National Healthcare Quality and Disparities Report
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Topics
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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
176 to 200 of 225 Research Studies DisplayedDugas AF, Kirsch TD, Toerper M
An electronic emergency triage system to improve patient distribution by critical outcomes.
This study derives and validates a computer-based electronic triage system (ETS) to improve patient acuity distribution based on serious patient outcomes. The authors found improved differentiation of patients compared to the current standard Emergency Severity Index.
AHRQ-funded; HS023641.
Citation: Dugas AF, Kirsch TD, Toerper M .
An electronic emergency triage system to improve patient distribution by critical outcomes.
J Emerg Med 2016 Jun;50(6):910-8. doi: 10.1016/j.jemermed.2016.02.026.
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Keywords: Care Management, Electronic Health Records (EHRs), Emergency Department, Health Information Technology (HIT), Healthcare Delivery
Chung S, Zhao B, Lauderdale D
Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.
The researchers examined patterns and predictors of initiation of treatment for incident diabetes in an ambulatory care setting in the US. They found that only half of patients were treated during the first year following diabetes incidence, and only 20% of patients received both medication prescription and lifestyle modification interventions.
AHRQ-funded; HS019815.
Citation: Chung S, Zhao B, Lauderdale D .
Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.
Prim Care Diabetes 2015 Feb;9(1):23-30. doi: 10.1016/j.pcd.2014.04.005..
Keywords: Ambulatory Care and Surgery, Care Management, Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Practice Patterns
Jindai K, Sterkel AK, Reed KD
Limb embolism in a 52-year-old woman.
In response to a photo quiz, the authors make the following diagnosis: arterial thrombus caused by Histoplasma capsulatum deriving from native valve endocarditis caused by the same organism. Various aspects of the case are discussed.
AHRQ-funded; HS022465; HS023779.
Citation: Jindai K, Sterkel AK, Reed KD .
Limb embolism in a 52-year-old woman.
Clin Infect Dis 2016 May 15;62(10):1320-1. doi: 10.1093/cid/ciw081.
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Keywords: Blood Clots, Care Management, Case Study, Diagnostic Safety and Quality, Patient Safety
Michelson KA, Monuteaux MC, Neuman MI
Variation and trends in anaphylaxis care in United States children's hospitals.
The authors sought to determine the extent of variation in treatment of children with anaphylaxis. They found that there is substantial variability in the use of common therapies and hospitalization rates for children cared for in U.S. children's hospitals, highlighting the need for research defining optimal care for anaphylaxis.
AHRQ-funded; HS000063.
Citation: Michelson KA, Monuteaux MC, Neuman MI .
Variation and trends in anaphylaxis care in United States children's hospitals.
Acad Emerg Med 2016 May;23(5):623-7. doi: 10.1111/acem.12922.
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Keywords: Children/Adolescents, Emergency Department, Hospitals, Care Management, Hospitalization
Khan MJ, Massad LS, Kinney W
A common clinical dilemma: Management of abnormal vaginal cytology and human papillomavirus test results.
The researchers reviewed the literature on vaginal cytology and high-risk HPV testing and developed guidance for the management of abnormal vaginal screening tests. Since vaginal cancer is rare, the authors suggested that asymptomatic low-risk women not be screened. They further proposed an algorithm based on expert opinion for managing women with abnormal vaginal test results.
AHRQ-funded; HS023009.
Citation: Khan MJ, Massad LS, Kinney W .
A common clinical dilemma: Management of abnormal vaginal cytology and human papillomavirus test results.
J Low Genit Tract Dis 2016 Apr;20(2):119-25. doi: 10.1097/lgt.0000000000000185.
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Keywords: Cancer, Care Management, Infectious Diseases, Sexual Health, Women
Thompson KD, Connor SJ, Walls DM
Patients with ulcerative colitis are more concerned about complications of their disease than side effects of medications.
The survey’s aim was to better understand what aspects of ulcerative colitis (UC) and UC management, are most concerning to patients, and how they would like to be informed about treatment options. It found that most patients (87 percent) wanted to share treatment decision making with their doctors. Patients were most concerned about the risk of colorectal cancer (37 percent), and the possible need for an ileostomy (29 percent).
AHRQ-funded; HS021747.
