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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results176 to 200 of 11623 Research Studies Displayed
Desai AD, Tolpadi A, Parast L
Improving the quality of written discharge instructions: a multisite collaborative project.
This study assessed the association between participation in an Institute for Healthcare Improvement Virtual Breakthrough Series collaborative and the quality of pediatric written discharge instructions across 8 US hospitals. The authors conducted a multicenter, interrupted time-series analysis of a medical records-based quality measure focused on written discharge instruction content (0-100 scale, higher scores reflect better quality). They obtained data from a random sample of pediatric patients (n = 5739) discharged from participating hospitals between September 2015 and August 2016, and between December 2017 and January 2020. The study periods consisted of 3 phases: 1) a 14-month pre-collaborative phase; 2) a 12-month quality improvement collaborative phase when hospitals implemented multiple rapid cycle tests of change and shared improvement strategies; and 3) a 12-month postcollaborative phase. Among hospitals with high baseline performance, measure scores improved beyond expected for the precollaborative trend, but hospitals with low baseline performance, measure scores increased at a lower than expected rate.
Citation: Desai AD, Tolpadi A, Parast L . Improving the quality of written discharge instructions: a multisite collaborative project. Pediatrics 2023 May; 151(5):e2022059452. doi: 10.1542/peds.2022-059452..
Keywords: Hospital Discharge, Transitions of Care, Hospitals
Sloane JF, Donkin C, Newell BR
Managing interruptions to improve diagnostic decision-making: strategies and recommended research agenda.
This article presented a modified model of interruptions to visualize the interruption process and to illustrate where potential interventions could be implemented. The authors considered empirically tested strategies from health care and cognitive psychology to lay the groundwork for additional research to mitigate effects of interruptions during diagnostic decision-making. Strategies to minimize the negative impacts of interruptions as well as strategies to prevent interruptions were highlighted, and the authors built upon these strategies to propose research priorities within the field of diagnostic safety.
Citation: Sloane JF, Donkin C, Newell BR . Managing interruptions to improve diagnostic decision-making: strategies and recommended research agenda. J Gen Intern Med 2023 May; 38(6):1526-31. doi: 10.1007/s11606-022-08019-w..
Keywords: Diagnostic Safety and Quality, Decision Making
Quinlan TAG, Lindrooth RC, Guiahi M
Medicaid payment for postpartum long-acting reversible contraception prompts more equitable use.
In addition to providing a global payment for maternity care, an increasing number of state Medicaid programs pay for immediate postpartum long-acting reversible contraception (LARC). The purpose of this study was to examine postpartum LARC utilization by race and ethnicity and overall among respondents with Medicaid-paid births during 2012-2018 in eight states that implemented immediate postpartum LARC payment and eight states without immediate postpartum LARC payment. The study found that the policy resulted in a 2.1-percentage-point increase in postpartum LARC use overall. Further analysis found no significant change among White mothers and a 3.7-percentage-point increase in use among Black mothers compared with White mothers. The researchers concluded that additional research is required to determine whether the increase was related with patients' preferences and whether hospitals' immediate postpartum LARC policies and practices utilize a patient-centered approach that reinforces reproductive autonomy and equity.
Citation: Quinlan TAG, Lindrooth RC, Guiahi M . Medicaid payment for postpartum long-acting reversible contraception prompts more equitable use. Health Aff 2023 May; 42(5):665-73. doi: 10.1377/hlthaff.2022.01178..
Keywords: Medicaid, Maternal Care, Women, Access to Care, Policy
Lee CI, Abraham L, Miglioretti DL
National performance benchmarks for screening digital breast tomosynthesis: update from the Breast Cancer Surveillance Consortium.
The purpose of this study was to develop performance benchmarks for digital breast tomosynthesis (DBT) screening and assess longitudinal performance patterns in United States community practice. Between 2011 and 2018 the researchers collected DBT screening examinations from five Breast Cancer Surveillance Consortium (BCSC) registries. Measures of performance were calculated based on the American College of Radiology Breast Imaging Reporting and Data System, fifth edition and included abnormal interpretation rate (AIR), cancer detection rate (CDR), sensitivity, specificity, and false-negative rate (FNR). These rates were compared with previously published BCSC and National Mammography Database benchmarks, concurrent BCSC DM screening examinations, and expert opinion acceptable performance ranges. The study included a total of 896,101 women undergoing 2,301,766 screening examinations and 1,843,591 DM examinations were included in this study. All performance measures were higher for DBT except sensitivity and FNR, when compared with BCSC DM screening examinations from the same time period and previously published BCSC and National Mammography Database performance benchmarks. The following rates of radiologists received acceptable performance ranges with DBT: 97.6% for CDR, 91.8% for sensitivity, 75.0% for AIR, and 74.0% for specificity.
