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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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151 to 175 of 11623 Research Studies DisplayedField C, Lynch CD, Fareed N
Association of community walkability and glycemic control among pregnant individuals with pregestational diabetes mellitus.
The role of community walkability in influencing glycemic regulation in expectant individuals with pre-existing diabetes is yet to be established. The purpose of this study was to explore the relationship between the walkability of a neighborhood at the community level and glycemic control, as indicated by hemoglobin A1c (A1C), in pregnant individuals with pregestational diabetes. The researchers conducted a retrospective examination of expectant individuals with pregestational diabetes who participated in a combined prenatal and diabetic care program from 2012 to 2016. The determinant of interest was community walkability, determined by the US Environmental Protection Agency National Walkability Index (score range 1-20), which includes intersection concentration (design), closeness to transit stops (distance), and a combination of job and household varieties (diversity). Participants from the most walkable neighborhoods were contrasted with those from less walkable neighborhoods as per the National Environmental Protection Agency's definition. The outcomes were glycemic control, including A1C, measured both in early and late pregnancy, and the average change in A1C throughout pregnancy. The study found that out of 417 expectant individuals, 10% resided in the most walkable areas. All 417 participants had an A1C assessment in early pregnancy, and 376 had another A1C assessment in late pregnancy. Pregnant individuals living in the most walkable areas were more likely to have an A1C <6.0% in early pregnancy, and an A1C <6.5% in late pregnancy compared with those in less walkable areas. The change in A1C across pregnancy was not related to walkability. The study concluded that individuals with pre-existing diabetes residing in more walkable areas demonstrated better glycemic control during both early and late pregnancy.
AHRQ-funded; HS028822.
Citation: Field C, Lynch CD, Fareed N .
Association of community walkability and glycemic control among pregnant individuals with pregestational diabetes mellitus.
Am J Obstet Gynecol MFM 2023 May; 5(5):100898. doi: 10.1016/j.ajogmf.2023.100898..
Keywords: Diabetes, Maternal Care, Social Determinants of Health, Women
Quigley DD, Slaughter ME, Qureshi N
Associations of pediatric nurse burnout with involvement in quality improvement.
The purpose of this study was to explore the relationships of inpatient pediatric nurse burnout with their perceptions on the importance of quality at the hospital, and with patient experience measurement, quality improvement (QI), unit culture, and staffing. The researchers implemented a cross-sectional study at an urban children's hospital and surveyed pediatric nurses about their perceptions including the Maslach Burnout Inventory. The study found that 27% of pediatric nurses reported burnout. Nurses who possessed greater confidence in patient experience measurement, received frequent patient experience performance reports, felt included in QI, and experienced QI efforts as integrated into patient care reported not being burned out when compared to those reporting burnout. Higher levels of open communication among nurses and unit-level teamwork were also related with lack of burnout, and a higher QI workload was related with burnout.
AHRQ-funded; HS025920.
Citation: Quigley DD, Slaughter ME, Qureshi N .
Associations of pediatric nurse burnout with involvement in quality improvement.
J Pediatr Nurs 2023 May-Jun; 70:e9-e16. doi: 10.1016/j.pedn.2022.11.001..
Keywords: Children/Adolescents, Burnout, Provider: Nurse, Quality Improvement, Quality of Care
Lyu PF, Chernew ME, McWilliams JM
Benchmarking changes and selective participation in the Medicare shared savings program.
In 2017 the Medicare Shared Savings Program (MSSP) began including regional spending into accountable care organization (ACO) benchmarks, demonstrating a preference for the participation of those ACOs and practices with lower baseline spending than their region. The purpose of this study was to isolate changes in spending due to changes in the mix of ACOs and practices participating in the MSSP as a method for characterizing providers' responses to these incentives. After 2017, the composition of the MSSP increasingly shifted to providers with lower preexisting levels of spending relative to their region, consistent with a selection response. Changes took place through the entry of new ACOs with lower baseline spending, the exit of higher-spending ACOs, and the reconfiguration of participant lists favoring lower-spending practices within continuing ACOs. The study found that although compositional changes could not be clearly tied to changes in benchmarking, the disproportionate participation of providers with lower baseline spending suggests sizable costs and the need for reforms in ACO benchmarking.
AHRQ-funded; HS027531.
Citation: Lyu PF, Chernew ME, McWilliams JM .
Benchmarking changes and selective participation in the Medicare shared savings program.
Health Aff 2023 May; 42(5):622-31. doi: 10.1377/hlthaff.2022.01061..
Keywords: Medicare, Healthcare Costs
Keita Fakeye MB, Samuel LJ, Drabo EF
Caregiving-related work productivity loss among employed family and other unpaid caregivers of older adults.
