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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 718 Research Studies Displayed
Koh MJ, Merrill MH, Koh MJ
Comparative outcomes for mature T and NK/T-cell lymphomas in people with and without HIV and to AIDS-defining lymphomas.
Citation: Koh MJ, Merrill MH, Koh MJ . Comparative outcomes for mature T and NK/T-cell lymphomas in people with and without HIV and to AIDS-defining lymphomas. Blood Adv 2022 Mar 8;6(5):1420-31. doi: 10.1182/bloodadvances.2021006208.
Keywords: Human Immunodeficiency Virus (HIV), Comparative Effectiveness, Outcomes, Evidence-Based Practice
Bergman ZR, Usher M, Olson A
Comparison of outcomes and process of care for patients treated at hospitals dedicated for COVID-19 care vs other hospitals.
The purpose of this study was to analyze the mortality rate and complications associated with treatment at the COVID-19-dedicated hospitals. Findings showed that, in this cohort study, COVID-19-dedicated hospitals in Minnesota had multiple benefits, including providing high-volume repetitive treatment and isolating patients with the infection. This experience suggests improved in-hospital mortality for patients treated at dedicated hospitals.
AHRQ-funded; HS026732; HS026379.
Citation: Bergman ZR, Usher M, Olson A . Comparison of outcomes and process of care for patients treated at hospitals dedicated for COVID-19 care vs other hospitals. JAMA Netw Open 2022 Mar;5(3):e220873. doi: 10.1001/jamanetworkopen.2022.0873..
Keywords: COVID-19, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes, Healthcare Delivery, Hospitals
de Loizaga SR, Schneider K, Beck AF
Socioeconomic impact on outcomes during the first year of life of patients with single ventricle heart disease: an analysis of the National Pediatric Cardiology Quality Improvement Collaborative Registry.
In a retrospective cohort analysis of infants enrolled in the National Pediatric Cardiology Improvement Collaborative, researchers investigated the impact of community-level deprivation on morbidity and mortality for infants with single ventricle heart disease in the first year of life. They found that community deprivation was associated with mortality and length of stay for patients with single ventricle congenital heart disease. While patients near the mean deprivation index had a higher hazard of one year mortality compared to those at the extremes of the deprivation index, length of stay and deprivation index were linearly associated, demonstrating the complex nature of socioeconomic factors.
Citation: de Loizaga SR, Schneider K, Beck AF . Socioeconomic impact on outcomes during the first year of life of patients with single ventricle heart disease: an analysis of the National Pediatric Cardiology Quality Improvement Collaborative Registry. Pediatr Cardiol 2022 Mar;43(3):605-15. doi: 10.1007/s00246-021-02763-2..
Keywords: Children/Adolescents, Social Determinants of Health, Quality Improvement, Quality of Care, Cardiovascular Conditions, Registries, Outcomes
Wallis CJD, Huang LC, Zhao Z
Association between pelvic nodal radiotherapy and patient-reported functional outcomes through 5 years among men undergoing external-beam radiotherapy for prostate cancer: an assessment of the Comparative Effectiveness Analysis of Surgery and Radiation (C
In this study, the investigators sought to compare functional outcomes for men receiving prostate and pelvic versus prostate-only radiotherapy, longitudinally over 5 years. The investigators concluded that there were no clinically important differences in disease-specific or general health-related quality of life with the addition of pelvic irradiation to prostate radiotherapy, supporting the use of pelvic radiotherapy when it may be of clinical benefit, such as men with increased risk of nodal involvement.
AHRQ-funded; HS022640; HS019356.
Citation: Wallis CJD, Huang LC, Zhao Z . Association between pelvic nodal radiotherapy and patient-reported functional outcomes through 5 years among men undergoing external-beam radiotherapy for prostate cancer: an assessment of the Comparative Effectiveness Analysis of Surgery and Radiation (C Urol Oncol 2022 Feb;40(2):56.e1-56.e8. doi: 10.1016/j.urolonc.2021.04.035..
Keywords: Cancer: Prostate Cancer, Cancer, Men's Health, Comparative Effectiveness, Outcomes, Evidence-Based Practice, Patient-Centered Outcomes Research, Quality of Life
Aronson PL, Fleischer E, Schaeffer P
Development of a parent-reported outcome measure for febrile infants ≤60 days old.
