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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
176 to 200 of 1004 Research Studies DisplayedScott Scott, Kempe A, Bajaj L
"These are our kids": qualitative interviews with clinical leaders in general emergency departments on motivations, processes, and guidelines in pediatric sepsis care.
Researchers sought to identify barriers and facilitators to pediatric sepsis care in general emergency departments (EDs), including care processes, the role of guidelines, and incentivized metrics. They interviewed medical directors, nurse managers, and quality coordinators. They found that leaders in general EDs were motivated to provide high-quality pediatric sepsis care but disagreed on whether reportable metrics would drive improvements. Leaders universally sought direct support from their nearest children's hospitals and actionable guidelines.
AHRQ-funded; HS025696.
Citation: Scott Scott, Kempe A, Bajaj L .
"These are our kids": qualitative interviews with clinical leaders in general emergency departments on motivations, processes, and guidelines in pediatric sepsis care.
Ann Emerg Med 2022 Oct;80(4):347-57. doi: 10.1016/j.annemergmed.2022.05.030..
Keywords: Children/Adolescents, Emergency Department, Sepsis, Guidelines, Evidence-Based Practice
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
Adam GP, Pappas D, Papageorgiou H
A novel tool that allows interactive screening of PubMed citations showed promise for the semi-automation of identification of biomedical literature.
This study looked at a novel tool named Pythia that allows interactive screening of PubMed citations to provide semi-automation of identification of biomedical literature for use with systematic reviews. Pythia incorporates a set of natural-language questions with machine-learning algorithms to rank all PubMed citations based on relevance, returning the 100 top-ranked citations. Of the seven systematic reviews conducted, the number of abstracts reviewed per relevant abstract number needed to read was lower than in the manually screened project in four reviews, higher in two, and had mixed results in one. The reviews that had greater overall sensitivity retrieved more relevant citations in early batches, but retrieval was generally unaffected by other aspects, such as study design, study size, and specific key question.
AHRQ-funded; HS027247.
Citation: Adam GP, Pappas D, Papageorgiou H .
A novel tool that allows interactive screening of PubMed citations showed promise for the semi-automation of identification of biomedical literature.
J Clin Epidemiol 2022 Oct;150:63-71. doi: 10.1016/j.jclinepi.2022.06.007..
Keywords: Research Methodologies, Evidence-Based Practice
Hoonakker PLT, Carayon P, Brown RL
A systematic review of the Consumer Emergency Care Satisfaction Scale (CECSS).
In this study, researchers systematically reviewed the literature on the Consumer Emergency Care Satisfaction Scale (CECSS) and examined its psychometric properties. Their systematic literature search resulted in 28 articles in which the CECSS was used, demonstrating that, from a psychometric perspective, the CECSS is a valid and reliable instrument. However, their study also showed that the CECSS has several weaknesses, and they made recommendations for its improvement.
AHRQ-funded; HS026624.
Citation: Hoonakker PLT, Carayon P, Brown RL .
A systematic review of the Consumer Emergency Care Satisfaction Scale (CECSS).
J Nurs Care Qual 2022 Oct-Dec;37(4):349-55. doi: 10.1097/ncq.0000000000000636..
Keywords: Emergency Department, Patient Experience
Chen Z, Gleason LJ, Sanghavi P
Accuracy of pressure ulcer events in US nursing home ratings.
This study investigated the accuracy of the government website Nursing Home Compare (NHC) pressure ulcer measures, which are chief indicators of nursing home patient safety. The authors identified hospital admissions for pressure ulcers and linked them to the nursing home-reported data at the patient level using Medicare fee-for-service beneficiaries who were nursing home residents between 2011 and 2017. Percentages of pressure ulcers that were appropriately reported by stage, long-stay versus short-stay status, and race was calculated. Reporting rates were low for both short-stay (70.2%) and long-stay (59.7%) for stage 2-4 pressure ulcer hospitalizations. Black residents experienced more severe pressure ulcers than White residents. Correlations between claims-based measures and NHC ratings were found to be poor.
AHRQ-funded; HS026957.
Citation: Chen Z, Gleason LJ, Sanghavi P .
Accuracy of pressure ulcer events in US nursing home ratings.
Med Care 2022 Oct;60(10):775-83. doi: 10.1097/mlr.0000000000001763.
