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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
1401 to 1425 of 12214 Research Studies DisplayedBeeber AS, Hoben M, Leeman J
Developing a toolkit to improve resident and family engagement in the safety of assisted living: Engage-A stakeholder-engaged research protocol.
This paper describes an AHRQ-funded study protocol (Engage) to develop a toolkit for increasing resident and family engagement in assisted living (AL) safety. The study goals are to engage AL residents and family caregivers, AL staff, and other AL stakeholders to (1) identify common AL safety problems; (2) prioritize safety problems and identify and evaluate existing PFE interventions with the potential to address safety problems in the AL setting; and (3) develop a testable toolkit to improve PFE in AL safety. Methods, including qualitative interviews, a scoping review of persona and family engagement (PFE) interventions, and stakeholder panel meetings are discussed. The authors also detail how the protocol was modified to address the unique challenges of the COVID-19 pandemic.
AHRQ-funded; HS026473.
Citation: Beeber AS, Hoben M, Leeman J .
Developing a toolkit to improve resident and family engagement in the safety of assisted living: Engage-A stakeholder-engaged research protocol.
Res Nurs Health 2022 Aug;45(4):413-23. doi: 10.1002/nur.22232..
Keywords: Patient and Family Engagement, Patient Safety, Caregiving, Public Health, Long-Term Care
Wang HS, Panagides J, Cahill D
Dietary risk factors for pediatric kidney stones: a case-control study.
This study’s objective was to perform a case-control study of the association of dietary nutrients with pediatric urolithiasis. Researchers obtained dietary information from pediatric urolithiasis patients and healthy controls; survey results were converted to standard nutrient intakes. Findings showed that higher dietary intake of calcium, sodium, and beta carotene, and lower potassium intake were associated with pediatric urolithiasis.
AHRQ-funded; HS000063.
Citation: Wang HS, Panagides J, Cahill D .
Dietary risk factors for pediatric kidney stones: a case-control study.
J Urol 2022 Aug;208(2):434-40. doi: 10.1097/ju.0000000000002687..
Keywords: Children/Adolescents, Nutrition, Kidney Disease and Health, Risk
Chang T, Sjoding MW, Wiens J
Disparate censorship & undertesting: a source of label bias in clinical machine learning.
This article examined the role of clinician and societal biases in machine learning (ML) models. This paper highlights disparate censorship (i.e., differences in testing rates across patient groups) as a source of label bias that clinical ML models may amplify, potentially causing harm. If a patient does not have test results, they are often assigned a negative label, which assumes that untested patients do not experience the outcome. Since testing may not be uniform in patient populations, this can give rise to disparate censorship. Using biased labels in standard ML pipelines could contribute to gaps in model performance across patient groups.
AHRQ-funded; HS027431.
Citation: Chang T, Sjoding MW, Wiens J .
Disparate censorship & undertesting: a source of label bias in clinical machine learning.
Proc Mach Learn Res 2022 Aug; 182:343-90..
Keywords: Health Information Technology (HIT), Diagnostic Safety and Quality
Kirby JB, Nogueira L, Zhao J
AHRQ Author: Kirby JB
Do disruptions in health insurance continue to affect access to care even after coverage is regained?
Researchers investigated the association between having a usual source of care provider (USCP) and past disruptions in insurance coverage among insured adults using a longitudinal, nationally representative sample. Using MEPS data, they found that, compared to people who were continuously insured, those with previous insurance coverage disruptions, even short ones, were less likely to have a USCP.
AHRQ-authored.
Citation: Kirby JB, Nogueira L, Zhao J .
Do disruptions in health insurance continue to affect access to care even after coverage is regained?
J Gen Intern Med 2022 Aug;37(10):2579-81. doi: 10.1007/s11606-021-07187-5..
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Access to Care
Jindal M, Thornton RLJ, McRae A
Effects of a curriculum addressing racism on pediatric residents' racial biases and empathy.
