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
6326 to 6350 of 12139 Research Studies DisplayedWhaley CM, Brown TT
Firm responses to targeted consumer incentives: evidence from reference pricing for surgical services.
This study examined how health care providers respond to a reference pricing insurance program that increases consumer cost sharing when they chose high-priced surgical providers. Geographic variation was used to estimate supply-side responses. Limited evidence of market segmentation and price reductions for providers with baseline prices above the reference price was found. However, 75% of the reduction in provider prices benefited a population that was not subject to the program.
AHRQ-funded; HS022098.
Citation: Whaley CM, Brown TT .
Firm responses to targeted consumer incentives: evidence from reference pricing for surgical services.
J Health Econ 2018 Sep;61:111-33. doi: 10.1016/j.jhealeco.2018.06.012..
Keywords: Health Insurance, Surgery, Payment, Healthcare Costs
Grundmeier RW, Xiao R, Ross RK
Grundmeier RW, Xiao R, Ross RK, Ramos MJ, Karavite DJ, Michel JJ, Gerber JS, et al. Identifying surgical site infections in electronic health data using predictive models,.
The objective of this study was to prospectively derive and validate a prediction rule for detecting cases warranting investigation for surgical site infections (SSI) after ambulatory surgery. The investigators concluded that electronic health record data can facilitate SSI surveillance with adequate sensitivity and positive predictive value.
AHRQ-funded; HS020921.
Citation: Grundmeier RW, Xiao R, Ross RK .
Grundmeier RW, Xiao R, Ross RK, Ramos MJ, Karavite DJ, Michel JJ, Gerber JS, et al. Identifying surgical site infections in electronic health data using predictive models,.
J Am Med Inform Assoc 2018 Sep;25(9):1160-66. doi: 10.1093/jamia/ocy075..
Keywords: Healthcare-Associated Infections (HAIs), Injuries and Wounds, Surgery, Electronic Health Records (EHRs), Health Information Technology (HIT), Risk, Patient Safety, Adverse Events, Ambulatory Care and Surgery
Vest JR, Simon K
Hospitals' adoption of intra-system information exchange is negatively associated with inter-system information exchange.
This study examined hospitals’ adoption of interoperability of health information technology (HIT). The relationship between hospitals’ intra- (within the same organization) and inter-system information exchange capabilities was explored using data from the 2010-2014 American Hospital Association’s Annual Health Information Technology Survey. As expected, there was more intra-system information exchange than inter-system but as time went on inter-system information exchange has increased. During the study period, hospitals were sharing 4.6 types of information by intra-system exchange, but only 2.7 types of information by inter-system exchange.
AHRQ-funded; HS024717.
Citation: Vest JR, Simon K .
Hospitals' adoption of intra-system information exchange is negatively associated with inter-system information exchange.
J Am Med Inform Assoc 2018 Sep;25(9):1189-96. doi: 10.1093/jamia/ocy058..
Keywords: Health Information Exchange (HIE), Health Systems, Health Information Technology (HIT), Hospitals
Bradley SM, Schweon SJ, Mody L
Identifying safe practices for use of the urinary leg bag drainage system in the postacute and long-term care setting: an integrative review.
In the postacute and long-term care setting, the practice of changing the indwelling urinary catheter large sterile drainage bag to a small-size leg drainage bag is intended to maintain a person's mobility, dignity, and comfort. There is scant evidence that assesses the impact of intermittent use of a leg bag on frequency of urinary tract infection since this breaks the closed urinary drainage system. The investigators identified the existence of low-level evidence that leg bags pose no evident, disproportionate risk of infection compared with maintaining a closed system.
AHRQ-funded; 290201000025I.
Citation: Bradley SM, Schweon SJ, Mody L .
Identifying safe practices for use of the urinary leg bag drainage system in the postacute and long-term care setting: an integrative review.
Am J Infect Control 2018 Sep;46(9):973-79. doi: 10.1016/j.ajic.2018.03.029..
