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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
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1 to 25 of 506 Research Studies Displayed
Bierman AS, Wang J, O'Malley PG
Transforming care for people with multiple chronic conditions: Agency for Healthcare Research and Quality's research agenda.
This article describes issues addressing the needs of those with multiple chronic conditions and discusses the AHRQ research agenda.
AHRQ-authored.
Citation:
Bierman AS, Wang J, O'Malley PG .
Transforming care for people with multiple chronic conditions: Agency for Healthcare Research and Quality's research agenda.
Health Serv Res 2021 Oct;56(Suppl 1):973-79. doi: 10.1111/1475-6773.13863..
Keywords:
Chronic Conditions, Health Services Research (HSR), Healthcare Delivery, Quality of Care, Primary Care, Guidelines, Evidence-Based Practice
Smith BM, Sharma R, Das A
Patient and family engagement strategies for children and adolescents with chronic diseases: a review of systematic reviews.
Patient and family engagement is important for family-centered care, particularly for children and adolescents with chronic disease. In this study the investigators aimed to 1) identify available evidence from systematic reviews on engagement strategies used to help children, adolescents, and their caregivers manage chronic conditions, and 2) identify gaps in the literature. They searched PubMed and CINAHL from January 2015 to January 2020 for systematic reviews on patient and family engagement strategies in the pediatrics population (<18 years).
AHRQ-funded; 290201500006I.
Citation:
Smith BM, Sharma R, Das A .
Patient and family engagement strategies for children and adolescents with chronic diseases: a review of systematic reviews.
Patient Educ Couns 2021 Sep;104(9):2213-23. doi: 10.1016/j.pec.2021.02.026..
Keywords:
Children/Adolescents, Patient and Family Engagement, Chronic Conditions, Patient-Centered Healthcare, Evidence-Based Practice, Patient Self-Management
Joseph CLM, Alexander GL, Lu M
Pilot study of a brief provider and EMR-based intervention for overweight teens with asthma.
The authors piloted an electronic medical record-based tailored discussion guide (TDG) and a brief provider training to address weight management in overweight teens with asthma. They observed modest improvements in patient-reported asthma outcomes and health behaviors. They found strong evidence that the TDG supports provider discussion of weight and asthma to create a more patient-centered conversation from the perspective of participating teens. They recommended addressing challenges to recruitment and clinic adaptation prior to advancing to a full-scale trial.
AHRQ-funded; HS022417.
Citation:
Joseph CLM, Alexander GL, Lu M .
Pilot study of a brief provider and EMR-based intervention for overweight teens with asthma.
Pilot Feasibility Stud 2021 Aug 30;7(1):167. doi: 10.1186/s40814-021-00848-6..
Keywords:
Children/Adolescents, Obesity: Weight Management, Obesity, Asthma, Chronic Conditions, Respiratory Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT)
Suls J, Bayliss EA, Berry J
Measuring multimorbidity: selecting the right instrument for the purpose and the data source.
Adults have a higher prevalence of multimorbidity-or having multiple chronic health conditions-than having a single condition in isolation. Researchers, health care providers, and health policymakers find it challenging to decide upon the most appropriate assessment tool from the many available multimorbidity measures. The objective of this study was to describe a broad range of instruments and data sources available to assess multimorbidity and offer guidance about selecting appropriate measures.
AHRQ-authored.
Citation:
Suls J, Bayliss EA, Berry J .
Measuring multimorbidity: selecting the right instrument for the purpose and the data source.
Med Care 2021 Aug;59(8):743-56. doi: 10.1097/mlr.0000000000001566..
Keywords:
Chronic Conditions
Schechter SB, Pantell MS, Parikh K
Impact of a national quality collaborative on pediatric asthma care quality by insurance status.
The objective of this study was to assess whether disparities in asthma care and outcomes based on insurance type existed before a national quality improvement (QI) collaborative, and to determine the effects of the collaborative on these disparities. The investigators concluded that at baseline, children with public insurance had higher asthma health care utilization than those with private insurance, despite receiving more evidence-based care.
AHRQ-funded; HS026383; HS024554; HS024592.
Citation:
Schechter SB, Pantell MS, Parikh K .
Impact of a national quality collaborative on pediatric asthma care quality by insurance status.
