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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
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1 to 25 of 341 Research Studies DisplayedAnesi GL, Dres E, Chowdhury M
Among-hospital variation in ICU admission practices and associated outcomes for patients with acute respiratory failure.
Prior research has demonstrated a connection between hospital strain and ICU admission, and has suggested that ICU admission, compared to ward admission, could be advantageous for certain patients with acute respiratory failure (ARF). The purpose of this study was to explore how strain-process-outcomes relationships in ARF patients may differ among hospitals and to identify hospital practice discrepancies that may explain such variation. The researchers analyzed high-acuity ARF patients who did not necessitate mechanical ventilation or vasopressors in the emergency department (ED) and were admitted to 27 US hospitals between 2013 and 2018. The researchers compared hospital strain-ICU admission relationships and hospital length of stay (LOS) and mortality for patients initially admitted to the ICU versus the ward. Additionally, they investigated hospital practices and assessed their associations with those processes and outcomes. The study found that substantial variation was observed among hospitals in ICU admission rates, hospital strain-ICU admission relationships, and the impact of ICU admission on hospital LOS and mortality. Overall, ED patients with ARF had a median hospital LOS that was 0.82 days shorter if initially admitted to the ICU rather than the ward. However, among the 27 hospitals this effect ranged from 5.85 days shorter to 4.38 days longer. In exploratory analyses, only a limited number of identified hospital practices—such as the presence of sepsis ED disposition guidelines and maximum ED patient capacity—were potentially linked to hospital strain-ICU admission relationships.
AHRQ-funded; HS026372.
Citation: Anesi GL, Dres E, Chowdhury M .
Among-hospital variation in ICU admission practices and associated outcomes for patients with acute respiratory failure.
Ann Am Thorac Soc 2023 Mar; 20(3):406-13. doi: 10.1513/AnnalsATS.202205-429OC.
Keywords: Intensive Care Unit (ICU), Respiratory Conditions, Hospital Discharge
Donovan LM, Parsons EC, McCall CA
Impact of mail-based continuous positive airway pressure initiation on treatment usage and effectiveness.
Traditional care for patients starting continuous positive airway pressure (CPAP) therapy has involved face-to-face visits with a trained professional for hands-on guidance and mask fitting assessment. However, in an effort to increase accessibility, numerous healthcare systems are transitioning to remote CPAP initiation by mailing equipment to patients. Although this method offers potential advantages, the impact on patient outcomes remains uncertain. Specifically, concerns have been raised about the potential decrease in CPAP adherence due to the absence of in-person training. The purpose of this study was to evaluate treatment usage following either in-person or mailed CPAP initiation. In response to the COVID-19 pandemic, the researcher’s medical center transitioned from in-person to mailed CPAP distribution in March 2020. A cohort of newly diagnosed obstructive sleep apnea (OSA) patients who began CPAP therapy in the months preceding (n = 433) and following (n = 186) this shift was form. The researchers then compared 90-day adherence between the two groups. The study found the average nightly PAP usage was moderate in both cohorts. No significant differences were observed in unadjusted or adjusted analyses.
AHRQ-funded; HS026369
Citation: Donovan LM, Parsons EC, McCall CA .
Impact of mail-based continuous positive airway pressure initiation on treatment usage and effectiveness.
Sleep Breath 2023 Mar;27(1):303-08. doi: 10.1007/s11325-022-02608-z.
Keywords: Respiratory Conditions, Sleep Problems, Patient Adherence/Compliance
Dunbar PJ, Sobotka SA, Rodean J
Prevalence of and spending on ear, nose, throat, and respiratory infections among children with chronic complex conditions.
The impact of ear, nose, throat, and respiratory infections (ENTRIs) on children with complex chronic conditions (CCCs) may vary from that of their counterparts. The purpose of this study was to examine the prevalence and expenditure of ENTRIs in children with and without CCCs. A retrospective evaluation of 3,880,456 children aged 0-18 years enrolled in 9 US state Medicaid programs in 2018, as recorded in the IBM Watson Marketscan Database, was conducted. Feudtner's classification system was employed to identify the type and quantity of CCCs. The prevalence of ENTRIs, defined as one or more healthcare visits for ENTRIs, and Medicaid expenditure on ENTRIs were compared based on CCC status using chi-square tests and logistic regression. The study found that ENTRIs were more prevalent in children with CCCs than in those without. Children with a CCC represented approximately one-fourth ($145.8 million [US]) of the total ENTRI expenditure. Excluding throat and sinus infections, the prevalence of ENTRIs rose with the number of CCCs. For instance, the prevalence of lower-airway infections increased from 12.5% to 37.5% as the number of CCCs grew from zero to ≥3. Inpatient care-associated ENTRI expenditure rose from 9.7% to 92.8% as the number of CCCs increased from zero to ≥3.
