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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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201 to 225 of 11623 Research Studies DisplayedHobensack M, Song J, Chae S
Capturing concerns about patient deterioration in narrative documentation in home healthcare.
This study aimed to build machine learning algorithms to identify “concerning” narrative notes of home healthcare (HHC) patients and identify emergency themes to support early identification of patients at risk for deterioration. Six algorithms were applied to 4000 narrative notes from a HHC agency to classify notes as either "concerning" or "not concerning." Emerging themes were identified using Latent Dirichlet Allocation bag of words topic modeling. Emerging themes of concern included patient-clinician communication, HHC services provided, gait challenges, mobility concerns, wounds, and caregivers. Most of these themes had already been identified in previous literature as increasing risk for adverse events.
AHRQ-funded; HS027742.
Citation: Hobensack M, Song J, Chae S .
Capturing concerns about patient deterioration in narrative documentation in home healthcare.
AMIA Annu Symp Proc 2023 Apr 29; 2022:552-59..
Keywords: Home Healthcare, Electronic Health Records (EHRs), Health Information Technology (HIT)
Moy AJ, Cato KD, Withall J
Using time series clustering to segment and infer emergency department nursing shifts from electronic health record log files.
Clinical shifts are an essential unit of work recognized in clinical settings and may function as a primary unit of analysis in the study of documentation burden. The purpose of this proof- of-concept study was to investigate the feasibility of a new approach utilizing time series clustering to segment and infer clinician shifts from electronic health record (HER) log files. The researchers recorded 33,535,585 events between April-June 2021 and computationally identified 43,911 potential shifts among 2,285 emergency department nurses. On average, shifts were 10.6±3.1 hours in duration. Researchers classified the shifts based on type: day, evening, night; and length: 12-hour, 8-hour, other. The preliminary results of the study found that unsupervised clustering methods may be a feasible approach for quickly identifying clinician shifts.
AHRQ-funded; HS028454.
Citation: Moy AJ, Cato KD, Withall J .
Using time series clustering to segment and infer emergency department nursing shifts from electronic health record log files.
AMIA Annu Symp Proc 2023 Apr 29; 2022:805-14..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Emergency Department, Workforce
Gupta N, Zebib L, Wittmann D
Understanding the sexual health perceptions, concerns, and needs of female partners of prostate cancer survivors.
The adverse effects of prostate cancer (PCa) and its treatment can critically undermine the sexual well-being of patients and couples. However, limited research has been dedicated to understanding the influence of PCa-induced sexual dysfunction on the female partners of survivors. The purpose of this study was to carry out a qualitative investigation to comprehensively capture the perceptions of female partners regarding the repercussions of PCa on their sex lives, and their partners’ sexual health concerns and unfulfilled needs. The researchers conducted semi-structured telephonic interviews concerning sexual health and unfulfilled needs with female partners of PCa survivors. Participants were recruited from multiple clinical sites and PCa caregivers' support groups from September 2021 to March 2022. Interviews were recorded, transcribed, and independently coded. The study outcomes were on the sexual health concerns and unfulfilled needs of the female partners. Of the 12 participants, the median age was 65 (between 53 and 81), nine identified as White, the median duration since their partner's PCa diagnosis was 2.25 years (ranging from 11 months to 20 years), and most reported their partner had undergone radical prostatectomy, radiation, and/or hormonal therapy. Major themes emerging from the study concerned the substantial effect of age- and PCa-related sexual dysfunction on the sexual quality of life for women, the joint nature of sexual dysfunction and recovery, the partner's role in managing and adapting to sexual dysfunction, communication barriers regarding sexual dysfunction within an intimate relationship, the absence of sexual health counseling and support from physicians, and the advantage of peer interactions and proactive information seeking in addressing unfulfilled sexual health needs. The study concluded that female partners perceive PCa-related sexual dysfunction as a shared issue for couples, express sorrow due to age- and PCa-related sexual losses, and experience a void in physician-led sexual health counseling and information.
AHRQ-funded; HS026120.