Despite the fact that a significant proportion of caregivers to elderly individuals are employed, little is known about short-term work impacts of caregiving while physically present at work using measures related to both missed work time and reduced productivity. The purpose of this study was to quantify the prevalence, costs, and correlates of caregiving-related work productivity loss. The researchers utilized the 2015 National Study of Caregiving and National Health and Aging Trends Study to estimate caregiving-related work absences (absenteeism) and reduced productivity while at work (presenteeism). The costs of lost productivity using hours lost, compensation, and a wage multiplier, accounting for the additional cost of replacing employee time were calculated. Researchers then separately examined the relationship between caregiving-related absenteeism and presenteeism. The study found that Nearly 1 in 4 of the estimated 8.8 million employed family caregivers reported either absenteeism or presenteeism over a 1-month period due to caregiving. Among those affected, caregiving decreased work productivity by an estimated $5600 per employee predominantly due to reduced performance at work. Loss of productivity was greater among the caregivers of older adults with substantial care needs and varied based on sociodemographic characteristics and caregiver supports.
AHRQ-funded; HS000029.
Citation: Keita Fakeye MB, Samuel LJ, Drabo EF .
Caregiving-related work productivity loss among employed family and other unpaid caregivers of older adults.
Value Health 2023 May; 26(5):712-20. doi: 10.1016/j.jval.2022.06.014..
Keywords: Caregiving, Elderly
Jacobs PD, Moriya AS
Changes in health coverage during the COVID-19 pandemic.
This AHRQ-authored paper used data from MEPS to examine patterns of health insurance coverage during the COVID-19 pandemic. The authors compared the proportion of people whose source of coverage changed from 2019 to 2020 with the proportion of people whose source changed from 2018 to 2019. The sample was limited to those who were interviewed in both 2018 and 2019 or in both 2019 and 2020. The analysis looked at people aged 63 or younger in the first year of the sample. The authors found increased stability for children and nonelderly adults during the first year of the pandemic. Fewer people who had Medicaid in 2019 became uninsured in 2020 (4.3%) than in 2018-19 (7.8%). Residents of Medicaid expansion states who were enrolled in 2019 were less likely to become uninsured in 2020 (3.6%) than was the case in the 2018-2019 period (6.0%). This was also true in non-Medicaid expansion states (6.6% vs 12.4%). However, residents of expansion states were more likely to become enrolled in Medicaid in 2020 if they were previously uninsured in 2019 (21.5%) compared with 2018-2019 (15.3%). For nonexpansion states, there was no detectable change in the percentage transitioning from uninsured to Medicaid over the two time periods (8.5% compared with 6.9%).
AHRQ-authored.
Citation: Jacobs PD, Moriya AS .
Changes in health coverage during the COVID-19 pandemic.
Health Affairs 2023 May; 42(5):721-26. doi: 10.1377/hlthaff.2022.01469..
Keywords: Medical Expenditure Panel Survey (MEPS), COVID-19, Health Insurance, Medicaid, Access to Care
Michelson KA, McGarghan FLE, Patterson EE
Clinician factors associated with delayed diagnosis of appendicitis.
The purpose of this study was to assess the relationship of clinician demographics and practice patterns with delayed appendicitis diagnosis. The researchers included children presenting with appendicitis at 13 regional emergency departments (EDs), screening patients for delayed diagnosis through a chart review for a previous ED visit within 7 days. The study found that among 7,452 children with appendicitis, 1.4% (105) had delayed diagnosis. Clinicians who used more blood tests in their general practice had a lower risk of delayed diagnosis of appendicitis. Clinicians' specialty, gender, rates of imaging, and experience were not related with delayed diagnosis.
AHRQ-funded; HS026503.
Citation: Michelson KA, McGarghan FLE, Patterson EE .
Clinician factors associated with delayed diagnosis of appendicitis.
Diagnosis 2023 May; 10(2):183-86. doi: 10.1515/dx-2022-0119..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Emergency Department
Chu CD, Lenoir KM, Rai NK
Concordance between clinical outcomes in the systolic blood pressure intervention trial and in the electronic health record.
