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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
251 to 275 of 305 Research Studies DisplayedDesRoches CM, Wong HS, Rich EC
AHRQ Author: Wong HS
Making the case for a new national data collection effort on physicians and their practices.
The pace of change in the U.S. health care system and the integral role played by physicians indicate a clear need for an ongoing, regular physician survey. The authors argue that the survey be designed to monitor over time the characteristics of all physicians in all specialties and the clinical, organizational, and financial contexts in which they operate.
AHRQ-authored
Citation: DesRoches CM, Wong HS, Rich EC .
Making the case for a new national data collection effort on physicians and their practices.
J Gen Intern Med 2015 Aug;30 Suppl 3:S553-4. doi: 10.1007/s11606-015-3386-3..
Keywords: Data, Practice Patterns, Provider, Provider: Physician
Fleming C, Rich E, DesRoches C
Measuring changes in the economics of medical practice.
This paper explores current issues relevant to defining and measuring the inputs and outputs of physician practice. It reviews practice inputs and outputs as typically described in the literature on the economics of medical practice, and identifies the conceptual challenges for defining these inputs and outputs in a complex and evolving health care system.
AHRQ-funded; 23320095642WC; 23337033T.
Citation: Fleming C, Rich E, DesRoches C .
Measuring changes in the economics of medical practice.
J Gen Intern Med 2015 Aug;30 Suppl 3:S562-7. doi: 10.1007/s11606-015-3368-5..
Keywords: Healthcare Delivery, Health Systems, Practice Patterns, Data
Converse L, Barrett K, Rich E
Methods of observing variations in physicians' decisions: the opportunities of clinical vignettes.
This review described various methods for measuring variations in physicians’ decisions and highlight a range of design features researchers should consider when developing a clinical vignette survey. It concluded by identifying areas for future research.
AHRQ-funded; 23320095642WC; 23337033T.
Citation: Converse L, Barrett K, Rich E .
Methods of observing variations in physicians' decisions: the opportunities of clinical vignettes.
J Gen Intern Med 2015 Aug;30 Suppl 3:S586-94. doi: 10.1007/s11606-015-3365-8..
Keywords: Decision Making, Evidence-Based Practice, Practice Patterns
Ray KN, Demirci JR, Bogen DL
Optimizing telehealth strategies for subspecialty care: recommendations from rural pediatricians.
The authors elicited rural pediatrician experiences and preferences regarding different pediatric subspecialty telehealth strategies. Rural pediatricians from 17 states described complementary roles for different subspecialty care telehealth strategies. Additionally, rural pediatricians, through semistructured telephone interviews, provided recommendations for optimizing individual telehealth strategies.
AHRQ-funded; HS022989.
Citation: Ray KN, Demirci JR, Bogen DL .
Optimizing telehealth strategies for subspecialty care: recommendations from rural pediatricians.
Telemed J E Health 2015 Aug;21(8):622-9. doi: 10.1089/tmj.2014.0186.
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Keywords: Children/Adolescents, Children/Adolescents, Practice Patterns, Rural Health, Telehealth
Bauer NS, Carroll AE, Saha C
Computer decision support changes physician practice but not knowledge regarding autism spectrum disorders.
This study examined whether adding an autism module promoting adherence to clinical guidelines to an existing computer decision support system (CDSS) changed physician knowledge and self-reported clinical practice. It found that a CDSS module to improve primary care management of ASD in pediatric practice led to significant improvements in physician-reported use of validated screening tools to screen for ASDs.
AHRQ-funded; HS018453.
Citation: Bauer NS, Carroll AE, Saha C .
Computer decision support changes physician practice but not knowledge regarding autism spectrum disorders.
Appl Clin Inform 2015;6(3):454-65. doi: 10.4338/aci-2014-09-ra-0084.
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Keywords: Health Information Technology (HIT), Practice Patterns, Clinical Decision Support (CDS), Children/Adolescents, Autism
Williams DJ, Edwards KM, Self WH
Antibiotic choice for children hospitalized with pneumonia and adherence to national guidelines.
