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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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26 to 50 of 11623 Research Studies DisplayedZhou S, Yang G, Zhang M
Mortality following durable left ventricular assist device implantation by timing and type of first infection.
Researchers examined the relationship between timing and type of first infection regarding mortality following left ventricular assist device implantation. The study cohort included nearly 13,000 Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support patients at 166 centers. The results showed that patients with any post-implantation infection had an increased risk of death; ventricular assist device-related infections and infections occurring in the intermediate interval (91-180 days after implantation) were associated with the largest increase in risk. The researchers recommended that infection prevention strategies should target non-ventricular assist device infections in the first 90 days, then shift to surveillance/prevention of driveline infections after 90 days.
AHRQ-funded; HS026003.
Citation: Zhou S, Yang G, Zhang M .
Mortality following durable left ventricular assist device implantation by timing and type of first infection.
J Thorac Cardiovasc Surg 2023 Aug; 166(2):570-79.e4. doi: 10.1016/j.jtcvs.2021.10.056..
Keywords: Mortality, Cardiovascular Conditions, Medical Devices, Heart Disease and Health
Tummalapalli SL, Struthers SA, White D
Optimal care for kidney health: development of a Merit-based Incentive Payment System (MIPS) value pathway.
This article detailed the iterative consensus-building process used by the American Society of Nephrology Quality Committee to develop the Optimal Care for Kidney Health Merit-based Incentive Payment System (MIPS) Value Pathway (MVP). The Optimal Care for Kidney Health MVP, published in the 2023 Medicare Physician Fee Schedule Final Rule, included measures related to angiotensin-converting enzyme inhibitor and angiotensin receptor blocker use, hypertension control, readmissions, acute kidney injury requiring dialysis, and advance care planning. The MVP nephrology’s goal was to streamline measure selection in MIPS and served as a case study of collaborative policymaking between one professional organization and national regulatory agencies.
AHRQ-funded; HS028684.
Citation: Tummalapalli SL, Struthers SA, White D .
Optimal care for kidney health: development of a Merit-based Incentive Payment System (MIPS) value pathway.
J Am Soc Nephrol 2023 Aug; 34(8):1315-28. doi: 10.1681/asn.0000000000000163..
Keywords: Kidney Disease and Health, Payment, Healthcare Costs, Medicare
Kim HS, Strickland KJ, Seitz AL
Patient perspectives on seeking emergency care for acute low back pain and access to physical therapy in the emergency department.
This study’s purpose was to explore patient perspectives on visiting the emergency department (ED) for low back pain to inform a more patient-centered approach to emergency care. The authors conducted focus group discussions and individual interviews among patients visiting an urban academic ED for acute low back pain. They recruited participants from an ongoing prospective study of 101 patients receiving either ED-initiated physical therapy or usual care. They conducted 4 focus group discussions among 18 participants (median age 46.5 years, 66.7% women, 61.1% Black) and individual interviews with 27 participants (median age 45 years, 55.6% women, 44.4% White). They identified 5 summary themes: (1) the decision to seek emergency care for low back pain is motivated by severe pain, resulting disability, and fears about a catastrophic diagnosis, (2) participants sought various goals from their ED visit but emphasized the primacy of pain control, (3) participants were reluctant to use pain medications but also acknowledged their benefit, (4) participants perceived a number of benefits from direct access to an ED physical therapist in the ED, and (5) participation in physical therapy ultimately facilitated recovery, but the pain was a barrier to performing exercises.
AHRQ-funded; HS023011; HS027426.
Citation: Kim HS, Strickland KJ, Seitz AL .
Patient perspectives on seeking emergency care for acute low back pain and access to physical therapy in the emergency department.
Ann Emerg Med 2023 Aug; 82(2):154-63. doi: 10.1016/j.annemergmed.2022.12.028..
Keywords: Emergency Department, Back Health and Pain, Pain
Miller ME, Rahim MQ, Coven SL
Pediatric hematology and oncology physician and nurse practitioner views of the HPV vaccine and barriers to administration.
