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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 11 of 11 Research Studies DisplayedDossett LA, Mott NM, Bredbeck BC
Using tailored messages to target overuse of Low-Value breast cancer care in older women.
The purpose of this study was to examine the role that an individual’s maximizing-minimizing trait, an inherent preference for more or less medical care, may influence the preference for low-value care in the omission of sentinel lymph node biopsy (SLNB) and post-lumpectomy radiotherapy in women 70 years of age or higher with early-stage, hormone-receptor positive invasive breast cancer. The researchers recruited women 70 years of age or higher (n=1600) who were maximizers (515), minimizers (550), or neutral (535), and presented them with a hypothetical breast cancer diagnosis and then randomized exposure to one of three follow-up messages. Messages included: 1) maximizer-tailored, 2) minimizer-tailored, or 3) neutral. The study reported that higher maximizing tendency correlated positively with electing both SLNB and radiotherapy on logistic regression. Any maximizer- or minimizer-tailoring decreased preference for SLNB in maximizing and neutral women but had no effect in minimizing women. Tailoring had no impact on radiotherapy decision, except for an increased probability of minimizers electing radiotherapy when presented with maximizer-tailored messaging. The study concluded that among women facing a hypothetical breast cancer diagnosis, tendencies for maximizing-minimizing are correlated with preferences for treatment.
AHRQ-funded; HS026030.
Citation: Dossett LA, Mott NM, Bredbeck BC .
Using tailored messages to target overuse of Low-Value breast cancer care in older women.
J Surg Res 2022 Feb;270:503-12. doi: 10.1016/j.jss.2021.10.005..
Keywords: Elderly, Cancer: Breast Cancer, Cancer, Women, Decision Making, Clinician-Patient Communication, Communication
Berlin NL, Skolarus TA, Kerr EA
Too much surgery: overcoming barriers to deimplementation of low-value surgery.
The objectives of this surgical perspective are to discuss the unique aspects of surgical care delivery acting as barriers to de-implementation and to suggest potential strategies to reduce low-value surgery in the United States. Successful de-implementation of low-value surgery will depend on understanding why low-value procedures persist, leveraging quality collaboratives to monitor appropriateness, implementing clinical decision support systems, and developing incentives for de-implementation.
AHRQ-funded; HS026030.
Citation: Berlin NL, Skolarus TA, Kerr EA .
Too much surgery: overcoming barriers to deimplementation of low-value surgery.
Ann Surg 2020 Jun;271(6):1020-22. doi: 10.1097/sla.0000000000003792..
Keywords: Surgery, Decision Making
Leeds IL, DiBrito SR, Canner JK
Cost-benefit limitations of extended, outpatient venous thromboembolism prophylaxis following surgery for Crohn's disease.
This goal of this study was to assess the cost-effectiveness of extended prophylaxis in patients with Crohn's disease after abdominal surgery. A decision tree model was used to assess cost-effectiveness and cost-per-case averted with extended-duration venous thromboembolism prophylaxis following abdominal surgery. Results showed that extended prophylaxis in patients with Crohn's disease postoperatively is not cost-effective when the cumulative incidence of posthospital thrombosis remains less than 4.9%. These findings are driven by the low absolute risk of thrombosis in this population and the considerable cost of universal treatment.
AHRQ-funded; HS024547.
Citation: Leeds IL, DiBrito SR, Canner JK .
Cost-benefit limitations of extended, outpatient venous thromboembolism prophylaxis following surgery for Crohn's disease.
Dis Colon Rectum 2019 Nov;62(11):1371-80. doi: 10.1097/dcr.0000000000001461..
Keywords: Prevention, Digestive Disease and Health, Surgery, Healthcare Costs, Adverse Events, Patient Safety, Blood Clots, Decision Making, Medication
Kunst NR, Alarid-Escudero F, Paltiel AD
A value of information analysis of research on the 21-gene assay for breast cancer management.
The authors aimed to quantify the value of conducting further research to reduce decision uncertainty in the use of the 21-gene assay Oncotype DX (21-GA). They found that current evidence strongly supports the use of the 21-GA in intermediate- and high-risk women and recommended that further research focus on low-risk women.
AHRQ-funded; HS023900.
Citation: Kunst NR, Alarid-Escudero F, Paltiel AD .
A value of information analysis of research on the 21-gene assay for breast cancer management.
Value Health 2019 Oct;22(10):1102-10. doi: 10.1016/j.jval.2019.05.004..
Keywords: Genetics, Cancer: Breast Cancer, Cancer, Decision Making, Research Methodologies
McGinn T, Cohen S, Khan S
The high cost of low value care.
The main focus of this study was bridging the "evidence gap" between frontline decision-making in health care and the actual evidence, with the hope of reducing unnecessary diagnostic testing and treatments. From their work in pulmonary embolism (PE) and over ordering of computed tomography pulmonary angiography, the investigators integrated the highly validated Wells' criteria into the electronic health record at two of their major academic tertiary hospitals.
AHRQ-funded; HS022061.
Citation: McGinn T, Cohen S, Khan S .
The high cost of low value care.
Trans Am Clin Climatol Assoc 2019;130:60-70..
