National Healthcare Quality and Disparities Report
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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
201 to 225 of 583 Research Studies DisplayedAntunez AG, Telem DA DA, Dossett LA
Assessment of surgical specialty societies' Choosing Wisely recommendations.
This research study assesses the Choosing Wisely initiative from the American Board of Internal Medicine Foundation which aims to reduce the use of low-value practices using evidence-based recommendation. The initiative has included participation from more than 80 specialty societies. The goal of this study was to assess deimplementation recommendations from surgical specialty societies to ascertain how many are directly applicable to surgical procedures or under surgeons’ control. They reviewed the recommendations proposed by surgical societies and requested participation from the eligible ones. Seventeen surgical societies submitted 110 recommendations on their surgical specialty. Out of those recommendations, more than (55%) were identified as perioperative care decisions and not under a surgeons’ control.
AHRQ-funded; HS026030.
Citation: Antunez AG, Telem DA DA, Dossett LA .
Assessment of surgical specialty societies' Choosing Wisely recommendations.
JAMA Surg 2019 Oct;154(10):971-73. doi: 10.1001/jamasurg.2019.2309..
Keywords: Surgery, Decision Making, Guidelines
Martino SC, Grob R, Davis S
Choosing doctors wisely: can assisted choice enhance patients' selection of clinicians?
In this study, the investigators conducted a simulated clinician-choice experiment, comparing choices and decision-making processes of participants (N = 688) randomized among four experimental arms: a conventional website reporting only quantitative performance information, a website reporting both qualitative (patient comments) and quantitative information, the second website augmented by a decision aid (labeling of patient comments), and the decision-aided website further augmented by the presence of a trained navigator.
AHRQ-funded; HS016978.
Citation: Martino SC, Grob R, Davis S .
Choosing doctors wisely: can assisted choice enhance patients' selection of clinicians?
Med Care Res Rev 2019 Oct;76(5):572-96. doi: 10.1177/1077558717743822..
Keywords: Patient Experience, Decision Making
Garrity B, Berry Crofton, C
Parent-to-parent advice on considering spinal fusion in children with neuromuscular scoliosis.
The purpose of this study was to convey advice from families whose children recently underwent spinal fusion to families whose children are under consideration for initial spinal fusion for neuromuscular scoliosis and to providers who counsel families on this decision. Results showed that parents of children who had recently undergone spinal fusion had strong perceptions about what information to convey to families considering surgery, which may improve communication between future parents and physicians. Further investigation is needed to assess how best to incorporate the wisdom and experiences of parent peers into shared decisionmaking and preparation for spinal fusion in children with neuromuscular scoliosis.
AHRQ-funded; HS024453.
Citation: Garrity B, Berry Crofton, C .
Parent-to-parent advice on considering spinal fusion in children with neuromuscular scoliosis.
J Pediatr 2019 Oct;213:149-54. doi: 10.1016/j.jpeds.2019.05.055..
Keywords: Decision Making, Patient and Family Engagement, Caregiving, Children/Adolescents, Back Health and Pain, Surgery
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
Vemulakonda VM, Hamer MK, Kempe A
Surgical decision-making in infants with suspected UPJ obstruction: stakeholder perspectives.
Although there are significant demographic and clinical variations in treatment decisions for infants with high-grade hydronephrosis concerning for ureteropelvic junction obstruction (UPJO), there has been little research on the roles of parents and surgeons in the surgical decision-making (DM) process. The purpose of this study was to understand parents' and surgeons' perceived roles in the surgical DM process for infants with high-grade hydronephrosis.
AHRQ-funded; HS024597.
Citation: Vemulakonda VM, Hamer MK, Kempe A .
Surgical decision-making in infants with suspected UPJ obstruction: stakeholder perspectives.
J Pediatr Urol 2019 Oct;15(5):469.e1-69.e9. doi: 10.1016/j.jpurol.2019.05.027..