This study’s goal was to examine provider views regarding HPV vaccination for pediatric survivors of cancer and pediatric patients with sickle cell disease. The authors conducted qualitative interviews with 20 pediatric hematology/oncology physicians and nurse practitioners. They found that 90% of interviewees support HPV vaccination in their population. The number of providers who reported that they counsel about HPV or provide HPV vaccination was 45%, even in stem cell and sickle cell clinics, where other childhood vaccines are commonly provided. Clinicians identified provider-level, clinic-level, and system-level barriers to giving the HPV vaccination, that included but was not limited to time/flow constraints, lack of resources, and continued education regarding the HPV vaccine.
AHRQ-funded; HS026390.
Citation: Miller ME, Rahim MQ, Coven SL .
Pediatric hematology and oncology physician and nurse practitioner views of the HPV vaccine and barriers to administration.
Hum Vaccin Immunother 2023 Aug 1; 19(2):2224089. doi: 10.1080/21645515.2023.2224089..
Keywords: Vaccination, Sexual Health, Infectious Diseases, Prevention, Provider: Clinician, Provider: Physician
Oke I, Gaier ED, Mantagos IS
Periodic trends in internet searches for ocular symptoms in the US.
This cross-sectional study examined publicly available Google Trends data on searching ocular symptoms from the United States from 2015 to 2019. The authors compiled a list of common ocular symptoms from the American Academy of Ophthalmology Eye Health website and Wills Eye Manual, with symptoms stratified into categories involving vision change, eye pain, or eye redness. Seasonal trends were demonstrated by 45% of the ocular symptoms included in this investigation. Search terms with best fit to the periodic model included stye, pink eye, dry eye, blurry vision, and swollen eye. Periodic search terms were more likely to involve eye redness (21% vs. 11%) and less likely to involve vision change (11% vs. 36%). Queries involving eye redness most often peaked in the spring and those involving eye pain peaked in the summer.
AHRQ-funded; HS000063.
Citation: Oke I, Gaier ED, Mantagos IS .
Periodic trends in internet searches for ocular symptoms in the US.
Ophthalmic Epidemiol 2023 Aug; 30(4):352-57. doi: 10.1080/09286586.2022.2119260..
Keywords: Eye Disease and Health
Sparling JL, Hong Mershon B, Abraham J
Perioperative handoff enhancement opportunities through technology and artificial intelligence: a narrative review.
This narrative review synthesized prior research on electronic tools for perioperative handoffs, limitations of current tools and barriers to their implementation, and use of AI and machine learning in perioperative care. Results showed that several efforts have incorporated electronic tools to improve perioperative handoffs, but were limited by imprecision in selecting handoff elements. AI and machine learning use and integration into handoff workflows were not yet being studied. Existing technology such as mobile applications, barcode scanners, and radio-frequency identification tags to advance perioperative safety were similarly not applied to handoffs.
AHRQ-funded; HS027769.
Citation: Sparling JL, Hong Mershon B, Abraham J .
Perioperative handoff enhancement opportunities through technology and artificial intelligence: a narrative review.
Jt Comm J Qual Patient Saf 2023 Aug; 49(8):410-21. doi: 10.1016/j.jcjq.2023.03.009..
Keywords: Health Information Technology (HIT), Workflow, Transitions of Care, Electronic Health Records (EHRs), Evidence-Based Practice
Weekes AJ, Davison J, Lupez K
Quality of life 1 month after acute pulmonary embolism in emergency department patients.
The objective of this prospective multicenter registry study was to determine whether any clinical or pathophysiologic features of pulmonary embolism were associated with worse Pulmonary Embolism Quality-of-Life (PEmb-QoL) scores after one month. Pulmonary embolism patients participated in QoL assessments and received PEmb-QoL questionnaires conducted by the researchers. Results indicated that acute clinical deterioration, right ventricular dysfunction, and pulmonary embolism PE severity were not predictors of QoL at 1 month post-embolism. Independent predictors of worsened QoL were COPD, rehospitalization, and hospital length of stay.