AHRQ-funded; HS026957..
AHRQ-funded; HS026957..
Keywords: Elderly, Nursing Homes, Long-Term Care, Pressure Ulcers, Quality Measures, Quality of Care, Patient Safety
Huang RJ, Epplein M, Hamashima C
An approach to the primary and secondary prevention of gastric cancer in the United States.
In 2020, a summit was convened at Stanford University to address the disparity of gastric cancer as a leading cause of mortality among certain racial, ethnic and immigrant groups in the United States, and the absence of a national strategy for addressing gastric cancer prevention. A working group was formed to conduct a structured literature review to critically evaluate the effectiveness, potential benefits, and potential harms of methods of primary and secondary prevention. The purpose of this article was to provide a consensus statement from that group. The authors found that the distribution of gastric cancer rates is highly inequitable and falls primarily on Asian, African American, Hispanic, and American Indian/Alaskan Native populations. The group concluded that there is an urgent need for cancer prevention trials in high-risk minority populations in the United States.
AHRQ-funded; HS026395.
Citation: Huang RJ, Epplein M, Hamashima C .
An approach to the primary and secondary prevention of gastric cancer in the United States.
Clin Gastroenterol Hepatol 2022 Oct;20(10):2218-28.e2. doi: 10.1016/j.cgh.2021.09.039..
Keywords: Cancer, Digestive Disease and Health, Prevention
Severance TS, Njuguna F, Olbara G
An evaluation of the disparities affecting the underdiagnosis of pediatric cancer in Western Kenya.
This study described the international collaboration to investigate disparities affecting the underdiagnosis of pediatric cancer in Western Kenya. Estimates of cancer incidence in similar populations around the world would indicate approximately 1500 patients should be diagnosed each year. However, internal review at a large tertiary hospital noted 200-250 patients were diagnosed annually, suggesting the remaining 75-80% of patients go undiagnosed and do not receive treatment. The authors reviewed 41 malaria slides at a local referring hospital that demonstrated both morphologic and genetic evidence of leukemia. This disparity suggested a lack of education and training that were the lead factors contributing to lower rates of diagnosis.
AHRQ-funded; HS026390.
Citation: Severance TS, Njuguna F, Olbara G .
An evaluation of the disparities affecting the underdiagnosis of pediatric cancer in Western Kenya.
Pediatr Blood Cancer 2022 Oct;69(10):e29768. doi: 10.1002/pbc.29768..
Keywords: Children/Adolescents, Cancer, Disparities, Diagnostic Safety and Quality
Qin CX, Auerbach SR, Charnaya O
Antibody response to three SARS-CoV-2 mRNA vaccines in adolescent solid organ transplant recipients.
The purpose of this observational cohort study was to assess whether a third SARS-CoV-2 vaccine would improve immunogenicity in adolescent solid organ transplant recipients (SOTRs), and to report the antibody response and safety of a third mRNA vaccine dose (D3) in adolescent SOTRs. Forty-two participants received three BNT162b2 doses and one received three mRNA-1273 doses. Participants were 6-13 years from transplant (median 10 [IQR]), and heart transplant was the most common procedure, in 41.9% of the participants. 9.3% of participants reported pre-D1 SARS-CoV-2 infections and 9.3% reported breakthrough infections. The study found that 88.4% of adolescent SOTRs had positive antibody responses 1 month post-D3, an increase from 63–73% post-D2. 54.5% of participants with prior negative responses seroconverted and 100% with positive responses increased or remained at maximum titer. Titers remained stable 3 months post-D3. There were no vaccine-related adverse events and four breakthrough infections. The researchers concluded that although this was a convenience sample, the results suggest there is an antibody response benefit to a third SARS-CoV-2 vaccine in adolescent SOTRs.
AHRQ-funded; HS026510.
Citation: Qin CX, Auerbach SR, Charnaya O .
Antibody response to three SARS-CoV-2 mRNA vaccines in adolescent solid organ transplant recipients.
Am J Transplant 2022 Oct;22(10):2481-83. doi: 10.1111/ajt.17085..
Keywords: Children/Adolescents, COVID-19, Vaccination, Transplantation
Snyder BM, Patterson MF, Gebretsadik T
Association between asthma status and prenatal antibiotic prescription fills among women in a Medicaid population.
