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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
1 to 25 of 469 Research Studies DisplayedHenderson JT, Webber EM, Weyrich MS
Screening for breast cancer: evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this study was to review research on various breast cancer screening strategies for the US Preventive Services Task Force. The researchers analyzed randomized clinical trials and nonrandomized studies, focusing on different screening approaches and their associated outcomes. The review encompassed seven randomized clinical trials and 13 nonrandomized studies, with only two nonrandomized studies reporting mortality outcomes. A nonrandomized trial emulation study found no significant mortality difference for screening beyond age 74 years. Advanced cancer detection rates were similar for annual and biennial screening intervals in a nonrandomized study. Three trials comparing digital breast tomosynthesis (DBT) mammography screening with digital mammography alone showed that DBT detected more invasive cancers at the first screening round, but there were no significant differences in interval cancers or risk of advanced cancer at subsequent screenings. Limited evidence suggested lower recall rates with DBT. For individuals with dense breasts, supplemental screening with magnetic resonance imaging reduced interval cancer risk but increased false-positive recalls and biopsies. Supplemental ultrasound screening showed no differences in interval cancers but increased false-positives.
AHRQ-funded; 75Q80120D00004.
Citation: Henderson JT, Webber EM, Weyrich MS .
Screening for breast cancer: evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2024 Jun 11; 331(22):1931-46. doi: 10.1001/jama.2023.25844..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Breast Cancer, Women, Screening, Evidence-Based Practice, Guidelines, Prevention, Cancer
Campbell KA, Sternberg SB, Benneyan J
Completion rates and timeliness of diagnostic colonoscopies for rectal bleeding in primary care.
This study looked at the completion rates and timeliness of diagnostic colonoscopies for rectal bleeding in primary care, as rectal bleeding is usually the most common presenting symptom of colorectal cancer. This retrospective cohort study was a medical record review of patients aged ≥ 40 with index diagnosis of rectal bleeding at 2 primary practices-an urban academic practice and affiliated community health center-between January 1, 2018, and December 31, 2020. Primary outcomes were percentages of patient cases classified as having completed recommended follow-up workup ("closed loop") vs. not ("open loop"). A total of 837 patients had been coded with rectal bleeding, with 67 excluded leaving 770 patients included. A total of 172 patients (22.3%) failed to undergo timely recommended workup. Reasons for a failed timely workup included the majority not having a procedure ordered, or the procedure was ordered but never scheduled or cancelled and not kept.
AHRQ-funded; HS027282.
Citation: Campbell KA, Sternberg SB, Benneyan J .
Completion rates and timeliness of diagnostic colonoscopies for rectal bleeding in primary care.
J Gen Intern Med 2024 May; 39(6):985-91. doi: 10.1007/s11606-023-08513-9..
Keywords: Diagnostic Safety and Quality, Screening, Cancer: Colorectal Cancer, Primary Care, Prevention, Cancer
Clifton RL, Carson I, Dir AL
Who gets screened and who tests positive? Drug screening among justice-involved youth in a midwestern urban county.
A study of justice-involved youth assigned to probation in a midwestern urban county examined factors influencing drug screening (DS) practices. Results showed that males were more likely to be screened and to test positive than females. Older youth were less likely to be screened, while a higher number of charges increased the likelihood of screening. Youth with violent offenses were more likely to be screened than those with other offenses but less likely to test positive. These findings suggest that DS decisions are influenced by various factors, including demographics and offense types. However, these factors may not always correlate with actual substance use, raising questions about the appropriateness of using demographic or charge-based criteria for determining who gets screened.
AHRQ-funded; HS022681.
Citation: Clifton RL, Carson I, Dir AL .
Who gets screened and who tests positive? Drug screening among justice-involved youth in a midwestern urban county.
Health Justice 2024 Apr 5; 12(1):13. doi: 10.1186/s40352-024-00273-w..
Keywords: Children/Adolescents, Substance Abuse, Screening, Urban Health
Bouchelle Z, Menko SG, Yazdani M
Parent perspectives on documentation and sharing of health-related social needs data.
