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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results126 to 150 of 11623 Research Studies Displayed
Meddings J, Gibbons JB, Reale BK
The impact of nurse practitioner care and accountable care organization assignment on skilled nursing services and hospital readmissions.
The purpose of this study was to determine the relationship between Accountable Care Organizations (ACO) designation and nurse practitioners (NP) care delivery during skilled nursing facilities (SNF) visits and the relationship between NP care delivery during SNF visits and unplanned hospital readmissions. The researchers obtained a sample of 527,329 fee-for-service Medicare beneficiaries with 1 or more SNF stays between 2012 and 2017 and then measured the association between patient ACO designation and evaluation and management care delivered by NPs in addition to the association between evaluation and management services delivered by NPs and hospital readmissions. The study found that ACO beneficiaries were 1.26% points more likely to receive 1 or more E&M services delivered by an NP during their SNF visits. ACO-designated beneficiaries receiving most of their E&M services from NPs during their SNF visits were at a lower risk of readmission than ACO-attributed beneficiaries receiving no NP E&M care.
Citation: Meddings J, Gibbons JB, Reale BK . The impact of nurse practitioner care and accountable care organization assignment on skilled nursing services and hospital readmissions. Med Care 2023 Jun; 61(6):341-48. doi: 10.1097/mlr.0000000000001826..
Keywords: Nursing, Provider: Nurse, Hospital Readmissions, Provider: Clinician
Suzuki H, Heintz BH, Livorsi DJ
Tracking antimicrobial stewardship activities beyond days of therapy (DOT): comparison of days of antibiotic spectrum coverage (DASC) and DOT at a single center.
Researchers evaluated the measurement performance by days of antibiotic spectrum coverage (DASC) versus days of therapy (DOT), the preferred metric for measuring inpatient antimicrobial consumption within the U.S. Their retrospective study analyzed inpatient antimicrobial use at the Iowa City Veterans’ Affairs Healthcare System acute-care hospital. Antimicrobial DOT did not decrease significantly during a period of robust stewardship activities, but a significant downward trend in the antimicrobial spectrum, as measured by DASC was detected. The researchers concluded that the DASC metric may help to monitor the effect of stewardship activities more broadly.
Citation: Suzuki H, Heintz BH, Livorsi DJ . Tracking antimicrobial stewardship activities beyond days of therapy (DOT): comparison of days of antibiotic spectrum coverage (DASC) and DOT at a single center. Infect Control Hosp Epidemiol 2023 Jun; 44(6):934-37. doi: 10.1017/ice.2022.312..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication
Kim KC, Khouja T, Burgette JM
Trends in dispensed prescriptions for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children by general dentists, 2012-2019.
This study examined trends in prescription fills for opioids, benzodiazepines, gabapentin, and stimulants to children <18 years from 2012 to 2019 in a national dataset comprising 92% of dispensed outpatient prescriptions by dentists. During this time, 3.8 million children filled prescriptions for high-alert drugs from general dentists. Opioids accounts for 69.4% of high-alert prescriptions, however from 2012 to 2019 fills for opioids, sedatives, benzodiazepines, and stimulants decreased by 65.2%, 43.4%, 43.6% and 89.3%, respectively. Gabapentin prescriptions increased by 8.1%. Older teenagers (15-17 years) received 42.5% of high-alert prescriptions. Low-income counties in Southern states were overrepresented among top-prescribing areas in 2019.
Citation: Kim KC, Khouja T, Burgette JM . Trends in dispensed prescriptions for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children by general dentists, 2012-2019. Pharmacoepidemiol Drug Saf 2023 Jun; 32(6):625-34. doi: 10.1002/pds.5589..
Keywords: Children/Adolescents, Dental and Oral Health, Opioids, Medication, Practice Patterns
McDaniel CE, Leyenaar JK, Bryan MA
Urban-rural disparities in interfacility transfers for children during COVID-19.