AHRQ-funded; HS025979.
Citation: Weekes AJ, Davison J, Lupez K .
Quality of life 1 month after acute pulmonary embolism in emergency department patients.
Acad Emerg Med 2023 Aug; 30(8):819-31. doi: 10.1111/acem.14692..
Keywords: Quality of Life, Respiratory Conditions, Emergency Department
Wang M, Wadhwani SI, Cullaro G
Racial and ethnic disparities among patients hospitalized for acute cholangitis in the United States.
Researchers used HCUP NIS data to analyze hospitalizations from 2009-18 to determine whether race/ethnicity is associated with hospitalization outcomes among patients admitted with acute cholangitis. Their analysis included patients aged 18 or older who were hospitalized with an ICD9/10 diagnosis of cholangitis. Results indicated that black patients had higher in-hospital mortality rates, were associated with fewer and delayed endoscopic retrograde cholangiopancreatography (ERCP) procedures, and had longer length of stay. The researchers concluded that future studies with more granular social determinants of health data should explore underlying reasons for these disparities to develop interventions aimed at reducing racial disparities in outcomes among patients with acute cholangitis.
AHRQ-funded; HS027369.
Citation: Wang M, Wadhwani SI, Cullaro G .
Racial and ethnic disparities among patients hospitalized for acute cholangitis in the United States.
J Clin Gastroenterol 2023 Aug 1; 57(7):731-36. doi: 10.1097/mcg.0000000000001743..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitalization, Racial and Ethnic Minorities
Lucy AT, Rakestraw SL, Stringer C
Readability of patient education materials for bariatric surgery.
This paper examined readability and reading level of online bariatric surgery and standardized perioperative electronic medical record (EMR) patient education materials (PEM). National organizations recommend that PEM not exceed a sixth grade reading level. One institution was used to assess readability of PEM. Text readability was assessed by seven validated instruments and mean readability scores calculated with standard deviations and compared using unpaired t-tests. A total of 32 webpages and seven EMR education documents were assessed. Web pages were overall assessed as "difficult to read" compared to "standard/average" readability EMR materials. All web pages were at or above high school reading levels, with the highest reading levels being pages with nutrition information and the lowest reading level patient testimonials. EMR materials were found to be at sixth to ninth grade reading level.
AHRQ-funded; HS023009.
Citation: Lucy AT, Rakestraw SL, Stringer C .
Readability of patient education materials for bariatric surgery.
Surg Endosc 2023 Aug; 37(8):6519-25. doi: 10.1007/s00464-023-10153-3..
Keywords: Surgery, Education: Patient and Caregiver, Obesity: Weight Management, Obesity, Health Literacy
Patel PB, Marcaccio CL, Swerdlow NJ
Thoracoabdominal aortic aneurysm life-altering events following endovascular aortic repair in the Vascular Quality Initiative.
This study’s objective was to examine the rates of postoperative mortality and morbidity stratified by type of endovascular aortic aneurysm repair (EVAR). The authors identified all patients who underwent EVAR in the Vascular Quality Initiative registry from January 2011 to May 2022. Patients were then stratified by repair type: infrarenal EVAR, complex EVAR, thoracic endovascular aortic repair (TEVAR), extent I to III thoracoabdominal aortic aneurysm (TAAA) repair, or aortic arch repair. Primary outcomes across the different treatment groups was postoperative thoracoabdominal aortic aneurysm life-altering events (TALE). They identified a total of 52,592 EVARs, 3768 complex EVARs, 3899 TEVARs, 1139 extent I to III TAAA repairs, and 479 arch repairs, with TALE observed in 1.2% of EVARs, 4.8% of complex EVARs, 6.0% of TEVARs, 10% of extent I to III TAAA repairs, and 14% of arch repairs. More proximal landing zone was associated with higher odds of TALE after complex EVAR, TEVAR, and extent I to III TAAA repair. Aortic diameter >65 mm was associated with higher odds of TALE after infrarenal EVAR, complex EVAR, TEVAR, and arch repair. The use of parallel grafting technique (chimney/snorkel/periscope) during extent I to III TAAA repair was also associated with higher odds of TALE. Preoperative chronic kidney disease was also associated with higher odds of TALE after infrarenal EVAR, complex EVAR, TEVAR, and extent I to III TAAA repair.
