National Healthcare Quality and Disparities Report
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- Access to Care (1)
- Adverse Drug Events (ADE) (1)
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- Quality Indicators (QIs) (1)
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- Racial and Ethnic Minorities (1)
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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 25 of 26 Research Studies DisplayedKohn R, Harhay MO, Bayes B
Influence of bedspacing on outcomes of hospitalised medicine service patients: a retrospective cohort study.
The objective of this cohort study was to assess the association of bedspacing with patient-centered outcomes among United States patients admitted to general medicine services. The study compared internal medicine, family medicine and geriatric service patients who were bedspaced versus cohorted for the entirety of their hospital stay within three large, urban hospitals. Findings showed that bedspacing was associated with adverse patient-centered outcomes. Recommendations for future work included a need to confirm these findings, to understand mechanisms contributing to adverse outcomes, and to identify factors that mitigate these adverse effects in order to provide high-value, patient-centered care to hospitalized patients.
AHRQ-funded; HS026372.
Citation: Kohn R, Harhay MO, Bayes B .
Influence of bedspacing on outcomes of hospitalised medicine service patients: a retrospective cohort study.
BMJ Qual Saf 2021 Feb;30(2):116-22. doi: 10.1136/bmjqs-2019-010675..
Keywords: Patient-Centered Outcomes Research, Outcomes, Inpatient Care, Hospitals, Healthcare Delivery, Care Management, Adverse Events
Kaiser SV, Johnson MD, Walls TA
Pathways to improve pediatric asthma care: a multisite, national study of emergency department asthma pathway implementation.
This quality improvement study’s aim was to determine the effects of pediatric asthma pathway implementation in a diverse, national sample of emergency departments (EDs). Desired outcomes included systemic corticosteroid administration within 60 minutes (primary), assessment of severity at ED triage, chest radiograph use, hospital admission or transfer for higher level of care, and ED length of stay. Charts were reviewed each month by EDs for children ages 2-17 years with a primary diagnosis of asthma. A total of 83 EDs were enrolled, with 37 of them children’s hospitals, and 46 community hospitals. Seventy-three percent completed the study (n = 22,963). There was a significant increase in systematic corticosteroid administration within 60 minutes of arrival as well as increased odds of severity assessment at triage and decreased rate of change in odds of hospital admission/transfer. Chest radiograph or ED length of stay was not associated with pathway implementation.
AHRQ-funded; HS024592.
Citation: Kaiser SV, Johnson MD, Walls TA .
Pathways to improve pediatric asthma care: a multisite, national study of emergency department asthma pathway implementation.
J Pediatr 2020 Aug;223:100-07.e2. doi: 10.1016/j.jpeds.2020.02.080..
Keywords: Children/Adolescents, Emergency Department, Asthma, Quality Improvement, Quality of Care, Care Management, Healthcare Delivery, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes
Kaiser SV, Jennings B, Rodean J
Pathways for improving inpatient pediatric asthma care (PIPA): a multicenter, national study.
This study examined whether implementation of a pathway strategy for inpatient pediatric asthma patients improve outcomes for these patients. Outcomes measured included length of stay (LOS), early administration of metered-dose inhalers, screening for secondhand tobacco exposure and referral to cessation resources, and 7-day hospital readmissions or emergency revisits. Eighty-five hospitals were enrolled and 68 completed the study with (n=12,013) admissions. Pathways were associated with increases in early administration of metered-dose inhalers, and referral to smoking cessation resources, but no statistically significant changes in the other outcomes were observed. Most hospitals did improve in at least one outcome.
AHRQ-funded; HS024592; HS024554.
Citation: Kaiser SV, Jennings B, Rodean J .
Pathways for improving inpatient pediatric asthma care (PIPA): a multicenter, national study.
Pediatrics 2020 Jun;145(6):e20193026. doi: 10.1542/peds.2019-3026..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Inpatient Care, Patient-Centered Outcomes Research, Outcomes, Hospitalization, Care Management
Persell SD, Liss DT, Walunas TL
Effects of 2 forms of practice facilitation on cardiovascular prevention in primary care: a practice-randomized, comparative effectiveness trial.
Effective quality improvement (QI) strategies are needed for small practices. The objective of this study was to compare practice facilitation implementing point-of-care (POC) QI strategies alone versus facilitation implementing point-of-care plus population management (POC+PM) strategies on preventive cardiovascular care. The investigators concluded that facilitator-led QI promoting population management approaches plus POC improvement strategies was not clearly superior to POC strategies alone.
AHRQ-funded; HS023921.
