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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
5851 to 5875 of 12182 Research Studies DisplayedCarnahan RM, Daly JM, Minion S
A needs assessment of family physicians to inform development of educational resources on antipsychotic use in dementia.
The authors assessed the needs and preferred resources of Iowa physicians to inform the development of educational resources for best practice dementia care and compared the responses of nursing home medical directors with nonmedical directors. They found that medical directors and nonmedical directors had similar preferences for resources used and information needs, with preference for online resources, pocket guides, a handbook, consulting pharmacists, and facility in-services being the most commonly preferred sources of new information. Medical directors were significantly more aware of the FDA warning on antipsychotic use in dementia and treated more nursing home patients. No differences were observed between groups related to confidence in and use of nondrug strategies instead of antipsychotics to manage behavioral symptoms of dementia.
AHRQ-funded; HS019355.
Citation: Carnahan RM, Daly JM, Minion S .
A needs assessment of family physicians to inform development of educational resources on antipsychotic use in dementia.
J Prim Care Community Health 2019 Jan-Dec;10:2150132719840113. doi: 10.1177/2150132719840113..
Keywords: Education: Continuing Medical Education, Medication, Dementia, Neurological Disorders, Elderly, Evidence-Based Practice, Guidelines, Long-Term Care
Shaker M, Kanaoka T, Feenan L
An economic evaluation of immediate vs non-immediate activation of emergency medical services after epinephrine use for peanut-induced anaphylaxis.
Layperson food allergy management plans commonly stipulate that if epinephrine is used to immediately call 911 and seek care in the nearest medical facility for observation. The purpose of this study was to evaluate the cost-effectiveness of this strategy, vs a watchful waiting approach before activating emergency medical services (EMS).
AHRQ-funded; HS024599.
Citation: Shaker M, Kanaoka T, Feenan L .
An economic evaluation of immediate vs non-immediate activation of emergency medical services after epinephrine use for peanut-induced anaphylaxis.
Ann Allergy Asthma Immunol 2019 Jan;122(1):79-85. doi: 10.1016/j.anai.2018.06.035..
Keywords: Emergency Department, Healthcare Costs
Murray SG, Avati A, Schmajuk G
Automated and flexible identification of complex disease: building a model for systemic lupus erythematosus using noisy labeling.
The authors adapted methods that allow for automated ‘noisy labeling’ of positive and negative controls to create a "silver standard" for machine learning to automate identification of systemic lupus erythematosus (SLE). Their final model outperformed all existing algorithms for SLE. They demonstrated how the probabilistic outputs of their model can be adapted to various clinical needs. Deploying a similar methodology to other complex diseases has the potential to dramatically simplify the landscape of population identification in the electronic health record.
AHRQ-funded; HS024412.
Citation: Murray SG, Avati A, Schmajuk G .
Automated and flexible identification of complex disease: building a model for systemic lupus erythematosus using noisy labeling.
J Am Med Inform Assoc 2019 Jan;26(1):61-65. doi: 10.1093/jamia/ocy154..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT)
Symer MM, Abelson JS, Yeo L
Barriers to regionalized surgical care: public perspective survey and geospatial analysis.
A cross-sectional telephone survey was performed as part of the Cornell National Social Survey. Participants had an average age of 50 and were 48.9% female. Almost half were unwilling to travel 5 hours or more to get regionalized care. Participants who were aged 70 or more had a decreased willingness to travel a perceived 30 minutes or more to a center. The higher the income, the more willingness to travel increased distances. Major perceived barriers were transportation, life disruption, social support, income levels, poor health and remoteness.
AHRQ-funded; HS000066.
Citation: Symer MM, Abelson JS, Yeo L .
Barriers to regionalized surgical care: public perspective survey and geospatial analysis.
Ann Surg 2019 Jan;269(1):73-78. doi: 10.1097/sla.0000000000002556..
Keywords: Surgery, Access to Care, Healthcare Delivery
Holscher CM, Luo X, Massie AB
Better graft outcomes from offspring donor kidneys among living donor kidney transplant recipients in the United States.
This study used Scientific Registry of Transplant Recipients data 2001-2016 to evaluate death-censored graft failure (DCGF) and mortality for recipients of offspring versus nonoffspring living donor kidneys, using Cox regression models with interaction terms. The investigators found that kidneys from offspring donors provided lower graft failure and comparable mortality.
