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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 22 of 22 Research Studies DisplayedOrtiz D, Perkins AJ, Fuchita M
Pre-existing anxiety and depression in injured older adults: an under-recognized comorbidity with major health implications.
The purpose of this retrospective post-hoc analysis study was to evaluate variations in baseline depression and anxiety screenings between older injured patients with pre-existing diagnoses and those without. Data from the Trauma Medical Home, a multicenter randomized controlled trial was used for analysis. The study found that almost 50% of the patients screened positive for at least mild depressive symptoms as measured by the Patient Health Questionnaire-9, and 41% of the patients screened positive for at least mild anxiety symptoms as measured by the Generalized Anxiety Disorder Scale. Female patients with a history of concurrent anxiety and depression, greater injury severity scores, and higher Charlson scores were more likely to have mild anxiety at the baseline assessment. Patients with a history of depression only, a prior history of depression and concurrent anxiety, and higher Charlson scores (greater medical comorbidity) were more likely to have experienced at least mild depression at the time of hospital discharge after traumatic injury.
AHRQ-funded; HS026390.
Citation: Ortiz D, Perkins AJ, Fuchita M .
Pre-existing anxiety and depression in injured older adults: an under-recognized comorbidity with major health implications.
Ann Surg Open 2022 Dec; 3(4):e217. doi: 10.1097/as9.0000000000000217..
Keywords: Elderly, Anxiety, Depression, Behavioral Health, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Injuries and Wounds
Bowman JA, Nuño M, Jurkovich GJ
Association of hospital-level intensive care unit use and outcomes in older patients with isolated rib fractures.
Researchers characterized interhospital variability in intensive care unit (ICU) vs non-ICU admission of older patients with isolated rib fractures and evaluated whether greater hospital-level use of ICU admission is associated with improved outcomes. This study included trauma patients who were admitted to trauma centers participating in the National Trauma Data Bank. The researchers found that admission location of older patients with isolated rib fractures was variable across hospitals, but hospitalization at a center with greater ICU use was associated with improved outcomes. They recommended that hospitals with low ICU use admit more such patients to an ICU.
AHRQ-funded; HS022236.
Citation: Bowman JA, Nuño M, Jurkovich GJ .
Association of hospital-level intensive care unit use and outcomes in older patients with isolated rib fractures.
JAMA Netw Open 2020 Nov 2;3(11):e2026500. doi: 10.1001/jamanetworkopen.2020.26500..
Keywords: Elderly, Injuries and Wounds, Intensive Care Unit (ICU), Hospitals, Patient-Centered Outcomes Research, Outcomes, Mortality
Bowman JA, Jurkovich GJ, Nuño M
Hospital-level intensive care unit admission for patients with isolated blunt abdominal solid organ injury.
This study’s objective was to determine the optimal level of care for hemodynamically stable patients with isolated blunt hepatic, renal, or splenic injuries. A retrospective cohort study was conducted using the 2015 and 2016 National Trauma Data Bank. The intervariability of intensive care unit (ICU) admission for these patients was determined. Hospitals were categorized into quartiles based on the proportion of eligible patients admitted to an ICU. Primary outcomes were a composite of organ failure, infection, or death during hospitalization. Findings were that greater hospital-level ICU use was not associated with a decreased likelihood of the composite outcome or infection or death. These outcomes were fairly rare to begin with.
AHRQ-funded; HS022236.
Citation: Bowman JA, Jurkovich GJ, Nuño M .
Hospital-level intensive care unit admission for patients with isolated blunt abdominal solid organ injury.
J Trauma Acute Care Surg 2020 Mar;88(3):408-15. doi: 10.1097/ta.0000000000002581.
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Keywords: Injuries and Wounds, Intensive Care Unit (ICU), Critical Care, Patient-Centered Outcomes Research, Evidence-Based Practice
Bowman JA, Jurkovich GJ, Nishijima DK
Older adults with isolated rib fractures do not require routine intensive care unit admission.
This study examined whether older adults with isolated rib fractures should be admitted to an intensive care unit (ICU) due to higher presumed morbidity and mortality. Patients 50 years and older who were admitted between 2013 and 2017 were analyzed. The outcomes being looked at were any critical care intervention or adverse event based on accepted critical care guidelines. Out of 401 patients, 251 (63%) were admitted to the ICU. In the ICU, 33% experienced an adverse event while only 7% admitted to the ward experienced an adverse event. The most common events were hypotension, frequent respiratory therapy and oxygen desaturation. Predictors of these events included incentive spirometry, use of a walker, increased chest Abbreviated Injury Scale score, age 72 or greater, and active smoking. The investigators concluded routine ICU admission is not necessary for most older adults with isolated rib fractures.
