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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 813 Research Studies DisplayedSolberg LI, Ziegenfuss JY, Rivard RL
Is there room for individual patient-specified preferences in the patient-reported outcome measurement revolution?
The goal of this study was to test the feasibility of collecting qualitative patient-preferred goals and its feasibility as an addition to a standardized process for collecting quantitative composite patient-reported outcome measures (PROMs) from patients undergoing knee joint replacement. The study found that joint replacement patients who responded to quantitative PROMS were willing to report on their other preferred outcomes.
AHRQ-funded; HS025618.
Citation: Solberg LI, Ziegenfuss JY, Rivard RL .
Is there room for individual patient-specified preferences in the patient-reported outcome measurement revolution?
J Patient Cent Res Rev 2023 Fall; 10(4):210-18. doi: 10.17294/2330-0698.2017..
Keywords: Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Ehmann MR, Klein EY, Zhao X
Epidemiology and clinical outcomes of community-acquired acute kidney injury in the emergency department: a multisite retrospective cohort study.
This retrospective cohort study’s objective was to describe the epidemiology of community-acquired acute kidney injury (CA-AKI) in the United States and the associated clinical outcomes. CA-AKI was identified using KDIGO (Kidney Disease: Improving Global Outcomes) serum creatinine (Scr)-based criteria. Outcomes for encounters resulting in hospitalization included the in-hospital trajectory of AKI severity, dialysis initiation, intensive care unit (ICU) admission, and death. Outcomes for all encounters included occurrence over 180 days of hospitalization, ICU admission, new or progressive chronic kidney disease, dialysis initiation, and death. For all encounters, 10.4% of patients met the criteria for any stage of AKI on arrival to the ED, with 16.6% of patients admitted to the hospital from the ED having CA-AKI on arrival to the ED. The likelihood of AKI recovery was inversely related to the CA-AKI stage on arrival to the ED. Among encounters for hospitalized patients, CA-AKI was associated with in-hospital dialysis initiation, ICU admission, and death compared with patients without CA-AKI. Among all encounters, CA-AKI was associated with new or progressive chronic kidney disease, dialysis initiation, subsequent hospitalization including ICU admission, and death during the subsequent 180 days.
AHRQ-funded; HS027793; HS026640.
Citation: Ehmann MR, Klein EY, Zhao X .
Epidemiology and clinical outcomes of community-acquired acute kidney injury in the emergency department: a multisite retrospective cohort study.
Am J Kidney Dis 2024 Jun; 83(6):762-71.e1. doi: 10.1053/j.ajkd.2023.10.009..
Keywords: Community-Acquired Infections, Kidney Disease and Health, Emergency Department, Outcomes
Hemmila MR, Neiman PU, Hoppe BL
Improving outcomes in emergency general surgery: construct of a collaborative quality initiative.
This study investigated emergency general surgery outcomes in order to construct a collaborative quality initiative to improve outcomes. The authors collected data at 10 hospitals from July 2019 to December 2022. They defined five different cohorts: acute appendicitis, acute gallbladder disease, small bowel obstruction, emergency laparotomy, and overall aggregate. Processes and inpatient outcomes examined included operative versus nonoperative management, mortality, morbidity (mortality and/or complication), readmissions, and length of stay. The cohorts included 19,956 emergency general surgery patients, of which 56.8% were female and 82.8% were White, and the mean (SD) age was 53.3 (20.8) years. After accounting for patient and disease factors, the adjusted aggregate mortality rate was 3.5%, morbidity rate was 27.6%, and the readmission rate was 15.1%. Operative management rates varied between hospitals from 70.9% to 96.9% for acute appendicitis and 19.8% to 79.4% for small bowel obstruction. Gastrofin challenge use in patients with a small bowel obstruction ranged from 10.7% to 61.4% of patients. A little over half (51.5%) of patients who underwent initial nonoperative management of acute cholecystitis had a cholecystostomy tube placed, with placement rate ranging from 23.5% to 62.1% across hospitals.
AHRQ-funded; HS028672.
Citation: Hemmila MR, Neiman PU, Hoppe BL .
Improving outcomes in emergency general surgery: construct of a collaborative quality initiative.
J Trauma Acute Care Surg 2024 May; 96(5):715-26. doi: 10.1097/ta.0000000000004248..