This study’s aim was to develop a patient-reported outcome measure for febrile infants 60 days or younger evaluated in the emergency department. This 3-part study included: 1) individual, semistructured interviews with parents of febrile infants 60 days or younger to generate potential items for the measure; 2) expert review with pediatric emergency medicine physicians and member checking with parents, and 3) cognitive interviews with a new sample of parents who gave feedback and rated the measure’s ease of use on a 4-point scale. In part 1 24 parents of 21 infants were interviewed. The interviews revealed several themes: parents' experiences with medical care, communication, and decision making; parents' emotions, particularly worry, fear, and stress; the infant's outcomes valued by parents; and the impact of the infant's illness on the family, from which 22 potential items for inclusion were identified. In part 2, 10 items were revised for clarity based on feedback from physicians and parents. In part 3, the authors further revised the measure for clarity and added an item. The final measure included 23 items.
Citation: Aronson PL, Fleischer E, Schaeffer P . Development of a parent-reported outcome measure for febrile infants ≤60 days old. Pediatr Emerg Care 2022 Feb;38(2):e821-e27. doi: 10.1097/pec.0000000000002378.
Keywords: Newborns/Infants, Patient-Centered Outcomes Research, Outcomes
Stevens JP, Hatfield LA, Nyweide DJ
Comparison of health outcomes among patients admitted on busy vs less busy days for hospitalists.
Increasingly, hospitalized patients are cared for by hospitalists. When caseloads are higher or patients require more acute care than usual, hospitalists may respond to their cognitive and time constraints by shifting diagnostic or procedural work to specialist colleagues, thereby delaying discharges or missing preventable safety events. This cohort study used Medicare claims data to analyze health outcomes of Medicare patients admitted to the hospital and being treated by hospitalists on busy vs less busy days.
Citation: Stevens JP, Hatfield LA, Nyweide DJ . Comparison of health outcomes among patients admitted on busy vs less busy days for hospitalists. JAMA Netw Open 2022 Jan;5(1):e2144261. doi: 10.1001/jamanetworkopen.2021.44261..
Keywords: Outcomes, Emergency Department, Practice Patterns, Hospital Readmissions
Choi KR, Bhakta B, Knight EA
Patient outcomes after applied behavior analysis for autism spectrum disorder.
The purpose of this study was to examine patterns of service receipt and patient outcomes for children receiving applied behavior analysis (ABA) for autism spectrum disorder (ASD) in an integrated health care system in which commercially insured children were covered by a state autism mandate. Findings showed that, in a health system implementation of ABA for children with ASD, there were high rates of ABA discontinuation and low ABA dosing. These challenges may diminish the potential benefits of ABA, even with mandated commercial insurance coverage.
Citation: Choi KR, Bhakta B, Knight EA . Patient outcomes after applied behavior analysis for autism spectrum disorder. J Dev Behav Pediatr 2022 Jan;43(1):9-16. doi: 10.1097/dbp.0000000000000995..
Keywords: Children/Adolescents, Autism, Behavioral Health, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Franklin PD, Bond CP, Rothrock NE
Strategies for effective implementation of patient-reported outcome measures in arthroplasty practice.
This study’s goal was to synthesize patient-reported outcome measure (PROM) implementation strategies that are successfully used by hundreds of arthroplasty surgeons and early PROM-adopter clinical systems. The authors developed guidelines to inform clinical care, drive quality-improvement activities, and support reporting for payer-sponsored incentives. They also outlined future research that is needed to define methods for optimal patient engagement, technology infrastructure, and operational systems to seamlessly integrate PROM collection in clinical care.
Citation: Franklin PD, Bond CP, Rothrock NE . Strategies for effective implementation of patient-reported outcome measures in arthroplasty practice. J Bone Joint Surg Am 2021 Dec 15;103(24):e97. doi: 10.2106/jbjs.20.02072..
