National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data & Analytics
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Program
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- National Healthcare Quality and Disparities Report Data Tools
- AHRQ Quality Indicator Tools for Data Analytics
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (427)
- Adverse Drug Events (ADE) (326)
- Adverse Events (745)
- Alcohol Use (63)
- Ambulatory Care and Surgery (212)
- Antibiotics (257)
- Antimicrobial Stewardship (159)
- Anxiety (48)
- Arthritis (131)
- Asthma (124)
- Autism (31)
- Back Health and Pain (58)
- Behavioral Health (730)
- Blood Clots (63)
- Blood Pressure (135)
- Blood Thinners (80)
- Brain Injury (64)
- Breast Feeding (18)
- Burnout (65)
- Cancer (804)
- Cancer: Breast Cancer (199)
- Cancer: Cervical Cancer (21)
- Cancer: Colorectal Cancer (119)
- Cancer: Lung Cancer (84)
- Cancer: Ovarian Cancer (9)
- Cancer: Prostate Cancer (108)
- Cancer: Skin Cancer (15)
- Cardiovascular Conditions (724)
- Care Coordination (107)
- Caregiving (231)
- Care Management (226)
- Case Study (101)
- Catheter-Associated Urinary Tract Infection (CAUTI) (56)
- Centers for Education and Research on Therapeutics (CERTs) (12)
- Central Line-Associated Bloodstream Infections (CLABSI) (62)
- Children's Health Insurance Program (CHIP) (40)
- Children/Adolescents (1595)
- Chronic Conditions (704)
- Clinical Decision Support (CDS) (205)
- Clinician-Patient Communication (288)
- Clostridium difficile Infections (56)
- Colonoscopy (38)
- Communication (391)
- Community-Acquired Infections (61)
- Community-Based Practice (155)
- Community Partnerships (18)
- Comparative Effectiveness (463)
- Complementary and Alternative Medicine (25)
- Comprehensive Unit-based Safety Program (CUSP) (9)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (86)
- COVID-19 (339)
- Critical Care (230)
- Cultural Competence (64)
- Data (174)
- Dementia (103)
- Dental and Oral Health (69)
- Depression (237)
- Diabetes (374)
- Diagnostic Safety and Quality (553)
- Dialysis (24)
- Digestive Disease and Health (113)
- Disabilities (75)
- Disparities (463)
- Domestic Violence (31)
- Ear Infections (5)
- Education (30)
- Education: Academic (27)
- Education: Continuing Medical Education (161)
- Education: Curriculum (23)
- Education: Patient and Caregiver (234)
- Elderly (957)
- Electronic Health Records (EHRs) (742)
- Electronic Prescribing (E-Prescribing) (26)
- Emergency Department (581)
- Emergency Medical Services (EMS) (164)
- Emergency Preparedness (26)
- Evidence-Based Practice (950)
- Eye Disease and Health (38)
- Falls (86)
- Family Health and History (71)
- Genetics (96)
- Guidelines (373)
- Healthcare-Associated Infections (HAIs) (424)
- Healthcare Cost and Utilization Project (HCUP) (379)
- Healthcare Costs (793)
- Healthcare Delivery (552)
- Healthcare Utilization (389)
- Health Information Exchange (HIE) (51)
- Health Information Technology (HIT) (1467)
- Health Insurance (436)
- Health Literacy (127)
- Health Promotion (80)
- Health Services Research (HSR) (329)
- Health Status (133)
- Health Systems (107)
- Heart Disease and Health (458)
- Hepatitis (43)
- Home Healthcare (144)
- Hospital Discharge (224)
- Hospitalization (540)
- Hospital Readmissions (325)
- Hospitals (773)
- Human Immunodeficiency Virus (HIV) (257)
- Imaging (248)
- Implementation (197)
- Infectious Diseases (262)
- Influenza (42)
- Injuries and Wounds (209)
- Inpatient Care (223)
- Intensive Care Unit (ICU) (274)
- Kidney Disease and Health (204)
- Labor and Delivery (106)
- Learning Health Systems (50)
- Lifestyle Changes (136)
- Long-Term Care (230)
- Low-Income (171)
- Maternal Care (191)
- Medicaid (366)
- Medical Devices (71)
- Medical Errors (206)
- Medical Expenditure Panel Survey (MEPS) (192)
- Medical Liability (26)
- Medicare (586)
- Medication (1709)
- Medication: Safety (238)
- Men's Health (54)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (73)
- Mortality (406)
- Neonatal Intensive Care Unit (NICU) (43)
- Neurological Disorders (198)
- Newborns/Infants (261)
- Nursing (115)
- Nursing Homes (332)
- Nutrition (136)
- Obesity (254)
- Obesity: Weight Management (105)
- Opioids (309)
- Organizational Change (73)
- Orthopedics (108)
- Osteoporosis (30)
- Outcomes (813)
- Pain (209)
- Palliative Care (139)
- Patient-Centered Healthcare (459)
- Patient-Centered Outcomes Research (1036)