The authors sought to evaluate the impact of participation in a curriculum addressing racism on pediatric residents' racial biases and empathy. They conducted a pre-post survey study in two urban, university-based, midsized pediatric residency programs. They found that, among participants with baseline pro-White bias, there was a statistically significant shift toward no preference, while among participants with a baseline pro-Black bias, there was a statistically significant shift toward no preference. Among all residents, there was a modest but statistically significant decrease in mean empathy.
AHRQ-authored.
Citation: Jindal M, Thornton RLJ, McRae A .
Effects of a curriculum addressing racism on pediatric residents' racial biases and empathy.
J Grad Med Educ 2022 Aug;14(4):407-13. doi: 10.4300/jgme-d-21-01048.1..
Keywords: Children/Adolescents, Racial and Ethnic Minorities, Education: Curriculum
Mercer AN, Mauskar S, Baird J
Family safety reporting in hospitalized children with medical complexity.
This prospective cohort study was conducted to evaluate safety concerns from families of hospitalized children with medical complexity (CMC) who are at high risk of medical errors. This survey was done predischarge with English- and Spanish-speaking parents/staff of hospitalized CMC on 5 units caring for complex care patients at a tertiary care children's hospital. A total of 155 parents and 214 staff completed surveys, with 43% (n = 66) having ≥1 hospital safety concerns, totaling 115 concerns (1-6 concerns each). A physician review found that 69% of concerns were medical errors, and 22% nonsafety-related quality issues. Most parents (68%) reported concerns to staff, particularly bedside nurses, but only 32% of parents recalled being told how to report safety concerns. Higher education and longer length of stay were associated with family safety concerns.
AHRQ-funded; HS025781.
Citation: Mercer AN, Mauskar S, Baird J .
Family safety reporting in hospitalized children with medical complexity.
Pediatrics 2022 Aug 1; 150(2):e2021055098. doi: 10.1542/peds.2021-055098..
Keywords: Children/Adolescents, Family Health and History, Chronic Conditions, Patient Safety, Medical Errors, Adverse Events, Inpatient Care
Kandaswamy S, Grimes J, Hoffman D
Free-text computerized provider order entry orders used as workaround for communicating medication information.
The objectives of this study are to identify the most common medication names communicated in free-text CPOE orders and their risk levels, to identify what actions physicians expect that nurses will complete when they place free-text CPOE orders, and to describe differences in these patterns across hospitals. Findings showed that the prevalence of medication information in free-text CPOE orders may suggest specific communication challenges in respect to urgency, uncertainty, planning, and other aspects of communication and clinical needs. Recommendations included understanding and addressing communication challenges around commonly mentioned medication names and actions, especially those that are high risk, in order to help reduce the risk of medication errors.
AHRQ-funded; HS025136; HS024755.
Citation: Kandaswamy S, Grimes J, Hoffman D .
Free-text computerized provider order entry orders used as workaround for communicating medication information.
J Patient Saf 2022 Aug 1;18(5):430-34. doi: 10.1097/pts.0000000000000948..
Keywords: Electronic Prescribing (E-Prescribing), Medication, Health Information Technology (HIT)
Feyman Y, Asfaw DA, Griffith KN
Geographic variation in appointment wait times for US military veterans.
The purpose of this cross-sectional study was to examine geographic variation in wait times experienced by veterans for primary care, mental health, and other specialties since the passage of the Veterans Access, Choice, and Accountability Act in 2014 and the VA MISSION (Maintaining Systems and Strengthening Integrated Outside Networks) Act in 2018. These acts allowed veterans to have access to community-based care centers. Data analysis was performed using data from the Veterans Health Administration (VHA) Corporate Data Warehouse. Participants include a final sample of 22,632,918 million appointments for 4,846,892 unique veterans who sought medical care from January 1, 2018, to June 30, 2021. The main outcomes were total appointment wait times in days for the categories of primary care, mental health, and all other specialties. VHA medical centers are organized into regions called Veterans Integrated Services Networks (VISNs); wait times were aggregated to the VISN level. The study found that Among non-VHA appointments, mean VISN-level appointment wait times were 38.9 days for primary care, 43.9 days for mental health, and 41.9 days for all other specialties. Among VHA appointments, mean VISN-level appointment wait times were 29.0 days for primary care, 33.6 days for mental health, and 35.4 days for all other specialties. There was substantial geographic variation in appointment wait times. The researchers concluded that VHA wait times in a majority of VISNs were lower than those for community-based clinicians.