This study examined the role that electronic health records (EHRs) can play in follow-up for concordance with trial-ascertained outcomes. The authors linked EHR and trial data for participants in the Systolic Blood Pressure Intervention Trial (SPRINT), a randomized trial comparing intensive and standard blood pressure targets. Among participants with available EHR data concurrent to trial-ascertained outcomes, they calculated sensitivity, specificity, positive predictive value, and negative predictive value for EHR-recorded cardiovascular disease (CVD) events, using the gold standard of SPRINT-adjudicated outcomes (myocardial infarction (MI)/acute coronary syndrome (ACS), heart failure, stroke, and composite CVD events). They additionally compared the incidence of non-CVD adverse events (hyponatremia, hypernatremia, hypokalemia, hyperkalemia, bradycardia, and hypotension) in trial versus EHR data. Of the 2468 SPRINT participants included, EHR data demonstrated ≥80% sensitivity and specificity, and ≥99% negative predictive value for MI/ACS, heart failure, stroke, and composite CVD events. Positive predictive value ranged from 26% for heart failure to 52% for MI/ACS. Conclusions were that EHR data uniformly identified more non-CVD adverse events and higher incidence rates compared with trial ascertainment.
AHRQ-funded; HS026383.
Citation: Chu CD, Lenoir KM, Rai NK .
Concordance between clinical outcomes in the systolic blood pressure intervention trial and in the electronic health record.
Contemp Clin Trials 2023 May; 128:107172. doi: 10.1016/j.cct.2023.107172..
Keywords: Blood Pressure, Electronic Health Records (EHRs), Health Information Technology (HIT), Cardiovascular Conditions
Jayadevappa R, Guzzo T, Vapiwala N
Continuity of care and advanced prostate cancer.
This study’s objective was to assess the association of provider continuity of care with outcomes among Medicare fee-for-service beneficiaries with advanced prostate cancer and its variation by race. This retrospective study used SEER-Medicare data of African American and white Medicare beneficiaries aged 66 or older and diagnosed with advanced prostate cancer between 2000 and 2011. The authors used at least 5 years of follow-up data. Short-term outcomes examined were emergency room (ER) visits, hospitalizations, and cost during acute survivorship phase (2-year post-diagnosis), and mortality (all-cause and prostate cancer-specific) during the follow-up period. They calculated continuity of care using Continuity of Care Index (COCI) and Usual Provider Care Index (UPCI), for all visits, oncology visits, and primary care visits in acute survivorship phase. They performed similar analysis for continuity of care in the 2-year period following acute survivorship phase. They found that a one unit increase in COCI was associated with reduction in short-term ER visits (incidence rate ratio [IRR] = 0.65), hospitalizations (IRR = 0.65), and cost (0.64) and lower hazard of long-term mortality. The benefits of higher continuity of care were greater for African Americans than white patients.
AHRQ-funded; HS024106.
Citation: Jayadevappa R, Guzzo T, Vapiwala N .
Continuity of care and advanced prostate cancer.
Cancer Med 2023 May; 12(10):11795-805. doi: 10.1002/cam4.5845..
Keywords: Cancer: Prostate Cancer, Cancer, Men's Health, Medicare
Lundberg DJ, Wrigley-Field E, Cho A
COVID-19 mortality by race and ethnicity in US metropolitan and nonmetropolitan areas, March 2020 to February 2022.
Previous research has determined that Hispanic and non-Hispanic Black residents in the United States experienced significantly higher COVID-19 mortality rates in 2020 than non-Hispanic White residents due to structural racism. In 2021, these disparities were observed to decrease. The purpose of this study was to evaluate the extent to which national decreases in racial and ethnic disparities in COVID-19 mortality between the initial pandemic wave and the subsequent Omicron wave reflect decreases in mortality vs other factors, such as the changing geography of the pandemic. The researchers conducted this cross-sectional study using data from the United States Centers for Disease Control and Prevention for COVID-19 deaths from March 1, 2020, through February 28, 2022, in U.S. resident adults aged 25 years and older. Deaths were examined by race and ethnicity across metropolitan and nonmetropolitan areas, and the national decrease in racial and ethnic disparities between the initial wave and Omicron waves was decomposed. The study included death certificates for 977, 018 U.S. that included a mention of COVID-19. The rate of COVID-19 deaths among adults residing in nonmetropolitan areas increased 5.4% during the initial wave to a peak of 23.4% during the Delta wave; the proportion was 21.5% during the Omicron wave. The national disparity in age-standardized COVID-19 death rates per 100,000 person-years for non-Hispanic Black compared with non-Hispanic White adults decreased by 293 deaths. After standardizing for age and racial and ethnic differences by metropolitan vs nonmetropolitan residence, increases in death rates among non-Hispanic White adults explained 40.7% of the decrease (40.7%); 19.6% of the decrease was explained by shifts in mortality to nonmetropolitan areas, where a disproportionate share of non-Hispanic White adults resided. The remaining 39.6% of the decrease was explained by decreases in death rates in non-Hispanic Black adults. The researchers concluded that the majority of the national decrease in racial and ethnic disparities in COVID-19 mortality between the initial wave and Omicron waves was explained by increased mortality among non-Hispanic White adults and changes in the geographic distribution of the pandemic.
