National Healthcare Quality and Disparities Report
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Topics
- Adverse Drug Events (ADE) (1)
- Blood Thinners (1)
- Cancer (3)
- Cardiovascular Conditions (2)
- Care Coordination (1)
- (-) Care Management (18)
- Children/Adolescents (2)
- Complementary and Alternative Medicine (1)
- Decision Making (1)
- Depression (1)
- Disparities (1)
- Electronic Health Records (EHRs) (1)
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- Evidence-Based Practice (1)
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- Hospitalization (1)
- Medication (5)
- Neurological Disorders (1)
- Obesity (1)
- Obesity: Weight Management (1)
- Opioids (3)
- Orthopedics (2)
- Outcomes (4)
- Pain (3)
- Patient-Centered Outcomes Research (3)
- Patient Adherence/Compliance (1)
- Quality Improvement (2)
- Quality of Care (1)
- Racial and Ethnic Minorities (1)
- Risk (1)
- (-) Surgery (18)
- Transitions of Care (1)
- Treatments (2)
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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 18 of 18 Research Studies DisplayedGupta AR, Brajcich BC, Yang AD
Necessity of posttreatment surveillance for low-grade appendiceal mucinous neoplasms.
This study’s objectives were to characterize posttreatment surveillance and determine the risk of recurrence following surgical resection of low-grade appendiceal mucinous neoplasms (LAMNs). Patients who underwent surgical rection of localized LAMNs in an 11-hospital regional healthcare system from 2000 to 2019 were included. A total of 114 patients with LAMNs were identified with various tumor grades, most of them pTis (80.7%). Patients were followed up with posttreatment surveillance (n = 39). No patients experienced tumor recurrence after a mean follow-up duration of 4.7 years, suggesting that routine surveillance may be unnecessary.
AHRQ-funded; HS026385.
Citation: Gupta AR, Brajcich BC, Yang AD .
Necessity of posttreatment surveillance for low-grade appendiceal mucinous neoplasms.
J Surg Oncol 2021 Dec;124(7):1115-20. doi: 10.1002/jso.26621..
Keywords: Cancer, Surgery, Care Management
Sharma D
Perioperative management of aneurysmal subarachnoid hemorrhage.
This article discusses aneurysmal subarachnoid hemorrhage, an acute neurologic emergency. Extracranial manifestations of aneurysmal subarachnoid hemorrhage include cardiac dysfunction, neurogenic pulmonary edema, fluid and electrolyte imbalances, and hyperglycemia. The author indicates that prompt definitive treatment of the aneurysm by craniotomy and clipping or endovascular intervention with coils and/or stents is needed to prevent rebleeding. The author also notes that data on the impact of anesthesia on long-term neurologic outcomes of aneurysmal subarachnoid hemorrhage do not exist.
AHRQ-funded; HS026690.
Citation: Sharma D .
Perioperative management of aneurysmal subarachnoid hemorrhage.
Anesthesiology 2020 Dec;133(6):1283-305. doi: 10.1097/aln.0000000000003558..
Keywords: Cardiovascular Conditions, Neurological Disorders, Surgery, Care Management
Berry JG, Glaspy T, Eagan B
Pediatric complex care and surgery comanagement: preparation for spinal fusion.
This study assessed the impact of preoperative comanagement with complex care pediatricians (CCP) on children with neuromuscular scoliosis undergoing spinal fusion surgery. A chart review of 79 children aged 5-21 years undergoing spinal fusion Jan. 2014-June 2016 was conducted at a children’s hospital. Cerebral palsy (64%) was the most common neuromuscular condition with the mean age of surgery of 14 years. Thirty-nine children had a preoperative CCP evaluation a median 63 days before the preanesthesia visit. More organ systems were affected by coexisting conditions in children with CCP evaluation than those without an evaluation. The rate of last-minute care coordination activities required for surgical clearance as well as last-minute development of new preoperative plans were lower for children with CCP evaluation than those without.
AHRQ-funded; HS024453.
Citation: Berry JG, Glaspy T, Eagan B .
Pediatric complex care and surgery comanagement: preparation for spinal fusion.
J Child Health Care 2020 Sep;24(3):402-10. doi: 10.1177/1367493519864741..
Keywords: Children/Adolescents, Surgery, Care Management, Care Coordination
Mohapatra A, Strope SA, Liu N
Importance of long-term follow-up after endoscopic management for upper tract urothelial carcinoma and factors leading to surgical management.
