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Topics
- Adverse Events (1)
- Arthritis (1)
- Back Health and Pain (4)
- Behavioral Health (1)
- Blood Thinners (1)
- Brain Injury (1)
- Cancer (3)
- Cancer: Colorectal Cancer (1)
- Cancer: Lung Cancer (2)
- Cardiovascular Conditions (1)
- Care Management (1)
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- (-) Comparative Effectiveness (31)
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- Dementia (1)
- Depression (1)
- (-) Elderly (31)
- Evidence-Based Practice (6)
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- Medication (8)
- Mortality (1)
- Nursing Homes (3)
- Nutrition (1)
- Outcomes (7)
- Pain (2)
- Patient-Centered Outcomes Research (13)
- Patient Self-Management (1)
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- Risk (1)
- Sex Factors (1)
- Surgery (6)
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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
1 to 25 of 31 Research Studies DisplayedMakam AN, Nguyen OK, Miller ME
Comparative effectiveness of long-term acute care hospital versus skilled nursing facility transfer.
This study compared the effectiveness of long-term acute care hospital (LTACH) use versus skilled nursing facility (SNF) transfer after hospitalization. Medicare claims linked to electronic health record (EHR) data from six Texas hospitals between 2009 and 2010 were used to conduct a retrospective cohort study of hospitalized patients transferred to either an LTACH or SNF and followed for one year. Out of 3505 patients, 18% were transferred to an LTACH and overall were younger, less likely to be female, and white, but sicker than transfers to an SNF. Patients transferred to an LTACH were less likely to survive (59 vs. 65%) or recover (62.5 vs 66%). Adjusting for demographic and clinical confounders found in Medicare claims and EHR data, transfer location was not significantly associated with differences in mortality but was associated with greater Medicare spending.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Miller ME .
Comparative effectiveness of long-term acute care hospital versus skilled nursing facility transfer.
BMC Health Serv Res 2020 Nov 11;20(1):1032. doi: 10.1186/s12913-020-05847-6..
Keywords: Comparative Effectiveness, Evidence-Based Practice, Long-Term Care, Elderly, Medicare, Transitions of Care, Nursing Homes, Hospitals
Zullo AR, Riester MR, Erqou S
Comparative effectiveness of angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors in older nursing home residents after myocardial infarction: a retrospective cohort study.
Evidence regarding differences in outcomes between angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) among older nursing home (NH) residents after acute myocardial infarction (AMI) is limited. The purpose of this study was to estimate the post-AMI effects of ARBs versus ACEIs on mortality, rehospitalization, and functional decline outcomes in this important population.
AHRQ-funded; HS022998.
Citation: Zullo AR, Riester MR, Erqou S .
Comparative effectiveness of angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors in older nursing home residents after myocardial infarction: a retrospective cohort study.
Drugs Aging 2020 Oct;37(10):755-66. doi: 10.1007/s40266-020-00791-w..
Keywords: Elderly, Nursing Homes, Heart Disease and Health, Medication, Evidence-Based Practice, Comparative Effectiveness, Patient-Centered Outcomes Research, Outcomes
Ochs-Ross R, Daly EJ, Zhang Y
Efficacy and safety of esketamine nasal spray plus an oral antidepressant in elderly patients with treatment-resistant depression-TRANSFORM-3.
This phase 3 double-blind study randomized patients with treatment-resistant depression age 65 or older to flexibly-dosed esketamine nasal spray and new oral antidepressant (esketamine/antidepressant) or new oral antidepressant and placebo nasal spray (antidepressant/placebo). The primary endpoint was change in the Montgomery-Asberg Depression Rating Scale (MADRS) over 28 days from baseline. Results showed that esketamine/antidepressant did not achieve statistical significance for patients ages 75 and older; however, greater differences were seen for patients ages 65-74 and patients with earlier onset of depression younger than age 55.
AHRQ-funded; HS023000.
Citation: Ochs-Ross R, Daly EJ, Zhang Y .
Efficacy and safety of esketamine nasal spray plus an oral antidepressant in elderly patients with treatment-resistant depression-TRANSFORM-3.
Am J Geriatr Psychiatry 2020 Feb;28(2):121-41. doi: 10.1016/j.jagp.2019.10.008..
