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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results1 to 25 of 737 Research Studies Displayed
Marcotte LM, Khor S, Flum DR
Factors associated with lung cancer risk factor documentation.
This cross-observational study’s objective was to identify factors associated with the minimum necessary information to determine an individual’s eligibility for lung cancer screening (ie, sufficient risk factor documentation) and to characterize clinic-level variability in documentation. The authors calculated the relative risk of sufficient lung cancer risk factor documentation by patient-, provider-, and system-level variables using Poisson regression models, clustering by clinic. They compared unadjusted, risk-adjusted, and reliability-adjusted proportions of patients with sufficient smoking documentation across 31 clinics using logistic regression models and 2-level hierarchical logit models to estimate reliability-adjusted proportions across clinics. A majority (60%) of 20,632 individuals were found to have sufficient risk factor documentation to determine screening eligibility. Patient-level factors were inversely associated with risk factor documentation including Black race, non-English preferred language, Medicaid insurance, and nonactivated patient portal, with documentation varying across clinics.
Citation: Marcotte LM, Khor S, Flum DR . Factors associated with lung cancer risk factor documentation. Am J Manag Care 2023 Sep; 29(9):89354..
Keywords: Cancer: Lung Cancer, Cancer, Risk
Sprague BL, Ichikawa L, Eavey J
Breast cancer risk characteristics of women undergoing whole-breast ultrasound screening versus mammography alone.
This study evaluated mammography screening failure risk among women undergoing supplemental ultrasound screening in clinical practice in comparison with women undergoing mammography alone. Screening ultrasounds and screening mammograms without supplemental screening were identified within three Breast Cancer Surveillance Consortium registries. A clinically significant proportion of women who had undergone mammography screening alone were at high mammography screening failure risk. Ultrasound screening was highly targeted to women with dense breasts, but only a small proportion were high mammography screening failure risk.
Citation: Sprague BL, Ichikawa L, Eavey J . Breast cancer risk characteristics of women undergoing whole-breast ultrasound screening versus mammography alone. Cancer 2023 Aug 15; 129(16):2456-68. doi: 10.1002/cncr.34768..
Keywords: Cancer: Breast Cancer, Cancer, Women, Imaging, Screening, Risk
O'Connor EA, Perdue LA, Coppola EL
Depression and suicide risk screening: updated evidence report and systematic review for the US Preventive Services Task Force.
The objectives of this article were to review the benefits and harms of depression and suicide risk screening and treatment and the accuracy of instruments to detect these conditions in primary care patients. Evidence gathered from the literature search supported screening for depression in primary care settings, including during pregnancy and postpartum. The authors noted, however, that there were numerous important gaps in the evidence for suicide risk screening.
AHRQ-funded; 290201500011I; 75Q80120D00004.
Citation: O'Connor EA, Perdue LA, Coppola EL . Depression and suicide risk screening: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2023 Jun 20; 329(23):2068-85. doi: 10.1001/jama.2023.7787..
Keywords: U.S. Preventive Services Task Force (USPSTF), Screening, Depression, Behavioral Health, Evidence-Based Practice, Guidelines, Risk
Ruderman SA, Nance RM, Drumright LN
Development of Frail RISC-HIV: a risk score for predicting frailty risk in the short-term for care of people with HIV.
The authors developed RISC-HIV, a frailty prediction risk score for HIV clinical decision-making. They predicted frailty risk among people with HIV (PWH) at seven US HIV clinics and followed for up to 2 years to identify short-term predictors of becoming frail. They concluded that RISC-HIV is a simple, easily implemented tool to assist in classifying PWH at risk for frailty in clinics.
Citation: Ruderman SA, Nance RM, Drumright LN . Development of Frail RISC-HIV: a risk score for predicting frailty risk in the short-term for care of people with HIV. AIDS 2023 May 1; 37(6):967-75. doi: 10.1097/qad.0000000000003501..
Keywords: Human Immunodeficiency Virus (HIV), Risk
Lowry KP, Ichikawa L, Hubbard RA
Variation in second breast cancer risk after primary invasive cancer by time since primary cancer diagnosis and estrogen receptor status.
