National Healthcare Quality and Disparities Report
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Topics
- Antibiotics (3)
- Blood Thinners (1)
- Cancer (2)
- Cancer: Breast Cancer (1)
- Cancer: Prostate Cancer (1)
- Cardiovascular Conditions (1)
- Clinical Decision Support (CDS) (2)
- (-) Decision Making (22)
- Dental and Oral Health (1)
- Diabetes (1)
- Diagnostic Safety and Quality (2)
- Digestive Disease and Health (1)
- Education: Continuing Medical Education (1)
- Education: Patient and Caregiver (1)
- Elderly (2)
- Electronic Health Records (EHRs) (1)
- Emergency Medical Services (EMS) (2)
- Evidence-Based Practice (4)
- Genetics (1)
- Guidelines (2)
- Healthcare Delivery (1)
- Healthcare Utilization (3)
- Health Information Exchange (HIE) (1)
- Health Information Technology (HIT) (2)
- Heart Disease and Health (1)
- Imaging (4)
- Kidney Disease and Health (1)
- Medication (7)
- Obesity (1)
- Obesity: Weight Management (1)
- Patient-Centered Healthcare (1)
- Patient and Family Engagement (1)
- Patient Safety (2)
- (-) Practice Patterns (22)
- Prevention (1)
- Primary Care (3)
- Primary Care: Models of Care (1)
- Provider (3)
- Provider: Clinician (2)
- Provider: Health Personnel (1)
- Provider: Physician (2)
- Respiratory Conditions (2)
- Risk (1)
- Substance Abuse (1)
- Surgery (1)
- Treatments (1)
- Urinary Tract Infection (UTI) (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 22 of 22 Research Studies DisplayedWallner LP, Banerjee M, Reyes-Gastelum D
Multilevel factors associated with more intensive use of radioactive iodine for low-risk thyroid cancer.
The use of radioactive iodine (RAI) for low-risk thyroid cancer is common, and variation in its use exists, despite the lack of benefit for low-risk disease and potential harms and costs. The objective of this study was to simultaneously assess patient- and physician-level factors associated with patient-reported receipt of RAI for low-risk thyroid cancer. The investigators concluded that physician perspectives and attitudes about using RAI, as well as patient volume, influenced RAI use for low-risk thyroid cancer.
AHRQ-funded; HS024512.
Citation: Wallner LP, Banerjee M, Reyes-Gastelum D .
Multilevel factors associated with more intensive use of radioactive iodine for low-risk thyroid cancer.
J Clin Endocrinol Metab 2021 May 13;106(6):e2402-e12. doi: 10.1210/clinem/dgab139..
Keywords: Cancer, Practice Patterns, Decision Making, Risk
Westafer LM, Kunz A, Bugajska P
Provider perspectives on the use of evidence-based risk stratification tools in the evaluation of pulmonary embolism: a qualitative study.
Providers often pursue imaging in patients at low risk of pulmonary embolism (PE), resulting in imaging yields <10% and false-positive imaging rates of 10% to 25%. Attempts to curb overtesting have had only modest success and no interventions have used implementation science frameworks. The objective of this study was to identify barriers and facilitators to the adoption of evidence-based diagnostic testing for PE.
AHRQ-funded; HS025701.
Citation: Westafer LM, Kunz A, Bugajska P .
Provider perspectives on the use of evidence-based risk stratification tools in the evaluation of pulmonary embolism: a qualitative study.
Acad Emerg Med 2020 Jun;27(6):447-56. doi: 10.1111/acem.13908..
Keywords: Respiratory Conditions, Evidence-Based Practice, Diagnostic Safety and Quality, Imaging, Decision Making, Clinical Decision Support (CDS), Practice Patterns, Provider: Physician, Provider: Clinician, Provider
Wang SV, Rogers JR, Jin Y
Stepped-wedge randomised trial to evaluate population health intervention designed to increase appropriate anticoagulation in patients with atrial fibrillation.
Clinical guidelines recommend anticoagulation for patients with atrial fibrillation (AF) at high risk of stroke; however, studies report 40% of this population is not anticoagulated. The purpose of this study was to evaluate a population health intervention to increase anticoagulation use in high-risk patients with AF. The investigators concluded that algorithms to identify underuse of anticoagulation among patients with AF in healthcare databases may not capture clinical subtleties or patient preferences and may overestimate the extent of undertreatment.
AHRQ-funded; HS022193.
