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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
26 to 50 of 700 Research Studies DisplayedTaylor Gangnon, R R, Powell WR
Association of rurality and identifying as Black with receipt of specialty care among patients hospitalized with a diabetic foot ulcer: a Medicare cohort study.
This national retrospective cohort study examined Medicare beneficiaries hospitalized with diabetic foot ulcers. Investigators sought to determine what proportion of rural patients, particularly those identifying as black, received specialty care in comparison with the national proportion. Their findings indicated that a smaller proportion of rural patients, particularly those identified as black, received specialty care compared with the overall cohort. They concluded that this might contribute to disparities in major amputations, but future studies are required to determine causality.
AHRQ-funded; HS026279.
Citation: Taylor Gangnon, R R, Powell WR .
Association of rurality and identifying as Black with receipt of specialty care among patients hospitalized with a diabetic foot ulcer: a Medicare cohort study.
BMJ Open Diabetes Res Care 2023 Apr; 11(2). doi: 10.1136/bmjdrc-2022-003185..
Keywords: Rural Health, Racial and Ethnic Minorities, Diabetes, Chronic Conditions, Disparities
Kuzma N, Khan A, Rickey L
Effect of Patient and Family Centered I-PASS on adverse event rates in hospitalized children with complex chronic conditions.
This study’s objective was to compare the effect of the intervention Patient and Family Centered (PFC)I-PASS on adverse events (AE) rates in children with and without complex chronic conditions (CCCs). A cohort of 3106 hospitalized children from seven North American pediatric hospitals between December 2014 and January 2017 were included. An effect modification analysis did not show difference in the intervention on children with and without CCCs. There was no statistically significant change in AEs for children with or without CCCs.
AHRQ-funded; HS022986.
Citation: Kuzma N, Khan A, Rickey L .
Effect of Patient and Family Centered I-PASS on adverse event rates in hospitalized children with complex chronic conditions.
J Hosp Med 2023 Apr;18(4):316-20. doi: 10.1002/jhm.13065.
Keywords: Children/Adolescents, Patient-Centered Healthcare, Chronic Conditions, Adverse Events, Inpatient Care, Transitions of Care
Bajaj JS, Peña-Rodriguez M, La Reau A
Longitudinal transkingdom gut microbial approach towards decompensation in outpatients with cirrhosis.
The purpose of this study was to ascertain the crucial role of predicting the onset of initial decompensation development. It emphasizes the significance of transkingdom gut microbial interactions, including archaeal methanogens, as potential markers and predictors, and the need for a longitudinal approach to do so. The study included cirrhosis outpatients who were categorized into three groups: those with compensated cirrhosis in Group 1, those with one incidence of decompensation in Group 2, and those with more than one incidence of decompensation in Group 3. Group 3 was further divided based on stability or further decompensation. The presence of bacteria, viruses, and archaea, along with α/β diversity and temporal taxa fluctuations adjusted for clinical variables were analyzed. The study tracked 157 outpatients and found that between 28% and 47% of those patients developed outcomes. Baseline between those who remained stable/developed outcome: While no differences were seen in α/β diversity, commensals were lower and pathobionts were higher in those who decompensated. After decompensation: those experiencing their first decompensation showed a larger decrease in α/β-diversity, bacterial change and viral change vs those with further decompensation. Archaea: 19% had Methanobacter brevii, which was similar between/within groups. The study concluded that the largest changes in transkingdom gut microbial were observed in those reaching the first decompensation, compared with subsequent decompensating events.
AHRQ-funded; HS025412.
Citation: Bajaj JS, Peña-Rodriguez M, La Reau A .
Longitudinal transkingdom gut microbial approach towards decompensation in outpatients with cirrhosis.
Gut 2023 Apr; 72(4):759-71. doi: 10.1136/gutjnl-2022-328403.
AHRQ-funded; HS025412.
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AHRQ-funded; HS025412.
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Keywords: Chronic Conditions, Ambulatory Care and Surgery, Outcomes
Miller-Rosales C, Brewster AL, Shortell SM
Multilevel influences on patient engagement and chronic care management.