Keywords: Care Management, Evidence-Based Practice, Healthcare-Associated Infections (HAIs), Long-Term Care, Patient Safety, Urinary Tract Infection (UTI)
Goto T, Shimada YJ, Faridi MK
Incidence of acute cardiovascular event after acute exacerbation of COPD.
There is a lack of comprehensive view of the association between acute exacerbation of COPD (AECOPD) and the risk of acute cardiovascular events. The purpose of this study was to determine the association of AECOPD with 30-day and 1-year incidences of acute cardiovascular event. The investigators concluded that AECOPD was associated with increased 30-day and 1-year incidences of acute cardiovascular event.
AHRQ-funded; HS023305.
Citation: Goto T, Shimada YJ, Faridi MK .
Incidence of acute cardiovascular event after acute exacerbation of COPD.
J Gen Intern Med 2018 Sep;33(9):1461-68. doi: 10.1007/s11606-018-4518-3.
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Keywords: Respiratory Conditions, Cardiovascular Conditions, Risk, Chronic Conditions, Heart Disease and Health, Outcomes
Gonzalez CM, Deno ML, Kintzer E
Patient perspectives on racial and ethnic implicit bias in clinical encounters: implications for curriculum development.
Patients describe feelings of bias and prejudice in clinical encounters; however, their perspectives on restoring the encounter, once bias is perceived, are not known. In order to inform the design of novel patient-centered curricular interventions, this study explored patients' perceptions of bias, and suggestions for restoring relationships if bias was perceived. The investigators concluded that participant lived experience and physician behaviors influence perceptions of bias, however clinical relationships can be restored following perceived bias.
AHRQ-funded; HS023199.
Citation: Gonzalez CM, Deno ML, Kintzer E .
Patient perspectives on racial and ethnic implicit bias in clinical encounters: implications for curriculum development.
Patient Educ Couns 2018 Sep;101(9):1669-75. doi: 10.1016/j.pec.2018.05.016..
Keywords: Racial and Ethnic Minorities, Disparities, Education: Patient and Caregiver, Patient Experience
Pelech D
Paying more for less? Insurer competition and health plan generosity in the Medicare Advantage program.
This paper explored the relationship between insurer competition and health plan benefit generosity by examining the impact of a regulatory change that caused the cancellation of 40% of the private plans in Medicare. The investigator found that insurers in markets affected by cancellation reduced the benefit generosity of the plans remaining in the market.
AHRQ-funded; HS023477; HS000055.
Citation: Pelech D .
Paying more for less? Insurer competition and health plan generosity in the Medicare Advantage program.
J Health Econ 2018 Sep;61:77-92. doi: 10.1016/j.jhealeco.2018.07.002..
Keywords: Healthcare Costs, Health Insurance, Medicare, Policy
Hartung DM, Hall J, Haverly SN
Pharmacists' role in opioid safety: a focus group investigation.
This qualitative study explores the pharmacist's role in promoting opioid safety from the perspective of pharmacists and patients. Using focus groups, results showed that pharmacists expressed discomfort filling potentially high-risk opioid prescriptions and noted barriers such as lack of clinical information and discomfort policing high-risk prescribing; and that patients were concerned about pharmacists potentially overstepping their professional responsibilities by interfering with prescribers' clinical decisions.
AHRQ-funded; HS024227.
AHRQ-funded; HS024227.
AHRQ-funded; HS024227.
Citation: Hartung DM, Hall J, Haverly SN .
Pharmacists' role in opioid safety: a focus group investigation.
Pain Med 2018 Sep;19(9):1799-806. doi: 10.1093/pm/pnx139..
Keywords: Provider: Pharmacist, Opioids, Medication: Safety, Medication, Patient Safety
Carr BG, Kilaru AS, Karp DN
Quality through coopetition: an empiric approach to measure population outcomes for emergency care-sensitive conditions.
Researchers developed a novel approach for measuring regional outcomes for emergency care-sensitive conditions. They identified regional use patterns for emergency conditions requiring a community-wide system response. They concluded that this method of attribution allows regional performance to be benchmarked and could be used to develop population-based outcome measures after life-threatening illness and injury.