Citation: Wang SV, Rogers JR, Jin Y .
Stepped-wedge randomised trial to evaluate population health intervention designed to increase appropriate anticoagulation in patients with atrial fibrillation.
BMJ Qual Saf 2019 Oct;28(10):835-42. doi: 10.1136/bmjqs-2019-009367..
Keywords: Blood Thinners, Heart Disease and Health, Cardiovascular Conditions, Medication, Health Information Technology (HIT), Decision Making, Electronic Health Records (EHRs), Practice Patterns, Healthcare Utilization
Suda KJ, Calip GS, Zhou J
Assessment of the appropriateness of antibiotic prescriptions for infection prophylaxis before dental procedures, 2011 to 2015.
This retrospective cohort study examined the use of antibiotic prophylaxis prescribed before dental procedures with patients who have commercial dental insurance. Data from the Truven insurance network was used for claims from 2009 to 2015. Patients in the study were given an antibiotic prescription 7 days before a dental visit. These patients have an appropriate cardiac diagnosis and the median age was 63 and majority female. The majority of dental visits were classified as diagnostic (70.2%) or and/or preventive (58.8%). There were prevalent comorbidities in some patients including prosthetic joint devices (42.5%) and cardiac conditions at higher risk of adverse outcome from infections (20.9%). It was found that 80.9% of antibiotic prescriptions were deemed to be unnecessary based on guidelines.
AHRQ-funded; HS025177.
Citation: Suda KJ, Calip GS, Zhou J .
Assessment of the appropriateness of antibiotic prescriptions for infection prophylaxis before dental procedures, 2011 to 2015.
JAMA Netw Open 2019 May 3;2(5):e193909. doi: 10.1001/jamanetworkopen.2019.3909..
Keywords: Decision Making, Dental and Oral Health, Medication, Practice Patterns, Prevention
Tamma PD, Miller MA, Cosgrove SE
AHRQ Author: Miller MA
Rethinking how antibiotics are prescribed: incorporating the 4 moments of antibiotic decision making into clinical practice.
This editorial viewpoint discusses structured approaches that emphasize the four critical time points (‘Moments’) in the process of antibiotic prescribing, and which may improve antibiotic decisionmaking by clinicians and communication about antibiotic decisions among health care practitioners. AHRQ’s Safety Program for Improving Antibiotic Use is highlighted, since it features the training of clinicians to incorporate the ‘4 moments’ of antibiotic decisionmaking into their thought processes when prescribing antibiotics. The 4 moments are described and an example provided for each. The authors conclude that an organized approach such as the 4 moments of antibiotic decisionmaking could be helpful if it is used every time antibiotic therapy is considered.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Tamma PD, Miller MA, Cosgrove SE .
Rethinking how antibiotics are prescribed: incorporating the 4 moments of antibiotic decision making into clinical practice.
JAMA 2019 Jan;321(2):139-40. doi: 10.1001/jama.2018.19509..
Keywords: Antibiotics, Decision Making, Medication, Patient Safety, Practice Patterns
Durkin MJ, Keller M, Butler AM
An assessment of inappropriate antibiotic use and guideline adherence for uncomplicated urinary tract infections.
In 2011, The Infectious Diseases Society of America released a clinical practice guideline (CPG) that recommended short-course antibiotic therapy and avoidance of fluoroquinolones for uncomplicated urinary tract infections (UTIs). This study assessed whether the CPG had an impact on national antibiotic prescribing practices. The study found that CPG was not associated with a clinically meaningful change in national antibiotic prescribing practices for UTIs.
AHRQ-funded; HS019455.
Citation: Durkin MJ, Keller M, Butler AM .
An assessment of inappropriate antibiotic use and guideline adherence for uncomplicated urinary tract infections.
Open Forum Infect Dis 2018 Sep;5(9):ofy198. doi: 10.1093/ofid/ofy198..
Keywords: Antibiotics, Decision Making, Guidelines, Practice Patterns, Urinary Tract Infection (UTI)
Kanters AE, Shubeck SP, Sandhu G
Justifying our decisions about surgical technique: evidence from coaching conversations.
The objective of this qualitative study was to determine the extent to which practicing surgeons participating in a coaching program justify their technical decisions based on their experience or based on evidence. The investigators found that practicing surgeons often justify their surgical decisions with anecdotal evidence and "lessons learned," rather than deferring to surgical literature. The authors suggest that this either represents a lack of evidence or poor uptake of existing data.
