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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
226 to 250 of 583 Research Studies DisplayedJohnston FM, Beckman M
Navigating difficult conversations.
In this paper, the authors discussed breaking bad news and navigating difficult conversations in surgical oncology practice. They note that mounting evidence supports a patient-centered communication approach and models of shared decisionmaking. Physician training in patient-centered cancer communication also continues to evolve.
AHRQ-funded; HS024736.
Citation: Johnston FM, Beckman M .
Navigating difficult conversations.
J Surg Oncol 2019 Jul;120(1):23-29. doi: 10.1002/jso.25472..
Keywords: Cancer, Clinician-Patient Communication, Communication, Decision Making, Patient-Centered Healthcare, Patient and Family Engagement, Provider: Physician, Surgery
Schoenfeld EM, Mader S, Houghton C
The effect of shared decisionmaking on patients' likelihood of filing a complaint or lawsuit: a simulation study.
This study examined the effect of shared decisionmaking on the likelihood of a patient filing a complaint or lawsuit after an adverse event. A simulation experiment using clinical vignettes was conducted. The participants, adults from the US were recruited from an online crowd-sourcing platform. They were randomized to vignettes with 1-3 levels of shared decision making. A total of 804 participants were recruited. Those who were exposed to shared decisionmaking were 80% less like to report a plan to contact a lawyer than those not exposed. They also showed higher levels of physician trust, and less likely to fault their physicians for an adverse outcome.
AHRQ-funded; HS024311.
Citation: Schoenfeld EM, Mader S, Houghton C .
The effect of shared decisionmaking on patients' likelihood of filing a complaint or lawsuit: a simulation study.
Ann Emerg Med 2019 Jul;74(1):126-36. doi: 10.1016/j.annemergmed.2018.11.017..
Keywords: Adverse Events, Decision Making, Medical Errors, Patient-Centered Healthcare, Patient and Family Engagement
Ahmad FS, Kallen MA, Schifferdecker KE
Development and initial validation of the PROMIS(R)-Plus-HF profile measure.
This paper describes the efforts to develop and validate the PROMIS®-Plus-HF (Patient-Reported Outcomes Measurement Information System®-Plus-Heart Failure) profile measure. The authors conducted 8 focus groups with 61 patients with HF and phone interviews with 10 HF clinicians. They tested the measure with a 600-patient sample. Validity was analyzed and confirmed using Pearson r and Spearman rho correlations with Kansas City Cardiomyopathy Questionnaire subscores. The measure consists of 86 items across 18 domains.
AHRQ-funded; HS026385.
Citation: Ahmad FS, Kallen MA, Schifferdecker KE .
Development and initial validation of the PROMIS(R)-Plus-HF profile measure.
Circ Heart Fail 2019 Jun;12(6):e005751. doi: 10.1161/circheartfailure.118.005751.
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Keywords: Patient-Centered Outcomes Research, Heart Disease and Health, Cardiovascular Conditions, Decision Making, Quality of Life, Health Status
Aronson PL, Schaeffer P, Fraenkel L
Physicians' and nurses' perspectives on the decision to perform lumbar punctures on febrile infants </=8 weeks old.
This paper discusses the reasons for wide variation in the decision to perform lumbar punctures (LPs) in febrile infants 8 weeks or less. Semi-structured interviews were conducted with 15 pediatric and general emergency medicine physicians and 8 pediatric emergency medicine nurses at an urban, academic medical center. Five themes emerged from the interviews that included: age of the infant, the physician’s clinical experience, physician’s use of research findings, the physician’s values, and the role of the primary care pediatrician.
AHRQ-funded; HS026006.
Citation: Aronson PL, Schaeffer P, Fraenkel L .
Physicians' and nurses' perspectives on the decision to perform lumbar punctures on febrile infants </=8 weeks old.
Hosp Pediatr 2019 Jun;9(6):405-14. doi: 10.1542/hpeds.2019-0002..
Keywords: Newborns/Infants, Decision Making, Provider: Physician, Provider: Nurse, Provider: Clinician, Provider, Emergency Department, Diagnostic Safety and Quality
Djulbegovic B, Reljic T, Elqayam S
Structured decision-making drives guidelines panels' recommendations "for" but not "against" health interventions.
This study examined the determinants of guideline panels’ recommendations and whether there is a difference between how they make recommendations for or against health interventions. They examined the factors considered by members of 8 panels convened by the American Society of Hematology (ASH) to develop guidelines using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. They found that “for” decisions were made using certainty in evidence, balance of benefits and harms, and variability in patients’ values and preferences. However there was less strength of recommendation (SOR) certainty when making “against” recommendations.