Keywords: Newborns/Infants, Decision Making, Surgery, Kidney Disease and Health, Caregiving, Provider: Physician, Provider, Patient and Family Engagement
McGinn T, Cohen S, Khan S
The high cost of low value care.
The main focus of this study was bridging the "evidence gap" between frontline decision-making in health care and the actual evidence, with the hope of reducing unnecessary diagnostic testing and treatments. From their work in pulmonary embolism (PE) and over ordering of computed tomography pulmonary angiography, the investigators integrated the highly validated Wells' criteria into the electronic health record at two of their major academic tertiary hospitals.
AHRQ-funded; HS022061.
Citation: McGinn T, Cohen S, Khan S .
The high cost of low value care.
Trans Am Clin Climatol Assoc 2019;130:60-70..
Keywords: Healthcare Costs, Evidence-Based Practice, Patient-Centered Outcomes Research, Decision Making, Comparative Effectiveness
Cochran AL, Rathouz PJ, Kocher KE
A latent variable approach to potential outcomes for emergency department admission decisions.
The authors sought to provide a general framework to evaluate admission decisions from electronic healthcare records. They estimated that while admitting a patient with higher latent needs reduced the 30-day risk of revisiting the emergency department or later being admitted through the emergency department by over 79%, admitting a patient with lower latent needs actually increased these 30-day risks by 3.0% and 7.6%, respectively.
AHRQ-funded; HS024160.
Citation: Cochran AL, Rathouz PJ, Kocher KE .
A latent variable approach to potential outcomes for emergency department admission decisions.
Stat Med 2019 Sep 10;38(20):3911-35. doi: 10.1002/sim.8210..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Emergency Department, Clinical Decision Support (CDS), Decision Making, Hospitalization
Wissel BD, Greiner HM, Glauser TA
Investigation of bias in an epilepsy machine learning algorithm trained on physician notes.
Racial disparities in the utilization of epilepsy surgery are well documented, but it is unknown whether a natural language processing (NLP) algorithm trained on physician notes would produce biased recommendations for epilepsy presurgical evaluations. To assess this, an NLP algorithm was trained to identify potential surgical candidates using 1097 notes from 175 epilepsy patients with a history of resective epilepsy surgery and 268 patients who achieved seizure freedom without surgery (total N = 443 patients).
AHRQ-funded; HS024977.
Citation: Wissel BD, Greiner HM, Glauser TA .
Investigation of bias in an epilepsy machine learning algorithm trained on physician notes.
Epilepsia 2019 Sep;60(9):e93-e98. doi: 10.1111/epi.16320..
Keywords: Neurological Disorders, Surgery, Clinical Decision Support (CDS), Healthcare Utilization, Health Information Technology (HIT), Decision Making
Gance-Cleveland B, Leiferman J, Aldrich H
Using the technology acceptance model to develop startsmart: mHealth for screening, brief intervention, and referral for risk and protective factors in pregnancy.
The purpose of this study was to develop StartSmart, a mobile health (mHealth) intervention to support evidence-based prenatal screening, brief intervention, and referral to treatment for risk and protective factors in pregnancy. Expert clinicians provided guidance on the screening instruments, resources, and practice guidelines. Clinicians suggested identifying specific prenatal visits for the screening. Patients reported that the tablet-based screening was useful to promote adherence to guidelines and provided suggestions for improvement.
AHRQ-funded; HS024738.
Citation: Gance-Cleveland B, Leiferman J, Aldrich H .
Using the technology acceptance model to develop startsmart: mHealth for screening, brief intervention, and referral for risk and protective factors in pregnancy.
J Midwifery Womens Health 2019 Sep;64(5):630-40. doi: 10.1111/jmwh.13009..
Keywords: Health Information Technology (HIT), Domestic Violence, Clinical Decision Support (CDS), Decision Making, Pregnancy, Women, Evidence-Based Practice, Screening, Prevention
Schroeder AD, Tubre DJ, Fitzgibbons RJ
Watchful waiting for inguinal hernia.
