National Healthcare Quality and Disparities Report
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Search All Research Studies
Topics
- Blood Pressure (1)
- Cardiovascular Conditions (1)
- Children/Adolescents (5)
- Chronic Conditions (4)
- Decision Making (1)
- (-) Diabetes (21)
- (-) Diagnostic Safety and Quality (21)
- Elderly (1)
- Electronic Health Records (EHRs) (4)
- Emergency Department (1)
- Eye Disease and Health (1)
- Genetics (3)
- Health Information Technology (HIT) (3)
- Heart Disease and Health (1)
- Imaging (1)
- Lifestyle Changes (1)
- Medication (1)
- Newborns/Infants (1)
- Patient-Centered Healthcare (1)
- Patient Self-Management (1)
- Pregnancy (1)
- Prevention (1)
- Racial and Ethnic Minorities (2)
- Registries (1)
- Risk (2)
- Screening (5)
- Sepsis (2)
- Urban Health (1)
- Web-Based (1)
- Women (1)
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 21 of 21 Research Studies DisplayedMichelson KA, Bachur RG, Cruz AT
Multicenter evaluation of a method to identify delayed diagnosis of diabetic ketoacidosis and sepsis in administrative data.
The objectives of this study were to derive a method of automated identification of delayed diagnosis of two serious pediatric conditions in the emergency department (ED). Subjects were patients under the age of 21 who had two EDs encounters within 7 days, the second resulting in a diagnosis of new-onset diabetic ketoacidosis (DKA) or sepsis. The results showed that delayed diagnosis was present in 89 % of DKA patients seen twice within 7 days. 17 % of sepsis patients were deemed to have delayed diagnosis; the authors noted that many children with sepsis delayed diagnosis may be identified using the proposed approach with low specificity, indicating a need for manual case review. The fewer days between ED encounters was the most important characteristic associated with delayed diagnosis.
AHRQ-funded; HS026503.
Citation: Michelson KA, Bachur RG, Cruz AT .
Multicenter evaluation of a method to identify delayed diagnosis of diabetic ketoacidosis and sepsis in administrative data.
Diagnosis 2023 Nov; 10(4):383-89. doi: 10.1515/dx-2023-0019..
Keywords: Diabetes, Diagnostic Safety and Quality, Sepsis
Michelson KA, Bachur RG, Grubenhoff JA
Outcomes of missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis, and sepsis in five pediatric hospitals.
This study’s objective was to determine 90-day complication rates and hospital utilization after a missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis (DKA), or sepsis. The authors evaluated patients under 21 years of age visiting five pediatric emergency departments (EDs) with a study condition. Case patients included had a preceding ED visit within 7 days of diagnosis and underwent case review to confirm a missed diagnosis. The authors compared complication rates and utilization between case and control patients after adjusting for age, sex, and insurance. They analyzed 29,398 children with appendicitis, 5366 with DKA, and 3622 with sepsis, of whom 429, 33, and 46, respectively, had a missed diagnosis. Patients with a missed appendicitis or DKA diagnosis had more hospital days and readmissions, but there were no significant differences for those with sepsis. Those with missed appendicitis were more likely to have abdominal abscess drainage or perforated appendicitis. Those with missed DKA were more likely to have cerebral edema, mechanical ventilation, or death. Those with missed sepsis were less likely to have mechanical ventilation.
AHRQ-funded; HS026503.
Citation: Michelson KA, Bachur RG, Grubenhoff JA .
Outcomes of missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis, and sepsis in five pediatric hospitals.
J Emerg Med 2023 Jul; 65(1):e9-e18. doi: 10.1016/j.jemermed.2023.04.006..
Keywords: Children/Adolescents, Sepsis, Diabetes, Diagnostic Safety and Quality
Tremblay ES, Millington K, Monuteaux MC
Plasma β-Hydroxybutyrate for the diagnosis of diabetic ketoacidosis in the emergency department.
Diabetic ketoacidosis (DKA) is a common emergency department presentation of both new-onset and established diabetes mellitus (DM). β-Hydroxybutyrate (BOHB) provides a direct measure of the pathophysiologic derangement in DKA as compared with the nonspecific measurements of blood pH and bicarbonate. The objective of this study was to characterize the relationship between BOHB and DKA. The investigators concluded that β-Hydroxybutyrate accurately predicted DKA in children and adolescents. More importantly, because plasma BOHB is the ideal biochemical marker of DKA, BOHB may provide a more optimal definition of DKA for management decisions and treatment targets.