AHRQ-funded; HS022236.
Citation: Bowman JA, Jurkovich GJ, Nishijima DK .
Older adults with isolated rib fractures do not require routine intensive care unit admission.
J Surg Res 2020 Jan;245:492-99. doi: 10.1016/j.jss.2019.07.098..
Keywords: Elderly, Injuries and Wounds, Intensive Care Unit (ICU), Patient-Centered Outcomes Research, Outcomes
Zhang T, Lary CW, Zullo AR
Post-hip fracture mortality in nursing home residents by obesity status.
This research letter discusses a study that examined whether obesity status affected mortality in post-hip fracture patients who were nursing home residents. A national cohort of nursing home (NH) residents was examined from national Medicare fee-for-service claims linked to the Minimum Data Set (MDS) from January 2008 through the end of 2009. A total of 33, 622 long-stay residents were identified who had been hospitalized for a hip fracture. They excluded 6918 patients due to a number of factors. They classified residents based on their BMI: normal BMI, overweight, mild obesity, or moderate/severe obesity. They found that being moderate/severely obese did not increase mortality.
AHRQ-funded; HS022998.
Citation: Zhang T, Lary CW, Zullo AR .
Post-hip fracture mortality in nursing home residents by obesity status.
J Am Geriatr Soc 2019 Sep;67(9):1983-85. doi: 10.1111/jgs.16028..
Keywords: Injuries and Wounds, Surgery, Nursing Homes, Obesity, Mortality, Elderly, Long-Term Care, Patient-Centered Outcomes Research
Fink HA, MacDonald R, Forte ML
Long-term drug therapy and drug discontinuations and holidays for osteoporosis fracture prevention: a systematic review.
Optimal long-term osteoporosis drug treatment (ODT) is uncertain. The purpose of this study was to summarize the effects of long-term ODT and ODT discontinuation and holidays. The investigators concluded that: long-term alendronate and zoledronic acid therapies reduce fracture risk in women with osteoporosis; long-term bisphosphonate treatment may increase risk for rare adverse events, and continuing treatment beyond 3 to 5 years may reduce risk for vertebral fractures; and long-term hormone therapy reduces hip fracture risks but has serious harms.
AHRQ-funded; 290201500008I.
Citation: Fink HA, MacDonald R, Forte ML .
Long-term drug therapy and drug discontinuations and holidays for osteoporosis fracture prevention: a systematic review.
Ann Intern Med 2019 Jul 2;171(1):37-50. doi: 10.7326/m19-0533.
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Keywords: Evidence-Based Practice, Injuries and Wounds, Medication, Osteoporosis, Outcomes, Patient-Centered Outcomes Research, Prevention
Gandek B, Roos EM, Franklin PD
A 12-item short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-12): tests of reliability, validity and responsiveness.
The purpose of this study was to evaluate reliability, validity and responsiveness of KOOS-12, a 12-item short form of the 42-item Knee injury and Osteoarthritis Outcome Score (KOOS) that provides Pain, Function and Quality of Life (QOL) scale scores and a summary knee impact score. Results showed that KOOS-12 was a reliable and valid alternative to KOOS in total knee replacement patients with moderate to severe knee osteoarthritis and provided three domain-specific and summary knee impact scores with substantially reduced respondent burden.
AHRQ-funded; HS024632; HS018910.
Citation: Gandek B, Roos EM, Franklin PD .
A 12-item short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-12): tests of reliability, validity and responsiveness.
Osteoarthritis Cartilage 2019 May;27(5):762-70. doi: 10.1016/j.joca.2019.01.011..
Keywords: Arthritis, Evidence-Based Practice, Injuries and Wounds, Outcomes, Pain, Patient-Centered Outcomes Research, Quality of Life
Zullo AR, Zhang T, Lee Y
Effect of bisphosphonates on fracture outcomes among frail older adults.
The purpose of this study was to estimate the effects of bisphosphonates on hip fractures, nonvertebral fractures, and severe esophagitis among frail, older adults. Participants were residents of long-stay U.S. nursing homes who were 65 years and older and had no recent use of osteoporosis medication. The matched cohort included new bisphosphonate users and an equal number of calcitonin users. Outcomes for hip fracture, nonvertebral fracture, and esophagitis were measured using Part A claims. Bisphosphonate users were less likely than calcitonin users to experience hip fracture, but had similar rates of nonvertebral fracture and esophagitis events. The researchers conclude that bisphosphonate use is associated with a meaningful reduction in hip fracture among frail, older adults.