This survey aimed to examine parents of pediatric patients’ preferences regarding how health-related social needs (HRSN) screening program data are documented and shared. The authors conducted semi-structured interviews with parents of hospitalized children participating in an HRSN screening program at a quaternary care children's hospital. Interviews were then coded to identify emergent themes. A total of 20 parents were interviewed with all being female, 55% identifying as Black or African American and 20% identifying as Hispanic or Latino. Parents expressed comfort with electronic health record documentation of HRSN data and the use of ICD-10 Revision Z codes as long as this information was used to provide families with meaningful support. Most parents viewed social workers and medical teams as being the most appropriate recipients of the data, with few parents feeling comfortable with HRSN data being shared with payors. Parents wanted transparency around HRSN data sharing, with many expressing concerns that documentation and sharing of HRSN data could lead to unwanted or unsafe disclosures or result in child welfare referrals.
AHRQ-funded; HS028555.
Citation: Bouchelle Z, Menko SG, Yazdani M .
Parent perspectives on documentation and sharing of health-related social needs data.
Hosp Pediatr 2024 Apr; 14(4):308-16. doi: 10.1542/hpeds.2023-007478..
Keywords: Children/Adolescents, Screening, Electronic Health Records (EHRs), Health Information Technology (HIT)
Marcotte LM, Langevin R, Hempstead BR
Leveraging human-centered design and causal pathway diagramming toward enhanced specification and development of innovative implementation strategies: a case example of an outreach tool to address racial inequities in breast cancer screening.
This study’s goal was to describe an approach that combines community-engaged methods, human-centered design (HCD) methods, and causal pathway diagramming (CPD) - a tool to map an implementation strategy as it is intended to work - to develop innovative implementation strategies. The authors used a case example of developing a conversational agent or chatbot to address racial inequities in breast cancer screening via mammography. With an interdisciplinary team including community members and operational leaders, they conducted a rapid evidence review and elicited qualitative data through interviews and focus groups using HCD methods to identify and prioritize key determinants (facilitators and barriers) of the evidence-based intervention (breast cancer screening) and the implementation strategy (chatbot). They identified key determinants for breast cancer screening and for the chatbot implementation strategy. They found that mistrust was a key barrier to both completing breast cancer screening and using the chatbot. They focused design for the initial chatbot interaction to engender trust and developed a CPD to guide chatbot development. They used the persuasive health message framework and conceptual frameworks about trust from marketing and artificial intelligence disciplines. They developed a CPD for the initial interaction with the chatbot with engagement as a mechanism to use and trust as a proximal outcome leading to further engagement with the chatbot.
AHRQ-funded; HS026369.
Citation: Marcotte LM, Langevin R, Hempstead BR .
Leveraging human-centered design and causal pathway diagramming toward enhanced specification and development of innovative implementation strategies: a case example of an outreach tool to address racial inequities in breast cancer screening.
Implement Sci Commun 2024 Mar 28; 5(1):31. doi: 10.1186/s43058-024-00569-w..
Keywords: Racial and Ethnic Minorities, Cancer: Breast Cancer, Cancer, Screening, Disparities
Bradford W, Akselrod H, Bassler J
Hospitalization is a missed opportunity for HIV screening, pre-exposure prophylaxis, and treatment.
This multisite, retrospective cohort study of hospitalized patients with opioid use disorder with infectious complications of injection drug use looked at rates of HIV screening, pre-exposure prophylaxis, and treatment among these patients. The authors included 322 patients, with most (300) now known to have HIV. Of those, only 2 had a documented discussion of PrEP, while only 1 was prescribed PrEP on discharge. Among the 22 people with HIV (PWH), only 13 had a viral load collected during admission of whom all were viremic and 10 were successfully linked to care post-discharge. Both groups had high rates of readmission, Medicaid or uninsured status, and unstable housing.
AHRQ-funded; HS013852.
Citation: Bradford W, Akselrod H, Bassler J .
Hospitalization is a missed opportunity for HIV screening, pre-exposure prophylaxis, and treatment.
Addict Sci Clin Pract 2024 Mar 26; 19(1):22. doi: 10.1186/s13722-024-00451-z..
Keywords: Human Immunodeficiency Virus (HIV), Screening, Prevention, Inpatient Care
Bhalla S, Natchimuthu V, Lee JL
Effect of patient navigation on completion of lung cancer screening in vulnerable populations.
