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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
801 to 825 of 12139 Research Studies DisplayedIngraham NE, Jones EK, King S
Re-aiming equity evaluation in clinical decision support: a scoping review of equity assessments in surgical decision support systems.
This scoping review explored surgical literature to determine frequency and rigor of clinical decision support (CDS) equity assessments and offer recommendations to improve CDS equity by appending existing frameworks. The authors performed a scoping review of PubMed and Google Scholar and identified 1,415 citations with 229 abstracts meeting criteria for review. A total of 84 papers underwent full review after 145 were excluded if they did not assess outcomes of an electronic CDS tool or have a surgical use case. Only 6% of surgical CDS systems reported equity analyses, suggesting that current methods for optimizing equity in surgical CDS are inadequate. The authors proposed revising the RE-AIM framework to include an Equity element (RE2-AIM) specifying that CDS foundational analyses and algorithms are performed or trained on balanced datasets with sociodemographic characteristics that accurately represent the CDS target population and are assessed by sensitivity analyses focused on vulnerable subpopulations.
AHRQ-funded; HS026379; HS024532.
Citation: Ingraham NE, Jones EK, King S .
Re-aiming equity evaluation in clinical decision support: a scoping review of equity assessments in surgical decision support systems.
Ann Surg 2023 Mar; 277(3):359-64. doi: 10.1097/sla.0000000000005661..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Disparities, Surgery
Tan MS, Heise CW, Gallo T
Relationship between a risk score for QT interval prolongation and mortality across rural and urban inpatient facilities.
The objectives of this retrospective observational study were to evaluate the relationship between a modified Tisdale QTc-risk score (QTc-RS), inpatient mortality, and length of stay in a broad inpatient population with an order for a medication with a known risk of torsades de pointes (TdP). Inpatient data from 28 healthcare facilities in the western US were used. The results indicated that there is a strong relationship between increased mortality as well as longer duration of hospitalization with an increasing QTc-RS.
AHRQ-funded; HS026662.
Citation: Tan MS, Heise CW, Gallo T .
Relationship between a risk score for QT interval prolongation and mortality across rural and urban inpatient facilities.
J Electrocardiol 2023 Mar;77:4-9. doi: 10.1016/j.jelectrocard.2022.11.008.
Keywords: Heart Disease and Health, Cardiovascular Conditions, Mortality, Rural Health, Urban Health, Risk
Liberman AL, Holl JL, Romo E
Risk assessment of the acute stroke diagnostic process using failure modes, effects, and criticality analysis.
The authors conducted a failure modes, effects, and criticality analysis (FMECA) of the emergency department (ED)-based acute stroke diagnostic process at three health systems in Chicago. The FMECA was designed to identify and rank order failures in the processes of care. The authors found that failure to use existing screening scales to identify patients with large-vessel occlusions early in the ED course ranked highest; other highly ranked failures were obtaining an accurate history of the index event, suspecting acute stroke in triage, and using established stroke screening tools at ED arrival to identify potential stroke patients. They concluded that these results highlight the crucial importance of the first steps in the diagnostic process.
AHRQ-funded; HS025359; HS027264.
Citation: Liberman AL, Holl JL, Romo E .
Risk assessment of the acute stroke diagnostic process using failure modes, effects, and criticality analysis.
Acad Emerg Med 2023 Mar; 30(3):187-95. doi: 10.1111/acem.14648..
Keywords: Stroke, Cardiovascular Conditions, Diagnostic Safety and Quality
Logan CD, Feinglass J, Halverson AL
Rural-urban disparities in receipt of surgery for potentially resectable non-small cell lung cancer.