AHRQ-funded; HS023597; HS000053.
Citation: Kanters AE, Shubeck SP, Sandhu G .
Justifying our decisions about surgical technique: evidence from coaching conversations.
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Keywords: Decision Making, Education: Continuing Medical Education, Provider, Practice Patterns, Surgery
McCreedy EM, Kane RL, Gollust SE
Patient-centered guidelines for geriatric diabetes care: potential missed opportunities to avoid harm.
Clinicians strive to deliver individualized, patient-centered care. However, these intentions are understudied. This research explored how patient characteristics associated with a high risk-to-benefit ratio with hypoglycemia medications affected decision making by primary care clinicians. The investigators found that primary care clinicians often chose to intensify glycemic control despite individual patient factors that warranted higher glycemic targets based on existing guidelines.
AHRQ-funded; HS000011.
Citation: McCreedy EM, Kane RL, Gollust SE .
Patient-centered guidelines for geriatric diabetes care: potential missed opportunities to avoid harm.
J Am Board Fam Med 2018 Mar-Apr;31(2):192-200. doi: 10.3122/jabfm.2018.02.170141..
Keywords: Diabetes, Elderly, Patient-Centered Healthcare, Guidelines, Evidence-Based Practice, Decision Making, Medication, Primary Care, Practice Patterns, Provider: Physician, Provider: Clinician, Provider
Halbert CH, Jefferson M, Melvin CL
Provider advice about weight loss in a primary care sample of obese and overweight patients.
In this study the investigators examined receipt of provider advice to lose weight among primary care patients who were overweight and obese. The investigators found that patient beliefs about their weight status and perceptions about shared decision-making are important to receiving provider advice about weight loss/management among primary care patients.
AHRQ-funded; HS023047.
Citation: Halbert CH, Jefferson M, Melvin CL .
Provider advice about weight loss in a primary care sample of obese and overweight patients.
J Prim Care Community Health 2017 Oct;8(4):239-46. doi: 10.1177/2150131917715336..
Keywords: Decision Making, Obesity, Obesity: Weight Management, Practice Patterns, Primary Care
Hersh AL, Kronman MP
Inappropriate antibiotic prescribing: wind at our backs or flapping in the breeze?
Much work in improving antibiotic prescribing remains to be done, although the authors believe they have the wind at their backs. The work of Handy et al highlights the fact that both clinical and nonclinical factors may contribute to inappropriate prescribing and that all domains of inappropriate antibiotic use must be targeted to achieve national goals for reducing inappropriate use.
AHRQ-funded; HS023320.
Citation: Hersh AL, Kronman MP .
Inappropriate antibiotic prescribing: wind at our backs or flapping in the breeze?
Pediatrics 2017 Apr;139(4). doi: 10.1542/peds.2017-0027.
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Keywords: Antibiotics, Decision Making, Medication, Practice Patterns
Tsai HT, Philips G, Taylor KL
Utilization and predictors of expectant management among elderly men with low-and intermediate-risk localized prostate cancer in U.S. urological practice.
Researchers assessed the use and predictors of expectant management (EM) to understand its uptake in U.S. practice. In U.S. practice, the utilization of EM steadily increased in low-risk prostate cancer and remained low in the intermediate-risk group over time. While patients with advanced age or comorbidities were more likely to receive EM, its use varied substantially by geographic region.
AHRQ-funded; HS022915.
Citation: Tsai HT, Philips G, Taylor KL .
Utilization and predictors of expectant management among elderly men with low-and intermediate-risk localized prostate cancer in U.S. urological practice.
Urol Pract 2017 Mar;4(2):132-39. doi: 10.1016/j.urpr.2016.05.005.
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Keywords: Decision Making, Elderly, Healthcare Utilization, Cancer: Prostate Cancer, Practice Patterns
Melnick ER, O'Brien EG, Kovalerchik O
The association between physician empathy and variation in imaging use.
This paper's objective was to describe empathy in a cohort of emergency physicians and evaluate its association with CT utilization. The authors found that, on the four psychometric scales used, performance was not predictive of risk-adjusted CT utilization in the emergency department. They concluded that the underlying physician-based factors that mediate interphysician variation remain to be clearly identified.
AHRQ-funded; HS021271.
Citation: Melnick ER, O'Brien EG, Kovalerchik O .
The association between physician empathy and variation in imaging use.