Keywords: Surgery, Outcomes, Quality Improvement, Quality of Care
Zheng H, Ash AS, Yang W
Strengthening quality measurement to predict success for total knee arthroplasty: results from a nationally representative total knee arthroplasty cohort.
In 2027, the Centers for Medicare & Medicaid Services (CMS) will begin mandating Patient-reported outcome measures (PROMs) to assess the quality of total knee arthroplasty (TKA). Using data from a national cohort of primary unilateral TKA patients, the authors developed, tested, and enhanced a model closely following a CMS-proposed measure to predict substantial clinical benefit. Only the enhanced model predicted success accurately across the spectrum of baseline scores. Findings were virtually identical when analyses were replicated on patients over 65. The authors concluded that adding a baseline knee-specific PROM score to a quality measurement model in a nationally representative cohort dramatically improved its predictive power.
AHRQ-funded; HS018910.
Citation: Zheng H, Ash AS, Yang W .
Strengthening quality measurement to predict success for total knee arthroplasty: results from a nationally representative total knee arthroplasty cohort.
J Bone Joint Surg Am 2024 Apr 17; 106(8):708-15. doi: 10.2106/jbjs.23.00602..
Keywords: Quality Measures, Quality of Care, Orthopedics, Surgery, Outcomes, Evidence-Based Practice, Patient-Centered Outcomes Research
Jain S, Rosenbaum PR, Reiter JG
Assessing the ambulatory surgery center volume-outcome association.
This study’s objective was to determine if low-volume ambulatory surgery centers (ASCs) have a higher rate of revisits after surgery, particularly among patients with multimorbidity. The authors created matched case-control study that used Medicare claims data and analyzed surgeries performed during 2018 and 2019 at ASCs. Commonly performed ambulatory surgeries were examined at 2328 ASCs and 4751 patients with a revisit (defined to be either 1 of 4735 revisits or 1 of 16 deaths without a revisit) within 7 days of surgery. These cases were each closely matched to 5 control patients without revisits (23,755 controls) from 2018 through 2019. Patients at a low-volume ASC had a higher odd of a 7-day revisit vs patients who had their surgery at a higher-volume ASC (odds ratio [OR], 1.21). The odds of revisit for patients with multimorbidity were higher at low-volume ASCs when compared with higher-volume ASCs (OR, 1.57). Among patients with multimorbidity in low-volume ASCs, for those who underwent orthopedic procedures, the odds of revisit were 84% higher (OR, 1.84) vs higher-volume centers, and for those who underwent general surgery or other procedures, the odds of revisit were 36% higher (OR, 1.36) vs a higher-volume center. Findings were not statistically significant for patients without multimorbidity.
AHRQ-funded; HS026116.
Citation: Jain S, Rosenbaum PR, Reiter JG .
Assessing the ambulatory surgery center volume-outcome association.
JAMA Surg 2024 Apr; 159(4):397-403. doi: 10.1001/jamasurg.2023.7161..
Keywords: Surgery, Ambulatory Care and Surgery, Outcomes
Ramadan OI, Rosenbaum PR, Reiter JG
Impact of hospital affiliation with a flagship hospital system on surgical outcomes.
The purpose of this study was to compare general surgery outcomes at flagship systems, flagship hospitals, and flagship hospital affiliates with matched controls. The researchers utilized Medicare claims data from 2018 and 2019 to match patients undergoing inpatient general surgery in flagship system hospitals to controls who underwent the same procedure at hospitals outside the system but within the same region. 32,228 closely matched pairs were formed across 35 regions. The study found that patients at flagship system hospitals had lower 30-day mortality than matched control patients, and patients at flagship hospitals had lower mortality than control patients. Patients at flagship hospital affiliates had similar mortality to matched controls, and flagship hospitals had lower mortality than affiliate hospitals.
AHRQ-funded; HS026116.
Citation: Ramadan OI, Rosenbaum PR, Reiter JG .
Impact of hospital affiliation with a flagship hospital system on surgical outcomes.
Ann Surg 2024 Apr; 279(4):631-39. doi: 10.1097/sla.0000000000006132..