This study examined the timing of second breast cancers by primary cancer estrogen receptor (ER) status in the Breast Cancer Surveillance Consortium. The cohort studied included women who were diagnosed with American Joint Commission on Cancer stage I-III breast cancer identified within six Breast Cancer Surveillance Consortium registries from 2000 to 2017. Characteristics collected during primary breast cancer diagnosis included demographics, ER status, and treatment. Second breast cancer events included subsequent ipsilateral or contralateral breast cancers diagnosed >6 months after primary diagnosis. Cumulative incidence and second breast cancer rates by primary cancer ER status during 1-5 versus 6-10 years after diagnosis was examined. At 10 years, the cumulative second breast cancer incidence was 11.8% for women with ER-negative disease and 7.5% for those with ER-positive disease. Women with ER-negative cancer had higher second breast cancer rates than those with ER-positive cancer during the first 5 years of follow-up. After 5 years, second breast cancer rates were similar for women with ER-negative versus ER-positive breast cancer.
Citation: Lowry KP, Ichikawa L, Hubbard RA . Variation in second breast cancer risk after primary invasive cancer by time since primary cancer diagnosis and estrogen receptor status. Cancer 2023 Apr 15;129(8):1173-82. doi: 10.1002/cncr.34679.
Keywords: Cancer: Breast Cancer, Cancer, Women, Risk
Antoon JW, Grijalva CG, Carroll AR
Parental perceptions of penicillin allergy risk stratification and delabeling.
The purpose of this study was to explore parental perceptions of the PCN allergy evaluation and removal process, especially in the hospital setting. Investigators conducted focus groups consisting of parent of children and adolescents with a PCN allergy label discharged from a large academic children’s hospital between January 1, 2019, and April 15, 2020. The focus groups answered questions about PCN allergy testing and evaluation, accuracy of the PCN allergy diagnosis, amoxicillin oral challenges, delabeling process, and preferred setting for PCN allergy delabeling evaluation (outpatient clinic, hospital, etc). The study concluded family concerns remained even after children passed an oral challenge, and that some parents preferred testing in a hospital setting and thought it was a safer location for the procedure.
Citation: Antoon JW, Grijalva CG, Carroll AR . Parental perceptions of penicillin allergy risk stratification and delabeling. Hosp Pediatr 2023 Apr; 13(4):300-08. doi: 10.1542/hpeds.2022-006737..
Keywords: Children/Adolescents, Antibiotics, Medication, Risk
Ray EM, Hinton SP, Reeder-Hayes KE
Risk factors for return to the emergency department and readmission in patients with hospital-diagnosed advanced lung cancer.
The objectives of this study were to examine the patterns of care and risk factors for subsequent acute care utilization among patients with hospital-diagnosed advanced lung cancer (ALC). Researchers identified patients with incident ALC from 2007-13 and an index hospitalization within 7 days of diagnosis in Surveillance, Epidemiology, and End Results-Medicare. Results showed that more than half of the incident ALC patients were hospitalized around the time of diagnosis; among those who survived to discharge, only 37% received systemic cancer treatment. Many patients experienced an early readmittance and most died within 6 months. The researchers conclude that such patients may benefit from increased access to palliative and other supportive care during hospitalization to prevent subsequent health care utilization.
Citation: Ray EM, Hinton SP, Reeder-Hayes KE . Risk factors for return to the emergency department and readmission in patients with hospital-diagnosed advanced lung cancer. Med Care 2023 Apr;61(4):237-46. doi: 10.1097/mlr.0000000000001829.
Keywords: Emergency Department, Hospital Readmissions, Cancer: Lung Cancer, Cancer, Risk
Tan MS, Heise CW, Gallo T
Relationship between a risk score for QT interval prolongation and mortality across rural and urban inpatient facilities.
The objectives of this retrospective observational study were to evaluate the relationship between a modified Tisdale QTc-risk score (QTc-RS), inpatient mortality, and length of stay in a broad inpatient population with an order for a medication with a known risk of torsades de pointes (TdP). Inpatient data from 28 healthcare facilities in the western US were used. The results indicated that there is a strong relationship between increased mortality as well as longer duration of hospitalization with an increasing QTc-RS.