This study’s goal was to identify temporal trends and differences in urban and rural pediatric interfacility transfers (IFTs) before and during the COVID-19 pandemic. The authors conducted a cross-sectional analysis of IFT among children <18 years from January 2019 to June 2022 using the Pediatric Health Information System. They calculated observed-to-expected (O-E) ratios of pre-pandemic (March 2019-Feb 2020) transfers compared to pandemic year 1 (March 2020-Feb 2021) and year 2 (March 2021-February 2022) using Poisson modeling. The O-E ratio of IFT in year 1 for urban children was 14.0% and 14.8% for rural children compared to pre-pandemic. In year 2, transfers rebounded with IFTs for rural-residing children increasing more than urban-residing children (101.7%) compared to 90.7%. For mental-health indications in year 2, rural transfer ratios were higher than urban, 126% compared to 113.7%.
Citation: McDaniel CE, Leyenaar JK, Bryan MA . Urban-rural disparities in interfacility transfers for children during COVID-19. J Rural Health 2023 Jun; 39(3):611-16. doi: 10.1111/jrh.12746..
Keywords: COVID-19, Children/Adolescents, Disparities, Rural Health, Urban Health, Rural/Inner-City Residents
Huo T, Glueck DH, Shenkman EA
Stratified split sampling of electronic health records
Data extracted from electronic health records may require very different approaches for model building and analysis than data from clinical research. Because electronic health record data is designed for clinical use, researchers need to engage in the iterative process of defining and provide clear definitions of outcome and predictor variables and assessing associations. This process can increase Type I error rates and decrease the chance of replicability. Failure to consider subgroups may mask heterogeneous relationships between predictor and outcome by subgroups, thus decreasing the generalizability of the findings. To improve the likelihood of both replicability and generalizability, the researchers recommended utilizing a stratified split sample approach for studies using electronic health records. The researchers illustrate the approach through an electronic health record study of the relationships between socio-demographic factors and uptake of hepatic cancer screening, and potential heterogeneity of association in subgroups defined by gender, self-identified race and ethnicity, census-tract level poverty and insurance type.
Citation: Huo T, Glueck DH, Shenkman EA . Stratified split sampling of electronic health records BMC Med Res Methodol 2023 May 25; 23(1):128. doi: 10.1186/s12874-023-01938-0..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Research Methodologies, Health Services Research (HSR)
May HP, Griffin JM, Herges JR
Comprehensive acute kidney injury survivor care: protocol for the Randomized Acute Kidney Injury in Care Transitions Pilot trial.
The researchers developed the multidisciplinary acute kidney injury (AKI) in Care Transitions (ACT) program, which incorporates post-AKI care in patients' primary care clinic. The purpose of this pilot trial, which received funding from the Agency for Health Care Research and Quality on April 21, 2021, and was approved by the Institutional Review Board on December 14, 2021, is to test the feasibility and acceptability of the ACT program and related study protocol, including recruitment and retention, procedures, and outcome measures. The study will include individuals who have stage 3 AKI during hospitalization, do not need dialysis upon discharge, have a local primary care provider, and are discharged to their home. Recipients of any transplant within 100 days of enrollment are excluded. As of March 14, 2023, seventeen participants each have been enrolled in the intervention and usual care groups. Patients who provide consent are randomized to receive the ACT program intervention or usual care. The ACT program includes predischarge kidney health education and coordinated postdischarge laboratory monitoring and follow-up with a primary care provider and pharmacist within 14 days. The usual care group receives no study-related intervention. This study includes qualitative interviews and surveys with patients and staff and will explore the feasibility of the ACT program. Notes of clinical encounters will be reviewed for dialogue and care plans related to kidney health. Quantitative measures of the feasibility and acceptability of ACT will be summarized via descriptive analyses.
Citation: May HP, Griffin JM, Herges JR . Comprehensive acute kidney injury survivor care: protocol for the Randomized Acute Kidney Injury in Care Transitions Pilot trial. JMIR Res Protoc 2023 May 22; 12:e48109. doi: 10.2196/48109..
Keywords: Kidney Disease and Health, Transitions of Care
Short VL, Abatemarco DJ, Sood E
The Child Healthcare at MATER Pediatric Study (CHAMPS): a 2-arm cluster randomized control trial of group well child care for mothers in treatment for opioid use disorder and their children.