Citation: Gupta N, Zebib L, Wittmann D .
Understanding the sexual health perceptions, concerns, and needs of female partners of prostate cancer survivors.
J Sex Med 2023 Apr 27; 20(5):651-60. doi: 10.1093/jsxmed/qdad027..
Keywords: Cancer: Prostate Cancer, Cancer, Sexual Health, Women
Crook S, Dragan K, Woo JL
Long-term health care utilization after cardiac surgery in children covered under Medicaid.
The purpose of this study was to examine the long-term burden of health care expenditures and utilization after pediatric cardiac surgery to improve care and reduce outcome inequities. The study compared children under the age of 18 undergoing cardiac surgery from 2006-2019 to a similar cohort of children without cardiac surgical disease. The research concluded that children after cardiac surgery have substantial long-term health care needs than noncardiac surgical comparators.
AHRQ-funded; HS000055.
Citation: Crook S, Dragan K, Woo JL .
Long-term health care utilization after cardiac surgery in children covered under Medicaid.
J Am Coll Cardiol 2023 Apr 25; 81(16):1605-17. doi: 10.1016/j.jacc.2023.02.021..
Keywords: Children/Adolescents, Healthcare Utilization, Long-Term Care, Cardiovascular Conditions, Medicaid, Surgery
Shi M, Fiori K, Kim RS
Social needs assessment and linkage to community health workers in a large urban hospital system.
The purpose of this study was to determine predictors of successful linkage with a community health worker (CHW) in patients with social needs. The researchers utilized a cross-sectional analysis of social needs assessments administered in an urban health system between April 2018 and December 2019. Social needs in the study included safety, getting along with household members, housing quality, housing instability, food insecurity, care for dependents, healthcare cost, healthcare related transportation, utilities, and legal assistance. Patients were entered into a separate database when they encountered a CHW. The main outcome was a successful "linkage," which was defined as having a positive social needs assessment in the medical record with a corresponding record in the CHW database. The study found that 25% of patients with at least 1 social need accepting help were linked to a CHW. Positive predictors included female gender, Spanish language preference compared to English, and having a food-related need. Negative predictors included age 18 to 65 and 0 to 5 compared to over 65, non-Hispanic White race compared to Hispanic race, and having needs of getting along with household members and safety.
AHRQ-funded; HS026396.
Citation: Shi M, Fiori K, Kim RS .
Social needs assessment and linkage to community health workers in a large urban hospital system.
J Prim Care Community Health 2023 Jan-Dec; 14:21501319231166918. doi: 10.1177/21501319231166918..
Keywords: Urban Health, Healthcare Delivery, Social Determinants of Health, Community-Based Practice, Rural/Inner-City Residents
Taft T, Rudd EA, Thraen I
"Are we there yet?" Ten persistent hazards and inefficiencies with the use of medication administration technology from the perspective of practicing nurses.
The objectives of this study were to characterize persistent hazards and inefficiencies in inpatient medication administration, to explore cognitive attributes of medication administration tasks, and to discuss strategies to reduce technology-related hazards. Researchers interviewed nurses at two urban US health systems. Persistent safety hazards and inefficiencies related to medication administration technology were organized around the perception-action cycle (PAC) cycle. The researchers concluded that errors may persist in medication administration despite successful deployment of Bar Code Medication Administration and Electronic Medication Administration Record. Opportunities to improve would require a deeper understanding of high-level reasoning in medication administration.
AHRQ-funded; HS025136.
Citation: Taft T, Rudd EA, Thraen I .
"Are we there yet?" Ten persistent hazards and inefficiencies with the use of medication administration technology from the perspective of practicing nurses.
J Am Med Inform Assoc 2023 Apr 19; 30(5):809-18. doi: 10.1093/jamia/ocad031..
Keywords: Medication, Electronic Prescribing (E-Prescribing), Health Information Technology (HIT), Patient Safety, Adverse Drug Events (ADE), Medical Errors, Medication: Safety
Kneifati-Hayek JZ, Applebaum JR, Schechter CB
Effect of restricting electronic health records on clinician efficiency: substudy of a randomized clinical trial.