AHRQ-funded; HS027285.
Citation: Patel PB, Marcaccio CL, Swerdlow NJ .
Thoracoabdominal aortic aneurysm life-altering events following endovascular aortic repair in the Vascular Quality Initiative.
J Vasc Surg 2023 Aug; 78(2):269-77.e3. doi: 10.1016/j.jvs.2023.03.499..
Keywords: Surgery, Stroke, Cardiovascular Conditions
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
Sharma H, Xu L
Use of intergovernmental transfers-based Medicaid supplemental payments to boost nursing home finances: evidence from Indiana nursing homes.
The objective of this study was to estimate the effect of participation in the intergovernmental transfers-based Medicaid supplemental payment program on nursing home revenue and expenditures. Data was taken from all Medicare and Medicaid-certified nursing homes in Indiana from 2009-17. The findings indicated that nursing homes owned or operated by nonstate governmental organizations received a fraction of the total supplemental payments on average, but the authors observed increased payments in later years. Participating nursing homes did not increase clinical expenses. The authors concluded that these findings raised questions regarding the transparency of financing arrangements between nonstate governmental organizations and nursing homes and the need to link supplemental payments to clinical expenses.
AHRQ-funded; HS027235.
Citation: Sharma H, Xu L .
Use of intergovernmental transfers-based Medicaid supplemental payments to boost nursing home finances: evidence from Indiana nursing homes.
Med Care 2023 Aug; 61(8):546-53. doi: 10.1097/mlr.0000000000001875..
Keywords: Nursing Homes, Medicare, Medicaid, Healthcare Costs
Loo S, Brady KJS, Ragavan MI
Validation of the Clinicians' Cultural Sensitivity Survey for use in pediatric primary care settings.
This study examined the validity of the Clinicians’ Cultural Sensitivity Survey (CCCS) for use in pediatric primary care, which was developed as a patient-reported survey assessing clinicians' recognition of cultural factors affecting care quality for older Latino patients. The authors adapted the survey for use with parents of pediatric patients. A convenience sampling approach was used to identify eligible parents during well-child visits at urban pediatric primary care clinic, and parents were administered the survey via electronic tablet. They first conducted exploratory factor analyses (EFAs) to explore the dimensionality of survey responses in the adapted CCSS, and then conducted a series of confirmatory factor analyses (CFAs) using maximum likelihood estimation based on the results of the EFAs. Exploratory and confirmatory factor analyses (N = 212 parent surveys) supported a three-factor structure assessing racial discrimination, culturally-affirming practices, and causal attribution of health problems. The 3-factor model also outperformed other potential factors in terms of fit statistics and demonstrated adequate fit.
AHRQ-funded; HS022242; HS026395.
Citation: Loo S, Brady KJS, Ragavan MI .
Validation of the Clinicians' Cultural Sensitivity Survey for use in pediatric primary care settings.
J Immigr Minor Health 2023 Aug; 25(4):790-802. doi: 10.1007/s10903-023-01469-2..
Keywords: Children/Adolescents, Primary Care, Cultural Competence, Healthcare Delivery
Schnipper JL, Reyes Nieva H, Yoon C
What works in medication reconciliation: an on-treatment and site analysis of the MARQUIS2 study.
The objective of this study was to assess the association of patient exposure to system-level intervention and receipt based on the results of the second Multicenter Medication Reconciliation Quality Improvement Study, which demonstrated a marked reduction in medication discrepancies per patient. Researchers conducted an on-treatment analysis of system-level interventions at 17 North American hospitals. The patient-level interventions most associated with discrepancy reductions were receipt of a best-possible medication history of admitted patients in the ED and admission and discharge medication reconciliation by a trained clinician. System-level interventions were also associated with a minor reduction in discrepancies for the average patient. The researchers concluded that these findings might be used to help hospitals and health systems prioritize interventions to improve medication safety during care transitions.