Group-based well child care is a shared medical appointment where families join as a group to receive pediatric primary care. Prior research indicates that this method of receiving care increases patient-reported satisfaction and adherence to recommended care. There is little evidence supporting the use of group well child care for mothers with opioid use disorder. The purpose of the Child Healthcare at MATER Pediatric Study (CHAMPS) is to assess a group model of well child care for mothers with opioid use disorder and their children to determine if a group well child care offered on-site at an opioid treatment program for pregnant and parenting women is beneficial over individual well child care. A total of 108 mother-child dyads will be enrolled into the study. In the intervention branch, group well child care will be provided on-site at a maternal substance use disorder treatment program. Mother-child dyads in the control branch will receive individual well child care from one nearby pediatric primary care clinic. Dyads in both study branches will be followed for 18 months, and their resulting data will be compared. Primary outcomes will include well child care quality and utilization, child health knowledge, and parenting quality.
Citation: Short VL, Abatemarco DJ, Sood E . The Child Healthcare at MATER Pediatric Study (CHAMPS): a 2-arm cluster randomized control trial of group well child care for mothers in treatment for opioid use disorder and their children. Trials 2023 May 17; 24(1):333. doi: 10.1186/s13063-023-07357-2..
Keywords: Children/Adolescents, Opioids, Substance Abuse, Behavioral Health
Smith SN, Lanham M, Seagull FJ
Implementing pharmacist-prescriber collaboration to improve evidence-based anticoagulant use: a randomized trial.
This article described a study designed to improve existing alert systems for direct oral anticoagulant medications (DOAC) by testing novel alerts that encourage collaboration between prescribers and expert pharmacists working in anticoagulation clinics. Its goals were to determine the effect of notifications targeting existing inappropriate DOAC prescriptions, to examine the effect of alerts on newly prescribed inappropriate DOACs, and to examine changes in the magnitude of effects over time for both the new and existing prescription alerts. Prescribing healthcare providers would be randomized to different types of electronic health record medication alerts when a patient has an unsafe anticoagulant prescription; the authors identified which alerts are most effective at encouraging evidence-based prescribing.
Citation: Smith SN, Lanham M, Seagull FJ . Implementing pharmacist-prescriber collaboration to improve evidence-based anticoagulant use: a randomized trial. Implement Sci 2023 May 15; 18(1):16. doi: 10.1186/s13012-023-01273-4..
Keywords: Provider: Pharmacist, Blood Thinners, Medication, Evidence-Based Practice
Piniella NR, Fuller TE, Smith L
Early expected discharge date accuracy during hospitalization: a multivariable analysis.
The purpose of this study was to assess the level at which accurate estimation of an expected discharge date (EDD) early during hospitalization impacts clinical operations and discharge planning. The researchers conducted a retrospective study of patients discharged from six general medicine units at an academic medical center in Boston, MA from January 2017 to June 2018. All EDD entries and patient, encounter, unit, and provider data were extracted from the electronic health record (EHR), and public weather data. The study found that of 3917 eligible hospitalizations 22.7% had at least one accurate early EDD entry. Clinician-entered EDD, admit day and discharge day during the work week, and teaching clinical units were the factors significantly positively associated with an accurate early EDD. An Elixhauser Comorbidity Index of 11 or more and length of stay of two or more days were the factors significantly negatively associated with an accurate early EDD. The researchers concluded that EDDs entered within the first 24 hours of admission were frequently inaccurate. Few of the factors associated with accurate early EDD entries would be useful for prospective prediction.
Citation: Piniella NR, Fuller TE, Smith L . Early expected discharge date accuracy during hospitalization: a multivariable analysis. J Med Syst 2023 May 12; 47(1):63. doi: 10.1007/s10916-023-01952-1..
Keywords: Hospital Discharge, Hospitalization
Enzinger AC, Ghosh K, Keating NL
Racial and ethnic disparities in opioid access and urine drug screening among older patients with poor-prognosis cancer near the end of life.
