntheses.
Syst Rev 2023 Aug 2; 12(1):134. doi: 10.1186/s13643-023-02279-1..
Keywords: Evidence-Based Practice, Health Services Research (HSR), Healthcare Delivery
Markham JL, Richardson T, Stephens JR
Essential concepts for reducing bias in observational studies.
This study discussed ways to reduce bias in pediatric observational studies, which may be used instead of randomized controlled trials (RCTs) due to barriers within pediatric populations, including lower disease prevalence, high costs, inadequate funding, and additional regulatory requirements. Observational studies do not involve randomization and thus have more potential for bias when compared with RCTs because of imbalances that can exist between comparison groups. The authors describe techniques to minimize bias by controlling for important measurable covariates within observational studies and discuss the challenges and opportunities in addressing specific variables.
AHRQ-funded; HS028845.
Citation: Markham JL, Richardson T, Stephens JR .
Essential concepts for reducing bias in observational studies.
Hosp Pediatr 2023 Aug; 13(8):e234-e39. doi: 10.1542/hpeds.2023-007116..
Keywords: Research Methodologies, Health Services Research (HSR)
Strayer TE, Hollingsworth EK, Shah AS
Why do older adults decline participation in research? Results from two deprescribing clinical trials.
The objective of this study was to examine reasons why hospitalized older adults declined participation in two deprescribing clinical trials, Shed-MEDS (non-Veterans) and VA DROP (Veterans). The reasons given by participating patients were condensed into three themes: feeling overwhelmed by current health status; lack of interest or mistrust; hesitancy to participate. A greater proportion of Veterans expressed a lack of interest or, while more non-Veterans expressed feeling overwhelmed by their current health status. The authors concluded that understanding the reasons why older adults decline participation can inform future strategies to engage this multimorbid population.
AHRQ-funded; HS026122.
Citation: Strayer TE, Hollingsworth EK, Shah AS .
Why do older adults decline participation in research? Results from two deprescribing clinical trials.
Trials 2023 Jul 18; 24(1):456. doi: 10.1186/s13063-023-07506-7..
Keywords: Elderly, Research Methodologies, Health Services Research (HSR)
Rees CA, Stewart AM, Portillo EN
Reporting of important social determinants of health in pediatric clinical trials.
The purpose of this study was to assess the rates and trends in the reporting of sexual orientation, gender identity, preferred language, and socioeconomic factors in published pediatric clinical trials. The researchers conducted a cross-sectional study of pediatric clinical trials in the United States published from January 1, 2011 through December 31, 2020 in 5 general pediatric and 5 general medical journals with the highest impact factor in their respective fields. Outcomes included reporting of sexual orientation, gender identity, socioeconomic factors, and preferred language. The study found that in 612 trials, 29.6% reported preferred language. Among these, 64.6% exclusively enrolled participants whose preferred language was English. From 2011 to 2020, there was a relative increase in the reporting of preferred language. Socioeconomic factors were reported in 47.9% of trials. There was no significant change in the reporting of socioeconomic factors of published trial results among adolescent participants reported any measure of sexual orientation, and 1.1% reported gender identity. The researchers concluded that despite sexual orientation, gender identity, preferred language, and socioeconomic factors being increasingly recognized as social determinants of health these variables were infrequently included in pediatric clinical trial results reporting.
AHRQ-funded; HS026503.
Citation: Rees CA, Stewart AM, Portillo EN .
Reporting of important social determinants of health in pediatric clinical trials.
Am J Prev Med 2023 Jun; 64(6):918-26. doi: 10.1016/j.amepre.2022.12.004..
Keywords: Children/Adolescents, Social Determinants of Health, Health Services Research (HSR)
Huo T, Glueck DH, Shenkman EA
Stratified split sampling of electronic health records
Data extracted from electronic health records may require very different approaches for model building and analysis than data from clinical research. Because electronic health record data is designed for clinical use, researchers need to engage in the iterative process of defining and provide clear definitions of outcome and predictor variables and assessing associations. This process can increase Type I error rates and decrease the chance of replicability. Failure to consider subgroups may mask heterogeneous relationships between predictor and outcome by subgroups, thus decreasing the generalizability of the findings. To improve the likelihood of both replicability and generalizability, the researchers recommended utilizing a stratified split sample approach for studies using electronic health records. The researchers illustrate the approach through an electronic health record study of the relationships between socio-demographic factors and uptake of hepatic cancer screening, and potential heterogeneity of association in subgroups defined by gender, self-identified race and ethnicity, census-tract level poverty and insurance type.
AHRQ-funded; HS028283.
Citation: Huo T, Glueck DH, Shenkman EA .