Citation: Lee CI, Abraham L, Miglioretti DL . National performance benchmarks for screening digital breast tomosynthesis: update from the Breast Cancer Surveillance Consortium. Radiology 2023 May; 307(4):e222499. doi: 10.1148/radiol.222499..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Imaging, Prevention, Women
Carlton EF, Becker NV, Moniz MH
Out-of-pocket spending for non-birth-related hospitalizations of privately insured US children, 2017 to 2019.
This study’s goal was to estimate out-of-pocket spending for non-birth pediatric hospitalizations of privately insured children from 2017 to 2019. This study used data from the IBM MarketScan Commercial Database. Among 183,780 hospitalizations, half were for female children, with a median age of 12 (4-16) years. Most (79.0%) hospitalizations were for children with a chronic condition and 24.1% were covered by a high-deductible health plan. Mean (SD) and median (IQR) out-of-pocket spending per hospitalization was $1313 and $656 respectively. Out-of-pocket spending exceeded $3000 for 14.0% of hospitalizations. Factors associated with higher out-of-pocket spending included hospitalization in quarter 1 compared with quarter 4 (average marginal effect [AME], $637) and lack of chronic conditions compared with having a complex chronic condition (AME, $732). Hospitalizations covered by the least generous plans (deductible of $3000 or more and coinsurance of 20% or more) found mean out-of-pocket spending was $1974, while the most generous plans (deductible less than $1000 and coinsurance of 1-19%), mean out-of-pocket spending was found to be $826.
AHRQ-funded; HS025465; HS028817.
Citation: Carlton EF, Becker NV, Moniz MH . Out-of-pocket spending for non-birth-related hospitalizations of privately insured US children, 2017 to 2019. JAMA Pediatr 2023 May; 177(5):516-25. doi: 10.1001/jamapediatrics.2023.0130..
Keywords: Children/Adolescents, Healthcare Costs, Hospitalization, Health Insurance
Becker NV, Carlton EF, Iwashyna TJ
Patient adverse financial outcomes before and after COVID-19 infection.
This study’s goal was to assess whether more adverse financial outcomes occurred after COVID-19 infection and hospitalization compared to those who were not hospitalized with COVID-19. The authors used credit report data from 132,109 commercially insured COVID-19 survivors to compare the rates of adverse financial outcomes for two cohorts of individuals with credit outcomes measured before and after COVID-19 infection, using an interaction term between cohort and hospitalization to test whether adverse credit outcomes changed more for hospitalized than nonhospitalized COVID-19 patients. There were greater adverse financial outcomes among persons hospitalized with COVID-19 (5-8 percentage points) than non-hospitalized COVID-19 patients (1-3 percentage points).
AHRQ-funded; HS028672; HS028817.
Citation: Becker NV, Carlton EF, Iwashyna TJ . Patient adverse financial outcomes before and after COVID-19 infection. J Hosp Med 2023 May; 18(5):424-28. doi: 10.1002/jhm.13105..
Keywords: COVID-19, Healthcare Costs, Hospitalization
Prasad PA, Correia J, Fang MC
Performance of point-of-care severity scores to predict prognosis in patients admitted through the emergency department with COVID-19.