Patients undergoing endoscopic management for upper tract urothelial carcinoma often progress to definitive therapy with radical nephroureterectomy. This study examined the rate of progression as well as risk factors for transitions in treatment over time. The investigators found that patients who progressed to radical nephroureterectomy after endoscopic management had fewer comorbid conditions and changes in disease status including visible lesions on ureteroscopy and positive biopsies.
AHRQ-funded; HS19455.
Citation: Mohapatra A, Strope SA, Liu N .
Importance of long-term follow-up after endoscopic management for upper tract urothelial carcinoma and factors leading to surgical management.
Int Urol Nephrol 2020 Aug;52(8):1465-69. doi: 10.1007/s11255-020-02439-5..
Keywords: Cancer, Surgery, Risk, Care Management
Soffin EM, Gibbons MM, Wick EC
Evidence review conducted for the Agency for Healthcare Research and Quality Safety Program for I
This evidence review was conducted as part of AHRQ’s Safety Program for Improving Surgical Care and Recovery. An evidence review of interventions was conducted to create an enhanced recovery after surgery (ERAS) protocol for anesthesiology for hip fracture repair surgery. The researchers identified anesthesiology components of care and evaluated them across the perioperative continuum. They created ERAS protocols for the preoperative, intraoperative, and postoperative phases.
AHRQ-funded; 233201500020I.
Citation: Soffin EM, Gibbons MM, Wick EC .
Evidence review conducted for the Agency for Healthcare Research and Quality Safety Program for I
Anesth Analg 2019 Jun;128(6):1107-17. doi: 10.1213/ane.0000000000003925..
Keywords: Evidence-Based Practice, Patient-Centered Outcomes Research, Surgery, Orthopedics, Quality Improvement, Quality of Care, Outcomes, Care Management
Childers CP, Dworsky JQ, Maggard-Gibbons M
The contemporary appendectomy for acute uncomplicated appendicitis in adults.
Epidemiologic data related to the surgical management of appendicitis are out of date. In this study, the authors contemplated the role of nonoperative therapy in uncomplicated appendicitis and developed a contemporary profile of the risks and benefits of operative appendectomy by merging the 2016 National Surgical Quality Improvement Program essential and appendectomy-targeted participant use files.
AHRQ-funded; HS025079.
Citation: Childers CP, Dworsky JQ, Maggard-Gibbons M .
The contemporary appendectomy for acute uncomplicated appendicitis in adults.
Surgery 2019 Mar;165(3):593-601. doi: 10.1016/j.surg.2018.09.009..
Keywords: Care Management, Quality Improvement, Surgery, Treatments
Parthipan A, Banerjee I, Humphreys K
Predicting inadequate postoperative pain management in depressed patients: a machine learning approach.
Researchers employed a machine-learning approach to identify patients who were prescribed a combination of selective serotonin reuptake inhibitors (SSRIs) and prodrug opioids in order to examine the effect of this combination on postoperative pain control. They identified patients who received surgery over a 9-year period by using EHR data from an academic medical center, then developed and validated natural language processing (NLP) algorithms to extract depression-related information from both structured and unstructured data elements. The machine-learning algorithm accurately predicted the increase or decrease of the discharge, 3-week, and 8-week follow-up pain scores when compared to the pre-operative pain score; pre-operative pain, surgery type, and opioid tolerance were the strongest predictors of postoperative pain control. The researchers conclude that their study results provide the first direct clinical evidence that the known ability of SSRIs to inhibit prodrug opioid effectiveness is associated with worse pain control among depressed patients. They suggest that prescribers might choose direct acting opioids such as oxycodone or morphine for depressed patients on SSRIs instead of prodrug opioids.
AHRQ-funded; HS024096.
Citation: Parthipan A, Banerjee I, Humphreys K .
Predicting inadequate postoperative pain management in depressed patients: a machine learning approach.
PLoS One 2019 Feb 6;14(2):e0210575. doi: 10.1371/journal.pone.0210575..
Keywords: Care Management, Depression, Medication, Opioids, Pain, Surgery
Wahl TS, Goss LE, Morris MS
Enhanced Recovery After Surgery (ERAS) eliminates racial disparities in postoperative length of stay after colorectal surgery.
The purpose of this study was to investigate the effects of enhanced recovery after surgery (ERAS) on racial disparities in postoperative length of stay (pLOS) after colorectal surgery. The authors hypothesized that ERAS would reduce disparities in pLOS between black and white patients. They concluded that ERAS eliminated racial differences in pLOS between black and white patients undergoing colorectal surgery. Reduced pLOS occurred without increases in mortality, readmissions, and most postoperative complications.