Citation: Thompson KD, Connor SJ, Walls DM .
Patients with ulcerative colitis are more concerned about complications of their disease than side effects of medications.
Inflamm Bowel Dis 2016 Apr;22(4):940-7. doi: 10.1097/mib.0000000000000740.
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Keywords: Adverse Drug Events (ADE), Cancer, Cancer: Colorectal Cancer, Care Management, Medication
Metersky ML, Eldridge N, Wang Y
AHRQ Author: Eldridge N
Predictors of warfarin-associated adverse events in hospitalized patients: Opportunities to prevent patient harm.
The researchers assessed the relationship between daily versus less frequent international normalized ratio ( INR) monitoring and overanticoagulation and warfarin-related adverse events. They bconcluded that daily INR measurement and recognition of a rapidly rising INR might decrease the frequency of warfarin-associated adverse events in hospitalized patients.
AHRQ-authored; AHRQ-funded; 290201200003C.
Citation: Metersky ML, Eldridge N, Wang Y .
Predictors of warfarin-associated adverse events in hospitalized patients: Opportunities to prevent patient harm.
J Hosp Med 2016 Apr;11(4):276-82. doi: 10.1002/jhm.2528.
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Keywords: Blood Thinners, Care Management, Adverse Drug Events (ADE), Patient Safety, Hospitalization, Prevention
Wernli KJ, Brenner AT, Rutter CM
Risks associated with anesthesia services during colonoscopy.
The researchers aimed to quantify the difference in complications from colonoscopy with vs without anesthesia services. They concluded that the overall risk of complications after colonoscopy increases when individuals receive anesthesia services. The widespread adoption of anesthesia services with colonoscopy should be considered within the context of all potential risks.
AHRQ-funded; HS013853; HS019482.
Citation: Wernli KJ, Brenner AT, Rutter CM .
Risks associated with anesthesia services during colonoscopy.
Gastroenterology 2016 Apr;150(4):888-94. doi: 10.1053/j.gastro.2015.12.018.
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Keywords: Adverse Events, Care Management, Colonoscopy, Disparities, Patient Safety, Risk
Howard HA, Malouin R, Callow-Rucker M
Care managers and knowledge shift in primary care patient-centered medical home transformation.
Based on a health insurance company-sponsored primary care transformation project, this study explores the perceptions of care management from the perspective of providers and practice staff to examine shifts in knowledge and their broader implications for primary care. It demonstrates how the diffusion of clinical power and knowledge production redefine primary care relationships to patients, as traditional hierarchies shift to team-based care.
AHRQ-funded; HS020046; HS01795.
Citation: Howard HA, Malouin R, Callow-Rucker M .
Care managers and knowledge shift in primary care patient-centered medical home transformation.
Hum Organ 2016 Spring;75(1):10-20..
Keywords: Care Management, Patient-Centered Healthcare, Primary Care, Practice Patterns, Teams
Baird J, Rehm RS, Hinds PS
Do you know my child? Continuity of nursing care in the pediatric intensive care unit.
The objective of this analysis was to explore the delivery of continuity of nursing care in the pediatric intensive care unit (PICU), from the perspective of both parents and nurses. Parents repeatedly endorsed a desire for continuity of nursing care, wanting to ensure that the bedside nurse valued their child as an individual and understood the complexities of the child's care regimen.
AHRQ-funded; HS000063.
Citation: Baird J, Rehm RS, Hinds PS .
Do you know my child? Continuity of nursing care in the pediatric intensive care unit.
Nurs Res 2016 Mar-Apr;65(2):142-50. doi: 10.1097/nnr.0000000000000135.
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Keywords: Care Management, Children/Adolescents, Critical Care, Healthcare Delivery, Intensive Care Unit (ICU), Nursing
Pathak RD, Schroeder EB, Seaquist ER
Severe hypoglycemia requiring medical intervention in a large cohort of adults with diabetes receiving care in U.S. integrated health care delivery systems: 2005-2011.
The researchers quantified the burden of severe hypoglycemia requiring medical intervention in a well-defined population of insured individuals receiving care for diabetes . Annual rates of severe hypoglycemia ranged from 1.4 to 1.6 events per 100 person-years. Rates of severe hypoglycemia were higher among those with older age, chronic kidney disease, congestive heart failure, cardiovascular disease, depression, and higher A1C levels.
