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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 785 Research Studies Displayed
Mullens CL, Lussiez A, Scott JW
Association of health professional shortage area hospital designation with surgical outcomes and expenditures among Medicare beneficiaries.
This study’s objective was to compare surgical outcomes and expenditures at hospitals located in Health Professional Shortage Areas to nonshortage area designated hospitals among Medicare beneficiaries. This cross-sectional retrospective study used data from 842,787 Medicare beneficiary patient admissions to hospitals with and without Health Professional Shortage Area designations for common operations including appendectomy, cholecystectomy, colectomy, and hernia repair from 2014 to 2018. Primary outcomes measures were 30-day mortality, hospital readmissions, and 30-day surgical episode payments. Patients (mean age=75.6 years, males=44.4%) undergoing common surgical procedures in shortage area hospitals were less likely to be White (84.6% vs 88.4%) and less likely to have≥2 Elixhauser comorbidities (75.5% vs 78.2%). Patients undergoing surgery at Health Professional Shortage Area hospitals had lower risk-adjusted rates of 30-day mortality (6.05% vs 6.69%) and readmission (14.99% vs 15.74%). Medicare expenditures at Health Professional Shortage Area hospitals were also lower than nonshortage designated hospitals ($28,517 vs $29,685).
AHRQ-funded; HS028606; HS028672.
Citation: Mullens CL, Lussiez A, Scott JW . Association of health professional shortage area hospital designation with surgical outcomes and expenditures among Medicare beneficiaries. Ann Surg 2023 Oct 1; 278(4):e733-e39. doi: 10.1097/sla.0000000000005762..
Keywords: Hospitals, Surgery, Medicare, Healthcare Costs, Workforce, Outcomes
Romijn AC, Rastogi V, Proaño-Zamudio JA
Early versus delayed thoracic endovascular aortic repair for blunt thoracic aortic injury: a propensity score-matched analysis.
This study examined the outcomes of ≤24 h) versus delayed (>24 h) thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI), taking the aortic injury severity into consideration. Current trauma surgery guidelines recommend delayed TEVAR. Patients undergoing TEVAR for BTAI in the American College of Surgeons Trauma Quality Improvement Program between 2016 and 2019 were included and then stratified into early (≤24 h) or delayed (>24 h). The cohort looked at included 1339 patients, of whom 1054 (79%) underwent early TEVAR. Compared with the delayed group, the early group had significantly less severe head injuries (early vs delayed; 25% vs 32%), fewer early interventions for AAS grade 1 occurred, and AAS grade 3 aortic injuries often were intervened upon within 24 hours (grade 1: 28% vs 47%; grade 3: 49% vs 23%). Compared with the delayed group, the early group had significantly higher in-hospital mortality (8.8% vs 4.4%, relative risk: 2.2, 95% CI: 1.1-4.4), alongside a shorter length of hospital stay (5.0 vs 10 days), a shorter intensive care unit length of stay (4.0 vs 11 days) and fewer days on the ventilator (4.0 vs 6.5 days). Regardless of the higher risk of acute kidney injury in the delayed group (3.3% vs 7.7%), no other differences in in-hospital complications were observed between the early and delayed group.
Citation: Romijn AC, Rastogi V, Proaño-Zamudio JA . Early versus delayed thoracic endovascular aortic repair for blunt thoracic aortic injury: a propensity score-matched analysis. Ann Surg 2023 Oct 1; 278(4):e848-e54. doi: 10.1097/sla.0000000000005817..
Keywords: Surgery, Cardiovascular Conditions, Risk, Outcomes
Smith JH, Silverberg JI
Correlation of clinician-reported outcomes with patient-reported outcomes by race and ethnicity in patients with atopic dermatitis.