AHRQ-funded; HS023757.
Citation: Schnipper JL, Reyes Nieva H, Yoon C .
What works in medication reconciliation: an on-treatment and site analysis of the MARQUIS2 study.
BMJ Qual Saf 2023 Aug; 32(8):457-69. doi: 10.1136/bmjqs-2022-014806..
Keywords: Medication, Medication: Safety, Quality Improvement, Quality of Care, Patient Safety, Hospital Discharge
Rome D, Sales A, Cornelius T
Impact of telemedicine modality on quality metrics in diverse settings: implementation science-informed retrospective cohort study.
The objective of this study was to assess telemedicine uptake during the COVID-19 pandemic and impact of visit modality on primary care quality metrics in diverse, low socioeconomic status settings. Research was informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Researchers found that there were marginally better quality metrics for in-person care versus video and phone visits, and that de-adoption of telemedicine was marked within 2 years in the study population. They concluded that the impact of visit modality on quality outcomes, provider and patient preferences, and technological barriers in historically marginalized settings should be considered.
AHRQ-funded; HS025198.
Citation: Rome D, Sales A, Cornelius T .
Impact of telemedicine modality on quality metrics in diverse settings: implementation science-informed retrospective cohort study.
J Med Internet Res 2023 Jul 26; 25:e47670. doi: 10.2196/47670..
Keywords: Telehealth, Health Information Technology (HIT), Implementation, Quality Measures, Quality of Care
Vest JR, Mazurenko O
Non-response bias in social risk factor screening among adult emergency department patients.
This study assessed differences between respondents and those refusing participation in social factor screening questionnaires to determine if non-response contributed to selection bias. Study subjects were patients from a mid-western state safety-net hospital's emergency department aged 18 or older, English or Spanish speakers, and able to complete a self-administered questionnaire. Results indicated that subjects with prior documentation of financial insecurity were less likely to respond to the screening questionnaire, but no other factors were significantly associated with response. The authors concluded that this study contributed to the growing social determinants of health literature by confirming that selection bias might exist within screening practices and research studies.
AHRQ-funded; HS028008.
Citation: Vest JR, Mazurenko O .
Non-response bias in social risk factor screening among adult emergency department patients.
J Med Syst 2023 Jul 22; 47(1):78. doi: 10.1007/s10916-023-01975-8..
Keywords: Emergency Department, Screening, Social Determinants of Health
Strayer TE, Hollingsworth EK, Shah AS
Why do older adults decline participation in research? Results from two deprescribing clinical trials.
The objective of this study was to examine reasons why hospitalized older adults declined participation in two deprescribing clinical trials, Shed-MEDS (non-Veterans) and VA DROP (Veterans). The reasons given by participating patients were condensed into three themes: feeling overwhelmed by current health status; lack of interest or mistrust; hesitancy to participate. A greater proportion of Veterans expressed a lack of interest or, while more non-Veterans expressed feeling overwhelmed by their current health status. The authors concluded that understanding the reasons why older adults decline participation can inform future strategies to engage this multimorbid population.
AHRQ-funded; HS026122.
Citation: Strayer TE, Hollingsworth EK, Shah AS .
Why do older adults decline participation in research? Results from two deprescribing clinical trials.
Trials 2023 Jul 18; 24(1):456. doi: 10.1186/s13063-023-07506-7..
Keywords: Elderly, Research Methodologies, Health Services Research (HSR)
Li D, Lu W, Shu D
Distributed Cox proportional hazards regression using summary-level information.
This article proposed a way to not share individual-level data in multi-site studies by using a general distributed methodology to fit Cox proportional hazards models. The authors state that this approach can be applied to both stratified and unstratified models, accommodate both discrete and continuous exposure variables, and permit the adjustment of multiple covariates. The fitting of stratified Cox models can be carried out with only one file transfer of summary-level information. They derived the asymptotic properties of the proposed estimators and compared the proposed estimators with the maximum partial likelihood estimators using pooled individual-level data and meta-analysis methods through simulation studies. They applied the proposed method to a real-world data set to examine the effect of sleeve gastrectomy versus Roux-en-Y gastric bypass on the time to first postoperative readmission.