AHRQ-funded; HS019859.
Citation: Pathak RD, Schroeder EB, Seaquist ER .
Severe hypoglycemia requiring medical intervention in a large cohort of adults with diabetes receiving care in U.S. integrated health care delivery systems: 2005-2011.
Diabetes Care 2016 Mar;39(3):363-70. doi: 10.2337/dc15-0858.
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Keywords: Care Management, Diabetes, Healthcare Delivery, Kidney Disease and Health
Wang SY, Hall J, Pollack CE
Trends in end-of-life cancer care in the Medicare program.
The researchers sought to examine contemporary trends in end-of-life cancer care and geographic variation of end-of-life care aggressiveness among Medicare beneficiaries. They found that the proportion of beneficiaries receiving at least one potentially aggressive end-of-life intervention increased in repeated hospitalization, repeated ED visits, ICU admissions, and late hospice enrollment but declined in in-hospital death. End-of-life chemotherapy use did not change significantly over time. They concluded that despite growing focus on providing appropriate end-of-life care, there has not been an improvement in aggressive end-of-life cancer care in the Medicare program.
AHRQ-funded; HS023900.
Citation: Wang SY, Hall J, Pollack CE .
Trends in end-of-life cancer care in the Medicare program.
J Geriatr Oncol 2016 Mar;7(2):116-25. doi: 10.1016/j.jgo.2015.11.007.
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Keywords: Cancer, Care Management, Elderly, Medicare, Palliative Care, Outcomes, Patient-Centered Outcomes Research, Practice Patterns
O'Donnell AJ, Bogner HR, Cronholm PF
Stakeholder perspectives on changes in hypertension care under the patient-centered medical home.
The researchers investigated changes in hypertension care under patient-centered medical home (PCMH) implementation in a large multipayer PCMH demonstration project that may have led to improvements in hypertension control. They concluded that practices undergoing PCMH transformation may consider stakeholder perspectives about patient-centered, team-based, and systems-based approaches as they work to optimize hypertension care.
AHRQ-funded; HS019150.
Citation: O'Donnell AJ, Bogner HR, Cronholm PF .
Stakeholder perspectives on changes in hypertension care under the patient-centered medical home.
Prev Chronic Dis 2016 Feb 25;13:E28. doi: 10.5888/pcd13.150383.
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Keywords: Care Management, Blood Pressure, Patient-Centered Healthcare, Primary Care
Berliner E
AHRQ Author: Berliner E
Multisociety letter to the Agency for Healthcare Research and Quality: serious methodological flaws plague technology assessment on pain management injection therapies for low back pain.
The recent publication of an AHRQ report on Pain Management Injection Therapies for Low Back Pain has raised significant concerns for physicians who utilize injection procedures to treat patients suffering with pain and functional limitations resulting from spinal pathology. The authors are concerned that the methodology used by the report cannot and does not make such determinations, and that the conclusions may lead to egregious denial of access to these procedures for many patients suffering from low back pain.
AHRQ-authored.
Citation: Berliner E .
Multisociety letter to the Agency for Healthcare Research and Quality: serious methodological flaws plague technology assessment on pain management injection therapies for low back pain.
Pain Med 2016 Jan;17(1):10-15. doi: 10.1111/pme.12934..
Keywords: Back Health and Pain, Care Management, Chronic Conditions, Evidence-Based Practice, Health Services Research (HSR), Pain, Research Methodologies
Stein BN, Pellish RS, Thompson KD
Using therapeutic drug monitoring to identify variable infliximab metabolism in an individual patient with ulcerative colitis.
In this case report, the authors demonstrate how therapeutic drug monitoring can be used to personalize a dosing regimen to ensure appropriate induction, and to safely deescalate therapy after remission is achieved. By identifying a change in drug clearance in an individual patient over time, they were able to attain significant cost savings despite the high price of serially measured drug and antibody concentrations.
AHRQ-funded; HS021747.
Citation: Stein BN, Pellish RS, Thompson KD .
Using therapeutic drug monitoring to identify variable infliximab metabolism in an individual patient with ulcerative colitis.