A randomized controlled trial in an urban safety-net healthcare system evaluated the effectiveness of telephone-based navigation for low-dose CT lung cancer screening (LCS). The study found no significant difference in the completion of the first three consecutive LCS steps between patients receiving navigation and those in usual care. However, when LCS steps were ordered, patients who received navigation demonstrated higher completion rates. Notably, the lack of order placement emerged as a key factor contributing to incomplete LCS steps. Based on these findings, researchers suggest that a combination of clinical team education, streamlined order placement processes, and patient navigation may be effective strategies for improving LCS uptake and completion in safety-net settings.
AHRQ-funded; HS022418.
Citation: Bhalla S, Natchimuthu V, Lee JL .
Effect of patient navigation on completion of lung cancer screening in vulnerable populations.
J Natl Compr Canc Netw 2024 Mar 15; 22(3):151-57. doi: 10.6004/jnccn.2023.7094..
Keywords: Cancer: Lung Cancer, Cancer, Vulnerable Populations, Screening, Patient-Centered Healthcare, Patient and Family Engagement
Harris S, Ching SJ, Agarwal R
AHRQ Author: Harris S
Screening and preventive interventions for oral health in children, adolescents, and adults.
This case study and quiz explores the U.S. Preventive Services Task Force (USPSTF) recommendations for oral health screenings in primary care settings. The case presents a scenario of a father and child who have lost dental insurance and experienced dietary changes, prompting the question of whether the primary care physician should screen them for oral health conditions. The USPSTF concludes there is insufficient evidence to recommend for or against oral health screening in asymptomatic adults and children over five in primary care, emphasizing the need for clinical judgment in such cases. The quiz further highlights that the USPSTF recommendations cover dental caries in children and adolescents (5-17 years old) and both dental caries and periodontal disease in adults (18+ years old). Additionally, tobacco use is identified as a risk factor for oral health conditions in adults.
AHRQ-authored.
Citation: Harris S, Ching SJ, Agarwal R .
Screening and preventive interventions for oral health in children, adolescents, and adults.
Am Fam Physician 2024 Mar; 109(3):261-62..
Keywords: U.S. Preventive Services Task Force (USPSTF), Children/Adolescents, Screening, Dental and Oral Health, Guidelines, Evidence-Based Practice
Oke I, Slopen N, Galbraith AA
Gaps in the vision screening pathway for school-aged US children
The purpose of this cross-sectional study was to survey the US pediatric population to identify gaps in the vision screening pathway. The researchers utilized deidentified data from the National Survey of Children’s Health (NSCH), a nationally representative survey of the non-institutionalized pediatric population in the US, and included 30,173 school-aged children from 6 to 17 years of age participating in the 2021 NSCH. Analysis included the 3 steps along the vision screening pathway: receipt of screening, referral for eye examination, and establishment of specialty care. The study found that 18,494 participants reported vision screening within the last 2 years. of those receiving screening, 5,134 were referred for an eye examination, and in those referred, 4,823 reported receiving care from a specialist. Children identifying as Hispanic, non- Hispanic Asian, or non-Hispanic Black, living in low-income households, and those who spoke a non-English primary household language had greater likelihood of receiving screening, were more likely to be referred for an eye examination, and had less likelihood of receiving care from a specialist. Children without health insurance, children with caregivers who had less than a high school education, and adolescents had a lower likelihood of receiving screening and a greater likelihood of receiving a referral for an eye examination.
AHRQ-funded; HS000063.
Citation: Oke I, Slopen N, Galbraith AA .
Gaps in the vision screening pathway for school-aged US children
JAMA Ophthalmol 2024 Mar; 142(3):268-70. doi: 10.1001/jamaophthalmol.2023.6316.
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Keywords: Eye Disease and Health, Children/Adolescents, Screening, Prevention
Liu PH, Singal AG, Murphy CC
Colorectal cancer screening receipt does not differ by 10-year mortality risk among older adults.