AHRQ-funded; HS024917.
Citation: Djulbegovic B, Reljic T, Elqayam S .
Structured decision-making drives guidelines panels' recommendations "for" but not "against" health interventions.
J Clin Epidemiol 2019 Jun;110:23-33. doi: 10.1016/j.jclinepi.2019.02.009..
Keywords: Decision Making, Guidelines, Patient-Centered Outcomes Research, Evidence-Based Practice
Pavlo AJ, O'Connell M, Olsen S
Missing ingredients in shared decision-making?
This article discusses the practice of shared decision making (SDM) for clinicians when making decisions in health care. This widespread practice is considered the best approach for person-centered care, but for individuals diagnosed with serious mental illness there are still many barriers to effective collaboration. The authors suggest that more emphasis needs to be placed on the doctor-patient relationship itself conducting SDM.
AHRQ-funded; HS023000.
Citation: Pavlo AJ, O'Connell M, Olsen S .
Missing ingredients in shared decision-making?
Psychiatr Q 2019 Jun;90(2):333-38. doi: 10.1007/s11126-019-9624-9..
Keywords: Chronic Conditions, Clinician-Patient Communication, Communication, Decision Making, Behavioral Health, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Patient and Family Engagement
Kruser JM, Benjamin BT, Gordon EJ
Patient and family engagement during treatment decisions in an ICU: a discourse analysis of the electronic health record.
This study looked at patient and family engagement during treatment decisions with patients in a medical ICU. A total of 52 patients were included who had been admitted to a hospital ICU during 2016. Half of them met a consensus definition of chronic critical illness, and the other half either died or had transitioned to hospice care in the ICU. Clinical electronic health records (EHRs) were used to document decision points. The phrase “goals of care” was frequently found in the HER and was used to indicate poor prognosis.
AHRQ-funded; HS000078.
Citation: Kruser JM, Benjamin BT, Gordon EJ .
Patient and family engagement during treatment decisions in an ICU: a discourse analysis of the electronic health record.
Crit Care Med 2019 Jun;47(6):784-91. doi: 10.1097/ccm.0000000000003711..
Keywords: Critical Care, Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT), Intensive Care Unit (ICU), Patient and Family Engagement
Ellis RJ, Brock Hewitt D, Liu JB
Preoperative risk evaluation for pancreatic fistula after pancreaticoduodenectomy.
The purpose of this study was to identify risk factors for clinically relevant postoperative pancreatic fistula that are routinely available in the preoperative setting. Results showed that outcomes were best for patients with three or fewer identified risk factors. The researchers conclude that risk evaluation could be a useful tool in patient counseling and surgical planning.
AHRQ-funded; HS000078.
Citation: Ellis RJ, Brock Hewitt D, Liu JB .
Preoperative risk evaluation for pancreatic fistula after pancreaticoduodenectomy.
J Surg Oncol 2019 Jun;119(8):1128-34. doi: 10.1002/jso.25464..
Keywords: Adverse Events, Decision Making, Patient Safety, Risk, Surgery
Ellis RJ, Gupta AR, Hewitt DB
Risk factors for post-pancreaticoduodenectomy delayed gastric emptying in the absence of pancreatic fistula or intra-abdominal infection.
Researchers sought to define the incidence of delayed gastric emptying (DGE) and identify risk factors for DGE in patients without pancreatic fistula or other intra-abdominal infections. They found that patients were more likely to develop DGE if they were over 74 years of age, male, had undergone pylorus-sparing pancreaticoduodenectomy (PD), or had a prolonged operative time. They conclude that the incidence of DGE after PD is notable even in patients without other abdominal complications and suggested that identification of patients at increased risk for DGE may aid patient counseling as well as decisions regarding surgical technique, enteral feeding access, and enhanced-recovery pathways.
AHRQ-funded; HS000078.
Citation: Ellis RJ, Gupta AR, Hewitt DB .
Risk factors for post-pancreaticoduodenectomy delayed gastric emptying in the absence of pancreatic fistula or intra-abdominal infection.
J Surg Oncol 2019 Jun;119(7):925-31. doi: 10.1002/jso.25398..
Keywords: Adverse Events, Decision Making, Patient Safety, Risk, Surgery
Links AR, Callon W, Wasserman C
Surgeon use of medical jargon with parents in the outpatient setting.