AHRQ-funded; HS026395.
Citation: Feyman Y, Asfaw DA, Griffith KN .
Geographic variation in appointment wait times for US military veterans.
JAMA Netw Open 2022 Aug;5(8):e2228783. doi: 10.1001/jamanetworkopen.2022.28783..
Keywords: Access to Care
Temkin-Greener H, Mao Y, McGarry B
Health care use and outcomes in assisted living communities: race, ethnicity, and dual eligibility.
The purpose of this study was to examine the type and quality of care received in residential long-term care setting by racial/ ethnic minorities or residents eligible for dual Medicare and Medicaid. With 2018 Medicare data, the researchers identified 255,564 fee-for-service Medicare beneficiaries over the age of 55 who were living in 24,108 assisted living facilities across the United States and evaluated the relationship between race/ethnicity and dual status with emergency room use, inpatient hospital admission, 30-day readmission, and placement in a nursing home. The study found variations within and across assisted living facilities for racial/ethnic minority and dual residents, suggesting that outcome disparities are the most significant by dual eligibility status instead of only race/ ethnicity. The researchers concluded that these results can be used to inform and guide future research, as well as healthcare providers and policy makers.
AHRQ-funded; HS026893.
Citation: Temkin-Greener H, Mao Y, McGarry B .
Health care use and outcomes in assisted living communities: race, ethnicity, and dual eligibility.
Med Care Res Rev 2022 Aug;79(4):500-10. doi: 10.1177/10775587211050189..
Keywords: Elderly, Racial and Ethnic Minorities, Long-Term Care, Medicare
Kim B, Mulready-Ward C, Thorpe LE
Housing environments and asthma outcomes within population-based samples of adults and children in NYC.
This study assessed the relationship between housing type (i.e., home ownership, public housing, rental assistance, rent-controlled housing, and other rental housing) and asthma outcomes among New York City (NYC) adults and children (ages 1-13). The authors used the 2019 NYC Community Health Survey (CHS) and 2019 NYC KIDS survey to analyze associations between housing type and ever having been diagnosed with asthma (“ever asthma”) and experiencing an asthma attack within the past year. They also examined whether associations were modified by smoking status (among adults), smoking within the house (among children), and overweight/obesity. Among adults, living in public housing, compared to home ownership, was associated with higher odds of ever asthma and past-year asthma attack. Rental assistance housing living was also significantly associated with ever asthma. Public or rental assistance housing associations and ever asthma were marginally significant among children but were more pronounced among ever smokers than among never smokers.
AHRQ-funded; HS026120.
Citation: Kim B, Mulready-Ward C, Thorpe LE .
Housing environments and asthma outcomes within population-based samples of adults and children in NYC.
Prev Med 2022 Aug;161:107147. doi: 10.1016/j.ypmed.2022.107147..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Social Determinants of Health, Vulnerable Populations, Urban Health, Chronic Conditions
Ramesh S, Ayres B, Eyck PT
Impact of subspecialty consultations on diagnosis in the pediatric intensive care unit.
This retrospective study used chart reviews of critically ill children in the pediatric intensive care unit (PICU) to determine the impact of subspecialty consultations on diagnosis. The majority of patients (87 of 101) were provided subspecialty consultations at the request of the PICU clinician. The consultations were equally for diagnosis (65%) and treatment (66%). There was a change in diagnosis for 21% of patients with consultants from PICU admission to discharge, with 61% attributed to subspecialty input. Forty-five percent of patients with consultations had additional imaging and/or laboratory testing and 55% had a medication change and/or a procedure performed immediately after consultation.