Citation: Tan MS, Heise CW, Gallo T . Relationship between a risk score for QT interval prolongation and mortality across rural and urban inpatient facilities. J Electrocardiol 2023 Mar;77:4-9. doi: 10.1016/j.jelectrocard.2022.11.008.
Keywords: Heart Disease and Health, Cardiovascular Conditions, Mortality, Rural Health, Urban Health, Risk
Shear K, Rice H, Garabedian PM
Usability testing of an interoperable computerized clinical decision support tool for fall risk management in primary care.
The purpose of this study was to conduct usability testing of the ASPIRE fall risk management tool for use in divergent primary care clinics. Participants recruited from two sites with different electronic health records and clinical organizations used ASPIRE across two clinical scenarios; they rated ASPIRE usability as above average, based on usability benchmarks. Time spent on tasks decreased significantly between the first and second scenarios, indicating ease of learnability. The authors conclude that ASPIRE could be integrated into diverse organizations, since it allows a tailored implementation without the need to build a new system for each organization. ASPIRE is therefore well positioned to impact the challenge of falls at scale.
Citation: Shear K, Rice H, Garabedian PM . Usability testing of an interoperable computerized clinical decision support tool for fall risk management in primary care. Appl Clin Inform 2023 Mar;14(2):212-26. doi: 10.1055/a-2006-4936.
Keywords: Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT), Falls, Primary Care, Risk, Prevention
Coley RY, Liao Q, Simon N
Empirical evaluation of internal validation methods for prediction in large-scale clinical data with rare-event outcomes: a case study in suicide risk prediction.
Clinical prediction models for uncommon outcomes, such as suicide, psychiatric hospitalizations, and opioid overdose, are garnering increased attention. Precise model validation is essential for choosing the appropriate model and deciding on its application. Split-sample estimation and validation of clinical prediction models, where data are divided into training and testing sets, may decrease predictive accuracy and precision. Utilizing the entire dataset for estimation and validation improves the sample size for both processes, but overfitting or optimism must be accounted for. The researchers compared split-sample and whole-sample approaches for estimating and validating a suicide prediction model. The study found that both the split-sample and whole-sample prediction models demonstrated similar prospective performance. Performance estimates assessed in the testing set for the split-sample model and through cross-validation for the whole-sample model correctly represented prospective performance. Validation of the whole-sample model using bootstrap optimism correction overestimated prospective performance. The researchers concluded that although previous studies have validated the bootstrap optimism correction for parametric models in small samples, this method did not accurately validate the performance of a rare-event prediction model estimated with random forests in a large clinical dataset. Cross-validation of prediction models estimated using all available data offers precise independent validation while maximizing sample size.
Citation: Coley RY, Liao Q, Simon N . Empirical evaluation of internal validation methods for prediction in large-scale clinical data with rare-event outcomes: a case study in suicide risk prediction. BMC Med Res Methodol 2023 Feb 1; 23(1):33. doi: 10.1186/s12874-023-01844-5..
Keywords: Research Methodologies, Risk
Aswani MS, Roberts ET
Social risk adjustment in the hospital readmission reduction program: pitfalls of peer grouping, measurement challenges, and potential solutions.
The objective of this study was to investigate the limitations of peer grouping and associated challenges in the measurement of social risk in Medicare's Hospital Readmission Reduction Program (HRRP). Public data on hospitals in the HRRP were used to examine the relationship between hospital dual share and readmission rates within peer groups as well as changes in hospital peer group assignments, readmission rates, and penalties, and the relationship between state Medicaid eligibility rules and peer groups. The findings indicated that peer grouping is limited in the extent to which it accounts for differences in hospitals' patient populations. The authors concluded that problems arise from the construction of peer groups and the measure of social risk used to define them.
Citation: Aswani MS, Roberts ET . Social risk adjustment in the hospital readmission reduction program: pitfalls of peer grouping, measurement challenges, and potential solutions. Health Serv Res 2023 Feb; 58(1):51-59. doi: 10.1111/1475-6773.13969..
Keywords: Hospital Readmissions, Hospitals, Risk
Song J, Chae S, Bowles KH
The identification of clusters of risk factors and their association with hospitalizations or emergency department visits in home health care.