This study analyzed the use of unexplained medical jargon with parents whose children have sleep-disordered breathing and their consultations with otolaryngologists in a pediatric surgical setting. Participants (64 parents and 8 otolaryngologists) completed questionnaires that evaluated demographics, clinical features and parental role in decision-making. Unexplained medical jargon was commonly used by physicians (mean total utterances per visit = 28.9) while parents used jargon a mean of 4.3 times. Clinicians used more jargon when they felt that parents had greater involvement in decision-making or when parents used more jargon themselves. These results will be incorporated into communication training for clinicians.
AHRQ-funded; HS022932.
Citation: Links AR, Callon W, Wasserman C .
Surgeon use of medical jargon with parents in the outpatient setting.
Patient Educ Couns 2019 Jun;102(6):1111-18. doi: 10.1016/j.pec.2019.02.002..
Keywords: Ambulatory Care and Surgery, Caregiving, Children/Adolescents, Clinician-Patient Communication, Communication, Decision Making, Education: Patient and Caregiver, Provider, Provider: Physician
Cochon LR, Kapoor N, Carrodeguas E
Variation in follow-up imaging recommendations in radiology reports: patient, modality, and radiologist predictors.
The purpose of this study was to determine the incidence and to identify factors associated with follow-up recommendations in radiology reports from multiple modalities, patient care settings, and imaging divisions. A trained algorithm classified 318,366 report; the findings indicate that substantial interradiologist variation exists in the probability of recommending a follow-up examination in a radiology report.
AHRQ-funded; HS024722.
Citation: Cochon LR, Kapoor N, Carrodeguas E .
Variation in follow-up imaging recommendations in radiology reports: patient, modality, and radiologist predictors.
Radiology 2019 Jun;291(3):700-07. doi: 10.1148/radiol.2019182826..
Keywords: Decision Making, Diagnostic Safety and Quality, Imaging, Patient Safety, Quality of Care, Quality Improvement
Gordon BE, Basak R, Carpenter WR
Factors influencing prostate cancer treatment decisions for African American and white men.
This prospective, population-based cohort study examined some possible reasons for mortality outcome differences for prostate cancer between African American (AA) and white patients. A cohort of 1170 men with nonmetastatic prostate cancer were enrolled from 2011 to 2013 before treatment in North Carolina. Participants were asked to rate their aggressiveness of their cancer, and also the importance of 10 factors their treatment decision-making process. Among low-risk patients, there was no difference in perception of their cancer as “not very aggressive”. Among high-risk patients, 54% of AA patients considered their cancer to be “not very aggressive” while only 24% of white patients did. For AA patients, cost, treatment time, and recovery time were considered very important more than white patients.
AHRQ-funded.
Citation: Gordon BE, Basak R, Carpenter WR .
Factors influencing prostate cancer treatment decisions for African American and white men.
Cancer 2019 May 15;125(10):1693-700. doi: 10.1002/cncr.31932..
Keywords: Decision Making, Cancer, Cancer: Prostate Cancer, Disparities, Men's Health, Outcomes, Patient-Centered Outcomes Research, Racial and Ethnic Minorities
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
Armstrong MJ
Developing the disorders of consciousness guideline and challenges of integrating shared decision-making into clinical practice.
The purpose of this study was to review methodology informing evidence-based guideline development and integration of guidelines into clinical care through shared decision-making (SDM) and to highlight challenges to SDM in disorders of consciousness. Recently published disorders of consciousness guideline recommendations provide strategies for clinicians to enhance quality care for these individuals and also to provide details helping clinicians partner with individuals with disorders of consciousness and their surrogates. Further research is recommended into many aspects of caring for individuals with disorders of consciousness and optimal strategies for partnering with surrogates in decision-making.
AHRQ-funded; HS024159.
Citation: Armstrong MJ .
Developing the disorders of consciousness guideline and challenges of integrating shared decision-making into clinical practice.
J Head Trauma Rehabil 2019 May/Jun;34(3):199-204. doi: 10.1097/htr.0000000000000496.
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Keywords: Decision Making, Guidelines, Evidence-Based Practice, Neurological Disorders, Patient-Centered Outcomes Research
Kilambi V, Bui K, Hazen GB
Evaluation of accepting kidneys of varying quality for transplantation or expedited placement with decision trees.
This article introduces a decision-tree methodology that analyzes a patient's dilemma: to accept a kidney offer now or reject it. The methodology calculates the survival benefit of accepting a kidney given a certain quality now and the survival benefit of rejecting it. The decision-tree tool presented could aid personalized transplant decision-making in the future by providing patients with calculated, individualized survival benefits between accepting and rejecting a kidney offer.
AHRQ-funded; HS024840.
Citation: Kilambi V, Bui K, Hazen GB .
Evaluation of accepting kidneys of varying quality for transplantation or expedited placement with decision trees.