The purpose of this study was to determine whether sepsis risk stratification scores can predict poor outcomes among hospitalized COVID-19 patients. The researchers retrospectively evaluated a cohort of adults presenting with COVID-19 to 156 Hospital Corporation of America (HCA) Healthcare emergency departments (Eds) from March 2, 2020, to February 11, 2021. The study administered the Quick Sequential Organ Failure Assessment (qSOFA), Shock Index, National Early Warning System-2 (NEWS2), and quick COVID-19 Severity Index (qCSI) at patient presentation. The primary outcome was in-hospital mortality, and secondary outcomes included intensive care unit (ICU) admission, mechanical ventilation, and vasopressors receipt. The study identified 90,376 patients with community-acquired COVID-19. 17.2% of patients died in-hospital, 28.6% went to the ICU, 13.7% received mechanical ventilation, and 13.6% received vasopressors. There were 3.8% qSOFA-positive, 45.1% Shock Index-positive, 49.8% NEWS2-positive, and 37.6% qCSI-positive at ED-triage. NEWS2 exhibited the highest AUROC for in-hospital mortality, followed by ICU admission, mechanical ventilation, and vasopressor receipt. The researchers concluded that sepsis severity scores at presentation have low discriminative power to predict outcomes in COVID-19 patients and are not reliable for clinical use.
Citation: Prasad PA, Correia J, Fang MC . Performance of point-of-care severity scores to predict prognosis in patients admitted through the emergency department with COVID-19. J Hosp Med 2023 May; 18(5):413-23. doi: 10.1002/jhm.13106..
Keywords: COVID-19, Emergency Department, Diagnostic Safety and Quality
Herges JR, May HP, Meade L
Pharmacist-provider collaborative visits after hospital discharge in a comprehensive acute kidney injury survivor model.
This pilot study’s objective was to describe pharmacist contributions to a comprehensive postdischarge acute kidney injury (AKI) survivorship program in primary care (the AKI in Care Transitions [ACT] program). The program was piloted from May to December of 2021 at Mayo Clinic as a bundled care strategy for patients who survived an episode of AKI and were discharged home without the need for hemodialysis. Predischarge patients received education and care coordination from nurses and later completed postdischarge laboratory assessment and clinician follow-up in primary care. During follow-up, patients completed a 30-minute comprehensive medication management visit with a pharmacist focusing on AKI survivorship considerations. Pharmacists made 28 medication therapy recommendations (median 3 per patient) and identified 14 medication discrepancies for the 11 patients who completed the pilot program, with 86% of the medication therapy recommendations being acted on by the PCP within 7 days. Six recommendations were made to initiate renoprotective medications, and 5 were acted on.
Citation: Herges JR, May HP, Meade L . Pharmacist-provider collaborative visits after hospital discharge in a comprehensive acute kidney injury survivor model. J Am Pharm Assoc 2023 May-Jun; 63(3):909-14. doi: 10.1016/j.japh.2022.12.029..
Keywords: Provider: Pharmacist, Kidney Disease and Health, Hospital Discharge
Kimchi A, Aronow HU, Ni YM
Postdischarge noninvasive telemonitoring and nurse telephone coaching improve outcomes in heart failure patients with high burden of comorbidity.
The purpose of this study was to explore how comorbidity burden modulates the effectiveness of Noninvasive telemonitoring and nurse telephone coaching (NTM-NTC) and identify patients with HF who may benefit from postdischarge NTM-NTC based on their burden of comorbidity. METHODS AND RESULTS: In the Better Effectiveness After Transition - Heart Failure trial, patients hospitalized for acute decompensated HF were randomized to postdischarge NTM-NTC or usual care. In this secondary analysis of 1313 patients with complete data, comorbidity burden was assessed by scoring complication and coexisting diagnoses from index admissions. Clinical outcomes included 30-day and 180-day readmissions, mortality, days alive, and combined days alive and out of the hospital. Patients had a mean of 5.7 comorbidities and were stratified into low (0-2), moderate (3-8), and high comorbidity (≥9) subgroups. Increased comorbidity burden was associated with worse outcomes. NTM-NTC was not associated with readmission rates in any comorbidity subgroup. Among high comorbidity patients, NTM-NTC was associated with significantly lower mortality at 30 days (hazard ratio 0.25, 95% confidence interval 0.07-0.90) and 180 days (hazard ratio 0.51, 95% confidence interval 0.27-0.98), as well as more days alive (160.1 vs 140.3, P = .029) and days alive out of the hospital (152.0 vs 133.2, P = .044) compared with usual care. CONCLUSIONS: Postdischarge NTM-NTC improved survival among patients with HF with a high comorbidity burden. Comorbidity burden may be useful for identifying patients likely to benefit from this management strategy.