The 2011 national guidelines for the management of childhood community-acquired pneumonia (CAP) recommended narrow-spectrum antibiotics (e.g., ampicillin) for most children hospitalized with CAP. The researchers assessed the impact of these guidelines on antibiotic prescribing at 3 children’s hospitals. They found that, after publication of national guidelines, third-generation cephalosporin use declined and penicillin/ampicillin use increased among children hospitalized with CAP.
AHRQ-authored; HS022342.
Citation: Williams DJ, Edwards KM, Self WH .
Antibiotic choice for children hospitalized with pneumonia and adherence to national guidelines.
Pediatrics 2015 Jul;136(1):44-52. doi: 10.1542/peds.2014-3047..
Keywords: Children/Adolescents, Hospitalization, Guidelines, Medication, Practice Patterns
Tjia J, Field T, Mazor K
Dissemination of evidence-based antipsychotic prescribing guidelines to nursing homes: a cluster randomized trial.
This study evaluated the effectiveness of efforts to translate and disseminate evidence-based guidelines about atypical antipsychotic use to nursing homes (NHs). It found that RE-AIM indicators suggest some success in disseminating the toolkit and differences in reach, adoption, and implementation according to dissemination strategy but no measurable effect on antipsychotic prescribing trends.
AHRQ-funded; HS019351.
Citation: Tjia J, Field T, Mazor K .
Dissemination of evidence-based antipsychotic prescribing guidelines to nursing homes: a cluster randomized trial.
J Am Geriatr Soc 2015 Jul;63(7):1289-98. doi: 10.1111/jgs.13488..
Keywords: Communication, Evidence-Based Practice, Guidelines, Long-Term Care, Medication, Nursing Homes, Practice Patterns, Tools & Toolkits, Implementation
Andrews SE, Alston MJ, Allshouse AA
Does the number of forceps deliveries performed in residency predict use in practice?
The researchers aimed to determine whether a threshold number of forceps deliveries in residency predicts use of forceps in independent practice. They concluded that, although exceeding 13 forceps deliveries made it highly likely that obstetricians would use them in practice, further study is necessary to set goals for a number of resident forceps deliveries that translate into use in practice.
AHRQ-funded; HS022143.
Citation: Andrews SE, Alston MJ, Allshouse AA .
Does the number of forceps deliveries performed in residency predict use in practice?
Am J Obstet Gynecol 2015 Jul;213(1):93.e1-4. doi: 10.1016/j.ajog.2015.03.025..
Keywords: Labor and Delivery, Patient-Centered Outcomes Research, Practice Patterns, Training, Women
Krell RW, Reames BN, Hendren S
Surgical referral for colorectal liver metastases: a population-based survey.
The researchers sought to understand medical oncologists’ perspectives on referral for colorectal liver metastases (CLM). They found wide variation in surgical referral patterns for CLM. Many felt that bilobar disease and tumor size were contraindications to liver-directed therapy despite a lack of supporting data.
AHRQ-funded; HS020937.
Citation: Krell RW, Reames BN, Hendren S .
Surgical referral for colorectal liver metastases: a population-based survey.
Ann Surg Oncol 2015 Jul;22(7):2179-94. doi: 10.1245/s10434-014-4318-x..
Keywords: Cancer, Surgery, Guidelines, Practice Patterns
Smith RJ, Kilaru AS, Perrone J
How, why, and for whom do emergency medicine providers use prescription drug monitoring programs?
The authors examined how emergency physicians use Prescription Drug Monitoring Programs (PDMPs), for which patients, and for what reasons. They found that providers use the information in PDMPs to alter clinical decisions and guide opioid prescribing patterns. Physicians used the databases additionally for improving their ability to facilitate discussions on addiction and for providing patient education. The authors recommended minimizing administrative barriers to PDMP access and suggested that alternative PDMP uses be further studied to determine their appropriateness and potentially expand their role in clinical practice.
AHRQ-funded; HS021956.
Citation: Smith RJ, Kilaru AS, Perrone J .
How, why, and for whom do emergency medicine providers use prescription drug monitoring programs?
Pain Med 2015 Jun;16(6):1122-31. doi: 10.1111/pme.12700.
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Keywords: Decision Making, Emergency Medical Services (EMS), Medication, Practice Patterns, Substance Abuse
Sorkin DH, Billimek J, August KJ
AHRQ Author: Ngo-Metzger Q
Mental health symptoms and patient-reported diabetes symptom burden: implications for medication regimen changes.
