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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.
Results1 to 25 of 128 Research Studies Displayed
Santana S, Brach C, Harris L
AHRQ Author: Brach C
Updating Health Literacy for Healthy People 2030: Defining Its Importance for a New Decade in Public Health.
The US Department of Health & Human Services (HHS) updates the Healthy People objectives each decade based on the most current science. For the development of HP2030, the HHS drew on recommendations from the Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 (Secretary's Advisory Committee), an independent advisory committee of national health experts, to update the 20-year old individual-focused Healthy People definition of health literacy. This paper discusses that process.
Citation: Santana S, Brach C, Harris L . Updating Health Literacy for Healthy People 2030: Defining Its Importance for a New Decade in Public Health. J Public Health Manag Pract 2021 Nov-Dec;27(Suppl 6):S258-S64. doi: 10.1097/phh.0000000000001324..
Keywords: Health Literacy, Public Health, Health Promotion
Anesi GL, Kerlin MP
The impact of resource limitations on care delivery and outcomes: routine variation, the coronavirus disease 2019 pandemic, and persistent shortage.
Researchers discuss the impact of resource limitations on care delivery and outcomes. They conclude that the interaction between resource limitation and care delivery and outcomes is complex and incompletely understood. Further, the COVID-19 pandemic provides a learning opportunity for strain response during both pandemic and non-pandemic times.
Citation: Anesi GL, Kerlin MP . The impact of resource limitations on care delivery and outcomes: routine variation, the coronavirus disease 2019 pandemic, and persistent shortage. Curr Opin Crit Care 2021 Oct 1;27(5):513-19. doi: 10.1097/mcc.0000000000000859..
Keywords: COVID-19, Public Health, Healthcare Delivery, Intensive Care Unit (ICU), Outcomes
Bartsch SM, Wedlock PT, O'Shea KJ
Lives and costs saved by expanding and expediting coronavirus disease 2019 vaccination.
The authors developed a computational model representing the United States population, COVID-19 coronavirus spread (February 2020-December 2022), and vaccination to determine the impact of increasing coverage and expediting time to achieve coverage. They concluded that their study quantified the potential value of decreasing vaccine hesitancy and increasing vaccination coverage and how this value may decrease with the time it takes to achieve coverage, emphasizing the need to reach high coverage levels as soon as possible, especially before the fall/winter.
Citation: Bartsch SM, Wedlock PT, O'Shea KJ . Lives and costs saved by expanding and expediting coronavirus disease 2019 vaccination. J Infect Dis 2021 Sep 17;224(6):938-48. doi: 10.1093/infdis/jiab233..
Keywords: COVID-19, Vaccination, Public Health
Chelen JSC, White DB, Zaza S
US ventilator allocation and patient triage policies in anticipation of the COVID-19 surge.
Researchers assessed policy preparedness and substantive triage criteria within existing policies using a cross-sectional survey distributed to public health personnel and healthcare providers between March 23 and April 23, 2020. They found that their sample of policies reflected organizational strategies of exemplar-based policy development and the use of objective criteria in triage decisions, either before or instead of clinical judgment, to support ethical distribution of resources.
Citation: Chelen JSC, White DB, Zaza S . US ventilator allocation and patient triage policies in anticipation of the COVID-19 surge. Health Secur 2021 Sep-Oct;19(5):459-67. doi: 10.1089/hs.2020.0166..
Keywords: COVID-19, Public Health, Emergency Preparedness, Policy
Smulowitz PB, O'Malley AJ, Khidir H
National trends In ED visits, hospital admissions, and mortality for Medicare patients during the COVID-19 pandemic.
Concerns about avoidance or delays in seeking emergency care during the COVID-19 pandemic are widespread, but national data on emergency department (ED) visits and subsequent rates of hospitalization and outcomes are lacking. In this study, the investigators examined trends in ED visits and rates of hospitalization and thirty-day mortality conditional on an ED visit for non-COVID-19 conditions during several stages of the pandemic and for areas that were considered COVID-19 hot spots versus those that were not.