AHRQ-funded; HS022998.
Citation: Zullo AR, Zhang T, Lee Y .
Effect of bisphosphonates on fracture outcomes among frail older adults.
J Am Geriatr Soc 2019 Apr;67(4):768-76. doi: 10.1111/jgs.15725..
Keywords: Elderly, Injuries and Wounds, Medication, Outcomes, Patient-Centered Outcomes Research
Marcolini EG, Albrecht JS, Sethuraman KN
Gender disparities in trauma care: how sex determines treatment, behavior, and outcome.
This study used US and European trauma database statistics, including the National Trauma Databank, to examine sex disparities in trauma care. Their findings indicate that sex differences in risk-taking behaviors that lead to traumatic injury have been associated with males, with female menstrual cycle timing, and with cortisol levels. Differences in access to services at trauma centers, including triage or transfer and level of medical attention are associated with sex as well race, rural or urban location, and insurance status. Outcomes, such as in-hospital mortality, multiple organ failure, pneumonia, and sepsis are associated with sex disparities in the general trauma patient; outcomes after general trauma and specifically traumatic brain injury show mixed results.
AHRQ-funded; HS024560.
Citation: Marcolini EG, Albrecht JS, Sethuraman KN .
Gender disparities in trauma care: how sex determines treatment, behavior, and outcome.
Anesthesiol Clin 2019 Mar;37(1):107-17. doi: 10.1016/j.anclin.2018.09.007..
Keywords: Access to Care, Disparities, Injuries and Wounds, Outcomes, Patient-Centered Outcomes Research, Risk, Sex Factors, Trauma
Myers SR, Branas CC, French B
A national analysis of pediatric trauma care utilization and outcomes in the United States.
The goal of this study was to provide the first national description of the proportion of injured children treated at pediatric trauma centers, and to clarify the presumed benefit of pediatric trauma center verification by comparing injury mortality across hospital types. The study used data from the 2006 Healthcare Cost and Utilization Project Kids Inpatient Database combined with national trauma center inventories. The results of the study may provide evidence that treatment of injured children at verified pediatric trauma centers may improve outcomes.
AHRQ-funded; HS017960; HS018604.
Citation: Myers SR, Branas CC, French B .
A national analysis of pediatric trauma care utilization and outcomes in the United States.
Pediatr Emerg Care 2019 Jan;35(1):1-7. doi: 10.1097/pec.0000000000000902..
Keywords: Children/Adolescents, Healthcare Utilization, Healthcare Cost and Utilization Project (HCUP), Injuries and Wounds, Outcomes, Patient-Centered Outcomes Research, Trauma
Wong C, Fagan B, Leland NE
Occupational therapy practitioners' perspectives on occupation-based interventions for clients with hip fracture.
This study identified perspectives of 18 occupational therapy practitioners on integrating occupation-based interventions during postacute care (PAC) rehabilitation for persons with hip fracture to identify occupational therapy's distinct contribution. The study concluded that identifying practitioners' perspectives on integrating occupation into rehabilitation may inform strategies to facilitate occupation-based interventions in PAC and define occupational therapy's role in this setting.
AHRQ-funded; HS022907.
Citation: Wong C, Fagan B, Leland NE .
Occupational therapy practitioners' perspectives on occupation-based interventions for clients with hip fracture.
Am J Occup Ther 2018 Jul/Aug;72(4):7204205050p1-50p7. doi: 10.5014/ajot.2018.026492..
Keywords: Injuries and Wounds, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Rehabilitation
Zullo AR, Zhang T, Beudoin FL
Pain treatments after hip fracture among older nursing home residents.
In this retrospective cohort study the investigators examined the association between use of opioids versus other analgesics with death and functioning after hip fracture in older nursing home (NH) residents. The investigators concluded that a rigorous study addressing the limitations of their study is critical to validate their preliminary findings and provide evidence about the effect of using opioid versus nonopioid analgesics to optimize acute pain in NH residents with a hip fracture.
AHRQ-funded; HS022998.
Citation: Zullo AR, Zhang T, Beudoin FL .
Pain treatments after hip fracture among older nursing home residents.
J Am Med Dir Assoc 2018 Feb;19(2):174-76. doi: 10.1016/j.jamda.2017.11.008..
Keywords: Opioids, Pain, Nursing Homes, Long-Term Care, Elderly, Medication, Injuries and Wounds, Patient-Centered Outcomes Research, Healthcare Utilization
Sears ED, Momoh AO, Chung KC
A national study of the impact of delayed flap timing for treatment of patients with deep sternal wound infection.
