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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
76 to 100 of 12392 Research Studies DisplayedBybee SG, Sharareh N, Guo JW
A secondary data analysis of technology access as a determinant of health and impediment in social needs screening and referral processes.
A study of social needs screening and referral interventions in an emergency department setting found that of 453 patients with unmet social needs requesting assistance, only 21% were successfully connected with community service specialists. Contact preferences varied among patients, with the majority preferring telephone outreach. However, preferences differed based on age, specific needs, outreach success, and changes in emergency department utilization. This suggests that traditional communication methods may not be effective for reaching the most vulnerable patients who experience unstable access to phones or the internet. Further research is needed to determine whether communication preferences can serve as an indicator of unmet needs and to adapt social needs interventions for better accessibility among these high-risk populations.
AHRQ-funded; HS026505.
Citation: Bybee SG, Sharareh N, Guo JW .
A secondary data analysis of technology access as a determinant of health and impediment in social needs screening and referral processes.
AJPM Focus 2024 Apr; 3(2):100189. doi: 10.1016/j.focus.2024.100189..
Keywords: Health Information Technology (HIT), Social Determinants of Health
Shapiro DJ, Hall M, Ramgopal S
Acute care utilization for ambulatory care-sensitive conditions among publicly insured children.
Researchers sought to describe patterns of utilization for ambulatory care-sensitive conditions (ACSCs) according to the initial site of care and to determine characteristics associated with seeking initial care in an acute care setting rather than in an office. They performed a retrospective analysis of pediatric encounters for ACSCs using data from the IBM Watson MarketScan Medicaid database. Results indicated that acute care settings are initial sites of care for more than one in four encounters for ACSCs among publicly insured children. The researchers concluded that expanding access to primary care on weekends may shift care for ACSCs to the medical home.
AHRQ-funded; HS000063.
Citation: Shapiro DJ, Hall M, Ramgopal S .
Acute care utilization for ambulatory care-sensitive conditions among publicly insured children.
Acad Emerg Med 2024 Apr; 31(4):343-53. doi: 10.1111/acem.14867..
Keywords: Children/Adolescents, Healthcare Utilization, Hospitalization, Medicaid, Ambulatory Care and Surgery
Tai-Seale M, Baxter SL, Vaida F
AI-generated draft replies integrated into health records and physicians' electronic communication.
The objective of this quality improvement (QI) study was to investigate association between generative artificial intelligence (GenAI) drafted replies for patient messages and physician time spent on answering messages and length of replies. Primary care physicians in an academic health system were randomized to an immediate activation group and a delayed activation group. Results showed that GenAI-drafted replies were associated with significantly increased read time and reply length, no change in reply time, and some perceived benefits. Participants recognized GenAI's value and suggested areas for improvement. The authors noted that rigorous empirical tests were necessary to examine GenAI's performance and that future studies should examine patient experience and compare multiple GenAIs, including those with medical training.
AHRQ-funded; HS029770.
Citation: Tai-Seale M, Baxter SL, Vaida F .
AI-generated draft replies integrated into health records and physicians' electronic communication.
JAMA Netw Open 2024 Apr; 7(4):e246565. doi: 10.1001/jamanetworkopen.2024.6565..
Keywords: Health Information Technology (HIT), Communication, Electronic Health Records (EHRs)
Shaller D, Nembhard I, Matta S
Assessing an innovative method to promote learning from patient narratives: Findings from a field experiment in ambulatory care.
The purpose of this study was to evaluate whether an online interactive report developed to help interpretation of patients' narrative feedback results in change in ambulatory staff learning and behavior at the individual staff and practice level, and patient experience survey scores. The researchers studied 22 ambulatory practice sites in an academic medical center utilizing three primary data sources: 333 staff surveys; 20 in-depth interviews with practice leaders and staff; and 9551 modified CG-CAHPS patient experience surveys augmented by open-ended narrative elicitation questions. The study found that interviews reported that the interface helped narrative interpretation and use for improvement. Staff survey analyses reported improved learning from narratives at intervention sites and higher behavior change at staff and practice levels. Patient experience scores for interactions with office staff and wait time information increased significantly at intervention sites, compared to control sites.
AHRQ-funded; HS016978.
Citation: Shaller D, Nembhard I, Matta S .
Assessing an innovative method to promote learning from patient narratives: Findings from a field experiment in ambulatory care.