AHRQ-funded; HS026965.
Citation: Ramesh S, Ayres B, Eyck PT .
Impact of subspecialty consultations on diagnosis in the pediatric intensive care unit.
Diagnosis 2022 Aug;9(3):379-84. doi: 10.1515/dx-2021-0137..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Diagnostic Safety and Quality
Hashemi A, Vasquez K, Guishard D
Implementing dash-aligned congregate meals and self-measured blood pressure in two senior centers: An open label study.
This study tested whether implementing two evidence-based interventions--DASH-aligned meals provided through an existing congregate meal program, and support for home Self-Measured Blood Pressure (SMBP) monitoring--lowers blood pressure among participants at two senior centers serving low-income, racially diverse communities. Participants were clients aged ≥60, eating ≥4 meals/week at two NYC senior centers. They received DASH-aligned congregate meals, and training in nutrition, BP management education, and personal SMBP device. Primary outcomes was a) change in systolic BP measured by independent health professionals, and b) change in percent with "controlled BP" (Eighth Joint National Committee (JNC-8) Guidelines), at Month 1 compared to Baseline. The authors enrolled 94 participants, with COVID closures interrupting implementation mid-study. Mean systolic BP at Month-1 changed by -4.41 mmHg compared to Baseline. Participants with controlled BP increased at Month 1 and changes in mean BP at Month 1 was significantly correlated with BMI, age, and baseline BP. Mean systolic mean SMBP changed by -6.9 mmHg at Months 5/6.
AHRQ-funded; HS021667.
Citation: Hashemi A, Vasquez K, Guishard D .
Implementing dash-aligned congregate meals and self-measured blood pressure in two senior centers: An open label study.
Nutr Metab Cardiovasc Dis 2022 Aug;32(8):1998-2009. doi: 10.1016/j.numecd.2022.05.018..
Keywords: Elderly, Blood Pressure, Community-Based Practice, Patient Self-Management, Nutrition, Lifestyle Changes, Vulnerable Populations
Newton H, Busch SH, Brunette MF
Innovations in care delivery for patients with serious mental illness among accountable care organizations.
The objective of this study was to examine whether and how organizations participating in accountable care organization (ACO) contracts integrate primary care and treatment for patients with serious mental illness. The study used the 2017-2018 National Survey of ACOs to measure ACO-reported use of three integrated care strategies. Of the 399 respondents who answered the survey, 76% reported using at least one integrated care strategy in at least one location. Use of care managers was most common followed by use of patient registry and colocation of a primary care clinician in a specialty mental health setting. Respondents with the largest Medicaid contract or largest commercial contract included quality measures specific to serious mental illness were more likely to use the integrated care delivery strategies.
AHRQ-funded; HS024075.
Citation: Newton H, Busch SH, Brunette MF .
Innovations in care delivery for patients with serious mental illness among accountable care organizations.
Psychiatr Serv 2022 Aug;73(8):889-96. doi: 10.1176/appi.ps.202000484..
Keywords: Healthcare Delivery, Behavioral Health
Choi KR, Hughesdon K, Britton L
Interpersonal trauma in the lives of nurses and perceptions of nursing work.
This study’s purpose was to explore associations between trauma experiences among nurses and nursing perceptions of risk for involuntary job loss and standing in society. This observational study used 2001 data from the Nurses’ Health Study which surveyed 53,323 female nurses. The outcome looked at were nurses’ perceptions of their risk for involuntary job loss and their social standing in the US and within their own community. The majority of nurses surveyed reported high rates of emotional trauma, in childhood and adulthood with lower rates of physical and sexual trauma. Emotional trauma was associated with perception of higher risk for involuntary job loss, but also higher perception of societal standing.