Acad Emerg Med 2016 Aug;23(8):895-904. doi: 10.1111/acem.13017.
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Keywords: Decision Making, Emergency Medical Services (EMS), Healthcare Utilization, Imaging, Practice Patterns
Renati S, Linder JA
Necessity of office visits for acute respiratory infections in primary care.
The researchers measured the proportion of primary care acute respiratory infection (ARI) visits that may not require an office visit. They concluded that about two-thirds of primary care ARI visits may not be necessary for appropriate antibiotic management.
AHRQ-funded; HS018419.
Citation: Renati S, Linder JA .
Necessity of office visits for acute respiratory infections in primary care.
Fam Pract 2016 Jun;33(3):312-7. doi: 10.1093/fampra/cmw019.
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Keywords: Decision Making, Medication, Primary Care, Practice Patterns, Respiratory Conditions
Wang RC, Rodriguez RM, Moghadassi M
External validation of the STONE score, a clinical prediction rule for ureteral stone: an observational multi-institutional study.
The STONE score is a clinical decision rule that classifies patients with suspected nephrolithiasis into low-, moderate-, and high-score groups, with corresponding probabilities of ureteral stone. The researchers evaluated the STONE score compared with physician gestalt. They concluded that in its present form, the STONE score lacks sufficient accuracy to allow clinicians to defer CT scan for suspected ureteral stone.
AHRQ-funded; HS021281; HS019312.
Citation: Wang RC, Rodriguez RM, Moghadassi M .
External validation of the STONE score, a clinical prediction rule for ureteral stone: an observational multi-institutional study.
Ann Emerg Med 2016 Apr;67(4):423-32.e2. doi: 10.1016/j.annemergmed.2015.08.019.
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Keywords: Decision Making, Diagnostic Safety and Quality, Imaging, Kidney Disease and Health, Practice Patterns
Potosky AL, O'Neill SC, Isaacs C
Population-based study of the effect of gene expression profiling on adjuvant chemotherapy use in breast cancer patients under the age of 65 years.
The authors evaluated the relation between gene expression profiling (GEP) testing and the use of adjuvant chemotherapy by women treated in a general oncology practice. They found that adjuvant chemotherapy use after GEP testing is generally consistent with the recommended test interpretation for women with a high or low predicted risk of recurrence. Chemotherapy use in the intermediate-risk group increased with Recurrence Score values, and evidence from ongoing randomized trials may help to clarify whether this finding reflects optimal interpretation of GEP test results.
AHRQ-funded; HS022915.
Citation: Potosky AL, O'Neill SC, Isaacs C .
Population-based study of the effect of gene expression profiling on adjuvant chemotherapy use in breast cancer patients under the age of 65 years.
Cancer 2015 Nov 15;121(22):4062-70. doi: 10.1002/cncr.29621.
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Keywords: Cancer, Cancer: Breast Cancer, Treatments, Decision Making, Genetics, Practice Patterns, Women
Siegel CA, Lofland JH, Naim A
Gastroenterologists' views of shared decision making for patients with inflammatory bowel disease.
The researchers examined gastroenterologists' perspectives about shared decision making (SDM) with patients with inflammatory bowel disease (IBD). They found three key barriers to practicing SDM were lack of time, reimbursement, and tools. They concluded that gastroenterologists lack the systematic approaches and tools for implementing SDM within their IBD practices.
AHRQ-funded; HS021747.
Citation: Siegel CA, Lofland JH, Naim A .
Gastroenterologists' views of shared decision making for patients with inflammatory bowel disease.
Dig Dis Sci 2015 Sep;60(9):2636-45. doi: 10.1007/s10620-015-3675-z.
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Keywords: Decision Making, Digestive Disease and Health, Patient and Family Engagement, Practice Patterns
Reschovsky JD, Rich EC, Lake TK
Factors contributing to variations in physicians' use of evidence at the point of care: a conceptual model.
The purpose of this article is to help identify modifiable factors that can influence clinical decisions at the point of care. It presents a conceptual model and literature review of physician decisionmaking. The authors describe the multitude of factors—drawn from different disciplines—that have been shown to influence physician point-of-care decisions. They also present a conceptual framework for organizing these factors.
AHRQ-funded; 23320095642; 23337033T.
Citation: Reschovsky JD, Rich EC, Lake TK .
Factors contributing to variations in physicians' use of evidence at the point of care: a conceptual model.