AHRQ-funded; HS023614.
Citation: Carr BG, Kilaru AS, Karp DN .
Quality through coopetition: an empiric approach to measure population outcomes for emergency care-sensitive conditions.
Ann Emerg Med 2018 Sep;72(3):237-45. doi: 10.1016/j.annemergmed.2018.03.004..
Keywords: Emergency Department, Outcomes, Quality of Care
Crossley JR, Tan TP, Smith KH
Review of clinical trial settings of drugs commonly used in primary care and approved between 2005 and 2012.
This study examined where clinical trial settings are conducted for drugs commonly used in primary care that were approved by the FDA between 2005 and 2012. The majority of clinical trials did not specify if the trials were conducted at a primary care facility or a specialist, however, of the principal investigators (PIs) the vast majority were specialty physicians. The authors believe that more adverse drug events would occur in clinical trials taking place at specialist offices due to more patients with comorbidities going there for treatment. An initiative called the FDA Drug Trials Snapshots was cited as a way to provide more demographic information of trial participants.
AHRQ-funded; HS022882.
Citation: Crossley JR, Tan TP, Smith KH .
Review of clinical trial settings of drugs commonly used in primary care and approved between 2005 and 2012.
J Gen Intern Med 2018 Sep;33(9):1431-32. doi: 10.1007/s11606-018-4486-7..
Keywords: Medication, Primary Care, Research Methodologies
Liu TL, Taylor YJ, Mahabaleshwarkar R
Shared decision making and time to exacerbation in children with asthma.
This study examined the use of shared decision making (SDM) to delay exacerbation in children with asthma. A prospective cohort of children at five primary care practices in Charlotte, North Carolina that serve vulnerable population was studied between 2011 and 2013. The cohort included 746 children, with 60.5% male and 54.2% African American with a mean age of 8.6 years. The final analysis included 100 matched pairs of children for use of SDM and normal care. There was a marginally significant difference in the time of exacerbation between the two groups.
AHRQ-funded; HS019946.
Citation: Liu TL, Taylor YJ, Mahabaleshwarkar R .
Shared decision making and time to exacerbation in children with asthma.
J Asthma 2018 Sep;55(9):949-55. doi: 10.1080/02770903.2017.1378357..
Keywords: Children/Adolescents, Decision Making, Asthma, Respiratory Conditions, Chronic Conditions, Primary Care
Davis CS, Green TC, Hernandez-Delgado H
Status of US state laws mandating timely reporting of nonfatal overdose.
Timely, actionable, nonfatal overdose data are urgently needed to improve public health response to the overdose crisis. The purpose of this paper was to provide background and catalyze discussion regarding this important issue. The authors briefly report the results of a systematic analysis of state laws mandating reporting of nonfatal overdose, and provide suggestions for improving the collection and use of nonfatal overdose data to improve the public health response to this ongoing epidemic.
AHRQ-funded; HS024021.
Citation: Davis CS, Green TC, Hernandez-Delgado H .
Status of US state laws mandating timely reporting of nonfatal overdose.
Am J Public Health 2018 Sep;108(9):1159-61. doi: 10.2105/ajph.2018.304589..
Keywords: Adverse Drug Events (ADE), Adverse Events, Medication, Opioids, Policy, Public Health, Substance Abuse
Meyers S, Claire Simon K, Bergman-Bock S
Structured clinical documentation to improve quality and support practice-based research in headache.
The authors developed a proprietary toolkit to aid clinicians when creating clinical documentation in electronic medical records (EMRs). This toolkit will help clinicians provide discrete data and not unstructured free text which many clinicians enter into the EMR. The toolkit collects hundreds of fields of data and interprets score tests for a number of difference assessment tools for anxiety disorder, depression, migraine disability, and insomnia. The toolkit was used at 4346 initial patient visits as of April 1, 2018. The toolkit is being shared with other clinics as part of the Neurology Practice-Based Research Network.
