National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
5451 to 5475 of 12139 Research Studies DisplayedMcClellan CB
Disparities in opioid related mortality between United States counties from 2000 to 2014.
This study examines disparities in opioid related mortality between United States counties from 2000 to 2014. Unfortunately, counties that had lower rates in 2000 had caught up by 2014. The authors suggest that prevention measures need to be broader in scope and be implemented in areas where the opioid crisis doesn’t seem as prevalent.
AHRQ-authored.
Citation: McClellan CB .
Disparities in opioid related mortality between United States counties from 2000 to 2014.
Drug Alcohol Depend 2019 Apr 25;199:151-58. doi: 10.1016/j.drugalcdep.2019.03.005..
Keywords: Disparities, Medication, Mortality, Opioids, Substance Abuse
Vergis A, Hardy K, Stogryn S
Fellow and attending surgeon operative notes are deficient in reporting established quality indicators for Roux-en-y gastric bypass: a preliminary retrospective analysis of operative dictation.
This retrospective analysis investigated the completeness of reporting documentation for Roux-en-Y Gastric Bypass (RYGB) surgery. A total of 40 bariatric fellow and 40 attending RYGB narrative reports were analyzed. Fellows had a mean completion rate of 66.4% compared to 61.5% for attendings. Fellows also did a better job of completing subsections, with the exception of closure details. This information is important to communicating operative events and can make an impact on patient safety and quality.
AHRQ-funded; HS018546.
Citation: Vergis A, Hardy K, Stogryn S .
Fellow and attending surgeon operative notes are deficient in reporting established quality indicators for Roux-en-y gastric bypass: a preliminary retrospective analysis of operative dictation.
Cureus 2019 Apr 24;11(4):e4535. doi: 10.7759/cureus.4535..
Keywords: Obesity, Quality of Care, Quality Indicators (QIs), Patient Safety, Provider, Provider: Physician, Surgery
Jarvenpaa M, Sater MRA, Lagoudas GK
A Bayesian model of acquisition and clearance of bacterial colonization incorporating within-host variation.
The authors present a Bayesian model that provides probabilities of whether two bacterial strains could be considered the same. This will help in predicting the spread of infections such as methicillin resistant Staphylococcus aureus (MRSA).
AHRQ-funded; HS019388.
Citation: Jarvenpaa M, Sater MRA, Lagoudas GK .
A Bayesian model of acquisition and clearance of bacterial colonization incorporating within-host variation.
PLoS Comput Biol 2019 Apr 22;15(4):e1006534. doi: 10.1371/journal.pcbi.1006534..
Keywords: Healthcare-Associated Infections (HAIs), Infectious Diseases, Methicillin-Resistant Staphylococcus aureus (MRSA), Patient Safety
Arasu VA, Miglioretti DL, Sprague BL
Population-based assessment of the association between magnetic resonance imaging background parenchymal enhancement and future primary breast cancer risk.
The purpose of this study was to evaluate comparative associations of breast magnetic resonance imaging (MRI) background parenchymal enhancement (BPE) and mammographic breast density with subsequent breast cancer risk. The investigators concluded that BPE was associated with future invasive breast cancer risk independent of breast density. They suggest that BPE should be considered for risk prediction models for women undergoing breast MRI.
AHRQ-funded; HS018366.
Citation: Arasu VA, Miglioretti DL, Sprague BL .
Population-based assessment of the association between magnetic resonance imaging background parenchymal enhancement and future primary breast cancer risk.
J Clin Oncol 2019 Apr 20;37(12):954-63. doi: 10.1200/jco.18.00378..
Keywords: Cancer, Cancer: Breast Cancer, Imaging, Patient-Centered Outcomes Research, Risk, Women
Armstrong MJ, Rastgardani T, Gagliardi AR
Barriers and facilitators of communication about off periods in Parkinson's disease: qualitative analysis of patient, carepartner, and physician Interviews.