In this article, the authors examine the available evidence regarding nonoperative treatment or ‘‘watchful waiting’’ of inguinal hernias. The goal was to develop evidence-based recommendations to provide patients with inguinal hernia the treatment strategy that will maximize benefit while minimizing potential risks.
AHRQ-funded; HS009860.
Citation: Schroeder AD, Tubre DJ, Fitzgibbons RJ .
Watchful waiting for inguinal hernia.
Adv Surg 2019 Sep;53:293-303. doi: 10.1016/j.yasu.2019.04.014.
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Keywords: Care Management, Evidence-Based Practice, Decision Making
Hoonakker PLT, Carayon P, Salwei ME
The design of PE Dx, a CDS to support pulmonary embolism diagnosis in the ED.
One possible explanation for user resistance to clinical decision support (CDS) procedures may be poor CDS design. This study describes the design of PE Dx, a CDS built to aid in the diagnosis of pulmonary embolism in the emergency department using human factors methods.
AHRQ-funded; HS022086.
Citation: Hoonakker PLT, Carayon P, Salwei ME .
The design of PE Dx, a CDS to support pulmonary embolism diagnosis in the ED.
Stud Health Technol Inform 2019 Aug 9;265:134-40. doi: 10.3233/shti190152..
Keywords: Blood Clots, Clinical Decision Support (CDS), Decision Making, Diagnostic Safety and Quality, Emergency Department, Respiratory Conditions
Brodney S, Fowler FJ, Barry MJ
Comparison of three measures of shared decision making: SDM Process_4, CollaboRATE, and SURE scales.
This study compared 3 different shared decision making (SDM) aids for patients facing surgery for hip or knee osteoarthritis, lumbar herniated disc or lumber spinal stenosis (backs). Patients were surveys after they used one of the following patient decision aids (PDAs): SMD Process_4, CollaboRATE, or SURE. The sample size was 649 with a mean age of 63.3 years, 51% female, and 60% were college educated. Most patients (69%) were facing hip or knee surgery. Results showed that the PDAs did aid patients – especially for hips/knees and were different for each PDA.
AHRQ-funded; HS025718.
Citation: Brodney S, Fowler FJ, Barry MJ .
Comparison of three measures of shared decision making: SDM Process_4, CollaboRATE, and SURE scales.
Med Decis Making 2019 Aug;39(6):673-80. doi: 10.1177/0272989x19855951..
Keywords: Decision Making, Surgery, Arthritis, Back Health and Pain
Harle CA, DiIulio J, Downs SM
Decision-centered design of patient information visualizations to support chronic pain care.
The objective of this study was to describe a decision-centered design process, and resultant interactive patient information displays, to support key clinical decision requirements in chronic noncancer pain care. Through critical decision method interviews and a half-day multidisciplinary design workshop, researchers designed an interactive prototype, the Chronic Pain Treatment Tracker. This prototype summarizes the current treatment plan, past treatment history, potential future treatments, and treatment options that require caution. The researchers concluded that the Chronic Pain Treatment Tracker presents clinicians with the information they need in a structure that promotes quick uptake, understanding, and action.
AHRQ-funded; HS023306.
Citation: Harle CA, DiIulio J, Downs SM .
Decision-centered design of patient information visualizations to support chronic pain care.
Appl Clin Inform 2019 Aug;10(4):719-28. doi: 10.1055/s-0039-1696668..
Keywords: Pain, Chronic Conditions, Decision Making, Health Information Technology (HIT), Clinical Decision Support (CDS), Care Management, Healthcare Delivery
Ingraham A, Wang X, Havlena J
Factors associated with the interhospital transfer of emergency general surgery patients.
Researchers used data from the Nationwide Inpatient Sample to determine patient- and hospital-level factors associated with interhospital emergency general surgery (EGS) transfers. They identified that hospital-level characteristics more strongly predicted the need for transfer than patient-related factors. They recommended considering these factors in order to facilitate transfer decision-making.