This substudy of a prior randomized controlled trial compared clinician efficiency between electronic health records (EHRs) where the EHR limits the clinician to opening 1 record at a time to unrestricted configuration allowing up to 4 records open concurrently. Among a total of 2556 clinicians, there was no significant difference between unrestricted and restricted groups in total active minutes per day (115.1 vs 113.3 min, respectively), overall or by clinician type and practice area.
AHRQ-funded; HS026121; HS023704.
Citation: Kneifati-Hayek JZ, Applebaum JR, Schechter CB .
Effect of restricting electronic health records on clinician efficiency: substudy of a randomized clinical trial.
J Am Med Inform Assoc 2023 Apr 19; 30(5):953-57. doi: 10.1093/jamia/ocad025..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT)
Grauer A, Rosen A, Applebaum JR
Examining medication ordering errors using AHRQ network of patient safety databases.
Research on the impact of Computerized Physician Order Entry (CPOE) systems on drug order inaccuracies has shown inconsistent results, with CPOE not reliably preventing such mistakes. The study utilized the Network of Patient Safety Databases (NPSD) from the Agency for Healthcare Research and Quality (AHRQ) to explore the frequency and degree of harm associated with reported events during the ordering stage, and to classify them by error type.
The researchers conducted a retrospective analysis of reported safety incidents provided by healthcare systems associated with patient safety organizations from June 2010 to December 2020. All errors related to medication and other substance orders reported to the NPSD using the common format v1.2 during this period were assessed. The researchers grouped and categorized the prevalence of reported medication order errors by error type, harm levels, and demographic data. The study found that during the study period, 12,830 mistakes were reported. Incorrect dosage accounted for 3,812 errors (29.7%), followed by incorrect medicine 2,086 (16.3%), and incorrect duration 765 (6.0%). Out of 5,282 incidents that affected the patient and had a known severity level, 12 resulted in fatalities, 4 led to severe harm, 45 caused moderate harm, 341 led to minor harm, and 4,880 resulted in no harm. The study concluded that the most frequently reported and damaging types of medication order errors were incorrect dose and incorrect medication orders.
The researchers conducted a retrospective analysis of reported safety incidents provided by healthcare systems associated with patient safety organizations from June 2010 to December 2020. All errors related to medication and other substance orders reported to the NPSD using the common format v1.2 during this period were assessed. The researchers grouped and categorized the prevalence of reported medication order errors by error type, harm levels, and demographic data. The study found that during the study period, 12,830 mistakes were reported. Incorrect dosage accounted for 3,812 errors (29.7%), followed by incorrect medicine 2,086 (16.3%), and incorrect duration 765 (6.0%). Out of 5,282 incidents that affected the patient and had a known severity level, 12 resulted in fatalities, 4 led to severe harm, 45 caused moderate harm, 341 led to minor harm, and 4,880 resulted in no harm. The study concluded that the most frequently reported and damaging types of medication order errors were incorrect dose and incorrect medication orders.
AHRQ-funded; HS026121.
Citation: Grauer A, Rosen A, Applebaum JR .
Examining medication ordering errors using AHRQ network of patient safety databases.
J Am Med Inform Assoc 2023 Apr 19; 30(5):838-45. doi: 10.1093/jamia/ocad007..
Keywords: Medication, Adverse Drug Events (ADE), Adverse Events, Medical Errors, Patient Safety, Electronic Prescribing (E-Prescribing), Health Information Technology (HIT), Medication: Safety
Moy AJ, Hobensack M, Marshall K
Understanding the perceived role of electronic health records and workflow fragmentation on clinician documentation burden in emergency departments.