This study examined receipt of past-year colorectal cancer (CRC screening) according to predicted 10-year mortality risk among 25,888 community-dwelling adults aged 65-84 years who were not up-to-date with screening in the nationwide National Health Interview Survey. Ten-year mortality risk was estimated using a validated index with the lowest to highest quintiles of the index ranging from 12%-79%. The authors also examined the proportion of screening performed among adults with life expectancy <10 years. They found that the prevalence of past-year CRC screening was 39.5%, 40.6%, 38.7%, 36.4%, and 35.4%, from the lowest to highest quintile of 10-year mortality risk, demonstrating that the odds of CRC screening did not differ in the lowest vs highest quintile. One-quarter of past-year CRC screening occurred in adults with life expectancy <10 years, and more than half (50.7%) of adults aged 75-84 years had 10-year mortality risk ≥50% at the time of screening. Invasive but not noninvasive screening increased as 10-year mortality risk increased among adults aged 70-79 years.
AHRQ-funded; HS022418.
Citation: Liu PH, Singal AG, Murphy CC .
Colorectal cancer screening receipt does not differ by 10-year mortality risk among older adults.
Am J Gastroenterol 2024 Feb; 119(2):353-63. doi: 10.14309/ajg.0000000000002536.
Keywords: Elderly, Cancer: Colorectal Cancer, Mortality, Screening, Colonoscopy
Miller AC, Koeneman SH, Suneja M
Diurnal temperature variation and the implications for diagnosis and infectious disease screening: a population-based study.
This study’s objective was to describe individual variation in diurnal temperature patterns during episodes of febrile activity using millions of recorded temperatures and evaluate the probability of recording a fever by sex and for different age groups. The authors used timestamped deidentified temperature readings from thermometers across the US to construct illness episodes where continuous periods of activity in a single user included a febrile reading. They modeled the mean temperature recorded and probability of registering a fever across the course of a day using sinusoidal regression models while accounting for user age and sex. They then estimated the probability of recording a fever by time of day for children, working-age adults, and older adults. They found wide variation in body temperatures over the course of a day and across individual characteristics, with temperature patterns differing between men and women, and average temperatures declining for older age groups. There was a wide variation of the likelihood of fever detection by the time of day and by an individual’s age or sex.
AHRQ-authored; HS027375.
Citation: Miller AC, Koeneman SH, Suneja M .
Diurnal temperature variation and the implications for diagnosis and infectious disease screening: a population-based study.
Diagnosis 2024 Feb 1; 11(1):54-62. doi: 10.1515/dx-2023-0074.
Keywords: Infectious Diseases, Screening
Feltner C, Wallace IF, Nowell SW
Screening for speech and language delay and disorders in children 5 years or younger: evidence report and systematic review for the US Preventive Services Task Force.
This evidence report and systematic review reviewed the evidence on screening for speech and language delay or disorders in children 5 years or younger to inform the US Preventive Services Task Force. This literature review looked at English-language studies of screening test accuracy, trials or cohort studies comparing screening vs no screening; randomized clinical trials (RCTs) of interventions. Main outcomes and measures were screening test accuracy, speech and language outcomes, school performance, function, quality of life, and harms. A total of 38 studies in 41 articles were included (N = 9006). There were 21 studies (n = 7489) that assessed the accuracy of 23 different screening tools that varied with regard to whether they were designed to be completed by parents vs trained examiners, and to screen for global (any) language problems vs specific skills (e.g., expressive language). Three studies assessing parent-reported tools for expressive language skills had consistently high sensitivity (range, 88%-93%) and specificity (range, 88%-85%). Other screening tools had widely varying accuracy. Seventeen RCTs (n = 1517) evaluated interventions for speech and language delay or disorders. There were no RCTs included on the harms of interventions.
AHRQ-funded; 75Q80120D00006.
Citation: Feltner C, Wallace IF, Nowell SW .
Screening for speech and language delay and disorders in children 5 years or younger: evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2024 Jan 23; 331(4):335-51. doi: 10.1001/jama.2023.24647..
Keywords: U.S. Preventive Services Task Force (USPSTF), Children/Adolescents, Screening, Prevention, Evidence-Based Practice
Peaker B, Dooley C B, Peaker B, Dooley C C
AHRQ Author: Peaker B
Screening for syphilis in nonpregnant adolescents and adults.
This case study described a 42-year-old male presenting at the clinic with low back pain that had been radiating down his right leg for one week. Case study questions related to the USPSTF recommendation on Screening for Syphilis in Nonpregnant Adolescents and Adults addressed why this patient was at increased risk, whether screening should take place, and why the USPSTF does not recommend screening for all people.