This study examined the correlation of clinician-reported outcome measures (ClinROMs) with patient-reported outcomes by race and ethnicity in patients with atopic dermatitis (AD). A prospective, dermatology practice-based study was conducted with children and adults with AD for patients enrolled January 2014 through September 2019. Electronic surveys were completed by patients or caregivers, including self-identified race and Hispanic ethnicity, Numerical Rating Scale (NRS) for average itch in the past 7 days, and Patient Oriented Eczema Measure (POEM). Different severity indexes including Ezcema Area and Severity Index (EASI), and objective-SCORing Atopic Dermatitis Index (SCORAD) were used by a dermatologist to perform total body skin assessments. Spear correlations were performed for POEM and NRS-itch versus objective-SCORAD and EASI. Overall, 1987 patients were included in the study (age less than 18 years: 101 [5.08%], age greater or equal to 18 years: 1886 [94.92%]), including 198 (9.96%) Black, 360 (18.12%) Asian, 8 (0.40%) Multiracial/Other, 1313 (66.08%) White, and 108 (5.44%) Hispanic. Black patients had a moderate correlation for POEM with objective-SCORAD and EASI, while NRS average-itch had a weak-moderate correlation. In White patients there were strong correlations for both measures. Patients who were Asian/Pacific Islander had numerically weaker correlations of POEM but strong or very strong correlations of NRS average-itch with objective-SCORAD and EASI compared to White patients while patients with Hispanic ethnicity also showed numerically weaker correlations for POEM with objective-SCORAD and EASI, and weaker correlations of NRS average-itch with EASI.
Citation: Smith JH, Silverberg JI . Correlation of clinician-reported outcomes with patient-reported outcomes by race and ethnicity in patients with atopic dermatitis. J Am Acad Dermatol 2023 Sep; 89(3):579-80. doi: 10.1016/j.jaad.2023.04.050..
Keywords: Racial and Ethnic Minorities, Skin Conditions, Outcomes
Mullens CL, Lussiez A, Scott JW
High-risk surgery among Medicare beneficiaries living in health professional shortage areas.
This study’s objective was to compare high-risk surgical outcomes at hospitals located in Health Professional Shortage Areas to nonshortage area designated hospitals among Medicare beneficiaries. The authors performed a retrospective review of Medicare beneficiaries living in health professional shortage areas and nonshortage areas who underwent abdominal aortic aneurysm repair, coronary artery bypass graft, esophagectomy, liver resection, pancreatectomy, or rectal resection between 2014 and 2018. They compared rates of postoperative complications and 30-day mortality between the patient cohorts. They used beneficiary and hospital ZIP codes to quantify travel time to obtain care. Compared with patients living in nonshortage areas, patients living in health professional shortage areas traveled longer (median 60.0 vs 28.0 minutes). There were no differences in risk-adjusted rates of complications (28.5% vs 28.6%) and small differences in rates of 30-day mortality (4.2% vs 4.4%) between beneficiaries living in shortage areas versus those not in shortage areas, respectively.
AHRQ-funded; HS028606; HS028672; HS027788.
Citation: Mullens CL, Lussiez A, Scott JW . High-risk surgery among Medicare beneficiaries living in health professional shortage areas. J Rural Health 2023 Sep; 39(4):824-32. doi: 10.1111/jrh.12748..
Keywords: Surgery, Hospitals, Workforce, Medicare, Outcomes
Ramadan OI, Kelz RR, Sharpe JE
Impact of Medicaid expansion on outcomes after abdominal aortic aneurysm repair.
Researchers sought to assess the association between Medicaid expansion and outcomes after abdominal aortic aneurysm repair using HCUP State Inpatient Databases data from 14 states. They examined data on 8995 adult patients under age 65 from both non-expansion states and Medicaid expansion states. The results indicated that Medicaid expansion was associated with decreased in-hospital mortality after abdominal aortic aneurysm repair among all patients, particularly among patients who were either on Medicaid or were uninsured. The researchers concluded that these results provided support for improved access to care for patients undergoing abdominal aortic aneurysm repair through Medicaid expansion.
Citation: Ramadan OI, Kelz RR, Sharpe JE . Impact of Medicaid expansion on outcomes after abdominal aortic aneurysm repair. J Vasc Surg 2023 Sep; 78(3):648-56.e6. doi: 10.1016/j.jvs.2023.04.029..
Keywords: Healthcare Cost and Utilization Project (HCUP), Medicaid, Outcomes, Access to Care
Silverstein GD, Styke SC, Kaur S
The relationship between depressive symptoms, eHealth literacy, and asthma outcomes in the context of a mobile health intervention.