- Patient Adherence/Compliance (230)
- Patient and Family Engagement (282)
- Patient Experience (260)
- Patient Safety (1307)
- Patient Self-Management (140)
- Payment (203)
- Pneumonia (85)
- Policy (438)
- Practice-Based Research Network (PBRN) (16)
- Practice Improvement (35)
- Practice Patterns (306)
- Pregnancy (289)
- Pressure Ulcers (30)
- Prevention (802)
- Primary Care (731)
- Primary Care: Models of Care (86)
- Provider (301)
- Provider: Clinician (67)
- Provider: Health Personnel (92)
- Provider: Nurse (115)
- Provider: Pharmacist (100)
- Provider: Physician (238)
- Provider: Physician Assistant (1)
- Provider Performance (200)
- Public Health (184)
- Public Reporting (40)
- Quality Improvement (558)
- Quality Indicators (QIs) (138)
- Quality Measures (229)
- Quality of Care (1001)
- Quality of Life (200)
- Racial and Ethnic Minorities (763)
- Registries (146)
- Rehabilitation (61)
- Research Methodologies (420)
- Respiratory Conditions (376)
- Risk (762)
- Rural/Inner-City Residents (29)
- Rural Health (140)
- Screening (469)
- Sepsis (144)
- Sex Factors (67)
- Sexual Health (126)
- Shared Decision Making (584)
- Sickle Cell Disease (49)
- Simulation (50)
- Skin Conditions (121)
- Sleep Problems (71)
- Social Determinants of Health (364)
- Social Media (46)
- Social Stigma (53)
- Stress (72)
- Stroke (162)
- Substance Abuse (311)
- Surgery (1132)
- Surveys on Patient Safety Culture (14)
- System Design (15)
- Teams (142)
- TeamSTEPPS (17)
- Telehealth (270)
- Tobacco Use (83)
- Tobacco Use: Smoking Cessation (22)
- Tools & Toolkits (49)
- Training (143)
- Transitions of Care (196)
- Transplantation (145)
- Trauma (108)
- Treatments (186)
- U.S. Preventive Services Task Force (USPSTF) (222)
- Uninsured (80)
- Urban Health (95)
- Urinary Tract Infection (UTI) (72)
- Vaccination (163)
- Vitamins and Supplements (10)
- Vulnerable Populations (232)
- Web-Based (84)
- Women (556)
- Workflow (67)
- Workforce (90)
- Young Adults (87)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
51 to 75 of 12392 Research Studies DisplayedBabiarz Babiarz, Ryu H, Williams C
Slicing through silos: development and evaluation of a hospital-based telehealth hepatitis C virus treatment program.
This single site prospective cohort study aimed to measure linkage to care with a hepatitis C virus (HCV) clinician and initiation of HCV treatment in hospitalized patients with substance use disorder (SUD). This hospital-based telehealth program initially assessed patients in-person by a social worker then seen via telehealth by a clinician who prescribed either glecaprevir/pibrentasvir or sofosbuvir/velpatasvir. In/person and/or telephonic outreach was then conducted by the research team during and after hospitalization. If the patient was cured of HCV, it was confirmed by sustained virologic response at 12 weeks (SVR12) post-treatment. All 25 patients enrolled had a history of SUD and 18 were unstably housed. Nineteen patients initiated treatment and 14 successfully completed treatment. Twelve patients completed post-treatment labs, including two who prematurely discontinued treatment. Eleven patients achieved confirmed cure with SVR12.
AHRQ-funded; HS026370.
Citation: Babiarz Babiarz, Ryu H, Williams C .
Slicing through silos: development and evaluation of a hospital-based telehealth hepatitis C virus treatment program.
Int J Drug Policy 2024 May; 127:104396. doi: 10.1016/j.drugpo.2024.104396..
Keywords: Hepatitis, Telehealth, Health Information Technology (HIT)
Rogerson C, Owora A, Tu W
The influence of social and environmental determinants of health on hospitalizations for pediatric asthma.
This retrospective cohort used data from the Indiana Network for Patient Care state-wide health information exchange to determine the influence of social, environmental, and demographic factors on hospital admissions and readmissions for pediatric asthma. Participants were children aged 2-18 admitted to the hospital with a respiratory diagnostic code 2010-2021. Social and environmental determinants of health data were obtained from the Indiana Social Assets and Vulnerabilities Indicators using geocoding systems. A high social vulnerability index was associated with an increased rate of hospital admissions for pediatric asthma. No environmental determinants of health were significantly associated with hospitalization rates.
AHRQ-funded; HS029088.
Citation: Rogerson C, Owora A, Tu W .