Citation: Smulowitz PB, O'Malley AJ, Khidir H . National trends In ED visits, hospital admissions, and mortality for Medicare patients during the COVID-19 pandemic. Health Aff 2021 Sep;40(9):1457-64. doi: 10.1377/hlthaff.2021.00561..
Keywords: COVID-19, Public Health, Emergency Department, Hospitalization
Santos T, Lee SD, East C
Can collaboration between nonprofit hospitals and local health departments influence population health investments by nonprofit hospitals?
The Patient Protection and Affordable Care Act (ACA) sought to improve population health by requiring nonprofit hospitals (NFPs) to conduct triennial community health needs assessments and address the identified needs. In this context, some states have encouraged collaboration between hospitals and local health department (LHD) to increase the focus of community benefit spending onto population health. The aim of the study was to examine whether a 2012 state law that required NFPs to collaborate with LHDs in local health planning influenced hospital population health improvement spending.
AHRQ-funded; HS024959; HS026116.
Citation: Santos T, Lee SD, East C . Can collaboration between nonprofit hospitals and local health departments influence population health investments by nonprofit hospitals? Med Care 2021 Aug;59(8):687-93. doi: 10.1097/mlr.0000000000001561..
Keywords: Hospitals, Public Health
Johnson CL, Schwartz H, Greenberg A
Patient perceptions on barriers and facilitators to accessing low-acuity surgery during COVID-19 pandemic.
The onset of the COVID-19 pandemic led to the postponement of low-acuity surgical procedures in an effort to conserve resources and ensure patient safety. This study aimed to characterize patient-reported concerns about undergoing surgical procedures during the pandemic. The investigators concluded that eliciting patients' perspectives, adapting processes to address potential barriers, and effectively educating patients about institutional measures to minimize in-hospital transmission of COVID-19 should be integrated into surgical care.
Citation: Johnson CL, Schwartz H, Greenberg A . Patient perceptions on barriers and facilitators to accessing low-acuity surgery during COVID-19 pandemic. J Surg Res 2021 Aug;264:30-36. doi: 10.1016/j.jss.2021.01.028..
Keywords: COVID-19, Surgery, Access to Care, Patient Experience, Public Health
Byhoff E, Paulus JK, Guardado R
Healthcare workers' perspectives on coronavirus testing availability: a cross sectional survey.
This article describes a survey that was conducted during the first wave of the COVID pandemic during March-August 2020 of hospital workers on their perceptions of, access to, and receipt of COVID testing. A survey was given to all hospital employees in a single academic medical center in Boston, Massachusetts. A total of 2543 employees responded to the survey. Respondents were mostly female (76%), white (55%), with the mean age being 40 years. They were nurses (27%), administrators (22%), and patient support roles (22%) of which 56% of respondents wanted COVID testing. Age, full-time status, employment tenure, changes in quality of life, changes in job duties, and worries about enough sick paid leave were associated with testing. Nurses were more likely to want testing than administrators and patient support staff.
Citation: Byhoff E, Paulus JK, Guardado R . Healthcare workers' perspectives on coronavirus testing availability: a cross sectional survey. BMC Health Serv Res 2021 Jul 21;21(1):719. doi: 10.1186/s12913-021-06741-5..
Keywords: COVID-19, Diagnosis, Provider: Health Personnel, Public Health
Dixon BE, Grannis SJ, McAndrews C BE, Grannis SJ, McAndrews C
Leveraging data visualization and a statewide health information exchange to support COVID-19 surveillance and response: application of public health informatics.
Researchers sought to support public health surveillance and response to coronavirus disease 2019 (COVID-19) through rapid development and implementation of novel visualization applications for data amalgamated across sectors. Capitalizing on a statewide health information exchange, in partnership with health system and public health leaders, Regenstrief biomedical informatics experts rapidly developed and deployed informatics tools to support surveillance and response to COVID-19. The authors concluded that the application of public health informatics methods and tools in Indiana holds promise for other states and nations.