AHRQ-funded; HS025138
Citation: Dunbar PJ, Sobotka SA, Rodean J .
Prevalence of and spending on ear, nose, throat, and respiratory infections among children with chronic complex conditions.
Acad Pediatr 2023 Mar;23(2):434-40. doi: 10.1016/j.acap.2022.07.004.
Keywords: Children/Adolescents, Respiratory Conditions, Chronic Conditions, Healthcare Costs
Smith SS, Caliendo A, Cheng BT
Patient perspectives on the drivers and deterrents of antibiotic treatment of acute rhinosinusitis: a qualitative study.
This study examined patient perceptions regarding what drives or deters them from wanting, seeking, and taking antibiotics for treatment of acute rhinosinusitis (ARS). Nineteen adults diagnosed with ARS within the prior 60 days at the Northwestern Medicine General Internal Medicine clinic in Chicago, IL were interviewed. Drivers of antibiotic use were: (1) symptoms, especially discolored rhinorrhea, and seeking relief, (2) belief that antibiotics are a convenient and/or effective way to relieve/cure sinusitis, and (3) desire for tangible outcomes of a clinic visit. Deterrents included: (1) concern about antibiotic resistance, (2) preference for other treatments or preference to avoid medications, and (3) desire to avoid a healthcare visit. A trustworthy physician’s recommendations for antibiotics were a driver, and a recommendation against antibiotics as well as a delayed antibiotic prescription also served as a deterrent.
AHRQ-funded; HS023011; 233201500020I; HS026506; HS028127.
Citation: Smith SS, Caliendo A, Cheng BT .
Patient perspectives on the drivers and deterrents of antibiotic treatment of acute rhinosinusitis: a qualitative study.
J Gen Intern Med 2023 Feb; 38(3):683-90. doi: 10.1007/s11606-022-07811-y..
Keywords: Antibiotics, Medication, Respiratory Conditions
Difazio RL, Shore BJ, Melvin P
Pneumonia after hip surgery in children with neurological complex chronic conditions.
The purpose of this retrospective cohort study was to estimate rates of postoperative pneumonia in children with neurological complex chronic conditions (CCC) undergoing hip surgery, to determine the effect of pneumonia on postoperative hospital resource use, and to identify predictors. Researchers used data from the Pediatric Health Information System for children 4 years and older with a neurological CCC who had undergone hip surgery from 2016 to 2018 in U.S. children's hospitals. Findings indicate that postoperative pneumonia in children with a neurological CCC was associated with longer length-of-stay, readmissions, and higher costs. Children who had undergone pelvic osteotomies and who had multimorbidity needed additional clinical support to prevent postoperative pneumonia and to decrease resource utilization.
AHRQ-funded; HS024453.
Citation: Difazio RL, Shore BJ, Melvin P .
Pneumonia after hip surgery in children with neurological complex chronic conditions.
Dev Med Child Neurol 2023 Feb; 65(2):232-42. doi: 10.1111/dmcn.15339..
Keywords: Children/Adolescents, Surgery, Neurological Disorders, Pneumonia, Respiratory Conditions, Hospital Readmissions, Adverse Events
Napolitano N, Polikoff L, Edwards L
Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children.