The influence of social and environmental determinants of health on hospitalizations for pediatric asthma.
J Asthma 2024 May; 61(5):453-62. doi: 10.1080/02770903.2023.2288323..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Social Determinants of Health, Chronic Conditions, Hospitalization, Hospital Readmissions
Hasjim BJ, Huang AA, Paukner M
Where you live matters: area deprivation predicts poor survival and liver transplant waitlisting.
This study investigated the impact of social determinants of health (SDOH) on outcomes for patients with cirrhosis in metropolitan Chicago. The researchers conducted a retrospective analysis of 15,101 adult cirrhosis patients across multiple institutions. The research utilized the area deprivation index and data from the American Census Survey to assess neighborhood-level SDOH. The findings revealed that for each quintile increase in area deprivation, there was an associated increase in the risk of cirrhosis decompensation and all-cause mortality. Conversely, the likelihood of being waitlisted for liver transplantation decreased with increasing area deprivation. Specific SDOH domains linked to lower chances of waitlisting and reduced survival included low income, low education levels, poor household conditions, and inadequate social support. These factors were all statistically significant.
AHRQ-funded; HS000084.
Citation: Hasjim BJ, Huang AA, Paukner M .
Where you live matters: area deprivation predicts poor survival and liver transplant waitlisting.
Am J Transplant 2024 May; 24(5):803-17. doi: 10.1016/j.ajt.2024.02.009..
Keywords: Transplantation, Social Determinants of Health
Amu-Nnadi CN, Ross ES, Garcia NH
Health system integration and cancer center access for rural hospitals.
This study’s goal was to assess health system integration and cancer center access for rural hospitals. The authors compared health systems with and without cancer centers based on rural hospital presence. They found that 90% of cancer centers are in a health system, and 72% of health systems (434/607) have a cancer center. Larger health systems with more trainees more often have cancer centers but are no more likely to include rural hospitals (11% vs 6%). The minority of cancer centers not in health systems (N = 95) more often serve low complexity patient populations in non-metropolitan areas.
AHRQ-funded; HS013852.
Citation: Amu-Nnadi CN, Ross ES, Garcia NH .
Health system integration and cancer center access for rural hospitals.
Am Surg 2024 May; 90(5):1023-29. doi: 10.1177/00031348231216497..
Keywords: Health Systems, Cancer, Rural Health, Rural/Inner-City Residents, Access to Care
Adams DR, Pérez-Flores NJ, Mabrouk F DR, Pérez-Flores NJ, Mabrouk F
Assessing access to trauma-informed outpatient mental health services for adolescents: a mystery shopper study.
A mystery shopper study examined the accessibility of trauma-informed mental health services for adolescents in Cook County, Illinois safety-net clinics. Posing as mothers of traumatized children, researchers were only able to schedule appointments in 17% of calls to community mental health centers (CMHCs) and federally qualified health centers (FQHCs). Appointment denials were primarily due to capacity constraints at CMHCs (67%) and administrative requirements to switch providers at FQHCs (62%). Notably, non-White callers were less likely to be offered an appointment than White callers, raising concerns about potential racial bias in scheduling practices. Wait times averaged 12 days, with CMHCs offering shorter wait times than FQHCs. Only 38% of schedulers reported offering trauma-informed therapy at their centers. These findings reveal significant disparities and barriers to accessing crucial mental health services for adolescents, particularly those from marginalized backgrounds.
AHRQ-funded; HS000084.
Citation: Adams DR, Pérez-Flores NJ, Mabrouk F DR, Pérez-Flores NJ, Mabrouk F .
Assessing access to trauma-informed outpatient mental health services for adolescents: a mystery shopper study.
Psychiatr Serv 2024 May; 75(5):402-09. doi: 10.1176/appi.ps.20230198..
Keywords: Children/Adolescents, Behavioral Health, Trauma, Access to Care
Kistler A, Decker S, Steiger D
AHRQ Author: Decker S
A multimode strategy to contact participants and collect responses in a supplement to a longitudinal household survey.
In seeking to understand connections between Americans’ health care expenditures and use and social determinants of health, The Agency for Healthcare Research and Quality (AHRQ) and Westat conducted a new Medical Expenditure Panel Survey (MEPS) supplemental study in 2021 using a multimode (web and paper) instrument. Participants were encouraged to complete the web survey, but were provided the option of responding by paper. Response was encouraged through a multimode contact strategy, including text messages, emails, and/or mailings. The purpose of this paper was to review the protocol for encouraging web response and the response rates when utilizing various contact modes. The overall unweighted response rate for the survey was 74.2%, with 69.3% of responses submitted via the web. Response rates were 85.5% which was the highest among adults for whom both email and mobile phone information were provided.
AHRQ-authored.
Citation: Kistler A, Decker S, Steiger D .