This study used data collected from the National Survey of Healthcare Organizations and Systems to examine health system- and physician practice-level capabilities associated with adoption of (1) patient engagement strategies and (2) chronic care management processes for adult patients with diabetes and/or cardiovascular disease. A total of 796 physician practices and 247 health systems were analyzed from 2017 to 2018. Health systems with processes to assess clinical evidence and with more advanced health information technology (HIT) functionality adopted more practice-level chronic care management processes, but not patient engagement strategies, compared with systems lacking these capabilities. More patient engagement strategies and chronic care management processes were adopted by physician practices with cultures oriented to innovation, more advanced HIT functionality, and with a process to assess clinical evidence than those without those characteristics.
AHRQ-funded; HS024075.
Citation: Miller-Rosales C, Brewster AL, Shortell SM .
Multilevel influences on patient engagement and chronic care management.
Am J Manag Care 2023 Apr; 29(4):196-202. doi: 10.37765/ajmc.2023.89348..
Keywords: Patient and Family Engagement, Chronic Conditions, Patient-Centered Healthcare
Bell SK, Dong ZJ, Desroches CM
Partnering with patients and families living with chronic conditions to coproduce diagnostic safety through OurDX: a previsit online engagement tool.
Involving patients and their families in the diagnostic process is crucial, but there is a lack of methods for consistent engagement. The implementation of policies providing patients with access to electronic health records offers new possibilities. The researchers evaluated a novel online tool ("OurDX"), co-created with patients and families, to examine the nature and frequency of potential safety issues identified by patients and their families with chronic health conditions and whether these insights were incorporated into visit notes. At two US healthcare facilities, patients and their families were encouraged to participate via an online pre-visit questionnaire, which covered: (1) visit priorities, (2) recent medical history and symptoms, and (3) potential diagnostic concerns. Two physicians assessed patient-reported diagnostic issues to validate and classify diagnostic safety opportunities (DSOs). The researchers performed a chart review to determine if patient inputs were integrated into the visit note. Descriptive statistics were employed to report implementation outcomes, DSO verification, and chart review findings. The study found that OurDX reports were completed in 7075 of 18,129 (39%) eligible pediatric subspecialty visits (site 1) and 460 of 706 (65%) eligible adult primary care visits (site 2). Of the patients expressing diagnostic concerns, 63% were confirmed as probable DSOs. Overall, 7.5% of pediatric and adult patients and their families with chronic health conditions identified probable DSOs. The most frequent DSO types included patients and families feeling unheard; issues or delays in tests or referrals; and complications or delays in clarification or subsequent steps. The chart review revealed that most clinician notes incorporated all or some of the patient or family priorities and patient-reported histories.
AHRQ-funded; HS027367
Citation: Bell SK, Dong ZJ, Desroches CM .
Partnering with patients and families living with chronic conditions to coproduce diagnostic safety through OurDX: a previsit online engagement tool.
J Am Med Inform Assoc 2023 Mar 16;30(4):692-702. doi: 10.1093/jamia/ocad003.
Keywords: Chronic Conditions, Diagnostic Safety and Quality, Health Information Technology (HIT), Patient and Family Engagement, Healthcare Delivery
Reeves SL, Peng HK, Wing JJJ
Changes in hydroxyurea use among youths enrolled in Medicaid with sickle cell anemia after 2014 revision of clinical guidelines.
The objective of this cross-sectional study was to describe changes in hydroxyurea use among youths with sickle cell anemia (SCA) before and after the release of the 2014 National Heart, Lung, and Blood Institute guidelines. Data was taken from Michigan and New York State Medicaid programs, 2010-18, and the study population included youths aged 1 to 17 with SCA. The findings suggest that hydroxyurea was substantially underused in spite of its establishment as the primary disease-modifying therapy for SCA, and that there was incomplete clinician or patient uptake of the new guidelines. The authors conclude that increased use of hydroxyurea may require a multifaceted approach that includes addressing multiple system- and patient-level barriers.
AHRQ-funded; HS027785.
Citation: Reeves SL, Peng HK, Wing JJJ .
Changes in hydroxyurea use among youths enrolled in Medicaid with sickle cell anemia after 2014 revision of clinical guidelines.
JAMA Netw Open 2023 Mar;6(3):e234584. doi: 10.1001/jamanetworkopen.2023.4584.