The purpose of this retrospective cohort study was to identify risk factor clusters in home health care and assess whether the clusters are related with hospitalizations or emergency department visits. The researchers included 61,454 patients associated with 79,079 episodes receiving home health care from one of the largest home health care organizations in the U.S. The study found that a total of 11.6% of home health episodes resulted in hospitalizations or emergency department visits. Three clusters were formed by the risk factors: 1) Cluster 1- a combination of risk factors related to situations where patients may experience increased pain ("impaired physical comfort with pain"). 2) Cluster 2 - characterized by multiple comorbidities or other risks for hospitalization (e.g., prior falls, called "high comorbidity burden"). 3) Cluster 3 - "impaired cognitive/psychological and skin integrity" which includes dementia or skin ulcer. The risk of hospitalizations or emergency department visits increased by 1.95 times for Cluster 2 and by 2.12 times for Cluster 3 when compared to cluster 1. The study concluded that Varying combinations of risk factors affected the likelihood of negative outcomes.
Citation: Song J, Chae S, Bowles KH . The identification of clusters of risk factors and their association with hospitalizations or emergency department visits in home health care. J Adv Nurs 2023 Feb; 79(2):593-604. doi: 10.1111/jan.15498..
Keywords: Emergency Department, Hospitalization, Home Healthcare, Risk
Conley CC, Wernli KJ, Knerr S
Using protection motivation theory to predict intentions for breast cancer risk management: intervention mechanisms from a randomized controlled trial.
The objective of this study was to evaluate direct and indirect effects of a web-based, Protection Motivation Theory (PMT)-informed education and decision support tool for risk-reducing medication and breast MRI among women with high risk of breast cancer. Findings indicated that PMT-informed intervention effected behavioral intentions. No direct intervention effect on intentions for risk-reducing medication or MRI were found, but there were significant indirect effects on risk-reducing medication intentions via perceived risk, self-efficacy, and response efficacy, and on MRI intentions via perceived risk and response efficacy, The authors suggested that future research should extend these findings from intentions to behavior.
Citation: Conley CC, Wernli KJ, Knerr S . Using protection motivation theory to predict intentions for breast cancer risk management: intervention mechanisms from a randomized controlled trial. J Cancer Educ 2023 Feb; 38(1):292-300. doi: 10.1007/s13187-021-02114-y..
Keywords: Cancer: Breast Cancer, Cancer, Risk, Education: Patient and Caregiver, Health Information Technology (HIT)
Holmer HK, Mackey K, Fiordalisi CV
Major update 2: antibody response and risk for reinfection after SARS-CoV-2 infection-final update of a living, rapid review.
This paper is a final updated living rapid review to synthesize evidence on the SARS-CoV-2 antibody response and reinfection risk with a focus on gaps identified in the author’s prior reports. A literature review was done for English-language cohort studies evaluating IgG antibody duration at least 12 months after SARS-CoV-2 infection, the antibody response among immunocompromised adults, predictors of nonseroconversion, and reinfection risk. Study data was extracted and two investigators rated quality. Most adults had IgG antibodies after SARS-CoV-2 infection at time points greater than 12 months. Although most immunocompromised adults develop antibodies, the overall proportion with antibodies is lower compared with immunocompetent adults. Prior infection provided substantial, sustained protection against symptomatic reinfection with the Delta variant (high strength of evidence) and reduced the risk for severe disease due to Omicron variant (moderate strength of evidence). Prior infection was less protective against reinfection with Omicron overall (moderate strength of evidence), but protection from earlier variants waned rapidly (low strength of evidence).
Citation: Holmer HK, Mackey K, Fiordalisi CV . Major update 2: antibody response and risk for reinfection after SARS-CoV-2 infection-final update of a living, rapid review. Ann Intern Med 2023 Jan; 176(1):85-91. doi: 10.7326/m22-1745..
Keywords: COVID-19, Evidence-Based Practice, Infectious Diseases, Risk
Liao JM, Wang E, Isidro U
The association between bundled payment participation and changes in medical episode outcomes among high-risk patients.