This study’s goal was to determine if apneic oxygenation (AO) delivered via nasal cannula during the apneic phase of tracheal intubation (TI) reduces adverse TI-associated events (TIAEs) in children. AO was implemented at 14 pediatric intensive care units as a quality improvement intervention from 2016 through 2020. Implementation consisted of an intubation safety checklist, leadership endorsement, use of a local champion, and data feedback to frontline clinicians. Of 6549 TIs during the study period, 2554 occurred during the pre-implementation phase and 3995 during post-implementation phase. AO utilization increased from 23 to 68%. It was utilized less often when intubating infants, those with a primary cardiac diagnosis or difficult airway features, and patients intubated due to respiratory or neurological failure or shock. Conversely, it was used more often in TIs done for procedures or those associated by video laryngoscopy. AO utilization was associated with a lower incidence of adverse TIAEs (AO 10.5% vs. without AO 13.5%). However, after further adjusting for patient and provider characteristics (secondary analysis), AO utilization was not independently associated with the occurrence of adverse TIAEs, and the occurrence of hypoxemia was not different (AO 14.2% versus without AO 15.2%).
AHRQ-funded; HS024511.
Citation: Napolitano N, Polikoff L, Edwards L .
Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children.
Crit Care 2023 Jan 17; 27(1):26. doi: 10.1186/s13054-023-04304-0..
Keywords: Children/Adolescents, Critical Care, Adverse Events, Respiratory Conditions
Duan KI, Birger M, Au DH
Health care spending on respiratory diseases in the United States, 1996-2016.
The objectives of this study were to estimate health care spending in the U.S. for 11 respiratory conditions from 1996 to 2016, and to provide an evaluation of factors associated with spending growth and detailed trends. Data was taken from the Institute of Health Metrics and Evaluation's Disease Expenditure Project Database. The results showed that spending on respiratory conditions is high, particularly for chronic conditions like asthma and chronic obstructive pulmonary disease. The authors concluded that these findings suggest that service price and intensity should be a key focus for policymakers who seek to reduce health care spending growth.
AHRQ-funded; HS026369.
Citation: Duan KI, Birger M, Au DH .
Health care spending on respiratory diseases in the United States, 1996-2016.
Am J Respir Crit Care Med 2023 Jan 15; 207(2):183-92. doi: 10.1164/rccm.202202-0294OC..
Keywords: Respiratory Conditions, Healthcare Costs, Asthma, Chronic Conditions
Rojas JC, Chokkara S, Zhu M
Care quality for patients with chronic obstructive pulmonary disease in the readmission penalty era.
The purpose of this study was to assess changes in the quality of care for patients hospitalized for Chronic obstructive pulmonary disease (COPD) after the implementation of the Hospital Readmissions Reduction Program (HRRP) which levied financial penalties on hospitals for excessive COPD readmissions. The researchers reviewed the records from 995 U.S. hospitals in the Premier Healthcare Database, evaluating patients older than 40 years of age hospitalized for COPD. The study included 662,842 pre-HRRP (January 2010-September 2014) and 285,508 post-HRRP (October 2014-December 2018) admissions, and found that recommended care increased at a rate of 0.16% per month pre-HRRP and 0.01% per month post-HRRP. Nonrecommended care decreased at a rate of 0.15% per month pre-HRRP and 0.13% per month post-HRRP. Ideal care increased at a rate of 0.24% per month pre-HRRP and 0.11% per month post-HRRP. The researchers concluded that after HRRP implementation, the pre-HRRP trends toward improving care quality for inpatient COPD care slowed.
AHRQ-funded; HS027804.
Citation: Rojas JC, Chokkara S, Zhu M .
Care quality for patients with chronic obstructive pulmonary disease in the readmission penalty era.
Am J Respir Crit Care Med 2023 Jan; 207(1):29-37. doi: 10.1164/rccm.202203-0496OC..
Keywords: Respiratory Conditions, Quality of Care, Hospital Readmissions, Chronic Conditions
Bergman ZR, Tignanelli CJ, Gould R
Factors associated with mortality in patients with COVID-19 receiving prolonged ventilatory support.
This study examined outcomes for COVID-19 patients who required mechanical ventilation from March 2020 through December 2021 across a system of 11 hospitals. A cohort of 600 patients were included, with in-hospital mortality of 40.3%. Increased age, prolonged ventilation, receiving corticosteroids, and being non-English speaking were associated with mortality. Intubations lasting longer than 21 days had a lower in-hospital mortality of 25.7%.
AHRQ-funded; HS026379.
Citation: Bergman ZR, Tignanelli CJ, Gould R .
Factors associated with mortality in patients with COVID-19 receiving prolonged ventilatory support.
Surg Infect 2022 Dec;23(10):893-901. doi: 10.1089/sur.2022.195..