Acad Pediatr 2021 Aug;21(6):1018-24. doi: 10.1016/j.acap.2021.02.009..
Keywords:
Children/Adolescents, Asthma, Chronic Conditions, Disparities, Quality Improvement, Quality of Care, Health Insurance
McCoy RG, Van Houten HK, Dunlay SM
Race and sex differences in the initiation of diabetes drugs by privately insured US adults.
The authors examined the differences in the use of three glucose-lowering medications as a function of both sex and race. They found that, compared to white men, GLP-1RA were 43% more likely to be started by White women, 12% more likely to be started by non-White men, and 21% less likely to be started by non-White women. SGLT2i were at least 10% less likely to be started by all groups compared to White men, and DPP4i were used more often by non-White than White patients of both sexes.
AHRQ-funded; HS024075.
Citation:
McCoy RG, Van Houten HK, Dunlay SM .
Race and sex differences in the initiation of diabetes drugs by privately insured US adults.
Race and sex differences in the initiation of diabetes drugs by privately insured US adults..
Keywords:
Diabetes, Chronic Conditions, Medication, Sex Factors, Racial / Ethnic Minorities
Fishbein AB, Lin B, Beaumont J
Nocturnal movements in children with atopic dermatitis have a timing pattern: a case-control study.
This case-control study compared nocturnal movements in children with atopic dermatitis (AD) with a control non-AD group. The study looked at nocturnal motor activity due to itch in children age 6 to 17 years with moderate-to-severe AD. The mean age of children with AD was 11.0 plus or minus 3.2 years, and without AD 11.5 plus or minute 3.3 years with the majority (65%) male. The AD scoring scale SCORAD was used to define moderate to severe AD. A home activity monitor, actigraphy and a sleep diary for 3 to 7 nights was used to monitor nocturnal movements and sleep. Activity counts were averaged across nights. Bouts of nocturnal activity increased in children with AD versus the controls between 1 and 6 hours after sleep onset. Nocturnal scratch activity peaks at 3 hours. Although AD patients were instructed to avoid oral antihistamine during the study, 5 patients took an antihistamine on some nights. Results showed no significant difference with respect to movement in the patients that took antihistamine some nights and not others. Timing of the nocturnal scratch behavior could potentially be targeted for treatment.
AHRQ-funded; HS023011.
Citation:
Fishbein AB, Lin B, Beaumont J .
Nocturnal movements in children with atopic dermatitis have a timing pattern: a case-control study.
J Am Acad Dermatol 2021 Aug;85(2):474-76. doi: 10.1016/j.jaad.2018.04.020..
Keywords:
Children/Adolescents, Skin Conditions, Chronic Conditions
Wallace DD, Lytle LA, Albrecht S
All of that causes me stress: an exploration of the sources of stress experienced by Latinxs living with prediabetes.
Latinxs immigrants in the United States experience sources of stress (i.e., stressors) that can limit their ability to engage in healthy behaviors. Stress has been linked to increased type 2 diabetes (T2D) risk in Latinxs living with prediabetes, a group disproportionately affected by T2D. The purpose of this qualitative study was to describe and contextualize the variety of stressors experienced by Latinxs immigrants diagnosed with prediabetes.
AHRQ-funded; HS000032.
Citation:
Wallace DD, Lytle LA, Albrecht S .
All of that causes me stress: an exploration of the sources of stress experienced by Latinxs living with prediabetes.
J Lat Psychol 2021 Aug;9(3):204-16. doi: 10.1037/lat0000168..
Keywords:
Stress, Racial / Ethnic Minorities, Diabetes, Chronic Conditions, Behavioral Health
Bedford T, Adediran T, Haycock NR
Patient and provider acceptability of a patient preauthorized concealed opioid reduction.
Researchers investigated patient and provider acceptance of a concealed opioid reduction for chronic pain. They conducted a cross-sectional survey with patients who are taking or have taken high dose opioids via REDcap, and with providers via a validated questionnaire. They found that patients and providers have positive attitudes toward a concealed reduction of opioid dosages. They concluded that their findings support future randomized controlled trials that compare concealed and overt opioid tapering in patients with chronic pain.
AHRQ-funded; HS022135.
Citation:
Bedford T, Adediran T, Haycock NR .