This study aimed to evaluate the impact of delayed flap closure on mortality and resource use for treatment of deep sternal wound infection. The timing of flap closure was delayed more than 7 days after diagnosis in 39 percent of patients. The study concluded that delay in flap closure was associated with greater mortality and resource use.
AHRQ-funded; HS023313.
Citation: Sears ED, Momoh AO, Chung KC .
A national study of the impact of delayed flap timing for treatment of patients with deep sternal wound infection.
Plast Reconstr Surg 2017 Aug;140(2):390-400. doi: 10.1097/prs.0000000000003514.
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Keywords: Injuries and Wounds, Surgery, Healthcare-Associated Infections (HAIs), Adverse Events, Patient-Centered Outcomes Research
Gandek B, Ware JE, Jr.
Validity and responsiveness of the knee injury and osteoarthritis outcome score: a comparative study among total knee replacement patients.
The researchers evaluated validity and responsiveness of the Knee Injury and Osteoarthritis Outcome Score (KOOS) in relation to other patient-reported outcome measures before and after total knee replacement (TKR). They concluded that KOOS scales were valid and responsive in a cohort of 1,143 US TKR patients. KOOS QOL performed particularly well in capturing aggregate knee-specific outcomes.
AHRQ-funded; HS018910; HS024632.
Citation: Gandek B, Ware JE, Jr. .
Validity and responsiveness of the knee injury and osteoarthritis outcome score: a comparative study among total knee replacement patients.
Arthritis Care Res 2017 Jun;69(6):817-25. doi: 10.1002/acr.23193.
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Keywords: Arthritis, Surgery, Patient-Centered Outcomes Research, Outcomes, Injuries and Wounds
O'Toole RV, Gary JL, Reider L
A prospective randomized trial to assess fixation strategies for severe open tibia fractures: modern ring external fixators versus internal fixation (FIXIT study).
The FIXIT study is a prospective, multicenter randomized trial comparing 1-year outcomes after treatment of severe open tibial shaft fractures with modern external ring fixation versus internal fixation among men and women of ages 18-64. The primary outcome is rehospitalization for major limb complications. One-year treatment costs and patient satisfaction will be compared between the 2 groups.
AHRQ-funded; HS000029.
Citation: O'Toole RV, Gary JL, Reider L .
A prospective randomized trial to assess fixation strategies for severe open tibia fractures: modern ring external fixators versus internal fixation (FIXIT study).
J Orthop Trauma 2017 Apr;31 Suppl 1:S10-s17. doi: 10.1097/bot.0000000000000804.
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Keywords: Injuries and Wounds, Surgery, Patient-Centered Outcomes Research, Comparative Effectiveness, Outcomes, Evidence-Based Practice
Obremskey WT, Schmidt AH, O'Toole RV
A prospective randomized trial to assess oral versus intravenous antibiotics for the treatment of postoperative wound infection after extremity fractures (POvIV study).
The POvIV study is a prospective, multicenter, randomized trial to compare oral (PO) with intravenous (IV) antibiotic therapy in patients with postoperative wound infections after extremity fractures. This study will be the largest prospective randomized trial to evaluate the safety and effectiveness of PO antibiotic use for treatment of postoperative wound infections. Results will inform clinician decisions on antibiotic delivery in patients with postoperative wound infections.
AHRQ-funded; HS000029.
Citation: Obremskey WT, Schmidt AH, O'Toole RV .
A prospective randomized trial to assess oral versus intravenous antibiotics for the treatment of postoperative wound infection after extremity fractures (POvIV study).
J Orthop Trauma 2017 Apr;31 Suppl 1:S32-s38. doi: 10.1097/bot.0000000000000802.
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Keywords: Antibiotics, Surgery, Injuries and Wounds, Healthcare-Associated Infections (HAIs), Comparative Effectiveness, Medication, Patient Safety, Adverse Events, Prevention, Patient-Centered Outcomes Research, Outcomes
Wegener ST, Pollak AN, Frey KP
The Trauma Collaborative Care Study (TCCS).
This article describes the Trauma Collaborative Care (TCC) program and the design of a multicenter study to evaluate its effectiveness for improving patient outcomes after major, high-energy orthopaedic trauma at level 1 trauma centers. Compared with standard treatment alone, it is hypothesized that access to the TCC program plus standard treatment will result in lower rates of poor patient-reported function, depression, and posttraumatic stress disorder.
AHRQ-funded; HS000029.
Citation: Wegener ST, Pollak AN, Frey KP .
The Trauma Collaborative Care Study (TCCS).
J Orthop Trauma 2017 Apr;31 Suppl 1:S78-s87. doi: 10.1097/bot.0000000000000792.