AHRQ-funded; HS013853.
Citation: Lundberg DJ, Wrigley-Field E, Cho A .
COVID-19 mortality by race and ethnicity in US metropolitan and nonmetropolitan areas, March 2020 to February 2022.
JAMA Netw Open 2023 May; 6(5):e2311098. doi: 10.1001/jamanetworkopen.2023.11098..
Keywords: COVID-19, Mortality, Racial and Ethnic Minorities
Strauss AT, Moughames E, Jackson JW
Critical interactions between race and the highly granular area deprivation index in liver transplant evaluation.
Researchers constructed a dataset for liver transplant disparities by linking individual patient-level data with the granular Area Deprivation Index. Their retrospective cohort study included 1377 adults who were referred to the researchers’ center for liver transplant evaluation. They tested for effect measure modification of the association between neighborhood socioeconomic status and transplant evaluation outcomes. They concluded that interventions that address neighborhood deprivation may benefit patients with low socioeconomic status as well as address racial and ethnic inequities.
AHRQ-funded; HS024600.
Citation: Strauss AT, Moughames E, Jackson JW .
Critical interactions between race and the highly granular area deprivation index in liver transplant evaluation.
Clin Transplant 2023 May; 37(5):e14938. doi: 10.1111/ctr.14938..
Keywords: Transplantation, Racial and Ethnic Minorities
Petragallo R, Bertram P, Halvorsen P
Development and multi-institutional validation of a convolutional neural network to detect vertebral body mis-alignments in 2D x-ray setup images.
In image-guided radiotherapy (IGRT), lack of correct alignment to the vertebral body continues to be a rare but serious risk to patient safety. The researchers propose that an automated image-review algorithm be included in the IGRT process as an interlock to detect off-by-one vertebral body errors. The purpose of this study was to describe the development and validation of a convolutional neural network (CNN)-based approach for an automated image-review algorithm using patient image data from a planar stereoscopic x-ray IGRT system. The researchers collected X-rays and digitally reconstructed radiographs (DRRs) from 429 spine radiotherapy patients treated using a stereoscopic x-ray image guidance system. True-negative, "no-error" cases were established using clinically-applied, physician approved alignments. "Off-by-one vertebral body" errors were simulated by translating DRRs along the spinal column using a semi-automated method. A leave-one-institution-out method was utilized to estimate the accuracy of the model on data from unseen institutions as follows: every image from five of the institutions was used to train a CNN model from scratch. The size of the resulting training set ranged from 5700 to 9372 images, and was dependent on which five institutions had contributed data. The training set was randomized and split using a 75/25 split into the final training/ validation sets. X-ray/ DRR image pairs and the related labels of "no-error" or "shift" were used as the model input. Accuracy of the model was assessed utilizing images from the sixth institution, which was omitted from the training phase. This test set ranged from 180 to 3852 images, again depending on which institution had been left out of the training phase. The trained model was utilized to categorize the images from the test set as either "no-error" or "shifted", and the model predictions were compared to the ground truth labels to evaluate model accuracy. This process was repeated until the images of each institution had been utilized as the testing dataset. The study found that when the six models were utilized to categorize unseen image pairs from the institution omitted during training, the resulting receiver operating characteristic area under the curve values ranged from 0.976 to 0.998.
AHRQ-funded; HS026486.
Citation: Petragallo R, Bertram P, Halvorsen P .
Development and multi-institutional validation of a convolutional neural network to detect vertebral body mis-alignments in 2D x-ray setup images.
Med Phys 2023 May; 50(5):2662-71. doi: 10.1002/mp.16359..
Keywords: Imaging, Patient Safety, Diagnostic Safety and Quality
Ruderman SA, Nance RM, Drumright LN
Development of Frail RISC-HIV: a risk score for predicting frailty risk in the short-term for care of people with HIV.
The authors developed RISC-HIV, a frailty prediction risk score for HIV clinical decision-making. They predicted frailty risk among people with HIV (PWH) at seven US HIV clinics and followed for up to 2 years to identify short-term predictors of becoming frail. They concluded that RISC-HIV is a simple, easily implemented tool to assist in classifying PWH at risk for frailty in clinics.
AHRQ-funded; HS026154.
Citation: Ruderman SA, Nance RM, Drumright LN .
Development of Frail RISC-HIV: a risk score for predicting frailty risk in the short-term for care of people with HIV.
AIDS 2023 May 1; 37(6):967-75. doi: 10.1097/qad.0000000000003501..