AHRQ-funded; HS025224.
Citation: Ingraham A, Wang X, Havlena J .
Factors associated with the interhospital transfer of emergency general surgery patients.
J Surg Res 2019 Aug;240:191-200. doi: 10.1016/j.jss.2018.11.053..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Surgery, Decision Making, Hospitals, Healthcare Delivery, Transitions of Care
Sepucha KR, Langford AT, Belkora JK
Impact of timing on measurement of decision quality and shared decision making: longitudinal cohort study of breast cancer patients.
Med Decis Making 2019 Aug;39(6):642-50. doi: 10.1177/0272989x19862545.
AHRQ-funded; HS025718.
Citation: Sepucha KR, Langford AT, Belkora JK .
Impact of timing on measurement of decision quality and shared decision making: longitudinal cohort study of breast cancer patients.
Med Decis Making 2019 Aug;39(6):642-50. doi: 10.1177/0272989x19862545..
Keywords: Decision Making, Cancer: Breast Cancer, Cancer, Surgery
Reeder HT, Shen C, Buxton AE
Joint shock/death risk prediction model for patients considering implantable cardioverter-defibrillators.
This study’s goal was to develop a joint shock/death risk prediction tool for patients who received implantable cardioverter-defibrillators (ICDs). Secondary analysis of patients was conducted as part of the SCD-HeFT trial (Sudden Cardiac Death in Heart Failure Trial). An illness-death regression model was applied for both ICD shocks and deaths. Among 803 ICD recipients, 430 (53.5%) did not receive an ICD shock or die, 206 (25.7%) received at least 1 shock but did not die, 113 (14.1%) died before receiving a shock, and 54 (6.7%) received at least 1 shock but still died. This predictive performance can be used as a tool for individualized counseling for patients contemplating an ICD.
AHRQ-funded; HS024520.
Citation: Reeder HT, Shen C, Buxton AE .
Joint shock/death risk prediction model for patients considering implantable cardioverter-defibrillators.
Circ Cardiovasc Qual Outcomes 2019 Aug;12(8):e005675. doi: 10.1161/circoutcomes.119.005675..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Medical Devices, Risk, Decision Making, Mortality
Goff SL, Garb JL, Guhn-Knight H
Spatial analysis of factors influencing choice of paediatric practice for mothers from low-income and minority populations.
Publicly reported quality data theoretically enable parents to choose higher-performing paediatric practices. However, little is known about how parents decide where to seek paediatric care. In this study, the investigators explored the relationship between geographic factors, care quality and choice of practice to see if the decision-making process could be described in terms of a 'gravity model' of spatial data.
AHRQ-funded; HS021879.
Citation: Goff SL, Garb JL, Guhn-Knight H .
Spatial analysis of factors influencing choice of paediatric practice for mothers from low-income and minority populations.
J Paediatr Child Health 2019 Aug;55(8):948-55. doi: 10.1111/jpc.14322..
Keywords: Caregiving, Decision Making, Low-Income, Quality of Care, Racial and Ethnic Minorities
Asti L, Bartsch SM, Umscheid CA
The potential economic value of sputum culture use in patients with community-acquired pneumonia and healthcare-associated pneumonia.
Researchers developed a decision model to determine the economic and clinical value of using sputum cultures in the treatment of community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP) from the hospital perspective under various conditions. They found that, overall, obtaining sputum cultures does not provide significant clinical or economic benefits for CAP or HCAP patients; however, it can reduce costs and shorten overall length of stay under some circumstances. They recommended that clinicians consider their local conditions when making decisions about sputum culture use.
AHRQ-funded; HS023317.
Citation: Asti L, Bartsch SM, Umscheid CA .
The potential economic value of sputum culture use in patients with community-acquired pneumonia and healthcare-associated pneumonia.
Clin Microbiol Infect 2019 Aug;25(8):1038.e1-38.e9. doi: 10.1016/j.cmi.2018.11.031..