This research characterized racial and ethnic disparities and trends in opioid access and urine drug screening (UDS) among older patients dying of cancer, and to explore potential mechanisms. Among 18,549 non-Hispanic White (White), Black, and Hispanic Medicare decedents older than 65 years with poor-prognosis cancers, the authors examined 2007-2019 trends in opioid prescription fills and potency (morphine milligram equivalents [MMEs] per day [MMEDs]) near the end of life (EOL), defined as 30 days before death or hospice enrollment. They found that between 2007 and 2019, White, Black, and Hispanic decedents experienced steady declines in EOL opioid access and rapid expansion of UDS. Compared with White patients, Black and Hispanic patients were less likely to receive any opioid (Black, -4.3 percentage points; Hispanic, -3.6 percentage points) and long-acting opioids (Black, -3.1 percentage points; Hispanic, -2.2 percentage points). They also received lower daily doses (Black, -10.5 MMED; Hispanic, -9.1 MMED) and lower total doses (Black, -210 MMEs; Hispanic, -179 MMEs). Black patients were also more likely to undergo UDS (0.5 percentage points).
Citation: Enzinger AC, Ghosh K, Keating NL . Racial and ethnic disparities in opioid access and urine drug screening among older patients with poor-prognosis cancer near the end of life. J Clin Oncol 2023 May 10; 41(14):2511-22. doi: 10.1200/jco.22.01413..
Keywords: Elderly, Opioids, Medication, Cancer, Racial and Ethnic Minorities, Disparities, Access to Care
Ye S, Li D, Yu T
The impact of surgical volume on hospital ranking using the standardized infection ratio.
Researchers investigated the effect of surgical volume on the accuracy of identifying poorly performing hospitals. Their research was based on the standardized infection ratio, and they applied their proposed method to data from HCA Healthcare from 2014-2016 on surgical site infections in colon surgery patients. They concluded that minimum surgical volumes and predicted events criteria are required to make hospital evaluation reliable, and that these criteria may vary by overall prevalence and between-hospital variability.
Citation: Ye S, Li D, Yu T . The impact of surgical volume on hospital ranking using the standardized infection ratio. Sci Rep 2023 May 10; 13(1):7624. doi: 10.1038/s41598-023-33937-y..
Keywords: Hospitals, Surgery, Healthcare-Associated Infections (HAIs), Provider Performance, Quality of Care
Watterson TL, Chui MA
Subjective perceptions of occupational fatigue in community pharmacists.
The objective of this study was to describe subjective perceptions of occupational fatigue in community pharmacists. Wisconsin pharmacists who were eligible to participate completed a demographic questionnaire, a Pharmacist Fatigue Instrument, and semi-structured interview. Interview results were separated into overarching themes that included mental fatigue, physical fatigue, active fatigue, and passive fatigue. The researchers concluded that interventions aimed at improving occupational fatigue in community pharmacies should consider key themes of fatigue that pharmacists experience.
Citation: Watterson TL, Chui MA . Subjective perceptions of occupational fatigue in community pharmacists. Pharmacy 2023 May 9; 11(3):84. doi: 10.3390/pharmacy11030084..
Keywords: Provider: Pharmacist, Burnout
Lindner SR, Balasubramanian B, Marino M
Estimating the cardiovascular disease risk reduction of a quality improvement initiative in primary care: findings from EvidenceNOW.
The purpose of this study was to estimate decreases in 10-year atherosclerotic cardiovascular disease (ASCVD) risk associated with EvidenceNOW, an initiative spanning multiple states that sought to improve cardiovascular preventive care by providing supportive interventions such as practice facilitation to address the “ABCS”: (A)spirin for high-risk patients, (B)lood pressure control for hypertensive people, (C)holesterol management, and (S)moking screening and cessation counseling. The researchers conducted an analytic modeling study that combined 1) data from 1,278 EvidenceNOW practices collected from 2015 to 2017; (2) patient-level information of 1,295 individuals who participated in the 2015 to 2016 National Health and Nutrition Examination Survey; and (3) 10-year ASCVD risk prediction equations. The study found the average 10-year ASCVD risk of these patients before intervention was 10.11%. Improvements in ABCS due to EvidenceNOW reduced their 10-year ASCVD risk to 10.03% which would prevent 3,169 ASCVD events over 10 years and $150 million in 90-day direct medical costs.