AHRQ-funded; HS024600.
Citation: Holscher CM, Luo X, Massie AB .
Better graft outcomes from offspring donor kidneys among living donor kidney transplant recipients in the United States.
Am J Transplant 2019 Jan;19(1):269-76. doi: 10.1111/ajt.15126..
Keywords: Transplantation, Surgery, Registries, Outcomes, Mortality, Adverse Events
Armstrong MJ, Alliance S, Corsentino P
Cause of death and end-of-life experiences in individuals with dementia with Lewy bodies.
Researchers investigate the natural history, cause of death, and end-of-life experiences of individuals diagnosed with dementia with Lewy bodies (DLB). In the 20-question survey, respondents indicated that physicians rarely discussed what to expect at the end of life and that the caregiver usually initiated such conversations. Failure to thrive was the most common cause of death, followed by pneumonia and swallowing difficulties, other medical conditions, and complications from falling. The researchers conclude that the study results highlight a critical need for better prognostic counseling and education for persons and families living with DLB, and they recommended further study.
AHRQ-funded; HS024159.
Citation: Armstrong MJ, Alliance S, Corsentino P .
Cause of death and end-of-life experiences in individuals with dementia with Lewy bodies.
J Am Geriatr Soc 2019 Jan;67(1):67-73. doi: 10.1111/jgs.15608..
Keywords: Dementia, Neurological Disorders, Patient Experience, Palliative Care, Mortality, Elderly
Cicero MX, Whitfill T, Walsh B
Correlation between paramedic disaster triage accuracy in screen-based simulations and immersive simulations.
This study examined the effectiveness of adding a screen-based simulation (SBS) to immersive simulation of a disaster for triage education of paramedics and emergency medical technicians (EMTs). A randomized controlled trial (RCT) was conducted with emergency medical personnel who had completed an immersive simulation of a school shooting, interacted with an SBS for 13 weeks, and completed the immersive simulation again. The participants were divided into groups: one who had gone through the Seconds to Survival (60S) disaster triage SBS and the other who had not. There was a significant increase in triage accuracy with immersive simulation, but SBS did not correlate with performance in the immersive simlation.
AHRQ-funded; HS022837.
Citation: Cicero MX, Whitfill T, Walsh B .
Correlation between paramedic disaster triage accuracy in screen-based simulations and immersive simulations.
Prehosp Emerg Care 2019 Jan-Feb;23(1):83-89. doi: 10.1080/10903127.2018.1475530..
Keywords: Emergency Preparedness, Emergency Medical Services (EMS), Simulation, Training, Education: Continuing Medical Education
Dykes PC, Bogaisky M, Carter EJ
Development and validation of a fall prevention knowledge test.
The authors developed and evaluated a fall prevention knowledge test (FPKT). The 11-item FPKT scale producing statistically significant differences confirmed validity. They recommended that a robust way to assess nurses' knowledge of fall prevention is needed to inform effective educational programs. They concluded that addressing gaps in validated FPKTs provides an opportunity to inform and evaluate effective fall prevention programs.
AHRQ-funded; HS025128; HS023535.
Citation: Dykes PC, Bogaisky M, Carter EJ .
Development and validation of a fall prevention knowledge test.
J Am Geriatr Soc 2019 Jan;67(1):133-38. doi: 10.1111/jgs.15563..
Keywords: Falls, Prevention, Provider: Nurse, Provider, Education: Continuing Medical Education
Fogler J, Kuhn J, Prock L
Diagnostic uncertainty in a complex young man: autism versus psychosis.
This paper provides a case study of boy, diagnosed with attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) who was born in Vietnam to a mother with mental illness.
AHRQ-funded; HS022242.
Citation: Fogler J, Kuhn J, Prock L .
Diagnostic uncertainty in a complex young man: autism versus psychosis.
J Dev Behav Pediatr 2019 Jan;40(1):72-74. doi: 10.1097/dbp.0000000000000635..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Autism, Behavioral Health, Case Study
McAlearney AS, Fareed N, Gaughan A
Empowering patients during hospitalization: perspectives on inpatient portal use.