This study examined the reasons there are lower rates of surgical treatment for potentially resectable non-small cell lung cancer (NSCLC) for patients living in rural areas than in urban areas. The National Cancer Database was used to identify patients with clinical stage I-IIIA NSCLC between 2004 and 2018. Reasons for nonreceipt of surgery was evaluated for rural and urban area patients. The study included 328,785 patients with NSCLC with 13% from rural areas. Overall, 62.4% of patients from urban areas and 58.8% of patients from rural areas underwent surgery. Patients from rural areas had increased odds of (1) being recommended primary nonsurgical management, (2) surgery being deemed contraindicated due to risk, (3) surgery being recommended but not performed, and (4) overall failure to receive surgery.
AHRQ-funded; HS026385.
Citation: Logan CD, Feinglass J, Halverson AL .
Rural-urban disparities in receipt of surgery for potentially resectable non-small cell lung cancer.
J Surg Res 2023 Mar;283:1053-63. doi: 10.1016/j.jss.2022.10.097.
Keywords: Cancer: Lung Cancer, Cancer, Disparities, Surgery, Rural Health, Access to Care
Kozhimannil KB, Lewis VA, Interrante JD
Screening for and experiences of intimate partner violence in the United States before, during, and after pregnancy, 2016-2019.
The objective of this study was to measure rates of intimate partner violence (IPV) screening during the perinatal period among people experiencing physical violence in the US. Data from the Pregnancy Risk Assessment Monitoring System was used to describe the incidence of physical IPV before or during pregnancy. The results indicated that nearly half of those reporting physical IPV were not screened before or after pregnancy. The authors concluded that public health efforts to improve maternal health must address universal screening for IPV as well as access to care.
AHRQ-funded; HS027640.
Citation: Kozhimannil KB, Lewis VA, Interrante JD .
Screening for and experiences of intimate partner violence in the United States before, during, and after pregnancy, 2016-2019.
Am J Public Health 2023 Mar; 113(3):297-305. doi: 10.2105/ajph.2022.307195..
Keywords: Screening, Domestic Violence, Pregnancy, Women, Maternal Care
Mills J, Harding MC
AHRQ Author: Mills J
Screening for obstructive sleep apnea in adults.
This Putting Prevention into Practice case study was created to increase understanding of the USPSTF final recommendation on screening for obstructive sleep apnea (OSA) in adults. A case study was presented using a 41-year-old man with a history of class 1 obesity but was otherwise feeling well. The patient has an uncle who was recently diagnosed with OSA, and the patient has some questions. Three multiple-choice questions are presented regarding USPSTF recommendations whether to screen for OSA for that patient.
AHRQ-authored.
Citation: Mills J, Harding MC .
Screening for obstructive sleep apnea in adults.
Am Fam Physician 2023 Mar;107(3):297-98.
Keywords: U.S. Preventive Services Task Force (USPSTF), Sleep Problems, Guidelines, Prevention, Evidence-Based Practice, Case Study
Gong F, Loeb S, Siu K
Sleep disturbances are underappreciated in prostate cancer survivorship.
Limited research exists on the prevalence of sleep issues in prostate cancer (PCa) survivors and the degree of urologist involvement in addressing sleep-related concerns. The researchers conducted a survey with PCa survivors (n = 167) and urologists (n = 145) to examine sleep problems and survivorship care practices. The study found a significant number of PCa survivors experienced sleep difficulties, with 50.9% reporting suboptimal sleep quality, 18.0% suffering from moderate/severe insomnia, and 36.5% at an elevated risk for sleep apnea. However, only a small number of urologists consistently screened for sleep disruptions, as advised in national cancer survivorship guidelines.
AHRQ-funded; HS026120
Citation: Gong F, Loeb S, Siu K .
Sleep disturbances are underappreciated in prostate cancer survivorship.
Prostate Cancer Prostatic Dis 2023 Mar;26(1):210-12. doi: 10.1038/s41391-022-00630-6.
Keywords: Cancer, Cancer: Prostate Cancer, Sleep Problems
Wu AJ, Du N, Chen TY
Sociodemographic differences of hospitalization and associations of resource utilization for failure to thrive.