Keywords: Human Immunodeficiency Virus (HIV), Risk
Dhudasia MB, Benitz WE, Flannery DD
Diagnostic performance and patient outcomes with c-reactive protein use in early-onset sepsis evaluations.
This study’s objective was to determine performance of C-reactive protein (CRP) in the diagnosis of early-onset sepsis, and to assess patient outcomes with and without routine use of CRP in infants in the neonatal intensive care unit (NICU). This retrospective cohort study looked at infants admitted to 2 NICUs from 2009 to 2014. During the time period, 10,134 infants were admitted, 89.9% had CRP, and 74.5% had blood culture obtained within 3 days of birth. CRP obtained plus/minus 4 hours had a sensitivity of 41.7%, specificity 89.9%, and positive likelihood ratio 4.12 in diagnosis of early-onset sepsis. When obtained 24-72 hours after blood culture, sensitivity of CRP increased significantly (89.5%), but specificity (55.7%) and positive likelihood ratio (2.02) decreased. Comparing the periods with (n = 4977) and without (n = 5135) routine use of CRP, the authors observed lower rates of early-onset sepsis evaluation (74.5% vs 50.5%), antibiotic initiation (65.0% vs 50.8%), and antibiotic prolongation in the absence of early-onset sepsis (17.3% vs 7.2%) in the later period.
AHRQ-funded; HS027468.
Citation: Dhudasia MB, Benitz WE, Flannery DD .
Diagnostic performance and patient outcomes with c-reactive protein use in early-onset sepsis evaluations.
J Pediatr 2023 May; 256:98-104.e6. doi: 10.1016/j.jpeds.2022.12.007..
Keywords: Newborns/Infants, Sepsis, Diagnostic Safety and Quality
Le P, Payne JY, Zhang L
Disease state transition probabilities across the spectrum of NAFLD: a systematic review and meta-analysis of paired biopsy or imaging studies.
This paper is a meta-analysis that summarized the rates of progression to and regression of nonalcoholic fatty liver (NAFL), nonalcoholic steatohepatitis (NASH), and fibrosis in adults with nonalcoholic fatty liver disease (NAFLD). PubMed/MEDLINE and 4 other databases were searched from 1985 to 2020. The authors included observational studies and randomized controlled trials in any language that used liver biopsy or imaging to diagnose NAFLD in adults with a follow-up period of ≥48 weeks. They screened 9744 articles and included 54 studies involving 26,738 patients. Among observational studies, 20% of healthy adults developed NAFL while 21% of people with fatty liver had resolution of NAFL after a median of approximately 4.5 years. In addition, 31% of patients developed NASH after 4.7 years, whereas in 29% of those with NASH, resolution occurred after a median of 3.5 years. Fibrosis stages range from F0 to F3, and time to progression by 1 fibrosis stage was 9.9, 10.3, 13.3, and 22.2 years for F0, F1, F2, and F3, respectively. In reverse, time to regress by 1 stage was 21.3, 12.5, 20.4, and 40.0 years for F4, F3, F2, and F1, respectively.
AHRQ-funded; HS026937.
Citation: Le P, Payne JY, Zhang L .
Disease state transition probabilities across the spectrum of NAFLD: a systematic review and meta-analysis of paired biopsy or imaging studies.
Clin Gastroenterol Hepatol 2023 May; 21(5):1154-68. doi: 10.1016/j.cgh.2022.07.033..
Keywords: Imaging, Diagnostic Safety and Quality
Marcaccio CL, Patel PB, Rastogi V
Efficacy and safety of single versus dual antiplatelet therapy in carotid artery stenting.
This study’s objective was to examine the efficacy and safety of preoperative single antiplatelet therapy (AP) therapy vs double antiplatelet therapy (DAPT) in patients who had undergone transfemoral CAS (tfCAS) or transcarotid artery revascularization (TCAR). The authors identified all patients who had undergone tfCAS or TCAR in the Vascular Quality Initiative database from 2016 to 2021. A total of 18,570 tfCAS patients were included, of which 70% had received DAPT, 5.6% no AP therapy, 10% ASA only, 8.0% ASA + AP loading dose, 4.6% P2Y12 inhibitor (P2Yi) only, and 2.9% P2Yi + AP loading dose. After adjustment, compared with DAPT, the incidence of stroke/death was higher with no AP therapy, ASA only, and ASA + AP loading dose, but was similar with P2Yi only, and P2Yi + AP loading dose. No differences were found in the incidence of bleeding rates between the treatment groups after tfCAS or TCAR. These findings support the current guidelines recommending DAPT before CAS but also suggest that P2Yi monotherapy might confer thromboembolic benefits similar to those with DAPT.