Transplantation 2019 May;103(5):980-89. doi: 10.1097/tp.0000000000002585..
Keywords: Transplantation, Kidney Disease and Health, Decision Making
Aouad M, Brown TT, Whaley CM
Reference pricing: the case of screening colonoscopies.
In this study, the investigators studied the introduction of reference pricing to the California Public Employees' Retirement System. The investigators found a 10 percentage point increase in the share of patients using an ambulatory surgery center (ASC), leading to a $2300 to $1700 reduction in prices paid for patients who switched to ASCs. They indicated that their results suggested the use of ASCs had a causal effect on prices paid and had no negative effect on patient health outcomes.
AHRQ-funded; HS022098.
Citation: Aouad M, Brown TT, Whaley CM .
Reference pricing: the case of screening colonoscopies.
J Health Econ 2019 May;65:246-59. doi: 10.1016/j.jhealeco.2019.03.002..
Keywords: Colonoscopy, Decision Making, Health Services Research (HSR), Healthcare Costs, Healthcare Delivery, Screening
Schiff GD, Tripathi JB, Galanter W
Drug formulary decision-making: ethnographic study of 3 pharmacy and therapeutics committees.
This study analyzed the processes of how 3 pharmacy and therapeutic (P&T) committees weighed options and their topics of discussion during meetings. There was a wide range of topics discussed with roughly half the time spent on drug safety than discussions of efficacy. Logistics of using the drugs in their institutions was also a popular topic. The issues varied from drug to drug, and there were quite a few tangential issues raised by committee members.
AHRQ-funded; HS016973.
Citation: Schiff GD, Tripathi JB, Galanter W .
Drug formulary decision-making: ethnographic study of 3 pharmacy and therapeutics committees.
Am J Health Syst Pharm 2019 Apr 8;76(8):537-42. doi: 10.1093/ajhp/zxz022..
Keywords: Decision Making, Medication
Pulia M, Fox B
Antibiotics should not be routinely prescribed after incision and drainage of uncomplicated abscesses.
This article considers recent challenges to the 2013 antimicrobial stewardship recommendation from the American College of Emergency Physicians on avoidance of systemic antibiotic therapy after adequate incision and drainage of uncomplicated abscesses. Although the latest results from randomized controlled trials indicate that there are benefits in favoring antibiotics in the management of uncomplicated abscesses, the authors note that these results have also ‘paradoxically given rise to a unique clinical dilemma that carries significant public health implications’ and may lead to tens of thousands of patients receiving unnecessary antibiotics treatment each year. To limit development of unnecessary antibiotic resistance and reduce possible adverse reactions to antibiotics, the authors propose that antibiotic usage for uncomplicated abscesses be considered only for high-risk patients, such as those with immunocompromised status, a history of MRSA infections, or limited access to follow-up care.
AHRQ-funded; HS024342.
Citation: Pulia M, Fox B .
Antibiotics should not be routinely prescribed after incision and drainage of uncomplicated abscesses.
Ann Emerg Med 2019 Apr;73(4):377-78. doi: 10.1016/j.annemergmed.2018.04.026..
Keywords: Antibiotics, Antimicrobial Stewardship, Decision Making, Medication
Spees LP, ledikwe JH, Kleinman NJ
Immediate motivators to seeking voluntary medical male circumcision among HIV-negative adult men in an urban setting in Botswana.
The goal of this study was to identify subpopulations of Botswanan men with high levels of voluntary medical male circumcision (VMMC) uptake. An observational cohort of men presenting for circumcision services at two high-volume clinics in Gabo-rone, Botswana's capital, were compared with a matched, population-based random sample of uncircumcised men with regard to factors that played a role in the men's decision to seek VMMC services. The results indicate that married men and highly educated men are more likely to undergo circumcision for personal hygiene reasons. The authors conclude that these findings have implications for activities designed to increase VMMC uptake in Botswana and reduce HIV acquisition risk in men.
AHRQ-funded; HS000032.
Citation: Spees LP, ledikwe JH, Kleinman NJ .
Immediate motivators to seeking voluntary medical male circumcision among HIV-negative adult men in an urban setting in Botswana.
AIDS Educ Prev 2019 Apr;31(2):136-51. doi: 10.1521/aeap.2019.31.2.136..
Keywords: Decision Making, Human Immunodeficiency Virus (HIV), Men's Health, Urban Health, Sexual Health
Ashcraft LE, Asato M, Houtrow AJ
Parent empowerment in pediatric healthcare settings: a systematic review of observational studies.