This study looked at the effects of instituting an inpatient portal at hospitals and its impact on feelings of patient empowerment. Patients (n=120) who used an inpatient portal were interviewed at day 15 of hospitalization or 6 months after discharge. They also interviewed care team members (n=331) at 4 weeks, 6 months, and 1 year after implementation about their perspectives on patient use of the portal. Three features were most commonly used: 1) ordering meals, 2) looking up health information, and 3) viewing the care team. Most patients did not feel comfortable using the secure message feature. The inpatient portal promoted independence, reduced anxiety, informed families, and increased empowerment. The findings suggest that hospitals should encourage implementation of inpatient portals in their institution.
AHRQ-funded; HS024091; HS024767; HS024379.
Citation: McAlearney AS, Fareed N, Gaughan A .
Empowering patients during hospitalization: perspectives on inpatient portal use.
Appl Clin Inform 2019 Jan;10(1):103-12. doi: 10.1055/s-0039-1677722..
Keywords: Health Information Technology (HIT), Patient and Family Engagement, Hospitalization, Hospitals
Burgdorf J, Mulcahy J, Amjad H
Family caregiver factors associated with emergency department utilization among community-living older adults with disabilities.
This study examined characteristics of family caregivers of older community-living adults with disabilities that use emergency departments (EDs). They found in their sample of 2521 community-living older adults that have visited the ED one or more times within 12 months of their interview that the primary caregivers provided greater than 40 hours of care per week, helped with health care tasks, or experienced physical strain.
AHRQ-funded; HS000029.
Citation: Burgdorf J, Mulcahy J, Amjad H .
Family caregiver factors associated with emergency department utilization among community-living older adults with disabilities.
J Prim Care Community Health 2019 Jan-Dec;10:2150132719875636. doi: 10.1177/2150132719875636..
Keywords: Elderly, Emergency Department, Disabilities, Healthcare Utilization, Caregiving
Fiori K, Patel M, Sanderson D
From policy statement to practice: integrating social needs screening and referral assistance with community health workers in an urban academic health center.
The authors described their experience implementing a novel social needs screening program at an academic pediatric clinic. They found that, on average, 76% of providers had their patients screened on more than half of eligible well-child visits. Their experience suggested that screening for social needs at well-child visits is feasible as part of routine primary care. They recommended that success would best be achieved by leveraging resources, obtaining provider buy-in, and defining program components to sustain activities.
AHRQ-funded; HS026396.
Citation: Fiori K, Patel M, Sanderson D .
From policy statement to practice: integrating social needs screening and referral assistance with community health workers in an urban academic health center.
J Prim Care Community Health 2019 Jan-Dec;10:2150132719899207. doi: 10.1177/2150132719899207..
Keywords: Children/Adolescents, Community-Based Practice, Healthcare Delivery, Implementation, Screening, Social Determinants of Health, Urban Health, Workflow, Primary Care
Weech-Maldonado R, Lord J, Pradhan R
High Medicaid nursing homes: organizational and market factors associated with financial performance.
The purpose of this study was to examine the organizational and market factors that may be associated with better financial performance among high Medicaid nursing homes. Data sources included Long-Term Care Focus (LTCFocus), Centers for Medicare and Medicaid Services' (CMS) Medicare Cost Reports, CMS Nursing Home Compare, and the Area Health Resource File (AHRF) for 2009-2015. Higher financial performing facilities were characterized as having nurse practitioners/physician assistants, more beds, higher occupancy rate, higher Medicare and Medicaid census, and being for-profit and located in less competitive markets.
AHRQ-funded; HS023345; HS013852.
Citation: Weech-Maldonado R, Lord J, Pradhan R .
High Medicaid nursing homes: organizational and market factors associated with financial performance.
Inquiry 2019 Jan-Dec;56:46958018825061. doi: 10.1177/0046958018825061..
Keywords: Nursing Homes, Medicaid, Medicare
Saff RR, Li Y, Santhanakrishnan N
Identification of inpatient allergic drug reactions using ICD-9-CM codes.
The study of allergic drug reactions has been limited because of challenges in identifying and confirming cases. The objective of this study was to determine the utility of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for identifying inpatient allergic drug reactions and to compare findings with previous data in the emergency department.