Keywords: COVID-19, Mortality, Respiratory Conditions
Campbell JI, Tabatneck M, Sun M
Increasing use of interferon gamma release assays among children ≥2 years of age in a setting with low tuberculosis prevalence.
This article describes a retrospective cohort study that examined interferon gamma release assays (IGRAs) use to diagnose tuberculosis (TB) infection in children aged 2–17. The objectives of the study were to evaluate whether testing approaches for TB has changed since 2015. Electronic health records were used to identify IGRAs and tuberculin skin tests (TSTs) completed by children in two Boston-area academic health systems. The researchers observed that the proportion of IGRA tests increased between 2015 and 2021 in this low TB-prevalence setting. Testing in public versus private insurance, inpatient/subspecialty settings, lower age, and non-English preferred language were associated with an increased chance of receiving an IGRA. Findings suggest that the TST is being “retired,” and that education and support for primary care clinicians could improve equitable access to IGRA testing for children.
AHRQ-funded; HS000063.
Citation: Campbell JI, Tabatneck M, Sun M .
Increasing use of interferon gamma release assays among children ≥2 years of age in a setting with low tuberculosis prevalence.
Pediatr Infect Dis J 2022 Dec;41(12):e534-e37. doi: 10.1097/inf.0000000000003685..
Keywords: Children/Adolescents, Treatments, Respiratory Conditions, Infectious Diseases
Soper NS, Appukutty AJ, Paje D
Antibiotic overuse after discharge from medical short-stay units.
This study investigated antibiotic overuse after discharge from medical short-stay units (SSUs). This cross-sectional study included patients hospitalized in 2 different medical SSUs with a total of 40 beds at a single academic medical center. Eligible adults were discharged with an oral antibiotic from either SSU from May 2018 to September 2019. Of 100 patients discharged from SSUs with antibiotics, 47 had a skin and soft-tissue infection (SSTI), 22 pneumonia, 21 UTI, and 10 had “other” infections. Overall, 78 cases (78%) were defined as overuse, including 39 of 47 of those treated for SSTI, 17 of 21 for UTI, and 14 of 22 for pneumonia. The most common types of overuse were excess duration and guideline discordant selection. Examples of factors influencing overuse included consultant recommendations, miscalculation of duration, and the need for source control procedure.
AHRQ-funded; HS026530.
Citation: Soper NS, Appukutty AJ, Paje D .
Antibiotic overuse after discharge from medical short-stay units.
Nov;43(11):1689-92. doi: 10.1017/ice.2021.346..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Pneumonia, Skin Conditions, Urinary Tract Infection (UTI), Respiratory Conditions, Hospital Discharge
Campbell JI, Menzies D
Testing and scaling interventions to improve the tuberculosis infection care cascade.
The purpose of this study was to review and summarize current literature on barriers and solutions occurring within the tuberculosis (TB) infection care cascade, focusing on children in high- and low-burden settings, and obtaining data and information from studies on both children and adults. The researchers concluded that identifying and addressing gaps in the TB care cascade requires the utilization of tools both novel and long-standing, and will be facilitated by shared clinical practice with primary care providers, methods of quality improvement, and innovative study designs.
AHRQ-funded; HS000063.
Citation: Campbell JI, Menzies D .
Testing and scaling interventions to improve the tuberculosis infection care cascade.
J Pediatric Infect Dis Soc 2022 Oct 31;11(Suppl 3):S94-s100. doi: 10.1093/jpids/piac070..
Keywords: Respiratory Conditions, Infectious Diseases, Quality Improvement, Quality of Care
Snyder BM, Patterson MF, Gebretsadik T
Association between asthma status and prenatal antibiotic prescription fills among women in a Medicaid population.
The objective of this study was to assess the relationship between maternal asthma and outpatient prenatal antibiotic prescription fills to inform antibiotic stewardship. With data from the Tennessee Medicaid Program, findings showed that women with asthma had an increased risk of filling at least one prenatal antibiotic prescription and had an increased number of fills during pregnancy compared to women without asthma. These findings highlight that pregnant women with asthma disproportionately fill more antibiotic prescriptions during pregnancy.
AHRQ-funded; HS018454.
Citation: Snyder BM, Patterson MF, Gebretsadik T .
Association between asthma status and prenatal antibiotic prescription fills among women in a Medicaid population.