Citation: Lindner SR, Balasubramanian B, Marino M . Estimating the cardiovascular disease risk reduction of a quality improvement initiative in primary care: findings from EvidenceNOW. J Am Board Fam Med 2023 May 8; 36(3):462-76. doi: 10.3122/jabfm.2022.220331R1..
Keywords: Cardiovascular Conditions, Primary Care, Evidence-Based Practice, Patient-Centered Outcomes Research, Quality Improvement, Quality of Care, Blood Pressure
Laytner L, Chen P, Nash S
Perspectives on non-prescription antibiotic use among Hispanic patients in the Houston Metroplex.
This study examined non-prescription use of antibiotics among Hispanic adults in the Houston area. The study included Hispanic primary care clinic patients with different types of health insurance coverage in the Houston metroplex who endorsed non-prescription use in a previous survey. Semistructured interviews were conducted in English or Spanish with 35 participants primarily female (68.6%) and aged 27 to 66. Participants reported obtaining antibiotics through under-the-counter US markets, trusted persons, and purchased without a prescription abroad. Factors contributing to non-prescription use included beliefs that the doctor visit was unnecessary, limited access to healthcare, and communication difficulties. However, participants expressed confidence in medical recommendations from pharmacists and trusted community members.
Citation: Laytner L, Chen P, Nash S . Perspectives on non-prescription antibiotic use among Hispanic patients in the Houston Metroplex. J Am Board Fam Med 2023 May 8; 36(3):390-404. doi: 10.3122/jabfm.2022.220416R1..
Keywords: Racial and Ethnic Minorities, Antibiotics, Medication, Antimicrobial Stewardship
Kannan S, Song Z
Changes in out-of-pocket costs for US hospital admissions between December and January every year.
Out-of-pocket costs for ICU care may be large at the beginning of the year due to high insurance deductibles that reset every year for US patients, and the expensive nature of ICU care. The purpose of this cross-sectional study was to explore cost-sharing changes from December to January for ICU admissions and non -ICU admissions among adults with employer-sponsored insurance. Among aggregate ICU hospitalizations, total cost-sharing averaged $1079 in December and $1871 in January, a 73.4% increase. Among non-ICU hospitalizations, total cost-sharing averaged $1043 in December and $1683 in January, a 61.3% increase. These increases and differences between ICU and non-ICU hospitalizations were greater among patients with high deductible health plans (HDHPs). For patients with HDHPs requiring an ICU stay, cost-sharing averaged $3093 per hospitalization in January vs $1301 in December.
Citation: Kannan S, Song Z . Changes in out-of-pocket costs for US hospital admissions between December and January every year. JAMA Health Forum 2023 May 5; 4(5):e230784. doi: 10.1001/jamahealthforum.2023.0784..
Keywords: Healthcare Costs, Hospitals, Hospitalization, Intensive Care Unit (ICU)
Kim B, Troxel WM, Dubowitz T
Neighborhood built environment and sleep health: a longitudinal study in low-income and predominantly African-American neighborhoods.
The purpose of this study was to explore the relationships between physical characteristics of neighborhoods and sleep health outcomes and evaluated the mediating role of physical activity in these relationships. The researchers conducted the longitudinal Pittsburgh Hill/Homewood Research on Eating, Shopping, and Health (PHRESH) Zzz Study in 2 low-income, primarily African-American neighborhoods in Pittsburgh, Pennsylvania (n = 1,051). The study included repeated measures of neighborhood characteristics and sleep health outcomes from 2013 to 2018, and systematic field observations captured built environment measures of walkability, urban design, and neighborhood disorder. Sleep health outcomes included insufficient sleep, sleep duration, wakefulness after sleep onset, and sleep efficiency. Urban design features were correlated with lower levels of wakefulness after sleep onset. Neighborhood disorder and crime rate were negatively related with sleep efficiency. Neighborhood walkability was not associated with sleep outcomes.
Citation: Kim B, Troxel WM, Dubowitz T . Neighborhood built environment and sleep health: a longitudinal study in low-income and predominantly African-American neighborhoods. Am J Epidemiol 2023 May 5; 192(5):736-47. doi: 10.1093/aje/kwad016..
Keywords: Sleep Problems, Racial and Ethnic Minorities, Low-Income
Sikora A, Rafiei A, Rad MG
Pharmacophenotype identification of intensive care unit medications using unsupervised cluster analysis of the icurx common data model.