Citation: Persell SD, Liss DT, Walunas TL .
Effects of 2 forms of practice facilitation on cardiovascular prevention in primary care: a practice-randomized, comparative effectiveness trial.
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Keywords: Cardiovascular Conditions, Prevention, Primary Care: Models of Care, Primary Care, Comparative Effectiveness, Patient-Centered Outcomes Research, Evidence-Based Practice, Quality Improvement, Quality of Care, Care Management, Healthcare Delivery
Barry-Menkhaus SA, Wagner DV, Riley AR
Small interventions for big change: brief strategies for distress and self-management amongst youth with type 1 diabetes.
In this article, the authors review existing evidence for brief interventions, describe several untested clinical strategies, and make recommendations for accelerating the translational study of brief interventions among youth with type 1 diabetes.
AHRQ-funded; HS022981.
Citation: Barry-Menkhaus SA, Wagner DV, Riley AR .
Small interventions for big change: brief strategies for distress and self-management amongst youth with type 1 diabetes.
Curr Diab Rep 2020 Jan 30;20(1):3. doi: 10.1007/s11892-020-1290-7..
Keywords: Diabetes, Patient-Centered Healthcare, Patient Self-Management, Patient Adherence/Compliance, Care Management, Patient-Centered Outcomes Research, Healthcare Delivery, Children/Adolescents
Murphy CC, Lee SJC, Gerber DE
Patient and provider perspectives on delivery of oral cancer therapies.
Investigators conducted a qualitative study exploring the range of patient and provider perspectives on oral cancer therapies. Through semi-structured interviews with patients and providers at a tertiary referral center and a county safetynet hospital in Dallas, Texas, they found that nearly all providers described challenges engaging with and educating patients about oral cancer therapies. Despite their initial hypothesis, the researchers also found that safetynet patients encountered few barriers accessing oral therapies when compared to patients receiving care in the tertiary referral center.
AHRQ-funded; HS022418.
Citation: Murphy CC, Lee SJC, Gerber DE .
Patient and provider perspectives on delivery of oral cancer therapies.
Patient Educ Couns 2019 Nov;102(11):2102-09. doi: 10.1016/j.pec.2019.06.019..
Keywords: Cancer, Healthcare Delivery, Access to Care, Patient-Centered Outcomes Research, Care Management
Makam AN, Tran T, Miller ME
The clinical course after long-term acute care hospital admission among older Medicare beneficiaries.
Investigators sought to examine the clinical course after long-term acute care (LTAC) admission. They found that hospitalized older adults transferred to LTAC hospitals had poor survival, spent most of their remaining life as an inpatient, and frequently underwent life-prolonging procedures. This prognostic understanding is essential to inform goals of care discussions and to prioritize healthcare needs for these adults. Given the exceedingly low rates of palliative care consultations, they recommend future research to examine unmet palliative care needs in this population.
AHRQ-funded; HS022418.
Citation: Makam AN, Tran T, Miller ME .
The clinical course after long-term acute care hospital admission among older Medicare beneficiaries.
J Am Geriatr Soc 2019 Nov;67(11):2282-88. doi: 10.1111/jgs.16106..
Keywords: Elderly, Medicare, Palliative Care, Patient-Centered Outcomes Research, Outcomes, Care Management, Healthcare Delivery
Ouayogode MH, Mainor AJ, Meara E
Association between care management and outcomes among patients with complex needs in Medicare accountable care organizations.
This study compared the performance of accountable care organizations (ACOS) for prevention quality indicator admissions and 30-day all-cause readmissions including hospitalization and emergency department visits, evaluation and management visits in ambulatory settings, median annual spending, lower median health care contact days and lower continuity-of-care-index for Medicare patients. This cross-sectional study surveyed 244 Medicare Shared Savings Program ACOs in the 2017-2018 National Survey of ACOs (of 351 Medicare ACO respondents conducted from July 20, 2017, to February 15, 2018 that was linked to 2016 Medicare administrative claims data. The study population included Medicare beneficiaries 66 years or older who were defined as having complex needs with higher costs because of frailty or 2 or more chronic conditions. There was not found to be much difference in quality between the lowest and top tertiles for care management and coordination activities.
AHRQ-funded; HS024075.
Citation: Ouayogode MH, Mainor AJ, Meara E .
Association between care management and outcomes among patients with complex needs in Medicare accountable care organizations.
JAMA Netw Open 2019 Jul 3;2(7):e196939. doi: 10.1001/jamanetworkopen.2019.6939..