Citation: Dixon BE, Grannis SJ, McAndrews C BE, Grannis SJ, McAndrews C . Leveraging data visualization and a statewide health information exchange to support COVID-19 surveillance and response: application of public health informatics. J Am Med Inform Assoc 2021 Jul 14;28(7):1363-73. doi: 10.1093/jamia/ocab004..
Keywords: COVID-19, Health Information Exchange (HIE), Health Information Technology (HIT), Public Health
Masonbrink AR, Harris M, Hall M
Safety events in children's hospitals during the COVID-19 pandemic.
The coronavirus disease 2019 (COVID-19) pandemic has impacted hospitals, potentially affecting quality and safety. The objective of this study was to compare pediatric hospitalization safety events during the pandemic versus previous years. The investigators concluded that postoperative sepsis rates increased among children hospitalized during COVID-19. They suggest that efforts are needed to improve safety of postoperative care for hospitalized children.
AHRQ-funded; HS024554; HS024592.
Citation: Masonbrink AR, Harris M, Hall M . Safety events in children's hospitals during the COVID-19 pandemic. Hosp Pediatr 2021 Jun;11(6):e95-e100. doi: 10.1542/hpeds.2020-004937..
Keywords: Children/Adolescents, COVID-19, Patient Safety, Sepsis, Adverse Events, Hospitalization, Hospitals, Inpatient Care, Infectious Diseases, Public Health
Kruse J, Toledo P, Belton TB
Readability, content, and quality of COVID-19 patient education materials from academic medical centers in the United States.
The internet is a frequently used resource for providing patient education materials (PEMs). The aim of this study was to evaluate the readability, content, and quality of web-based PEMs on COVID-19 from US academic medical centers. Despite availability of web-based PEMs for COVID-19, the readability was significantly higher than the National Institute of Health and US Department of Health and Human Services recommended sixth grade reading level and actionability of PEMs was low.
AHRQ-funded; HS025267; HS026169.
Citation: Kruse J, Toledo P, Belton TB . Readability, content, and quality of COVID-19 patient education materials from academic medical centers in the United States. Am J Infect Control 2021 Jun;49(6):690-93. doi: 10.1016/j.ajic.2020.11.023..
Keywords: COVID-19, Education: Patient and Caregiver, Health Literacy, Public Health, Infectious Diseases
Wurcel AG, Reyes J, Zubiago J
"I'm not gonna be able to do anything about it, then what's the point?": A broad group of stakeholders identify barriers and facilitators to HCV testing in a Massachusetts jail.
Despite national guidelines promoting hepatitis C virus (HCV) testing in prisons, there is substantial heterogeneity on the implementation of HCV testing in jails. IN this study, the investigators sought to better understand barriers and opportunities for HCV testing by interviewing a broad group of stakeholders involved in HCV testing and treatment policies and procedures in Massachusetts jails.
Citation: Wurcel AG, Reyes J, Zubiago J . "I'm not gonna be able to do anything about it, then what's the point?": A broad group of stakeholders identify barriers and facilitators to HCV testing in a Massachusetts jail. PLoS One 2021 May 26;16(5):e0250901. doi: 10.1371/journal.pone.0250901..
Keywords: Hepatitis, Vulnerable Populations, Screening, Prevention, Public Health, Social Stigma
Dickinson-Copeland CM, Immergluck LC, Britez M
Increased risk of sub-clinical blood lead levels in the 20-county metro Atlanta, Georgia area-a laboratory surveillance-based study.
This study looked at the distribution of blood lead levels (BLLs) in children aged 0-72 months and their associations with sociodemographic and area-level variables. Data from the Georgia Department of Public Health’s Healthy Homes for Lead Prevention Program surveillance data was used to describe the distribution of BLLs in metro Atlanta area children from 2010 to 2018. Residential addresses were geocoded and if BLLs were spatially clustered they were defined at “Hotspots”. Geographically defined hotspots for both clinical (≥5 µg/dL) and sub-clinical (2 to <5 µg/dL) BLLs diffused from the city-central area into suburban areas. Predictors of sub-clinical BLL levels from those with lower (<2 µg/dL) or higher ((≥5 µg/dL) BLLs included non-Medicaid insurance, the proportion of renters in a given geographical area, and proportion of individuals with a GED/high school diploma. Over half of the study children had sub-clinical BLL levels, a range that does not currently trigger public health measures but could result in adverse development outcomes if ignored.