AHRQ-funded; HS024057.
Citation: Meyers S, Claire Simon K, Bergman-Bock S .
Structured clinical documentation to improve quality and support practice-based research in headache.
Headache 2018 Sep;58(8):1211-18. doi: 10.1111/head.13348..
Keywords: Quality Improvement, Quality of Life, Tools & Toolkits, Neurological Disorders, Electronic Health Records (EHRs), Health Information Technology (HIT), Practice-Based Research Network (PBRN)
Slight SP, Seger DL, Franz C
The national cost of adverse drug events resulting from inappropriate medication-related alert overrides in the United States.
Investigators worked to determine the national cost of adverse drug events (ADEs) in the United States in 2014. They used three different regression models. They used a random sample of 40,990 adult inpatients at the Brigham and Women’s Hospital in Boston with over 1.6 million medication orders. They extrapolated the medication orders using 2014 National Inpatient Sample (NIS) data. They estimated that out of 78.8 million total medication alerts, 5.5 million medication alerts would have been inappropriately overridden resulting in 196,660 ADEs. They estimated it would have cost between $871 million and $1.8 billion for treating these preventable ADEs in the United States.
AHRQ-funded; HS021094.
Citation: Slight SP, Seger DL, Franz C .
The national cost of adverse drug events resulting from inappropriate medication-related alert overrides in the United States.
J Am Med Inform Assoc 2018 Sep;25(9):1183-88. doi: 10.1093/jamia/ocy066..
Keywords: Healthcare Cost and Utilization Project (HCUP), Adverse Drug Events (ADE), Adverse Events, Clinical Decision Support (CDS), Health Information Technology (HIT), Healthcare Costs, Medical Errors, Medication
Skinner D, Franz B, Howard J
The politics of primary care expansion: lessons from cancer survivorship and substance abuse.
The purpose of this study was to understand the perspectives of primary care innovators treating patient populations not traditionally considered to be within the purview of primary care. The authors indicated that their study findings suggested that the politics surrounding entrenched professional identities contributed to barriers faced by conference participants in their efforts to provide innovative care for these nontraditional populations. Specifically, obstacles surfaced in relation to sharing patients across disciplinary boundaries, which resulted in issues of possessiveness, a questioning of provider qualifications, and a lack of interprofessional trust.
AHRQ-funded; HS021287.
Citation: Skinner D, Franz B, Howard J .
The politics of primary care expansion: lessons from cancer survivorship and substance abuse.
J Healthc Manag 2018 Sep-Oct;63(5):323-36. doi: 10.1097/jhm-d-16-00030..
Keywords: Primary Care, Primary Care: Models of Care, Patient-Centered Healthcare, Cancer, Substance Abuse, Policy, Healthcare Delivery, Organizational Change, Quality of Care
Johnson AM, Spaete JP, Jowell PS
Top ten tips palliative care clinicians should know about interventional symptom management options when caring for patients with gastrointestinal malignancies.
In this article, the researchers brought together a team of interventional gastroenterologists and palliative care experts to collate practical pearls for the types of endoscopic interventions used for symptom management in patients with GI malignancies.
AHRQ-funded; HS023681.
Citation: Johnson AM, Spaete JP, Jowell PS .
Top ten tips palliative care clinicians should know about interventional symptom management options when caring for patients with gastrointestinal malignancies.
J Palliat Med 2018 Sep;21(9):1339-43. doi: 10.1089/jpm.2018.0251..
Keywords: Palliative Care, Education: Continuing Medical Education, Cancer
Nease DE, Campbell-Scherer D
2018 PBRN Conference highlights: addressing health disparities in PBRN research.
This paper describes the highlights from the 2018 North American Primary Care Research Group (NAPCRG) Practice-Based Research Network (PBRN) Conference which focused on health disparities in practice based research.
AHRQ-funded; HS024893.
Citation: Nease DE, Campbell-Scherer D .