This study’s goal was to understand the perceived role of electronic health records (EHR) and workflow fragmentation on clinician documentation burden in the emergency department (ED). The authors conducted semistructured interviews with a national sample of US prescribing providers and registered nurses who actively practice in the adult ED setting and use Epic Systems' EHR. They recruited 12 prescribing providers and 12 registered nurses. Six themes were found related to EHR factors perceived to contribute to documentation burden including lack of advanced EHR capabilities, absence of EHR optimization for clinicians, poor user interface design, hindered communication, increased manual work, and added workflow blockages, and five themes associated with cognitive load. The relationship between workflow fragmentation and EHR documentation burden brought up two themes: underlying sources and adverse consequences.
AHRQ-funded; HS028454.
Citation: Moy AJ, Hobensack M, Marshall K .
Understanding the perceived role of electronic health records and workflow fragmentation on clinician documentation burden in emergency departments.
J Am Med Inform Assoc 2023 Apr 19; 30(5):797-808. doi: 10.1093/jamia/ocad038..
Keywords: Electronic Health Records (EHRs), Workflow, Health Information Technology (HIT), Emergency Department
Henrikson NB, Ivlev I, Blasi PR
Skin cancer screening: updated evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this study was to investigate the advantages and potential risks of skin cancer screening to assist the decision-making of the US Preventive Services Task Force. The researchers utilized the data sources MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials, dated between June 1, 2015, and January 7, 2022. Two independent reviewers evaluated the articles and extracted pertinent data from studies of fair or good quality; the findings were summarized narratively. The primary outcomes and indicators were morbidity; mortality; stage, precursor lesions, or lesion thickness of skin cancer at detection; potential harms of screening. Twenty studies from 29 articles were included (N = 6,053,411). Direct evidence on the effectiveness of screening was obtained from 3 nonrandomized analyses of 2 population-based skin cancer screening initiatives in Germany (n = 1,791,615), indicating no significant reduction in melanoma mortality benefit at the population level over a period of 4 to 10 years of follow up activities. Six studies (n = 2,935,513) offered inconclusive evidence on the relationship between physician-conducted skin examination and lesion thickness or stage at diagnosis. Usual care vs. routine physician-conducted skin examination was not associated with increased detection of skin cancer or precursor lesions (5 studies) or stage at melanoma detection (3 studies). The correlation between physician-conducted skin examination and lesion thickness at detection was inconsistent (3 studies). Nine studies (n = 1 326 051) found a consistent positive association between more advanced stage at melanoma detection and increasing risk of melanoma-associated and all-cause mortality. Two studies (n = 232) found negligible enduring cosmetic or psychosocial harms related to screening.
AHRQ-funded; 75Q80120D00004.
Citation: Henrikson NB, Ivlev I, Blasi PR .
Skin cancer screening: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2023 Apr 18; 329(15):1296-307. doi: 10.1001/jama.2023.3262..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Skin Cancer, Cancer, Screening, Prevention, Evidence-Based Practice, Guidelines
Lowry KP, Ichikawa L, Hubbard RA
Variation in second breast cancer risk after primary invasive cancer by time since primary cancer diagnosis and estrogen receptor status.
This study examined the timing of second breast cancers by primary cancer estrogen receptor (ER) status in the Breast Cancer Surveillance Consortium. The cohort studied included women who were diagnosed with American Joint Commission on Cancer stage I-III breast cancer identified within six Breast Cancer Surveillance Consortium registries from 2000 to 2017. Characteristics collected during primary breast cancer diagnosis included demographics, ER status, and treatment. Second breast cancer events included subsequent ipsilateral or contralateral breast cancers diagnosed >6 months after primary diagnosis. Cumulative incidence and second breast cancer rates by primary cancer ER status during 1-5 versus 6-10 years after diagnosis was examined. At 10 years, the cumulative second breast cancer incidence was 11.8% for women with ER-negative disease and 7.5% for those with ER-positive disease. Women with ER-negative cancer had higher second breast cancer rates than those with ER-positive cancer during the first 5 years of follow-up. After 5 years, second breast cancer rates were similar for women with ER-negative versus ER-positive breast cancer.
AHRQ-funded; HS018366.