Keywords: Patient-Centered Outcomes Research, Orthopedics, Quality Improvement, Quality of Care, Evidence-Based Practice, Implementation, Outcomes
Kittelson AJ, Loyd BJ, Graber J
Examination of exclusion criteria in total knee arthroplasty rehabilitation trials: influence on the application of evidence in day-to-day practice.
This study investigated whether total knee arthroplasty (TKA) patients seen in routine practice who meet common exclusion criteria in clinical trials recover differently compared to research-eligible patients. Postoperative functional outcomes were compared using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Timed Up and Go (TUG). A total of 2,528 participants from 27 trials were compared to 474 patients from the clinical dataset. Research participants were older, with lower BMI than patients in the clinical dataset. There were no differences observed in functional recovery rate between groups, except for patients with diabetes whose TUG recovered more slowly than “eligible” patients.
Citation: Kittelson AJ, Loyd BJ, Graber J . Examination of exclusion criteria in total knee arthroplasty rehabilitation trials: influence on the application of evidence in day-to-day practice. J Eval Clin Pract 2021 Dec;27(6):1335-42. doi: 10.1111/jep.13564..
Keywords: Orthopedics, Surgery, Rehabilitation, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes
Zachrison KS, Schwamm LH, Xu H
Frequency, characteristics, and outcomes of endovascular thrombectomy in patients with stroke beyond 6 hours of onset in US clinical practice.
In 2018, 2 randomized controlled trials showed the benefit of endovascular thrombectomy (EVT) in acute ischemic stroke patients treated 6 to 24 hours from last known well using imaging-guided selection. However, little is known about outcomes in contemporary nontrial settings. In this study, the investigators assessed the frequency of EVT and outcomes beyond 6 hours in the US Get With The Guidelines-Stroke clinical registry.
Citation: Zachrison KS, Schwamm LH, Xu H . Frequency, characteristics, and outcomes of endovascular thrombectomy in patients with stroke beyond 6 hours of onset in US clinical practice. Stroke 2021 Dec;52(12):3805-14. doi: 10.1161/strokeaha.121.034069..
Keywords: Stroke, Cardiovascular Conditions, Surgery, Outcomes
Thelen AE, Kendrick DE, Chen X
Novel method to link surgical trainee performance data to patient outcomes.
A significant roadblock in surgical education research has been the inability to compare trainee performance to the outcomes of those surgeons after they enter independent practice. In this study, the investigators described the feasibility of an innovative method to link trainee performance data with patient outcomes. They indicated that this innovation could enable future research investigating the relationship between surgical trainee performance and patient outcomes in independent practice.
Citation: Thelen AE, Kendrick DE, Chen X . Novel method to link surgical trainee performance data to patient outcomes. Am J Surg 2021 Dec;222(6):1072-78. doi: 10.1016/j.amjsurg.2021.10.018..
Keywords: Surgery, Education: Continuing Medical Education, Provider Performance, Provider: Physician, Outcomes
Coley RY, Boggs JM, Beck A
Predicting outcomes of psychotherapy for depression with electronic health record data.
This study evaluated models for predicting outcomes of psychotherapy for depression in a clinical practice setting. Findings showed that prediction models did not accurately predict depression treatment outcomes despite using rich electronic health record data and advanced analytic techniques. Recommendations included caution when considering prediction models for psychiatric outcomes using baseline intake information and transparent research to evaluate performance of any model intended for clinical use.
Citation: Coley RY, Boggs JM, Beck A . Predicting outcomes of psychotherapy for depression with electronic health record data. J Affect Disord Rep 2021 Dec;6:100198. doi: 10.1016/j.jadr.2021.100198..
Keywords: Depression, Behavioral Health, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient-Centered Outcomes Research, Outcomes
Weekes AJ, Raper JD, Lupez K
Development and validation of a prognostic tool: pulmonary embolism short-term clinical outcomes risk estimation (PE-SCORE).
The objective of this study was to develop and validate a prognostic model for clinical deterioration or death within days of pulmonary embolism (PE) diagnosis using point-of-care criteria. In this study, the investigators used prospective registry data from six emergency departments. The primary composite outcome was death or deterioration (respiratory failure, cardiac arrest, new dysrhythmia, sustained hypotension, and rescue reperfusion intervention) within 5 days.