Keywords: Children/Adolescents, Sickle Cell Disease, Chronic Conditions, Evidence-Based Practice
Brown T, Brody R, Sackey J
Dietary intake correlated to waist-to-hip ratio in patients on maintenance hemodialysis.
Patients with end-stage renal disease (ESRD) undergoing regular hemodialysis (RHD) are susceptible to protein-energy malnutrition (PEM). Insufficient dietary consumption and changes in body measurements are among the diagnostic criteria for PEM. The purpose of this study was to measure the adherence of ESRD patients on RHD to the 2020 National Kidney Foundation Kidney Disease Outcome Quality Initiative (NKF-KDOQI) recommendations for nutritional sufficiency during a dialysis day (DD) and analyze the association between dietary energy (DEI) and protein (DPI) intake and body measurements. The study utilized a secondary review of clinical and demographic data from 142 adults in the Rutgers Nutrition and Kidney Disease database. The correlations between DEI, DPI, and body measurements such as body mass index (BMI), BMI classification, waist circumference, and waist-to-hip ratio (WHR) were evaluated. The study found that the median age of the participants was 55.7 years, with 58% being male and 83.8% identifying as Black/African American. The median time spent on dialysis was 42.0 months (approximately 3.5 years). Seventy-five percent of the participants were classified as overweight or obese. The WHR was 1.0 ± 0.8 cm for males and 0.9 ± 0.1 cm for females. Neither DEI nor DPI on a DD complied with the NKF-KDOQI 2020 recommendations. The median DEI was 17.6 ± 8.4 kcal/kg, and DPI was 0.7 ± 0.4 g/kg. Significant positive correlations were found between DEI and DPI and WHR for the entire sample. In females, a significant positive correlation emerged between DPI and WHR. The researchers concluded that the nutritional consumption of ESRD patients undergoing RHD falls short of the NKF-KDOQI 2020 guidelines on a DD.
AHRQ-funded; HS023434
Citation: Brown T, Brody R, Sackey J .
Dietary intake correlated to waist-to-hip ratio in patients on maintenance hemodialysis.
J Ren Nutr 2023 Mar;33(2):355-62. doi: 10.1053/j.jrn.2022.09.012.
Keywords: Kidney Disease and Health, Nutrition, Chronic Conditions
Wirth AN, Cushman NA, Reilley BA
Evaluation of treatment access and scope of a multistate hepatitis C virus Extension for Community Healthcare Outcomes telehealth service in the US Indian Health System, 2017-2021.
Researchers evaluated the extent to which Indian Country Extension for Community Healthcare Outcomes (ECHO) telehealth clinics increase access to hepatitis C virus (HCV) treatment and serve American Indians/Alaska Native (AI/AN) patients holistically. They conducted a retrospective descriptive analysis of Indian Country ECHO treatment recommendations from 2017 to 2021. Most patients received recommendations for HCV treatment by their primary care providers, along with recommendations beyond the scope of HCV. The researchers concluded that Indian Country ECHO telehealth clinic provided comprehensive recommendations to effectively integrate evidence-based HCV treatment with holistic care at the primary care level.
AHRQ-funded; HS026370.
Citation: Wirth AN, Cushman NA, Reilley BA .
Evaluation of treatment access and scope of a multistate hepatitis C virus Extension for Community Healthcare Outcomes telehealth service in the US Indian Health System, 2017-2021.
J Rural Health 2023 Mar;39(2):358-66. doi: 10.1111/jrh.12733.
Keywords: Hepatitis, Access to Care, Racial and Ethnic Minorities, Community-Based Practice, Telehealth, Health Information Technology (HIT), Chronic Conditions
Dunbar PJ, Sobotka SA, Rodean J
Prevalence of and spending on ear, nose, throat, and respiratory infections among children with chronic complex conditions.