Citation: Lowry KP, Ichikawa L, Hubbard RA .
Variation in second breast cancer risk after primary invasive cancer by time since primary cancer diagnosis and estrogen receptor status.
Cancer 2023 Apr 15;129(8):1173-82. doi: 10.1002/cncr.34679.
Keywords: Cancer: Breast Cancer, Cancer, Women, Risk
Herrick HM, O'Reilly M, Lee S
Providing Oxygen during Intubation in the NICU Trial (POINT): study protocol for a randomised controlled trial in the neonatal intensive care unit in the USA.
This article is a study protocol describing a pilot randomized controlled trial called Providing Oxygen during Intubation in the NICU Trial or POINT. This study’s objective will be to determine among infants ≥28 weeks' corrected gestational age (cGA) who undergo intubation in the neonatal intensive care unit (NICU) whether apnoeic oxygenation with a regular low-flow nasal cannula (NC), compared with standard of care (no additional respiratory support), reduces the magnitude of SpO(2) decline during intubation. This severe desaturation occurs in nearly half of neonatal intubations. This multicenter, prospective, unblinded, pilot randomized controlled trial recruited 120 infants, 10 in the run-in phase, and 110 in the randomization phase at two tertiary care hospitals in Pennsylvania. Patients will be randomized to 6 L NC 100% oxygen versus standard of care (no respiratory support) at time of intubation, with primary outcome the magnitude of oxygen desaturation during intubation. Secondary outcomes will include additional efficacy, safety, and feasibility outcomes.
AHRQ-funded; HS029029.
Citation: Herrick HM, O'Reilly M, Lee S .
Providing Oxygen during Intubation in the NICU Trial (POINT): study protocol for a randomised controlled trial in the neonatal intensive care unit in the USA.
BMJ Open 2023 Apr 13; 13(4):e073400. doi: 10.1136/bmjopen-2023-073400..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Critical Care
Barger LK, Weaver MD, Sullivan JP
Impact of work schedules of senior resident physicians on patient and resident physician safety: nationwide, prospective cohort study.
The purpose of this study was to determine if long weekly work hours and shifts of extended duration are associated with adverse patient and physician safety outcomes. The criteria included work hours and shifts (≥24 hours) and for senior resident physicians (postgraduate year 2 and above; PGY2+). This study was conducted in the U.S. and spanned eight academic years. The analysis concluded that working 48 hours per week or longer, and extended shifts endanger even experienced (ie, PGY2+) resident physicians and their patients. It recommends lowering weekly work hour limits, as the European Union has done, and eliminating shifts of extended duration to protect the more than 150 000 physicians training in the US and their patients.
AHRQ-funded; HS012032.
Citation: Barger LK, Weaver MD, Sullivan JP .
Impact of work schedules of senior resident physicians on patient and resident physician safety: nationwide, prospective cohort study.
BMJ Med 2023; 2(1):e000320. doi: 10.1136/bmjmed-2022-000320..
Keywords: Provider: Physician, Burnout, Patient Safety
Lee BY, Greene D, Scannell SA
The need for systems approaches for precision communications in public health.
This paper discusses the major challenges in communicating health-related information due to the involvement of multiple complex systems from the creation of the information to the sources and channels of dispersion to the information users themselves. The virality of COVID-19 misinformation and disinformation brought this issue to light very prominently. The authors discuss a range of systems approaches and methods, such as systems mapping and systems modeling, that can help better elucidate complex systems. They believe using these methods to better characterize the various systems involved in communicating public health-related information can lead to the development of more tailored, precise, and proactive communications. Their hope is that proceeding in an iterative manner to help design, implement, and adjust such communications strategies can increase impact and leave less opportunity for misinformation and disinformation to spread.
AHRQ-funded; HS028165.
Citation: Lee BY, Greene D, Scannell SA .
The need for systems approaches for precision communications in public health.
J Health Commun 2023 Apr 7; 28(sup1):13-24. doi: 10.1080/10810730.2023.2220668..