J Asthma 2022 Oct;59(10):2100-07. doi: 10.1080/02770903.2021.1993247..
Keywords: Asthma, Respiratory Conditions, Pregnancy, Antibiotics, Antimicrobial Stewardship, Medication, Maternal Care, Women, Chronic Conditions
Weekes AJ, Raper JD, Thomas AM
Electrocardiographic findings associated with early clinical deterioration in acute pulmonary embolism.
Investigators sought to determine associations of early ECG patterns with clinical deterioration (CD) within 5 days and with RV abnormality (abnlRV) by echocardiography in PE. They found that supraventricular tachycardia was an independent predictor of CD, while T-wave inversion, incomplete right bundle branch block, ST-segment elevation aVR, sinus tachycardia, and S1-Q3-T3 were independent predictors of abnlRV. They suggested that finding one or more of these ECG patterns may increase considerations for performance of echocardiography to look for RV abnormalities and, if present, inform concerns for early clinical deterioration.
AHRQ-funded; HS025979.
Citation: Weekes AJ, Raper JD, Thomas AM .
Electrocardiographic findings associated with early clinical deterioration in acute pulmonary embolism.
Acad Emerg Med 2022 Oct;29(10):1185-96. doi: 10.1111/acem.14554..
Keywords: Respiratory Conditions, Blood Clots
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.
AHRQ-funded; HS026390.
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
Khorasani S, Zubiago J, Carreiro J
Influenza vaccination in Massachusetts jails: a mixed-methods analysis.
The objectives of this study were to survey health administrators in Massachusetts county jails about institutional influenza vaccine policies and practices and estimate influenza vaccination rates in Massachusetts jails from 2013 to 2020. Findings showed that influenza vaccination rates in Massachusetts jails were low, and delivery practices in jails varied. The authors noted that lack of influenza vaccinations in jails is a gap in health care that needs to be prioritized, especially considering the current COVID-19 pandemic. They suggested that further investigations for effective and equitable vaccination in this population should involve people who are incarcerated and people who make influenza vaccine policies in jails.
AHRQ-funded; HS026008.
Citation: Khorasani S, Zubiago J, Carreiro J .
Influenza vaccination in Massachusetts jails: a mixed-methods analysis.
Public Health Rep 2022 Sep-Oct;137(5):936-43. doi: 10.1177/00333549211041659..
Keywords: Influenza, Vaccination, Respiratory Conditions
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.
AHRQ-funded; HS026485.
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
Adams C, Chamberlain A, Wang Y
The role of staff in transmission of SARS-CoV-2 in long-term care facilities.
The purpose of this study was to assess the role of long-term care facility (LTCF) staff in transmission of the SARS-CoV-2 virus. From March 2020 to September the researchers evaluated residents and staff of 60 LTCFs in Georgia. The study found that after vaccines were first distributed to LTCFs in December 202, case counts, outbreak size and duration, and time-varying reproduction number [R(t)] declined rapidly. Staff cases were six times more infectious than resident cases, and unvaccinated resident cases were more infectious than vaccinated resident cases. The researchers concluded that staff were the primary drivers of COVID-19 transmission in LTCFs and vaccines slowed the transmission of the virus and contributed to a reduction in cases in LTCFs.
AHRQ-funded; HS025987.
Citation: Adams C, Chamberlain A, Wang Y .
The role of staff in transmission of SARS-CoV-2 in long-term care facilities.
Epidemiology 2022 Sep 1;33(5):669-77. doi: 10.1097/ede.0000000000001510..
Keywords: COVID-19, Respiratory Conditions, Long-Term Care, Public Health
Vaughn VM, Gandhi TN, Hofer TP
A statewide collaborative quality initiative to improve antibiotic duration and outcomes in patients hospitalized with uncomplicated community-acquired pneumonia.
Researchers sought to improve antibiotic duration for community-acquired pneumonia (CAP) across 41 hospitals participating in the Michigan Hospital Medicine Safety Consortium (HMS). They found that, across diverse hospitals, HMS participation was associated with more appropriate use of short-course therapy and fewer adverse events in hospitalized patients with uncomplicated CAP.
AHRQ-funded; HS026530.
Citation: Vaughn VM, Gandhi TN, Hofer TP .