Keywords: Hospitals, Surgery, Outcomes
Savitz ST, Falk K, Stearns SC
Race-ethnicity and sex differences in 1-year survival following percutaneous coronary intervention among Medicare fee-for-service beneficiaries.
The objectives of this study were to evaluate differences in 1-year survival after percutaneous coronary intervention (PCI) by sex and race-ethnicity, and to explore the role of socioeconomic characteristics (SEC) to observed differences. A 20% sample of Medicare claims data for beneficiaries aged 65 and over was used to identify fee-for-service patients who received PCI from 2007-2015. Results indicated that women were more likely to experience PCI in the setting of acute myocardial infarction and had less transition to outpatient care during the period, while black patients experienced higher 1-year mortality following PCI; the authors concluded that the latter was explained by differences in baseline comorbidities, county medical resources, and state of residence.
AHRQ-funded; HS000032.
Citation: Savitz ST, Falk K, Stearns SC .
Race-ethnicity and sex differences in 1-year survival following percutaneous coronary intervention among Medicare fee-for-service beneficiaries.
J Eval Clin Pract 2024 Apr; 30(3):406-17. doi: 10.1111/jep.13954..
Keywords: Racial and Ethnic Minorities, Cardiovascular Conditions, Heart Disease and Health, Surgery, Outcomes, Social Determinants of Health
Aklilu AM, Kumar S, Nugent J
COVID-19-associated acute kidney injury and longitudinal kidney outcomes.
This retrospective longitudinal multicenter cohort study’s objective was to assess long-term kidney outcomes of patient who had COVID-19-associated acute kidney injury (AKI). This study was conducted in a large hospital system using electronic health records data on adult hospitalized patients with AKI and COVID-19 or other illnesses. Included patients were those 1) who were hospitalized during the COVID-19 pandemic (March 2020-June 2022), were screened for SARS-CoV-2, had AKI, and survived to discharge, or 2) had been hospitalized during the 5 years before the pandemic (October 2016-January 2020), had a positive influenza A or B test result, had AKI, and survived to discharge. The study cohort included 9624 hospitalized patients (mean age, 69.0 years; 4955 females) with AKI, including 987 patients with COVID-AKI, 276 with influenza-associated AKI, and 8361 with AKI associated with other illnesses (other-AKI). When compared with the other 2 groups, patients with COVID-19-associated AKI were slightly younger in age, had a higher baseline eGFR, worse baseline comorbidity scores, higher markers of illness severity, and longer hospital stay. Compared with the other-AKI group, the COVID-AKI group had lower major adverse kidney events (MAKE) (adjusted hazard ratio [aHR], 0.67) due to lower all-cause mortality (aHR, 0.31) and lower rates of worsened kidney function.
AHRQ-funded; HS027626.
Citation: Aklilu AM, Kumar S, Nugent J .
COVID-19-associated acute kidney injury and longitudinal kidney outcomes.
JAMA Intern Med 2024 Apr; 18(4):414-23. doi: 10.1001/jamainternmed.2023.8225..
Keywords: COVID-19, Kidney Disease and Health, Outcomes
Bernstein EY, Bernstein TP, Trivedi S
Outcomes after initiation of medications for alcohol use disorder at hospital discharge.
This study looked at outcomes after initiation of medications for alcohol use disorder (MAUD), which are very underutilized. The primary outcome was a composite of all-cause mortality or return to hospital within 30 days of discharge. Secondary outcomes included the previous components separately, return to hospital for alcohol-related diagnoses, and primary care or mental health follow-up within 30 days of discharge. There were 6794 unique individuals representing 9834 alcohol-related hospitalizations (median [IQR] age, 54 years; 3205 hospitalizations among females [32.6%]; 1754 hospitalizations among Black [17.8%], 712 hospitalizations among Hispanic [7.2%], and 7060 hospitalizations among White [71.8%] patients). Of these, 2% of hospitalizations involved discharged MAUD initiation. Discharge MAUD initiation was associated with a 42% decreased incidence of the primary outcome (incident rate ratio, 0.58). These findings were consistent among secondary outcomes (eg, incident rate ratio for all-cause return to hospital, 0.56) except for mortality, which was rare in both groups. Discharge MAUD initiation was associated with a 51% decreased incidence of alcohol-related return to hospital.
AHRQ-funded; HS026215.