Keywords: Communication, Public Health
Rao Rao, Akrobetu DJ, Dickert NW
Deciding whether to take sacubitril/valsartan: how cardiologists and patients discuss out-of-pocket costs.
The purpose of this study was to characterize patient-cardiologist discussions concerning out-of-pocket costs associated with sacubitril/valsartan during the early post-approval period. Researchers conducted a content analysis of 222 deidentified transcripts of audio-recorded outpatient encounters in which cardiologists and patients discussed whether to initiate, continue, or discontinue sacubitril/valsartan. Issues of cost occurred in nearly half the discussions, but the researchers note that cost conversations were generally superficial, rarely addressing affordability or cost-value judgments. Cardiologists frequently provided patients with free sacubitril/valsartan samples with no plan to address costs after the sample course ran out.
AHRQ-funded; HS026081.
Citation: Rao Rao, Akrobetu DJ, Dickert NW .
Deciding whether to take sacubitril/valsartan: how cardiologists and patients discuss out-of-pocket costs.
J Am Heart Assoc 2023 Apr 4; 12(7):e028278. doi: 10.1161/jaha.122.028278..
Keywords: Decision Making, Medication, Cardiovascular Conditions, Healthcare Costs
Krevat SA, Samuel S, Boxley C
Identifying electronic health record contributions to diagnostic error in ambulatory settings through legal claims analysis.
The purpose of this study was to evaluate legal claims data to assess whether there is a relationship between problems with electronic health records and diagnostic errors. The researchers also explored specific types of errors that took place and at which point in the diagnostic process the errors occurred.
AHRQ-funded; HS027119.
Citation: Krevat SA, Samuel S, Boxley C .
Identifying electronic health record contributions to diagnostic error in ambulatory settings through legal claims analysis.
JAMA Netw Open 2023 Apr 3; 6(4):e238399. doi: 10.1001/jamanetworkopen.2023.8399..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Diagnostic Safety and Quality
Raffa BJ, Schilling S, Henry MK
Ingestion of illicit substances by young children before and during the COVID-19 pandemic.
The objectives of this retrospective cross-sectional study were to assess changes in overall illicit substance ingestion rates among children less than 6 years old before and during the COVID-19 pandemic, and to examine changes by substance type. Results showed an immediate and sustained increase in illicit substance ingestions during the pandemic; no association between medicinal or recreational cannabis legalization and the rate of cannabis ingestion encounters was found. The authors concluded that additional studies were needed to contextualize these findings in the setting of pandemic-related stress and to identify interventions to prevent accidental ingestions.
AHRQ-funded; HS028847.
Citation: Raffa BJ, Schilling S, Henry MK .
Ingestion of illicit substances by young children before and during the COVID-19 pandemic.
JAMA Netw Open 2023 Apr 3; 6(4):e239549. doi: 10.1001/jamanetworkopen.2023.9549..
Keywords: COVID-19, Children/Adolescents, Substance Abuse
Frenier C, McIntyre A
Insurance coverage transitions after disenrollment from Medicaid in Minnesota.
The transition of health insurance following withdrawal from Medicaid is an under-explored area of study. This is particularly significant with the impending cessation of Medicaid's continuous coverage policy due to pandemic relief measures, a shift that is predicted to affect about 18 million individuals. The purpose of this study was to analyze the pattern of insurance transition post-Medicaid disenrollment, specifically in a state where Medicaid expansion was adopted and continuous coverage and eligibility policies were relatively liberal. The study cohort was derived from the Minnesota All Payer Claims Database (MN APCD), with a focus on residents aged 64 or less, who had experienced Medicaid enrollment cessation between January 2018 and February 2019. The final sample included 346,734 cases of Medicaid disenrollment. The study found that approximately 50% of individuals who disenrolled from Medicaid in Minnesota were without observable coverage six months later, with a significant percentage returning to Medicaid within a year. It was also observed that many enrollees didn't transition seamlessly to new coverage, indicating that a meaningful proportion of disenrollment may have occurred among those who were still eligible for Medicaid or experienced short-term changes in eligibility that didn't last for an entire year.