A multimode strategy to contact participants and collect responses in a supplement to a longitudinal household survey.
Survey Methods: Insights From the Field 2024 May 1. doi: 10.13094/SMIF-2024-00001..
Keywords: Medical Expenditure Panel Survey (MEPS)
Kostick-Quenet KM, Lang B, Dorfman N
Patients' and physicians' beliefs and attitudes towards integrating personalized risk estimates into patient education about left ventricular assist device therapy.
This study explored stakeholder attitudes toward the utility, acceptability, usefulness, and best practices for integrating personalized risk (PR) estimates into patient education and decision making about Left Ventricular Assist Device (LVAD). This was a 5-year multi-institutional AHRQ project where the authors conducted 40 interviews with stakeholders (physicians, nurse coordinators, patients, and caregivers) and analyzed using Thematic Content Analysis. All stakeholder groups voiced positive views towards PR integration in decision making. Physicians felt PR can improve their decision making by enhancing insight into outcomes, enhance tailored pre-emptive care, increase confidence in decisions, and reduce bias and subjectivity. All stakeholder groups raised concerns about accuracy, representativeness and relevance of algorithms; predictive uncertainty; utility in relation to physician's expertise; potential negative reactions among patients; and overreliance.
AHRQ-funded; HS027784.
Citation: Kostick-Quenet KM, Lang B, Dorfman N .
Patients' and physicians' beliefs and attitudes towards integrating personalized risk estimates into patient education about left ventricular assist device therapy.
Patient Educ Couns 2024 May; 122:108157. doi: 10.1016/j.pec.2024.108157.
Keywords: Education: Patient and Caregiver, Risk, Cardiovascular Conditions
Gaughan AA, MacEwan SR, Gregory ME
When infections are found: a qualitative study characterizing best management practices for central line-associated bloodstream infection and catheter-associated urinary tract infection performance monitoring and feedback.
The purpose of this study was to address the knowledge gap between management practices and their role in HAI performance monitoring and feedback. The researchers had previously conducted semi-structured interviews with staff at 18 hospitals to explore the role of management practices related to the prevention of central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs). Across the sites researchers found common approaches, such as investigating HAIs without blame and identifying opportunities for improvement.
AHRQ-funded; HS024958.
Citation: Gaughan AA, MacEwan SR, Gregory ME .
When infections are found: a qualitative study characterizing best management practices for central line-associated bloodstream infection and catheter-associated urinary tract infection performance monitoring and feedback.
Nurs Rep 2024 Apr 27; 14(2):1058-66. doi: 10.3390/nursrep14020080..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Catheter-Associated Urinary Tract Infection (CAUTI), Urinary Tract Infection (UTI), Patient Safety, Prevention
Zittleman L, Westfall JM, Callen D
Does engagement matter? The impact of patient and community engagement on implementation of cardiovascular health materials in primary care settings.
This report described uptake by primary care practices of cardiovascular disease (CVD) prevention materials produced through local community engagement efforts using Boot Camp Translation (BCT). Four BCTs were conducted, and the locally created materials made available to participating urban and rural practices in an "enhanced" arm of a randomized trial. While practices ordered a wide variety of BCT products, they were more likely to order materials developed by their local BCT. The authors concluded that the greater uptake of locally created materials supported the use of patient engagement methods such as BCT to increase implementation and delivery of guideline-based care.
AHRQ-funded; HS023904.
Citation: Zittleman L, Westfall JM, Callen D .
Does engagement matter? The impact of patient and community engagement on implementation of cardiovascular health materials in primary care settings.
BMC Prim Care 2024 Apr 25; 25(1):135. doi: 10.1186/s12875-024-02365-w..
Keywords: Primary Care, Patient and Family Engagement, Cardiovascular Conditions, Health Promotion, Prevention
Chang S, Liu M, Braun-Inglis C
Cancer care coordination in rural Hawaii: a focus group study.
A focus group study of rural cancer patients in Hawaii revealed that challenges with care coordination (CC) significantly impact their cancer care experiences. Discussions highlighted issues such as limited access to care (27.3%), insurance concerns (9.1%), inter-island travel difficulties (6.1%), and low health literacy (4.5%). However, participants also identified facilitators of CC, including the use of electronic patient portals (12.1%), team-based approaches (9.1%), family caregiver support (4.5%), and assistance from local clinic staff (4.5%). These findings suggest potential intervention targets to improve cancer care delivery for rural populations in Hawaii, focusing on both addressing barriers and leveraging existing strengths within the care system.
AHRQ-funded; HS027286.
Citation: Chang S, Liu M, Braun-Inglis C .
Cancer care coordination in rural Hawaii: a focus group study.
BMC Health Serv Res 2024 Apr 24; 24(1):518. doi: 10.1186/s12913-024-10916-1..