This research evaluated whether the association between participation in bundled payments for medical conditions and episode outcomes differed for clinically high-risk versus other patients in regard to length of stay (LOS) at skilled nursing facilities (SNFs). Participants included 471,421 Medicare patients hospitalized at bundled payment and propensity-matched non-participating hospitals. Primary outcomes were SNF LOS and 90-day unplanned readmissions. SNF length of stay was differentially lower among frail patients, patients with advanced age (>85 years), and those with prior institutional post-acute care provider utilization compared to non-frail, younger, and patients without prior utilization, respectively. Bundled payment participation was also associated with differentially greater SNF LOS among disabled patients. It was not associated with differential changes in readmissions in any high-risk group but was associated with changes in quality, utilization, and spending measures for some groups.
Citation: Liao JM, Wang E, Isidro U . The association between bundled payment participation and changes in medical episode outcomes among high-risk patients. Healthcare 2022 Dec 12; 10(12). doi: 10.3390/healthcare10122510..
Keywords: Payment, Quality Improvement, Quality of Care, Risk, Policy
Tan MS, Gomez-Lumbreras A, Villa-Zapata L
Colchicine and macrolides: a cohort study of the risk of adverse outcomes associated with concomitant exposure.
The authors conducted a cohort study using electronic health records comparing encounters with colchicine plus a macrolide and colchicine with an antibiotic non-macrolide, then assessed the relationship between the two groups. They found that heart failure was more frequent in the colchicine plus a macrolide cohort and that there was also a higher mortality rate. As there is a significant increase in the risk of hepatic failure and mortality when colchicine is concomitantly administered with a macrolide, they concluded that colchicine should not be used concomitantly with these antibiotics or should be temporarily discontinued to avoid toxic levels of colchicine.
Citation: Tan MS, Gomez-Lumbreras A, Villa-Zapata L . Colchicine and macrolides: a cohort study of the risk of adverse outcomes associated with concomitant exposure. Rheumatol Int 2022 Dec;42(12):2253-59. doi: 10.1007/s00296-022-05201-5..
Keywords: Adverse Drug Events (ADE), Adverse Events, Medication, Risk, Antibiotics, Medication: Safety, Patient Safety
Lewinski AA, Jazowski SA, Goldstein KM
Intensifying approaches to address clinical inertia among cardiovascular disease risk factors: a narrative review.
Researchers conducted a narrative literature review to identify individual-level and multifactorial interventions that have been successful in addressing clinical inertia. They found that, in order to reduce clinical inertia and achieve optimal cardiovascular disease risk factor control, interventions should consider the role of multiple representatives, be feasible for implementation in healthcare systems, and be flexible for an individual patient's adherence needs.
Citation: Lewinski AA, Jazowski SA, Goldstein KM . Intensifying approaches to address clinical inertia among cardiovascular disease risk factors: a narrative review. Patient Educ Couns 2022 Dec;105(12):3381-88. doi: 10.1016/j.pec.2022.08.005..
Keywords: Cardiovascular Conditions, Risk
Govindan S, O'Malley ME, Flanders SA
The MI-PICC Score: a risk-Prediction Model for PICC-associated Complications in the ICU.
The authors examined predictive factors for adverse events in critically ill patients with peripherally inserted central catheters (PICCs). They found that PICC-related complications in the ICU were significantly associated with history of deep vein thrombosis, active diagnosis of cancer, presence of a second central venous catheter, blood transfusion through the PICC, and PICC dwell time.
Citation: Govindan S, O'Malley ME, Flanders SA . The MI-PICC Score: a risk-Prediction Model for PICC-associated Complications in the ICU. Am J Respir Crit Care Med 2022 Nov 15;206(10):1286-89. doi: 10.1164/rccm.202204-0760LE..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Critical Care, Intensive Care Unit (ICU), Risk, Adverse Events
Yabroff KR, Han X, Zhao J
AHRQ Author: Kirby J
Association of health insurance coverage disruptions with mortality risk among US working-age adults.
This cohort study assessed associations of a prior coverage disruption with mortality risk among large, nationally representative cohorts of working-age adults aged 18 to 64 with public or private health insurance coverage. Most research had previously been conducted among Medicaid enrollees, and little is known about insurance disruption among privately insured adults. The study used data from the 2000 to 2018 National Health Interview Survey (NIHS), specifically from the NHIS Linked Mortality files which contain data from the National Death Index. All data was deidentified and publicly available. The authors found that disruptions were associated with a higher mortality risk in either publicly or privately insured adults.