Health Serv Res 2024 Apr; 59(2):e14245. doi: 10.1111/1475-6773.14245..
Keywords: Ambulatory Care and Surgery, Patient Experience, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Quality Improvement, Quality of Care
Jain S, Rosenbaum PR, Reiter JG
Assessing the ambulatory surgery center volume-outcome association.
This study’s objective was to determine if low-volume ambulatory surgery centers (ASCs) have a higher rate of revisits after surgery, particularly among patients with multimorbidity. The authors created matched case-control study that used Medicare claims data and analyzed surgeries performed during 2018 and 2019 at ASCs. Commonly performed ambulatory surgeries were examined at 2328 ASCs and 4751 patients with a revisit (defined to be either 1 of 4735 revisits or 1 of 16 deaths without a revisit) within 7 days of surgery. These cases were each closely matched to 5 control patients without revisits (23,755 controls) from 2018 through 2019. Patients at a low-volume ASC had a higher odd of a 7-day revisit vs patients who had their surgery at a higher-volume ASC (odds ratio [OR], 1.21). The odds of revisit for patients with multimorbidity were higher at low-volume ASCs when compared with higher-volume ASCs (OR, 1.57). Among patients with multimorbidity in low-volume ASCs, for those who underwent orthopedic procedures, the odds of revisit were 84% higher (OR, 1.84) vs higher-volume centers, and for those who underwent general surgery or other procedures, the odds of revisit were 36% higher (OR, 1.36) vs a higher-volume center. Findings were not statistically significant for patients without multimorbidity.
AHRQ-funded; HS026116.
Citation: Jain S, Rosenbaum PR, Reiter JG .
Assessing the ambulatory surgery center volume-outcome association.
JAMA Surg 2024 Apr; 159(4):397-403. doi: 10.1001/jamasurg.2023.7161..
Keywords: Surgery, Ambulatory Care and Surgery, Outcomes
Westafer LM, Beck SA, Simon C
Barriers and facilitators to harm reduction for opioid use disorder: a qualitative study of people with lived experience.
The purpose of this study was to identify patient-focused barriers and facilitators to harm reduction strategies in the Emergency department (ED). The researchers conducted semi-structured interviews with a convenience sample of 25 people in Massachusetts diagnosed with an opioid use issue. The study observed themes including accessibility of harm reduction supplies, lack of self-care resulting from withdrawal and feelings of hopelessness, the influence of stigma on the potential for using harm reduction practices, habit and knowledge, and the need for user-centered harm reduction programs.
AHRQ-funded; HS025701.
Citation: Westafer LM, Beck SA, Simon C .
Barriers and facilitators to harm reduction for opioid use disorder: a qualitative study of people with lived experience.
Ann Emerg Med 2024 Apr; 83(4):340-50. doi: 10.1016/j.annemergmed.2023.11.020..
Keywords: Opioids, Substance Abuse, Behavioral Health
Kalwani NM, Osmanlliu E, Parameswaran V
Changes in telemedicine use and ambulatory visit volumes at a multispecialty cardiovascular center during the COVID-19 pandemic.
Researchers conducted a retrospective cohort study to examine trends in telemedicine use and visit volumes across cardiology subspecialties during the early months of the COVID-19 pandemic. Data from patients with ambulatory visits at a multispecialty cardiovascular center in Northern California were analyzed. Results showed that telemedicine visits increased dramatically during the COVID period; usage was above 75% of visits in all cardiology subspecialties in April 2020, stabilizing at rates ranging from over 95% (electrophysiology) to under 25% (heart transplant and vascular medicine). Visit volumes were below pre-COVID levels from March to May 2020, but exceeded pre-COVID levels after June 2020. The researchers concluded that telemedicine can be used to deliver a significant proportion of outpatient cardiovascular care and may increase access to care in cardiology clinics.
AHRQ-funded; HS026128.
Citation: Kalwani NM, Osmanlliu E, Parameswaran V .
Changes in telemedicine use and ambulatory visit volumes at a multispecialty cardiovascular center during the COVID-19 pandemic.
J Telemed Telecare 2024 Apr; 30(3):543-48. doi: 10.1177/1357633x211073428..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Cardiovascular Conditions, Ambulatory Care and Surgery
Arbaje AI, Hsu YJ, Zhou Z
Characterizing changes to older adults' care transition patterns from hospital to home care in the initial year of COVID-19.