AHRQ-funded; HS017589.
Citation: Frenier C, McIntyre A .
Insurance coverage transitions after disenrollment from Medicaid in Minnesota.
JAMA Netw Open 2023 Apr 3; 6(4):e239379. doi: 10.1001/jamanetworkopen.2023.9379..
Keywords: Health Insurance, Medicaid, Uninsured
Steeves-Reece AL, Davis MM, Hiebert Larson J
Patients' willingness to accept social needs navigation after in-person versus remote screening.
The authors conducted a cross-sectional study in order to assess possible adverse effects of screening patients remotely on patient engagement and interest in accepting social needs navigation. Participants were Medicare and Medicaid beneficiaries in the Oregon Accountable Health Communities (AHC) model. The results indicated that over 70% of participants were willing to accept help with social needs; neither the mode of screening nor interaction term were significantly associated with willingness to accept navigation assistance. The authors concluded remote screening may not adversely affect patient willingness to accept health care-based navigation for social needs.
AHRQ-funded; HS027707.
Citation: Steeves-Reece AL, Davis MM, Hiebert Larson J .
Patients' willingness to accept social needs navigation after in-person versus remote screening.
J Am Board Fam Med 2023 Apr 3;36(2):229-39. doi: 10.3122/jabfm.2022.220259R1.
Keywords: Telehealth, Screening, Health Information Technology (HIT), Social Determinants of Health
Su YR, Buist DSM, Lee JM
Performance of statistical and machine learning risk prediction models for surveillance benefits and failures in breast cancer survivors.
The authors compared the relative predictive performance of statistical and machine learning (ML) models to guide modeling strategy selection for surveillance mammography outcomes in women with a personal history of breast cancer. They cross-validated seven risk prediction models for two surveillance outcomes, using 9,447 mammograms. The results suggested that regularized regression outperformed other modeling approaches for predicting breast cancer surveillance mammography outcomes and balanced the trade-off between model flexibility and interpretability.
AHRQ-funded; HS018366.
Citation: Su YR, Buist DSM, Lee JM .
Performance of statistical and machine learning risk prediction models for surveillance benefits and failures in breast cancer survivors.
Cancer Epidemiol Biomarkers Prev 2023 Apr 3; 32(4):561-71. doi: 10.1158/1055-9965.Epi-22-0677..
Keywords: Cancer: Breast Cancer, Cancer, Health Information Technology (HIT), Imaging
Steiger KG, Boehmer KR, Klanderman MC
Who is most burdened in health care? An analysis of responses to the ICAN Discussion Aid.
The objective of this study was to create a model based on patients' characteristics that predicted the number of burdens reported using the ICAN Discussion Aid, in order to target use of this tool to the patients most likely to benefit. Participants were 635 adult patients who completed the ICAN Aid at a Scottsdale, Arizona, family medicine clinic; patient characteristics were gathered from their health records. The results showed that the number of burdens a patient will report on the ICAN Aid can be approximated based on certain patient characteristics. Adults with major depression, a BMI of 26 or greater, and those of a younger age may have greater reported burdens on ICAN. The authors noted that these finding will need to be validated in independent samples.
AHRQ-funded; HS026379; HS026379.
Citation: Steiger KG, Boehmer KR, Klanderman MC .
Who is most burdened in health care? An analysis of responses to the ICAN Discussion Aid.
J Am Board Fam Med 2023 Apr 3;36(2):277-88. doi: 10.3122/jabfm.2022.220251R1.
Keywords: Depression, Behavioral Health
Wendel CL, LaPierre TA, Sullivan DL
"Anything that benefits the workers should benefit the client": opportunities and constraints in self-directed care during the COVID-19 pandemic.