AHRQ-funded; HS000063.
Citation: Tremblay ES, Millington K, Monuteaux MC .
Plasma β-Hydroxybutyrate for the diagnosis of diabetic ketoacidosis in the emergency department.
Pediatr Emerg Care 2021 Dec;37(12):e1345-e50. doi: 10.1097/pec.0000000000002035..
Keywords: Children/Adolescents, Emergency Department, Diabetes, Diagnostic Safety and Quality
Thomas TW, Golin C, Samuel-Hodge CD
Race and gender differences in abnormal blood glucose screening and clinician response to prediabetes: a mixed-methods assessment.
The projected three-fold increase in diabetes burden by 2060 in the United States will affect certain race and gender groups disproportionately. The objective of this mixed-methods study was to assess differences in prediabetes screening and clinician response to prediabetes by patient race and gender. The investigators found that qualitatively, physicians reported a non-systematic approach to prediabetes screening and follow-up care related to: 1) System-level barriers to screening and treatment; 2) Implicit bias; 3) Patient factors; and 4) Physician preferences for prediabetes treatment.
AHRQ-funded; HS025561; HS000032.
Citation: Thomas TW, Golin C, Samuel-Hodge CD .
Race and gender differences in abnormal blood glucose screening and clinician response to prediabetes: a mixed-methods assessment.
Prev Med 2021 Jul;148:106587. doi: 10.1016/j.ypmed.2021.106587..
Keywords: Diabetes, Racial and Ethnic Minorities, Screening, Diagnostic Safety and Quality
Koller KR, Day GE, Hiratsuka VY
Increase in diabetes among urban Alaska Native people in the Alaska EARTH follow-up study: a call for prediabetes screening, diagnosis, and referral for intervention.
This study estimated incidence of diabetes (DM) and pre-DM relative to DM risk factors among relatively healthy Alaska Native and American Indian (AN) adults living in urban south-central Alaska. Results showed that, controlling for age and sex, obesity, abdominal adiposity, pre-DM, and metabolic syndrome independently increased DM risk. Recommendations included advising health care providers of AN populations to seize the opportunity to screen, refer, and treat individuals with pre-DM and other modifiable DM risk factors prior to DM diagnosis in order to alter the epidemiologic course of disease progression in this urban AN population.
AHRQ-funded; HS000084.
Citation: Koller KR, Day GE, Hiratsuka VY .
Increase in diabetes among urban Alaska Native people in the Alaska EARTH follow-up study: a call for prediabetes screening, diagnosis, and referral for intervention.
Diabetes Res Clin Pract 2020 Sep;167:108357. doi: 10.1016/j.diabres.2020.108357..
Keywords: Diabetes, Racial and Ethnic Minorities, Urban Health, Risk, Prevention, Screening, Diagnostic Safety and Quality, Chronic Conditions
Misra-Hebert AD, Milinovich A, Zajichek A
Natural language processing improves detection of nonsevere hypoglycemia in medical records versus coding alone in patients with type 2 diabetes but does not improve prediction of severe hypoglycemia events: an analysis using the electronic medical record
The purpose of this study was to determine if natural language processing (NLP) improves detection of non-severe hypoglycemia (NSH) in patients with type 2 diabetes and no NSH documentation by diagnosis codes and to measure if NLP detection improves the prediction of future severe hypoglycemia (SH). The authors identified NSH events by diagnosis codes and NLP 2005 to 2017 and built an SH prediction model. Their findings showed that detection of NSH improved with NLP in patients with type 2 diabetes without improving SH prediction.
AHRQ-funded; HS024128.
Citation: Misra-Hebert AD, Milinovich A, Zajichek A .
Natural language processing improves detection of nonsevere hypoglycemia in medical records versus coding alone in patients with type 2 diabetes but does not improve prediction of severe hypoglycemia events: an analysis using the electronic medical record
Diabetes Care 2020 Aug;43(8):1937-40. doi: 10.2337/dc19-1791..
Keywords: Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Diagnostic Safety and Quality
Schroeder EB, Adams JL, Chonchol M
Predictors of hyperkalemia and hypokalemia in individuals with diabetes: a classification and regression tree analysis.
Both hyperkalemia and hypokalemia can lead to cardiac arrhythmias and are associated with increased mortality. Information on the predictors of potassium in individuals with diabetes in routine clinical practice is lacking. The objective of this study was to identify predictors of hyperkalemia and hypokalemia in adults with diabetes.