The objective of this study was to examine sociodemographic differences between elective and nonelective admissions for failure to thrive. Researchers investigated associations between admission type and hospital resource utilization, including length of stay and feeding tube placement. The study included data on children less than 2 years old with failure to thrive in the Kids' Inpatient Database. The findings showed differences by race and ethnicity, income, and insurance type, among other factors. Nonelective admissions had higher proportions of infants who were Black, Hispanic, and of lower-income, and were associated with longer lengths of stay. The researchers concluded that future research is needed to elucidate drivers of these differences, particularly those related to racial and ethnic disparities and structural racism.
AHRQ-funded; HS000063.
Citation: Wu AJ, Du N, Chen TY .
Sociodemographic differences of hospitalization and associations of resource utilization for failure to thrive.
J Pediatr Gastroenterol Nutr 2023 Mar;76(3):385-89. doi: 10.1097/mpg.0000000000003694.
Keywords: Newborns/Infants, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Healthcare Utilization, Children/Adolescents, Racial and Ethnic Minorities, Low-Income
Cochran A, Rayo MF
Toward joint activity design: augmenting user-centered design with heuristics for supporting joint activity.
This paper discusses the development of a clinical decision support application for preventing hospital-acquired infection called GeoHAI, which has yielded positive results in early usability testing and is expected to test positively in supporting joint activity, which will be measured through the novel implementation of Joint Activity Monitoring. The design and implementation of this application will help to unify the work of Human-Centered Design and Cognitive Systems Engineering through demonstration of the possibilities and necessities. The authors are calling this unified process Joint Activity Design, which supports designing for machines to be good team players.
AHRQ-funded; HS027200.
Citation: Cochran A, Rayo MF .
Toward joint activity design: augmenting user-centered design with heuristics for supporting joint activity.
Proc Int Symp Hum Factors Ergon Healthc 2023 Mar; 12(1):19-23. doi: 10.1177/2327857923121006..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Orthopedics
Kempker JA, Stearns E, Peterson EN
U.S. adult critical care beds per capita: a 2021 county-level cross-sectional study.
This study used November 2021 hospital data from the Department of Health and Human Services' Protect Public Data Hub to describe the per capita distribution of staffed adult critical care beds across the US. There was a high percentage of hospitals reporting (98.6%). A total of 4,846 adult hospitals accounted for 79,876 adult critical care beds in the US and its’ territories. The authors crudely aggregated the data at the national-level to 0.31 adult critical care beds per 1,000 adults. The median crude per capita density of adult critical care beds per 1,000 adults across U.S. counties was 0.00 per 1,000 adults. Spatially smoothed county-level estimates were obtained using Empirical Bayes and Spatial Empirical Bayes approaches, resulting in an estimated 0.18 adult critical care beds per 1,000 adults. Counties in the upper quartile had higher average adult population counts (mean 159,000 vs 32,000 adults per county) compared to counties in the lower quartile of adult critical care bed density.
AHRQ-funded; HS025240.
Citation: Kempker JA, Stearns E, Peterson EN .
U.S. adult critical care beds per capita: a 2021 county-level cross-sectional study.
Crit Care Explor 2023 Mar;5(3):e0868. doi: 10.1097/cce.0000000000000868.
Keywords: Critical Care, Public Health
Salwei ME, Anders S, Slagle JM
Understanding patient and clinician reported nonroutine events in ambulatory surgery.