The impact of ear, nose, throat, and respiratory infections (ENTRIs) on children with complex chronic conditions (CCCs) may vary from that of their counterparts. The purpose of this study was to examine the prevalence and expenditure of ENTRIs in children with and without CCCs. A retrospective evaluation of 3,880,456 children aged 0-18 years enrolled in 9 US state Medicaid programs in 2018, as recorded in the IBM Watson Marketscan Database, was conducted. Feudtner's classification system was employed to identify the type and quantity of CCCs. The prevalence of ENTRIs, defined as one or more healthcare visits for ENTRIs, and Medicaid expenditure on ENTRIs were compared based on CCC status using chi-square tests and logistic regression. The study found that ENTRIs were more prevalent in children with CCCs than in those without. Children with a CCC represented approximately one-fourth ($145.8 million [US]) of the total ENTRI expenditure. Excluding throat and sinus infections, the prevalence of ENTRIs rose with the number of CCCs. For instance, the prevalence of lower-airway infections increased from 12.5% to 37.5% as the number of CCCs grew from zero to ≥3. Inpatient care-associated ENTRI expenditure rose from 9.7% to 92.8% as the number of CCCs increased from zero to ≥3.
AHRQ-funded; HS025138
Citation: Dunbar PJ, Sobotka SA, Rodean J .
Prevalence of and spending on ear, nose, throat, and respiratory infections among children with chronic complex conditions.
Acad Pediatr 2023 Mar;23(2):434-40. doi: 10.1016/j.acap.2022.07.004.
Keywords: Children/Adolescents, Respiratory Conditions, Chronic Conditions, Healthcare Costs
Schnall R, Sanabria G, Jia R, Sanabria G, Jia H
Efficacy of an mHealth self-management intervention for persons living with HIV: the WiseApp randomized clinical trial.
This study’s objective was to determine the efficacy of WiseApp, a user-centered design mHealth intervention to improve antiretroviral therapy (ART) adherence and viral suppression in persons living with HIV (PLWH). This randomized case-control trial had two study arms: a randomized controlled efficacy trial arm (n = 99) and an attention control intervention arm (n = 101) among PLWH living in New York City. The authors found a significant improvement in ART adherence in the intervention arm compared to the attention control arm from day 1 (69.7% vs 48.3%) to day 59 (51.2% vs 37.2%) of the study period. From day 60 to 120, the intervention had higher but not statistically significant adherence rates. Secondary analyses showed no difference in change from baseline to 3 or 6 months between the 2 study arms.
AHRQ-funded; HS025071.
Citation: Schnall R, Sanabria G, Jia R, Sanabria G, Jia H .
Efficacy of an mHealth self-management intervention for persons living with HIV: the WiseApp randomized clinical trial.
J Am Med Inform Assoc 2023 Feb 16; 30(3):418-26. doi: 10.1093/jamia/ocac233..
Keywords: Telehealth, Patient Self-Management, Human Immunodeficiency Virus (HIV), Chronic Conditions, Health Information Technology (HIT)
Gay HC, Yu J, Persell SD
Comparison of sodium-glucose cotransporter-2 inhibitor and glucagon-like peptide-1 receptor agonist prescribing in patients with diabetes mellitus with and without cardiovascular disease.
Researchers sought to describe trends in prescribing for sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP1-RAs) to reduce cardiovascular events and mortality in adult patients with type 2 diabetes mellitus (T2DM) in diverse care settings. Their focus was on outpatient clinics in a midwestern integrated health system and small- and medium-sized community-based primary care practices and health centers in three Midwestern states. Results showed that an increase in prescription rates was greater for SGLT2is than for GLP1-RAs in a large integrated medical center and community primary care practices; overall, prescription rates for eligible patients were low, and the researchers observed racial disparities.
AHRQ-funded; HS026385; HS023921.
Citation: Gay HC, Yu J, Persell SD .
Comparison of sodium-glucose cotransporter-2 inhibitor and glucagon-like peptide-1 receptor agonist prescribing in patients with diabetes mellitus with and without cardiovascular disease.
Am J Cardiol 2023 Feb 15; 189:121-30. doi: 10.1016/j.amjcard.2022.10.041..
Keywords: Diabetes, Cardiovascular Conditions, Chronic Conditions, Medication, Primary Care
Herman WH, Bullock A, Boltri JM
AHRQ Author: Tracer H
The National Clinical Care Commission report to Congress: background, methods, and foundational recommendations.