The Common Data Model for Intensive Care Unit (ICU) Medications (CDM-ICURx) may provide the needed infrastructure to clinicians and researchers to support artificial intelligence analysis of medication-related outcomes and healthcare costs. The purpose of this study was to identify novel patterns of medication clusters (termed 'pharmacophenotypes') correlated with ICU adverse events (e.g., fluid overload) and patient-centered outcomes (e.g., mortality). The researchers conducted a retrospective, observational cohort study of 991 critically ill adults with a total of 30,550 medication orders. To identify pharmacophenotypes, unsupervised machine learning analysis with automated feature learning was performed on the medication administration records of each patient during the first 24 hours of their stay in the intensive care unit. Five unique patient clusters and six unique pharmacophenotypes were identified. For patient outcomes, compared to patients in Clusters 1 and 3, patients in Cluster 5 had a significantly shorter duration of mechanical ventilation and ICU length of stay; for medications, Cluster 5 had a higher distribution of Pharmacophenotype 1 and a smaller distribution of Pharmacophenotype 2, compared to Clusters 1 and 3. For outcomes, patients in Cluster 2 had the highest severity of illness and greatest medication regimen complexity, but they also had the lowest overall mortality; for medications, Cluster 2 also had a higher distribution of Pharmacophenotype 6.
Citation: Sikora A, Rafiei A, Rad MG . Pharmacophenotype identification of intensive care unit medications using unsupervised cluster analysis of the icurx common data model. Crit Care 2023 May 2; 27(1):167. doi: 10.1186/s13054-023-04437-2..
Keywords: Medication, Intensive Care Unit (ICU)
Meyerhoff J, Kruzan KP, Reddy M
Preparing a workforce of care coordinators to address patient mental health needs in the digital age: training and needs identification.
Previous research shows Care Coordinators (CCs) are frequently the primary point of contact for patients with medical health and mental health comorbidities in integrated healthcare settings, and they are less comfortable addressing mental health concerns than physical health concerns. The purpose of this study was to assess the effectiveness of training to support CCs' management of patient mental health needs prior to digital mental health intervention implementation. The researchers delivered a 1-hour training focused on the evaluation and management of depression and suicide-related thoughts and behaviors to CCs within a large healthcare system's Division of Ambulatory Care Coordination. Prior to and following the training CCs completed online surveys. The study found that training resulted in increased comfort working with clinical populations. including patients with suicide-related ideations and behaviors.
Citation: Meyerhoff J, Kruzan KP, Reddy M . Preparing a workforce of care coordinators to address patient mental health needs in the digital age: training and needs identification. SAGE Open Nurs 2023 Jan-Dec; 9. doi: 10.1177/23779608231173279..
Keywords: Behavioral Health, Training, Patient-Centered Healthcare, Care Management, Healthcare Delivery
Jonas DE, Riley SR, Lee LC
Screening for latent tuberculosis infection in adults: updated evidence report and systematic review for the US Preventive Services Task Force.
This systematic review and evidence report analyzed the benefits and harms of screening for latent tuberculosis infection (LTBI) of adults, which was used to inform the U.S. Preventive Services Task Force for their final recommendation. A systematic review was conducted of English-language studies of LTBI screening, LTBI treatment, or accuracy of the tuberculin skin test (TST) or interferon-gamma release assays (IGRAs). A total of 113 publications were identified, with no studies directly evaluating the benefits and harms of screening. For treatment of LTBI, a large (n = 27,830), good-quality randomized clinical trial found a relative risk (RR) for progression to active tuberculosis at 5 years of 0.35 for 24 weeks of isoniazid compared with placebo (number needed to treat, 112) and an increase in hepatotoxicity (RR, 4.59; number needed to harm, 279). Meta-analysis found greater risk for hepatotoxicity with isoniazid than with rifampin (pooled RR, 4.22; n = 7339).
Citation: Jonas DE, Riley SR, Lee LC . Screening for latent tuberculosis infection in adults: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2023 May 2; 329(17):1495-509. doi: 10.1001/jama.2023.3954..