Citation: Weekes AJ, Raper JD, Lupez K . Development and validation of a prognostic tool: pulmonary embolism short-term clinical outcomes risk estimation (PE-SCORE). PLoS One 2021 Nov 18;16(11):e0260036. doi: 10.1371/journal.pone.0260036..
Keywords: Respiratory Conditions, Risk, Outcomes
Greenwood-Ericksen M, Kamdar N, Lin P
Association of rural and critical access hospital status with patient outcomes after emergency department visits among Medicare beneficiaries.
This study compared 30-day mortality rates after emergency department (ED) visits to rural or critical access hospitals (CAHs) compared to urban hospitals for Medicare beneficiaries. A 20% sample of Medicare beneficiaries was used from January 2011 to October 31, 2015. The primary outcome measured was 30-day mortality. Secondary outcome examined was ED visits with and without rehospitalization. Mortality rates were comparable with both groups, although patients in rural EDs experienced more transfers and less hospitalization.
Citation: Greenwood-Ericksen M, Kamdar N, Lin P . Association of rural and critical access hospital status with patient outcomes after emergency department visits among Medicare beneficiaries. JAMA Netw Open 2021 Nov;4(11):e2134980. doi: 10.1001/jamanetworkopen.2021.34980..
Keywords: Hospitals, Rural Health, Urban Health, Emergency Department, Mortality, Outcomes
Jiang DH, Mundell BF, Shah ND
Impact of high deductible health plans on diabetes care quality and outcomes: systematic review.
The authors sought to provide a systematic literature review of the impact of high deductible health plans (HDHPs) on the utilizations of services required for optimal management of diabetes and subsequent health outcomes. They found that, although HDHPs reduce some health care utilization and costs, they appear to do so at the expense of limiting high-value care and medication adherence.
AHRQ-funded; HS025517; HS024075; HS025164; HS025402.
Citation: Jiang DH, Mundell BF, Shah ND . Impact of high deductible health plans on diabetes care quality and outcomes: systematic review. Endocr Pract 2021 Nov;27(11):1156-64. doi: 10.1016/j.eprac.2021.07.001..
Keywords: Health Insurance, Diabetes, Chronic Conditions, Outcomes, Quality of Care, Patient-Centered Outcomes Research
Delaney LD, Howard R, Palazzolo K
Outcomes of a presurgical optimization program for elective hernia repairs among high-risk patients.
The authors evaluated the feasibility of evidence-based patient optimization before surgery by implementing a low-cost preoperative optimization clinic. They found that a hernia optimization clinic safely improved management of high-risk patients and increased operative yield for the institution. They concluded that their results represented an opportunity to create sustainable and scalable models that provide longitudinal care and optimize patients to improve outcomes of hernia repair.
Citation: Delaney LD, Howard R, Palazzolo K . Outcomes of a presurgical optimization program for elective hernia repairs among high-risk patients. JAMA Netw Open 2021 Nov;4(11):e2130016. doi: 10.1001/jamanetworkopen.2021.30016..
Keywords: Surgery, Risk, Evidence-Based Practice, Quality Improvement, Quality of Care, Outcomes
Austin EJ, LeRouge C, Lee JR
A learning health systems approach to integrating electronic patient-reported outcomes across the health care organization.
The authors reported on their effort to develop generalizable learnings that can support the integration of electronic patient-reported outcome measures into clinical practice within a learning health system (LHS) framework. They concluded that the guidelines produced from this work highlighted the complex, multidisciplinary nature of implementing change within LHS contexts, as well as the value of action research approaches to enable rapid, iterative learning that leverages the knowledge and experience of communities of practice.
Citation: Austin EJ, LeRouge C, Lee JR . A learning health systems approach to integrating electronic patient-reported outcomes across the health care organization. Learn Health Syst 2021 Oct;5(4):e10263. doi: 10.1002/lrh2.10263..
Keywords: Learning Health Systems, Health Information Technology (HIT), Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Kaufmann TL, Getz KD, Hsu JY
Identification of patient-reported outcome phenotypes among oncology patients with palliative care needs.