AHRQ-authored.
Citation: Peaker B, Dooley C B, Peaker B, Dooley C C .
Screening for syphilis in nonpregnant adolescents and adults.
Am Fam Physician 2024 Jan; 109(1):79-80..
Keywords: U.S. Preventive Services Task Force (USPSTF), Screening, Evidence-Based Practice, Sexual Health, Children/Adolescents
Balbin CA, Kawamoto K
The SIMPLE architectural pattern for integrating patient-facing apps into clinical workflows: desiderata and application for lung cancer screening.
To address the need for electronic health record (EHR) systems to accept the connection of any patient-facing digital health app using the SMART on FHIR standard, the authors proposed the Standards-based Implementation Maximizing Portability Leveraging the EHR (SIMPLE). SIMPLE’s architectural pattern was designed to meet several key requirements, such as not requiring patients to install new software; not retaining patient data outside of the EHR; leveraging existing personal health record (PHR) capabilities to optimize user experience; and maximizing portability.
AHRQ-funded; HS028791.
Citation: Balbin CA, Kawamoto K .
The SIMPLE architectural pattern for integrating patient-facing apps into clinical workflows: desiderata and application for lung cancer screening.
AMIA Annu Symp Proc 2024 Jan 11; 2023:844-53..
Keywords: Workflow, Health Information Technology (HIT), Cancer: Lung Cancer, Cancer, Screening
Ferrari RM, Atkins DL, Wangen M
Patient perspectives on a proposed pharmacy-based colorectal cancer screening program.
The objective of this study was to assess patient perspectives on receiving fecal immunochemical colorectal cancer (CRC) screening tests through pharmacies. Researchers conducted semi-structured interviews with participants in North Carolina and Washington. Survey participants reported pharmacy-based CRC screening programs to be highly acceptable, citing convenience, ease of access, and avoidance of co-pays, but they also had concerns about privacy and coordination with primary care providers. The researchers concluded that CRC screening in pharmacies is potentially a good option, provided patients have privacy and their primary care providers are informed.
AHRQ-funded; HS026122.
Citation: Ferrari RM, Atkins DL, Wangen M .
Patient perspectives on a proposed pharmacy-based colorectal cancer screening program.
Transl Behav Med 2023 Dec 15; 13(12):909-18. doi: 10.1093/tbm/ibad057..
Keywords: Provider: Pharmacist, Cancer: Colorectal Cancer, Colonoscopy, Screening, Prevention
Danan ER, Than C, Chawla N
Abnormal cervical cancer screening results among US veteran and non-veteran participants in the National Health Interview Survey (NHIS).
Researchers tested whether Veterans with a recent cervical cancer screening test were more likely than non-Veterans to have received an abnormal result. Data was taken from the National Health Interview Survey (NHIS). An adjusted regression model of the date indicated that a previously observed association between Veteran status and abnormal screening result was explained by differences in sociodemographic and health factors between Veterans and non-Veterans. The researchers concluded that clinicians should address modifiable risk factors and provide evidence-based follow-up for abnormal results.
AHRQ-funded; HS026379.
Citation: Danan ER, Than C, Chawla N .
Abnormal cervical cancer screening results among US veteran and non-veteran participants in the National Health Interview Survey (NHIS).
Prev Med Rep 2023 Dec; 36:102472. doi: 10.1016/j.pmedr.2023.102472..
Keywords: Cancer: Cervical Cancer, Cancer, Screening, Women, Prevention
Frehn JL, Li JN, Liu KR
Implementation of a universal screening and follow-up care system for pediatric developmental and behavioral health in federally qualified health center sites.
This study assessed the results of implementing an intervention to increase screening of developmental delays in children at six federally qualified health center (FQHC) sites in Northern California from April 2014 to April 2017. The goals of the intervention were to increase (a) standardized developmental screening at recommended intervals and (b) follow-up care and support for early intervention services. The aim was to optimize each site's screening processes, supported by an automated electronic tablet-based system. Social workers were hired to conduct follow-up clinical assessments, provide psychosocial education and treatment, provide referrals, provide case management support, and collaborate with service partners. During the last year of the intervention, when tablet-based screening was adopted, the sites screened an estimated 6,550 children ages 0-18 at 23 intervals in three domains (developmental, autism, and psychosocial/behavioral), compared to a baseline where they screened children ages 0-3 at four intervals in one domain. Screening rates increased from 65.3% to 75.5% after automation was extended from the first to the second site and continued its’ increase to 91.8% after automation was expanded to the remaining sites. Ranges for follow-up visits were between 74% and 88%.