Keywords: U.S. Preventive Services Task Force (USPSTF), Infectious Diseases, Screening, Prevention, Evidence-Based Practice
Fraiman YS, Cheston CC, Morales D
A mixed methods study of perceptions of bias among neonatal intensive care unit staff.
This study’s goal was to characterize the perceptions of bias among neonatal intensive care units (NICU) staff. The authors distributed a survey to all staff (N = 245) in a single academic Level IV NICU, with a response of 178 respondents. More respondents agreed that bias had a greater impact on others vs. their own behaviors. They agreed that behaviors were influenced more by implicit than explicit biases and felt that other staff had implicit bias but that they have less bias than others. Healthcare staff provided ideas for strategies and approaches to mitigate the impact of bias. The authors propose the use of mixed methods studies as they are effective ways of understanding environment-specific perceptions of bias, and contextual assets and barriers when creating interventions to reduce bias and improve equity.
Citation: Fraiman YS, Cheston CC, Morales D . A mixed methods study of perceptions of bias among neonatal intensive care unit staff. Pediatr Res 2023 May; 93(6):1672-78. doi: 10.1038/s41390-022-02217-2..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Provider: Health Personnel
McGowan M, D'Amico M, Kang M
A survey of patient-centered practices in perinatal quality collaboratives.
This research brief shows the results of a web-based survey of US perinatal quality collaborative (PQC) leaders to explore patient-centered practices for quality improvement (QI) initiatives. The survey consisted of multiple-choice questions including procedures for soliciting community input through community advisory boards, (CABs), social media, surveys, and town halls and measures to capture individual patient experiences, including patient-reported outcomes (PROs) and patient-reported experience measures (PREMs). Over one third (35%) of the 40 PQCs responded with over half reporting an active CAB, with the most common participants including community members. CAB recruitment was most often performed by existing PQC members or leaders. Only half of CABs offered their members compensation. Four organizations used no patient-centered strategies, and only two collected PREMs. In total 12 out of 14 respondents provided at least one free survey response. The respondents highlighted how patient engagement is a powerful tool for shaping diverse aspects of PQCs, from “birth equity” to “how to engage community and patients.”
Citation: McGowan M, D'Amico M, Kang M . A survey of patient-centered practices in perinatal quality collaboratives. Int J Gynaecol Obstet 2023 May; 161(2):670-71. doi: 10.1002/ijgo.14636..
Keywords: Patient-Centered Healthcare, Maternal Care, Quality of Care
Ahmad FA, Chan P, McGovern C
Adapting an electronic STI risk assessment program for use in pediatric primary care.
This study’s goal was to evaluate the usability of an electronic risk assessment tool to support sexually transmitted disease (STI) testing in the authors’ pediatric emergency department that they had previously designed and implemented. They conducted qualitative interviews of pediatricians, clinic staff, and adolescents from 4 pediatric practices as part of a study whose goal is to ultimately implement STI screening in pediatric primary care. The goal of the interviews was (1) to understand contextual factors related to STI screening in primary care, which they reported previously, and (2) to obtain feedback on their electronic platform, the questionnaire content, and their perspective on implementing it in primary care settings. They received quantitative feedback using the System Usability Scale (SUS). The SUS is a validated, reliable tool to measure the usability of hardware, software, websites, and applications, with a score of 68 (range 0-100) being average usability. They recruited 14 physicians, 9 clinic staff, and 12 adolescents. Participants rated the tool with a median score of 92.5, which shows a high level of usability.
Citation: Ahmad FA, Chan P, McGovern C . Adapting an electronic STI risk assessment program for use in pediatric primary care. J Prim Care Community Health 2023 Jan-Dec; 14:21501319231172900. doi: 10.1177/21501319231172900..
Keywords: Children/Adolescents, Sexual Health, Infectious Diseases, Primary Care, Health Information Technology (HIT), Screening, Prevention
Patel D, Ng T, Madani LS
Antibiotic stewardship to reduce inappropriate antibiotic prescribing in integrated academic health-system urgent care clinics.