This retrospective study used patient-reported outcome (PRO) data to characterize oncology patients with palliative care needs. The objective was to determine if PRO data can identify latent phenotypes that characterize indications for specialty palliative care referral. Self-reported symptoms were collected on the Edmonton Symptom Assessment Symptom from solid tumor oncology patients (n = 745) referred to outpatient palliative care at eight community and academic sites from October 2012 to October 2018. The authors identified four PRO phenotypes: low symptoms (39.6%); moderate pain/fatigue + mood (24.2%); moderate pain/fatigue + appetite + dypsnea (27%); and high symptoms (9.3%). A secondary analysis of 421 patients found that two brief items assessing social and existential needs aligned with higher severity symptoms and psychological distress phenotypes.
Citation: Kaufmann TL, Getz KD, Hsu JY . Identification of patient-reported outcome phenotypes among oncology patients with palliative care needs. JCO Oncol Pract 2021 Oct;17(10):e1473-e88. doi: 10.1200/op.20.00849..
Keywords: Cancer, Palliative Care, Patient-Centered Outcomes Research, Outcomes
Cardell CF, Knapp L, Cohen ME
Successful implementation of enhanced recovery in elective colorectal surgery is variable and dependent on the local environment.
This study looked at the results of a national colorectal enhanced recovery program (ERP) to improve patient outcomes. A total of 207 hospitals participated between 2017 and 2020. Quantitative (patient-level process and outcome) and qualitative (survey and structured interviews with hospital teams) data were collected and analyzed. Results shows that 62 hospitals were characterized as High Performance, and 52 as High Improvement. High Performance hospitals were larger with more annual colorectal surgeries. Fewer barriers to staff-buy-in and competing priorities, and more experience with standardized perioperative care were also characteristics of High Performance hospitals. High Improvement hospitals had lower baseline process measure (PM) adherence and less experience with perioperative care but had positive trends in annual patient outcomes such as annual morbidity, readmission, and prolonged length of stay compared to Low Improvement Hospitals.
Citation: Cardell CF, Knapp L, Cohen ME . Successful implementation of enhanced recovery in elective colorectal surgery is variable and dependent on the local environment. Ann Surg 2021 Oct 1;274(4):605-12. doi: 10.1097/sla.0000000000005069..
Keywords: Surgery, Quality Improvement, Quality of Care, Outcomes, Patient-Centered Outcomes Research, Provider Performance
Anesi GL, Kerlin MP
The impact of resource limitations on care delivery and outcomes: routine variation, the coronavirus disease 2019 pandemic, and persistent shortage.
Researchers discuss the impact of resource limitations on care delivery and outcomes. They conclude that the interaction between resource limitation and care delivery and outcomes is complex and incompletely understood. Further, the COVID-19 pandemic provides a learning opportunity for strain response during both pandemic and non-pandemic times.
Citation: Anesi GL, Kerlin MP . The impact of resource limitations on care delivery and outcomes: routine variation, the coronavirus disease 2019 pandemic, and persistent shortage. Curr Opin Crit Care 2021 Oct 1;27(5):513-19. doi: 10.1097/mcc.0000000000000859..
Keywords: COVID-19, Public Health, Healthcare Delivery, Intensive Care Unit (ICU), Outcomes
Mathis MR, Yule S, Wu X
The impact of team familiarity on intra and postoperative cardiac surgical outcomes.
The authors hypothesized that familiarity among cardiac surgery team members may be an important contributor to better outcomes and thus serve as a target for enhancing outcomes. They found that high team familiarity was associated with reduced cardiopulmonary bypass duration for medium-risk and high-risk patients. Increasing team familiarity was not significantly associated with the odds of major morbidity and mortality. They concluded that team familiarity, which was predictive of improved intraoperative efficiency without compromising major postoperative outcomes, may serve as a novel quality improvement target in the setting of cardiac surgery.
Citation: Mathis MR, Yule S, Wu X . The impact of team familiarity on intra and postoperative cardiac surgical outcomes. Surgery 2021 Oct;170(4):1031-38. doi: 10.1016/j.surg.2021.05.020..
Keywords: Teams, Surgery, Heart Disease and Health, Cardiovascular Conditions, Outcomes
Jacobs M, Ellis C
Estimating the cost and value of functional changes in communication ability following telepractice treatment for aphasia.