AHRQ-funded; HS026407.
Citation: Choi KR, Hughesdon K, Britton L .
Interpersonal trauma in the lives of nurses and perceptions of nursing work.
West J Nurs Res 2022 Aug;44(8):734-42. doi: 10.1177/01939459211015894..
Keywords: Provider: Nurse, Domestic Violence
Curatolo M, Rundell SD, Gold LS
Long-term effectiveness of epidural steroid injections after new episodes of low back pain in older adults.
The purpose of this prospective study was to compare older adults undergoing epidural steroid injections (ESI) with patients not receiving ESI to test the hypotheses that those on ESI: 1) have worse outcomes before ESI, 2) have improved outcomes after ESI, and 3) have improved outcomes due to a specific ESI effect. The researchers evaluated patients 65 years of age or older from 3 United States health care systems who presented to primary care with new episodes of back pain. The three outcomes assessed were back and leg pain intensity, disability, and quality of life, all of which were evaluated at baseline, and then with 3-, 6-, 12- and 24- month follow-ups. The study found that in ESI patients, pain intensity, disability, and quality of life at baseline were significantly worse than in non-ESI patients. The study concluded that adults 65 and older who were treated with ESI have long-term improvement, but the improvement is not likely to be related to a specific effect of ESI, making epidural steroid injections unlikely to provide long-term benefits.
AHRQ-funded; HS019222; HS022972.
Citation: Curatolo M, Rundell SD, Gold LS .
Long-term effectiveness of epidural steroid injections after new episodes of low back pain in older adults.
Eur J Pain 2022 Aug;26(7):1469-80. doi: 10.1002/ejp.1975..
Keywords: Elderly, Back Health and Pain, Pain, Treatments
Auty SG, Griffith KN
Medicaid expansion increased appointment wait times in Maine and Virginia.
The purpose of this study was to explore whether a sudden influx of Medicaid enrollees from the Affordable Care Act Medicaid expansion increased wait times for primary and specialty care in community care (CC) and the Veteran’s Hospital Administration (VHA) in two states (Maine and Virginia.) The researchers examined data on wait times for new patients seeking specialty
and primary care from VHA and community providers during 2015–2019. There were no statistically significant differences in pre-trends in wait times in the years prior to Medicaid expansion in Maine and Virginia for VHA and CC appointments. After Medicaid expansion in 2019, Maine and Virginia experienced adjusted increases in CC wait times for both primary (9.5 days) and specialty (10.0 days) care. Non-expansion states experienced lesser increases in CC wait times for primary (4.5 days) and specialty (3.7 days). Conversely, adjusted VHA wait times for primary (−3.1 days) and specialty (−1.1 days) care decreased in Maine and Virginia, but did not change significantly in nonexpansion states. The researchers concluded that improved access to care without corresponding changes in the supply of medical professionals may lead to increased wait times, as evidenced by increased private-sector wait times for specialty care in Maine and Virginia after Medicaid expansion.
and primary care from VHA and community providers during 2015–2019. There were no statistically significant differences in pre-trends in wait times in the years prior to Medicaid expansion in Maine and Virginia for VHA and CC appointments. After Medicaid expansion in 2019, Maine and Virginia experienced adjusted increases in CC wait times for both primary (9.5 days) and specialty (10.0 days) care. Non-expansion states experienced lesser increases in CC wait times for primary (4.5 days) and specialty (3.7 days). Conversely, adjusted VHA wait times for primary (−3.1 days) and specialty (−1.1 days) care decreased in Maine and Virginia, but did not change significantly in nonexpansion states. The researchers concluded that improved access to care without corresponding changes in the supply of medical professionals may lead to increased wait times, as evidenced by increased private-sector wait times for specialty care in Maine and Virginia after Medicaid expansion.
AHRQ-funded; HS026395.
Citation: Auty SG, Griffith KN .