Citation: Dickinson-Copeland CM, Immergluck LC, Britez M . Increased risk of sub-clinical blood lead levels in the 20-county metro Atlanta, Georgia area-a laboratory surveillance-based study. Int J Environ Res Public Health 2021 May 13;18(10). doi: 10.3390/ijerph18105163..
Keywords: Newborns/Infants, Children/Adolescents, Social Determinants of Health, Public Health, Public Health
Barry CL, Anderson KE, Han H
Change over time in public support for social distancing, mask wearing, and contact tracing to combat the COVID-19 pandemic among US adults, April to November 2020.
This study examined changes over time in attitudes towards social distancing, mask wearing, and contact tracing to combat the COVID-19 pandemic among US adults, April to November 2020. Surveys of a nationally representative cohort of US adults were conducted in April, July, and November 2020. Support for social distancing dropped from 89% in April to 79% in July but remained stable in November at 78%. In July and November, more than 75% of respondents supported mask wearing and nearly as many supported contact tracing. Support differences were most pronounced by age, partisanship, and trust in science. Higher support for contact tracing was independently predicted by having a more fluid worldview.
Citation: Barry CL, Anderson KE, Han H . Change over time in public support for social distancing, mask wearing, and contact tracing to combat the COVID-19 pandemic among US adults, April to November 2020. Am J Public Health 2021 May;111(5):937-48. doi: 10.2105/ajph.2020.306148..
Keywords: COVID-19, Public Health, Emergency Preparedness, Infectious Diseases
Hofstetter AM, Schaffer S
Childhood and adolescent vaccination in alternative settings.
This article reviews the unique advantages, challenges, and experiences regarding vaccine delivery in alternative settings, such as schools, emergency rooms, hospitals, and pharmacies. It describes the key components that each setting must possess as well as other important factors to consider when assessing the ability of each to deliver vaccines to the children and adolescents they serve. It is important to emphasize that these settings should not replace the medical home as the primary location for vaccination, but rather serve as a critical safety net for high-risk individuals and communities and in situations where access to traditional locations may be limited, such as during the COVID-19 pandemic.
Citation: Hofstetter AM, Schaffer S . Childhood and adolescent vaccination in alternative settings. Acad Pediatr 2021 May-Jun;21(4s):S50-s56. doi: 10.1016/j.acap.2021.02.001..
Keywords: Children/Adolescents, Vaccination, Healthcare Delivery, Public Health
Zubiago J, Murphy M, Guardado R
Increased HIV testing in people who use drugs hospitalized in the first wave of the COVID-19 pandemic.
During the COVID-19 pandemic, due to lapses in harm reduction services, several public health experts forecasted subsequent increases in diagnosis of HIV in PWUD. As many inpatient hospitals reworked patient flow during the COVID-19 surge, the investigators hypothesized that HIV testing in PWUD would decrease. To answer this question, they compiled a deidentified list of hospitalized patients with electronic medical record indicators of substance use-a positive urine toxicology screen, prescribed medications to treat opioid use disorder, a positive CIWA score, or a positive CAGE score-admitted between January, 2020 and August, 2020.
Citation: Zubiago J, Murphy M, Guardado R . Increased HIV testing in people who use drugs hospitalized in the first wave of the COVID-19 pandemic. J Subst Abuse Treat 2021 May;124:108266. doi: 10.1016/j.jsat.2020.108266..
Keywords: Human Immunodeficiency Virus (HIV), Opioids, Substance Abuse, Alcohol Use, Hospitalization, COVID-19, Public Health, Screening
Springs S, Baruch J
Artists on the research team: an interdisciplinary approach to team science, research rigor, and creative dialogue.
Under the stewardship of two Rhode Island state agencies, an innovative research-driven enterprise, comprising researchers, clinicians, and community artists, was brought together to integrate arts-based interventions into statewide public health policy and practice. In this paper, the investigators discussed their work with the Rhode Island Arts and Health Advisory Group as a case study to illuminate their experiences in collaborating with artists on public health policy and practice research.