This prospective observational study’s objective was to understand the incidence and nature of patient- and clinician-reported nonroutine events (NREs) in ambulatory surgery. The authors interviewed patients about NREs that occurred during their perioperative care using a structured interview tool before discharge and in a 7-day follow-up call and concurrently interviewed the clinicians caring for these patients immediately postoperatively to collect NREs. The authors trained 2 clinicians and 2 patients to assess and code each reported NRE for type, theme, severity, and likelihood of reoccurrence (i.e., likelihood that the same event would occur for another patient). Out of 145 ambulatory surgery cases 101 (70%) contained at least one NRE. Overall, 214 NREs were reported, of those 88 were by patients and 126 by clinicians. Cases containing clinician-reported NREs were associated with increased patient body mass index and lower postcase patient ratings of being treated with respect. Cases containing patient-reported NREs were associated with longer case duration, higher postcase clinician frustration ratings, higher ratings of patient stress, and lower patient ratings of their quality of life, the quality of clinician teamwork, being treated with respect, and being listened to carefully. Trained patient raters evaluated NRE severity significantly higher than did clinician raters, while clinicians rated recurrence likelihood significantly higher than patients for both clinician and patient-reported NREs. Combining patient- and clinician-reported NREs seems to be a promising patient-centered method of identifying healthcare system deficiencies and opportunities for improvement.
AHRQ-funded; HS026395.
Citation: Salwei ME, Anders S, Slagle JM .
Understanding patient and clinician reported nonroutine events in ambulatory surgery.
J Patient Saf 2023 Mar 1; 19(2):e38-e45. doi: 10.1097/pts.0000000000001089..
Keywords: Ambulatory Care and Surgery, Quality of Life
Shear K, Rice H, Garabedian PM
Usability testing of an interoperable computerized clinical decision support tool for fall risk management in primary care.
The purpose of this study was to conduct usability testing of the ASPIRE fall risk management tool for use in divergent primary care clinics. Participants recruited from two sites with different electronic health records and clinical organizations used ASPIRE across two clinical scenarios; they rated ASPIRE usability as above average, based on usability benchmarks. Time spent on tasks decreased significantly between the first and second scenarios, indicating ease of learnability. The authors conclude that ASPIRE could be integrated into diverse organizations, since it allows a tailored implementation without the need to build a new system for each organization. ASPIRE is therefore well positioned to impact the challenge of falls at scale.
AHRQ-funded; HS027557.
Citation: Shear K, Rice H, Garabedian PM .
Usability testing of an interoperable computerized clinical decision support tool for fall risk management in primary care.
Appl Clin Inform 2023 Mar;14(2):212-26. doi: 10.1055/a-2006-4936.
Keywords: Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT), Falls, Primary Care, Risk, Prevention
Temkin-Greener H, Mao Y, Li Y
Using Medicare enrollment data to identify beneficiaries in assisted living.
The authors developed an approach for identifying Medicare beneficiaries residing in US assisted living (AL) communities in 2018. Data sources included a national directory of licensed ALs, a file of US addresses and their associated 9-digit ZIP codes (ZIP+4), the Medicare Enrollment Database (EDB), the Master Beneficiary Summary File (MBSF), and the Minimum Data Set (MDS). The cohorts of beneficiaries identified as AL residents exhibited good construct validity; AL residents also showed similar demographic characteristics to the 2018 sample from the National Survey of Long-Term Care Providers. The authors concluded that, as this residential setting continues to grow, future studies will need effective approaches such as their proposed methodology for identifying Medicare beneficiaries who reside in AL facilities in order to evaluate the quality of care they receive.
AHRQ-funded; HS026893.
Citation: Temkin-Greener H, Mao Y, Li Y .
Using Medicare enrollment data to identify beneficiaries in assisted living.
J Am Med Dir Assoc 2023 Mar;24(3):277-83. doi: 10.1016/j.jamda.2022.01.062.
Keywords: Medicare, Nursing Homes, Research Methodologies
Denstaedt SJ, Cano J, Wang XQ
Blood count derangements after sepsis and association with post-hospital outcomes.