Keywords: Medication, Depression, Behavioral Health, Elderly, Comparative Effectiveness, Treatments, Evidence-Based Practice
Ezer N, Kale M, Sigel K
Outcomes after video-assisted thoracoscopic lobectomy versus open lobectomy for early-stage lung cancer in older adults.
This study evaluated whether the improved perioperative outcomes associated with video-assisted thoracoscopic surgery (VATS) lobectomy are explained by surgeon characteristics, including case volume and specialty training. It concluded that VATS lobectomy for non-small cell lung cancer (NSCLC) is associated with better postoperative outcomes, but similar long-term survival, compared with open lobectomy among older adults, even after controlling for surgeon experience.
AHRQ-funded; HS019670.
Citation: Ezer N, Kale M, Sigel K .
Outcomes after video-assisted thoracoscopic lobectomy versus open lobectomy for early-stage lung cancer in older adults.
Ann Am Thorac Soc 2018 Jan;15(1):76-82. doi: 10.1513/AnnalsATS.201612-980OC.
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Keywords: Comparative Effectiveness, Elderly, Cancer: Lung Cancer, Surgery
Reid MC, Henderson CR, Jr., Trachtenberg MA
Implementing a pain self-management protocol in home care: a cluster-randomized pragmatic trial.
The researchers sought to determine the effectiveness of a cognitive-behavioral pain self-management protocol delivered by physical therapists for use by older adults with activity-limiting pain receiving home care. Their real-world pragmatic trial found no effect of implementation of a pain self-management intervention in a home care setting.
AHRQ-funded; HS020648.
Citation: Reid MC, Henderson CR, Jr., Trachtenberg MA .
Implementing a pain self-management protocol in home care: a cluster-randomized pragmatic trial.
J Am Geriatr Soc 2017 Aug;65(8):1667-75. doi: 10.1111/jgs.14836.
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Keywords: Home Healthcare, Patient Self-Management, Pain, Elderly, Comparative Effectiveness
Palamaner Subash Shantha G, Bhave PD, Girotra S
Sex-specific comparative effectiveness of oral anticoagulants in elderly patients with newly diagnosed atrial fibrillation.
This study assessed the sex-specific, comparative effectiveness of direct oral anticoagulants (rivaroxaban and dabigatran), compared to each other and to warfarin among patients with atrial fibrillation. It concluded that the reduced risk of ischemic stroke in patients taking rivaroxaban, compared with dabigatran and warfarin, seems to be limited to men, whereas the higher risk of bleeding seems to be limited to women.
AHRQ-funded; HS023104.
Citation: Palamaner Subash Shantha G, Bhave PD, Girotra S .
Sex-specific comparative effectiveness of oral anticoagulants in elderly patients with newly diagnosed atrial fibrillation.
Circ Cardiovasc Qual Outcomes 2017 Apr;10(4). doi: 10.1161/circoutcomes.116.003418.
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Keywords: Elderly, Heart Disease and Health, Blood Thinners, Medication, Comparative Effectiveness, Cardiovascular Conditions, Sex Factors, Patient-Centered Outcomes Research, Evidence-Based Practice
Arvold ND, Cefalu M, Wang Y
Comparative effectiveness of radiotherapy with vs. without temozolomide in older patients with glioblastoma.
It is unknown whether the addition of temozolomide (TMZ) to radiotherapy (RT) is associated with improved overall survival among older glioblastoma patients. This study found that among a large cohort of older glioblastoma patients treated in a real-world setting, the addition of TMZ to RT was associated with a small survival gain.
AHRQ-funded; HS021991.
Citation: Arvold ND, Cefalu M, Wang Y .
Comparative effectiveness of radiotherapy with vs. without temozolomide in older patients with glioblastoma.
J Neurooncol 2017 Jan;131(2):301-11. doi: 10.1007/s11060-016-2294-7.
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Keywords: Cancer, Comparative Effectiveness, Elderly, Medication, Patient-Centered Outcomes Research
Makris UE, Edwards TC, Lavallee DC
Patient priority weighting of the Roland Morris Disability Questionnaire does not change results of the lumbar epidural steroid injections for spinal stenosis trial.