The purpose of this study was to conceptualize and implement antibiotic stewardship activities in urgent care that targets non-antibiotic-appropriate acute respiratory tract infections (ARIs) that also decreases general antibiotic prescribing and preserves patient satisfaction. The stewardship initiative commenced in fiscal year 2020 and included development of measures, comparative feedback, and education for clinicians and patients. The study measured antibiotic prescribing in fiscal years (FY) 2019, 2020, and 2021 for the stewardship goals, possible diagnosis-shifting visits, and overall prescribing. The researchers also collected patient satisfaction data for ARI visits. The study found that from FY 2019 to FY21, 576,609 patients made 1,358,816 visits to 17 urgent care clinics, including 105,781 visits for which stewardship measures were applied and 149,691 visits for which diagnosis shifting measures were applied. The antibiotic prescribing rate decreased for stewardship-measure visits from 34% in FY 2019 to 12% in FY 2021 The antibiotic prescribing rate decreased for diagnosis-shifting visits from 63% to 35%, and the antibiotic prescribing rate decreased overall from 30% to 10%. The patient satisfaction rate increased from 83% in FY 2019 to 89% in FY 2020 and FY 2021. There was no significant relationship between antibiotic prescribing rates of individual clinicians and ARI visit patient satisfaction.
AHRQ-funded; 233201500020I; HS026506; HS028127.
Citation: Patel D, Ng T, Madani LS . Antibiotic stewardship to reduce inappropriate antibiotic prescribing in integrated academic health-system urgent care clinics. Infect Control Hosp Epidemiol 2023 May; 44(5):736-45. doi: 10.1017/ice.2022.164..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication
Mao Y, Li Y, McGarry B
Are online reviews of assisted living communities associated with patient-centered outcomes?
The purpose of this study was to explore the relationship between assisted living (AL) online quality review ratings and AL residents' home time. The researchers identified Medicare beneficiaries who entered AL communities in 2018, with the main outcome of resident home time in the year after AL admission. Additional outcomes were the percentage of time spent in emergency room, inpatient hospital, nursing home, and inpatient hospice. The study sample included 59,831 residents in 12,143 ALs. AL online Google reviews for 2013-2017 were linked to 2018-2019 Medicare data. AL average rating score and rating status were generated using Google reviews. The study found that from 2013 to 2017, ALs received an average rating of 4.1 on Google, with a standard deviation of 1.1. Each one-unit increase in the AL's average online rating was associated with an increase in residents' risk-adjusted home time by 0.33 percentage points. Residents in high-rated ALs had a 0.64 pp increase in home time compared with residents in ALs without ratings. Thet study concluded that higher online rating scores were positively associated with residents' home time, and a lack of ratings was related with decreased home time.
Citation: Mao Y, Li Y, McGarry B . Are online reviews of assisted living communities associated with patient-centered outcomes? J Am Geriatr Soc 2023 May; 71(5):1505-14. doi: 10.1111/jgs.18192..
Keywords: Elderly, Long-Term Care, Patient-Centered Healthcare, Nursing Homes, Provider Performance, Medicare, Medicaid
Jazowski SA, Samuel-Ryals CA, Wood WA
Association between low-income subsidies and inequities in orally administered antimyeloma therapy use.
This study’s goal was to determine the association between low-income subsidies and inequities in orally administered antimyeloma therapy use. This retrospective cohort study used Surveillance, Epidemiology, and End Results-Medicare data to identify beneficiaries diagnosed with multiple myeloma between 2007 and 2015. The authors examined therapy initiation in the 30, 60, and 90 days following diagnosis and adherence to and discontinuation of treatment in the 180 days following initiation. They found that receipt of full subsidies was not associated with earlier initiation of or improved adherence to orally administered antimyeloma therapy. Full-subsidy enrollees were 22% more likely to experience earlier treatment discontinuation than nonsubsidy enrollees. Black full-subsidy and nonsubsidy enrollees were 14% less likely than their White counterparts to ever initiate treatment.
Citation: Jazowski SA, Samuel-Ryals CA, Wood WA . Association between low-income subsidies and inequities in orally administered antimyeloma therapy use. Am J Manag Care 2023 May; 29(5):246-54. doi: 10.37765/ajmc.2023.89357..
Keywords: Healthcare Costs, Medication, Low-Income