Citation: Springs S, Baruch J . Artists on the research team: an interdisciplinary approach to team science, research rigor, and creative dialogue. Health Promot Pract 2021 May;22(1_suppl):83s-90s. doi: 10.1177/1524839921996301..
Keywords: Public Health, Policy
Rhee C, Kanjilal S, Baker M
Duration of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infectivity: when is it safe to discontinue isolation?
This review examined the current evidence of when a Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) patient is no longer infectious and no longer needs to be in isolation. Most patients have persistently positive tests for weeks to months following clinical recovery; but this may not indicate their infectivity. SARS-CoV-2 appears to be most contagious around the time of symptom onset. Infectivity decreases to near-zero after about 10 days in mild-moderately ill patients and 15 days in severely-critically ill and immunocompromised patients. The longest interval associated with replication-competent virus found so far is 20 days from symptom onset.
Citation: Rhee C, Kanjilal S, Baker M . Duration of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infectivity: when is it safe to discontinue isolation? Clin Infect Dis 2021 Apr 26;72(8):1467-74. doi: 10.1093/cid/ciaa1249..
Keywords: COVID-19, Respiratory Conditions, Public Health, Infectious Diseases
Byrnes ME, Brown CS, De Roo A
Elective surgical delays due to COVID-19: the patient lived experience.
This study looked at the effects of the COVID-19 pandemic on scheduling of elective cardiac and vascular surgery. The authors interviewed 47 individuals who experienced a postponement of surgery due to coronavirus. Patients described 3 key issues around their postponement: 1) surgery as part of a “return to normal”; 2) postponement took a toll on their physical health and mental wellbeing; and 3) many patients in their study said they would “rather die from a heart attack” than be exposed to the coronavirus.
Citation: Byrnes ME, Brown CS, De Roo A . Elective surgical delays due to COVID-19: the patient lived experience. Med Care 2021 Apr;59(4):288-94. doi: 10.1097/mlr.0000000000001503..
Keywords: COVID-19, Surgery, Public Health, Patient Experience, Infectious Diseases
O'Donoghue A, Dechen T, O'Donoghue A, Dechen T, Pavlova W W
Reopening businesses and risk of COVID-19 transmission.
In this paper, the authors used anonymized cell-phone data to quantify the potential risk of COVID-19 transmission in business establishments by building a Business Risk Index that measures transmission risk over time. They used two metrics, visits per square foot and the average duration of visits from January 2020 to June 2020. They found that an increase in a county's average Business Risk Index is associated with an increase in positive COVID-19 cases in 1 week. Their risk index provides a way for policymakers and hospital decision-makers to monitor the potential risk of COVID-19 transmission from businesses based on the frequency and density of visits to businesses.
Citation: O'Donoghue A, Dechen T, O'Donoghue A, Dechen T, Pavlova W W . Reopening businesses and risk of COVID-19 transmission. NPJ Digit Med 2021 Mar 16;4(1):51. doi: 10.1038/s41746-021-00420-9..
Keywords: COVID-19, Community-Acquired Infections, Public Health, Risk
Ye S, Hiura G, Fleck E
Hospital readmissions after implementation of a discharge care program for patients with COVID-19 illness.
The surge of coronavirus 2019 (COVID-19) hospitalizations in New York City required rapid discharges to maintain hospital capacity. The objective of this study was to determine whether lenient provisional discharge guidelines with remote monitoring after discharge resulted in safe discharges home for patients hospitalized with COVID-19 illness. The investigators found that lenient discharge criteria in conjunction with remote monitoring after discharge were associated with a rate of early readmissions after COVID-related hospitalizations that was comparable to the rate of readmissions after other reasons for hospitalization before the COVID pandemic.
AHRQ-funded; HS024262; HS025198.
Citation: Ye S, Hiura G, Fleck E . Hospital readmissions after implementation of a discharge care program for patients with COVID-19 illness. J Gen Intern Med 2021 Mar;36(3):722-29. doi: 10.1007/s11606-020-06340-w..