Citation: Kimchi A, Aronow HU, Ni YM . Postdischarge noninvasive telemonitoring and nurse telephone coaching improve outcomes in heart failure patients with high burden of comorbidity. J Card Fail 2023 May; 29(5):774-83. doi: 10.1016/j.cardfail.2022.11.012..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Telehealth, Health Information Technology (HIT), Hospital Discharge
Richmond J, Murray MH, Milder CM
Racial disparities in lung cancer stage of diagnosis among adults living in the southeastern United States.
The purpose of this study was to identify factors contributing to racial disparities in stage of lung cancer stage diagnosis in low-income adults. The researchers identified cases of incident lung cancer from the prospective observational Southern Community Cohort Study by linking them with state cancer registries in 12 southeastern states. A subset of participants who answered psychosocial questions such as those related to racial discrimination experiences were assessed to determine if model predictive power improved. The study identified 1,572 patients with incident lung cancer with available lung cancer stage. Compared with White participants Black participants with lung cancer reflected higher unadjusted odds of distant stage diagnosis. Higher neighborhood area deprivation was related with distant stage diagnosis. No significant differences were found in distant stage disease for Black vs White participants after controlling for individual- and area-level factors, but participants with COPD showed decreased odds of distant stage diagnosis in the primary model.
Citation: Richmond J, Murray MH, Milder CM . Racial disparities in lung cancer stage of diagnosis among adults living in the southeastern United States. Chest 2023 May; 163(5):1314-27. doi: 10.1016/j.chest.2022.11.025..
Keywords: Disparities, Racial and Ethnic Minorities, Cancer: Lung Cancer, Cancer
Auger KA, Demeritt B, Beck AF
Reducing caregiver hunger during pediatric hospitalization.
This paper describes an effort to decrease the mean percentage of caregivers who reported being hungry while their child is hospitalized. The objective was to decrease the mean percentage of caregivers of Medicaid-insured and uninsured children who reported being hungry during their child's hospitalization from 86% to <24%. The authors were able to decrease caregiver hunger on a 41-bed inpatient unit at their large, urban academic hospital from 86% to 15.5% with the use of 2 meal vouchers per caregiver per day. Data collection was interrupted due to the COVID-19 pandemic, however that time was used to advocate for hospital-funded support for optimal and sustainable changes to caregiver meal access. As a result of the pilot test, permanent hospital funding was secured to provide cards to purchase 2 meals per caregiver per hospital day, resulting in a sustained decrease in rates of caregiver hunger.
Citation: Auger KA, Demeritt B, Beck AF . Reducing caregiver hunger during pediatric hospitalization. Pediatrics 2023 May; 151(5). doi: 10.1542/peds.2022-058080..
Keywords: Children/Adolescents, Caregiving
Steuart R, Ale GB, Woolums A
Respiratory culture organism isolation and test characteristics in children with tracheostomies with and without acute respiratory infection.
The objectives of this single-center, retrospective cohort study were to determine the association of respiratory culture organism isolation with diagnosis of acute respiratory infections (ARI), and to assess test characteristics of respiratory cultures in the diagnosis of bacterial ARI. The study included respiratory cultures of children with tracheostomies obtained from 2010 to 2018. Results indicated that children with ARI diagnosis had higher odds of organism identification. The authors concluded that the utility of respiratory culture testing to screen for, diagnose, and direct treatment of ARI in children with tracheostomies is limited.
Citation: Steuart R, Ale GB, Woolums A . Respiratory culture organism isolation and test characteristics in children with tracheostomies with and without acute respiratory infection. https://www.pubmed.ncbi.nlm.nih.gov/36751142
Pediatr Pulmonol 2023 May; 58(5):1481-91. doi: 10.1002/ppul.26349..
Pediatr Pulmonol 2023 May; 58(5):1481-91. doi: 10.1002/ppul.26349..
Keywords: Children/Adolescents, Respiratory Conditions
Oke I, Reshef ER, Elze T
Smoking is associated with a higher risk of surgical intervention for thyroid eye disease in the IRIS registry.
