National Healthcare Quality and Disparities Report
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 2 of 2 Research Studies DisplayedRomijn AC, Rastogi V, Proaño-Zamudio JA
Early versus delayed thoracic endovascular aortic repair for blunt thoracic aortic injury: a propensity score-matched analysis.
This study examined the outcomes of ≤24 h) versus delayed (>24 h) thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI), taking the aortic injury severity into consideration. Current trauma surgery guidelines recommend delayed TEVAR. Patients undergoing TEVAR for BTAI in the American College of Surgeons Trauma Quality Improvement Program between 2016 and 2019 were included and then stratified into early (≤24 h) or delayed (>24 h). The cohort looked at included 1339 patients, of whom 1054 (79%) underwent early TEVAR. Compared with the delayed group, the early group had significantly less severe head injuries (early vs delayed; 25% vs 32%), fewer early interventions for AAS grade 1 occurred, and AAS grade 3 aortic injuries often were intervened upon within 24 hours (grade 1: 28% vs 47%; grade 3: 49% vs 23%). Compared with the delayed group, the early group had significantly higher in-hospital mortality (8.8% vs 4.4%, relative risk: 2.2, 95% CI: 1.1-4.4), alongside a shorter length of hospital stay (5.0 vs 10 days), a shorter intensive care unit length of stay (4.0 vs 11 days) and fewer days on the ventilator (4.0 vs 6.5 days). Regardless of the higher risk of acute kidney injury in the delayed group (3.3% vs 7.7%), no other differences in in-hospital complications were observed between the early and delayed group.
AHRQ-funded; HS027285.
Citation: Romijn AC, Rastogi V, Proaño-Zamudio JA .
Early versus delayed thoracic endovascular aortic repair for blunt thoracic aortic injury: a propensity score-matched analysis.
Ann Surg 2023 Oct 1; 278(4):e848-e54. doi: 10.1097/sla.0000000000005817..
Keywords: Surgery, Cardiovascular Conditions, Risk, Outcomes
Apathy NC, Dixit RA, Boxley CL
Variations in physician telemedicine provision.
This study’s objective was to quantify physician variation in telemedicine provisions and the extent to which telemedicine use is explainable by the individual physician, adjusting for temporal, patient, and visit factors. This cross-sectional study used data on adult primary care visits across MedStar Health, Stanford Health Care, and Intermountain Healthcare systems. Primary care physicians who conducted at least 1000 visits between March 13, 2020 and December 31, 2021 were included. Primary care visits were defined in the electronic health record and scheduling systems as completed outpatient visits with those included primary care physicians. The sample consisted of 2,410,471 visits total, with 25.6% via telemedicine seen by 729 physicians. Substantial variation in telemedicine provision was shown across physicians. At least 237 physicians (32.5%) had at least 1 high-outlier week of telemedicine provision. Patient demographics only accounted for 2.3% of the variation in telemedicine use, with the site accounting for 16.3% of the variation. Residual (unexplained) variation accounted for more than half of the explanations. Telemedicine use has slowly declined, largely due to the lack of physical examinations.
AHRQ-funded; HS028255.
Citation: Apathy NC, Dixit RA, Boxley CL .
Variations in physician telemedicine provision.
JAMA Netw Open 2023 Jul; 6(7):e2321955. doi: 10.1001/jamanetworkopen.2023.21955..
Keywords: Low-Income, Social Determinants of Health, Outcomes, Risk