National Healthcare Quality and Disparities Report
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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
476 to 500 of 545 Research Studies DisplayedGoldstein SL
Automated/integrated real-time clinical decision support in acute kidney injury.
The author argues that early, real-time identification and notification to healthcare providers of patients at risk for, or with, acute or chronic kidney disease can drive simple interventions to reduce harm. Similarly, he believes that screening patients at risk for acute kidney injury with these platforms to alert research personnel will lead to improve study subject recruitment.
AHRQ-funded; HS023763; HS021114.
Citation: Goldstein SL .
Automated/integrated real-time clinical decision support in acute kidney injury.
Curr Opin Crit Care 2015 Dec;21(6):485-9. doi: 10.1097/mcc.0000000000000250.
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Keywords: Clinical Decision Support (CDS), Kidney Disease and Health, Electronic Health Records (EHRs), Patient-Centered Outcomes Research, Diagnostic Safety and Quality
Almario CV, Chey WD, Iriana S
Computer versus physician identification of gastrointestinal alarm features.
This study's objective was to compare the number of alarms documented by physicians during usual care vs. that collected by a computer algorithm called Automated Evaluation of Gastrointestinal Symptoms (AEGIS). AEGIS identified more patients with positive alarm features compared to physicians and also documented more positive alarms. Moreover, clinicians documented only 30% of the positive alarms self-reported by patients through AEGIS.
AHRQ-funded; HS000046.
Citation: Almario CV, Chey WD, Iriana S .
Computer versus physician identification of gastrointestinal alarm features.
Int J Med Inform 2015 Dec;84(12):1111-7. doi: 10.1016/j.ijmedinf.2015.07.006.
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Keywords: Clinical Decision Support (CDS), Diagnostic Safety and Quality, Digestive Disease and Health, Electronic Health Records (EHRs), Patient Safety
Nadpara P, Madhavan SS, Tworek C
Guideline-concordant timely lung cancer care and prognosis among elderly patients in the United States: a population-based study.
This study evaluated the variations in guideline-concordant timely lung cancer care and prognosis among elderly in the US. It found that the time to diagnosis and treatment varied significantly among the elderly. However, 77.5 percent received guideline-concordant timely lung cancer care. The likelihood of receiving timely care significantly decreased with early stage diagnosis, increasing age, non-white race, higher comorbidity score, and lower income.
AHRQ-funded; HS018622.
Citation: Nadpara P, Madhavan SS, Tworek C .
Guideline-concordant timely lung cancer care and prognosis among elderly patients in the United States: a population-based study.
Cancer Epidemiol 2015 Dec;39(6):1136-44. doi: 10.1016/j.canep.2015.06.005.
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Keywords: Cancer: Lung Cancer, Elderly, Guidelines, Disparities, Diagnostic Safety and Quality
Easter JS, Haukoos JS, Meehan WP
Will neuroimaging reveal a severe intracranial injury in this adult with minor head trauma?: The rational clinical examination systematic review.
The study objective was to assess systematically the accuracy of symptoms and signs in adults with minor head trauma in order to identify those with severe intracranial injuries. It found that combinations of history and physical examination features in clinical decision rules can identify patients with minor head trauma at low risk of severe intracranial injuries.
AHRQ-funded; HS017526.
Citation: Easter JS, Haukoos JS, Meehan WP .
Will neuroimaging reveal a severe intracranial injury in this adult with minor head trauma?: The rational clinical examination systematic review.
JAMA 2015 Dec 22-29;314(24):2672-81. doi: 10.1001/jama.2015.16316..
Keywords: Falls, Brain Injury, Imaging, Trauma, Diagnostic Safety and Quality
Yaghi S, Herber C, Willey JZ
Itemized NIHSS subsets predict positive MRI strokes in patients with mild deficits.
The researchers' aim was to identify predictors of MRI-positive stroke from the itemized NIHSS. They concluded that NIHSS score subsets predict diffusion-weighted imaging positivity in mild strokes, and the presence of neglect or visual field deficits on the NIHSS subsets is most likely to have an MRI correlate even in patients with low NIHSS.
AHRQ-funded; HS013852.
Citation: Yaghi S, Herber C, Willey JZ .
Itemized NIHSS subsets predict positive MRI strokes in patients with mild deficits.
J Neurol Sci 2015 Nov 15;358(1-2):221-5. doi: 10.1016/j.jns.2015.08.1548.
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Keywords: Diagnostic Safety and Quality, Imaging, Stroke
Cutting EM, Overby CL, Banchero M
Using workflow modeling to identify areas to improve genetic test processes in the University of Maryland Translational Pharmacogenomics Project.