This study’s purpose was to describe the association of smoking status with surgical intervention for thyroid eye disease (TED) at the population-level. This retrospective cohort study included all adults (aged ≥18 years) with Graves disease (87,774 total) in the Intelligent Research in Sight (IRIS) Registry (January 1, 2013, to December 31, 2020). Primary outcomes were surgical intervention for TED, stratified into orbital decompression, strabismus surgery, and eyelid recession surgery. The median age was 59 years, and 81% were female. Current smokers had a greater 5-year cumulative probability of orbital decompression (3.7% vs 1.9%), strabismus surgery (4.6% vs 2.2%), and eyelid recession (4.1% vs 2.6%) compared to never smokers. After adjusting for demographic factors, current smokers were at greater risk for orbital decompression, strabismus surgery, and eyelid recession than never smokers. Former smokers were at higher risk for each type of surgery for TED, although at lower levels than current smokers.
Citation: Oke I, Reshef ER, Elze T . Smoking is associated with a higher risk of surgical intervention for thyroid eye disease in the IRIS registry. Am J Ophthalmol 2023 May; 249:174-82. doi: 10.1016/j.ajo.2023.01.020..
Keywords: Tobacco Use, Eye Disease and Health
Cantor AG, Nelson HD, Pappas M
Telehealth for women's preventive services for reproductive health and intimate partner violence: a comparative effectiveness review.
This comparative effectiveness review was conducted on the effectiveness and harms of telehealth interventions for women's reproductive health and intimate partner violence (IPV) services. A literature search was conducted for randomized controlled trials (RCTs) and observational studies of telehealth strategies for women's reproductive health and IPV versus usual care for the period July 2016 to May 2022. Eight RCTs, 1 nonrandomized trial, and 7 observational studies were included (7 studies of contraceptive care and 9 of IPV services). Telehealth services demonstrated similar care as usual care for contraceptive use, sexually transmitted infections, and pregnancy (low strength of evidence [SOE]). Evidence on abortion was insufficient. Outcomes were also similar between telehealth and usual care interventions to replace or supplement IPV services and comparators for repeat IPV, depression, posttraumatic stress disorder, fear of partner, coercive control, self-efficacy, and safety behaviors (low SOE). Telehealth barriers identified included limited internet access, digital literacy, technical challenges, and confidentiality concerns. Safety strategies increased telehealth use for IPV services. Evidence lacked on access, health equity, or harms.
Citation: Cantor AG, Nelson HD, Pappas M . Telehealth for women's preventive services for reproductive health and intimate partner violence: a comparative effectiveness review. J Gen Intern Med 2023 May; 38(7):1735-43. doi: 10.1007/s11606-023-08033-6..
Keywords: Telehealth, Health Information Technology (HIT), Women, Prevention, Domestic Violence, Evidence-Based Practice, Maternal Care, Sexual Health, Patient-Centered Outcomes Research, Comparative Effectiveness
Keller S, Miller MA, Cosgrove SE
AHRQ Author: Miller MA
The AHRQ Safety Program for Improving Antibiotic Use in Practice.
The Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use was an antibiotic stewardship intervention implemented across the United States in 2020 in 389 primary and urgent care practices. The AHRQ Toolkit to Improve Antibiotic Use in Ambulatory Care has been created based on integration of the educational material used in the AHRQ safety program and the experiences of the participating practices. The toolkit includes presentations on developing, implementing, and maintaining antibiotic stewardship activities; a gap analysis tool; and a guide to accessing and reporting antibiotic prescription data. Practices can use these tools to build their antibiotic stewardship teams and begin working on programs. Improving antibiotic prescribing in ambulatory care is a critical need. Utilizing the AHRQ Toolkit to Improve Antibiotic Use in Ambulatory Care can assist practices in achieving their antibiotic stewardship goals.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Keller S, Miller MA, Cosgrove SE . The AHRQ Safety Program for Improving Antibiotic Use in Practice. Am Fam Physician 2023 May; 107(5):456-57..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Ambulatory Care and Surgery, Tools & Toolkits
Casalino LP, Jung HY, Bodenheimer T
The association of teamlets and teams with physician burnout and patient outcomes.