AHRQ-funded; HS022728; HS025375.
Citation: Saff RR, Li Y, Santhanakrishnan N .
Identification of inpatient allergic drug reactions using ICD-9-CM codes.
J Allergy Clin Immunol Pract 2019 Jan;7(1):259-64.e1. doi: 10.1016/j.jaip.2018.07.022..
Keywords: Adverse Drug Events (ADE), Adverse Events, Medication: Safety, Medication, Diagnostic Safety and Quality, Patient Safety
Shah T, Patel-Teague S, Kroupa L
Impact of a national QI programme on reducing electronic health record notifications to clinicians.
In this study, the investigators evaluated the impact of a national, multicomponent, quality improvement (QI) programme designed to reduce low-value EHR notifications. The investigators found that, based on prior estimates on time to process notifications, this national QI programme potentially saved 1.5 hours per week per PCP to enable higher value work. The investigators also found that the number of daily notifications remained high, suggesting the need for additional multifaceted interventions and protected clinical time to help manage them.
AHRQ-funded; HS022087.
Citation: Shah T, Patel-Teague S, Kroupa L .
Impact of a national QI programme on reducing electronic health record notifications to clinicians.
BMJ Qual Saf 2019 Jan;28(1):10-14. doi: 10.1136/bmjqs-2017-007447..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Indicators (QIs), Quality Improvement, Quality of Care, Primary Care, Primary Care: Models of Care
Herrera CN, Brochier A, Pellicer M
Implementing social determinants of health screening at community health centers: clinician and staff perspectives.
Screening for social determinants of health (SDOH) during primary care office visits is recommended by pediatric and internal medicine professional guidelines. Less is known about how SDOH screening and service referral can be successfully integrated into clinical practice. SDOH screening and referral care models can help support the mission of community health centers by identifying unmet material needs. Additional support for SDOH models might include piloting the SDOH screening model workflow and formalizing the workflow before implementation, including the specific roles for clinicians, staff, and patient navigators.
AHRQ-funded; HS022242.
Citation: Herrera CN, Brochier A, Pellicer M .
Implementing social determinants of health screening at community health centers: clinician and staff perspectives.
J Prim Care Community Health 2019 Jan-Dec;10:2150132719887260. doi: 10.1177/2150132719887260..
Keywords: Social Determinants of Health, Screening, Community-Based Practice, Primary Care, Provider: Clinician, Provider
Deutsch GB, Deneve JL, Al-Kasspooles MF
Intellectual equipoise and challenges: accruing patients with advanced cancer to a trial randomizing to surgical or nonsurgical management (SWOG S1316).
Prospective, randomized trials are needed to determine optimal treatment approaches for palliative care problems such as malignant bowel obstruction (MBO). In this paper, the authors report their experience accruing randomized patients to the Prospective Comparative Effectiveness Trial for Malignant Bowel Obstruction (SWOG S1316) study, comparing surgical and nonsurgical management of MBO. Accrual is ongoing. Experience gained from the S1316 study can aid future palliative care trials. They note that it is possible to randomize patients to palliative studies by giving clinicians clear recommendations utilizing an algorithm of conversation, allotment of necessary time to discuss the trial, and encouragement to overcome internal bias.
AHRQ-funded; HS021491.
Citation: Deutsch GB, Deneve JL, Al-Kasspooles MF .
Intellectual equipoise and challenges: accruing patients with advanced cancer to a trial randomizing to surgical or nonsurgical management (SWOG S1316).
Am J Hosp Palliat Care 2020 Jan;37(1):12-18. doi: 10.1177/1049909119851471..
Keywords: Cancer, Surgery, Comparative Effectiveness, Palliative Care
Turan B, Crockett KB, Kempf MC
Internal working models of attachment relationships and hiv outcomes among women living with HIV.
Treatment adherence and viral suppression remain suboptimal in the United States. Attachment insecurity may be one understudied factor affecting adherence. In this study, the investigators examined cross-sectional associations of the 2 attachment-related insecurity dimensions with antiretroviral treatment (ART) adherence, HIV visit adherence, CD4 cell counts, and viral suppression. The authors suggest that interventions may need to focus on the vulnerable subpopulation with high attachment insecurity and incorporate existing strategies that address insecure attachment models.