Medicaid expansion increased appointment wait times in Maine and Virginia.
J Gen Intern Med 2022 Aug;37(10):2594-96. doi: 10.1007/s11606-021-07086-9..
Keywords: Medicaid, Access to Care
Singal AG, Chen Y, Sridhar S
Novel application of predictive modeling: a tailored approach to promoting hcc surveillance in patients with cirrhosis.
Researchers conducted a secondary analysis of a randomized clinical trial evaluating a mailed outreach strategy to promote hepatocellular carcinoma (HCC) surveillance among cirrhosis patients at a safety-net health system. They found that predictive models can help stratify patients' likelihood to respond to surveillance outreach invitations, facilitating tailored strategies to maximize effectiveness and cost-effectiveness of HCC surveillance population health programs.
AHRQ-funded; HS022418.
Citation: Singal AG, Chen Y, Sridhar S .
Novel application of predictive modeling: a tailored approach to promoting hcc surveillance in patients with cirrhosis.
Clin Gastroenterol Hepatol 2022 Aug;20(8):1795-802.e2. doi: 10.1016/j.cgh.2021.02.038..
Keywords: Cancer, Chronic Conditions, Screening
Ofoma UR, Drewry AM, Maddox TM
Outcomes of in-hospital cardiac arrest among hospitals with and without telemedicine critical care.
This study compared survival rates for inpatients who suffered in-hospital cardiac arrest (IHCA) who had access to Telemedicine Critical Care (TCC) during nights and weekends (off-hours) compared to those who did not. The authors identified 44,585 adults at 280 U.S. hospitals in the Get With The Guidelines® - Resuscitation registry who suffered IHCA in an Intensive Care Unit (ICU) or hospital ward between July 2017 and December 2019. The majority (60.6%) of IHCAs occurred in an ICU, and 32.2% participants suffered IHCA at hospitals with TCC. No difference was found in acute resuscitation survival rates or survival to discharge rates for either IHCA between TCC and non-TCC hospitals. Timing of cardiac arrest did not modify the association between TCC availability and acute resuscitation survival or survival to discharge.
AHRQ-funded; HS019455.
Citation: Ofoma UR, Drewry AM, Maddox TM .
Outcomes of in-hospital cardiac arrest among hospitals with and without telemedicine critical care.
Resuscitation 2022 Aug;177:7-15. doi: 10.1016/j.resuscitation.2022.06.008..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Telehealth, Health Information Technology (HIT), Outcomes, Critical Care, Intensive Care Unit (ICU)
Gaugler JE, Rosebush CA, Zmora R
Outcomes of remote activity monitoring for persons living with dementia over an 18-month period.
The purpose of this study was to evaluate whether Remote Activity Monitoring (RAM) technology was associated with reductions in negative health transitions and service utilization for persons with Alzheimer's disease or a related dementia over an 18-month period. The researchers enrolled 88 recipients and their caregivers in a clinical trial, with 88 care recipients and their caregivers in the RAM intervention arm and 91 care recipients and their caregivers in the control arm. The treatment group had the RAM system installed in their home. The attention control group did not receive RAM technology. Baseline and follow-up surveys assessed whether the care recipient had fallen or wandered in the past 6 months (yes/no). Caregivers were also asked whether the care recipient had used any of the following healthcare services in the past 6 months: nursing home stays, assisted living stays other residential care stays, hospital stays, or emergency room visits. The study found that in adjusted models, emergency department visits were almost 50% lower in the intervention group compared with the control group. In addition, the odds of experiencing a higher frequency of falls versus a lower frequency of falls was 0.36 for those in the intervention group compared with controls. The RAM technology did not have a statistically significant effect on any other outcome. The researchers concluded that although RAM did not provide direct support for the management of behaviors for persons with AD/ADRD, the findings imply that this technology may prevent some adverse health events for people living with dementia in the community. The ongoing, unobtrusive monitoring and system alerts of RAM may have resulted in caregivers identifying activity or the lack thereof that may
have prevented falls and wandering events. In turn, emergency room use among persons with dementia may have been avoided.
have prevented falls and wandering events. In turn, emergency room use among persons with dementia may have been avoided.