The aim of this paper was to examine the relative contribution of glycaemic control (HbA1C) and depressive symptoms on diabetes-related symptom burden (hypoglycaemia and hyperglycaemia) in order to guide medication modification. The authors found that mental health symptoms are associated with higher levels of patient-reported diabetes-related symptoms, but the association between diabetes-related symptoms and subsequent regimen modifications is diminished in patients with greater depressive symptoms.
AHRQ-authored.
Citation: Sorkin DH, Billimek J, August KJ .
Mental health symptoms and patient-reported diabetes symptom burden: implications for medication regimen changes.
Fam Pract 2015 Jun;32(3):317-22. doi: 10.1093/fampra/cmv014.
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Keywords: Depression, Diabetes, Medication, Practice Patterns, Social Determinants of Health
Dinan MA, Mi X, Reed SD
Initial trends in the use of the 21-gene recurrence score assay for patients with breast cancer in the Medicare population, 2005-2009.
The researchers examined trends in the use of the 21-gene recurrence score (RS) assay in routine clinical practice in a nationally representative sample of women with breast cancer. They found that the RS assay was adopted quickly in clinical practice after the Medicare coverage decision in 2006, and use appears to be consistent with guidelines and equitable across geographic and racial groups.
AHRQ-funded; HS022189.
Citation: Dinan MA, Mi X, Reed SD .
Initial trends in the use of the 21-gene recurrence score assay for patients with breast cancer in the Medicare population, 2005-2009.
JAMA Oncol 2015 May;1(2):158-66. doi: 10.1001/jamaoncol.2015.43..
Keywords: Cancer, Cancer: Breast Cancer, Genetics, Guidelines, Medicare, Practice Patterns, Women
De Martino RR, Hoel AW, Beck AW
Participation in the Vascular Quality Initiative is associated with improved perioperative medication use, which is associated with longer patient survival.
The researchers analyzed the effect of Vascular Quality Initiative (VQI) participation on perioperative (preoperative and postoperative) medical management (MM) use over time and the effect of discharge MM on patient survival. They demonstrated that MM is associated with improved survival after a number of vascular procedures, and that VQI participation improves the use of MM, demonstrating that involvement in an organized quality effort can affect patient outcomes.
AHRQ-funded; HS021581.
Citation: De Martino RR, Hoel AW, Beck AW .
Participation in the Vascular Quality Initiative is associated with improved perioperative medication use, which is associated with longer patient survival.
J Vasc Surg 2015 Apr;61(4):1010-9. doi: 10.1016/j.jvs.2014.11.073.
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Keywords: Medication, Quality Improvement, Patient-Centered Outcomes Research, Practice Patterns
Martin BI, Lurie JD, Tosteson AN
Use of bone morphogenetic protein among patients undergoing fusion for degenerative diagnoses in the United States, 2002 to 2012.
The authors examined whether published concerns about the safety of bone morphogenetic protein (BMP) altered clinical practice. They found that use of BMP in spinal fusion surgery declined subsequent to published safety concerns and revelations of financial conflicts of interest for investigators involved in the pivotal clinical trials.
AHRQ-funded; HS021695.
Citation: Martin BI, Lurie JD, Tosteson AN .
Use of bone morphogenetic protein among patients undergoing fusion for degenerative diagnoses in the United States, 2002 to 2012.
Spine J 2015 Apr;15(4):692-9. doi: 10.1016/j.spinee.2014.12.010.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Patient Safety, Patient-Centered Outcomes Research, Practice Patterns, Surgery
Magnan EM, Gittelson R, Bartels CM
Establishing chronic condition concordance and discordance with diabetes: a Delphi study.
This study aimed to provide more information for the future research and clinical use of the concordant/discordant framework by increasing the number of conditions that can be characterized as concordant or discordant with diabetes. By finding that 12 conditions were concordant with diabetes care and 50 were discordant, the study significantly adds to the number of conditions for which there is information on concordance and discordance for diabetes care.
AHRQ-funded; HS018368; HS007646; HS021899.
Citation: Magnan EM, Gittelson R, Bartels CM .
Establishing chronic condition concordance and discordance with diabetes: a Delphi study.