This study assessed the cost, cost-effectiveness, and perceived value associated with improved functional communication in individuals receiving telerehabilitation treatment for aphasia. Twenty persons with aphasia completed between 5 and 12 telehealth sessions of 45-60 minutes within a 6-week timeframe using a Language-Oriented Treatment (LOT). Measures were used to obtain baseline and treatment status using the National Outcomes Measures (NOMS) comprehension and verbal expression and the ASHA Quality of Communication Life (QCL). African Americans were twice as likely as Whites to experience improvement after treatment. The likelihood of improvement also increased with each additional year of education but decreased with age. The average cost of treatment varied between $540 and $1,296. However, on average the monetary equivalent in patient’s improved QCL was between $1,790 to $3,912, showing the QCL far exceeded the financial cost of treatment.
Citation: Jacobs M, Ellis C . Estimating the cost and value of functional changes in communication ability following telepractice treatment for aphasia. PLoS One 2021 Sep 17;16(9):e0257462. doi: 10.1371/journal.pone.0257462..
Keywords: Telehealth, Health Information Technology (HIT), Healthcare Costs, Outcomes
Kwee Wong, LL Sato, MM
Transarterial radioembolization for hepatocellular carcinoma with major vascular invasion: a nationwide propensity score-matched analysis with target trial emulation.
This study’s objective was to compare overall survival (OS) rates for hepatocellular carcinoma (HCC) with major vascular invasion (HCC-MVI) for patients undergoing either transarterial radioembolization (TARE) or systemic therapy. The National Cancer Database was used to identify 1,514 patients with HCC-MVI. TARE use had doubled between 2010 and 2015. OS was compared for the two treatments and TARE was found to be associated with significant survival benefits compared with systemic therapy.
Citation: Kwee Wong, LL Sato, MM . Transarterial radioembolization for hepatocellular carcinoma with major vascular invasion: a nationwide propensity score-matched analysis with target trial emulation. J Vasc Interv Radiol 2021 Sep;32(9):1258-66.e6. doi: 10.1016/j.jvir.2021.07.001..
Keywords: Cancer, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Stevens JP, Dechen T, Schwartzstein RM
Association of dyspnoea, mortality and resource use in hospitalised patients.
As many as one in 10 patients experience dyspnoea at hospital admission but the relationship between dyspnoea and patient outcomes is unknown. In this study, the investigators sought to determine whether dyspnoea on admission predicts outcomes. They conducted a retrospective cohort study in a single, academic medical centre. They analysed 67 362 consecutive hospital admissions with available data on dyspnoea, pain and outcomes.
Citation: Stevens JP, Dechen T, Schwartzstein RM . Association of dyspnoea, mortality and resource use in hospitalised patients. Eur Respir J 2021 Sep 2;58(3). doi: 10.1183/13993003.02107-2019..
Keywords: Respiratory Conditions, Mortality, Outcomes
Fredericksen RJ, Harding BN, Ruderman SA
Patient acceptability and usability of a self-administered electronic patient-reported outcome assessment in HIV care: relationship with health behaviors and outcomes.
The authors assessed acceptability/usability of tablet-based patient-reported outcome (PRO) assessments among patients in HIV care and relationships with health outcomes using a modified Acceptability E-Scale (AES) within a self-administered PRO assessment. They found that higher acceptability was associated with better quality of life and adherence while lower acceptability was associated with higher depression symptoms, recent illicit opioid use, and multiple recent sex partners. While patients endorsing depression symptoms, recent opioid use, sex without condoms, or multiple sex partners found PROs less acceptable, overall, patients found the assessments highly acceptable and easy to use.
Citation: Fredericksen RJ, Harding BN, Ruderman SA . Patient acceptability and usability of a self-administered electronic patient-reported outcome assessment in HIV care: relationship with health behaviors and outcomes. AIDS Care 2021 Sep;33(9):1167-77. doi: 10.1080/09540121.2020.1845288..
Keywords: Human Immunodeficiency Virus (HIV), Quality of Life, Patient-Centered Outcomes Research, Outcomes, Chronic Conditions