Keywords: Cancer, Care Coordination, Rural/Inner-City Residents, Rural Health
Idnay B, Liu J, Fang Y
Sociotechnical feasibility of natural language processing-driven tools in clinical trial eligibility prescreening for Alzheimer's disease and related dementias.
This study investigated the sociotechnical feasibility of natural language processing (NLP)-driven tools for Alzheimer’s disease and related dementia research (ADRD) prescreening so that researchers can effectively identify eligible clinical trial participants. The authors conducted a randomized experiment with 60 clinical research staff using three prescreening tools (Criteria2Query, Informatics for Integrating Biology and the Bedside [i2b2], and Leaf). Usability of each tool was analyzed using the Health Information Technology Usability Evaluation Scale. Leaf had the highest score for usability followed by Criteria2Query and i2b2. Cognitive complexity was found to be affected by age, computer literacy, and number of criteria, but wasn’t significantly associated with usability. The authors concluded that adopting NLP for ADRD prescreening demands careful task delegation, comprehensive training, precise translation of eligibility criteria, and increased research accessibility.
AHRQ-funded; HS028752.
Citation: Idnay B, Liu J, Fang Y .
Sociotechnical feasibility of natural language processing-driven tools in clinical trial eligibility prescreening for Alzheimer's disease and related dementias.
J Am Med Inform Assoc 2024 Apr 19; 31(5):1062-73. doi: 10.1093/jamia/ocae032..
Keywords: Dementia, Neurological Disorders, Health Information Technology (HIT), Research Methodologies
Barton HJ, Maru A, Leaf MA
Academic detailing as a health information technology implementation method: supporting the design and implementation of an emergency department-based clinical decision support tool to prevent future falls.
This study investigated the effectiveness of academic detailing, a method involving personalized education sessions with clinicians, in implementing a machine learning-based clinical decision support (CDS) tool designed to prevent future falls in elderly emergency department patients. Through qualitative analysis of interviews with clinicians who had encountered the CDS tool, researchers identified several factors influencing its use, including aspects of the tool's design, clinicians' understanding of the tool and referral process, the fast-paced emergency department environment, clinicians' perception of patient fall risk, and the complexity of the referral process. Academic detailing sessions allowed for real-time clarification of misconceptions and demonstration of the tool's functionality, highlighting its potential as a valuable strategy for supporting the implementation and optimization of health information technologies. Additionally, insights gained from these sessions can inform both immediate adjustments to the implementation process and long-term redesign of the tool to better align with clinicians' needs and workflows.
AHRQ-funded; HS027735.
Citation: Barton HJ, Maru A, Leaf MA .
Academic detailing as a health information technology implementation method: supporting the design and implementation of an emergency department-based clinical decision support tool to prevent future falls.
JMIR Hum Factors 2024 Apr 18; 11:e52592. doi: 10.2196/52592..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Implementation, Emergency Department, Falls, Prevention
He Z, Bhasuran B, Jin Q
Quality of answers of generative large language models versus peer users for interpreting laboratory test results for lay patients: evaluation study.
This study compared the quality of answers of generative large language models (LLMs) versus peer users for interpreting laboratory test results for lay patients. The authors collected laboratory test result-related Q&A data from Yahoo! Answers and selected 53 Q&A pairs for this study. Using the LangChain framework and ChatGPT web portal, they generated responses to the 53 questions from 5 LLMs: GPT-4, GPT-3.5, LLaMA 2, MedAlpaca, and ORCA_mini. They assessed the similarity of their answers using standard Q&A similarity-based evaluation metrics. They used an LLM-based evaluator to judge whether a target model had higher quality in terms of relevance, correctness, helpfulness, and safety than the baseline model. They performed a manual evaluation with medical experts for all the responses to 7 selected questions on the same 4 aspects. They used GPT-4 output as the reference answer and found the responses from GPT-3 were the most similar, followed by those from LLaMA 2, ORCA_mini, and MedAlpaca. Human answers from Yahoo data were scored the lowest. They also identified a number of ways to improve the quality of LLM responses.
AHRQ-funded; HS029969.
Citation: He Z, Bhasuran B, Jin Q .
Quality of answers of generative large language models versus peer users for interpreting laboratory test results for lay patients: evaluation study.
J Med Internet Res 2024 Apr 17; 26:e56655. doi: 10.2196/56655..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT)
Zheng H, Ash AS, Yang W
Strengthening quality measurement to predict success for total knee arthroplasty: results from a nationally representative total knee arthroplasty cohort.
In 2027, the Centers for Medicare & Medicaid Services (CMS) will begin mandating Patient-reported outcome measures (PROMs) to assess the quality of total knee arthroplasty (TKA). Using data from a national cohort of primary unilateral TKA patients, the authors developed, tested, and enhanced a model closely following a CMS-proposed measure to predict substantial clinical benefit. Only the enhanced model predicted success accurately across the spectrum of baseline scores. Findings were virtually identical when analyses were replicated on patients over 65. The authors concluded that adding a baseline knee-specific PROM score to a quality measurement model in a nationally representative cohort dramatically improved its predictive power.