The researchers reevaluated whether outcomes for older adults receiving epidural steroid injections with or without corticosteroid improve after using patient-prioritized Roland-Morris Disability Questionnaire (RDQ) items. Their findings provide additional evidence that epidural injection of corticosteroid + lidocaine offered minimal or no short-term benefit as compared with epidural injection of lidocaine alone for older adults with lumbar spinal stenosis.
AHRQ-funded; HS019222; HS022418.
Citation: Makris UE, Edwards TC, Lavallee DC .
Patient priority weighting of the Roland Morris Disability Questionnaire does not change results of the lumbar epidural steroid injections for spinal stenosis trial.
Spine 2017 Jan;42(1):42-48. doi: 10.1097/brs.0000000000001647.
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Keywords: Comparative Effectiveness, Patient-Centered Outcomes Research, Elderly, Back Health and Pain, Medication
Reid MC, Eccleston C, Pillemer K
Management of chronic pain in older adults.
This review summarized recent evidence on the assessment and management of pain in older patients. Evidence is taken from systematic reviews, meta-analyses, individual trials, and clinical guidelines. Based on their review, the authors argue that all older adults with chronic pain should undergo a comprehensive geriatric pain assessment and that a comprehensive assessment can guide selection of treatments most likely to benefit the patient and identify targets for intervention besides pain relief.
AHRQ-funded; HS020648.
Citation: Reid MC, Eccleston C, Pillemer K .
Management of chronic pain in older adults.
BMJ 2015;350:h532. doi: 10.1136/bmj.h532..
Keywords: Care Management, Chronic Conditions, Elderly, Comparative Effectiveness, Evidence-Based Practice, Pain
Bekelis K, Gottlieb D, Su Y
Surgical clipping versus endovascular coiling for elderly patients presenting with subarachnoid hemorrhage.
The authors studied elderly Medicare patients who underwent treatment for ruptured cerebral aneurysms. They did not demonstrate a difference in mortality, rate of discharge to rehabilitation, and readmissions between surgical clipping and endovascular coiling of ruptured cerebral aneurysms, although clipping was associated with a slightly longer length of stay.
AHRQ-funded; HS021581.
Citation: Bekelis K, Gottlieb D, Su Y .
Surgical clipping versus endovascular coiling for elderly patients presenting with subarachnoid hemorrhage.
J Neurointerv Surg 2016 Sep;8(9):913-8. doi: 10.1136/neurintsurg-2015-011890.
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Keywords: Brain Injury, Surgery, Comparative Effectiveness, Outcomes, Elderly
Vemana G, Kim EH, Bhayani SB
Survival comparison between endoscopic and surgical management for patients with upper tract urothelial cancer: a matched propensity score analysis using surveillance, epidemiology and end results-Medicare data.
The researchers sought to determine survival differences among patients receiving endoscopic vs surgical management for upper tract urothelial carcinoma (UTUC). They found that although initial survival outcomes are similar for endoscopic and surgical management of nonmuscle-invasive, low-grade UTUC, both cancer-specific survival and overall survival are significantly inferior for the endoscopic management group in the longer term. They also found that transition from initial endoscopic management to surgical intervention appears to have limited impact on survival.
AHRQ-funded; HS019455.
Citation: Vemana G, Kim EH, Bhayani SB .
Survival comparison between endoscopic and surgical management for patients with upper tract urothelial cancer: a matched propensity score analysis using surveillance, epidemiology and end results-Medicare data.
Urology 2016 Sep;95:115-20. doi: 10.1016/j.urology.2016.05.033.
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Keywords: Cancer, Comparative Effectiveness, Elderly, Mortality, Surgery
Wang TY, Vora AN, Peng SA
Effectiveness and safety of aldosterone antagonist therapy use among older patients with reduced ejection fraction after acute myocardial infarction.
The purpose of this paper is to describe how aldosterone antagonist treatment is used among older myocardial infarction (MI) patients in routine practice. They found that aldosterone antagonist use was not associated with lower mortality except in symptomatic HF patients, and risks of hyperkalemia were low at 30 days, but significantly higher among patients prescribed aldosterone antagonists, as was risk of acute renal failure compared with patients not prescribed aldosterone antagonists. They concluded that these results underscore the importance of close post-discharge monitoring of this patient population.
AHRQ-funded; HS021092.