AHRQ-funded; HS027285.
Citation: Marcaccio CL, Patel PB, Rastogi V .
Efficacy and safety of single versus dual antiplatelet therapy in carotid artery stenting.
J Vasc Surg 2023 May; 77(5):1434-46.e11. doi: 10.1016/j.jvs.2022.12.034..
Keywords: Blood Thinners, Medication, Medication: Safety, Cardiovascular Conditions, Stroke, Adverse Drug Events (ADE), Adverse Events, Patient Safety
Brown-Johnson C, Calma J, Amano A
Evaluating the implementation of patient-reported outcomes in heart failure clinic: a qualitative assessment.
This study evaluated clinician perceptions of the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12), a patient reported outcome (PRO) survey that captures symptom frequency, symptom burden, physical limitations, social limitations, and quality of life. The authors conducted interviews with cardiologists from 4 institutions across the United States and Canada (n=16) and observed clinic visits at 1 institution in Northern California (n=5). They conducted 2 rounds of interviews and did a qualitative analysis on (1) rapid analysis constructed around major themes related to the aims of the study and (2) content analysis with codes derived from the rapid analysis and implementation science. Most cardiologists reported the KCCQ-12 was acceptable, appropriate, and useful in clinical care. The survey was found to improve the consistency of patient history taking, focus patient-clinician conversations, collect a more accurate account of patient quality of life, track trends in patient well-being over time, and refine clinical decision-making.
AHRQ-funded; HS026128.
Citation: Brown-Johnson C, Calma J, Amano A .
Evaluating the implementation of patient-reported outcomes in heart failure clinic: a qualitative assessment.
Circ Cardiovasc Qual Outcomes 2023 May; 16(5):e009677. doi: 10.1161/circoutcomes.122.009677..
Keywords: Patient-Centered Outcomes Research, Outcomes, Heart Disease and Health, Cardiovascular Conditions
Griesemer I, Lightfoot AF, Eng E
Examining ACCURE's nurse navigation through an antiracist lens: transparency and accountability in cancer care.
This paper discussed an intervention that was conducted to eliminate racial disparity in cancer treatment through a program called Accountability for Cancer Care through Undoing Racism and Equity (ACCURE). The program successfully eliminated the Black-White disparity in cancer treatment completion among patients with early-stage breast and lung cancer. It used specially trained nurse navigators who leveraged real-time data to follow-up with patients during their treatment journeys. Thematic analysis on all clinical notes that were written by ACCURE navigators after each contact with patients in the specialized navigation arm (n = 162) was conducted by community and academic research partners. The authors identified six themes in the navigator notes that demonstrated enhanced accountability of the care system to patient needs. Those themes include: (1) patient-centered advocacy, (2) addressing system barriers to care, (3) connection to resources, (4) re-engaging patients after lapsed treatment, (5) addressing symptoms and side effects, and (6) emotional support.
AHRQ-funded; HS000032.
Citation: Griesemer I, Lightfoot AF, Eng E .
Examining ACCURE's nurse navigation through an antiracist lens: transparency and accountability in cancer care.
Health Promot Pract 2023 May; 24(3):415-25. doi: 10.1177/15248399221136534..
Keywords: Cancer, Racial and Ethnic Minorities, Disparities, Health Promotion
Chandanabhumma PP, Zhou S, Fetters MD
Expanding our methodological toolbox to improve quality: the role of mixed-methods evaluations.
This article discusses ways that using mixed-methods studies can enhance quality improvement interventions instead of relying solely on quantitative evidence. Mixed-methods design helped to advance an evidence-based, customizable infection prevention toolkit for durable left ventricular assist device therapy. Strengths of using mixed-methods studies include: (1) the use of qualitative research methodologies (eg, eliciting patient or clinician perspectives on barriers and facilitators of best practices) and (2) integrating qualitative and quantitative data and analyses to understand more fully effective strategies for achieving optimal care and outcomes for these patients across diverse settings. The study: 1) used quantitative clinical data merged with Medicare claims to evaluate interhospital variability in the incidence of infection; 2) used qualitative methods to understand local practice patterns across low- and high-performing centers; and 3) integrated both data sources to gain a comprehensive understanding of the overall findings.
AHRQ-funded; HS026003.
Citation: Chandanabhumma PP, Zhou S, Fetters MD .
Expanding our methodological toolbox to improve quality: the role of mixed-methods evaluations.
Circ Cardiovasc Qual Outcomes 2023 May; 16(5):e009629. doi: 10.1161/circoutcomes.122.009629..