A retrospective cohort study examining the impact of COVID-19 on home healthcare (HH) services for older adults in Baltimore and New York City found a 23% decline in HH admissions during the first year of the pandemic. Compared to the prior year, patients receiving HH services during the pandemic were more likely to be younger, have greater medical complexities, and be assessed as having higher rehospitalization risk. Despite this, 30-day rehospitalization rates were lower during the pandemic, particularly for COVID-positive patients. Notably, delays in initiating HH services after discharge were associated with reduced emergency department visits and rehospitalizations in New York City. These findings highlight the pandemic's impact on both the utilization and characteristics of patients receiving HH services, suggesting potential unmet needs among older adults. They emphasize the importance of understanding HH agency responsiveness during public health crises to ensure continued access to care for this vulnerable population.
AHRQ-funded; HS026599.
Citation: Arbaje AI, Hsu YJ, Zhou Z .
Characterizing changes to older adults' care transition patterns from hospital to home care in the initial year of COVID-19.
J Am Geriatr Soc 2024 Apr; 72(4):1079-87. doi: 10.1111/jgs.18839..
Keywords: Elderly, COVID-19, Transitions of Care, Home Healthcare
Young JC, Webster-Clark M, Shmuel S
Clarifying the causal contrast: an empirical example applying the prevalent new user study design.
Using MarketScan claims data, researchers examined the impact of adding "switchers" to incident new users on the estimated hazard ratio of hospitalized heart failure between patients initiating GLP-1 receptor agonists (GLP-1 RA) and sulfonylureas (SU). The results indicated that when analyses were conducted only among incident new users, GLP-1 RA had a protective effect; however, among switchers from SU to GLP-1 RA, effect estimates shifted substantially toward the null. The researchers concluded that combining patients with varying treatment histories can result in poor confounding control and camouflage important heterogeneity.
AHRQ-funded; HS000032.
Citation: Young JC, Webster-Clark M, Shmuel S .
Clarifying the causal contrast: an empirical example applying the prevalent new user study design.
Pharmacoepidemiol Drug Saf 2024 Apr; 33(4):e5790. doi: 10.1002/pds.5790..
Keywords: Diabetes, Heart Disease and Health, Medication, Cardiovascular Conditions
Smith B, Smith BP, Hollis RH
Development of a comprehensive survey to assess key socioecological determinants of health.
The purpose of this study was to develop and evaluate a comprehensive tool assessing socioecological determinants of health in patients requiring colorectal surgery. The study utilized a modified Delphi process to develop a comprehensive tool that included 31 socioecological determinants of health. Analysis indicated acceptability and feasibility were positive for all domains. Overall, 83% of participants confirmed that others would have no challenges completing the survey, 90.4% of respondents reported the survey was not burdensome, 97.6% of patients reported having enough time to complete the survey, and 80.9% agreed the survey was well integrated into their appointment.
AHRQ-funded; HS023009.
Citation: Smith B, Smith BP, Hollis RH .
Development of a comprehensive survey to assess key socioecological determinants of health.
Surgery 2024 Apr; 175(4):991-99. doi: 10.1016/j.surg.2023.11.011..
Keywords: Social Determinants of Health, Disparities, Surgery
Walker DM, Hefner JL, MacEwan SR
Differences by race in outcomes of an in-person training intervention on use of an inpatient portal: a secondary analysis of a randomized clinical trial.
The objective of this study was to compare differences in effectiveness of patient training and portal functionality interventions implemented to increase portal use among racial groups. This secondary analysis used data from a randomized clinical trial. Findings indicated that providing in-person training or robust portal functionality did not narrow the divide between Black participants and White participants with respect to portal use. The authors concluded that health systems may need to consider intentional interventions that address underlying issues which contribute to this inequity.
AHRQ-funded; HS024379; HS024091.
Citation: Walker DM, Hefner JL, MacEwan SR .
Differences by race in outcomes of an in-person training intervention on use of an inpatient portal: a secondary analysis of a randomized clinical trial.
JAMA Netw Open 2024 Apr; 7(4):e245091. doi: 10.1001/jamanetworkopen.2024.5091..