Citation: Wang TY, Vora AN, Peng SA .
Effectiveness and safety of aldosterone antagonist therapy use among older patients with reduced ejection fraction after acute myocardial infarction.
J Am Heart Assoc 2016 Jan 21;5(1). doi: 10.1161/jaha.115.002612.
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Keywords: Comparative Effectiveness, Elderly, Medication, Heart Disease and Health, Patient-Centered Outcomes Research
Poonawalla IB, Piller LB, Lairson DR
Impact of hematopoietic growth factors on blood transfusion needs, incidence of neutropenia, and overall survival among elderly advanced ovarian cancer patients treated with chemotherapy.
The researchers sought to determine the effectiveness of erythropoietin-stimulating agent (ESA) and granulocyte colony-stimulating factor (CSF) in reducing blood transfusion needs and neutropenia incidence in community-dwelling elderly ovarian cancer patients. They found that erythropoietin-stimulating agents were effective in reducing blood transfusion need. Granulocyte colony-stimulating factors were effective in lowering neutropenia incidence and also were associated with improved survival in elderly ovarian cancer patients.
AHRQ-funded; HS018956.
Citation: Poonawalla IB, Piller LB, Lairson DR .
Impact of hematopoietic growth factors on blood transfusion needs, incidence of neutropenia, and overall survival among elderly advanced ovarian cancer patients treated with chemotherapy.
Int J Gynecol Cancer 2016 Jan;26(1):95-103. doi: 10.1097/igc.0000000000000564.
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Keywords: Cancer, Treatments, Comparative Effectiveness, Elderly, Patient-Centered Outcomes Research
Yun H, Xie F, Delzell E
The comparative effectiveness of biologics among older adults and disabled rheumatoid arthritis patients in the Medicare population.
Older and disabled rheumatoid arthritis (RA) patients are often not present in large numbers in clinical trials or registries. Using a novel, claims-based clinical effectiveness algorithm with the potential to compare the effectiveness of different biologics among this population using large administrative databases, researchers found that abatacept, adalimumab and etanercept are more effective than infliximab among RA patients initiating biologics.
AHRQ-funded; HS021694; HS023009; HS018517.
Citation: Yun H, Xie F, Delzell E .
The comparative effectiveness of biologics among older adults and disabled rheumatoid arthritis patients in the Medicare population.
Br J Clin Pharmacol 2015 Dec;80(6):1447-57. doi: 10.1111/bcp.12709.
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Keywords: Comparative Effectiveness, Patient-Centered Outcomes Research, Elderly, Arthritis, Medicare
Simmons SF, Keeler E, An R
Cost-effectiveness of nutrition intervention in long-term care.
The researchers sought to determine the cost-effectiveness of two nutrition interventions on food, beverage, and supplement intake and body weight. They found that oral liquid nutrition supplements and snack offers were efficacious in promoting caloric intake when coupled with assistance to promote consumption and a variety of options, but neither intervention resulted in significant weight gain.
AHRQ-funded; HS018580.
Citation: Simmons SF, Keeler E, An R .
Cost-effectiveness of nutrition intervention in long-term care.
J Am Geriatr Soc 2015 Nov;63(11):2308-16. doi: 10.1111/jgs.13709..
Keywords: Elderly, Long-Term Care, Nursing Homes, Nutrition, Comparative Effectiveness
Rundell SD, Gellhorn AC, Comstock BA
Clinical outcomes of early and later physical therapist services for older adults with back pain.
The purpose of this study was to compare clinical outcomes of patients receiving early or later PT services with those not receiving PT among older adults presenting to primary care for a new visit for back pain. It found that among older adults early referral to PT resulted in no or minimal differences in pain, function, or health-related quality at 3, 6, or 12 months compared with a matched group that did not receive early PT.
AHRQ-funded; HS019222.
Citation: Rundell SD, Gellhorn AC, Comstock BA .
Clinical outcomes of early and later physical therapist services for older adults with back pain.
Spine J 2015 Aug;15(8):1744-55. doi: 10.1016/j.spinee.2015.04.001..