BMC Fam Pract 2015 Mar 28;16:42. doi: 10.1186/s12875-015-0253-6..
Keywords: Chronic Conditions, Diabetes, Primary Care, Practice Patterns
Hersh AL, Gerber JS, Hicks LA
Lessons learned in antibiotic stewardship: fluoroquinolone use in pediatrics.
For adults, fluoroquinolones are the leading class of antibiotics prescribed in ambulatory care visits, whereas, in children, they are the least frequently prescribed class. This paper highlights the impact of physicians' perception of direct patient harm in antibiotic decision making which has implications for antibiotic stewardship.
AHRQ-funded; HS020921.
Citation: Hersh AL, Gerber JS, Hicks LA .
Lessons learned in antibiotic stewardship: fluoroquinolone use in pediatrics.
J Pediatric Infect Dis Soc 2015 Mar;4(1):57-9. doi: 10.1093/jpids/piu044.
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Keywords: Antibiotics, Children/Adolescents, Medication, Children/Adolescents, Practice Patterns
Hendrix KS, Downs SM, Carroll AE
Pediatricians' responses to printed clinical reminders: does highlighting prompts improve responsiveness?
The authors tested whether selectively highlighting clinical decision support prompts in yellow would improve physicians' responsiveness. They found that highlighting reminder prompts did not increase physicians' responsiveness. They suggested possible explanations and offer alternative strategies to increasing physician responsiveness to prompts.
AHRQ-funded; HS020640; HS018453; HS017939.
Citation: Hendrix KS, Downs SM, Carroll AE .
Pediatricians' responses to printed clinical reminders: does highlighting prompts improve responsiveness?
Acad Pediatr 2015 Mar-Apr;15(2):158-64. doi: 10.1016/j.acap.2014.10.009.
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Keywords: Clinical Decision Support (CDS), Children/Adolescents, Primary Care, Practice Patterns, Quality Improvement
Dauw CA, Alruwaily AF, Bierlein MJ
Provider variation in the quality of metabolic stone management.
The researchers quantified the degree of variation in repeat 24-hour urine testing attributable to providers and assessed differences in repeat testing rates between specialist and primary care physicians. They found, that, while most variation in follow-up testing was attributable to the patient, the provider contribution was nontrivial (18 percent). The specialty of the ordering provider was also important.
AHRQ-funded; HS020927.
Citation: Dauw CA, Alruwaily AF, Bierlein MJ .
Provider variation in the quality of metabolic stone management.
J Urol 2015 Mar;193(3):885-90. doi: 10.1016/j.juro.2014.09.111..
Keywords: Care Management, Chronic Conditions, Practice Patterns
Schroeder MC, Robinson JG, Chapman CG
Use of statins by Medicare beneficiaries post myocardial infarction: poor physician quality or patient-centered care?
This study assessed whether patterns of statin use by Medicare beneficiaries post-discharge may be due to a mix of high-quality and low-quality physicians. It found that the distribution of statin fill rates across physicians was normal, with no clear distinctions in physician quality. Physicians, especially cardiologists, with relatively younger and healthier patient populations had higher rates of statin use.
AHRQ-funded; HS019574.
Citation: Schroeder MC, Robinson JG, Chapman CG .
Use of statins by Medicare beneficiaries post myocardial infarction: poor physician quality or patient-centered care?
Inquiry 2015 Feb 27;52. doi: 10.1177/0046958015571131..
Keywords: Care Management, Medication, Heart Disease and Health, Medicare, Patient-Centered Healthcare, Practice Patterns
Linder JA
Sore throat: avoid overcomplicating the uncomplicated.
In this editorial, the author described issues involving sore throat diagnosis and delineated various points concerning an article within the same journal issue, concluding that physicians should remember that the prevalence of group A streptococcus in adults with a sore throat is approximately 10%; and that they should use the Centor scoring criteria; selectively use rapid antigen-detection testing; limit antibiotic treatment to patients most likely to have group A streptococcus; and most of the time when prescribing antibiotics, use penicillin.
AHRQ-funded; HS018419.
Citation: Linder JA .
Sore throat: avoid overcomplicating the uncomplicated.
Ann Intern Med 2015 Feb 17;162(4):311-2. doi: 10.7326/m14-2899.