Keywords: Pneumonia, Community-Acquired Infections, Healthcare-Associated Infections (HAIs), Infectious Diseases, Healthcare Costs, Clinical Decision Support (CDS), Decision Making
Snyder ME, Jaynes H, Gernant SA
Alerts for community pharmacist-provided medication therapy management: recommendations from a heuristic evaluation.
This study evaluated the effectiveness of alerts for community pharmacist-provided medication therapy management (MTM). The alerts come in five categories: indication, effectiveness, safety, adherence, and cost-containment. The heuristic evaluation used the Instrument for Evaluating Human-Factors Principles in Medication-Related Decision Support Alerts (I-MeDeSA). Four analysts’ individual ratings were summed for each alert, and a mean score on the modified I-MeDeSA was computed. The analysts’ scores were similar. The scores indicated opportunities for improvement across all MTM alert categories including principles of alert prioritization; text-based information; alarm philosophy; and corrective actions.
AHRQ-funded; HS025005.
Citation: Snyder ME, Jaynes H, Gernant SA .
Alerts for community pharmacist-provided medication therapy management: recommendations from a heuristic evaluation.
BMC Med Inform Decis Mak 2019 Jul 16;19(1):135. doi: 10.1186/s12911-019-0866-0..
Keywords: Decision Making, Health Information Technology (HIT), Medication, Provider, Provider: Pharmacist
Gressler LE, Natafgi NM, DeForge BR
What motivates people with substance use disorders to pursue treatment? A patient-centered approach to understanding patient experiences and patient-provider interactions.
The purpose of this study was to identify and define potential positive and negative factors in patient experiences and patient-provider interactions that are associated with the pursuit and maintenance of treatment by those suffering from substance use disorders (SUD). The investigators conducted two focus groups with patients in treatment for SUD and four in-depth interviews with healthcare providers involved in the treatment of patients with SUD.
AHRQ-funded; HS022135.
Citation: Gressler LE, Natafgi NM, DeForge BR .
What motivates people with substance use disorders to pursue treatment? A patient-centered approach to understanding patient experiences and patient-provider interactions.
J Subst Use 2019;24(6):587-99. doi: 10.1080/14659891.2019.1620891..
Keywords: Clinician-Patient Communication, Decision Making, Healthcare Utilization, Patient-Centered Healthcare, Patient Experience, Patient and Family Engagement, Substance Abuse
Ronis SD, Kleinman LC, Stange KC
A learning loop model of collaborative decision-making in chronic illness.
In this article, the authors discuss their learning loop model, which posits the relationship between pediatric patients, their parents, and their clinicians as central to the collaborative decision-making process in the setting of chronic illness. The model incorporates the evolution of both context and developmental capacity over time. It suggests that "meta-learning" from the experience of and outcomes from iterative decision is a key factor that may influence relationships and thus continued engagement in collaboration by patients, their parents, and their clinicians.
AHRQ-funded; HS024433.
Citation: Ronis SD, Kleinman LC, Stange KC .
A learning loop model of collaborative decision-making in chronic illness.
Acad Pediatr 2019 Jul;19(5):497-503. doi: 10.1016/j.acap.2019.04.006..
Keywords: Children/Adolescents, Chronic Conditions, Decision Making, Patient-Centered Healthcare, Primary Care: Models of Care, Primary Care, Clinician-Patient Communication, Communication
Armstrong MJ, Gronseth GS, Day GS
Patient stakeholder versus physician preferences regarding amyloid PET testing.
Patient and caregiver perspectives on amyloid positron emission tomography (PET) use are largely unexplored, particularly as compared with clinician views. In this study, the investigators surveyed clinicians, patients, caregivers, and dementia advocates on topics relating to an evidence-based guideline on amyloid PET use. They found that patients and caregivers emphasized the importance of having a dementia diagnosis and placed more value on testing and outcomes for asymptomatic populations than clinicians.