The objective of this study was to assess the relationship between maternal asthma and outpatient prenatal antibiotic prescription fills to inform antibiotic stewardship. With data from the Tennessee Medicaid Program, findings showed that women with asthma had an increased risk of filling at least one prenatal antibiotic prescription and had an increased number of fills during pregnancy compared to women without asthma. These findings highlight that pregnant women with asthma disproportionately fill more antibiotic prescriptions during pregnancy.
AHRQ-funded; HS018454.
Citation: Snyder BM, Patterson MF, Gebretsadik T .
Association between asthma status and prenatal antibiotic prescription fills among women in a Medicaid population.
J Asthma 2022 Oct;59(10):2100-07. doi: 10.1080/02770903.2021.1993247..
Keywords: Asthma, Respiratory Conditions, Pregnancy, Antibiotics, Antimicrobial Stewardship, Medication, Maternal Care, Women, Chronic Conditions
Shah W, Villaflores CW, Chuong LH
Association between in-person vs telehealth follow-up and rates of repeated hospital visits among patients seen in the emergency department.
This study investigated whether the rates of emergency department (ED) return visits and hospitalization differ between patients who obtain in-person versus telehealth encounters for post-ED follow-up care. This retrospective cohort study included adult patients who came to either of 2 in-system EDs of a single urban integrated academic system from April 2020 to September 2021, were discharged home, and obtained a follow-up appointment with a primary care physician within 14 days of their index ED visit. Overall, the study recorded 12,848 patients with 16,987 ED encounters (mean age 53 years; 57% women, 12% Black or African American; 22% Hispanic or Latinx; and 58% White) included. Overall, 17% of initial ED encounters led to returns to the ED, and 4% subsequent hospitalizations. Telehealth vs in-person follow-up visits were associated with increased rates of ED returns (28.3 more ED returns per 1000 encounters) and hospitalizations (10.6 more hospitalizations per 1000 encounters).
AHRQ-funded; HS026372.
Citation: Shah W, Villaflores CW, Chuong LH .
Association between in-person vs telehealth follow-up and rates of repeated hospital visits among patients seen in the emergency department.
JAMA Netw Open 2022 Oct;5(10):e2237783. doi: 10.1001/jamanetworkopen.2022.37783..
Keywords: Telehealth, Health Information Technology (HIT), Emergency Department, Healthcare Utilization, Hospitals
Sakai-Bizmark R, Kumamaru H, Estevez D
Association between suicide attempt and previous healthcare utilization among homeless youth.
The purpose of this study was to examine the association between prior emergency department visit or hospitalization and subsequent suicide attempt among homeless youth aged 10-17 years old using New York statewide databases. Findings showed an association between prior healthcare utilization and decreased risk of suicide attempt among homeless youth.
AHRQ-funded; 900014-17-05.
Citation: Sakai-Bizmark R, Kumamaru H, Estevez D .
Association between suicide attempt and previous healthcare utilization among homeless youth.
Suicide Life Threat Behav 2022 Oct;52(5):994-1001. doi: 10.1111/sltb.12897..
Keywords: Children/Adolescents, Vulnerable Populations, Behavioral Health, Healthcare Utilization
Becker NV, Scott JW, Moniz MH
Association of chronic disease with patient financial outcomes among commercially insured adults.
This study examined the association between chronic disease and adverse financial outcomes. The authors used claims data for patients enrolled in a preferred provider organization in Michigan. Patients diagnosed with thirteen common chronic conditions (cancer, congestive heart failure, chronic kidney disease, dementia, depression and anxiety, diabetes, hypertension, ischemic heart disease, liver disease, chronic obstructive pulmonary disease and asthma, serious mental illness, stroke, and substance use disorders) were included in the cohort of 2,854,481 adults aged 21 and over. The cohort included 61.4% with no chronic conditions, 17.7% with 1 chronic condition, 14.8% with 2 to 3 chronic conditions, 5.4% with 4 to 6 chronic conditions, and 0.7% with 7 to 13 chronic conditions. Among the cohort, 9.6% had medical debt in collections, 8.3% had nonmedical debt in collections, 16.3% had delinquent debt, 19.3% had a low credit score, and 0.6% had recent bankruptcy. For individuals with 0 vs 7 to 13 chronic conditions, the predicted probabilities of having any medical debt in collections (7.6% vs 32%), any nonmedical debt in collections (7.2% vs 24%), any delinquent debt (14% vs 43%), a low credit score (17% vs 47%) or recent bankruptcy (0.4% vs 1.7%) were all considerably higher for individuals with more chronic conditions and increased with each added chronic condition. Among individuals with medical debt in collections, the estimated amount increased with the number of chronic conditions ($784 for individuals with 0 conditions vs $1252 for individuals with 7-13 conditions).