Keywords: Healthcare Costs, Evidence-Based Practice, Patient-Centered Outcomes Research, Decision Making, Comparative Effectiveness
Aouad M, Brown TT, Whaley CM
Reference pricing: the case of screening colonoscopies.
In this study, the investigators studied the introduction of reference pricing to the California Public Employees' Retirement System. The investigators found a 10 percentage point increase in the share of patients using an ambulatory surgery center (ASC), leading to a $2300 to $1700 reduction in prices paid for patients who switched to ASCs. They indicated that their results suggested the use of ASCs had a causal effect on prices paid and had no negative effect on patient health outcomes.
AHRQ-funded; HS022098.
Citation: Aouad M, Brown TT, Whaley CM .
Reference pricing: the case of screening colonoscopies.
J Health Econ 2019 May;65:246-59. doi: 10.1016/j.jhealeco.2019.03.002..
Keywords: Colonoscopy, Decision Making, Health Services Research (HSR), Healthcare Costs, Healthcare Delivery, Screening
Balentine CJ, Vanness DJ, Schneider DF
Cost-effectiveness of lobectomy versus genetic testing (Afirma(R)) for indeterminate thyroid nodules: considering the costs of surveillance.
This study evaluated whether diagnostic thyroidectomy for indeterminate thyroid nodules would be more cost-effective than genetic testing after including the costs of long-term surveillance. Its base case estimate suggests that diagnostic lobectomy dominates genetic testing as a strategy for ruling out malignancy of indeterminate thyroid nodules.
AHRQ-funded; HS023009.
Citation: Balentine CJ, Vanness DJ, Schneider DF .
Cost-effectiveness of lobectomy versus genetic testing (Afirma(R)) for indeterminate thyroid nodules: considering the costs of surveillance.
Surgery 2018 Jan;163(1):88-96. doi: 10.1016/j.surg.2017.10.004.
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Keywords: Cancer, Decision Making, Diagnostic Safety and Quality, Genetics, Healthcare Costs, Screening, Surgery
Robinson JC, Brown TT, Whaley C
Reference pricing changes the 'choice architecture' of health care for consumers.
This article summarizes reference pricing's impacts to date on patient choice, provider prices, surgical complications, and employer spending and estimates its potential impacts if expanded to more services and a broader population. Reference pricing induces consumers to select lower-price alternatives for all of the forms of care studied, leading to significant reductions in prices paid and spending incurred by insurers and employers.
AHRQ-funded; HS022098.
Citation: Robinson JC, Brown TT, Whaley C .
Reference pricing changes the 'choice architecture' of health care for consumers.
Health Aff 2017 Mar;36(3):524-30. doi: 10.1377/hlthaff.2016.1256.
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Keywords: Decision Making, Education: Patient and Caregiver, Healthcare Costs, Healthcare Delivery
Schlesinger M, Grob R
Treating, fast and slow: Americans' understanding of and responses to low-value care.
This article explores Americans’ understanding of low-value care in 2015, assesses the impact of media messaging, and tests alternative message framing. The study concluded that the public’s awareness of low-value care is incomplete, with substantial disparities related to race, ethnicity, and socioeconomic status.
AHRQ-funded; HS021858; HS016978.
Citation: Schlesinger M, Grob R .
Treating, fast and slow: Americans' understanding of and responses to low-value care.
Milbank Q 2017 Mar;95(1):70-116. doi: 10.1111/1468-0009.12246..
Keywords: Healthcare Delivery, Decision Making, Healthcare Costs, Quality of Care
Armstrong MJ, Mullins CD
Value assessment at the point of care: incorporating patient values throughout care delivery and a draft taxonomy of patient values.
In this commentary, the authors propose a taxonomy of values underlying patient decision making and provide examples of how these impact provision of health care. Their draft taxonomy describes four categories of patient values: global, decisional, situational, and external, highlights different values impacting decision making and facilitates a more complete value assessment at the point of care.
AHRQ-funded; HS024159.
Citation: Armstrong MJ, Mullins CD .
Value assessment at the point of care: incorporating patient values throughout care delivery and a draft taxonomy of patient values.
Value Health 2017 Feb;20(2):292-95. doi: 10.1016/j.jval.2016.11.008.
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Keywords: Decision Making, Healthcare Delivery, Patient and Family Engagement
George AJ, Boehme AK, Dunn CR
Trimming the fat in acute ischemic stroke: an assessment of 24-h CT scans in tPA patients.
The authors questioned the utility of routine 24-h computed tomography imaging and looked at the National Institutes of Health Stroke Scale as a possible clinical screen for selecting candidates for 24-h imaging. They found that routine 24-h computed tomography scan in patients without 24-h National Institutes of Health Stroke Scale worsening was less likely to yield information that results in a deviation from standard acute stroke care, and that no patient without worsening had parenchymal hematoma on 24-h computed tomography. They concluded that application of this Stroke Scale to distinguish patients who should have 24-h follow-up imaging from those who will not benefit is a potential avenue for improving utilization of resources and warrants further study.
AHRQ-funded; HS013852.
Citation: George AJ, Boehme AK, Dunn CR .
Trimming the fat in acute ischemic stroke: an assessment of 24-h CT scans in tPA patients.
Int J Stroke 2015 Jan;10(1):37-41. doi: 10.1111/ijs.12293.
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Keywords: Decision Making, Imaging, Stroke