AHRQ-funded; HS022963; HS019859.
Citation: Schroeder EB, Adams JL, Chonchol M .
Predictors of hyperkalemia and hypokalemia in individuals with diabetes: a classification and regression tree analysis.
J Gen Intern Med 2020 Aug;35(8):2321-28. doi: 10.1007/s11606-020-05799-x..
Keywords: Diabetes, Diagnostic Safety and Quality
Mahtta D, Ahmed ST, Shah NR
Facility-level variation in cardiac stress test use among patients with diabetes: findings from the Veterans Affairs national database.
The authors evaluate facility-level variation in cardiac stress test use among patients with diabetes mellitus (DM) across the Veterans Affairs (VA) health care system. Their results suggest that significant residual variation in overall stress test use exists among veterans with DM. They recommend future studies to assess system-wide appropriateness of stress testing, to assess patient-level symptom data, and to conduct qualitative analyses in order to understand individual provider-level drivers behind such variation.
AHRQ-funded; HS022998.
Citation: Mahtta D, Ahmed ST, Shah NR .
Facility-level variation in cardiac stress test use among patients with diabetes: findings from the Veterans Affairs national database.
Diabetes Care 2020 May;43(5):e58-e60. doi: 10.2337/dc19-2160..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Diabetes, Decision Making, Diagnostic Safety and Quality, Chronic Conditions
Bowen ME, Xuan L, Lingvay I
Doc, I just ate: interpreting random blood glucose values in patients with unknown glycemic status.
This study sought to improve interpretation of RBG values in non-fasting individuals without self-reported dysglycemia and characterize the relationship between RBG and time since last caloric intake. It concluded that, in a nationally representative sample of non-fasting, community-dwelling individuals, those with undiagnosed dysglycemia had significantly higher RBG values than those with normoglycemia within 9 hours of caloric intake.
AHRQ-funded; HS022418.
Citation: Bowen ME, Xuan L, Lingvay I .
Doc, I just ate: interpreting random blood glucose values in patients with unknown glycemic status.
J Gen Intern Med 2018 Feb;33(2):142-44. doi: 10.1007/s11606-017-4213-9.
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Keywords: Diabetes, Diagnostic Safety and Quality, Screening
Letourneau LR, Carmody D, Wroblewski K
Diabetes presentation in infancy: high risk of diabetic ketoacidosis.
In this study, the largest of its kind, diabetic ketoacidosis (DKA) was more frequent than in other early-onset U.S. studies or other cohorts of patients with neonatal diabetes. The authors argue that continuing to educate pediatric providers about the many ways that infants can present with diabetes may help to diagnose cases more efficiently and ultimately decrease the frequency of DKA at diagnosis.
AHRQ-funded; HS023007.
Citation: Letourneau LR, Carmody D, Wroblewski K .
Diabetes presentation in infancy: high risk of diabetic ketoacidosis.
Diabetes Care 2017 Oct;40(10):e147-e48. doi: 10.2337/dc17-1145.
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Keywords: Diabetes, Diagnostic Safety and Quality, Newborns/Infants, Children/Adolescents
Bowen ME, Merchant Z, Abdullah K
Patient, provider, and system factors associated with failure to follow-up elevated glucose results in patients without diagnosed diabetes.
Patient, provider, and system factors associated with failure to follow-up elevated glucose values in electronic medical records (EMRs) are not well described. The researchers conducted a chart review in a comprehensive EMR with a patient portal and results management features but found no associations between patient characteristics, diabetes risk factors, or provider characteristics and follow-up failures.
AHRQ-funded; HS022418.
Citation: Bowen ME, Merchant Z, Abdullah K .
Patient, provider, and system factors associated with failure to follow-up elevated glucose results in patients without diagnosed diabetes.
Health Serv Res Manag Epidemiol 2017 Aug 29;4:2333392817721647. doi: 10.1177/2333392817721647.
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Keywords: Diabetes, Electronic Health Records (EHRs), Web-Based, Patient-Centered Healthcare, Diagnostic Safety and Quality
Chandakkar PS, Venkatesan R, Li B
MIRank-KNN: multiple-instance retrieval of clinically relevant diabetic retinopathy images.