This study’s objective was to evaluate the associations between health/eHealth literacy and depressive symptoms with app usage and clinical outcomes. The authors recruited adults with persistent asthma to utilize the ASTHMAXcel PRO mobile app. Participants completed the following questionnaires: Patient Health Questionnaire-9 (PHQ-9) to assess for depressive symptoms, Asthma Control Test (ACT), Mini Asthma Quality of Life (QOL) Questionnaire, and the Newest Vital Sign (NVS) tool to measure health literacy. Subsets of participant data were available on eHealth literacy (eHeals) (n = 24) and average number of app logins across 2 months (n = 40). The average participant age was 44.0 years, with 74% identifying as female. Increased depressive symptoms were associated with worse asthma control and asthma QOL, but not eHealth literacy. Higher eHealth literacy was associated with worse asthma QOL and more app logins. NVS scores weren’t associated with any measures.
Citation: Silverstein GD, Styke SC, Kaur S . The relationship between depressive symptoms, eHealth literacy, and asthma outcomes in the context of a mobile health intervention. Psychosom Med 2023 Sep 1; 85(7):605-11. doi: 10.1097/psy.0000000000001170..
Keywords: Health Literacy, Asthma, Telehealth, Health Information Technology (HIT), Education: Patient and Caregiver, Outcomes, Respiratory Conditions, Chronic Conditions
Nguyen JK, P P
Comparison of survival outcomes among older adults with major trauma after trauma center versus non-trauma center care in the United States.
This study’s objective was to compare level 1 and 2 trauma centers with similarly sized non-trauma centers on survival after major trauma among older adults. The authors used claims of 100% of 2012-2017 Medicare fee-for-service beneficiaries who received hospital care after major trauma. They assessed the roles of prehospital care, hospital quality, and volume. Thirty-day mortality was higher overall at level 1 versus non-trauma centers by 2.2 percentage points (pp). Thirty-day mortality was higher at level 1 versus non-trauma centers by 2.3 pp for falls and 2.3 pp for motor vehicle crashes. Outcomes were similar at level 1 and 2 trauma centers. The difference was not explained by hospital quality and volume. There were also no statistical differences in the ambulance-transported group, after adjusting for prehospital variables.
Citation: Nguyen JK, P P . Comparison of survival outcomes among older adults with major trauma after trauma center versus non-trauma center care in the United States. Health Serv Res 2023 Aug; 58(4):817-27. doi: 10.1111/1475-6773.14148..
Keywords: Elderly, Trauma, Outcomes, Injuries and Wounds, Emergency Department, Hospitals
Krishnan JA, Margellos-Anast H, Kumar R
Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan.
The purpose of this clinical trial was to compare an emergency-department- (ED) only intervention and home visits by community health workers for 6 months (ED-plus-home) and enhanced usual care (UC). The study enrolled children aged 5 to 11 years with uncontrolled asthma. The primary outcomes were change over 6 months in the Patient-Reported Outcomes Measurement Information System Asthma Impact Scale score in children and Satisfaction with Participation in Social Roles score in caregivers. The secondary outcomes included guideline-recommended ED discharge care and self-management. The study found that of the 373 children recruited, only 63% completed the 6-month follow-up visit. Differences in Asthma Impact Scores or caregivers' Satisfaction with Participation in Social Roles scores were not significant. However, in the intervention groups guideline-recommended ED discharge care improved significantly versus in the UC group, and self-management behaviors were significantly improved in the ED-plus-home group versus in the ED-only and UC groups.
Citation: Krishnan JA, Margellos-Anast H, Kumar R . Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan. J Allergy Clin Immunol Glob 2023 Aug; 2(3). doi: 10.1016/j.jacig.2023.100100..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice, Emergency Department, Clinical Decision Support (CDS), Health Information Technology (HIT), Racial and Ethnic Minorities
Howard R, Thumma J, Ehlers A, et al.
Trends in surgical technique and outcomes of ventral hernia repair in the United States.
Surgical options for ventral hernia repair (VHR) have expanded considerably over the past 2 decades. Their diffusion and impact on population-level outcomes is not well described. The purpose of this retrospective cohort study was to characterize national trends in surgical technique and rates of reoperation for recurrence for patients undergoing VHR in the U.S. The researchers conducted a study of Medicare beneficiaries undergoing elective, inpatient umbilical, ventral, or incisional hernia repair between 2007 and 2015. The study found 141,261 patients underwent VHR during the study period. Between 2007 and 2018, the utilization of minimally invasive surgery increased from 2.1% to 22.2%, mesh utilization increased from 63.2% to 72.5%, and myofascial release utilization increased from 1.8% to 16.3%. The 5-year overall incidence of reoperation for recurrence was 14.1%. longitudinally, patients were more likely to remain free from reoperation for hernia recurrence 5 years after surgery.