This article discusses barriers and facilitators of communication with Parkinson’s disease patients, care partners, and their physicians specifically during off periods. Twenty persons with Parkinson’s and their care partners, and 20 physicians participated in interviews using a semi-structured questionnaire. Communication barrier levels were identified as patient-level, caregiver-level, and physician-level. For patients cognitive impairment and reluctance to discuss symptoms was the largest barrier. Caregiver absence was also a barrier. For physicians barriers were distraction by technology and lack of appreciation of off period burdens. Various tools such as home diaries, questionnaires and mobile phone videos can be used to aid communication regarding off periods. Patients and their caregivers stressed the need for more formal educational materials and improved educational tools.
AHRQ-funded; HS024159.
Citation: Armstrong MJ, Rastgardani T, Gagliardi AR .
Barriers and facilitators of communication about off periods in Parkinson's disease: qualitative analysis of patient, carepartner, and physician Interviews.
PLoS One 2019 Apr 18;14(4):e0215384. doi: 10.1371/journal.pone.0215384..
Keywords: Communication, Clinician-Patient Communication, Neurological Disorders, Caregiving, Education: Patient and Caregiver, Health Literacy, Patient and Family Engagement
Wedlock PT, Mitgang EA, Oron AP
Modeling the economic impact of different vial-opening thresholds for measles-containing vaccines.
The lack of specific policies on how many children must be present at a vaccinating location before a healthcare worker can open a measles-containing vaccine (MCV) - i.e. the vial-opening threshold - has led to inconsistent practices, which can have wide-ranging systems effects. Using HERMES-generated simulation models of the routine immunization supply chains of Benin, Mozambique and Niger, the investigators evaluated the impact of different vial-opening thresholds (none, 30% of doses must be used, 60%) and MCV presentations (10-dose, 5-dose) on each supply chain.
AHRQ-funded; HS023317.
Citation: Wedlock PT, Mitgang EA, Oron AP .
Modeling the economic impact of different vial-opening thresholds for measles-containing vaccines.
Vaccine 2019 Apr 17;37(17):2356-68. doi: 10.1016/j.vaccine.2019.03.017..
Keywords: Vaccination, Infectious Diseases, Healthcare Costs, Public Health
Cantor AG, Hendrickson R, Blazina I
Screening for elevated blood lead levels in childhood and pregnancy: updated evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this study was to synthesize evidence on the effects of screening, testing, and treatment for elevated blood lead level in pregnant women and children aged 5 years and younger in the primary care setting to inform the US Preventive Services Task Force. The investigators found that screening questionnaires were not accurate for identifying children with elevated blood lead levels. Additionally, chelating agents in children were not significantly associated with sustained effects on blood level levels but were associated with harms.
AHRQ-funded; 290201500009I.
Citation: Cantor AG, Hendrickson R, Blazina I .
Screening for elevated blood lead levels in childhood and pregnancy: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2019 Apr 16;321(15):1510-26. doi: 10.1001/jama.2019.1004..
Keywords: Children/Adolescents, Evidence-Based Practice, Pregnancy, Prevention, Screening, U.S. Preventive Services Task Force (USPSTF), Women
Mabry-Hernandez I, Ojeda LC
AHRQ Author: Mabry-Hernandez I
Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults.
This Putting Prevention Into Practice (PPIP) case-study quiz illustrates the recommendations of the U.S. Preventive Services Task Force on Behavioral Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults. Three questions were created about a 32-year old women presents with normal blood glucose levels, but has a BMI of 34. The answers are given below the quiz which illustrate the recommendations that were given.
AHRQ-authored.
Citation: Mabry-Hernandez I, Ojeda LC .
Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults.
Am Fam Physician 2019 Apr 15;99(8):515-16..
Keywords: Case Study, Obesity, Obesity: Weight Management, Screening, U.S. Preventive Services Task Force (USPSTF)
Sharma A, Sun JL, Lokhnygina Y
Patient phenotypes, cardiovascular risk, and ezetimibe treatment in patients after acute coronary syndromes (from IMPROVE-IT).