AHRQ-funded; HS024159.
Citation: Armstrong MJ, Gronseth GS, Day GS .
Patient stakeholder versus physician preferences regarding amyloid PET testing.
Alzheimer Dis Assoc Disord 2019 Jul-Sep;33(3):246-53. doi: 10.1097/wad.0000000000000311..
Keywords: Decision Making, Dementia, Diagnostic Safety and Quality, Evidence-Based Practice, Guidelines, Imaging, Neurological Disorders, Patient-Centered Outcomes Research, Provider, Provider: Physician
Pang PS, Fermann GJ, Hunter BR
TACIT (High Sensitivity Troponin T Rules Out Acute Cardiac Insufficiency Trial).
This study examined the use of high-sensitivity troponin assays to determine whether a patient presenting in the emergency department with chest pains is safe for discharge. An observational study called High Sensitivity Troponin T Rules Out Acute Cardiac Insufficiency Trial (TACIT) explored whether serial high-sensitivity troponin (hsTnT) might aid in making diagnosis of acute heart failure faster. The presence of hsTnT above the 99th percentile usually indicates acute heart failure. Patients in the cohort with hsTnT at or above the 99th percentile were older, more often male, less often black, and more likely to have chronic kidney disease. The study found no difference in risk for 90-day death or rehospitalization or return ED visits in the group with hsTnT above the 99th percentile than those with levels below the 99th percentile so hsTnT would not be considered useful.
AHRQ-funded; HS025411.
Citation: Pang PS, Fermann GJ, Hunter BR .
TACIT (High Sensitivity Troponin T Rules Out Acute Cardiac Insufficiency Trial).
Circ Heart Fail 2019 Jul;12(7):e005931. doi: 10.1161/circheartfailure.119.005931..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Emergency Department, Risk, Decision Making
Hinson JS, Martinez DA, Cabral S
Triage performance in emergency medicine: a systematic review.
The authors synthesized existing emergency department (ED) triage literature by using a framework that enables performance comparisons and benchmarking across triage systems, with respect to clinical outcomes and reliability. They found that a substantial proportion of ED patients who die post-encounter or who are critically ill are not designated as high acuity at triage. They suggested that the opportunity exists to improve interrater reliability and triage performance in identifying patients at risk of adverse outcome.
AHRQ-funded; HS023641.
Citation: Hinson JS, Martinez DA, Cabral S .
Triage performance in emergency medicine: a systematic review.
Ann Emerg Med 2019 Jul;74(1):140-52. doi: 10.1016/j.annemergmed.2018.09.022..
Keywords: Emergency Department, Decision Making, Critical Care, Outcomes, Health Information Technology (HIT)
Bateni SB, Davidson AJ, Arora M
Is breast-conserving therapy appropriate for male breast cancer patients? A national cancer database analysis.
The purpose of this study was to compare overall survival rates among male breast cancer patients who underwent breast-conserving therapy (BCT) versus mastectomy. A retrospective analysis identified 8445 stage I-II male breast cancer patients from the National Cancer Database and grouped them according to surgical and radiation therapy (RT). Most of the patients underwent total mastectomy, while 18.2% underwent BCT, 12.4% underwent total mastectomy with RT, and 8.2% underwent partial mastectomy alone. Partial mastectomy alone, total mastectomy alone, and total mastectomy with RT were associated with worse overall survival rates compared with BCT. The authors conclude that BCT is associated with greater survival, but the underlying mechanisms of this association warrant further study.
AHRQ-funded; HS022236.
Citation: Bateni SB, Davidson AJ, Arora M .
Is breast-conserving therapy appropriate for male breast cancer patients? A national cancer database analysis.
Ann Surg Oncol 2019 Jul;26(7):2144-53. doi: 10.1245/s10434-019-07159-4..
Keywords: Cancer, Cancer: Breast Cancer, Decision Making, Mortality, Outcomes, Patient-Centered Outcomes Research