Citation: Yabroff KR, Han X, Zhao J . Association of health insurance coverage disruptions with mortality risk among US working-age adults. JAMA Health Forum 2022 Nov;3(11):e224258. doi: 10.1001/jamahealthforum.2022.4258..
Keywords: Health Insurance, Mortality, Risk, Access to Care
Interrante JD, Tuttle MS, Admon LK
Severe maternal morbidity and mortality risk at the intersection of rurality, race and ethnicity, and Medicaid.
Using maternal discharge records from childbirth hospitalizations in the HCUP National Inpatient Sample, 2007-15, researchers examined differences in rates of severe maternal morbidity and mortality by rural or urban geography, race and ethnicity, and clinical factors among Medicaid-funded births and privately insured hospital births. The highest rate of severe maternal morbidity and mortality occurred among rural Indigenous Medicaid-funded births; births among Black rural and urban residents and among Hispanic urban residents also experienced elevated rates. The researchers concluded that heightened rates of severe maternal morbidity and mortality among Medicaid-funded births indicate an opportunity for state and federal policy responses to address the maternal health challenges faced by Medicaid beneficiaries, including Black, Indigenous, and rural residents
Citation: Interrante JD, Tuttle MS, Admon LK . Severe maternal morbidity and mortality risk at the intersection of rurality, race and ethnicity, and Medicaid. Womens Health Issues 2022 Nov-Dec;32(6):540-49. doi: 10.1016/j.whi.2022.05.003..
Keywords: Healthcare Cost and Utilization Project (HCUP), Maternal Care, Women, Pregnancy, Mortality, Risk, Racial and Ethnic Minorities, Medicaid
Owora AH, Li R R, Tepper RS
Impact of time-varying confounders on the association between early-life allergy sensitization and the risk of current asthma: a post hoc analysis of a birth cohort.
The purpose of this study was to explore whether allergen avoidance in infants genetically predisposed to asthma can weaken the increased risk of current asthma that is associated with early-life allergy sensitization. The researchers utilized a post hoc analysis to estimate the average causal effect of early-life allergy sensitization and allergen avoidance on the risk of current asthma. The study found that that the odds of current asthma were higher among children with an early-life allergy sensitization at 7 years of age. No differences were demonstrated at 15-years of age. Overall, the odds of current asthma were lower among children randomized to the Canadian Asthma Primary Prevention Study (CAPPS) intervention. CAPPS was developed to decrease exposure in the first year of infancy to indoor aeroallergens and to promote prolonged breastfeeding and delayed introduction of milk and solid foods. The study also found that female children had 28% lower odds of current asthma than male children. The researchers concluded that early life is a vital time when allergy sensitization may provoke pathogenesis towards school-age asthma onset, and allergen avoidance during the same period may reduce the risk of current asthma. Confounding due to time-varying allergy sensitization states and asthma-related treatment exposure may explain some of the null associations reported in previous research.
Citation: Owora AH, Li R R, Tepper RS . Impact of time-varying confounders on the association between early-life allergy sensitization and the risk of current asthma: a post hoc analysis of a birth cohort. Allergy 2022 Oct;77(10):3141-44. doi: 10.1111/all.15403..
Keywords: Asthma, Respiratory Conditions, Children/Adolescents, Risk
Grauer A, Duran AT, Liyanage-Don NA
Association between telemedicine use and diabetes risk factor assessment and control in a primary care network.
The purpose of this retrospective cohort study was to explore whether there is a relationship between telemedicine use in primary care and risk factor assessment and control for patients with diabetes mellitus. The study included patients with diabetes mellitus ages 18-75 with a telemedicine visit in a primary care network between February 2020 and December 2020. Researchers evaluated whether low-density lipoprotein cholesterol (LDL-C), blood pressure (BP), and hemoglobin A1c (HbA1c) and were assessed for each patient. The study identified 1,824 patients with diabetes during the study period and found that telemedicine use was associated with a lower proportion of patients with all three risk factors assessed. The researchers concluded that telemedicine use was related with gaps in risk factor assessment for patients with diabetes during the COVID-19 pandemic.