AHRQ-funded; HS013852.
Citation: Turan B, Crockett KB, Kempf MC .
Internal working models of attachment relationships and hiv outcomes among women living with HIV.
J Acquir Immune Defic Syndr 2019 Jan;80(1):e1-e8. doi: 10.1097/qai.0000000000001872..
Keywords: Human Immunodeficiency Virus (HIV), Patient Adherence/Compliance, Women, Medication
Knox-Rice T, Xuan L, Wadsworth H
Knox-Rice T, Xuan L, Wadsworth H, Halm EA, Rhodes RL. Examining the association between healthcare utilization and clinical characteristics among cancer patients in a safety net health system.
The goal of this study was to examine the association between available patient and clinical characteristics and healthcare utilization in a cohort of breast, lung, and colorectal cancer patients within a safety-net hospital system. The investigators found that some patient and clinical characteristics associated with increased ER visits and hospitalizations in this cohort included race/ethnicity, palliative care referral, markers of advanced disease, and number opioids prescribed.
AHRQ-funded; R24 HS022418.
Citation: Knox-Rice T, Xuan L, Wadsworth H .
Knox-Rice T, Xuan L, Wadsworth H, Halm EA, Rhodes RL. Examining the association between healthcare utilization and clinical characteristics among cancer patients in a safety net health system.
J Palliat Med 2019 Jan;22(1):80-83. doi: 10.1089/jpm.2018.0202..
Keywords: Cancer, Healthcare Utilization, Palliative Care, Hospitals
Hornsby WE, Sareini MA, Golbus JR
Lower extremity function is independently associated with hospitalization burden in heart failure with preserved ejection fraction.
Frailty reflects decreased resilience to physiological stressors; its prevalence and prognosis are not fully defined in heart failure with preserved ejection fraction (HFpEF). Using the Short Physical Performance Battery, the results of this study showed that lower extremity function independently predicted hospitalization burden in outpatients with HFpEF. Recommendations include additional studies to explore shared mechanisms and treatment implications of frailty in HFpEF.
AHRQ-funded; HS024567.
Citation: Hornsby WE, Sareini MA, Golbus JR .
Lower extremity function is independently associated with hospitalization burden in heart failure with preserved ejection fraction.
J Card Fail 2019 Jan;25(1):2-9. doi: 10.1016/j.cardfail.2018.09.002..
Keywords: Cardiovascular Conditions, Elderly, Hospitalization
Singal AG, Tiro JA, Murphy CC
Mailed outreach invitations significantly improve HCC surveillance rates in patients with cirrhosis: a randomized clinical trial.
Mailed outreach invitations significantly improve HCC surveillance rates in patients with cirrhosis: a randomized clinical trial.
Hepatology 2019 Jan;69(1):121-30. doi: 10.1002/hep.30129.
In this study, the investigators compared the effectiveness of mailed outreach and patient navigation strategies to increase hepatocellular carcinoma (HCC) surveillance in a racially diverse cohort of patients with cirrhosis. They conducted a pragmatic randomized clinical trial comparing mailed outreach for screening ultrasound, mailed outreach plus patient navigation, or usual care with visit-based screening. The investigators concluded that mailed outreach invitations and navigation significantly increased HCC surveillance versus usual care in patients with cirrhosis.
Hepatology 2019 Jan;69(1):121-30. doi: 10.1002/hep.30129.
In this study, the investigators compared the effectiveness of mailed outreach and patient navigation strategies to increase hepatocellular carcinoma (HCC) surveillance in a racially diverse cohort of patients with cirrhosis. They conducted a pragmatic randomized clinical trial comparing mailed outreach for screening ultrasound, mailed outreach plus patient navigation, or usual care with visit-based screening. The investigators concluded that mailed outreach invitations and navigation significantly increased HCC surveillance versus usual care in patients with cirrhosis.
AHRQ-funded; HS022418.
Citation: Singal AG, Tiro JA, Murphy CC .
Mailed outreach invitations significantly improve HCC surveillance rates in patients with cirrhosis: a randomized clinical trial.
Hepatology 2019 Jan;69(1):121-30. doi: 10.1002/hep.30129..