AHRQ-funded; HS018910.
Citation: Zheng H, Ash AS, Yang W .
Strengthening quality measurement to predict success for total knee arthroplasty: results from a nationally representative total knee arthroplasty cohort.
J Bone Joint Surg Am 2024 Apr 17; 106(8):708-15. doi: 10.2106/jbjs.23.00602..
Keywords: Quality Measures, Quality of Care, Orthopedics, Surgery, Outcomes, Evidence-Based Practice, Patient-Centered Outcomes Research
Lu A, Armstrong M, Alexander R
Trends in pediatric prescription-opioid overdoses in U.S. emergency departments from 2008-2020: an epidemiologic study of pediatric opioid overdose ED visits.
This study looked at trends in pediatric prescription-opioid overdose visits to the emergency room from 2008 to 2020. This retrospective epidemiological study used the 2008-2020 Nationwide Emergency Department Sample. National estimates were broken down by zip code, emergency department (ED) disposition, and hospital location/teaching status. The prescription-opioid overdose ED visits for patients from 0-17 years old in the United States decreased by 22% from 2008 to 2019, then increased by 12% in 2020. Most patients were discharged to home following their ED visit, however, from 2019 to 2020 there was a 42% increase in patients admitted. The overdose rates per 100,000 children were highest in the 0 to 1 and 12 to 17 age groups, with the 12 to 17 group increasing by 27% in 2020. The West saw an increase of 58% in 2019-2020 and the Midwest increased by 20%.
AHRQ-funded; HS029183.
Citation: Lu A, Armstrong M, Alexander R .
Trends in pediatric prescription-opioid overdoses in U.S. emergency departments from 2008-2020: an epidemiologic study of pediatric opioid overdose ED visits.
PLoS One 2024 Apr 17; 19(4):e0299163. doi: 10.1371/journal.pone.0299163..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Opioids, Substance Abuse, Emergency Department, Medication, Behavioral Health
Ratliff HC, Yakusheva O, Boltey EM
Patterns of interactions among ICU interprofessional teams: a prospective patient-shift-level survey approach.
The objective of this study was to determine number and types of individuals who interact in the care of mechanically ventilated (MV) patients. Researchers conducted a prospective, patient-shift-level survey in two ICUs. They surveyed each patients’ assigned physician, nurse, and respiratory therapist each shift about who they interacted with when providing the Awakening, Breathing Coordination, Delirium monitoring and Early mobility bundle (ABCDE). The results indicated that clinicians interacted with 3-4 other clinicians each shift, fewer on nights; nurses interacted with the most clinicians and family members. The researchers concluded that interventions targeting shift-level teams, focusing on nurses and family members, may improve ABCDE delivery and ICU teamwork.
AHRQ-funded; HS024552.
Citation: Ratliff HC, Yakusheva O, Boltey EM .
Patterns of interactions among ICU interprofessional teams: a prospective patient-shift-level survey approach.
PLoS One 2024 Apr16; 19(4):e0298586. doi: 10.1371/journal.pone.0298586..
Keywords: Teams, Intensive Care Unit (ICU), Critical Care
Zhang Y, Leifheit KM, Lee KT
The association of oncology provider density with black-white disparities in cancer mortality in US counties.
In an ecological study of 1048 U.S. counties, researchers examined the association between oncology provider density and Black-White cancer mortality disparities. Oncology provider density was estimated using National Plan and Provider Enumeration System data; the cancer mortality ratio was calculated using cancer mortality rates from State Cancer Profiles. The results showed that higher provider density was associated with significantly lower cancer mortality among White persons, but not among Black persons. The researchers concluded that higher density alone may not resolve cancer mortality disparities, and that attention to ensuring equitable care is critical.
AHRQ-funded; HS000046.
Citation: Zhang Y, Leifheit KM, Lee KT .
The association of oncology provider density with black-white disparities in cancer mortality in US counties.
Cancer Control 2024 Jan-Dec; 31:10732748241244929. doi: 10.1177/10732748241244929..
Keywords: Cancer, Mortality, Racial and Ethnic Minorities, Disparities, Provider
Jones BLH, Geier M, Neuhaus
Withdrawal during outpatient low dose buprenorphine initiation in people who use fentanyl: a retrospective cohort study.