This AHRQ-authored paper describes the background, methods, and recommendations of the National Clinical Care Commission (NCCC) focused on factors likely to improve the delivery of high-quality care to all people with diabetes. It is the first in a series of five articles describing the recommendations. The Commission made recommendations at all levels: patient, practice, health system, and health policy. This is the first paper in a series of five articles about the NCCC recommendations. The five articles include recommendations to 1) reduce diabetes-related risks, prevent type 2 diabetes, and avert diabetes complications through changes in federal policies and programs affecting the general population; 2) prevent type 2 diabetes in at-risk individuals through targeted lifestyle and medication interventions; and 3) improve the treatment of diabetes and its complications to improve the health outcomes of people with diabetes. This first article reviews the successes and limitations of previous federal efforts to combat diabetes, describes the establishment of and charge to the NCCC, and discusses the development of a hybrid conceptual model that guided the NCCC’s novel all-of-government approach to address diabetes as a societal and medical problem. The authors then review the procedures used by the NCCC to gather information from federal agencies, stakeholders, key informants, and the public and to conduct literature reviews. Finally, they review the NCCC's three foundational recommendations: 1) improve the coordination of non-health-related and health-related federal agencies to address the social and environmental conditions that are accelerating the diabetes epidemic; 2) ensure that all Americans at risk for and with diabetes have health insurance and access to health care; and 3) ensure that all federal policies and programs promote health equity in diabetes.
AHRQ-authored; AHRQ-funded.
Citation: Herman WH, Bullock A, Boltri JM .
The National Clinical Care Commission report to Congress: background, methods, and foundational recommendations.
Diabetes Care 2023 Feb; 46(2):e14-e23. doi: 10.2337/dc22-0611..
Keywords: Diabetes, Chronic Conditions, Prevention, Research Methodologies
Schillinger D, Bullock A, Powell C
The National Clinical Care Commission report to Congress: leveraging federal policies and programs for population-level diabetes prevention and control: recommendations from the National Clinical Care Commission.
The purpose of this article was to explore and consider the National Clinical Care Commission’s (NCCC) population-wide recommendations focusing on food systems; consumption of water over beverages sweetened with sugar; labeling of food and beverages; marketing and advertising; workplace, ambient, and built environments; and research to address the myriad of complex factors contributing to Type 1 and 2 diabetes. The authors’ recommendations are directed toward federal policies, agencies, departments and programs, including the Environmental Protection Agency, the Food and Drug Administration, the Department of Housing and Urban Development, and others.
AHRQ-funded.
Citation: Schillinger D, Bullock A, Powell C .
The National Clinical Care Commission report to Congress: leveraging federal policies and programs for population-level diabetes prevention and control: recommendations from the National Clinical Care Commission.
Diabetes Care 2023 Feb; 46(2):e24-e38. doi: 10.2337/dc22-0619..
Keywords: Diabetes, Chronic Conditions, Policy, Prevention
Greenlee MC, Bolen S, Chong W
The National Clinical Care Commission report to Congress: leveraging federal policies and programs to improve diabetes treatment and reduce complications.
This paper is the fourth in a series of five articles describing the recommendations of the National Clinician Care Commission (NCCC) on diabetes care. This paper focused on the recommendations of the Treatment and Complications subcommittee of the National Clinical Care Commission. The Commission made recommendations at all levels: patient, practice, health system, and health policy. They also identified several areas that need additional research, such as studying the barriers to uptake of diabetes self-management education and support, exploring methods to implement team-based care, and evaluating the importance of digital connectivity as a social determinant of health.
AHRQ-funded.
Citation: Greenlee MC, Bolen S, Chong W .
The National Clinical Care Commission report to Congress: leveraging federal policies and programs to improve diabetes treatment and reduce complications.
Diabetes Care 2023 Feb; 46(2):e51-e59. doi: 10.2337/dc22-0621..
Keywords: Diabetes, Chronic Conditions, Policy, Prevention, Quality of Life
Boltri JM, Tracer H, Strogatz D
AHRQ Author: Tracer H
The National Clinical Care Commission report to Congress: leveraging federal policies and programs to prevent diabetes in people with prediabetes.
This article described the recommendations of a National Clinical Care Commission subcommittee focused primarily on the prevention of type 2 diabetes in people with prediabetes. The goal of these recommendations is to improve current Federal diabetes prevention activities by increasing awareness of and diagnosis of prediabetes on a population basis, facilitating FDA review and approval of metformin for diabetes prevention, and supporting research to enhance the effectiveness of diabetes prevention. The recommendations also highlight the importance of research to advance understanding of the etiology of and opportunities for prevention of type 1 diabetes.