Citation: Howard R, Thumma J, Ehlers A, et al.. Trends in surgical technique and outcomes of ventral hernia repair in the United States. Ann Surg 2023 Aug 1; 278(2):274-79. doi: 10.1097/sla.0000000000005654..
Keywords: Surgery, Outcomes
Taylor KK, Neiman PU, Bonner S
Unmet social health needs as a driver of inequitable outcomes after surgery: a cross-sectional analysis of the National Health Interview Survey.
The objective of this study was to identify opportunities to improve surgical equity by evaluating unmet social health needs by race, ethnicity, and insurance type. Researchers used the National Health Interview Survey for 2008-2018 to identify adults aged 18 and older who reported surgery in the past year. The results indicated that unmet social health needs varied significantly by race, ethnicity, and insurance, and were independently associated with poor health among surgical populations.
AHRQ-funded; HS028672; HS027788.
Citation: Taylor KK, Neiman PU, Bonner S . Unmet social health needs as a driver of inequitable outcomes after surgery: a cross-sectional analysis of the National Health Interview Survey. Ann Surg 2023 Aug 1; 278(2):193-200. doi: 10.1097/sla.0000000000005689.
Keywords: Social Determinants of Health, Surgery, Disparities, Outcomes
Ayers DC, Yousef M, Yang W
Age-related differences in pain, function, and quality of life following primary total knee arthroplasty: results from a FORCE-TJR (Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement) cohort.
The purpose of this prospective, multicenter cohort study was to evaluate the differences in pain, function, and quality of life (QoL) reported 1 year after total knee arthroplasty (TKA) across varying age groups. The researchers preoperatively assessed 11,602 unilateral primary TKA patients, and collected demographic data, comorbid conditions, and patient-reported outcome measures including the knee injury and osteoarthritis outcome score (KOOS), KOOS-12, KOOS Joint Replacement, and Short-Form health survey (12-item) and then collected again at 1-year postoperatively. The study found that prior to surgery, patients less than 55 years reported worse KOOS pain (39), function (50), and QoL (18) scores with poor mental health score (47) than other older patient groups. At 1 year after TKA, patients less than 55 years reported lower KOOS pain, function, and QoL scores when compared to patients 75 years or older. The differences in score changes among the age groups were statistically significant but clinically irrelevant. Further statistical analyses revealed that age was a significant predictor for pain, but not for function at 1 year where KOOS pain score was predicted to be higher in patients 75 years or older when compared to patients less than 55 years of age.
Citation: Ayers DC, Yousef M, Yang W . Age-related differences in pain, function, and quality of life following primary total knee arthroplasty: results from a FORCE-TJR (Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement) cohort. J Arthroplasty 2023 Jul; 38(7 Suppl 2):S169-S76. doi: 10.1016/j.arth.2023.04.005..
Keywords: Orthopedics, Surgery, Quality of Life, Outcomes, Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research, Pain
Derington CG, Goodrich GK, Xu S
Association of direct oral anticoagulation management strategies with clinical outcomes for adults with atrial fibrillation.
This study investigated the impact of an anticoagulation management service (AMS) on clinical outcomes of adults with atrial fibrillation (AF). This retrospective cohort study was conducted in 3 Kaiser Permanente regions, with each region taking a slightly different approach to direct oral anticoagulant (DOAC) care. These approaches included (1) usual care (UC) by the prescribing clinician, (2) UC plus an automated population management tool (PMT), or (3) pharmacist-managed AMS care. The study included 44,746 adults with a diagnosis of AF who initiated DOAC or warfarin between August 2016 and January 1, 2020, 6182 in the UC model, 33,624 in the UC plus PMT care model, and 4939 in the AMS care model. Baseline characteristics (mean age, 73.1 years, 56.1% male, 67.2% non-Hispanic White, median CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years, diabetes, stroke, vascular disease, age 65-74 years, female sex] score of 3 [IQR, 2-5]) were well balanced after inverse probability of treatment weighting (IPTW). The cohort was followed over a median of 2 years, and patients who received the UC plus PMT or AMS care model did not have significantly better outcomes than those who received only UC.