Keywords: Racial and Ethnic Minorities, Electronic Health Records (EHRs), Health Information Technology (HIT), Education: Patient and Caregiver
Devine JW, Tadrous M, Hernandez I
Effects of the valsartan recall on heart failure patients: a nationwide analysis.
This study’s objective was to determine if the 2018 generic valsartan recall created a higher likelihood of unfavorable outcomes to heart failure patients receiving valsartan at the recall date than patients using comparable antihypertensives. The authors conducted a cohort study of Optum's de-identified Clinformatics® Datamart (July 2017-January 2019). They compared heart failure patients with commercial or Medicare Advantage insurance who received valsartan to patients who received non-recalled angiotensin receptor blockers (ARBs) and angiotensin converting enzyme-inhibitors (ACE-Is) for 1 year prior and including the recall date. Outcomes examined included a composite for all-cause hospitalization, emergency department (ED), and urgent care (UC) use and a measure of cardiac events which included hospitalizations for acute myocardial infarction and hospitalizations/ED/UC visits for stroke/transient ischemic attack, heart failure or hypertension at 6-months post-recall. Of the 87,130 adherent patients, 15% were valsartan users and 85% were users of non-recalled ARBs/ACE-Is. Valsartan use was not associated with an increased risk of all-cause hospitalization/ED/UC use six-months post-recall (HR 1.00), compared with individuals taking non-recalled ARBs/ACE-Is. Similarly, cardiac events 6-months post-recall did not differ between individuals on valsartan and non-recalled ARBs/ACE-Is.
AHRQ-funded; HS027985.
Citation: Devine JW, Tadrous M, Hernandez I .
Effects of the valsartan recall on heart failure patients: a nationwide analysis.
Pharmacoepidemiol Drug Saf 2024 Apr; 33(4):e5777. doi: 10.1002/pds.5777..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Medication
Michelson KA, Rees CA, Florin TA
Emergency department volume and delayed diagnosis of serious pediatric conditions.
The objective of this retrospective cohort study was to evaluate the association between annual pediatric volume in emergency departments (EDs) with delayed diagnosis. Subjects were children under 18 treated at 954 EDs in eight states with a first-time diagnosis of any of 23 acute, serious conditions, identified using HCUP State ED and Inpatient databases. The findings indicated that EDs with fewer pediatric encounters had more possible delayed diagnoses across all 23 conditions; there were decreased rates of possible delayed diagnosis with increasing ED volume for 21 of 23 conditions. The authors concluded that tools to support timely diagnosis in low-volume EDs are needed.
AHRQ-funded; HS026503.
Citation: Michelson KA, Rees CA, Florin TA .
Emergency department volume and delayed diagnosis of serious pediatric conditions.
JAMA Pediatr 2024 Apr; 178(4):362-68. doi: 10.1001/jamapediatrics.2023.6672..
Keywords: Children/Adolescents, Emergency Department, Diagnostic Safety and Quality
Peebles PJ, Jensen EA, Herrick HM
Endotracheal tube size adjustments within seven days of neonatal intubation.
The purpose of this retrospective multicenter cohort study was to determine weight-based Neonatal endotracheal tube (ETT) sizes for infants undergoing tracheal intubation, and to compare these with recommendations from the Neonatal Resuscitation Program (NRP). The study found that of 7,293 intubations assessed, the initial ETT was downsized in 5.0% of encounters and upsized within 7 days in 1.5%. ETT downsizing was most common when NRP-recommended sizes were attempted in the following weight subgroups: 12.6% with a 3.0 mm and 17.1% with a 3.5 mm. Among infants in these 2 weight subgroups, choice of ETTs 0.5 mm smaller than NRP recommendations was independently related with lower odds of adverse outcomes when compared with NRP-recommended sizes. For infants weighing 1000 to 1199 g: any tracheal intubation related event, 20.8% with 2.5 mm versus 21.9% with 3.0 mm; severe oxygen desaturation, 35.2% with 2.5 mm vs 52.9% with 3.0 mm. Among infants weighing 2000 to 2199 g: severe oxygen desaturation, 41% with 3.0 mm versus 56% with 3.5mm.
AHRQ-funded; HS029029.
Citation: Peebles PJ, Jensen EA, Herrick HM .
Endotracheal tube size adjustments within seven days of neonatal intubation.
Pediatrics 2024 Apr; 153(4):e2023062925. doi: 10.1542/peds.2023-062925..