AHRQ-authored; AHRQ-funded.
Citation: Boltri JM, Tracer H, Strogatz D .
The National Clinical Care Commission report to Congress: leveraging federal policies and programs to prevent diabetes in people with prediabetes.
Diabetes Care 2023 Feb; 46(2):e39-e50. doi: 10.2337/dc22-0620..
Keywords: Diabetes, Prevention, Chronic Conditions
Herman WH, Schillinger D, Bolen S
AHRQ Author: Tracer H
The National Clinical Care Commission report to Congress: recommendations to better leverage federal policies and programs to prevent and control diabetes.
This AHRQ-authored article is an overview paper of the recommendations of the National Clinical Care Commission (NCCC) Report to Congress to better leverage federal policies and programs to prevent and control diabetes. The NCCC surveyed federal agencies and conducted follow-up meetings with representatives from 10 health-related and 11 non-health-related federal agencies. They held 12 public meetings, solicited comments, met with numerous interested parties and key informants, and performed comprehensive literature reviews. The final report was transmitted to Congress in January 2022 and contained 39 specific recommendations, including 3 foundational recommendations that addressed the necessity of an all-of-government approach to diabetes, health equity, and access to health care. Recommendations were made at the general population level and the individual level to strengthen federal policies and programs to increase awareness of prediabetes and remove barriers to proven effective treatments for diabetes and its complications.
AHRQ-authored; AHRQ-funded.
Citation: Herman WH, Schillinger D, Bolen S .
The National Clinical Care Commission report to Congress: recommendations to better leverage federal policies and programs to prevent and control diabetes.
Diabetes Care 2023 Feb; 46(2):255-61. doi: 10.2337/dc22-1587..
Keywords: Diabetes, Chronic Conditions, Policy, Prevention
Conlin PR, Boltri JM, Bullock A
The National Clinical Care Commission report to Congress: summary and next steps.
This article summarized recommendations of the National Clinical Care Commission (NCCC) to prevent and control diabetes and its complications more effectively. The NCCC has determined that diabetes should not be considered solely as a medical problem but must also as a societal problem. Its recommendations cover policies and programs of both non-health-related and health-related federal agencies, including three recommendations that: non-health-related and health-related federal agencies coordinate their activities to better address diabetes; all federal agencies and departments ensure health equity as a guiding principle for their policies and programs that impact diabetes; all Americans have access to comprehensive and affordable health care. The NCCC also recommends that a coordinating Office of National Diabetes Policy be established.
AHRQ-authored; AHRQ-funded.
Citation: Conlin PR, Boltri JM, Bullock A .
The National Clinical Care Commission report to Congress: summary and next steps.
Diabetes Care 2023 Feb; 46(2):e60-e63. doi: 10.2337/dc22-0622..
Keywords: Diabetes, Chronic Conditions, Policy, Prevention
Duan KI, Birger M, Au DH
Health care spending on respiratory diseases in the United States, 1996-2016.
The objectives of this study were to estimate health care spending in the U.S. for 11 respiratory conditions from 1996 to 2016, and to provide an evaluation of factors associated with spending growth and detailed trends. Data was taken from the Institute of Health Metrics and Evaluation's Disease Expenditure Project Database. The results showed that spending on respiratory conditions is high, particularly for chronic conditions like asthma and chronic obstructive pulmonary disease. The authors concluded that these findings suggest that service price and intensity should be a key focus for policymakers who seek to reduce health care spending growth.
AHRQ-funded; HS026369.
Citation: Duan KI, Birger M, Au DH .
Health care spending on respiratory diseases in the United States, 1996-2016.
Am J Respir Crit Care Med 2023 Jan 15; 207(2):183-92. doi: 10.1164/rccm.202202-0294OC..
Keywords: Respiratory Conditions, Healthcare Costs, Asthma, Chronic Conditions
Rojas JC, Chokkara S, Zhu M
Care quality for patients with chronic obstructive pulmonary disease in the readmission penalty era.