Citation: Derington CG, Goodrich GK, Xu S . Association of direct oral anticoagulation management strategies with clinical outcomes for adults with atrial fibrillation. JAMA Netw Open 2023 Jul; 6(7):e2321971. doi: 10.1001/jamanetworkopen.2023.21971..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Blood Thinners, Medication, Outcomes, Stroke
Silver CM, Yang AD, Shan Y
Changes in surgical outcomes in a Statewide Quality Improvement Collaborative with introduction of simultaneous, comprehensive interventions.
Researchers investigated whether a comprehensive quality improvement program implemented simultaneously across hospitals at the formation of a quality improvement collaborative (QIC) would improve patient outcomes. They analyzed risk-adjusted rates of postoperative morbidity and mortality for patients who had undergone surgery at hospitals in the Illinois Surgical Quality Improvement Collaborative (ISQIC); analyses compared ISQIC hospitals with hospitals in the NSQIP Participant Use File (PUF). Although complication rates decreased at both ISQIC and PUF hospitals, findings showed that participation in ISQIC was associated with a significantly greater improvement in death or serious morbidity. The researchers concluded that these results emphasize the potential of QICs to improve patient outcomes.
Citation: Silver CM, Yang AD, Shan Y . Changes in surgical outcomes in a Statewide Quality Improvement Collaborative with introduction of simultaneous, comprehensive interventions. J Am Coll Surg 2023 Jul 1; 237(1):128-38. doi: 10.1097/xcs.0000000000000679..
Keywords: Surgery, Outcomes, Quality Improvement, Quality of Care, Hospitals
Bossick AS, Painter I, Williams EC
Development of a composite risk index of reproductive autonomy using state laws: association with maternal and neonatal outcomes.
This study investigated whether greater reproductive autonomy would be associated with lower rates of severe maternal morbidity (SMM), pregnancy-related mortality (PRM), preterm birth (PTB), and low birthweight. It was hypothesized that greater reproductive autonomy would lower the risks of poor maternal and neonatal outcomes. The authors developed a composite index to quantify state legislation, which was used to examine the association with maternal and neonatal outcomes. A Delphi panel was used to inform index development, and restrictive policies were assigned values of -1 and enabling policies +1. Publicly available data was used to conduct a cross-sectional study of all live births in the 50 US states for people ages 15 to 44 from 2016 to 2018 to examine the association between the risk index and PRM, SMM, PTB, and low birthweight. There were 11,530,785 births, 2,846 pregnancy-related deaths, and 154,384 cases of SMM from 2016 to 2018. The Delphi panel found a summed state measure of 106 laws in 8 categories that could affect reproductive anatomy. In adjusted analyses, states in the most enabling reproductive autonomy quartile had a 44.7 per 10,000 higher rate of SMM compared with the most restrictive quartile. However, the most enabling quartile was associated with a 9.87 per 100,000 lower rate of PRM and 0.67 per 100 lower rate of PTB compared with the most restrictive quartile.
Citation: Bossick AS, Painter I, Williams EC . Development of a composite risk index of reproductive autonomy using state laws: association with maternal and neonatal outcomes. Womens Health Issues 2023 Jul-Aug; 33(4):359-66. doi: 10.1016/j.whi.2023.03.008..
Keywords: Maternal Care, Sexual Health, Women, Newborns/Infants, Outcomes, Patient-Centered Outcomes Research
Yadavalli SD, Romijn AC, Rastogi V
Outcomes following thoracic endovascular aortic repair for blunt thoracic aortic injury stratified by Society for Vascular Surgery grade.
Researchers analyzed data on patients undergoing thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI) within the Society for Vascular Surgery aortic injury grading system to assess its association with outcomes. Their findings indicated higher perioperative and 5-year mortality in TEVAR patients with grade 4 BTAI, but no association with the aortic injury grade after risk adjustment. More than 5% of TEVAR patients with BTAI had a grade 1 injury, with a significant rate of spinal cord ischemia potentially attributable to TEVAR; this proportion did not decrease over time. The researchers suggested that future efforts should focus on careful selection of patients with BTAI who will experience more benefit than harm from operative repair and prevent inadvertent use of TEVAR in low-grade injuries.