This study examined withdrawal symptoms from opioids when using low dose initiation (LDI) strategies with buprenorphine. The authors conducted a retrospective chart review of patients with opioid use disorder (OUD) using daily fentanyl who were prescribed 7-day or 4-day LDI at 2 substance use disorder treatment clinics in San Francisco. Withdrawal severity and precipitated withdrawal, defined as acute worsening of withdrawal symptoms immediately after taking buprenorphine, were extracted from chart documentation by two addiction medicine experts. There were 175 initiations in 126 patients, who had a mean age of 37, 71% male, 26% women, and 2% non-binary; 21% were Black, 16% Latino, and 52% white. Other characteristics were that 60% were unstably housed and 75% had Medicaid insurance. Substance co-use included 74% amphetamine use, 29% cocaine, 22% benzodiazepines, and 19% alcohol. They found deviation from protocol instructions in 22% of these initiations with follow up. Withdrawal symptoms were found in 31% of the cohort, including 21% with mild symptoms, 8% moderate and 2% severe. Precipitated withdrawal occurred in 8% of initiations with follow-up. Of those, 7 had deviation from protocol instructions, with 3 cases (3%) in which precipitated withdrawal occurred without protocol deviation.
AHRQ-funded; HS026383.
Citation: Jones BLH, Geier M, Neuhaus .
Withdrawal during outpatient low dose buprenorphine initiation in people who use fentanyl: a retrospective cohort study.
Harm Reduct J 2024 Apr 9; 21(1):80. doi: 10.1186/s12954-024-00998-9..
Keywords: Opioids, Medication, Substance Abuse, Behavioral Health, Ambulatory Care and Surgery
Clifton RL, Carson I, Dir AL
Who gets screened and who tests positive? Drug screening among justice-involved youth in a midwestern urban county.
A study of justice-involved youth assigned to probation in a midwestern urban county examined factors influencing drug screening (DS) practices. Results showed that males were more likely to be screened and to test positive than females. Older youth were less likely to be screened, while a higher number of charges increased the likelihood of screening. Youth with violent offenses were more likely to be screened than those with other offenses but less likely to test positive. These findings suggest that DS decisions are influenced by various factors, including demographics and offense types. However, these factors may not always correlate with actual substance use, raising questions about the appropriateness of using demographic or charge-based criteria for determining who gets screened.
AHRQ-funded; HS022681.
Citation: Clifton RL, Carson I, Dir AL .
Who gets screened and who tests positive? Drug screening among justice-involved youth in a midwestern urban county.
Health Justice 2024 Apr 5; 12(1):13. doi: 10.1186/s40352-024-00273-w..
Keywords: Children/Adolescents, Substance Abuse, Screening, Urban Health
Fenwick K, Dossett EC, Gitlin R
Addressing pregnancy and parenting in mental health care: perspectives of women with serious mental illness.
In a study exploring the experiences and preferences of women with serious mental illness (SMI) regarding pregnancy and parenting discussions with their mental health providers, researchers found that these conversations were often limited or unsatisfactory, particularly regarding medication risks during pregnancy. Women's openness to discussing pregnancy varied depending on the topic and their personal circumstances, and trust in their provider played a significant role. Discussions about parenting were generally viewed as helpful, but participants identified areas where additional support could be beneficial. These findings highlight the need for improved communication and resources to better address the unique needs of women with SMI who are pregnant or parenting.
AHRQ-funded; HS026407.
Citation: Fenwick K, Dossett EC, Gitlin R .
Addressing pregnancy and parenting in mental health care: perspectives of women with serious mental illness.
Health Affairs 2024 Apr; 43(4):582-89. doi: 10.1377/hlthaff.2023.01450..
Keywords: Women, Maternal Care, Behavioral Health
Callaway Kim K, Rothenberger SD, Tadrous M
Drug Shortages Prior to and During the COVID-19 Pandemic.
A recent study analyzing U.S. pharmaceutical purchase data from 2017 to 2021 found that 13.7% of reported drug supply chain issues were associated with subsequent drug shortages, compared to 4.1% for drugs without reported issues. This association was even more pronounced during the initial months of the COVID-19 pandemic, with 34.2% of drugs with reported supply chain issues experiencing shortages from February to April 2020. The study also found that shortages were more likely to occur for parenteral drugs (administered by injection), essential medicines, and brand-name drugs. These findings underscore the vulnerability of the U.S. drug supply chain and highlight the need for ongoing policy efforts to mitigate the impact of future disruptions and prioritize essential medications.
AHRQ-funded; HS027985.
Citation: Callaway Kim K, Rothenberger SD, Tadrous M .
Drug Shortages Prior to and During the COVID-19 Pandemic.
JAMA Netw Open 2024 Apr; 7(4):e244246. doi: 10.1001/jamanetworkopen.2024.4246..
Keywords: Medication, COVID-19
Djulbegovic B, Hozo I, Cuker A
Improving methods of clinical practice guidelines: from guidelines to pathways to fast-and-frugal trees and decision analysis to develop individualised patient care.