This cross-sectional observational study’s goal was to determine the prevalence and performance of primary care teamlets and teams. Survey participants included 688 general internists and family physicians. Physicians were assigned to one of four teamlet/team categories (e.g., teamlet/no team) and, in secondary analyses, to one of eight teamlet/team categories that classified teamlets into high, medium, and low collaboration as perceived by the physician (e.g., teamlet perceived-high collaboration/no team) based on their responses. The majority of physicians (77.4%) practiced in teamlets; 36.7% in teams. The four categories were divided as follows: 49.1% practiced in the teamlet/no team category; 28.3% in the teamlet/team category; 8.4% in no teamlet/team; 14.1% in no teamlet/no team. Results showed that 15.7%, 47.4%, and 14.4% of physicians practiced in perceived high-, medium-, and low-collaboration teamlets. Physicians who did not practice in a teamlet or team had significantly lower rate of burnout compared to the three teamlet/team categories. There were no significant differences in outcomes or Medicare spending by teamlet/team or teamlet perceived-collaboration/team categories compared to no teamlet/no team, for Medicare beneficiaries in general, or for dual-eligible beneficiaries.
Citation: Casalino LP, Jung HY, Bodenheimer T . The association of teamlets and teams with physician burnout and patient outcomes. J Gen Intern Med 2023 May; 38(6):1384-92. doi: 10.1007/s11606-022-07894-7..
Keywords: Teams, Burnout, Primary Care, Provider: Physician
Willer RJ, Brady PW, Tyler AN
The current state of high-flow nasal cannula protocols at children's hospitals.
The objectives of this cross-sectional study of the Pediatric Health Information Systems (PHIS) database were to describe the state of non-ICU high flow nasal cannula (HFNC) protocols at children's hospitals and to explore associations between HFNC protocol types and utilization outcomes. Results showed a steady increase in adopting non-ICU HFNC protocols during the study period, but no differences in hospital characteristics were observed between ICU-only hospitals, age-based hospitals, and weight-based hospitals. Weight-based HFNC protocols were associated with decreased ICU utilization in comparison with age-based HFNC protocols. The researchers concluded children's hospitals have adopted non-ICU HFNC protocols for patients with bronchiolitis, the majority of which are now utilizing weight-based maximum flow rates.
Citation: Willer RJ, Brady PW, Tyler AN . The current state of high-flow nasal cannula protocols at children's hospitals. Hosp Pediatr 2023 May; 13(5):e109-e13. doi: 10.1542/hpeds.2022-006969..
Keywords: Children/Adolescents, Respiratory Conditions
Oladapo-Shittu O, Hannum SM, Salinas AB
The need to expand the infection prevention workforce in home infusion therapy.
This study looked at the prevalence of formal surveillance and infection prevention training for home infusion staff. The authors interviewed home infusion staff who perform surveillance activities about barriers to and facilitators for central line-associated bloodstream infection (CLABSI) surveillance and identified barriers to training in CLABSI surveillance. Their findings showed a lack of formal surveillance training which can be addressed by by adapting existing training resources to the home infusion setting.
Citation: Oladapo-Shittu O, Hannum SM, Salinas AB . The need to expand the infection prevention workforce in home infusion therapy. Am J Infect Control 2023 May; 51(5):594-96. doi: 10.1016/j.ajic.2022.11.008.AHRQ-funded; HS027819..
Keywords: Healthcare-Associated Infections (HAIs), Prevention, Home Healthcare, Central Line-Associated Bloodstream Infections (CLABSI)
Bond AM, Dean EB, Desai SM
The role of financial incentives in biosimilar uptake in Medicare: Evidence from the 340b program.
This study’s goal was to investigate whether the 340B Drug Pricing Program, which offers eligible hospitals substantial discounts on drug purchases, inhibits biosimilar uptake. Almost one-third of eligible US hospitals participate in the program. The authors used regression discontinuity design and two high-volume biologics with biosimilar competitors, filgrastim and infliximab to estimate that 340B program eligibility was associated with a 22.9-percentage-point reduction in biosimilar adoption. Additionally, 340B program eligibility was associated with 13.3 more biologic administrations annually per hospital and $17,919 more biologic revenue per hospital. The effect was found to be that it inhibited biosimilar uptake, possibly because of financial incentives that make reference drugs more profitable than biosimilar medications.
Citation: Bond AM, Dean EB, Desai SM . The role of financial incentives in biosimilar uptake in Medicare: Evidence from the 340b program. Health Aff 2023 May; 42(5):632-41. doi: 10.1377/hlthaff.2022.00812..