Patient and provider acceptability of a patient preauthorized concealed opioid reduction.
Pain Med 2021 Jul 25;22(7):1651-59. doi: 10.1093/pm/pnaa454..
Keywords:
Opioids, Medication, Pain, Chronic Conditions
Bogetz JF, Revette A, DeCourcey DD
Clinical care strategies that support parents of children with complex chronic conditions.
This paper examines the best clinical care strategies that support parents of children with complex chronic conditions facing inpatient and end-of-life care in the ICU. Qualitative analysis of 21 open-response items from the cross-sectional “Survey of Caring for Children with Complex Chronic Conditions” was done. Open-ended responses from 110 of 114 survey respondents who were parents of children who received care at a large academic institution and died between 2006 and 2015 were analyzed. Most of the children had congenital/chromosomal complex chronic conditions and had died an average of 3.9 years prior to their parents’ study participation. The respondents emphasized the relational aspects of clinical care including inclusivity of their expertise on their child’s needs, recognition of their unique experiences as parents, and maintenance of connection with clinicians through bereavement.
AHRQ-funded; HS022986.
Citation:
Bogetz JF, Revette A, DeCourcey DD .
Clinical care strategies that support parents of children with complex chronic conditions.
Pediatr Crit Care Med 2021 Jul;22(7):595-602. doi: 10.1097/pcc.0000000000002726..
Keywords:
Children/Adolescents, Chronic Conditions, Palliative Care, Inpatient Care
Lee S, Rastogi S, Hsu DY
Association of bullous pemphigoid and comorbid health conditions: a case-control study.
Bullous pemphigoid is an autoimmune skin disease characterized by the formation of blisters between the epidermis and dermis. Comorbidities of pemphigoid have not been well-described. Identification of comorbidities associated with pemphigoid is important to decrease morbidity and mortality. The purpose of the study was to identify the comorbid health conditions of bullous pemphigoid. The investigators concluded bullous pemphigoid patients needed screening for comorbid health conditions even though treatment options did not seem to be associated with these comorbidities.
AHRQ-funded; HS023011.
Citation:
Lee S, Rastogi S, Hsu DY .
Association of bullous pemphigoid and comorbid health conditions: a case-control study.
Arch Dermatol Res 2021 Jul;313(5):327-32. doi: 10.1007/s00403-020-02100-2..
Keywords:
Skin Conditions, Chronic Conditions
VanderPluym JH, Halker Singh RB, Urtecho M
Acute treatments for episodic migraine in adults: a systematic review and meta-analysis.
Migraine is common and can be associated with significant morbidity, and several treatment options exist for acute therapy. The objective of this study was to evaluate the benefits and harms associated with acute treatments for episodic migraine in adults. The investigators concluded that there are several acute treatments for migraine, with varying strength of supporting evidence. Use of triptans, nonsteroidal anti-inflammatory drugs, acetaminophen, dihydroergotamine, calcitonin gene-related peptide antagonists, lasmiditan, and some nonpharmacologic treatments were associated with improved pain and function.
AHRQ-funded; 290201500013I.
Citation:
VanderPluym JH, Halker Singh RB, Urtecho M .
Acute treatments for episodic migraine in adults: a systematic review and meta-analysis.
JAMA 2021 Jun 15;325(23):2357-69. doi: 10.1001/jama.2021.7939..
Keywords:
Neurological Disorders, Pain, Chronic Conditions, Treatments
Cemballi AG, Karter AJ, Schillinger D
Descriptive examination of secure messaging in a longitudinal cohort of diabetes patients in the ECLIPPSE study.
This longitudinal study looked at trends in secure messaging (SM) use in health care system patient portals using a diverse cohort of diabetes patients enrolled in the ECLIPPSE study from 2006 to 2015. The authors found a 10-fold increase in overall messaging volume during that time period. A majority of patients were using SM by 2015, including those with lower income or with self-reported limited health literacy. At the beginning of the survey period more physicians than nurses were using SM, but that changed over time as well.
AHRQ-funded; HS026383.
Citation:
Cemballi AG, Karter AJ, Schillinger D .
Descriptive examination of secure messaging in a longitudinal cohort of diabetes patients in the ECLIPPSE study.
J Am Med Inform Assoc 2021 Jun 12;28(6):1252-58. doi: 10.1093/jamia/ocaa281..