Citation: Bernstein EY, Bernstein TP, Trivedi S .
Outcomes after initiation of medications for alcohol use disorder at hospital discharge.
JAMA Netw Open 2024 Mar 4; 7(3):e243387. doi: 10.1001/jamanetworkopen.2024.3387..
Keywords: Medication, Alcohol Use, Substance Abuse, Behavioral Health, Outcomes, Hospital Discharge
Sheehan MM, Zilberberg MD, Lindenauer PK
Associations between present-on-admission do-not-resuscitate orders and short-term outcomes in patients with pneumonia.
The purpose of this study was to examine whether early Do-not-resuscitate (DNR) orders are related with differences in treatments and outcomes in patients hospitalized with pneumonia. The study found that of 768,015 patients, 12.3% had an early DNR order. Patients with DNR orders were older, with higher comorbidity burden, intensive care use, and in-hospital mortality. There was little association between predicted mortality and DNR orders, and DNR orders were relationship with lower intensive care use compared with those without.
AHRQ-funded; HS025026; HS024277.
Citation: Sheehan MM, Zilberberg MD, Lindenauer PK .
Associations between present-on-admission do-not-resuscitate orders and short-term outcomes in patients with pneumonia.
South Med J 2024 Mar; 117(3):165-71. doi: 10.14423/smj.0000000000001663..
Keywords: Pneumonia, Respiratory Conditions, Outcomes
Neerland C, Slaughter-Acey J, Behrens K
An evidence map for social and structural determinants for maternal morbidity and mortality: a systematic review.
The study aimed to identify social and structural determinants of maternal morbidity and mortality during prenatal and postpartum periods in the U.S. Out of 8,378 references screened, 118 studies were included, covering domains like identity, socioeconomic factors, violence, and trauma. Findings revealed mixed patterns between risk factors and outcomes, with notable attention to depression and mental health. Advancing the field long-term should involve developing comprehensive datasets to thoroughly investigate intersections with biological and medical risk factors.
AHRQ-funded; 75Q80120D00008.
Citation: Neerland C, Slaughter-Acey J, Behrens K .
An evidence map for social and structural determinants for maternal morbidity and mortality: a systematic review.
Obstet Gynecol 2024 Mar; 143(3):383-92. doi: 10.1097/aog.0000000000005489.
Keywords: Social Determinants of Health, Maternal Care, Mortality, Evidence-Based Practice, Risk, Women, Outcomes
Steuart R, Pan AY, Woolums A
Respiratory culture growth and 3-years lung health outcomes in children with bronchopulmonary dysplasia and tracheostomies.
The goal of this cohort study is to determine the long-term effects of pathogenic identification on respiratory cultures in children. The study included infants and children with BPD and tracheostomies. The cohort study conclusions suggest that respiratory pathogens including P. aeruginosa may not promote long-term respiratory dysfunction, but identification of P. aeruginosa may delay decannulation.
AHRQ-funded; HS025138.
Citation: Steuart R, Pan AY, Woolums A .
Respiratory culture growth and 3-years lung health outcomes in children with bronchopulmonary dysplasia and tracheostomies.
Pediatr Pulmonol 2024 Feb; 59(2):300-13. doi: 10.1002/ppul.26746..
Keywords: Children/Adolescents, Respiratory Conditions, Outcomes
Khalaf N, Ali B, Liu Y
Emergency presentations predict worse outcomes among patients with pancreatic cancer.
This study evaluated the association between pancreatic emergency presentation (EP) and cancer stage, treatment, and survival. The authors conducted a retrospective cohort study among patients with pancreatic adenocarcinoma diagnosed from 2007 to 2019 at a tertiary-care Veterans Affairs medical center. They used electronic health records to identify EP cases, defined as a new pancreatic cancer diagnosis made within 30 days of an ED visit where cancer was suspected. Of 243 identified pancreatic cancer patients, 66.7% had EPs. Although there was no difference in stage by EP status, patients diagnosed through EPs were 72% less likely to receive cancer treatment compared to non-emergency presenters. Patients with EPs also had a 73% higher mortality risk. This difference in mortality remained statistically significant after adjusting for cancer stage and receipt of cancer treatment.
AHRQ-funded; HS029347; HS028595.