Keywords: Newborns/Infants, Critical Care
Armstrong-Hough M, Lin P, Venkatesh S
Ethnic disparities in deep sedation of patients with acute respiratory distress syndrome in the United States: secondary analysis of a multicenter randomized trial.
A recent study reveals that Hispanic patients with acute respiratory distress syndrome (ARDS) are five times more likely to be placed under deep sedation compared to non-Hispanic White patients. This disparity was observed across 48 U.S. hospitals participating in a clinical trial. The study also found that hospitals with at least one Hispanic ARDS patient tended to keep all their patients, regardless of ethnicity, in deep sedation for longer durations. These findings highlight a significant disparity in sedation practices and call for urgent investigation into the underlying causes and potential solutions to address this inequity in critical care.
AHRQ-funded; HS028038.
Citation: Armstrong-Hough M, Lin P, Venkatesh S .
Ethnic disparities in deep sedation of patients with acute respiratory distress syndrome in the United States: secondary analysis of a multicenter randomized trial.
Ann Am Thorac Soc 2024 Apr; 21(4):620-26. doi: 10.1513/AnnalsATS.202307-600OC..
Keywords: Disparities, Racial and Ethnic Minorities, Respiratory Conditions
Wilsterman EJ, Nellis ME, Panisello
Evaluating airway management in patients with trisomy 21 in the PICU and cardiac ICU: a retrospective cohort study.
This retrospective database study tested the hypothesis that in children with trisomy 21, tracheal intubation (TI) is associated with greater odds of adverse airway outcomes (AAOs), including TI-associated events, and peri-intubation hypoxemia. Data was taken from the National Emergency Airway Registry for Children (NEAR4KIDS). The participants were a cohort of children under 18 who underwent TI in the pediatric ICU or cardiac ICUs in a NEAR4KIDS center. The results suggested that, in spite of differences in airway risks and TI approaches, no association between the diagnosis of trisomy 21 and higher AAOs was identified.
AHRQ-funded; HS024511.
Citation: Wilsterman EJ, Nellis ME, Panisello .
Evaluating airway management in patients with trisomy 21 in the PICU and cardiac ICU: a retrospective cohort study.
Pediatr Crit Care Med 2024 Apr; 25(4):335-43. doi: 10.1097/pcc.0000000000003418..
Keywords: Critical Care, Intensive Care Unit (ICU), Children/Adolescents
Hechtman RK, Kipnis P, Cano J
Heterogeneity of benefit from earlier time-to-antibiotics for sepsis.
The objectives of this observational cohort study were to identify patient characteristics associated with greater benefit from shorter time-to-antibiotics. Subjects were patients hospitalized with community-onset sepsis and treated with antimicrobials within 12 hours. The findings indicated that metastatic cancer and shock were associated with the greatest benefit. The researchers concluded that shorter time-to-antibiotics for sepsis is particularly important among patients with these conditions.
AHRQ-funded; HS026725.
Citation: Hechtman RK, Kipnis P, Cano J .
Heterogeneity of benefit from earlier time-to-antibiotics for sepsis.
Am J Respir Crit Care Med 2024 Apr 1; 209(7):852-60. doi: 10.1164/rccm.202310-1800OC..
Keywords: Antibiotics, Sepsis, Medication
Antwi YA, Meille G, Moriya AS
AHRQ Author: Meille G, Moriya Asako S
Heterogeneous effects of the Affordable Care Act on emergency department visits and payer composition among older adults by race and ethnicity.
This AHRQ-authored paper’s goal was to estimate the impact of the Affordable Care Act (ACA) on emergency department (ED) visits and the composition of insurance coverage for White, Black, and Hispanic older adults. Their estimation strategy used changes in the discontinuity of health insurance coverage at age 65 and the variation in state decisions about Medicaid expansion under the ACA. They found that uninsured ED visits decreased for older adults in all three racial and ethnic groups in Medicaid expansion and non-expansion states. The magnitude of the decreases varied from four visits per 1,000 persons among White older adults in non-expansion states to 23 visits per 1,000 persons among Black and Hispanic older adults in expansion states. Insurance coverage gains came primarily from Medicaid in expansion states and private insurance in non-expansion states, regardless of race or ethnicity. They found suggestive evidence of increased ED visits for Black and Hispanic populations that had low insurance coverage rates before 2014.
AHRQ-authored.