Citation: Yadavalli SD, Romijn AC, Rastogi V . Outcomes following thoracic endovascular aortic repair for blunt thoracic aortic injury stratified by Society for Vascular Surgery grade. J Vasc Surg 2023 Jul; 78(1):38-47.e2. doi: 10.1016/j.jvs.2023.03.021..
Keywords: Outcomes, Cardiovascular Conditions
Balk EM, Danilack VA, Bhuma MR
Reduced compared with traditional schedules for routine antenatal visits: a systematic review.
This systematic review’s objective was to assess differences in maternal and child outcomes in studies comparing reduced routine antenatal visit schedules with traditional schedules. The search was conducted in multiple databases searching for antenatal (prenatal) care, pregnancy, obstetrics, telemedicine, remote care, smartphones, telemonitoring, and related terms. Abstrackr was used for double independent screening for studies comparing televisits and in person routine antenatal care visits for maternal, child, health care utilization, and harm outcomes. The authors found five randomized controlled trials and five nonrandomized comparative studies that compared reduced routine antenatal visit schedules with traditional schedules. The studies did not find differences between schedules in gestational age at birth, likelihood of being small for gestational age, likelihood of a low Apgar score, likelihood of neonatal intensive care unit admission, maternal anxiety, likelihood of preterm birth, and likelihood of low birth weight. There was also insufficient evidence for numerous prioritized outcomes of interest, including completion of the American College of Obstetricians and Gynecologists-recommended services and patient experience measures.
Citation: Balk EM, Danilack VA, Bhuma MR . Reduced compared with traditional schedules for routine antenatal visits: a systematic review. Obstet Gynecol 2023 Jul 1; 142(1):8-18. doi: 10.1097/aog.0000000000005193..
Keywords: Maternal Care, Newborns/Infants, Women, Patient-Centered Outcomes Research, Outcomes, Comparative Effectiveness, Evidence-Based Practice
Solano QP, Howard R, Mullens CL
The impact of frailty on ventral hernia repair outcomes in a statewide database.
Researchers examined the association of frailty with short-term postoperative outcomes after ventral hernia repair (VHR). They retrospectively reviewed the Michigan Surgery Quality Collaborative Hernia Registry (MSQC-HR) for adult patients who underwent VHR. : After controlling for patient, operative, and hernia characteristics, frailty was found to be independently associated with increased odds of postoperative complications. The researchers concluded that their findings highlight the importance of preoperative frailty assessment for risk stratification and to inform patient counseling.
Citation: Solano QP, Howard R, Mullens CL . The impact of frailty on ventral hernia repair outcomes in a statewide database. Surg Endosc 2023 Jul; 37(7):5603-11. doi: 10.1007/s00464-022-09626-8..
Keywords: Surgery, Outcomes
Apathy NC, Dixit RA, Boxley CL
Variations in physician telemedicine provision.
This study’s objective was to quantify physician variation in telemedicine provisions and the extent to which telemedicine use is explainable by the individual physician, adjusting for temporal, patient, and visit factors. This cross-sectional study used data on adult primary care visits across MedStar Health, Stanford Health Care, and Intermountain Healthcare systems. Primary care physicians who conducted at least 1000 visits between March 13, 2020 and December 31, 2021 were included. Primary care visits were defined in the electronic health record and scheduling systems as completed outpatient visits with those included primary care physicians. The sample consisted of 2,410,471 visits total, with 25.6% via telemedicine seen by 729 physicians. Substantial variation in telemedicine provision was shown across physicians. At least 237 physicians (32.5%) had at least 1 high-outlier week of telemedicine provision. Patient demographics only accounted for 2.3% of the variation in telemedicine use, with the site accounting for 16.3% of the variation. Residual (unexplained) variation accounted for more than half of the explanations. Telemedicine use has slowly declined, largely due to the lack of physical examinations.
Citation: Apathy NC, Dixit RA, Boxley CL . Variations in physician telemedicine provision. JAMA Netw Open 2023 Jul; 6(7):e2321955. doi: 10.1001/jamanetworkopen.2023.21955..