The authors of this article performed a hierarchical cluster analysis to identify acute coronary syndrome (ACS) patients at high risk for adverse clinical events. Post-ACS patients were randomized to ezetimibe+simvastatin or placebo+simvastatin. Ezetimibe's impact on outcomes across clusters; the ability of the cluster analysis to discriminate for outcomes was compared with the Global Registry of Acute Coronary Events (GRACE) score. Outcomes included cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, hospitalization for unstable angina, or coronary revascularization at least 30 days after randomization. Compared with GRACE, cluster analysis did not provide superior outcome discrimination. Consistent ezetimibe treatment effect was identified across clusters. The authors conclude that cluster analysis identified significant difference in risk of outcomes across cluster groups.
AHRQ-funded; HS023000.
Citation: Sharma A, Sun JL, Lokhnygina Y .
Patient phenotypes, cardiovascular risk, and ezetimibe treatment in patients after acute coronary syndromes (from IMPROVE-IT).
Am J Cardiol 2019 Apr 15;123(8):1193-201. doi: 10.1016/j.amjcard.2019.01.034..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Outcomes, Patient-Centered Outcomes Research, Risk
Lapcharoensap W, Cong A, Sherman J
Safety and ergonomic challenges of ventilating a premature infant during delayed cord clamping.
This study discussed the reasons that delayed cord clamping (DCC) for term and preterm infants is endorsed by multiple medical organizations. It has been shown to reduce hemorrhage, lower incidence of necrotizing enterocolitis and the need for transfusions in preterm infants. The writers held a number of multidisciplinary simulation workshops of vaginal and Caesarean deliveries, with providers starting positive pressure ventilation and ending with CPAP on a preterm manikin. Videos were also reviewed and identified 5 themes of concern: sterility, equipment, mobility, space, and workflow.
AHRQ-funded; HS023506.
Citation: Lapcharoensap W, Cong A, Sherman J .
Safety and ergonomic challenges of ventilating a premature infant during delayed cord clamping.
Children 2019 Apr 13;6(4). doi: 10.3390/children6040059..
Keywords: Adverse Events, Labor and Delivery, Newborns/Infants, Patient Safety
Roche SD, Reichheld AM, Demosthenes N
Measuring the quality of inpatient specialist consultation in the intensive care unit: Nursing and family experiences of communication.
The purpose of this study was to document the receipt of communication by nurses and family members regarding consultations performed on their patient or loved one, and to quantify how this impacted their overall perceptions of the quality of specialty care. The investigators found that most ICU families and nurses had no interaction with specialist providers. They concluded that nurses' frequent exclusion from conversations about specialty care may pose safety risks and increase the likelihood of mixed messages for patients and families, most of whom desire some interaction with specialists.
AHRQ-funded; K08 HS024288.
Citation: Roche SD, Reichheld AM, Demosthenes N .
Measuring the quality of inpatient specialist consultation in the intensive care unit: Nursing and family experiences of communication.
PLoS One 2019 Apr 11;14(4):e0214918. doi: 10.1371/journal.pone.0214918..
Keywords: Clinician-Patient Communication, Communication, Quality of Care, Intensive Care Unit (ICU), Patient Experience, Inpatient Care
Darby JL, Davis BS, Barbash IJ
An administrative model for benchmarking hospitals on their 30-day sepsis mortality.
The goal of this study was to develop an administrative risk-adjustment model suitable for profiling hospitals on their 30-day mortality rates for patients with sepsis. The investigators concluded that a novel claims-based risk-adjustment model demonstrated wide variation in risk-standardized 30-day sepsis mortality rates across hospitals. Individual hospitals' performance rankings were stable across years and after the addition of laboratory data. They assert that this model provides a robust way to rank hospitals on sepsis mortality while adjusting for patient risk.
AHRQ-funded; HS025455.
Citation: Darby JL, Davis BS, Barbash IJ .
An administrative model for benchmarking hospitals on their 30-day sepsis mortality.
BMC Health Serv Res 2019 Apr 11;19(1):221. doi: 10.1186/s12913-019-4037-x..
Keywords: Hospitals, Mortality, Quality of Care, Sepsis
Schaffer SJ, Rand CM, Humiston SG
Practical considerations in developing a successful school-located influenza vaccination (SLIV) program.