J Clin Gastroenterol 2016 Jan;50(1):66-8. doi: 10.1097/mcg.0000000000000370.
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Keywords: Care Management, Digestive Disease and Health, Quality of Care, Medication
Michelson KA, Ho T, Pelletier A
A mobile, collaborative, real time task list for inpatient environments.
The researchers created a mobile, collaborative, real-time task list application on the iOS platform. They then described their experience designing and piloting the application with an inpatient pediatric ward team at an academic pediatric hospital. They found that physicians preferred the immediacy and familiarity of paper, and did not experience an efficiency benefit when using the electronic tasklist.
AHRQ-funded; HS000063.
Citation: Michelson KA, Ho T, Pelletier A .
A mobile, collaborative, real time task list for inpatient environments.
Appl Clin Inform 2015 Nov 18;6(4):677-83. doi: 10.4338/aci-2015-05-cr-0050.
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Keywords: Care Management, Communication, Health Information Technology (HIT), Inpatient Care, Health Information Technology (HIT)
Tataris KL, Mercer MP, Govindarajan P
Prehospital aspirin administration for acute coronary syndrome (ACS) in the USA: an EMS quality assessment using the NEMSIS 2011 database.
The researchers sought to determine (1) the proportion of patients with suspected cardiac ischaemia who received aspirin and (2) patient and prehospital characteristics that independently predicted administration of aspirin. Patients living in the Southern region of the USA and patients with governmental (federally administered such as Veteran's Health Care, but not Medicare or Medicaid) insurance had the lowest odds of receiving aspirin.
AHRQ-funded; HS017965.
Citation: Tataris KL, Mercer MP, Govindarajan P .
Prehospital aspirin administration for acute coronary syndrome (ACS) in the USA: an EMS quality assessment using the NEMSIS 2011 database.
Emerg Med J 2015 Nov;32(11):876-81. doi: 10.1136/emermed-2014-204299.
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Keywords: Cardiovascular Conditions, Care Management, Emergency Medical Services (EMS), Heart Disease and Health, Healthcare Delivery, Medication
Jung HY, Trivedi AN, Grabowski DC
Integrated Medicare and Medicaid managed care and rehospitalization of dual eligibles.
The objective of this study was to conduct an early evaluation of an innovative program that coordinates benefits for elderly dual eligibles. The authors found no statistically significant effect of senior care options on rehospitalization. They concluded that coordinating the financing and delivery of services through an integrated managed program may not sufficiently address the problems of inefficiency and fragmentation in care for hospitalized dual eligible enrollees.
AHRQ-funded; HS020756.
Citation: Jung HY, Trivedi AN, Grabowski DC .
Integrated Medicare and Medicaid managed care and rehospitalization of dual eligibles.
Am J Manag Care 2015 Oct;21(10):711-7.
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Keywords: Healthcare Delivery, Care Management, Medicaid, Medicare, Hospital Readmissions
Alexander JA, Markowitz AR, Paustian ML
Implementation of patient-centered medical homes in adult primary care practices.
This study examined the following research questions: Is the level of, and change in, implementation of patient-centered medical home (PCMH) associated with medical surgical cost, preventive services utilization, and quality of care in the following year? Results showed that both level and amount of change are independently and positively associated with measures of quality of care and use of preventive services.
AHRQ-funded; HS019147.
Citation: Alexander JA, Markowitz AR, Paustian ML .
Implementation of patient-centered medical homes in adult primary care practices.
Med Care Res Rev 2015 Aug;72(4):438-67. doi: 10.1177/1077558715579862.
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Keywords: Care Management, Quality of Care, Patient-Centered Healthcare, Primary Care
Erickson KF, Mell M, Winkelmayer WC
Provider visits and early vascular access placement in maintenance hemodialysis.
This study examined whether patients seen more frequently by their nephrologist or advanced practitioner in the first 90 days of hemodialysis were more likely to undergo surgery to create an AV fistula or place an AV graft during that period. It concluded that patients seen more frequently by care providers in the first 90 days of hemodialysis undergo earlier AV fistula creation or graft placement.
AHRQ-funded; HS019178.
Citation: Erickson KF, Mell M, Winkelmayer WC .