Keywords:
Diabetes, Chronic Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT)
Bernard DM, Encinosa W, Cohen J
Patient factors that affect opioid use among adults with and without chronic pain.
Investigators sought to determine patient characteristics associated with opioid use among adults with and without chronic pain treatment. Using MEPS data, they found that health-related attitudes affect both adults with and without chronic pain treatment similarly. Adults with self-reliant health attitudes were less likely to start and more likely to discontinue opioid use. Exercise was associated with higher probability of choosing no analgesic treatments over using opioids and also with higher probability of discontinuing opioid use in the year following opioid initiation for those electing to use them.
AHRQ-authored.
Citation:
Bernard DM, Encinosa W, Cohen J .
Patient factors that affect opioid use among adults with and without chronic pain.
Res Social Adm Pharm 2021 Jun;17(6):1059-65. doi: 10.1016/j.sapharm.2020.07.036..
Keywords:
Medical Expenditure Panel Survey (MEPS), Opioids, Medication, Pain, Chronic Conditions
Lee K, Gani F, Canner JK
Racial disparities in utilization of palliative care among patients admitted with advanced solid organ malignancies.
The primary objective of this study was to describe racial differences in the use of inpatient palliative care consultations (IPCC) for patients with advanced cancer who are admitted to a hospital in the United States. Hospital admissions of patients with advanced cancers were identified through the National Inpatient Dataset. Findings showed that death during hospitalization was a significant modifier of the relationship between race and receipt of palliative care consultation. There were significant racial disparities in the utilization of IPCC for patients with advanced cancer.
AHRQ-funded; HS024736.
Citation:
Lee K, Gani F, Canner JK .
Racial disparities in utilization of palliative care among patients admitted with advanced solid organ malignancies.
Am J Hosp Palliat Care 2021 Jun;38(6):539-46. doi: 10.1177/1049909120922779..
Keywords:
Healthcare Cost and Utilization Project (HCUP), Palliative Care, Cancer, Disparities, Racial / Ethnic Minorities, Healthcare Utilization, Inpatient Care, Chronic Conditions
Doshi H, Hsia B, Shahani J
Impact of technology-based interventions on patient-reported outcomes in asthma: a systematic review.
This systematic review’s goal was to identify which technology-based interventions (TBIs) for asthma management have been formally evaluated using patient-reported outcomes (PROs). The authors aimed to: 1) identify the TBIs that have been evaluated in clinical trials using PROs; 2) identify the most commonly used PROs in these trials; and 3) determine the impact of TBIs on PROs in the management of chronic asthma. PubMed and Clinicaltrials.gov databases were searched for English-language studies published between January 2000 and February 2020. The final analysis included 14 clinical trials with 1 to 3 arms. Five different TBI types were identified, most commonly involving multimedia education. Four different categories of PROs were identified. At least 1 PRO domain with positive outcomes were reported by patients in 12 of 14 studies.
AHRQ-funded; R18 HS025645.
Citation:
Doshi H, Hsia B, Shahani J .
Impact of technology-based interventions on patient-reported outcomes in asthma: a systematic review.
J Allergy Clin Immunol Pract 2021 Jun;9(6):2336-41. doi: 10.1016/j.jaip.2021.01.027..
Keywords:
Asthma, Respiratory Conditions, Chronic Conditions, Telehealth, Health Information Technology (HIT)
Smith JM, Lin H, Thomas-Hawkins C
Timing of home health care initiation and 30-day rehospitalizations among Medicare beneficiaries with diabetes by race and ethnicity.
Older adults with diabetes are at elevated risk of complications following hospitalization. Home health care services mitigate the risk of adverse events and facilitate a safe transition home. In the United States, when home health care services are prescribed, federal guidelines require they begin within two days of hospital discharge. This study examined the association between timing of home health care initiation and 30-day rehospitalization outcomes in a cohort of 786,734 Medicare beneficiaries following a diabetes-related index hospitalization admission during 2015.
AHRQ-funded; HS022406.
Citation:
Smith JM, Lin H, Thomas-Hawkins C .
Timing of home health care initiation and 30-day rehospitalizations among Medicare beneficiaries with diabetes by race and ethnicity.