AHRQ-funded; HS028672.
Citation: Becker NV, Scott JW, Moniz MH .
Association of chronic disease with patient financial outcomes among commercially insured adults.
JAMA Intern Med 2022 Oct;182(10):1044-51. doi: 10.1001/jamainternmed.2022.3687..
Keywords: Chronic Conditions, Healthcare Costs, Cancer, Kidney Disease and Health
Sonik RA, Herrera AL
Associations between inspections for unsafe housing conditions and evictions in New York City public housing buildings.
The authors sought to examine the relationship between evictions and formal housing safety inspections triggered by tenant complains about poor conditions. Studying residential buildings within New York City Housing Authority developments, they found that these buildings were in areas with greater social vulnerability than 90% of other census tracts in the state. Further, adjusted predicted probabilities of an eviction increased from 34 to 43% in the presence of a rodent inspection and from 34 to 46% in the presence of an indoor environmental inspection, indicating that inspections for unsafe housing conditions were associated with evictions at the building level.
AHRQ-funded; HS026317.
Citation: Sonik RA, Herrera AL .
Associations between inspections for unsafe housing conditions and evictions in New York City public housing buildings.
J Community Health 2022 Oct;47(5):849-52. doi: 10.1007/s10900-022-01114-3..
Keywords: Social Determinants of Health, Public Health
Harrison JD, Sudore RL, Auerbach AD
Automated telephone follow-up programs after hospital discharge: do older adults engage with these programs?
The purpose of this study was to examine whether and how older adults experience automated post-hospital discharge telephone follow-up programs and characterize the prevalence of patient-reported post-discharge issues. Eighteen thousand and seventy-six patients, all part of a post-hospital discharge program between May 1, 2018 and April 30, 2019, were included and categorized into age groups. The study found that more patients 65-84 years old were reached compared to patients 64 years old or less (84.3% compared to 78.9%). Patients aged 85 or older were more likely to have questions about their follow-up plans and require assistance scheduling appointments compared to those 64 years old or less (19.0% vs. 11.9%). The researchers concluded that post-hospital automated telephone calls are effective at reaching older adults.
AHRQ-funded; HS026383.
Citation: Harrison JD, Sudore RL, Auerbach AD .
Automated telephone follow-up programs after hospital discharge: do older adults engage with these programs?
J Am Geriatr Soc 2022 Oct;70(10):2980-87. doi: 10.1111/jgs.17939..
Keywords: Elderly, Patient and Family Engagement, Hospital Discharge, Transitions of Care, Telehealth, Health Information Technology (HIT)
Yan CH, Ramanathan S, Suda KJ
Barriers to and facilitators of opioid prescribing by dentists in the United States: a qualitative study.
In this study, a national sample of US dentists was interviewed to understand the barriers and facilitators to opioid prescribing. Findings showed that dentists' opioid decision making is influenced by a range of real-world practice experiences and patient and clinic factors. Recommendations included targeting knowledge gaps in dentistry for education, clinical guidelines, and policy interventions in order to ensure safe and appropriate prescribing of opioids.
AHRQ-funded; HS025177.
Citation: Yan CH, Ramanathan S, Suda KJ .
Barriers to and facilitators of opioid prescribing by dentists in the United States: a qualitative study.
J Am Dent Assoc 2022 Oct;153(10):957-69.e1. doi: 10.1016/j.adaj.2022.05.009..
Keywords: Dental and Oral Health, Opioids, Medication
Harris S, Inoue S
AHRQ Author: Harris S
Behavioral counseling interventions to promote a healthy diet and physical activity for CVD prevention in adults without CVD risk factors.