Keywords: Medicare, Medication, Healthcare Costs
Silber JH, Rosenbaum PR, Reiter JG
The safety of performing surgery at ambulatory surgery centers versus hospital outpatient departments in older patients with or without multimorbidity.
The objective of this matched cohort study was to determine if there are differential outcomes in older patients undergoing surgical procedures at ambulatory surgery centers (ASCs) versus hospital outpatient departments (HOPDs). The results indicated that revisits and complication rates for ASC patients were lower than for closely matched HOPD patients. The observed initial baseline risk in HOPD patients was higher than the baseline risk for the same procedures performed at the ASC, which suggested that surgeons are selecting their riskier patients to be treated at the HOPD rather than the ASC.
Citation: Silber JH, Rosenbaum PR, Reiter JG . The safety of performing surgery at ambulatory surgery centers versus hospital outpatient departments in older patients with or without multimorbidity. Med Care 2023 May; 61(5):328-37. doi: 10.1097/mlr.0000000000001836..
Keywords: Elderly, Surgery, Patient Safety, Ambulatory Care and Surgery
Time to publication of cost-effectiveness analyses for medical devices.
This study examined the availability of cost-effectiveness analyses for medical devices, in terms of both the number of studies and when studies are published. The longer the time between FDA approval/clearance and publication of cost-effectiveness analyses of medical devices, the longer that decision makers will not have the evidence they and their patients need when making initial decisions related to newly available medical devices. An analysis was conducted using the Tufts University Cost-Effectiveness Analysis Registry to identify studies of medical devices that were linked to FDA databases. The years between FDA approval/clearance and publication of cost-effectiveness analyses were calculated. The authors identified a total of 218 cost-effectiveness analyses of medical devices in the United States published between 2002 and 2020. Of those studies, 39.4% were linked to FDA databases. Studies examining devices approved via premarket approval were published a mean of 6.0 years after the device received FDA approval, whereas studies examining devices that were cleared via the 510(k) process were published a mean of 6.5 years after the device received FDA clearance.
Citation: Everhart AO . Time to publication of cost-effectiveness analyses for medical devices. Am J Manag Care 2023 May; 29(5):265-68. doi: 10.37765/ajmc.2023.89359..
Keywords: Medical Devices, Healthcare Costs
Sanghavi P, Chen Z
Underreporting of quality measures and associated facility characteristics and racial disparities in US nursing home ratings.
The purpose of this study was to evaluate the relationship between nursing home characteristics and reporting of 2 of 3 specific clinical outcomes reported by the Nursing Home Care Compare (NHCC) website: major injury falls and pressure ulcers. The researchers of this quality improvement study utilized hospitalization data for all Medicare fee-for-service beneficiaries between January 1, 2011, and December 31, 2017. Hospital admission claims for major injury falls and pressure ulcers were linked with facility-reported evaluations at the nursing home resident level. For each linked hospital claim, it was determined whether the nursing home had reported the event and rates of reporting were computed. To evaluate whether nursing homes reported similarly on both measures, the researchers estimated the relationship between reporting of major injury falls and pressure ulcers within a nursing home, and explored racial and ethnic disparities that could otherwise explain the associations. The study sample included 13,179 nursing homes where 131,000 residents experienced major injury fall or pressure ulcer hospitalizations. Of the 98,669 major injury fall hospitalizations, 60.0% were reported, and of the 39,894 stage 3 or 4 pressure ulcer hospitalizations, 67.7% were reported. Underreporting for both conditions was pervasive, with 69.9% and 71.7% of nursing homes having reporting rates less than 80% for major injury fall and pressure ulcer hospitalizations, respectively. Lower reporting rates had few correlations with facility characteristics other than racial and ethnic composition. Facilities with high vs low fall reporting rates had significantly more White residents (86.9% vs 73.3%), and facilities with high vs low pressure ulcer reporting rates had significantly fewer White residents (69.7% vs 74.9%).
Citation: Sanghavi P, Chen Z . Underreporting of quality measures and associated facility characteristics and racial disparities in US nursing home ratings. JAMA Netw Open 2023 May; 6(5):e2314822. doi: 10.1001/jamanetworkopen.2023.14822..