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Keywords: Antibiotics, Diagnostic Safety and Quality, Infectious Diseases, Medication, Pneumonia, Respiratory Conditions, Practice Patterns
Bobo WV, Reilly-Harrington NA, Ketter TA
Complexity of illness and adjunctive benzodiazepine use in outpatients with bipolar I or II disorder: results from the Bipolar CHOICE study.
This study examined patient- and illness-related factors associated with benzodiazepine use among patients with bipolar I or II disorder enrolled in the Bipolar CHOICE study. It found that higher anxiety symptom level, higher number of non–benzodiazepine psychotropic medications, lamotrigine use, college education, and high household income were significant and independent predictors of benzodiazepine use.
AHRQ-funded; HS019371.
Citation: Bobo WV, Reilly-Harrington NA, Ketter TA .
Complexity of illness and adjunctive benzodiazepine use in outpatients with bipolar I or II disorder: results from the Bipolar CHOICE study.
J Clin Psychopharmacol 2015 Feb;35(1):68-74. doi: 10.1097/jcp.0000000000000257..
Keywords: Medication, Behavioral Health, Practice Patterns
Hollingsworth JM, Funk RJ, Garrison SA
Differences between physician social networks for cardiac surgery serving communities with high versus low proportions of black residents.
The researchers examined physician social networks, where individual physicians are tied together by a series of shared patients. They mapped these networks using medical claims data from the Medicare program and found substantial differences between physician social networks formed around CABG procedures serving health services areas with high and low proportions of black residents. Their conclusion was that physicians serving these communities are more isolated.
AHRQ-funded; HS020927.
Citation: Hollingsworth JM, Funk RJ, Garrison SA .
Differences between physician social networks for cardiac surgery serving communities with high versus low proportions of black residents.
Med Care 2015 Feb;53(2):160-7. doi: 10.1097/mlr.0000000000000291..
Keywords: Practice Patterns, Surgery, Heart Disease and Health, Medicare
Ayers DC, Li W, Harrold L
Preoperative pain and function profiles reflect consistent TKA patient selection among US surgeons.
This study compared early data from a recently established US national total knee arthroplasty (TKA) cohort including patients from 123 surgeons in 22 states to evaluate preoperative variability in patient selection across surgeons. Their findings suggest that no clinical difference could be detected in the median (typical) patient across all sites.
AHRQ-funded; HS018910.
Citation: Ayers DC, Li W, Harrold L .
Preoperative pain and function profiles reflect consistent TKA patient selection among US surgeons.
Clin Orthop Relat Res 2015 Jan;473(1):76-81. doi: 10.1007/s11999-014-3716-5..
Keywords: Surgery, Pain, Healthcare Utilization, Practice Patterns
White AA, Brock DM, McCotter PI
Risk managers' descriptions of programs to support second victims after adverse events.
The researchers surveyed US members of the American Society for Healthcare Risk Management about the presence, features, and perceived efficacy of their organization’s provider support program. The majority reported that their organization had a support program, but features varied widely and there are substantial opportunities to improve services.
AHRQ-funded; HS019531.
Citation: White AA, Brock DM, McCotter PI .
Risk managers' descriptions of programs to support second victims after adverse events.
J Healthc Risk Manag 2015;34(4):30-40. doi: 10.1002/jhrm.21169..
Keywords: Adverse Events, Patient Safety, Medical Errors, Practice Patterns
McCullagh LJ, Sofianou A, Kannry J
User centered clinical decision support tools: adoption across clinician training level.
This study examined the differences in adoption of CDS tools across providers’ training level. It found that the completion rates of the CDS calculator and medication order sets were higher among first year residents compared to all other training levels. Attending physicians were the less likely to accept the initial step of the CDS tool (29.3 percent) or complete the medication order sets (22.4 percent) that guided their prescription decisions.
AHRQ-funded; HS018491.
Citation: McCullagh LJ, Sofianou A, Kannry J .
User centered clinical decision support tools: adoption across clinician training level.
Appl Clin Inform 2014 Dec 17;5(4):1015-25. doi: 10.4338/aci-2014-05-ra-0048.
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Keywords: Clinical Decision Support (CDS), Decision Making, Practice Patterns