This paper discussed strategies in developing a successful school-located influenza vaccination (SLIV) program. The authors indicate that adequate planning is crucial for SLIV success. In addition, they delineate several components that are important for a SLIV program to be successful: 1. Buy-in from school districts and school nurses, 2. Timing of SLIV clinics, 3. Publicizing SLIV to parents, 4. Obtaining vaccination consent, 5. Adequacy of resources, 6. Billing, and 7. Sustainability
AHRQ-funded; HS021163.
Citation: Schaffer SJ, Rand CM, Humiston SG .
Practical considerations in developing a successful school-located influenza vaccination (SLIV) program.
Vaccine 2019 Apr 10;37(16):2171-73. doi: 10.1016/j.vaccine.2019.01.088..
Keywords: Vaccination, Influenza, Infectious Diseases, Children/Adolescents
Grob R, Darien G, Meyers D
AHRQ Author: Meyers D
Why physicians should trust in patients.
This viewpoint article explores shifting the patient-physician relationship from simply emphasizing patients’ adherence to cultivating patients’ ability to contribute to the development of care plans that reflect their own values and preferences.
AHRQ-authored.
Citation: Grob R, Darien G, Meyers D .
Why physicians should trust in patients.
JAMA 2019 Apr 9;321(14):1347-48. doi: 10.1001/jama.2019.1500..
Keywords: Clinician-Patient Communication, Patient and Family Engagement, Communication
Levis B, Benedetti A, Thombs BD
Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis.
This study’s goal was to determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9) in diagnosing major depression. A bivariate random effects meta-analysis was done to estimate sensitivity and specificity for cut-off scores 5-15. It was determined that the PHQ-9 is similarly sensitive for use as the Mini International Neuropychiatric (MINI) diagnosis tool, but may be less specific for younger patients. However, a cut-off score of 10 or above can be used regardless of age.
AHRQ-funded; HS018246.
Citation: Levis B, Benedetti A, Thombs BD .
Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis.
BMJ 2019 Apr 9;365:l1476. doi: 10.1136/bmj.l1476..
Keywords: Depression, Diagnostic Safety and Quality, Behavioral Health, Screening
Schiff GD, Tripathi JB, Galanter W
Drug formulary decision-making: ethnographic study of 3 pharmacy and therapeutics committees.
This study analyzed the processes of how 3 pharmacy and therapeutic (P&T) committees weighed options and their topics of discussion during meetings. There was a wide range of topics discussed with roughly half the time spent on drug safety than discussions of efficacy. Logistics of using the drugs in their institutions was also a popular topic. The issues varied from drug to drug, and there were quite a few tangential issues raised by committee members.
AHRQ-funded; HS016973.
Citation: Schiff GD, Tripathi JB, Galanter W .
Drug formulary decision-making: ethnographic study of 3 pharmacy and therapeutics committees.
Am J Health Syst Pharm 2019 Apr 8;76(8):537-42. doi: 10.1093/ajhp/zxz022..
Keywords: Decision Making, Medication
Rogal SS, Yakovchenko V, Waltz TJ
Longitudinal assessment of the association between implementation strategy use and the uptake of hepatitis C treatment: year 2.
The goal of the evaluation described in this article was to assess how site-level implementation strategies from providers in the VA’s Hepatitis Innovation Team (HIT) Collaborative were associated with hepatitis C (HCV) treatment initiation and how the use of these strategies changed over time. Key HCV providers at each of the 130 VA sites was asked in two consecutive fiscal years to complete an online survey which examined the use of 73 implementation strategies; providers reported on whether or not the use of each implementation strategy was due to the HIT Collaborative. The number of veterans initiating treatment for HCV at each site was captured using national data. The strategies that were more likely to be used in the second year included promoting adaptability, sharing knowledge between sites, tailoring strategies to deliver HCV care, and using mass media. The total number of veterans initiating treatment was positively correlated with the total number of strategies used in both years. The authors conclude that their results suggest the measuring of implementation strategies over time is a useful way to catalog implementation of evidence-based practices over time and over multiple settings.