AHRQ-funded; HS000046.
Citation: Frehn JL, Li JN, Liu KR .
Implementation of a universal screening and follow-up care system for pediatric developmental and behavioral health in federally qualified health center sites.
Fam Syst Health 2023 Dec; 41(4):454-66. doi: 10.1037/fsh0000803..
Keywords: Children/Adolescents, Disabilities, Screening, Implementation
Chou R, Selph SS, Bougatsos C
Screening, referral, behavioral counseling, and preventive interventions for oral health in adults: a systematic review for the US Preventive Services Task Force.
The purpose of this study was to conduct a systematic evidence review on the effectiveness of primary care screening and prevention of dental caries and periodontal disease in adults to inform the US Preventive Services Task Force. The main outcomes were dental caries, periodontal disease, morbidity, quality of life, harms; and diagnostic test accuracy. Five randomized clinical trials, 5 nonrandomized trials, and 6 observational studies with a total 3,300 participants were included. There were no trials that evaluated primary care counseling or dental referral. There was very limited evidence on screening accuracy, silver diamine fluoride, xylitol; and harms were very limited, although serious harms were not reported. One small study (n = 86) found oral health examination by 2 primary care clinicians associated with low sensitivity and high specificity for periodontal disease and with variable sensitivity and high specificity for dental caries. Four studies (n = 965) found screening questionnaires associated with a pooled sensitivity of 0.72 and specificity of 0.74 for periodontal disease. For preventive interventions there were no studies that evaluated primary care counseling or dental referral, and evidence from 2 poor-quality trials (n = 178) of sealants, and 1 fair-quality and 4 poor-quality trials (n = 971) of topical fluorides, was found to be insufficient. Three fair-quality trials (n = 590) of persons with mean age 72 to 80 years found silver diamine fluoride solution associated with fewer new root caries lesions or fillings vs placebo (mean reduction, -0.33 to -1.3) and decreased likelihood of new root caries lesion (2 trials). There were no trials that evaluated primary care-administered preventive interventions.
AHRQ-funded; 75Q80120D00006.
Citation: Chou R, Selph SS, Bougatsos C .
Screening, referral, behavioral counseling, and preventive interventions for oral health in adults: a systematic review for the US Preventive Services Task Force.
JAMA 2023 Nov 14; 330(18):1780-90. doi: 10.1001/jama.2023.20685..
Keywords: U.S. Preventive Services Task Force (USPSTF), Screening, Dental and Oral Health, Prevention, Evidence-Based Practice, Guidelines
Chou R, Bougatsos C, Griffin J
Screening, referral, behavioral counseling, and preventive interventions for oral health in children and adolescents aged 5 to 17 years: a systematic review for the US Preventive Services Task Force.
The purpose of this study was to conduct a systematic evidence review on the effectiveness of primary care screening and prevention of dental caries in children and adolescents aged 5 to 17 years to inform the US Preventive Services Task Force. The main outcomes were dental caries, morbidity, functional status, quality of life, harms; and diagnostic test accuracy. Three systematic reviews with a total of 20,684 participants were included along with 19 randomized clinical trials, 3 nonrandomized trials, and 1 observational study with a total of 15,026 participants. When administered by dental professionals or in school settings, fluoride supplements compared with placebo or no intervention were associated with decreased change from baseline in the number of decayed, missing, or filled permanent teeth (DMFT index) or decayed or filled permanent teeth (DFT index) at 1.5 to 3 years (6 trials; n = 1395). Fluoride gels were associated with a DMFT- or DFT-prevented fraction of 0.18 at outcomes closest to 3 years (4 trials; n = 1525); fluoride varnish was associated with a DMFT- or DFT-prevented fraction of 0.44 at 1 to 4.5 years (5 trials; n = 3902); and resin-based sealants were associated with decreased risk of carious first molars at 48 to 54 months (4 trials; n = 440). There were no trials that evaluated primary care counseling or dental referral. There was very limited evidence on screening accuracy, silver diamine fluoride, xylitol; and harms were very limited, although serious harms were not reported.