Provider visits and early vascular access placement in maintenance hemodialysis.
J Am Soc Nephrol 2015 Aug;26(8):1990-7. doi: 10.1681/asn.2014050464..
Keywords: Care Management, Kidney Disease and Health, Healthcare Utilization, Outcomes
Magnan EM, Palta M, Pandhi N
The relationship of individual comorbid chronic conditions to diabetes care quality.
The aim of this study was to determine which chronic conditions were related to lack of achievement or achievement of diabetes care quality goals to determine potential targets for future interventions. It found that 62 chronic conditions varied in their relationships to diabetes care goal achievement for specific care goals. For example, congestive heart failure was related to lack of achievement of cholesterol management goals.
AHRQ-funded; HS018368; HS021899.
Citation: Magnan EM, Palta M, Pandhi N .
The relationship of individual comorbid chronic conditions to diabetes care quality.
BMJ Open Diabetes Res Care 2015 Jul 23;3(1):e000080. doi: 10.1136/bmjdrc-2015-000080..
Keywords: Care Management, Chronic Conditions, Diabetes, Quality of Care
Van Cleave J, Boudreau AA, McAllister J
Care coordination over time in medical homes for children with special health care needs.
This study explored how care coordination changes conceptually and practically in primary care practices when implementing the medical home and to identify reasons for different types of changes. They found that in high-performing medical homes, care coordination activities changed from being mostly reactive to patients’ episodic needs to being more systematically proactive and comprehensive.
AHRQ-funded; HS019157.
Citation: Van Cleave J, Boudreau AA, McAllister J .
Care coordination over time in medical homes for children with special health care needs.
Pediatrics 2015 Jun;135(6):1018-26. doi: 10.1542/peds.2014-1067..
Keywords: Care Coordination, Care Management, Patient-Centered Healthcare, Primary Care
Hartley KA, Miller CS, Gephart SM
Facilitated tucking to reduce pain in neonates: evidence for best practice.
The researchers investigated the effect of facilitated tucking on pain behaviors in those who received the intervention compared with those who did not, and what alternative interventions for nonpharmacologic pain reduction are supported by strong research evidence? Their review demonstrated that facilitated tucking reduces the expression of pain in premature infants.
AHRQ-funded; HS022908.
Citation: Hartley KA, Miller CS, Gephart SM .
Facilitated tucking to reduce pain in neonates: evidence for best practice.
Adv Neonatal Care 2015 Jun;15(3):201-8. doi: 10.1097/anc.0000000000000193..
Keywords: Care Management, Evidence-Based Practice, Newborns/Infants, Pain
Juckett DA, Davis FN, Gostine M
Patient-reported outcomes in a large community-based pain medicine practice: evaluation for use in phenotype modeling.
The researchers aimed to build a phenotype-to-outcome model targeting chronic pain to be used to drive clinical decision support for pain medicine in the community setting. Exploratory factor analysis of the intake Pain Health Assessment revealed 15 orthogonal factors representing pain levels; physical, social, and emotional functions; the effects of pain on these functions; vitality and health; and measures of outcomes and satisfaction.
AHRQ-funded; HS022335.
Citation: Juckett DA, Davis FN, Gostine M .
Patient-reported outcomes in a large community-based pain medicine practice: evaluation for use in phenotype modeling.
BMC Med Inform Decis Mak 2015 May 28;15:41. doi: 10.1186/s12911-015-0164-4..
Keywords: Care Management, Chronic Conditions, Community-Based Practice, Electronic Health Records (EHRs), Health Information Technology (HIT), Outcomes, Pain
Annis AM, Holtrop JS, Tao M
Comparison of provider and plan-based targeting strategies for disease management.
The researchers described and contrasted the targeting methods and engagement outcomes for health plan-delivered disease management with those of a provider-delivered care management program. They concluded that both provide advantages and that an optimal model may be to combine the strengths of each approach to maximize benefits in care management.
AHRQ-funded; HS020108.
Citation: Annis AM, Holtrop JS, Tao M .
Comparison of provider and plan-based targeting strategies for disease management.
Am J Manag Care 2015 May;21(5):344-51.
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Keywords: Care Management, Primary Care, Health Insurance, Healthcare Delivery