J Gen Intern Med 2015 Aug;30 Suppl 3:S555-61. doi: 10.1007/s11606-015-3366-7..
Keywords: Healthcare Delivery, Decision Making, Evidence-Based Practice, Primary Care: Models of Care, Practice Patterns
Converse L, Barrett K, Rich E
Methods of observing variations in physicians' decisions: the opportunities of clinical vignettes.
This review described various methods for measuring variations in physicians’ decisions and highlight a range of design features researchers should consider when developing a clinical vignette survey. It concluded by identifying areas for future research.
AHRQ-funded; 23320095642WC; 23337033T.
Citation: Converse L, Barrett K, Rich E .
Methods of observing variations in physicians' decisions: the opportunities of clinical vignettes.
J Gen Intern Med 2015 Aug;30 Suppl 3:S586-94. doi: 10.1007/s11606-015-3365-8..
Keywords: Decision Making, Evidence-Based Practice, Practice Patterns
Smith RJ, Kilaru AS, Perrone J
How, why, and for whom do emergency medicine providers use prescription drug monitoring programs?
The authors examined how emergency physicians use Prescription Drug Monitoring Programs (PDMPs), for which patients, and for what reasons. They found that providers use the information in PDMPs to alter clinical decisions and guide opioid prescribing patterns. Physicians used the databases additionally for improving their ability to facilitate discussions on addiction and for providing patient education. The authors recommended minimizing administrative barriers to PDMP access and suggested that alternative PDMP uses be further studied to determine their appropriateness and potentially expand their role in clinical practice.
AHRQ-funded; HS021956.
Citation: Smith RJ, Kilaru AS, Perrone J .
How, why, and for whom do emergency medicine providers use prescription drug monitoring programs?
Pain Med 2015 Jun;16(6):1122-31. doi: 10.1111/pme.12700.
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Keywords: Decision Making, Emergency Medical Services (EMS), Medication, Practice Patterns, Substance Abuse
McCullagh LJ, Sofianou A, Kannry J
User centered clinical decision support tools: adoption across clinician training level.
This study examined the differences in adoption of CDS tools across providers’ training level. It found that the completion rates of the CDS calculator and medication order sets were higher among first year residents compared to all other training levels. Attending physicians were the less likely to accept the initial step of the CDS tool (29.3 percent) or complete the medication order sets (22.4 percent) that guided their prescription decisions.
AHRQ-funded; HS018491.
Citation: McCullagh LJ, Sofianou A, Kannry J .
User centered clinical decision support tools: adoption across clinician training level.
Appl Clin Inform 2014 Dec 17;5(4):1015-25. doi: 10.4338/aci-2014-05-ra-0048.
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Keywords: Clinical Decision Support (CDS), Decision Making, Practice Patterns
Kruger JF, Chen AH, Rybkin A
Clinician perspectives on considering radiation exposure to patients when ordering imaging tests: a qualitative study.
The authors examined outpatient clinician attitudes towards considering radiation exposure when ordering CT scans and clinician reactions to displaying radiation exposure information for CT scans at clinician electronic order entry. They found that displaying clinically relevant radiation exposure information at order entry may improve clinician knowledge and inform patient-clinician discussions regarding risks and benefits of imaging.
AHRQ-funded; HS018090.
Citation: Kruger JF, Chen AH, Rybkin A .
Clinician perspectives on considering radiation exposure to patients when ordering imaging tests: a qualitative study.
BMJ Qual Saf 2014 Nov;23(11):893-901. doi: 10.1136/bmjqs-2013-002773.
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Keywords: Decision Making, Provider: Health Personnel, Imaging, Patient Safety, Practice Patterns
Del Fiol G, Workman TE, Gorman PN
Clinical questions raised by clinicians at the point of care: a systematic review.
The researchers conducted a systematic review of studies examining the questions that clinicians raise in the context of patient care decisionmaking. They concluded that clinicians frequently raise questions about patient care in their practice. Although they are effective at finding answers to questions they pursue, roughly half of the questions are never pursued.
AHRQ-funded; HS018352.
Citation: Del Fiol G, Workman TE, Gorman PN .
Clinical questions raised by clinicians at the point of care: a systematic review.
JAMA Intern Med. 2014 May;174(5):710-8. doi: 10.1001/jamainternmed.2014.368..
Keywords: Education: Patient and Caregiver, Decision Making, Health Information Exchange (HIE), Health Information Technology (HIT), Practice Patterns