AHRQ-funded; 75Q80120D00006.
Citation: Chou R, Bougatsos C, Griffin J .
Screening, referral, behavioral counseling, and preventive interventions for oral health in children and adolescents aged 5 to 17 years: a systematic review for the US Preventive Services Task Force.
JAMA 2023 Nov 7; 330(17):1674-86. doi: 10.1001/jama.2023.20435..
Keywords: Children/Adolescents, Dental and Oral Health, Screening, Prevention, Evidence-Based Practice, U.S. Preventive Services Task Force (USPSTF), Guidelines
Huffstetler AN, Villalobos G, Brooks EM
The current state of alcohol screening and management in Virginia primary care practices: an evaluation of preventive service use.
This study used the recommendations of the US Preventive Services Task Force on screening and behavioral counseling for adults over 18 years for unhealthy alcohol use to examine the current state of alcohol screening and management in Virginia primary care practices. Clinicians were advised to use the following recommended screening instruments: the Alcohol Use Disorders Identification Test-Concise and or Single Alcohol Screening Question. Baseline data showed that clinicians appropriately screened only 10.8% of patients and only identified 9.6% as having risky drinking. However, 24% of patients reported risky drinking on a survey, demonstrating the implementation gap of the USPSTF recommendation and opportunity to improve health.
AHRQ-funded; HS027077.
Citation: Huffstetler AN, Villalobos G, Brooks EM .
The current state of alcohol screening and management in Virginia primary care practices: an evaluation of preventive service use.
Med Clin North Am 2023 Nov; 107(6s):e1-e17. doi: 10.1016/j.mcna.2023.07.001..
Keywords: U.S. Preventive Services Task Force (USPSTF), Alcohol Use, Screening, Substance Abuse, Behavioral Health, Primary Care, Evidence-Based Practice
Marcotte LM, Deeds S, Wheat C
Automated opt-out vs opt-in patient outreach strategies for breast cancer screening: a randomized clinical trial.
The objective of this study was to evaluate the effect on breast cancer screening of an opt-out automatic mammography referral strategy compared with an opt-in automated telephone message strategy. Participants in the pragmatic randomized clinical trial, conducted at a Veterans Affairs (VA) medical center, were female veterans aged 45-75 eligible for breast cancer screening and enrolled in VA primary care. The results indicated that the opt-out population-based breast cancer screening outreach approach compared with an opt-in approach did not result in a significant difference in mammography completion, but did lead to more canceled mammography referrals, which increased staff burden.
AHRQ-funded; HS026369.
Citation: Marcotte LM, Deeds S, Wheat C .
Automated opt-out vs opt-in patient outreach strategies for breast cancer screening: a randomized clinical trial.
JAMA Intern Med 2023 Nov; 183(11):1187-94. doi: 10.1001/jamainternmed.2023.4321..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Prevention, Health Promotion
Kukhareva PV, Li H, Caverly TJ
Implementation of lung cancer screening in primary care and pulmonary clinics: pragmatic clinical trial of electronic health record-integrated everyday shared decision-making tool and clinician-facing prompts.
The authors conducted pre- and post-intervention analysis in primary care and pulmonary clinics to explore whether clinician-facing electronic health record (EHR) prompts and an EHR-integrated shared decision-making (SDM) tool designed to support incorporation of SDM into primary care could improve low-dose computer tomography scan imaging ordering and completion. Subjects were patients who met US Preventive Services Task Force criteria for lung cancer screening (LCS). The results indicated that EHR prompts and the EHR-integrated SDM tool were promising approaches to improving LCS in the primary care setting. The authors noted that further research is warranted.
AHRQ-funded; HS026198; HS028791.
Citation: Kukhareva PV, Li H, Caverly TJ .
Implementation of lung cancer screening in primary care and pulmonary clinics: pragmatic clinical trial of electronic health record-integrated everyday shared decision-making tool and clinician-facing prompts.