Keywords: COVID-19, Hospital Discharge, Hospital Readmissions, Hospitals, Public Health, Hospitalization, Risk
Teixeira da Silva D, Biello K, Lin WY
COVID-19 vaccine acceptance among an online sample of sexual and gender minority men and transgender women.
Sexual and gender minority (SGM) populations are particularly vulnerable to poor COVID-19 outcomes and are more likely to experience stigma and medical mistrust that may impact COVID-19 vaccine acceptance. This study examined the prevalence of COVID testing and diagnosis and assessed COVID-19 vaccine acceptance among a large sample of SGM. The investigators found that black participants were significantly less likely to accept a COVID-19 vaccine, and Asian participants were significantly more likely to accept a vaccine, compared to White peers.
Citation: Teixeira da Silva D, Biello K, Lin WY . COVID-19 vaccine acceptance among an online sample of sexual and gender minority men and transgender women. Vaccines 2021 Mar;9(3). doi: 10.3390/vaccines9030204..
Keywords: Vaccination, COVID-19, Public Health, Racial / Ethnic Minorities, Vulnerable Populations
Malloy GSP, Puglisi L, Brandeau ML
Effectiveness of interventions to reduce COVID-19 transmission in a large urban jail: a model-based analysis.
The authors sought to estimate the impact of various mitigation strategies on COVID-19 transmission in a US jail beyond those offered in national guidelines. They found that depopulation, single celling, and asymptomatic testing within jails can be effective strategies to mitigate COVID-19 transmission in addition to standard public health measures. They recommended that decision makers prioritize reductions in the jail population, single celling, and testing asymptomatic populations as additional measures to manage COVID-19 within correctional settings.
Citation: Malloy GSP, Puglisi L, Brandeau ML . Effectiveness of interventions to reduce COVID-19 transmission in a large urban jail: a model-based analysis. BMJ Open 2021 Feb 17;11(2):e042898. doi: 10.1136/bmjopen-2020-042898..
Keywords: COVID-19, Public Health, Vulnerable Populations, Prevention, Infectious Diseases
Anderson KE, McGinty EE, Presskreischer R
Reports of forgone medical care among US adults during the initial phase of the COVID-19 pandemic.
This survey measured the frequency of foregone medical care due to COVID-19 from March to mid-July 2020. Johns Hopkins created the COVID-19 Civic Life and Public Health Survey wave 1, with 1468 individuals completing the survey. The sample of respondents were 52% women, 63% non-Hispanic White, 12% Black, and 17% Hispanic. The mean age of respondents was 48 years. A total of 41% of respondents forwent medical care during the March to mid-July time period. Among the 1055 individuals who reported needing care, 52% reported forgoing care for any reason, 29% forwent care owing to fear of COVID-19 transmission, and 7% forwent care owing to financial concerns associated with the pandemic. Respondents lacking any health insurance were more likely to forgo care than respondents with Medicare or commercial insurance.
Citation: Anderson KE, McGinty EE, Presskreischer R . Reports of forgone medical care among US adults during the initial phase of the COVID-19 pandemic. JAMA Netw Open 2021 Jan 4;4(1):e2034882. doi: 10.1001/jamanetworkopen.2020.34882..
Keywords: COVID-19, Access to Care, Healthcare Utilization, Public Health, Infectious Diseases
Lee BY, Bartsch SM, Ferguson MC
The value of decreasing the duration of the infectious period of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Researchers developed a computational model of the U.S. simulating the spread of SARS-CoV-2 and the potential clinical and economic impact of reducing the infectious period duration. They reported that their study quantifies the potential effects of reducing the SARS-CoV-2 infectious period duration.
Citation: Lee BY, Bartsch SM, Ferguson MC . The value of decreasing the duration of the infectious period of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. PLoS Comput Biol 2021 Jan;17(1):e1008470. doi: 10.1371/journal.pcbi.1008470..
Keywords: COVID-19, Respiratory Conditions, Public Health, Prevention, Infectious Diseases