Stratified split sampling of electronic health records
BMC Med Res Methodol 2023 May 25; 23(1):128. doi: 10.1186/s12874-023-01938-0..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Research Methodologies, Health Services Research (HSR)
Jaramillo ET, Willging CE, Saldana L
Barriers and facilitators to implementing evidence-based interventions in the context of a randomized clinical trial in the United States: a qualitative study.
This study examined factors that facilitate or impede success in the implementation of evidence-based interventions in a clinical trial. This study utilized the clinical trial SafeCare®, a child maltreatment intervention. Qualitative data were obtained between May and October 2017 as part of a larger mixed-methods study involving a cluster randomized trial comparing SafeCare to usual services for caregivers within nine child welfare agencies across four states. Individual interviews were conducted with a purposive sample of 21 child welfare administrators and 24 supervisors, and 19 focus groups were conducted with 84 providers. Facilitators and barriers were determined with facilitators including: 1) Benefits afforded through RCT participation; (2) Shared vision and sustained buy-in across system and organizational levels; and (3) Ongoing leadership support for SafeCare and the RCT. The three barriers identified that hindered SafeCare were: (1) Insufficient preparation to incorporate SafeCare into services; (2) Perceived lack of fit, leading to mixed support for SafeCare and the RCT; and (3) Requirements of RCT participation at the provider level.
AHRQ-funded; HS023370.
Citation: Jaramillo ET, Willging CE, Saldana L .
Barriers and facilitators to implementing evidence-based interventions in the context of a randomized clinical trial in the United States: a qualitative study.
BMC Health Serv Res 2023 Jan 26; 23(1):88. doi: 10.1186/s12913-023-09079-2..
Keywords: Evidence-Based Practice, Health Services Research (HSR)
Anhang Price R, Quigley DD DD, Hargraves JL
A systematic review of strategies to enhance response rates and representativeness of patient experience surveys.
The purpose of this systematic review study was to explore evidence on survey administration strategies to increase response rates and representativeness of patient surveys. The researchers examined 40 peer-reviewed randomized experiments of administration protocols for patient experience surveys. The study found that when compared to mail-only or telephone-only administration of surveys, mail administration with telephone follow-up provides a median response rate benefit of 13%. Researchers also discovered that while surveys administered only by web usually result in lower response rates than those administered by mail or telephone, the limited evidence for a web-mail-telephone process suggests a potential response rate benefit over a mail-telephone process. Monetary incentives are related with substantial improvements in response rates. The study concluded that mixed-mode survey administration results in increased patient survey response rates than a single mode.
AHRQ-funded; HS025920.
Citation: Anhang Price R, Quigley DD DD, Hargraves JL .
A systematic review of strategies to enhance response rates and representativeness of patient experience surveys.
Med Care 2022 Dec;60(12):910-18. doi: 10.1097/mlr.0000000000001784..
Keywords: Patient Experience, Research Methodologies, Health Services Research (HSR)
Saldanha IJ, Adam GP, Bañez LL
AHRQ Author: Bañez LL
Inclusion of nonrandomized studies of interventions in systematic reviews of interventions: updated guidance from the Agency for Health Care Research and Quality Effective Health Care program.
A guidance workgroup comprised systematic review experts utilized an informal consensus generation method to develop guidelines to inform decisions regarding the inclusion of nonrandomized studies of interventions (NRSIs) in systematic reviews (SRs) of the effects of interventions. The study found that varying topics may require varying decisions regarding NRSI inclusion. The researchers identified key considerations to inform the decisions; from refinement of topics through to development of protocols. During the scoping and refinement of topics, considerations were associated with the clinical decisional dilemma, adequacy of randomized controlled trials (RCTs) to address the crucial questions, risk of bias in NRSIs, and the degree to which NRSIs are likely to complement RCTs. When NRSIs are included, during SR team formation, familiarity with topic-specific data sources and advanced analytic methods for NRSIs should be considered. During protocol development, the decision regarding NRSI inclusion or exclusion should be justified, and potential implications explained. When NRSIs are included, the protocol should describe the processes for synthesizing evidence from RCTs and NRSIs and determining the overall strength of evidence. CONCLUSION: We identified specific considerations for decisions regarding NRSI inclusion in SRs and highlight the importance of flexibility and transparency.
AHRQ-authored; AHRQ-funded; 290-2017-00003 -C; 75Q80120D00001- 75Q8120D00003; 75Q80120D00005 - 75Q8120D00009.
Citation: Saldanha IJ, Adam GP, Bañez LL .
Inclusion of nonrandomized studies of interventions in systematic reviews of interventions: updated guidance from the Agency for Health Care Research and Quality Effective Health Care program.
J Clin Epidemiol 2022 Dec; 152:300-06. doi: 10.1016/j.jclinepi.2022.08.015..
Keywords: Evidence-Based Practice, Research Methodologies, Health Services Research (HSR)
Holtrop JS, Davis MM
Primary care research is hard to do during COVID-19: challenges and solutions.