Keywords: Research Methodologies, Quality Improvement, Quality of Care
Navanandan N, McNulty MC, Suresh K
Factors associated with clinician self-reported resource use in acute care and ambulatory pediatrics.
This study’s objective was to determine predictors of resource use among pediatric providers for common respiratory illnesses. The authors surveyed pediatric primary care, emergency department (ED)/urgent care (UC), and hospital medicine providers at a free-standing children's hospital system. Five clinical vignettes were created to assess factors affecting resource use for upper respiratory infections, bronchiolitis, and pneumonia, including provider-type, practice location, tolerance to uncertainty, and medical decision-making behaviors. Response rate was 75.3%. The ED and UC and primary care providers had higher vignette scores, indicating higher resource use, compared with inpatient providers; advanced practice providers (APPs) had higher vignette scores compared with physicians. Being an ED/UC provider, an APP, and greater concern for bad outcomes were associated with higher vignette scores.
AHRQ-funded; HS026512.
Citation: Navanandan N, McNulty MC, Suresh K .
Factors associated with clinician self-reported resource use in acute care and ambulatory pediatrics.
Clin Pediatr 2023 May; 62(4):329-37. doi: 10.1177/00099228221128074..
Keywords: Children/Adolescents, Respiratory Conditions
Simpson KR, Spetz J, Gay CL
Hospital characteristics associated with nurse staffing during labor and birth: Inequities for the most vulnerable maternity patients.
The objective of this study was to estimate the relationship between hospital characteristics and adherence with Association of Women's Health, Obstetric and Neonatal Nurses nurse staffing guidelines. Registered nurses were enrolled in a cross-sectional survey; hospital characteristics were obtained from the 2018 American Hospital Association Annual Survey. The findings indicated that, overall, nurses reported strong adherence to staffing guidelines within their hospitals. Higher birth volume, teaching status, higher percentage of Medicaid-paid births, and presence of a neonatal intensive care unit were all associated with lower mean adherence scores.
AHRQ-funded; HS025715.
Citation: Simpson KR, Spetz J, Gay CL .
Hospital characteristics associated with nurse staffing during labor and birth: Inequities for the most vulnerable maternity patients.
Nurs Outlook 2023 May; 71(3):101960. doi: 10.1016/j.outlook.2023.101960..
Keywords: Hospitals, Maternal Care, Provider: Nurse, Workforce, Vulnerable Populations
Valley TS, Schutz A, Miller J
Hospital factors that influence ICU admission decision-making: a qualitative study of eight hospitals.
In order to understand factors influencing how intensive care unit (ICU) admission decisions are made, researchers conducted qualitative analysis of eight U.S. hospitals. Semi-structured, one-on-one interviews with 87 participants were supplemented by site visits and clinical observations. Four hospital-level factors were identified which influenced ICU admission decisionmaking. The researchers concluded that healthcare systems should evaluate use of ICU care and establish institutional patterns to ensure that ICU admission decisions are patient-centered as well as account for resources and hospital-specific constraints.
AHRQ-funded; HS028038.
Citation: Valley TS, Schutz A, Miller J .
Hospital factors that influence ICU admission decision-making: a qualitative study of eight hospitals.
Intensive Care Med 2023 May; 49(5):505-16. doi: 10.1007/s00134-023-07031-w..
Keywords: Intensive Care Unit (ICU), Hospitals, Decision Making, Hospitalization
Skains RM, Zhang Y, Osborne JD
Hospital-associated disability due to avoidable hospitalizations among older adults.
A frequent complication during the course of acute care hospitalizations in older adults is Hospital-associated disability (HAD). Numerous admissions are for ambulatory care sensitive conditions (ACSCs), which are considered potentially avoidable hospitalizations-conditions that may be able to be treated in outpatient settings to prevent hospitalization and HAD. The purpose of this study was to compare the incidence of HAD between older adults hospitalized for ACSCs versus those hospitalized for other diagnoses. The researchers conducted a retrospective cohort study of 38,960 older adults 65 years of age or older admitted to inpatient (non-ICU) medical and surgical units of a large southeastern regional academic medical center. The primary study outcome was HAD. The study found that 10% of older adults were admitted for an ACSC, with rates of HAD in those admitted for ACSCs lower than those admitted for other conditions. Age, comorbidity, admission functional status, and admission cognitive impairment were significant predictors for development of HAD. Compared with admissions for other conditions, ACSC admissions to medical and medical/surgical services had decreased odds of HAD, with no significant differences between ACSC and non-ACSC admissions to surgical services.
AHRQ-funded; HS013852.
Citation: Skains RM, Zhang Y, Osborne JD .