AHRQ-funded; HS013852.
Citation: Wahl TS, Goss LE, Morris MS .
Enhanced Recovery After Surgery (ERAS) eliminates racial disparities in postoperative length of stay after colorectal surgery.
Ann Surg 2018 Dec;268(6):1026-35. doi: 10.1097/sla.0000000000002307..
Keywords: Surgery, Racial and Ethnic Minorities, Disparities, Care Management, Healthcare Delivery, Hospitalization, Patient-Centered Outcomes Research, Outcomes
Balentine CJ, Leverson G, Vanness DJ
Selecting post-acute care settings after abdominal surgery: are we getting it right?
Using Nationwide Inpatient Sample data, the authors investigated whether variation in post-acute care (PAC) services could be explained by surgeons discharging clinically similar patients to different PAC destinations. They found considerable potential for reducing variation in PAC use and costs by better understanding how surgeons make decisions about PAC placement.
AHRQ-funded; HS023009.
Citation: Balentine CJ, Leverson G, Vanness DJ .
Selecting post-acute care settings after abdominal surgery: are we getting it right?
Am J Surg 2018 Aug;216(2):260-66. doi: 10.1016/j.amjsurg.2017.08.043..
Keywords: Care Management, Decision Making, Healthcare Cost and Utilization Project (HCUP), Surgery, Transitions of Care
Desai K, Carroll I, Asch SM
Utilization and effectiveness of multimodal discharge analgesia for postoperative pain management.
In this study, the investigators sought to assess the association between discharge multimodal analgesia and postoperative pain outcomes in two diverse health care settings. They evaluated patients undergoing four common surgeries associated with high pain in electronic health records from an academic hospital (AH) and Veterans Health Administration (VHA). The investigators found that a majority of surgical patients received a multimodal pain approach at discharge yet many received only opioids. Multimodal regimen at discharge was associated with better follow-up pain and all-cause readmissions compared to the opioid-only regimen.
AHRQ-funded; HS024096.
Citation: Desai K, Carroll I, Asch SM .
Utilization and effectiveness of multimodal discharge analgesia for postoperative pain management.
J Surg Res 2018 Aug;228:160-69. doi: 10.1016/j.jss.2018.03.029..
Keywords: Care Management, Medication, Opioids, Pain, Surgery
George JA, Koka R, Gan TJ
Review of the enhanced recovery pathway for children: perioperative anesthetic considerations.
Enhanced recovery after surgery (ERAS) pathways have been used for two decades to improve perioperative recovery in adults. Nevertheless, little is known about their effectiveness in children. The purpose of this review was to consider pediatric ERAS pathways, review the literature concerned with their potential benefit, and compare them with adult ERAS pathways.
AHRQ-funded; HS022932.
Citation: George JA, Koka R, Gan TJ .
Review of the enhanced recovery pathway for children: perioperative anesthetic considerations.
Can J Anaesth 2018 May;65(5):569-77. doi: 10.1007/s12630-017-1042-6..
Keywords: Care Management, Children/Adolescents, Surgery
Childers CP, Maggard-Gibbons M, Ulloa JG
Perioperative management of antiplatelet therapy in patients undergoing non-cardiac surgery following coronary stent placement: a systematic review.
Researchers conducted a systematic review on the use of antiplatelet therapy (APT) after non-cardiac surgery (NCS) following stent placement surgery done previously. There has been some debate among the American College of Cardiology and American Heart Association as to the guidelines of how long to delay NCS after stent placement. Out of 4,882 articles, only 16 were included in the review. All of them were small. Reviewers looked for rates of cardiac events and/or bleeding events with the different APT strategies used. There did not seem to be much difference in outcomes between the different strategies.
AHRQ-funded; HS025079.
Citation: Childers CP, Maggard-Gibbons M, Ulloa JG .
Perioperative management of antiplatelet therapy in patients undergoing non-cardiac surgery following coronary stent placement: a systematic review.
Syst Rev 2018 Jan 10;7(1):4. doi: 10.1186/s13643-017-0635-z..
Keywords: Adverse Drug Events (ADE), Blood Thinners, Cardiovascular Conditions, Care Management, Medication, Outcomes, Surgery
Tedesco D, Gori D, Desai KR
Drug-free interventions to reduce pain or opioid consumption after total knee arthroplasty: a systematic review and meta-analysis.