Chest 2023 Nov; 164(5):1325-38. doi: 10.1016/j.chest.2023.04.040..
Keywords: Cancer: Lung Cancer, Cancer, Screening, Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Shared Decision Making
Oke I, Slopen N, Hunter DG
Vision testing for adolescents in the US.
The purpose of this cross-sectional study was to characterize patterns in vision testing as a function of age among United States adolescents and identify sociodemographic factors related with vision testing. The researchers utilized data from 24,752 adolescent children (aged 12 to <18 years) from the 2018-2019 National Survey of Children's Health, a nationally representative survey of the noninstitutionalized United States pediatric population. The primary outcome of the study was the caregiver report of vision testing within the last 12 months. Vision testing in any setting within the previous year was reported by caregivers of 18,621 adolescents. Vision testing was reported to have occurred at an eye clinic in 13,323 participants, at a primary care clinic in 5,230 participants, at a school in 2,594 participants, and at a health center in 635 participants. The rate of adolescents reported to have vision tested decreased with age due to a decrease in testing in primary care and school settings. After adjusting for age and sex, there were lower odds of vision testing reported for adolescents who were uninsured vs insured, had caregivers with less than vs greater than high school education, and were from a family born outside vs inside the United States.
AHRQ-funded; HS000063.
Citation: Oke I, Slopen N, Hunter DG .
Vision testing for adolescents in the US.
JAMA Ophthalmol 2023 Nov; 141(11):1068-72. doi: 10.1001/jamaophthalmol.2023.4475..
Keywords: Children/Adolescents, Eye Disease and Health, Screening
Henderson JT, Webber EM, Thomas RG
Screening for hypertensive disorders of pregnancy: updated evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this study was to conduct a systematic review to update the evidence on the effectiveness of screening for hypertensive disorders of pregnancy with the purpose of informing the U.S. Preventive Services Task Force. The main outcome was Morbidity or mortality, with measures of health-related quality of life. The review included 6 fair-quality studies comparing changes in prenatal screening practices with routine screening at in-person office visits (usual care). This systematic review did not find evidence that any alternate screening strategies for hypertensive disorders of pregnancy had increased effectiveness over routine blood pressure measurement at in-person prenatal visits. No harms of the different screening strategies were identified.
AHRQ-funded; 75Q80120D00004.
Citation: Henderson JT, Webber EM, Thomas RG .
Screening for hypertensive disorders of pregnancy: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2023 Sep 19; 330(11):1083-91. doi: 10.1001/jama.2023.4934..
Keywords: U.S. Preventive Services Task Force (USPSTF), Blood Pressure, Screening, Prevention, Evidence-Based Practice, Guidelines, Maternal Care, Women
Landy R, Gomez I, Caverly TJ
Methods for using race and ethnicity in prediction models for lung cancer screening eligibility.
The purpose of this study was to compare eligibility for lung cancer screening in a representative United States population by refitting the life-years gained from screening-computed tomography (LYFS-CT) model to exclude race and ethnicity versus a counterfactual eligibility method that recalculates life expectancy for racial and ethnic minority individuals utilizing the same covariates but substitutes White race and utilizes the higher predicted life expectancy, preventing historically underserved groups from being penalized. The National Health Interview Survey (NHIS) 2015-2018 included 25,601 individuals aged 50 to 80 years who ever smoked. The study found that removing race and ethnicity from the submodels underestimated lung cancer death risk and all-cause mortality in African American individuals. It also overestimated mortality in Hispanic American and Asian American individuals. As a result, the LYFS-CT NoRace model increased Hispanic American and Asian American eligibility by 108% and 73%, respectively, while decreasing African American eligibility by 39%. Utilizing LYFS-CT with the counterfactual all-cause mortality model better maintained calibration across groups and increased African American eligibility by 13% without decreasing eligibility for Hispanic American and Asian American individuals.
AHRQ-funded; HS026198.
Citation: Landy R, Gomez I, Caverly TJ .
Methods for using race and ethnicity in prediction models for lung cancer screening eligibility.
JAMA Netw Open 2023 Sep; 6(9):e2331155. doi: 10.1001/jamanetworkopen.2023.31155..
Keywords: Racial and Ethnic Minorities, Cancer: Lung Cancer, Cancer, Screening, Prevention