Keywords: Back Health and Pain, Elderly, Primary Care, Comparative Effectiveness, Patient-Centered Outcomes Research
Chen CY, Stevenson LW, Stewart GC
Real world effectiveness of primary implantable cardioverter defibrillators implanted during hospital admissions for exacerbation of heart failure or other acute co-morbidities: cohort study of older patients with heart failure.
The researchers examined the effectiveness of primary implantable cardioverter defibrillators (ICDs) in elderly patients receiving the device during a hospital admission for exacerbation of heart failure or other acute co-morbidities. They concluded that the benefits of primary ICD therapy seen in pivotal trials were not apparent in patients aged 66 or over who received ICDs during a hospital admission for exacerbation of heart failure or other acute co-morbidities.
AHRQ-funded; 290-2005-0016-I -TO3; HS017731.
Citation: Chen CY, Stevenson LW, Stewart GC .
Real world effectiveness of primary implantable cardioverter defibrillators implanted during hospital admissions for exacerbation of heart failure or other acute co-morbidities: cohort study of older patients with heart failure.
BMJ 2015 Jul 14;351:h3529. doi: 10.1136/bmj.h3529..
Keywords: Comparative Effectiveness, Elderly, Medical Devices, Heart Disease and Health, Outcomes
Parmar AD, Sheffield KM, Adhikari D
PREOP-Gallstones: a prognostic nomogram for the management of symptomatic cholelithiasis in older patients.
The objective of this study was to develop and validate a risk prediction model that would identify older patients who are at highest risk for recurrent episodes. It concluded that surgeons can use a prognostic nomogram to accurately provide patients with their 2-year risk of developing gallstone-related complications, allowing patients and physicians to make informed decisions in the context of their symptom severity and its impact on their quality of life.
AHRQ-funded; HS022134
Citation: Parmar AD, Sheffield KM, Adhikari D .
PREOP-Gallstones: a prognostic nomogram for the management of symptomatic cholelithiasis in older patients.
Ann Surg. 2015 Jun;261(6):1184-90. doi: 10.1097/sla.0000000000000868..
Keywords: Comparative Effectiveness, Risk, Elderly, Decision Making
Duong VH, Baer MR, Hendrick F
AHRQ Author: Davidoff AJ
Variations in erythropoiesis-stimulating agent administration in transfusion-dependent myelodysplastic syndromes impact response.
The researchers studied the association of timing of erythropoiesis-stimulating agents (ESA) initiation, agent, and number of weeks of ESA use with response in myelodysplastic syndrome (MDS) patients in routine practice. They found that variations in ESA administration impacted response in transfusion-dependent MDS patients, with higher response rates with early administration and use of darbepoetin, and low response likelihood in non-responders beyond 16 weeks of therapy.
AHRQ-authored.
Citation: Duong VH, Baer MR, Hendrick F .
Variations in erythropoiesis-stimulating agent administration in transfusion-dependent myelodysplastic syndromes impact response.
Leuk Res 2015 Jun;39(6):586-91. doi: 10.1016/j.leukres.2015.03.013.
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Keywords: Comparative Effectiveness, Elderly, Treatments
Rao SS, Benninga MA, Bharucha AE
ANMS-ESNM position paper and consensus guidelines on biofeedback therapy for anorectal disorders.
This society position paper examined the study performance characteristics and efficacy of biofeedback therapy for anorectal disorders, and provided evidence based recommendations including: (1) Biofeedback therapy is recommended for the short-term and long-term treatment of constipation with dyssynergic defecation (DD). Level I, Grade A. (2)Biofeedback therapy is recommended for the short-term and long-term treatment of Fecal Incontinence (FI). Level II, Grade B.
AHRQ-funded; HS018695.
Citation: Rao SS, Benninga MA, Bharucha AE .
ANMS-ESNM position paper and consensus guidelines on biofeedback therapy for anorectal disorders.
Neurogastroenterol Motil 2015 May;27(5):594-609. doi: 10.1111/nmo.12520..
Keywords: Elderly, Comparative Effectiveness, Patient-Centered Outcomes Research
Smith-Ray RL, Hughes SL, Prohaska TR
Impact of cognitive training on balance and gait in older adults.
The researchers assessed whether a commercially available computer-based cognitive training program delivered in a classroom format over a 10-week period improved physical performance outcomes related to walking and balance in older adults. They found that the time to complete the Timed Up and Go increased less for the intervention group; however, there were no significant differences by group on gait speed or gait speed while distracted.