The purpose of this study was to assess changes in the quality of care for patients hospitalized for Chronic obstructive pulmonary disease (COPD) after the implementation of the Hospital Readmissions Reduction Program (HRRP) which levied financial penalties on hospitals for excessive COPD readmissions. The researchers reviewed the records from 995 U.S. hospitals in the Premier Healthcare Database, evaluating patients older than 40 years of age hospitalized for COPD. The study included 662,842 pre-HRRP (January 2010-September 2014) and 285,508 post-HRRP (October 2014-December 2018) admissions, and found that recommended care increased at a rate of 0.16% per month pre-HRRP and 0.01% per month post-HRRP. Nonrecommended care decreased at a rate of 0.15% per month pre-HRRP and 0.13% per month post-HRRP. Ideal care increased at a rate of 0.24% per month pre-HRRP and 0.11% per month post-HRRP. The researchers concluded that after HRRP implementation, the pre-HRRP trends toward improving care quality for inpatient COPD care slowed.
AHRQ-funded; HS027804.
Citation: Rojas JC, Chokkara S, Zhu M .
Care quality for patients with chronic obstructive pulmonary disease in the readmission penalty era.
Am J Respir Crit Care Med 2023 Jan; 207(1):29-37. doi: 10.1164/rccm.202203-0496OC..
Keywords: Respiratory Conditions, Quality of Care, Hospital Readmissions, Chronic Conditions
Weiner M, Adeoye P, Boeh MJ
Continuous glucose monitoring and other wearable devices to assess hypoglycemia among older adult outpatients with diabetes mellitus.
The purpose of this study was to assess whether vulnerable older adults could use wearable devices, and explore Hypoglycemia frequency over a two week period. The researchers recruited 10 participants with diabetes mellitus to pilot test a continuous glucometer, physical activity monitor, electronic medication bottles, and smartphones which that provided prompts about medications, behaviors, and symptoms. A sample of 70 then wore glucometers and activity monitors and used the smartphone and bottles for a duration of 2 weeks and provided feedback. The study found that patients were interested in assistance with the interpretation of graphs, had challenges with keeping the glucometers attached. Nearly 23% of respondents indicated that they never check their blood sugars. In two weeks of monitoring, 73% had HG and 42% had serious, clinically significant HG.
AHRQ-funded; HS024384.
Citation: Weiner M, Adeoye P, Boeh MJ .
Continuous glucose monitoring and other wearable devices to assess hypoglycemia among older adult outpatients with diabetes mellitus.
Appl Clin Inform 2023 Jan; 14(1):37-44. doi: 10.1055/a-1975-4136..
Keywords: Elderly, Diabetes, Chronic Conditions, Ambulatory Care and Surgery, Patient Self-Management, Medical Devices
Zisman-Ilani Y, Thompson KD, Siegel LS
Crohn's disease shared decision making intervention leads to more patients choosing combination therapy: a cluster randomised controlled trial.
The purpose of this multi-site cluster randomised controlled trial was to test the impact of standard Crohn's disease care and compare with the impact of shared decision making (SDM) on the provider’s choice of therapy, quality of decisions, and provider trust. A total of 158 adult patients with Crohn's disease within 15 years of their diagnosis, with no prior Crohn's disease complications, and who were candidates to receive immunomodulators or biologics, from 14 diverse gastroenterology practices in the US, participated in the study. 99 of those participants received the intervention and 59 received standard care. The study found that participants in the intervention group chose combination therapy more frequently, had a significantly lower decisional conflict, and had greater trust in their provider.
AHRQ-funded; HS021747.
Citation: Zisman-Ilani Y, Thompson KD, Siegel LS .
Crohn's disease shared decision making intervention leads to more patients choosing combination therapy: a cluster randomised controlled trial.
Aliment Pharmacol Ther 2023 Jan;57(2):205-14. doi: 10.1111/apt.17286..
Keywords: Digestive Disease and Health, Chronic Conditions, Decision Making, Patient-Centered Healthcare, Clinician-Patient Communication
Fareed N, Swoboda C, Singh P
Developing and testing an integrated patient mHealth and provider dashboard application system for type 2 diabetes management among Medicaid-enrolled pregnant individuals based on a user-centered approach: mixed-methods study.