The researchers used information gained from focus groups in order to illustrate the current process of delivering genetic test results to clinicians. They proposed a business process model and notation (BPMN) representation of this process for a Translational Pharmacogenomics Project being implemented at the University of Maryland Medical Center. They found that the current process could be improved to reduce input errors, better inform and notify clinicians about the implications of certain genetic tests, and make results more easily understood. They demonstrated theiruse of BPMN to improve this important clinical process for CYP2C19 genetic testing.
AHRQ-funded; HS023390.
Citation: Cutting EM, Overby CL, Banchero M .
Using workflow modeling to identify areas to improve genetic test processes in the University of Maryland Translational Pharmacogenomics Project.
AMIA Annu Symp Proc 2015 Nov 5;2015:466-74.
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Keywords: Genetics, Diagnostic Safety and Quality, Medication, Workflow, Quality Improvement, Quality of Care, Organizational Change
Spatz ES, Curry LA, Masoudi FA
The variation in recovery: role of gender on outcomes of young AMI Patients (VIRGO) classification system: a taxonomy for young women with acute myocardial infarction.
The authors developed a novel taxonomy among adults up to age 55 with acute myocardial infarction (AMI) enrolled in the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study. They found that approximately 1 in 8 young women with AMI is unclassified by the Universal Definition of MI. They proposed a more inclusive taxonomy that could serve as a framework for understanding biological disease mechanisms, therapeutic efficacy, and prognosis in this population.
AHRQ-funded; HS023000.
Citation: Spatz ES, Curry LA, Masoudi FA .
The variation in recovery: role of gender on outcomes of young AMI Patients (VIRGO) classification system: a taxonomy for young women with acute myocardial infarction.
Circulation 2015 Nov 3;132(18):1710-8. doi: 10.1161/circulationaha.115.016502.
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Keywords: Diagnostic Safety and Quality, Heart Disease and Health, Sex Factors
Murphy DR, Wu L, Thomas EJ
Electronic trigger-based intervention to reduce delays in diagnostic evaluation for cancer: a cluster randomized controlled trial.
The researchers tested whether prospective use of electronic health record-based trigger algorithms to identify patients at risk of diagnostic delays could prevent delays in diagnostic evaluation for cancer. They found that electronic trigger-based interventions seem to be effective in reducing time to diagnostic evaluation of colorectal and prostate cancer as well as improving the proportion of patients who receive follow-up.
AHRQ-funded; HS017820.
Citation: Murphy DR, Wu L, Thomas EJ .
Electronic trigger-based intervention to reduce delays in diagnostic evaluation for cancer: a cluster randomized controlled trial.
J Clin Oncol 2015 Nov 1;33(31):3560-7. doi: 10.1200/jco.2015.61.1301..
Keywords: Cancer: Colorectal Cancer, Cancer: Lung Cancer, Cancer: Prostate Cancer, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT)
Callaghan BC, Kerber KA, Pace RJ
Headache neuroimaging: routine testing when guidelines recommend against them.
The aim of this article was to determine the patient-level factors associated with headache neuroimaging in outpatient practice. It concluded that neuroimaging is routinely ordered in outpatient headache patients including populations where guidelines specifically recommend against their use (migraines, chronic headaches, no red flags).
AHRQ-funded; HS017690.
Citation: Callaghan BC, Kerber KA, Pace RJ .
Headache neuroimaging: routine testing when guidelines recommend against them.
Cephalalgia 2015 Nov;35(13):1144-52. doi: 10.1177/0333102415572918.
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Keywords: Neurological Disorders, Imaging, Decision Making, Guidelines, Diagnostic Safety and Quality
Johnco CJ, Salloum A, Lewin AB
Refining clinical judgment of treatment response and symptom remission identification in childhood anxiety using a signal detection analysis on the pediatric anxiety rating scale.
The purpose of this study was to determine guidelines for delineating treatment response and symptom remission for children with anxiety disorder based on the five item Pediatric Anxiety Rating Scale (PARS5), and replicate guidelines using the six item PARS (PARS6). Optimal prediction of treatment response based on gold standard criteria was achieved at 15-20 percent reduction in symptoms on the PARS5 (with 20 percent reduction achieving marginally higher accuracy), and 20 percent reduction on the PARS6.
AHRQ-funded; HS018665.
Citation: Johnco CJ, Salloum A, Lewin AB .
Refining clinical judgment of treatment response and symptom remission identification in childhood anxiety using a signal detection analysis on the pediatric anxiety rating scale.
J Child Adolesc Psychopharmacol 2015 Nov;25(9):674-83. doi: 10.1089/cap.2015.0102.