AHRQ-funded; HS018295.
Citation: Smith-Ray RL, Hughes SL, Prohaska TR .
Impact of cognitive training on balance and gait in older adults.
J Gerontol B Psychol Sci Soc Sci 2015 May;70(3):357-66. doi: 10.1093/geronb/gbt097..
Keywords: Elderly, Health Information Technology (HIT), Comparative Effectiveness, Outcomes
Malhotra J, Mhango G, Gomez JE
Adjuvant chemotherapy for elderly patients with stage I non-small-cell lung cancer >/=4 cm in size: an SEER-Medicare analysis.
The researchers compared overall survival and rates of serious adverse events (defined as those requiring admission to hospital) between patients treated with resection alone, platinum-based adjuvant chemotherapy, or postoperative radiation (PORT) with or without adjuvant chemotherapy. Platinum-based adjuvant chemotherapy is associated with reduced mortality and increased serious adverse events in elderly patients with stage I non-small-cell lung cancer ≥4 cm in size.
AHRQ-funded; HS019670.
Citation: Malhotra J, Mhango G, Gomez JE .
Adjuvant chemotherapy for elderly patients with stage I non-small-cell lung cancer >/=4 cm in size: an SEER-Medicare analysis.
Ann Oncol 2015 Apr;26(4):768-73. doi: 10.1093/annonc/mdv008..
Keywords: Cancer: Lung Cancer, Elderly, Treatments, Adverse Events, Comparative Effectiveness
Rundell SD, Sherman KJ, Heagerty PJ
The clinical course of pain and function in older adults with a new primary care visit for back pain.
This study reports the clinical course of older adults presenting for a new primary care visit for back pain, with no healthcare visit for back pain within the prior 6 months, by describing pain intensity, disability, pain interference, and resolution of back pain over 12 months. It found that improvements in disability and interference with activity over 12 months differed according to age, duration of back pain, symptoms of depression and anxiety, and expectation for recovery.
AHRQ-funded; HS019222.
Citation: Rundell SD, Sherman KJ, Heagerty PJ .
The clinical course of pain and function in older adults with a new primary care visit for back pain.
J Am Geriatr Soc 2015 Mar;63(3):524-30. doi: 10.1111/jgs.13241..
Keywords: Elderly, Primary Care, Back Health and Pain, Comparative Effectiveness, Outcomes
Rundell SD, Sherman KJ, Heagerty PJ
Patient-reported outcomes associated with use of physical therapist services by older adults with a new visit for back pain.
The researchers conducted an observational comparative effectiveness research study to investigate the association between types or amounts of physical therapist services and outcomes, such as disability and pain intensity, among older adults. Higher amounts of active physical therapy were associated with decreased back and leg pain and increased odds of clinically meaningful improvements in back and leg pain relative to results obtained with no active physical therapy.
AHRQ-funded; HS019222.
Citation: Rundell SD, Sherman KJ, Heagerty PJ .
Patient-reported outcomes associated with use of physical therapist services by older adults with a new visit for back pain.
Phys Ther 2015 Feb;95(2):190-201. doi: 10.2522/ptj.20140132..
Keywords: Back Health and Pain, Patient-Centered Outcomes Research, Comparative Effectiveness, Treatments, Elderly
Campbell NL, Skaar TC, Perkins AJ
Characterization of hepatic enzyme activity in older adults with dementia: potential impact on personalizing pharmacotherapy.
The purpose of this study was to determine the frequency of pharmacogenomic variants and concurrent medications that may alter the efficacy and tolerability of acetylcholinesterase inhibitors (AChEIs). Its results indicate that both pharmacogenomic variants and concomitant medications may affect the pharmacokinetics and ultimately the efficacy and tolerability of Alzheimer’s disease medications.
AHRQ-funded; HS019818.
Citation: Campbell NL, Skaar TC, Perkins AJ .
Characterization of hepatic enzyme activity in older adults with dementia: potential impact on personalizing pharmacotherapy.
Clin Interv Aging 2015 Jan 14;10:269-75. doi: 10.2147/cia.s65980..
Keywords: Elderly, Dementia, Comparative Effectiveness, Medication