National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Anxiety (1)
- Behavioral Health (1)
- (-) Brain Injury (5)
- Children/Adolescents (2)
- Clinical Decision Support (CDS) (1)
- Decision Making (1)
- Elderly (2)
- Health Information Technology (HIT) (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 5 of 5 Research Studies DisplayedMarks MR, Dux MC, Rao V
Treatment patterns of anxiety and posttraumatic stress disorder following traumatic brain injury.
Investigators examined psychotropic medication use and psychotherapy patterns among individuals diagnosed with anxiety disorders and PTSD post-traumatic brain injury (TBI). They found that receipt of pharmacotherapy pre- and post-TBI was considerably more common than receipt of psychotherapy. Individuals diagnosed with anxiety were 66% less likely to receive psychotherapy compared with individuals diagnosed with PTSD. Overall, psychotropic medication use and rates of antidepressant prescription use in the anxiety group were higher compared to those in the PTSD group.
AHRQ-funded; HS024560.
Citation: Marks MR, Dux MC, Rao V .
Treatment patterns of anxiety and posttraumatic stress disorder following traumatic brain injury.
J Neuropsychiatry Clin Neurosci 2022 Summer;34(3):247-53. doi: 10.1176/appi.neuropsych.21040104..
Keywords: Anxiety, Behavioral Health, Trauma, Brain Injury, Treatments, Practice Patterns, Medication
Greenberg JK, Olsen MA, Johnson GW
Measures of intracranial injury size do not improve clinical decision making for children with mild traumatic brain injuries and intracranial injuries.
This study evaluated whether measuring traumatic brain injury size (eg, hematoma size) in children with mild traumatic brain injuries (mTBIs) and intracranial injuries (ICIs) improves risk prediction compared with the KIIDS intracranial injury decision support tool for traumatic brain injury (KIIDS-TBI) model. The cohort included children ≤18 years who presented to 1 of the 5 centers within 24 hours of TBI, had Glasgow Coma Scale scores of 13 to 15, and had ICI on neuroimaging. The data set was split into training and testing cohorts. The generalized linear model (GLM) and recursive partitioning (RP) models showed similar specificity across all risk cutoffs, but the GLM model had higher sensitivity. By comparison, the KIIDS-TBI model had slightly higher sensitivity but lower specificity.
AHRQ-funded; HS027075.
Citation: Greenberg JK, Olsen MA, Johnson GW .
Measures of intracranial injury size do not improve clinical decision making for children with mild traumatic brain injuries and intracranial injuries.
Neurosurgery 2022 Jun;90(6):691-99. doi: 10.1227/neu.0000000000001895..
Keywords: Children/Adolescents, Brain Injury, Decision Making
Evans E, Krebill C, Gutman R
Functional motor improvement during inpatient rehabilitation among older adults with traumatic brain injury.
This retrospective cohort study’s goal was to describe the proportion of older adults with traumatic brain injury (TBI) who exhibited minimal detectable change (MDC) and a minimally clinically important difference (MCID) in motor function from inpatient rehabilitation facility (IRF) admission to discharge; and to identify characteristics associated with clinically meaningful improvement in motor function and better discharge functional status. This study used Medicare administrative data probabilistically linked to the National Trauma Data Bank. The authors found that from IRF admission to discharge 84% of patients achieved the MDC threshold, and 68% of patients achieved the MCID threshold for FIM-M scores. A higher probability of achieving the MCID for IM-M scores included better admission motor and cognitive function, lower comorbidity burden, and a length of stay longer than 10 days but only among individuals with lower admission motor function. Older age was associated with a lower FIM-M discharge score but was not associated with the probability of achieving the MCID in FIM-M score.
AHRQ-funded; HS000011.
Citation: Evans E, Krebill C, Gutman R .
Functional motor improvement during inpatient rehabilitation among older adults with traumatic brain injury.
PM R 2022 Apr; 14(4):417-27. doi: 10.1002/pmrj.12644..
Keywords: Elderly, Rehabilitation, Brain Injury, Inpatient Care
Kumar RG, Zhang W, Evans E
Research letter: characterization of older adults hospitalized with traumatic brain injury admitted to long-term acute care hospitals.
The objective of this study was to describe patient, hospital, and geographic characteristics of older adult Medicare beneficiaries who were hospitalized with traumatic brain injury (TBI) then admitted to long-term acute care hospitals. Participants were predominantly White males with an average age of 77.1. Average acute hospital length of stay was 19.4 days. Only 4% of patients were discharged home after a long-term acute care hospital stay; the primary discharge disposition was to skilled nursing facilities. Geographic analyses indicated that Southern and Midwestern states had the greatest number of long-term acute care hospital facilities and highest proportion of admissions. The authors concluded that more research is needed to understand long-term functional outcomes among this population.
AHRQ-funded; HS000011.
Citation: Kumar RG, Zhang W, Evans E .
Research letter: characterization of older adults hospitalized with traumatic brain injury admitted to long-term acute care hospitals.
J Head Trauma Rehabil 2022 Mar-Apr; 37(2):89-95. doi: 10.1097/htr.0000000000000685..
Keywords: Elderly, Brain Injury, Long-Term Care
Greenberg JK, Otun A, Kyaw PT
Usability and acceptability of clinical decision support based on the KIIDS-TBI tool for children with mild traumatic brain injuries and intracranial injuries.
The Kids Intracranial Injury Decision Support tool for Traumatic Brain Injury (KIIDS-TBI) is a validated risk prediction model designed to manage children with mild traumatic brain injuries (mTBI) and intracranial injuries. Implementing electronic clinical decision support (CDS) may help integrate this evidence-based guidance into clinical practice. The purpose of this study was to assess the acceptability and usability of an electronic CDS tool for managing children with mTBI and intracranial injuries. Emergency medicine and neurosurgery physicians (10 each) from 10 hospitals in the United States participated in usability testing of a novel CDS prototype within a simulated electronic health record environment. The testing involved a think-aloud protocol, an acceptability and usability survey, and a semi-structured interview. The prototype underwent two updates during testing based on user feedback. Usability issues identified in the videos were categorized using content analysis, while interview transcripts were analyzed using thematic analysis. The study found that of the 20 participants, the majority worked at teaching hospitals (80%), freestanding children's hospitals (95%), and level-1 trauma centers (75%). During the two prototype updates, issues with clarity of terminology and navigation within the CDS interface were identified and resolved. As a result, the number of usability problems decreased from 35 in phase 1 to 8 in phase 3, and the number of errors made dropped from 18 in phase 1 to 2 in phase 3. According to the survey, 90% of participants found the tool easy to use, 95% found the tool useful in determining a patient's level of care, 90% found it likely to improve resource utilization, and 79% found it likely to improve patient safety. Interview themes focused on the CDS's capability to support evidence-based decision-making and enhance clinical workflow, as well as suggested implementation strategies and potential challenges.
AHRQ-funded; HS027075.
Citation: Greenberg JK, Otun A, Kyaw PT .
Usability and acceptability of clinical decision support based on the KIIDS-TBI tool for children with mild traumatic brain injuries and intracranial injuries.
Appl Clin Inform 2022 Mar; 13(2):456-67. doi: 10.1055/s-0042-1745829..
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Brain Injury, Health Information Technology (HIT)