In this Putting Prevention into Practice case study to increase understanding of the USPSTF final recommendation on behavioral counseling interventions to promote a healthy diet and physical activity for CVD prevention in adults without CVD risk factors, a 49-year old patient presents for a wellness visit. The patient’s vital signs are described as well as their daily habits, diet, and other medical history. Three multiple-choice questions are presented regarding risk factors, interventions to be recommended, and the benefits of behavioral counseling to promote a healthy diet and physical activity, followed by their answers.
AHRQ-authored.
Citation: Harris S, Inoue S .
Behavioral counseling interventions to promote a healthy diet and physical activity for CVD prevention in adults without CVD risk factors.
Am Fam Physician 2022 Oct;106(4):439-40..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Prevention, Nutrition, Lifestyle Changes
Togun AT, Karaca-Mandic P, Wurtz R
Changes in opioid marketing practices after release of the CDC guidelines.
This study investigated changes in opioid marketing practices after release of the 2016 CDC guidelines. The study’s objectives were to (1) evaluate whether the release of the guidelines was associated with changes in total monthly marketing spending received per physician, monthly marketing encounter frequency per physician, and spending per encounter during opioid marketing; and (2) evaluate whether such changes in marketing differed between specialist physicians and primary care physicians (PCPs) and between urban and rural primary care service areas (PCSAs). This retrospective observational cross-sectional study used opioid marketing spending data from the CMS Open Payments database between August 2013 and December 2017. After release of the CDC guidelines the monthly number of marketing encounters per physician and total monthly amount received per physician decreased, but the amount spent at each marketing encounter increased. There was an immediate increase in level of opioid marketing spending per encounter by $0.59 and an over-time increase in rate of spending per encounter of $0.04 per month.
AHRQ-funded; HS025164.
Citation: Togun AT, Karaca-Mandic P, Wurtz R .
Changes in opioid marketing practices after release of the CDC guidelines.
Am J Manag Care 2022 Oct;28(10):507-13. doi: 10.37765/ajmc.2022.89248..
Keywords: Opioids, Medication, Practice Patterns
Chatterjee P, Liao JM, Wang E
Characteristics, utilization, and concentration of outpatient care for dual-eligible Medicare beneficiaries.
The purpose of this study was to describe the distribution of outpatient care for dual-eligible Medicare beneficiaries ("duals") and characterize the intensity of outpatient care utilization of duals vs non-dual-eligible beneficiaries ("nonduals"). The researchers assessed the distribution of outpatient care across physician practices and compared the use of different outpatient services between duals and nonduals. The study found that nearly 80% of outpatient visits for duals were provided by 35% of practices. Compared with low-dual and no-dual practices, high-dual practices served more patients, with morhe comorbidities. Duals had 2 less outpatient visits per year compared with nonduals with substantially fewer subspecialty care visits despite having more comorbidities.
AHRQ-funded; HS027595.
Citation: Chatterjee P, Liao JM, Wang E .
Characteristics, utilization, and concentration of outpatient care for dual-eligible Medicare beneficiaries.
Am J Manag Care 2022 Oct;28(10):e370-e77. doi: 10.37765/ajmc.2022.89189..
Keywords: Ambulatory Care and Surgery, Medicare, Medicaid, Care Management, Healthcare Utilization
Alagoz E, Saucke M, Arroyo N
Communication during interhospital transfers of emergency general surgery patients: a qualitative study of challenges and opportunities.
This study’s objective was to understand the nature of and challenges to communication between referring (RP) and accepting (AP) providers transferring emergency general surgery (EGS) patients from the transfer center nurse’s (TCN) perspective. Worse outcomes have been shown to be experienced by transferred EGS patients than directly admitted patients. The authors interviewed 17 transfer center nurses (TCNs) at an academic medical center regarding (in)efficient and (in)effective communication between RPs and APs. The in-person interviews were recorded, transcribed and managed in NVivo. Four researchers developed a codebook, which was then co-coded with the transcripts. A consensus was developed to discuss emergency themes and arrive at higher-level concepts. Issues relating to ineffective communication included RPs that provided incomplete information because of a lack of necessary infrastructure, personnel, or technical knowledge; competing clinical demands; or a fear of the transfer request being rejected. Inefficient communication resulted from RPs being unfamiliar with the information APs expected and the lack of a structured process to share information and communication also failed when providers disagreed about the necessity of the transfer.