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Keywords: Injuries and Wounds, Outcomes, Patient-Centered Outcomes Research, Behavioral Health, Screening, Trauma
Conlon C, Asch S, Hanson M
Assessing the value of high-quality care for work-associated carpal tunnel syndrome in a large integrated health care system: study design.
The researchers described the design of a study that is assessing quality of care for work-associated carpal tunnel syndrome and associations with clinical outcomes and costs. They found that time off work was generally short and related to surgery. They recommended systematic efforts to evaluate and improve quality of medical care for this condition.
AHRQ-funded; HS018982.
Citation: Conlon C, Asch S, Hanson M .
Assessing the value of high-quality care for work-associated carpal tunnel syndrome in a large integrated health care system: study design.
Perm J 2016 Fall;20(4):87-95. doi: 10.7812/tpp/15-220.
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Keywords: Healthcare Delivery, Quality of Care, Injuries and Wounds, Neurological Disorders, Patient-Centered Outcomes Research
Bowling CB, Bromfield SG, Colantonio LD
Association of reduced eGFR and albuminuria with serious fall injuries among older adults.
The researchers studied adverse outcomes in patients on dialysis as a result of falls. They found that among participants with CKD, cumulative 1-year mortality rates among patients with a serious fall and age-matched controls were 21.0% and 5.5%, respectively, and noted that elevated ACR but not lower eGFR was associated with serious fall injuries. They concluded that evaluation for fall risk factors and fall prevention strategies should be considered for older adults with elevated ACR.
AHRQ-funded; HS023009.
Citation: Bowling CB, Bromfield SG, Colantonio LD .
Association of reduced eGFR and albuminuria with serious fall injuries among older adults.
Clin J Am Soc Nephrol 2016 Jul 7;11(7):1236-43. doi: 10.2215/cjn.11111015.
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Keywords: Elderly, Falls, Patient-Centered Outcomes Research, Kidney Disease and Health, Injuries and Wounds
Roberts ET, DuGoff EH, Heins SE
Evaluating clinical practice guidelines based on their association with return to work in administrative claims data.
The researchers examined the association between non-adherence to clinical practice guidelines (CPGs) and time to return to work (RTW) for patients with workplace injuries. They found that early receipt of care and getting less than the recommended amount of care were correlated with faster RTW, while excessive physical therapy, bracing, and injections were associated with slower RTW. They recommended that CPGs supported by observational studies or randomized trials may have a more certain relationship to health outcomes.
AHRQ-funded; HS000029.
Citation: Roberts ET, DuGoff EH, Heins SE .
Evaluating clinical practice guidelines based on their association with return to work in administrative claims data.
Health Serv Res 2016 Jun;51(3):953-80. doi: 10.1111/1475-6773.12360.
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Keywords: Guidelines, Injuries and Wounds, Patient-Centered Outcomes Research
Sanger P, Hartzler A, Lober WB
Design considerations for post-acute care mHealth: patient perspectives.
The authors are developing an mHealth platform to engage patients in wound tracking to identify and manage surgical site infections (SSI) after hospital discharge. Their key design qualities include: meeting basic accessibility, usability and security needs; encouraging patient-centeredness; facilitating better, more predictable communication; and supporting personalized management by providers. In this article, they illustrated their application of these guiding design considerations and proposed a new framework for mHealth design based on illness duration and intensity.
AHRQ-funded; HS019482.
Citation: Sanger P, Hartzler A, Lober WB .
Design considerations for post-acute care mHealth: patient perspectives.
AMIA Annu Symp Proc 2014 Nov 14;2014:1920-9.
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Keywords: Telehealth, Patient Self-Management, Surgery, Injuries and Wounds, Healthcare-Associated Infections (HAIs), Hospital Discharge, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Adverse Events
Band RA, Salhi RA, Holena DN
Severity-adjusted mortality in trauma patients transported by police.
Two decades ago, Philadelphia began allowing police transport of patients with penetrating trauma. In this retrospective cohort study, the investigators conduct a large, multiyear, citywide analysis of this policy. They examine the association between mode of out-of-hospital transport (police department versus emergency medical services [EMS]) and mortality among patients with penetrating trauma in Philadelphia.
AHRQ-funded; HS017960.
Citation: Band RA, Salhi RA, Holena DN .
Severity-adjusted mortality in trauma patients transported by police.
Ann Emerg Med 2014 May;63(5):608-14.e3. doi: 10.1016/j.annemergmed.2013.11.008..
Keywords: Injuries and Wounds, Mortality, Patient-Centered Outcomes Research, Trauma