AHRQ-funded; HS026121; HS024262.
Citation: Grauer A, Duran AT, Liyanage-Don NA . Association between telemedicine use and diabetes risk factor assessment and control in a primary care network. J Endocrinol Invest 2022 Sep;45(9):1749-56. doi: 10.1007/s40618-022-01814-6..
Keywords: Diabetes, Chronic Conditions, Telehealth, Health Information Technology (HIT), Primary Care, Risk
Gallo T, Heise CW, Woosley RL
Clinician satisfaction with advanced clinical decision support to reduce the risk of torsades de pointes.
The purpose of this study was to create an advanced torsades de pointes (TdP) clinical decision support (CDS) advisory that provides relevant, patient-specific information, including 1-click management options, and to evaluate clinician satisfaction with the CDS. The researchers implemented the advanced TdP CDS across a health system comprising 29 hospitals. A brief electronic survey was developed to collect clinician feedback on the advisory and was emailed to 442 clinicians who received the advisory. Feedback was generally positive across the 38 responding providers, with 79% of respondents reporting that the advisory assisted with their care for their patients and 87% responding that the alerts clearly specified alternative actions. The researchers concluded that providers who receive an advanced TdP risk CDS alert generally view the alert favorably.
Citation: Gallo T, Heise CW, Woosley RL . Clinician satisfaction with advanced clinical decision support to reduce the risk of torsades de pointes. J Patient Saf 2022 Sep 1;18(6):e1010-e13. doi: 10.1097/pts.0000000000000996..
Keywords: Clinical Decision Support (CDS), Decision Making, Risk, Provider: Clinician, Heart Disease and Health, Cardiovascular Conditions
Laskow T, Zhu J, Buta B
Risk factors for nonresilient outcomes in older adults after total knee replacement.
The purpose of this study was to develop a simple measure of physical resilience and identify risk factors for nonresilient patient outcomes in total knee replacement procedures (TKR). The researchers conducted a secondary analysis of the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) cohort study, including 7,239 adults aged 60 or older who underwent TKR between 2011 and 2015. The study found that the variables of age, body mass index, and Charlson Comorbidity Index (CCI) were associated with increased risk of physically nonresilient outcomes across the 3 patient-reported outcomes of the physical component summary (PCS), bodily pain (BP), and vitality (VT). A household income of greater than $45 000 associated with lower risk for PCS (RR = 0.81 [0.70-0.93]), BP (RR = 0.80 [0.69-0.91]), and VT (RR = 0.86 [0.78-0.93]). CONCLUSIONS: We operationalized physical resilience and identified factors predicting resilience after TKR. This approach may aid clinical risk stratification, guide further investigation of causes, and ultimately aid patients through the design of interventions to enhance physical resilience.
Citation: Laskow T, Zhu J, Buta B . Risk factors for nonresilient outcomes in older adults after total knee replacement. J Gerontol A Biol Sci Med Sci 2022 Sep;77(9):1915-22. doi: 10.1093/gerona/glab257..
Keywords: Orthopedics, Surgery, Elderly, Risk
Dikranian L, Barry S, Ata A
Sars-CoV-2 with concurrent respiratory viral infection as a risk factor for a higher level of care in hospitalized pediatric patients.
This study’s objective was to evaluate if the presence of concurrent respiratory viral infections in pediatric patients admitted to the hospital with SARS-CoV-2 was associated with an increased rate of ICU level of care. Data from 67 participating hospitals was provided through The Society of Critical Care Medicine Discovery Network Viral Infection and Respiratory Illness Universal Study database. A total of 922 patients were included, with 391 requiring ICU level care and 31 having concurrent non-SARS-CoV-2 viral coinfection. After accounting for age, positive blood culture, positive sputum culture, preexisting chronic medical conditions, the presence of a viral respiratory coinfection was associated with increased need for ICU care.
Citation: Dikranian L, Barry S, Ata A . Sars-CoV-2 with concurrent respiratory viral infection as a risk factor for a higher level of care in hospitalized pediatric patients. Pediatr Emerg Care 2022 Sep;38(9):472-76. doi: 10.1097/pec.0000000000002814..
Keywords: COVID-19, Children/Adolescents, Respiratory Conditions, Risk