Keywords: Cancer, Racial and Ethnic Minorities, Prevention, Comparative Effectiveness, Screening
Foglia EE, Ades A, Sawyer T
Neonatal intubation practice and outcomes: an international registry study.
Neonatal tracheal intubation is a critical but potentially dangerous procedure. In this study, the investigators sought to characterize intubation practice and outcomes in the NICU and delivery room (DR) settings and to identify potentially modifiable factors to improve neonatal intubation safety. They developed the National Emergency Airway Registry for Neonates and collected standardized data for patients, providers, practices, and outcomes of neonatal intubation. They suggest that their results will inform future interventional studies to improve neonatal intubation safety.
AHRQ-funded; HS024511.
Citation: Foglia EE, Ades A, Sawyer T .
Neonatal intubation practice and outcomes: an international registry study.
Pediatrics 2019 Jan;143(1). doi: 10.1542/peds.2018-0902..
Keywords: Emergency Department, Health Services Research (HSR), Intensive Care Unit (ICU), Newborns/Infants, Outcomes, Patient Safety, Registries
Weech-Maldonado R, Pradhan R, Dayama N
Nursing home quality and financial performance: is there a business case for quality?
This study examined the relationship between nursing home quality and financial performance. The study found that the operating margin was lower in nursing homes that: reported higher LPN hours per resident day and higher RN skill mix (structure); higher use of catheters, lower pressure ulcer prevention, and lower restorative ambulation (process); and more residents with contractures, pressure ulcers, hospitalizations and health deficiencies (outcomes). The results suggested that there was a business case for quality, whereas nursing homes that have better processes and outcomes of care perform better financially.
AHRQ-funded; HS023345; HS013852.
Citation: Weech-Maldonado R, Pradhan R, Dayama N .
Nursing home quality and financial performance: is there a business case for quality?
Inquiry 2019 Jan-Dec;56:46958018825191. doi: 10.1177/0046958018825191..
Keywords: Nursing Homes, Quality of Care, Healthcare Costs
Nijhawan AE, Higashi RT, Marks EG
Patient and provider perspectives on 30-day readmissions, preventability, and strategies for improving transitions of care for patients with HIV at a safety net hospital.
Researchers assessed perceived causes of 30-day hospital readmissions, factors associated with preventability, and strategies to reduce preventable readmissions and improve continuity of care for HIV-positive individuals. Using semi-structured interviews, they found that the 30-day metric should be adjusted for safety net institutions and patients with AIDS; that participants disagreed about preventability; and that various stakeholders proposed readmission reduction strategies that spanned the inpatient to outpatient care continuum. They then outlined multiple interventions which could substantially decrease hospital readmissions in this underserved population.
AHRQ-funded; HS022418.
Citation: Nijhawan AE, Higashi RT, Marks EG .
Patient and provider perspectives on 30-day readmissions, preventability, and strategies for improving transitions of care for patients with HIV at a safety net hospital.
J Int Assoc Provid AIDS Care 2019 Jan-Dec;18:2325958219827615. doi: 10.1177/2325958219827615..
Keywords: Human Immunodeficiency Virus (HIV), Transitions of Care, Hospital Readmissions, Hospitals
Olivieri-Mui B, McGuire J, Cahill S
People living with HIV in U.S. nursing homes in the fourth decade of the epidemic.
This study described the sociodemographic characteristics as well as the antiretroviral therapy treatment and physical and mental health among Medicare-eligible persons living with HIV (PLWH) in nursing homes (NHs). Of the newer admissions, results showed that they were older, had higher prevalence of viral hepatitis and anemia, but had less pneumonia and dementia. NH nurses can better anticipate health care needs of PLWH using these health profiles, understanding that there have been changes in the health of PLWH at admission over time.
AHRQ-funded; HS025662.
Citation: Olivieri-Mui B, McGuire J, Cahill S .
People living with HIV in U.S. nursing homes in the fourth decade of the epidemic.
J Assoc Nurses AIDS Care 2019 Jan-Feb;30(1):20-34. doi: 10.1097/jnc.0000000000000033..
Keywords: Human Immunodeficiency Virus (HIV), Nursing Homes, Long-Term Care, Elderly, Infectious Diseases, Medicare