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Keywords: Children/Adolescents, Anxiety, Diagnostic Safety and Quality, Guidelines
Murphy DR, Thomas EJ, Meyer AN
Development and validation of electronic health record-based triggers to detect delays in follow-up of abnormal lung imaging findings.
In this study, the researchers developed an electronic health record (EHR)-based trigger algorithm to identify delays in follow-up evaluation of patients with imaging findings suggestive of lung cancer. After validating the trigger with retrospective data, they concluded that EHR-based triggers can be used to identify patients with suspicious imaging findings in whom follow-up diagnostic evaluation was delayed.
AHRQ-funded; HS017820.
Citation: Murphy DR, Thomas EJ, Meyer AN .
Development and validation of electronic health record-based triggers to detect delays in follow-up of abnormal lung imaging findings.
Radiology 2015 Oct;277(1):81-7. doi: 10.1148/radiol.2015142530..
Keywords: Cancer: Lung Cancer, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Imaging
Burns KM, Encinosa WE, Pearson GD
AHRQ Author: Encinosa WE
Electrocardiogram in preparticipation athletic evaluations among insured youths.
The researchers retrospectively characterized electrocardiogram (ECG) use among preparticipation history and examinations (PPEs). They found that thirteen percent of PPEs with ECG and 0.5 percent of PPEs alone led to a cardiology referral. After PPEs with ECG, cardiac disease was identified in 18 percent (2 percent sports-limiting); after PPEs alone, cardiac disease was identified in 0.5 percent (0.03 percent sports-limiting).
AHRQ-authored.
Citation: Burns KM, Encinosa WE, Pearson GD .
Electrocardiogram in preparticipation athletic evaluations among insured youths.
J Pediatr 2015 Oct;167(4):804-09.e1. doi: 10.1016/j.jpeds.2015.06.011..
Keywords: Children/Adolescents, Heart Disease and Health, Cardiovascular Conditions, Diagnostic Safety and Quality
Hidalgo B, Kaphingst KA, Stafford J
Diagnostic accuracy of self-reported racial composition of residential neighborhood.
The purpose of this study was to examine the diagnostic accuracy of self-reported measures of individuals’ perceptions of the racial and ethnic composition of their communities with objective data (i.e., census). It found that respondents who self-identified as white were more likely to self-report racial composition of their neighborhood consistent with 2010 Census estimates.
AHRQ-funded; HS020309.
Citation: Hidalgo B, Kaphingst KA, Stafford J .
Diagnostic accuracy of self-reported racial composition of residential neighborhood.
Ann Epidemiol 2015 Aug;25(8):597-604. doi: 10.1016/j.annepidem.2015.04.003..
Keywords: Diagnostic Safety and Quality, Social Determinants of Health, Racial and Ethnic Minorities
Greenberg JK, Ladner TR, Olsen MA
Validation of an International Classification of Diseases, Ninth Revision Code algorithm for identifying Chiari Malformation type 1 surgery in adults.
The purpose of this study was to validate 2 ICD-9-CM code algorithms identifying patients undergoing CM-1 decompression surgery. It concluded that the ICD-9-CM code Algorithm 2 has excellent positive predictive value and good sensitivity to identify adult CM-1 decompression surgery.
AHRQ-funded; HS019455.
Citation: Greenberg JK, Ladner TR, Olsen MA .
Validation of an International Classification of Diseases, Ninth Revision Code algorithm for identifying Chiari Malformation type 1 surgery in adults.
Neurosurgery 2015 Aug;77(2):269-73. doi: 10.1227/neu.0000000000000778..
Keywords: Data, Diagnostic Safety and Quality, Surgery
Scifres CM, Abebe KZ, Jones KA
Gestational diabetes diagnostic methods (GD2M) pilot randomized trial.
The researchers tested the feasibility of conducting a pragmatic randomized controlled trial (RCT) comparing the International Association of Diabetes in Pregnancy Study Groups (IADPSG) versus Carpenter-Coustan diagnostic criteria for gestational diabetes (GDM), and examined patient and provider views on GDM screening. They found that both pregnant women and providers value GDM screening, and pregnant women can be recruited to a blinded, randomized GDM screening trial with minimal attrition and missing data.
AHRQ-funded; HS019461.
Citation: Scifres CM, Abebe KZ, Jones KA .
Gestational diabetes diagnostic methods (GD2M) pilot randomized trial.
Matern Child Health J 2015 Jul;19(7):1472-80. doi: 10.1007/s10995-014-1651-4..
Keywords: Diabetes, Diagnostic Safety and Quality, Pregnancy, Screening, Women
Eckerle MD, Namde M, Holland CK
Opportunities for earlier HIV diagnosis in a pediatric ED.