Citation: Khalaf N, Ali B, Liu Y .
Emergency presentations predict worse outcomes among patients with pancreatic cancer.
Dig Dis Sci 2024 Feb; 69(2):603-14. doi: 10.1007/s10620-023-08207-6.
Keywords: Cancer, Emergency Department, Outcomes
Kalata S, Schaefer SL, Nuliyahu U
Low-volume elective surgery and outcomes in Medicare beneficiaries treated at hospital networks.
This cross-sectional study’s objective was to quantify low-volume surgery and associated outcomes within hospital networks. This study used Medicare Provider Analysis and Review data to examine fee-for-service beneficiaries aged 66 to 99 years who underwent 1 of 10 elective surgical procedures (abdominal aortic aneurysm repair, carotid endarterectomy, mitral valve repair, hip or knee replacement, bariatric surgery, or resection for lung, esophageal, pancreatic, or rectal cancers) in a network hospital from 2016 to 2018. Hospital volume for each procedure (calculated with the use of National Inpatient Sample data) was compared with yearly hospital volume standards for that procedure recommended by The Leapfrog Group. The authors analyzed primary outcomes which were postoperative complications, 30-day readmission, and 30-day mortality, stratified by the volume status of the hospital and network type. Secondary outcome was the availability of a different high-volume hospital within the same network or outside the network and its proximity to the patient (based on hospital referral region and zip code). In all, data were analyzed for 950,079 Medicare fee-for-service beneficiaries (average age 74.4 years; 621,138 females and 427,931 males) who underwent 1,049,069 procedures at 2469 hospitals within 382 networks. Of these networks, almost 100% [380 (99.5%)] had at least 1 low-volume hospital performing the elective procedure of interest. In 79.8% of procedures that were performed at low-volume hospitals, there was a hospital that met volume standards within the same network and hospital referral region located a median (IQR) distance of 29 (12-60) miles from the patient's home. In adjusted analyses, postoperative outcomes were inferior at low-volume hospitals compared with hospitals meeting volume standards, with a 30-day mortality of 8.1% at low-volume hospitals vs 5.5% at hospitals that met volume standards.
AHRQ-funded; HS028606.
Citation: Kalata S, Schaefer SL, Nuliyahu U .
Low-volume elective surgery and outcomes in Medicare beneficiaries treated at hospital networks.
JAMA Surg 2024 Feb; 159(2):203-10. doi: 10.1001/jamasurg.2023.6542.
Keywords: Surgery, Medicare, Hospitals, Outcomes
Kovacevic M, Montes M, Tirone V
Treating a common comorbidity: pain outcomes following a 3-week cognitive processing therapy-based intensive treatment for posttraumatic stress disorder address.
This study examined changes in pain, posttraumatic stress disorder (PTSD), and depressive symptoms among 125 veterans completing a 3-week cognitive processing therapy (CPT)-based intensive treatment program (ITP) for PTSD. The authors explored whether pretreatment pain interference predicted changes in PTSD and depressive symptom severity and whether larger changes in pain interference over the course of treatment were associated with larger changes in PTSD and depressive symptom severity. Higher levels of pretreatment pain interference were associated with higher PTSD, and depressive symptom severity, over time. Larger reductions in pain interference corresponded to more improvement in PTSD symptoms, but not depressive symptoms.
AHRQ-funded; HS028511.
Citation: Kovacevic M, Montes M, Tirone V .
Treating a common comorbidity: pain outcomes following a 3-week cognitive processing therapy-based intensive treatment for posttraumatic stress disorder address.
J Trauma Stress 2024 Feb; 37(1):47-56. doi: 10.1002/jts.22979.
Keywords: Pain, Behavioral Health, Outcomes, Chronic Conditions
Danielson EC, Li W, Suleiman L
Social risk and patient-reported outcomes after total knee replacement: implications for Medicare policy.
The objective of this study was to determine if county- or patient-level social risk factors are associated with patient-reported outcomes after total knee replacement when added to the comprehensive joint replacement risk-adjustment model. Patient and outcomes data from the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement cohort were merged with the CDC Social Vulnerability Index. The findings indicated that patient-reported race, education, and income were associated with patient-reported pain or functional scores; pain improvement was negatively associated with Black race and positively associated with higher annual incomes. The authors concluded that these findings suggested that patient-level social factors warrant further investigation to promote health equity in patient-reported outcomes after total knee replacement.