Int J Environ Res Public Health 2021 May 25;18(11). doi: 10.3390/ijerph18115623..
Keywords:
Elderly, Home Healthcare, Hospital Readmissions, Medicare, Diabetes, Chronic Conditions, Racial / Ethnic Minorities
Overstreet DS, Michl AN, Penn TM
Temporal summation of mechanical pain prospectively predicts movement-evoked pain severity in adults with chronic low back pain.
The objective of this study was to determine whether quantitative sensory tests of endogenous pain inhibition and facilitation prospectively predict movement-evoked pain and chronic low back pain severity self-reported on a validated questionnaire. Through surveys using the Brief Pain Inventory-Short Form, findings suggested that a pro-nociceptive pain modulatory balance characterized by enhanced pain facilitation may be an important driver of movement-evoked pain severity and poor physical function in individuals with chronic low back pain.
AHRQ-funded; HS013852.
Citation:
Overstreet DS, Michl AN, Penn TM .
Temporal summation of mechanical pain prospectively predicts movement-evoked pain severity in adults with chronic low back pain.
BMC Musculoskelet Disord 2021 May 10;22(1):429. doi: 10.1186/s12891-021-04306-5..
Keywords:
Back Health and Pain, Pain, Chronic Conditions, Diagnosis
Oikonomidi T, Ravaud P, James A
An international, mixed-methods study of the perceived intrusiveness of remote digital diabetes monitoring.
This paper describes an international online vignette-based survey to assess the relationship between remote digital monitoring (RDM) modalities for diabetes and intrusiveness in patients’ lives. The survey was conducted from February-June 2019 in 30 countries with 1010 participants. A total of 2680 vignette-assessments were completed with 52% on type 1 diabetes. Increased intrusiveness was associated with food monitoring compared with glucose- and PA-monitoring alone and permanent monitoring with real-time physician-generated feedback compared with monitoring for a week with feedback. Public-sector data handling was associated with decreased intrusiveness as compared with the private sector.
AHRQ-authored.
Citation:
Oikonomidi T, Ravaud P, James A .
An international, mixed-methods study of the perceived intrusiveness of remote digital diabetes monitoring.
Mayo Clin Proc 2021 May;96(5):1236-47. doi: 10.1016/j.mayocp.2020.07.040..
Keywords:
Telehealth, Health Information Technology (HIT), Diabetes, Chronic Conditions, Lifestyle Changes, Patient Self-Management
Kim D, Lee Y, Thorsness R
Racial and ethnic disparities in excess deaths among persons with kidney failure during the COVID-19 pandemic, March-July 2020.
This national study estimated excess deaths for the kidney failure population by race and ethnicity from March 1 through August 1, 2020. Findings showed that, among the US kidney failure population, the number of excess deaths was 16% higher than expected, similar to reports for the general population. However, results showed that the relative increase in deaths among Black and Hispanic patients was more than 4-fold higher than that observed among White patients. The magnitude of these disparities was larger than corresponding relative ratios reported among COVID-19–associated deaths in the general population.
AHRQ-funded; HS028285.
Citation:
Kim D, Lee Y, Thorsness R .
Racial and ethnic disparities in excess deaths among persons with kidney failure during the COVID-19 pandemic, March-July 2020.
Am J Kidney Dis 2021 May;77(5):827-29. doi: 10.1053/j.ajkd.2021.02.003..
Keywords:
COVID-19, Racial / Ethnic Minorities, Disparities, Mortality, Kidney Disease and Health, Chronic Conditions, Social Determinants of Health
Schulz GL, Kelly KP, Holtmann M
Navigating decisional conflict as a family when facing the decision of stem cell transplant for a child or adolescent with sickle cell disease.
Patients with sickle cell disease (SCD) face unpredictable disease, with stem cell transplant being a curative treatment option with risks. The aim of this study was to describe the level and source of decisional conflict in families of children/adolescents with SCD facing a transplant decision. The investigators concluded that varying levels and sources of decisional conflict existed in pediatric patients with SCD and their families considering transplant.
AHRQ-funded; HS022140.
Citation:
Schulz GL, Kelly KP, Holtmann M .
Navigating decisional conflict as a family when facing the decision of stem cell transplant for a child or adolescent with sickle cell disease.