The researchers sought to determine whether there were opportunities for earlier HIV diagnosis in the PED for a cohort of young adults diagnosed with HIV. They concluded that there are opportunities for earlier diagnosis of HIV in PEDs, affirming the importance of HIV screening implementation in these settings. However, PEDs are unlikely to have the same frequency of contact with undiagnosed individuals as do adult EDs.
AHRQ-funded; HS021749.
Citation: Eckerle MD, Namde M, Holland CK .
Opportunities for earlier HIV diagnosis in a pediatric ED.
Am J Emerg Med 2015 Jul;33(7):917-9. doi: 10.1016/j.ajem.2015.04.006..
Keywords: Human Immunodeficiency Virus (HIV), Diagnostic Safety and Quality, Screening, Children/Adolescents, Emergency Medical Services (EMS)
Lo Re V, Carbonari DM, Forde KA
Validity of diagnostic codes and laboratory tests of liver dysfunction to identify acute liver failure events.
The researchers examined positive predictive values (PPVs) of hospital ICD-9 diagnoses and laboratory tests of liver dysfunction for identifying acute liver failure (ALF) within a large, community-based integrated care organization. They found that algorithms comprising relevant hospital diagnoses, laboratory evidence of liver dysfunction, and prescriptions for hepatic encephalopathy treatment had low PPVs for confirmed (ALF) events. Studies of ALF will need to rely on medical records to confirm this outcome.
AHRQ-funded; HS018372.
Citation: Lo Re V, Carbonari DM, Forde KA .
Validity of diagnostic codes and laboratory tests of liver dysfunction to identify acute liver failure events.
Pharmacoepidemiol Drug Saf 2015 Jul;24(7):676-83. doi: 10.1002/pds.3774..
Keywords: Diagnostic Safety and Quality, Digestive Disease and Health
Gallego CJ, Shirts BH, Bennette CS
Next-generation sequencing panels for the diagnosis of colorectal cancer and polyposis syndromes: a cost-effectiveness analysis.
The researchers evaluated the cost effectiveness of next-generation sequencing (NGS) panels for the diagnosis of colorectal cancer and polyposis (CRCP) syndromes in patients referred to cancer genetics clinics. They concluded that the use of an NGS panel that includes genes associated with highly penetrant CRCP syndromes in addition to Lynch syndrome genes as a first-line test is likely to provide meaningful clinical benefits in a cost-effective manner.
AHRQ-funded; HS021686.
Citation: Gallego CJ, Shirts BH, Bennette CS .
Next-generation sequencing panels for the diagnosis of colorectal cancer and polyposis syndromes: a cost-effectiveness analysis.
J Clin Oncol 2015 Jun 20;33(18):2084-91. doi: 10.1200/jco.2014.59.3665..
Keywords: Cancer, Cancer: Colorectal Cancer, Decision Making, Diagnostic Safety and Quality, Genetics, Healthcare Costs, Screening
Haney E, Smith ME, McDonagh M
Diagnostic methods for myalgic encephalomyelitis/chronic fatigue syndrome: a systematic review for a National Institutes of Health Pathways to Prevention Workshop.
The purpose of this systematic review was to evaluate and compare studies of methods to diagnose myalgic encephalomyelitis /chronic fatigue syndrome (ME/CFS), identify limitations of current studies, and determine needs for future research. It found that 9 sets of clinical criteria are used to define ME/CFS, yet none of the current diagnostic methods have been adequately tested to identify patients with ME/CFS when diagnostic uncertainty exists.
AHRQ-funded; 290201200014I.
Citation: Haney E, Smith ME, McDonagh M .
Diagnostic methods for myalgic encephalomyelitis/chronic fatigue syndrome: a systematic review for a National Institutes of Health Pathways to Prevention Workshop.
Ann Intern Med 2015 Jun 16;162(12):834-40. doi: 10.7326/m15-0443..
Keywords: Comparative Effectiveness, Diagnostic Safety and Quality, Evidence-Based Practice
Liu Y, Chen Y, Chu H
A unification of models for meta-analysis of diagnostic accuracy studies without a gold standard.
Recently, two models have been proposed to account for imperfect reference test, namely, a multivariate generalized linear mixed model (MGLMM) and a hierarchical summary receiver operating characteristic (HSROC) model. Both models are very flexible in accounting for heterogeneity in accuracies of tests across studies as well as the dependence between tests. In this article, we show that these two models, although with different formulations, are closely related and are equivalent in the absence of study-level covariates.
AHRQ-funded; HS022900; HS020666.