A statewide collaborative quality initiative to improve antibiotic duration and outcomes in patients hospitalized with uncomplicated community-acquired pneumonia.
Clin Infect Dis 2022 Aug 31;75(3):460-67. doi: 10.1093/cid/ciab950..
Keywords: Community-Acquired Infections, Pneumonia, Antibiotics, Antimicrobial Stewardship, Medication, Respiratory Conditions
Duan KI, Wong ES, Liao JM
Long-term trends in home respiratory medical equipment among U.S. Medicare patients.
The purpose of this study was to explore how respiratory durable medical equipment (DME) supply has changed since Medicare implemented the Competitive Bidding Program (CBP) in 2011and increased the scale of the program nationally in 2013 and 2016. The researchers analyzed all publicly available nationwide Medicare DME data from 2013 to 2019 and analyzed all respiratory DME included in the CBP (excluding accessories such as masks, tubing, and filters). The researchers found that the three highest-volume respiratory DME products were stationary oxygen concentrators, continuous positive airway pressure (CPAP) devices, and gaseous portable oxygen. Decreases in suppliers across all items and increases in claims per supplier for the majority of items suggest greater market concentration of respiratory DME suppliers for Medicare beneficiaries. Even as the Medicare population expanded by 2.6% between 2013 and 2019, the number of patients receiving home oxygen decreased, results that could represent reduced access to home oxygen DME. Finally, in contrast to declines in use for most home oxygen items, the percentage of Medicare beneficiaries using portable oxygen concentrators and CPAP devices increased significantly. The researchers conclude that this analysis addresses a critical knowledge gap and highlights the need for future work evaluating how policies such as the CBP affect respiratory DME access and outcomes.
AHRQ-funded; HS026369.
Citation: Duan KI, Wong ES, Liao JM .
Long-term trends in home respiratory medical equipment among U.S. Medicare patients.
Am J Respir Crit Care Med 2022 Aug 15;206(4):509-11. doi: 10.1164/rccm.202202-0238LE..
Keywords: Home Healthcare, Medicare, Respiratory Conditions
Rothberg MB, Imrey PB, Guo N MB, Imrey PB, Guo N
A risk model to identify Legionella among patients admitted with community-acquired pneumonia: a retrospective cohort study.
This study’s goal was to derive and externally validate a model to predict a positive Legionella test among adult inpatients diagnosed with pneumonia. The study used data from 177 US hospitals in the Premier Healthcare Database and 12 Cleveland Clinic Health System (CCHS) hospitals. Of 166,689 patients hospitalized for pneumonia, out of 43,070 tested for Legionella 642 (1.5%) tested positive. The strongest predictors of a positive test were a local outbreak, June-October occurrence, hyponatremia, smoking and diarrhea. A negative test was associated with prior admission within 6 months and chronic pulmonary disease.
AHRQ-funded; HS024277.
Citation: Rothberg MB, Imrey PB, Guo N MB, Imrey PB, Guo N .
A risk model to identify Legionella among patients admitted with community-acquired pneumonia: a retrospective cohort study.
J Hosp Med 2022 Aug;17(8):624-32. doi: 10.1002/jhm.12919..
Keywords: Pneumonia, Community-Acquired Infections, Infectious Diseases, Respiratory Conditions
Kim B, Mulready-Ward C, Thorpe LE
Housing environments and asthma outcomes within population-based samples of adults and children in NYC.
This study assessed the relationship between housing type (i.e., home ownership, public housing, rental assistance, rent-controlled housing, and other rental housing) and asthma outcomes among New York City (NYC) adults and children (ages 1-13). The authors used the 2019 NYC Community Health Survey (CHS) and 2019 NYC KIDS survey to analyze associations between housing type and ever having been diagnosed with asthma (“ever asthma”) and experiencing an asthma attack within the past year. They also examined whether associations were modified by smoking status (among adults), smoking within the house (among children), and overweight/obesity. Among adults, living in public housing, compared to home ownership, was associated with higher odds of ever asthma and past-year asthma attack. Rental assistance housing living was also significantly associated with ever asthma. Public or rental assistance housing associations and ever asthma were marginally significant among children but were more pronounced among ever smokers than among never smokers.
AHRQ-funded; HS026120.
Citation: Kim B, Mulready-Ward C, Thorpe LE .