AHRQ-funded; HS022836.
Citation: Gaugler JE, Rosebush CA, Zmora R .
Outcomes of remote activity monitoring for persons living with dementia over an 18-month period.
J Am Geriatr Soc 2022 Aug;70(8):2439-42. doi: 10.1111/jgs.17839..
Keywords: Elderly, Dementia, Neurological Disorders, Telehealth, Health Information Technology (HIT), Outcomes, Caregiving
Cutler GJ, Bergmann KR, Doupnik SK
Pediatric mental health emergency department visits and access to Inpatient care: a crisis worsened by the COVID-19 pandemic.
The purpose of this study was to explore the author’s previous research findings on trends in pediatric emergency department (ED) visits for mental health (MH) vs non-mental health in light of more recent related data corresponding with the COVID-19 pandemic. The study found that recent research supports the dramatic increase in pediatric MH ED visits found in the author’s previous research and provides additional evidence that the increase has been driven by specific MH diagnoses. The researchers conclude that depressive disorders, self-harm behavior, and non-alcohol substance use disorders should be prioritized for the development of ED- and hospital-based strategies, and that EDs, hospitals, health systems, and the government urgently need to increase capacity for MH services and identify innovative solutions to improve access to high quality MH care for children.
AHRQ-funded; HS026385.
Citation: Cutler GJ, Bergmann KR, Doupnik SK .
Pediatric mental health emergency department visits and access to Inpatient care: a crisis worsened by the COVID-19 pandemic.
Acad Pediatr 2022 Aug;22(6):889-91. doi: 10.1016/j.acap.2022.03.015..
Keywords: Children/Adolescents, COVID-19, Behavioral Health, Emergency Department, Access to Care, Public Health, Inpatient Care
Livaudais M, Deng D, Frederick T
Perceived value of the electronic health record and its association with physician burnout.
The objective of this study was to investigate how seniority/years of practice, gender, and screened burnout status were associated with opinions of electronic health record (EHR) use on quality, cost, and efficiency of care. Ambulatory primary care and subspecialty clinicians at three different institutions were surveyed. Findings showed that burnout status was significantly associated with clinicians' perceived value of EHR technologies, while years of practice and gender were not.
AHRQ-funded; HS022065.
Citation: Livaudais M, Deng D, Frederick T .
Perceived value of the electronic health record and its association with physician burnout.
Appl Clin Inform 2022 Aug;13(4):778-84. doi: 10.1055/s-0042-1755372..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Burnout, Provider: Physician
Lai LY, Oerline MK, Caram MEV
Risk of metabolic and cardiovascular adverse events with abiraterone or enzalutamide among men with advanced prostate cancer.
Investigators examined the association between the use of abiraterone or enzalutamide and the risk of metabolic or cardiovascular adverse events while on treatment for advanced prostate cancer. They found that, compared with men not receiving abiraterone, men receiving abiraterone were at increased risk of both a major composite adverse event and a minor composite adverse event. Compared with men not receiving enzalutamide, men receiving enzalutamide were at an increased risk of a major composite adverse event but not a minor composite adverse event. They recommended careful monitoring and management of men on abiraterone or enzalutamide through team-based approaches.
AHRQ-funded; HS027507.
Citation: Lai LY, Oerline MK, Caram MEV .
Risk of metabolic and cardiovascular adverse events with abiraterone or enzalutamide among men with advanced prostate cancer.
J Natl Cancer Inst 2022 Aug 8;114(8):1127-34. doi: 10.1093/jnci/djac081..