The objective of this systematic review was to synthesize potential antecedents and consequences of parent empowerment in healthcare settings. The authors identified six themes within consequences of empowerment: increased parent involvement in daily care, improved symptom management, enhanced informational needs and tools, increased involvement in care decisions, increased advocacy for child, and engagement in empowering others. Six themes summarizing antecedents of empowerment also emerged: parent-provider relationships.
AHRQ-funded; HS022989.
Citation: Ashcraft LE, Asato M, Houtrow AJ .
Parent empowerment in pediatric healthcare settings: a systematic review of observational studies.
Patient 2019 Apr;12(2):199-212. doi: 10.1007/s40271-018-0336-2..
Keywords: Caregiving, Children/Adolescents, Clinician-Patient Communication, Decision Making, Patient and Family Engagement
Hong M, Casado BL, Lee SE
The intention to discuss advance care planning in the context of Alzheimer's disease among Korean Americans.
The authors examined the intention to discuss advance care planning (ACP) for a family member with Alzheimer's disease among Korean Americans. Path analyses were conducted on a cross-sectional convenience sample; age, gender, education, and knowledge about Alzheimer's disease and ACP were included as covariates. From their findings, the authors recommended promoting ACP among this population and designing educational interventions to address positive attitudes and subjective norms toward ACP.
AHRQ-funded; HS022947.
Citation: Hong M, Casado BL, Lee SE .
The intention to discuss advance care planning in the context of Alzheimer's disease among Korean Americans.
Gerontologist 2019 Mar 14;59(2):347-55. doi: 10.1093/geront/gnx211..
Keywords: Elderly, Dementia, Neurological Disorders, Decision Making, Racial and Ethnic Minorities
Shaffer VA, Wegier P, Valentine KD
Patient judgments about hypertension control: the role of variability, trends, and outliers in visualized blood pressure data.
Uncontrolled hypertension is a significant health problem in the United States, even though multiple drugs exist to effectively treat this chronic disease. As part of a larger project developing data visualizations to support shared decision making about hypertension treatment, the investigators conducted a series of studies to understand how perceptions of hypertension control were impacted by data variations inherent in the visualization of blood pressure (BP) data.
AHRQ-funded; HS023328.
Citation: Shaffer VA, Wegier P, Valentine KD .
Patient judgments about hypertension control: the role of variability, trends, and outliers in visualized blood pressure data.
J Med Internet Res 2019 Mar 26;21(3):e11366. doi: 10.2196/11366..
Keywords: Blood Pressure, Decision Making, Patient-Centered Healthcare, Medication, Chronic Conditions
Hero JO, Sinaiko AD, Kingsdale J
Decision-making experiences of consumers choosing individual-market health insurance plans.
This study researched the experiences of consumers choosing individual-market health insurance plans using either Marketplaces established by the Affordable Care Act (ACA) or directly through an insurance carrier. Consumers in 2017 reported that they had an easier overall experience using Marketplace than those who enrolled directly. Consumers with low health literacy had poor experiences with either method.
AHRQ-funded; HS024700.
Citation: Hero JO, Sinaiko AD, Kingsdale J .
Decision-making experiences of consumers choosing individual-market health insurance plans.
Health Aff 2019 Mar;38(3):464-72. doi: 10.1377/hlthaff.2018.05036..
Keywords: Decision Making, Health Insurance, Health Literacy
Dworsky JQ, Russell MM
Surgical decision making for older adults.
This article addressed surgical decision making for older adults. Its outline included: consideration of health goals, description of what surgery would be like, daily life after recovery, and final decision-making.
AHRQ-funded; HS000046.
Citation: Dworsky JQ, Russell MM .
Surgical decision making for older adults.
JAMA 2019 Feb 19;321(7):716. doi: 10.1001/jama.2019.0283..
Keywords: Surgery, Decision Making, Elderly
Cerully JL, Parker AM, Rybowski L
Improving patients' choice of clinician by including roll-up measures in public healthcare quality reports: an online experiment.
The purpose of this paper was to determine how presenting quality scores at different levels of aggregation affects patients' clinician choices. A simulated clinician-choice experiment with 550 panelists was employed. The results suggested that roll-ups in healthcare quality reports, alone or as a complement to drill-downs, can help patients make better decisions.
AHRQ-funded; HS016978.
Citation: Cerully JL, Parker AM, Rybowski L .
Improving patients' choice of clinician by including roll-up measures in public healthcare quality reports: an online experiment.
J Gen Intern Med 2019 Feb;34(2):243-49. doi: 10.1007/s11606-018-4725-y..
Keywords: Decision Making, Quality of Care, Provider Performance