2018 PBRN Conference highlights: addressing health disparities in PBRN research.
Ann Fam Med 2018 Sep;16(5):470-71. doi: 10.1370/afm.2305..
Keywords: Disparities, Practice-Based Research Network (PBRN), Primary Care
Morgan JR, Barlam TF, Drainoni ML
A qualitative study of the real-world experiences of infectious diseases fellows regarding antibiotic stewardship.
A qualitative study was performed to explore infectious disease (ID) fellows' experiences and perspectives regarding their antibiotic stewardship training and their role as future antibiotic stewards. The investigators concluded that ID fellowship training was not successfully conveying the public health importance of antibiotic stewardship or the role of ID physicians as leaders of antibiotic stewardship programs. They noted that fellows were more focused on concrete tasks related to stewardship.
AHRQ-funded; HS022242.
Citation: Morgan JR, Barlam TF, Drainoni ML .
A qualitative study of the real-world experiences of infectious diseases fellows regarding antibiotic stewardship.
Open Forum Infect Dis 2018 Sep;5(9):ofy102. doi: 10.1093/ofid/ofy102..
Keywords: Antibiotics, Antimicrobial Stewardship, Education: Continuing Medical Education, Infectious Diseases
Naylor MD, Hirschman KB, Toles MP
Adaptations of the evidence-based Transitional Care Model in the U.S.
The goal of this study was to describe and classify common local adaptations of the evidence-based intervention Transitional Care Model (TCM); this model is comprised of 10 components that have been proven in multiple clinical trials to improve care and outcomes for chronically ill older adults who are transitioning home from hospitals. 582 U.S.-based transitional care clinicians in health systems and community-based organizations were asked to complete a survey, then researchers interviewed a subset of survey respondents regarding implementation of TCM in their distinct organizations. The results suggest hypotheses that can be used to guide rigorous examination of the association between adaptations of TCM components and desired outcomes, and reinforce a need for investment in adaptation science.
AHRQ-funded; HS022406.
Citation: Naylor MD, Hirschman KB, Toles MP .
Adaptations of the evidence-based Transitional Care Model in the U.S.
Soc Sci Med 2018 Sep;213:28-36. doi: 10.1016/j.socscimed.2018.07.023..
Keywords: Elderly, Chronic Conditions, Evidence-Based Practice, Transitions of Care
Durkin MJ, Keller M, Butler AM
An assessment of inappropriate antibiotic use and guideline adherence for uncomplicated urinary tract infections.
In 2011, The Infectious Diseases Society of America released a clinical practice guideline (CPG) that recommended short-course antibiotic therapy and avoidance of fluoroquinolones for uncomplicated urinary tract infections (UTIs). This study assessed whether the CPG had an impact on national antibiotic prescribing practices. The study found that CPG was not associated with a clinically meaningful change in national antibiotic prescribing practices for UTIs.
AHRQ-funded; HS019455.
Citation: Durkin MJ, Keller M, Butler AM .
An assessment of inappropriate antibiotic use and guideline adherence for uncomplicated urinary tract infections.
Open Forum Infect Dis 2018 Sep;5(9):ofy198. doi: 10.1093/ofid/ofy198..
Keywords: Antibiotics, Decision Making, Guidelines, Practice Patterns, Urinary Tract Infection (UTI)
Hudson JL, Moriya AS
AHRQ Author: Hudson JL, Moriya AS
Association between marketplace policy and public coverage among Medicaid or Children's Health Insurance Program-eligible children and parents.
This paper examines the association between marketplace policy and public coverage among Medicaid or Children’s Health Insurance Program (CHIP)-eligible children and parents. The study’s results suggest that streamlining Medicaid/CHIP enrollment may have played a substantial role in increased take-up of public coverage.
AHRQ-authored.
Citation: Hudson JL, Moriya AS .
Association between marketplace policy and public coverage among Medicaid or Children's Health Insurance Program-eligible children and parents.
JAMA Pediatr 2018 Sep;172(9):881-82. doi: 10.1001/jamapediatrics.2018.1497..