Estimating long-term prognosis for sepsis survivors remains challenging. Prolonged inflammation following sepsis is linked to a higher likelihood of readmission and mortality. Complete blood count (CBC) parameters, as indicators of inflammation, might hold prognostic significance for sepsis survivors when measured at the time of hospital discharge. The purpose of this study was to assess the additional value of CBC parameters in predicting 90-day outcomes in sepsis survivors, beyond clinical features alone. Electronic health records were utilized to identify sepsis-related hospitalizations at US Veterans Affairs hospitals involving live discharge and relevant laboratory data (2013-2018). The researchers examined the relationship between eight CBC parameters and 90-day outcomes (mortality, readmission, cause-specific readmissions) using multivariable logistic regression models. The study found 155,988 eligible sepsis hospitalizations. Anemia and lymphopenia were the most prevalent blood count abnormalities at discharge. In multivariable models, all parameters correlated with the primary outcome of 90-day mortality or readmission and enhanced model discrimination beyond clinical features alone. Hemoglobin exhibited the highest prognostic distinction, with a 1.5-fold increase in the incidence of the primary outcome in the lowest quintile compared to the highest quintile Hemoglobin and neutrophil-lymphocyte ratio contributed the most added value in predicting the primary outcome and 90-day mortality independently. Absolute lymphocyte count offered minimal value in forecasting 90-day outcomes.
AHRQ-funded; HS026725
Citation: Denstaedt SJ, Cano J, Wang XQ .
Blood count derangements after sepsis and association with post-hospital outcomes.
Front Immunol 2023 Feb 28;14:1133351. doi: 10.3389/fimmu.2023.1133351.
Keywords: Sepsis, Outcomes
Michelson KA, Bachur RG, Dart AH
Identification of delayed diagnosis of paediatric appendicitis in administrative data: a multicentre retrospective validation study.
This study’s objective was to derive and validate a tool that retrospectively identifies delayed diagnosis of pediatric appendicitis in administrative data with high accuracy. A cross-sectional study of five pediatric emergency departments (EDs) was conducted using a cohort of 669 patients under 21 years old with possible delayed diagnosis of appendicitis, defined as two ED encounters within 7 days, the second with appendicitis. Delayed diagnosis occurred in 70.4% of patients. The tool had an area under the curve (AUC) of 0.892 in the derivation group and 0.859 in the validation group. The positive predictive value (PPV) for delay at a maximal accuracy threshold was 84.7% and identified 87.3% of delayed cases. The PPV at a stricter threshold was 94.9% and identified 46.8% of delayed cases.
AHRQ-funded; HS026503.
Citation: Michelson KA, Bachur RG, Dart AH .
Identification of delayed diagnosis of paediatric appendicitis in administrative data: a multicentre retrospective validation study.
BMJ Open 2023 Feb 28;13(2):e064852. doi: 10.1136/bmjopen-2022-064852.
Keywords: Children/Adolescents, Diagnostic Safety and Quality
Majumder MS, Cusick M, Rose S
Measuring concordance of data sources used for infectious disease research in the USA: a retrospective data analysis.
This study’s objective was to investigate the strengths and limitations of sources currently being used for infectious disease research. This retrospective data analysis used four different data sources to determine differences in the yearly number of national-level and state-level disease-specific case counts and disease clusters for three diseases (measles, mumps, and varicella) during a 5-year study period (2013-2017). The four sources used were Optum (health insurance billing claims data), HealthMap (online news surveillance data), Morbidity and Mortality Weekly Reports (official government reports) and National Notifiable Disease Surveillance System (government case surveillance data). The authors found that when compared with the other three sources of interest, Optum data showed substantially higher, implausible standardized case counts for all three diseases. All four sources identified variations in state-level reporting.
AHRQ-funded; HS026128.
Citation: Majumder MS, Cusick M, Rose S .
Measuring concordance of data sources used for infectious disease research in the USA: a retrospective data analysis.
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Keywords: Infectious Diseases, Research Methodologies
Shmuel S, Leonard CE, Bykov K
Breaking research silos and stimulating "innovation at the edges" in epidemiology.
The authors discuss the importance of promoting an exchange of ideas across seemingly disparate epidemiologic subdisciplines. This exchange could lead to opportunities to learn from and to merge knowledge across subdisciplines, as well as promote "innovation at the edges." The authors also outline specific steps to promote such innovation at the researcher, institution, and professional society level.