Hospital-associated disability due to avoidable hospitalizations among older adults.
J Am Geriatr Soc 2023 May; 71(5):1395-405. doi: 10.1111/jgs.18238..
Keywords: Elderly, Hospitalization, Hospital Discharge
Karlic KJ, Valley TS, Cagino LM
Identification of patient safety threats in a post-intensive care clinic.
This observational cohort study examined patient safety threats at a post-ICU clinic in an academic, tertiary care medical center and whether post-ICU clinics improve patient safety. The study identified 83 patients, of which 60 patients had 96 separate safety threats. The threats were categorized into 7 themes: medication errors (27%); inadequate medical follow-up (25%); inadequate patient support (16%); high-risk behaviors (5%); medical complications (5%); equipment/supplies failures (4%); and other (18%). They were also categorized as 41% preventable, 27% ameliorable, and 32% were neither preventable nor ameliorable.
AHRQ-funded; HS028038.
Citation: Karlic KJ, Valley TS, Cagino LM .
Identification of patient safety threats in a post-intensive care clinic.
Am J Med Qual 2023 May-Jun; 38(3):117-21. doi: 10.1097/jmq.0000000000000118..
Keywords: Patient Safety, Transitions of Care, Adverse Events
Hewner S, Smith E, Sullivan SS
Identifying high-need primary care patients using nursing knowledge and machine learning methods.
This study examined how patient cohorts generated by machine learning can be enhanced with clinical knowledge to increase translational value and provide a practical approach to patient segmentation based on a mix of medical, behavioral, and social factors. The authors used a primary care practice dataset (N=3438) of high need patients defined by practice criteria and parsed it to a subset population of patients with diabetes (n=1233). Three expert nurses selected variables for k-means cluster analysis using knowledge of critical factors for care coordination, and their knowledge was again applied to describe the psychosocial phenotypes in four prominent clusters, aligned with social and medical care plans. Four distinct clusters were used to create four cohorts including: (1) A large cluster of racially diverse female, non-English speakers with low medical complexity, and history of childhood illness; (2) A large cluster of English speakers with significant comorbidities (obesity and respiratory disease); (3) A small cluster of males with substance use disorder and significant comorbidities (mental health, liver and cardiovascular disease) who frequently visit the hospital; and (4) A moderate cluster of older, racially diverse patients with renal failure.
AHRQ-funded; HS028000.
Citation: Hewner S, Smith E, Sullivan SS .
Identifying high-need primary care patients using nursing knowledge and machine learning methods.
Appl Clin Inform 2023 May; 14(3):408-17. doi: 10.1055/a-2048-7343..
Keywords: Primary Care, Health Information Technology (HIT), Nursing
Mota L, Marcaccio CL, Zhu M
Impact of neighborhood social disadvantage on the presentation and management of peripheral artery disease.
This study’s goal was to examine the impact of neighborhood social disadvantage on the presentation and management of peripheral artery disease (PAD). An area deprivation index (ADI) score was assigned to each patient in the Vascular Quality Initiative registry who underwent infrainguinal revascularization (open or endovascular) or amputation for symptomatic PAD between 2003 and 2020. ADI scores range from 1 to 100 based on residential zip code, and patients were categorized by ADI quintiles (Q1 to Q5). Outcomes of interest included indication for procedure (claudication, rest pain, or tissue loss) and rates of revascularization (vs primary amputation). The 79,974 identified patients were categorized as: Q1: 9604 (12%), Q2:14,961 (18.7%), Q3: 19,800 (24.8%), Q4: 21,735 (27.2%), and Q5: 13,873 (17.4%). There were significant trends toward lower rates of claudication (Q1: 39% vs Q5: 34%), higher rates of rest pain (Q1: 12.4% vs Q5: 17.8%) as the indication for intervention, and lower rates of revascularization (Q1: 80% vs Q5: 69%) with increasing ADI quintiles. There was a progressively higher likelihood of presenting with rest pain vs claudication, with patients in Q5 having the highest probability when compared with those in Q1 in adjusted analyses. Patients in Q5, when compared with those in Q1, also had a higher likelihood of presenting with tissue loss vs claudication. Patients in Q2-Q5 also had a lower likelihood of undergoing any revascularization procedure compared with patients in Q1.
AHRQ-funded; HS027285.
Citation: Mota L, Marcaccio CL, Zhu M .
Impact of neighborhood social disadvantage on the presentation and management of peripheral artery disease.
J Vasc Surg 2023 May; 77(5):1477-85. doi: 10.1016/j.jvs.2022.12.062..
Keywords: Cardiovascular Conditions, Disparities, Social Determinants of Health