Keywords: Children's Health Insurance Program (CHIP), Health Insurance, Medicaid, Policy
Hirayama A, Goto T, Faridi MK
Association of obstructive sleep apnoea with acute severity of chronic obstructive pulmonary disease exacerbation: a population-based study.
This retrospective cohort study investigated the association of coexistent obstructive sleep apnoea with acute severity markers (i.e. invasive positive pressure ventilation use and hospital length of stay) among adults hospitalised for acute exacerbation of chronic obstructive pulmonary disease.
AHRQ-funded; HS023305.
Citation: Hirayama A, Goto T, Faridi MK .
Association of obstructive sleep apnoea with acute severity of chronic obstructive pulmonary disease exacerbation: a population-based study.
Intern Med J 2018 Sep;48(9):1150-53. doi: 10.1111/imj.14016..
Keywords: Respiratory Conditions, Hospitalization, Sleep Problems, Chronic Conditions
Badawy SM, Thompson AA, Liem RI
Beliefs about hydroxyurea in youth with sickle cell disease.
The objectives of this study were to assess beliefs about hydroxyurea using the Beliefs about Medicines Questionnaire (BMQ), and to examine the relationship of patients' beliefs to their hydroxyurea adherence and health-related quality of life (HRQOL). The investigators found that beliefs about hydroxyurea correlated with HRQOL scores and adherence levels. The authors suggest that addressing patients' concerns about hydroxyurea and medications overall as well as routine assessment of adherence and beliefs could help to overcome adherence barriers.
AHRQ-funded; HS023011.
Citation: Badawy SM, Thompson AA, Liem RI .
Beliefs about hydroxyurea in youth with sickle cell disease.
Hematol Oncol Stem Cell Ther 2018 Sep;11(3):142-48. doi: 10.1016/j.hemonc.2018.01.001..
Keywords: Children/Adolescents, Medication, Patient Adherence/Compliance, Quality of Life, Sickle Cell Disease
Kline CE, Burke LE, Sereika SM
Bidirectional relationships between weight change and sleep apnea in a behavioral weight loss intervention.
This study examined the relationship between weight change and obstructive sleep apnea (OSA) in the context of behavioral weight loss intervention. A total of 114 adults who were overweight or obese participated in a 12-month behavioral weight loss intervention program from April 2012 to February 2015. Over half (58%) had OSA at the baseline. Those with OSA were found to lose less weight and were less adherent to daily calorie and activity goals. The results suggest that OSA screening should be used before attempting weight loss and also may indicate additional behavioral counseling.
AHRQ-funded; HS022989.
Citation: Kline CE, Burke LE, Sereika SM .
Bidirectional relationships between weight change and sleep apnea in a behavioral weight loss intervention.
Mayo Clin Proc 2018 Sep;93(9):1290-98. doi: 10.1016/j.mayocp.2018.04.026..
Keywords: Sleep Problems, Obesity: Weight Management, Obesity, Lifestyle Changes, Respiratory Conditions
Bindman AB, Cox DF
AHRQ Author: Bindman AB
Changes in health care costs and mortality associated with transitional care management services after a discharge among Medicare beneficiaries.
Medicare adopted transitional care management (TCM) payment codes in 2013 to encourage clinicians to furnish TCM services after beneficiaries were discharged to the community from medical facilities. The purpose of this study was to investigate whether the receipt of TCM services was associated with the subsequent health care costs and mortality of the beneficiaries in the month after the service was provided. The study concluded that despite the apparent benefits of TCM services for Medicare beneficiaries, the use of this service remains low.
AHRQ-authored.
Citation: Bindman AB, Cox DF .
Changes in health care costs and mortality associated with transitional care management services after a discharge among Medicare beneficiaries.
JAMA Intern Med 2018 Sep;178(9):1165-71. doi: 10.1001/jamainternmed.2018.2572..
Keywords: Healthcare Costs, Hospital Discharge, Medicare, Mortality, Transitions of Care