This study examined challenges in conducting primary care research during the COVID-19 pandemic. The authors used their experience on over 15 individual projects during the pandemic. They identified 3 key challenges to conducting primary care research: (1) practice delivery trickle-down effects, (2) limited/changing resources and procedures for research, and (3) a generally tense milieu in US society during the pandemic. They presented strategies, informed by a set of questions, to help researchers decide how to address these challenges observed during our studies. They encouraged normalization and self-compassion; and encouraged researchers and funders to embrace pragmatic and adaptive research designs as the circumstances with COVID-19 evolve over time.
AHRQ-funded; HS027080.
Citation: Holtrop JS, Davis MM .
Primary care research is hard to do during COVID-19: challenges and solutions.
Ann Fam Med 2022 Nov-Dec; 20(6):568-72. doi: 10.1370/afm.2889..
Keywords: COVID-19, Primary Care, Health Services Research (HSR), Research Methodologies
Coley RY, Duan KI, Hoopes AJ
A call to integrate health equity into learning health system research training.
This paper is a call to integrate health equity into the competency domain for learning health systems (LHS) research training. In 2016, AHRQ recommended seven domains for training and mentoring researchers, but health equity was not included. Scholars in the Consortium for Applied Training to Advance the Learning health system with Scholars/Trainees (CATALyST) K12 program recommend that competency domains be extended to reflect growing demands for evidence on health inequities and interventions to alleviate them. The authors present real-life case studies in an LHS research training program that illustrate facilitators, challenges, and potential solutions at the program, funder, and research community-level to receiving training and mentorship in health equity-focused LHS science. They recommend actions in four areas for LHS research training programs: (a) integrate health equity throughout the current LHS domains; (b) develop training and mentoring in health equity; (c) establish program evaluation standards for consideration of health equity; and (d) bring forth relevant, extant expertise from the areas of health disparities research, community-based participatory research, and community-engaged health services research.
AHRQ-funded; HS026369.
Citation: Coley RY, Duan KI, Hoopes AJ .
A call to integrate health equity into learning health system research training.
Learn Health Syst 2022 Oct;6(4):e10330. doi: 10.1002/lrh2.10330..
Keywords: Learning Health Systems, Health Systems, Health Services Research (HSR), Training, Disparities
Franklin PD, Drane D, Wakschlag L
Development of a learning health system science competency assessment to guide training and proficiency assessment.
This paper describes the development of the learning health systems (LHS) Competency Assessment by the AHRQ-funded ACCELERAT K12 training program. Domain experts and trainees were recruited to define and operationalize items to include in an LHS Competency Assessment to support emerging and existing LHS scientists in prioritizing and monitoring proficiency development. The method used was to conduct sequential interviews with 18 experts who iteratively defined skills and tasks to illustrate stage in proficiency and its progression for each of 42 competencies in the seven LHS expertise domains: systems science; research questions and standards of scientific evidence; research methods; informatics; ethics of research and implementation in health systems; improvement and implementation science; and engagement, leadership, and research management. The LHS Competency Assessment was reviewed, and pilot tested by current trainees and further refinement was completed using their feedback. The LHS Competency Assessment was found to offer consistent, graded criteria across the seven LHS domains.
AHRQ-funded; HS026369.
Citation: Franklin PD, Drane D, Wakschlag L .
Development of a learning health system science competency assessment to guide training and proficiency assessment.
Learn Health Syst 2022 Oct;6(4):e10343. doi: 10.1002/lrh2.10343..
Keywords: Learning Health Systems, Health Systems, Health Services Research (HSR), Training, Education: Curriculum
O'Malley AJ, Landon BE, Zaborski LA
Weak correlations in health services research: weak relationships or common error?
This study examined whether the correlation between a provider's effect on one population of patients and the same provider's effect on another population is underestimated if the effects for each population are estimated separately as opposed to being jointly modeled as random effects, and characterized how the impact of the estimation procedure varies with sample size. The authors used Medicare claims and enrollment data on emergency department (ED) visits, including patient characteristics, the patient’s hospitalization status, and identification of the doctor responsible for the decision to hospitalize the patient. The simulation analysis demonstrated that the joint modeling approach is generally close to unbiased, whereas the stratified approach can be severely biased in small samples. Correlations included 0.98 for female and male patients and only 0.38 using stratified estimation. Correlations for White and non-White patients are 0.99 and 0.28, and for Medicaid dual-eligible and non-dual-eligible patients 0.99 and 0.31, respectively.
AHRQ-funded; HS025408.
Citation: O'Malley AJ, Landon BE, Zaborski LA .
Weak correlations in health services research: weak relationships or common error?
Health Serv Res 2022 Feb;57(1):182-91. doi: 10.1111/1475-6773.13882..
Keywords: Health Services Research (HSR), Research Methodologies