Citation: Danielson EC, Li W, Suleiman L .
Social risk and patient-reported outcomes after total knee replacement: implications for Medicare policy.
Health Serv Res 2024 Feb; 59(1):e14215. doi: 10.1111/1475-6773.14215.
Keywords: Surgery, Orthopedics, Medicare, Outcomes, Patient-Centered Outcomes Research, Social Determinants of Health
Al Hussein Al Awamlh B, Wallis CJD, Penson DF
Functional outcomes after localized prostate cancer treatment.
The objective of this observational cohort study was to compare rates of adverse functional outcomes between specific treatments for localized prostate cancer. Researchers used data from five U.S. Surveillance, Epidemiology, and End Results Program registries. Participants were patients treated for localized prostate cancer in 2011-2012. The results indicated that radical prostatectomy was associated with worse urinary incontinence, but not with worse sexual function, at 10-year followup when compared with radiotherapy or surveillance. Among patients with unfavorable-prognosis disease, external beam radiotherapy with androgen deprivation therapy was associated with worse bowel and hormone function at 10-year followup compared with radical prostatectomy.
AHRQ-funded; HS019356; HS022640.
Citation: Al Hussein Al Awamlh B, Wallis CJD, Penson DF .
Functional outcomes after localized prostate cancer treatment.
JAMA 2024 Jan 23; 331(4):302-17. doi: 10.1001/jama.2023.26491.
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Keywords: Cancer: Prostate Cancer, Cancer, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Olaya F, Brin M, Caraballo PB
A randomized controlled trial of the dissemination of an mHealth intervention for improving health outcomes: the WiseApp for Spanish-speakers living with HIV study protocol.
The purpose of this study is to test the effectiveness of an mHealth tool to improve adherence to HIV medication in Spanish-speaking people living in New York City and the Dominican Republic. The researchers developed the WiseApp study as a two-arm randomized controlled trial. The 248 participants from New York and the Dominican Republic were randomly assigned to receive a CleverCap pill bottle that is linked to the WiseApp (intervention) or to the standard of care (control). The participants completed surveys at the baseline, 3-month, 6-month, and 12-month follow-up visits. Through blood draws at each study timepoint, the study team collected HIV-1 viral load and CD4 count results. Results will be forthcoming.
AHRQ-funded; HS028523.
Citation: Olaya F, Brin M, Caraballo PB .
A randomized controlled trial of the dissemination of an mHealth intervention for improving health outcomes: the WiseApp for Spanish-speakers living with HIV study protocol.
BMC Public Health 2024 Jan 17; 24(1):201. doi: 10.1186/s12889-023-17538-y..
Keywords: Human Immunodeficiency Virus (HIV), Telehealth, Health Information Technology (HIT), Cultural Competence, Outcomes
Roberts ET, Xue L, Lovelace J
Changes in care associated with integrating Medicare and Medicaid for dual-eligible individuals.
This study’s objective was to evaluate changes in care associated with integrating Medicare and Medicaid coverage in a fully integrated dual-eligible special needs plan (FIDE-SNP) in Pennsylvania. This cohort study used a difference-in-differences analysis compared changes in care between 2 cohorts of dual-eligible individuals: (1) an integration cohort composed of Medicare Dual Eligible Special Needs Plan enrollees who joined a companion Medicaid plan following a 2018 state reform mandating Medicaid managed care (leading to integration), and (2) a comparison cohort with nonintegrated coverage before and after the start of Medicaid managed care. Analyses were conducted of outcomes in 4 domains: use of home- and community-based services (HCBS), care management and coordination, hospital stays and postacute care, and long-term nursing home stays. The study included 7967 individuals in the integration cohort and 3832 individuals in the comparison cohort. HCBS use increased differentially in the integration vs comparison cohorts by 0.61 days/person-month. However, integration was not associated with changes in care management and coordination, including medication use for chronic conditions (-0.02 fills/person-month) or follow-up outpatient care after a hospital stay (-0.01 visits/hospital stay). There was no significant difference in hospital stays between the cohorts.
AHRQ-funded; HS026727.
Citation: Roberts ET, Xue L, Lovelace J .