Keywords: Cardiovascular Conditions, Cancer: Prostate Cancer, Cancer, Risk, Adverse Events, Medication, Adverse Drug Events (ADE), Medication: Safety, Patient Safety
Khouja T, Zhou J, Gellad WF
Serious opioid-related adverse outcomes associated with opioids prescribed by dentists.
This study’s objective was to evaluate adverse outcomes and persistent opioid use (POU) after opioid prescriptions by dentists, based on whether opioids were overprescribed or within recommendations. A cross-sectional analysis of adults with dental visit and corresponding opioid prescription from 2011 to 2017 within a nationwide commercial claims database was conducted. As per CDC guidelines, opioid overprescribing was defined as >120 morphine milligram equivalents. Of 633,387 visits, 16.6% had POU and 2.6% experienced an adverse outcome. POU was higher when opioids were overprescribed with visits associated with mild pain and those with substance use disorders having the highest risk of both outcomes.
AHRQ-funded; HS025177.
Citation: Khouja T, Zhou J, Gellad WF .
Serious opioid-related adverse outcomes associated with opioids prescribed by dentists.
Pain 2022 Aug 1;163(8):1571-80. doi: 10.1097/j.pain.0000000000002545..
Keywords: Opioids, Dental and Oral Health, Substance Abuse, Behavioral Health, Practice Patterns, Pain, Medication, Adverse Drug Events (ADE), Adverse Events
Wasp GT, Knutzen KE, Murray GF
Systemic therapy decision making in advanced cancer: a qualitative analysis of patient-oncologist encounters.
This study sought to characterize patient-oncologist communication and decision making about continuing or limiting systemic therapy in encounters after an initial consultation, with a particular focus on whether and how oncologists foster shared decision making (SDM). The authors performed content analysis of outpatient oncology encounters at two US National Cancer Institute-designated cancer centers audio recorded between November 2010 and September 2014. A multidisciplinary team used a hybrid approach of inductive and deductive coding and theme development with a combination of random and purposive sampling. Among 31 randomly sampled dyads with 3 encounters each (93 total), systematic therapy decision making was discussed in 90% encounters. Only 34 oncologists broached limiting therapy, which 27 framed as temporary; nine as completion of a standard regime; and five as permanent discontinuation. Thematic analysis found that that (1) patients and oncologists framed continuing therapy as the default, (2) deficiencies in the SDM process (facilitating choice awareness, discussing options, and incorporating patient preferences) contributed to this default, and (3) oncologists use persuasion rather than deliberation when broaching discontinuation.
AHRQ-funded; HS022242.
Citation: Wasp GT, Knutzen KE, Murray GF .
Systemic therapy decision making in advanced cancer: a qualitative analysis of patient-oncologist encounters.
JCO Oncol Pract 2022 Aug;18(8):e1357-e66. doi: 10.1200/op.21.00377..
Keywords: Shared Decision Making, Cancer, Clinician-Patient Communication
Reeves SL, Patel PN, Madden B
Telehealth use before and during the COVID-19 pandemic among children with sickle cell anemia.
This study’s goal was to determine telehealth use before and during the COVID pandemic for children ages 1-17 years old with sickle cell anemia (SCA). The authors identified children with SCA continuously enrolled in Michigan Medicaid from January 2019 to December 2020. The study population consisted of 493 children with SCA with a mean age of 8.7 years at study entry. Pre-pandemic there were 4,367 outpatient visits, with all but 19 in-person. Telehealth visits peaked in April 2020 and then began declining. The majority of telehealth visits were with hematologists, followed up adult subspecialists (27%) and pediatrics/family medicine.
AHRQ-funded; HS027632.
Citation: Reeves SL, Patel PN, Madden B .
Telehealth use before and during the COVID-19 pandemic among children with sickle cell anemia.
Telemed J E Health 2022 Aug;28(8):1166-71. doi: 10.1089/tmj.2021.0132..
Keywords: Children/Adolescents, COVID-19, Telehealth, Health Information Technology (HIT), Sickle Cell Disease, Chronic Conditions, Access to Care