A novel approach to clinical practice guideline development is proposed, addressing the limitations of current methods. This approach involves converting evidence-based pathways into fast-and-frugal decision trees (FFTs) and integrating them with generalized decision curve analysis to provide clear, personalized management recommendations. The process is illustrated using heparin-induced thrombocytopenia (HIT) as an example. By converting American Society of Hematology guidelines into an FFT and considering thrombotic complications and major bleeding, the researchers found that direct oral anticoagulants (DOACs) were superior to other treatments if the FFT-predicted probability of HIT exceeded 3%. This framework offers a transparent and individualized approach to guideline development, potentially improving patient care and addressing criticisms of current methods.
AHRQ-funded; HS024917.
Citation: Djulbegovic B, Hozo I, Cuker A .
Improving methods of clinical practice guidelines: from guidelines to pathways to fast-and-frugal trees and decision analysis to develop individualised patient care.
J Eval Clin Pract 2024 Apr; 30(3):393-402. doi: 10.1111/jep.13953..
Keywords: Guidelines, Patient-Centered Healthcare, Evidence-Based Practice
Foer D, Rubins DM, Nguyen V
Utilization of electronic health record sex and gender demographic fields: a metadata and mixed methods analysis.
An assessment of electronic health record (EHR) metadata revealed that while all patients had a "Legal Sex" entry as mandated, completion rates for "Gender Identity" and "Sex Assigned at Birth" were only 20% and 19%, respectively. Notably, 321,185 patients experienced changes in these fields over time, with administrators initiating the majority of changes. Provider utilization varied significantly by subspecialty, with identified barriers including system limitations and individual perceptions. This study underscores the need for improved accuracy and consistency in sex and gender data collection in EHRs, as well as greater awareness and standardized workflows among providers to ensure appropriate utilization of these fields.
AHRQ-funded; HS028916.
Citation: Foer D, Rubins DM, Nguyen V .
Utilization of electronic health record sex and gender demographic fields: a metadata and mixed methods analysis.
J Am Med Inform Assoc 2024 Apr 3; 31(4):910-18. doi: 10.1093/jamia/ocae016..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT)
Bouchelle Z, Menko SG, Yazdani M
Parent perspectives on documentation and sharing of health-related social needs data.
This survey aimed to examine parents of pediatric patients’ preferences regarding how health-related social needs (HRSN) screening program data are documented and shared. The authors conducted semi-structured interviews with parents of hospitalized children participating in an HRSN screening program at a quaternary care children's hospital. Interviews were then coded to identify emergent themes. A total of 20 parents were interviewed with all being female, 55% identifying as Black or African American and 20% identifying as Hispanic or Latino. Parents expressed comfort with electronic health record documentation of HRSN data and the use of ICD-10 Revision Z codes as long as this information was used to provide families with meaningful support. Most parents viewed social workers and medical teams as being the most appropriate recipients of the data, with few parents feeling comfortable with HRSN data being shared with payors. Parents wanted transparency around HRSN data sharing, with many expressing concerns that documentation and sharing of HRSN data could lead to unwanted or unsafe disclosures or result in child welfare referrals.
AHRQ-funded; HS028555.
Citation: Bouchelle Z, Menko SG, Yazdani M .
Parent perspectives on documentation and sharing of health-related social needs data.
Hosp Pediatr 2024 Apr; 14(4):308-16. doi: 10.1542/hpeds.2023-007478..
Keywords: Children/Adolescents, Screening, Electronic Health Records (EHRs), Health Information Technology (HIT)
Amonoo HL, Guo M, Boardman AC
A positive psychology Intervention for caregivers of hematopoietic stem cell transplantation survivors (PATH-C): initial testing and single-arm pilot trial.
This study looked at the feasibility and acceptability of the Positive Affect in the Transplantation of Hematopoietic Stem Cells (PATH) intervention for hematopoietic stem cell transplantation (HSCT) caregivers for to identify caregiver preferences to tailor PATH for HSCT caregivers. The researchers conducted 15 semistructured qualitative exit interviews out of 18 total participants to explore HSCT caregivers' perception of PATH's content, benefits of PATH, as well as facilitators and barriers to engaging with the intervention. Certain sociodemographic factors such as being retired and the manualized structure of PATH were cited as facilitators to intervention engagement. Barriers to PATH engagements included time constraints and competing caregiving responsibilities. Caregivers preferred remote intervention delivery within the first 100 days post HSCT.
AHRQ-funded; HS013853.
Citation: Amonoo HL, Guo M, Boardman AC .
A positive psychology Intervention for caregivers of hematopoietic stem cell transplantation survivors (PATH-C): initial testing and single-arm pilot trial.
Transplant Cell Ther 2024 Apr; 30(4):448.e1-48.e14. doi: 10.1016/j.jtct.2024.01.064..
Keywords: Caregiving, Stress