AHRQ-funded; HS027623.
Citation: Shmuel S, Leonard CE, Bykov K .
Breaking research silos and stimulating "innovation at the edges" in epidemiology.
Am J Epidemiol 2023 Feb 24;192(3):323-27. doi: 10.1093/aje/kwac192.
Keywords: Evidence-Based Practice, Research Methodologies, Medication
Miyashita M, Balogun OB, Olopade OI
The optimization of postoperative radiotherapy in de novo stage IV breast cancer: evidence from real-world data to personalize treatment decisions.
The purpose of this study was to investigate the survival benefit of radiotherapy in de novo stage IV breast cancer. Data were taken from the National Cancer DataBase on Stage IV breast cancer patients who received breast surgery and had survived 12 months after diagnosis. Radiotherapy was found to be associated with improved survival in patients with bone or lung metastasis but not patients with liver or brain metastasis. It was also associated with improved survival in patients with one or two metastatic sites but not three or more. Survival impact did not differ among subtypes. The authors concluded that these “real-world data” show that postoperative radiotherapy might improve overall survival for de novo Stage IV breast cancer with bone or lung metastasis, regardless of subtypes.
AHRQ-funded; HS025806.
Citation: Miyashita M, Balogun OB, Olopade OI .
The optimization of postoperative radiotherapy in de novo stage IV breast cancer: evidence from real-world data to personalize treatment decisions.
Sci Rep 2023 Feb 18; 13(1):2880. doi: 10.1038/s41598-023-29888-z..
Keywords: Cancer: Breast Cancer, Cancer, Evidence-Based Practice, Women
Schnall R, Sanabria G, Jia R, Sanabria G, Jia H
Efficacy of an mHealth self-management intervention for persons living with HIV: the WiseApp randomized clinical trial.
This study’s objective was to determine the efficacy of WiseApp, a user-centered design mHealth intervention to improve antiretroviral therapy (ART) adherence and viral suppression in persons living with HIV (PLWH). This randomized case-control trial had two study arms: a randomized controlled efficacy trial arm (n = 99) and an attention control intervention arm (n = 101) among PLWH living in New York City. The authors found a significant improvement in ART adherence in the intervention arm compared to the attention control arm from day 1 (69.7% vs 48.3%) to day 59 (51.2% vs 37.2%) of the study period. From day 60 to 120, the intervention had higher but not statistically significant adherence rates. Secondary analyses showed no difference in change from baseline to 3 or 6 months between the 2 study arms.
AHRQ-funded; HS025071.
Citation: Schnall R, Sanabria G, Jia R, Sanabria G, Jia H .
Efficacy of an mHealth self-management intervention for persons living with HIV: the WiseApp randomized clinical trial.
J Am Med Inform Assoc 2023 Feb 16; 30(3):418-26. doi: 10.1093/jamia/ocac233..
Keywords: Telehealth, Patient Self-Management, Human Immunodeficiency Virus (HIV), Chronic Conditions, Health Information Technology (HIT)
Gay HC, Yu J, Persell SD
Comparison of sodium-glucose cotransporter-2 inhibitor and glucagon-like peptide-1 receptor agonist prescribing in patients with diabetes mellitus with and without cardiovascular disease.
Researchers sought to describe trends in prescribing for sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP1-RAs) to reduce cardiovascular events and mortality in adult patients with type 2 diabetes mellitus (T2DM) in diverse care settings. Their focus was on outpatient clinics in a midwestern integrated health system and small- and medium-sized community-based primary care practices and health centers in three Midwestern states. Results showed that an increase in prescription rates was greater for SGLT2is than for GLP1-RAs in a large integrated medical center and community primary care practices; overall, prescription rates for eligible patients were low, and the researchers observed racial disparities.