Keywords: Care Management, Elderly, Medicare, Outcomes, Patient-Centered Outcomes Research, Quality of Care, Quality Indicators (QIs)
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
Ellis CT, Cole AL, Sanoff HK
Evaluating surveillance patterns after chemoradiation-only compared with conventional management for older patients with rectal cancer.
This study examined surveillance patterns for elderly patients who were treated only with chemoradiation (CR) as opposed to traditional treatment (chemoradiation and protectomy). In the cohort study, a total of 2,482 individuals met the inclusion criteria, with 21% receiving CR-only treatment, and 79% had conventional treatment. In comparison to patients who had traditional treatment, patients with CR-only treatment had far less follow-up during the first 2 years post-treatment. Adherence to guideline-recommended surveillance was poor for all Medicare patients, but especially for CR-only treated patients.
AHRQ-funded; HS000032.
Citation: Ellis CT, Cole AL, Sanoff HK .
Evaluating surveillance patterns after chemoradiation-only compared with conventional management for older patients with rectal cancer.
J Am Coll Surg 2019 May;228(5):782-91.e2. doi: 10.1016/j.jamcollsurg.2019.01.010..
Keywords: Cancer, Cancer: Colorectal Cancer, Care Management, Treatments, Elderly, Patient-Centered Outcomes Research
Balk EM, Rofeberg VN, Adam GP
Pharmacologic and nonpharmacologic treatments for urinary incontinence in women: a systematic review and network meta-analysis of clinical outcomes.
The purpose of this study was to compare the effectiveness of pharmacologic and nonpharmacologic interventions to improve or cure stress, urgency, or mixed UI in nonpregnant women. The investigators concluded that most nonpharmacologic and pharmacologic interventions were more likely than no treatment to improve UI outcomes. They also concluded that behavioral therapy, alone or in combination with other interventions, was generally more effective than pharmacologic therapies alone in treating both stress and urgency UI.
AHRQ-funded; 290201500002I.
Citation: Balk EM, Rofeberg VN, Adam GP .
Pharmacologic and nonpharmacologic treatments for urinary incontinence in women: a systematic review and network meta-analysis of clinical outcomes.
Ann Intern Med 2019 Apr 2;170(7):465-79. doi: 10.7326/m18-3227..
Keywords: Care Management, Comparative Effectiveness, Evidence-Based Practice, Medication, Outcomes, Patient-Centered Outcomes Research, Women
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
Lifland B, Wright DR, Mangione-Smith R
The impact of an adolescent depressive disorders clinical pathway on healthcare utilization.
The purpose of this study was to examine the association between level of adherence to an adolescent depressive disorders inpatient clinical pathway with psychiatric patients’ length of stay (LOS), cost, and readmissions. Patients in the high-adherence category were found to have significantly longer LOS and higher costs when compared to those in the low-adherence category. The authors conclude that understanding which of the care processes within the pathway are most cost-effective for improving patient-centered outcomes requires further investigation.
AHRQ-funded; HS024299.
Citation: Lifland B, Wright DR, Mangione-Smith R .
The impact of an adolescent depressive disorders clinical pathway on healthcare utilization.
Adm Policy Ment Health 2018 Nov;45(6):979-87. doi: 10.1007/s10488-018-0878-6..
Keywords: Care Management, Children/Adolescents, Depression, Healthcare Costs, Healthcare Utilization, Hospital Readmissions, Hospitalization, Inpatient Care, Behavioral Health, Outcomes, Patient-Centered Outcomes Research
Pantalone KM, Misra-Hebert AD, Hobbs TM
Clinical inertia in type 2 diabetes management: evidence from a large, real-world data set.
The failure of clinicians to intensify therapy when clinically indicated has been termed “clinical inertia.” This paper discusses clinical inertia in diabetes 2 management.
AHRQ-funded; HS024128.
Citation: Pantalone KM, Misra-Hebert AD, Hobbs TM .
Clinical inertia in type 2 diabetes management: evidence from a large, real-world data set.
Diabetes Care 2018 Jul;41(7):e113-e14. doi: 10.2337/dc18-0116..
Keywords: Care Management, Diabetes, Patient-Centered Outcomes Research
Mahmoud L, Zullo AR, Thompson BB
Outcomes of protocolised analgesia and sedation in a neurocritical care unit.
Researchers conducted a retrospective cohort study of 1197 mechanically ventilated patients admitted to a 12-bed neurocritical care unit (NCCU) over four years in order to evaluate the effect of an analgesia-based sedation protocol on medication use and costs in the NCCU. The protocol resulted in increased in fentanyl use and decreased in propofol use, but their findings indicate no effect on healthcare utilization, healthcare costs, or in-hospital mortality. Based on these results, the researchers suggest that similar NCCUs should consider using population-specific protocols to manage analgesia and sedation.