Computer-aided diagnosis has the potential of improving diabetic retinopathy (DR) screening or diagnosis. The researchers developed a feature space of a modified color correlogram appended with statistics of steerable Gaussian filter responses selected by fast radial symmetric transform points. Experiments with real DR images collected from five different datasets demonstrate that the proposed approach is able to outperform existing methods.
AHRQ-funded; HS019792.
Citation: Chandakkar PS, Venkatesan R, Li B .
MIRank-KNN: multiple-instance retrieval of clinically relevant diabetic retinopathy images.
J Med Imaging 2017 Jul;4(3):034003. doi: 10.1117/1.jmi.4.3.034003.
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Keywords: Diabetes, Imaging, Eye Disease and Health, Health Information Technology (HIT), Diagnostic Safety and Quality
Bowen ME, Xuan L, Lingvay I
Performance of a random glucose case-finding strategy to detect undiagnosed diabetes.
This study describes a case-finding approach using non-diagnostic random glucose values to identify individuals in need of diabetes testing and compares its performance to current screening guidelines. Using random glucose >/=100 mg/dL to identify individuals in need of diabetes, it determined that screening is highly sensitive and specific, performing better than current screening guidelines. Case-finding strategies informed by random glucose data may improve diabetes detection.
AHRQ-funded; HS022418.
Citation: Bowen ME, Xuan L, Lingvay I .
Performance of a random glucose case-finding strategy to detect undiagnosed diabetes.
Am J Prev Med 2017 Jun;52(6):710-16. doi: 10.1016/j.amepre.2017.01.023.
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Keywords: Diabetes, Diagnostic Safety and Quality, Risk, Screening
Flory JH, Roy J, Gagne JJ
Missing laboratory results data in electronic health databases: implications for monitoring diabetes risk.
Researchers assessed the value of lab results added to diagnosis codes and dispensing claims to identify incident diabetes. Inclusion of lab results increased the number of diabetes outcomes identified by 21 percent. In settings where capture of lab results was relatively complete, the absence of lab results was associated with implausibly low rates of the outcome.
AHRQ-funded; HS023898.
Citation: Flory JH, Roy J, Gagne JJ .
Missing laboratory results data in electronic health databases: implications for monitoring diabetes risk.
J Comp Eff Res 2017 Jan;6(1):25-32. doi: 10.2217/cer-2016-0033.
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Keywords: Diabetes, Diagnostic Safety and Quality, Electronic Health Records (EHRs)
Carmody D, Naylor RN, Bell CD
GCK-MODY in the US National Monogenic Diabetes Registry: frequently misdiagnosed and unnecessarily treated.
GCK-MODY (diabetes caused by mutations in the glucokinase (GCK) gene) leads to mildly elevated blood glucose typically not requiring therapy. It has been described in all ethnicities, but mainly in Caucasian Europeans. The researchers describe our US cohort of GCK-MODY. Their data show that a high detection rate of GCK-MODY is possible based on clinical phenotype and that prior to genetic diagnosis, a large percentage are inappropriately treated with glucose-lowering therapies.
AHRQ-funded; HS023007.
Citation: Carmody D, Naylor RN, Bell CD .
GCK-MODY in the US National Monogenic Diabetes Registry: frequently misdiagnosed and unnecessarily treated.
Acta Diabetol 2016 Oct;53(5):703-8. doi: 10.1007/s00592-016-0859-8.
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Keywords: Diabetes, Registries, Diagnostic Safety and Quality, Genetics
Kopylov U, Boucher G, Waterman M
Genetic predictors of benign course of ulcerative colitis - a North American inflammatory bowel disease genetics consortium study.
The aim of this project was to identify the genetic predictors of benign ulcerative colitis (UC) phenotype. No single-nucleotide polymorphisms from inflammatory bowel disease susceptibility loci were found to be associated with a benign UC disease course. These findings suggested on the exploratory analysis merit extension to larger discovery cohorts.
AHRQ-funded; HS021747.
Citation: Kopylov U, Boucher G, Waterman M .
Genetic predictors of benign course of ulcerative colitis - a North American inflammatory bowel disease genetics consortium study.
Inflamm Bowel Dis 2016 Oct;22(10):2311-6. doi: 10.1097/mib.0000000000000913.
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Keywords: Diabetes, Diagnostic Safety and Quality, Genetics
Scifres CM, Abebe KZ, Jones KA
Gestational diabetes diagnostic methods (GD2M) pilot randomized trial.