Changes in care associated with integrating Medicare and Medicaid for dual-eligible individuals.
JAMA Health Forum 2023 Dec; 4(12):e234583. doi: 10.1001/jamahealthforum.2023.4583..
Keywords: Medicare, Medicaid, Health Insurance, Surgery, Outcomes
Rastogi V, Guetter CR, Patel PB
Clinical presentation, outcomes, and threshold for repair by sex in degenerative saccular vs fusiform aneurysms in the descending thoracic aorta.
The purpose of this study was to explore variations in presentation, treatment, and outcomes between saccular thoracic aortic aneurysms (TAAs) and fusiform TAAs in the descending thoracic aorta. The researchers also explored the need for sex-specific treatment thresholds for TAAs. The study found that among 655 emergent/urgent thoracic endovascular aneurysm repairs (TEVARs), 37% were performed for saccular TAAs, whereas among 1352 elective TEVARs, 35% had saccular TAA morphology. Compared with fusiform TAAs, saccular TAAs more frequently underwent emergent/urgent (ruptured/symptomatic) TEVAR below the repair threshold in both females and males. Among patients with emergent/urgent fusiform TAAs, females presented at smaller diameters compared with males, yet there was no variance in preoperative aneurysm diameter among patients with saccular TAAs. Emergent/urgent treated saccular TAAs had similar postoperative outcomes and 5-year mortality compared with fusiform TAAs. In the elective cohort, patients with saccular TAAs had comparable postoperative mortality compared with those with fusiform TAAs, but a lower rate of postoperative spinal cord ischemia. additionally, patients with saccular TAAs had a higher rate of 5-year mortality compared with their fusiform counterparts.
AHRQ-funded; HS027285.
Citation: Rastogi V, Guetter CR, Patel PB .
Clinical presentation, outcomes, and threshold for repair by sex in degenerative saccular vs fusiform aneurysms in the descending thoracic aorta.
J Vasc Surg 2023 Dec; 78(6):1392-401.e1. doi: 10.1016/j.jvs.2023.06.104..
Keywords: Outcomes, Cardiovascular Conditions
Fingar KR, Weiss AJ, Roemer M
AHRQ Author: Roemer M, Reid LD
Effects of the COVID-19 early pandemic on delivery outcomes among women with and without COVID-19 at birth.
This AHRQ-authored paper examined the early pandemic-related changes in birth outcomes for pregnant women with and without a COVID-19 diagnosis at delivery. They compared four delivery outcomes-preterm delivery (PTD), severe maternal morbidity (SMM), stillbirth, and cesarean birth-between 2017 and 2019 (prepandemic) and between April and December 2020 (early pandemic) using interrupted time series models on 11.8 million deliveries, stratified by COVID-19 infection status at birth with entropy weighting for historical controls, from the HCUP across 43 states and the District of Columbia. Relative to 2017-2019, women without COVID-19 at delivery in 2020 had lower odds of PTD (OR = 0.93) and SMM (OR = 0.88) but increased odds of stillbirth (OR = 1.04). COVID-19 deliveries had an excess of each outcome, by factors of 1.07-1.46 for outcomes except SMM at 4.21. The effect for SMM was more pronounced for Asian/Pacific Islander non-Hispanic (API; OR = 10.51) and Hispanic (OR = 5.09) pregnant women than for White non-Hispanic (OR = 3.28) women.
AHRQ-authored; AHRQ-funded; 290201800001C.
Citation: Fingar KR, Weiss AJ, Roemer M .
Effects of the COVID-19 early pandemic on delivery outcomes among women with and without COVID-19 at birth.
Birth 2023 Dec; 50(4):996-1008. doi: 10.1111/birt.12753..
Keywords: Healthcare Cost and Utilization Project (HCUP), COVID-19, Maternal Care, Women, Outcomes
Bingham CA, Harris JG, Qui T
Pediatric Rheumatology Care and Outcomes Improvement Network's quality measure set to improve care of children with juvenile idiopathic arthritis.