Patient Educ Couns 2021 May;104(5):1086-93. doi: 10.1016/j.pec.2020.10.011..
Keywords:
Children/Adolescents, Sickle Cell Disease, Chronic Conditions, Transplantation, Decision Making
Aiyegbusi OL, Nair D, Peipert JD
A narrative review of current evidence supporting the implementation of electronic patient-reported outcome measures in the management of chronic diseases.
This review discusses and summarizes evidence of the impact of electronic patient-reported outcomes measures (ePROMs) on clinical parameters and outcomes relevant to chronic diseases. Various studies have demonstrated the feasibility of ePROMs in routine clinical practice with patients increasing expressing a preference for an electronic mode of administration. These ePROMs could have significant impacts on outcomes valued by patients, healthcare providers, and researchers. Recently published literature.
AHRQ-funded; HS026395.
Citation:
Aiyegbusi OL, Nair D, Peipert JD .
A narrative review of current evidence supporting the implementation of electronic patient-reported outcome measures in the management of chronic diseases.
Ther Adv Chronic Dis 2021 May 24;12:20406223211015958. doi: 10.1177/20406223211015958..
Keywords:
Chronic Conditions, Patient Experience, Health Information Technology (HIT), Outcomes, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Evidence-Based Practice
Carey RM, Wright JT, Taler SJ
Guideline-driven management of hypertension: an evidence-based update.
This paper is an evidence-based update to the 2017 American College of Cardiology/American Heart Association Blood Pressure Guideline. The authors conducted a literature review of relevant observational studies, randomized clinical trials, and meta-analyses published between January 2018 and March 2021. Topics included blood pressure (BP) measurement, patient evaluation, patient evaluation for secondary hypertension, cardiovascular disease risk assessment and BP threshold for drug therapy, lifestyle and pharmacological management, treatment target BP goal, management of hypertension in older adults, diabetes, chronic kidney disease, resistant hypertension, and optimization of care using patient, provider, and health system approaches.
AHRQ-funded; HS027944.
Citation:
Carey RM, Wright JT, Taler SJ .
Guideline-driven management of hypertension: an evidence-based update.
Circ Res 2021 Apr 2;128(7):827-46. doi: 10.1161/circresaha.121.318083..
Keywords:
Hypertension, Cardiovascular Conditions, Evidence-Based Practice, Guidelines, Chronic Conditions, Blood Pressure
Lipsett SC, Haines L, Monuteaux MC
Variation in oophorectomy rates for children with ovarian torsion across US children's hospitals.
A multicenter study of 1783 children diagnosed with ovarian torsion from 2012 to 2017 undergoing oophorectomy was conducted. Four-hundred and two children (22.5%) underwent oophorectomy. Odds of oophorectomy were higher in children under 11 years of age, children with public insurance, and children with complex chronic conditions.
AHRQ-funded; HS026503.
Citation:
Lipsett SC, Haines L, Monuteaux MC .
Variation in oophorectomy rates for children with ovarian torsion across US children's hospitals.
J Pediatr 2021 Apr;231:269-72.e1. doi: 10.1016/j.jpeds.2020.12.019..
Keywords:
Children/Adolescents, Chronic Conditions, Surgery, Hospitals
Anderson KE, Alexander GC, Niles L
Quality of preventive and chronic illness care for insured adults with opioid use disorder.
Investigators sought to measure quality of non-opioid use disorder (OUD) preventive and chronic illness care and care coordination for individuals with OUD compared with individuals without OUD. They used deidentified data on outpatients throughout the United States from claims for commercially insured and Medicare Advantage enrollees aged 18 years or older with diagnosis codes for OUD. They found that individuals with OUD have moderately lower quality of care across preventive and chronic illness care and care coordination for non-OUD care compared with individuals without OUD. They recommended more attention to measurement and improvement of non-OUD care for these individuals.
AHRQ-funded; HS000029.
Citation:
Anderson KE, Alexander GC, Niles L .
Quality of preventive and chronic illness care for insured adults with opioid use disorder.
JAMA Netw Open 2021 Apr;4(4):e214925. doi: 10.1001/jamanetworkopen.2021.4925..
Keywords:
Opioids, Medication, Substance Abuse, Quality Indicators (QIs), Quality of Care, Behavioral Health, Chronic Conditions, Prevention