AHRQ-funded; HS026385; HS023921.
Citation: Gay HC, Yu J, Persell SD .
Comparison of sodium-glucose cotransporter-2 inhibitor and glucagon-like peptide-1 receptor agonist prescribing in patients with diabetes mellitus with and without cardiovascular disease.
Am J Cardiol 2023 Feb 15; 189:121-30. doi: 10.1016/j.amjcard.2022.10.041..
Keywords: Diabetes, Cardiovascular Conditions, Chronic Conditions, Medication, Primary Care
Darling KE, Warnick J, Guthrie KM
Weight management engagement for teens from low-income backgrounds: qualitative perspectives from adolescents and caregivers.
Adolescents from low-income backgrounds are at a higher risk for obesity and obesity-related negative health outcomes. In addition, these adolescents have lower access to, and success in, weight management (WM) programs. The purpose of this qualitative study was to explore engagement in a hospital-based WM program from the adolescent and caregiver perspective at varying levels of program initiation and engagement. The researchers conducted qualitative interviews with 55 participants, including 29 adolescents and 26 caregivers. This included: a) those who were referred to WM treatment, but never initiated (non-initiators); b) those who dropped out from treatment; and c) those who that had continuous participation in treatment (engaged). The study found that participants across all groups reported that they did not have a complete understanding of the scope or goals of the WM program after initial referral. In addition, many participants identified misperceptions of the program (e.g., perceptions of a screening visit as compared to an intensive program). Both caregivers and adolescents identified caregivers as drivers of engagement, with adolescents often tentative about participation in the program. However, engaged adolescents found the program valuable and sought ongoing participation following caregiver initiation.
AHRQ-funded; HS02707.
Citation: Darling KE, Warnick J, Guthrie KM .
Weight management engagement for teens from low-income backgrounds: qualitative perspectives from adolescents and caregivers.
J Pediatr Psychol 2023 Feb 15; 48(7):593-601. doi: 10.1093/jpepsy/jsad008..
Keywords: Children/Adolescents, Obesity: Weight Management, Obesity, Low-Income, Patient and Family Engagement
Cook RR, Foot C, Arah OA
Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations.
The co-use of stimulants and opioids is increasing rapidly. Medications for opioid use disorder (MOUD) have demonstrated efficacy in randomized clinical trials (RCTs), but stimulant use may decrease the likelihood of initiating MOUD treatment. Moreover, trial participants may not represent "real-world" populations who would benefit from treatment. The study analyses included 673 clinical trial participants, 139 NSDUH respondents (weighted to represent 661,650 people), 71,751 TEDS treatment episodes, and 1,933 ROI participants. The study found that in RCTs, stimulant use reduced the likelihood of MOUD initiation by 32%. Stimulant use associations were slightly attenuated and non-significant among housed adults needing treatment and adults entering OUD treatment. The association was more pronounced, but still non-significant among rural people injecting drugs. Stimulant use had a larger negative impact on XR-NTX initiation compared to buprenorphine, especially in the rural population. The researchers concluded that stimulant use is a barrier to buprenorphine or XR-NTX initiation in clinical trials and real-world populations that would benefit from OUD treatment. Interventions to address stimulant use among patients with OUD are urgently needed, particularly among rural people injecting drugs, who already face limited access to MOUD.
AHRQ-funded; HS026370.
Citation: Cook RR, Foot C, Arah OA .
Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations.
Addict Sci Clin Pract 2023 Feb 14; 18(1):11. doi: 10.1186/s13722-023-00364-3..
Keywords: Substance Abuse, Behavioral Health, Opioids, Medication
Asher GN, Feltner C, Harrison WN
Serologic screening for genital herpes: updated evidence report and systematic review for the US Preventive Services Task Force.