The authors systematically reviewed and meta-analyzed evidence of nonpharmacological interventions for postoperative pain management after total knee arthroplasty. The most commonly performed interventions included in the review were continuous passive motion, preoperative exercise, cryotherapy, electrotherapy, and acupuncture. In the meta-analysis, electrotherapy and acupuncture after total knee arthroplasty were associated with reduced and delayed opioid consumption.
AHRQ-funded; HS024096.
Citation: Tedesco D, Gori D, Desai KR .
Drug-free interventions to reduce pain or opioid consumption after total knee arthroplasty: a systematic review and meta-analysis.
JAMA Surg 2017 Oct 18;152(10):e172872. doi: 10.1001/jamasurg.2017.2872.
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Keywords: Care Management, Medication, Opioids, Orthopedics, Pain, Surgery
Smith AB, Basch E
Role of patient-reported outcomes in postsurgical monitoring in oncology.
This article describes the benefits of electronic patient-reported outcomes (ePROs) in postsurgical symptom monitoring for surgical oncology patients; ePROs can identify at-risk patients, provide closer monitoring, and provide a mechanism to identify and treat complications before they worsen. The article also summarizes the literature of ePRO use in surgical oncology.
AHRQ-funded; HS024134.
Citation: Smith AB, Basch E .
Role of patient-reported outcomes in postsurgical monitoring in oncology.
J Oncol Pract 2017 Aug;13(8):535-38. doi: 10.1200/jop.2017.023838..
Keywords: Cancer, Care Management, Health Information Technology (HIT), Electronic Health Records (EHRs), Surgery, Outcomes
Finnegan MA, Shaffer R, Remington A
Emergency department visits following elective total hip and knee replacement surgery: identifying gaps in continuity of care.
The researchers sought to characterize 30-day ED visits following a major joint replacement surgical procedure. They concluded that ED visits following an elective major joint replacement surgical procedure were numerous and most commonly for pain-related diagnoses. Medicaid patients had almost double the risk of an ED or pain-related ED visit following a surgical procedure.
AHRQ-funded; HS024096.
Citation: Finnegan MA, Shaffer R, Remington A .
Emergency department visits following elective total hip and knee replacement surgery: identifying gaps in continuity of care.
J Bone Joint Surg Am 2017 Jun 21;99(12):1005-12. doi: 10.2106/jbjs.16.00692.
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Keywords: Care Management, Emergency Department, Surgery
Lou I, Balentine C, Clarkson S
How long should we follow patients after apparently curative parathyroidectomy?
This study aimed to evaluate the risk of recurrent hyperparathyroidism in the 10 years after operation. It evaluated 196 patients with a 14.8 percent 10-year recurrence rate. It found that median time to recurrence was 6.3 years and 34.5 percent of all recurrences were identified more than 10 years after operation.
AHRQ-funded; HS023009.
Citation: Lou I, Balentine C, Clarkson S .
How long should we follow patients after apparently curative parathyroidectomy?
Surgery 2017 Jan;161(1):54-61. doi: 10.1016/j.surg.2016.05.049.
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Keywords: Care Management, Patient-Centered Outcomes Research, Surgery
Polsky S, Donahoo WT, Lyons EE
Evaluation of care management intensity and bariatric surgical weight loss.
This study examined the effect of pre- and postoperative care management on weight loss following bariatric surgery. It found no statistically significant associations between either preoperative or postoperative care management intensity and postoperative change in body mass index at year 1 or year 2. Results were limited by heterogeneity of care management across sites and an inability to assess adherence to care management programs.
AHRQ-funded; HS019912.
Citation: Polsky S, Donahoo WT, Lyons EE .
Evaluation of care management intensity and bariatric surgical weight loss.
Am J Manag Care 2015 Mar;21(3):182-9..
Keywords: Care Management, Obesity, Obesity: Weight Management, Patient Adherence/Compliance, Surgery
Jacoby VL, Jacoby A, Learman LA
Use of medical, surgical and complementary treatments among women with fibroids.
This study examined the use of medical management, uterus-preserving surgery, and complementary treatments among women with uterine fibroids. It found that uterus-preserving fibroid surgery is effective, but many symptomatic women can be successfully treated with nonsurgical management, including complementary and alternative therapy.
AHRQ-funded; HS011657; HS07373; HS09478.
Citation: Jacoby VL, Jacoby A, Learman LA .
Use of medical, surgical and complementary treatments among women with fibroids.
Eur J Obstet Gynecol Reprod Biol 2014 Nov;182:220-5. doi: 10.1016/j.ejogrb.2014.09.004..
Keywords: Care Management, Complementary and Alternative Medicine, Medication, Surgery, Treatments, Women