Housing environments and asthma outcomes within population-based samples of adults and children in NYC.
Prev Med 2022 Aug;161:107147. doi: 10.1016/j.ypmed.2022.107147..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Social Determinants of Health, Vulnerable Populations, Urban Health, Chronic Conditions
Rudin RS, Qureshi N, Foer D
Toward an asthma patient-reported outcome measure for use in digital remote monitoring.
The purpose of this study was to create a patient-reported outcome measure (PROM) and evaluate its suitability for digital remote asthma symptom monitoring to identify uncontrolled asthma. The researchers modified the asthma control measure (ACM), an existing, non-licensed PROM, and tested it with the asthma control questionnaire (ACQ-5) on 498 individuals with asthma, all of whom were recruited through an online platform. The study concluded that the modified ACM can be used in digital remote monitoring, does not require a license, and is able to differentiate between patients with uncontrolled asthma and patients with well-controlled asthma.
AHRQ-funded; HS026432.
Citation: Rudin RS, Qureshi N, Foer D .
Toward an asthma patient-reported outcome measure for use in digital remote monitoring.
J Asthma 2022 Aug;59(8):1697-702. doi: 10.1080/02770903.2021.1955378..
Keywords: Asthma, Respiratory Conditions, Telehealth, Health Information Technology (HIT)
Keller SC, Caballero TM, Tamma PD
Assessment of changes in visits and antibiotic prescribing during the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use and the COVID-19 pandemic.
This cohort study evaluated the effectiveness of the AHRQ Safety Program for Improving Antibiotic Use aimed to improve antibiotic prescribing in ambulatory practices by engaging clinicians and staff to incorporate antibiotic stewardship into practice culture, communication, and decision-making. The study ran from December 2019 through November 2020. A total of 389 ambulatory care practices with over 6.5 million visits to 5483 clinicians were compared from the baseline to completion of the program. Participants included 82 primary care practices, 103 urgent care practices, 34 federally supported practices, 21 pediatric-only practices, 39 pediatric urgent care practices, 21 pediatric-only practices, and 14 other practice types. Of the 389 practices who completed the program, 75% submitted completed data. Visits per practice per month decreased from a mean of 1624 at baseline to a nadir of 906 early in the COVID-19 pandemic (April 2020) and were 1797 at the end of the program. Total antibiotic prescribing decreased from 18.2% of visits at baseline to 9.5% at completion of the program. Acute respiratory infection (ARI) visits per practice per month decreased from a baseline of 321 to a nadir of 76 early in the pandemic (May 2020) and gradually increased through completion of the program (n = 239). Antibiotic prescribing for ARIs decreased from 39.2% at baseline to 24.7% at completion of the program.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Keller SC, Caballero TM, Tamma PD .
Assessment of changes in visits and antibiotic prescribing during the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use and the COVID-19 pandemic.
JAMA Netw Open 2022 Jul;5(7):e2220512. doi: 10.1001/jamanetworkopen.2022.20512..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, COVID-19, Public Health, Respiratory Conditions
Saxena FE, Bierman AS, Glazier RH
Association of Early Physician Follow-up With Readmission Among Patients Hospitalized for Acute Myocardial Infarction, Congestive Heart Failure, or Chronic Obstructive Pulmonary Disease.
Investigators assessed whether hospitalized patients with early physician follow-up after discharge had lower rates of overall and condition-specific readmissions within 30 days and 90 days of discharge. Studying adults in Ontario, Canada, with first admission for acute myocardial infarction, congestive heart failure, or chronic obstructive pulmonary disease, the findings suggested that early follow-up in conjunction with a comprehensive transitional care strategy for hospitalized patients with medically complex conditions coupled with ongoing effective chronic disease management may be associated with reduced 90-day readmissions.
AHRQ-authored.
Citation: Saxena FE, Bierman AS, Glazier RH .
Association of Early Physician Follow-up With Readmission Among Patients Hospitalized for Acute Myocardial Infarction, Congestive Heart Failure, or Chronic Obstructive Pulmonary Disease.
JAMA Netw Open 2022 Jul;5(7):e2222056. doi: 10.1001/jamanetworkopen.2022.22056..
Keywords: Hospital Readmissions, Hospitalization, Cardiovascular Conditions, Respiratory Conditions, Transitions of Care