Citation: Antwi YA, Meille G, Moriya AS .
Heterogeneous effects of the Affordable Care Act on emergency department visits and payer composition among older adults by race and ethnicity.
American Journal of Health Economics 2024 Spring; 10(2):272-99. doi: 10.1086/728787..
Keywords: Healthcare Cost and Utilization Project (HCUP), Elderly, Emergency Department, Policy, Racial and Ethnic Minorities, Healthcare Utilization
Bartsch SM, Weatherwax C, Wasserman MR
How the timing of annual COVID-19 vaccination of nursing home residents and staff affects its value.
An agent-based model simulating a typical nursing home (NH) was used to assess the impact of different annual COVID-19 vaccination schedules. The study found that late summer or early fall vaccination campaigns averted the most COVID-19 cases, providing significant cost savings to both healthcare systems and society. Notably, these findings held true across varying scenarios including different COVID-19 peak times, community transmission levels, and vaccine efficacy rates. While the ideal timing was not affected by most factors, faster waning vaccine efficacy did favor earlier vaccination. These results support aligning COVID-19 vaccination with seasonal influenza campaigns, typically starting in September or October, to effectively protect NH residents and staff against winter surges of SARS-CoV-2.
AHRQ-funded; HS028165.
Citation: Bartsch SM, Weatherwax C, Wasserman MR .
How the timing of annual COVID-19 vaccination of nursing home residents and staff affects its value.
J Am Med Dir Assoc 2024 Apr; 25(4):639-46.e5. doi: 10.1016/j.jamda.2024.02.005..
Keywords: COVID-19, Vaccination, Nursing Homes, Elderly
Ramadan OI, Rosenbaum PR, Reiter JG
Impact of hospital affiliation with a flagship hospital system on surgical outcomes.
The purpose of this study was to compare general surgery outcomes at flagship systems, flagship hospitals, and flagship hospital affiliates with matched controls. The researchers utilized Medicare claims data from 2018 and 2019 to match patients undergoing inpatient general surgery in flagship system hospitals to controls who underwent the same procedure at hospitals outside the system but within the same region. 32,228 closely matched pairs were formed across 35 regions. The study found that patients at flagship system hospitals had lower 30-day mortality than matched control patients, and patients at flagship hospitals had lower mortality than control patients. Patients at flagship hospital affiliates had similar mortality to matched controls, and flagship hospitals had lower mortality than affiliate hospitals.
AHRQ-funded; HS026116.
Citation: Ramadan OI, Rosenbaum PR, Reiter JG .
Impact of hospital affiliation with a flagship hospital system on surgical outcomes.
Ann Surg 2024 Apr; 279(4):631-39. doi: 10.1097/sla.0000000000006132..
Keywords: Hospitals, Surgery, Outcomes
Nguyen KH, Oronce CIA, Adia AC
Inability to access needed medical care among Asian American, Native Hawaiian, and Pacific Islander Medicaid enrollees.
Researchers examined self-reported inability to access needed medical care and patients’ reasons for not accessing medical care among adult Medicaid enrollees, disaggregated across Asian American, Native Hawaiian, and Pacific Islander ethnic groups. Their findings indicated that Chinese, Other Asian, Native Hawaiian enrollees were significantly less likely to report being unable to access needed medical care compared with non-Hispanic White enrollees. The most common reason given was that health plans would not approve, cover, or pay for care. The researchers concluded that different interventions specific to certain ethnic groups may be needed to mitigate inequities.
AHRQ-funded; HS022241.
Citation: Nguyen KH, Oronce CIA, Adia AC .
Inability to access needed medical care among Asian American, Native Hawaiian, and Pacific Islander Medicaid enrollees.
J Ambul Care Manage 2024 Apr-Jun; 47(2):96-103. doi: 10.1097/jac.0000000000000489..
Keywords: Access to Care, Racial and Ethnic Minorities, Medicaid
Adler JT, Kuk AE, Cron DC
Insurance transitions from employer-based insurance to Medicare and waitlisting for kidney transplantation: placing Marietta v. DaVita in context.