AHRQ-funded; HS019461.
Citation: Rogal SS, Yakovchenko V, Waltz TJ .
Longitudinal assessment of the association between implementation strategy use and the uptake of hepatitis C treatment: year 2.
Implement Sci 2019 Apr 8;14(1):36. doi: 10.1186/s13012-019-0881-7..
Keywords: Evidence-Based Practice, Hepatitis, Implementation
Shen NT, Londono C, Gold S
Systematic review with meta-analysis on transplantation for alcohol-related liver disease: very low evidence of improved outcomes.
Under the hypothesis that, while liver transplantation for patients with alcohol-related liver disease (ALD) may improve mortality and relapse, findings will be limited by pre-specified causes of heterogeneity, researchers conducted a systematic review. Data from 10 studies comparing use of liver transplant in ALD to no-transplant was analyzed. Primary outcome of both was short- and long-term mortality and relapse. The results of the review indicate that liver transplantation for ALD patients suggests reduced mortality and relapse in heterogeneous, institution-specific populations. The authors note that, to understand efficacy of transplanting ALD, their research approach must change.
AHRQ-funded; HS000066.
Citation: Shen NT, Londono C, Gold S .
Systematic review with meta-analysis on transplantation for alcohol-related liver disease: very low evidence of improved outcomes.
World J Gastroenterol 2019 Apr 7;25(13):1628-39. doi: 10.3748/wjg.v25.i13.1628..
Keywords: Alcohol Use, Evidence-Based Practice, Mortality, Outcomes, Patient-Centered Outcomes Research, Surgery, Transplantation
Mazur LM, Mosaly PR, Moore C
Association of the usability of electronic health records with cognitive workload and performance levels among physicians.
This research studied the association between the usability of electronic health records (EHRs) and cognitive workload and performance levels among physicians. Current EHRs have problems dealing with patients who had abnormally managed test results due to not appearing for their scheduled follow-up evaluation. Performance and cognitive workload were both quantified with 38 physicians, with 25 (66%) of them female.
AHRQ-funded; HS024062.
Citation: Mazur LM, Mosaly PR, Moore C .
Association of the usability of electronic health records with cognitive workload and performance levels among physicians.
JAMA Netw Open 2019 Apr 5;2(4):e191709. doi: 10.1001/jamanetworkopen.2019.1709..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Physician
Monestime JP, Biener AI, Wolford M
AHRQ Author: Wolford M
Characteristics of office-based providers associated with secure electronic messaging use: achieving meaningful use.
The purpose of this study was to identify characteristics of office-based provider used as a usual source of care (USC) associated with secure electronic messaging (SM) use. The investigators concluded that patients were more likely to have visited a USC that exchanged SMs if that practice also used other electronic health records functionalities. The authors indicated that findings suggested that while patients' USC practices were likely to exchange secure messages, there is a disparity in SM use between physician-owned practices, and hospital-owned practices.
AHRQ-authored.
Citation: Monestime JP, Biener AI, Wolford M .
Characteristics of office-based providers associated with secure electronic messaging use: achieving meaningful use.
Int J Med Inform 2019 Apr 4;129:43-48. doi: 10.1016/j.ijmedinf.2019.04.002..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Expenditure Panel Survey (MEPS), Patient-Centered Healthcare, Provider
Anstey DE, Moise N, Kronish I
Masked hypertension: whom and how to screen?
The purpose of this study was to review issues regarding the practical implementation of screening strategies for masked hypertension. In this review, challenges to screening strategies for masked hypertension, and factors that should be considered when deciding to screen using ambulatory or home blood pressure monitoring were highlighted.
AHRQ-funded; HS024262.
Citation: Anstey DE, Moise N, Kronish I .
Masked hypertension: whom and how to screen?
Curr Hypertens Rep 2019 Apr 4;21(4):26. doi: 10.1007/s11906-019-0931-1..
Keywords: Blood Pressure, Screening
Jue JJ, Cunningham S, Lohr K
AHRQ Author: Nix M
Developing and testing the Agency for Healthcare Research and Quality's National Guideline Clearinghouse Extent of Adherence to Trustworthy Standards (NEATS) Instrument.