AHRQ-funded; HS022998.
Citation: Mahmoud L, Zullo AR, Thompson BB .
Outcomes of protocolised analgesia and sedation in a neurocritical care unit.
Brain Inj 2018;32(7):941-47. doi: 10.1080/02699052.2018.1469167..
Keywords: Care Management, Brain Injury, Critical Care, Healthcare Costs, Intensive Care Unit (ICU), Medication, Neurological Disorders, Outcomes, Patient-Centered Outcomes Research
Klinge M, Coppler T, Liebschutz JM
The assessment and management of pain in cirrhosis.
The treatment of pain in patients with cirrhosis is complicated by unpredictable hepatic drug metabolism and a higher risk of adverse drug reactions. The researchers aimed to conduct a scoping review regarding pain management in cirrhosis. As with other populations, a multi-dimensional treatment approach to pain with a focus on physical, behavioral, procedural and pharmacologic treatment is recommended when caring for patients with cirrhosis and pain.
AHRQ-funded; HS022989.
Citation: Klinge M, Coppler T, Liebschutz JM .
The assessment and management of pain in cirrhosis.
Curr Hepatol Rep 2018 Mar;17(1):42-51. doi: 10.1007/s11901-018-0389-7.
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Keywords: Adverse Drug Events (ADE), Care Management, Chronic Conditions, Evidence-Based Practice, Medication, Pain, Patient-Centered Outcomes Research
Sangha RS, Naidech AM, Corado C
Challenges in the medical management of symptomatic intracranial stenosis in an urban setting.
The researchers hypothesized that recurrent stroke risk among patients treated with aggressive medical management (AMM) is similar to that found in the medical arm of the SAMMPRIS trial (Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis). However, results indicated that recurrent stroke risk within 30 days in patients with symptomatic intracranial atherosclerotic disease was higher than that observed in the medical arm of SAMMPRIS even in the subgroup receiving AMM.
AHRQ-funded; HS023437.
Citation: Sangha RS, Naidech AM, Corado C .
Challenges in the medical management of symptomatic intracranial stenosis in an urban setting.
Stroke 2017 Aug;48(8):2158-63. doi: 10.1161/strokeaha.116.016254.
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Keywords: Brain Injury, Urban Health, Stroke, Patient-Centered Outcomes Research, Care Management
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
Rolfson O, Wissig S, van Maasakkers L
Defining an international standard set of outcome measures for patients with hip or knee osteoarthritis: consensus of the International Consortium for Health Outcomes Measurement Hip and Knee Osteoarthritis Working Group.
The researchers defined a minimum Standard Set of outcome measures and case-mix factors for monitoring, comparing, and improving healthcare for patients with clinically diagnosed hip or knee osteoarthritis (OA) with a focus on defining the outcomes that matter most to patients. The Working Group reached consensus on a concise set of outcome measures to evaluate patients' joint pain, physical functioning, health-related quality of life, work status, mortality, reoperations, readmissions, and overall satisfaction with treatment result.
AHRQ-funded; HS018910.
Citation: Rolfson O, Wissig S, van Maasakkers L .
Defining an international standard set of outcome measures for patients with hip or knee osteoarthritis: consensus of the International Consortium for Health Outcomes Measurement Hip and Knee Osteoarthritis Working Group.
Arthritis Care Res 2016 Nov;68(11):1631-39. doi: 10.1002/acr.22868.
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Keywords: Arthritis, Care Management, Chronic Conditions, Patient-Centered Outcomes Research
Patil SJ, Ruppar T, Koopman RJ
Peer support interventions for adults with diabetes: a meta-analysis of hemoglobin A1c outcomes.
This study aimed to estimate the effect of peer support interventions delivered by people affected by diabetes (those with the disease or a caregiver) on hemoglobin A1c (HbA1c) levels in adults. It found that peer support interventions for diabetes overall achieved a statistically significant but minor improvement in HbA1c levels.
AHRQ-funded; HS022140.
Citation: Patil SJ, Ruppar T, Koopman RJ .
Peer support interventions for adults with diabetes: a meta-analysis of hemoglobin A1c outcomes.
Ann Fam Med 2016 Nov;14(6):540-51. doi: 10.1370/afm.1982.