Keywords: Quality Measures, Quality of Care, Elderly, Disparities, Racial and Ethnic Minorities, Nursing Homes, Pressure Ulcers, Healthcare-Associated Infections (HAIs), Quality Indicators (QIs), Long-Term Care
Agochukwu-Mmonu N, Qin Y, Kaufman S
Understanding the role of urology practice organization and racial composition in prostate cancer treatment disparities.
This study examined the associations between urology practice organization and racial composition and treatment patterns for Medicare beneficiaries with incident prostate cancer. The authors used a 20% sample of national Medicare data to identify beneficiaries diagnosed with prostate cancer between January 2010 and December 2015 and followed them through 2016. They then linked urologists to their practices with tax identification numbers and patients to their practices based on their primary urologist. They identified 54,443 patients with incident prostate cancer, with most (87%) White and 9% Black. They found wide variation in racial practice composition and practice segregation. Patients in practices with the highest proportion of Black patients had the lowest socioeconomic status (43.1%), highest comorbidity (9.9% with comorbidity score ≥ 3), and earlier age at prostate cancer diagnosis (33.5% age 66-69 years). Black patients had lower odds of definitive therapy and underwent less treatment than White patients in every practice context. Black patients had lower predicted probability of treatment (66%) than White patients (69%).
Citation: Agochukwu-Mmonu N, Qin Y, Kaufman S . Understanding the role of urology practice organization and racial composition in prostate cancer treatment disparities. JCO Oncol Pract 2023 May; 19(5):e763-e72. doi: 10.1200/op.22.00147..
Keywords: Cancer: Prostate Cancer, Cancer, Men's Health, Disparities, Racial and Ethnic Minorities
Orth LE, Feudtner C, Kempe A
A coordinated approach for managing polypharmacy among children with medical complexity: rationale and design of the Pediatric Medication Therapy Management (pMTM) randomized controlled trial.
Pediatric polypharmacy (the use of 5 concurrent medications or more) is widespread and increases the risk of medication-related problems (MRPs). Although MRPs are related with pediatric morbidity and healthcare use, polypharmacy is rarely evaluated during typical clinical care for CMC. The purpose of this randomized controlled trial will be to examine whether a pharmacist-led Pediatric Medication Therapy Management (pMTM) intervention decreases MRP counts, as well as symptom burden and acute healthcare use, and will test the hypotheses that a patient-centered medication optimization intervention delivered by pediatric pharmacists will result in lower MRP counts, stable or improved symptom burdens, and fewer cumulative acute healthcare encounters at 90 days following pMTM compared to usual care. Eligible participants include all children ages 2 to 18 years old, with more than 1 complex chronic condition, and with 5 or more active medications, as well as their primary caregivers. Child participants and their primary caregivers will be randomized to pMTM or usual care before a non-acute primary care visit and followed for 90 days. Secondary outcomes include Parent-Reported Outcomes of Symptoms (PRO-Sx) symptom burden scores and acute healthcare visit counts. Costs of program replication will be evaluated using time-driven activity-based scoring.
Citation: Orth LE, Feudtner C, Kempe A . A coordinated approach for managing polypharmacy among children with medical complexity: rationale and design of the Pediatric Medication Therapy Management (pMTM) randomized controlled trial. BMC Health Serv Res 2023 Apr 29; 23(1):414. doi: 10.1186/s12913-023-09439-y..
Keywords: Children/Adolescents, Medication, Patient-Centered Healthcare
Zhang J, Kummerfield E, Hultman G
Application of causal discovery algorithms in studying the nephrotoxicity of remdesivir using longitudinal data from the EHR.
Researchers analyzed the role of remdesivir in the mechanism and optimal treatment of the development of acute kidney injury (AKI) in the setting of COVID. Applying causal discovery machine learning techniques, they built multifactorial causal models of COVID-AKI; risk factors and renal function measures were represented in a temporal sequence using longitudinal data from Electronic Health Records. Their results indicated a need for assessment of renal function on second- and third-day use of remdesivir, and also showed that remdesivir may pose less risk to AKI than existing conditions of chronic kidney disease.
Citation: Zhang J, Kummerfield E, Hultman G . Application of causal discovery algorithms in studying the nephrotoxicity of remdesivir using longitudinal data from the EHR. AMIA Annu Symp Proc 2023 Apr 29; 2022:1227-36..
Keywords: COVID-19, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Adverse Drug Events (ADE), Adverse Events