Genital herpes, a viral sexually transmitted infection (STI) caused by herpes simplex virus (HSV) subtypes HSV-1 or HSV-2, is a prevalent STI in the US. Early identification of unrecognized HSV-2 infection could reduce transmission and morbidity. In 2016, the US Preventive Services Task Force (USPSTF) recommended against routine serologic screening for genital herpes in asymptomatic individuals. This updated evidence report aimed to identify studies published since the previous 2016 evidence review. A literature search was conducted from September 30, 2015, through January 16, 2022, with ongoing surveillance through July 22, 2022. The review identified no new eligible studies, leading to unchanged overall conclusions from the 2016 recommendation against screening. The prior recommendation was based on psychosocial harms from false-positive test results due to poor screening test accuracy and uncertain benefit of preventive viral medications for reducing viral shedding or improving health outcomes. The review focused on the general population of asymptomatic adolescents and adults and may not be applicable to populations at higher risk for infection, such as those with HIV or other immunosuppressive conditions.
AHRQ-funded; 75Q80120D00007.
Citation: Asher GN, Feltner C, Harrison WN .
Serologic screening for genital herpes: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2023 Feb 14; 329(6):510-12. doi: 10.1001/jama.2022.20356..
Keywords: U.S. Preventive Services Task Force (USPSTF), Sexual Health, Infectious Diseases, Screening, Guidelines, Evidence-Based Practice, Prevention
Hakimjavadi R, Karunananthan S, Alexander G
What is the level of information technology maturity in Ontario's long-term care homes? A cross-sectional survey study protocol.
As the number of Canadians aged 75 years and older is projected to double in the next two decades, long-term care (LTC) systems will face increasing pressure. Health information technology (IT) has demonstrated its ability to enhance the quality, safety, and efficiency of care across various clinical environments and could potentially improve LTC for residents. The purpose of this cross-sectional study will be to thoroughly assess the extent of health IT adoption in Ontario's LTC homes and establish a baseline comprehension for future planning. The researchers will utilize the LTC IT Maturity Instrument to evaluate IT capabilities, the extent of IT usage, and the degree of internal/external IT integration across the domains of resident care, clinical support, and administrative activities. All LTC homes in Ontario will be invited to participate.
AHRQ-funded; HS022497.
Citation: Hakimjavadi R, Karunananthan S, Alexander G .
What is the level of information technology maturity in Ontario's long-term care homes? A cross-sectional survey study protocol.
BMJ Open 2023 Feb 10; 13(2):e064745. doi: 10.1136/bmjopen-2022-064745..
Keywords: Health Information Technology (HIT), Long-Term Care, Nursing Homes
Chiotos K, Blumenthal J, Boguniewicz J
Antibiotic indications and appropriateness in the pediatric intensive care unit: a 10-center point prevalence study.
The purpose of this study was to describe indications and appropriateness of antibiotic orders in pediatric intensive care unit (PICU) patients. The study found that of 1462 patients admitted to participating PICUs, 58% had at least 1 antibiotic order, with 1277 antibiotic orders being reviewed. Common indications were empiric therapy for suspected bacterial infections without sepsis or septic shock, nonoperative prophylaxis, empiric therapy for sepsis or septic shock, community-acquired pneumonia, and post-operative prophylaxis. Appropriateness was evaluated for 985 orders for which an evidence-based heading for appropriateness could be created. Of these, 34% were categorized as inappropriate. Indications with the most orders classified as inappropriate were empiric therapy for suspected bacterial infection without sepsis or septic shock, sepsis or septic shock, CAP, ventilator-associated infections, and post-operative prophylaxis. The proportion of antibiotics classified as inappropriate differed across institutions.
AHRQ-funded; HS026393.
Citation: Chiotos K, Blumenthal J, Boguniewicz J .
Antibiotic indications and appropriateness in the pediatric intensive care unit: a 10-center point prevalence study.
Clin Infect Dis 2023 Feb 8; 76(3):e1021-e30. doi: 10.1093/cid/ciac698..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Antibiotics, Medication, Antimicrobial Stewardship, Sepsis