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Keywords: Care Management, Diabetes, Patient-Centered Outcomes Research
Gaither JR, Goulet JL, Becker WC
The effect of substance use disorders on the association between guideline-concordant long-term opioid therapy and all-cause mortality.
The objective of this study was to determine whether the presence of a substance use disorder (SUD) modifies the association between guideline-concordant care and 1-year all-cause mortality among patients receiving long-term opioid therapy (LtOT) for pain. It found that for clinicians prescribing LtOT to patients with untreated SUDs, engaging patients with psychotherapeutic and SUD treatment services may reduce mortality.
AHRQ-funded; U19 HS021112.
Citation: Gaither JR, Goulet JL, Becker WC .
The effect of substance use disorders on the association between guideline-concordant long-term opioid therapy and all-cause mortality.
J Addict Med 2016 Nov/Dec;10(6):418-28. doi: 10.1097/adm.0000000000000255.
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Keywords: Care Management, Medication, Mortality, Substance Abuse, Opioids, Patient-Centered Outcomes Research
Gernant SA, Snyder ME, Jaynes H
The effectiveness of pharmacist-provided telephonic medication therapy management on emergency department utilization in home health patients.
This article's objective is to evaluate the effectiveness of a telephonic medication therapy management (MTM) service on reducing emergency department utilization within a Medicare-insured home health population. The authors found that this pharmacist-delivered telephonic medication therapy management program did not decrease emergency department utilization overall but may further reduce the such risk among patients who are at lower risk of utilization.
AHRQ-funded; HS022119.
Citation: Gernant SA, Snyder ME, Jaynes H .
The effectiveness of pharmacist-provided telephonic medication therapy management on emergency department utilization in home health patients.
J Pharm Technol 2016 Oct 1;32(5):179-84. doi: 10.1177/8755122516660376.
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Keywords: Care Management, Emergency Department, Medication, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Prevention, Provider: Pharmacist, Provider
Luo Z, Chen Q, Annis AM
A comparison of health plan- and provider-delivered chronic care management models on patient clinical outcomes.
Two contrasting strategies of chronic care management include provider-delivered care management (PDCM) and health plan-delivered care management (HPDCM). The researchers aimed to compare the effectiveness of PDCM vs. HPDCM on improving clinical outcomes for patients with chronic diseases. They found that in a commercially insured population, neither PDCM nor HPDCM resulted in substantial improvement in patients' clinical indicators in the first year.
AHRQ-funded; HS020108.
Citation: Luo Z, Chen Q, Annis AM .
A comparison of health plan- and provider-delivered chronic care management models on patient clinical outcomes.
J Gen Intern Med 2016 Jul;31(7):762-70. doi: 10.1007/s11606-016-3617-2.
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Keywords: Chronic Conditions, Care Management, Primary Care: Models of Care, Primary Care, Healthcare Delivery, Comparative Effectiveness, Patient-Centered Outcomes Research, Health Insurance
Silverberg JI
Practice gaps in pruritus.
There are several practice gaps in the evaluation and management of itch. These gaps include a dearth of objective measures of itch, infrequent use of validated patient-reported outcomes for itch, non-evidence-based treatment, and lack of consensus about the ideal workup for generalized itch. The present article reviews these gaps and presents potential solutions.
AHRQ-funded; HS023011.
Citation: Silverberg JI .
Practice gaps in pruritus.
Dermatol Clin 2016 Jul;34(3):257-61. doi: 10.1016/j.det.2016.02.008.
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Keywords: Care Management, Evidence-Based Practice, Patient-Centered Outcomes Research
Wang SY, Hall J, Pollack CE
Trends in end-of-life cancer care in the Medicare program.
The researchers sought to examine contemporary trends in end-of-life cancer care and geographic variation of end-of-life care aggressiveness among Medicare beneficiaries. They found that the proportion of beneficiaries receiving at least one potentially aggressive end-of-life intervention increased in repeated hospitalization, repeated ED visits, ICU admissions, and late hospice enrollment but declined in in-hospital death. End-of-life chemotherapy use did not change significantly over time. They concluded that despite growing focus on providing appropriate end-of-life care, there has not been an improvement in aggressive end-of-life cancer care in the Medicare program.
AHRQ-funded; HS023900.
Citation: Wang SY, Hall J, Pollack CE .
Trends in end-of-life cancer care in the Medicare program.
J Geriatr Oncol 2016 Mar;7(2):116-25. doi: 10.1016/j.jgo.2015.11.007.
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Keywords: Cancer, Care Management, Elderly, Medicare, Palliative Care, Outcomes, Patient-Centered Outcomes Research, Practice Patterns