In 2011, the Institute of Medicine (IOM) (now the National Academy of Medicine) published standards for trustworthy guidelines and recommended that the National Guideline Clearinghouse (NGC) of the Agency for Healthcare Research and Quality clearly indicate the extent to which guidelines adhere to these standards. To accomplish this, the authors developed and tested the NGC Extent of Adherence to Trustworthy Standards (NEATS) instrument which they discuss in this paper.
AHRQ-authored; AHRQ-funded; 290-2013-00006C.
Citation: Jue JJ, Cunningham S, Lohr K .
Developing and testing the Agency for Healthcare Research and Quality's National Guideline Clearinghouse Extent of Adherence to Trustworthy Standards (NEATS) Instrument.
Ann Intern Med 2019 Apr 2. doi: 10.7326/m18-2950..
Keywords: Implementation, Evidence-Based Practice, Guidelines
Balk EM, Rofeberg VN, Adam GP
Pharmacologic and nonpharmacologic treatments for urinary incontinence in women: a systematic review and network meta-analysis of clinical outcomes.
The purpose of this study was to compare the effectiveness of pharmacologic and nonpharmacologic interventions to improve or cure stress, urgency, or mixed UI in nonpregnant women. The investigators concluded that most nonpharmacologic and pharmacologic interventions were more likely than no treatment to improve UI outcomes. They also concluded that behavioral therapy, alone or in combination with other interventions, was generally more effective than pharmacologic therapies alone in treating both stress and urgency UI.
AHRQ-funded; 290201500002I.
Citation: Balk EM, Rofeberg VN, Adam GP .
Pharmacologic and nonpharmacologic treatments for urinary incontinence in women: a systematic review and network meta-analysis of clinical outcomes.
Ann Intern Med 2019 Apr 2;170(7):465-79. doi: 10.7326/m18-3227..
Keywords: Care Management, Comparative Effectiveness, Evidence-Based Practice, Medication, Outcomes, Patient-Centered Outcomes Research, Women
Crawford ED, Koo PJ, Shore N
A clinician's guide to next generation imaging in patients with advanced prostate cancer (RADAR III).
This paper reports on the convening of the Radiographic Assessments for Detection of Advanced Recurrence (RADAR III) Group to offer guidance on the use of next generation imaging to stage prostate cancer based on available data and clinical experience. The RADAR III Group recommends next generation imaging techniques in select patients in whom disease progression is suspected based on biomarker values, comorbidities and symptoms.
AHRQ-funded.
Citation: Crawford ED, Koo PJ, Shore N .
A clinician's guide to next generation imaging in patients with advanced prostate cancer (RADAR III).
J Urol 2019 Apr;201(4):682-92. doi: 10.1016/j.juro.2018.05.164..
Keywords: Men's Health, Cancer: Prostate Cancer, Cancer, Diagnostic Safety and Quality, Imaging, Evidence-Based Practice, Guidelines
Goodman KE, Lessler J, Harris AD
A methodological comparison of risk scores versus decision trees for predicting drug-resistant infections: a case study using extended-spectrum beta-lactamase (ESBL) bacteremia.
Timely identification of multidrug-resistant gram-negative infections remains an epidemiological challenge. Statistical models for predicting drug resistance can offer utility where rapid diagnostics are unavailable or resource-impractical. The investigators previously reported on a decision tree for predicting extended-spectrum beta-lactamase bloodstream (ESBL) infections. Their objective in the current study was to develop a risk score from the same ESBL dataset to compare these 2 methods and to offer general guiding principles for using each approach.
AHRQ-funded; HS025089.
Citation: Goodman KE, Lessler J, Harris AD .
A methodological comparison of risk scores versus decision trees for predicting drug-resistant infections: a case study using extended-spectrum beta-lactamase (ESBL) bacteremia.
Infect Control Hosp Epidemiol 2019 Apr;40(4):400-07. doi: 10.1017/ice.2019.17..
Keywords: Research Methodologies, Risk, Infectious Diseases