Keywords: Low-Income, Social Determinants of Health, Outcomes, Risk
Stroumsa D, Moniz MH, Crissman H
Pregnancy outcomes in a US cohort of transgender people.
This letter summarized a study which assessed severe parental morbidity, cesarean deliveries, and preterm births among trans people compared with cisgender people. Data on deliveries was taken the Truven MarketScan Medicaid and commercial databases separately. Results indicated that trans individuals had similar rates of severe parental morbidity as cisgender people. Rates of cesarean delivery were significantly lower among trans people. No significant difference were found in preterm birth rates.
Citation: Stroumsa D, Moniz MH, Crissman H . Pregnancy outcomes in a US cohort of transgender people. JAMA 2023 Jun 6; 329(21):1879-81. doi: 10.1001/jama.2023.7688..
Keywords: Maternal Care, Outcomes
Wang SX, Marcaccio CL, Patel PB
Distal embolic protection use during transfemoral carotid artery stenting is associated with improved in-hospital outcomes.
Researchers sought to assess in-hospital outcomes in patients who had undergone transfemoral carotid artery stenting (tfCAS) with and without embolic protection using a distal filter. Patients undergoing tfCAS were identified in the Vascular Quality Initiative and those who received proximal embolic balloon protection were excluded. Outcomes of interest were stroke, death, composite stroke/death, myocardial infarction, transient ischemic attack, and hyperperfusion syndrome. Results indicated that tfCAS performed without attempted distal embolic protection was associated with higher risk of in-hospital stroke and death; tfCAS after a failed attempt at filter placement had equivalent stroke/death to patients with no filter attempted, but higher risk of stroke/death compared with those with successfully placed filters. The researchers concluded that these findings support current Society for Vascular Surgery guidelines and, if a filter cannot be safely placed, alternative approaches to carotid revascularization should be considered.
Citation: Wang SX, Marcaccio CL, Patel PB . Distal embolic protection use during transfemoral carotid artery stenting is associated with improved in-hospital outcomes. J Vasc Surg 2023 Jun; 77(6):1710-19.e6. doi: 10.1016/j.jvs.2023.01.210..
Keywords: Cardiovascular Conditions, Outcomes, Stroke
Saldanha IJ, Adam GP, Kanaan G
Health insurance coverage and postpartum outcomes in the US: a systematic review.
The objective of this evidence review was to assess whether extension of health insurance coverage or improvements in health care access are associated with postpartum health care utilization and maternal outcomes. Findings with moderate strength of evidence suggested that more comprehensive association was likely to be related to greater postpartum visit attendance; findings with low strength of evidence indicated a possible association between more comprehensive insurance, fewer preventable readmissions, and emergency department visits. The authors concluded that these findings suggested that evidence evaluating insurance coverage and postpartum visit attendance and unplanned care utilization is, at best, of moderate strength of evidence. They recommended that future research should evaluate clinical outcomes associated with more comprehensive insurance coverage.
Citation: Saldanha IJ, Adam GP, Kanaan G . Health insurance coverage and postpartum outcomes in the US: a systematic review. JAMA Netw Open 2023 Jun; 6(6):e2316536. doi: 10.1001/jamanetworkopen.2023.16536..
Keywords: Health Insurance, Maternal Care, Women, Outcomes, Medicaid, Patient-Centered Outcomes Research, Evidence-Based Practice
Lake ET, Staiger D, Smith JG
The association of missed nursing care with very low birthweight infant outcomes.
This study examined the association of missed nursing care and health outcomes of very low birthweight (VLBW) infants in neonatal intensive care units (NICUs). The authors used 2016 hospital administrative discharge abstracts for VLBW newborns (n = 7,595) and NICU registered nurse survey responses (n = 6,963) from the National Database of Nursing Quality Indicators. Mortality, morbidity, and length of stay (LOS) was examined in 190 sample hospitals from 19 states in all regions. There was a significant association between higher odds of bloodstream infection and longer LOS, but not mortality or severe intraventricular hemorrhage and missed nursing care.
Citation: Lake ET, Staiger D, Smith JG . The association of missed nursing care with very low birthweight infant outcomes. Med Care Res Rev 2023 Jun; 80(3):293-302. doi: 10.1177/10775587221150950..