The objective of this study was to describe the selection, development, and implementation of quality measures for juvenile idiopathic arthritis (JIA) by the Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), a multihospital learning health network. Clinicians in PR-COIN and parents of children with JIA collaboratively selected outcome quality measures and a committee of rheumatologists and data analysts developed operational definitions. Initial measures were clinical inactive disease, low pain score, and optimal physical functioning; the revised set included additional measures of disease activity, data quality, and a balancing measure. The authors concluded that PR-COIN's set of JIA quality measures is the first comprehensive set used at the point-of-care for a large cohort of JIA patients in a variety of pediatric rheumatology practice settings.
AHRQ-funded; HS021114.
Citation: Bingham CA, Harris JG, Qui T .
Pediatric Rheumatology Care and Outcomes Improvement Network's quality measure set to improve care of children with juvenile idiopathic arthritis.
Arthritis Care Res 2023 Dec; 75(12):2442-52. doi: 10.1002/acr.25168.
Keywords: Children/Adolescents, Arthritis, Quality Measures, Quality Improvement, Quality of Care, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Zondlak AN, Oh EJ, Neiman PU
Association of intellectual disability with delayed presentation and worse outcomes in emergency general surgery.
Individuals with intellectual disabilities may be at higher risk of delayed presentation and worse outcomes for emergency general surgery (EGS) conditions. The purpose of this study was to explore the relationship between intellectual disability and both severity of disease and clinical outcomes in patients presenting with typical EGS conditions. The study found that of 1,317,572 adult EGS admissions, 0.38% of patients had an ICD-9/-10 code consistent with current intellectual disability. EGS patients with intellectual disabilities had 31% greater odds of more severe disease at presentation when compared with neurotypical patients. Intellectual disability was also related with a higher likelihood of complications and mortality, longer lengths of stay, lower rate of discharge to home, and higher inpatient costs.
AHRQ-funded; HS028672; HS027788.
Citation: Zondlak AN, Oh EJ, Neiman PU .
Association of intellectual disability with delayed presentation and worse outcomes in emergency general surgery.
Ann Surg 2023 Nov 1; 278(5):e1118-e22. doi: 10.1097/sla.0000000000005863..
Keywords: Healthcare Cost and Utilization Project (HCUP), Disabilities, Surgery, Outcomes
Bauer TM, Yaser JM, Daramola T
Cardiac rehabilitation reduces two-year mortality after coronary artery bypass grafting.
This study analyzed the outcome of cardiac rehabilitation (CR) use for patients who have undergone coronary revascularization procedures. The study looked at Medicare fee-for-service claims linked to surgical data patients discharged alive following isolated coronary artery bypass grafting (CABG) from January 2015 to October 2019. A total of 3,848/6,412 (60.0%) of patients were enrolled in CR for an average of 23.2 sessions with 770/6,412 (12.0%) completing all recommended 36 sessions. Predictors of post-discharge CR use included increasing age, discharge to home (vs extended care facility), and shorter length of stay. Unadjusted and inverse probability treatment weighting (IPTW) analyses showed significant reduction in 2-year mortality in CR users as compared to CR non-users (unadjusted 9.4%).
AHRQ-funded; HS027830.
Citation: Bauer TM, Yaser JM, Daramola T .
Cardiac rehabilitation reduces two-year mortality after coronary artery bypass grafting.
Ann Thorac Surg 2023 Nov; 116(5):1099-105. doi: 10.1016/j.athoracsur.2023.05.044..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Surgery, Mortality, Outcomes
O'Leary KJ, Johnson JK, Williams MV
Effect of complementary interventions to redesign care on teamwork and quality for hospitalized medical patients: a pragmatic controlled trial.
The objective of this pragmatic controlled trial was to evaluate the effect of interventions to redesign hospital care delivery on teamwork and patient outcomes. Survey participants were healthcare professionals and hospitalized medical patients in medical units at four U.S. hospitals. The results showed that the median teamwork climate score was higher after the intervention among nurses, but that interventions to redesign care for hospitalized patients were not associated with improved patient outcomes.
AHRQ-funded; HS02564.
Citation: O'Leary KJ, Johnson JK, Williams MV .
Effect of complementary interventions to redesign care on teamwork and quality for hospitalized medical patients: a pragmatic controlled trial.
Ann Intern Med 2023 Nov; 176(11):1456-64. doi: 10.7326/m23-0953..
Keywords: Teams, Inpatient Care, Hospitals, Quality of Care, Outcomes