The objective of this study was to develop user specifications for a tailored and integrated technology, patient application (mHealth) and provider dashboard, that provides a complete view of Medicaid-enrolled patients with type 2 diabetes (T2D) during pregnancy and to develop prototypes based on users’ needs. Participating patients and providers stated a core set of expectations for the mHealth and dashboard applications. Participants then provided feedback to improve these applications. The authors concluded that digital health tools could transform health care among Medicaid-enrolled patients with T2D during pregnancy, with the goal of managing their blood glucose levels. Refining the stated needs and preferences of patients and providers to develop applications holds potential for tackling complicated health care issues.
AHRQ-funded; HS028822.
Citation: Fareed N, Swoboda C, Singh P .
Developing and testing an integrated patient mHealth and provider dashboard application system for type 2 diabetes management among Medicaid-enrolled pregnant individuals based on a user-centered approach: mixed-methods study.
Digit Health 2023 Jan-Dec; 9:20552076221144181. doi: 10.1177/20552076221144181..
Keywords: Patient-Centered Healthcare, Telehealth, Diabetes, Pregnancy, Chronic Conditions, Women, Health Information Technology (HIT)
Rodriguez HP, Ciemins EL, Rubio K
Health systems and telemedicine adoption for diabetes and hypertension care.
This study examined differences in telemedicine use for adults with diabetes and/or hypertension across 10 health systems and analyzed practice and patient characteristics associated with greater use. Encounter-level data from the AMGA Optum Data Warehouse for March 13, 2020 to December 31, 2020 were analyzed. This included 3,016,761 clinical encounters from 764,521 adults with diabetes and/or hypertension attributed to 1 of 1207 practice sites with at least 50 system-attributed patients. Telemedicine use time was divided into adoption (weeks 0-4), de-adoption (weeks 5-12), and maintenance (weeks 13-42) periods. Telemedicine use peaked after 4 weeks at 11-42% of weekly encounters. Small practices had lower telemedicine use for adults with diabetes during the maintenance period compared with larger practices, with ownership showing no association with telemedicine use. Practices with higher proportions of Black patients continued their expansion of telemedicine use during the de-adoption and maintenance periods.
Citation: Rodriguez HP, Ciemins EL, Rubio K .
Health systems and telemedicine adoption for diabetes and hypertension care.
Am J Manag Care 2023 Jan; 29(1):42-49. doi: 10.37765/ajmc.2023.89302..
Keywords: Telehealth, Health Information Technology (HIT), Diabetes, Blood Pressure, Chronic Conditions
Chang E, Ali R, Seibert J
Interventions to improve outcomes for high-need, high-cost patients: a systematic review and meta-analysis.
The authors of this article reviewed evidence on the effectiveness of complex interventions designed to change the healthcare of high-need, high-cost patients. They found limited evidence of intervention effectiveness in relation to cost and use, but note that additional evidence is needed to strengthen their confidence in these findings. Few studies reported clinical/functional or social risk factor outcomes or sufficient details for determining why individual interventions work. They conclude that future evaluations could provide additional insights in assessing the impact of complex interventions.
AHRQ-funded; 290201500011I.
Citation: Chang E, Ali R, Seibert J .
Interventions to improve outcomes for high-need, high-cost patients: a systematic review and meta-analysis.
J Gen Intern Med 2023 Jan; 38(1):185-94. doi: 10.1007/s11606-022-07809-6..
Keywords: Healthcare Costs, Healthcare Delivery, Chronic Conditions, Healthcare Utilization
Mills J, Barnhart H
AHRQ Author: Mills J
Screening for prediabetes and type 2 diabetes in children and adolescents.
This Putting Prevention into Practice case study is used to increase understanding of the USPSTF final recommendation on screening for prediabetes and type 2 diabetes in children and adolescents. A case study was presented using a 12-year-old-patient with no specific concerns but had gained 18 pounds since their last wellness visit and lives a sedentary lifestyle. The patient’s family history of type 2 diabetes mellitus in maternal and paternal grandparents is described. Three multiple-choice questions are presented regarding harms and benefits of screening for prediabetes and type 2 diabetes for that patient.
AHRQ-authored.
Citation: Mills J, Barnhart H .
Screening for prediabetes and type 2 diabetes in children and adolescents.
Am Fam Physician 2023 Jan; 107(1):79-80..
Keywords: U.S. Preventive Services Task Force (USPSTF), Children/Adolescents, Diabetes, Screening, Evidence-Based Practice, Guidelines, Prevention, Chronic Conditions, Case Study