AHRQ-funded; HS025224.
Citation: Alagoz E, Saucke M, Arroyo N .
Communication during interhospital transfers of emergency general surgery patients: a qualitative study of challenges and opportunities.
J Patient Saf 2022 Oct 1;18(7):711-16. doi: 10.1097/pts.0000000000000979..
Keywords: Care Coordination, Communication, Transitions of Care, Surgery
Li RD, Joung RH, BC BC
Comprehensive evaluation of the trends in length of stay and post-discharge complications after colon surgery in the USA.
The purpose of this study focusing on colon surgery was to 1) describe temporal changes in length of stay (LOS) and post-discharge complications and 2) assess risk factors related with post-discharge complications. The study found that of the 98,136 patients who underwent colon resection between 2012 and 2018, the median LOS decreased from 5 days in 2012 to 4 days in 2018. Overall, the 30-day complication rate was 21.5%, which decreased during the study period. Of the 13 individual complications evaluated, 4 demonstrated a significant increase in the proportion of post-discharge events including overall SSI, superficial SSI, wound disruption, and UTI. Factors associated with the development of any post-discharge complication included female sex, ASA III/IV/V, dependent functional status, and higher BMI. Intraoperative factors included wound class, operation time, and approach. The study concluded that LOS and 30-day complications decreased over time, however the percentage of incidents taking place post-discharge increased for a number of complications.
AHRQ-funded; HS024516; HS026385
Citation: Li RD, Joung RH, BC BC .
Comprehensive evaluation of the trends in length of stay and post-discharge complications after colon surgery in the USA.
J Gastrointest Surg 2022 Oct;26(10):2184-92. doi: 10.1007/s11605-022-05391-0..
Keywords: Surgery, Adverse Events, Hospital Discharge
Glynn A, Hernandez I, Roberts ET
Consequences of forgoing prescription drug subsidies among low-income Medicare beneficiaries with diabetes.
This study’s objective was to estimate the take-up of the Medicare Part D Low-Income Subsidy (LIS) among Medicare beneficiaries with diabetes and examine differences in out-of-pocket costs and prescription drug use between LIS enrollees and LIS-eligible non-enrollees. Data from the Health and Retirement Study linked to Medicare administrative data from 2008 to 2016 was used. The authors first estimated LIS take-up stratified by income (≤100% of the Federal Poverty Level [FPL] and >100% to ≤150% of FPL). Second, to assess the consequences of forgoing the LIS among near-poor beneficiaries (incomes >100% to ≤150% of FPL), they conducted propensity score-weighted regression analyses to compare out-of-pocket costs, prescription drug use, and cost-related medication non-adherence among LIS enrollees and LIS-eligible non-enrollees. Among Medicare beneficiaries with diabetes, 68.1% of those considered near-poor (incomes >100% to ≤150% of FPL) received the LIS, compared to 90.3% of those with incomes ≤100% of FPL. Among near-poor beneficiaries, LIS-eligible non-enrollees incurred higher annual out-of-pocket drug spending ($518], filled 7.3 fewer prescriptions for diabetes, hypertension, and hyperlipidemia drugs, and were 8.9 percentage points more likely to report skipping drugs due to cost. all compared to LIS enrollees.
AHRQ-funded; HS026727.
Citation: Glynn A, Hernandez I, Roberts ET .
Consequences of forgoing prescription drug subsidies among low-income Medicare beneficiaries with diabetes.
Health Serv Res 2022 Oct;57(5):1136-44. doi: 10.1111/1475-6773.13990..
Keywords: Medication, Diabetes, Chronic Conditions, Low-Income, Medicare, Healthcare Costs
Quigley DD, Qureshi N, Palimaru A
Content and actionability of recommendations to providers after shadow coaching.
This paper examined the content of the recommendations given to shadow-coached providers aimed at improving provider-patient interactions, to characterize these recommendations, and to examine their actionability. Using CAHPS data, the study’s findings showed that patient experience surveys were effective at identifying where improvement is needed but are not always informative enough to instruct providers on how to modify and improve their interactions with patients. Analyzing the feedback given to coached providers as part of an effective shadow-coaching program provides details about implementation on shadow-coaching feedback.
AHRQ-funded; HS025920.
Citation: Quigley DD, Qureshi N, Palimaru A .