The researchers tested the feasibility of conducting a pragmatic randomized controlled trial (RCT) comparing the International Association of Diabetes in Pregnancy Study Groups (IADPSG) versus Carpenter-Coustan diagnostic criteria for gestational diabetes (GDM), and examined patient and provider views on GDM screening. They found that both pregnant women and providers value GDM screening, and pregnant women can be recruited to a blinded, randomized GDM screening trial with minimal attrition and missing data.
AHRQ-funded; HS019461.
Citation: Scifres CM, Abebe KZ, Jones KA .
Gestational diabetes diagnostic methods (GD2M) pilot randomized trial.
Matern Child Health J 2015 Jul;19(7):1472-80. doi: 10.1007/s10995-014-1651-4..
Keywords: Diabetes, Diagnostic Safety and Quality, Pregnancy, Screening, Women
Carmody D, Lindauer KL, Naylor RN
Adolescent non-adherence reveals a genetic cause for diabetes.
Glucokinase related maturity-onset diabetes of the young (GCK-MODY) is frequently unrecognized or misdiagnosed as Type 1 or Type 2 diabetes, resulting in unnecessary pharmacologic therapy. The authors recommend considering a genetic cause when evaluating every person with new-onset hyperglycaemia or those with atypical diabetes. Testing costs for the most common MODY causing genes may be offset by savings made in therapeutic costs. They suggest that it is important that all clinicians supervising diabetes care recognize the cardinal features that distinguish GCK-MODY from other forms of diabetes.
AHRQ-funded; HS023007.
Citation: Carmody D, Lindauer KL, Naylor RN .
Adolescent non-adherence reveals a genetic cause for diabetes.
Diabet Med 2015 Jun;32(6):e20-3. doi: 10.1111/dme.12669.
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Keywords: Children/Adolescents, Diabetes, Diagnostic Safety and Quality, Genetics, Medication
Wallace ML, Magnan EM, Thorpe CT
Diagnosis and treatment of incident hypertension among patients with diabetes: a U.S. multi-disciplinary group practice observational study.
The researchers aimed to evaluate rates and associations of hypertension diagnosis and treatment among patients with diabetes mellitus and incident hypertension. They found that among patients with diabetes mellitus, even using a cut-point of 140/90 mmHg, approximately 50 percent remained undiagnosed and untreated for hypertension.
AHRQ-funded; HS018368.
Citation: Wallace ML, Magnan EM, Thorpe CT .
Diagnosis and treatment of incident hypertension among patients with diabetes: a U.S. multi-disciplinary group practice observational study.
J Gen Intern Med 2015 Jun;30(6):768-76. doi: 10.1007/s11606-015-3202-0..
Keywords: Blood Pressure, Diabetes, Diagnostic Safety and Quality, Chronic Conditions
Leung LA, Swaminathan S, Trivedi AN
Diabetes diagnosis and exercise initiation among older Americans.
The investigators sought to determine whether exercise participation increased following a new diagnosis of diabetes using a sample of U.S. individuals aged 50 and over who did not report exercise prior to diagnosis. They found that over 35% of persons with a new diagnosis of diabetes initiated moderate or vigorous exercise in the year following their diagnosis.
AHRQ-funded; HS000011.
Citation: Leung LA, Swaminathan S, Trivedi AN .
Diabetes diagnosis and exercise initiation among older Americans.
Prev Med 2014 Aug;65:128-32. doi: 10.1016/j.ypmed.2014.05.001.
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Keywords: Diabetes, Diagnostic Safety and Quality, Elderly, Lifestyle Changes, Patient Self-Management
Lawrence JM, Black MH, Zhang JL
Validation of pediatric diabetes case identification approaches for diagnosed cases by using information in the electronic health records of a large integrated managed health care organization.
The researchers explored the utility of different algorithms for diabetes case identification by using electronic health records. They found that case identification accuracy was highest in 75% of bootstrapped samples for those who had 1 or more outpatient diabetes diagnoses or 1 or more insulin prescriptions and in 25% of samples for those who had 2 or more outpatient diabetes diagnoses and 1 or more antidiabetic medications.
AHRQ-funded; HS019859.
Citation: Lawrence JM, Black MH, Zhang JL .
Validation of pediatric diabetes case identification approaches for diagnosed cases by using information in the electronic health records of a large integrated managed health care organization.
Am J Epidemiol 2014 Jan;179(1):27-38. doi: 10.1093/aje/kwt230..
Keywords: Children/Adolescents, Diabetes, Chronic Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT), Diagnostic Safety and Quality