Citation: Liu Y, Chen Y, Chu H .
A unification of models for meta-analysis of diagnostic accuracy studies without a gold standard.
Biometrics 2015 Jun;71(2):538-47. doi: 10.1111/biom.12264..
Keywords: Diagnostic Safety and Quality
Carmody D, Lindauer KL, Naylor RN
Adolescent non-adherence reveals a genetic cause for diabetes.
Glucokinase related maturity-onset diabetes of the young (GCK-MODY) is frequently unrecognized or misdiagnosed as Type 1 or Type 2 diabetes, resulting in unnecessary pharmacologic therapy. The authors recommend considering a genetic cause when evaluating every person with new-onset hyperglycaemia or those with atypical diabetes. Testing costs for the most common MODY causing genes may be offset by savings made in therapeutic costs. They suggest that it is important that all clinicians supervising diabetes care recognize the cardinal features that distinguish GCK-MODY from other forms of diabetes.
AHRQ-funded; HS023007.
Citation: Carmody D, Lindauer KL, Naylor RN .
Adolescent non-adherence reveals a genetic cause for diabetes.
Diabet Med 2015 Jun;32(6):e20-3. doi: 10.1111/dme.12669.
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Keywords: Children/Adolescents, Diabetes, Diagnostic Safety and Quality, Genetics, Medication
Murray DJ, Freeman BD, Boulet JR
Decision making in trauma settings: simulation to improve diagnostic skills.
The objective of this study was to determine whether simulation could be used to provide teams the experiences in managing scenarios that require the use of heuristic as well as analytic diagnostic skills to effectively recognize and treat potentially life-threatening injuries. The results of this preliminary study indicates that teams led by more senior residents received higher scores when managing heuristic scenarios but were less effective when managing the scenarios that require a more analytic approach.
AHRQ-funded; HS018734; HS022265.
Citation: Murray DJ, Freeman BD, Boulet JR .
Decision making in trauma settings: simulation to improve diagnostic skills.
Simul Healthc 2015 Jun;10(3):139-45. doi: 10.1097/sih.0000000000000073..
Keywords: Decision Making, Diagnostic Safety and Quality, Critical Care, Patient Safety, Medical Errors
Wallace ML, Magnan EM, Thorpe CT
Diagnosis and treatment of incident hypertension among patients with diabetes: a U.S. multi-disciplinary group practice observational study.
The researchers aimed to evaluate rates and associations of hypertension diagnosis and treatment among patients with diabetes mellitus and incident hypertension. They found that among patients with diabetes mellitus, even using a cut-point of 140/90 mmHg, approximately 50 percent remained undiagnosed and untreated for hypertension.
AHRQ-funded; HS018368.
Citation: Wallace ML, Magnan EM, Thorpe CT .
Diagnosis and treatment of incident hypertension among patients with diabetes: a U.S. multi-disciplinary group practice observational study.
J Gen Intern Med 2015 Jun;30(6):768-76. doi: 10.1007/s11606-015-3202-0..
Keywords: Blood Pressure, Diabetes, Diagnostic Safety and Quality, Chronic Conditions
Makam AN, Nguyen OK, Auerbach AD
Diagnostic accuracy and effectiveness of automated electronic sepsis alert systems: a systematic review.
This review aimed to determine whether automated real-time electronic sepsis alerts can: (1) accurately identify sepsis and (2) improve process measures and outcomes. It found that automated sepsis alerts derived from electronic health data may improve care processes but tend to have poor positive predictive value and do not improve mortality or length of stay.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Auerbach AD .
Diagnostic accuracy and effectiveness of automated electronic sepsis alert systems: a systematic review.
J Hosp Med 2015 Jun;10(6):396-402. doi: 10.1002/jhm.2347..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Sepsis, Diagnostic Safety and Quality, Patient-Centered Outcomes Research
Chou R, Cuevas C, Fu R
Imaging techniques for the diagnosis of hepatocellular carcinoma: a systematic review and meta-analysis.
This review evaluated the test performance of ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) in the detection of hepatocellular carcinoma (HCC). It concluded that CT and MRI are associated with higher sensitivity than ultrasonography without contrast for detection of HCC. For detection of focal liver lesions, the sensitivities of all three techniques are similar.
AHRQ-funded; 290200710057I
Citation: Chou R, Cuevas C, Fu R .
Imaging techniques for the diagnosis of hepatocellular carcinoma: a systematic review and meta-analysis.
Ann Intern Med. 2015 May 19;162(10):697-711. doi: 10.7326/m14-2509..
Keywords: Cancer, Comparative Effectiveness, Diagnostic Safety and Quality, Imaging