In a retrospective cohort study of incident dialysis patients aged 18-62 with employer-sponsored group health plans (EGHPs), researchers found that 36% switched to Medicare before the end of the 30-month coordination period. Patients residing in counties with higher social vulnerability and those with non-commercial dialysis modalities were more likely to switch early. Early switchers were less likely to be waitlisted for kidney transplantation, even after adjusting for various confounders. This association persisted even among patients who maintained their EGHP for at least one month after starting dialysis. These findings highlight the potential impact of recent legal changes allowing EGHPs to decrease dialysis reimbursements, which may increase early switching to Medicare and consequently affect transplant access.
AHRQ-funded; HS028476.
Citation: Adler JT, Kuk AE, Cron DC .
Insurance transitions from employer-based insurance to Medicare and waitlisting for kidney transplantation: placing Marietta v. DaVita in context.
J Am Soc Nephrol 2024 Apr; 35(4):495-98. doi: 10.1681/asn.0000000000000298..
Keywords: Transplantation, Kidney Disease and Health, Health Insurance, Access to Care, Medicare
Fowler ME, Murdaugh D, Harmon C
Longitudinal changes in patient-reported cognitive complaints among older adults with gastrointestinal malignancies - results from the Cancer and Aging Resilience Evaluation (CARE) Registry.
This longitudinal study evaluated early cognitive complaints (CC) in older adults and predictors among older adults with cancer. The authors examined early CC change on the PROMIS® Short Form4a Cognitive Function among adults ≥ 60 years with GI cancer enrolled in the Cancer and Aging Resilience Evaluation (CARE) undergoing geriatric assessment (GA) at baseline and one 3-6-month follow-up. They included 218 participants. The median follow-up time was 3.7 months, the mean age was 69.2 ± 7.1, and 57.3% were male. They most commonly had colorectal cancer (30.7%) with most stage at III/IV (73.7%). About half (51.8%) had stable cognition baseline to follow-up, 20.6% improved (≥ 5 increase), and 27.5% declined (≥ 5 decrease). Using follow-up t-score, there were no significant baseline predictors. The baseline t-score was the best-fitting predictor of follow-up t-score.
AHRQ-funded; HS013852.
Citation: Fowler ME, Murdaugh D, Harmon C .
Longitudinal changes in patient-reported cognitive complaints among older adults with gastrointestinal malignancies - results from the Cancer and Aging Resilience Evaluation (CARE) Registry.
J Cancer Surviv 2024 Apr; 18(2):521-30. doi: 10.1007/s11764-022-01254-4..
Keywords: Elderly, Cancer
O'Connor KE, Shanholtz CE, Espeleta HC
Mental health symptoms and engagement in a stepped-care mental health service among patients with a violent versus nonviolent injury.
This study examined differences in engagement between survivors of nonviolent versus violent injury in the Trauma Resilience and Recovery Program (TRRP), a technology-enhanced model designed to provide evidence-based mental health screening and treatment. Data was analyzed from adult patients enrolled in TRRP and admitted to a Level-I trauma service. Results showed that engagement in services at bedside was similar for survivors of violent and nonviolent traumatic injury; patients with a violent injury had higher levels of posttraumatic stress disorder and depressive symptoms 30 days after injury, but were less likely to engage in mental health screening. The authors concluded that patients with violent traumatic injury have higher levels of mental health needs but face greater barriers to accessing services. Effective strategies are needed to ensure continuity of care and access to mental health care.
AHRQ-funded; HS028006.
Citation: O'Connor KE, Shanholtz CE, Espeleta HC .
Mental health symptoms and engagement in a stepped-care mental health service among patients with a violent versus nonviolent injury.
J Trauma Acute Care Surg 2024 Apr; 96(4):650-57. doi: 10.1097/ta.0000000000004078..
Keywords: Behavioral Health, Patient and Family Engagement, Trauma
Howard RA, Thelen Ae, Chen X
Mortality and severe complications among newly graduated surgeons in the United States.
The objective of study was to evaluate severe complications and mortality over years of independent practice among general surgeons to discover if patient outcomes differed between early and later career surgeons. Medicare claims data was evaluated for 30-day outcomes for 26 operations. The results indicated that rates of mortality and severe complications were higher among newly graduated surgeons compared to later career surgeons.
AHRQ-funded; HS027653.
Citation: Howard RA, Thelen Ae, Chen X .
Mortality and severe complications among newly graduated surgeons in the United States.
Ann Surg 2024 Apr; 279(4):555-60. doi: 10.1097/sla.0000000000006128..
Keywords: Mortality, Provider: Physician, Surgery, Adverse Events