The purpose of this study was to assess how self-directed care (SDC) models reacted to the COVID-19 pandemic and to examine the impact of COVID-19 on Home and Community Based Services (HCBS) services in Kansas. The study found that self-directed consumers carried levels of employer responsibility with limited resources and systemic barriers contributing to unmet care needs, stress, and burden. Flexibilities in policies related to the hiring of family members were helpful, but inadequate to address working conditions lacking in resources and labor shortages that were amplified by the pandemic.
AHRQ-funded; HS028172.
Citation: Wendel CL, LaPierre TA, Sullivan DL .
"Anything that benefits the workers should benefit the client": opportunities and constraints in self-directed care during the COVID-19 pandemic.
J Appl Gerontol 2023 Apr; 42(4):7334648221143604. doi: 10.1177/07334648221143604.
Keywords: COVID-19, Patient Self-Management
Sibley AL, Baker R, Levander XA
"I am not a junkie": social categorization and differentiation among people who use drugs.
The purpose of this qualitative study, framed by Social Identity Theory/Self-Categorization Theory, was to investigate strategies of within-group categorization and differentiation among people who use drugs (PWUD) and the roles these social categories play in shaping intragroup attitudes, perceptions, and behaviors. Data were taken from the Rural Opioid Initiative. Through interviews with participating PWUDs, researchers identified several facets of identity, behavioral and demographic, along which PWUDs perceived salient social boundaries. Patterns of categorization and differentiation revealed negative intragroup attitudes, including stigma, that may hinder collective action in this marginalized group.
AHRQ-funded; HS026370.
Citation: Sibley AL, Baker R, Levander XA .
"I am not a junkie": social categorization and differentiation among people who use drugs.
Int J Drug Policy 2023 Apr;114:103999. doi: 10.1016/j.drugpo.2023.103999.
Keywords: Substance Abuse, Behavioral Health, Social Stigma
Straccia A, Chassagne F, Bass DI
A novel patient-specific computational fluid dynamics study of the activation of primary collateral pathways in the Circle of Willis during vasospasm.
This study presented a novel technique to create patient-specific computational fluid dynamics simulations of the Circle of Willis (a redundant network of blood vessels that perfuses the brain) before and during vasospasm. Computed tomographic angiography scans are segmented to model the vasculature, and transcranial Doppler ultrasound measurements of blood flow velocity are applied as boundary conditions. The authors stated that this analysis can be applied in future to a cohort of patients to investigate the relationship between the locations and severities of vasospasm, anatomical variability in individuals’ Circle of Willis, and the activation of collateral pathways.
AHRQ-funded; HS026690.
Citation: Straccia A, Chassagne F, Bass DI .
A novel patient-specific computational fluid dynamics study of the activation of primary collateral pathways in the Circle of Willis during vasospasm.
J Biomech Eng 2023 Apr;145(4):041008. doi: 10.1115/1.4055813.
Keywords: Cardiovascular Conditions, Simulation
Nembhard IM, David G, Ezzeddine I
A systematic review of research on empathy in health care.
This systematic review’s aim was to summarize the predictors and outcomes of empathy by health care personnel, methods used to study their empathy, and the effectiveness of interventions targeting their empathy, in order to advance understanding of the role of empathy in health care and facilitate additional research aimed at increasing positive patient care experiences and outcomes. English-language publications were searched for empirical studies of research from 1971 to April 2021. Out of 2270 articles, 455 reporting on 270 analyses satisfied the inclusion criteria. The authors found that most studies have been survey-based, cross-sectional examinations. Greater empathy is associated with better clinical outcomes and patient care experiences; and empathy predictors are many and fall into five categories (provider demographics, provider characteristics, provider behavior during interactions, target characteristics, and organizational context). One-hundred twenty-eight intervention studies were found of which 80% found a positive and significant effect. Except for 4 studies, interventions were educational programs focused on individual clinicians or trainees.
AHRQ-funded; HS016978.
Citation: Nembhard IM, David G, Ezzeddine I .
A systematic review of research on empathy in health care.
Health Serv Res 2023 Apr;58(2):250-63. doi: 10.1111/1475-6773.14016.
Keywords: Provider: Health Personnel, Patient Experience