Content and actionability of recommendations to providers after shadow coaching.
Qual Manag Health Care 2022 Oct-Dec;31(4):199-209. doi: 10.1097/qmh.0000000000000354..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Quality Improvement, Quality of Care, Practice Improvement, Clinician-Patient Communication, Communication
Tisdale RL, Cusick MM, Aluri KZ
Cost-effectiveness of dapagliflozin for non-diabetic chronic kidney disease.
The purpose of this study was to determine the cost-effectiveness of adding dapagliflozin to standard management of patients with non-diabetic chronic kidney disease (CKD). Findings showed that adding dapagliflozin to standard care improved life expectancy by 2 years, increased discounted quality-adjusted life years, and reduced the total incidence of both kidney failure on kidney replacement therapy (KRT) and average years on KRT over the lifetime of the cohort. Further, dapagliflozin plus standard care was more effective than standard care alone while increasing lifetime costs.
AHRQ-funded; HS026128.
Citation: Tisdale RL, Cusick MM, Aluri KZ .
Cost-effectiveness of dapagliflozin for non-diabetic chronic kidney disease.
J Gen Intern Med 2022 Oct;37(13):3380-87. doi: 10.1007/s11606-021-07311-5..
Keywords: Kidney Disease and Health, Medication, Chronic Conditions, Healthcare Costs
Campbell NL, Pitts C, Corvari C
Deprescribing anticholinergics in primary care older adults: experience from two models and impact on a continuous measure of exposure.
The purpose of this study was to assess two pilot pharmacist-based advanced practice deprescribing intervention models and their impact on patients’ exposure to high-risk anticholinergics. The researchers conducted pilot studies of a collaborative clinic-based pharmacist deprescribing intervention and a telephone-based pharmacist deprescribing intervention. Deprescribing was defined as a discontinuation or dose reduction. Patients participating in the clinic-based pharmacy model were aged 55 years and older and were referred for deprescribing at a specialty clinic. Patients participating in the telephone-based pharmacy model were aged 65 years and older and called by a clinical pharmacist for deprescribing without referral. The study found that among the 24 medications deemed eligible for deprescribing for the18 patients in the clinic-based model, 23 were deprescribed. The clinic-based deprescribing model resulted in a 93% reduction in median annualized total standardized dose (TSD), 56% lowered their annualized exposure below a cognitive risk threshold, and 17% of medications were represcribed within 6 months. Among the 24 medications deemed eligible for deprescribing for the 24 patients in the telephone-based pharmacy model, 50% were deprescribed. There was no change in the median annualized TSD, the annualized TSD was lowered below a cognitive risk threshold in 46%, and no medications were represcribed within 6 months. The researchers concluded that pharmacist-based deprescribing successfully reduced exposure to high-risk anticholinergics in the study population.
AHRQ-funded; HS24384.
Citation: Campbell NL, Pitts C, Corvari C .
Deprescribing anticholinergics in primary care older adults: experience from two models and impact on a continuous measure of exposure.
Journal of the American College of Pharmacy 2022 Oct;5(10):1039-47. doi: 10.1002/jac5.1682..
Keywords: Elderly, Primary Care, Medication, Provider: Pharmacist, Medication: Safety, Patient Safety
Carroll AR, Smith CM, Frazier SB
Designing and conducting scholarly quality improvement: a practical guide for improvers everywhere.
The purpose of this article was to assist quality improvement teams to disseminate their work more expansively through publication by providing methods that many journals want in QI articles with specific examples of published works cited throughout the article. The researchers present improvement frameworks that teams should identify and utilize as a basis throughout their projects. The researchers review critical elements of QI projects, such as the formation of teams, the development of a concise and clear purpose statement, definitions of measures, and other QI tools such as fishbone diagrams and Pareto charts. Lastly, the researchers emphasize the importance of analyzing data longitudinally to explore the impacts of plan-do-study-act cycles on data.
AHRQ-funded; HS026122.
Citation: Carroll AR, Smith CM, Frazier SB .
Designing and conducting scholarly quality improvement: a practical guide for improvers everywhere.
Hosp Pediatr 2022 Oct; 12(10):e359-e63. doi: 10.1542/hpeds.2022-006717..
Keywords: Quality Improvement, Quality of Care