AHRQ-funded; HS026214.
Citation: Li D, Lu W, Shu D .
Distributed Cox proportional hazards regression using summary-level information.
Biostatistics 2023 Jul 14; 24(3):776-94. doi: 10.1093/biostatistics/kxac006..
Keywords: Research Methodologies
Sikora A, Devlin JW, Yu M
Evaluation of medication regimen complexity as a predictor for mortality.
This single-center, observational cohort study of adult intensive care units (ICUs) sought to evaluate the benefit of adding medication regimen complexity-ICU scores to illness severity-based hospital mortality prediction models. While medication regimen complexity was associated with increased hospital mortality, the authors concluded from their findings that a prediction model that included medication regimen complexity only modestly improved mortality prediction.
AHRQ-funded; HS029009; HS028485.
Citation: Sikora A, Devlin JW, Yu M .
Evaluation of medication regimen complexity as a predictor for mortality.
Sci Rep 2023 Jul 4; 13(1):10784. doi: 10.1038/s41598-023-37908-1..
Keywords: Medication, Mortality
Levander XA, Carmody T, Cook RR
A gender-based secondary analysis of the ADAPT-2 combination naltrexone and bupropion treatment for methamphetamine use disorder trial.
This study’s objective was to determine if there were gender-based differences in treatment for methamphetamine use disorder (MUD) in general comparing treatment with placebo and due to use of a hormonal method of contraception (HMC). This research was a secondary analysis of ADAPT-2, a randomized, double-blind, placebo-controlled, multicenter, two-stage sequential parallel comparison design trial. This cohort study comprised 126 women (403 total participants); average age of 40.1 years with moderate to severe MUD. At baseline, women used methamphetamine intravenously fewer days than men [15.4 versus 23.1% days] and more women than men had anxiety (59.5 versus 47.6%). Of the 113 women capable of becoming pregnant, 31 used HMC. Treatment response for women was 29% in Stage 1 and 5.6% in Stage 2 compared with 3.2% and 0% on placebo, respectively. A treatment effect was found independently for females and males; with no between-gender treatment effect (0.144 females versus 0.100 males). Treatment effect did not differ by HMC use (0.156 HMC versus 0.128 none).
AHRQ-funded; HS026370.
Citation: Levander XA, Carmody T, Cook RR .
A gender-based secondary analysis of the ADAPT-2 combination naltrexone and bupropion treatment for methamphetamine use disorder trial.
Addiction 2023 Jul; 118(7):1320-28. doi: 10.1111/add.16163..
Keywords: Substance Abuse, Medication, Behavioral Health, Sex Factors
Bushnell G, Lloyd J, Olfson M
Antipsychotic medication use in Medicaid-insured children decreased substantially between 2008 And 2016.
In the early 2000s there was a rapid growth of pediatric antipsychotic prescribing, especially in the Medicaid population, and concerns grew about the safety and appropriateness of such prescribing. Numerous states implemented policy and educational programs focused on safer and more stringent utilization of antipsychotics. Antipsychotic utilization leveled off toward the end of the 2000s, but no recent national trend estimates of antipsychotic utilization in children enrolled in Medicaid exist. The authors of this study report a substantial decrease in antipsychotic use among children ages 2-17 between 2008 and 2016. Declines existed across foster care status, age, sex, and racial and ethnic groups studied. The rate of children with an antipsychotic prescription who received any diagnosis related to a pediatric indication that was approved by the Food and Drug Administration increased from 38 percent in 2008 to 45 percent in 2016.
AHRQ-funded; HS02600.
Citation: Bushnell G, Lloyd J, Olfson M .
Antipsychotic medication use in Medicaid-insured children decreased substantially between 2008 And 2016.