Keywords: Healthcare Cost and Utilization Project (HCUP), Quality Indicators (QIs), Nursing, Newborns/Infants, Outcomes, Healthcare Utilization, Quality of Care
Brown-Johnson C, Calma J, Amano A
Evaluating the implementation of patient-reported outcomes in heart failure clinic: a qualitative assessment.
This study evaluated clinician perceptions of the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12), a patient reported outcome (PRO) survey that captures symptom frequency, symptom burden, physical limitations, social limitations, and quality of life. The authors conducted interviews with cardiologists from 4 institutions across the United States and Canada (n=16) and observed clinic visits at 1 institution in Northern California (n=5). They conducted 2 rounds of interviews and did a qualitative analysis on (1) rapid analysis constructed around major themes related to the aims of the study and (2) content analysis with codes derived from the rapid analysis and implementation science. Most cardiologists reported the KCCQ-12 was acceptable, appropriate, and useful in clinical care. The survey was found to improve the consistency of patient history taking, focus patient-clinician conversations, collect a more accurate account of patient quality of life, track trends in patient well-being over time, and refine clinical decision-making.
Citation: Brown-Johnson C, Calma J, Amano A . Evaluating the implementation of patient-reported outcomes in heart failure clinic: a qualitative assessment. Circ Cardiovasc Qual Outcomes 2023 May; 16(5):e009677. doi: 10.1161/circoutcomes.122.009677..
Keywords: Patient-Centered Outcomes Research, Outcomes, Heart Disease and Health, Cardiovascular Conditions
Herb J, Rodriguez-Ormaza N, Cunningham C
Gastrostomy tube outcomes among surgical and non-surgical services: a retrospective review.
The purpose of this retrospective analysis study was to evaluate variations in baseline characteristics, complications, and mortality in patients receiving a gastrostomy tube (GT) by surgical or non-surgical services. The researchers assessed adult patients who underwent GT placement from 2014 to 2017 at a single institution. The study found that of the 1,339 adults who underwent GT placement, surgical and non-surgical services performed 45 percent and 55 percent of procedures, respectively. Gastrostomy tube-related complications were similar with 29.6% surgical vs 28.8% non-surgical. The thirty-day mortality rate of 23.7 percent among non-surgical services than the 16.5 percent rate for surgical services.
Citation: Herb J, Rodriguez-Ormaza N, Cunningham C . Gastrostomy tube outcomes among surgical and non-surgical services: a retrospective review. Am Surg 2023 Apr; 89(4):813-20. doi: 10.1177/00031348211047173..
Keywords: Surgery, Digestive Disease and Health, Outcomes
Bajaj JS, Peña-Rodriguez M, La Reau A
Longitudinal transkingdom gut microbial approach towards decompensation in outpatients with cirrhosis.
The purpose of this study was to ascertain the crucial role of predicting the onset of initial decompensation development. It emphasizes the significance of transkingdom gut microbial interactions, including archaeal methanogens, as potential markers and predictors, and the need for a longitudinal approach to do so. The study included cirrhosis outpatients who were categorized into three groups: those with compensated cirrhosis in Group 1, those with one incidence of decompensation in Group 2, and those with more than one incidence of decompensation in Group 3. Group 3 was further divided based on stability or further decompensation. The presence of bacteria, viruses, and archaea, along with α/β diversity and temporal taxa fluctuations adjusted for clinical variables were analyzed. The study tracked 157 outpatients and found that between 28% and 47% of those patients developed outcomes. Baseline between those who remained stable/developed outcome: While no differences were seen in α/β diversity, commensals were lower and pathobionts were higher in those who decompensated. After decompensation: those experiencing their first decompensation showed a larger decrease in α/β-diversity, bacterial change and viral change vs those with further decompensation. Archaea: 19% had Methanobacter brevii, which was similar between/within groups. The study concluded that the largest changes in transkingdom gut microbial were observed in those reaching the first decompensation, compared with subsequent decompensating events.
Citation: Bajaj JS, Peña-Rodriguez M, La Reau A . Longitudinal transkingdom gut microbial approach towards decompensation in outpatients with cirrhosis. Gut 2023 Apr; 72(4):759-71. doi: 10.1136/gutjnl-2022-328403.
Keywords: Chronic Conditions, Ambulatory Care and Surgery, Outcomes