Health Aff 2023 Jul; 42(7):973-80. doi: 10.1377/hlthaff.2022.01625..
Keywords: Children/Adolescents, Medication, Medicaid, Behavioral Health
Wissel BD, Greiner HM, Glauser TA
Automated, machine learning-based alerts increase epilepsy surgery referrals: a randomized controlled trial.
Researchers conducted a prospective, randomized controlled trial of a natural language processing-based clinical decision support system in the electronic health record at 14 pediatric neurology outpatient clinics to determine whether automated, electronic alerts increased referrals for epilepsy surgery. Children with epilepsy and at least two prior neurology visits were screened by the system prior to their scheduled visit to identify potential surgical candidates, and the potential candidates randomized 2:1 for their providers to receive an alert or standard of care (no alert). The results showed that patients whose providers received an alert were more likely to be referred for a presurgical evaluation. The researchers concluded that machine learning-based automated alerts may improve the utilization of referrals for epilepsy surgery evaluations.
AHRQ-funded; HS024977.
Citation: Wissel BD, Greiner HM, Glauser TA .
Automated, machine learning-based alerts increase epilepsy surgery referrals: a randomized controlled trial.
Epilepsia 2023 Jul; 64(7):1791-99. doi: 10.1111/epi.17629..
Keywords: Neurological Disorders, Surgery, Health Information Technology (HIT)
Sideman AB, Gilissen J, Harrison KL
Caregiver experiences navigating the diagnostic journey in a rapidly progressing dementia.
This mixed-methods study examined the diagnostic journey experience from the perspective of caregivers of people who died from sporadic Creutzfeldt-Jakob Disease (sCJD). Qualitative data were drawn from interviews with former caregivers of 12 people who had died from sCJD. Four overarching themes were identified, as well as 4 phases along the diagnostic journey. Findings suggested that more work was needed to improve clinician diagnostic knowledge and communication practices. The authors also noted that caregivers need better support during the diagnostic journey and concluded that lessons learned from studying sCJD and other rapidly progressive dementias is likely to be applicable to more common dementias.
AHRQ-funded; HS022241.
Citation: Sideman AB, Gilissen J, Harrison KL .
Caregiver experiences navigating the diagnostic journey in a rapidly progressing dementia.
J Geriatr Psychiatry Neurol 2023 Jul; 36(4):282-94. doi: 10.1177/08919887221135552..
Keywords: Caregiving, Dementia, Neurological Disorders
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.
AHRQ-funded; HS024516.
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
Michelson KA, McGarghan FLE, Waltzman ML
Community validation of an approach to detect delayed diagnosis of appendicitis in big databases.
This study’s goal was to further validate a trigger tool that has been used in community emergency departments (EDs) to detect delayed diagnosis of pediatric appendicitis. The authors studied patients <21 years old diagnosed with appendicitis from 2008 to 2019 in 8 eastern Massachusetts EDs. Eligible patients had 2 ED encounters within 7 days, the second time ending with an appendicitis diagnosis. Trained reviewers evaluated medical records that showed delayed diagnosis. The previously validated trigger tool was applied to participants’ electronic medical record data, with the tool assigning a probability of delayed diagnosis for each patient. Four confidence thresholds were determined, and the area under the receiver operating curve was calculated. The authors analyzed 68 children with 2 encounters leading to a diagnosis of appendicitis (i.e., possible delay). A delayed diagnosis prediction was assigned to patients at 4 thresholds of confidence (>0%, >50%, >75%, and >90% confident), the positive predictive values were respectively 74%, 89%, 92%, and 89%; the negative predictive values were respectively 100%, 57%, 50%, and 33%. The area under the receiver operating curve was 0.837.
AHRQ-funded; HS026503.
Citation: Michelson KA, McGarghan FLE, Waltzman ML .
Community validation of an approach to detect delayed diagnosis of appendicitis in big databases.
Hosp Pediatr 2023 Jul; 13(7):e170-e74. doi: 10.1542/hpeds.2023-007204..
Keywords: Children/Adolescents, Diagnostic Safety and Quality
